American heart journal最新文献

{"title":"Re. response to “Occlusion vs subocclusion of the left main, the ECG pattern has the word”","authors":"Scott W. Sharkey MD , Frank Aguirre MD , Balaj Rai MD , Timothy D Henry MD","doi":"10.1016/j.ahj.2025.107304","DOIUrl":"10.1016/j.ahj.2025.107304","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"293 ","pages":"Article 107304"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-guided disease management to prevent heart failure in adult cancer survivors of previous cardiotoxic cancer treatments: Baseline results of the REDEEM trial","authors":"Joshua Wong MBBS ,&nbsp;Joel Smith MSc ,&nbsp;Cheng Hwee Soh PhD ,&nbsp;Erin Howden PhD ,&nbsp;Jack S. Talbot PhD ,&nbsp;Mark Nolan MBBS, PhD ,&nbsp;Kristyn Whitmore BSN ,&nbsp;Leah Wright PhD ,&nbsp;Ashleigh-Georgia Sherriff BSMRes ,&nbsp;Eswar Sivaraj MSc ,&nbsp;Greg Wheeler MBBS ,&nbsp;Kirsty Wiltshire MBBS ,&nbsp;Phillip Campbell MB,ChB ,&nbsp;Satish Ramkumar MBBS, BMedSci, MMed, PhD ,&nbsp;Constantine Tam MBBS, MD ,&nbsp;Thomas H. Marwick MBBS, PhD, MPH","doi":"10.1016/j.ahj.2025.09.009","DOIUrl":"10.1016/j.ahj.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.</div></div><div><h3>Objectives</h3><div>The REDEEM (<em>Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents</em>) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.</div></div><div><h3>Methods</h3><div>Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multidisciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO₂peak) over 6 months.</div></div><div><h3>Results</h3><div>Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8 ± 6.8%), subclinical LV dysfunction was common (GLS 15.6 ± 2.1%) and 39% had evidence of functional impairment (VO₂peak≤18ml/kg/min⁻¹). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72–1.11], <em>P</em> = .360).</div></div><div><h3>Conclusions</h3><div>Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.</div></div><div><h3>Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT04962711, <span><span>https://www.clinicaltrials.gov/study/NCT04962711</span><svg><path></path></svg></span></div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107277"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REview and improvement of cardiac implanTable device Infection management qualitY initiative (RECTIFY): Rationale and design for a cardiac implantable electronic device infection quality initiative demonstration project","authors":"Nkiru Osude MD, MS ,&nbsp;Christopher B. Granger MD ,&nbsp;Rebecca Young MS ,&nbsp;Hussein Al-Khalidil PhD ,&nbsp;Kimberly Ward MPH ,&nbsp;Monica Leyva MHARCIS ,&nbsp;Cameron Lambert MD ,&nbsp;Michael Tillery ,&nbsp;Albert Lin MD ,&nbsp;Rohit Mehta MD ,&nbsp;Misra Satish MD ,&nbsp;Graham Peigh MD, MSc ,&nbsp;Austin Wright ,&nbsp;Laurence M. Epstein MD ,&nbsp;Carina Blomstrom Lundqvist MD, PhD ,&nbsp;Jonathn P. Piccini MD, MHSc ,&nbsp;M. Rizwan Sohail MD ,&nbsp;Sean D. Pokorney MD, MBA","doi":"10.1016/j.ahj.2025.08.017","DOIUrl":"10.1016/j.ahj.2025.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac implantable electronic device (CIED) infections are a growing concern due to their associated high morbidity, mortality, and healthcare costs. Current guidelines given complete device and lead removal for CIED infection a class I recommendation, yet adherence to these guidelines is low with delays in extraction associated with poor adverse clinical events.</div></div><div><h3>Obejctives</h3><div>To determine the effect of implementation of quality improvement (QI) interventions on patients with CIED infections, including rates of extraction and time to extraction.</div></div><div><h3>Methods</h3><div>This is a prospective interventional study conducted across 3 U.S. health systems that employs QI interventions aimed at increasing early identification of CIED infections. The study will have a retrospective review of treatment of CIED infection patients, followed by a 6-month QI intervention period, and a 12-month prospective data collection period after the QI intervention. Eligible patients will have a CIED and a presumed CIED infection (pocket or systemic infection). The primary endpoints are the change in the number of extractions performed for CIED infections and the time to extraction during the study.</div></div><div><h3>Conclusions</h3><div>The REview and improvement of Cardiac implanTable device InFection qualitY initiative (RECTIFY) is a multi-center demonstration project aimed to identify and address health system-wide barriers to timely diagnosis and guideline-driven management of CIED infections.</div><div><strong>Trial Registration:</strong> The trial was registered with the U.S. National Library of Medicine at the National Institutes of Health (NCT05471973).</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107264"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolocumab before percutaneous coronary intervention for acute myocardial infarction: Design of the AMUNDSEN trial","authors":"Gilles Montalescot MD-PhD ,&nbsp;Leonardo Bolognese MD ,&nbsp;Stanislaw Bartus MD ,&nbsp;Angel Cequier-Fillat MD ,&nbsp;Holger Thiele MD ,&nbsp;François Mach MD ,&nbsp;J. Wouter Jukema MD ,&nbsp;Emile Ferrari MD-PhD ,&nbsp;Géraud Souteyrand MD ,&nbsp;Claire Bouleti MD-PhD ,&nbsp;Grégoire Range MD ,&nbsp;Marco Chioccioli MD ,&nbsp;Andréa Picchi MD ,&nbsp;Laure Batias-Moreau MD ,&nbsp;Giovanni Esposito MD ,&nbsp;Nassim Braik MD ,&nbsp;Nassim Redjimi MD ,&nbsp;Benjamin Duband MD ,&nbsp;Paul Guedeney MD-PhD ,&nbsp;Michel Zeitouni MD-PhD ,&nbsp;Eric Vicaut MD-PhD","doi":"10.1016/j.ahj.2025.107295","DOIUrl":"10.1016/j.ahj.2025.107295","url":null,"abstract":"<div><h3>Rationale</h3><div>PCSK9 inhibitors are currently recommended as third-line therapy for post–myocardial infarction (MI) patients, added to high-dose statin, ezetimibe, and potentially bempedoic acid when the LDL-C target of &lt;55 mg/dL is not achieved. These guideline-driven indications result in delayed initiation of PCSK9 inhibitors, potentially missing the opportunity for benefit during the acute phase. Recent studies have demonstrated that early PCSK9 inhibition promotes anti-inflammatory effects and plaque stabilization, suggesting a potential role early in MI management.</div></div><div><h3>Methods</h3><div>The AMUNDSEN trial is a randomized, international, phase IV study using a PROBE (Prospective Randomized Open, Blinded Endpoint) design to evaluate the effects of early PCSK9 inhibition in high-risk acute MI patients undergoing percutaneous coronary intervention (PCI). A total of 2,166 patients were enrolled, including those with ST-elevation MI undergoing primary PCI and those with non–ST-elevation MI with an indication for PCI, all presenting with at least 1 high-risk clinical characteristic. Patients were randomized to receive either immediate evolocumab prior to PCI alongside standard care or standard care alone. The primary objective is to achieve both <em>a</em> ≥ 50% reduction in LDL-C from baseline and a target LDL-C &lt; 55 mg/dL at 12 months. The main clinical objective is to assess the composite of all-cause death or unplanned hospitalization for a cardiovascular (CV) reason at 12 months.</div></div><div><h3>Current status</h3><div>Enrollment and randomization are complete. Lipid and clinical follow-up are ongoing. Results from this study will clarify the lipid-lowering efficacy and clinical impact of early evolocumab initiation in the acute MI setting.</div></div><div><h3>Conclusion</h3><div>The AMUNDSEN trial will provide critical insights into the potential benefits of early PCSK9 inhibition in high-risk MI patients undergoing PCI.</div></div><div><h3>Clinical trial registration</h3><div>NCT (clinicaltrials.gov): 04951856 - EUCT number: 2024-518195-31-00.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107295"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial work indexes in elite athletes: An emerging echocardiographic tool to confirm physiologic cardiac remodeling in elite athletes with mildly reduced systolic function","authors":"Giuseppe Di Gioia MD ,&nbsp;Armando Ferrera MD ,&nbsp;Viviana Maestrini MD, PhD ,&nbsp;Sara Monosilio MD, PhD ,&nbsp;Federica Mango MD ,&nbsp;Davide Ortolina MD ,&nbsp;Antonio Pelliccia MD ,&nbsp;Maria Rosaria Squeo MD","doi":"10.1016/j.ahj.2025.09.003","DOIUrl":"10.1016/j.ahj.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Athlete's heart, characterized by cardiac chambers adaptations to exercise has some diagnostic overlaps with dilated cardiomyopathy (DCM). In the setting of differential diagnosis, myocardial work indexes (MWI), afterload-independent tool, could be helpful to identify early subclinical alterations. The aim of our study was to assess the utility of MWI in athletes with mildly reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods</h3><div>We enrolled 306 Olympic athletes (55.5% males) practicing endurance and mixed disciplines, mean age 26.3 ± 4.3 years old, who underwent cardio-pulmonary exercise test (CPET) and transthoracic echocardiogram. Athletes were divided in those with lower (&lt;55%) and normal LVEF (≥55%). Strain rate and MWI were performed and the following parameters collected: global longitudinal strain, global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).</div></div><div><h3>Results</h3><div>Twenty-seven athletes had LVEF&lt;55% (mean 51.5% ± 2.6%). Athletes with EF &lt; 55% presented larger LVEDVi (79.1 ± 15.7 vs. 73.2 ± 13.8 mm/m2, <em>P</em> = .035), LV mass (<em>P</em> = .049) and LAVi (<em>P</em> = .016). No differences were found in GWI (1,757.9 ± 242 vs 1,839.8 ± 255.6 mmHg%, <em>P</em> = .112), GCW (2,121.6 ± 269.3 vs. 2,209.3 ± 281 mmHg%, <em>P</em> = .124), GWW (95.2 ± 40.7 vs. 87.1 ± 47.4 mmHg%, <em>P</em> = .394) or GWE (95.2 ± 1.7 vs. 95.7 ± 2%, <em>P</em> = .181). At CPET, in those with EF &lt; 55%, higher Watts (340.0 ± 83.7 vs. 291.6 ± 84.8, <em>P</em> = .004), VO₂ mL/min/Kg (51.0 ± 13.5 vs. 46.0 ± 10.1, <em>P</em> = .020) and O2 pulse (23.5 ± 4.6 vs. 21 ± 5.3, <em>P</em> = .020) were found.</div></div><div><h3>Conclusions</h3><div>MWI could be used as additive tool to characterize the physiologic nature of mildly reduced EF of endurance athletes, presenting with better functional parameters but preserved MWI values. MWI may be helpful in differential diagnosis of athlete’s heart from DCM.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107271"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-based left atrial appendage CLOSURE in patients with atrial fibrillation at high risk of stroke and bleeding as compared to best medical therapy: Rationale and design of the prospective randomized CLOSURE-AF trial","authors":"Ulf Landmesser MD ,&nbsp;Carsten Skurk MD ,&nbsp;Paulus Kirchhof MD ,&nbsp;Thorsten Lewalter MD ,&nbsp;Johannes Hartung MD ,&nbsp;Andi Rroku MD ,&nbsp;Burkert Pieske MD ,&nbsp;Johannes Brachmann MD ,&nbsp;Ibrahim Akin MD ,&nbsp;Claudius Jacobshagen MD ,&nbsp;Benjamin Meder MD ,&nbsp;Andreas Zeiher MD ,&nbsp;Stefan D. Anker MD ,&nbsp;Holger Thiele MD ,&nbsp;Stefan Blankenberg MD ,&nbsp;Steffen Massberg MD ,&nbsp;Heribert Schunkert MD ,&nbsp;Norbert Frey MD ,&nbsp;Alexander Joost MD ,&nbsp;Martin Bergmann MD ,&nbsp;Ingo Eitel MD","doi":"10.1016/j.ahj.2025.09.005","DOIUrl":"10.1016/j.ahj.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous catheter‐based left atrial appendage (LAA) closure is a potential alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF). The effectiveness and safety of LAA closure in patients with AF at high risk of stroke (CHA2DS2‐VASc Score ≥2) and high risk of bleeding compared to best medical care including a nonvitamin K antagonist oral anticoagulant [NOAC] when considered eligible is not known.</div></div><div><h3>Methods/Design</h3><div>The prospective, multicenter, randomized clinical Left atrial appendage CLOSURE in patients with Atrial Fibrillation at high risk of stroke and bleeding compared to medical therapy (CLOSURE-AF) trial compared catheter-based LAA closure to best medical care (including NOAC therapy if considered eligible) in patients with AF at high risk of stroke and with either a history of bleeding or a high estimated bleeding risk (HASBLED ≥ 3). The primary endpoint is time to a composite of first stroke (ischemic or hemorrhagic), systemic embolism, cardiovascular or unexplained death or major bleeding (Bleeding Academic Research Consortium 3-5). Secondary outcomes include components of the primary outcome and total mortality. The primary efficacy analysis will be performed in the intention‐to‐treat population using Cox regression models for noninferiority with an option to test for superiority once noninferiority has been proven.</div></div><div><h3>Results</h3><div>The first patient in the CLOSURE-AF trial was enrolled in March 2018. By April 2025 the complete study cohort of <em>n</em> = 912 patients had been enrolled in 42 sites.</div></div><div><h3>Conclusion</h3><div>CLOSURE-AF will contribute evidence on the effectiveness and safety of LAA occlusion compared to optimal medical therapy in patients with AF at high risk of stroke and bleeding. The trial results will help to define the clinical use of catheter-based LAA closure in the future.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NCT03463317</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107273"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete revascularization in patients with acute myocardial infarction and multivessel disease: Pooled analysis of Kaplan-Meier-derived individual-patient-data","authors":"Ahmed Abdelaziz MD ,&nbsp;Shrouk Ramadan MD ,&nbsp;Mohammed Tarek Hasan MD ,&nbsp;Muhammad Desouky MD ,&nbsp;Karim Atta MBBS ,&nbsp;Abdelrahman Hafez MD ,&nbsp;Mahmoud Mohamed Shams MD ,&nbsp;Ahmed Helmi MD ,&nbsp;Rahma AbdElfattah Ibrahim MD ,&nbsp;Ahmed Sobhy MD ,&nbsp;Rehab Adel Diab MD ,&nbsp;Fayed Mohamed Rzk MD ,&nbsp;Ahmed Farid Gadelmawla MD ,&nbsp;Ziad Mohsen Alenna MD ,&nbsp;Mohamed Abdelaziz MD ,&nbsp;Mohamed Nabil Hamouda MD ,&nbsp;Noha Hammad MD ,&nbsp;Daniel Lorenzatti MD ,&nbsp;Carl J Lavie MD ,&nbsp;Leandro Slipczuk MD, PhD ,&nbsp;Gregg W Stone MD","doi":"10.1016/j.ahj.2025.107284","DOIUrl":"10.1016/j.ahj.2025.107284","url":null,"abstract":"<div><div>Complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease reduces major adverse cardiac events (MACE) compared with incomplete revascularization, although whether survival is improved is uncertain. For this systematic review and meta-analysis, all randomized trials of complete vs incomplete revascularization in patients with acute MI without cardiogenic shock were identified from PubMed, Scopus, Web of Science, and Cochrane Library databases from inception to December 31, 2024. The primary and major secondary endpoints were MACE and all-cause mortality derived from reconstructed time-to-event individual-patient-data from published Kaplan-Meier curves. Additional outcomes included cardiovascular mortality, MI, and unplanned repeat revascularizations. Outcomes were expressed as hazard ratios with 95% confidence intervals. This study was registered with the PROSPERO (number, CRD42023415428). A total of 9 randomized trials with 9,658 patients (86.8% with STEMI) were identified among whom 4,671 (48.4%) patients had complete revascularization. Patients with complete revascularization had a lower 5-year risk of MACE (HR: 0.59, 95% CI: 0.54 to 0.66, <em>P</em> &lt; .001) compared with incomplete revascularization. Complete revascularization was also associated with lower 5-year risks of all-cause mortality (HR: 0.64, 95% CI: 0.56 to 0.72, <em>P</em> &lt; .001), cardiovascular mortality (HR: 0.82, 95% CI: 0.71 to 0.95, <em>P</em> = .008), MI (HR: 0.69, 95% CI: 0.55 to 0.87, <em>P</em> &lt; .001), and unplanned repeat revascularizations (HR: 0.62, 95% CI: 0.54 to 0.71, <em>P</em> &lt; .001). Complete revascularization results in lower risks of all-cause and cardiovascular mortality, MI, unplanned repeat revascularizations and MACE in patients with acute MI and multivessel disease. These results support current guidelines recommending CR in hemodynamically stable patients with STEMI, emphasizing that this approach may improve survival.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107284"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter by Golestanieraghi regarding article, “Association between vasopressin administration and mortality in patients with cardiogenic shock”","authors":"Dhruv Sarma BMBCh ,&nbsp;Aniket S Rali MD ,&nbsp;Jacob C Jentzer MD","doi":"10.1016/j.ahj.2025.09.002","DOIUrl":"10.1016/j.ahj.2025.09.002","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107270"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal versus conventional radial large-bore access for percutaneous coronary intervention of complex coronary lesions: Rationale and design of the DISCO COMPLEX randomized superiority trial","authors":"Juan F. Iglesias MD ,&nbsp;Gregor Leibundgut MD ,&nbsp;Dik Heg PhD ,&nbsp;Gabriele L. Gasparini MD ,&nbsp;Grigorios Tsigkas MD, PhD ,&nbsp;Claudiu Ungureanu MD ,&nbsp;Giuseppe Colletti MD ,&nbsp;Sophie Degrauwe MD ,&nbsp;Panagiotis Xaplanteris MD, PhD ,&nbsp;Karsten Schenke MD ,&nbsp;Alexandru Achim MD ,&nbsp;Maarten AH van Leeuwen MD, PhD ,&nbsp;Maia Muresan MSc ,&nbsp;Shigeru Saito MD ,&nbsp;Gregory A. Sgueglia MD, PhD ,&nbsp;Adel Aminian MD","doi":"10.1016/j.ahj.2025.107291","DOIUrl":"10.1016/j.ahj.2025.107291","url":null,"abstract":"<div><h3>Rationale</h3><div>Distal radial access (DRA) has emerged as a promising alternative to conventional transradial access (TRA) for coronary angiography and percutaneous coronary intervention (PCI). However, existing randomized evidence on DRA primarily involves low-risk patients undergoing diagnostic angiography or noncomplex PCI using ≤6 French (Fr) introducer sheaths. The clinical benefits of DRA among patients undergoing PCI for complex coronary lesions using large-bore guide catheters remain therefore uncertain.</div></div><div><h3>Design</h3><div>DISCO COMPLEX is an investigator-initiated, prospective, multicenter, international, open-label, randomized, controlled trial with a blinded outcome assessment and superiority design. The trial will compare in a 1:1 ratio large-bore DRA versus conventional TRA using a 7-Fr introducer sheath in 708 patients undergoing PCI for complex coronary lesions (chronic total occlusions, left main disease, heavily calcified lesions, or complex bifurcations) with a 7-Fr guide catheter. The primary hypothesis is that large-bore DRA is superior to conventional TRA with respect to the incidence of forearm radial artery occlusion (RAO) assessed by Doppler ultrasound at hospital discharge. The prespecified DISCOPHILE COMPLEX hand function substudy is a noninferiority trial evaluating whether large-bore DRA is not inferior to conventional TRA with respect to change in full-<em>Disabilities of the Arm, Shoulder and Hand</em> (DASH) questionnaire score from baseline to 12 months in participants of the DISCO COMPLEX trial.</div></div><div><h3>Enrolment status</h3><div>The trial aims to recruit a total of 708 patients from 10 to 15 participating centers across Europe. The first patient was enrolled on August 31, 2023. As of August 20, 2025, 385 patients have been included.</div></div><div><h3>Conclusion</h3><div>DISCO COMPLEX is the first randomized clinical trial designed to test the superiority of large-bore DRA over conventional TRA in reducing RAO rates among patients undergoing complex PCI with 7-Fr guide catheters.</div></div><div><h3>Trial Registration</h3><div>Clinicaltrials.gov: Identifier, NCT05490238.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107291"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Medical treatment of hypercortisolism with relacorilant: Final results of the phase 3 GRACE study” [American Heart Journal 278S (2024) Pages 10-11]","authors":"Rosario Pivonello ,&nbsp;Giorgio Arnaldi ,&nbsp;Richard J. Auchus ,&nbsp;Corin Badiu ,&nbsp;Robert S. Busch ,&nbsp;Salvatore Cannavo ,&nbsp;Ulrich Dischinger ,&nbsp;Georgiana A. Dobri ,&nbsp;Diane Donegan ,&nbsp;Atanaska Elenkova ,&nbsp;Pouneh K. Fazeli ,&nbsp;Richard A. Feelders ,&nbsp;Rogelio Garcia-Centeno ,&nbsp;Aleksandra Gilis-Januszewska ,&nbsp;Oksana Hamidi ,&nbsp;Zeina C. Hannoush ,&nbsp;Harold J. Miller ,&nbsp;Aurelian-Emil Ranetti ,&nbsp;Monica Recasens ,&nbsp;Martin Reincke ,&nbsp;Andreas G. Moraitis","doi":"10.1016/j.ahj.2025.107286","DOIUrl":"10.1016/j.ahj.2025.107286","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107286"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}