Predictors of mortality in severe mental illness inpatients: A 10-year prospective cohort study.

Bridging the global survival gap in cystic fibrosis: Evidence from a 30-year longitudinal Mexican cohort.

Cardiovascular diseases (CVD) are the leading cause of death worldwide, with excess visceral adipose tissue (VAT) being identified as an independent indicator of poor cardiovascular outcomes. We examined the association between three indices of VAT, namely, metabolic score for visceral fat (METS-VF), visceral adiposity index (VAI), and lipid accumulation product (LAP), and the development of CVD in a large cohort of middle-aged Korean adults. The study recruited 8192 participants without CVD at baseline from the Korean Genome and Epidemiology Study. METS-VF, VAI, and LAP were calculated using established formulas based on anthropometric and metabolic parameters. Incident CVD was defined based on self-reported physician diagnoses confirmed by trained interviewers. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for incident CVD. Heagerty's integrated areas under the receiver operating characteristic curves (iAUC) were used to compare the discriminatory performance of three indices. The adjusted HRs (95% CIs) for incident CVD in the highest tertile compared with the lowest tertile were 1.62 (1.29-2.03), 1.38 (1.08-1.77), and 1.66 (1.32-2.09) for METS-VF, VAI, and LAP, respectively. METS-VF showed statistically higher discriminatory performance than VAI and LAP for incident CVD (p < 0.001), although the overall discriminative ability of indices was modest. METS-VF, VAI, and LAP were independently associated with an increased risk of CVD events. Among these indices, METS-VF demonstrated relatively better discriminatory performance, suggesting its potential role as a complementary tool for cardiovascular risk stratification.

Major wound complications after conventional preoperative radiotherapy in STS patients: incidence, predictors, and timing.

Survival in node-positive early oral squamous cell carcinoma following sentinel lymph node biopsy or elective neck dissection.

Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). However, risk stratification and prognostic prediction remain limited. To assess the incremental prognostic value of combined left atrial (LA) and left ventricular (LV) strain in predicting MACE among ESRD patients receiving renal replacement therapy. Prospective. Three hundred thirteen ESRD patients (mean age: 53.8 ± 14.0 years; 202 males) undergoing maintenance dialysis. Balanced steady-state free precession (bSSFP) cine sequence at 3.0 T. Myocardial strain was analyzed from bSSFP cine images using feature-tracking software (CVI42). LA strain components were reservoir (LARS), conduit (LAScd), and contractile (LASct) strain, and LV strain included global longitudinal (GLS), radial (GRS), and circumferential (GCS) strain. Patients were followed up via clinical records and MACE were documented. Prognostic models were constructed using multivariable Cox proportional hazards regression. The baseline prediction model of conventional cardiovascular risk factors was then compared with models incorporating LARS and GLS to assess incremental prognostic value. Cox proportional hazards regression identified predictors of MACE, and model performance was evaluated using C-index, Akaike and Bayesian information criteria (AIC/BIC), and Kaplan-Meier analysis. p < 0.05 was considered significant. During a median follow-up of 16.93 months, 61 patients developed MACE. LARS (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.87-0.94) and LV GLS (HR 1.21, 95% CI 1.08-1.36) were independent predictors. The Cox model incorporating both LARS and LV GLS showed improved discrimination compared with the clinical risk factor model (C-index 0.79 vs. 0.70). Stratification by both LA and LV strain markers significantly improved MACE prediction (log-rank: p < 0.001). The integration of LA and LV strain offered superior prognostic value for MACE prediction in ESRD patients, enabling refined risk stratification beyond traditional measures. 2. Stage 3.

Cardiorenal Syndrome and Depressive Symptoms: Exploring the Mood-Kidney Link With Heart Failure Risk in a Post-hoc Analysis of SPRINT.

Risk Stratification in Patients with TASC II D Aortoiliac Occlusive Disease Undergoing Revascularization: Validation of the CHA2DS2-VA Score for Long-Term Outcomes.

Prediction of hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) after hepatitis B surface antigen (HBsAg) seroclearance is important for optimizing surveillance strategies. This study aimed to identify independent risk factors of HCC after HBsAg seroclearance and to develop and validate a risk prediction model. A total of 6536 CHB patients who achieved HBsAg seroclearance between January 2006 and June 2025 were retrospectively screened, with 3852 patients meeting the criteria for final analysis. A predictive model was developed via multivariate Cox proportional hazards regression analysis, with discrimination assessed using Harrell's C-index and time-dependent receiver operating characteristic curve area under the curve (AUC). Internal validation of the model was conducted through bootstrap resampling analysis. During 21,711 person-years of follow-up, 128 patients (3.3%) developed HCC (incidence rate: 0.59% per year). Multivariable analysis identified age, male sex, cirrhosis, antiviral therapy (AVT)-induced seroclearance and lower levels of platelets and albumin as independent predictors of HCC. The six independent variables were used for constructing the novel prediction model. Harrell's C-index of the model was 0.766. The novel model has a good predictive ability for HCC risk in the 3-year (AUC = 0.785), 5-year (AUC = 0.775) and 10-year (AUC = 0.830) with similar discriminative performance observed in internal validation. The independent risk factors of HCC occurrence are age ≥ 50 years, male, platelet count≤ 150 × 109/L, albumin level ≤ 44 g/L, with cirrhosis at HBsAg seroclearance and AVT-induced HBsAg seroclearance. Our six-factor model enables risk stratification among patients achieving HBsAg seroclearance and may assist in informing surveillance strategies in clinical practice.

Anti-C1q antibody and antiphospholipid antibodies jointly predict thrombosis in membranous lupus nephritis: a retrospective cohort study.

Evaluation of the effectiveness of a screening program as compared to usual care in identifying patients with post-partum depression: a cohort study of 20,448 births in Bizkaia (Spain).

The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker integrating systemic inflammation (elevated C-reactive protein), nutritional status (decreased albumin), and immune function (reduced lymphocyte count). Its prognostic significance for mortality in the general population remains insufficiently characterized. We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 1999-2010), comprising 11,797 adults (5,671 men [weighted 48.4%] and 6,126 women [weighted 51.6%]; median age, 45 years). The CALLY index was calculated for each participant. Associations between the CALLY index and all-cause and cardiovascular mortality were evaluated using Kaplan-Meier analysis (for descriptive visualization), weighted multivariable Cox proportional hazards regression, Fine-Gray competing risk models, and restricted cubic spline (RCS) regression. Predictive performance was assessed using time-dependent receiver operating characteristic (ROC) analysis. The incremental predictive value beyond established risk factors was quantified using the integrated discrimination improvement (IDI) and category-free net reclassification improvement (NRI). Compared with the lowest quartile, the highest CALLY quartile was associated with lower risks of all-cause mortality (multivariable-adjusted hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.74; P < 0.001) and cardiovascular mortality (HR, 0.51; 95% CI, 0.39-0.68; P < 0.001). In Fine-Gray competing risk models, the subdistribution hazard ratio for cardiovascular mortality was 0.55 (95% CI, 0.39-0.76; P < 0.001), with a lower cumulative incidence of cardiovascular death in quartile 4 versus quartile 1 (Gray's test, P < 0.001). RCS analyses revealed significant non-linear associations: an approximately L-shaped relationship for all-cause mortality and a monotonically decreasing non-linear pattern for cardiovascular mortality (both P for non-linearity < 0.001). The CALLY index provided modest incremental predictive value beyond established risk factors for all-cause mortality (IDI, 0.4%; P = 0.007), but individual-level risk reclassification was limited (continuous NRI, 2.7%; P = 0.272). Significant effect modification for all-cause mortality was observed only for alcohol use (P for interaction = 0.005). Higher CALLY index values were significantly associated with lower mortality risk. The CALLY index demonstrated a significant, independent, and non-linear inverse association with all-cause and cardiovascular mortality in US adults. Its standalone predictive discrimination was modest (time-dependent AUC < 0.70), but its integration into multivariable risk models provided modest yet statistically significant incremental prognostic information (IDI, 0.4%; P = 0.007). Individual-level risk reclassification was limited (continuous NRI, 2.7%; P = 0.272). These findings suggest that CALLY may serve as a complementary biomarker for risk stratification when integrated with conventional risk factors rather than as a standalone prediction tool.

The composite indicator (TyG-CVAI), constructed by combining the triglyceride-glucose index and the Chinese visceral adiposity index, can quantify the combined pathogenic effects of insulin resistance and visceral obesity. However, an in-depth exploration of the long-term longitudinal evolution trajectories, cumulative exposure burden of TyG-CVAI, and its nonlinear association with the risk of cardiovascular disease (CVD) subtypes is still lacking. This study aims to prospectively evaluate the dynamic evolution pattern of TyG-CVAI and its predictive value for incident CVD, stroke, and heart disease. Based on the Kailuan prospective cohort, this study included 32,841 participants without CVD prior to the 2012 baseline. Using data from four repeated measurements between 2006 and 2012, the longitudinal evolution trajectories of TyG-CVAI were identified through the K-means clustering algorithm, and its cumulative exposure burden (cumTyG-CVAI) was calculated. Multivariable Cox proportional hazards regression models were utilized to evaluate its association with incident CVD and its subtypes after 2012, and its dose-response relationship and predictive accuracy were assessed using restricted cubic splines (RCS) and receiver operating characteristic (ROC) curves. During a median follow-up of 6.9 years, a total of 3,212 incident CVD events were recorded. Longitudinal analysis identified three distinct evolutionary trajectories: low, moderate, and high. After fully adjusting for confounding factors, compared with the low trajectory group, the high trajectory group faced the highest risk of incident total CVD (HR 1.837, 95% CI 1.588-2.126), stroke (HR 1.919, 95% CI 1.672-2.203), and heart disease (HR 2.260, 95% CI 1.827-2.796). For each standard deviation (SD) increase in cumulative TyG-CVAI, the risks of the aforementioned outcomes significantly increased by 29.2%-34.1%, respectively. RCS analysis showed that TyG-CVAI was positively and linearly correlated with the risk of stroke, while exhibiting a significant nonlinear threshold effect with the risks of total CVD (cumulative inflection point: 4683.98) and heart disease (cumulative inflection point: 4828.73). ROC analysis confirmed that the cumulative TyG-CVAI (AUC: 0.624-0.655) provided incremental improvements in predictive performance compared with single baseline measurements and traditional single or composite metabolic indices (all P < 0.05). The dynamic elevation of TyG-CVAI and its long-term cumulative burden are independent predictors of incident CVD, stroke, and heart disease. Compared to single baseline assessments and traditional static indicators, cumulative TyG-CVAI demonstrates improved risk stratification value for cardiovascular risk, highlighting the clinical utility of integrating longitudinal metabolic monitoring into routine cardiovascular screening. Furthermore, this index shows a nonlinear threshold effect with heart disease and a linear correlation with stroke, highlighting the clinical value of integrating longitudinal metabolic monitoring into routine cardiovascular stratification to achieve precise prevention.

Curative-intent resection of colorectal cancer (CRC) liver metastasis (CRLM), combined with perioperative chemotherapy, is the standard of treatment for selected patients. However, accurately predicting which patients will benefit from this strategy remains challenging. Circulating tumour DNA (ctDNA) has emerged as a promising non-invasive biomarker for detecting minimal residual disease and predicting prognosis. This study aims to evaluate the prognostic value of ctDNA in patients with CRC undergoing surgery for CRLM. CRC patients undergoing LIver curative-intent MEtastasis Surgery is a prospective multicentre, observational cohort study designed to enrol 232 patients with upfront or potentially resectable CRLM. All patients will receive standard-of-care treatment. Serial blood samples will be collected at multiple time points: before chemotherapy (baseline, if applicable), before surgery, after surgery and during follow-up. The primary objective is to assess the association between preoperative ctDNA status and disease-free survival. Secondary objectives include evaluating ctDNA dynamics over time, exploring associations with clinical and pathological features and identifying prognostic factors for recurrence and survival. ctDNA will be analysed using targeted next-generation sequencing and digital droplet PCR. Outcomes will be assessed using Kaplan-Meier survival analysis, Cox proportional hazards models and multivariable regression modelling. This protocol was approved by the Comités de Protection des Personnes Ouest-I Ethics Committee (N°2022-A02593-40) on 31 January 2023. Study findings will be disseminated through peer-reviewed publications and relevant national and international conference presentations. This study was registered in ClinicalTrials.gov (NCT05627681).

Acquired immunodeficiency syndrome (AIDS) remains a major global public health challenge despite substantial advances in combination antiretroviral therapy (cART). Evidence on long-term survival and mortality predictors among adult patients living with HIV in Oman remains limited. This study evaluated long-term survival probability and predictors of mortality among adults living with HIV initiating cART in Oman over 32 years. An ambidirectional cohort study was conducted using data from the HIV/AIDS registry at the national tertiary referral hospital, the Royal Hospital in Oman, covering the period from January 1992 to December 2024. A total of 549 adult patients living with HIV who initiated cART were included in the study. Clinical and laboratory data were extracted from electronic medical records and analyzed using descriptive statistics, Kaplan-Meier survival analysis, and multivariable Cox proportional hazards regression. Among 549 adult patients living with HIV, 99 deaths occurred during follow-up, including 83 AIDS-related and 16 non-AIDS-related deaths. The overall mortality incidence rate was 1.5 deaths per 1,000 person-months (95% CI: 1.21-1.80). Median survival was not reached during follow-up because the cumulative survival probability remained above 50%. In the adjusted Cox model, participants aged 18-27 years (AHR = 0.36, 95% CI: 0.20-0.67) and 28-37 years (AHR = 0.36, 95% CI: 0.21-0.64) had significantly lower mortality hazards compared with those aged > 47 years. Patients diagnosed at WHO clinical stage 1 (AHR = 0.15, 95% CI: 0.07-0.32), stage 2 (AHR = 0.24, 95% CI: 0.07-0.78), and stage 3 (AHR = 0.42, 95% CI: 0.27-0.67) had lower mortality risk than those diagnosed at stage 4. Hemoglobin ≤ 10g/dL was independently associated with increased mortality (AHR = 1.75, 95% CI: 1.09-2.81). Although crude analyses showed higher mortality among males, gender was not independently associated with mortality after adjustment for confounders. Timing of cART initiation was also not independently associated with mortality after adjustment. Long-term survival probability among adult patients living with HIV in Oman was favorable, with a median survival of over 32 years of follow-up. Younger age at diagnosis, earlier WHO clinical stage, and higher hemoglobin levels were independently associated with lower mortality risk. These findings highlight the importance of early HIV diagnosis and sustained clinical monitoring to improve long-term outcomes.

The association between fractional exhaled nitric oxide (FeNO) and airway inflammation is evident. However, the precise relationship of FeNO with pulmonary health and all-cause mortality among participants without airflow limitation remains undisclosed. We investigated the association of FeNO with respiratory symptoms, lung function, and all-cause mortality in this population. Participants included in the 2007-2012 National Health and Nutrition Examination Survey cycles with complete questionnaire information, quality-controlled prebronchodilator spirometry data, acceptable FeNO data, and full follow-up records until December 31, 2019, were included. The skewed distribution of FeNO was addressed by applying natural logarithmic transformation. Multivariable linear regression, logistic regression, and Cox proportional-hazards regression analyses were used to investigate the relationship of FeNO with spirometry, respiratory symptoms, and all-cause mortality. Subgroup analyses were performed based on sex, age, body mass index, smoking status, and blood eosinophil count to validate the robustness of the results. The data of 5,842 eligible participants were analyzed. After adjusting for confounding factors, for each 1unit increment in ln (FeNO), the risk of chronic cough and wheezing decreased by 28% and 22%, respectively. Additionally, forced vital capacity increased by 27.9 mL, and forced expiratory volume in 1 second increased by 27.8 mL. During the average follow-up of 10 years, 255 participants experienced mortality. There was a non-linear relationship between FeNO and all-cause mortality. Specifically, when ln (FeNO) was <2.6 (FeNO < 13.5 ppb), the hazard ratio was 0.45 (95% confidence interval 0.29-0.70; p < 0.001). The subgroup analyses demonstrated consistent results. Elevated FeNO was closely associated with fewer respiratory symptoms and improved lung function in a population without airflow limitation. A non-linear relationship existed between FeNO and all-cause mortality, with mortality initially decreasing as FeNO increased, followed by stabilization.

The influenza virus exerts a substantial impact on morbidity, mortality, and overall disease burden among the population, particularly among intensive care unit (ICU) patients. Although multiple biomarkers have been studied for mortality risk stratification in this population, the prognostic relationship of the lactate-to-albumin ratio (LAR) remains incompletely defined in critically ill patients with influenza. This study aims to investigate whether baseline ICU admission LAR levels are independently associated with mortality in critically ill patients with influenza cases and assess its incremental predictive value beyond established scoring systems. Utilizing data from the Medical Information Mart for Intensive Care IV database (MIMIC-IV, version 3.1), this retrospective cohort study enrolled adult patients diagnosed with influenza who required ICU admission. LAR was calculated based on lactate and albumin levels measured within 24h of ICU admission. The primary outcome was 30-day mortality, with secondary outcomes including in-hospital, 60-day, 90-day, and 1-year mortality. The association between LAR and mortality risk was assessed using univariate and multivariate Cox proportional hazards regression models, with robustness evaluated through subgroup analyses and sensitivity analyses. Survival differences across LAR levels were compared via Kaplan-Meier curves and log-rank tests. Discriminative performance was assessed using receiver operating characteristic (ROC) curves and the C-index. A total of 142 critically ill patients with influenza were included, with an overall 30-day mortality of 22.53%. Univariate Cox regression analysis demonstrated that a higher LAR was associated with an increased risk of 30-day mortality in ICU patients with influenza (HR 2.43, 95% CI 1.80-3.29; P < 0.001). After adjusting for confounding factors, multivariable Cox proportional hazards analysis confirmed this association, showing a similarly elevated risk (HR 2.93, 95% CI 1.95-4.39; P < 0.001). Kaplan-Meier analysis indicated a substantially lower 30-day survival for the high-LAR group (Log-rank P < 0.0001). The AUC of LAR for predicting mortality was 0.783, comparable to APS III (AUC 0.785, 95% CI 0.696-0.874; P = 0.140), SAPS II (AUC 0.717, 95% CI 0.617-0.817; P = 0.157), OASIS (AUC 0.643, 95% CI 0.531-0.756; P = 0.168), and SOFA (AUC 0.687, 95% CI 0.580-0.794; P = 0.160). Notably, the AUC for albumin alone was 0.791, compared with 0.783 for LAR. This study found that early LAR upon ICU admission is independently associated with the 30-day mortality rate in critically ill patients with influenza. Its predictive ability seems to be comparable to established clinical scoring systems. However, LAR did not outperform albumin alone, and its added prognostic value beyond albumin remains uncertain, and further validation in prospective studies is still needed.

Systemic lupus erythematosus (SLE), an autoimmune disorder, is linked to a heightened risk of multiple malignancies, including thyroid cancer. Thyroid cancer is the most prevalent malignancy of the endocrine system, and its autoimmune-related pathological features render it an optimal subject for investigating the mechanisms of their comorbidity. The molecular mechanisms underlying this comorbidity are still ambiguous. The accurate diagnosis and treatment of thyroid cancer urgently necessitate innovative molecular targets that extend beyond conventional pathological characteristics. This study seeks to employ integrated bioinformatics approaches to elucidate potential shared molecular mechanisms and immunological features between thyroid cancer and systemic lupus erythematosus (SLE), aiming to enhance understanding of their comorbidity and identify novel intervention targets. This study initially acquired gene expression data for TC and SLE from the GEO database and subsequently screened and identified differentially expressed genes (DEGs) shared by both diseases. Subsequently, we conducted Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Reactome functional enrichment analyses on these 46 shared differentially expressed genes (DEGs) and further assessed the activation status of pertinent pathways using Gene Set Enrichment Analysis (GSEA). Subsequently, we employed CIBERSORTx to examine immune infiltration patterns and developed protein-protein interaction networks utilising the STRING database. We identified hub genes utilising the MCODE and cytoHubba plugins and visualised the findings with Cytoscape software. We additionally assessed the diagnostic efficacy of these core hub genes in an independent dataset utilising ROC curves and investigated their prognostic relevance in thyroid cancer through Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression. Ultimately, we employed the Network Analyst platform to forecast transcription factor-gene and miRNA-gene regulatory networks and identified potential targeted therapeutic compounds utilising the DSigDB database. This study identified 46 differentially expressed genes (DEGs) commonly linked to thyroid cancer and systemic lupus erythematosus (SLE), which were significantly enriched in signalling pathways associated with immune-inflammatory activation, type I interferon responses, and complement pathway activation. Moreover, GSEA findings validated that immune-inflammatory and autoimmune-related pathways are markedly activated in both conditions. Twelve hub genes were discerned through protein-protein interaction networks. Analysis of immune infiltration indicated that thyroid cancer and systemic lupus erythematosus exhibit a shared characteristic of innate immune dysregulation, marked by the infiltration of myeloid cells (neutrophils, M0/M2 macrophages). Receiver operating characteristic (ROC) curve analysis identified six significant core hub genes with substantial diagnostic value: C1QB, LCN2, C1QC, LTF, VSIG4, and C3AR1. Univariate survival analysis indicated that elevated expression of C1QC and C3AR1 significantly enhances overall survival in thyroid cancer patients; however, multivariate COX regression analysis revealed that their independent prognostic significance necessitates further validation. This study predicted the interaction networks of transcription factors and miRNAs regulating key genes, with LCN2 demonstrating the highest connectivity to miRNAs, and identified candidate therapeutic compounds linked to it. This study employed bioinformatics analysis to identify critical shared hub genes and molecular pathways connecting thyroid cancer and systemic lupus erythematosus, offering novel insights into their shared pathogenesis and the advancement of targeted biomarkers and therapeutic strategies.

The role of adjuvant immunotherapy (IO) in the treatment of Merkel cell carcinoma (MCC) is currently being explored in clinical trials. Here we aim to evaluate the real-world impact of adjuvant IO on survival in patients with MCC. A retrospective analysis of the National Cancer Database was performed to identify patients with stage I-III MCC. Our main predictor of interest was IO in an adjuvant setting, stratified by receipt of radiotherapy (RT). A multivariable Cox proportional hazards regression model with inverse probability treatment weighting was used to estimate overall survival. A total of 353 patients received adjuvant IO, while 5,340 underwent surgery without adjuvant therapy. Among patients who received adjuvant IO, 10.2% had stage I disease, 7.1% stage II, and 82.7% stage III. Overall, adjuvant IO was not associated with a difference in survival (hazard ratio [HR], 1.04; 95% CI, 0.86-1.26). Stratified analyses by stage demonstrated similar findings (stage I: HR, 1.4; 95% CI, 0.79-2.50; stage II: HR, 1.45; 95% CI, 0.67-3.13; stage III: HR, 0.98; 95% CI, 0.79-1.20). However, when an interaction term with RT was introduced with adjuvant IO, both treatments were associated with improved survival compared with surgery alone (HR, 0.53; 95% CI, 0.28-0.99), whereas adjuvant IO without RT was not associated with a significant survival difference (HR, 1.14; 95% CI, 0.83-1.60). The association between adjuvant IO on survival may be modified by RT, which should be considered when interpreting current adjuvant IO trials in MCC.

Objective: To evaluate the efficacy and safety of ticagrelor versus clopidogrel in real-world patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRF-less) following percutaneous coronary intervention (PCI). Methods: This retrospective cohort study was based on a single-center, prospective PCI registry. SMuRF-less ACS patients (defined as the concurrent absence of hypertension, diabetes mellitus, hyperlipidemia, and current smoking at admission) who underwent PCI at the General Hospital of Northern Theater Command between March 2016 and March 2023 were consecutively enrolled. Patients were categorized into clopidogrel and ticagrelor groups based on the P2Y12 receptor inhibitor prescribed at discharge. The primary efficacy endpoint was major adverse cardiovascular events at 12 months, defined as a composite of cardiac death, myocardial infarction, or ischemic stroke. The primary safety endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. Multivariable Cox proportional hazards regression models were used to compare outcomes between the two groups. Results: A total of 3 323 SMuRF-less ACS patients were included (age (61.8±10.6) years; 1 120 (33.7%) female), comprising 2 694 (81.1%) in the clopidogrel group and 629(18.9%) in the ticagrelor group. Compared with the clopidogrel group, the ticagrelor group had a higher proportion of acute myocardial infarction, younger age, a higher proportion of males, and higher estimated glomerular filtration rate and hemoglobin levels (all P<0.05). During the 12-month follow-up, the incidence of the primary efficacy endpoint, major adverse cardiovascular events, did not differ significantly between the ticagrelor and clopidogrel groups (1.4% (9/629) vs. 2.0% (55/2 694), HR=0.90, 95%CI: 0.43-1.87, P=0.778). However, the ticagrelor group had a significantly higher incidence of the primary safety endpoint, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, compared with the clopidogrel group (9.2% (58/629) vs. 5.9% (160/2 694), HR=1.79, 95%CI: 1.30-2.47, P<0.001). Conclusions: Among SMuRF-less ACS patients undergoing PCI, ticagrelor did not reduce ischemic events compared with clopidogrel, but was associated with a significantly higher bleeding risk. Clopidogrel may represent a more appropriate P2Y₁₂ receptor inhibitor for this population.