Open Heart

BackgroundPrevious evidence has established the role of pharmacists in heart failure (HF) care. However, the specific role of health-system pharmacists within in- and outpatient settings for HF patients has been left unexplored. This systematic review and meta-analysis aimed to evaluate the impact of health-system pharmacy interventions on all-cause and HF hospitalizations. MethodsA systematic literature search was performed using PUBMED and EMBASE, following PRISMA guidelines. Randomized contr...

BackgroundIt was recently reported that highly elevated plasma activity of the ADP-scavenging enzyme creatine kinase (CK), to >10 times the upper reference limit (URL), is independently associated with fatal or non-fatal bleeding during treatment for ST-segment elevation myocardial infarction (OR 2.6 [95% CI, 1.8 to 2.7]/log CK increase). Evidence indicates that CK attenuates ADP-dependent platelet aggregation. This study investigates whether moderately elevated CK in non-ST-segment elevation ac...

BackgroundUnfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). However, current guidelines do not provide clear recommendations for UFH pretreatment before arrival at the coronary catheterisation laboratory. MethodsBetween June and July 2023, we systematically searched PubMed, Embase and Cochrane databases for studies comparing UFH pretreatments in patients with STEMI. A rando...

BackgroundMean platelet volume (MPV) is a widely available laboratory index, however its prognostic significance in patients with coronary artery disease (CAD) is still unclear. We intended to investigate and pool the evidence on the prognostic utility of admission MPV in predicting clinical outcomes in patients with CAD. MethodsPubMed, Web of Science, and Scopus were the major databases used for literature search. The risk of bias was assessed using the quality in prognostic factor studies. We...

BackgroundGuidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain. MethodsIn a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/L to sex-specific 99th percentile) in whom myocardial infarction was ruled out were enrolled and underwent coronary computed tomography angiography (CCT...

BackgroundIn multivessel disease (MVD) patients with successful primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), the Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction (FLOWER-MI) trial showed that a fractional flow reserve (FFR)-guided strategy was not superior to an angiography-guided strategy for treatment of non-infarct-related artery lesions regarding the one-year risk of death from any cause, MI, or u...

BackgroundWhether symptom descriptors meaningfully change post-test probability for occlusion myocardial infarction (OMI) in the emergency department (ED) remains uncertain, particularly when the reference standard is imperfect and may miss NSTEMI-OMI without ST elevation. MethodsWe retrospectively analyzed 13,262 ED encounters (2021-2025) with chest pain, ECG, and hs-cTnI testing. The index test was a legacy descriptor (type A/B vs C/D). The composite reference was door-to-balloon activation o...

BACKGROUNDShenfu injection, as a traditional Chinese medicine, can alleviate reperfusion injury after ST-segment elevation myocardial infarction (STEMI) through multiple pharmacologic effects. This trial aimed to evaluate the effect of Shenfu injection on myocardial injury in STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODSThis was a multicenter, randomized, double-blind, parallel-group, placebo-controlled trial. First-time anterior STEMI patients undergoing p...

BackgroundHighly elevated plasma activity of the ADP scavenging enzyme creatine kinase (CK) might reduce ADP and ADP-dependent platelet activation. Therefore, we studied, whether high CK after myocardial infarction (MI) is associated with bleeding. MethodsData of the Thrombolysis In Myocardial Infarction Study Group phase II trial on the efficacy of angioplasty following intravenous recombinant tissue-type plasminogen activator (rt-PA), are used to assess whether peak plasma CK (CKmax) is indep...

Background and aimsThe utility of cardiovascular and inflammatory biomarkers to detect coronary obstruction and predict survival benefit of revascularisation in chronic coronary syndrome (CCS) remains unclear. MethodsPatients undergoing coronary angiography for suspected CCS were studied. High-sensitivity cardiac troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and copeptin were measured. Diagnostic per...

BackgroundThe dual-antiplatelet therapies (DAPT) of clopidogrel, prasugrel, or ticagrelor in concomitant use with acetylsalicylic acid are the contemporary treatment regimens for acute coronary syndromes (ACS). Systematic comparative effectiveness and safety analyses currently lack clinically meaningful interpretations of the summarized evidence. MethodsWe systematically searched MEDLINE, EMBASE, CENTRAL, and clinicaltrials.gov for randomized controlled trials (RCTs) that reported on either the...

BackgroundAmong patients with ST segment elevation myocardial infarction (STEMI), higher concentrations of high sensitivity troponin T (hs-cTnT) are associated with larger MI size and predict a worse prognosis. In the 2467 patient CELEBRATE trial, a single subcutaneous injection of the short-acting glycoprotein IIb/IIIa receptor blocker antagonist zalunfiban at first medical contact significantly improved the primary outcome including clinical endpoints. In this study, we assessed the impact of ...

BackgroundIn the setting of ST-segment elevation myocardial infarction (STEMI), imaging-based biomarkers could be useful for guiding oral anticoagulation for primary prevention of stroke. ObjectivesTo test the efficacy of intraventricular blood stasis imaging for predicting a composite primary endpoint of cardioembolic risk during the first 6 months after STEMI. MethodsThe Imaging Silent Brain Infarct in Acute Myocardial Infarction (ISBITAMI, NCT02917213) was a prospective clinical study inclu...

ObjectivesWhile the use of novel oral anticoagulants (NOACs) has been approved in the treatment of non-valvular atrial fibrillation (NVAF), we are lacking studies on individual NOACs in NVAF with valvular heart disease (VHD) including bio-prosthetic valve and valve repair. We aimed to determine the efficacy and safety of rivaroxaban compared to warfarin in prevention of thromboembolism in patients with NVAF with VHD. MethodsWe searched PubMed, MEDLINE, and EMBASE including only RCTs and Cohort ...

BACKGROUNDTicagrelor has many protective cardiovascular properties in addition to its potent antiplatelet action. This study aims to compare the effects of ticagrelor versus clopidogrel on infarcted mass, quantified by cardiac magnetic resonance imaging (cMRI), in patients with ST-segment elevation acute myocardial infarction (STEMI). METHODS AND RESULTSAdult patients of both sexes with STEMI under pharmaco-invasive strategy were included (n=225). Patients were thrombolized within six hours of ...

PurposeIn July 2018, the Food and Drug Administration recalled valsartan due to carcinogenic impurities, leading to an unprecedented drug shortage leading to management challenges impacting a large population of valsartan users. However, the extent to which the valsartan recall impacted clinical outcomes is unknown. Our objective was to compare the risk of adverse events between patients with hypertension using valsartan and a propensity-score-matched group of patients using non-recalled angiote...

BackgroundAim of this study was to test if oral anticoagulant (OAC) use in patients with heart failure (HF), accompanied by atrial fibrillation (AF), leads to a favorable outcome. Further, the specific impact of non-vitamin K oral anticoagulants (NOACs) is analyzed. MethodsAnonymous data from all patients with a health insurance at the largest entity which covers approximately 30% of the German population. Patients with a claims record for hospitalization with the main diagnosis of HF and AF fr...

BackgroundCarriers of the CYP2C19 Loss of Function (LoF) allele may experience decreased efficacy of clopidogrel in secondary prevention after cardiovascular events. Randomized clinical trials of clopidogrel in patients with known CYP2C19 carrier status provided inconsistent results. Our aim was to pool the evidence on the effect of clopidogrel on outcome, according to CYP2C19 LoF status, in a meta-analysis. MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) on ...

ObjectiveHeart failure (HF) is a common disease among elderly individuals and is associated with poor quality of life and prognosis. Individuals at risk of developing HF are often already patients in primary healthcare, but it is often a difficult diagnosis at an early stage. Identifying patients at high risk for HF and initiating early treatment is crucial for their outcomes. Using the variables gender, age, multimorbidity (MM) level, and socioeconomic status (SES), we aimed to study the possib...

BackgroundElevated plasma/serum troponin, indicating perioperative myocardial injury (PMI), is common after non-cardiac surgery. However, underlying mechanisms remain unclear. Acute coronary syndrome (ACS) is associated with the early appearance of circulating microRNAs, which regulate post-translational gene expression. We hypothesised that if PMI and ACS share pathophysiological mechanisms, common microRNA signatures should be evident. MethodsNested case-control study of samples obtained befo...