Background Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated cardio- and renoprotective effects in patients with heart failure and type 2 diabetes mellitus (T2DM). However, their impact on patients undergoing transcatheter mitral valve repair (TEER) remains unclear. This study aimed to evaluate the effects of SGLT2i use and clinical outcomes in patients with T2DM undergoing TEER.Methods A multicenter retrospective analysis using the TriNetX Research Network identified adults with T2DM who underwent TEER between 2015 and 2023. Patients receiving SGLT2is at the time of TEER (n = 325) were propensity-score-matched 1 : 1 to a non-SGLT2i group (n = 325). The primary outcomes at 1 year included all-cause mortality, major adverse cardiovascular events (MACE; composite of acute myocardial infarction, cardiac arrest, acute heart failure, and ischemic stroke), acute kidney injury (AKI), and major adverse kidney events (MAKE; composite of stage 5 chronic kidney disease, end-stage kidney disease, dialysis dependence, or kidney failure).Results After matching, the cohorts were well balanced across most baseline characteristics, with a residual difference in baseline renal function (higher eGFR in the SGLT2i group). At 1 year, SGLT2i use was associated with lower all-cause mortality (15.1 vs. 20.0%; hazard ratio 0.68, P = 0.038) and reduced MAKE (6.2 vs. 11.7%; hazard ratio 0.47, P = 0.005). There were no significant differences in MACE (52.0 vs. 46.2%, P = 0.136) or AKI (31.7 vs. 32.9%, P = 0.737).Conclusion Among patients with T2DM undergoing TEER, SGLT2i use was associated with significantly lower all-cause mortality and lower risk of MAKE at 1 year, despite similar rates of MACE and AKI. These findings support their potential renoprotective effects and overall survival benefits of SGLT2is in this high-risk population and warrant prospective validation.
Background/objectives We aimed to assess the clinical characteristics and in-hospital outcomes of elderly vs. nonelderly patients treated with cangrelor during percutaneous coronary intervention (PCI). Methods Patients undergoing PCI with cangrelor between January 2019 and May 2023 in seven Italian institutions were retrospectively enrolled. Patients aged >= 75 years at the time of PCI were classified as elderly. The primary endpoint was net adverse clinical events (NACE), a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis, and Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding, evaluated at 48 h post-PCI. The impact of advanced age (>= 75 years) on clinical outcomes was assessed using multivariable logistic regression (LR), inverse probability of treatment weighting (IPTW), and doubly robust (DR) models. Results A total of 1071 patients were included, of whom 340 (32%) were elderly. At 48 h, elderly patients had higher odds of NACE [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.12-3.97, P = 0.021 by multivariable LR; OR 1.98, 95% CI 1.45-2.27, P < 0.001 with IPTW; and OR 2.09, 95% CI 1.51-2.93, P < 0.001 by DR estimation]. These results were driven by an increased risk of both ischemic and bleeding events, the latter including access-site and nonaccess-site hemorrhages of both minor and major severity. Conclusions In this real-world study of patients undergoing PCI with cangrelor, elderly individuals accounted for one-third of the population. Elderly patients were at higher risk of NACE, driven by both ischemic and bleeding events.
Aims Balloon-expandable valve (BEV) and self-expanding valve (SEV) platforms have undergone significant technological advancements. This study aimed to compare postoperative outcomes in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve implantation (TAVI) using newer-generation BEV and SEV devices. Methods We retrospectively analyzed all patients who underwent TAVI for severe native AS at a single center between January 2018 and December 2023. Exclusion criteria included emergency procedures, active endocarditis, prior aortic valve interventions, bicuspid valves, primary aortic regurgitation, non-transfemoral access, concomitant coronary procedures, and use of retracted valves. Bioprosthetic valve dysfunction (BVD) was assessed according to modified Valve Academic Research Consortium 3 (VARC-3) definitions. Results Propensity score matching was used to create 354 well balanced pairs. Periprocedural outcomes, including mortality, were comparable between the matched BEV and SEV groups. However, echocardiographic evaluation at discharge revealed significantly higher mean transvalvular gradients (P < 0.001) and peak velocities (P < 0.001) in the BEV group. During follow-up, the SEV group showed a significantly lower incidence of BVD [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.45-0.91; P = 0.013], particularly regarding higher rates of severe prosthesis-patient mismatch (P = 0.001) and at least moderate structural valve deterioration (P = 0.006). No significant differences were observed in all-cause (HR: 1.18, 95% CI: 0.90-1.56, P = 0.235), or cardiac-related mortality (HR: 1.29, 95% CI: 0.91-1.83, P = 0.157). Conclusion Among patients treated with newer-generation transcatheter valves, SEV demonstrated more favorable hemodynamic performance compared with BEV. However, short- and mid-term mortality rates remained similar between the two groups. Longer-term follow-up of randomized trials is needed to confirm these findings.
Background Oral PCSK9 inhibitors are investigational agents that may broaden therapeutic choice beyond injectable PCSK9-targeting therapies, but their efficacy and short-term safety across evaluated dose strata remain incompletely characterized.Objectives To assess lipid-lowering efficacy and short-term safety across the lowest and highest evaluated dose strata in randomized trials.Methods We systematically searched PubMed, Embase, and CENTRAL from inception to November 2025 and included randomized, placebo-controlled trials of oral PCSK9 inhibitors reporting lipid or safety outcomes. Primary efficacy analyses evaluated percentage change in LDL-C separately for the lowest and highest evaluated dose strata. Secondary outcomes included ApoB, non-HDL-C, and Lp(a). Safety outcomes included any adverse event, serious adverse events (SAEs), and selected individual adverse events. Random-effects pairwise meta-analyses were performed separately for the two prespecified dose strata, with exploratory tests for subgroup differences. Sensitivity analyses excluded the HeFH trial. Certainty of evidence was graded using GRADE.Results Four trials (949 participants) met inclusion criteria. Both dose strata significantly reduced LDL-C, ApoB, non-HDL-C, and Lp(a), with larger pooled reductions generally observed in the highest evaluated stratum. Available short-term safety analyses did not detect statistically significant increases in overall, serious, or selected individual adverse events in either stratum. Sensitivity analyses yielded consistent estimates. Certainty of evidence for all primary efficacy outcomes was moderate.Conclusion Oral PCSK9 inhibitors substantially reduced atherogenic lipoproteins across the evaluated dose strata. These findings demonstrate pharmacodynamic lipid-lowering efficacy but do not establish a class-wide dose-response relationship, cardiovascular outcome benefit, or clinical equivalence to outcome-proven PCSK9 monoclonal antibodies. Longer-term safety and dedicated cardiovascular outcome trials are required.
Background and aims The triglyceride-glucose (TyG) index has emerged as a powerful and accessible marker of insulin resistance and a predictor of adverse events in patients undergoing percutaneous coronary intervention (PCI). Yet, its prognostic relevance in large, demographically diverse populations remains unestablished. This study sought to evaluate the association between the TyG index and clinical outcomes in a broad cohort of patients undergoing PCI at a high-volume tertiary care center in the United States.Methods We included consecutive patients undergoing PCI from 2012 to 2022. Quartiles of the TyG index, calculated as Ln(fasting triglycerides & times; fasting glucose/2), were derived and patients were stratified accordingly. The incidence of major adverse cardiovascular events (MACE), consisting of all-cause mortality, myocardial infarction (MI), or stroke, was assessed at 1 year. Multivariable Cox regression analyses were performed using the lowest TyG quartile as the reference.Results A total of 21 124 patients were enrolled. Those with higher TyG index values were more likely to be female and to have cardiovascular risk factors or comorbidities. They also exhibited a greater extent of coronary artery disease (CAD) and more complex PCI features, while showing a lower prevalence of moderate-to-severe coronary calcifications. At 1 year, MACE incidence increased progressively across quartiles, with the highest risk observed in the fourth quartile compared with the first. After multivariable adjustment, this association remained significant and was primarily driven by spontaneous MI.Conclusion In this large PCI cohort, the TyG index correlated with adverse cardiovascular outcomes, supporting its potential role in clinical practice.
