American Journal of Cardiology最新文献

{"title":"Hemodynamic Response to Exercise and Quality of Life in Patients With Hypertrophic Cardiomyopathy Without Left Ventricular Outflow Tract Obstruction.","authors":"Helga Gudmundsdottir, Anna Axelsson Raja, Kasper Rossing, Hanne Rasmusen, Martin Snoer, Lars Juel Andersen, Rikke Gottlieb, Alex Hørby Christensen, Henning Bundgaard, Finn Gustafsson, Jens Jakob Thune","doi":"10.1016/j.amjcard.2025.05.012","DOIUrl":"10.1016/j.amjcard.2025.05.012","url":null,"abstract":"<p><p>In hypertrophic cardiomyopathy (HCM), impaired exercise capacity and quality of life (QoL) are indicative of a poor prognosis irrespective of left ventricular outflow tract (LVOT) obstruction. Exercise limitations are considered a substantial contributor to reduced QoL in HCM but the relationship between hemodynamic determinants of exercise capacity and QoL in HCM remains unknown. This study assessed the relationship between exercise hemodynamics and QoL in patients with HCM without LVOT obstruction. Patients underwent hemodynamic assessment via right heart catheterization, with measurements taken at rest and during exercise. Patient-reported QoL was assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS). Hemodynamic metrics correlating with QoL were identified. Fifty-nine patients were included (27% females, mean age 58 ± 12 years). The cohort demonstrated mild to moderate QoL impairments, with a median overall summary KCCQ score of 83 (IQR: 71 to 95). At rest, QoL correlated with cardiac output (r = 0.3, p = 0.01) and mean pulmonary arterial pressure (r = -0.4, p = 0.003). During mild exercise (25 watts), an inverse correlation was observed between the KCCQ-OSS and left ventricular filling pressure (r = -0.4, p < 0.001), and at peak exercise, a positive correlation was observed between the KCCQ-OSS and cardiac output (r = 0.4, p < 0.001). In multivariate analysis, left ventricular filling pressure measured during mild exercise (β = -0.8, [95% CI: -1.49, -0.09], p = 0.035) emerged as the sole independent hemodynamic predictor of QoL. In conclusion, in patients with HCM without LVOT obstruction, QoL is significantly associated with several hemodynamic parameters, with elevated left ventricular filling pressures during mild exercise emerging as a key determinant.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085687","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":"Corrigendum to Impella Versus Non-Impella for Nonemergent High-Risk Percutaneous Coronary Intervention The American Journal of Cardiology (2024) Volume 225, 15 August. Pages 4-9. DOI: 10.1016/j.amjcard.2024.05.038","authors":"Pavan Reddy MD ,&nbsp;Ilan Merdler MD, MHA ,&nbsp;Cheng Zhang PhD ,&nbsp;Matteo Cellamare PhD ,&nbsp;Itsik Ben-Dor MD ,&nbsp;Nelson L. Bernardo MD ,&nbsp;Hayder D. Hashim MD ,&nbsp;Lowell F. Satler MD ,&nbsp;Toby Rogers MD, PhD ,&nbsp;Ron Waksman MD","doi":"10.1016/j.amjcard.2025.04.008","DOIUrl":"10.1016/j.amjcard.2025.04.008","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"249 ","pages":"Page 18"},"PeriodicalIF":2.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934897","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":"Outcomes of Percutaneous Coronary Interventions Following Transcatheter Aortic Valve Replacement: Insights From the CathPCI Registry","authors":"Christina Lalani MD ,&nbsp;Ravi K. Sharma MD ,&nbsp;Jonathan Sevilla-Cazes MD ,&nbsp;Kevin Kennedy MS ,&nbsp;Neel M. Butala MD ,&nbsp;Eric A. Secemsky MD, MSc ,&nbsp;Duane Pinto MD ,&nbsp;Marie-France Poulin MD ,&nbsp;Roger Laham MD ,&nbsp;Dhaval Kolte MD, PhD, MPH ,&nbsp;David J. Cohen MD, MSc ,&nbsp;Robert W. Yeh MD, MSc","doi":"10.1016/j.amjcard.2025.05.006","DOIUrl":"10.1016/j.amjcard.2025.05.006","url":null,"abstract":"<div><div>Although transcatheter aortic valve replacement (TAVR) devices can impair coronary access, there are limited real-world data comparing outcomes of percutaneous coronary intervention (PCI) in post-TAVR versus non-TAVR patients. In this study, we compare procedural characteristics and outcomes between patients with versus without a history of TAVR who undergo PCI. We used claims data for the Medicare population to evaluate the incidence of PCI after TAVR between 2011 and 2017. Then, using the CathPCI Registry, we compared PCI outcomes between patients with a history of TAVR versus propensity score-matched non-TAVR patients. Of the 52,780 Medicare patients who underwent TAVR between 2011 and 2017, the incidence of acute myocardial infarction (AMI) was 10.2% and of PCI was 5.1% at 5 years. At 5 years, the incidence of stroke was 5.0% and of death was 64.0%. In the CathPCI Registry, procedural success for PCI was similar between 1,309 post-TAVR patients versus 5,236 propensity-score matched patients without prior TAVR. However, post-TAVR patients required greater fluoroscopic time (21.9 vs 17.7 minutes, p &lt;0.001) and had higher rates of post-procedural stroke (0.8% vs 0.4%, p = 0.02) and bleeding (5.1% vs 2.9%, p &lt;0.001). Post-TAVR patients were more likely to have repeat PCI in the 3 years post-PCI (HR: 1.36, 95% C.I: 1.09, 1.70) and had higher rates of stroke (HR: 1.65, C.I.: 1.07 to 2.56, p = 0.023) and death (HR: 1.23, C.I.: 1.11-1.38, p &lt;0.001) compared to non-TAVR patients. In conclusion, in the CathPCI Registry, patients with a history of TAVR appeared to have similar procedural success but longer fluoroscopic times, more frequent post-procedural bleeding and stroke, and a higher likelihood of a repeat PCI compared with matched patients without a history of TAVR.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 18-24"},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962731","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":"Young Adults Undergoing Percutaneous Coronary Intervention for Myocardial Infarction in the United States, 2011 to 2023.","authors":"Usman Ali Akbar, Mohamad B Taha, Hassaan B Arshad, Kershaw V Patel, Edo Kaluski, Neal S Kleiman, Alpesh R Shah, Safi U Khan","doi":"10.1016/j.amjcard.2025.05.007","DOIUrl":"10.1016/j.amjcard.2025.05.007","url":null,"abstract":"<p><p>The prognostic impact of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in young adults undergoing percutaneous coronary intervention (PCI) remains under explored. We compared the long-term outcomes of young adults undergoing PCI for STEMI and NSTEMI. We used the United States (US) TriNetX database (2011 to 2023), encompassing young adults aged 18 to 50 years hospitalized for myocardial infarction (MI), who received PCI within 24 hours of presentation. We used 1:1 propensity score matching to adjust for baseline differences; cardiovascular outcomes were assessed at 5 years using Cox proportional hazards models. Of 16,209 patients, 53% presented with STEMI and 47% with NSTEMI. After matching, 9,680 patients were analyzed (4,840 in each group). At 5 years, patient with STEMI exhibited higher risk of all-cause mortality [hazard ratio (HR), 1.21 (95% confidence interval, 1.04 to 1.39)], and heart failure (HF) [1.25 (1.12 to 1.41)] compared with those with NSTEMI. There were no significant differences between groups for MI (HR: 0.85 [0.66 to 1.08]), stroke (HR: 1.12 [0.94 to 1.34]), major bleeding (HR: 1.15 [0.99 to 1.29]) and renal replacement therapy (0.1 vs 0.1 per 100 person-years; HR: 0.77 [0.46 to 1.29]). In conclusion, young adults with STEMI undergoing PCI had a higher risk of mortality and HF compared with those with NSTEMI at 5 years. These findings underscore the importance of early and aggressive intervention to mitigate long-term cardiovascular risks in this population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952720","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":"Geographic Variation in Cardiometabolic and Lifestyle Risk Factors Across US States, 2011 to 2021","authors":"Rachel K. Gardner MD ,&nbsp;Archana Tale MPH ,&nbsp;Rishi K. Wadhera MD, MPP, MPhil","doi":"10.1016/j.amjcard.2025.05.002","DOIUrl":"10.1016/j.amjcard.2025.05.002","url":null,"abstract":"<div><div>Although cardiovascular death rates vary markedly across US states, little is known about whether state-based inequities in the burden of cardiometabolic and lifestyle risk factors have changed over the past decade. We conducted a serial cross-sectional analysis of US adults using the Behavioral Risk Factor Surveillance System (BRFSS) survey, to evaluate changes in the age- and sex-adjusted prevalence of cardiometabolic risk factors (diabetes, hypertension, hyperlipidemia, and obesity) and lifestyle risk factors (binge alcohol drinking, physical inactivity, and cigarette smoking) across US states from 2011 to 2021. The study population included 945,160 adults in 2011 and 2021. The age- and sex-adjusted prevalence of diabetes (10.9% [95% CI, 10.7%, 11.0%] to 12.4% [12.2%, 12.6%]), hypertension (32.4% [32.1%, 32.7%] to 33.7% [33.4%, 34.0%]), and obesity (27.5% [27.2%, 27.7%] to 33.1% [32.8%, 33.5%]) increased from 2011 to 2021, while hyperlipidemia decreased (38.5% [38.2%, 38.8%] to 35.5% [35.2%, 35.9%]). State-based inequities in the prevalence of diabetes, hypertension, and obesity widened over this period. Across lifestyle factors, the prevalence of binge alcohol use (18.3% [18.0%, 18.5%] to 15.4% [15.2%, 15.7%]), physical inactivity (25.7% [25.4%, 27.4%] to 24.0% [23.6%, 23.7%]), and cigarette smoking (20.1% [19.8%, 20.3%] to 13.4% [13.2%, 13.7%]) decreased, while state-based inequities across these factors generally narrowed. In conclusion, the prevalence of hypertension, diabetes mellitus, and obesity increased among US adults from 2011 to 2021 while state-based inequities in the prevalence of these risk factors widened. In contrast, binge alcohol drinking, physical inactivity, and cigarette smoking all declined. Our findings suggest an urgent need for targeted strategies to address widening state-based inequities in cardiometabolic risk factors.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 46-53"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963005","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":"Impact of Annulus Size on Bioprosthetic Valve Failure after Self-Expanding Transcatheter Heart Valves Replacement","authors":"Hirofumi Hioki MD ,&nbsp;Masanori Yamamoto MD ,&nbsp;Tetsuro Shimura MD ,&nbsp;Shinichi Shirai MD ,&nbsp;Kenichi Ishizu MD ,&nbsp;Yohei Ohno MD ,&nbsp;Fumiaki Yashima MD ,&nbsp;Toru Naganuma MD ,&nbsp;Yusuke Watanabe MD ,&nbsp;Futoshi Yamanaka MD ,&nbsp;Gaku Nakazawa MD ,&nbsp;Masahiko Noguchi MD ,&nbsp;Masaki Izumo MD ,&nbsp;Masahiko Asami MD ,&nbsp;Hidetaka Nishina MD ,&nbsp;Yasushi Fuku MD ,&nbsp;Toshiaki Otsuka MD ,&nbsp;Kentaro Hayashida MD ,&nbsp;OCEAN-TAVI Investigators","doi":"10.1016/j.amjcard.2025.05.008","DOIUrl":"10.1016/j.amjcard.2025.05.008","url":null,"abstract":"<div><div>There is limited evidence on the prognosis and long-term valve durability after transcatheter aortic valve replacement (TAVR) in patients with small aortic annulus (SAA) and large aortic annulus (LAA). This analysis was sought to evaluate the impact of annular size differences on patients’ and valve outcomes. A total of 1,211 patients undergoing TAVR using self-expandable transcatheter heart valve (SE-THV) were retrospectively analyzed. The cut-off for SAA was defined as annulus perimeter of &lt; 72 mm. The primary endpoints were all-cause mortality and bioprosthetic valve failure (BVF) between the SAA and LAA groups. As a sub-analysis, the impact of postprocedural mean pressure gradient (mPG) ≥ 20mmHg and severe prosthesis-patient mismatch (PPM) on these outcomes were also evaluated. Of all patients, 60.1% (<em>n</em> = 723) had SAA. At 7 years after TAVR, the SAA group had lower incidence of all-cause mortality (53.7% vs 63.7%, log-rank p = 0.05) and lower event rate of BVF than LAA (1.2% vs 4.6%, p = 0.01 for Gray’s test). Multivariate Cox-regression and Fine-Gray competing risk regression analysis demonstrated the presence of SAA was related to better prognosis (Hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.67 to 0.98) and lower BVF (adjusted subdistribution HR, 0.41; 95% CI, 0.17 to 0.98). There were no impact of postprocedural mPG ≥ 20 mmHg or severe PPM on the difference of mortality and BVF. Further, these results were consistent in the patients with SAAs. In conclusion, SAA had better long-term patients’ prognosis and valve durability after TAVR with SE-THV.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 10-17"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960056","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 Prognostic Value of Risk Factors for Predicting Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Network Meta-Analysis","authors":"Negin Sadat Hosseini Mohammadi MD, MPH ,&nbsp;Kiarash Tavakoli MD, MPH ,&nbsp;Morvarid Taebi MD ,&nbsp;Ali Zafari MD ,&nbsp;Mobina Riahi MD ,&nbsp;Mohammad Mahdi Molaei MD ,&nbsp;Mashood Ahmad Farooqi MD ,&nbsp;Ramtin Khanipour MD ,&nbsp;Houshang Bavandpour Karvane MD ,&nbsp;Soraya Shahrzad MD ,&nbsp;Marmar Vaseghi MD ,&nbsp;Ghanunjaya R. Lakkirrddy MD, FHRS ,&nbsp;Jishanth Mattumpuram MD ,&nbsp;Stylianos Tzeis MD ,&nbsp;Yaser Jenab MD ,&nbsp;Kaveh Hosseini MD, MPH","doi":"10.1016/j.amjcard.2025.05.009","DOIUrl":"10.1016/j.amjcard.2025.05.009","url":null,"abstract":"<div><div>This study compares the prognostic value of risk factors for Permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR). PubMed, Embase, Scopus, and Cochrane Library databases were searched until November 2024 for studies reporting PPI incidence within 30 days post-TAVR. A random-effect model was used to pool risk ratios (RR) and standardized mean differences (SDM) for binary and continuous risk factors. Network meta-analysis estimated pooled risk differences (ΔRR) for binary predictors with male sex as the reference. Significant predictors were ranked based on their surface under the cumulative ranking curve (SUCRA) values. A total of 108 studies comprising 77,538 patients (14,560 requiring PPI) were included. Male sex (RR: 1.13), baseline atrial fibrillation (AF) (RR: 1.12), 2nd degree Mobitz I (RR: 5.16) and Mobitz II (RR: 2.30) atrioventricular blocks (AVB), 3rd degree AVB (RR: 13.46), left anterior (LAHB) (RR: 1.79) and posterior hemiblocks (LPHB) (RR: 2.57), bifascicular block (RR: 2.34), right bundle branch block (RBBB) (RR: 3.20) and intraprocedural AVB (RR: 4.15) were identified as predictors for PPI post-TAVR. The risk of PPI was higher with self-expandable valves (RR: 1.79), subclavian access (RR: 1.75), and 29 mm prostheses (RR: 1.33) compared to balloon-expandable valves, transfemoral access, and 23 mm prostheses. Network meta-analysis ranked 3rd degree AVB (SUCRA &lt;0.01), Mobitz I AVB (SUCRA: 0.14), Mobitz II AVB (SUCRA: 0.33), intraprocedural AVB (SUCRA: 0.42), bifascicular block (SUCRA: 0.48), RBBB (SUCRA: 0.49) and LPHB (SUCRA: 0.54) as major predictors of PPI in descending order of significance. In conclusion, clinicians should closely monitor conduction abnormalities as key predictors of PPI following TAVR. Additionally, other risk factors such as subclavian access, self-expanding implantation, AF, large prosthesis diameter, and male sex should not be overlooked.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 79-89"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952146","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":"Socioeconomic Disparities in the Care of for High-Risk Pulmonary Embolism in the United States, 2016 to 2020","authors":"Apoorva Doshi MD ,&nbsp;Prakash Upreti MD ,&nbsp;Vikas Aggarwal MD ,&nbsp;Athena Poppas MD ,&nbsp;Peter A. Soukas MD ,&nbsp;J. Dawn Abbott MD ,&nbsp;Saraschandra Vallabhajosyula MD, MSc","doi":"10.1016/j.amjcard.2025.05.003","DOIUrl":"10.1016/j.amjcard.2025.05.003","url":null,"abstract":"<div><div>There are limited data on the impact of socioeconomic factors on the management and outcomes of high-risk acute pulmonary embolism (PE). Using the National Inpatient Sample (NIS) from 2016 to 2020, we identified adult (≥18 years) admissions with high-risk PE (defined as PE with one of: cardiogenic shock, vasopressor use, or cardiac arrest). Socioeconomic determinants included sex, race, insurance payer, and economic status. Outcomes of interest included in-hospital mortality, rates of mechanical circulatory support (MCS) and definitive PE interventions, hospitalization duration, and hospitalization costs. Among 21,521 high-risk PE hospitalizations (median age 65 years, 53% male, 64% white race), the socioeconomic variables remained stable during the 5-year period. MCS utilization was 4%, with lower rates of utilization in Medicare and Medicaid beneficiaries, uninsured admissions, and those from the lowest income quartile (all p &lt;0.05). Racial minorities, those from lower economic status, and uninsured admissions received advanced PE interventions less frequently. There did not appear to be notable sex disparities in use of advanced PE therapies. Overall, in-hospital mortality was 50%, with higher adjusted in-hospital mortality in female, African American, Hispanic, uninsured, and economically disadvantaged individuals. In conclusion, significant inequities in in-hospital mortality, mechanical circulatory support, and definitive pulmonary embolism therapy utilization persist among high-risk PE hospitalizations in the United States based on sex, race, income, and insurance status.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 61-69"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965836","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":"Implementation of a High-Sensitivity Cardiac Troponin Assay and Diagnostic Protocol for Suspected Acute Coronary Syndrome","authors":"Dustin G. Mark MD ,&nbsp;Jie Huang PhD ,&nbsp;Keane K. Lee MD, MS ,&nbsp;Dana R. Sax MD, MPH ,&nbsp;Dustin W. Ballard MD, MBE ,&nbsp;David R. Vinson MD ,&nbsp;Mary E. Reed DrPH","doi":"10.1016/j.amjcard.2025.05.005","DOIUrl":"10.1016/j.amjcard.2025.05.005","url":null,"abstract":"<div><div>We assessed if implementation of a high-sensitivity cardiac troponin I (hs-cTnI) assay and 0/2-hour diagnostic protocol for evaluation of suspected acute coronary syndromes was associated with improved resource utilization by retrospectively studying adult emergency department (ED) encounters for chest pain/discomfort at 21 hospitals in an integrated health system. The hs-cTnI assay (Beckman Access) and corresponding 0/2-hour protocol were introduced on November 16, 2022. The preimplementation period was January 1, 2018 to June 30, 2019 (prior to the COVID-19 pandemic) and the postimplementation period was January 1, 2023 to June 30, 2024. Co-primary outcomes were ED disposition and 30-day coronary testing, assessed following adjustment for confounders and within strata of predicted risk. There were 87,647 preimplementation and 97,677 postimplementation encounters with similar demographics (median age 59 years, 55.2% vs 55.5% female) and risk factors (diabetes 26.6% vs 25.8%; chronic kidney disease 13.5% vs 13.6%; coronary revascularization 12.3% vs 10.6%). Adjusted prepost analyses revealed an increase in ED discharges (75.0% vs 78.9%, adjusted difference +3.9%, 95% CI +3.4% to +4.4%) and a decrease in 30-day coronary testing (36.2% vs 24.1%, adjusted difference−12.1%, 95% CI −12.9% to −−11.4%). Notably, results differed by predicted risk strata, with decreased ED discharges and increased 30-day coronary testing among nonlow risk encounters. In conclusion, hs-cTnI assay and protocol implementation was associated with decreased overall resource utilization among ED patients with chest pain, despite increased utilization among nonlow risk encounters. Structured use of hs-cTn assays can improve alignment between risk and resource allocation in this population.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 25-33"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961256","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":"Fitness and Mortality Outcomes Associated With Supramaximal Peak Heart Rate on Treadmill Exercise Stress Testing","authors":"Parth S. Patel MD ,&nbsp;Samuel Heller Jr. BA ,&nbsp;Kathryn F. Larson MD ,&nbsp;Nadia M. Elfessi PA-C ,&nbsp;Nora Sydo MD, PhD ,&nbsp;Karina Gonzalez Carta MD, MS ,&nbsp;Nasir Hussain MD ,&nbsp;Thomas G. Allison PhD, MPH ,&nbsp;Darrell B. Newman MD","doi":"10.1016/j.amjcard.2025.05.004","DOIUrl":"10.1016/j.amjcard.2025.05.004","url":null,"abstract":"<div><div>Inability to reach age-predicted peak heart rate (APPHR) on treadmill exercise testing (TMET) is associated with lower fitness and increased mortality. The significance of a “supramaximal” heart rate (≥105% of APPHR) is poorly understood; as such, we sought to investigate this relationship. We queried the Mayo Stress database from 1993 to 2010 for patients &gt;30 years old without cardiovascular disease and not on antichronotropic therapy. Patients were stratified into groups based on APPHR: &lt;75%, 75% to 84%, 85% to 94%, 95% to 104%, and ≥105%, with 105% to 114% and ≥115% subgroups. Functional aerobic capacity (FAC) was assessed by ANOVA and all-cause mortality by cox hazard regression; we adjusted for confounders. In total, 18,961 patients were included; 1150 (6.1%) died. 2,144 (11.3%) of patients achieved submaximal APPHR (&lt;85%), 2,917 achieved supramaximal APPHR (≥105%). Patients with submaximal APPHR had significantly lower FAC: 76.4% (p &lt;0.0001) [&lt;75%], 83.5% (p &lt;0.0001) [≥75% to &lt;85%]. Those with supramaximal APPHR had significantly higher FAC: 102.0% (p &lt;0.0001). Patients with submaximal APPHR had significantly higher mortality risks: &lt;75% (adjusted HR 2.36 [1.83 to 3.04], p &lt;0.0001) and ≥75 to &lt;85% (adjusted HR 1.93 [1.62 to 2.31], p &lt;0.0001). Those with supramaximal APPHR, after adjustment for cardiac risk factors and resting heart rate, had significantly lower mortality risk (adjusted HR 0.83 [0.70 to 0.99], p = 0.0414). In conclusion, supramaximal heart rate on TMET was associated with significantly higher FAC and lower all-cause mortality risk.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 54-60"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962254","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}