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J Am Heart Assoc. 2025 Jun 17;14(12):e040526. doi: 10.1161/JAHA.124.040526. Epub 2025 Jun 11.

ABSTRACT

BACKGROUND: Patients with both peripheral artery disease (PAD) and coronary artery disease are at heightened risk for adverse cardiovascular outcomes. Although long-term risk has been well documented, contemporary in-hospital outcomes for patients with PAD presenting with acute myocardial infarction (AMI) are less well characterized.

METHODS: We analyzed 493 740 AMI hospitalizations from 670 US sites in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2019 and March 2023. Primary outcomes were in-hospital mortality and major bleeding; secondary end points included cardiac arrest, cardiogenic shock, heart failure, stroke, and new dialysis initiation. Subgroup analyses were conducted by age, sex, race, AMI type, revascularization status, and extent of coronary disease. We used the NCDR validated risk model for multivariable adjustment.

RESULTS: PAD was present in 36 274 patients with AMI (7.4%). In-hospital mortality was significantly higher in patients with PAD compared with those without (8.23% versus 4.87%; adjusted odds ratio [aOR], 1.25 [95% CI, 1.19-1.31]). Increased mortality persisted across age groups (<65 years: aOR, 1.42; ≥65 years: aOR, 1.18) and AMI type (non-ST-segment-elevation MI: aOR, 1.14; ST-segment-elevation MI: aOR, 1.46), with significant interactions by both age and AMI type. Among revascularized patients, mortality was elevated in those with PAD (aOR, 1.49). PAD was associated with increased rates of major bleeding (aOR, 1.23), particularly among revascularized patients (aOR, 1.31), as well as cardiac arrest, shock, heart failure, stroke, and new dialysis.

CONCLUSIONS: PAD was independently associated with markedly worse in-hospital outcomes in AMI, highlighting the need for risk mitigation strategies in this high-risk population.

PMID:40497502 | DOI:10.1161/JAHA.124.040526

Catheter Cardiovasc Interv. 2025 Jun 11. doi: 10.1002/ccd.31680. Online ahead of print.

ABSTRACT

BACKGROUND: Even after complete revascularization (CR), patients with acute myocardial infarction (AMI) still face significant risks of adverse events, frequently linked to vulnerable plaque progression in nonsignificant stenosis.

AIMS: To investigate the relationship between the radial wall strain (RWS) of nonsignificant stenosis lesions and major adverse cardiac events (MACE) in patients with AMI following CR.

METHODS: This cohort study included patients with AMI who received CR of all culprit and non-culprit lesions with diameter stenosis (DS%) > 70% during index or staged percutaneous coronary intervention within 45 days, with at least one de novo native lesion (DS% of 30%-70%) for RWS analysis. The primary outcome was MACE comprising cardiovascular death, nonfatal myocardial infarction, unstable angina, and heart failure.

RESULTS: During a median follow-up of 3.6 years, 55 among 225 patients (24.4%) experienced MACE, mainly driven by unstable angina. Maximum RWS (RWSmax) was predictive of MACE with an area under the curve of 0.84 (95% CI: 0.78-0.90; p < 0.001) and an optimal cutoff > 14.5%. In the multivariable Cox regression model, RWSmax > 14.5% was an independent predictor for MACE among patients with AMI after CR (HR: 8.06; 95% CI: 3.98-16.35; p < 0.001). In patients with Murray law-based quantitative flow ratio (μQFR) > 0.8, the prognostic impact of RWSmax on MACE was comparable to that observed in patients with μQFR < 0.8 (P for interaction = 0.236).

CONCLUSIONS: Among patients with AMI who received CR, a high-strain pattern detected by RWS analysis in nonsignificant stenosis lesions was associated with a worse clinical outcome.

PMID:40495557 | DOI:10.1002/ccd.31680

J Stroke. 2025 May;27(2):228-236. doi: 10.5853/jos.2025.00409. Epub 2025 May 31.

ABSTRACT

BACKGROUND AND PURPOSE: The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90-110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.

METHODS: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.

RESULTS: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45-1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09-0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60-2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.

CONCLUSION: In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

PMID:40494581 | PMC:PMC12152449 | DOI:10.5853/jos.2025.00409

Sleep Med. 2025 May 19;133:106587. doi: 10.1016/j.sleep.2025.106587. Online ahead of print.

ABSTRACT

OBJECTIVE/BACKGROUND: Limited research assesses cardiovascular risk in people with idiopathic hypersomnia. This study compared cardiovascular conditions or events among individuals with idiopathic hypersomnia with those among matched non-idiopathic hypersomnia controls.

PATIENTS/METHODS: Claims from Merative™ MarketScan® Research Databases (12/2013-2/2020) were analyzed. Eligible individuals with idiopathic hypersomnia were ≥18 years of age upon cohort entry, continuously enrolled for 365 days before and after cohort entry (gaps ≤30 days allowed), and without cataplexy. Individuals with idiopathic hypersomnia entered the cohort upon their earliest medical claim with an idiopathic hypersomnia diagnosis code. Controls were matched 5:1, without replacement, to individuals with idiopathic hypersomnia using demographic characteristics. Odds of prevalent cardiovascular conditions or events during the 2-year assessment period (365 days before and after cohort entry date) were compared using unconditional logistic regression. Results were reported as odds ratios (ORs) with 95 % confidence intervals (CIs).

RESULTS: Final cohorts included 11,412 individuals with idiopathic hypersomnia and 57,058 matched controls. Odds (OR, 95 % CI) of cardiovascular disease (2.26, 2.14-2.38), major adverse cardiovascular event (2.08, 1.89-2.30), stroke (2.07, 1.87-2.29), hypertension diagnosis or antihypertensive use (2.02, 1.93-2.12), heart failure (1.97, 1.76-2.20), atrial fibrillation (1.91, 1.66-2.20), myocardial infarction (1.74, 1.42-2.12), and coronary revascularization (1.58, 1.12-2.17) were higher in individuals with idiopathic hypersomnia than matched controls.

CONCLUSIONS: Individuals with idiopathic hypersomnia had higher odds of prevalent cardiovascular conditions or events than matched controls. These results reinforce that clinicians should be aware of patients' cardiovascular risk profiles when selecting idiopathic hypersomnia treatments.

PMID:40494110 | DOI:10.1016/j.sleep.2025.106587