European heart journal open最新文献

{"title":"Cardiovascular disease in breast cancer patients: a nationwide real-world evidence study 2013-20.","authors":"Ingrid Engebretsen, Francisco Oteiza, Elisabeth Floberghagen Birkelund, Signe Marie Brandal, Christoffer Bugge, Sigrun Halvorsen","doi":"10.1093/ehjopen/oeaf043","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf043","url":null,"abstract":"<p><strong>Aims: </strong>Various measures have been implemented in clinical practice to reduce the risk of cardiovascular complications during breast cancer (BC) treatment. The aim of this study was to investigate whether women diagnosed with BC exhibit a higher incidence of cardiovascular disease (CVD).</p><p><strong>Methods and results: </strong>Matched cohort study. Using data from the Cancer Registry of Norway and the Norwegian Patient Registry, we created a nationwide cohort of women diagnosed with BC between 2013 and 2020 and age-matched controls (matching ratio 1:10). For BC patients, the index date was the date of their BC diagnosis. For controls, the index date was a random date within the index year of the matched BC patient. For eight selected CVDs, we compared the prevalence before BC diagnosis between cases and controls, as well as the overall incidence, hazard ratios (HRs), and cumulative incidences post BC diagnosis. Follow-up was through 2021. Our study population consisted of 27 526 BC patients and 269 904 matched controls. Among the subset of patients without CVD prior to index, BC patients had significantly increased overall and cumulative risk of pulmonary embolism (HR = 3.00, 95% CI: [2.51-3.59]), atrial fibrillation (1.53 [1.38-1.70]), other cardiac arrhythmias (1.43 [1.27-1.61]), heart failure (1.93 [1.33-2.80]), hypertensive heart disease (1.79 [1.67-1.91]), and heart valve disease (2.02 [1.79-2.27]).</p><p><strong>Conclusion: </strong>In this contemporary cohort, BC patients still had an increased risk of several CVDs compared to age-matched controls. Further research is needed to determine the causes of this increased risk, but clinicians should be aware and optimize therapy accordingly.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf043"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced dose direct oral anticoagulants and time-in-therapeutic-range defined warfarin in new-onset atrial fibrillation: a report from the nationwide FinACAF study.","authors":"Alex Luojus, Mika Lehto, Olli Halminen, Ossi Lehtonen, Mikko Niemi, Konsta Teppo, Jaana Kuoppala, Jari Haukka, Jukka Putaala, Miika Linna, Pirjo Mustonen, Aapo Aro, Juha Hartikainen, Gregory Yoke Hong Lip, Kari Eino Juhani Airaksinen","doi":"10.1093/ehjopen/oeaf046","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf046","url":null,"abstract":"<p><strong>Aims: </strong>Direct oral anticoagulants (DOACs) at reduced dosage regimens are the first choice of ischaemic stroke (IS) prevention for patients with atrial fibrillation (AF) and elevated bleeding risk or renal insufficiency. We compared the outcomes of reduced dose DOACs and warfarin.</p><p><strong>Methods and results: </strong>We included all new-onset patients with AF in Finland from 2011 to 2018. Adjusted hazard ratios (HRs) for IS, intracranial haemorrhage (ICH), bleeding, and mortality were calculated for dabigatran (<i>n</i> = 2 672), rivaroxaban (<i>n</i> = 1 866), apixaban (<i>n</i> = 3 936), and warfarin (<i>n</i> = 43 548). Patients on warfarin were grouped into quartiles by their individual time-in-therapeutic range (TTR), with the second best TTR quartile as a reference group for comparisons. Risk of IS was highest in the low TTR quartiles of warfarin, lowest in the best TTR quartile (0.65 95% confidence interval, 0.51-0.83), and did not differ for dabigatran, rivaroxaban, and apixaban compared with the second best TTR quartile. Risk of ICH was highest in low TTR quartiles of warfarin (HRs 7.20, 5.48-9.46 and 1.91, 1.44-2.55), and was not different in patients on dabigatran, rivaroxaban, and apixaban. Risk of all-cause death and bleeding were lowest in the two best TTR quartiles, and highest in the poorest TTR group. Mortality was higher for dabigatran, rivaroxaban, and apixaban, compared with the second best TTR quartile of warfarin.</p><p><strong>Conclusion: </strong>DOACs with reduced doses are efficient and safe stroke prevention therapy in high-risk patients with AF when compared with warfarin therapy of sufficient TTR. In this comparison, warfarin therapy of excellent TTR-quality was associated with the lowest risk of bleeding and mortality.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf046"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis: the ongoing quest for therapeutic modulators to prevent cardiovascular adverse outcomes.","authors":"Benjamin Marchandot, Olivier Morel","doi":"10.1093/ehjopen/oeaf044","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf044","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf044"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice patterns and percutaneous coronary intervention outcomes: a comparison between Sweden and the US.","authors":"Revathy Sampath-Kumar, Moman Mohammad, Sacharias von Koch, Ryan Reeves, Belal Al Khiami, Lawrence Ang, Anna Melendez, Ehtisham Mahmud, Ori Ben-Yehuda, David Erlinge","doi":"10.1093/ehjopen/oeaf045","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf045","url":null,"abstract":"<p><strong>Aims: </strong>Comparisons of international practice patterns and their impact on percutaneous coronary intervention (PCI) outcomes are lacking. We compared temporal PCI trends between Sweden and a large university hospital system in the US.</p><p><strong>Methods and results: </strong>Data within the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and the University of California San Diego Health internal National Cardiovascular Data Registry (NCDR) CathPCI Registry were used to identify patients who underwent PCI from 2007 to 2021. Baseline characteristics and practice patterns were assessed using all patients (275 021 Swedish cohort, 9883 US cohort). Mortality was analysed using a random-effects Cox model, restricted to patients treated at university hospitals and excluding those with cardiac arrest or cardiogenic shock (108 136 Swedish cohort, 9592 US cohort). The Swedish cohort was older, had a greater proportion of men, and was more likely to smoke (all <i>P</i> < 0.001). The US cohort had a higher body mass index and was more likely to have diabetes, hyperlipidaemia, prior PCI, congestive heart failure, and peripheral arterial disease (all <i>P</i> < 0.001). Sweden had lower rates of PCI for stable angina and lower use of mechanical circulatory support (all <i>P</i> < 0.001). More STEMI patients were treated with only heparin as anticoagulation in Sweden, even in the contemporary era. There was earlier adoption and increased utilization of ticagrelor and radial access in Sweden, while there was earlier use of drug-eluting stents in the US. Fractional flow reserve was used more frequently in Sweden. There was no difference in adjusted all-cause mortality 1 year post-PCI for any indication between university hospitals in Sweden and the US (hazard ratio [HR] 1.09; 95% CI 0.86-1.37; <i>P</i> = 0.48), and this finding was consistent across subgroups.</p><p><strong>Conclusion: </strong>Despite significant differences in patient populations and practice variations, we found no difference in post-PCI mortality between university hospitals in Sweden and the US.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf045"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival benefit of secondary prevention medical therapy in takotsubo cardiomyopathy: a Bayesian network meta-analysis.","authors":"Daud Mutahar, Ammar Zaka, Stephen Bacchi, Brandon Stretton, Joshua G Kovoor, Aashray K Gupta, Naim Mridha","doi":"10.1093/ehjopen/oeaf040","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf040","url":null,"abstract":"<p><strong>Aims: </strong>Takotsubo cardiomyopathy (TTC) is a form of transient left ventricular systolic dysfunction without evidence of complicated coronary artery disease. Efficacy of medical therapy in secondary prevention of all-cause mortality is not well established. We performed a systematic review and network meta-analysis to compare survival benefit of secondary prevention medical therapy in patients with TTC.</p><p><strong>Methods and results: </strong>PubMed, Embase, and Cochrane were searched up to 6 January 2024. Eligible studies included multivariable-adjusted or propensity-matched studies of patients receiving medical therapy with beta-blockers, angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARBs), aspirin, and statins after an index presentation with TTC. The primary outcome was all-cause mortality at any time point. Secondary outcome was TTC recurrence. Random-effect hierarchical Bayesian meta-analysis was performed. We identified 13 observational studies. Takotsubo cardiomyopathy mortality was reported in 435 (4.7%) out of 9237 patients, across a median follow-up of 2.18 years. Mean age was 69.7 ± 12.5 years, and 7906 patients (90.7%) were females. Beta-blockers were associated with a statistically significant reduction in mortality compared to control [hazard ratio (HR) 0.65, 95% confidence interval (CI) (0.55-0.77)]. ACE inhibitors/ARBs showed a nonsignificant trend towards mortality reduction [HR 0.76, 95% CI (0.54-1.07)]. Statins [HR 0.96, 95% CI (0.77-1.19)] and aspirin [HR 0.87, 95% CI (0.55-1.38)] showed no significant mortality benefit. Bayesian probability ranks favoured beta-blockers as the most effective treatment for TTC mortality prevention.</p><p><strong>Conclusion: </strong>This review highlights the modest efficacy of secondary prevention medications in the management of TTC, as ACE or ARBs, beta-blockers, aspirin, and statins failed to demonstrate comparative mortality benefit. Randomized controlled trials are needed to confirm efficacy of pharmacotherapy in this vulnerable patient cohort.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf040"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbidity-bridging metabolic pathways: linking early cardiovascular disease risk and depression symptoms using a multi-modal approach.","authors":"Angela Koloi, Arja Rydin, Yuri Milaneschi, Femke Lamers, Jos A Bosch, Emma Pruin, Sander W van der Laan, Pashupati P Mishra, Terho Lehtimäki, Mika Kähönen, Olli T Raitakari, Dimitrios I Fotiadis, Rick Quax","doi":"10.1093/ehjopen/oeaf038","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf038","url":null,"abstract":"<p><strong>Aims: </strong>Prevalence of cardiovascular diseases (CVDs) and depression is rising globally. Their co-occurrence associates with poorer outcomes, potentially due to shared metabolic pathways. This study aimed to identify metabolic pathways linking depression symptoms and CVD risk factors.</p><p><strong>Methods and results: </strong>Data from the Young Finns Study (YFS, <i>n</i> = 1,599, mean age 37 ± 5, 54% female) served as input for a network (mixed graphical models). Confirmatory analysis through covariate-adjusted regression was done with UK Biobank (UKB, <i>n</i> = 69,513, mean age 63 ± 7, 64% female). Mendelian randomization assessed causality using genome-wide association studies data. The study examined 52 plasma metabolites measured by nuclear magnetic resonance spectroscopy. Outcomes included depression symptoms (BDI in YFS, PHQ-9 in UKB) and CVD risk factors [systolic/diastolic blood pressure, carotid intima-media thickness (cIMT)]. Mendelian randomization inferred causal links between metabolites and depression or (intermediate markers of) CVD. Two bridge metabolites were identified: glucose linked to sleep pattern (<i>P</i> = 0.034); omega-3 fatty acids (FAs) linked to appetite change (<i>P</i> < 0.001); and both connected to cIMT (both <i>P</i> = 0.002). Mendelian randomization suggested glucose as causal in coronary artery disease (CAD) risk, while omega-3 FAs showed potential causal links to CAD, coronary artery calcification, and cIMT.</p><p><strong>Conclusion: </strong>This study integrated three statistical techniques and identified two metabolic markers (glucose, omega-3 FAs) connecting depression and CVD on a symptom and risk factor level. The associations, established in a relatively young cohort, were replicated in a predominantly middle-aged cohort and emphasize both the generalizability of the findings across different populations and value of symptom-level analysis in depression and CVD comorbidity research.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf038"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Energetics of flow restoration after premature ventricular contractions depends on microvascular vasodilation capacity: Insights from wave intensity analysis.","authors":"Ahmet Tas, Fevzi Alp Findik, Yaren Alan, Ilke Kara Tas, Tim P van de Hoef, Kim H Parker, Murat Sezer, Jan J Piek","doi":"10.1093/ehjopen/oeaf041","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf041","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf041"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individually designed ablation of low-voltage areas in persistent atrial fibrillation-a randomized controlled trial (IDEAL-AF): study design and rationale.","authors":"Astrid Paul Nordin, Mats Jensen-Urstad, Emmanouil Charitakis, Finn Åkerström, Henrik Almroth, Csaba Herczku, Jari Tapanainen, Niklas Höglund, Nikola Drca","doi":"10.1093/ehjopen/oeaf037","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf037","url":null,"abstract":"<p><strong>Aims: </strong>Voltage-based ablation is a promising catheter ablation strategy for atrial fibrillation (AF) in which low-voltage zones (LVZs) are targeted as a complement to pulmonary vein isolation (PVI). In a randomized setting, we intend to investigate whether PVI plus ablation of LVZs, compared to PVI-only, decreases the incidence of arrhythmia recurrence and improves health-related quality of life (HRQoL) in patients with persistent AF and LVZs.</p><p><strong>Methods and results: </strong>Individually designed ablation of low-voltage areas in persistent atrial fibrillation trial (IDEAL-AF; NCT04377594) is a multi-centre, randomized, controlled clinical trial. Patients with persistent AF and LVZs ≥ 3.0 cm² outside the PVI ablation lines will be randomized in a 1:1 ratio to either PVI or PVI plus LVZ ablation. The primary outcome will be the recurrence of atrial arrhythmias off anti-arrhythmic drugs during 12 months of follow-up after one to two ablation procedures within 6 months. A 3-month blanking period will be applied after the first procedure. Patients will be monitored using a smart phone-based ECG recording device throughout the follow-up period. With an anticipated enrolment of 936 patients, this study has 80% power to detect a 20% absolute risk reduction in the primary endpoint. Additionally, HRQoL improvement will be assessed using three questionnaires.</p><p><strong>Conclusion: </strong>IDEAL-AF is a multi-centre, randomized, controlled clinical trial investigating whether ablation of LVZs in addition to PVI reduces the recurrence rate of atrial arrhythmias and improves HRQoL compared to PVI-only in patients with persistent AF and LVZs. This study has the potential to modify recommendations regarding ablation techniques for this specific patient cohort.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf037"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of cell fate by shock wave therapy in ischaemic heart disease.","authors":"Michael Graber, Can Gollmann-Tepeköylü, Victor Schweiger, Jakob Hirsch, Leo Pölzl, Felix Nägele, Daniela Lener, Hubert Hackl, Sieghart Sopper, Elke Kirchmair, Sophia Mair, Jakob Voelkl, Christina Plattner, Felix Eichin, Zlatko Trajanoski, Anne Krogsdam, Jonas Eder, Manuel Fiegl, Dominik Hau, Ivan Tancevski, Michael Grimm, John P Cooke, Johannes Holfeld","doi":"10.1093/ehjopen/oeaf011","DOIUrl":"10.1093/ehjopen/oeaf011","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac shockwave therapy (SWT) improves left ventricular (LV) function in patients with ischaemic cardiomyopathy. Shockwave therapy activates Toll-like receptor 3 (TLR3), a receptor-inducing chromatin remodelling and nuclear reprogramming of cardiac cells. We hypothesized that mechanical activation of TLR3 facilitates reprogramming of fibroblasts towards endothelial cells restoring myocardial perfusion and function.</p><p><strong>Methods and results: </strong>Human cardiac fibroblasts were treated by mechanical stimulation via SWT or TLR3 agonist Poly(I:C) in the presence of endothelial induction medium. A lineage tracing experiment was performed in a transgenic mouse model of Fsp1-Cre/LacZ mice after coronary occlusion. Left ventricular function and scarring were assessed. Single-cell sequencing including RNA trajectory analysis was performed. Chromatin remodelling and epigenetic plasticity were evaluated via western blot and Assay for Transposase-Accessible Chromatin sequencing. Mechanical stimulation of human fibroblasts with SWT activated TLR3 signalling and enhanced the expression of endothelial genes in a TLR3-dependent fashion. The induced endothelial cells (ECs) resembled genuine ECs in that they produced endothelial nitric oxide and formed tube-like structures in Matrigel. In a lineage tracing experiment in Fsp1-Cre/LacZ mice, shockwave treatment increased LacZ/CD31-positive cells (indicating transdifferentiation) after coronary occlusion. Furthermore, SWT reduced myocardial scar size and improved LV function. Single-cell RNA-seq and RNA trajectory analyses revealed that SWT induced an endothelial fibroblast cluster and mechanical stimulation induced significant changes in chromatin organization, with chromatin being more accessible after both treatments in 1705 genomic regions.</p><p><strong>Conclusion: </strong>Shockwave therapy enhances DNA accessibility via TLR3 activation and facilitates the transdifferentiation of fibroblasts towards endothelial cells in ischaemic myocardium.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf011"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relation between delayed reperfusion treatment and reduced left ventricular ejection fraction in patients with ST-segment elevation myocardial infarction: a national prospective cohort study.","authors":"Bård Uleberg, Kaare Harald Bønaa, Kari Krizak Halle, Bjarne K Jacobsen, Beate Hauglann, Eva Stensland, Olav Helge Førde","doi":"10.1093/ehjopen/oeaf034","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf034","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this nationwide study of patients with acute ST-segment elevation myocardial infarction (STEMI) was to investigate the relation between delayed reperfusion and mildly to moderately reduced and severely reduced left ventricular ejection fraction (LVEF).</p><p><strong>Methods and results: </strong>In this national population-based cohort study, log-binominal and modified Poisson regression models were applied to examine the associations between delayed reperfusion (i.e. fibrinolysis > 30 min or primary percutaneous coronary intervention > 120 min after first medical contact) and reduced LVEF, adjusted for reperfusion strategy, and patient characteristics. A total of 6567 Norwegian patients with STEMI registered in the Norwegian Registry of Myocardial Infarction during 2015-2018 were included in the analyses. Among them, 57% had normal LVEF (≥50%), 39% had mildly to moderately reduced LVEF (31-49%), and 4% had severely reduced LVEF (≤30%), measured during the acute admission. The adjusted relative risk of having a mildly to moderately reduced LVEF was 1.11 [95% confidence interval (CI) 1.04-1.18] for patients receiving delayed vs. timely reperfusion, and the adjusted relative risk of having severely reduced LVEF was 1.76 (95% CI 1.37-2.25) for patients receiving delayed vs. timely reperfusion. Reperfusion strategy, either primary percutaneous coronary intervention (pPCI) or a pharmacoinvasive strategy (PI), was not a significant determinant for reduced LVEF in any of the analyses.</p><p><strong>Conclusion: </strong>Delayed reperfusion treatment in STEMI increases the risk of mildly to moderately reduced LVEF, and the risk of severely reduced LVEF substantially, compared with timely reperfusion. The risk of reduced LVEF did not differ between patients treated with pPCI or PI.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf034"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}