Backgrounds: The AFIRE (Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease) trial demonstrated that rivaroxaban monotherapy was non-inferior in efficacy and superior in safety compared to rivaroxaban plus single antiplatelet therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). This study examined whether systolic blood pressure (SBP) affects clinical outcomes and modifies the impact of antithrombotic therapy. Methods: In this post hoc analysis, participants were stratified based on median SBP at baseline: >126 mmHg (High SBP group, n = 1042) and ≤126 mmHg (Low SBP group, n = 1093). The primary efficacy endpoint was a composite of cardiovascular events and all-cause death. The primary safety endpoint was major bleeding. Results: The mean SBP was 139 mmHg and 114 mmHg in the High and Low SBP groups, respectively. In the propensity score-matched cohort (n = 1684), the Low SBP group had a significantly higher incidence of the primary efficacy endpoint (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.01–1.88; p = 0.039), while the primary safety endpoint was comparable between groups. In the Low SBP group, rivaroxaban monotherapy was associated with lower risks of both the primary efficacy (HR, 0.60; 95% CI, 0.41–0.86; p = 0.006) and safety endpoints (HR, 0.40; 95% CI, 0.22–0.74; p = 0.003) compared with combination therapy, whereas no significant differences were observed in the High SBP group. Conclusions: Lower SBP was associated with increased risk of cardiovascular events and all-cause death. Rivaroxaban monotherapy demonstrated more favorable efficacy and safety outcomes particularly patients with lower SBP.

In a large-scale randomized controlled study of heart failure (HF), angiotensin receptor-neprilysin inhibitors (ARNI) reduced cardiovascular events compared to enalapril, but resulted in more symptomatic hypotension. However, changes in blood pressure (BP) during hospitalization in patients with decompensated HF treated with ARNI remain unknown. We retrospectively analyzed BP during hospitalization for decompensated HF in a multi-center registry. Among 166 patients treated with newly prescribed renin-angiotensin system inhibitor (75.7 ± 13.4 years, 57.2

Prehospital-electrocardiography (ECG) has been shown to be effective in reducing time to reperfusion in patients with myocardial infarction; however, its utility in disaster settings remains unclear.K-ACTIVE is a cardiovascular emergency registry comprising 58 hospitals in Kanagawa, Japan. 5,821 ST-segment–elevation myocardial infarction (STEMI) cases were enrolled during before-pandemic (January 2017 to December 2019; N = 3,946) and pandemic (January 2020 to November 2021; N = 1,875) (Cohort A). Additionally, 2,980 cases with complete time-course documentation from symptom onset to device insertion were analyzed (Cohort B). In Cohort A, the rates of primary percutaneous coronary intervention (PCI) and pre-hospital-ECG use were preserved during pandemic (94.1

Background Appropriate defecation patterns may be important for the prevention of recurrent cardiovascular events. Objectives This study aimed to investigate the association of defecation patterns and laxative use during hospitalization with future cardiovascular events in patients with acute coronary syndrome (ACS). Methods This 2-center retrospective observational study included 1,817 patients hospitalized for ACS. In addition to: 1) “average daily defecation frequency,” we comprehensively evaluated the following abnormal defecation patterns; 2) “% of nondefecation days;” 3) “consecutive nondefecation days;” and 4) “maximum daily defecation frequency.” Cutoff values were determined using maximization of the log-rank statistic. The primary outcome was a composite of all-cause mortality, myocardial infarction, ischemic stroke, and hemorrhagic stroke. Laxatives were categorized into stimulant and nonstimulant types, and their associations with defecation patterns and cardiovascular outcomes were assessed. Results During a median follow-up of 48 months (IQR: 29-74 months), 375 of 1,817 patients (20.6 [95% CI: 18.8-22.6]%) developed the primary outcome. Frequent nondefecation days (adjusted HR for ≥33.8%: 1.549; 95% CI: 1.217-1.971; P < 0.001)—corresponding to at least 1 nondefecation day every 3 days—and high maximum daily defecation-frequency (adjusted HR for ≥5 times/d: 1.803; 95% CI: 1.273-2.554; P < 0.001) were significant predictors. Those with reduced defecation frequency more often used stimulant laxative, which was independently associated with the primary outcome (adjusted HR: 1.285; 95% CI: 1.003-1.646; P = 0.047). Conclusions Abnormal defecation patterns and stimulant laxative use during ACS hospitalization were independent factors associated with an increased risk of future cardiovascular events.

Background The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial demonstrated that rivaroxaban monotherapy has noninferior efficacy and superior safety compared with combination therapy (rivaroxaban plus a single antiplatelet) in patients with atrial fibrillation and stable coronary artery disease. Objectives This post hoc analysis aimed to explore the impact of medication adherence on the AFIRE trial results. Methods A total of 2,120 patients were categorized into adherent and nonadherent groups based on self-reported assessments, which were further validated through on-site visits to the facilities. Adherence was defined as continuous medication use as prescribed. The primary efficacy endpoint was a composite of stroke, systemic embolism, myocardial infarction, revascularization requiring unstable angina, or all-cause death. The primary safety endpoint was major bleeding events. Results Among the 2,012 (94.9%) adherent patients, rivaroxaban monotherapy showed significantly better outcomes compared with combination therapy regarding both efficacy (HR: 0.72; 95% CI: 0.53-0.96; P = 0.028) and safety (HR: 0.63; 95% CI: 0.41-0.97; P = 0.034). However, no significant differences in outcomes were shown in nonadherent patients (n = 108). There was no interaction between medication adherence and the randomized treatment group. In clinically high-risk patients with a history of angina pectoris, compared with nonadherent patients (n = 68), those who demonstrated medication adherence (n = 1,281) exhibited significantly better efficacy outcomes (HR: 0.52; 95% CI: 0.30-0.97; P = 0.041). Conclusions High adherence to rivaroxaban monotherapy was associated with improved outcomes, underscoring the importance of adherence in achieving optimal therapeutic effects (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease [AFIRE], NCT02642419; AFIRE Study: Atrial Fibrillation and Ischemic events with Rivaroxaban in patiEnts with stable coronary artery disease Study, UMIN000016612).

Although anemia is associated with adverse outcomes after acute myocardial infarction (MI), the specific impact of anemia on individual components of the cardiovascular events remains inadequately clarified. This study consisted of 3,229 patients with acute MI from the J-MINUET study. There were 930 patients (28.8%) with anemia, defined as hemoglobin (Hb) levels < 12 g/dL in women and < 13 g/dL in men: 533 (16.5%) with mild anemia (Hb levels 11-12/13 g/dL) and 397 patients (12.3%) with moderate to severe anemia (Hb levels < 11 g/dL). Composite outcomes included all-cause death, admission for heart failure (HF), stroke, and recurrent MI. At 3-year follow-up, the incidence of the composite outcomes was 17.9% in patients with no anemia, 32.3% in those with mild anemia (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.60-2.38, P < 0.001), and 56.1% in those with moderate to severe anemia (HR 3.91, 95%CI 3.26-4.69, P < 0.001). The impact of anemia was greatest for death, followed by admission for HF and stroke. This effect was more pronounced in patients with moderate to severe anemia. The influence of anemia on recurrent MI was less significant. While chronic kidney disease (CKD) amplified the adverse outcomes of anemia, the impact of anemia and its severity on the incidence of cardiovascular events was consistent regardless of CKD status. In conclusion, the most profound effect of anemia was observed for death, followed by HF and stroke in patients with MI, particularly in moderate to severe anemia, while the association with recurrent MI was less pronounced.

Although anemia is associated with adverse outcomes after acute myocardial infarction (MI), the specific impact of anemia on individual components of the cardiovascular events remains inadequately clarified. This study consisted of 3,229 patients with acute MI from the J-MINUET study. There were 930 patients (28.8%) with anemia, defined as hemoglobin (Hb) levels < 12 g/dL in women and < 13 g/dL in men: 533 (16.5%) with mild anemia (Hb levels 11-12/13 g/dL) and 397 patients (12.3%) with moderate to severe anemia (Hb levels < 11 g/dL). Composite outcomes included all-cause death, admission for heart failure (HF), stroke, and recurrent MI. At 3-year follow-up, the incidence of the composite outcomes was 17.9% in patients with no anemia, 32.3% in those with mild anemia (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.60-2.38, P < 0.001), and 56.1% in those with moderate to severe anemia (HR 3.91, 95%CI 3.26-4.69, P < 0.001). The impact of anemia was greatest for death, followed by admission for HF and stroke. This effect was more pronounced in patients with moderate to severe anemia. The influence of anemia on recurrent MI was less significant. While chronic kidney disease (CKD) amplified the adverse outcomes of anemia, the impact of anemia and its severity on the incidence of cardiovascular events was consistent regardless of CKD status. In conclusion, the most profound effect of anemia was observed for death, followed by HF and stroke in patients with MI, particularly in moderate to severe anemia, while the association with recurrent MI was less pronounced.

Antithrombotic therapy is crucial for older patients with coronary artery disease (CAD) and atrial fibrillation (AF) who are at a high risk of bleeding and thrombotic events. To examine the age-stratified effects of rivaroxaban monotherapy compared with those of rivaroxaban plus antiplatelet agent combination therapy. This was a post hoc secondary analysis of the Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease (AFIRE) open-label randomized clinical trial. This was a multicenter study conducted in Japan from February 23, 2015, to July 31, 2018. Patients with AF and stable CAD who had undergone percutaneous coronary intervention or coronary artery bypass grafting 1 or more years earlier or who had angiographically confirmed CAD that did not require revascularization were enrolled. Participants were stratified into 4 groups by age (<70 years, 70-74 years, 75-79 years, and ≥80 years). Study data were analyzed from August 2024 to July 2025. Rivaroxaban monotherapy or rivaroxaban plus antiplatelet agent therapy. The primary efficacy end point was a major adverse cardiovascular event, defined as a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause. The primary safety end point was major bleeding. This study included a total of 2215 participants (mean [SD] age, 74.3 [8.2] years; 1751 male [79.1%]). The incidence of primary efficacy end points per patient-year for rivaroxaban monotherapy vs rivaroxaban plus antiplatelet agent therapy was 3.2% vs 4.3% (<70 years), 3.2% vs 2.8% (70-74 years), 3.8% vs 5.3% (75-79 years), and 6.2% vs 10.3% (≥80 years). The hazard ratios were 0.74 (95% CI, 0.40-1.37) for those younger than 70 years, 1.16 (95% CI, 0.55-2.45) for those aged 70 to 74 years, 0.72 (95% CI, 0.41-1.26) for those aged 75 to 79 years, and 0.61 (95% CI, 0.40-0.93) for those 80 years and older (P for interaction =.51). For the primary safety end points, the incidence was 0.5% vs 2.3% (<70 years), 2.2% vs 2.4% (70-74 years), 1.1% vs 2.1% (75-79 years), and 2.9% vs 4.3% (≥80 years). The hazard ratios were 0.23 (95% CI, 0.06-0.79) for those younger than 70 years, 0.91 (95% CI, 0.39-2.15) for those aged 70 to 74 years, 0.52 (95% CI, 0.19-1.42) for those aged 75 to 79 years, and 0.67 (95% CI, 0.35-1.27) for those 80 years and older (P for interaction =.33). Results of this post hoc analysis of the AFIRE randomized clinical trial reveal that rivaroxaban monotherapy reduced the risk of major cardiovascular events and major bleeding across the broad range of age in patients with AF and stable CAD. Possible age-related differences in trends, with more pronounced efficacy in older patients and more pronounced safety in younger patients, should be considered as hypothesis generating and require further research. ClinicalTrials.gov Identifier: NCT02642419.

Background:The association between a history of cancer and clinical outcomes in patients with acute myocardial infarction (AMI) remains unclear. This study aimed to analyze the characteristics and clinical outcomes of AMI patients based on their history of cancer in a contemporary cohort undergoing antithrombotic therapy with potent P2Y12 inhibitors. Methods:Consecutive patients with spontaneous onset were enrolled in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. The outcomes included all-cause death, major bleeding, and composite ischemic events defined as cardiovascular (CV) death, MI, and ischemic stroke. Results:A total of 3,411 AMI patients were enrolled with a median follow-up duration of 358 days. Among those, 292 patients (8.6 %) had a history of cancer. They were older and had lower body mass index. While they had a similar risk of composite ischemic event and major bleeding, they were at higher risk for all-cause mortality than those without (adjHR 1.64 [95 %CI 1.16-2.32], P = 0.005). The risk for non-CV death and death due to cancer were higher in the cancer group (adjHR 2.05 [1.24-3.39], P = 0.005; adjHR 18.16 [6.76-48.97], P < 0.001, respectively). When further stratified by age, the difference in all-cause mortality became pronounced in the group aged < 75 years but not in the group aged ≥ 75 years (adjHR 3.32 [1.88-5.85] and 1.26 [0.81-1.96], respectively; P-interaction = 0.008). Conclusion:The JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged < 75 years. These results might suggest the need for a multidisciplinary approach to improve their prognosis.

Background: Few studies have investigated the clinical characteristics and in-hospital outcomes of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) using real-world databases in the coronary intervention era. Methods and Results: We conducted a retrospective analysis of 22,236 patients (mean [+/- SD] age 68 +/- 13 years, 23.4% female) enrolled in the Japan Acute Myocardial Infarction Registry (JAMIR) between 2011 and 2016. Based on urgent coronary angiography findings, 286 (1.3%) patients were diagnosed as MINOCA, and the remaining 21,950 (98.7%) as MI with obstructive coronary artery disease (MI-CAD). MINOCA patients were characterized by younger age, fewer coronary risk factors, lower rate of ST-elevation myocardial infarction, lower Killip classification, and lower peak creatinine phosphokinase levels than MI-CAD patients. In-hospital all-cause mortality did not differ between the MINOCA and MI-CAD groups (5.2% vs. 5.7%, respectively; P=0.82). Comparing cause- specific mortality, non-cardiac mortality was higher in the MINOCA than MI-CAD group (4.2% vs. 1.6%; P<0.01). Importantly, non- cardiac death was more prevalent among elderly (>= 65 years) than younger (<65 years) patients in the MI-CAD group, whereas this trend was not observed in the MINOCA group. Conclusions: Analysis of the real-world JAMIR database revealed a relatively high prevalence of non-cardiac death among MINOCA patients, underscoring the need for comprehensive management to improve disease prognosis, particularly in younger patients.

Background:Elevated white blood cell (WBC) counts have been associated with major adverse cardiovascular events (MACE). However, their incremental prognostic values, especially considering factors such as race, sex difference, clinical characteristics, and statin dosage, are not well defined. This study aimed to explore the relationship between baseline WBC counts and subsequent MACE in Japanese patients with stable coronary artery disease (CAD) receiving high and low doses of pitavastatin, as a sub-analysis of the REAL-CAD study. Methods and Results:A total of 10,123 patients with baseline WBC count data were included in this analysis. Patients were categorized into quartiles based on their baseline WBC counts, and the cumulative 4-year incidence of MACE, defined as cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring hospitalization, was compared among the quartiles. MACE occurred in 491 patients, and Kaplan-Meier curve analysis showed a significantly higher incidence of MACE in the fourth quartile compared with the first quartile (hazard ratio [HR]: 1.910, 95 % confidence interval [CI]: 1.477-2.471). Multivariate analysis indicated that the highest quartile of WBC count was an independent determinant of future MACE (HR: 1.879, 95 %CI: 1.439-2.454), adjusting for age, sex, diabetes, current smoking, statin dosage, and baseline high-sensitive C-reactive protein. Conclusions:Elevated WBC counts increased the risk of cardiovascular events in Japanese patients with stable CAD, highlighting the importance of inflammation as a residual risk after statin treatments in the Japanese population. Further research is needed to evaluate the clinical benefits of screening and treatment strategies based on WBC counts.

BACKGROUND:Current guidelines recommend early revascularization in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI). However, guideline-recommended first medical contact-to-device times is reportedly achieved in only 40% of patients. METHODS AND RESULTS:We retrospectively analyzed 369 patients with AMI complicated by CS from the Kanagawa-Acute Cardiovascular Registry to evaluate factors influencing delays in treatment and their effect on in-hospital mortality. Patients were stratified into 2 groups based on the median door-to-cardiac catheterization laboratory (D2C) time (≤39 or >39 min). In the group with D2C time ≤39 min, the first-contact physician was more frequently a cardiologist (71.9% vs. 47.0%; P<0.001) and significantly more patients had chest pain as the chief complaint (70.3% vs. 47.4%; P<0.001). Although pre- and post-percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow was similar between the 2 groups, in-hospital mortality was significantly lower in the D2C time ≤39 min group (18.8% vs. 37.6%; P<0.001). Multivariate logistic regression analysis revealed that D2C time >39 min was independently associated with a non-cardiologist being the first-contact physician, the absence of chest pain, a higher heart rate, and elevated creatinine levels. CONCLUSIONS:D2C time ≤39 min is correlated with reduced mortality in AMI patients with CS. Implementing systems to ensure cardiologists are the initial responders and optimizing in-hospital workflows could reduce the D2C time and improve outcomes.

ABSTRACT Background Rhythm control therapy improves the quality of life and prognosis of patients with atrial fibrillation (AF). We assessed the characteristics and clinical outcomes of AF patients with stable coronary artery disease (CAD) undergoing rhythm control therapy. Methods We analyzed 2215 participants from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, including 588 patients who received rhythm control therapy and 1627 who did not. Results At baseline, patients who received rhythm control therapy were generally younger, exhibited a higher prevalence of paroxysmal AF, experienced less heart failure, and had lower CHADS2 scores (CHF, hypertension, age ≥ 75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) than those who did not. Among the rivaroxaban monotherapy and combination therapy groups, patients with a history of rhythm control therapy showed a lower incidence of the primary efficacy endpoint (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death). However, following multivariate analysis and propensity score matching, no statistically significant difference in the primary efficacy endpoint was observed between patients with and without prior rhythm control therapy (adjusted HR 0.75, 95% CI 0.37–1.51, p = 0.43 in the rivaroxaban group; adjusted HR 0.75, 95% CI 0.43–1.30, p = 0.30 in the combination therapy group). Conclusions The initially observed benefit of rhythm control therapy was not significant after adjusting for baseline characteristics in patients with AF and stable CAD treated with rivaroxaban with or without additional antiplatelet therapy.

Background:The AHEAD score - comprising atrial fibrillation, haemoglobin, elderly age, abnormal renal function, and diabetes mellitus - is a validated prognostic model for patients with heart failure. However, its predictive value in acute myocardial infarction (MI), particularly in large real-world cohorts, remains uncertain. Aims:We aimed to assess the utility of the AHEAD score in predicting 1-year all-cause mortality in patients with acute MI. Methods:This secondary analysis of the Japan Acute Myocardial Infarction Registry (JAMIR) included 3,067 patients with acute MI enrolled across 50 Japanese institutions between December 2015 and May 2017. Patients were stratified by AHEAD score at admission. The primary endpoint was all-cause mortality within 1 year after acute MI. Multivariable Cox regression, Kaplan-Meier survival analysis, and restricted cubic spline modelling were used to evaluate the association between the AHEAD score and mortality. Results:Higher AHEAD scores were associated with older age, more comorbidities, a higher Killip class, and delayed reperfusion. The 1-year all-cause mortality rate increased significantly with rising AHEAD scores. The AHEAD score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.60; 95% confidence interval: 1.39-1.84; p<0.001), and this association was consistent across predefined subgroups. Spline analysis demonstrated a linear relationship between the AHEAD score and the mortality risk. Conclusions:The AHEAD score is a simple, bedside-accessible tool that effectively predicts 1-year all-cause mortality in patients with acute MI, regardless of the presence of heart failure. Its use may aid early risk stratification and guide clinical decision-making in acute cardiovascular care. This study was registered with the Japanese UMIN Clinical Trials Registry (UMIN000019479).

BACKGROUND:The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI. METHODS:This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (-) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups. RESULTS:The patient backgrounds of the PH-ECG (+) and PH-ECG (-) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (-) group [2756 (1292-6009) IU/ml vs. 2270 (957-5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20-33) min vs. 27 (20-35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52-103) min vs. 83 (62-111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24-2.83), p = 0.003]. CONCLUSIONS:PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.

BACKGROUND AND AIMS:Previous studies have not found a consistent association between circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) levels and the risk of cardiovascular events partly due to measurement methods that cannot distinguish between uncleaved and furin-cleaved forms of PCSK9. METHODS:This is a prespecified sub-study of the REAL-CAD study which is a prospective, multicenter, randomized trial to compare high- versus low-dose statin in patients with stable coronary artery disease (CAD). The primary endpoint was major adverse cerebrovascular and cardiovascular events (MACCE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. In this case-cohort study, serum mature (uncleaved) and furin-cleaved PCSK9 levels obtained at 6 months after randomization were measured among 426 participants who developed MACCE (cases) and 1,478 randomly selected participants (sub-cohort). RESULTS:From 1,478 patients in the sub-cohort, the Cox proportional hazards models with a pseudolikelihood method for case-cohort design revealed that the risk of the primary endpoint in patients with the highest quartile of mature PCSK9 levels was similar to that in the lowest quartile (hazard ratio [HR] 0.809; 95% confidence intervals [CI], 0.541-1.209). Similarly, the HR for the highest to lowest quartiles of furin-cleaved PCSK9 was 0.948 (95% CI, 0.645-1.392) (P = 0.784). Compared to the lowest quartile, neither serum mature nor furin-cleaved PCSK9 levels predicted MACCE. CONCLUSIONS:In a large-scale secondary prevention cohort, serum mature and furin-cleaved PCSK9 levels did not provide useful information for predicting future cardiovascular events in statin-treated patients with stable CAD.

Abstract Background The influence of acute kidney injury (AKI) and chronic kidney disease (CKD) on long-term outcomes following AMI in the era of modern primary PCI with optimal-medical-therapy (OMT) is still in debate. Methods A total of 3,281 patients with acute myocardial infarction (AMI) were enrolled in the J-MINUET registry with primary PCI of 93.1% in STEMI Consecutive patients hospitalized within 48 h of onset of AMI at 28 Japanese medical institutions were enrolled in the J-MINUET study (UMIN000010037). AKI was defined as an increase in serum-creatinine ≥0.3mg/dL or ≥50% within-48h during-hospitalization. CKD was defined as estimated glomerular filtration-rate [eGFR]<60mL/min/1.73m2. Major adverse cardiac event (MACE) was defined as a composite of all-cause death, cardiac-failure, MI and stroke. Patients were divided into 4 groups based on the presence or absence of CKD and the occurrence or non-occurrence of AKI. The parameters were assessed by the Cox proportional hazards model. Differences were considered statistically significant at P<0.05. Results Of the 3,281 patients with AMI, 3220 patients had complete data set. The average age was 69±13 years old and 75.3% of the patients were male. Of the 3220 patients, 1375 patients had CKD (42.7%) and AKI occurred in 365 patients (11.3%) during the initial hospital stay. AKI more frequently occurred in 305 CKD patients (22.2%) than 60 non-CKD patients (3.3%) (p<0.0001). A total of 898 MACE occurred (27.4%) during follow-up period (median of 768days). Kaplan-Meier curves illustrated event-free survival for MACE over 3 years stratified by the 4 groups (Figure). Conclusions While both CKD without AKI and non-CKD with AKI showed similar effect on the incidence of MACE, the worst clinical outcome was observed in patients having AKI on pre-existed CKD.

A recent meta‐analysis found no benefit of uric acid‐lowering therapy including febuxostat on death, cardiovascular events, or renal impairment. However, there may be populations that benefit from febuxostat in reducing mortality and cerebral and cardiovascular events. The aim of the present study was to examine the clinical benefit of febuxostat in elderly patients stratified by age using Febuxostat for Cerebral and CaRdiorenovascular Events PrEvEntion StuDy (FREED) data. FREED was a randomized study involving patients aged 65 years or older with hyperuricemia and risk factors for cerebral, cardiovascular, or renal diseases. A total of 1,070 patients were included in this post hoc analysis, divided into 2 age groups: 65–74 years and ≥ 75 years. Patients were randomized into febuxostat and non‐febuxostat groups, with uric acid levels monitored for 36 months. The primary composite end point included cerebral, cardiovascular, and renal events. In patients aged between 65 and 74 years, febuxostat significantly reduced the risk of future cerebral and cardiorenovascular events. However, no effects of febuxostat were found in the older population aged ≥ 75 years. Heterogeneity in potential interactions between the age and febuxostat treatment was particularly observed in non‐fatal cerebral and cardiovascular events and all‐cause death. Patients aged ≥ 75 years exhibited more pre‐existing factors associated with cerebral and cardiorenovascular events than those aged 65–74 years. The effectiveness of febuxostat varies by age group, with potential benefits for patients aged 65–74 years. The effects of febuxostat are complex and it is important to consider patient characteristics in its clinical use.

BACKGROUND:The comparative efficacy and safety of adjusted- and standard-dose prasugrel in East Asian patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) remain unclear. This study aimed to comparatively assess the ischaemic and bleeding outcomes of adjusted-dose (maintenance dose: 3.75 mg) and standard-dose (maintenance dose: 10 mg) prasugrel in East Asian patients with AMI undergoing PCI. METHODS:From a combined dataset sourced from nationwide AMI registries in Japan and South Korea (n = 17,118), patients treated with either adjusted- or standard-dose prasugrel were identified. Patients who did not undergo emergent PCI, those on oral anticoagulants, and those meeting the criteria of contraindication of prasugrel in South Korea (age ≥ 75 years, body weight < 60 kg, or history of stroke) were excluded. Major adverse cardiovascular events (MACE) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding events were compared between the adjusted-dose (n = 1160) and standard-dose (n = 1086) prasugrel groups. RESULTS:Within the propensity-matched cohort (n = 702 in each group), no significant difference was observed in the in-hospital MACE between the adjusted- and standard-dose prasugrel groups (1.85% vs. 2.71%, odds ratio [OR] 0.68, 95% confidence interval [CI] 0.33-1.38, p = 0.286). However, the incidence of in-hospital major bleeding was significantly lower in the adjusted-dose prasugrel group than in the standard-dose group (0.43% vs. 1.71%, OR 0.25, 95% CI 0.07-0.88, p = 0.031). The cumulative 12-month incidence of MACE was equivalent in both groups (4.70% vs. 4.70%, OR 1.00, 95% CI 0.61-1.64, p = 1.000). CONCLUSIONS:Among East Asian patients with AMI undergoing PCI, those administered adjusted-dose prasugrel exhibited a lower risk of in-hospital bleeding events than those administered standard-dose prasugrel, while maintaining a comparable 1-year incidence of MACE.