American Journal of Cardiology最新文献

{"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}

{"title":"Interpreting Lipid Biomarkers in Cardiac Allograft Vasculopathy","authors":"Victorious-Benedicta Olamona,&nbsp;Mahmood Ahmad MD","doi":"10.1016/j.amjcard.2025.05.001","DOIUrl":"10.1016/j.amjcard.2025.05.001","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Page 9"},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957231","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":"Pacemaker Prediction Following Trans-aortic Valvular Intervention-Do Risk Scores Help?","authors":"Leonard Ilkhanoff, Brett D Atwater","doi":"10.1016/j.amjcard.2025.04.026","DOIUrl":"10.1016/j.amjcard.2025.04.026","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956446","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":"Incidence and Risk of Heart Failure in Patients With Coronary Heart Disease and Stroke: A Population-Based Cohort Study","authors":"Xiaofei Liu MS ,&nbsp;Peng Shen MD ,&nbsp;Yi Chen MS ,&nbsp;Yexiang Sun MPH ,&nbsp;Qi Chen MPH ,&nbsp;Hongbo Lin MD ,&nbsp;Xun Tang PhD, MHS ,&nbsp;Pei Gao PhD","doi":"10.1016/j.amjcard.2025.04.028","DOIUrl":"10.1016/j.amjcard.2025.04.028","url":null,"abstract":"<div><div>Heart failure (HF) is a major global health issue, with coronary heart disease (CHD) and stroke being risk factors with different mechanisms. The risk of HF in stroke patients remain poorly characterized despite the potential contributions of \"stroke-heart syndrome.\" This study aimed to evaluate HF incidence and risk factors across different cardiovascular disease (CVD) subtypes in a large population-based Chinese cohort. This study included 13,258 CVD patients, i.e. 3,470 patients with CHD (including 610 with myocardial infarction [MI]) and 10,048 with total stroke (comprising 8,631 ischemic and 1,515 hemorrhagic stroke), and 66,290 age- and sex-matched controls without CVD (1:5 ratio). The primary outcome was new-onset HF. Cumulative incidence functions were estimated with non-HF death as a competing event, stratified by CVD subtypes. Cox proportional hazard models were used to assess the risk factors of HF and compare relative hazard ratio (HR) between CHD and stroke patients. The 10-year cumulative incidence of HF was 25.3% in patients with CHD (24.6% in MI patients), 13.5% in stroke patients (14.7% and 7.3% for ischemic and hemorrhagic stroke, respectively), and 6.9% in controls. Hypertension (81.8% in CHD, 81.0% in stroke) significantly increased HF risk compared to those without it (incidence rate ratio: 1.74, 95% CI: 1.41 to 2.12 for stroke; 1.42, 95% CI: 1.12 to 1.78 for CHD). Obesity showed a stronger association with HF in stroke patients than in CHD patients (HR: 1.43, 95%CI: 1.15 to 1.78 vs 0.94, 95%CI: 0.69 to 1.28, ratio of HRs: 1.67, 95% CI: 1.14 to 2.42). Other significant risk factors in both CHD and stroke patients include older age, male sex, former smoking, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease. In conclusion, heart failure incidence varies by CVD subtypes, with the highest risk rates in CHD and MI patients, followed by stroke. Hypertension and obesity notably increase HF risk for stroke patients. Tailored risk management strategies are needed, considering the differential impact of risk factors across CVD subtypes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 70-78"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963529","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 Influence of Height on Occupational Radiation Exposure of Interventional Cardiologists During Selective Coronary Angiography Using a Radial Artery Approach","authors":"Richard Casazza MAS ,&nbsp;Bilal Malik MD ,&nbsp;Arsalan Hashmi ,&nbsp;Joshua Fogel Phd ,&nbsp;Enrico Montagna RT ,&nbsp;Darren Gibson RT ,&nbsp;Andres Palacio RT ,&nbsp;Habiba Beginyazova RT ,&nbsp;Robert Frankel MD ,&nbsp;Jacob Shani MD","doi":"10.1016/j.amjcard.2025.04.027","DOIUrl":"10.1016/j.amjcard.2025.04.027","url":null,"abstract":"<div><div>Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Operator height can influence operator radiation exposure. This single-center retrospective study (<em>n</em> = 534) assessed the cumulative radiation (CR) exposure in μSv and normalized radiation exposure (CR/DAP) using three different ranges of height (short, regular, and tall) of the primary operator at four anatomical locations when using a radial artery approach. A multivariate linear regression analyses for cumulative operator radiation dose found that tall operator height had significantly lesser values than regular operator height for the thorax (p &lt;0.001), abdomen (p = 0.01), left eye (p &lt;0.001), and right eye (p &lt;0.001). Short operator height did not significantly differ from regular operator height. Multivariate linear regression analyses for normalized operator radiation dose found that tall operator height had significantly lesser values than regular operator height for the thorax (p &lt;0.001), abdomen (p = 0.01), left eye (p &lt;0.001), and right eye (p = 0.002). Short operator height did not significantly differ from regular operator height. In conclusion, there was an association of lower operator radiation dose in the thorax, abdomen, left eye, and right eye for tall operators as compared to regular height operators. We recommend regular height operators be exceedingly vigilant with their personal radiation protection techniques. Furthermore, these same protection techniques should be considered with patients that have a higher likelihood of generating greater dose-area-products.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961354","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":"Factors Associated with the Uncoupling of Perceived and Achieved Exercise Capacity in Patients Undergoing Cardiopulmonary Exercise Testing","authors":"Kaivalya Dandamudi MD ,&nbsp;Adarsh Mallepally BS ,&nbsp;Teymur Zavar BS ,&nbsp;Justin M. Canada PhD ,&nbsp;Ross Arena PhD ,&nbsp;Inna Tchoukina MD ,&nbsp;Cory R. Trankle MD","doi":"10.1016/j.amjcard.2025.04.029","DOIUrl":"10.1016/j.amjcard.2025.04.029","url":null,"abstract":"<div><div>An objective of the Duke Activity Status Index (DASI) is to standardize assessments of exertional intolerance. However, patient factors associated with inaccurate assessments of exercise capacity with this tool are not well described. Patients who completed the DASI in preparation for a treadmill cardiopulmonary exercise test (CPET) at our institution from 2022 to 2023 were analyzed. Metabolic equivalents of task (METs) were calculated from the DASI score and measured from CPET. Clinical characteristics were compared using Chi square or Mann-Whitney U tests between those who overestimated versus underestimated exercise capacity via the DASI. Correlations were assessed with a Spearman test, and a binary logistic regression model was fit to the clinical characteristics to identify patient characteristics associated with overestimating METs with the DASI. Overall, 512 patients were included in the current study, and the majority (419 [82%]) overestimated exercise capacity via the DASI. DASI-predicted METs had moderate correlation with CPET-achieved METs (Spearman’s rho = +0.620, p &lt;0.001). Patients who overestimated exercise capacity by DASI were more likely to be older, female sex, Black race, on beta blockers, of higher body mass index, and with cardiac comorbidities. The regression model (Χ² = 87.6, p &lt;0.001, Nagelkerke R² = 0.259) found older age, female sex, diagnosis of heart failure, and congenital heart disease most strongly associated with overestimating exercise capacity (all p ≤0.002). In conclusion, a majority of patients referred for CPET overestimate exercise capacity by DASI score, particularly those with older age, female sex, heart failure, and congenital heart disease.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 48-53"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957750","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":"Safety and Effectiveness of the High-Sensitivity HEART Pathway Safely Across Age Groups in Patients With Suspected Acute Coronary Syndrome","authors":"Michael Supples MD, MPH ,&nbsp;Simon Smits BS ,&nbsp;Akalya Villenthi MS ,&nbsp;Anna C. Snavely PhD ,&nbsp;Nicklaus P. Ashburn MD, MS ,&nbsp;Simon A. Mahler MD, MS","doi":"10.1016/j.amjcard.2025.04.022","DOIUrl":"10.1016/j.amjcard.2025.04.022","url":null,"abstract":"<div><div>The high-sensitivity HEART Pathway (hs-HP) is a risk stratification algorithm for Emergency Department (ED) patients with chest pain. However, its diagnostic performance across age subgroups is unknown. We conducted a subgroup analysis of the 5-site hs-HP implementation study. Pre-implementation (1/2019-4/2020) the traditional HEART Pathway was used with contemporary troponins. Postimplementation (11/2020-2/2022) the hs-HP was used with high-sensitivity troponins to risk-stratify patients into rule-out, observation, and rule-in groups. Patients were classified as young (aged: 18 to 45), middle-aged (46 to 64), or older (≥65). Effectiveness and safety outcomes included 30-day hospitalizations and 30-day all-cause mortality or myocardial infarction (MI), respectively. Multivariable logistic regression was used to compare outcomes pre- vs. postimplementation within age subgroups. The 26,126 patients accrued (12,317 pre- and 13,809 postimplementation) were 35.3% non-White and 52.7% female. Postimplementation, hospitalizations decreased 18.1% among the older patients (70.6% vs. 52.5%; aOR 0.47, 95% CI, 0.42 to 0.52), 18.2% in middle-aged (50.0% vs. 31.8%; aOR 0.48, 95% CI, 0.44 to 0.52), and 7.5% among young patients (20.1% vs. 7.6%; aOR 0.69, 95% CI, 0.59 to 0.76). In older patients, 30-day death or MI occurred in 12.9% (497/3,861) postimplementation vs. 13.5% (482/3,571) preimplementation (aOR 1.02; 95% CI, 0.89 to 1.18). In middle-aged patients, 7.0% (382/5,495) had 30-day death or MI postimplementation vs. 7.5% (395/5,257) preimplementation (aOR 1.01; 95% CI, 0.87-1.18). Finally, 30-day death or MI occurred in 1.5% (66/4,453) of young patients postimplementation vs. 2.0% (71/3,489) preimplementation (aOR 1.01; 95% CI 0.69 to 1.48). In conclusion, the hs-HP significantly reduced hospitalizations across all age groups of patients with chest pain, without increasing 30-day adverse events.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 38-47"},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952284","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}