http:www.cardiocirugia.sld.cu

Int J Mol Sci. 2025 Jun 6;26(12):5453. doi: 10.3390/ijms26125453.

ABSTRACT

Surgical myocardial revascularization, regardless of the technique used, causes ischemia-reperfusion injury (IRI) in the myocardium mediated by inflammation and degradation of the endothelial glycocalyx (EG). We investigated the difference between on-pump and off-pump techniques in terms of the concentration of proinflammatory interleukin (IL)-18 and the EG degradation products syndecan-1 and hyaluronic acid measured by ELISA in the peripheral and cardiac circulation during open heart surgery and in the early postoperative period. The concentration of IL-18, C-reactive protein (CRP), and cardiac troponin T (cTnT) and the leukocyte count increased statistically significantly in revascularized patients at 24 and 72 h after revascularization compared to the beginning of the procedure and was always statistically significantly higher in on-pump patients. Syndecan-1 and hyaluronic acid only increased in on-pump patients 24 and 72 h after revascularization. IL-18 correlated positively with syndecan-1 and CRP only in the pump setting and with the number of leukocytes in both revascularization regimens 24 and 72 h after the surgery. cTnT and hyaluronic acid did not correlate with IL-18. Our results suggest that IL-18 plays an important role in the early inflammatory response in patients during open heart surgery and in the early postoperative period, leading to additional damage to the EG, while it is probably not responsible for myocardial necrosis. It could serve as a biomarker to identify high-risk patients and as a therapeutic target to reduce inflammation and EG degradation. In addition, measurement of IL-18 could help improve the treatment, recovery, and outcomes of patients after heart surgery.

PMID:40564918 | PMC:PMC12193331 | DOI:10.3390/ijms26125453

Biomedicines. 2025 Jun 14;13(6):1470. doi: 10.3390/biomedicines13061470.

ABSTRACT

Background/Objectives: Polymer-free drug-eluting stents (PF-DESs) aim to mitigate long-term adverse effects associated with polymer-based platforms. However, clinical comparisons with biodegradable polymer DESs (BP-DESs) remain limited. The objective of this review is to assess the efficacy and safety of PF-DESs versus thin-struts (<100 μm) BP-DESs in patients undergoing percutaneous coronary intervention (PCI). Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PF-DESs and BP-DESs in adults undergoing PCI. PubMed, Embase, and CENTRAL were searched up to 1 February 2025. A random-effects model was used to calculate pooled risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Outcomes included myocardial infarction (MI), all-cause and cardiac death, target lesion revascularization (TLR), stent thrombosis, and angiographic/OCT parameters. Subgroup and sensitivity analyses were conducted for outcomes with high heterogeneity (I2 > 50%). Results: Nine RCTs (n = 9597) were included. At 12 months, no significant differences were found between PF-DESs and BP-DESs for TLR (RR 1.51; 95% CI: 0.83-2.75), MI, or stent thrombosis. At 24 months, MI and all-cause death were similar between groups. A subgroup analysis showed lower cardiac death with the BioFreedom stent (RR 0.57; 95% CI: 0.35-0.90), not observed in non-BioFreedom devices. No significant differences were detected in angiographic or OCT outcomes, though heterogeneity was high. Conclusions: PF-DESs and BP-DESs demonstrated comparable clinical performance. The observed benefit in cardiac death with BioFreedom may reflect device-specific effects and merits further investigation.

PMID:40564189 | PMC:PMC12190656 | DOI:10.3390/biomedicines13061470

Biomedicines. 2025 May 23;13(6):1289. doi: 10.3390/biomedicines13061289.

ABSTRACT

Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient outcomes. Even when the infarct-related artery is successfully revascularized, a significant percentage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR) and the coronary flow reserve (CFR), have been considered as gold standards. However, they are constrained by their hazards and complexity. Non-invasive techniques, such as echocardiography Doppler for CFR assessment, positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and some other techniques provide alternatives, but their accessibility, cost and implementation during the peri-AMI period raise obstacles to their wider use. This review highlights both invasive and non-invasive modalities as it examines the diagnostic methods and prognostic significance of CMVD development early after AMI. Enhancing long-term results in this high-risk population requires a thorough understanding of pathophysiology and a commitment to larger diagnostic and prognostic studies for CMVD.

PMID:40564009 | PMC:PMC12189317 | DOI:10.3390/biomedicines13061289

Cardiovasc Revasc Med. 2025 Jun 21:S1553-8389(25)00312-4. doi: 10.1016/j.carrev.2025.06.027. Online ahead of print.

ABSTRACT

BACKGROUND: Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) of complex coronary lesions is currently recommended by international guidelines. Complex coronary anatomy is observed in up to one third of the patients undergoing coronary interventions and is associated with worse clinical outcomes. Data on lesion characteristics and outcomes are scarce in census-defined minority groups.

METHODS/DESIGN: The Intravascular Ultrasound Guidance for Complex High-Risk Indicated Procedures in Underrepresented Patient Populations (UPP) Registry is a prospective, observational, multicenter, single-arm study describing the safety and efficacy of IVUS-guided PCI in approximately 1010 subjects who self-identify within a demographic minority and undergo complex high-risk procedures. Criteria for optimal stenting include final minimal stent area (MSA) >5 mm2 or MSA >90 % of the distal reference lumen, plaque burden <50 % within 5 mm proximal or distal to stent edges, and absence of edge dissections involving the media and > 3 mm in length. The primary endpoint of target-vessel failure is a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target-vessel revascularization at 1 year. Secondary endpoints include the individual components of the primary end point as well as procedural and imaging endpoints.

SUMMARY: The IVUS CHIP UPP Registry is the first prospective investigation of procedural and clinical outcomes related to an IVUS-guided PCI for management of complex coronary lesions among minority patient populations in the United States.

PMID:40562607 | DOI:10.1016/j.carrev.2025.06.027

West J Emerg Med. 2025 May 20;26(3):729-736. doi: 10.5811/westjem.35271.

ABSTRACT

INTRODUCTION: The use of coronary artery bypass grafting (CABG) for primary revascularization during the acute care of ST-elevation myocardial infarction (STEMI) patients has declined significantly in the past decade; but there is little data to determine whether there has been a change in the use of CABG for STEMI patients treated by emergency medical services (EMS). In this study we described the incidence of urgent or emergent CABG for STEMI patients treated in a large, regionalized cardiac care system.

METHODS: We obtained data obtained for patients transported by EMS between January 2011-December 2022 who were diagnosed with acute STEMI on prehospital or emergency department (ED) electrocardiogram and taken for primary diagnostic catheterization. All STEMI patients were transported by EMS to one of 34 STEMI receiving centers (SRC) in a regionalized cardiac care system, all of which are required to maintain onsite cardiac surgery as a condition of their SRC designation. Patients were considered to have undergone urgent or emergent CABG if it was performed within 72 hours of the primary diagnostic cardiac catheterization. We excluded patients if no diagnostic catheterization was performed or if CABG was performed >72 hours after diagnostic catheterization. The primary outcome was the incidence of urgent or emergent CABG. Patients were further stratified by time between diagnostic catheterization and CABG (<24 hours, 24-48 hours, 48-72 hours).

RESULTS: A total of 28,349 patients were transported by EMS and diagnosed with an acute STEMI during the study period. Only 384 (1.35%) patients underwent CABG within 72 hours of diagnostic catheterization: 268 (0.95%) underwent CABG in <24 hours; 71 (0.25%) in 24-48 hours, and 45 (0.16%) in 48-72 hours. The median age of patients undergoing CABG was 64 years (interquartile range 58-72). Twenty-eight (7.3%) experienced prehospital cardiac arrest, and eight (2.1%) required vasopressors. Prior to undergoing CABG, 137 patients (36%) underwent primary percutaneous coronary intervention. The proportion of patients undergoing CABG within 72 hours remained relatively stable between 2011-2022 at 1.19% and 1.96%, respectively.

CONCLUSION: Urgent or emergent CABG remained infrequently performed for acute STEMI patients after primary diagnostic catheterization. There was little change in the percentage of STEMI patients who received CABG within 72 hours of diagnostic catheterization over the past decade. These findings suggest that regional or local policies requiring on-site cardiac surgery at SRCs may be reconsidered.

PMID:40562005 | PMC:PMC12208032 | DOI:10.5811/westjem.35271

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