Myocardial ischemia-reperfusion injury (MIRI) remains a critical clinical condition with limited preventive and therapeutic strategies, underscoring the need for novel interventions. The gut-heart axis and exosomal crosstalk hold therapeutic promise for cardioprotection, yet the fundamental question of which specific gut cells release the beneficial exosomes is unanswered. This study aimed to elucidate whether ginseng polysaccharides WGPA exert remote cardiac protection by regulating intestinal immune homeostasis, specifically through promoting the release of exosomes from regulatory T cells (Tregs). Using integrated in vivo and in vitro models, we evaluated the protective effects of WGPA against MIRI. The results demonstrated that WGPA pretreatment significantly attenuated myocardial injury and improved cardiac function. Mechanistically, WGPA selectively activated intestinal Tregs and enhanced the release of HSP70-enriched exosomes. These exosomes entered systemic circulation and were delivered to the heart, where surface HSP70 interacted with TLR4 on cardiomyocytes, activating downstream protective signaling pathways and ultimately suppressing cardiomyocyte death and inflammatory responses. Our study reveals for the first time a complete mechanism by which medicinal plant polysaccharides confer cross-organ cardioprotection via the “intestinal Tregs–exosome–heart” axis, providing a novel theoretical basis and a potential intervention strategy for the prevention and treatment of MIRI.

Both frailty and metabolic syndrome (Met) frequently coexist in older adults, creating a complex syndemic that possibly amplifies cardiovascular disease (CVD) risks. This study aims to evaluate whether frailty and metabolic syndrome severity have a synergistic impact on the risk of cardiovascular events among middle-aged and older cohorts in China. We analyzed data from China Health and Retirement Longitudinal Study (CHARLS) 2011–2020 of 8,992 individuals. The associations of frailty (as represented by frailty index) and metabolic syndrome severity (as represented by metabolic syndrome score) with CVD risks were examined using Cox regression and restricted cubic splines. The predictive performance was assessed by receiver operating characteristic (ROC) curve analysis. Furthermore, potential mediating factors were investigated through mediation analysis. Individuals with high frailty index (FI) and high metabolic syndrome score (MetS) (FI > 4.36 and MetS > 0.17) were at the highest CVD risk (HR = 1.295, 95

BACKGROUND:Post-procedural high-sensitivity cardiac troponin T (hs-TnT) is an established prognostic marker after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), yet its prognostic value may not be uniform across age groups, particularly when mortality and ischemic endpoints are considered separately. METHODS:From a prospective PCI registry (March 2016-March 2019), 14,210 ACS patients were stratified by age (<65 vs ≥65 years) and post-procedural hs-TnT (<5× vs ≥5× upper reference limit). The primary endpoint was 12-month all-cause mortality; the secondary endpoint was ischemic events (cardiac death, myocardial infarction, or stroke). Age × hs-TnT interaction was assessed using multivariable Cox models and tensor product restricted cubic spline models. RESULTS:At 12 months, 221 deaths and 312 ischemic events occurred. Elevated hs-TnT was associated with increased mortality in patients aged ≥65 (adjusted hazard ratio [aHR], 2.80; 95% CI, 1.84-4.27) but not in those aged <65 (aHR, 1.25; 95% CI, 0.75-2.07; P for interaction = 0.006). A concordant pattern was observed for cardiac death (P for interaction = 0.020). In contrast, elevated hs-TnT predicted ischemic events equally regardless of age (aged <65: aHR, 2.18; aged ≥65: aHR, 2.17; P for interaction = 0.995). Tensor product analysis confirmed a significant interaction for mortality (P = 0.048) but not for ischemic events (P = 0.935). CONCLUSIONS:Age selectively modified the prognostic value of post-procedural hs-TnT for mortality, but not for ischemic events, in patients with ACS undergoing PCI. Age-stratified interpretation of post-procedural hs-TnT may improve post-PCI risk stratification if externally validated.

This study aimed to evaluate changes in computed tomography-derived fractional flow reserve (CT-FFR) and qualitative/quantitative plaque characteristics before and after transcatheter aortic valve replacement (TAVR), and assess the correlation between CT-FFR changes and plaque progression/regression. We retrospectively analyzed coronary computed tomography angiography (CCTA) data from patients with coronary stenosis (30–90

Patients with acute coronary syndrome (ACS) who have concurrent high ischemic and high bleeding risk are common after percutaneous coronary intervention (PCI), yet evidence guiding P2Y12 inhibitor selection remains limited. We compared ticagrelor and clopidogrel in ACS patients meeting OPT-BIRISK dual high-risk criteria after drug-eluting stent (DES) implantation.We retrospectively analyzed a single-center PCI registry. ACS patients undergoing new-generation DES implantation (March 2019-March 2022) who met both high ischemic and high bleeding risk criteria were classified by discharge P2Y12 inhibitor. Propensity score overlap weighting was adjusted for confounding. The primary endpoint was 12-month net adverse clinical events (NACE): all-cause death, myocardial infarction, stroke, or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding.The final cohort comprised 20,213 dual high-risk patients (ticagrelor, 4,563 [22.6%]; clopidogrel, 15,650 [77.4%]). NACE was similar between groups (4.58% vs. 5.21%; adjusted hazard ratio [aHR], 1.05; 95% confidence interval [CI], 0.89-1.23; p = 0.568). Ticagrelor was not associated with reduced ischemic events (aHR, 0.90; 95% CI, 0.72-1.12; p = 0.333) but with higher BARC type 3 or 5 bleeding (2.17% vs. 1.57%; aHR, 1.39; 95% CI, 1.08-1.77; p = 0.009). In exploratory subgroup analysis, ticagrelor was associated with higher NACE in patients aged 75 years or older (p-Value for interaction = 0.04).In dual high-risk ACS patients undergoing DES implantation, discharge ticagrelor-based dual antiplatelet therapy was associated with higher bleeding risk without reducing NACE or ischemic events compared with clopidogrel. These observational findings support individualized P2Y12 inhibitor selection and warrant prospective confirmation.

Abdominal aortic aneurysm (AAA) is a fatal cardiovascular disease with no effective drug treatment currently available. The aberrant expression levels of microRNAs (miRNAs or miRs) contribute to AAA pathogenesis. In the present study, miRNA microarray analysis was performed to screen for differentially expressed miRNAs in the aortas of AAA mice compared with those in control mice, and to clarify the role and mechanism of miRNA‑378a‑5p (miR‑378a‑5p) in the AAA development. A comprehensive miRNA microarray analysis was conducted to screen for differentially expressed miRNAs in the aortas of AAA mice and control mice. Reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) was used to detect the expression levels of miR‑378a‑5p in the serum and aortas of patients with AAA and mice. To clarify the role of miR‑378a‑5p in the AAA development in vivo, miR‑378a‑5p antagomir and angomir were administered to ApoE‑/‑ mice using tail venous injection, followed by Angiotensin II (Ang II) infusion. Next, the role of miR‑378a‑5p in the phenotypic switching and migration of vascular smooth muscle cells (VSMCs) was examined in vivo and in vitro. Mechanistically, the targets of miR‑378a‑5p were identified by bioinformatics analysis, luciferase assay, RT‑qPCR and western blotting. Co‑immunoprecipitation assay combined with mass spectrometry were carried out for excavating potential downstream effectors. The expression of miR‑378a‑5p was decreased in the serum and aortas of patients with AAA (aortic dissection) and mice, and tumor necrosis factor‑α‑treated VSMCs. In vivo, the antagomir‑378a‑5p aggravated AAA formation, as evidenced by a larger maximal aortic diameter and greater medial elastin degradation than in control mice. miR‑378a‑5p angomir had the opposite effect. In vitro, miR‑378a‑5p overexpression significantly promoted the contraction ability and suppressed the migration of VSMCs, whereas miR‑378a‑5p knockdown inhibited the contraction ability and increased the migration of VSMCs. Mechanistically, it was identified that miR‑378a‑5p played a protective role in AAA development by regulating actin‑binding LIM protein 1 (ABLIM1)‑megakaryoblastic leukemia 1 (MKL1) pathway. miR‑378a‑5p exerts protective effects against AAA by maintaining VSMCs homeostasis via the ABLIM1‑MKL1 pathway. Therefore, targeting miR‑378a‑5p may be an attractive therapeutic strategy for AAA treatment.

Image(s) Emergency coronary angiography and computed tomography angiography showing catheterization laboratory (Cath-Lab) clues to type A aortic dissection presenting as acute myocardial infarction. Case Summary A 67-year-old man underwent emergency angiography for anterior ST-segment elevation. Difficult coronary engagement, thin strip-like left coronary narrowing, and marked catheter swing prompted reassessment. Computed tomography angiography confirmed type A aortic dissection involving the left main ostium, and unnecessary percutaneous coronary intervention was avoided. Five recurring angiographic warning clues are summarized. Take-Home Messages These 5 practical Cath-Lab clues would help you away from emergency type A aortic dissection trap. Timely recognition of Cath-Lab clues and pause; activate the aortic surgical team.

Background Patients with acute coronary syndrome (ACS) who have concurrent high ischemic and high bleeding risk represent a common but understudied group after percutaneous coronary intervention. Evidence guiding P2Y₁₂ inhibitor selection in this setting remains limited. This study compared ticagrelor and clopidogrel in ACS patients meeting OPT-BIRISK dual high-risk criteria after drug-eluting stent implantation. Methods In this retrospective analysis of a single-center, real-world PCI registry, patients with ACS undergoing new-generation drug-eluting stent (DES) implantation between March 2019 and March 2022 were included. Patients meeting both high ischemic risk and high bleeding risk criteria according to the OPT-BIRISK standard were identified and classified by P2Y₁₂ inhibitor prescribed at discharge. Propensity score overlap weighting adjusted for confounding. The primary endpoint was net adverse clinical events (NACE), a composite of all-cause death, myocardial infarction, stroke, or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 12 months. Results Of 30,562 ACS patients, 22,012 (72.0%) met dual high-risk criteria. The final cohort comprised 20,213 patients (ticagrelor, 4,563 [22.6%]; clopidogrel, 15,650 [77.4%]). NACE risk was similar between groups (4.58% vs 5.21%; adjusted hazard ratio [aHR], 1.05; 95% confidence interval [CI], 0.89 to 1.23; P = 0.568). Ticagrelor was not associated with a significant reduction in ischemic events (aHR, 0.90; 95% CI, 0.72 to 1.12; P = 0.333), but was associated with a higher risk of Bleeding Academic Research Consortium type 3 or 5 bleeding (2.17% vs 1.57%; aHR, 1.39; 95% CI, 1.08 to 1.77; P = 0.009). In exploratory subgroup analysis, ticagrelor was associated with higher net adverse clinical events in patients aged 75 years or older (P for interaction = 0.04). Conclusions In ACS patients with concurrent high ischemic and high bleeding risk undergoing drug-eluting stent implantation, discharge ticagrelor-based dual antiplatelet therapy was associated with higher bleeding risk without a significant reduction in NACE or ischemic events compared with clopidogrel. These observational findings support individualized P2Y₁₂ inhibitor selection and warrant prospective confirmation.

BACKGROUND:Pulmonary hypertension that is caused by left heart disease and is associated with heart failure may be driven by sympathetic overactivation leading to increased pulmonary vascular resistance, right ventricular dysfunction, and poor outcomes. Pulmonary-artery denervation may reduce sympathetic activity, although its clinical effects on left heart disease-associated pulmonary hypertension are unknown. METHODS:We conducted a multicenter, randomized trial in China involving patients with pulmonary hypertension associated with left heart disease and heart failure. Patients were randomly assigned in a 1:1 ratio to receive pulmonary-artery denervation plus guideline-directed medical therapy or to receive medical therapy alone. The primary outcome was clinical worsening - a composite of death, heart or lung transplantation, hospitalization for heart failure, outpatient worsening of heart failure, or a decline in the 6-minute walk distance - through the latest follow-up. RESULTS:A total of 264 patients underwent randomization: 134 to receive pulmonary-artery denervation plus medical therapy and 130 to receive medical therapy alone. During a median follow-up of 338 days, the Kaplan-Meier estimated 2-year incidence of clinical worsening was 25.7% in the pulmonary-artery denervation group and 51.5% in the medical-therapy group (hazard ratio, 0.49; 95% confidence interval, 0.30 to 0.82; P = 0.006). Access-site hematomas occurred in two patients in the pulmonary-artery denervation group and in one patient in the medical-therapy group; there were no other procedural complications. Adverse events during follow-up occurred with similar frequency in the two groups. CONCLUSIONS:Among patients with pulmonary hypertension associated with left heart disease and heart failure receiving guideline-directed medical therapy, pulmonary-artery denervation resulted in fewer events of clinical worsening than medical therapy. (Funded by Pulnovo Medical and others; PADN-HF-PH ClinicalTrials.gov number, NCT05824923.).

Objectives:This study aimed to examine the association between the Geriatric Nutritional Risk Index (GNRI) and mortality outcomes, encompassing all-cause, cardiovascular, and diabetes-associated deaths, among adults living with obesity. Methods:This prospective cohort analysis employed nationally representative survey information from 8834 adults with obesity (BMI ≥30 kg/m2) enrolled in ten consecutive cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. Vital status was determined via linkage to the National Death Index, with follow-up extending through December 31, 2019. Multivariate Cox proportional hazards models, restricted cubic spline analyses, and stratified subgroup evaluations were performed. Results:Throughout the observation period, 2110 deaths from all causes, 715 cardiovascular-related deaths, and 111 diabetes-attributed deaths were recorded. Following comprehensive covariate adjustment, low GNRI (<98) exhibited markedly higher risks of all-cause death (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.43, 1.96), cardiovascular death (HR: 1.61; 95% CI: 1.20, 2.13), and diabetes-associated death (HR: 2.44; 95% CI: 1.41, 4.17) relative to those with high GNRI (≥98). Non-linear relationships were detected for all-cause and cardiovascular mortality, with threshold values identified at GNRI levels of 100.5 and 98.7, respectively. The observed associations persisted consistently across the majority of demographic and clinical strata. Conclusions:Lower GNRI scores demonstrated independent associations with heightened mortality among adults with obesity. These results offer supportive evidence for incorporating nutritional risk screening into routine clinical management approaches for this patient population.

Objective:To investigate the joint effect of free fatty acid (FFA) and the triglyceride-glucose (TyG) index on the prognosis of overweight and obese coronary artery disease (CAD) patients. Methods:A total of 5,887 patients were enrolled in this study. Restricted cubic spline analyses were used to assess the dose-response relationship of FFA and TyG with major adverse cardiovascular and cerebrovascular events (MACCE). Mediation analysis was used to examine whether TyG mediated the association between FFA and MACCE. Kaplan-Meier survival curves were used to compare the cumulative incidence of events. Multivariable Cox models were used to explore the independent association between Low-/High-FFA and Low-/High-TyG on outcomes. Results:FFA and TyG were independent predictors of MACCE. TyG mediated 10.7% of the association between FFA and MACCE. Patients with high FFA and TyG levels exhibited a markedly higher MACCE risk (adjusted hazard ratio: 1.951, 95% confidence interval: 1.533-2.484; P < 0.001), with a significant interaction between FFA and TyG. Among patients with elevated FFA levels, MACCE increased progressively across higher TyG tertiles ( P for trend = 0.001). Conclusions:FFA and the TyG index independently predict adverse outcomes in overweight or obese CAD patients, with the TyG index mediating the relationship between FFA and MACCE. Their combined assessment enhances the risk stratification in this population.

The management of antithrombotic therapy represents a pivotal aspect in the treatment of coronary artery disease (CAD). In China, this field has evolved from a phase of learning from international evidence to a new era characterized by significant domestic innovation and contribution. This review systematically synthesizes the clinical evidence and advancements in antithrombotic strategies for CAD within the Chinese context, focusing on risk assessment, therapeutic optimization, and the standardization of clinical practice. The cornerstone of contemporary antithrombotic decision-making lies in the precise balance between ischemic and bleeding risks. Recognizing the limitations of applying Western-derived risk scores to the Chinese population due to genetic, lifestyle, and clinical practice differences, China has developed its own risk stratification tools. The OPT-CAD score, derived from a large, nationwide cohort, provides a more accurate prediction of long-term ischemic events and all-cause mortality for Chinese patients compared to the GRACE score. Similarly, the CAMI bleeding score outperforms traditional scores like CRUSADE in predicting in-hospital major bleeding after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). These tools mark a critical transition from reliance on foreign models to the provision of locally validated rulers for risk assessment, enabling more tailored treatment strategies. In optimizing antithrombotic strategies, Chinese research has made substantial contributions to global guidelines, particularly in navigating the ischemia-bleeding trade-off. For antiplatelet therapy, the paradigm has shifted from a uniform, intense regimen to personalized, de-escalation approaches. Landmark Chinese studies, such as CREATE and I LOVE IT 2, have provided robust evidence for shortening dual antiplatelet therapy (DAPT) duration after implantation of specific drug-eluting stents. Furthermore, studies like TWILIGHT-China and ULTIMATE-DAPT have demonstrated the safety and efficacy of early transition to P2Y12 inhibitor monotherapy after a brief period (1-3 months) of DAPT in high-risk patients, reducing bleeding without increasing ischemic events. The OPT-BIRISK trial offered a novel strategy for patients with both high ischemic and high bleeding risk, showing the benefit of extended clopidogrel monotherapy after completing standard DAPT. Research has also extended to minimizing extracardiac harm, with the OPT-PEACE trial using novel endoscopic technology to quantify gastrointestinal injury from different antiplatelet regimens, informing safer drug selection. In addition, the OPTION trial suggested indobufen as a potential alternative to aspirin in combination with clopidogrel. Regarding periprocedural anticoagulation during PCI, Chinese-led trials have reshaped international perspectives. The BRIGHT study introduced an innovative strategy of post-PCI high-dose infusion of bivalirudin, which mitigated the increased acute stent thrombosis risk previously associated with this agent and significantly reduced bleeding. The subsequent BRIGHT-4 trial confirmed these benefits in a contemporary STEMI population, leading to upgraded recommendations in international guidelines. The standardization of clinical practice in China has been greatly advanced by the development and continuous updating of national guidelines and expert consensuses, which promote uniformity in treatment standards across different healthcare settings, guide individualized risk stratification, and ultimately drive continuous quality improvement in antithrombotic care for CAD patients nationwide. In the future, the antithrombotic therapy in China is oriented towards greater precision, safety, and accessibility. Key directions include leveraging big data and artificial intelligence to refine risk prediction and decision support, expanding high-quality real-world evidence, developing safer novel agents (e.g., vicagrel), and improving patient-centric management through digital health technologies. As the burden of CAD continues to grow with an aging population, China is poised to further integrate innovation, localization, and multidisciplinary collaboration to optimize antithrombotic strategies, aiming to improve patient outcomes and contribute Chinese wisdom to the global fight against cardiovascular disease.

BACKGROUND:Residual left ventricular (LV) hypertrophy and incomplete reverse remodelling after transcatheter aortic valve replacement (TAVR) are associated with adverse outcomes. Whether renin-angiotensin system inhibitors (RASi) promote reverse remodelling in patients with heart failure and LV ejection fraction (LVEF) ≥40% following TAVR remains uncertain. METHODS:In this multicentre, prospective, randomised, open-label, blinded-endpoint trial, patients aged ≥60 years with symptomatic severe aortic stenosis, LVEF ≥40% and successful TAVR were randomly assigned (1:1) to standard care alone or standard care plus RASi (ACE inhibitor, angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor). The primary endpoint was change in LV mass index (LVMI) at 12 months. Secondary endpoints included changes in LV volumes, LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and functional status. RESULTS:A total of 200 patients were randomised; 194 were included in the modified intention-to-treat analysis (RASi n=95; control n=99). At 12 months, RASi therapy was associated with a greater reduction in LVMI compared with control (adjusted mean difference -12.77 g/m², 95% CI -24.73 to -0.81; p=0.036). Consistent improvements were observed in LV end-diastolic and end-systolic volumes. Functional status (New York Heart Association class) improved modestly in the RASi group. No significant differences were observed in LVEF or NT-proBNP. CONCLUSION:In patients with heart failure and LVEF ≥40% following TAVR, RAS inhibition led to enhanced reverse LV remodelling over 12 months, reflected by greater regression of LV mass and volumes. These findings support the potential role for RASi in modifying post-TAVR myocardial remodelling, although larger trials are required to determine whether these structural benefits translate into improved clinical outcomes. TRIAL REGISTRATION NUMBER:ChiCTR2100042266.

BACKGROUND:The novel thin-strut sirolimus-eluting iron bioresorbable scaffold (IBS) demonstrated safety and efficacy in a nonrandomized first-in-human study. OBJECTIVES:The objective of this study was to compare the IBS with contemporary metallic cobalt chromium everolimus-eluting stents (CoCr-EES) in patients with coronary artery disease. METHODS:IRONMAN-II was a prospective, multicenter, single-blinded, noninferiority randomized trial across 36 centers in China. Eligible patients had myocardial ischemia and 1 or 2 de novo target lesions. Patients were randomly assigned (1:1) to IBS or CoCr-EES, with allocation masked. Optical coherence tomography (OCT) was performed in the first 25 participant pairs. Clinical follow-up was scheduled at 1, 6, and 12 months, and annually to 5 years, with angiographic and OCT follow-up at 2 years. The primary endpoint was 2-year angiographic in-segment late lumen loss (LLL). Powered secondary endpoints included target vessel quantitative flow ratio (QFR) and OCT-derived cross-sectional mean flow area. Other secondary endpoints included target lesion failure (cardiac death, target vessel myocardial infarction [MI], or ischemia-driven target vessel revascularization), the patient-oriented composite endpoint (all-cause death, MI, or any revascularization), their individual components, and device thrombosis. RESULTS:Between March 10 and December 13, 2022, 518 patients were randomized to IBS (n = 259) or CoCr-EES (n = 259). At 2 years, lesion-level in-segment LLL was 0.28 (0.52) mm with IBS and 0.23 (0.43) mm with CoCr-EES (difference: 0.08 mm; 95% CI: -0.02 to 0.18; Pnoninferiority = 0.03). Mean QFR was 0.90 (0.13) with IBS and 0.92 (0.09) with CoCr-EES (difference: -0.02; 95% CI: -0.04 to 0; Pnoninferiority = 0.05). Mean OCT flow area was 6.92 (3.48) mm2 with IBS and 6.64 (2.44) mm2 with CoCr-EES (difference: 0.27; 95% CI: -0.09 to 0.63; Pnoninferiority < 0.0001). Two-year target lesion failure occurred in 7.4% of IBS patients and 5.4% of CoCr-EES patients (HR: 1.37; 95% CI: 0.69-2.73; P = 0.37). No significant between-group differences in the rates of patient-oriented composite endpoint, death, or MI were present between the 2 groups. No scaffold thromboses occurred in the IBS group, whereas 1 stent thrombosis occurred with CoCr-EES. Binary restenosis and revascularization rates were higher with IBS, however, most such events were non-ischemia-driven. CONCLUSIONS:In IRONMAN-II, the sirolimus-eluting IBS was noninferior to CoCr-EES for 2-year in-segment LLL, QFR, and OCT-derived flow area. Clinical event rates were also comparable between groups although non-ischemia-driven revascularization rates were higher after IBS. Longer-term follow-up is necessary to demonstrate whether late benefits are realized after complete IBS resorption. (A Clinical Investigation to Evaluate the Safety and Efficacy of IBS in Patients With Coronary Artery Disease; NCT05206084).

Background Among patients with acute coronary syndromes at both high bleeding and ischemic risk (birisk), extended clopidogrel monotherapy after 9 to 12 months of dual‐antiplatelet therapy reduces bleeding without increasing ischemia. Whether this benefit extends to birisk patients with diabetes is unknown. Methods This prespecified subgroup analysis of the OPT‐BIRISK (Optimal Antiplatelet Therapy for High Bleeding and Ischemic Risk Patients) trial included birisk patients with acute coronary syndrome who had completed 9 to 12 months of dual‐antiplatelet therapy after percutaneous coronary intervention. Patients were then randomized 1:1 to 9 months of clopidogrel plus placebo versus clopidogrel plus aspirin. Outcomes were compared by diabetes status. The primary end point was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding at 9 months after randomization. The key secondary end point was major adverse cardiac and cerebral events, defined as a composite outcome of all‐cause death, myocardial infarction, stroke, or clinically driven revascularization. Results Of 7758 patients, 4072 (52.5%) had diabetes. Clopidogrel monotherapy decreased Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (2.1% versus 3.2%; hazard ratio [HR], 0.66 [95% CI, 0.45–0.97]) with no increase in major adverse cardiac and cerebral events (2.9% versus 3.6%; HR, 0.79 [95% CI, 0.56–1.12]) compared with clopidogrel plus aspirin in patients with diabetes. Outcomes were consistent in patients without diabetes, with no significant interactions by diabetes status. Conclusions In birisk patients with acute coronary syndrome who were stable on dual‐antiplatelet therapy with clopidogrel plus aspirin for 9 to 12 months after percutaneous coronary intervention, clopidogrel monotherapy for an additional 9 months reduced clinically relevant bleeding without increasing ischemic events compared with continued dual‐antiplatelet therapy, irrespective of diabetes status. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT03431142.

Background: This study aimed to explore the association between serum lipoprotein(a) [Lp(a)] levels and recurrent acute coronary syndrome (ACS) and revascularization of target lesions in patients with ACS who showed no functional ischemia on fractional flow reserve (FFR) testing during coronary angiography (CAG). Methods: The retrospective observational study was conducted at the General Hospital of Northern Theater Command and included 513 patients with new ACS recruited from 23 February 2016 to 6 November 2023 and followed up. These patients underwent CAG examination and were found to have at least one coronary artery with moderate or greater stenosis, and also underwent FFR measurement with FFR value >0.80. Patients experienced recurrent ACS and underwent unplanned revascularization were defined as the revascularization group, while patients did not experience recurrent ACS and undergo unplanned revascularization were assigned to the no revascularization group. The study employed propensity score matching (PSM) and receiver operating characteristic (ROC) curve analysis to evaluate the correlation between serum Lp(a) and recurrent ACS and unplanned revascularization in target lesion with FFR value >0.80. Results: Serum Lp(a) levels were higher in female patients. There were no statistically significant differences in the basic clinical characteristics, medication use, laboratory test results or ejection fraction values between the two groups. During a average follow-up of 6.5 years, 119 patients (23.2%) experienced recurrent ACS and unplanned revascularization in the target lesion. The level of serum Lp(a) in the patients that underwent unplanned revascularization was significantly higher than in the group that did not undergo repeated revascularization (65.80 mmol/L vs. 60.57 mmol/L, p = 0.034). Conclusion: Serum Lp(a) is an independent risk factor for recurrent ACS and unplanned revascularization in patients with ACS and FFR negative plaque.