BACKGROUND:Elevated blood pressure (BP) in patients with atrial fibrillation (AF) is strongly linked to poor outcomes. OBJECTIVE:This study assessed the impact of BP on the risk of ischemic stroke and all-cause death in patients with AF across different age groups. METHODS:We included 338,747 patients newly diagnosed with AF between 2009 and 2016, with national health screening data. Patients were divided into 4 age groups (40-49, 50-59, 60-69, and ≥70 years) and categorized by systolic BP (SBP) and diastolic BP (DBP) according to the 2023 European hypertension guidelines as follows: optimal BP, normal BP, high-normal BP, grade 1 hypertension, and grade ≥2 hypertension. The primary outcome was ischemic stroke, and the secondary outcome was all-cause death. We additionally performed analyses stratified by anti-hypertensive treatment status. RESULTS:Over a median follow-up of 6.0 years (interquartile range, 4.0-8.6), 39,329 patients experienced a stroke, and 104,712 died. Stroke incidence was significantly higher in grade 1 and grade ≥2 hypertension across all age groups. Stroke risk increased with SBP ≥160 mmHg and DBP ≥90 mmHg, particularly in younger patients with elevated BP. Grade ≥2 hypertension was consistently linked to higher mortality across all age groups, whereas normal BP was associated with the lowest mortality rates. Extremely low BP was also related to a higher risk of mortality. CONCLUSION:High BP was associated with higher risks of stroke and mortality in AF patients, especially in younger individuals. Conversely, excessively low BP was linked to higher mortality, highlighting the importance of balanced BP control in patients with AF.

BACKGROUND:Left bundle branch area pacing (LBBAP) is a physiologic pacing strategy encompassing heterogeneous pacing subtypes. However, predictors of clinically significant tricuspid regurgitation (TR) after LBBAP, particularly according to pacing subtype, remain unclear. OBJECTIVE:To identify the incidence and predictors of significant TR following LBBAP. METHODS:We retrospectively analyzed patients from 31 centers who underwent successful LBBAP between 2021 and 2024 and had no or mild TR at baseline. LBBAP was categorized as left bundle branch pacing, left fascicular pacing, and left ventricular septal pacing (LVSP). The primary outcome was incident TR, defined as new-onset moderate-or-greater TR on follow-up echocardiography performed 6-12 months after the index procedure. Multivariable logistic regression was performed to identify predictors of incident TR. RESULTS:Among 523 patients (mean age, 72.5 ± 11.9 years; 45.5% male), 35 (6.7%) developed incident TR during 1-year follow-up. Compared with patients without incident TR, those with incident TR had a significantly higher prevalence of atrial fibrillation (AF), higher baseline TR maximal velocity (Vmax), longer baseline QRS duration, and a higher frequency of LVSP. On multivariable analysis, AF (odds ratio [OR], 12.55; 95% confidence interval [CI], 3.18-49.55), LVSP (OR, 9.08; 95% CI, 2.35-35.12), baseline TR Vmax of ≥2.8 m/second (OR, 4.19; 95% CI, 1.20-14.60), and baseline QRS duration of ≥120 ms (OR, 3.80; 95% CI, 1.01-14.32) were independently associated with incident TR. CONCLUSION:Incident TR occurred in 6.7% of patients following successful LBBAP. LVSP, prevalent AF, elevated TR Vmax, and prolonged QRS duration were independent predictors of incident TR.

Direct oral anticoagulants (DOACs) are widely used in patients with atrial fibrillation (AF) to prevent stroke but increase the risk of upper gastrointestinal bleeding (UGIB). We aimed to quantify patient-perceived health-related quality-of-life (HRQoL) decrements associated with DOAC-related clinical events—stroke and UGIB—using a vignette-based approach. A survey was conducted with 391 AF patients on DOACs, embedded within a randomized trial evaluating proton pump inhibitor (PPI) co-therapy. Participants evaluated four hypothetical health states (stroke, post-stroke, UGIB, and post-UGIB) using EQ-5D-5L. The mean EQ-5D index for current health was 0.90 (SD 0.11). When imagining stroke, 89–95

Background Bachmann’s bundle area pacing (BBAP) is an emerging physiological atrial pacing strategy. However, real-world data from Asian populations remains limited. Objective To evaluate feasibility, safety, and mid-term lead performance of BBAP in a Korean two-center cohort. Methods This retrospective study included consecutive patients who underwent BBAP between December 2024 and March 2026. Procedural success was defined by prespecified paced P-wave morphology criteria. Baseline characteristics, procedural findings, and serial atrial lead parameters over 6 months were analyzed. Results Among 112 patients (median age 73 years; 42.9% male), BBAP was successfully achieved in 101 (90.2%). Compared with patients with successful BBAP, those with unsuccessful BBAP were older (median 79 vs. 73 years, p=0.018), were more frequently male (72.7% vs. 39.6%, p=0.036), had a longer P-wave duration (median 140 ms vs. 121 ms, p=0.022), and had a lower left ventricular ejection fraction (median 59% vs. 63%, p=0.046). In successful cases, paced P-wave duration was significantly shorter than baseline sinus P-wave duration (100 ms [IQR 88–112] vs 121 ms [IQR 110–130]; p<0.001). Over 6 months, lead performance remained stable, with decreasing impedance (703 to 589 Ω; p-for-trend <0.001), preserved sensing amplitude (1.6 to 1.9 mV; p-for-trend=0.141), and no significant overall change in pacing threshold (0.75 to 0.81 V; overall p=0.066). Only 1 lead dislodgement (1.0%) and 3 significant threshold rises (3.0%) occurred. Conclusion In this initial Korean two-center experience, BBAP showed high procedural success, acceptable safety, and stable mid-term lead performance. Older age and lower ejection fraction were associated with procedural failure.

Background and Objective: Continuous wearable electrocardiogram (ECG) monitoring is increasingly used for ambulatory arrhythmia surveillance, yet forecasting impending atrial fibrillation (AF) is challenged by inter-patient ECG variability. This study investigated whether personalizing a global model via fine-tuning on an individual's ECG signals improves short-term forecasting of impending AF. Methods: A global model trained on the ICENTIA11K dataset was compared against personalized models fine-tuned across three cohorts: ICENTIA11K, IRIDIA-AF, and MobiCARE. Following preprocessing, models processed 60-second ECG segments for a five-minute forecast horizon. We evaluated the impact of adaptation data volume and analyzed ECG features, such as heart rate and RMSSD. Results: Personalized models significantly outperformed the global model, achieving AUROCs of 0.711 vs. 0.614 in ICENTIA11K and 0.686 vs. 0.585 in MobiCARE. Personalization benefits increased with the amount of patient-specific fine-tuning data. While the global model's accuracy rose as AF onset approached, personalized models in the two external cohorts exhibited distinct temporal dynamics, which may indicate the capture of patient-specific characteristics less dependent on proximity to the AF event. Pre-AF episodes showed elevated heart rates and RMSSD. Feature attributions highlighted clinically relevant precursors, including frequent premature atrial complexes (PACs) and short supraventricular tachycardias (SVTs). Conclusions: Adapting deep learning models with patient-specific wearable ECG data significantly enhances short-term forecasting of impending AF. This personalized framework supports timely preventive interventions and improved AF management in ambulatory monitoring environments.

BACKGROUND AND OBJECTIVES:In the PERIXa study, a standardized periprocedural interruption protocol for factor Xa (FXa) inhibitors led to very low major bleeding rates and no thromboembolic events among patients undergoing procedures with minimal to low bleeding risk. However, dental procedures showed the highest all-bleeding rate. This sub-analysis assessed bleeding outcomes by dental procedure type, FXa inhibitor, and dosing regimen to inform tailored anticoagulation strategies in dental practice. METHODS:This analysis included atrial fibrillation (AF) patients from PERIXa who underwent dental procedures managed with a standardized FXa inhibitor interruption protocol. All-bleeding events-comprising major, clinically relevant non-major, and minor bleeding-as well as thromboembolic events and all-cause death, were evaluated within 30 days. Intraoperative bleeding severity was reported by dentists using standardized questionnaires. RESULTS:Among 820 patients (mean age 71.3 ±9.4 years; 42.0% female) undergoing dental procedures with periprocedural direct oral anticoagulant (DOAC) interruption per the PERIXa protocol, the overall all-bleeding rate was 5.0%, with major bleeding occurring in only 0.2%. No thromboembolic events or deaths were reported. Bleeding risk did not differ significantly by procedure type, DOAC agent, or regimen, though numerically higher all-bleeding rates were observed with implants and combined procedures. Most dentists reported no or manageable bleeding, with no significant variation across groups. CONCLUSIONS:Dental procedures performed under the PERIXa protocol were associated with low bleeding risk and excellent thromboembolic safety. These findings support the applicability of the protocol across various dental interventions and DOAC regimens in patients with AF.

Background Direct oral anticoagulants (DOACs) are the cornerstone of thromboembolic prevention in patients with atrial fibrillation, venous thromboembolism, or other cardiovascular conditions. However, DOAC use is associated with an increased risk of bleeding, with gastrointestinal (GI) bleeding being the most common site of major bleeding. Proton pump inhibitors (PPIs) are reasonably used during combined antithrombotic therapy or based on individual bleeding risk; nonetheless, evidence supporting their benefit in patients receiving DOAC therapy remains limited. Methods The Gastrointestinal protection Using proton-pump inhibitor in pAtients who RequireD Oral AntiCoagulants (GUARD-OAC) trial is a prospective, multicenter, open-label, randomized controlled trial evaluating the GI protective effect of PPI coadministration with DOAC. Eligible participants are patients with cardio- or cerebrovascular disease requiring long-term anticoagulation (≥ 1 year), who are currently receiving or initiating DOAC therapy, and have a HAS-BLED score of ≥ 1. The primary outcome is a composite of upper GI clinical events, including bleeding, symptomatic gastroduodenal ulcer, persistent pain of presumed GI origin with underlying multiple erosive disease, obstruction, or perforation. The secondary outcomes are the individual components of the primary outcome, GI symptoms or signs, cardiovascular or all bleeding events, and all-cause mortality. Assuming a 40% relative risk reduction of the primary outcome in the PPI plus DOAC group compared to the DOAC alone group, a total of 3,846 patients will be enrolled and followed for one year. A Clinical Events Committee will adjudicate clinical outcomes and adverse events for causality and attribution, and an independent Data Safety Monitoring Board will oversee the study. The GUARD-OAC trial is funded by the Ministry of Health & Welfare, Republic of Korea. Conclusions The GUARD-OAC trial is the first randomized controlled trial exploring the efficacy of PPI cotherapy in patients receiving DOACs, providing evidence that may inform future guidelines on GI protection in this population. Trial registration Clinical Research Information Service, Identifier KCT0006848

BackgroundWhile left atrial (LA) volume enlargement is a well-known predictor of recurrence after catheter ablation for atrial fibrillation (AF), the association between the recurrence and other atrial volumetrics remains uncertain. This study aimed to assess the association between various atrial volumetrics and the 12-month recurrence of AF after catheter ablation (AFCA).MethodsPatients with a history of AFCA who underwent pre-procedural cardiac computed tomography were retrospectively included. Atrial volumes were measured using artificial intelligence-based segmentation software (AutoSeg-H). Atrial volumetrics included total LA, LA body, LA appendage (LAA), total right atrium (RA), RA body, and RA appendage (RAA) volumes. AF recurrence was defined as any documented atrial arrhythmia (AA) within 12 months following AFCA. All volumetrics were dichotomized using cutoffs that optimally predicted 12-month AA recurrence on the receiver operating characteristic curve. Cox regression models were used to estimate adjusted hazard ratios (aHRs) of the dichotomized volumetrics.ResultsAmong 199 included patients, 45 (22.6%) underwent AA recurrence within 12 months. All atrial volumetrics were significantly higher in the recurrence group than in the non-recurrence group. Optimal cutoffs used for dichotomizing volumetrics were: total LA ≥129.1, LA body ≥112.0, LAA ≥15.3, total RA ≥123.0, RA body ≥82.1, and RAA ≥13.2 (unit: mL). All dichotomized volumetrics, except RAA ≥ 13.2, were significantly associated with recurrence. LAA volume ≥15.3 [aHR 1.97; 95% confidence interval (CI), 1.04–3.74; P = 0.038] and RA body volume ≥82.1 (aHR 2.39; 95% CI, 1.03–5.55; P = 0.042) were independent predictors for 12-month AA recurrence after AFCA.ConclusionsMost dichotomized atrial volumetrics were associated with 12-month AA recurrence after AFCA. In particular, LAA ≥15.3 mL and RA body ≥82.1 mL were independently associated with recurrence, suggesting that structural remodeling in these regions may contribute to post-ablation AA recurrence.

BACKGROUND:The benefit of combining early rhythm control (ERC) and exercise habit change in atrial fibrillation (AF) is unknown. OBJECTIVE:To evaluate the primary outcomes - major adverse cardiovascular event (MACE) and all-cause death - according to the combination of ERC status and exercise habit change. METHOD:From the National Health Information Database, we included 161,379 patients diagnosed with AF. Rhythm control initiated within two-year from AF diagnosis was defined as ERC. Based on the status of regular exercise at serial health examinations before and after AF diagnosis, exercise habit change was categorized into persistent non-exercisers, exercise dropouts, new exercisers, and exercise maintainers. RESULT:During a mean follow-up of 4.6 years, ERC was associated with a lower risk of MACE and all-cause death; adjusted hazard ratio (aHR) and 95% confidence interval (CI) was 0.832 (0.797-0.868) for MACE and 0.953 (0.915-0.992) for all-cause death (both p<0.001). Exercise maintenance was also associated with a lower risk of MACE and all-cause death: adjusted HR (95% CI)=0.822 (0.763-0.886) for MACE and 0.708 (0.658-0.762) for all-cause death (both p<0.001). There was a progressive decrease in the risk of MACE and all-cause death as AF patient engaged in ERC or regular exercise; the combination of ERC and exercise maintenance provided the greatest benefit, associated with the lowest risk of MACE [aHR (95% CI)=0.641 (0.576-0.713)] and all-cause death [aHR (95%CI)=0.564 (0.499-0.636)], both p<0.001. CONCLUSION:The combination of ERC and exercise maintenance yielded a synergistic effect, maximizing the reduction in MACE and all-cause death risks, highlighting integrated management in AF.

BACKGROUND AND AIMS:A recent European trial found that in frail elderly patients with atrial fibrillation (AF), switching from well-managed warfarin to direct oral anticoagulants (DOACs) was associated with higher bleeding risk. This study aimed to evaluate the safety and effectiveness of switching from warfarin to DOACs in frail elderly Asian AF patients. METHODS:The Korean national claims database was used to identify AF patients aged ≥75 years who were prescribed warfarin between January 2013 and August 2015, had Hospital Frailty Risk Score ≥ 5, and experienced no major bleeding or thromboembolic events during this period. To evaluate the effect of switching from warfarin to a DOAC, a time-varying approach based on anticoagulant exposure was applied. The primary outcome was major bleeding. Secondary outcomes included thromboembolic events, net clinical outcome (NCO; composite of major bleeding and thromboembolic events), and all-cause death. RESULTS:Among 12 461 patients, 9112 patients remained on warfarin, whereas 3349 switched to DOACs at least once. During a total follow-up of 11 842 person-years, DOAC treatment was associated with higher risks of major bleeding (hazard ratio 1.36, 95% confidence interval 1.01-1.81), thromboembolic events (1.61, 1.30-2.00), NCO (1.58, 1.29-1.94), and all-cause death (1.20, 1.02-1.42). In various subgroup analyses, DOAC treatment tended to show higher risks of all outcomes compared with warfarin treatment. CONCLUSIONS:In frail elderly Asian AF patients stably maintained on warfarin, switching to DOACs was associated with higher risks of adverse clinical events, suggesting the need for careful consideration before routine switching.

The association between atrial fibrillation (AF) and uterine fibroids (UF) is unclear, though UF are linked to an elevated risk of cardiovascular disease. This study aimed to investigate the AF risk in UF patients. Females aged 20-39 who received health examinations from 2009 to 2012 were included. UF were defined using the ICD-10 codes, and surgical treatment status was defined by procedural codes. The primary outcome was incident AF, evaluated using a Cox regression model, which also assessed AF risk according to surgical treatment status. Among 2,574,349 participants (UF 20,682 [0.8%], mean age 29.8 ± 4.3 years, mean follow-up duration 7.3 ± 1.1 years), 3,868 patients developed AF (n = 61, UF; n = 3,807, control). AF incidence was higher in the UF group than the control (0.41 and 0.20 per 1,000 person-years, respectively). Multivariate Cox-regression analysis identified UF as an independent risk factor for AF (aHR 1.50, 95% CI 1.16-1.93, p = 0.002). Compared to the control group, UF group with surgery had similar AF risk (aHR 1.22, 95% CI 0.79-1.90), however, those without surgery had higher AF risk (aHR 1.69, 95% CI 1.24-2.30). UF patients were associated with increased risk of AF. Careful monitoring of arrhythmia development is warranted in women with UF.

BACKGROUND:Limited data exist on reducing the atrial fibrillation (AF) burden, the regression from persistent to paroxysmal AF, and symptom improvement after cryoablation in patients with persistent AF. OBJECTIVES:This study sought to evaluate the efficacy of cryoablation in reducing the AF burden, regression to paroxysmal AF, and symptom improvement in patients with early persistent AF. METHODS:This investigator-initiated, multicenter, and prospective cohort study enrolled the patients with early persistent AF (≤3 years). All patients were inserted an implantable loop recorder at the time of trial entry. AF burden (percentage of time in AF) and actual AF type were evaluated during pre-cryoablation and 12-month follow-up after cryoablation. AF-related symptoms and quality of life were assessed. RESULTS:A total of 130 patients were enrolled (median age 61 years [Q1-Q3: 54-67 years]; median duration of persistent AF 6 months [Q1-Q3: 4-10 months]). The mean AF burden before cryoablation was 77 ± 34% (25.4% of high-burden paroxysmal AF; 74.6% of implantable loop recorder-confirmed persistent AF), which was reduced to 9 ± 21% after 12-month follow-up (mean 68 ± 37% of AF burden reduction; P < 0.001). Of the total, 38.5% had no recurrence of AF, 43.1% had a recurrence of paroxysmal AF, and 18.5% had a recurrence of persistent AF. Among those with confirmed persistent AF at baseline, 76% of patients showed regression to paroxysmal AF or no recurrence. After cryoablation, 77% of patients improved AF-related symptoms and quality of life as assessed by 36-Item Short Form Survey questionnaires. CONCLUSIONS:In patients with early persistent AF, cryoablation significantly reduced AF burden and achieved regression of AF type followed by symptom improvement. (Cryoablation for Pulmonary Vein Isolation Alone in Patients with Early Persistent AF Assessed by Continuous Monitoring [COOL-PER]; NCT05507749).

AIMS:Based on the diagnostic sequence in relation to stroke, a recent classification of atrial fibrillation (AF) categorizes AF into known AF (KAF) and AF detected after stroke or transient ischaemic attack (AFDAS). However, relatively little is known about AF 'concurrently diagnosed with stroke'-perhaps the 'grey zone' of AF between KAF and AFDAS, which has been less characterized in terms of its resemblance to clinical characteristics and outcomes compared with AFDAS or KAF. METHODS AND RESULTS:Patients with AF who were admitted for acute ischaemic stroke (IS) in 2010-20 were retrospectively reviewed. Clinical characteristics and net clinical outcome (NCO)-the composite of recurrent stroke, major bleeding, hospitalization or emergency department visits for cardiovascular events, and death-were compared between AF diagnosed before stroke (prior AF) and incident AF diagnosed concurrently with IS (AFDCS). A total of 720 patients with AF and acute IS (mean age, 72.5 ± 10.1 years; 60.3% male) were included: prior AF, 62.6% (n = 451), and AFDCS, 37.4% (n = 269). Prior AF presented with more prevalent diabetes, heart failure, vascular disease, and valvular heart disease than AFDCS (all P < 0.05). The AFDCS had a significantly higher left ventricular ejection fraction and smaller left atrial diameter than prior AF. During a median follow-up of 2.0 (interquartile range 0.6-4.6) years, AFDCS was associated with a lower risk of NCO than prior AF without significant differences in the risk of recurrent stroke: adjusted hazard ratio (95% confidence interval), 0.776 (0.611-0.986), P = 0.038 for NCO and 0.784 (0.450-1.365), P = 0.389 for recurrent stroke. CONCLUSION:Prior AF and AFDCS have distinctive clinical profiles supporting AF is a disease of continuum according to its diagnostic vicinity to the IS. In terms of recurrent IS, AFDCS has a comparable risk with prior AF, indicating the importance of early detection and integrated management of AF for patients with IS.

BACKGROUNDS AND AIMS:Left bundle branch area pacing (LBBAP) has been shown to reduce the risk of pacing-facilitated heart failure (HF) compared to right ventricular pacing (RVP), but limited data exists comparing LBBAP with stylet-driven leads (SDL) and conventional RVP. The study aims to compare clinical outcomes between LBBAP using SDL and conventional RVP. METHODS:From December 2018 to December 2023, patients who underwent pacemaker implantation at two tertiary hospitals were enrolled. Exclusions included those requiring cardiac resynchronization therapy and patients with ventricular pacing burden ≤ 10%. LBBAP was performed using SDL (Solia S60, Biotronik) with a fixed curve delivery sheath. Composite outcome I consisted of HF admission, pacing-induced cardiomyopathy (defined as an LVEF decline of ≥ 10% or below 50%), and upgrade to biventricular pacing. Composite outcome II included all-cause death in addition to the components of composite outcome I. RESULTS:A total of 738 patients (mean age 72.1 years; 52% of men; 243 LBBAP vs. 495 RVP) were included. Atrioventricular block was more common pacing indication in LBBAP group than RVP group (88.1% vs. 69.3%, p < 0.001). Compared to RVP group, ventricular pacing burden was higher in the LBBAP group (96% vs. 86%, p < 0.001). LBBAP was associated with a lower risk of composite outcome I and II compared to RVP (adjusted HR 0.27 [95% confidence interval 0.11-0.68], p = 0.006 for composite outcome I, aHR 0.41 [0.20-0.84], p = 0.015 for composite outcome II), mainly driven by a lower risk of pacing-induced cardiomyopathy by 70%. There were no significant differences in procedure-related complications. CONCLUSION:LBBAP with SDL was associated with a lower risk of adverse clinical outcomes compared to conventional RVP in patients requiring substantial ventricular pacing.

Abstract Background Diabetes mellitus (DM) and proteinuria each independently raise the risk of atrial fibrillation (AF). We aimed to investigate the relationship between proteinuria and the risk of incident AF across glycemic stages. Methods A cohort of 4,044,524 individuals without prior AF and type 1 DM was selected from the 2009 Korean National Health Insurance Service health checkup data. The individuals were categorized into five glycemic stages: normal, prediabetes, new-onset DM, early DM (< 5 years), and late DM (≥ 5 years). Proteinuria was graded using a urine dipstick test. The development of incident AF was tracked until 2023. Results Overall, the cohort (mean age 47 ± 14 years, 44.8% female) showed increasing annual AF incidence rates from 2.05 to 7.22 per 1000 person-years from normal to late DM (p < 0.001). Incidence rates increased from 2.46 to 8.18 per 1000 person-years with increasing proteinuria (p < 0.001). Adjusted Cox regression models revealed a heightened AF risk with higher proteinuria across all glycemic stages (adjusted hazard ratios for urine dipstick 3+/4+: 1.58, 1.64, 2.39, 2.12, and 2.53 for normal, prediabetes, new-onset DM, early DM, and late DM, respectively). The proteinuria-AF association was more pronounced in individuals with DM than in those without DM but was similar among the new-onset and established DM groups. Conclusions Proteinuria is an independent and significant risk factor for incident AF at all glycemic stages. The risk of incident AF in patients with DM can be stratified by measuring the level of proteinuria rather than comparing the duration of DM. Tailoring clinical strategies to proteinuria level could potentially mitigate this risk, improving patient outcomes. Graphical abstract

BACKGROUND:Although the invasive measurement of intra-arterial pressure is considered the gold standard, it is not feasible for routine clinical practice. This study aimed to investigate the prognostic value of invasively measured aortic pulse pressure (aPP) in patients undergoing invasive coronary angiography (ICA). METHODS:A total of 1110 patients who underwent ICA (mean age 65 years, 35.5% female) were prospectively enrolled. Just before ICA, aortic pressures were measured using a pigtail catheter positioned 3 cm above the aortic valve. Major adverse cardiovascular events (MACE), a composite of cardiac death, nonfatal acute myocardial infarction, coronary revascularization, and ischemic stroke, were assessed during clinical follow-up after ICA. RESULTS:During a median follow-up of 6.3 years (interquartile range, 2.8-8.9 years), there were 153 cases of MACE (13.8%). Patients with MACE had a higher aPP compared to those without MACE (83.0 ± 25.3 vs. 62.9 ± 18.1 mmHg; P < 0.001). Kaplan-Meier survival analysis demonstrated that a higher aPP (≥78 mmHg) was associated with an increased risk of MACE (log-rank P < 0.001). Multiple Cox regression analysis revealed that an increase in aPP by 10 mmHg was significantly associated with a higher risk of MACE, even after adjusting for potential confounders (hazard ratio, 1.68; 95% confidence interval, 1.49-1.82; P < 0.001). CONCLUSION:Invasively measured aPP is a strong and independent predictor of long-term cardiovascular outcomes in patients undergoing ICA. aPP could be a valuable addition to current risk assessment tools in this high-risk population.