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BACKGROUND AND AIMS: Extracellular vesicles (EVs) secreted by cardiosphere-derived cells exert immunomodulatory effects through the transmission of small non-coding RNAs. METHODS: The mechanism and role of yREX3, a small Y RNA abundant in EVs in myocardial injury, was investigated. RESULTS: yREX3 attenuates cardiac ischaemic injury by selective DNA methylation. Synthetic yREX3 encapsulated in lipid nanoparticles triggers broad transcriptomic changes in macrophages, localizes to the nucleus, and mediates epigenetic silencing of protein interacting with C kinase-1 (Pick1) through methylation of upstream CpG sites. Moreover, yREX3 interacts with polypyrimidine tract binding protein 3 (PTBP3) to methylate the Pick1 gene locus in a DNA methyltransferase-dependent manner. Suppression of Pick1 in macrophages potentiates Smad3 signalling and enhances efferocytosis, minimizing heart necrosis in rats with myocardial infarction. Adoptive transfer of Pick1-deficient macrophages recapitulates the cardioprotective effects of yREX3 in vivo. CONCLUSIONS: These findings highlight the role of a small Y RNA mined from EVs with a novel gene-methylating mechanism.

This article discusses three studies related to cardiovascular disease. The first study examines the use of genetic information to improve risk assessment for cardiovascular events. The second study explores the role of the spleen in cardioprotective effects. The third study investigates the mechanisms of sudden cardiac arrest in patients without obstructive coronary artery disease. These studies provide valuable insights into risk assessment, cardioprotective mechanisms, and the pathophysiology of sudden cardiac arrest. Further research is needed in these areas to improve patient care and outcomes. [Extracted from the article]

Background and Aims The spleen serves as an important relay organ that releases cardioprotective factor(s) upon vagal activation during remote ischaemic conditioning (RIC) in rats and pigs. The translation of these findings to humans was attempted. Methods Remote ischaemic conditioning or electrical auricular tragus stimulation (ATS) were performed in 10 healthy young volunteers, 10 volunteers with splenectomy, and 20 matched controls. Venous blood samples were taken before and after RIC/ATS or placebo, and a plasma dialysate was infused into isolated perfused rat hearts subjected to global ischaemia/reperfusion. Results Neither left nor right RIC or ATS altered heart rate and heart rate variability in the study cohorts. With the plasma dialysate prepared before RIC or ATS, respectively, infarct size (% ventricular mass) in the recipient rat heart was 36 ± 6% (left RIC), 34 ± 3% (right RIC) or 31 ± 5% (left ATS), 35 ± 5% (right ATS), and decreased with the plasma dialysate from healthy volunteers after RIC or ATS to 20 ± 4% (left RIC), 23 ± 6% (right RIC) or to 19 ± 4% (left ATS), 26 ± 9% (right ATS); infarct size was still reduced with plasma dialysate 4 days after ATS and 9 days after RIC. In a subgroup of six healthy volunteers, such infarct size reduction was abrogated by intravenous atropine. Infarct size reduction by RIC or ATS was also abrogated in 10 volunteers with splenectomy, but not in their 20 matched controls. Conclusions In humans, vagal innervation and the spleen as a relay organ are decisive for the cardioprotective signal transduction of RIC and ATS. [ABSTRACT FROM AUTHOR]

This article from the European Heart Journal discusses several studies related to cardiovascular health. The first study examines the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention (PCI). The authors find that all definitions of PMI are associated with an increased risk of all-cause death after PCI. The second study evaluates the safety and efficacy of a leaflet modification device called ShortCut in patients at risk for coronary artery obstruction undergoing transcatheter aortic valve implantation (TAVI). The authors conclude that ShortCut is safe and associated with favorable clinical outcomes. The third study compares ticagrelor monotherapy with ticagrelor-based dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) undergoing drug-eluting stent (DES) implantation. The authors find that ticagrelor monotherapy after short-term DAPT is associated with less major bleeding without an increase in ischemic events. The fourth study examines the relationship between adulthood adiposity and cardiac structure and function in later life. The authors find that higher adiposity over adulthood is associated with adverse cardiac structure and function. The fifth study investigates the effects of a 20-year infancy-onset dietary intervention on retinal microvasculature in young adulthood. The authors find that the dietary intervention has favorable effects on retinal microvasculature. The article also includes commentaries and a discussion forum. [Extracted from the article]

Background and Aims Conflicting data are available regarding the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention. The purpose of this study was to evaluate the incidence and prognostic implication of PMI according to the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition. Methods Studies reporting adjusted effect estimates were systematically searched. The primary outcome was all-cause death, while cardiac death was included as a secondary outcome. Studies defining PMI according to biomarker elevation without further evidence of myocardial ischaemia ('ancillary criteria') were included and reported as 'definition-like'. Data were pooled in a random-effect model. Results A total of 19 studies and 109 568 patients were included. The incidence of PMI was progressively lower across the UDMI, ARC-2, and SCAI definitions. All PMI definitions were independently associated with all-cause mortality [UDMI: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.32–1.97; I 2 34%; ARC-2: HR 2.07, 95% CI 1.40–3.08, I 2 0%; SCAI: HR 3.24, 95% CI 2.36–4.44, I 2 78%]. Including ancillary criteria in the PMI definitions were associated with an increased prognostic performance in the UDMI but not in the SCAI definition. Data were consistent after evaluation of major sources of heterogeneity. Conclusions All currently available international definitions of PMI are associated with an increased risk of all-cause death after percutaneous coronary intervention. The magnitude of this latter association varies according to the sensitivity and prognostic relevance of each definition. [ABSTRACT FROM AUTHOR]

Background and Aims In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is recommended for 12 months after drug-eluting stent (DES) implantation. Monotherapy with a potent P2Y12 inhibitor after short-term DAPT is an attractive option to better balance the risks of ischaemia and bleeding. Therefore, this study evaluated the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS. Methods Electronic databases were searched from inception to 11 November 2023, and for the primary analysis, individual patient data were pooled from the relevant randomized clinical trials comparing ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT, exclusively in ACS patients undergoing DES implantation. The co-primary endpoints were ischaemic endpoint (composite of all-cause death, myocardial infarction, or stroke) and bleeding endpoint [Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding] at 1 year. Results Individual patient data from two randomized clinical trials including 5906 ACS patients were analysed. At 1 year, the primary ischaemic endpoint did not differ between the ticagrelor monotherapy and ticagrelor-based DAPT groups [1.9% vs. 2.5%; adjusted hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.56–1.13; P =.194]. The incidence of the primary bleeding endpoint was lower in the ticagrelor monotherapy group (2.4% vs. 4.5%; adjusted HR 0.54; 95% CI 0.40–0.72; P <.001). The results were consistent in a secondary aggregate data meta-analysis including the ACS subgroup of additional randomized clinical trials which enrolled patients with ACS as well as chronic coronary syndrome. Conclusions In ACS patients undergoing DES implantation, ticagrelor monotherapy after short-term DAPT was associated with less major bleeding without a concomitant increase in ischaemic events compared with ticagrelor-based 12-month DAPT. Study registration PROSPERO (ID: CRD42023476470). [ABSTRACT FROM AUTHOR]

The mean age of patients with coronary artery disease (CAD) is steadily increasing. In older patients, there is a tendency to underutilize invasive approach, coronary revascularization, up-to-date pharmacological therapies, and secondary prevention strategies, including cardiac rehabilitation. Older adults with CAD commonly exhibit atypical symptoms, multi-vessel disease involvement, complex coronary anatomy, and a higher presence of risk factors and comorbidities. Although both invasive procedures and medical treatments are characterized by a higher risk of complications, avoidance may result in a suboptimal outcome. Often, overlooked factors, such as coronary microvascular disease, malnutrition, and poor physical performance, play a key role in determining prognosis, yet they are not routinely assessed or addressed in older patients. Historically, clinicians have relied on sub-analyses or observational findings to make clinical decisions, as older adults were frequently excluded or under-represented in clinical studies. Recently, dedicated evidence through randomized clinical trials has become available for older CAD patients. Nevertheless, the management of older CAD patients still raises several important questions. This review aims to comprehensively summarize and critically evaluate this emerging evidence, focusing on invasive management and coronary revascularization. Furthermore, it seeks to contextualize these interventions within the framework of improved risk stratification tools for older CAD patients, through user-friendly scales along with emphasizing the importance of promoting physical activity and exercise training to enhance the outcomes of invasive and medical treatments. This comprehensive approach may represent the key to improving prognosis in the complex and growing patient population of older CAD patients. [ABSTRACT FROM AUTHOR]

Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology demand a disease-tailored approach. In both conditions, fast treatment plays a crucial role as ischaemia and eventually infarction develop rapidly. Furthermore, in both fields, the introduction of fibrinolytic treatments historically preceded the implementation of endovascular techniques. However, in contrast to STEMI, only a minority of AIS patients will eventually be considered eligible for reperfusion treatment. Non-invasive cerebral imaging always precedes cerebral angiography and thrombectomy, whereas coronary angiography is not routinely preceded by non-invasive cardiac imaging in patients with STEMI. In the late or unknown time window, the presence of specific patterns on brain imaging may help identify AIS patients who benefit most from reperfusion treatment. For STEMI, a uniform time window for reperfusion up to 12 h after symptom onset, based on old placebo-controlled trials, is still recommended in guidelines and generally applied. Bridging fibrinolysis preceding endovascular treatment still remains the mainstay of reperfusion treatment in AIS, while primary percutaneous coronary intervention is the strategy of choice in STEMI. Shortening ischaemic times by fine-tuning collaboration networks between ambulances, community hospitals, and tertiary care hospitals, optimizing bridging fibrinolysis, and reducing ischaemia–reperfusion injury are important topics for further research. The aim of this review is to provide insights into the common as well as diverging pathophysiology behind current reperfusion strategies and to explore new ways to enhance their clinical benefit. [ABSTRACT FROM AUTHOR]

The article discusses the results of the FORZA trial, which compared the use of fractional flow reserve (FFR) and optical coherence tomography (OCT) for the management of angiographically intermediate coronary lesions (AICLs). The trial found that both FFR and OCT guidance provided similar rates of major adverse cardiac events (MACE) at the 5-year follow-up. The study suggests that OCT could be a valuable alternative to FFR for the management of patients with AICLs, but further investigation is needed to determine the optimal use of these tools. The article acknowledges the limitations of the study, including a small sample size and unreliable symptom assessment at long-term follow-up. [Extracted from the article]

Ventricular septal defects are a rare complication after acute myocardial infarction with a mortality close to 100% if left untreated. However, even surgical or interventional closure is associated with a very high mortality and currently no randomized controlled trials are available addressing the optimal treatment strategy of this disease. This state-of-the-art review and clinical consensus statement will outline the diagnosis, hemodynamic consequences and treatment strategies of ventricular septal defects complicating acute myocardial infarction with a focus on current available evidence and a focus on major research questions to fill the gap in evidence. [ABSTRACT FROM AUTHOR]

This article provides a summary of several studies on various topics related to cardiovascular care. One study focuses on ventricular septal defects (VSDs) that occur after acute myocardial infarction (AMI), discussing the diagnosis, consequences, and treatment strategies for VSDs. Another study explores the increased risk of heart failure in patients with inflammatory bowel disease (IBD), finding that IBD patients have a moderately higher risk of developing heart failure for at least 20 years after diagnosis. The article also discusses the use of a point-of-care high-sensitivity cardiac troponin I (hs-cTnI) assay to assess patients with suspected AMI, finding that this assay can effectively and safely assess the risk of AMI. Additionally, the article summarizes three other studies on infective endocarditis, coronary artery bypass grafting, and myocarditis, providing valuable insights into different aspects of cardiovascular health and treatment. [Extracted from the article]

Background and Aims Strategies to assess patients with suspected acute myocardial infarction (AMI) using a point-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI) assay may expedite emergency care. A 2-h POC hs-cTnI strategy for emergency patients with suspected AMI was derived and validated. Methods In two international, multi-centre, prospective, observational studies of adult emergency patients (1486 derivation cohort and 1796 validation cohort) with suspected AMI, hs-cTnI (Siemens Atellica® VTLi) was measured at admission and 2 h later. Adjudicated final diagnoses utilized the hs-cTn assay in clinical use. A risk stratification algorithm was derived and validated. The primary diagnostic outcome was index AMI (Types 1 and 2). The primary safety outcome was 30-day major adverse cardiac events incorporating AMI and cardiac death. Results Overall, 81 (5.5%) and 88 (4.9%) patients in the derivation and validation cohorts, respectively, had AMI. The 2-h algorithm defined 66.1% as low risk with a sensitivity of 98.8% [95% confidence interval (CI) 89.3%–99.9%] and a negative predictive value of 99.9 (95% CI 99.2%–100%) for index AMI in the derivation cohort. In the validation cohort, 53.3% were low risk with a sensitivity of 98.9% (95% CI 92.4%–99.8%) and a negative predictive value of 99.9% (95% CI 99.3%–100%) for index AMI. The high-risk metrics identified 5.4% of patients with a specificity of 98.5% (95% CI 96.6%–99.4%) and a positive predictive value of 74.5% (95% CI 62.7%–83.6%) for index AMI. Conclusions A 2-h algorithm using a POC hs-cTnI concentration enables safe and efficient risk assessment of patients with suspected AMI. The short turnaround time of POC testing may support significant efficiencies in the management of the large proportion of emergency patients with suspected AMI. [ABSTRACT FROM AUTHOR]

Background and Aims It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors. [ABSTRACT FROM AUTHOR]

Background and Aims A routine invasive strategy is recommended in the management of higher risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs). However, patients with previous coronary artery bypass graft (CABG) surgery were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. A comprehensive search was performed of PubMed, EMBASE, Cochrane, and ClinicalTrials.gov. Eligible studies were RCTs of routine invasive vs. a conservative or selective invasive strategy in patients presenting with NSTE-ACS that included patients with previous CABG. Summary data were collected from the authors of each trial if not previously published. Outcomes assessed were all-cause mortality, cardiac mortality, myocardial infarction, and cardiac-related hospitalization. Using a random-effects model, risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results Summary data were obtained from 11 RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive) followed up for a weighted mean of 2.0 (range 0.5–10) years. A routine invasive strategy did not reduce all-cause mortality (RR 1.12, 95% CI 0.97–1.29), cardiac mortality (RR 1.05, 95% CI 0.70–1.58), myocardial infarction (RR 0.90, 95% CI 0.65–1.23), or cardiac-related hospitalization (RR 1.05, 95% CI 0.78–1.40). Conclusions This is the first meta-analysis assessing the effect of a routine invasive strategy in patients with prior CABG who present with NSTE-ACS. The results confirm the under-representation of this patient group in RCTs of invasive management in NSTE-ACS and suggest that there is no benefit to a routine invasive strategy compared to a conservative approach with regard to major adverse cardiac events. These findings should be validated in an adequately powered RCT. [ABSTRACT FROM AUTHOR]

This article covers various topics related to cardiovascular disease (CVD) and its prevention. It discusses the role of aspirin in preventing atherothrombosis, the potential role of triglycerides in CVD, the effectiveness of invasive strategies in managing non-ST-elevation acute coronary syndromes (NSTE-ACS) in patients with previous coronary artery bypass graft (CABG) surgery, the outcomes of patients with stable coronary artery disease (CAD) who do not have standard modifiable cardiovascular risk factors (SMuRFs), and the use of apolipoprotein B (apoB) as a marker for ASCVD risk. The first article finds that apoB provides significant information for predicting new-onset ASCVD events. The second article shows that evinacumab effectively reduces LDL-C levels in patients with homozygous familial hypercholesterolaemia (HoFH). The third article suggests that xylitol may increase the risk of major adverse cardiovascular events. These articles offer valuable insights into biomarkers and treatments for hypercholesterolaemia. [Extracted from the article]

This article discusses the management of non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with previous coronary artery bypass graft surgery (CABG). While a routine invasive approach with coronary angiography is recommended for NSTE-ACS patients, it is unclear if this approach is beneficial for those with prior CABG. A meta-analysis of 11 randomized clinical trials found no significant difference in mortality, cardiac mortality, myocardial infarction, or cardiac hospitalizations between a routine invasive and selective invasive approach in this high-risk population. However, further research is needed to determine the best management strategy for NSTE-ACS patients with prior CABG. [Extracted from the article]

Background and Aims Platelet-fibrin clot strength (PFCS) is linked to major adverse cardiovascular event (MACE) risk. However, the association between PFCS and platelet reactivity and their prognostic implication remains uncertain in patients undergoing percutaneous coronary intervention (PCI). Methods In PCI-treated patients (n = 2512) from registry data from January 2010 to November 2018 in South Korea, PFCS using thromboelastography and platelet reactivity using VerifyNow were measured. High PFCS (PFCSHigh) was defined as thromboelastography maximal amplitude ≥ 68 mm, and high platelet reactivity (HPR) was defined as >208 P2Y12 reaction units. Patients were stratified into four groups according to maximal amplitude and P2Y12 reaction unit levels: (i) normal platelet reactivity (NPR)-PFCSNormal (31.8%), (ii) HPR-PFCSNormal (29.0%), (iii) NPR-PFCSHigh (18.1%), and (iv) HPR-PFCSHigh (21.1%). Major adverse cardiovascular event (all-cause death, myocardial infarction, or stroke) and major bleeding were followed up to 4 years. Results High platelet reactivity and PFCSHigh showed an additive effect for clinical outcomes (log-rank test, P <.001). Individuals with NPR-PFCSNormal, NPR-PFCSHigh, HPR-PFCSNormal, and HPR-PFCSHigh demonstrated MACE incidences of 7.5%, 12.6%, 13.4%, and 19.3%, respectively. The HPR-PFCSHigh group showed significantly higher risks of MACE compared with the NPR-PFCSNormal group [adjusted hazard ratio (HRadj) 1.89; 95% confidence interval (CI) 1.23–2.91; P =.004] and the HPR-PFCSNormal group (HRadj 1.60; 95% CI 1.12–2.27; P =.009). Similar results were observed for all-cause death. Compared with HPR-PFCSNormal phenotype, NPR-PFCSNormal phenotype was associated with a higher risk of major bleeding (HRadj 3.12; 95% CI 1.30–7.69; P =.010). Conclusions In PCI patients, PFCS and platelet reactivity demonstrated important relationships in predicting clinical prognosis. Their combined assessment may enhance post-PCI risk stratification for personalized antithrombotic therapy. [ABSTRACT FROM AUTHOR]

Background and Aims Atrial fibrillation (AF) and flutter are common causes of hospitalizations but contemporary long-term outcomes following these episodes are uncertain. This study assessed outcomes up to 10 years after an acute AF or flutter hospitalization. Methods Patients hospitalized acutely with a primary diagnosis of AF or flutter from 2008–17 from all public and most private hospitals in Australia and New Zealand were included. Kaplan–Meier methods and flexible parametric survival modelling were used to estimate survival and loss in life expectancy, respectively. Competing risk model accounting for death was used when estimating incidence of non-fatal outcomes. Results A total of 260 492 adults (mean age 70.5 ± 14.4 years, 49.6% female) were followed up for 1 068 009 person-years (PY), during which 69 167 died (incidence rate 6.5/100 PY) with 91.2% survival at 1 year, 72.7% at 5 years, and 55.2% at 10 years. Estimated loss in life expectancy was 2.6 years, or 16.8% of expected life expectancy. Re-hospitalizations for heart failure (2.9/100 PY), stroke (1.7/100 PY), and myocardial infarction (1.1/100 PY) were common with respective cumulative incidences of 16.8%, 11.0%, and 7.1% by 10 years. Re-hospitalization for AF or flutter occurred in 21.3% by 1 year, 35.3% by 5 years, and 41.2% by 10 years (11.6/100 PY). The cumulative incidence of patients undergoing catheter ablation of AF was 6.5% at 10 years (1.2/100 PY). Conclusions Patients hospitalized for AF or flutter had high death rates with an average 2.6-year loss in life expectancy. Moreover, re-hospitalizations for AF or flutter and related outcomes such as heart failure and stroke were common with catheter ablation used infrequently for treatment, which warrant further actions. [ABSTRACT FROM AUTHOR]

This article from the European Heart Journal discusses various topics related to the management of cardiovascular diseases. It begins with a review of when cardiovascular medications should be discontinued, highlighting the lack of guidance on this topic. The article then focuses on the management of non-ST-elevation acute coronary syndrome (NSTEACS) in older patients, finding that routine invasive treatment reduces the risk of repeat myocardial infarction or urgent revascularization. The article also explores the use of B-type natriuretic peptide (BNP) as a prognostic marker in adult congenital heart disease (ACHD), and the identification of slow-conducting anatomical isthmuses in patients with repaired tetralogy of Fallot. Finally, it discusses the assessment of the anomalous right coronary artery originating from the left sinus of Valsalva using cardiac magnetic resonance imaging. Overall, the article provides valuable insights into the evolving management of adult congenital heart disease. [Extracted from the article]

Background and Aims Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) are less likely to receive guideline-recommended care including coronary angiography and revascularization. Evidence-based recommendations regarding interventional management strategies in this patient cohort are scarce. This meta-analysis aimed to assess the impact of routine invasive vs. conservative management of NSTEACS by using individual patient data (IPD) from all available randomized controlled trials (RCTs) including older patients. Methods MEDLINE, Web of Science and Scopus were searched between 1 January 2010 and 11 September 2023. RCTs investigating routine invasive and conservative strategies in persons >70 years old with NSTEACS were included. Observational studies or trials involving populations outside the target range were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction (MI) at 1 year. One-stage IPD meta-analyses were adopted by use of random-effects and fixed-effect Cox models. This meta-analysis is registered with PROSPERO (CRD42023379819). Results Six eligible studies were identified including 1479 participants. The primary endpoint occurred in 181 of 736 (24.5%) participants in the invasive management group compared with 215 of 743 (28.9%) participants in the conservative management group with a hazard ratio (HR) from random-effects model of 0.87 (95% CI 0.63–1.22; P =.43). The hazard for MI at 1 year was significantly lower in the invasive group compared with the conservative group (HR from random-effects model 0.62, 95% CI 0.44–0.87; P =.006). Similar results were seen for urgent revascularization (HR from random-effects model 0.41, 95% CI 0.18–0.95; P =.037). There was no significant difference in mortality. Conclusions No evidence was found that routine invasive treatment for NSTEACS in older patients reduces the risk of a composite of all-cause mortality and MI within 1 year compared with conservative management. However, there is convincing evidence that invasive treatment significantly lowers the risk of repeat MI or urgent revascularisation. Further evidence is needed from ongoing larger clinical trials. [ABSTRACT FROM AUTHOR]

Aspirin has been known for a long time and currently stays as a cornerstone of antithrombotic therapy in cardiovascular disease. In patients with either acute or chronic coronary syndromes undergoing percutaneous coronary intervention aspirin is mandatory in a dual antiplatelet therapy regimen for prevention of stent thrombosis and/or new ischaemic events. Aspirin is also currently a first-option antithrombotic therapy after an aortic prosthetic valve replacement and is occasionally required in addition to oral anticoagulants after implantation of a mechanical valve. Presumed or demonstrated aspirin hypersensitivity is a main clinical problem, limiting the use of a life-saving medication. In the general population, aspirin hypersensitivity has a prevalence of 0.6%–2.5% and has a plethora of clinical presentations, ranging from aspirin-exacerbated respiratory disease to anaphylaxis. Although infrequent, when encountered in clinical practice aspirin hypersensitivity poses for cardiologists a clinical dilemma, which should never be trivialized, avoiding—as much as possible—omission of the drug. We here review the epidemiology of aspirin hypersensitivity, provide an outline of pathophysiological mechanisms and clinical presentations, and review management options, starting from a characterization of true aspirin allergy—in contrast to intolerance—to suggestion of desensitization protocols. [ABSTRACT FROM AUTHOR]

consideration of genetic factors in cardiovascular disease research. These findings contribute to the understanding of ischaemic heart disease and offer potential strategies for improving patient outcomes. [Extracted from the article]

Background and Aims The Glu504Lys polymorphism in the aldehyde dehydrogenase 2 (ALDH2) gene is closely associated with myocardial ischaemia/reperfusion injury (I/RI). The effects of ALDH2 on neutrophil extracellular trap (NET) formation (i.e. NETosis) during I/RI remain unknown. This study aimed to investigate the role of ALDH2 in NETosis in the pathogenesis of myocardial I/RI. Methods The mouse model of myocardial I/RI was constructed on wild-type, ALDH2 knockout, peptidylarginine deiminase 4 (Pad4) knockout, and ALDH2/PAD4 double knockout mice. Overall, 308 ST-elevation myocardial infarction patients after primary percutaneous coronary intervention were enrolled in the study. Results Enhanced NETosis was observed in human neutrophils carrying the ALDH2 genetic mutation and ischaemic myocardium of ALDH2 knockout mice compared with controls. PAD4 knockout or treatment with NETosis-targeting drugs (GSK484, DNase1) substantially attenuated the extent of myocardial damage, particularly in ALDH2 knockout. Mechanistically, ALDH2 deficiency increased damage-associated molecular pattern release and susceptibility to NET-induced damage during myocardial I/RI. ALDH2 deficiency induced NOX2-dependent NETosis via upregulating the endoplasmic reticulum stress/microsomal glutathione S-transferase 2/leukotriene C4 (LTC4) pathway. The Food and Drug Administration-approved LTC4 receptor antagonist pranlukast ameliorated I/RI by inhibiting NETosis in both wild-type and ALDH2 knockout mice. Serum myeloperoxidase–DNA complex and LTC4 levels exhibited the predictive effect on adverse left ventricular remodelling at 6 months after primary percutaneous coronary intervention in ST-elevation myocardial infarction patients. Conclusions ALDH2 deficiency exacerbates myocardial I/RI by promoting NETosis via the endoplasmic reticulum stress/microsomal glutathione S-transferase 2/LTC4/NOX2 pathway. This study hints at the role of NETosis in the pathogenesis of myocardial I/RI, and pranlukast might be a potential therapeutic option for attenuating I/RI, particularly in individuals with the ALDH2 mutation. [ABSTRACT FROM AUTHOR]

Despite improvements in clinical outcomes following acute myocardial infarction, mortality remains high, especially in patients with severely reduced left ventricular ejection fraction (LVEF <30%), emphasizing the need for effective cardioprotective strategies adjunctive to recanalization. Traditional cell therapy has shown equivocal success, shifting the focus to innovative cardioactive biologicals and cell mimetic therapies, particularly extracellular vesicles (EVs). EVs, as carriers of non-coding RNAs and other essential biomolecules, influence neighbouring and remote cell function in a paracrine manner. Compared to cell therapy, EVs possess several clinically advantageous traits, including stability, ease of storage (enabling off-the-shelf clinical readiness), and decreased immunogenicity. Allogeneic EVs from mesenchymal and/or cardiac stromal progenitor cells demonstrate safety and potential efficacy in preclinical settings. This review delves into the translational potential of EV-based therapeutic approaches, specifically highlighting findings from large-animal studies, and offers a synopsis of ongoing early-stage clinical trials in this domain. [ABSTRACT FROM AUTHOR]

Background and Aims Studies on the impact of syphilis on the cardiovascular system in large populations are limited. This study investigated the effects of syphilis on cardiovascular outcomes. Methods Medical records from 2010 to 2015 were retrieved from the Taiwan National Health Insurance Research Database, linked to the Notifiable Infectious Diseases database from the Taiwan Centers for Disease Control. Patients with syphilis were identified, excluding those with missing information, under 20 years of age, or with a history of human immunodeficiency virus infection, acute myocardial infarction, heart failure, aortic regurgitation, replacement of the aortic valve, aneurysm and/or dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, and venous thromboembolism. Primary outcomes included new-onset acute myocardial infarction, heart failure, aortic regurgitation, aneurysm and dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, cardiovascular death, and all-cause mortality. Results A total of 28 796 patients with syphilis were identified from 2010 to 2015. After exclusions and frequency matching, 20 601 syphilis patients and 20 601 non-syphilis patients were analysed. The relative rate (RR) was utilized in the analysis, as the competing risk of death was not considered. Compared with patients without syphilis, patients with syphilis had increased risks of acute myocardial infarction (RR 38%, 95% confidence interval [CI] 1.19–1.60, P <.001), heart failure (RR 88%, 95% CI 1.64–2.14, P <.001), aortic regurgitation (RR 81%, 95% CI 1.18–2.75, P =.006), atrial fibrillation (RR 45%, 95% CI 1.20–1.76, P <.001), ischaemic stroke (RR 68%, 95% CI 1.52–1.87, P <.001), haemorrhagic stroke (RR 114%, 95% CI 1.74–2.64, P <.001), venous thromboembolism (RR 67%, 95% CI 1.23–2.26, P =.001), cardiovascular death (RR 155%, 95% CI 2.11–3.08, P <.001), and all-cause death (RR 196%, 95% CI 2.74–3.19, P <.001) but not for aneurysm and dissection of the aorta. Conclusions This study demonstrates that patients with syphilis have a higher risk of cardiovascular events and all-cause mortality compared with those without syphilis. [ABSTRACT FROM AUTHOR]

Background and Aims The ecto–nucleoside triphosphate diphosphohydrolases of the CD39 family degrade ATP and ADP into AMP, which is converted into adenosine by the extracellular CD73/ecto-5-nucleotidase. This pathway has been explored in antithrombotic treatments but little in myocardial protection. We have investigated whether the administration of solCD39L3 (AZD3366) confers additional cardioprotection to that of ticagrelor alone in a pre-clinical model of myocardial infarction (MI). Methods Ticagrelor-treated pigs underwent balloon-induced MI (90 min) and, before reperfusion, received intravenously either vehicle, 1 mg/kg AZD3366 or 3 mg/kg AZD3366. All animals received ticagrelor twice daily for 42 days. A non-treated MI group was run as a control. Serial cardiac magnetic resonance (baseline, Day 3 and Day 42 post-MI), light transmittance aggregometry, bleeding time, and histological and molecular analyses were performed. Results Ticagrelor reduced oedema formation and infarct size at Day 3 post-MI vs. controls. A 3 mg/kg AZD3366 provided an additional 45% reduction in oedema and infarct size compared with ticagrelor and a 70% reduction vs. controls (P <.05). At Day 42, infarct size declined in all ticagrelor-administered pigs, particularly in 3 mg/kg AZD3366-treated pigs (P <.05). Left ventricular ejection fraction was diminished at Day 3 in placebo pigs and worsened at Day 42, whereas it remained unaltered in ticagrelor ± AZD3366-administered animals. Pigs administered with 3 mg/kg AZD3366 displayed higher left ventricular ejection fraction upon dobutamine stress at Day 3 and minimal dysfunctional segmental contraction at Day 42 (χ 2 P <.05 vs. all). Cardiac and systemic molecular readouts supported these benefits. Interestingly, AZD3366 abolished ADP-induced light transmittance aggregometry without affecting bleeding time. Conclusions Infusion of AZD3366 on top of ticagrelor leads to enhanced cardioprotection compared with ticagrelor alone. [ABSTRACT FROM AUTHOR]

The article discusses the potential benefits of blocking acid-sensing ion channel 1a (ASIC1a) in reducing myocardial injury in rodent models of myocardial infarction (MI). The study found that administering the ASIC1a inhibitor, Hi1a, before or after the onset of ischemia reduced infarct size and prevented cardiac dysfunction associated with MI. Hi1a was also found to have minimal adverse effects on heart rhythm and blood pressure. The findings suggest that Hi1a could be a promising drug candidate for treating severe ischemic injury in patients with MI. Further research is needed to evaluate Hi1a in larger animal models and in co-morbid conditions to assess its potential for clinical translation. [Extracted from the article]

Background and Aims Patients with kidney failure have a higher risk of cardiovascular disease compared with the general population. Whilst temporal trends of myocardial infarction and stroke are declining in the general population, these have not been evaluated in patients with kidney failure. This study aimed to describe national trends in the incidence, treatment, and outcomes of myocardial infarction and stroke in patients with kidney failure (i.e. on dialysis or with a kidney transplant) over a 20-year period, stratified by age and sex. Methods In this retrospective national data linkage study, all patients with kidney failure in Scotland (UK) receiving kidney replacement therapy between January 1996 and December 2016 were linked to national hospitalization, prescribing, and death records. The primary outcomes were the incidence of myocardial infarction and stroke, and subsequent cardiovascular death. Generalized additive models were constructed to estimate age-standardized, sex-stratified incidence rates and trends in cardiovascular and all-cause death. Results Amongst 16 050 patients with kidney failure [52 (SD 15) years; 41.5% women], there were 1992 [66 (SD 12) years; 34.8% women] and 996 [65 (SD 13) years; 45.1% women] incident myocardial infarctions and strokes, respectively, between January 1996 and December 2016. During this period, the age-standardized incidence of myocardial infarction per 100 000 decreased in men {from 4376 [95% confidence interval (CI) 3998–4785] to 1835 (95% CI 1692–1988)} and women [from 3268 (95% CI 2982–3593) to 1369 (95% CI 1257–1491)]. Similarly, the age-standardized incidence of stroke per 100 000 also decreased in men [from 1978 (95% CI 1795–2175) to 799 (95% CI 729–875)] and women [from 2234 (95% CI 2031–2468) to 903 (95% CI 824–990)]. Compared with the general population, the incidence of myocardial infarction was four- to eight-fold higher in patients with kidney failure, whilst for stroke it was two- to four-fold higher. The use of evidence-based cardioprotective treatment increased over the study period, and the predicted probability of cardiovascular death within 1 year of myocardial infarction for a 66-year-old patient with kidney failure (mean age of the cohort) fell in men (76.6% to 38.6%) and women (76.8% to 38.8%), and also decreased in both sexes following stroke (men, from 63.5% to 41.4%; women, from 67.6% to 45.8%). Conclusions The incidence of myocardial infarction and stroke has halved in patients with kidney failure over the past 20 years but remains significantly higher than in the general population. Despite improvements in treatment and outcomes, the prognosis of these patients following myocardial infarction and stroke remains poor. [ABSTRACT FROM AUTHOR]

This article from the European Heart Journal covers various topics related to cardiovascular health. It includes a clinical consensus document on exercise therapy for peripheral artery disease (PAD), emphasizing the importance of exercise as a management strategy. Another viewpoint article discusses the use of artificial intelligence (AI) in cardiovascular imaging and provides a framework for assessing the quality and clinical value of AI applications. The article also presents a study on the increased risk of myocarditis associated with SARS-CoV-2 mRNA booster vaccines in young adults. Additionally, it discusses trends in the incidence, treatment, and outcomes of myocardial infarction (MI) and stroke in patients with kidney failure. Lastly, the article explores the association between urinary biomarker levels and the risk of future vascular events in patients with diabetes. The authors provide conclusions and insights on each topic, highlighting the need for further research and improvements in patient care. [Extracted from the article]

This article provides a summary of the top 10 papers in ischaemic heart disease selected by the European Heart Journal Editors. The three main areas discussed include microvascular dysfunction, the role of revascularization for managing obstructive coronary artery disease, and the management of patients with acute coronary syndrome and clinical outcomes. The articles cover topics such as the association between coronary microvascular dysfunction and cerebral microvascular abnormalities, the diagnostic and prognostic performance of microvascular resistance reserve, the causes of Takotsubo syndrome, the effectiveness of revascularization by percutaneous coronary intervention, the management of left main coronary artery disease, the use of PCI for managing angina in chronic coronary syndrome patients, outcomes in patients who remained stable 1 year after myocardial infarction, the timing of complete revascularization in myocardial infarction patients, the de-escalation of dual antiplatelet therapy, and the value of serial cardiac troponin measurement in patients with acute coronary syndrome. It is important to note that the selection of these papers is based on the editors' views and not a systematic search based on specific objective criteria. [Extracted from the article]

Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities. [ABSTRACT FROM AUTHOR]

Background and Aims Transcatheter aortic valve implantation (TAVI) has become a viable treatment option for patients with severe aortic valve stenosis across a broad range of surgical risk. The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize patients at lower surgical risk to TAVI or surgical aortic valve replacement (SAVR). The aim of the present study was to report clinical and bioprosthesis outcomes after 10 years. Methods The NOTION trial randomized 280 patients to TAVI with the self-expanding CoreValve (Medtronic Inc.) bioprosthesis (n = 145) or SAVR with a bioprosthesis (n = 135). The primary composite outcome was the risk of all-cause mortality, stroke, or myocardial infarction. Bioprosthetic valve dysfunction (BVD) was classified as structural valve deterioration (SVD), non-structural valve dysfunction (NSVD), clinical valve thrombosis, or endocarditis according to Valve Academic Research Consortium-3 criteria. Severe SVD was defined as (i) a transprosthetic gradient of 30 mmHg or more and an increase in transprosthetic gradient of 20 mmHg or more or (ii) severe new intraprosthetic regurgitation. Bioprosthetic valve failure (BVF) was defined as the composite rate of death from a valve-related cause or an unexplained death following the diagnosis of BVD, aortic valve re-intervention, or severe SVD. Results Baseline characteristics were similar between TAVI and SAVR: age 79.2 ± 4.9 years and 79.0 ± 4.7 years (P =.7), male 52.6% and 53.8% (P =.8), and Society of Thoracic Surgeons score < 4% of 83.4% and 80.0% (P =.5), respectively. After 10 years, the risk of the composite outcome all-cause mortality, stroke, or myocardial infarction was 65.5% after TAVI and 65.5% after SAVR [hazard ratio (HR) 1.0; 95% confidence interval (CI) 0.7–1.3; P =.9], with no difference for each individual outcome. Severe SVD had occurred in 1.5% and 10.0% (HR 0.2; 95% CI 0.04–0.7; P =.02) after TAVI and SAVR, respectively. The cumulative incidence for severe NSVD was 20.5% and 43.0% (P <.001) and for endocarditis 7.2% and 7.4% (P = 1.0) after TAVI and SAVR, respectively. No patients had clinical valve thrombosis. Bioprosthetic valve failure occurred in 9.7% of TAVI and 13.8% of SAVR patients (HR 0.7; 95% CI 0.4–1.5; P =.4). Conclusions In patients with severe AS and lower surgical risk randomized to TAVI or SAVR, the risk of major clinical outcomes was not different 10 years after treatment. The risk of severe bioprosthesis SVD was lower after TAVR compared with SAVR, while the risk of BVF was similar. [ABSTRACT FROM AUTHOR]

The article discusses the findings of the REDUCE-IT trial, which investigated the use of icosapent ethyl (IPE) in patients with recent acute coronary syndrome (ACS). The trial discovered that IPE significantly reduced the occurrence of cardiovascular events in patients with recent ACS, with a 37% reduction in the primary composite outcome and a 36% reduction in total primary composite outcomes. These benefits were achieved without an increased risk of bleeding, even in patients receiving dual antiplatelet therapy. However, the use of IPE was associated with a higher risk of atrial fibrillation or flutter. Overall, the study suggests that IPE may be beneficial for patients with recent ACS, but further research is necessary to fully understand its safety and effectiveness. This document is a disclosure statement and conclusion from a post hoc subgroup analysis of the REDUCE-IT trial. The analysis found that icosapent ethyl (IPE) significantly reduced the risk of ischemic events in high-risk, statin-treated patients with recent acute coronary syndrome (ACS) within 12 months. The results suggest that initiating IPE in eligible patients as soon as possible after ACS may provide substantial benefits without excess bleeding. However, the authors caution that further confirmation is needed and the results should be interpreted with caution. The document also includes declarations of interest from the authors and information about the trial's funding, ethical approval, and clinical trial number. [Extracted from the article]

Background and Aims Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. Methods Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. Results Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10–1.17], P <.001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18–1.26), P <.001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72–0.93), P =.003], total CV events [HR 0.93 (95% CI 0.88–0.98), P =.008], total coronary events [HR 0.92 (95% CI 0.86–0.99), P =.024], and atrial fibrillation [HR 0.91 (95% CI 0.83–0.99), P =.030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82–1.01), P =.073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. Conclusions Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period. [ABSTRACT FROM AUTHOR]

This article discusses the balance between the risk of thrombosis and bleeding in patients with cancer and acute myocardial infarction (AMI) when deciding on antithrombotic treatment. The use of dual platelet antiplatelet therapy (DAPT) has been a common treatment for AMI patients, but it carries an increased risk of bleeding. Guidelines recommend individualizing DAPT based on the patient's thrombotic and bleeding risk. However, current risk prediction tools do not include cancer as a factor, despite its impact on bleeding risk. A modified version of the PRECISE-DAPT score that incorporates cancer as a predictor for bleeding has been proposed, showing higher accuracy in predicting bleeding events in both cancer and non-cancer patients. This modified score could help identify more cancer patients as high bleeding risk and potentially reduce the risk of bleeding events by shortening DAPT duration. However, the study has limitations, such as the lack of certain variables in the databases used for the modified score. Further research is needed to develop more accurate risk assessment tools for bleeding events in cancer patients. The article emphasizes the importance of maintaining clinical judgment and common sense in decision-making, especially for complex patients like those with cancer and AMI. [Extracted from the article]

A recent study published in the European Heart Journal explores the role of the spleen in cardioprotection. The study focuses on the use of remote ischaemic conditioning (RIC), a technique that involves inducing transient ischaemia in one organ to protect another. While previous clinical trials of RIC have shown mixed results, this study suggests that the spleen may play a key role in transmitting cardioprotective signals. The study found that vagal nerve stimulation and spleen activation through auricular tragus stimulation (ATS) released cardioprotective factors in humans. However, the specific molecules involved have not yet been identified. The findings highlight the potential of targeting the vagal-spleen axis for cardioprotection and may lead to new therapeutic options. [Extracted from the article]

The ULTIMATE-DAPT trial, a randomized clinical trial conducted in China, compared the use of ticagrelor alone versus ticagrelor plus aspirin in patients with acute coronary syndromes (ACS) who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The trial found that ticagrelor monotherapy after 1 month reduced the risk of clinically relevant bleeding by 55% compared to dual antiplatelet therapy (DAPT) with ticagrelor and aspirin for 12 months, with a non-inferior rate of ischaemic outcomes. However, there were some limitations to the study, and further research is needed to determine the appropriate antiplatelet strategy after PCI. [Extracted from the article]

The article discusses the controversy surrounding the definition and significance of periprocedural myocardial infarction (MI), which occurs during or after a medical procedure. The authors analyze data from 19 studies and find that different definitions of periprocedural MI have varying associations with mortality. The study suggests that stringent thresholds of biomarker elevation should be used to diagnose periprocedural MI after percutaneous coronary intervention (PCI), and that the Society of Cardiac Angiography and Interventions (SCAI) definition may be the most appropriate for clinical trials. The authors emphasize the importance of capturing and reporting prognostically relevant infarctions. [Extracted from the article]

The article discusses the use of antiplatelet therapy in patients with acute coronary syndrome (ACS) and the balance between ischaemic and bleeding risks. The standard treatment for ACS involves dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor for 12 months. However, this increases the risk of bleeding. Recent studies have explored the use of ticagrelor monotherapy after a short period of DAPT, which has shown a reduction in bleeding rates without an increase in ischaemic events. However, the applicability of these findings to different patient populations and the role of genetic testing in selecting the appropriate antiplatelet therapy remain uncertain. Physicians should evaluate each patient individually to create a personalized antithrombotic strategy. [Extracted from the article]

A study published in the European Heart Journal investigated the use of intravascular ultrasound (IVUS) in the treatment of femoropopliteal artery disease with drug-coated balloons (DCBs). The study found that IVUS guidance improved primary patency and led to a more aggressive treatment of the lesions, resulting in a greater acute luminal gain. The use of IVUS was particularly beneficial for more complex lesions. The study suggests that intravascular imaging can lead to improved outcomes in DCB treatment. [Extracted from the article]

The article discusses the findings of the Danish-German Cardiogenic Shock study, which aimed to assess the impact of a temporary mechanical circulatory support device called Impella CP on the survival of patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock. The study involved 355 patients who were randomized to receive either Impella CP in addition to standard care or standard care alone. The primary endpoint of death from any cause at 180 days was lower in the Impella CP group compared to the standard care group. However, the Impella CP group had a higher incidence of complications. The study highlights the need for further strategies to improve outcomes for patients with cardiogenic shock. [Extracted from the article]

This article discusses the challenges in identifying vulnerable atherosclerotic plaques that can cause myocardial infarctions. The concept of the "vulnerable plaque" originated in the 1980s and refers to plaque rupture and plaque erosion as the main mechanisms of myocardial infarction. The authors propose using plasma cell-free DNA methylation as a potential non-invasive biomarker to detect plaque-specific methylation signatures in patients at risk for myocardial infarction. They aim to develop a polymerase chain reaction (PCR)-based assay to quantify DNA methylation and assess its performance compared to whole genome methylation sequencing. The successful implementation of a plaque biomarker could greatly impact healthcare by enabling targeted detection of dangerous plaques in both men and women. [Extracted from the article]

A secondary analysis of the CLARIFY cohort was conducted to examine the characteristics and outcomes of patients with stable coronary artery disease (CAD) who did not have standard modifiable cardiovascular risk factors (SMuRF). These SMuRFless participants made up 4.4% of the cohort and were found to have better outcomes compared to those with at least one SMuRF. The study highlights the need for improved strategies for secondary prevention in CAD patients and emphasizes the importance of equitable access to evidence-based management for SMuRFless individuals. The findings also suggest the potential value of more aggressive beta-blockage or anti-arrhythmic therapies in the short term for SMuRFless patients. [Extracted from the article]

This article is a comment on a systematic review and network meta-analysis that compared the outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) guided by intravascular imaging or angiography alone. The analysis included 22 randomized controlled trials (RCTs) and found that intravascular imaging-guided PCI was associated with a 29% reduction in the risk of target lesion failure (TLF) compared to angiography-guided PCI. The use of intravascular imaging also resulted in lower risks of target lesion revascularization, target-vessel myocardial infarction, cardiac death, stent thrombosis, all myocardial infarctions, and all-cause death. The analysis did not find significant differences between intravascular ultrasound (IVUS) and optical coherence tomography (OCT) guidance. However, the authors note that the results should be interpreted with caution due to the study-level design and the need for more evidence to confirm the clinical benefit of OCT guidance. The article concludes that intravascular imaging guidance of PCI may improve outcomes in the appropriate clinical setting and calls for efforts to overcome barriers to its use. [Extracted from the article]

This article discusses the importance of assessing platelet reactivity and clot strength in patients undergoing percutaneous coronary intervention (PCI) to predict major adverse cardiovascular events (MACE) and major bleeding. The study found that patients with high platelet reactivity (HPR) and high clot strength had the highest risk of MACE. However, the study only assessed thrombotic status during the peri-PCI period while on dual antiplatelet therapy, and the findings may not be applicable to populations with different genetic variations or patients taking different antiplatelet medications. The authors suggest that future research should consider combining platelet reactivity, coagulation, and fibrinolysis assessments to enhance risk stratification. [Extracted from the article]

AimsIn a retrospective analysis of dal-Outcomes, the effect of dalcetrapib on cardiovascular events was influenced by an adenylate cyclase type 9 (ADCY9) gene polymorphism. The dal-GenE study was conducted to test this pharmacogenetic hypothesis.Methods and resultsdal-GenE was a double-blind trial in patients with an acute coronary syndrome within 1-3 months and the AA genotype at variant rs1967309 in the ADCY9 gene. A total of 6147 patients were randomly assigned to receive dalcetrapib 600 mg or placebo daily. The primary endpoint was the time from randomization to first occurrence of cardiovascular death, resuscitated cardiac arrest, non-fatal myocardial infarction, or non-fatal stroke. After a median follow-up of 39.9 months, the primary endpoint occurred in 292 (9.5%) of 3071 patients in the dalcetrapib group and 327 (10.6%) of 3076 patients in the placebo group [hazard ratio 0.88; 95% confidence interval (CI) 0.75-1.03; P = 0.12]. The hazard ratios for the components of the primary endpoint were 0.79 (95% CI 0.65-0.96) for myocardial infarction, 0.92 (95% CI 0.64-1.33) for stroke, 1.21 (95% CI 0.91-1.60) for death from cardiovascular causes, and 2.33 (95% CI 0.60-9.02) for resuscitated cardiac arrest. In a pre-specified on-treatment sensitivity analysis, the primary endpoint event rate was 7.8% (236/3015) in the dalcetrapib group and 9.3% (282/3031) in the placebo group (hazard ratio 0.83; 95% CI 0.70-0.98).ConclusionDalcetrapib did not significantly reduce the risk of occurrence of the primary endpoint of ischaemic cardiovascular events at end of study. A new trial would be needed to test the pharmacogenetic hypothesis that dalcetrapib improves the prognosis of patients with the AA genotype.Clinical trial registrationTrial registration dal-GenE ClinicalTrials.gov Identifier: NCT02525939.

This article provides a comprehensive overview of various topics related to cardiovascular risk. It highlights the increased risk of cardiovascular disease (CVD) among individuals with severe mental illness (SMI) and the inadequate cardiovascular care they often receive. The article also explores the impact of cardiovascular risk communication on patient-perceived risk and changes in risk factors. It discusses the rise in cardiovascular hospitalizations among younger adults in the USA, with a focus on the disparities between low- and higher-income communities. Additionally, the article examines the association between long-term exposure to air pollutants and the risk of abdominal aortic aneurysm (AAA), finding that air pollution significantly increases the risk of AAA. The article also presents three different studies on CVD risk factors, including the association between lipoprotein(a) (Lp(a)) and coronary heart disease (CHD), the relationship between frailty and CVD, and the link between high-risk human papillomavirus (HR-HPV) infection and CVD mortality. Overall, this article provides valuable insights into the various factors contributing to cardiovascular risk. [Extracted from the article]

The Canadian Cardiovascular Society (CCS) has proposed a new classification system for acute atherothrombotic myocardial infarction (AMI) based on tissue injury severity. The classification consists of four stages: Stage 1 is characterized by reversible injury and myocardial edema, Stage 2 involves irreversible cardiomyocyte necrosis, Stage 3 includes microvascular dysfunction, and Stage 4 is marked by microvascular destruction and hemorrhage. This new classification provides a more nuanced understanding of AMI and could be used for risk assessment and personalized care. It also offers potential targets for therapeutic interventions to improve patient outcomes. [Extracted from the article]

Background and Aims Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25–64 years were evaluated, overall and by community-level income. Methods Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25–64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities. Results Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P <.001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P <.001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P <.001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period. Conclusions There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow. [ABSTRACT FROM AUTHOR]

This article provides an overview of several studies related to cardiovascular disease (CVD) and potential treatment strategies. One study suggests that targeting blood DKK1 may be a promising approach to reducing diabetic injuries. Another study examines the impact of genetic variations in ANGPTL3 on triglyceride levels and cardiovascular risk. A third study investigates the use of colchicine to prevent sympathetic denervation after a heart attack. Finally, a study explores the potential of intracoronary delivery of extracellular vesicles from human cardiac progenitor cells for reducing infarct size in a heart attack. The article concludes by emphasizing the importance of these findings for future research and clinical trials. [Extracted from the article]