American Journal of Cardiology最新文献

{"title":"Selective Use of Thromboaspiration in STEMI: CMR Evidence Against Routine Practice","authors":"Tom Bourcier MD ,&nbsp;Jeremie Riou MD ,&nbsp;Wissam Abi Khalil MD ,&nbsp;Thomas Benard MD ,&nbsp;Anicet Betard MD ,&nbsp;Audrey Camarzana MD ,&nbsp;Stéphane Delepine MD, PhD ,&nbsp;Serge Willoteaux MD, PhD ,&nbsp;Alain Furber MD, PhD ,&nbsp;Fabrice Prunier MD, PhD ,&nbsp;Loic Biere MD, PhD","doi":"10.1016/j.amjcard.2025.11.024","DOIUrl":"10.1016/j.amjcard.2025.11.024","url":null,"abstract":"<div><div>Thromboaspiration (TA) has been proposed as an adjunct to primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) to reduce thrombus burden. However, its effect on microvascular perfusion remains uncertain, and concerns have been raised about its potential to aggravate microvascular injury. This study aimed to evaluate the impact of TA on microvascular obstruction (MVO) using cardiac magnetic resonance imaging in a large cohort of STEMI patients. We prospectively enrolled 460 STEMI patients treated with primary PCI within 12 hours of symptom onset. TA was performed in 193 patients (42%). Cardiac magnetic resonance was performed at day 6 and 3 months to assess infarct size and MVO. A propensity score-based average treatment effect analysis was used to adjust for baseline differences. Subgroup analyses were conducted according to symptom-to-treatment time, thrombus burden (thrombolysis in myocardial infarction thrombus score), and sex. TA was independently associated with higher MVO incidence (odds ratios [OR] 1.52; 95% confidence intervals [CI]: 1.16 to 1.98; p = 0.0024) and greater MVO extent (standardized mean differences 0.42; 95% CI: 0.02 to 0.72; p = 0.041). The association was particularly significant in patients reperfused beyond 6 hours (OR 3.46; 95% CI: 1.92 to 6.23; p &lt; 0.0001) and those with nonocclusive thrombus (thrombolysis in myocardial infarction thrombus score “1 to 4”) (OR 2.23; 95% CI: 1.29 to 3.85; p = 0.004). Sex-stratified analysis showed increased MVO risk in men (OR 1.52; 95% CI: 1.14 to 2.05; p = 0.005) but not in women. TA during primary PCI was associated with increased occurrence and extent of MVO, particularly in patients with delayed reperfusion or nonocclusive thrombus. These findings reinforce current ESC guidelines against routine TA use and suggest that its application should be restricted to carefully selected patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 8-13"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896066","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":"Imaging to Rule Out Thrombus Before Ablation","authors":"Bharat Rawlley MB, BS,&nbsp;Kartik Gupta MD","doi":"10.1016/j.amjcard.2025.12.009","DOIUrl":"10.1016/j.amjcard.2025.12.009","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Page 7"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888842","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":"Angiography-Derived Index of Microvascular Resistance in Patients With Anterior ST-Segment Elevation Myocardial Infarction After Successful Primary Percutaneous Coronary Intervention","authors":"Ciro Pollio Benvenuto MD ,&nbsp;Domenico Galante MD ,&nbsp;Frederik Zimmermann PhD ,&nbsp;Andrea Viceré MD ,&nbsp;Vincenzo Viccaro MD ,&nbsp;Chiara Giuliana MD ,&nbsp;Simona Todisco MD ,&nbsp;Michele Bellamoli MD ,&nbsp;Luca Bettari PhD ,&nbsp;Diego Maffeo MD ,&nbsp;Francesco Burzotta PhD ,&nbsp;Antonio Maria Leone PhD ,&nbsp;Andrea Buono MD","doi":"10.1016/j.amjcard.2025.11.023","DOIUrl":"10.1016/j.amjcard.2025.11.023","url":null,"abstract":"<div><div>Microvascular dysfunction following primary percutaneous coronary intervention (pPCI) is a well-established determinant of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients. Although the invasive Index of Microcirculatory Resistance (IMR) has demonstrated prognostic value, its reliance on thermodilution limits its routine applicability. Angiography-derived functional indices, already validated in the epicardial domain, may offer a simplified, non-invasive alternative for microvascular assessment. To evaluate the prognostic performance of the angiography-derived Index of Microcirculatory Resistance (AngioIMR), we retrospectively analyzed 180 consecutive patients undergoing percutaneous coronary intervention (pPCI) for anterior STEMI at Fondazione Poliambulanza, Brescia, between January 1, 2016, and February 1, 2024. AngioIMR was computed using the formula: AngioIMR = MAP × QFR × TFC. The primary endpoint was a composite of all-cause death, target vessel myocardial infarction, or hospitalization for heart failure. The secondary endpoint additionally included hospitalization for angina. Over a 5-years follow-up, primary and secondary endpoints occurred in 16 (8.9%) and 23 (13%) patients, respectively. The optimal AngioIMR cut-off was 43 (AUC 0.800; 95% CI: 0.714–0.887; p &lt;0.001), with sensitivity 87.5%, specificity 63.4%, PPV 18.9%, and NPV 98.1%. The incidence of both the primary and secondary endpoints were significantly higher in patients with AngioIMR ≥ 43: 18.9% versus 1.9% (p &lt;0.001) and 28.4% versus 1.9% (p &lt;0.001), respectively. AngioIMR ≥ 43 was associated with increased risk of adverse outcomes (HR: 9.5; 95% CI: 2.2–42.0; p &lt;0.001), and remained an independent predictor at multivariable analysis. In conclusion, AngioIMR may be a promising tool to stratify prognosis in patients with STEMI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 1-6"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892026","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 Santreva™-ATK Endovascular Revascularization Catheter in the RESTOR-1 Peripheral CTO Crossing Pivotal Study","authors":"Subhash Banerjee MD ,&nbsp;Christopher Metzger MD ,&nbsp;Mallik Thatipelli MBBS ,&nbsp;Venkatesh G. Ramaiah MD ,&nbsp;Sameh Sayfo MD, MBA ,&nbsp;Tony Das MD ,&nbsp;Shirling Tsai MD ,&nbsp;Omar Hyder MD ,&nbsp;Nicolas W. Shammas MD ,&nbsp;Matthew Bunte MD, MS, MBA ,&nbsp;Georges Nseir MD ,&nbsp;Anish Thomas MD ,&nbsp;Robert Beasley MD ,&nbsp;Christopher Bosarge MD ,&nbsp;Paul Gagne MD ,&nbsp;Christopher Kwolek MD ,&nbsp;Siddhartha Rao MD ,&nbsp;Scott Novak PhD ,&nbsp;Ashish Pershad MD ,&nbsp;Craig Walker MD ,&nbsp;Peter Soukas MD","doi":"10.1016/j.amjcard.2026.01.007","DOIUrl":"10.1016/j.amjcard.2026.01.007","url":null,"abstract":"<div><div>Data on recanalization of femoropopliteal (FP) chronic total occlusions (CTOs) and characterization of the traversed crossing track are limited. The AngioSafe Peripheral-2 CTO Crossing Catheter (Santreva™-ATK) was evaluated in a prospective, single-arm, multicenter trial conducted at 14 U.S. sites. Adults ≥18 years with Rutherford class (RC) 2–5 peripheral arterial disease and <em>de novo</em> FP CTOs ≤30 cm in length with at least 1 patent distal runoff vessel were eligible. The primary endpoint was clinical success, defined as device-facilitated guidewire placement into the distal true lumen without device-related major adverse events (MAEs) within 24 hours or through discharge, benchmarked to a 70% performance goal. Angiography and/or intravascular ultrasound (IVUS) were performed before definitive therapy. Seventy-four subjects (mean age 69.4 ± 9.0 years; 35% women; 45% with diabetes mellitus; 82% current or former smokers) were enrolled, with antegrade crossing used in all cases. The mean target CTO length was 131.6 ± 90.4 mm. The primary endpoint was achieved in 87.8% (95% Confidence Interval or CI 0.78–0.94) patients overall; 90% per protocol (95% CI 0.80-0.96); in moderate-to-severe calcification (n=53), 86.7% (95% CI 0.74–0.94) overall and 88% (95% CI 0.76-0.95) per protocol. IVUS (n = 54) demonstrated 80% exclusively intraplaque crossings. The device created an angiographically visible channel (mean diameter 2.87 ± 0.74 mm; reference vessel diameter 4.9 ± 0.89 mm), corresponding to a 59% luminal gain. At 30 days, mean RC improved from 3.40 ± 0.09 to 1.25 ± 0.20 and pain score from 5.24 ± 0.36 to 2.06 ± 0.33 (both p &lt; 0.001). No device-related MAEs occurred through 30 days. Santreva^TM-ATK demonstrated high rates of procedural success, intraplaque passage, and safety in FP CTOs, including heavily calcified lesions, with no device-related MAEs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 33-42"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028117","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":"Primary Pericardial Mesothelioma: A Rare and Aggressive Malignancy – Case Report and Literature Review","authors":"Agustina Alves de Lima MD,&nbsp;María Celeste Carrero MD, PhD,&nbsp;Pablo Guillermo Stutzbach MD,&nbsp;Julio Sanmartino MD,&nbsp;Leonardo Seoane MD, MSc,&nbsp;Mariano Vrancic MD,&nbsp;Juan Pablo Costabel MD, MSc","doi":"10.1016/j.amjcard.2025.12.008","DOIUrl":"10.1016/j.amjcard.2025.12.008","url":null,"abstract":"<div><div>Primary tumors of the pericardium are exceptionally rare, with primary pericardial mesothelioma (PPM) being the most frequently encountered histological subtype. PPM is an aggressive malignancy with a poor prognosis and a median survival of approximately six months from symptom onset. Due to its nonspecific clinical presentation, diagnosis is often delayed and typically occurs at an advanced stage. We report the case of a 47-year-old woman who presented with recurrent hemorrhagic pericardial effusions and signs of hemodynamic compromise. Histopathological analysis of the resected pericardium confirmed a diagnosis of biphasic pericardial mesothelioma, predominantly epithelioid in subtype. This case highlights the diagnostic challenges and poor outcomes associated with PPM, underscoring the need for heightened clinical suspicion, timely intervention, and further research into effective management strategies</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 22-26"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905373","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 Impact of Atherectomy in Severely Calcified Lesions in Impella-Supported High-Risk Percutaneous Coronary Intervention","authors":"Batlah Falah MD, MPH ,&nbsp;Duzhi Zhao MS ,&nbsp;Julia B. Thompson MS ,&nbsp;Mir B. Basir DO ,&nbsp;Bjorn Redfors MD, PhD ,&nbsp;Michael J. Schonning MS, MBS ,&nbsp;William W. O’Neill MD ,&nbsp;Jason Wollmuth MD","doi":"10.1016/j.amjcard.2025.11.019","DOIUrl":"10.1016/j.amjcard.2025.11.019","url":null,"abstract":"<div><div>Severe coronary artery calcification (CAC) complicates high-risk percutaneous coronary intervention (HRPCI), particularly in patients with impaired left ventricular function. Atherectomy may facilitate lesion preparation, but its use in high-risk settings is limited. We therefore aimed to assess the impact of CAC severity and atherectomy on outcomes in Impella-supported HRPCI. In the PROTECT III study (NCT04136392), 1,015 of 1,237 patients had data on CAC severity and atherectomy. Patients were grouped as severe CAC without atherectomy (<em>n</em> = 298), severe CAC with atherectomy (<em>n</em> = 326), and no severe CAC (<em>n</em> = 400). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/TIA, or repeat revascularization) at 30- and 90-days. Secondary endpoints included 1-year mortality, PCI-related complications, and hemodynamic instability. Patients with severe CAC had higher baseline SYNTAX scores and more left main disease. Atherectomy was associated with slightly longer procedural times, but not increased periprocedural complications or hemodynamic instability. At 90 days, MACCE was highest in the untreated severe CAC group (16.1% vs 12.6% vs 9.2%; overall log-rank p = 0.048). One-year mortality was also highest in this group (23.7%; p = 0.02). However, CAC severity and atherectomy use were not independent predictors of outcomes. Sensitivity analysis excluding patients with atherectomy but no severe CAC showed higher mortality risk in untreated severe CAC cases (adjHR: 0.59; overall p = 0.026). In conclusion, Severe CAC is common in patients undergoing Impella-supported HRPCI and is associated with worse outcomes. Atherectomy was safe but its benefit remains uncertain. These findings highlight the prognostic relevance of CAC and the potential role of calcium modification in HRPCI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 14-21"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892027","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":"Thrombus and Healing in Femoropopliteal Arterial Disease: Insights Into the Mechanisms of Symptomatic Peripheral Arterial Disease Progression.","authors":"Nicolas W Shammas","doi":"10.1016/j.amjcard.2026.03.009","DOIUrl":"10.1016/j.amjcard.2026.03.009","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462489","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":"\"It ain't over till it's over\"-Yogi Berra.","authors":"Roger M Mills","doi":"10.1016/j.amjcard.2026.03.012","DOIUrl":"10.1016/j.amjcard.2026.03.012","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455260","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":"Same-Day Discharge After Percutaneous Coronary Intervention for Chronic Total Occlusions: Patient's Characteristics and Procedural Success Predict Timing of Hospital Leave and Outcome.","authors":"Gjin Ndrepepa","doi":"10.1016/j.amjcard.2026.03.007","DOIUrl":"10.1016/j.amjcard.2026.03.007","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368940","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":"Revisiting Beta-Blockers in Heart Failure With Preserved Ejection Fraction-A Systematic Review and Meta-analysis.","authors":"Milena Dal Witt de Souza, Ana Paula Deluca, Juan Peres de Oliveira, Mrunalini Dandamudi, Pedro Batista, Juliana Giorgi, Caroline de Oliveira Fischer Bacca","doi":"10.1016/j.amjcard.2026.02.055","DOIUrl":"10.1016/j.amjcard.2026.02.055","url":null,"abstract":"<p><p>Despite advances in device therapy and the emergence of novel treatments, beta-blockers (BBs) remain a commonly prescribed medication in heart failure (HF). However, HF with preserved ejection fraction (HFpEF) is underdiagnosed and undertreated, and the specific role of BB therapy in this population remains controversial. A comprehensive search was conducted on PubMed, Embase, and Cochrane databases to identify studies evaluating the impact of BB use on clinical outcomes in patients with HFpEF. Data were pooled using a random-effects model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using I² statistics. We identified 13 observational studies comprising 442,543 patients, of whom 48.3% were women, with a mean age of 76.0 ± 8.3 years. In pooled analyses, BB use was associated with a lower risk of all-cause mortality (HR 0.81, 95% CI 0.73-0.90, p < 0.001). BB therapy was also associated with lower risks of cardiovascular death (HR 0.76, 95% CI 0.64-0.90, p < 0.01), HF hospitalization (HR 0.88, 95% CI 0.78-1.00, p = 0.05), and the composite outcome of death or HF hospitalization (HR 0.89, 95% CI 0.82-0.98, p = 0.02). In conclusion, in this observational meta-analysis, BB use was associated with lower mortality risk in HFpEF, whereas associations with hospitalization outcomes were heterogeneous. These findings should be interpreted as hypothesis-generating and warrant confirmation in adequately powered randomized trials.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353338","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}