Cardiovascular Effects and Tolerability of GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of 99,592 patients.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant cardiovascular (CV) benefits particularly in patients with diabetes mellitus (DM), but the safety and efficacy of different GLP-1 RAs across diverse populations remain insufficiently defined.

Objectives: Previous meta-analyses of GLP-1 RAs have been limited by restricted populations, omission of recent trials, or incomplete safety synthesis; this study integrates the latest evidence across 21 RCTs and diverse populations using advanced meta-analytic methods.

Methods: Randomized controlled trials comparing GLP-1 RAs vs controls or placebo were included.

Impact of Race on Profiles of Platelet Reactivity and Clinical Outcomes in Clopidogrel-Treated Participants.

Black individuals undergoing percutaneous coronary intervention (PCI) experience higher rates of major adverse cardiovascular events (MACE) than non-Black individuals. This study assessed the racial differences in platelet reactivity and clinical outcomes among clopidogrel-treated participants. Two cohorts were analyzed.

Antiplatelet Monotherapies for Long-Term Secondary Prevention Following Percutaneous Coronary Intervention.

In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), antiplatelet therapy is the cornerstone of treatment for secondary prevention. Although dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y inhibitor is the current standard of care, being, respectively, recommended for 6 and 12 months in patients with chronic and acute coronary syndrome without a need for oral anticoagulation, the continuous improvement in PCI technology and pharmacology have significantly reduced the need for long-term DAPT. Mounting evidence supports the administration of P2Y inhibitor monotherapy, particularly ticagrelor, after a short period of DAPT following PCI as a strategy to reduce bleeding without a trade-off in ischemic events compared to standard DAPT.

Aspirin or P2Y Inhibitor Monotherapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes.

Background: In patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), shortening dual antiplatelet therapy (DAPT) duration reduces bleeding, but the relative benefit of maintaining aspirin or P2Y inhibitor monotherapy is debated.

Objectives: The authors sought to compare the net benefits of aspirin vs P2Y inhibitor monotherapy after short DAPT.

Methods: Randomized trials of short DAPT in ACS patients undergoing PCI were identified.

Sex differences in dual antiplatelet therapy de-escalation strategies after percutaneous coronary intervention: a network meta-analysis.

Background And Aims: Dual antiplatelet therapy (DAPT) de-escalation strategies improve outcomes after percutaneous coronary intervention (PCI) compared to standard DAPT. However, the potential impact of sex on the safety and efficacy of these strategies is yet to be fully investigated.

Methods: Randomized controlled trials comparing de-escalated vs standard DAPT regimens in patients without baseline indication for oral anticoagulation reporting outcomes stratified by sex were included.

Phenotype, P2Y Inhibitor Selection, and Clinical Outcomes in Patients on Maintenance Clopidogrel Therapy.

Background: Use of genotyping to guide antiplatelet therapy is associated with improved clinical outcomes in patients naïve to P2Y inhibitors undergoing percutaneous coronary intervention. The relationship between genotype and clinical outcomes in patients on maintenance clopidogrel at the time of percutaneous coronary intervention is unknown.

Methods: This was a retrospective, multicenter cohort study.

Influence of patient's weight and body mass index on presentation, time of onset, and impact of postoperative venous thromboembolism (RIETE registry).

The influence of weight and body mass index (BMI) on the initial presentation of venous thromboembolism (VTE) has not been consistently studied in patients undergoing non-bariatric surgery. This study aimed to assess and compare the time-course, initial presentation, and 3-month outcomes of patients with acute VTE after non-orthopedic surgery, according to weight and BMI. We conducted an observational study using an international database (RIETE registry), an ongoing inception cohort of patients with confirmed postoperative VTE.

Effect of DAPAgliflozin on Myocardial Fibrosis and Ventricular Function in Patients with ST-Segment Elevation Myocardial Infarction-DAPA-STEMI Trial.

Myocardial fibrosis leads to ventricular dysfunction and worsened prognosis, especially after ST-segment elevation myocardial infarction (STEMI). Sodium-glucose cotransporter 2 inhibitors (SGLT2is) offer cardiovascular benefits by reducing markers of myocardial fibrosis and fibroblast activity. However, the effects of SGLT2i on myocardial fibrosis deposition among STEMI patients undergoing primary percutaneous coronary intervention (PCI) have not yet been evaluated.

[[Long-term prognostic impact of the left anterior descending coronary artery as the STEMI-related culprit vessel: subanalysis of the EXAMINATION-EXTEND trial]].

Introduction And Objectives: There is limited data on the impact of the culprit vessel on very long-term outcomes after ST-elevation myocardial infarction (STEMI). The aim was to analyze the impact of the left anterior descending coronary artery (LAD) as the culprit vessel of STEMI on very long-term outcomes.

Methods: We analyzed patients included in the EXAMINATION-EXTEND study (NCT04462315) treated with everolimus-eluting stents or bare-metal stents after STEMI (1498 patients) and stratified according to the culprit vessel (LAD vs other vessels).

Antiplatelet therapy following conservatively managed spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a relatively uncommon but increasingly recognized etiology of acute coronary syndrome (ACS). Conservative management is generally recommended, but optimal medical therapy is unknown. The majority of patients are discharged on dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor based on trials and guidelines developed for ACS caused by plaque rupture and subsequent platelet activation and aggregation.

Smoking Status at Baseline and 10-Year Outcomes After Drug-Eluting Stent Implantation: Insights From the DECADE Cooperation.

Background: Studies investigating 10-year outcomes according to smoking status at baseline in a largescale population undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are scarce.

Objectives: The authors sought to assess the association between smoking status at baseline and 10-year outcomes after PCI with DES implantation.

Methods: We pooled individual participant data from 5 randomized trials including patients with 10-year follow-up after DES implantation.

Antiangiogenic effect of circulating extracellular vesicles in acute coronary syndrome: Role of miR-199a-3p and miR-125a-5p.

Objective: Circulating extracellular vesicles (EVs) have a great impact on human health as biomarkers and messengers in intercellular signalling. We aimed to determine how the miRNA profile of circulating EVs during an acute coronary event interferes with the vasculogenic potential of endothelial cells (EC).

Approach And Results: EVs were purified from the plasma of patients in the acute phase of non-ST segment elevation myocardial infarction (NSTEMI, n = 33) and from healthy donors (n = 19) used as a control group.

Switching Platelet P2Y Receptor Inhibiting Therapies.

Antiplatelet therapy involving aspirin and a P2Y receptor inhibitor is fundamental in managing patients with atherothrombotic disease. Switching between P2Y inhibitors is frequently observed in clinical settings for various reasons, such as safety, efficacy, patient adherence, or cost concerns. Although it occurs often, the optimal method for switching remains a concern owing to potential drug interactions, which can result in either inadequate platelet inhibition and subsequent thrombotic events or low platelet reactivity and increased bleeding risks due to therapy overlap.

Rationale and Design of a Study to Assess the Engagement and Usefulness of the Care4Today Connect Digital Health Application for Disease Management in Coronary Artery Disease and Peripheral Artery Disease (iPACE-CVD Study).

Introduction: Coronary artery disease (CAD) and peripheral artery disease (PAD) increase the risks of cardiovascular events and death. Digital health technologies are rapidly expanding to improve healthcare quality and access. The Care4Today Connect (C4T CAD-PAD) mobile application is designed to help patients with CAD and/or PAD improve medication adherence, learn about their disease, make lifestyle modifications, and enhance healthcare provider (HCP) connection via an HCP-facing portal.

Clopidogrel-Mediated P2Y Inhibition According to Renal Function in Patients With Diabetes Mellitus and CAD.

This prospective ex vivo and in vitro pharmacodynamic (PD)/pharmacokinetic investigation was conducted in patients with diabetes mellitus with (n = 31) and without chronic kidney disease (n = 30). PD assessments included platelet reactivity index, maximum platelet aggregation, and P2Y reaction units. Ex vivo pharmacokinetic assessments included plasma levels of clopidogrel and its active metabolite.

Genotype Is Associated With Adverse Cardiovascular Outcomes in Black Patients Treated With Clopidogrel Undergoing Percutaneous Coronary Intervention.

Background: Cytochrome P450 2C19 (CYP2C19) intermediate and poor metabolizer patients exhibit diminished clopidogrel clinical effectiveness after percutaneous coronary intervention (PCI). However, outcome studies to date have lacked racial diversity. Thus, the impact of genotype on cardiovascular outcomes in patients treated with clopidogrel who identify as Black or African American remains unclear.

Comparative effects of different antiplatelet strategies in carriers of CYP2C19 loss-of-function alleles: a network meta-analysis.

Background: Carriers of cytochrome 2C19 (CYP2C19) loss-of-function (LoF) alleles treated with clopidogrel have impaired drug metabolism, resulting in reduced active metabolite levels, high platelet reactivity (HPR), and an increased risk of thrombotic events. Several alternative antiplatelet therapies have been proposed to overcome HPR in these patients, but their comparative effects remain poorly explored.

Methods: Randomized controlled trials (RCTs) comparing different oral antiplatelet therapies in carriers of CYP2C19 LoF alleles undergoing percutaneous coronary interventions (PCI) were included.