American Journal of Cardiology最新文献

{"title":"Coronary Revascularization of Ischemic Territories Improves Myocardial Perfusion, Increases Submaximal Aerobic Capacity and Reduces Exercise-Induced Angina in Patients with Chronic Coronary Syndrome.","authors":"Henrik Mosén, Anna Székely, Katarina Steding-Ehrenborg, Shahnaz Akil Engblom, Fredrik Hedeer, Håkan Arheden, David Erlinge, Henrik Engblom","doi":"10.1016/j.amjcard.2026.08.024","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.024","url":null,"abstract":"<p><p>Chronic coronary syndrome (CCS) is associated with reduced stress perfusion, a predictor of adverse cardiovascular outcome. To what extent myocardial perfusion is related to cardiorespiratory fitness is not completely known. The aim was to investigate if change in myocardial perfusion correlates to change in aerobic capacity after revascularization. Sixty-two patients with suspected or established CCS underwent cardiopulmonary exercise testing (CPET) and [¹³N]NH₃ positron emission tomography (PET) before and after elective invasive coronary angiography. Thirty-six patients were revascularized and 26 were not. The angiographer was blinded to the results from CPET and PET. Myocardial perfusion was defined as decreased when below 2 ml/min/g and as myocardial perfusion reserve (MPR) < 2. Change in oxygen uptake at submaximal effort (VO₂ at AT) correlated positively to change in MPR in revascularized patients (r=0.36, p=0.04), but not in conservatively treated patients (r=0.03, p=0.90). Change in VO₂peak, however, did not correlate to change in myocardial perfusion in any of the groups. Myocardial perfusion at stress and MPR increased significantly after revascularization, when baseline perfusion was decreased (P=0.01 stress and P=0.001 MPR, respectively). Furthermore, the number of patients with exercise-induced angina decreased significantly for the revascularized patients (42% (14/33) at baseline vs 3% (1/33) at follow-up, p<0.001) whereas half of the conservatively treated patients still had exercise-induced angina at follow-up (42% (10/24) at baseline vs 21% (5/24) at follow-up, p=0.12). In conclusion, change in myocardial perfusion correlates with change in submaximal aerobic capacity after revascularization and revascularization reduces exercise-induced angina.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a Null Association Truly Exclude Renal Risk After CTO PCI?","authors":"Ahmet Güner","doi":"10.1016/j.amjcard.2026.08.020","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.020","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cancer-associated Lipid Paradox: Implications for Cardiovascular Risk and Lipid Management.","authors":"Nicole Prescott, Victoria J Eichten, Vishal Ahuja, Courtney M Campbell, Anand Gupta, Catherine A Raver, Michael D Duncan, Javed Butler, Byron Cryer, Ronan J Kelly, Subhash Banerjee","doi":"10.1016/j.amjcard.2026.08.022","DOIUrl":"10.1016/j.amjcard.2026.08.022","url":null,"abstract":"<p><p>Cardiovascular disease has emerged as a leading cause of morbidity and mortality among patients with cancer, yet conventional lipid-based risk assessment remains poorly suited to this population. Growing evidence supports a cancer-associated lipid paradox, in which atherosclerotic events occur frequently despite low or well-controlled low-density lipoprotein cholesterol (LDL-C) levels. This paradox reflects the convergence of systemic inflammation, immune activation, hypercoagulability, tumor-driven metabolic reprogramming, and therapy-related vascular injury. Collectively, these processes decouple circulating lipid concentrations from cardiovascular risk. Cancer therapies including anthracyclines, immune checkpoint inhibitors, human epidermal growth factor receptor 2-targeted agents androgen-deprivation therapy, and thoracic radiation promote endothelial dysfunction, atherosclerotic plaque inflammation, and instability through mechanisms largely independent of LDL-C burden. Concurrent reductions in circulating cholesterol related to cancer metabolism, cachexia, and treatment effects may further obscure the residual cardiovascular risk in cancer patients. Lipoprotein(a) has also emerged as a potential mediator of inflammation and thrombosis-driven risk that is not captured by standard lipid metrics. This review synthesizes mechanistic, angiographic, and clinical evidence underpinning the lipid paradox in cancer, evaluates contemporary lipid-lowering strategies, and proposes a precision cardio-oncology framework that moves beyond LDL-centric paradigms toward a dynamic longitudinal risk-based prevention. Such an approach is essential to reduce cardiovascular events and to ultimately improve long-term outcomes in cancer survivors.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe and Fast Radial Artery Hemostasis Using Synergistic Strategies: SAFE and FAST Trial.","authors":"Khyati Khattar, Anurag Barot, Aman T Patel, Sunil V Rao, Chi-Hong Tseng, Nishant Sethi, Tejas Patel, Rajendra Sardesai, Samir B Pancholy","doi":"10.1016/j.amjcard.2026.08.021","DOIUrl":"10.1016/j.amjcard.2026.08.021","url":null,"abstract":"<p><p>Transradial access (TRA) has been increasingly utilized for cardiac catheterization. Pursuit of faster patient throughput has generated a need for more rapid hemostasis protocols that are safe, effective, and affordable. Patients undergoing diagnostic cardiac catheterization using TRA at 2 tertiary-care centers were randomized to receive the standard of care procedure utilizing 5/6 French hydrophilic introducer sheath, with 50 units/kg of heparin during the procedure and a 2-hour hemostatic compression using a single-balloon device (Group 1), or 25 units/kg of heparin, with 1-hour hemostatic compression using a dual-balloon device capable of simultaneous ipsilateral ulnar artery compression (Group 2). The primary study endpoint was a composite of radial artery occlusion, rebound bleeding, or hematoma formation. A total of 451 patients were randomized: 224 in Group 1 and 227 in Group 2. A significant reduction in the primary endpoint was observed in Group 2 as compared with Group 1 (4% vs 10.3%, p = 0.01). Patent hemostasis was achieved in 97% of patients in Group 2, compared with 81% in Group 1 (p = 0.001), with fewer nursing visits in Group 2 (5.3 ± 0.8 vs 3.1 ± 0.3, p = 0.001). Group 2 patients also achieved successful hemostasis with a significant reduction in duration of compression (mean reduction = 62 minutes, p = 0.001). In conclusion, a strategy of using a lower dose of heparin with ulnar artery compression achieves shorter duration hemostasis after TRA with significantly less rebound bleeding and radial artery occlusion, as compared with the conventional strategy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Aspirin Discontinuation Versus 12-Month Dual Antiplatelet Therapy after Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials.","authors":"Abhigna Kolupoti, Eduardo Itaya, Bryan O Perez Martinez, JuYong Lee, Michael Azrin, Patrick Corcoran, Khagendra Dahal","doi":"10.1016/j.amjcard.2026.07.029","DOIUrl":"10.1016/j.amjcard.2026.07.029","url":null,"abstract":"<p><p>In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), 12-month dual antiplatelet therapy (DAPT) has long been the standard of care. However, emerging evidence suggests that discontinuing aspirin early while maintaining P2Y12 inhibitor monotherapy may reduce bleeding without compromising ischemic protection. We performed a systematic review and meta-analysis to evaluate the impact of early aspirin discontinuation compared with standard 12-month DAPT on clinical outcomes after PCI for ACS. A meta-analysis was performed including randomized clinical trials and post-hoc analyses of randomized trials comparing early aspirin discontinuation (within 1 to 3 months post-PCI) to standard 12-month DAPT in ACS populations. The major endpoints were a composite of net adverse clinical events (NACE), major adverse cardiovascular events (MACE), all cause and cardiovascular mortality, MI, stroke, stent thrombosis (ST), target vessel revascularization (TVR), and bleeding. A random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Nine studies were included, encompassing 31,505 patients (15,700 early discontinuation; 15,805 standard DAPT). Across the 9 included studies, early aspirin discontinuation was associated with a significant reduction in NACE compared with standard DAPT (OR 0.77, 95% CI 0.65 to 0.91; p = 0.002) due to reduction in BARC ≥2 bleeding [0.41; 0.32 to 0.52; p <0.00001]. Early aspirin discontinuation, compared to 12-month DAPT resulted in similar risk of MACE [0.88; 0.73 to 1.07; p = .19], all-cause mortality [0.84; 0.69 to 1.03; p = 0.09], cardiovascular mortality [1.02; 0.74 to 1.41; p = 0.92], MI [0.98; 0.77 to 1.25; p = 0.87], stroke [0.97; 0.73 to 1.29; p = 0.82], ST [1.29; 0.83 to 2.0; p = 0.26] and TVR [1.00; 0.79 to 1.27; p = 1.00]. In ACS patients treated with PCI, early discontinuation of aspirin while maintaining P2Y12 inhibitor monotherapy appears to reduce adverse clinical events compared with standard 12-month DAPT. These findings show net benefit of following early aspirin discontinuation strategy due to reduction in major bleeding events without jeopardizing ischemic outcomes.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine to Refined: The Aspirin Paradigm After PCI in Acute Coronary Syndromes.","authors":"Swotantra Gautam, Timir Paul","doi":"10.1016/j.amjcard.2026.08.014","DOIUrl":"10.1016/j.amjcard.2026.08.014","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Clinical Outcomes of Elective Coronary Atherectomy in Hospitals With Versus Without On-Site Surgical Backup: A Contemporary Nationwide Analysis.","authors":"Amninder Singh, Manan Pancholy, Smeet Thaker, Nikhil Shokeen, Amit Bhandari, Jonathan Kovacs, Tejas M Patel, J Dawn Abbott","doi":"10.1016/j.amjcard.2026.08.008","DOIUrl":"10.1016/j.amjcard.2026.08.008","url":null,"abstract":"<p><p>The safety of complex percutaneous coronary intervention (PCI) at hospitals without on-site cardiac surgical backup (Non-SOS) has been broadly established, but data specifically addressing elective coronary atherectomy in this setting remain limited. To evaluate whether on-site cardiac surgical backup status influences clinical outcomes of elective coronary atherectomy procedures using contemporary nationwide data. A retrospective cohort study was conducted using the National Inpatient Sample (NIS) from 2016 to 2023. Elective hospitalizations involving coronary atherectomy were identified using ICD-10-PCS codes. Facilities were stratified by on site coronary artery bypass grafting capability. The primary outcome was in hospital mortality. Inverse probability treatment weighting was utilized to adjust for baseline differences. A separate adjusted analysis evaluated annual hospital atherectomy volume and mortality using Firth's penalized logistic regression. We identified 21,595 weighted elective coronary atherectomy procedures (93.4% at SOS hospitals). After Inverse probability treatment weighting adjustment, in-hospital mortality, although numerically higher, did not differ significantly between SOS and Non-SOS centers (OR 0.503; 95% CI 0.203 to 1.249; p = 0.139). Emergency coronary artery bypass grafting was performed in 1.4% of SOS patients, with a 14.0% mortality rate. Emergent transfer rates were higher at Non SOS hospitals (1.8% vs 0.6%; p = 0.026). Annual hospital atherectomy volume ≥30 procedures was independently associated with lower mortality (Firth-adjusted OR 0.06; 95% CI 0.01 to 0.21; p <0.001). Elective coronary atherectomy was performed with comparable in hospital mortality regardless of on-site surgical backup status. Hospital atherectomy volume was the strongest institutional predictor of mortality.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admitting Diagnosis in In-Hospital STEMI: When the Reason for Admission Becomes a Barrier to Life-Saving Therapy.","authors":"Zihao Lai, Guihao Chen","doi":"10.1016/j.amjcard.2026.08.019","DOIUrl":"10.1016/j.amjcard.2026.08.019","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Aneurysmal and Ectatic Disease: Cath-Lab Diagnosis and Contemporary Interventional Management.","authors":"Giulia Alagna, Francesca Campanella, Lucio Giuseppe Granata, Pierre Sabouret, Alessandro Lupi, Giuseppe Andò","doi":"10.1016/j.amjcard.2026.08.016","DOIUrl":"10.1016/j.amjcard.2026.08.016","url":null,"abstract":"<p><p>Coronary aneurysmal and ectatic disease (CAA/CAE) is an increasingly recognized condition in contemporary catheterization laboratory practice and is predominantly associated with atherosclerotic remodeling. It is characterized by excessive positive remodeling, vessel wall degeneration, altered coronary hemodynamics, and a prothrombotic milieu, all of which contribute to an increased risk of ischemic events. Invasive angiography remains the primary diagnostic tool, while intravascular imaging is essential for accurate morphological characterization, detection of intraluminal thrombus, and guidance of percutaneous interventions. Revascularization strategies should be individualized, with percutaneous intervention reserved for flow-limiting lesions and surgery considered for giant or complex aneurysms. Evidence guiding antithrombotic therapy is limited and largely observational. A recent network meta-analysis suggests that dual antiplatelet therapy is associated with the greatest reduction in major adverse cardiovascular events, whereas routine oral anticoagulation has not demonstrated consistent benefit. Current ACC/AHA and ESC guidelines do not provide specific recommendations for aneurysmal disease; therefore, antithrombotic management is generally extrapolated from standard recommendations according to clinical presentation. In conclusion, pending the results of ongoing trials, a phenotype-driven and individualized approach remains the most appropriate management strategy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Differences in Transcatheter Coarctation Repair Among Adolescents and Adults.","authors":"Katia Bravo-Jaimes, Keila Lopez, Jamil Aboulhosn, Kevin Kennedy, Christopher McLeod, Renée P Bullock-Palmer","doi":"10.1016/j.amjcard.2026.08.017","DOIUrl":"10.1016/j.amjcard.2026.08.017","url":null,"abstract":"<p><p>Racial and ethnic (RAE) differences in the presentation and outcomes of coarctation of the aorta (CoA) among adolescents and adults undergoing transcatheter coarctation repair (TCR) remain poorly defined. We retrospectively analyzed patients aged ≥16 years who underwent TCR at US centers participating in the NCDR IMPACT registry between 2011 and 2023. Among 2,267 patients, 70.9% were Non-Hispanic White (NHW), 18.5% Hispanic (H), 7.4% Non-Hispanic Black (NHB), and 3.3% Non-Hispanic Other (NHO), demonstrating underrepresentation of Hispanic and NHB patients. Late CoA presentation occurred in 53.6% of patients and did not differ across RAE groups (p = 0.076). Older age was the only independent predictor of late presentation (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.13 to 1.40; p <0.001). Late presentation was more frequent in adult-based than pediatric-based hospitals (60.1% vs 48.6%, p <0.001) but was not associated with center procedural volume. Adverse TCR outcomes occurred in 8.8% of patients and were similar across RAE groups (p = 0.392). Higher median household income was independently associated with lower odds of adverse outcomes (OR 0.78, 95% CI 0.62 to 0.97; p = 0.027), while outcomes did not differ by hospital type, TCR volume, or ACHA accreditation status. Sensitivity analyses comparing NHW versus non-NHW patients showed no significant differences in presentation or procedural outcomes, although in-hospital mortality was higher among non-NHW patients (0.6% vs 0.1%, p = 0.012). In conclusion, in this large contemporary registry, RAE was not associated with late presentation or adverse TCR outcomes. Although Hispanic, NHB, and NHO patients were underrepresented, TCR was associated with favorable outcomes across groups, supporting its safety and effectiveness while highlighting the need for improved CoA detection and equitable access to specialized congenital heart disease care.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}