American Journal of Cardiology最新文献

{"title":"Early Aortic Valve Replacement in Asymptomatic Severe Aortic Stenosis: A Meta-Analysis of Randomized Controlled Trials","authors":"Sameena K. Brar BS ,&nbsp;Derek W. Leong MD ,&nbsp;Rabia R. Razi MD, MPH ,&nbsp;Naing Moore MD ,&nbsp;Ray Zadegan MD ,&nbsp;Prakash Mansukhani MD ,&nbsp;Somjot S. Brar MD, MPH","doi":"10.1016/j.amjcard.2025.02.025","DOIUrl":"10.1016/j.amjcard.2025.02.025","url":null,"abstract":"<div><div>Determining the best time for aortic valve replacement (AVR) in asymptomatic severe aortic stenosis (AS) with preserved left ventricular function remains controversial, as current guidelines recommend waiting until symptoms appear. Recent evidence suggests that early AVR may improve outcomes for select patients. This meta-analysis of randomized controlled trials evaluated the efficacy of early AVR, including surgical and transcatheter approaches, versus conservative management in asymptomatic severe AS. We systematically searched PubMed, Embase, CENTRAL, and ClinicalTrials.gov to identify eligible trials. The outcomes of interest included all-cause mortality, unplanned hospitalization, stroke, as well as the composite endpoint of each trial, which was derived from combinations of these outcomes. Four trials involving 1,427 patients were included. Early AVR significantly reduced the risk of unplanned hospitalizations (HR 0.42, 95% CI 0.33 to 0.53, p &lt;0.001, I² = 0%). Although there was a trend towards reduced all-cause mortality, it did not reach statistical significance (HR 0.76, 95% CI 0.48 to 1.21, I² = 42%). Stroke also trended lower with early AVR (HR 0.63, 95% CI 0.40 to 1.00, p = 0.05, I² = 0%). In conclusion, these findings indicate that early AVR may provide clinical benefits by reducing adverse events in asymptomatic severe AS, in particular unplanned rehospitalization, suggesting that early AVR could be beneficial and should be considered in future guideline revisions.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"245 ","pages":"Pages 11-16"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584298","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":"Meta-Analysis of Racial and Ethnic Disparities in Rhythm Control Strategies for Atrial Fibrillation in the United States","authors":"Sheikh Moinul MD ,&nbsp;Manuel Urina-Jassir MD ,&nbsp;Joan Rodriguez-Taveras MD ,&nbsp;Adelqui O. Peralta MD ,&nbsp;Peter S. Hoffmeister MD ,&nbsp;Scott Kinlay MBBS, PhD ,&nbsp;Hirad Yarmohammadi MD, MPH ,&nbsp;William E. Boden MD ,&nbsp;Jacob Joseph MBBS, MD ,&nbsp;Matthew F. Yuyun MD, MPhil, PhD","doi":"10.1016/j.amjcard.2025.02.028","DOIUrl":"10.1016/j.amjcard.2025.02.028","url":null,"abstract":"<div><div>Rhythm control strategies are a key component of atrial fibrillation (AF) therapy, with recent reports suggesting racial and ethnic disparities in their utilization. We aimed to determine differences in the utilization of catheter ablation (CA), direct current cardioversion (DCCV), and anti-arrhythmic drugs (AAD) among different racial and ethnic groups. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library (from inception to January 31st, 2024) for studies including adults with AF and reporting CA, DCCV, or AAD utilization rates in at least 2 racial and ethnic groups. Our primary outcome was the likelihood of Black, Hispanic, and Asian individuals undergoing each rhythm control strategy compared to White patients. Pooled estimates were calculated with a random-effects model and were reported as odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs). Nineteen studies were included comprising 12,598,109 patients. The pooled ORs (95% CI) of undergoing CA for Black individuals was 0.68 (95% CI 0.56 to 0.83), for Hispanic individuals was 0.72 (95% CI 0.63 to 0.82), and for Asian individuals was 0.64 (95% CI 0.48 to 0.86), compared to White individuals. The likelihood of undergoing DCCV (OR [95% CI]) was lower in Black (0.69 [95% CI 0.57 to 0.82]), Hispanic (0.67 [95% CI 0.57 to 0.80]), Asian (0.68 [95% CI 0.64 to 0.72]) patients compared to White patients. Our results identified that racial and ethnic minoritized groups with AF are significantly less likely to undergo treatment with a rhythm control strategy. In conclusion, these findings highlight a significant gap in healthcare delivery that stakeholders, healthcare systems, and clinicians should address.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"245 ","pages":"Pages 1-10"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539919","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 Octogenarians Undergoing Edge-to-Edge Transcatheter Valve Repair for Tricuspid Regurgitation: Inverse Propensity Score-Weighted Analysis","authors":"Fabrizio Monaco MD ,&nbsp;Jacopo D'Andria Ursoleo MD ,&nbsp;Emanuele Ghirardi MDs ,&nbsp;Viviana Teresa Agosta MD ,&nbsp;Alice Bottussi MD ,&nbsp;Samuele Bugo MD ,&nbsp;Francesco Maisano MD ,&nbsp;Marina Pieri MD","doi":"10.1016/j.amjcard.2025.02.033","DOIUrl":"10.1016/j.amjcard.2025.02.033","url":null,"abstract":"<div><div>There is a scarcity of data for perioperative outcomes of octogenarians undergoing tricuspid transcatheter edge-to-edge repair (TEER), despite both the potential procedural effectiveness in treating tricuspid regurgitation and a low incidence of severe complications observed in the nonelderly population. We assessed the characteristics and outcomes of TEER in octogenarians compared to those in patients under 80 years old treated at a referral tertiary teaching hospital. We retrospectively enrolled all adult patients undergoing tricuspid TEER. The population was stratified based on age: ≥80 and &lt;80 years. Inverse probability of treatment weighting (IPTW) propensity score was used to mitigate the risk of selection bias. Between January 2017 and September 2023, 101 patients underwent tricuspid TEER. Thirty-six (36%) were octogenarians. Crude treatment estimates indicated that preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) was significantly higher in octogenarians compared to younger patients (19 mm [IQR: 17 to 21] vs. 17 mm [IQR: 14–18]; p = 0.005). At discharge, octogenarians showed a TAPSE 2.71 mm higher than that observed in the &lt;80 age group (95% CI: 0.79 to 4.62; p = 0.006) according to crude treatment estimates. After adjusting with IPTW-weighting, the TAPSE difference remained significant, with octogenarians having a 2.44 mm higher TAPSE (95% CI: 0.54 to 4.35; p = 0.012). IPTW-adjusted analyses indicated comparable clinical outcomes between the two groups. Adverse events and survival in octogenarians were similar to those observed in patients aged &lt;80 years. Our findings indicate that age alone should not be the sole criterion to deny TEER.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 32-40"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536579","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":"Navigating Electrocardiographic Risk Stratification and Therapeutic Strategies in Acute Coronary Syndrome Without ST-Segment Elevation","authors":"Andreas Y. Andreou MD","doi":"10.1016/j.amjcard.2025.02.032","DOIUrl":"10.1016/j.amjcard.2025.02.032","url":null,"abstract":"<div><div>Of the patients suffering acute proximal left anterior descending (LAD) artery occlusion, a small but not insignificant minority does not manifest the classical ST-segment elevation myocardial infarction (STEMI) electrocardiographic (ECG) patterns. They manifest junctional upsloping ST-segment depression followed by tall, symmetrical T waves in the precordial leads instead, known as the de Winter pattern. Such patients may suffer a nearly transmural infarct if not managed promptly with percutaneous coronary intervention (PCI). Therefore, they should be treated as suffering a STEMI equivalent. The patient presented here suffered a total proximal “wrap-around” LAD artery in-stent occlusion manifesting the de Winter ECG pattern. The latter, was correctly and promptly recognized and the patient was managed successfully with emergency PCI achieving a good outcome. Discussion pertains to the morphology of ST-segment depression (STD) and the polarity and magnitude of the T waves accompanying STD which provide prognostic information and facilitate risk stratification in patients presenting with non-ST-segment elevation acute coronary syndrome. The pathophysiology underlying the de Winter ECG pattern and the appropriate therapeutic strategy are also discussed. The Littmann concept is also discussed, providing a reliable explanation for the ST-segment elevation observed in a misplaced lead V1.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 28-31"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536577","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":"Real-World Impact of Mavacamten on Diastolic Function in Hypertrophic Cardiomyopathy: Insights Beyond Gradient Reduction","authors":"Roopa A. Rao MBBS,&nbsp;Mithilesh K. Das MD, MBA","doi":"10.1016/j.amjcard.2025.02.011","DOIUrl":"10.1016/j.amjcard.2025.02.011","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 95-96"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531174","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":"Home-Based Exercise and Patient-Reported Outcome Measures in Peripheral Artery Disease: The LITE Randomized Clinical Trial","authors":"Mary O. Whipple PhD, RN ,&nbsp;Shujun Xu MS ,&nbsp;Dongxue Zhang MS ,&nbsp;Jack M. Guralnik MD, PhD ,&nbsp;Bonnie Spring PhD ,&nbsp;Lu Tian ScD ,&nbsp;Diane Treat-Jacobson PhD, RN ,&nbsp;Lihui Zhao PhD ,&nbsp;Michael H. Criqui MD, MPH ,&nbsp;Mary M. McDermott MD","doi":"10.1016/j.amjcard.2025.02.027","DOIUrl":"10.1016/j.amjcard.2025.02.027","url":null,"abstract":"<div><div>In patients with peripheral artery disease (PAD), we evaluated the effects of 12 months of walking exercise at a pace inducing ischemic leg symptoms (high intensity) on the attainment of meaningful improvement in patient-reported outcome measures (PROMs) and 6-minute walk, compared to walking exercise at a comfortable pace (low intensity) and a nonexercise control. Participants completed the 6-minute walk test (6MWT) to evaluate objective walking ability. PROMs included the Walking Impairment Questionnaire (WIQ) distance and speed scores (range 0 to 100, 100-best, minimal clinically important difference (MCID) = 15 and 11, respectively). 240 participants (61.7% Black, 48.3% female) participated. High intensity exercise increased 6MWT compared to control (+44.8 meters (95% CI:21.7,68.0) and compared to low-intensity exercise (+37.6 meters [95% CI:18.6,56.5]). Low intensity exercise had no significant benefit compared to control (+7.3 meters [95% CI:-16.3,30.9]). High intensity significantly increased attainment of the MCID for the 6MWT compared to low intensity (OR:2.43 [95% CI:1.35,4.38]) and compared to control (OR:5.22 [95% CI:2.32,11.76]). Compared to control, high intensity exercise significantly increased the odds of attaining an MCID for the WIQ distance score (OR:2.30 [95% CI:1.05,5.04]) and WIQ speed score (OR:2.94 [95% CI:1.27,6.83]). Compared to low intensity, high intensity did not significantly increase the odds of attaining an MCID for the WIQ distance (OR:0.93 [95% CI:0.53,1.66]) or the WIQ speed score (OR:1.31 [95% CI:0.71,2.43]). In conclusion, in people with PAD, high intensity walking exercise increased the odds of meaningful improvement in PROMs compared to control, but not compared to low-intensity exercise. Despite this, high intensity exercise improved 6MWT more than the low intensity exercise and nonexercise control groups (NCT02538900).</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 41-47"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531172","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":"Brugada Syndrome in Sports Cardiology: An Expert Opinion Statement of the Italian Society of Sports Cardiology (SICSport)","authors":"Antonio Scarà MD ,&nbsp;Luigi Sciarra ,&nbsp;Antonio Dello Russo ,&nbsp;Elena Cavarretta ,&nbsp;Zefferino Palamà MD ,&nbsp;Alessandro Zorzi ,&nbsp;Francesco Brancati ,&nbsp;Paolo Compagnucci PhD ,&nbsp;Michela Casella ,&nbsp;Valeria Novelli PhD ,&nbsp;Giampiero Patrizi MD ,&nbsp;Pietro Delise MD","doi":"10.1016/j.amjcard.2025.02.031","DOIUrl":"10.1016/j.amjcard.2025.02.031","url":null,"abstract":"<div><div>Brugada syndrome (BrS) is a genetic disorder marked by a characteristic electrocardiogram (ECG) pattern of ST-segment elevation and T-wave inversion in right precordial leads, which is associated with an increased risk of ventricular fibrillation in the absence of structural heart disease. Despite advancements in understanding its epidemiology, pathophysiology, and treatment, there is considerable variability in how sports cardiologists approach BrS. This expert opinion by the Italian Society of Sports Cardiology (SICSPORT) aim to review the current definition, diagnosis, epidemiology, genetics, risk stratification, and treatment of BrS and provide guidance for sport eligibility provides guidance for sports doctors and cardiologists in assessing competitive sports eligibility in athletes with BrS. A multiparametric approach to diagnosis and risk stratification is recommended, noting that the presence of a Brugada ECG pattern (BrP) does not confirm a BrS diagnosis. The risk of sudden cardiac death (SCD) is low in asymptomatic individuals with type 1 BrP, especially those with a drug-induced pattern. Pharmacological testing is not required for type 2 or 3 patterns without other risk factors. Low-risk individuals do not require therapy, while intermediate or high-risk patients may need pharmacological treatment, ICD implantation, or ablation. Asymptomatic individuals with type 2 or 3 BrP, no family history of SCD, and no other risk factors may be eligible for competitive sports, as well as asymptomatic type 1 BrP without risk factors and negative electrophysiological study. Conversely, sports eligibility should be denied in patients with BrS who have a history of syncope or cardiac arrest (high-risk subjects), regardless of ICD presence.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 9-17"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Profile and Mortality of Infective Endocarditis Over the Past Decade: A Systematic Review and Meta-Analysis of 133 Studies","authors":"Andreas Tzoumas MD ,&nbsp;Marios Sagris MD ,&nbsp;Dimitrios Xenos MD ,&nbsp;Athina Ntoumaziou MD ,&nbsp;Ioannis Kyriakoulis MD ,&nbsp;Fotis Kakargias MD ,&nbsp;Wasla Liaqat MD ,&nbsp;Sanjana Nagraj MBBS ,&nbsp;Riya Patel MBBS ,&nbsp;Grigorios Korosoglou MD ,&nbsp;Dimitris Tousoulis MD, PhD ,&nbsp;Konstantinos Tsioufis MD, PhD ,&nbsp;Damianos G. Kokkinidis MD ,&nbsp;Leonidas Palaiodimos MD","doi":"10.1016/j.amjcard.2025.02.023","DOIUrl":"10.1016/j.amjcard.2025.02.023","url":null,"abstract":"<div><div>Infective endocarditis (IE) is an increasingly prevalent condition with relatively high mortality, whose epidemiology has become more complex with an aging population, an increased number of comorbidities, and an increasing incidence of health-care associated IE. Epidemiological data on the causative microorganisms of IE, prevalence of involvement of the different cardiac valves, and IE-associated mortality are clinically relevant. Eligible studies were identified through a systematic search of PubMed/MEDLINE database from 2010 to 2020, and a random effects model meta-analysis was conducted. 133 studies comprising 132,584 patients from six continents were included in this systematic review. The most common causative agents were Staphylococci species in 36% of cases, followed by Streptococci species (26%) and Enterococci species (10%). Out of studies that provided further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans group Streptococcus (12%). The short-term mortality rate (defined as in-hospital or 30-day mortality) was 17%. The highest mortality was reported in studies from Latin America with a mean mortality rate of 33% and the lowest mortality was reported in studies from Oceania at 13%. The aortic valve was the most commonly affected valve (46%), followed closely by the mitral valve (43%). The prevalence of tricuspid valve IE was 7% and multivalvular IE occurred in 14% of cases. Our study highlights a shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE.</div></div><div><h3>Protocol registration</h3><div>PROSPERO CRD42024602342.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 67-88"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522403","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":"Chronic Total Occlusion Percutaneous Coronary Intervention: The Present and the Future","authors":"Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.amjcard.2025.02.022","DOIUrl":"10.1016/j.amjcard.2025.02.022","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 1-2"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522399","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":"Machine Learning Predicts Bleeding Risk in Atrial Fibrillation Patients on Direct Oral Anticoagulant","authors":"Rahul Chaudhary ,&nbsp;Mehdi Nourelahi ,&nbsp;Floyd W. Thoma ,&nbsp;Walid F. Gellad ,&nbsp;Wei-Hsuan Lo-Ciganic ,&nbsp;Rohit Chaudhary ,&nbsp;Anahita Dua ,&nbsp;Kevin P. Bliden ,&nbsp;Paul A. Gurbel ,&nbsp;Matthew D. Neal ,&nbsp;Sandeep Jain ,&nbsp;Aditya Bhonsale ,&nbsp;Suresh R. Mulukutla ,&nbsp;Yanshan Wang ,&nbsp;Matthew E. Harinstein ,&nbsp;Samir Saba ,&nbsp;Shyam Visweswaran","doi":"10.1016/j.amjcard.2025.02.030","DOIUrl":"10.1016/j.amjcard.2025.02.030","url":null,"abstract":"<div><div>Predicting major bleeding in nonvalvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized care. Alternatives like left atrial appendage closure devices lower stroke risk with fewer nonprocedural bleeds. This study compares machine learning (ML) models with conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) for predicting bleeding events requiring hospitalization in AF patients on DOACs at their index cardiologist visit. This retrospective cohort study used electronic health records from 2010 to 2022 at the University of Pittsburgh Medical Center. It included 24,468 nonvalvular AF patients (age ≥18) on DOACs, excluding those with prior significant bleeding or warfarin use. The primary outcome was hospitalization for bleeding within one year, with follow-up at one, two, and five years. ML algorithms (logistic regression, classification trees, random forest, XGBoost, k-nearest neighbor, naïve Bayes) were compared for performance. Of 24,468 patients, 553 (2.3%) had bleeding within one year, 829 (3.5%) within two years, and 1,292 (5.8%) within five years. ML models outperformed HAS-BLED, ATRIA, and ORBIT in 1-year predictions. The random forest model achieved an AUC of 0.76 (0.70 to 0.81), G-Mean of 0.67, and net reclassification index of 0.14 compared to HAS-BLED's AUC of 0.57 (p &lt; 0.001). ML models showed superior results across all timepoints and for hemorrhagic stroke. SHAP analysis identified new risk factors, including BMI, cholesterol profile, and insurance type. In conclusion, ML models demonstrated improved performance to conventional bleeding risk scores and uncovered novel risk factors, offering potential for more personalized bleeding risk assessment in AF patients on DOACs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 58-66"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}