Pavani G, Pavani M, Cerrato E
… +8 more, Zecchino S, Zanda G, Piedimonte G, Rolfo C, Franzè A, Tomassini F, Chinaglia A, Varbella F
Am J Cardiol
· 2026 Jun · PMID 41905528
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An iatrogenic pseudoaneurysm of the left main coronary artery (LMCA) originating from in-stent restenosis represents an exceedingly rare and life-threatening complication of percutaneous coronary intervention. When such...An iatrogenic pseudoaneurysm of the left main coronary artery (LMCA) originating from in-stent restenosis represents an exceedingly rare and life-threatening complication of percutaneous coronary intervention. When such a lesion presents as an ST-elevation myocardial infarction (STEMI), it creates a clinical scenario of extraordinary therapeutic complexity. We report the case of a 78-year-old man with a history of complex multivessel percutaneous coronary intervention who presented with an anteroseptal STEMI. His emergent coronary angiogram identified the culprit lesion as critical in-stent restenosis of a previously stented LMCA trifurcation, which was further complicated by a large pseudoaneurysm within the stent body. Following hemodynamic stabilization with an intra-aortic balloon pump, a novel hybrid percutaneous strategy was undertaken. The intervention involved meticulous high-pressure balloon angioplasty to address the restenosis, followed by the complete exclusion of the pseudoaneurysm using endovascular coil embolization. Finally, coronary perfusion was re-established by implanting a contemporary drug-eluting stent. Postprocedural optical coherence tomography confirmed the successful sealing of the pseudoaneurysm and optimal stent apposition. This case documents a uniquely catastrophic clinical event and appears to be the first documented instance of an iatrogenic LMCA pseudoaneurysm secondary to ISR presenting as a STEMI. Our successful management demonstrates that a hybrid technique integrating coil embolization with modern drug-eluting stent implantation is a viable and effective strategy for confronting this formidable clinical challenge.
Edens M, Oliva A, Sartori S
… +13 more, Muro FMD, Nicolas J, Vogel B, Feng Y, Bay B, Moreno P, Gitto M, Sweeny J, Serrao G, Dangas GD, Sharma S, Mehran R, Kini A
Am J Cardiol
· 2026 Jun · PMID 41905527
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There is limited sex-specific data on patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), and little is known about the optimal management in female patients, including the impact of mechanical...There is limited sex-specific data on patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), and little is known about the optimal management in female patients, including the impact of mechanical circulatory support. This present study aims to evaluate sex-related clinical differences and disparities in the presentation, management, and outcome of male and female patients with AMI-CS who underwent percutaneous coronary intervention (PCI). Cardiogenic shock patients who underwent PCI at a large U.S. tertiary care center from 2012 onwards were included and stratified by sex. The primary outcome was all-cause death at 1 year after PCI. Survival curves were derived using the Cox proportional hazards regression model and covariate adjustment for confounders was performed. A total of 349 patients were included, and 106 (30.4%) were female. Baseline characteristics were similar with the exception of anemia, hypertension, and kidney disease, which were more common in female patients. Females were significantly less likely to receive a microaxial flow pump (21.7% vs 38.3%, p = 0.003) but were significantly more likely to receive an intraortic balloon pump (64.2% vs 46.9%, p = 0.003). At 1-year follow up, female patients had a higher incidence of all-cause death compared to male patients (48.0% vs 36.8%, hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.01 to 2.10), with early separation of curves within 30 days. In conclusion, among patients presenting with AMI-CS, female patients had a significantly higher unadjusted mortality at 1 year. These findings highlight the need for further investigation into the optimal management of AMI-CS in female patients.
Mallepally A, Patel A, Slivnick J
… +2 more, Shah KB, Trankle CR
Am J Cardiol
· 2026 Jun · PMID 41905526
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Transthyretin amyloid cardiomyopathy (ATTR-CM) is notoriously associated with delayed diagnosis and treatment barriers. Factors such as social determinants of health (SDOH) and race may have impacts on clinical outcomes....Transthyretin amyloid cardiomyopathy (ATTR-CM) is notoriously associated with delayed diagnosis and treatment barriers. Factors such as social determinants of health (SDOH) and race may have impacts on clinical outcomes. We sought to examine the impacts of SDOH and Black versus White race on clinical outcomes in ATTR-CM using a large national administrative claims dataset. We performed a retrospective cohort study in TriNetX of adults diagnosed with ATTR-CM from 2015 to 2023, identifying those with or without diagnosis codes for high-risk SDOH (ICD-10-CM Z55-65), which capture adverse conditions related to education, employment, housing, and economic instability. The cohort was further stratified by self-identified Black or White race. Propensity score matching of demographics and comorbidities was performed for between-group analyzes. The primary endpoint was a composite of all-cause mortality and hospitalization. Three-year event-free survival was estimated with Kaplan-Meier curves, and multivariable Cox proportional hazards models were used to examine between-group events. In total, 22,303 patients with ATTR-CM were identified, of whom 1,874 (8.4%) had diagnostic codes associated with high-risk SDOH. After propensity score matching, patients with high-risk SDOH had worse event-free survival compared to patients with low-risk SDOH (log-rank Chi-square = 92.611, p < 0.001), with high-risk SDOH being the among the strongest independent predictors of adverse outcomes (hazard ratio = 1.498, 95% confidence intervals [1.411 to 1.591], p < 0.001). Among patients with high-risk SDOH, similar event rates were observed between Black and White patients (log-rank Chi-square = 2.944, p = 0.139). However, in those with low-risk SDOH, Black patients experienced significantly worse event-free survival (log-rank Chi-square = 46.793, p < 0.001). In conclusion, among patients with ATTR-CM, diagnostic codes for high-risk SDOH were associated with worse clinical outcomes.
Rempakos A, Strepkos D, Alexandrou M
… +28 more, Mutlu D, Carvalho PEP, Kladou E, Sara JDS, Ser OS, Ybarra LF, Alaswad K, Basir MB, Khelimskii D, Jaffer F, Young L, Poommipanit P, Kumar S, Elguindy A, Chandwaney R, Cevik C, Ahmad Y, Azzalini L, Gorgulu S, Goktekin O, Rafeh NA, Mastrodemos O, Rangan BV, Jalli S, Voudris K, Sandoval Y, Burke MN, Brilakis ES
Am J Cardiol
· 2026 Jun · PMID 41903926
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The global chronic total occlusion (CTO) crossing algorithm was developed by experts to improve CTO percutaneous coronary intervention (PCI) outcomes but has yet to be validated using real-world data. To evaluate the ass...The global chronic total occlusion (CTO) crossing algorithm was developed by experts to improve CTO percutaneous coronary intervention (PCI) outcomes but has yet to be validated using real-world data. To evaluate the association between adherence to the global CTO crossing algorithm and outcomes in CTO PCI. We examined the clinical and angiographic characteristics and procedural outcomes of 13,852 CTO PCIs at 43 US and non-US centers between 2012 and 2025. Adherence to the global CTO crossing algorithm was defined using 3 characteristics: proximal cap ambiguity, poor distal vessel quality, and use of primary antegrade dissection/re-entry (ADR). Among 13,852 CTO PCIs, 70% (n = 9,693) followed the global CTO crossing algorithm. Discordant cases more frequently involved the right coronary artery (61.5% vs 49.4%, p < 0.001) and exhibited greater complexity: longer occlusions, proximal cap ambiguity, blunt/no stump, poor distal vessel quality, and calcification (all p < 0.001). Discordant lesions also had a higher J-CTO score (2.55 ± 1.18 vs 2.23 ± 1.27; p < 0.001). Algorithm adherence was associated with higher crossing success with the initially selected technique (72.5% vs 49.4%), technical (87.9% vs 85.6%), and procedural success (86.7% vs 84.2%) (all p < 0.001). The incidence of perforation was lower in concordant cases (4.1% vs 6.1%; p < 0.001), although major adverse cardiovascular events (MACE) were comparable. On multivariable analysis, algorithm adherence was independently associated with technical success (odds ratio 1.22; 95% confidence interval 1.04-1.42; p = 0.014). Adherence to the global CTO crossing algorithm is associated with greater crossing success using the initially selected strategy, higher technical success, and similar in-hospital MACE.
Adrejiya P, Mehta K, Patel D
… +3 more, Shah A, Bergmark B, Sharkawi M
Am J Cardiol
· 2026 Jun · PMID 41903925
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Transcatheter chordal repair enables off-pump, echocardiography-guided treatment of degenerative mitral regurgitation, but real-world outcomes remain variably reported. We performed a systematic review and meta-analysis...Transcatheter chordal repair enables off-pump, echocardiography-guided treatment of degenerative mitral regurgitation, but real-world outcomes remain variably reported. We performed a systematic review and meta-analysis of studies evaluating outcomes after transcatheter chordal repair in adults with primary degenerative mitral regurgitation. Pooled event rates were calculated using random-effects models. Seventeen studies (n = 3,787) were included. Mitral regurgitation ≤ mild was achieved in 93.9% of patients at discharge and 82.5% at 30 days, while moderate mitral regurgitation occurred in 5.0% and 17.5%, respectively. Procedural success was 96.2%, although small-study effects were suggested. Early adverse events were infrequent, with 30-day mortality of 1.2%, stroke of 0.7%, and myocardial infarction of 1.2%. Reintervention occurred in 4.5%. In conclusion, transcatheter chordal repair demonstrates high technical success and favorable early safety; however, early mitral regurgitation recurrence and heterogeneity highlight the need for anatomy-guided patient selection and cautious interpretation given single-arm study limitations.
Celeski M, Golino M, Muro FMD
… +11 more, Martino G, Bernardi M, Lo Sasso L, Di Gioia G, Biccirè FG, Popolo Rubbio A, Vecchione C, Cesaro A, Polimeni A, Mollo P, Testa L
Am J Cardiol
· 2026 Jun · PMID 41903924
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Coronary artery disease (CAD) remains the leading global cause of cardiovascular morbidity and mortality, driven by dysregulated lipid metabolism, chronic vascular inflammation, thrombosis, and genetic susceptibility. Ma...Coronary artery disease (CAD) remains the leading global cause of cardiovascular morbidity and mortality, driven by dysregulated lipid metabolism, chronic vascular inflammation, thrombosis, and genetic susceptibility. Management has long relied on mechanical revascularization-percutaneous coronary intervention and coronary artery bypass grafting supported by antithrombotic therapy. While these restore perfusion and reduce ischemic events, they do not address atherogenesis at the molecular level and leave substantial residual risk, often with increased bleeding. Advances in genomics, proteomics, lipidomics, inflammation biology, and artificial intelligence are transforming understanding of CAD pathophysiology and therapy. These innovations support a shift toward "pharmacological revascularization," extending beyond luminal repair to molecular plaque stabilization, inflammation modulation, metabolic correction, and sustained reduction of atherothrombotic risk. This review integrates evidence from multi-omics, advanced vascular imaging, and targeted therapies-including lipid-modifying, metabolic, anti-inflammatory, RNA-based, and gene-editing approaches-to propose a precision, data-driven framework focused on long-term restoration of vascular health.
Quevedo-Candela F, Cieza T, Ruhl A
… +2 more, Nolte C, Bertrand OF
Am J Cardiol
· 2026 Jun · PMID 41903923
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The management of side branch (SB) lesions in true coronary bifurcations remains controversial, particularly regarding long-term risks associated with metallic implants. Drug-coated balloons (DCB) have emerged as an alte...The management of side branch (SB) lesions in true coronary bifurcations remains controversial, particularly regarding long-term risks associated with metallic implants. Drug-coated balloons (DCB) have emerged as an alternative to drug-eluting stents (DES), offering a scaffold-free approach that may simplify percutaneous coronary intervention (PCI) and reduce adverse events. We performed a systematic review and meta-analysis of randomized and observational studies directly comparing placlitaxel DCB and limus-eluting DES for SB treatment. The primary endpoint was major adverse cardiac events (MACE) including cardiovascular death, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR); secondary endpoints included target lesion revascularization, binary restenosis, myocardial infarction, and all-cause or cardiovascular mortality. Risk of bias was assessed using RoB 2 and Newcastle-Ottawa tools. Five studies (n = 898) were included. In pooled random-effects analyses, DCB use was associated with a significant reduction in MACE (odds ratio 0.48, 95% confidence interval 0.27 to 0.81; p = 0.008) and target lesion revascularization (odds ratio 0.35, 95% confidence interval 0.19 to 0.68; p = 0.001). Late lumen loss was significantly lower with DCB across studies. In conclusion, placlitaxel DCBs therefore appeared to be an effective alternative to DES for SB lesions in true bifurcations. Larger randomized trials are still required to confirm these findings and clarify their role in bifurcation (side branch) PCI.
Ozbay B, Gokhale T, Saba SF
… +2 more, Villanueva F, Sade LE
Am J Cardiol
· 2026 Jun · PMID 41903922
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Specific tools are lacking for sudden cardiac arrest (SCA) risk assessment in patients with preserved left ventricular ejection fraction (LVEF) and nonhypertrophic ventricles. We hypothesized that echocardiographic globa...Specific tools are lacking for sudden cardiac arrest (SCA) risk assessment in patients with preserved left ventricular ejection fraction (LVEF) and nonhypertrophic ventricles. We hypothesized that echocardiographic global longitudinal strain (GLS) and left ventricular mechanical dispersion (LVMD) identify patients at risk of SCA in subjects with preserved LVEF. In this case-control study, patients evaluated in the electrophysiology clinic due to SCA between 2017 and 2022 were identified and matched 1:2 by age and sex with controls without SCA. Subjects were included if they had preserved LVEF (≥50%). GLS and LVMD (standard deviation of time to peak regional longitudinal strain from 16 segments) were computed offline using speckle-tracking echocardiography. For patients without coronary artery disease (CAD) or ischemic stroke, we calculated atherosclerotic cardiovascular disease and PREVENT risk scores. In 129 subjects (43 SCA, 86 controls) CAD was more frequent in the SCA group (48% vs 29%, p = 0.039). GLS, and LVMD significantly differed between the groups. Impaired GLS (≥-14%), prolonged LVMD (≥75 ms) and CAD were associated with SCA. Yet, GLS and LVMD were independent and incremental to the association between CAD and SCA. Adding GLS increased the strength of the association between CAD and SCA (Chi-square = 13.2, p = 0.001), and adding both GLS and LVMD further strengthened this association (Chi-square = 16.3, p <0.001). In patients without overt cardiovascular disease, GLS and LVMD remained significantly associated with SCA independently of atherosclerotic cardiovascular disease and PREVENT risk scores. In patients with preserved LVEF, GLS and LVMD appear to be promising SCA risk markers beyond CAD.
Adrejiya P, Bhanushali A, Mehta K
… +2 more, Amin M, Velarde GP
Am J Cardiol
· 2026 Jun · PMID 41895364
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Breast arterial calcification (BAC) is commonly observed on screening mammography and may provide a low-cost opportunistic marker to enhance cardiovascular risk assessment in women, in whom cardiometabolic risk is often...Breast arterial calcification (BAC) is commonly observed on screening mammography and may provide a low-cost opportunistic marker to enhance cardiovascular risk assessment in women, in whom cardiometabolic risk is often underrecognized by traditional scores. We performed a PRISMA-guided systematic review and meta-analysis of PubMed, Embase, Scopus, and ClinicalTrials.gov through April 30, 2025, to evaluate the association between BAC and both future cardiovascular events and underlying coronary pathology. Cohort studies reporting adjusted hazard ratios (HRs) for incident cardiovascular events were pooled using random-effects meta-analysis, with prespecified subgroup analyses by BAC ascertainment method and study design, while additional studies reporting odds ratios (ORs) for coronary artery disease (CAD) or coronary artery calcium (CAC) were synthesized separately. Four cohort studies, including approximately 25,000 women with 6 to 12 years of follow-up demonstrated that BAC was associated with significantly higher incident cardiovascular events (pooled HR 1.82, 95% CI 1.37 to 2.43; p <0.001), with the strongest association observed for radiologist-reported BAC and concordant findings across artificial intelligence-derived and densitometric measures, and no evidence of small-study effects. Across OR-based analyses including approximately 5,000 women, BAC was strongly associated with underlying coronary pathology, with a pooled adjusted OR of 4.00 (95% CI 2.44 to 6.56) for CAD and similarly elevated odds for CAC. In conclusion, BAC detected on routine mammography identifies women at substantially higher future cardiovascular risk and is strongly associated with subclinical coronary disease, supporting its potential role as a scalable, no-added-cost marker to enhance cardiovascular risk assessment in women.
Am J Cardiol
· 2026 Jun · PMID 41895363
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Cardiovascular diseases is the primary cause of death worldwide, responsible for about 17.9 million casualties annually. Among these, sudden cardiac arrest (SCA) emerging as an increasing health challenge, especially in...Cardiovascular diseases is the primary cause of death worldwide, responsible for about 17.9 million casualties annually. Among these, sudden cardiac arrest (SCA) emerging as an increasing health challenge, especially in younger populations. A large number of SCA cases occur in individuals under 50, where inherited arrhythmias and structural cardiac disorder, like hypertrophic cardiomyopathy are predominant causes, while coronary artery disease is the major cause in older adults. In spite of advancements in medicine, survival rate after SCA remains critically low. Early detection by family screening and genetic testing, combined with public awareness and education is vital to reduce the risk of sudden tragedy. This review synthesizes evidence on epidemiology, trends, and preventive strategies, highlighting the need to integrate precision medicine, campaigns for public health and focused awareness programs to counter the growing global burden of SCA among young individuals.
Gurgoglione FL, Frazzetto M, Gitto M
… +11 more, Leone PP, Iwańczyk S, Wańha W, Bossi I, Latini RA, Chiarito M, Godino C, Sardella G, Stefanini G, Colombo A, Cortese B
Am J Cardiol
· 2026 Jun · PMID 41895362
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Chronic kidney disease (CKD) is associated with adverse outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Drug-coated balloons (DCB) have emerged as a promising stentless alternative...Chronic kidney disease (CKD) is associated with adverse outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Drug-coated balloons (DCB) have emerged as a promising stentless alternative. This study aimed to compare the clinical outcomes of DCB-only PCI versus current-generation DES in patients with CKD. This pooled analysis integrated data from seven observational studies. The DCB cohort included the EASTBOURNE, Milan-DCB, RISE, and DRAGON registries. The DES cohort comprised the ULISSE, ASTUTE, RUDI-FREE, and DRAGON registries. The study population included 1.732 patients with CKD (eGFR <60 ml/min/1.73 m²), of whom 765 were treated with DCB and 967 with DES. The primary endpoint was major adverse cardiovascular events (MACE). Propensity score matching was applied to balance clinical and angiographic features. In the matched population (460 patients per group), the rate of MACE was similar between the two groups (hazard ratio [HR]: 1.09, 95% confidence interval: 0.71 to 1.66) at a mean follow-up of 564 days. DCB treatment was associated with a significantly lower incidence of Bleeding Academic Research Consortium major bleeding (HR 0.13; 95% confidence interval 0.03 to 0.48; p < 0.001). DCB-based PCI was associated with a lower risk of MACE in small-vessel disease (HR: 0.54; p for interaction = 0.04) and long (≥30 mm) lesions (HR: 0.44; p for interaction = 0.02). DCB treatment was associated with comparable rates of MACE at mid-term follow-up and a significantly lower incidence of major bleeding compared to current-generation DES in patients with CKD. These insights may facilitate a personalized revascularization approach in CKD patients.
Sawalha K, Ezenna C, Abughazaleh S
… +2 more, Chi KY, Goldsweig AM
Am J Cardiol
· 2026 Jun · PMID 41895360
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Intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) are both used to guide left atrial appendage occlusion (LAAO). Earlier comparative analyzes predate widespread adoption of 3-dimensional ICE,...Intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) are both used to guide left atrial appendage occlusion (LAAO). Earlier comparative analyzes predate widespread adoption of 3-dimensional ICE, and ICE was often reserved for patients with comorbidities precluding TEE. With continued technological advancements and increasing adoption of ICE, contemporary real-world comparisons are warranted. We conducted a large propensity-matched analysis using the TriNetX database to compare early outcomes between ICE- and TEE-guided LAAO from 2015 through 2025. Adults undergoing LAAO were identified using procedural codes, and 1:1 propensity score matching yielded 6,357 patients in each group. The primary outcome was major adverse events (MAE), defined as a composite of all-cause mortality, stroke, myocardial infarction, bleeding, pericardial effusion, cardiac arrest, and vascular complications. Secondary outcomes included pericardiocentesis, device-related thrombus, and peri-device leak at 7 and 45 days. At 7 days, ICE guidance was associated with a lower risk of MAE compared with TEE (766 vs 937 events; HR 0.81, 95% CI 0.74 to 0.89; p <0.0001), as well as lower rates of stroke and pericardial effusion. At 45 days, ICE remained associated with lower MAE risk (1,040 vs 1,193 events; HR 0.87; p = 0.0005), stroke, cardiac arrest, and pericardial effusion. Pericardiocentesis occurred more frequently in the ICE cohort. There were no significant differences in bleeding, device-related thrombus, peri-device leak, or mortality between groups. In conclusion, ICE-guided LAAO was associated with fewer early composite adverse events compared with TEE guidance, with similar mortality and device-related complication rates. These findings support the expanding use of ICE as an effective alternative imaging modality for LAAO.
Issaka Y, Abdul-Kareem H, Meyahnwi D
… +2 more, Ntow MA, Hahn S
Am J Cardiol
· 2026 Jun · PMID 41895359
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Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a cardiometabolic syndrome driven by obesity and related metabolic risk factors, yet strategies to prevent progression to clinically ov...Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a cardiometabolic syndrome driven by obesity and related metabolic risk factors, yet strategies to prevent progression to clinically overt heart failure in at-risk populations remain limited. We evaluated the association between initiation of glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy and subsequent heart failure hospitalization among adults with cardiometabolic risk and no prior heart failure using the TriNetX US Collaborative Network (2010 to 2024). In a new-user, active-comparator design, adults initiating a GLP-1RA were compared with those initiating sitagliptin, with 1:1 propensity score matching to balance demographics, cardiometabolic comorbidities, medications, and laboratory measures. The primary outcome was heart failure hospitalization, assessed from 1 day through 5 years after treatment initiation. Secondary outcomes included clinically diagnosed HFpEF, defined by International Classification of Diseases, Tenth Revision codes, and all-cause mortality. After matching, 219,189 patients were included in each group with well-balanced baseline characteristics. During follow-up, GLP-1RA initiation was associated with a lower cumulative incidence of heart failure hospitalization compared with sitagliptin (5.4% vs 8.1%; risk ratio 0.66; 95% confidence interval 0.65 to 0.68), with consistent findings across landmark, era-restricted, and agent-specific sensitivity analyses. Associations were also observed for lower rates of clinically diagnosed HFpEF (risk ratio 0.72; 95% confidence interval 0.70 to 0.74) and all-cause mortality. In conclusion, among adults with cardiometabolic risk and no prior heart failure, initiation of GLP-1RA therapy was associated with lower rates of heart failure hospitalization compared with sitagliptin, suggesting potential modification of clinical trajectories leading to overt heart failure that warrants confirmation in prospective studies.
Burhan M, Ibrahim T, Naveed MA
… +7 more, Ansari Z, Ansab M, Fatima K, Ashraf S, Shahid ZUA, Raza A, Raza SHA
Am J Cardiol
· 2026 Jun · PMID 41887560
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This updated systematic review and meta-analysis evaluated the efficacy and safety of olezarsen in patients with dyslipidemia. PubMed, Embase, Cochrane CENTRAL, and Scopus were searched through September 2025 for randomi...This updated systematic review and meta-analysis evaluated the efficacy and safety of olezarsen in patients with dyslipidemia. PubMed, Embase, Cochrane CENTRAL, and Scopus were searched through September 2025 for randomized controlled trials comparing olezarsen with placebo. Seven trials (n = 2,121) were included. Olezarsen significantly reduced triglycerides (mean difference [MD] -59.20 mg/dL), very-low-density lipoprotein cholesterol (MD -52.68 mg/dL), apolipoprotein B (MD -10.74 mg/dL), non-HDL cholesterol (MD -17.06 mg/dL), and apolipoprotein C-III (MD -64.16 mg/dL), and increased HDL cholesterol (MD 30.97 mg/dL), with no significant effect on LDL cholesterol. Injection site reactions (risk ratio [RR] 3.93) and platelet counts <140,000/µL (RR 4.76) were increased, whereas serious adverse events and significant liver enzyme elevations were comparable to placebo. Certainty of evidence ranged from moderate to low. In conclusion, olezarsen produces substantial improvements in triglyceride-rich lipoproteins with an acceptable safety profile; long-term cardiovascular outcome trials are warranted.
Güner A, Alizade E, Tanık VO
… +14 more, Püşüroğlu H, Karaüzüm K, Varım P, Çizgici AY, Kümet Ö, Akyüz AR, Arslan E, Serin E, Deniz MF, Hakgor A, Suna M, Aktürk İF, Uzun F, Other Members of the EVOLUTE-WOVEN Study Investigators
Am J Cardiol
· 2026 Jun · PMID 41887558
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Woven coronary artery anomaly (WCAA) is a rare congenital anomaly in which a coronary artery is divided into thin channels. This study aimed to assess the clinical outcomes of the percutaneous coronary intervention (PCI)...Woven coronary artery anomaly (WCAA) is a rare congenital anomaly in which a coronary artery is divided into thin channels. This study aimed to assess the clinical outcomes of the percutaneous coronary intervention (PCI) and guideline-directed medical therapy (GDMT) in patients with WCAA under mid-term follow-up. From 2011 to 2025, patients who underwent PCI or received GDMT for WCAA were retrospectively collected. The primary outcome measurement was defined as a major adverse cardiac event (MACE) and was the composite of cardiac death, target-vessel myocardial infarction (MI), target vessel revascularization, or rehospitalization for angina pectoris. The secondary endpoint was defined as the combination of death or target-vessel MI during follow-up. Sixty-one consecutive WCAA patients [male:52 (85%), mean age:56.27 ± 9.89 years] were included in this multicenter (n = 12) study. The study cohort was divided into 2 groups: PCI (n = 30) and GDMT (n = 31). The most commonly used guidewires for successful wiring were Fielder XT-R and Gladius MG. The MACE (19% vs 3.3%, p = 0.104), death or MI (13% vs 3.3%, p = 0.354), and rehospitalization for angina (19% vs 3.3%, p = 0.104) rates were numerically higher in the GDMT group than in the PCI group. Inverse probability weighted-Cox regression analysis showed that the MACE (unadjusted HR 0.091, p = 0.028) was significantly different, while death or MI (unadjusted HR 0.160, p = 0.101) did not differ between the 2 groups. In conclusion, current data suggest that PCI may be associated with a lower risk of MACE, mainly driven by rehospitalization for angina pectoris, and comparable death or MI to GDMT; however, a strong inference cannot be made due to the retrospective observational design.
Suruagy-Motta RFO, Carvalho PEP, da Silva LD
… +10 more, de Oliveira Oldra LG, Pereira MSS, Silva LV, Almeida LGS, Ferreira LCC, Pinto ELO, Pileggi B, Filho EM, Gibson CM, Brilakis ES
Am J Cardiol
· 2026 Jun · PMID 41887557
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Drug-coated balloons are the preferred treatment for in-stent restenosis (ISR), avoiding the need for a second metallic layer. While both paclitaxel-coated balloons (PCB) and limus-coated balloons (LCB, typically sirolim...Drug-coated balloons are the preferred treatment for in-stent restenosis (ISR), avoiding the need for a second metallic layer. While both paclitaxel-coated balloons (PCB) and limus-coated balloons (LCB, typically sirolimus or biolimus) are used, direct comparative evidence is limited, particularly regarding their long-term angiographic efficacy and clinical safety. We conducted a systematic review and study-level meta-analyzis of studies comparing LCB with PCB for coronary ISR. A comprehensive search was performed across PubMed, Embase, Cochrane, Scopus, Web of science for randomized controlled trials. Outcomes were compared using risk ratios (RR) for categorical data and mean differences for continuous data in a random-effects model. Heterogeneity was assessed using the I statistic. Six randomized controlled trials involving 1,038 patients were included (552 in the LCB group and 481 in the PCB group). Compared with PCB, LCB were associated with a significantly higher risk of clinically driven target lesion revascularization (RR: 1.48; 95% CI: 1.02 to 2.14; p = 0.04; I = 0%) and target lesion failure (RR: 1.19; 95% CI: 0.87 to 1.62; p = 0.27; I = 0%). In contrast, both platforms demonstrated no differences in all-cause mortality (RR: 0.98; p = 0.96), myocardial infarction (RR: 0.73; p = 0.46), stent thrombosis (RR: 0.66; p = 0.57), or MACE (RR: 1.09; p = 0.58). Angiographic outcomes were comparable, including late lumen loss (mean differences: -0.00 mm; p = 0.65; I = 74.7%) and minimal lumen diameter (mean differences: -0.12 mm; p = 0.07). In patients with ISR, PCB reduced repeat revascularization compared with LCB. These data suggest a modest advantage for PCB in preventing restenosis following drug-coated balloon angioplasty for ISR.