QuestionDoes achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) levels help prevent neoatherosclerosis after drug-eluting stent implantation in patients with ST-segment elevation myocardial infarction (STEMI)?FindingsIn this secondary analysis of the CONNECT randomized clinical trial, neoatherosclerosis was less frequent in patients who achieved guideline-endorsed LDL-C levels and received high-intensity statin therapy. On-treatment LDL-C level emerged as an independent determinant of neoatherosclerosis.MeaningAchieving guideline-recommended LDL-C levels through intensive lipid-lowering therapy may help prevent neoatherosclerosis formation and prevent late stent failure in patients with STEMI. ImportanceNeoatherosclerosis represents a major cause of late stent failure and results in cardiac events after drug-eluting stent (DES) implantation. Achieving secondary preventive low-density lipoprotein cholesterol (LDL-C) target levels can reduce plaque progression in native coronary arteries; however, its association with neoatherosclerosis formation remains unclear.ObjectiveTo determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation.Design, Setting, and ParticipantsThis is a post hoc analysis of the CONNECT randomized clinical trial conducted at 7 sites in Switzerland and Japan that had randomized 239 patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) with biodegradable- or durable-polymer everolimus-eluting stents between June 2017 and June 2020. The prevalence of neoatherosclerosis was assessed with optical coherence tomography (OCT) 3 years after primary PCI. Data analysis for this post hoc analysis was conducted from September 2024 to October 2025.InterventionPatients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines.Main Outcomes and MeasuresThe prevalence of neoatherosclerosis 3 years after primary PCI was compared between patients with vs without achievement of guideline-endorsed target LDL-C levels. A multivariable predictor analysis was performed to determine whether on-treatment LDL-C levels were associated with occurrence of neoatherosclerosis.ResultsAmong 178 patients (mean [SD] age, 63.4 [10.9] years; 27 [15%] female) who underwent OCT at 3 years, 98 patients (55%) achieved the target LDL-C level and 80 patients (45%) did not. The mean (SD) on-treatment LDL-C levels for these groups were 48 (13) and 87 (37) mg/dL, respectively (to convert to millimoles per liter, multiply by 0.0259). The prevalence of neoatherosclerosis was lower in patients who achieved the target LDL-C level as compared with patients who did not (7 patients [7%] vs 15 patients [19%], respectively; odds ratio for those who did not achieve the LDL-C target level, 3.00; 95% CI, 1.19-8.24; P = .02). On-treatment LDL-C level (per 25-mg/dL increase) emerged as an independent determinant of neoatherosclerosis at 3 years in multivariable logistic regression analysis (odds ratio, 1.46; 95% CI, 1.09-2.01; P = .01).Conclusions and RelevanceOn-treatment LDL-C level emerged as an independent predictor of neoatherosclerosis 3 years after DES implantation for STEMI. Neoatherosclerosis was less frequent among patients who achieved the guideline-recommended on-treatment LDL-C level, underscoring the importance of LDL-C lowering in preventing neoatherosclerosis formation.Trial RegistrationClinicalTrials.gov Identifier: NCT03440801 This secondary analysis of the CONNECT randomized clinical trial evaluates whether achieving a guideline-endorsed low-density lipoprotein cholesterol level after drug-eluting stent implantation in patients with ST-segment elevation myocardial infarction (STEMI) is associated with reduced risk of long-term neoatherosclerosis formation.
INTRODUCTION:Antibiotics and proton pump inhibitors (PPIs) have been associated with the reduced efficacy of immune checkpoint inhibitor (ICI) in patients with advanced non-small cell lung cancer (NSCLC). This study assessed the clinical impact of these medications in the neoadjuvant setting. PATIENTS AND METHODS:This multicenter retrospective study was conducted in 29 Japanese institutions. Between March 2023 and July 2024, 131 patients with resectable clinical stage II-III NSCLC who received neoadjuvant chemoimmunotherapy with nivolumab were enrolled. In total, 113 patients who underwent definitive surgery were included in the surgical outcome analysis. We investigated the association between the use of antibiotics and PPIs within 30 days before treatment initiation and clinicopathological factors, including the pathological complete response (pCR) and major pathological response (MPR). RESULTS:Among 113 patients, 5 (4.4%) had received antibiotics and 23 (20.4%) PPIs. Antibiotic and PPI use showed no significant differences in any clinicopathological factors. Antibiotic and PPI use was not significantly associated with the objective response rate (ORR), pCR, or MPR; antibiotic (use/non-use): 80.0%/70.4% (p = 1.000), 40.0%/35.8% (p = 1.000), 60.0%/59.6% (p = 1.000) and PPI (use/non-use): 78.3%/68.9% (p = 0.532), 43.5%/33.3% (p = 0.507), 60.9%/58.9% (p = 1.000). CONCLUSION:Prior use of antibiotics and PPIs was not significantly associated with radiological or pathological response of neoadjuvant ICI in patients with resectable NSCLC. Further studies with larger sample size and longer survival follow-up are needed.
Background Concealed nodoventricular orthodromic re-entrant tachycardia (NV-ORT) is an extremely rare form of paroxysmal supraventricular tachycardia that can mimic the electrophysiologic characteristics of slow/fast atrioventricular nodal re-entrant tachycardia (AVNRT). Case Summary A 65-year-old woman presenting with narrow QRS tachycardia underwent an electrophysiologic study, which revealed dual atrioventricular nodal physiology and inducible wide QRS tachycardia with right bundle branch block triggered by catheter stimulation, accompanied by an atrio-His jump. Ventricular overdrive pacing demonstrated a ventricular-ventricular-atrial activation sequence, orthodromic His capture, and termination without atrial capture during the fusion period. The tachycardia was diagnosed as NV-ORT, and successful slow pathway ablation eliminated inducibility. Discussion NV-ORT closely resembles slow/fast atrioventricular nodal re-entrant tachycardia, but diagnosis can be challenging when ventriculoatrial conduction block is absent or retrograde conduction occurs via the fast pathway. Take-Home Message Recognition of NV-ORT requires careful analysis of pacing responses and His potentials.
The effect of CT slice thickness on hematoma volume estimation using planimetry and ABC/2 in intracerebral hemorrhage (ICH) has not been characterized. This study aimed to identify the optimal slice thickness and estimation methodology. Consecutive patients with ICH were retrospectively reviewed. Baseline and follow-up CT scans with slice thickness ≤ 1.25 mm were collected and resliced to thicknesses of 1.25 mm, 2.5 mm, and 5.0 mm. Hematoma volume was measured using planimetry and ABC/2, yielding six estimates per scan. Volume estimates by planimetry at 1.25 mm were used as the reference standard, and percentage errors were compared among the six estimates. A total of 255 patients were enrolled. Pairwise comparisons revealed that greater slice thickness was significantly associated with higher absolute percentage error in planimetry on both baseline and follow-up CT scans, except for 2.5 mm vs. 5.0 mm on follow-up. With ABC/2, only the pairs of 1.25 mm vs. 2.5 mm and 1.25 mm vs. 5.0 mm on baseline showed significant differences. Each planimetry–ABC/2 comparison demonstrated significant differences. Signed percentage errors with planimetry remained consistently within narrow ranges regardless of slice thickness, hematoma volume, and shape, whereas those with ABC/2 varied markedly depending on these factors. This study showed that CT slice thickness affects hematoma volume estimation, with differing impacts by methodology. In planimetry, percentage errors increased slightly with greater thickness but remained small. In ABC/2, percentage errors were generally larger, varied substantially with slice thickness, hematoma volume, and shape.
