{"title":"Renal Denervation: Patient Selection and When to Refer.","authors":"Raven A Voora, Michael J Bloch, Naomi Dl Fisher","doi":"10.1016/j.amjcard.2025.06.009","DOIUrl":"10.1016/j.amjcard.2025.06.009","url":null,"abstract":"<p><p>The US FDA approved Renal Denervation for hypertension treatment in November 2023. Regardless of the methodology used to denervate, most but not all people had a clinically significant reduction in blood pressure in the months following the procedure. In this review we summarize the current data informing patient selection, and provide guidance on when to refer potential patients for consideration of this therapy in the management of uncontrolled hypertension.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274019","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}
Zade Bihag MD , Jay Patel DO , Jeff F. Mather MS , Robert Hagberg MD , Jawad Haider MD , Talhat Azemi MD , Immad Sadiq MD , Mohiuddin Cheema MD , Bryan Piccirillo MD , Sheelagh Pousatis MD , Priyesh Thakurathi MD , David Yaffee MD , Sabet W. Hashim MD , Raymond G. McKay MD
{"title":"6 Year Follow-Up of Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valves: A Propensity-Matched Analysis","authors":"Zade Bihag MD , Jay Patel DO , Jeff F. Mather MS , Robert Hagberg MD , Jawad Haider MD , Talhat Azemi MD , Immad Sadiq MD , Mohiuddin Cheema MD , Bryan Piccirillo MD , Sheelagh Pousatis MD , Priyesh Thakurathi MD , David Yaffee MD , Sabet W. Hashim MD , Raymond G. McKay MD","doi":"10.1016/j.amjcard.2025.06.002","DOIUrl":"10.1016/j.amjcard.2025.06.002","url":null,"abstract":"<div><div>Prior reports comparing long-term outcomes of balloon-expandable (BE) versus self-expanding (SE) transcatheter aortic valve implantation (TAVI) have been limited. We compared in-hospital, 1-year, and 6-year outcomes in 1,685 BE (S3, Ultra) versus 776 SE (Evolut R, PRO, PRO+) patients undergoing transfemoral TAVI at a single center. Valve-in-valve and nontransfemoral access cases were excluded. Propensity-score matched BE (<em>n</em> = 683) and SE (<em>n</em> = 680) cohorts did not differ with respect to age (82.2 ± 8.0 vs 82.1 ± 7.8 years, p = 0.407), baseline demographics and comorbidities, pre-TAVI echo and cardiac catheterization results, and STS Risk Score (7.9 ± 5.9 vs 7.9 ± 5.5%, p = 0.481). BE vs SE patients had similar in-hospital mortality (0.9 vs 0.6%, p = 0.0.072), stroke (1.3 vs 1.8%, p = 0.503), major vascular complications (2.8 vs 2.2%, p = 0.495) and composite bleeding (4.7 vs 3.4%, p = 0.178), although the BE cohort required fewer permanent pacemakers (8.3 vs 13.3%, p = 0.003). At 1-year, BE and SE patients had similar all-cause mortality (10.8 vs 11.2%, p = 0.825), hospital readmission (22.5 vs 19.6%, p = 0.192), and KCCQ12 scores (83.7 ± 25.5 vs 83.0 ± 24.6, p = 0.606). At a median follow-up of 77.0 (72.6 to 81.5) months, Kaplan-Meier survival analysis demonstrated no difference in BE vs SE all-cause mortality (33.2 vs 40.4%, p = 0.586), with no differences in late valve-related outcomes including myocardial infarction, stroke, AV endocarditis, and AV re-intervention (balloon aortic valvuloplasty, percutaneous paravalvular leak closure, repeat TAVI, surgical AV replacement). However, BE patients more commonly required treatment for subclinical leaflet thrombosis, while SE patients had a higher incidence of transient ischemic attack during follow-up. In conclusion, BE and SE TAVI patients have similar in-hospital, 1-year and median 6-year adverse outcomes, other than higher subclinical leaflet thrombosis in BE patients and an increased transient ischemic attack rate in SE patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 78-85"},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257139","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 Aortic Valve Replacement Versus Clinical Surveillance in Asymptomatic Patients With Severe Aortic Stenosis","authors":"Yasuaki Takeji MD , Tomohiko Taniguchi MD , Takeshi Morimoto MD , Shinichi Shirai MD , Takeshi Kitai MD , Hiroyuki Tabata MD , Nobuhisa Ohno MD , Ryosuke Murai MD , Kohei Osakada MD , Koichiro Murata MD , Masanao Nakai MD , Hiroshi Tsuneyoshi MD , Tomohisa Tada MD , Masashi Amano MD , Shin Watanabe MD , Hiroki Shiomi MD , Hirotoshi Watanabe MD , Yusuke Yoshikawa MD , Ryusuke Nishikawa MD , Yuki Obayashi MD , Takeshi Kimura MD","doi":"10.1016/j.amjcard.2025.06.004","DOIUrl":"10.1016/j.amjcard.2025.06.004","url":null,"abstract":"<div><div>The optimal timing for aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains debatable. This study aimed to compare the clinical outcomes of early AVR and clinical surveillance in asymptomatic patients with high-gradient severe AS. Among 3369 patients enrolled in the CURRENT AS Registry-2, which included consecutive patients with severe AS, we identified 596 asymptomatic patients with high-gradient severe AS (initial AVR strategy: 285 patients; clinical surveillance strategy: 311 patients). A propensity score-matched cohort was constructed, comprising 206 patients each in the initial AVR and clinical surveillance groups. The primary outcome measure was a composite of all-cause death, stroke, or hospitalization for heart failure (HF). In the propensity score-matched cohort, the mean age was 79.6 years, and the median Society of Thoracic Surgeons-predicted risk of mortality was 3.2%. In the initial AVR group, surgical and transcatheter AVR were performed in 83 and 123 patients, respectively, whereas in the clinical surveillance group, conversion to AVR occurred in 11.1%, 32.9%, and 69.0% patients at 6 months, 1 year, and 3 years. The cumulative 3-year incidence of the primary outcome was not significantly different between the initial AVR and clinical surveillance groups (26.4% vs 28.4%; log-rank p = 0.46; hazard ratio [HR]: 0.85, 95% confidence interval [CI]: 0.56–1.29). In conclusion, in asymptomatic patients with high-gradient severe AS, the initial AVR strategy compared to clinical surveillance was not associated with a lower risk for a composite of all-cause death, stroke or hospitalization for HF.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 68-77"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257140","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":"Remodeling and Reverse-Remodeling of Left Atrium and Appendage After Catheter Ablation for Atrial Fibrillation","authors":"Tetsuma Kawaji MD, PhD , Takanori Aizawa MD, PhD , Issei Seto , Saki Yamano CE , Misaki Naka MD , Bingyuan Bao MD, PhD , Shun Hojo MD , Shintaro Matsuda MD , Masashi Kato MD, PhD , Takafumi Yokomatsu MD , Shinji Miki MD, PhD","doi":"10.1016/j.amjcard.2025.06.001","DOIUrl":"10.1016/j.amjcard.2025.06.001","url":null,"abstract":"<div><div>The processes of remodeling and reverse-remodeling of left atrial (LA) and LA appendage (LAA) after catheter ablation for atrial fibrillation (AF) are insufficiently evaluated. A total of 372 consecutive AF patients undergoing ablation procedure with contrast CT images and whose follow-up CT images were acquired after the procedure were enrolled. From those CT images, LA volume (LAV), LA emptying fraction (LAEF), LAA volume (LAAV), and LAAEF were measured. Mean age of patients was 70 years, and CHA<sub>2</sub>DS<sub>2</sub>-VASc score was 2.5 ± 1.7. Mean LAV, LAEF, LAAV, and LAAEF were 121.3 ml, 22.1%, 18.6 ml, and 23.5%, respectively. For patients with LA and LAA remodeling, nonparoxysmal AF (non-PAF) was more prevalent and strongly correlated with heart failure-related parameters. All types of remodeling were associated with recurrent postprocedure atrial tachyarrhythmias, and LAV emerged as an independent risk factor for recurrent tachyarrhythmias (adjusted hazard ratio 1.01, p = 0.02) in multivariable analysis. Follow-up CT images showed that LAV and LAAV significantly decreased, while LAEF and LAAEF significantly increased accompanied by a reduction in filling defects in the LAA. After the procedure, reverse-remodeling was prominent in non-PAF patients, while LAEF significantly decreased in PAF patients. The decrease in LAEF for PAF patients was significantly larger in those who received additional ablation beyond pulmonary vein isolation (PVI) than those who received PVI alone. On the other hand, in non-PAF patients, postprocedure LA reverse-remodeling was consistent regardless of ablation strategy, but significantly poor in those with recurrence. In conclusions, LA and LAA remodeling were more prevalent in non-PAF patients. LA and LAA reverse-remodeling after the ablation procedure were remarkable in non-PAF patients, especially those without recurrence. Meanwhile, LAEF decreased after the procedure in PAF patients, particularly in those who received additional ablation beyond PVI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 23-31"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245932","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":"Angiographic No-Reflow in Patients With Acute Coronary Syndrome Caused by Calcified Nodules","authors":"Yuichi Ozaki MD, PhD, Hironori Kitabata MD, PhD, Ryo Hikida MD, Yuta Takano MD, Yosuke Katayama MD, PhD, Masahiro Takahata MD, PhD, Teruaki Wada MD, PhD, Akira Taruya MD, PhD, Manabu Kashiwagi MD, PhD, Yasutsugu Shiono MD, PhD, Akio Kuroi MD, PhD, Takashi Tanimoto MD, PhD, Takashi Yamano MD, PhD, Atsushi Tanaka MD, PhD","doi":"10.1016/j.amjcard.2025.06.008","DOIUrl":"10.1016/j.amjcard.2025.06.008","url":null,"abstract":"<div><div>Acute coronary syndrome (ACS) caused by calcified nodules (CNs) has a poor prognosis. The no-reflow phenomenon in CNs has not been well studied. We investigated the incidence of the no-reflow phenomenon, evaluated the relationship between the no-reflow phenomenon and plaque components in patients with ACS caused by CNs, and compared the clinical outcomes on the basis of plaque morphology and components. This study enrolled 355 ACS patients who had de novo culprit lesions in a native coronary artery. The culprit lesions were assessed by both optical coherence tomography (OCT) and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). The patients were classified into 3 groups according to OCT findings (plaque rupture [PR], plaque erosion [PE], or CN), and then respectively divided into 2 groups using a maximum lipid core burden index in 4 mm (maxLCBI<sub>4mm</sub>) cutoff value of 400 on NIRS-IVUS. The maxLCBI<sub>4mm</sub> in the infarct-related lesion was greater in patients with PR (641 [461–772]) than in those with PE (vs 533 [373 to 713], p = 0.004) and CN (vs 479 [342 to 639], p = 0.002). In patients with CN, the maxLCBI<sub>4mm</sub> was significantly greater in patients with the no-reflow phenomenon than in those without (p = 0.027). The incidence of major adverse cardiovascular events was significantly higher in patients with CN and a maxLCBI<sub>4mm</sub> ≥400 than in those with other plaque features (p = 0.024). Underlying lipidic components are associated with the no-reflow phenomenon in CNs. CNs and a large lipid core provide worse long-term clinical outcomes after percutaneous coronary intervention in ACS.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 59-67"},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245927","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}
Deniz Mutlu MD , Ozgur Selim Ser MD , Dimitrios Strepkos MD , Pedro E.P. Carvalho MD , Michaella Alexandrou MD , Barkin Kultursay MD , Ali Karagoz MD , Oleg Krestyaninov MD , Dmitrii Khelimskii MD , Mahmut Uluganyan MD , Korhan Soylu MD , Ufuk Yildirim MD , Mehmet Semih Belpinar MD , Olga Mastrodemos BA , Bavana V. Rangan BDS, MPH , Jaskanwal Deep Singh Sara MD , Sandeep Jalli MD , Konstantinos Voudris MD , Yader Sandoval MD , M. Nicholas Burke MD , Emmanouil S. Brilakis MD, PhD
{"title":"Impact of Bifurcation Angle on Side Branch Occlusion in Provisional Bifurcation Percutaneous Coronary Intervention: Analysis from the PROGRESS-BIFURCATION Registry","authors":"Deniz Mutlu MD , Ozgur Selim Ser MD , Dimitrios Strepkos MD , Pedro E.P. Carvalho MD , Michaella Alexandrou MD , Barkin Kultursay MD , Ali Karagoz MD , Oleg Krestyaninov MD , Dmitrii Khelimskii MD , Mahmut Uluganyan MD , Korhan Soylu MD , Ufuk Yildirim MD , Mehmet Semih Belpinar MD , Olga Mastrodemos BA , Bavana V. Rangan BDS, MPH , Jaskanwal Deep Singh Sara MD , Sandeep Jalli MD , Konstantinos Voudris MD , Yader Sandoval MD , M. Nicholas Burke MD , Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.amjcard.2025.05.033","DOIUrl":"10.1016/j.amjcard.2025.05.033","url":null,"abstract":"<div><div>Limited information exists on the impact of the bifurcation angle on side branch occlusion (SBO) in provisional percutaneous coronary intervention (PCI). We examined the procedural characteristics and outcomes of 1015 bifurcation PCIs (855 patients) that were performed using the provisional technique between 2014 and 2023 from a multicenter bifurcation PCI registry (NCT05100992). The median bifurcation angle was 60° (interquartile range [IQR] 40°–80°). Patients were divided into 3 groups: narrow angle (<45°), middle angle (45–70°), and wide angle (>70°). Patients in all groups had similar baseline clinical characteristics. Lesions in the wide-angle group had larger proximal and distal main vessel and side branch diameter. Technical and procedural success and in-hospital major adverse cardiovascular events (MACE) were similar in all groups. Overall SBO was 14.6% and was more likely to be observed in the narrow angle group (22.6%) than the remaining groups (middle angle 11.7%, wide angle 12.8%, p <0.001). In multiple logistic regression analysis, wider bifurcation angle was associated with lower risk of SBO (adjusted odds ratio [aOR] per 10-degree increments: 0.88 [95% confidence interval (CI), 0.80 to 0.98; p = 0.017]). A U-shaped association was seen between bifurcation angle and SBO, where restricted cubic spline analysis demonstrated that the lowest risk of SBO was at a bifurcation angle of 100° (aOR 0.19, 95% CI 0.07 to 0.55, p = 0.002). In patients undergoing provisional stenting, narrow bifurcation angle was associated with higher SBO risk.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 41-48"},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245930","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}
Rik Adrichem MD, Cindy Yang BSc, Marcel L. Geleijnse MD, PhD, Mark M.P. van den Dorpel MD, Paul A. Cummins RN, Isabella Kardys MD, PhD, Joost Daemen MD, PhD, Rutger-Jan Nuis MD, PhD, Nicolas M. Van Mieghem MD, PhD
{"title":"Transcatheter Aortic Valve Replacement for Patients With Moderate Aortic Stenos is—A Propensity Matched Analysis","authors":"Rik Adrichem MD, Cindy Yang BSc, Marcel L. Geleijnse MD, PhD, Mark M.P. van den Dorpel MD, Paul A. Cummins RN, Isabella Kardys MD, PhD, Joost Daemen MD, PhD, Rutger-Jan Nuis MD, PhD, Nicolas M. Van Mieghem MD, PhD","doi":"10.1016/j.amjcard.2025.05.032","DOIUrl":"10.1016/j.amjcard.2025.05.032","url":null,"abstract":"<div><div>Moderate aortic stenosis (AS) has been linked to impaired long-term survival. Whether transcatheter aortic valve replacement (TAVR) may improve clinical outcome of moderate AS is unknown. We aimed to investigate the potential clinical benefits of TAVR for patients with moderate AS irrespective of LVEF. We used univariable and multivariable Cox regression models to find predictors for mortality and a composite of mortality and heart failure hospitalizations. We also performed a propensity score-matched comparison of outcomes between patients with moderate AS who underwent TAVR, and those with clinical surveillance with surgical aortic valve replacement or TAVR only upon progression to severe AS. We identified 115 patients with moderate AS who underwent TAVR and 220 patients with moderate AS who underwent clinical surveillance. TAVR patients were older, had more comorbidities and were more symptomatic than the clinical surveillance patients. TAVR was associated with lower all-cause mortality (multivariable adjusted HR: 0.51, 95% CI 0.35 to 0.76) and reduced incidence of the composite endpoint of all-cause mortality and heart failure hospitalizations (adjusted HR: 0.53, 95% CI 0.36 to 0.77). These results were reinforced in our propensity score matched analysis (unadjusted matched HR: 0.50, 95% CI 0.33 to 0.75). In conclusion, TAVR may improve clinical outcome in patients with moderate AS. Our findings justify randomized controlled trials that evaluate TAVR in patients with moderate AS.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 32-40"},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245943","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":"Clinical Outcomes of Intravenous Iron Therapy in Systolic Heart Failure Patients Receiving SGLT2 Inhibitors.","authors":"Waleed Alruwaili, Syed Ahmed, Seher Berzingi, Lalitsiri Atti, Amro Taha, Sittinun Thangjui, Harshith Thyagaturu, Sudarshan Balla","doi":"10.1016/j.amjcard.2025.06.006","DOIUrl":"10.1016/j.amjcard.2025.06.006","url":null,"abstract":"<p><p>SGLT2 inhibitors (SGLT2i) can mimic iron deficiency (ID) by altering iron biomarkers. Although intravenous (IV) iron therapy is an established treatment for ID in HF, it remains unclear whether concomitant use of IV iron and SGLT2i increases the risk of thromboembolic events (TE). We aim to evaluate the risks associated with combined IV iron therapy and SGLT2i in patients with systolic HF and ID. Using the TriNetX database, we identified patients with systolic HF on SGLT2i at baseline with a diagnosis of ID (serum ferritin <100 μg/L). Patients were stratified by IV iron therapy use. Propensity score matching was used to balance confounding factors between groups. Cox Proportional Hazard ratio was calculated for TE, all-cause mortality, major adverse cardiovascular events (MACE), and HF exacerbation over a 1-year follow-up. Of 14,863 patients, 2,908 (19.5%) received IV iron therapy. The mean age in the treatment group and the control group was 66.8 years (54.5% male) and 67.2 years (54.7% male), respectively. IV iron treatment was associated with significantly increased risks of TE (HR: 1.38; 95% CI: 1.02 to 1.87; p = 0.032), MACE (HR: 1.26; 95% CI: 1.05 to 1.51; p = 0.010), all-cause mortality (HR: 1.45; 95% CI: 1.25 to 1.67; p <0.001), and HF exacerbation (HR: 1.65; 95% CI: 1.27 to 2.13; p <0.001). Patients with systolic HF and ID receiving combined IV iron therapy and SGLT2 inhibitors had significantly increased risks of TE, MACE, all-cause mortality, and HF exacerbations. Further mechanistic studies are required to elucidate the interactions between IV iron and SGLT2i.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245928","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":"Proton Pump Inhibitor Use, Gastrointestinal Bleeding Reduction, and Long-Term Prognosis After Percutaneous Coronary Intervention","authors":"Tatsuya Tokai MD , Masanobu Ishii MD, MPH, PhD , Yasuhiro Otsuka MD , So Ikebe MD , Taishi Nakamura MD, PhD , Kenichi Tsujita MD, PhD , Naoyuki Akashi MD, PhD , Hideo Fujita MD, PhD , Yasuhiro Nakano MD, PhD , Tetsuya Matoba MD, PhD , Takahide Kohro MD, PhD , Yusuke Oba MD, PhD , Tomoyuki Kabutoya MD, PhD , Kazuomi Kario MD, PhD , Yasushi Imai MD, PhD , Arihiro Kiyosue MD, PhD , Yoshiko Mizuno MD, PhD , Kotaro Nochioka MD, PhD , Masaharu Nakayama MD, PhD , Takamasa Iwai MD , Ryozo Nagai MD, PhD","doi":"10.1016/j.amjcard.2025.05.037","DOIUrl":"10.1016/j.amjcard.2025.05.037","url":null,"abstract":"<div><div>Proton pump inhibitors (PPI) reduce gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI), but their impact on mortality and major adverse cardiovascular events (MACE) remains unclear. This study investigated the association between PPI-related GIB reduction and MACE and mortality using a real-world database. We analyzed 6,457 patients undergoing PCI (2013 to 2019), using the Clinical Deep Data Accumulation System including electronic medical records from 7 Japanese hospitals. Patients were grouped by PPI use. The primary outcome was GIB and secondary outcomes were all-cause mortality and MACE. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and Cox regression were used to estimate hazard ratios. To estimate causal inference, mediation analysis was conducted to assess the indirect effects of PPI use via GIB reduction. PSM and IPTW analyses revealed a lower GIB incidence in the PPI group (PSM: <0.1%, IPTW: 1.6%) than in the non-PPI group (PSM: 2.3%, IPTW: 2.7%). No significant association was found between PPI use and all-cause death or MACE. However, in patients with acute coronary syndrome (ACS), IPTW analysis indicated that PPI use was associated with lower all-cause death (HR: 0.582, 95% CI: 0.364 to 0.931) and MACE (HR: 0.570, 95% CI: 0.344 to 0.946). Importantly, mediation analysis suggested that GIB reduction partially mediated the association between PPI use and lower mortality. In conclusion, PPI use after PCI was associated with lower GIB risk. In ACS patients, it may be associated with a reduction in all-cause mortality, partially mediated by GIB reduction.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 78-87"},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245931","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}
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