Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
BACKGROUND AND AIMS:Atrial functional mitral regurgitation (AFMR) commonly affects elderly and frail individuals. The prognostic impact of transcatheter edge-to-edge repair (TEER) for AFMR has not been investigated. METHODS:Patients with AFMR who underwent TEER were selected from the OCEAN-Mitral registry, and medically managed controls were selected from the REVEAL-AFMR registry, using an identical AFMR definition. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. The secondary endpoint was all-cause mortality. RESULTS:A total of 1081 patients (mean age 80.1 ± 8.2 years, 60.5% female) with moderate or severe AFMR were included, of whom 441 underwent TEER and 640 remained on medical treatment. Overlap weighting based on the propensity score yielded well-balanced characteristics (n = 441 vs 640; all standardized mean differences <0.01), where TEER was associated with a lower incidence of the primary (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.43-0.99, P = .044) and secondary endpoints (HR 0.58, 95% CI 0.35-0.99, P = .044). In an exploratory subgroup analysis, favourable outcomes might be pronounced in patients with ≤mild residual AFMR after TEER, while event rates in those with ≥ moderate residual AFMR were comparable with the medication group. As sensitivity analyses, inverse probability of treatment weighting (n = 158 vs 173), propensity score matching (n = 104 vs 104), and multivariable Cox regression (n = 441 vs. 640) all confirmed favourable associations of TEER with both endpoints. CONCLUSIONS:In real-world data, TEER for patients with moderate or severe AFMR were associated with a lower incidence of adverse events compared with medical treatment.
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.
BACKGROUND:The poor prognosis of hemodialysis (HD) patients following transcatheter aortic valve replacement (TAVR) has been established; however, data on the outcomes in the latest generation of devices remain inconsistent. OBJECTIVES:The authors aimed to compare the 1-year clinical outcomes post-TAVR using the latest generation of devices in HD and non-HD patients. METHODS:From the multicenter registry, 760 HD and 3,928 non-HD patients were identified from the OCEAN-TAVI (Optimized transCathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation; UMINID:000020423) registry. To minimize differences in baseline characteristics, 1:1 propensity score matching (PSM) was performed (490 patients each). The primary clinical endpoint was all-cause mortality at 1 year. Secondary endpoints included cardiovascular death, stroke, and heart failure rehospitalization. RESULTS:In the overall cohort, during 208 (41-373) days of follow-up, HD patients had higher 1-year mortality than non-HD patients (105 of 760 [13.8%] vs 189 of 3,928 [4.8%], HR: 2.62; 95% CI: 2.13-3.23; P < 0.001); this difference was attenuated (59 of 490 [12.0%] vs 65 of 490 [13.3%], HR: 1.03; 95% CI: 0.75-1.42; P = 0.858) following well-balanced PSM. There were no significant differences in any secondary endpoints between the 2 groups after PSM; however, HD remained an independent predictor of 1-year mortality in a multivariate analysis of the cohort before PSM. CONCLUSIONS:The poor prognostic value of HD was attenuated after adjusting for baseline risk factors. These findings suggest that the poor outcomes of HD patients result from the burden of multiple comorbidities in addition to the HD risk itself. Considering TAVR as a treatment option for exceptionally high-risk populations will aid in the careful patient selection and realistic prognostic assessments.
BACKGROUND:The interplay between atrial fibrillation (AF) and tricuspid regurgitation (TR) has been recognized. However, it is not simple and has not been fully investigated. OBJECTIVES:The aim of this study was to examine the association among AF, TR, and outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER). METHODS:Patients were divided into 4 groups according to the presence of AF and postprocedural significant TR (moderate or greater): no AF and no TR, no AF with significant TR, AF and no TR, and AF with significant TR. The primary outcome was cardiovascular death or heart failure (HF) hospitalization. Right heart structure and function were also evaluated according to AF and TR status. RESULTS:The numbers of patients in each group were 1,184 (no AF and no TR), 229 (no AF with significant TR), 1,423 (AF and no TR), and 830 (AF with significant TR). AF was associated with a higher prevalence of significant TR at baseline and more frequent TR progression and less common improvement during follow-up. Both AF and TR appeared to be independently associated with right-ventricular remodeling and dysfunction, with distinct patterns observed according to MR and TR pathologies. TR grade moderate or greater after M-TEER was associated with a higher adjusted risk for cardiovascular death or HF hospitalization, especially in patients with AF (Pinteraction = 0.02). CONCLUSIONS:Patients with AF, compared with those without AF, experienced greater incidence and progression and less common improvement of TR after M-TEER. In addition, both AF and TR appeared to be independently associated with worse right ventricular status and an increased risk for HF outcomes.
