Murasato Y, Higashi K, Sugino H
… +19 more, Arikawa M, Mori F, Ueda Y, Matsumura K, Abe M, Koizumi T, Shimomura M, Tayama S, Saeki T, Imagawa S, Takenaka T, Morita Y, Kashima K, Takami A, Ono Y, Fukae A, Takahashi K, Yoshida H, LM-JANHO investigators
Am J Cardiol
· 2026 Jun · PMID 41881097
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We evaluated 3-year clinical outcomes after contemporary left main percutaneous coronary intervention in patients with and without acute coronary syndrome (ACS) in a real-world cohort, in which intracoronary imaging guid...We evaluated 3-year clinical outcomes after contemporary left main percutaneous coronary intervention in patients with and without acute coronary syndrome (ACS) in a real-world cohort, in which intracoronary imaging guidance was routinely used. Among 758 consecutive patients undergoing left main percutaneous coronary intervention for unprotected de novo lesions, 97.6% received imaging guidance. Patients were categorized by presenting ACS (n = 241) or without ACS (n = 516). Three-year major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause mortality, clinically driven revascularization, myocardial infarction, and cerebrovascular events were analyzed. Patients with ACS presented more true bifurcation lesions (31.9% vs 24.2%), cardiogenic shock (18.3% vs 0.2%), and increased mechanical circulatory support use (40.2% vs 5.6%). They had significantly higher MACCE (40.7% vs 28.5%; hazard ratio [HR] 1.81) and mortality rates (25.8% vs 10.2%; HR 3.09), primarily due to higher mortality within 30 days (HR 9.05), while revascularization rates were similar (13.4% vs 15.8%). MACCE predictors in ACS included male (HR 2.62), mechanical circulatory support (HR 2.44), and radial access (HR 0.42). In patients without ACS, left ventricular ejection fraction <40% (HR 2.27), severe calcification requiring coronary atherectomy (HR 1.86), two-stent implantation (HR 1.99), and radial access (HR 0.59) were predictive. In this cohort with extensive use of intracoronary imaging, rates of two-stent implantation (8.9%), target lesion revascularization (4.0%), myocardial infarction (3.0%), and stent thrombosis (0.3%) were low. In conclusion, in contemporary left main percutaneous coronary intervention practice, patients presenting with ACS experienced worse 3-year outcomes, largely attributable to early mortality. After the early phase, longer-term outcomes, including revascularization, were comparable between ACS and non-ACS presentations.
Am J Cardiol
· 2026 Jun · PMID 41881096
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Finerenone is a novel nonsteroidal mineralocorticoid-receptor antagonist (MRA) that reduces adverse cardiovascular and renal outcomes in patients with chronic kidney disease and diabetes. Its comparative effectiveness ag...Finerenone is a novel nonsteroidal mineralocorticoid-receptor antagonist (MRA) that reduces adverse cardiovascular and renal outcomes in patients with chronic kidney disease and diabetes. Its comparative effectiveness against steroidal MRAs in cardio-oncology patients with higher clinical burden remains unknown. We aim to evaluate whether finerenone use in cardio-oncology patients is associated with reduced heart failure admissions and hyperkalemia events compared with spironolactone over 1 year. Secondary exploratory outcomes were also analyzed. We conducted a retrospective observational analysis using the TriNetX database comprising adults with a history of cancer, heart failure with a baseline ejection fraction ≥40%, and MRA initiation. Cardiovascular and renal outcomes were compared over 1 year of drug initiation after 1:1 propensity matching using Cox proportional hazard ratios (HRs). A total of 872 matched patients were included (mean age = 72, 45% female, 50% white, 23% receiving chemotherapy, 69% chronic kidney disease, and 90% diabetes). Finerenone users were associated with a lower risk of heart failure exacerbation (HR 0.51; 95% CI 0.35-0.76), all-cause mortality (HR 0.41; 95% CI 0.21-0.80), severe hyperkalemia (HR 0.57; 95% CI 0.40-0.83), and renal failure (HR 0.71; 95% CI 0.54-0.93) compared to spironolactone over 1 year. Individual risk of stroke was not different; however, composite major adverse cardiac events was lower with finerenone (HR 0.67; 95% CI 0.51-0.88), driven primarily by fewer heart failure events. In conclusion, finerenone was associated with fewer cardiac and renal adverse events with lower observed mortality compared with spironolactone in patients with a cancer history and heart failure (left ventricular ejection fraction ≥40%).
Mortada I, Lee AW, Quach V
… +6 more, Rice J, Mansour S, Chatila K, Shalaby M, Blackwell TA, Jneid H
Am J Cardiol
· 2026 Jun · PMID 41862113
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Tirzepatide has demonstrated cardiometabolic benefits in clinical trials, but real-world cardiovascular outcomes among patients without diabetes following acute cardiovascular events or stroke remain understudied. We eva...Tirzepatide has demonstrated cardiometabolic benefits in clinical trials, but real-world cardiovascular outcomes among patients without diabetes following acute cardiovascular events or stroke remain understudied. We evaluated clinical outcomes associated with early tirzepatide use after acute myocardial infarction (AMI) or ischemic stroke in patients without diabetes. We conducted a retrospective study using the TriNetX Research Network (110 healthcare organizations). Adults ≥18 years and body mass index ≥27 kg/m² without diabetes, with AMI or ischemic stroke from June 2022 to November 2025 were included. Patients treated with tirzepatide within 14 days of AMI/stroke were compared with those not receiving tirzepatide. Propensity score matching (1:1) across 28 covariates balanced demographics, comorbidities, medications, and laboratory values, yielding 833 patients per cohort. Outcomes were assessed over 2 years and included all-cause emergency room visit or hospitalization, acute kidney injury (AKI), ischemic stroke, heart-failure (HF) hospitalization, and major adverse cardiovascular events. Cox proportional hazard models were used to estimate hazard ratios (HRs). After matching, tirzepatide use was associated with significantly lower risk of all-cause emergency room visit or hospitalization (HR 0.64, 95% CI 0.548-0.741), AKI (HR 0.65, 95% CI 0.441-0.962), ischemic stroke (HR 0.82, 95% CI 0.703-0.947), and HF hospitalization (HR 0.24, 95% CI 0.0001-0.383). Major adverse cardiovascular events hazard did not differ significantly (HR 0.91, 95% CI 0.814-1.021). In conclusion, early tirzepatide initiation after AMI/stroke in patients without diabetes was associated with fewer hospitalizations and reduced renal, HF, and stroke events. These findings support prospective trials of tirzepatide for secondary cardiovascular prevention in non-diabetic patients.
Dave P, Moey MYY, Alfaifi A
… +4 more, Attumalil TV, Pandya D, Fam NP, Alnasser SM
Am J Cardiol
· 2026 Jun · PMID 41862112
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Persistent left atrial appendage thrombus despite anticoagulation is common. Current guidelines advise against percutaneous mitral balloon valvuloplasty (PMBV) because of perceived thromboembolic risk, leaving surgical m...Persistent left atrial appendage thrombus despite anticoagulation is common. Current guidelines advise against percutaneous mitral balloon valvuloplasty (PMBV) because of perceived thromboembolic risk, leaving surgical mitral valve replacement-an option associated with substantial morbidity-as the primary alternative. However, the procedural risk of PMBV in the setting of left atrial appendage thrombus remains poorly established. We conducted a systematic review and meta-analysis to assess this. Of the 2,136 studies identified in the initial search, 17 were included in the analysis, comprising 386 patients undergoing PMBV with left atrial appendage (LAA) thrombus. The rate of stroke or embolic complication was 2.8% (95% CI 1.4% to 5.5%). No stroke or embolic complications occurred in Type Ia thrombus. In conclusion, LAA-confined thrombus (Type 1a) was not associated with embolic events, supporting a morphology-based approach to patient selection and emphasizing the need for prospective data to refine the current guidelines.
Dubosq-Lebaz M, Kim J, Li S
… +3 more, Gouëffic Y, Sobocinski J, Secemsky E
Am J Cardiol
· 2026 Jun · PMID 41850470
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Outcomes in chronic limb-threatening ischemia (CLTI) depend on timely revascularization and sustained continuity of specialty care. Although community-level socioeconomic disadvantage is associated with worse outcomes, t...Outcomes in chronic limb-threatening ischemia (CLTI) depend on timely revascularization and sustained continuity of specialty care. Although community-level socioeconomic disadvantage is associated with worse outcomes, the impact of individual-level socioeconomic vulnerability on longitudinal outcomes and healthcare utilization after CLTI revascularization remains unclear. We analyzed 333,173 Medicare beneficiaries who underwent CLTI revascularization between 2016 and 2023. Socioeconomic vulnerability was defined by Dual Enrollment (DE) in Medicaid. Outcomes were assessed using Kaplan-Meier analyses and multivariable Cox proportional hazards models. The primary clinical outcome was major amputation. A composite endpoint of major amputation or death was analyzed to contextualize overall disease burden. The study period was stratified into pre-COVID (01/2016-03/2020), COVID (03/2020-12/2021), and post-COVID (12/2021-12/2023) phases. Healthcare utilization was compared between DE and Medicare-Only patients. Among the included patients, 26.2% were DE. DE patients were younger, more frequently female, and had a higher comorbidity burden. The crude cumulative incidence of the primary outcome was higher in DE patients (80.1% vs 79.7%; unadjusted HR 1.07, 95% CI 1.06-1.08), but this difference was not significant after adjustment (adjusted HR 1.00, 95% CI 0.99-1.01). DE patients had higher rates of major amputation (17.8% vs 12.7%; adjusted HR 1.10, 95% CI 1.07-1.12), with no adjusted differences in repeat revascularization or all-cause mortality. During COVID, DE patients had a higher adjusted risk of the primary outcome (HR 1.05, 95% CI 1.02-1.08), whereas risks were similar pre- and postpandemic. DE identifies CLTI patients at increased risk of limb loss despite similar adjusted survival, highlighting individual-level barriers to care continuity and the need for targeted strategies to reduce preventable amputations.
Nastasi D, Pruiti P, Grazia AD
… +1 more, Capodanno D
Am J Cardiol
· 2026 Jun · PMID 41839341
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Cardiac wall perforation is a recognized complication of pacemaker lead fixation. It is typically associated with deterioration of electrical parameters; however, this case demonstrates that perforation may occur despite...Cardiac wall perforation is a recognized complication of pacemaker lead fixation. It is typically associated with deterioration of electrical parameters; however, this case demonstrates that perforation may occur despite normal parameters and apparently normal device function. In patients with recent cardiac electronic device implantation, persistent or pleuritic chest pain should raise suspicion of myocardial perforation. Transthoracic echocardiography may be diagnostic, and cardiac computed tomography provides definitive confirmation when uncertainty remains.
Am J Cardiol
· 2026 Jun · PMID 41839340
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Cardioneuroablation (CNA) is an emerging treatment for refractory vasovagal syncope (VVS). While biatrial approaches are common, the efficacy of a stepwise strategy-beginning with right-sided ablation and progressing to...Cardioneuroablation (CNA) is an emerging treatment for refractory vasovagal syncope (VVS). While biatrial approaches are common, the efficacy of a stepwise strategy-beginning with right-sided ablation and progressing to the left atrium only if necessary-remains incompletely defined. We conducted an observational, retrospective registry (2024-2025) of 57 patients (mean age 34.5 ± 16.8 years) with highly refractory cardioinhibitory (Vasovagal Syncope International Study 2A/2B, 77.2%) or mixed (Vasovagal Syncope International Study 1, 22.8%) VVS. All patients had normal intrinsic conduction verified by electrophysiological study and a positive atropine challenge. A fragmented electrogram-guided stepwise CNA was performed. Left-sided ablation was performed exclusively if right-sided ablation failed to meet predefined end points (fragmented electrogram elimination, heart rate [HR] increase >25%, and postablation atropine response <10%). Acute procedural success was achieved in 96.5% of cases. Right-sided ablation alone met denervation criteria in 30 patients (52.6%), while 27 (47.4%) required a subsequent biatrial approach. The requirement for a biatrial approach was not significantly predicted by the predominant rhythm disturbance (sinus slowing vs AV block). At a mean follow-up of 12.5 ± 6.0 months, there were 0% syncope recurrences. Significant improvements were observed at 6 months in mean HR (59.7 ± 9.9 to 79.6 ± 7.8 beat/min; p < 0.001) and in all time- and frequency-domain HR variability parameters, confirming sustained parasympathetic withdrawal. A stepwise, electrogram-guided CNA is a highly safe and effective therapy for carefully selected patients with functional VVS. Initial right-sided ablation is sufficient in over half of the cases, safely optimizing procedure time and avoiding unnecessary left atrial access without compromising clinical outcomes.
Kalambay JD, Tashli M, Zaman M
… +3 more, Elwidaa A, Shet V, Phillip M
Am J Cardiol
· 2026 Jun · PMID 41833647
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Kounis syndrome (KS), an allergic acute coronary syndrome, remains incompletely characterized because available evidence is largely limited to case reports and small case series. We conducted a Preferred Reporting Items...Kounis syndrome (KS), an allergic acute coronary syndrome, remains incompletely characterized because available evidence is largely limited to case reports and small case series. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis with pooled patient-level data to quantitatively synthesize demographic patterns, clinical features, management strategies, and outcomes across published KS cases. A PubMed search identified 892 records, of which 3 studies met eligibility criteria, yielding 71 extractable cases. Study-level proportions were pooled using random-effects models with assessment of between-study heterogeneity. Age distribution varied by trigger, with contrast-related cases occurring at older ages, cephalosporin-associated cases at intermediate ages, and nonsteroidal anti-inflammatory drug-related cases at younger ages. Male predominance was consistent, with pooled estimates approximating 75%. ST-segment elevation was common, and angiographic abnormalities were present in 42%. Subtype distribution demonstrated substantial heterogeneity, particularly for Type I KS. Allergic-directed therapies, including corticosteroids and antihistamines, were frequently reported, whereas ischemia-directed therapies and invasive procedures were inconsistently documented. Recovery was the predominant outcome (94%), while mortality was low (4%). Shock and cardiac arrest occurred in a minority of cases, and pooled estimates demonstrated only a weak association between severity markers and mortality. In conclusion, this systematic review and meta-analysis provide a quantitative synthesis of KS, demonstrating trigger-specific demographic patterns, consistent male predominance, and generally favorable outcomes, although reporting variability limits definitive inference.
Salib A, Hay M, Abrahams T
… +4 more, Muthalaly R, Aldous E, Tu H, Nerlekar N
Am J Cardiol
· 2026 Jun · PMID 41833646
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Previous meta-analyses have shown that metabolic surgery reduces mortality as well as major adverse cardiovascular events. However, it remains underutilized as a cardiovascular intervention. This study aims to identify p...Previous meta-analyses have shown that metabolic surgery reduces mortality as well as major adverse cardiovascular events. However, it remains underutilized as a cardiovascular intervention. This study aims to identify patient subgroups most likely to benefit as well as compare outcomes from different metabolic surgery procedures. We systematically searched online databases for comparative cohorts (surgery vs no surgery) with ≥4-year follow-up and >200 participants. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality, myocardial infarction, heart failure (HF), stroke, and new atrial fibrillation (AF). Only unadjusted hazard ratios (HR) were extracted using random-effects models, and meta-regression was performed to identify any significant predictors. We included 25 studies (n = 659,517). MS was associated with lower risk of mortality (18 studies; HR 0.55 (95% CI [0.45, 0.67], p < 0.001), cardiovascular mortality (4; 0.36, [0.18, 0.72], p = 0.004), myocardial infarction (6; 0.61 [0.41, 0.90], p = 0.01), new HF (7; 0.55 [0.47, 0.65], p < 0.001), stroke (6, 0.80 [0.66 to 0.96], p = 0.02), and AF (3, 0.70 [0.55 to 0.89], p = 0.003). There were no specific study-level predictors that modified all-cause mortality. Associations were seen for cardiovascular mortality (ischemic heart disease, HF, and smoking) and AF (younger age, smoking). Benefits across all end points were consistent regardless of procedure subtypes. In conclusion, MS confers broad cardiovascular benefit with minimal effect modification from specific patient factors. Individual patient-level analyses and comparisons with modern incretin therapies are warranted.
Am J Cardiol
· 2026 Jun · PMID 41833644
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Cardiovascular disease remains the leading cause of mortality in New Mexico, where access to timely acute cardiac care is substantially influenced by geography. Large portions of the state are characterized by vast dista...Cardiovascular disease remains the leading cause of mortality in New Mexico, where access to timely acute cardiac care is substantially influenced by geography. Large portions of the state are characterized by vast distances, limited specialty infrastructure, and a predominantly rural and frontier population, exposing the limitations of population-density-based models of regionalized cardiovascular care. Drawing on clinical experience across both tertiary referral centers and rural hospitals and informed by publicly available state-level mortality and health infrastructure data, this Perspective examines "cardiology deserts" as a manifestation of system-level inequities in time-critical cardiac care delivery. The geographic clustering of 24/7 percutaneous coronary intervention-capable centers along major population corridors, particularly the I-25 axis, leaves extensive regions of the state reliant on prolonged interfacility transfer or delayed reperfusion strategies. Statewide cardiovascular mortality patterns parallel these spatial distributions, suggesting that geographic distance-independent of individual patient characteristics-functions as a clinically meaningful barrier to timely reperfusion, disproportionately affecting rural, frontier, Hispanic, and Native American communities. Addressing cardiology deserts in New Mexico requires a reframing of regionalized cardiac care that explicitly recognizes geography as a determinant of time-sensitive cardiovascular outcomes. Potential strategies include strengthening pharmaco-invasive reperfusion pathways, expanding telecardiology support for rural clinicians, and redesigning transfer networks to better reflect the realities of low-density practice environments. Without deliberate system-level adaptation, geographic distance will remain an underrecognized contributor to avoidable cardiovascular mortality in geographically expansive regions. In conclusion, aligning regional cardiac care models with geographic realities will be essential to reducing avoidable cardiovascular mortality in rural and frontier regions.
The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from acr...The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart team fellowship programs and specialized working groups to guide cardiovascular diagnostics and treatments focusing on critical areas such as congenital heart surgery, valve surgery and coronary artery bypass surgery (CABG) procedures which are becoming increasingly necessary in Africa due to the rise in cardiovascular emergencies, and finally explore solutions tailored to the continent's unique healthcare challenges. The incentives generated from the summit are formulated as the "2025 Accra Declaration" to serve as roadmaps and implementable guidelines for promoting high-level cardiovascular surgery and reforms in Africa in collaboration with cardiologists and other allied cardiovascular professionals.
Harmouch W, Thakker R, Shah S
… +7 more, Attaran R, Alqarqaz M, Basir MB, Anouti K, Motiwala A, Rangasetty U, Jneid H
Am J Cardiol
· 2026 May · PMID 41812921
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Complete revascularization (CR) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) is recommended, but the timing of revascularization, either immediate or staged remains a...Complete revascularization (CR) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) is recommended, but the timing of revascularization, either immediate or staged remains a topic of debate. A systematic search of MEDLINE, Scopus, and Cochrane databases was performed to identify randomized controlled trials (RCTs) that evaluated patients with STEMI and MVD and compared outcomes between immediate CR versus staged CR. The primary outcome was major adverse cardiovascular events. Eleven RCTs were included in this analysis with 4,472 patients assessed at a weighted mean follow-up of 18.5 months. Patients were 79% male with an average age of 64 years. Five RCTs utilized some degree of intravascular imaging or physiology, 7 RCTs explicitly excluded left main (LM) disease, and 6 RCTs exclusively utilized drug-eluting stents (DES). Compared to staged CR, immediate CR did not significantly reduce the incidence of major adverse cardiovascular events (risk ratios [RR] 0.92 [0.73, 1.17]), all-cause mortality (RR 1.31 [0.97, 1.78]), cardiovascular mortality (RR 1.28 [0.87, 1.90]), recurrent myocardial infarction (MI) (RR 0.78 [0.57, 1.07]), unplanned revascularization (RR 0.87 [0.67, 1.14]), or stent thrombosis (RR 1.39 [0.79, 2.43]). Safety endpoints were comparable between both groups: stroke (RR 0.91 [0.51, 1.62]), major bleeding (RR 0.76 [0.49, 1.18]), and acute nephropathy (RR 0.88 [0.59, 1.31]). Sensitivity analysis demonstrated consistent findings regarding the primary outcome across all scenarios. Immediate and staged CR demonstrated similar efficacy and safety. In conclusion, these neutral findings were consistent despite heterogeneity across RCTs, and support a revascularization approach incorporating anatomic complexity, physiology, procedural logistics, and patient-specific factors when determining the optimal timing of CR in patients with STEMI and MVD.