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Background: Fatal arrhythmic events (FAEs), such as sudden cardiac death (SCD) and fatal ventricular arrhythmias, are a devastating complication in patients with coronary artery disease (CAD). Therefore, in this study we aimed to assess the incidence of FAEs in more recent Japanese patients with CAD and to examine whether risk stratification of FAEs can still be feasible using the left ventricular ejection fraction (LVEF)., Methods and Results: In the CREDO Kyoto PCI/CABG registry cohorts-2 and -3, there were 25,843 patients with LVEF data who received a first coronary revascularization (LVEF ≤35% group: N=1,671, 35%45%: N=21,503). FAEs were defined as a composite of SCD or hospitalization for serious ventricular arrhythmias. The cumulative 5-year incidence of FAEs was 2.4% and it increased with decreasing LVEF (LVEF ≤35%: 8.84%, 35%45%: 1.67%, log-rank P<0.0001). The adjusted risk of FAEs also increased with decreasing LVEF., Conclusions: LVEF is still a strong independent factor for predicting FAEs in patients with CAD in the PCI era. There was no obvious decrease in the incidence of FAEs between the 2 cohorts. The risk factors for FAEs through the 2 cohorts, other than low LVEF, included age ≥75 years, diabetes, heart failure, hemodialysis, atrial fibrillation, and anemia.

Background: Atrial functional mitral regurgitation (AFMR) arises from left atrial (LA) dilation, commonly associated with atrial fibrillation, and leads to progressive cardiac damage. This study evaluated the prognostic value of a novel echocardiographic cardiac damage classification system for patients with moderate or severe AFMR., Methods: In a retrospective multicentre study, 1007 patients with AFMR were stratified into four groups based on echocardiographic findings: group 1, LA damage (dilation); group 2, left ventricular damage (reduced ejection fraction and/or dilation); group 3, right heart damage (tricuspid regurgitation and/or pulmonary hypertension); and group 4, combined left and right heart damage. The primary outcome was a composite of all-cause death, heart failure hospitalisations and mitral valve (MV) interventions over a median follow-up of 3.0 years., Results: The cohort's mean age was 78±10 years, with 56% female. Event rates for the primary outcome were progressively higher across groups 1-4 (31.0%, 38.0%, 46.3% and 57.2%, respectively; p<0.001). After multivariable adjustment, group 4 was associated with a significantly higher risk of the primary outcome compared with group 1 (HR 1.65, 95% CI 1.29 to 2.11, p<0.001). This classification consistently stratified risks for individual components of the composite endpoint, particularly in patients without MV intervention., Conclusions: A cardiac damage classification system based on echocardiographic parameters provides prognostic insights in patients with AFMR, identifying subgroups at higher risk of adverse outcomes. Future studies are needed to validate its use in guiding therapeutic decisions., Competing Interests: Competing interests: NK received research grants from EchoNous Inc., AMI Inc., and AstraZeneca and speaker honoraria from Eli Lilly, Novartis, Otsuka pharmaceutical, and Nippon Boehringer-Ingelheim outside this work and is affiliated with a department funded by Paramount Bed Ltd. MO received research grants from the Fukuda Foundation for Medical Technology, the Mochida Memorial Foundation for Medical and Pharmaceutical Research, Nippon Shinyaku, Takeda Science Foundation, the Japanese Circulation Society, the Japanese College of Cardiology, JSPS KAKENHI 21K16078, AMED (23jm0210104h0002), AMI Inc., Boehringer-Ingelheim, and Janssen and speaker honoraria from AstraZeneca, Eli Lilly, Novartis, Otsuka pharmaceutical, and Boehringer-Ingelheim outside this work. KS belongs to an endowed department funded by Medtronic and DVX. TK receives research grants from the Japanese Circulation Society. YF has received speaker honoraria from Daiichi Sankyo and Bayer. YO is a clinical proctor of transcatheter edge-to-edge repair for Abbott Medical and has received speaker fees from Abbott Medical. Other authors have nothing to disclose regarding the submitted manuscript., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)