Incidence Of Major Adverse Cardiovascular Events Research Articles

Clinical Efficacy and Safety of Reduced-Dose Prasugrel After Percutaneous Coronary Intervention for Taiwanese Patients with Acute Coronary Syndromes

Background/Objectives: The efficacy and safety of reduced-dose prasugrel (loading dose/maintenance dose: 20/3.75 mg) in preventing major adverse cardiovascular events (MACEs) among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have been well-estab-lished. However, long-term real-world data for this population remains limited in Taiwan. Methods: This study enrolled 226 Taiwanese ACS patients (with 448 lesions) who received reduced-dose pra-sugrel after PCI and completed one year of follow-up. Results: The primary efficacy outcome was the in-cidence of MACEs. After one year, the MACE rate was 7.1% (16/226). A comparative analysis of MACEs was conducted across subgroups stratified by age (<75 vs. ≥75 years), body mass index (<25 vs. ≥25 kg/m2), body weight (<60 vs. ≥60 kg), and estimated glomerular filtration rate (<60 vs. ≥60 mL/min/1.73 m2). Patients with impaired renal function had a 4.03-fold higher risk (95% con-fidence interval = 1.37–11.90, p = 0.01) of MACEs than those with optimal renal function. The primary safety endpoint was major bleeding events (Bleeding Academic Research Consortium types 3 or 5), which occurred in 0.8% (2/226) of patients, all gastrointestinal. The secondary end-point was net adverse clinical events (NACEs), a composite of MACEs and major bleeding, with an observed rate of 8.0% (18/226). Conclusions: Reduced-dose prasugrel demonstrated both safety and efficacy in Taiwanese ACS patients undergoing PCI.

Comparative Effectiveness of Lercanidipine and Amlodipine on Major Adverse Cardiovascular Events in Hypertensive Patients.

Lercanidipine, a newer-generation calcium channel blocker, is recognized for its effective antihypertensive properties and reduced side effects. This study aims to compare the effectiveness of lercanidipine and amlodipine in preventing major adverse cardiovascular events (MACE) in hypertensive patients. A multicenter, retrospective observational study was conducted using the electronic medical records database from three tertiary hospitals in South Korea between 2017 and 2021. Hypertensive patients treated with either amlodipine or lercanidipine were analyzed. Propensity score matching (PSM) was utilized to minimize confounders, matching patients in a 3:1 ratio. The primary endpoint was the incidence of MACE, a composite of cardiovascular death, myocardial infarction, stroke, heart failure hospitalizations, and coronary revascularization over a 3-year follow-up period. A total of 47640 patients were evaluated, and 6029 patients were matched. Before PSM, the lercanidipine group had a higher cardiovascular risk (SCORE-2/SCORE-2OP value: 11.6% ± 9.2 vs 10.9% ± 8.8, p<0.01) and a higher incidence of MACE compared to the amlodipine group (4.1% vs 3.4%, p<0.01). After PSM, the incidence of MACE was numerically lower in the lercanidipine group compared to the amlodipine group (2.8% vs 4.1%, p=0.11), though this difference was not statistically significant. Blood pressure control remained comparable between the two groups over the 3-year follow-up period. Lercanidipine demonstrated comparable effectiveness to amlodipine in preventing MACE among hypertensive patients. Given its comparable antihypertensive efficacy and potential for fewer side effects based on prior studies, lercanidipine may be considered a preferable option for hypertension management.

Intracoronary administration of tenecteplase to prevent PCI-related myocardial infarction in patients with echo-attenuated coronary plaques: study protocol for a multicenter, prospective, randomized controlled trial

BackgroundPercutaneous coronary intervention (PCI)-related myocardial infarction (MI), especially the distal type associated with microvascular dysfunction, is not an uncommon complication of the procedure. Specific lesion features, the echo-attenuated plaques (EA) in particular, are well-established contributors to the pathogenesis of distal-type MI. These plaques are prone to disruption during PCI, leading to microvascular thrombosis and distal embolism. Tenecteplase (TNK), a 3rd-generation thrombolytic drug, has demonstrated effective thrombolytic capacity without significantly increasing the bleeding risk. Our study aims to evaluate whether a low-dose intracoronary TNK administration prior to PCI in patients with intravascular ultrasound (IVUS)-detected EA can reduce the occurrence of PCI-related MI and improve clinical outcomes.MethodsThis trial is designed as a multicenter, prospective randomized controlled trial with a 1-month follow-up. The primary outcome of the study is the incidence of PCI-related myocardial infarction (MI) occurring within 48 h after PCI, which serves as a valid surrogate endpoint for assessing the efficacy of tenecteplase-based PCI in preventing future major adverse cardiovascular events (MACE) in patients with EA (Bulluck, et. al, Eur Heart J 42:2630–42, 2021) {1b.1}. Secondary outcomes include the proportion of patients with elevated postoperative high-sensitivity cTnI exceeding 5, 10, 35, and 70 times of the normal baseline, incidence of coronary slow flow after stent implantation and post-dilation, frame count of angiographic flow after stent implantation and post-dilation, as well as the incidence of MACE during hospitalization and at the 1-month follow-up.DiscussionThis trial may demonstrate that an immediate intracoronary administration of low-dose TNK following PCI can effectively lower the incidence of PMI in patients with EA, while confirming the safety of this therapeutic approach.Trial registrationChinese Clinical Trial Registry (ChiCTR2400084840). Registered on May 27, 2024.

A Meta-Analysis of Timing of Complete Revascularization in Patients with ST-Elevation Myocardial Infarction

Background: Recent randomized clinical trials (RCTs) of STEMI patients with multi-vessel disease (MVD) reported potential superiority of immediate (ICR) vs. staged complete revascularization (SCR). Inherently, the risk of procedural MI is less likely to be detected in ICR patients, and this may have influenced the results. Recently published meta-analyses encompassed observational studies without including STEMI data from the BioVasc trial. The aim of this meta-analysis was to perform an updated comparison of the two strategies in STEMI patients with MVD. Methods: Electronic databases were searched from their inception till August 2024 to identify RCTs assessing CR timing in STEMI patients with MVD. Only studies with an endpoint involving major adverse cardiovascular events (MACE) were included. Results: Six RCTs totaling 2023 patients were included in the analysis. The median time to staged PCI was 19 days. The incidence of MACE (as defined by each study’s protocol) was comparable between the two strategies [RR 0.86, 95% CI (0.58 to 1.27)]. There was also no difference in the risk of non-procedural MI [RR 0.91, 95% CI (0.49–1.67)], death [RR 1.47, 95% CI (0.89–2.44)] and cardiovascular death [RR 1.53, 95% CI (0.79–2.98)]. There was a significant 40% reduction in unplanned revascularization in patients undergoing ICR versus SCR [RR 0.60 (0.40 to 0.89), p = 0.01]. Conclusions: ICR reduced the risk of unplanned revascularization compared to SCR but had a comparable effect on MACE, death, cardiovascular death and non-procedural MI. Both strategies are safe in managing patients with acute MI and MVD.

Analysis of missing data in electronic health records of people with diabetes in primary care in Spain: A population-based cohort study

IntroductionResearchers conducting studies based on electronic health records (EHRs) often have to deal with missing data. We aimed to analyze patterns of missing data in lipid profile, sociodemographic variables and risk factors contained in the EHRs of the CARDIABETES project and compare different strategies for addressing the issue. MethodsWe conducted a retrospective cohort study of people with diabetes, based on EHRs in the Spanish Pharmacoepidemiological Research Database for Public Health Systems (BIFAP). Our response variable was major adverse cardiovascular events (MACE), including all-cause death and hospital admission for cerebrovascular disease or ischemic heart disease. We analyzed patterns of missing data, associations between missingness and MACE, and the effect of eliminating cases with missing data or imputing missing data. ResultsOur total sample included 309,556 people with diabetes. The proportion of individuals with at least one missing value was 76.0%. Regarding diabetes control measures, 10.8% of records had missing glycated hemoglobin values, and 21.4% had missing basal blood glucose values. We observed a non-random pattern of association between missingness and MACE. The strategy of eliminating records with missing data greatly reduced the number of cases and statistical power, and altered the average participant characteristics and cumulative incidence of MACE. By imputing missing data, we were able to circumvent these problems. ConclusionA considerable proportion of missing data was observed for variables such as fasting blood glucose and glycated hemoglobin, and also for other variables such as blood test parameters, BMI, and tobacco and alcohol use. The missing data show a non-random pattern and are associated with a higher incidence of MACE. The strategy of eliminating records with missing data greatly reduced the number of cases and statistical power. The recommended solution is to impute missing data with methods that take all the variables into account, such as MICE with PPM.

Prognostic value of extracellular volume fraction in myocardial infarction and myocardial infarction with nonobstructive coronary arteries: A multicenter study

The aim of the present retrospective study was to evaluate the prognostic role of the extracellular volume fraction (ECV) in patients with myocardial infarction (MI) and myocardial infarction with nonobstructive coronary arteries (MINOCA). The present study hypothesized that ECV is associated with major adverse cardiovascular events (MACEs) in MI and MINOCA patients. Cardiac magnetic resonance (CMR) imaging was performed on 351 consecutive patients (mean age: 58±12 years; 252 [71.8%] males) who were diagnosed with MI between October 2015 and November 2023. From CMR imaging, the extent of late gadolinium enhancement (LGE), native T1 and ECV were derived. Patients were categorized into groups according to the degree of coronary artery stenosis, namely, patients with MINOCA and patients with obstructive MI. Follow-up was performed to assess MACEs. The final cohort consisted of 61 MINOCA patients and 290 obstructive MI patients. During a mean follow-up of 27±16 months, there was no statistically significant difference in the incidence of MACEs between patients with MINOCA and those with obstructive MI, and the two groups of patients had similar ECVs (32.2±3.6 vs. 32.3±6.0, p=0.864). According to the multivariate Cox regression, ECV was an independent predictor of MACEs (HR: 1.13; p<0.001) and significantly improved the prognostic value of the baseline multivariate models (C-statistic improvement: 0.816-0.864, p=0.001). Similarly, ECV maintained an independent association with MACEs in the MINOCA (HR: 1.35; p<0.001) and obstructive MI (HR: 1.13; p<0.001) groups. In MI and MINOCA patients, ECV is an independent predictor of MACEs. MINOCA is not a benign disease, and its long-term prognosis is as poor as that of patients with obstructive MI.

Risk of Major Adverse Cardiovascular Events in Home Dialysis Compared to In-Center Hemodialysis

Background: Among dialysis patients, cardiovascular events are the leading cause of death. Little is known about how the frequency and type of cardiovascular events differ between various dialysis modalities. We compared risk of major adverse cardiovascular events (MACE) in patients who started continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and home hemodialysis (HD) with in-center HD patients. Methods: We included 968 patients who entered dialysis in the Helsinki-Uusimaa healthcare district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home HD and 432 on in-center HD at day 90 from the start of dialysis. MACE was defined as acute myocardial infarction, stroke, or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for potential confounding factors. Results: Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6%) during the first year of follow-up. The cumulative incidence of first MACE was similar in in-center HD and CAPD patients and higher than that in APD and home HD patients. After adjustment for possible confounders, the hazard ratio (HR) of MACE was 1.22 [95% confidence intervals (CI) 0.73–2.05] for CAPD, 0.86 [95% CI 0.47–1.57] for APD and 0.67 [95% CI 0.30–1.50] for home HD compared to in-center HD. Unexpectedly, compared to in-center HD, PD associated with lower risk of MACE among females (HR 0.37, 95% CI 0.14–0.99) and higher risk among males (HR 1.80, 95% CI 1.11–2.92). Conclusions: In this cohort, the risk of MACE was comparable across in-center and home dialysis modalities. However, the result differed between males and females, which requires further research.

Predictive value of triglyceride-glucose index for the evaluation of coronary artery disease severity and occurrence of major adverse cardiovascular events.

The triglyceride-glucose (TyG) index has been proposed as an independent predictor of coronary artery disease (CAD). In this retrospective study we further examine this association and its utility as a predictor for major adverse cardiovascular events (MACE). A total of 870 patients who underwent coronary angiography between May 2008 and June 2009 were included in this retrospective study. The TyG index was calculated using the formula Ln (fasting TG [mg/dL] × FBG [mg/dL]/2). The association of TyG index with the presence and severity of CAD, cardiovascular risk factors, and inflammatory markers was evaluated at baseline. In the longitudinal study, the multivariate adjusted Cox hazard model was used to investigate the associations of the TyG index with the occurrence of MACE during a 5-year follow-up, which was defined as endpoint. The TyG index was significantly associated with the presence and severity of CAD. Multiple linear regression analysis showed that a high TyG index, together with inflammatory markers and dyslipidemia, were independently associated with greater stenotic occlusion of coronary arteries (adjusted R2 = 0.031, p<0.001). Kaplan-Meier survival curve (free of MACE) by tertiles of the TyG index showed a higher incidence of MACE in the upper tertile (log-rank test, p = 0.02). Multivariate Cox analysis demonstrated that the risk of incident MACE during the follow-up was associated with higher levels of TyG index, even after adjusting for inflammatory parameters and cardiovascular risk factors: hazard ratio (HR), 1.54 (95% confidence interval 1.18-2.13; p<0.01). We conclude that elevated TyG index is independently associated with a higher risk of CAD and a poor prognosis for MACE.

Trends in dual antiplatelet therapy regimens and clinical outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention with drug‐eluting stents: A multicenter real‐world study

AbstractBackgroundThe patterns of dual antiplatelet therapy (DAPT) use and the associated clinical outcomes in current practice remain limited. This study evaluates DAPT regimen patterns and clinical outcomes among acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).MethodsThis multicenter retrospective cohort study included ACS patients treated with PCI from January 2017 to February 2022 at five tertiary hospitals in Thailand. DAPT was categorized as nonpotent (NP‐DAPT) or potent (P‐DAPT). We described DAPT trends, with major adverse cardiovascular events (MACEs) and major bleeding, as primary efficacy and safety outcomes. Outcomes were assessed using inverse probability treatment weighting (IPTW) with Cox's proportional hazards model.ResultsThe study included 1877 patients with ACS undergoing PCI. The mean age was 64.51 years (standard deviation 11.34), with 639 (34.04%) female patients and 1159 (61.75%) presenting ST‐elevation myocardial infarction (STEMI). Of these, 924 (49.23%) received NP‐DAPT, and 953 (50.77%) were prescribed P‐DAPT. Crude MACE incidence was lower in the P‐DAPT compared to the NP‐DAPT group (6.82% vs. 10.28%). After applying IPTW and conducting Cox's proportional hazard analysis, no significant differences in MACE were observed between groups (hazard ratio [HR]: 0.85, 95% confidence interval [CI]: 0.58–1.25, p = 0.408), nor in major bleeding (HR: 0.80, 95% CI: 0.37–1.70, p = 0.555). P‐DAPT was associated with any higher bleeding risk (HR: 1.52, 95% CI: 1.13–2.03, p = 0.005).ConclusionStandard DAPT remains predominant among Thai ACS patients, with NP‐DAPT prescriptions approaching those of P‐DAPT. Despite similar rates of MACE and major bleeding between the groups, P‐DAPT was associated with a higher risk of any bleeding.

Clinical Significance of Undetectable High-sensitivity Cardiac Troponin I in Thai Individuals with Low Cardiovascular Risk

Background: The long-term prognosis in individuals who have undetectable high-sensitivity cardiac troponin I (hs-TnI) is poorly defined in those with low cardiovascular risk. We aimed to examine whether individuals with undetectable hs-TnI have better cardiovascular outcomes in the low-cardiovascular-risk population. Methods: Data from a low-cardiovascular-risk population (&lt;7.5%) with no established atherosclerotic cardiovascular disease were derived from the Electricity Generating Authority of Thailand 2007–09 survey. Hs-TnI was measured using the Abbott ARCHITECT STAT assay. We categorised hs-TnI levels into undetectable hs-TnI, low hs-TnI and intermediate and higher hs-TnI by sex-specific cut-off. The low-cardiovascular-risk population was classified into extremely low risk (&lt;5%) and low risk (5–7.5%). Data on major adverse cardiovascular events (MACE) and all-cause mortality were collected until 31 December 2019. Survival analysis and subgroup analysis were performed. Results: A total of 3,442 participants were eligible. Mean age was 43.6 years; 65.5% were male. Hs-TnI was detected in 79.8% (median hs-TnI 2.6 ng/l). During a median follow-up of 10.3 years, 52 events (1.5%) of MACE and 60 events (1.7%) of all-cause mortality occurred. After adjusting for conventional risk factors, an increasing level of hs-TnI was significantly associated with the incidence of MACE (HR 1.03; 95% CI [1.02–1.04]; p&lt;0.001). Compared with the intermediate and higher hs-TnI group, the undetectable hs-TnI group and low hs-TnI group, respectively, had 79% and 52% lower incidences of MACE (HR 0.21; 95% CI [0.05–0.79] and HR 0.48; 95% CI [0.23–1.00]), p for trend 0.04. In subgroup analysis, the incidence of MACE remained higher in individuals with either extremely low or low CV risk with detectable hs-TnI compared with those undetectable hs-TnI (P for interaction 0.83). Conclusion: Among individuals with low cardiovascular risk, hs-TnI testing can provide risk prognostication. Undetectable hs-TnI could serve as a negative risk marker for adverse cardiovascular events.

Association among major adverse cardiovascular events with immune checkpoint inhibitors: A systematic review and meta-analysis.

This meta-analysis aimed to determine the incidence and overall risk of major adverse cardiovascular events (MACEs) related to immune checkpoint inhibitors (ICIs). We systematically searched all cohort studies, including the available MACE data in cancer patients receiving ICIs, in PubMed, Embase, and the Cochrane Library, from their inception to September 5, 2023. The primary outcome was the incidence of MACEs associated with ICI exposure, and the secondary outcome was the overall risk of MACEs associated with ICI exposure versus non-ICI exposure controls. Risk ratios with 95% confidence intervals were used in the random- or fixed-effects models. Overall, 26 cohort studies met the inclusion criteria, involving 109,883 cancer patients. In the median follow-up period ranging from 3.3 to 55.2 months, the incidence of MACEs associated with ICI exposure was 8.22%, ranging from 0.55% to 3.98%, among the nine MACEs, including myocarditis, tachyarrhythmia, pericarditis, pericardial effusions, cardiovascular death, myocardial infarction, heart failure, stroke, and conduction disorder. The incidence of MACE associated with non-ICI exposure was 3.84%, ranging from 0.81% to 4.72%. The risks of all-grade MACEs and pericardial effusions were significantly higher in the ICI group than in the non-ICI controls. ICI treatment, age, male sex, and prior radiation therapy were significantly associated with MACEs. The risk of MACEs during ICI treatment in patients with cancer is more common than is currently recognized. ICI use is closely associated with an increased risk of MACEs. Patients at risk were older, male, and had a history of radiation therapy.

Abstract 4137781: Relationship between Race, Predelivery Cardiology Care and Cardiovascular Outcomes in Pre-eclampsia/Eclampsia among a Commercially Insured Population

Background: Inequities in Preeclampsia/Eclampsia (PrE/E) persist. It is unknown if the receipt of cardiology care relates to future risk of major adverse cardiovascular events (MACE) in Black and White patients with PrE/E. We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1-year post-delivery for Black and White patients with PrE/E. Methods: Using Optum’s Clinformatics® Data Mart Database (CDM), we identified Black and White patients with PrE/E who had a delivery between 2008 to 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Cox regression models were used to assess the hazard of MACE by cardiology care for Black and White patients. Results: Among 29,336 patients (83.4% White, 16.6% Black, mean age of 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White, 13.0% Black). Black patients had a higher incidence of MACE than White patients at 1-yr post-delivery (2.7% vs 1.4%). After adjusting for age and clinical comorbidities, receipt of cardiology care was associated with lower hazard of MACE for White patients (HR= 0.68, 95%CI: 0.50-0.92 p=0.013) but not Black patients (HR: 1.22, 95% CI: 0.82-1.81; p= 0.328). The interaction effect between race and cardiology care was statistically significant (p=0.013) Conclusions: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. However, cardiology care significantly lowered the hazard of MACE for only White women. This observation does not suggest that cardiology care is detrimental to Black individuals but underscores the necessity to investigate why outcomes are disparate among these racial groups.

Abstract 4124182: Depression Symptomatology as Predictor of Incident Major Vascular Outcomes: Results from the Hispanic Community Health Study/Study of Latinos

Background: Cardiovascular disease (CVD) has consistently been associated with higher depression symptoms and disorders. Conversely, fewer studies have shown that depression predicts risk of incident CVD and mortality. Objective: To examine the association of depression symptoms with incident major adverse cardiovascular events (MACE) among Hispanics/Latinos living in US. Methods: MACE-free Hispanic Community Health Study/Study of Latinos participants who underwent baseline evaluation between 2008-2011 (n=15,180) were included. MACE was defined as the composite of incident stroke, myocardial infarction (MI), or decompensated heart failure (HF), adjudicated using standard criteria up to year 2019. Depression symptoms were assessed at baseline with a 10-item Center for Epidemiological Studies Depression Scale (CES-D 10, range 0-30 points, 5 points increments), with clinically significant depression defined as CES-D 10 ≥10 points. The incident rate ratio (IRR) of MACE across CES-D 10 scores was determined using Poisson regression models, adjusting for baseline sociodemographic characteristics and Framingham Risk Scores. Analyses were weighted for complex survey design and non-response. Results: The mean age (95% CI) was 40.4 (39.9-40.9) years, and the mean CES-D 10 score was 8.4, 95%CI (7.2-9.5) for those with MACE vs 6.9, 95%CI (6.7-7.0) for individuals without MACE (p&lt;0.05). Clinically significant depression symptoms were present in 29% of the population. There were 321 total MACE outcomes that occurred between baseline and year 2019, with 120 MACE occurrences in individuals with CES-D 10 ≥10 points. In the fully adjusted model, increasing CES-D 10 was associated with higher incidence of MACE (for all: IRR 1.22, 95% CI (1.10-1.36); for those with CES-D 10 scores ≥10: IRR 1.62, 95% CI (1.21-2.17). Additionally, participants with CES-D 10 scores ≥10 were 1.4 times more likely to develop MACE compared to those with CES-D 10 scores &lt;10 (HR 1.41, 95% CI=1.13-1.83, Figure). Among MACE sub-components, incident HF was twice as high in the population with CES-D 10 ≥10 points versus those with CES-D 10 &lt;10 points (HR 2.36, 95% CI (1.58-3.51)). Conclusion: The findings of this cohort study indicate that depression symptomatology is associated with incident overall MACE and HF, and that clinically significant depression symptoms further increased risk for MACE and HF, making early treatment of depression a possible target for decreasing CVD incidence.

Relationship Between Race, Predelivery Cardiology Care and Cardiovascular Outcomes in Pre-Eclampsia/Eclampsia Among a Commercially Insured Population.

Background: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in Preeclampsia/Eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1-year post-delivery for Black and White patients with PrE/E. Methods: Using Optum's de-identified Clinformatics® Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare incidence of MACE by race. Regression models were used to assess hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. Results: Among 29,336 patients (83.4% White, 16.6% Black, 99.5% commercially insured, mean age 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White, 13.0% Black). Black patients had higher incidence of MACE than White patients at 1-yr post-delivery (2.7% vs 1.4%) with the majority within 14 days of delivery (Black: 58.7%; White: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with lower hazard of MACE for White patients within 14 days following delivery (HR 0.31, 95%CI: 0.21-0.46, p<0.001) but not Black patients (HR 1.00, 95%CI: 0.60-1.67; p= 0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (p<0.001) but not the remainder of the year (p=0.56). Conclusions: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days following delivery.

Increased risk of major adverse cardiovascular events in patients with deep and infected diabetes-related foot ulcers.

Diabetes-related foot ulceration (DFU) is associated with increased cardiovascular risk, but the mechanisms remain unclear. Inflammation and infection are mediators of CVD, which may be important in DFU. Prospectively collected data from patients attending a multidisciplinary DFU service were analysed. A deep ulcer was defined as one that reached muscle, tendon or deeper structures. Patients were categorised into four DFU groups: not deep and no infection (D-/I-), not deep but infected (D-/I+), deep with no infection (D+/I-) or deep with infection (D+/I+). Incident major adverse cardiovascular events (MACE) were defined as hospitalisation for myocardial infarction, stroke or transient ischaemic attack, or heart failure. Survival analyses were performed using the logrank test and multivariate Cox regression. Of 513 patients, 241 (47.0%) were in the D-/I- group, 110 (21.4%) were in the D-/I+ group, 35 (6.8%) were in the D+/I- group and 127 (24.8%) were in the D+/I+ group. MACE or all-cause mortality occurred in 75 patients (14.6%), and MACE alone occurred in 46 patients (9.0%) after median follow-up of 381 days (IQR 220-551) and 404 days (IQR 228-576), respectively. Infection was associated with significantly higher MACE or all-cause mortality (21.5% vs 8.7%; p<0.001) and MACE alone (13.5% vs 5.1%; p=0.003). MACE or all-cause mortality was significantly higher in the D+/I+ group (D-/I- 7.9%; D-/I+ 15.5%; D+/I- 14.3%; D+/I+ 26.8%; p<0.001), as was MACE alone (D-/I- 5.0%; D-/I+ 10.9%; D+/I- 5.7%; D+/I+ 15.7%; p=0.017). Infection and a deep ulcer were independent predictors of adverse outcomes. Deep and/or infected DFUs are associated with increased cardiovascular risk compared with DFUs that are not deep or infected. These findings provide a potential mechanistic explanation that requires investigation.

Risk of Major Adverse Cardiovascular Outcomes in Families With MASLD: A Population-Based Multigenerational Cohort Study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a risk factor for cardiovascular disease. However, whether family members of individuals with MASLD also share an increased cardiovascular risk is unknown. We created a nationwide multigenerational cohort study identifying all family members of Swedish adults diagnosed with biopsy-proven MASLD (1969-2017) and of matched general population comparators (by age, sex, calendar year, and county of residence). We calculated incidence rates and used Cox models to calculate adjusted hazard ratios (aHRs) and 95% CIs for incident major adverse cardiovascular events (MACE), including acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox models were adjusted for education, country of birth, diabetes, hypertension, obesity, dyslipidemia, chronic kidney disease, chronic obstructive pulmonary disease, and the Charlson comorbidity index. We identified 22 267 MASLD first-degree relatives (FDRs; parents, siblings, and offspring) and 5687 MASLD spouses, as well as 118 056 comparator FDRs and 29 389 comparator spouses without earlier cardiovascular disease. Overall, the mean age was 41.8 years (SD, 18.0), and 51.5% were females. Over a median of 24.6 years, the incidence rate for MACE was higher in MASLD FDRs than in comparator FDRs (65.0 versus 62.5/10 000 person-years; aHR, 1.06 [95% CI, 1.01-1.11]). MASLD FDRs had higher rates of acute myocardial infarction (23.0 versus 20.9/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]) and cardiovascular death (aHR, 1.09 [95% CI, 1.01-1.18]). Across generations of FDRs, the risk of MACE was uniformly increased with no differences by relationship (ie, parents, siblings, and offspring; Pinteraction>0.05). MASLD spouses were also at an increased risk of MACE (117.6 versus 103.5/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]). First-degree relatives of individuals with biopsy-proven MASLD are at slightly higher risk of incident MACE, but absolute risks do not support early screening for cardiovascular disease. Shared lifestyle factors may be the main contributors, as spouses of MASLD patients also had higher risks of MACE.

The HALP score predicts no-reflow phenomenon and long-term prognosis in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention.

Despite recent advances in the management of ST-segment elevation myocardial infarction (STEMI), the clinical outcome of some patients is still unsatisfactory. Therefore, early evaluation to identify high-risk individuals in STEMI patients is essential. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, as a new indicator that can reflect both nutritional status and inflammatory state of the body, can provide prognostic information. In this context, the present study was designed to investigate the relationship between HALP scores assessed at admission and no-reflow as well as long-term outcomes in patients with STEMI. A total of 1040 consecutive STEMI patients undergoing primary PCI were enrolled in this retrospective study. According to the best cutoff value of HALP score of 40.11, the study samples were divided into two groups. The long-term prognosis was followed up by telephone. Long-term mortality was significantly higher in patients with HALP scores lower than 40.11 than in those higher than 40.11. The optimal cutoff value of HALP score for predicting no-reflow was 41.38, the area under the curve (AUC) was 0.727. The best cutoff value of HALP score for predicting major adverse cardiovascular events (MACE) was 40.11, the AUC was 0.763. The incidence of MACE and all-cause mortality was higher in the HALP score <40.11 group. HALP score can independently predict the development of no-reflow and long-term mortality in STEMI patients undergoing PCI.

Temporal Trends in Atrial Fibrillation Ablation in the Elderly: Incidence of MACE and Recurrence Rates.

The elderly population with atrial fibrillation (AF) is growing. There is limited evidence to suggest AF ablation as an effective treatment for the elderly. This study aimed to investigate the temporal trends of first-time ablations in the elderly, the impact of age on major adverse cardiovascular events (MACE), and a composite endpoint of AF-related hospitalizations, repeat AF ablation, or use of antiarrhythmic drugs (AADs). Utilizing the Danish administrative registers, we incorporated individuals undergoing their first-time AF ablation from 2001 to 2020. Our cohort was divided into 3 age groups (<60, 60-74, and≥75 years) and scrutinized across 4 consecutive 5-year intervals. Cox proportional-hazard multivariable analyses and cumulative incidences were used to evaluate the endpoints of 5-year MACE incidence and a 1-year composite endpoint of AF-related hospitalizations, repeat AF ablation, or use of antiarrhythmic drugs. Elderly patients who underwent AF ablation increased significantly, from none in 2001 to 9% in 2020. The 5-year incidence of MACE in the elderly decreased from 61.9% (95%CI: 41.1%-82.7%) to 38.1% (95%CI: 31.9%-44.2%). The HR for age≥75 years in the last time period was 1.52 (95%CI: 1.26-1.83). The 1-year composite outcome varied from 35.6% to 52.0%; age was not a consistent predictor. AF ablation use in the elderly has significantly increased over time. A notable decrease in MACE was evident across all age cohorts, with a particularly pronounced trend observed among the elderly population. Age was not an independent predictor of the composite endpoint.

Presence of patent foramen ovale does not increase cerebrovascular event rates in patients with atrial fibrillation following left atrial appendage closure

ObjectiveBoth atrial fibrillation (AF) and patent foramen ovale (PFO) has been associated with occurrences of ischemic stroke. The aim of this study was to investigate whether patients with concomitant AF and PFO were at an increased risk of stroke, and whether PFO closure was necessary for the prevention of stroke in AF patients who underwent left atrial appendage closure (LAAC). MethodWe retrospectively analyzed 614 patients who underwent LAAC at Wuhan Asia Heart Hospital from May 2014 to April 2021. We compared the baseline clinical characteristics and ischemic stroke rates before LAAC, major adverse cardiovascular events (MACEs) and other long-term outcomes between AF patients with and without PFO after LAAC. The predictor for ischemic stroke or TIA after LAAC was analyzed with univariate and multivariable Cox regression, and the long-term cumulative survival rates of AF patients with PFO compared to those without PFO after LAAC were analyzed with the Kaplan–Meier graph. ResultsA total of 614 patients who underwent LAAC and had completed follow-up data were included in our study. Among them, 74 patients were diagnosed with AF with PFO, and 540 with AF without PFO. There was no significant difference between their baseline clinical data, including ischemic stroke rates (p = 0.961). Patients with and without PFO had similar device implantation success rates (98.6 % vs 99.4 %, P = 0.403) and procedure-related complications. During follow-up (medium follow-up period 36.9 months), no significant difference was observed in the incidence of MACEs (8.1 % in PFO group vs 5.7 % in non-PFO group, P = 0.432) or the cumulative ischemic stroke/TIA rates (5.4 % in PFO group vs 4.3 % in non-PFO group, P = 0.554). The Cox multivariable regression analysis indicated that the presence of PFO in patients with AF had no correlation with ischemic stroke or TIA after LAAC implantation (HR 1.685, 95 % CI 0.570–4.978, P = 0.345). The only predictor for ischemic stroke/TIA events after LAAC was major leakage (>5 mm) seen on transesophageal echocardiography (TEE) or left atrial CTA at the 45-day follow-up (HR 10.352, 95 % CI 1.221–87.736, P = 0.032). ConclusionAF patients with PFO are not at increased risk for ischemic stroke or TIA before LAAC. The presence of PFO in AF patients did not affect the success rate and safety of LAAC. The presence of mild PFO is not a viable predictor of stroke events in AF patients who underwent LAAC during long-term follow-up. Major leakage (>5 mm) is associated with a higher ischemic stroke/TIA rate in AF patients who underwent LAAC.

Major adverse cardiovascular events after modified morrow surgery in hypertrophic obstructive cardiomyopathy: A 12-year cohort study

ObjectiveThis study investigates the incidence and risk factors for major adverse cardiovascular events (MACE) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing modified Morrow surgery. It also aims to develop a predictive model for MACE to improve clinical risk assessment. MethodsThis retrospective cohort study included 292 HOCM patients who underwent modified Morrow surgery. The primary endpoint was the incidence of MACE. Univariate and multivariate logistic regression were used to identify independent risk factors for MACE, and a predictive model was developed. ResultsMACE occurred in 39.04 % of patients (114/292), with 4.7 % mortality (14/292), 3.1 % cardiac arrest, 2.7 % requiring intra-aortic balloon pump (IABP) support, and 1.0 % requiring extracorporeal membrane oxygenation (ECMO). Low cardiac output syndrome occurred in 19.2 %, atrial fibrillation in 18.2 %, and third-degree atrioventricular block (AVB) in 3.1 %. Key risk factors included age (OR = 1.044), eGFR (OR = 1.025), preoperative pulmonary hypertension >30 mmHg (OR = 2.274), interventricular septal thickness (OR = 1.084), MRI delayed enhancement (OR = 2.021), and postoperative leukocytosis (OR = 1.061). The predictive model demonstrated strong performance (AUC = 0.815, P < 0.001). ConclusionPatients with HOCM undergoing modified Morrow surgery are at high risk of MACE. Key risk factors include age, eGFR, pulmonary artery pressure, septal thickness, MRI delayed enhancement, and postoperative leukocytosis. A predictive model based on these factors aids in tailoring perioperative management.