Minfang Guan

Background: Coronary embolism (CE) is an underrecognized cause of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). Dedicated management guidelines are lacking because of limited evidence. Methods: This retrospective cohort study leveraged routinely collected electronic health records and regional death registry data from a tertiary hospital in China (2014–2023). Among 4777 patients with AMI, CE was diagnosed using a 3‐stage validation process: modified Shibata criteria, blinded angiographic core laboratory assessment, and final adjudication. Patients were categorized into 3 groups: CE with AF (n=78), non‐CE AMI with AF (n=205), and non‐CE AMI without AF (n=3937). Overlap weighting based on propensity scores was used to balance baseline covariates, and weighted Cox proportional hazards models with competing‐risk analysis were applied for comparative outcome analyses. Results: CE accounted for 1.6% (95% CI, 1.3%–2.0%) of all AMI cases and was present in 14.7% to 27.6% of AF‐related AMI. Compared with non‐CE AMI patients without AF, those with CE and AF had significantly higher risks of all‐cause mortality (overlap‐weighted hazard ratio [HR], 1.77 [95% CI, 1.15–2.71]) and ischemic stroke (overlap‐weighted HR, 4.45 [95% CI, 2.34–8.45]), despite 79.2% receiving therapeutic anticoagulation. Conclusions: CE complicating AF represents a high‐risk phenotype characterized by high residual thromboembolic risk despite anticoagulation. An integrated management strategy is proposed for future investigation, incorporating multimodal imaging, embolism‐targeted reperfusion, and optimization of antithrombotic therapy, including standard‐dose direct oral anticoagulants. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06845956.

Background: To explore the potential categories of compliance development track of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) using growth mixture modeling (GMM) to analyze its predictive factors, providing evidence for dynamic adherence monitoring and tailored interventions. Methods: A total of 150 patients with ACS after PCI were selected by convenience sampling. Patients were studied using Self-Efficacy for Appropriate Medication Use Scale (SEAMS), family APGAR index (APGAR), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-2 (PHQ-2) at baseline. The compliance of patients with DAPT was assessed using Morisky Medication Adherence Scales-8 (MMAS-8) at 1, 3, 6, 9, and 12 months after discharge. The mixed model of latent variable growth was used to identify the development track of compliance. Multiple logistic regression was used to analyze the predictive factors of different development track categories. Results: Two development track categories of DAPT compliance in patients with ACS after PCI were identified in the low compliance-decreased group (7.41%) and the persistent high compliance group (92.59%). Multivariate logistic regression analysis showed that age ≥60 years, body mass index (BMI), and the family APGAR index were the predictive factors of different development track categories of DAPT compliance in patients with ACS after PCI. Conclusion: Significant population heterogeneity was observed in the development track of DAPT in ACS patients within 12 months after PCI. The compliance of most patients remained stable, and only a few remained at a low level and showed a significant downward trend. Based on these predictive factors, healthcare personnel can identify patients in the low compliance–decreased group early and implement targeted and specific interventions to improve DAPT compliance of ACS patients after PCI.

Background: Rehabilitation through exercise is the core content of cardiac rehabilitation, which is conducive to promoting myocardial recovery and reducing mortality. However, the overall participation rate in exercise rehabilitation is low. Thus, this study aimed to comprehensively evaluate the barriers and facilitators of exercise rehabilitation for patients with myocardial infarction using the updated Consolidated Framework for Implementation Research (CFIR 2.0). Methods: Systematic research retrieval was reviewed via PubMed, Embase, Web of Science, Cochrane Library, ProQuest, and PsycINFO databases. Based on CFIR 2.0, this study used descriptive analyses to analyze the research results of each included document and identify it as a barrier or facilitator. Results: In total, 5185 studies were obtained from a preliminary search; 11 studies were ultimately included; 5 studies were quantitative. This study summarized 50 influencing factors, including 27 barriers and 23 facilitators. Most factors were related to the individual domain (64%). The remaining factors were related to the inner setting domain (20%), innovation domain (10%), implementation process domain (4%), and outer setting domain (2%). Conclusions: This study integrated the barriers and facilitators of exercise rehabilitation of patients with myocardial infarction. The study emphasizes the importance of considering the individual domain, inner setting domain, innovation domain, implementation process domain, and outer setting domain factors when implementing exercise rehabilitation. This study provides a systematic foundation for optimizing cardiac rehabilitation programs. The PROSPERO Registration: CRD42024521287, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024521287.