Atherosclerotic cardiovascular diseases (ASCVDs) represent a global health burden contributing to substantial morbidity and mortality. The neutrophil gelatinase-associated lipocalin (NGAL), a small glycoprotein, is secreted by inflammatory neutrophils, macrophages, and dendritic cells, playing a role in inflammation. However, its relevance as a predictor of ASCVDs risk across patients from low to very high-risk, and correlation with the need for revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) remains largely unexplored. Our objective was to assess plasma NGAl levels in patients with low to very high risk of ASCVD and their relationship with the severity of CAD and the requirement for revascularization.

Outpatients and patients undergoing catheterization were categorized into low, moderate, high, and very high risk of ASCVD. Plasma levels of NGAL were measured using ELISA and analyzed in relation to CAD status and the need for revascularization by PCI or CABG.

Plasma NGAl levels were elevated in CAD patients, with higher levels in patients with acute coronary syndrome compared to those with stable angina. A gradual increase in plasma NGAl levels was noted with the elevated risk of ASCVD and degree of coronary artery stenosis. Notably, plasma NGAl level was independently correlated with ASCVD risk and the need for revascularization by PCI.

Our study indicates that plasma NGAl levels are linked to the risk of ASCVD and may help predict the development and severity of CAD. Further research targeting NGAL could explore its potential to mitigate the risk of ASCVD.

Patients who undergo noncardiac surgery shortly after percutaneous coronary intervention (PCI) experience higher rates of perioperative ischemic events, but delaying surgery may affect disease staging and influence cancer recurrence. We aimed to evaluate the association between time from PCI to cancer surgery and cardiovascular and oncologic outcomes in patients with early-stage cancer.

We included patients with early-stage cancer with a history of PCI who underwent cancer surgery (N=3621). The patients were divided into 2 groups based on the time between the dates of PCI and cancer surgery (<12 and ≥12 months). We also grouped patients who underwent early surgery and late surgery, defined as patients who underwent surgery ≥1 and <1 month after cancer diagnosis. Outcomes included bleeding, spontaneous myocardial infarction, repeat revascularization, cancer recurrence, and death. The time from PCI to cancer surgery <12 months group had higher bleeding (hazard ratio [HR], 1.30 [95% CI, 1.18-1.32]), spontaneous myocardial infarction (HR,1.96 [95% CI, 1.32-2.92]), cancer recurrence (HR, 1.26 [95% CI, 1.01-1.56]), and mortality (HR, 1.23 [95% CI, 1.04-1.44]) compared with the ≥12 months group. Among the time from PCI to cancer surgery <12 months group, the early-surgery group had lower cancer recurrence risk than those who underwent late surgery (HR, 0.70 [95% CI, 0.49-0.99]) without differences in bleeding and cardiac outcome.

Although patients who undergo surgery within 12 months of PCI have higher risks of bleeding and cardiovascular events, delaying surgery may increase the risk of cancer recurrence. Therefore, the timing of surgery should be a personalized decision, weighing the risks of cardiovascular complications against the potential oncologic outcomes.

URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06357000.

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Limited data exist on noncardiac surgery patients with prior percutaneous coronary intervention (PCI) in the contemporary era. The objective was to examine rate, characteristics, and outcomes of patients who underwent noncardiac surgery within 2 years of PCI and develop a risk model of factors that predict long-term postoperative outcomes among patients with recent PCI.

Patients in the Veterans Affairs Surgical Quality Improvement Program database who underwent noncardiac surgery between October 1, 2017 and September 30, 2021 were included. Patients with versus without PCI within 2 years were propensity matched to examine major adverse cardiovascular events (MACE), defined as a 1-year composite of mortality, revascularization, and rehospitalization for myocardial infarction or stroke. Among patients with recent PCI, multivariable logistic regression was used to develop a risk model to predict 1-year postoperative MACE. Among 334 828 patients undergoing surgery, 2297 (0.68%) had PCI within 2 years. Among 9160 propensity-matched veterans, there was no difference in MACE between patients with and without preceding PCI (hazard ratio [HR], 1.04 [95% CI, 0.96-1.17]). Patients with versus without preceding PCI within 2 years had lower risk of all-cause death (HR, 0.83 [95% CI, 0.72-0.96]) but higher risk of revascularization (HR, 1.88 [95% CI, 1.50-2.36]) at 1 year. A 13-component MACE prediction model among patients with recent PCI had moderate discrimination (area under the receiver operating characteristic curve 0.73 derivation, 0.72 validation).

Among patients who underwent surgery, risk of MACE did not differ, but the risk of revascularization was higher and all-cause death was lower in patients with versus without recent PCI. A risk model can be used to stratify risk of surgery among patients with preceding PCI.

Complications of intracranial hemorrhage (ICH) after percutaneous coronary intervention (PCI), although rare, have a poor prognosis with high mortality rates. This study aims to provide information on the clinical characteristics and outcomes of hospitalized patients with ICH after PCI.

This retrospective study included 24 patients enrolled from February 2014 to September 2023, which occurred ICH during post-PCI hospitalization. We mainly analyzed general, procedural, ICH features and subsequent outcomes. In addition, the predictive ability of the CRUSADE, ARC-HBR, and ACUITY scores was assessed with the receiver operating characteristics area under the curve (AUC).

Among the 24 patients, the mean age was 62.21 ± 10.01 years, and 66.7% (n = 16) were men. The mortality of ICH patients after PCI was very high (n = 13, 54.2%). In addition, the most common initial manifestation of ICH patients was the disturbance of consciousness (n = 14, 58.3%). Over half of the cases (58.3%) occurred ICH within the first 12 h following PCI. 13 patients (54.2%) had an ICH volume ≥30 cm3, and of these patients, a total of 11(84.6%) died. ICH volume ≥30 cm3 (p = 0.038), and the use of mechanical ventilators (p = 0.011) were significantly higher in patients who died. The AUC of CRUSADE, ARC-HBR, and ACUITY scores were 0.500, 0.619, and 0.545, respectively.

In our study, the mortality of ICH after PCI was high. The high volume of ICH indicates a high risk of death.

Background/Objectives: Intracardiac thrombosis (ICT) is a serious complication in acute myocardial infarction (AMI) patients. This study aimed to identify potential risk factors of ICT in AMI patients, providing valuable insights for clinical management. Methods: A case-control study was conducted involving consecutive AMI patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University between January 2019 and December 2022. Binary logistic regression identified independent risk factors of ICT and a nomogram prediction model was constructed and validated for accuracy. Conclusions: A total of 7341 patients with ICT and 74 without ICT were included. Multivariate logistic regression identified male gender, acute anterior wall myocardial infarction (AWMI), ventricular aneurysm, and lower prothrombin activity as independent risk factors of ICT in AMI patients. A nomogram based on these factors demonstrated excellent performance (AUC: 0.910, 95% CI: 0.877-0.943, p < 0.001), with calibration and sensitivity analyses confirming its robustness. This nomogram provides an accurate tool for predicting ICT risk, facilitating personalized management and early intervention in AMI patients.

This review examines the current evidence and management strategies for stable coronary artery disease (CAD) and acute coronary syndrome (ACS) in patients with cancer. We outline the unique challenges, optimal treatment approaches, and outcomes in this growing population.

First-line medications for CAD management are consistently underutilized in cancer patients despite serving as standard of care. As a corollary, medical optimization in CAD management in general is less likely to occur in patients with cancer. Early invasive strategies in ACS show improved survival, yet cancer patients receive percutaneous coronary intervention less frequently than non-cancer patients. Optimization of medical management should be prioritized in stable CAD; revascularization with PCI is first line for most patients presenting with ACS. Modification of risk factors contributing to both CAD and cancer is of utmost importance. Cancer survivors should receive vigilant, long-term monitoring for the development of signs of CAD.

A study was conducted to explore the predictive effect of atypical right bundle-branch blocks (ARBBB) on in-hospital sudden cardiac death (SCD), cardiac rupture (CR), and long-term prognosis in patients with acute myocardial infarction undergoing percutaneous coronary intervention with a drug-eluting stent.

A total of 13 886 patients with first-episode acute myocardial infarction who underwent percutaneous coronary intervention with a drug-eluting stent at 3 centers from January 2017 to January 2022 were included in this retrospective study. Patients were categorized into 4 groups: ARBBB (n=348), typical right BBB (n=374), left BBB (n=366), and non-BBB (n=12 798). The primary end points were in-hospital SCD and CR, the secondary end points were 2-year major adverse cardiovascular and cerebrovascular events. During the in-hospital observation period, 334 patients (2.4%) experienced SCD, with 98 (0.7%) attributed to CR. The incidences of in-hospital SCD and CR in the group with ARBBB were significantly higher than those in the other 3 groups (ARBBB versus left BBB versus typical right BBB versus non-BBB: SCD, 10.6% versus 5.7% versus 4.3% versus 2.0%, P=0.001; CR, 5.7% versus 2.7% versus 1.3% versus 0.5%, P<0.001). ARBBB was a statistically significant predictor of in-hospital SCD (hazard ratio [HR], 2.45 [95% CI, 1.65-4.78], P<0.001) and CR (HR, 3.32 [95% CI, 1.77-7.74], P<0.001). ARBBB could also predicted the 2-year major adverse cardiovascular and cerebrovascular events (HR, 2.99 [95% CI, 1.65-5.53], P<0.001).

ARBBB is a predictor of in-hospital SCD, CR, and 2-year major adverse cardiovascular and cerebrovascular events in patients with first-episode acute myocardial infarction undergoing percutaneous coronary intervention with a drug-eluting stent.

Although patients with high bleeding risk (HBR) often have complex coronary artery lesions, it is not known whether intravascular imaging-guided percutaneous coronary intervention (PCI) improves their prognosis. We sought to investigate the benefit of intravascular imaging-guided PCI for complex coronary artery lesions in patients with HBR.

This was a secondary analysis of the RENOVATE-COMPLEX-PCI trial (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) in which patients with complex coronary artery lesions undergoing PCI were enrolled at 20 sites in Korea from May 2018 through May 2021. Patients were randomized to receive intravascular imaging-guided PCI or angiography-guided PCI and classified according to the presence of HBR. The primary end point was target vessel failure, which was a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.

Of 1639 trial population, 478 patients met HBR criteria. There was no significant difference in the risk of the primary end point between HBR and non-HBR patients (11.8% versus 8.2%; adjusted hazard ratio [HR], 1.05 [95% CI, 0.72-1.54]; P=0.790). However, patients with HBR were at higher risk for cardiac death or spontaneous target vessel-related myocardial infarction (adjusted HR, 2.04 [95% CI, 1.09-3.80]; P=0.025), all-cause death (adjusted HR, 3.30 [95% CI, 1.93-5.62]; P<0.001), and cardiac death (adjusted HR, 2.36 [95% CI, 1.10-5.09]; P=0.028). Intravascular imaging-guided PCI showed a lower risk of the primary end point compared with angiography-guided PCI in both HBR patients (9.7% versus 15.8%; adjusted HR, 0.57 [95% CI, 0.31-1.02]; P=0.060) and non-HBR patients (6.9% versus 10.8%; adjusted HR, 0.65 [95% CI, 0.43-0.99]; P=0.045), without significant interaction (P for interaction=0.796).

Patients with HBR were associated with an increased risk of adverse cardiovascular events after complex PCI compared with those without HBR. Intravascular imaging-guided PCI showed a lower risk of the target vessel failure without significant interaction between treatment strategy and the presence of HBR in patients undergoing complex PCI.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.

Long stents reduce the risk for in-stent restenosis associated with percutaneous coronary interventions in long, tapered coronary lesions.

The Morph India study investigated the long-term safety and clinical performance of the BioMime Morph sirolimus-eluting stent (SES), a tapered stent used for treating long coronary lesions.

This is a prospective, multicentre, single-arm, real-world, post-marketing surveillance study conducted among patients with long coronary lesions (length >26 mm to ≤56 mm, reference vessel diameter 2.25-3.50 mm) implanted with the BioMime Morph SES. The primary endpoint was freedom from target lesion failure (TLF). The incidence of target vessel failure (TVF) - defined as a composite of cardiac death related to the target vessel, target vessel myocardial infarction (TVMI), and ischaemia-driven target vessel revascularisation (ID-TVR) - was the secondary endpoint. An angiographic follow-up was conducted at 9 months, and subjects were followed up for 3 years.

Out of 448 enrolled patients, 420 patients completed the 3-year follow-up. The rate of freedom from TLF was 99.31% at 12 months and 98.80% at 3 years. In 3 years, there were 4 events each of TVMI, TVR (including ID-TVR) and ischaemia-driven target lesion revascularisation (all 0.95%). Quantitative coronary angiography analysis at a mean of 9.2 months revealed in-segment late lumen loss (LLL) of 0.29±0.23 mm and in-device LLL of 0.35±0.11 mm. The in-device minimal lumen diameter improved from 0.63±0.42 mm at preprocedure to 2.13±0.37 mm (p<0.001) at 9.2 months.

The 3-year safety and clinical outcomes of BioMime Morph SES for treating long coronary lesions were satisfactory. Further long-term comparative studies are necessary to validate these results.

The antithrombotic strategy for patients with atrial fibrillation (AF) and coronary artery disease following percutaneous coronary intervention is shifting towards less intensive. Nevertheless, for patients with AF and acute coronary syndrome (ACS), an optimal antithrombotic strategy is yet to be established.

We conducted a multi-center cohort study involving 146 Japanese centers that had prospectively registered 460 patients with AF and ACS followed for 2 years. Primary endpoint was the composite of thrombotic and bleeding events, and secondary endpoints included heart failure hospitalization. At the time of study registration, 86 % of participants had received direct oral anticoagulants (DOACs) and 75 % had received aspirin-based triple antithrombotic therapy (TAT) between March 2017 and August 2019. Apixaban was the most frequently used DOAC (29 %). While the proportion of anticoagulants did not change according to the time course, the intensity of antiplatelets significantly attenuated over time (dual antiplatelet at baseline: 75 %, and at 2-years: 7 %). The cumulative incidence of the primary outcome measure was similar in patients with warfarin and DOACs. However, the risk of heart failure hospitalization was significantly higher in those with warfarin compared to DOACs (Hazard ratio: 2.8, 95 % confidence interval: 1.1-5.8, p = 0.022).

The present findings suggest the appropriate optimization of antithrombotic medication balancing in patients with AF and ACS in Japan by reducing the intensity of antiplatelets during the study period.

Aspirin is commonly recommended for individuals who have experienced stroke or myocardial infarction (MI). Indobufen, a cyclooxygenase-1 inhibitor, has been studied as a potential alternative. We conducted a meta-analysis and trial sequential analysis (TSA) to compare indobufen with aspirin in patients requiring antiplatelet therapy.

We searched PubMed, Scopus, and Cochrane Central for studies that compared indobufen and aspirin antiplatelet therapies. We focused on efficacy outcomes, such as composite vascular events, MI, and ischemic stroke, and safety outcomes, such as major bleeding and any bleeding. Heterogeneity was assessed using I2 statistics, and our analysis followed the PRISMA guidelines.

The review included 5 studies with 11,943 patients (indobufen n = 5952, 49.84 %), three involving post-MI and two involving post-stroke patients. No significant differences were found between the groups in composite vascular events at 90 days (RR 0.84; 95 % CI 0.46-1.53; p = 0.560; I2 = 53 %) and 1-year (RR 1.13; 95 % CI 0.99-1.29; p = 0.08; I2 = 0 %). MI (RR 0.73; 95 % CI 0.43-1.22; p = 0.22; I2 = 0 %), ischemic stroke (RR 1.16; 95 % CI 0.99-1.37; p = 0.06; I2 = 0 %), and cardiovascular death (RR 1.35; 95 % CI 0.80-2.26; p = 0.257; I2 = 0 %) at 1-year also showed no significant differences. Major bleeding at 1 year (RR 0.73; 95 % CI 0.41-1.31; p = 0.297; I2 = 64 %) was comparable, but any bleeding at 1 year showed a significant difference (RR 0.65; 95 % CI 0.43-0.98; p = 0.03; I2 = 87 %) favoring indobufen. Subgroup analysis of RCTs showed marginally significant increased risk regarding ischemic stroke with indobufen (RR 1.18; 95 % CI 1.00-1.39; p = 0.05).

The efficacy and safety of antiplatelet therapy with indobufen were comparable to those of aspirin alone. Therefore, indobufen can be considered as a suitable alternative for patients who are intolerant or hypersensitive to aspirin. Nevertheless, additional trials involving larger populations are required to establish their clinical applicability.

Transcatheter aortic valve replacement (TAVR) has become a viable treatment option for patients with severe aortic stenosis among all risk subsets. As TAVR use becomes more prevalent and patients live longer with their transcatheter valve, an increasing number of these patients can be expected to present with ACS. Overall, there is a paucity of high-quality data detailing incidence, pathophysiology, and management of ACS in this subset. While most ACS cases post-TAVR are Type II myocardial infarctions (MI), the incidence of Type I MI and ST-elevation myocardial infarction is not negligible. Additionally, ACS in TAVR patients is associated with poor outcomes. While medical management is similar in this cohort to non-TAVR patients, procedural issues pose a unique challenge, especially as related to coronary access in the presence of valve prosthesis. Despite the proven benefit of invasive therapies in the management of ACS in non-TAVR patients, administrative databases suggest a lower utilization of invasive therapies in this cohort, which may highlight a disparity in care and potential for improvement. In this review, we summarize available data regarding the incidence, pathophysiology, and management of ACS in TAVR patients as well as strategies for coronary access post-TAVR.

A discrepancy exists between the European and American guideline recommendations for the routine use of proton pump inhibitors (PPIs) in patients treated with dual antiplatelet therapy (DAPT).

This study aimed to determine the association between the co-prescription of PPIs and DAPT and the occurrence of gastrointestinal bleeding and ischaemic events in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

A search was conducted using a nationwide Korean claims database to identify patients with AMI undergoing PCI with DAPT. Patients were matched using a large-scale propensity score (PS) algorithm according to the co-prescription of PPIs. The primary efficacy endpoint was major gastrointestinal bleeding requiring transfusion with hospitalisation within 1 year. The primary safety endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiovascular death, spontaneous myocardial infarction, repeat revascularisation and ischaemic stroke within 1 year.

Among the total population, 30.0% of patients (n=35,566) received PPIs with DAPT after PCI for AMI. After PS matching, 35,560 pairs were generated. Compared to patients without PPIs, those on PPIs were associated with a significantly lower 1-year risk of major gastrointestinal bleeding (0.7% vs 0.4%, hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.48-0.73). The 1-year risk of MACCE did not differ significantly between the groups with or without PPIs (13.4% vs 13.1%, HR 0.98, 95% CI: 0.94-1.02). The beneficial effects of PPIs on gastrointestinal bleeding, without increased risk of cardiovascular events, were observed consistently, regardless of P2Y12 inhibitor type, PPI type, or individual bleeding risk.

In real-world data from a large study of East Asian patients with AMI undergoing PCI and maintaining DAPT, PPI use significantly reduced the risk of major gastrointestinal bleeding without increasing ischaemic events, irrespective of bleeding risk or type of P2Y12 inhibitor. (ClinicalTrials.gov: NCT06241833).

Owing to limited data on the optimal timing of rotational atherectomy (RA), we sought to evaluate the clinical impact of the early application of the RA strategy. Consecutive patients with severe coronary artery calcification were enrolled, who underwent percutaneous coronary intervention (PCI) using RA between January 2010 and October 2019 at 9 tertiary centers. Direct RA was defined as the early application of RA before the balloon was expanded to a size more than or equal to 2.0 mm. The primary endpoint was the composite outcome of technical failure or severe coronary dissection (type D, E, or F) during entire procedure. Of 581 lesions, 360 (62.0%) lesions underwent direct RA. The technical success rate was higher in the direct RA group than in the indirect RA group (97.5% vs. 93.7%, p = 0.021). The primary endpoint was more frequently observed in the indirect RA group than in the direct RA group (24.4% vs. 11.9%, p < 0.001). Multivariate logistic regression analysis revealed that the risk of the primary endpoint was higher in the indirect RA group than in the direct RA group (odds ratio 2.512, 95% CI 1.547-4.078, p < 0.001). Early application of RA may reduce the incidences of in-hospital adverse events and procedure-related complications.

Intravascular imaging-guided percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with complex coronary artery lesions compared with angiography-guided PCI. However, the prognostic impact of suboptimal findings on intravascular imaging such as stent underexpansion, malapposition, or dissection is unclear in the era of contemporary drug-eluting stents.

From RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) which compared imaging-guided PCI with angiography-guided PCI in patients with complex lesions, post-PCI intravascular imaging findings, including minimum stent area (MSA), relative stent underexpansion (MSA≤80% of the average reference lumen area), malapposition, or dissection, were assessed in nonleft main target lesions. The primary end point was target lesion failure (TLF), a composite of cardiac death, target lesion-related myocardial infarction, target lesion revascularization, or definite stent thrombosis.

A total of 897 nonleft main lesions from 714 patients undergoing imaging-guided PCI were included. During a median follow-up duration of 2.1 years, the optimal cutoff value of MSA to predict the occurrence of TLF was 5.5 mm2, and MSA<5.5 mm2 was associated with a significantly higher risk of TLF than MSA≥5.5 mm2 (2.2% versus 4.8%; adjusted hazard ratio, 3.09 [95% CI, 1.01-9.50]; P=0.048). Compared with the reference group (MSA≥5.5 mm2 and no suboptimal findings), the subgroup of patients with MSA≥5.5 mm2 and post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, or major dissection was associated with a numerically increased risk of TLF (0.0% versus 3.2%; P=0.057). Compared with the same reference group, the subgroup of patients with MSA<5.5 mm2 and suboptimal post-PCI intravascular imaging findings was associated with a significantly increased risk of TLF (0.0% versus 4.7%; P=0.017).

After intravascular imaging-guided PCI with contemporary drug-eluting stents for nonleft main complex lesions, inadequate absolute stent expansion was independently associated with a higher risk of TLF. Suboptimal post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, and major dissection seem to contribute to the risk of TLF.

https://www.clinicaltrials.gov; Unique identifier: NCT03381872.

Adenosine administration can improve coronary blood flow in patients undergoing primary percutaneous coronary intervention (PCI); however, the therapeutic effects of adenosine on ST resolution and major adverse cardiovascular events (MACEs) after PCI remain unclear. This study aimed to assess the therapeutic effects of adjunctive adenosine administration on patients with acute myocardial infarction (AMI) undergoing PCI using a meta-analytic approach.

We conducted a systematic search across PubMed, Embase, and the Cochrane Library to identify eligible randomized controlled trials (RCTs) published from inception through to March 2024. Primary outcomes included ST resolution and MACEs. The pooled analyses were all conducted using the random-effects model. Additionally, exploratory analyses were carried out through the application of sensitivity and subgroup analyses.

Twenty-one RCTs involving 2467 patients with AMI were selected for the meta-analysis. Adenosine significantly increased the incidence of ST resolution (relative risk [RR]: 1.30; 95% confidence interval [CI]: 1.15-1.46; p < 0.001), while it significantly reduced the risk of MACEs (RR: 0.67; 95% CI: 0.51-0.87; p = 0.003). Moreover, the use of adenosine was associated with reduced incidences of no reflow (RR: 0.35; 95% CI: 0.24-0.52; p < 0.001) and myocardial blush grade (MBG) 0 to 1 (RR: 0.75; 95% CI: 0.58-0.99; p = 0.041). Furthermore, adenosine significantly reduced the risk of heart failure (RR: 0.66; 95% CI: 0.44-0.99; p = 0.044). Finally, adenosine use was associated with a lower creatine kinase-MB (CK-MB) peak value (weighted mean difference: -36.94; 95% CI: -73.76- -0.11; p = 0.049).

This study revealed that adenosine use was associated with an increased incidence of ST resolution, and reduced risk of MACEs.

INPLASY202510051, https://inplasy.com/inplasy-2025-1-0051/.

Approximately 20 % of emergency department (ED) visits involve cardiovascular symptoms. While ECGs are crucial for diagnosing serious conditions, interpretation accuracy varies among emergency physicians. Artificial intelligence (AI), such as ChatGPT, could assist in ECG interpretation by enhancing diagnostic precision.

This single-center, retrospective observational study, conducted at Merano Hospital's ED, assessed ChatGPT's agreement with cardiologists in interpreting ECGs. The primary outcome was agreement level between ChatGPT and cardiologists. Secondary outcomes included ChatGPT's ability to identify patients at risk for Major Adverse Cardiac Events (MACE).

Of the 128 patients enrolled, ChatGPT showed good agreement with cardiologists on most ECG segments, excluding T wave (kappa = 0.048) and ST segment (kappa = 0.267). Significant discrepancies arose in the assessment of critical cases, as ChatGPT classified more patients as at risk for MACE than were identified by physicians.

ChatGPT demonstrates moderate accuracy in ECG interpretation, yet its current limitations, especially in assessing critical cases, restrict its clinical utility in ED settings. Future research and technological advancements could enhance AI's reliability, potentially positioning it as a valuable support tool for emergency physicians.

Patients with peripheral artery disease (PAD) undergo lower extremity revascularization (LER) for symptomatic relief or limb salvage. Despite LER, patients remain at increased risk of platelet-mediated complications, such as major adverse cardiac and limb events (MACLEs). Platelet activity is associated with cardiovascular events, yet little is known about the dynamic nature of platelet activity over time. We, therefore, investigated the change in platelet activity over time and its association with long-term cardiovascular risk.

Patients with PAD undergoing LER were enrolled into the multicenter, prospective Platelet Activity and Cardiovascular Events study. Platelet aggregation was assessed by light transmission aggregometry to submaximal epinephrine (0.4 μmol/L) immediately before LER, and on postoperative day 1 or 2 (POD1 or POD2) and 30 (POD30). A hyperreactive platelet phenotype was defined as >60% aggregation. Patients were followed longitudinally for MACLEs, defined as the composite of death, myocardial infarction, stroke, major lower extremity amputation, or acute limb ischemia leading to reintervention.

Among 287 patients undergoing LER, the mean age was 70 ± 11 years, 33% were female, 61% were White, and 89% were on baseline antiplatelet therapy. Platelet aggregation to submaximal epinephrine induced a bimodal response; 15.5%, 16.8%, and 16.4% of patients demonstrated a hyperreactive platelet phenotype at baseline, POD1, and POD30, respectively. Platelet aggregation increased by 18.5% (P = .001) from baseline to POD1, which subsequently returned to baseline at POD30. After a median follow-up of 19 months, MACLEs occurred in 165 patients (57%). After adjustment for demographics, clinical risk factors, procedure type, and antiplatelet therapy, platelet hyperreactivity at POD1 was associated with a significant hazard of long-term MACLE (adjusted hazard ratio, 4.61; 95% confidence interval, 2.08-10.20; P < .001).

Among patients with severe PAD, platelet activity increases after LER. Platelet hyperreactivity to submaximal epinephrine on POD1 is associated with long-term MACLE. Platelet activity after LER may represent a modifiable biomarker associated with excess cardiovascular risk.

Randomized controlled trials (RCTs) have examined the clinical impact of abbreviating the duration of dual antiplatelet therapy (DAPT) and have reported outcomes in men and women.

The authors examined the safety and efficacy of different durations of DAPT following percutaneous coronary intervention (PCI) in men and women.

We searched Cochrane, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases for RCTs that compared any 2 of 1, 3, 6, or 12 months of DAPT after PCI and reported outcomes in men and women. We performed a systematic review and network meta-analysis to examine sex-based differences in net adverse clinical events (NACE), major adverse cardiovascular events (MACE), and bleeding.

Fifteen RCTs were included, comprising 44,610 men (74.7%) and 15,132 women (25.3%). No difference in NACE or MACE was observed between 1, 3, 6, or 12 months of DAPT in both sexes. In both men and women, 1 and 3 months of DAPT were each associated with lower risk of bleeding compared with 12 months of DAPT. In women, 3 months of DAPT was associated with a lower risk of bleeding compared with 6 months. Similar results were found in sensitivity analysis of acute coronary syndrome-only trials.

No significant sex-based differences in NACE or MACE were observed with different durations of DAPT after PCI, while a lower bleeding risk was observed with shorter DAPT (1-3 months) among both sexes. This suggests that shorter DAPT may be preferred in both sexes following PCI, especially in those with high bleeding risk.

ObjectiveThe aim of this study is to examine the impact of controlled stepwise reperfusion by modulating pre-dilation balloon pressure during primary percutaneous coronary interventions (PPCI) in patients with ST-elevation myocardial infarction (STEMI).MethodsConsecutive STEMI patients requiring PPCI with thrombolysis in myocardial infarction (TIMI) flow grades 0 or 1, were randomly divided into an experimental group and a control group. For the control group, the pre-dilation balloon was removed immediately after achieving antegrade perfusion beyond the lesion. The experimental group underwent stepwise reperfusion, with the balloon pressure being gradually reduced. Baseline data, intra/post-procedural PPCI data, 3-month left ventricular ejection fraction (LVEF), and major adverse cardiac events (MACE) were documented and compared between the two groups.ResultsThe control group experienced more severe symptoms during the procedure (p = 0.034), higher post-procedural corrected TIMI frame counts (p = 0.047), more significant hemodynamic changes (p = 0.031), and increased rates of ventricular tachycardia/ventricular fibrillation (p = 0.035). Additionally, they had a higher total number of arrhythmias (p = 0.017), a lower 90-min ST segment resolution rate (p = 0.045), and elevated cTNI levels one week after the procedure (p = 0.047). Three months later, the control group demonstrated a lower LVEF compared to the experimental group (p = 0.048) and a trend towards more drug-treated arrhythmias (p = 0.073). No differences were observed in other statistical results.ConclusionIn patients with STEMI undergoing PPCI, controlled stepwise reperfusion by adjusting the pre-dilation balloon pressure effectively reduces myocardial ischemia-reperfusion injury, improves myocardial perfusion, and supports the recovery of cardiac function.

The TWILIGHT trial showed that, among high-risk patients who underwent percutaneous coronary intervention (PCI) and were event-free at 3 months, ticagrelor monotherapy versus ticagrelor plus aspirin reduced bleeding without increasing ischemic events.

This posthoc analysis describes the risk profiles and outcomes of patients enrolled in the TWILIGHT trial. The primary outcome was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding, and the key secondary outcome was a composite of death, myocardial infarction, or stroke within 1 year after randomization.

The proportion of patients (n = 7,119) fulfilling ≤ 3, 4, 5, or ≥ 6 risk factors was 21.5%, 32.7%, 27.4%, and 18.4%, respectively. Troponin-positive acute coronary syndrome (ACS) was the most prevalent clinical criterion (64.9%), and multivessel disease (MVD) was the most prevalent angiographic criterion (66.5%). The most frequent intersection of criteria was the combination of troponin-positive ACS, atherosclerotic vascular disease, MVD, left main or proximal anterior descending lesion, and stent length > 30 mm. A stepwise increase in ischemic but not in bleeding risk was noted with an increasing number of high-risk criteria. Compared with ticagrelor plus aspirin, ticagrelor monotherapy reduced bleeding regardless of the number of risk factors (≤ 3-RF: 3.5% vs 5.8%, HR 0.59, 95% CI [0.38-0.93]; 4-RF: 3.7% vs 6.4%, HR 0.57, 95% CI [0.37-0.86]; 5-RF: 3.8% vs 8.6%, HR 0.44, 95% CI [0.29-0.66]; ≥ 6-RF: 5.3% vs 7.9%, HR 0.65, 95% CI [0.44-0.96]; p-interaction = .56) without significantly increasing the ischemic risk (≤ 3-RF: 1.6% vs 2.1%, HR 0.75, 95% CI [0.38-1.50]; 4-RF: 3.5% vs 2.2%, HR 1.58, 95% CI [0.91-2.75]; 5-RF: 4.1% vs 5.0%, HR 0.80, 95% CI [0.51-1.24]; ≥ 6-RF: 6.7% vs 6.9%, HR 0.98, 95% CI [0.67-1.43]; p-interaction = .22).

In the TWILIGHT trial, the high-risk features correlated more strongly with ischemic than with bleeding risk. Nonetheless, the benefits of ticagrelor compared with ticagrelor plus aspirin were consistent, irrespective of the number of high-risk features. These findings are only applicable to patients who are event-free at 3 months after PCI.

The trial was registered with ClinicalTrials.gov, NCT02270242.

Endovascular treatment for vertebral artery dissecting aneurysms (VADAs) includes overlapping stents and flow diverters. This study compared the safety and effectiveness of overlapping stents and flow diverters for unruptured VADAs.

We retrospectively enrolled patients with unruptured VADAs who underwent overlapping stents or flow diverters at two tertiary hospitals in South Korea. The primary clinical outcome was the occurrence of stroke. The primary angiographic outcomes (>12 months) were categorized as regression, no decrease in size, recanalization, or stent occlusion, of which only regression was defined as a favorable angiographic outcomes.

Of the 146 patients with VADAs, 25 (17.1%) had flow diverters and 121 (82.9%) had overlapping stents. For the primary angiographic outcomes over 12 months, the rate of favorable angiographic outcomes for flow diverters was 81.8% and for overlapping stents (triple stents) was 98.8% (P=0.006). In the multivariale analysis, after adjusting for partially thrombosed aneurysms, aneurysm shape, non-dominant vessel, posterior inferior cerebellar artery involvement, and procedure type, overlapping stents (triple stents) was not associated with favorable angiographic outcomes compared with flow diverters (OR 7.040, 95% CI 0.549 to 90.294; P=0.134), but partially thrombosed aneurysms was inversely associated with favorable angiographic outcomes (OR 0.056, 95% CI 0.005 to 0.589; P=0.016). The primary clinical outcome followed up to the last angiography did not occur in all patients.

There was no difference in safety and effectiveness between overlapping stents and flow diverters in unruptured VADAs. Further endovascular treatment studies are needed regarding the association of partially thrombosed aneurysms with unfavorable angiographic outcomes.

Effective management of dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) implantation is crucial for preventing adverse events. Traditional prognostic tools, such as rule-based methods or Cox regression, despite their widespread use and ease, tend to yield moderate predictive accuracy within predetermined timeframes. This study introduces a new contrastive learning-based approach to enhance prediction efficacy over multiple time intervals.

We utilized retrospective, real-world data from the OneFlorida + Clinical Research Consortium. Our study focused on two primary endpoints: ischemic and bleeding events, with prediction windows of 1, 2, 3, 6, and 12 months post-DES implantation. Our approach first utilized an auto-encoder to compress patient features into a more manageable, condensed representation. Following this, we integrated a Transformer architecture with multi-head attention mechanisms to focus on and amplify the most salient features, optimizing the representation for better predictive accuracy. Then, we applied contrastive learning to enable the model to further refine its predictive capabilities by maximizing intra-class similarities and distinguishing inter-class differences. Meanwhile, the model was holistically optimized using multiple loss functions, to ensure the predicted results closely align with the ground-truth values from various perspectives. We benchmarked model performance against three cutting-edge deep learning-based survival models, i.e., DeepSurv, DeepHit, and SurvTrace.

The final cohort comprised 19,713 adult patients who underwent DES implantation with more than 1 month of records after coronary stenting. Our approach demonstrated superior predictive performance for both ischemic and bleeding events across prediction windows of 1, 2, 3, 6, and 12 months, with time-dependent concordance (Ctd) index values ranging from 0.88 to 0.80 and 0.82 to 0.77, respectively. It consistently outperformed the baseline models, including DeepSurv, DeepHit, and SurvTrace, with statistically significant improvement in the Ctd-index values for most evaluated scenarios.

The robust performance of our contrastive learning-based model underscores its potential to enhance DAPT management significantly. By delivering precise predictive insights at multiple time points, our method meets the current need for adaptive, personalized therapeutic strategies in cardiology, thereby offering substantial value in improving patient outcomes.

Fibroblasts in the fibrotic heart exhibit a heterogeneous biological behavior. The specific subsets of fibroblasts that contribute to progressive cardiac fibrosis remain unrevealed. Our aim is to identify the heart fibroblast (FB) subsets that most significantly promote fibrosis and the related critical genes as biomarkers for ischemic heart disease.

The single nuclei RNA sequencing (snRNA-seq) and bulk RNA sequencing datasets used in this study were obtained from the Gene Expression Omnibus (GEO). The activity of gene sets related to progressive fibrosis was quantified for each FB cluster using the AddmoleculeScore function. Differentially expressed genes (DEGs) for the specific cell cluster with the highest fibrotic transcription dynamics were identified and integrated with bulk RNA sequencing data for analysis. Multiple machine learning models were employed to identify the optimal gene panel for diagnosing ischemic heart disease (IHD) based on the intersected DEGs. The effectiveness and robustness of the gene-derived diagnostic tool were validated using two independent IHD cohorts.Subsequently, we validated the signature genes using a rat post-myocardial infarction heart failure model.

We conducted an analysis on high-quality snRNA-seq data obtained from 3 IHD and 4 cardiac sarcoidosis heart samples, resulting in the identification of 16 FB clusters. Cluster2 exhibited the highest gene activity in terms of fibrosis-related transcriptome dynamics. The characteristic gene expression profile of this FB subset indicated a specific upregulation of COL1A1 and several pro-fibrotic factors, including CCDC102B, GUCY1A3, TEX41, NREP, TCAP, and WISP, while showing a downregulation of NR4A1, an endogenous inhibitor of the TGF-β pathway. Consequently, we designated this subgroup as COL1A1hiNR4A1low FB. Gene set enrichment analysis (GSEA) shows that the gene expression pattern of COL1A1hiNR4A1low FB was closer to pathways associated with cardiac fibrosis. Through machine learning, ten feature genes from COL1A1hiNR4A1low FB were selected to construct a diagnostic tool for IHD. The robustness of this new tool was validated using an independent cohort and heart failure rats.

COL1A1hiNR4A1low FB possess heightened capability in promoting cardiac fibrosis. Additionally, it offers molecular insights into the mechanisms underlying the regulation of the TGF-β pathway. Furthermore, the characteristic genes of COL1A1hiNR4A1 FB could serve as valuable tools for diagnosing of IHD.

Cardiovascular disease is characterized by chronic inflammation and atherosclerosis (AS) is the pathological basis. Mitigating endothelial dysfunction and mononuclear cell adhesion is a crucial approach in impeding the initial advancement of AS. As an inflammation-immune regulation-related protein, 2'-5'-oligoadenylate synthetase 1 (OAS1) plays a critical role in inflammation, but its impact on endothelial dysfunction and mononuclear cell adhesion is not well understood. In this study, bioinformatic analysis revealed a significant enrichment of OAS1 in atherosclerotic plaques within human aortic sections. In addition, OAS1 was detected in atherosclerotic plaques within human aortic sections across various stages of development, with elevated expression observed in more advanced plaques. The expression of OAS1 exhibited a distinct temporal and concentration-dependent upregulation in response to lipopolysaccharide (LPS) stimulation. Notably, the deficiency of OAS1 markedly attenuated the elevation in reactive oxygen species (ROS) levels, nitric oxide (NO) concentrations, and monocyte adhesion induced by LPS. A positive correlation was observed between the levels of NFκBp65 and OAS1 in human plaques, and the deletion of OAS1 led to a down-regulation of P65 expression. Furthermore, the simultaneous knockdown of OAS1 and NFκBp65 resulted in a significant amelioration of endothelial dysfunction (including ROS, NO, and inflammation factors) and monocyte adhesion, suggesting a synergistic interaction between OAS1 and NFκBp65. These findings underscore the potential of OAS1 to modulate the extent of endothelial dysfunction and monocyte adhesion through its regulation of NFκBp65 thereby positioning it as a promising therapeutic target for the management of AS.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The substrates for arrhythmias in myocarditis and ischemic heart disease (IHD) are different, but it is yet to be determined whether there is a difference in outcomes following catheter ablation (CA) for ventricular tachycardia (VT) associated with these two conditions. This study aimed to compare outcomes after CA of VT in patients with myocarditis versus those with IHD.

Patients undergoing CA for sustained VT confirmed by endomyocardial biopsy as myocarditis, and patients with IHD experiencing sustained VT undergoing CA were retrospectively enrolled from February 2017 to March 2023. Initially, an endocardial approach was employed, reserving epicardial ablation procedures for non-responders. The primary endpoint was VT recurrence during follow up. All-cause mortality, repeat CA for VT and implantable cardioverter-defibrillator (ICD) implantation served as secondary endpoints. Kaplan-Meier curves compared outcomes between patient groups.

This study included 109 patients with IHD and 20 patients with myocarditis who underwent CA for sustained VT, from February 2017 to March 2023. Compared with IHD patients, myocarditis patients had a statistically significant lower complete short-term success rate of CA (60.0% vs. 85.3%, p = 0.013). During a follow-up period of 37 ± 21 months, 8 (40.0%) myocarditis patients experienced VT recurrence compared to 57 (52.3%) IHD patients, with no statistically significant difference between the two groups. During follow-up, 2 (10.0%) myocarditis patients died and 2 (10.0%) underwent repeat CA for VT recurrence, while 9 (8.3%) IHD patients died, 14 (12.8%) underwent a second CA for VT recurrence, and 8 (7.3%) received an ICD implantation. Additionally, there were no notable variations between the two groups regarding all-cause mortality, repeat CA for VT and ICD implantation.

It was demonstrated that the efficacy of CA in sustained VT in myocarditis patients was similar to that in IHD. For myocarditis patients with VT, CA might be equally effective.

Percutaneous coronary intervention (PCI) is a mainstay procedure for the treatment of coronary artery disease. PCI techniques have evolved considerably since the advent of PCI in 1978, and with this evolution in techniques has come changes in the best practices for patient management following PCI. The objective of this review is to provide a comprehensive overview of key considerations in patient management following PCI. The long-term management of patients post-PCI should follow 3 main principles: 1) lifestyle modification and reduction of risk factors; 2) implementation of secondary prevention therapies; and 3) timely detection of restenosis. Best practices in achieving these principles include promotion of smoking cessation, regular physical activity, and a healthy diet, as well as blood pressure, diabetes mellitus, lipid, and weight management; prescription of secondary prevention therapies balancing ischemic and bleeding risk; and avoidance of routine surveillance for restenosis.

Salvianolate for injection (SFI) is a widely used treatment for acute myocardial infarction (AMI). This study aims to assess the efficacy and safety of SFI in treating AMI by synthesizing evidence from published randomized controlled trials (RCTs).

Seven databases were searched for relevant RCTs published up to 1 July 2024. Two investigators independently conducted the literature searches, data extraction, and quality assessment. Subgroup and sensitivity analyses were performed to address potential heterogeneity. Data analyses were conducted using RevMan 5.4 software.

Thirty RCTs with a total of 3,931 participants were included in the study and analyzed. The results revealed that SFI significantly reduced major adverse cardiac events (MACEs) (RR = 0.34, 95% CI: 0.24 to 0.49, p < 0.05). In addition, SFI lowered creatine kinase-MB (CK-MB) (MD = -5.65, 95% CI: -9.55 to -1.76, p < 0.05) and improved left ventricular ejection fraction (LVEF) (MD = 6.2, 95% CI: 4.82 to 7.57, p < 0.05). Further reductions were observed in C-reactive protein (CRP) (MD = -6.17, 95% CI: -8.11 to -4.23, p < 0.05), malondialdehyde (MDA) (MD = -1.95, 95% CI: -2.08 to -1.83, p < 0.05), and endothelin-1 (ET-1) (MD = -12.27, 95% CI: -17.13 to -7.40, p < 0.05). The incidence of adverse events did not significantly differ between the EG and CG [RR = 0.74, 95% CI: 0.42 to 1.33, p = 0.32].

This study suggests that SFI may be a promising alternative therapy for treating AMI without increasing the risk of adverse events. However, our findings may be limited by the quality of the existing studies. High-quality RCTs are needed to provide more robust evidence.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024567279.

This study aims to develop and validate a nomogram model for predicting the risk of obstructive coronary artery disease (CAD) in patients with rheumatoid arthritis (RA), incorporating low-density lipoprotein cholesterol (LDL-C), Th17 cells, and interleukin (IL)-17 levels. The proposed model seeks to enable personalized cardiovascular risk assessment for RA patients, thereby optimizing clinical management strategies.

A total of 120 patients with rheumatoid arthritis (RA) who were treated at the Second Hospital of Shanxi Medical University between January 2019 and September 2023 were enrolled in this study. Based on coronary angiography results, patients were categorized into the RA-obstructive CAD group and the RA-non-obstructive CAD group. Additionally, 53 healthy controls (HC group) were included. Clinical characteristics, laboratory parameters, peripheral blood lymphocyte subsets, and cytokine levels were collected for analysis. Univariate logistic regression was used to identify risk factors associated with RA-obstructive CAD. These variables were further refined using a random forest model for optimal selection. Finally, multivariate logistic regression analysis was performed with the selected variables to develop a nomogram model, which was subsequently validated to assess its performance.

Compared with the RA-non-obstructive CAD group, the RA-obstructive CAD group demonstrated significantly elevated levels of immune cell subsets, such as Th17 cells, and cytokines, including IL-17, IL-2, and IL-4, along with a reduction in Treg cells. (2) In the training cohort, univariate and multivariate logistic regression analyses identified LDL-C (OR = 0.04, P < 0.001), Th17 cells (OR = 0.76, P = 0.005), and IL-17 (OR = 0.75, P = 0.001) as independent risk factors for obstructive CAD in RA patients. Subsequently, a predictive nomogram model for RA-obstructive CAD risk was developed based on these indicators, incorporating LDL-C, Th17 cells, and IL-17.

This study developed a predictive nomogram for RA-obstructive CAD by combining traditional risk factors, such as LDL-C, with immune biomarkers Th17 and IL-17. The model demonstrated robust predictive accuracy, enabling more precise risk assessment of CAD in RA patients. It offers clinicians a valuable tool for advancing cardiovascular risk management in RA, underscoring its significant potential for clinical application.

The optimal timing for complete revascularization (CR) in patients with acute myocardial infarction (AMI) and multivessel disease (MVD) remain uncertain.

This post-hoc analysis of the FRAME-AMI trial included AMI patients with MVD (n = 549). They were classified into immediate (n = 329) and staged CR (n = 220) groups. All percutaneous coronary interventions were performed during inex hospitalization. The primary endpoint was a composite of all-cause death, acute myocardial infarction, and repeated revascularization. Secondary endpoints included each component of the primary endpoint. Additional comparisons for the outcomes in ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) were also performed.

The incidence of the primary endpoint was not significantly different in any of the AMI patients [12.7% [immediate CR] vs. 17.4% [staged CR], p = 0.905, adjusted hazard ratio [HR] of staged CR = 0.81, 95% confidence interval = 0.43-1.53, p = 0.528]. Other secondary endpoints were also not significantly different. Analyses of STEMI and Neither the primary or secondary endpoints of NSTEMI patients were significantly different.

In this post-hoc analysis of the FRAME-AMI trial, no significant difference in clinical outcomes was observed between the immediate and staged CR strategies for AMI with MVD and the subgroups, such as STEMI or NSTEMI. However, the results should be interpreted carefully because of the many limitations, including a limited sample size and a lack of statistical power. Trial Registration: FRAME-AMI clinicaltrials.gov, identifier (NCT02715518).