http:www.cardiocirugia.sld.cu

Clin Pract. 2025 May 30;15(6):106. doi: 10.3390/clinpract15060106.

ABSTRACT

BACKGROUND/AIM: The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients.

METHOD: We analyzed STEMI patients without cardiogenic shock at admission included in our STEMI Register. The patients were treated with primary PCI. The follow-up period was eight years.

RESULTS: From 1 December 2006 to 31 December 2016, a total of 3079 patients were included in the Register. In the first year, MACE was registered in 348 (11.3%) patients. The remaining patients were considered stable. They were included in further analysis. At eight years, the rates were as follows: MACE 3.9%, non-fatal recurrent infarction 2.1%, TVR 1.8%, non-fatal stroke 0.5%, and mortality 2.1%. Predictors for 8-year MACE were age >60 years (60-69 vs. <60 years HR 1.65; 70-79 vs. <60 years HR 1.82; ≥80 vs. <60 years HR 3.16), EF < 50% (EF 40-49% HR 2.38; EF < 40% HR 2.32), diabetes mellitus (HR 1.49), and 3-vessel coronary artery disease (HR 1.44).

CONCLUSIONS: Four predictors identified stable post-STEMI patients who remained at a higher risk for the occurrence of MACE. Stable post-STEMI patients with one or more of these risk factors may require more aggressive secondary prevention measures or a personalized approach to improve their prognosis.

PMID:40558224 | PMC:PMC12192057 | DOI:10.3390/clinpract15060106

Am J Cardiovasc Drugs. 2025 Jun 24. doi: 10.1007/s40256-025-00739-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.

METHODS: Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.

RESULTS: The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.

CONCLUSIONS: After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.

PMID:40555879 | DOI:10.1007/s40256-025-00739-8

JACC Adv. 2025 Jun 18;4(7):101913. doi: 10.1016/j.jacadv.2025.101913. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with chest pain who are very low risk, defined by a History, Electrocardiogram, Age, and Risk factors (HEAR) score ≤1, may not require troponin testing.

OBJECTIVES: The aim of this study was to determine whether troponin testing is needed in patients with HEAR scores ≤1 in a multisite U.S.

METHODS: We conducted an observational cohort study using the Wake Forest Chest Pain Registry. Patients ≥18 years old with HEART Pathway assessments and high-sensitivity troponin testing were accrued from 5 U.S. emergency departments (November 1, 2020-July 7, 2022). HEAR scores were prospectively completed by the treating clinician for patients with no known coronary artery disease and a nonischemic electrocardiogram. The outcome was 30-day major adverse cardiovascular events (MACE) (death, myocardial infarction [MI], and revascularization). The proportion of patients with HEAR scores ≤1 with MACE within 30 days was determined, and test characteristics were calculated. The net reclassification improvement index for troponin testing among patients with HEAR scores ≤1 was determined.

RESULTS: Among 9,105 patients, 17.2% (1,565/9,105) had a HEAR score ≤1. At 30 days, MACE occurred in 0.7% (11/1,565; 95% CI: 0.4-1.3), with 3 deaths, 8 MIs, and 1 revascularization. The sensitivity and negative predictive value for 30-day MACE in patients with a HEAR score ≤1 were 97.9% (95% CI: 96.2-98.9) and 99.3% (95% CI: 98.7-99.6). Troponin testing correctly reclassified 8 with death, MI, or revascularization. Troponin was elevated among 74 without MACE, yielding a nonsignificant net reclassification improvement index of 0.7% (95% CI: -0.4 to 1.8).

CONCLUSIONS: Patients with no known coronary artery disease, a nonischemic electrocardiogram, and a HEAR score ≤1 had a missed MACE rate <1%. Troponin testing identified additional patients with MACE but did not significantly improve risk stratification accuracy.

PMID:40554408 | DOI:10.1016/j.jacadv.2025.101913

Front Cardiovasc Med. 2025 Jun 9;12:1515916. doi: 10.3389/fcvm.2025.1515916. eCollection 2025.

ABSTRACT

AIMS: This study aimed to confirm the correlation between lipoprotein(a) [Lp(a)] and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) combined with heart failure with preserved ejection fraction (HFpEF).

METHODS: This retrospective study was conducted at the First Affiliated Hospital of Dalian Medical University and included 399 patients who were diagnosed with AMI combined with HFpEF and who were hospitalised and underwent percutaneous coronary intervention (PCI) treatment between January 1, 2018, and January 1, 2023. Based on Lp(a) levels, patients were divided into three tertiles: T1 (≤356 mg/L), T2 [356 mg/L < Lp(a) ≤ 487 mg/L], and T3 (>487 mg/L). The study employed univariate and multivariate Cox regression analysis, subgroup analysis, and receiver operating characteristic (ROC) curve analysis to evaluate the correlation between Lp(a) and MACE.

RESULTS: Compared to the non-MACE group, the MACE group had higher levels of Lp(a) (P < 0.001). Tertile-based analysis of Lp(a) levels showed that as Lp(a) increased, the incidence of MACE, rehospitalization due to worsening HF, non-fatal recurrent MI, and unplanned repeat revascularization all increased significantly (all P < 0.05). During an average follow-up period of 30.5 months, multivariate Cox regression analysis confirmed that Lp(a) consistently remained an independent predictor of MACE across unadjusted, partially adjusted, and fully adjusted models (all P < 0.05). Further component analysis indicated that Lp(a) was significantly associated with cardiac death, rehospitalization due to worsening HF, and non-fatal recurrent MI, with the highest risk observed in the T3 group. Subgroup analysis further demonstrated that the association between elevated Lp(a) and MACE remained statistically significant across various strata (all P < 0.05). ROC curve analysis revealed that the area under the curve (AUC) for Lp(a) in predicting MACE was 0.662 (95% CI: 0.607-0.718), which was higher than that of systolic blood pressure (AUC = 0.560) and fasting plasma glucose (AUC = 0.543), but not significantly different from age (AUC = 0.610, P = 0.211).

CONCLUSIONS: In patients with AMI combined with HFpEF, elevated Lp(a) levels were significantly associated with an increased risk of MACE, and this association remained consistent across multiple subgroups.

PMID:40552189 | PMC:PMC12183255 | DOI:10.3389/fcvm.2025.1515916

Eur J Med Res. 2025 Jun 23;30(1):511. doi: 10.1186/s40001-025-02796-w.

ABSTRACT

BACKGROUND: The atherogenic index of plasma (AIP) as a novel lipid biomarker has been shown to be an important predictor of atherosclerosis and coronary artery disease. However, it remains unclear whether AIP has prognostic value for patients with premature coronary artery disease (PCAD). Therefore, the present investigation aims to explore the relationship between AIP and major adverse cardiovascular events (MACE) in the PCAD population.

METHODS: A total of 721 patients with PCAD diagnosed by coronary angiography were enrolled in this study. Their AIP was calculated as log [triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C)]. The primary outcome of this study was MACE, defined as a combination of cardiovascular (CV) death, coronary artery revascularization, non-fatal myocardial infarction (MI), and non-fatal stroke.

RESULTS: After a median follow-up time of 52 months, 138 patients developed MACE. The patients in the highest AIP tertile group have a higher incidence of MACE (26.6% vs 11.8% and 19.8%, p < 0.001). The Kaplan-Meier curves demonstrated that there were significant differences in the risk of MACE among different AIP groups (log-rank p < 0.001). In addition, the multivariable Cox regression model showed that the hazard ratio of MACE in the highest tertile group was 2.27 (95% CI 1.30-3.94), and 1.33 (95% CI 1.06-1.67) for per SD increase in AIP.

CONCLUSIONS: AIP is significantly associated with the risk of MACE in patients with PCAD and serves as a novel independent prognostic marker for this population.

PMID:40551214 | PMC:PMC12183880 | DOI:10.1186/s40001-025-02796-w

Circulation. 2025 Jun 24;151(25):1767-1779. doi: 10.1161/CIRCULATIONAHA.124.071980. Epub 2025 Jun 23.

ABSTRACT

BACKGROUND: Clinical guidelines recommend different revascularization strategies for nonculprit lesions in patients with ST-segment-elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI). Whether the prevalence of untreated high-risk vulnerable plaques differs in STEMI and NSTEMI and affects their outcomes is unknown.

METHODS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II), a multicenter, prospective natural history study, patients with recent myocardial infarction underwent 3-vessel coronary angiography with coregistered near-infrared spectroscopy and intravascular ultrasound after successful percutaneous coronary intervention of obstructive lesions from 2014 through 2017. Two-feature high-risk plaques were defined as those with both plaque burden ≥70% and maximum lipid core burden index over any 4-mm segment ≥324.7. The primary end point was major adverse cardiovascular events arising from untreated nonculprit lesions during a median 3.7-year follow-up.

RESULTS: Of 898 patients, 199 (22.2%) with 849 nonculprit lesions had STEMI and 699 (77.8%) with 2784 nonculprit lesions had NSTEMI. By intravascular ultrasound, the median nonculprit lesion length was 17.4 mm (interquartile range, 16.3-18.5) in STEMI and 17.7 mm (interquartile range, 17.1-18.4) in NSTEMI (P=0.63), and the median minimal lumen area was 5.5 mm2 (interquartile range, 5.3-5.7 mm2) in STEMI and 5.5 mm2 (interquartile range, 5.3-5.6 mm2) in NSTEMI (P=0.99). At the lesion level, the prevalence of 2-feature high-risk nonobstructive nonculprit plaques was slightly higher in patients with STEMI than in patients with NSTEMI (12.8% versus 10.1%; P=0.03). At the patient level, however, the prevalence of 2-feature high-risk plaques was similar in STEMI versus NSTEMI (38.8% versus 32.7%; P=0.11). The prevalence of patients with 1 or more lesions meeting at least 1 high-risk plaque criterion was also similar (plaque burden ≥70%, 63.3% versus 57.8% [P=0.16]; maximum lipid core burden index over any 4-mm segment ≥324.7, 63.3% versus 57.6% [P=0.15]). The 4-year rates of nonculprit lesion-related major adverse cardiovascular events were similar in STEMI versus NSTEMI (8.6% versus 7.8%; hazard ratio, 1.02 [95% CI, 0.57-1.81]; P=0.95), as were the rates of all major adverse cardiovascular events (14.2% versus 13.0%; hazard ratio, 1.06 [95% CI, 0.68-1.64]; P=0.80).

CONCLUSIONS: In the PROSPECT II study, the per-patient prevalence of high-risk vulnerable plaques was comparable in STEMI versus NSTEMI, as was the overall long-term incidence of nonculprit lesion-related and all major adverse cardiovascular events. These results support a similar revascularization strategy for nonculprit lesions in patients with STEMI or NSTEMI after culprit lesion management.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02171065.

PMID:40549845 | DOI:10.1161/CIRCULATIONAHA.124.071980

PLoS One. 2025 Jun 23;20(6):e0326516. doi: 10.1371/journal.pone.0326516. eCollection 2025.

ABSTRACT

Beta-blockers have been considered the cornerstone of treatment for patients with acute myocardial infarction (AMI). However, long-term benefits of vasodilating beta-blockers remain uncertain. This study aimed to investigate the long-term clinical benefits of vasodilating beta-blockers compared to conventional beta-blockers in AMI patients with mildly reduced ejection fraction (mrEF). Among 13,624 patients who enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH Registry, 2,662 AMI patients with mrEF, who were prescribed beta-blockers at discharge were selected for this study. The primary outcome was a composite of cardiac death, recurrent MI, or hospitalization for heart failure (HF) during 3-year follow up period. In the entire cohort, the use of vasodilating beta-blockers at discharge was associated with lower incidence of primary outcome at 3-year (hazard ratio [HR] 0.80; 95% confidence interval [CI], 0.62-0.98; P = 0.039) compared to the use of conventional beta-blockers at discharge. In the propensity score-matched (PSM) cohort, the use of vasodilating beta-blockers at discharge was also associated with a significantly lower incidence of primary outcome (HR, 0.66; 95% CI, 0.50-0.88; P = 0.004) compared to the use of conventional beta-blockers at discharge. Furthermore, in the PSM cohort, the use of vasodilating beta-blockers was associated with lower incidences of the cardiac death (HR, 0.60; 95% CI, 0.39-0.92; P = 0.020), hospitalization for HF (HR, 0.72; 95% CI, 0.46-0.98; P = 0.042), and all-cause death (HR, 0.67; 95% CI, 0.48-0.93; P = 0.017) compared to the use of conventional beta-blockers. However, no significant differences were observed between the groups in the incidences of recurrent MI (HR, 0.62; 95% CI, 0.34-1.14; P = 0.122), any revascularization (HR, 1.04; 95% CI, 0.76-1.42; P = 0.821), stroke (HR, 0.84; 95% CI, 0.44-1.60; P = 0.589), stent thrombosis (HR, 1.12; 95% CI, 0.40-3.11; P = 0.833). In AMI patients with mrEF, the use of vasodilating beta-blockers at discharge was associated with better long-term clinical outcomes compared to the use of conventional beta-blockers.

PMID:40549765 | PMC:PMC12184898 | DOI:10.1371/journal.pone.0326516

JAMA Intern Med. 2025 Jun 23:e252058. doi: 10.1001/jamainternmed.2025.2058. Online ahead of print.

ABSTRACT

IMPORTANCE: The optimal management strategy for older patients who present with acute coronary syndrome (ACS) remains unclear due to a paucity of randomized evidence. New large and longer-term randomized data are available.

OBJECTIVE: To test the association of an early invasive strategy vs a conservative strategy with clinical outcomes for patients 70 years or older who present with ACS.

DATA SOURCES: A literature search strategy was designed in collaboration with a medical librarian. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched ,with no language restrictions from inception through October 2024. Bibliographies of previous reviews and conference abstracts from major cardiovascular scientific meetings were handsearched.

STUDY SELECTION: Studies were deemed eligible following review by 2 independent, masked investigators if they randomly allocated patients 70 years or older who presented with ACS to early invasive or conservative management and reported clinical end points. Observational analyses were excluded. No trials were excluded based on sample size or follow-up duration.

DATA EXTRACTION AND SYNTHESIS: Data were extracted independently and in triplicate. Clinical end points were pooled in meta-analyses that applied fixed-effects and random-effects modeling to calculate summary estimates for relative risks (RRs) and hazard ratios, along with their corresponding 95% CIs.

MAIN OUTCOMES AND MEASURES: The prespecified primary end point was all-cause death. Secondary end points included recurrent myocardial infarction (MI), repeated coronary revascularization, major bleeding, cardiovascular death, death or MI, stroke, heart failure hospitalization, major adverse cardiac events, major adverse cardiovascular or cerebrovascular events, and length of hospital stay.

RESULTS: The sample size-weighted mean age of participants across included trials was 82.6 years, and 46% were female. In the pooled analysis, there was no significant difference in all-cause death between the invasive and conservative strategies (RR, 1.05; 95% CI, 0.98-1.11; P = .15; I2 = 0%). An early invasive strategy was associated with a reduced risk of recurrent MI of 22% (RR, 0.78; 95% CI, 0.67-0.91; P = .001; I2 = 0%) and repeated coronary revascularization during follow-up of 57% (RR, 0.43; 95% CI, 0.30-0.60; P < .001; I2 = 33.3%). However, an invasive strategy was associated with an increased risk of major bleeding (RR, 1.60; 95% CI, 1.01-2.53; P = .05; I2 = 16.7). No differences were observed in secondary end points. Results in the non-ST-elevation ACS population were consistent with the overall findings.

CONCLUSIONS AND RELEVANCE: The results of this systematic review and meta-analysis suggest that, in older patients with ACS, an early invasive strategy was not associated with reduced all-cause death compared with conservative management. An early invasive strategy was associated with reduced recurrent MI and repeated coronary revascularization during follow-up but increased risk of major bleeding. Competing risks associated with an early invasive strategy should be weighed in shared therapeutic decision-making for older patients with ACS.

PMID:40549394 | PMC:PMC12186514 | DOI:10.1001/jamainternmed.2025.2058

Heart Vessels. 2025 Jun 23. doi: 10.1007/s00380-025-02564-0. Online ahead of print.

ABSTRACT

Given the limited published data, we examined three-year outcomes in patients with and without diabetes mellitus (DM) in non-ST-segment elevation myocardial infarction (NSTEMI), according to left ventricular ejection fraction (LVEF). A total of 4594 patients were classified into DM (n = 1608) and non-DM (n = 2986) groups. They were further classified into heart failure with reduced EF (HFrEF, LVEF ≤ 40%), HF with mildly reduced EF (HFmrEF, LVEF 41-49%), and HF with preserved EF (HFpEF, LVEF ≥ 50%) subgroups. The primary outcome was all-cause mortality, and secondary outcomes included cardiac death (CD), non-CD (NCD), recurrent MI, any revascularization, and hospitalization for HF (HHF). In both DM and non-DM groups, in-hospital all-cause mortality rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups, but were similar between the HFmrEF and HFpEF subgroups. In the DM group, the three-year all-cause mortality (P < 0.001 for both), CD, NCD, recurrent MI, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In the non-DM group, the three-year all-cause mortality (P = 0.001 and P < 0.001, respectively), CD, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In both DM and non-DM groups, the three-year all-cause mortality and NCD rates were higher in the HFmrEF group than in the HFpEF group. Regardless of the presence of DM, the three-year outcomes were best in HFpEF, worst in HFrEF, and intermediate in HFmrEF patients.

PMID:40549147 | DOI:10.1007/s00380-025-02564-0

Clin Res Cardiol. 2025 Jun 23. doi: 10.1007/s00392-025-02700-w. Online ahead of print.

ABSTRACT

BACKGROUND: The use of drug-coated balloons (DCB) in percutaneous coronary interventions (PCI) is increasing due to potential benefits mainly by avoiding foreign material although a widespread application area beyond in-stent restenosis lacks robust clinical data to date. As such, we aimed to assess the safety and efficacy of DCBs in treating de novo lesions.

METHODS: For this analysis, we included all patients treated with DCB in a de novo lesions from 2010 to 2019 at our institution. We performed a 1:1 propensity score matching to pair each DCB intervention with a comparable DES intervention. Follow-up continued until 09/2022 to assess clinical outcomes.

RESULTS: A total of 303 patients with de novo lesion were matched to 303 patients with comparable baseline characteristics. The median follow-up time was 5.7 years (IQR 2.7-9.3). There were no significant differences in cardiovascular (CV) mortality (HR 1.01 [95% CI 0.87-1.19], p value 0.874), all-cause mortality (HR 1.05 [95% CI 0.91-1.22], p value 0.491), MACE (HR 1.10 [95% CI 0.96-1.26], p value 0.170), acute myocardial infarction (HR 1.08 [95% CI 0.90-1.19], p value 0.308), or any revascularization (HR 1.03 [95% CI 0.90-1.19], p value 0.671) between both groups. However, we observed a trend toward lower rates of target lesion revascularization in patients with small vessel disease (HR 0.84 [95% CI 0.68-1.02], p value 0.072), and in side branch lesions (HR 0.79 [95% CI 0.58-1.04], p value 0.096).

CONCLUSION: DCBs demonstrated long-term safety and efficacy in de novo lesions, with promising trends in reducing target lesion revascularization in small vessel disease and side branches.

PMID:40549036 | DOI:10.1007/s00392-025-02700-w

Eur J Clin Pharmacol. 2025 Jun 23. doi: 10.1007/s00228-025-03869-9. Online ahead of print.

ABSTRACT

BACKGROUND: Myocardial infarction (MI) triggers inflammation that affects post-MI outcomes. Colchicine shows potential in treating cardiovascular (CV) conditions; however, its role in reducing adverse CV events post-MI remains uncertain.

METHODS: We conducted a thorough search across PubMed, Embase, Web of Science from inception to February 2025 for randomized controlled trials (RCTs) comparing colchicine and control in MI patients. Outcomes were analyzed using a random-effects model to pool relative risks (RRs) and mean differences (MD) with 95% confidence intervals (CIs).

RESULTS: A total of 14 RCTs incorporating 14,326 patients were included. The incidence of adverse CV events, all-cause mortality, cardiac-specific mortality, non-cardiac specific mortality, recurrent MI, repeat revascularization and post-MI heart failure (HF), post-MI atrial fibrillation (AF), and stroke were comparable between colchicine and control groups. In both colchicine and control groups, a similar change in high-sensitivity C-reactive protein (hs-CRP) from the baseline was observed. Regarding the safety profile, both colchicine and control had overall comparable any adverse effects; however, gastrointestinal adverse events (RR: 1.74, 95% CI [1.20, 2.51], P = 0.003) were higher in the colchicine group. The incidence of myelotoxicity or infections was comparable between both groups.

CONCLUSIONS: Colchicine was not beneficial in reducing adverse CV events, mortality, recurrent MI, repeat revascularization, post-MI HF, post-MI AF, and stroke following acute MI compared to control. However, colchicine use was associated with a higher incidence of gastrointestinal adverse events, with no notable increase in any adverse effects, myelotoxicity, or infections.

PMID:40548988 | DOI:10.1007/s00228-025-03869-9

Int J Cardiol Cardiovasc Risk Prev. 2025 Jun 7;26:200444. doi: 10.1016/j.ijcrp.2025.200444. eCollection 2025 Sep.

ABSTRACT

AIM: This study aims to identify three-month and one year mortality rate, LDL level and adherence to guideline-recommended medication in patients with myocardial infarct (MI) receiving cardiac rehabilitation (CR) compared to patients who do not.

METHOD: In this retrospective study, patients hospitalized in North Denmark Regional Hospital in Hjoerring (capture population 200.000) with acute coronary syndrome between January 1st, 2017, to December 31st, 2021, were included. Baseline characteristics, initial treatment of revascularization and all-cause mortality were examined through the Danish National Patient Registry, the Regional Cardiac Rehabilitation Database, and medical chart review. Patients were grouped by revascularization (yes/no) during hospitalization and CR. Adjusted Cox proportional regression model was used to assess differences in mortality and LDL levels.

RESULTS: A total of 1209 myocardial infarction (MI) survivors were included in this study. A total of 1209 myocardial infarction (MI) survivors were included. Significant LDL reductions at 6- and 12-month follow-ups were observed in patients receiving both cardiac rehabilitation (CR) and lipid-modifying therapy at baseline (p = .001), but not in those without CR. In revascularized patients, use of multiple antithrombotic agents was lower in the no CR group at three months (57.1 % vs 78.8 %, p = .002) and one year (60 % vs 78.5 %, p = .010). Three-month mortality rate was higher among patients who did not undergo CR, both in the revascularization group (19 % vs 2 %, p = 0.001) and the non-revascularization group (18 % vs 3 %, p = 0.001).

CONCLUSION: Patients undergoing CR were associated with lower LDL-levels, higher adherence to guideline-recommended medication and lower mortality rate at three-month follow-up.

PMID:40546975 | PMC:PMC12182385 | DOI:10.1016/j.ijcrp.2025.200444

Obesity (Silver Spring). 2025 Jun 22. doi: 10.1002/oby.24332. Online ahead of print.

ABSTRACT

OBJECTIVE: Obesity is a major cause of morbidity and mortality worldwide. Tirzepatide is a glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide-1 receptor agonist providing substantial weight reduction and metabolic benefits both in type 2 diabetes and obesity. We hypothesized that tirzepatide can improve morbidity and mortality in adults with obesity or overweight but without diabetes.

METHODS: SURMOUNT-MMO is a randomized, double-blind, event-driven trial to investigate the impact on morbidity and mortality with once-weekly tirzepatide compared with placebo in adults living with obesity, without diabetes, and with, or at risk of, cardiovascular disease. The primary endpoint is time to first occurrence of a five-component composite outcome of nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, heart failure events, or death from any cause.

RESULTS: The trial will enroll ~15,000 participants aged ≥40 from 664 sites across 27 countries with BMI ≥27.0 kg/m2 and either established cardiovascular disease or multiple cardiovascular risk factors.

CONCLUSIONS: SURMOUNT-MMO will provide evidence of the clinical benefits of tirzepatide on multiple outcomes among individuals with overweight or obesity but without diabetes. This is the first outcome trial of an incretin medication that assesses both primary and secondary cardiovascular disease prevention.

PMID:40545827 | DOI:10.1002/oby.24332

Diabetes Care. 2025 Jun 22:dc250942. doi: 10.2337/dc25-0942. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical efficacy of intensive LDL cholesterol (LDL-C) lowering in type 1 diabetes mellitus (T1DM).

RESEARCH DESIGN AND METHODS: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized participants with atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or placebo (median follow-up 2.2 years). The primary end point (PEP) was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization.

RESULTS: Of 27,564 participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197 (0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the 2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in participants with no diabetes, T2DM, and T1DM, respectively (P < 0.0001). Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79-0.96), 0.84 (0.75-0.93), and 0.66 (0.32-1.38) in the no diabetes, T2DM, and T1DM groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%, respectively.

CONCLUSIONS: Intensive LDL-C lowering may provide substantial clinical benefit in individuals with T1DM and ASCVD. Additional randomized controlled cardiovascular outcomes trials are needed in this population.

PMID:40544474 | DOI:10.2337/dc25-0942

Orv Hetil. 2025 Jun 22;166(25):963-969. doi: 10.1556/650.2025.33315. Print 2025 Jun 22.

ABSTRACT

Bevezetés: A szívinfarktusos betegek kezelésének eredményességét, életkilátásait jelentősen befolyásolja a teljes ischaemiás idő, amelyet a panasz kezdetétől az ér megnyitásáig számítunk. Célkitűzés: Vizsgálatunkban a teljes ischaemiás idő összetevőinek hosszát elemeztük, és összehasonlítottuk az 5 évvel korábbi vizsgálat eredményeivel. Módszer: 2022. 07. 01. és 2023. 06. 30. közötti időszakban 8705 (4334 [49,8%] STEMI, 3428 [39,4%] nő) infarktusos beteget regisztráltunk, akiknél a teljes ischaemiás idő összetevőinek számításához minden adat rendelkezésre állt. Az idők esetén a mediánértéket és a nevezetes kvartiliseket (alsó kavartilis Q1 és felső kvartilis Q3) adtuk meg, előző tanulmányunkhoz hasonlóan. A diagnózist a kórházi kezelés során állapították meg a kezelőorvosok az érvényes kritériumok alapján. Vizsgáltuk a panasz kezdetétől a mentőszolgálat értesítéséig eltelt időt (a beteg késlekedése), a mentő helyszínre érkezésének (M1) és a helyszíni ellátás (M2) idejét, valamint a helyszínről a kórházi felvételéig eltelt időt (M3). A kórházi ellátás értékelésénél a felvétel és az ér megnyitása között eltelt időt („ajtó–tű idő”) adtuk meg. Az adatokat országos és megyei bontásban is megadtuk. Eredmények: STEMI-betegeknél országosan a betegek késésének mediánértéke 140 perc (Q1: 51; Q3: 458) volt. A mentő helyszínre érkezési idejének mediánértéke 13,2 perc (Q1: 8,0; Q3: 21,1), a helyszíni ellátás idejének mediánértéke 25,5 perc (Q1: 17,6; Q3: 34,9), a helyszínről a kórházba érkezés idejének mediánértéke 31,0 perc (Q1: 19,5; Q3: 43,7) volt. A helyszínre érkezés tartománya 8,8–17,9 perc között változott a különböző megyékben. STEMI-betegeknél a medián ajtó–tű idő országosan 51,5 perc (Q1: 28,7; Q3: 121,7) volt. Az NSTEMI-csoportban a betegek késlekedésének mediánértéke 373 perc (Q1: 106; Q3: 1184), a helyszínre érkezési idő 14,2 perc (Q1: 8,5; Q3: 24,8) volt. STEMI esetén a betegek késlekedése – a korábbival összehasonlítva – közel 40 perccel nőtt (101 vs. 140 perc), a mentő helyszínre érkezésének mediánértéke (13,0 vs. 13,2 perc) érdemben nem változott. Az ajtó–tű idő a jelen vizsgálatban közel 15 perccel volt hosszabb, mint korábban (37,0 vs. 51,5 perc). A STEMI-betegcsoportban a kezelések 4,1%-ában 2 órán belül, 38,3%-ában 4 órán belül került sor az ér megnyitására. Következtetés: A teljes ischaemiás idő tekintetében a betegek késlekedése a meghatározó tényező, emiatt a kezelések jelentős részében nem az optimális időben került sor a revascularisatióra. Orv Hetil. 2025; 166(25): 963–969.

PMID:40544442 | DOI:10.1556/650.2025.33315

J Cardiothorac Surg. 2025 Jun 21;20(1):266. doi: 10.1186/s13019-025-03512-9.

ABSTRACT

BACKGROUND: Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.

METHODS: PubMed, Google Scholar, and Cochrane Library were searched until May 2024 for studies comparing the radial and femoral approaches in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, and hospital stay. Generic inverse variance (GIV) was used to pool the risk ratio for dichotomous outcomes and mean difference (MD) for the continuous outcomes, with corresponding 95% confidence intervals (CIs).

RESULTS: Twelve studies including 15,700 patients with a mean age of 77.77 years in the radial group and 74.04 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was a significantly lower risk (RR: 0.23; 95% CI [0.12, 0.41]; p < 0.00001) in the radial group as compared to the femoral group. From the secondary outcomes, radial access was found to have significantly lower MACE (RR:0.80; 95% CI [0.68, 0.93]; p = 0.004), shorter procedural time (MD: -6.95; 95% CI [-11.52, -2.38], p = 0.003) and hospital stay (MD: -2.8; 95% CI [-5.56, -0.04], p = 0.05) as compared to femoral group. In contrast, all the other secondary outcomes were found to be insignificant.

CONCLUSION: Rotational atherectomy using the radial approach has a significantly lower rate of major vascular site bleeding and MACE and is associated with significantly shorter procedural time and hospital stay.

PMID:40544305 | PMC:PMC12182652 | DOI:10.1186/s13019-025-03512-9

Cardiovasc Revasc Med. 2025 Jun 13:S1553-8389(25)00296-9. doi: 10.1016/j.carrev.2025.06.010. Online ahead of print.

ABSTRACT

Advancements in percutaneous coronary intervention (PCI) technology and post-PCI patient management have led to improvements in clinical outcomes in coronary artery disease patients. At the forefront of these advancements is intravascular imaging - reduced risks of death, myocardial infarction, repeat revascularization, and stent thrombosis have been demonstrated with intravascular imaging-guided PCI compared with angiography guidance alone. The latest 2024 European Society of Cardiology chronic coronary syndrome guidelines and the 2025 American College of Cardiology/American Heart Association acute coronary syndrome guidelines provide a Class I recommendation for use of intravascular imaging in complex PCI. At the recently concluded Cardiovascular Research Technologies 2025 Meeting, a dedicated session titled "Beyond the Guidelines - Intravascular Imaging Guidance of PCI, Diagnosis and Treatment" was conducted to address gaps in the existing guidelines. This review summarizes the scenarios not covered by the current guidelines, key takeaways from the discussion by the expert panel, and the audience's perspective on critical questions needed for future guideline developments.

PMID:40544127 | DOI:10.1016/j.carrev.2025.06.010

Can J Cardiol. 2025 Jun 19:S0828-282X(25)00391-5. doi: 10.1016/j.cjca.2025.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: A 2022 meta-analysis concluded colchicine reduced the cardiac risk in secondary prevention. Nevertheless, a large, randomized clinical trial (RCT) continued to randomize patients to colchicine or placebo and in 2025 published findings of no benefit. Bayesian sequential analyses and hierarchical meta-analysis can assist in understanding not only the interpretation of this latest trial but also the totality of the evidence.

METHODS: A systematic review and Bayesian meta-analysis including the recent CLEAR trial results was performed. The primary outcome was major adverse cardiovascular events (MACE), a composite of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization. Bayesian sequential analyses were performed with vague (result dominated by CLEAR), fully informative (based on all previous studies), and "focused" (considering only the largest and most similar previous trial) priors and results compared with a hierarchical meta-analysis. The probabilities of clinically meaningful results were based on > absolute 15% MACE reduction.

RESULTS: While the 2022 meta-analysis suggested a statistically significant MACE decrease with colchicine, the Bayesian reanalysis showed a 95% credible interval (95% CrI 0.26, 1.70) for the next study, justifying CLEAR continuation. The Bayesian sequential analyses using vague, all-inclusive, and focused priors showed 58%, 100% and 92% probabilities respectively of MACE decrease with colchicine. Clinically meaningful probability decreases, based on > absolute 15% reduction, were smaller, ranging between 2% to 41%.

CONCLUSIONS: Bayesian analyses offer advantages in trial design and interpretation, suggesting some benefit for colchicine in secondary cardiovascular prevention, but considerably less certainty of its clinical importance.

PMID:40543648 | DOI:10.1016/j.cjca.2025.06.008

J Endovasc Ther. 2025 Jun 21:15266028251325054. doi: 10.1177/15266028251325054. Online ahead of print.

ABSTRACT

OBJECTIVE: Carotid artery restenosis can occur after both carotid artery stenting (CAS) and carotid endarterectomy (CEA). This systematic review and meta-analysis aim to determine which revascularization technique, CAS, or CEA, is superior for treating primary carotid restenosis, irrespective of the initial revascularization method used.

DESIGN: Systematic review and meta-analysis.

METHODS: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRALs) databases were searched for eligible studies on December 19th, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Primary endpoint was the occurrence of transient ischemic attack (TIA) or any stroke. Secondary endpoints were technical success, death within 30 days, myocardial infarction (MI), local complications, cerebral hyperperfusion syndrome (CHS), cranial nerve injury (CNI), dys-/arrythmia, secondary restenosis, repeat revascularization, and long-term survival. Results were adjusted for symptomatic status and primary treatment strategy.

RESULTS: Nineteen studies comprising 10,171 procedures in 10,041 patients were included. Baseline characteristics were comparable between groups. Main findings were (1) No difference in primary outcome; however, if adjusted for symptomatic status the rate of TIA/any stroke is higher (OR: 2.05, 95% CI: 1.29-3.27, p < 0.01) after CEA compared to CAS; (2) Significant higher rate of MI (OR: 1.85, 95% CI: 1.19-2.86, p < 0.01) after CEA; (3) Besides CNI, which appears to be commonly temporary and occurred only after CEA (7.56%, 95% CI: 4.21%-13.22%), no significant differences in other secondary endpoints were observed between groups. Long-term risk of secondary restenosis was similar between CEA compared to CAS (OR: 0.98, 95% CI: 0.39-2.49, p = 0.95); (4) Correction for the index procedure did not affect conclusions.

CONCLUSION: Based on limited-quality studies, mostly retrospective and nonrandomized in design, both CAS and CEA represent feasible treatment approaches for patients with primary restenosis, with comparable primary outcome between the two groups. However, based on the obtained results, CAS appears to be preferable. Patients should be critically evaluated in a multidisciplinary team and further research is desirable.Clinical ImpactThis review expands on previous studies by incorporating a larger patient cohort and more recent literature while offering new insights into restenosis. Unlike earlier research, this study uniquely evaluates first repeat revascularization outcomes (CAS and CEA) independently of the initial procedure, suggesting that patient and plaque characteristics might be more influential than the primary technique. Sensitivity analysis confirmed this, as stratification by index procedure did not alter conclusions. Although lower TIA/stroke and mortality rates were observed in CAS-treated patients, these findings were not statistically significant in the overall group. These results may help guide clinical decision-making for optimal restenosis management.

PMID:40542821 | DOI:10.1177/15266028251325054

Cardiovasc Revasc Med. 2025 Jun 4:S1553-8389(25)00288-X. doi: 10.1016/j.carrev.2025.06.003. Online ahead of print.

ABSTRACT

BACKGROUND: Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.

METHODS: Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).

RESULTS: The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4-55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38-8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06-7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02-0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08-0.89).

CONCLUSIONS: Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.

PMID:40541478 | DOI:10.1016/j.carrev.2025.06.003