European heart journal open最新文献

{"title":"Cardiac autonomic function in elderly patients with and without atrial fibrillation.","authors":"Peter Hämmerle, Johannes Schier, Konstantinos D Rizas, Vincent Schlageter, Emel Kaplan, Stefanie Aeschbacher, Marius Rast, Philipp Krisai, Michael Coslovsky, Tobias Reichlin, Julia B Bardoczi, Nicolas Rodondi, Andreas S Müller, Alain M Bernheim, Giorgio Moschovitis, Maria Luisa De Perna, David Conen, Christian Sticherling, Stefan Osswald, Axel Bauer, Felix Mahfoud, Michael Kühne, Christine S Zuern","doi":"10.1093/ehjopen/oeag056","DOIUrl":"10.1093/ehjopen/oeag056","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac autonomic dysfunction is associated with an adverse prognosis in patients with atrial fibrillation (AF). However, the association of AF itself with cardiac autonomic function (CAF) remains unclear. We aimed to investigate whether CAF, assessed by heart rate variability (HRV), differs across patients with and without AF.</p><p><strong>Methods and results: </strong>We enrolled patients from a prospective multicentre study (Swiss-AF) with a 5-min resting ECG recording in SR or AF without pacing. Cardiac autonomic function was quantified by periodic repolarization dynamics (PRD), a marker of sympathetic activity, and by conventional HRV parameters. We included 2289 patients, 807 (35%) SR patients, 932 (41%) AF patients with SR ECGs (AF-SR), and 550 (24%) AF patients with AF ECGs (AF-AF). Mean age was 74 vs. 70 vs. 75 years; 37%, 31%, and 24% were female. Median PRD was 4.8 deg (IQR 2.6-6.7) in the SR group, 5.1 deg (IQR 2.9-6.9) in the AF-SR group, and 7.0 deg (IQR 5.8-8.4) in the AF-AF group (<i>P</i> < 0.001). After full adjustment (SR group = reference group), the AF-AF group showed a stronger association with elevated PRD (β-coefficient 2.10, 95% CI 1.79-2.41, <i>P</i> < 0.001) than the AF-SR group (β-coefficient 0.36, 95% CI 0.08-0.64, <i>P</i> = 0.011). Most other HRV parameters indicated greater autonomic impairment in the AF-SR group compared to the SR group.</p><p><strong>Conclusion: </strong>Atrial fibrillation was associated with increased sympathetic activity, with the greatest impairment observed in patients during AF, independent of cardiovascular risk factors. Periodic repolarization dynamics may represent a useful marker for the assessment of CAF in AF patients.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag056"},"PeriodicalIF":0.0,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725132","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":"Heart failure hospitalization reduction and long-term safety with remote pulmonary artery pressure monitoring: results of the CardioMEMS heart failure system outside United States (of America) post-market study.","authors":"Pascal de Groote, Scott McKenzie, Andrew Flett, Paul Foley, Kasper Rossing, Michele Ciccarelli, Anne-Catherine Pouleur, Carlo Gazzola, Eunyoung Park, François Roubille","doi":"10.1093/ehjopen/oeag021","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag021","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to analyse the feasibility, safety, and clinical benefit of the CardioMEMS HF System in different healthcare systems outside the United States of America.</p><p><strong>Methods and results: </strong>Prospective, open-label registry of NYHA class III patients with at least one heart failure hospitalization (HFH) within 12 months before enrolment, regardless of left ventricular ejection fraction. The primary safety endpoints assess the freedom from device/system-related complications (DSRC) and freedom from pressure sensor failure (PSF) at 2 years post-implant. The primary efficacy endpoint was the rate of HFH one year before and one year after implantation.Three hundred and four patients from 37 centres in 6 countries underwent a CardioMEMS implant procedure, which was successful in 98.3% of the cases. At 2 years, there were no DSRCs and only 1 PSF. There were 517 HFH in the year before implant compared with 144 HFH in the year post-implant (risk reduction: 69% (RR: 0.31 95% CI [0.25-0.37]; <i>P</i> < 0.0001). Pulmonary artery (PA) pressures were significantly lowered (mean PA pressure reduction: -3.07 ± 5.91 mmHg, <i>P</i> < 0.0001) with a significant improvement in functional class and quality of life (mean EQ-5D-5L visual analogue score increase 8.1 ± 22.7, <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>The results of the COAST study demonstrate that the CardioMEMS HF System is a reliable device, with no device-related complications and very few pressure sensor failures. Its use is associated with a substantial HFH risk reduction, with a significant reduction in PA pressures, an improvement in NYHA classification, and an improvement in quality of life.</p><p><strong>Clinical registration number: </strong>ClinicalTrials.gov Identifier: NCT02954341.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag021"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610960","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":"Structural heart disease screening using artificial intelligence-enabled electrocardiogram and novice handheld cardiac ultrasound: a cost analysis.","authors":"Reid P Schlesinger, Francisco B Alexandrino, Eunjung Lee, Abhishek J Deshmukh, Vuyisile T Nkomo, Jae K Oh, Peter A Noseworthy, Patricia A Pellikka, Attia Zachi, Francisco Lopez-Jimenez, Paul A Friedman, Garvan C Kane, Sorin V Pislaru, Jared Bird, Gal Tsaban","doi":"10.1093/ehjopen/oeag049","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag049","url":null,"abstract":"<p><strong>Aims: </strong>Early detection of structural heart disease (SHD) improves patient outcomes. However, population-based screening is not recommended due to the lack of accurate and cost-effective tools. We evaluated the costs of artificial intelligence-enabled electrocardiogram (AI-ECG) alone vs. AI-ECG followed by handheld cardiac ultrasound (HCU) for SHD screening.</p><p><strong>Methods and results: </strong>We performed a model-based cost analysis using data from 286 adult patients who underwent ECG and same-day HCU performed by a novice operator. Transthoracic echocardiogram (TTE) was the reference standard. We compared two screening strategies: (i) AI-ECG alone and (ii) a stepwise approach (AI-ECG followed by HCU). We assessed costs per diagnosis of aortic stenosis (AS), increased left ventricular wall thickness (ILVWT), and left ventricular systolic dysfunction (LVSD). Sensitivity analyses were conducted for varying disease prevalence. The stepwise approach decreased the cost per diagnosis of AS from $6386 (AI-ECG alone) to $2746 (57.0% savings), ILVWT from $4448 to $2895 (34.9% savings), and LVSD from $1469 to $1296 (11.8% savings). Overall, the cost per diagnosis for all SHDs combined decreased from $1940 to $1570 (19.1% savings). Sensitivity analysis demonstrated that cost savings were inversely proportional to disease prevalence. Nevertheless, stepwise screening remained cost-saving compared with AI-ECG alone until prevalence exceeded ∼55.9% for AS, 28.9% for ILVWT, 20.7% for LVSD, and 40.8% for all SHDs combined.</p><p><strong>Conclusion: </strong>A stepwise screening strategy incorporating HCU after a positive AI-ECG reduces the immediate costs of SHD detection by minimizing unnecessary TTEs. This approach may enhance the feasibility of population-based SHD screening, particularly in lower-prevalence settings.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag049"},"PeriodicalIF":0.0,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679640","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":"Hormone replacement therapy and cardiovascular risk in postmenopausal women.","authors":"Isabella Blackburn, Vijay Kunadian","doi":"10.1093/ehjopen/oeag054","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag054","url":null,"abstract":"<p><p>Menopause hormone replacement therapy (HRT) remains the main strategy for managing menopausal symptoms and preventing osteoporosis in postmenopausal women. However, its cardiovascular effects are complex and influenced by multiple factors. Early initiation of HRT within 10 years of menopause onset consistently demonstrates cardiovascular benefits, whereas delayed initiation may increase risks such as stroke and venous thromboembolism. Transdermal and bioidentical hormones generally show a safer cardiovascular profile compared to oral synthetic preparations. Current guidelines advocate for individualized therapy considering patient preferences and risk stratification. However, significant knowledge gaps remain regarding long-term safety, diverse populations, and optimized risk assessment tools. The development of a menopause-specific cardiovascular risk calculator could enhance patient-centred care and guide shared decision-making. This review synthesizes current evidence from major randomized trials, observational studies, and meta-analyses, highlighting the critical role of timing, hormone formulation, administration route, and baseline cardiovascular risk in determining HRT's cardiovascular outcomes. It also underscores the importance of precision medicine in optimizing cardiovascular and overall health outcomes for postmenopausal women using HRT.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag054"},"PeriodicalIF":0.0,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792914","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":"Long-term outcomes after septal reduction therapy for obstructive hypertrophic cardiomyopathy: a nationwide cohort study.","authors":"Andreas Schelldorfer, Rahel Laager, Laurent M Haegeli, Philipp Schuetz, Alexander Kutz, H Yakup Yakupoglu","doi":"10.1093/ehjopen/oeag053","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag053","url":null,"abstract":"<p><strong>Aims: </strong>With cardiac myosin inhibitors emerging as a novel pharmacological option instead of septal reduction therapies (SRT) in obstructive hypertrophic cardiomyopathy (HCM), contemporary data on national long-term outcomes after SRT are needed.</p><p><strong>Methods and results: </strong>In this nationwide cohort study from 2015 to 2021, patients with obstructive HCM undergoing SRT (surgical myectomy or transcoronary ablation of septal hypertrophy) were 1:8 propensity score-matched with non-obstructive HCM patients or surgical controls undergoing appendectomy without heart disease in recent records. As assessed in time-to-event analyses, the primary outcome was a composite of all-cause mortality after discharge and rehospitalization for heart failure. After matching, 125 patients with obstructive HCM hospitalized for SRT were compared to 743 patients hospitalized with non-obstructive HCM. The incidence rate (IR) of the primary outcome was lower in the SRT group {12.62 vs. 74.86 per 1000 patient-years (py); hazard ratio (HR), 0.17 [95% confidence interval (CI), 0.07-0.42]; median follow-up 31 months}. In the second comparison, 126 patients with obstructive HCM undergoing SRT were matched to 560 surgical controls without heart disease undergoing laparoscopic appendectomy. The IR of the primary outcome after SRT was comparable to that of surgical controls without heart disease [12.61 vs. 8.09 per 1000 py; HR, 1.53 (95% CI, 0.56-4.18); median follow-up 41 months].</p><p><strong>Conclusion: </strong>In this nationwide cohort study, SRT was associated with a lower incidence of all-cause mortality after discharge and rehospitalization for heart failure compared to patients hospitalized with non-obstructive HCM, with an incidence comparable to surgical controls without heart disease.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag053"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792916","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: commentary.","authors":"Sergei V Jargin","doi":"10.1093/ehjopen/oeag052","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag052","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag052"},"PeriodicalIF":0.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725220","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":"Prognostic utility of Killip classification in acute myocardial infarction: a retrospective cohort analysis in contemporary clinical practice.","authors":"Vita Speckauskiene, Diana Meilutyte-Lukauskiene, Reda Cerapaite-Trusinskiene, Jannik Mueller, Andrius Macas","doi":"10.1093/ehjopen/oeag050","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag050","url":null,"abstract":"<p><strong>Aims: </strong>The Killip classification is a long-established bedside tool for early haemodynamic risk stratification in ST-elevation myocardial infarction (STEMI). However, its prognostic performance in contemporary STEMI populations treated with primary percutaneous coronary intervention (PCI) remains debated. We aimed to re-evaluate the association between Killip class and in-hospital mortality in a modern STEMI cohort.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study including 288 consecutive adults admitted with confirmed STEMI to the Hospital of the Lithuanian University of Health Sciences, Kaunas Clinics, between 1 January 2018 and 31 December 2021. STEMI was diagnosed according to the Fourth Universal Definition of Myocardial Infarction and ESC guidelines. The primary endpoint was in-hospital all-cause mortality. Independent predictors were identified using multivariable logistic regression. Model discrimination was assessed using receiver operating characteristic (ROC) analysis. Overall, in-hospital mortality was 18.2% (52/286 evaluable patients). Mortality increased substantially across Killip classes, from 1.0% in Class I and 3.0% in Class II to 69.6% in Class IV (<i>P</i> < 0.001). In multivariable analysis, Killip Class IV remained an independent predictor of in-hospital mortality (OR 60.94, 95%: CI 15.98-232.46; <i>P</i> < 0.001), together with age, body mass index, troponin level, and asystole. The final model demonstrated excellent discrimination (AUC 0.969, 95% CI: 0.945-0.992).</p><p><strong>Conclusion: </strong>In this temporary STEMI cohort, Killip Class IV was strongly and independently associated with in-hospital mortality. Although lower Killip classes showed limited prognostic separation, the Killip classification remains a rapid and clinically accessible tool for early risk assessment, particularly in haemodynamically unstable patients.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag050"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647883","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":"Trajectories of total and domain-specific physical activity and vascular structure and function in mid-adulthood: the Childhood Determinants of Adult Health study.","authors":"Jack T Evans, Verity J Cleland, Seana Gall, Terence Dwyer, Alison J Venn, Rachel E Climie","doi":"10.1093/ehjopen/oeag038","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag038","url":null,"abstract":"<p><strong>Aims: </strong>Physical activity is a target for early and ongoing cardiovascular health maintenance. However, relationships between life course trajectories of total activity and all comprising domains (leisure, transport, occupational, domestic) with vascular function and structure have not been examined. This study aimed to determine associations between life course activity trajectories and mid-adulthood vascular structure and function.</p><p><strong>Methods and results: </strong>Using the Australian Childhood Determinants of Adult Health Study [four time points (ages 9-49 years); 1985 baseline], latent class growth mixture modelling assessed life course trajectories of questionnaire-measured total and domain-specific activity (<i>n</i> = 2311). Relationships between trajectories and vascular structure [carotid intima-media thickness (<i>n</i> = 914), carotid plaques (<i>n</i> = 867)] and vascular function [Young's elastic modulus (<i>n</i> = 765), carotid distensibility (n = 765)] were analysed using log-binomial and multivariable regression adjusted for mid-adulthood body mass index, smoking status, occupation type, area-level socio-economic status, and high- and low-density lipoprotein cholesterol. 'Consistently high' leisure activity was associated with reduced risk of plaques (RR = 0.56; 95% CI = 0.23-0.89). 'High-increasing' school/occupational activity was associated with higher carotid intima-media thickness (<i>β</i> = 0.06; 95% CI = 0.01-0.11). No associations were observed among Young's elastic modulus, carotid distensibility, or transport and domestic activity.</p><p><strong>Conclusion: </strong>This study was the first to assess life course trajectories of total and domain-specific activity against vascular structure and function. Findings highlight that maintaining high levels of leisure-time activity across the life course may be associated with better vascular structure in mid-adulthood.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag038"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647976","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":"Determining free-living daily energy expenditure and physical activity in chronic heart failure: questionnaire-doubly labelled water-motion sensors.","authors":"Martin Garet, Sylvie Normand, Martine Laville, Jean Michel Gaspoz, Laure Meiller, Valerie Sauvinet, Antoine Da Costa, Jean Claude Barthelemy, Frederic Roche","doi":"10.1093/ehjopen/oeag048","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag048","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate free-living Total and Physical Activity Energy Expenditures (TEE/PAEE) and to assess the validity of the Daily Activity Questionnaire in Heart Failure (DAQIHF) in chronic heart failure (CHF) patients against the doubly labelled water (DLW) and motion sensors methods.</p><p><strong>Methods and results: </strong>Twenty-nine women/men (12/17) with CHF performed an incremental symptom-limited peak V̇O₂ test. Free-living TEE and PAEE were estimated with the DAQIHF (TEEquest), motion sensor (Armband® TEEActi) and measured over 2 weeks using DLW (TEEDLW). Resting metabolic rate (RMR) and body composition were assessed with different methods, and peak V̇O₂ with quality of life were correlated to TEE. Bland-Altman and Student's <i>t</i>-test analyses were used to compare methods. Statistical significance was set for <i>P</i> < 0.05. Mean TEE did not significantly differ between TEEDLW and TEEquest (+352.4 kJ.24h^-1; +5.3%; <i>P</i> & NS) for the whole group, nor between women or men, NYHA class, or cardiomyopathy: dilated cardiomyopathy/ischaemic cardiomyopathy. Bland-Altman plots revealed no systematic bias for TEE between methods. In a subgroup of women, TEEquest was significantly higher than TEEacti (<i>P</i> < 0.05). RMR estimated from bioelectric impedance overestimated measured RMR (16.4%, <i>P</i> & 0.0028). Patients spent 9.4% of their TEE in activities ≥3 metabolic equivalents. Measured peak V̇O₂ and estimated from the questionnaire were similar (14.1 ± 4.7 vs. 14.8 ± 3.4 mL.min^-1.kg^-1; <i>P</i> < 0.0001) and were correlated to both TEEDLW and TEEquest (<i>R</i> & 0.85 and 0.82, respectively, both <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>Free-living TEE and peak V̇O₂ can be estimated from the DAQIHF in patients with CHF across all activity domains allowing a complete description/assessment of daily physical activity intensities associated with powerful prognostic risk factors.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag048"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701302","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":"Five-year outcomes of percutaneous coronary intervention and coronary artery bypass grafting for multivessel disease: a national population-based study of regional practice.","authors":"Muhammad Rashid, Florence Lai, Suraj Pathak, Weiqi Liao, Hardeep Aujla, Sarah Murray, Jeremy Dearling, Ann Cheng, Robert Grant, Nick Curzen, Mamas A Mamas, Gavin J Murphy","doi":"10.1093/ehjopen/oeag043","DOIUrl":"10.1093/ehjopen/oeag043","url":null,"abstract":"<p><strong>Aims: </strong>To study how the regional preferences for less invasive multivessel coronary revascularization would adversely affect long-term clinical outcomes.</p><p><strong>Methods: </strong>A national retrospective cohort study utilizing instrumental variable analysis to estimate the causal effect of revascularization strategy.England, using national linked Hospital Episode Statistics (HES) with office of national statistic mortality data from 2007 to 2020.The analysis included 173 771 individuals with complete 5-year follow-up who underwent multivessel revascularization for coronary artery disease. Of this cohort, 63 189 (36.4%) received percutaneous coronary intervention (PCI) and 110 582 (63.6%) received coronary artery bypass grafting (CABG). In total, 37 894 (21.8%) participants were female, and 153 048 (88.2%) were of White ethnicity.The exposure was the preference between multivessel PCI or CABG. The regional ratio of CABG-to-PCI procedures was used as the instrumental variable.The primary outcome was all-cause mortality, assessed in-hospital and up to 5 years post-procedure.</p><p><strong>Results: </strong>The all-cause mortality was 2.1% (<i>n</i> & 3587) in-hospital and 16.4% (<i>n</i> & 28 474) at 5 years. The proportion of patients undergoing CABG varied significantly across regions (25.4-82.3%), demonstrating validity as an instrumental variable. In the primary analysis, CABG was associated with higher in-hospital all-cause mortality vs. PCI [average treatment effect (ATE), 1.1%; 95% confidence interval (CI), 0.6-1.6%] but lower 5-year all-cause mortality (ATE, -5.4%; 95% CI, -7.0 to -3.7%). Adjusted hazard ratios stratified by quartiles of regional CABG-to-PCI ratios showed an increase in in-hospital mortality but a decrease in 5-year mortality as the proportion of CABG increased.</p><p><strong>Conclusion: </strong>Regional preferences for revascularization with multivessel PCI result in lower in-hospital all-cause mortality, a key quality metric, but worse long-term outcomes for individuals with multivessel coronary artery disease.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag043"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725103","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}