Yan Sun

Background: Elderly patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) have a markedly high mortality. Although ticagrelor has demonstrated superiority over clopidogrel in the AMI population, its efficacy and safety in elderly patients with AMI-CS remain uncertain. This study aimed to compare the associations of ticagrelor and clopidogrel with early in-hospital clinical outcomes in elderly patients with AMI-CS. Methods: This retrospective study included 839 patients aged ≥65 years with AMI-CS who underwent percutaneous coronary intervention (PCI) at participating hospitals in China within the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project between November 2014 and December 2020. Patients with missing information on dual antiplatelet therapy (DAPT), those who did not receive DAPT within 24 hours of first medical contact, and those with combined use of or switching between P2Y12 inhibitors during hospitalization were excluded. Patients were grouped according to the P2Y12 inhibitor received: ticagrelor (n=314) or clopidogrel (n=525). The primary outcomes were all-cause mortality and major bleeding during the first 15 days of hospitalization; major adverse cardiovascular events (MACE) were a secondary outcome. Multivariable Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used to adjust for potential confounders. Results: Compared with clopidogrel, ticagrelor was associated with higher risk of all-cause mortality [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI): 1.05–2.21, P=0.03] and MACE (adjusted HR 1.48, 95% CI: 1.09–2.01, P=0.01) during the first 15 days of hospitalization, without a statistically significant difference in major bleeding (adjusted HR 1.76, 95% CI: 0.68–4.52, P=0.24). Subgroup analyses generally showed a similar direction of association for all-cause mortality. The associations with mortality and MACE remained statistically significant after PSM; the corresponding IPTW estimates were directionally similar but not statistically significant. Conclusions: Among elderly AMI-CS patients undergoing PCI, ticagrelor did not confer a clinical benefit over clopidogrel and was associated with increased in-hospital mortality and MACE without a significant increase in major bleeding. These findings highlight the need for cautious selection of P2Y12 inhibitors in this high-risk population and further prospective studies to guide individualized therapy.

This study aimed to explore the effect of long-term (≥1 year) sleep quality on coronary lesion complexity and cardiovascular prognosis in young acute coronary syndrome (ACS) patients. We consecutively recruited young patients aged from 18 to 44 years old with first-episode ACS and significant epicardial stenosis on coronary angiography from January 2016 to January 2017. Coronary lesion complexity was evaluated based on SYNTAX scores. Long-term sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) (PSQI ≤ 5 and PSQI > 5 groups). The primary endpoints were major adverse cardiovascular events (MACEs). A total of 466 young ACS patients (93.13% male; median age, 41 years) were included. Poor sleepers (PSQI > 5) had higher SYNTAX scores. After adjusting for confounders, PSQI scores (continuous variables, OR: 1.264; 95%CI: 1.166–1.371; p < 0.001) and PSQI grade (binary variable, OR: 3.864; 95%CI: 2.313–6.394; p = 0.001) were significantly associated with an increased risk of complex coronary lesions. During a median follow-up of 74 months, long-term poor sleep quality (PSQI > 5) was significantly associated with an increased risk of MACEs (HR: 4.266; 95%CI: 2.274–8.001; p < 0.001). Long-term poor sleep quality was a risk factor for complex coronary lesions and has adverse effects on cardiovascular prognosis in the young ACS population.

(1) Background: The aim of this study was to investigate whether the prognostic value of the atherogenic index of plasma (AIP) for adverse cardiovascular events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) varied across different BMI groups. (2) Methods: This study was a retrospective analysis of a prospective registry involving 1725 ACS patients undergoing PCI. The primary endpoint was a composite of all-cause death, non-fatal ischemic stroke, non-fatal spontaneous myocardial infarction (MI), and unplanned repeat revascularization. (3) Results: The study population finally consisted of 526 patients with BMI < 24 kg/m² (age 62 ± 10 years; male 64.3%), 827 patients with 24 kg/m² ≤ BMI < 28 kg/m² (age 60 ± 10 years; male 81.8%), and 372 patients with BMI ≥ 28 kg/m² (age 57 ± 11 years; male 81.2%). The AIP as a continuous variable increased the risk for the primary endpoint in ACS patients undergoing PCI with BMI < 24 kg/m² (HR 2.506; 95% CI 1.285–4.885; p = 0.007), while it did not increase the risk in patients with BMI ≥ 24 kg/m² (hazard ratio [HR]: 1.747; 95% CI 0.921–3.316; p = 0.088 for patients with 24 kg/m² ≤ BMI < 28 kg/m²; and HR: 2.096; 95% CI 0.835–5.261; p = 0.115 for patients with BMI ≥ 28 kg/m², respectively). Compared with the lowest AIP tertile, the top AIP tertile was associated with a significantly increased risk of the primary endpoint in BMI < 24 kg/m² group (HR: 1.772, 95% CI: 1.110 to 2.828, p = 0.016). (4) Conclusions: The AIP was significantly associated with an increased risk of adverse cardiovascular events in ACS patients undergoing PCI with BMI < 24 kg/m², but not in the patients with BMI ≥ 24 kg/m².