Metabolic abnormalities may contribute to in-stent restenosis (ISR) after percutaneous coronary intervention, but the comparative associations of commonly used metabolic indices with ISR within the same patient population remain incompletely characterized.

To compare the associations of the triglyceride-glucose (TyG) index, atherogenic index of plasma (AIP), and metabolic score for insulin resistance (METS-IR) with angiographically detected ISR and its severity, and to explore potential heterogeneity according to sex and clinical presentation.

Retrospective, propensity-score-matched case-control study of patients undergoing follow-up coronary angiography between 2019 and 2024.

The propensity-score-matched cohort comprised 774 patients, including 387 patients with ISR and 387 matched controls without ISR. Angiographic severity analyses were performed among the 387 matched patients with ISR.

TyG, AIP, and METS-IR were assessed separately in multivariable models. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), paired DeLong testing, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Sex- and clinical-presentation analyses were considered exploratory.

The baseline clinical and procedural model yielded an AUC of 0.716 (95% CI 0.672-0.763) for ISR occurrence. Addition of TyG increased the AUC to 0.756 (95% CI 0.708-0.803; ΔAUC +0.040; paired DeLong p=0.003), while addition of AIP increased the AUC to 0.772 (95% CI 0.726-0.806; ΔAUC +0.056; p<0.001). Addition of METS-IR did not improve discrimination (AUC 0.716, 95% CI 0.671-0.748; p=0.642). Bootstrap analyses supported the incremental discrimination associated with TyG and AIP but not METS-IR. For ISR severity, addition of TyG or AIP produced only modest increases in AUC, neither of which was significant by paired DeLong testing. Formal interaction analyses did not demonstrate significant effect modification by sex, and analyses according to clinical presentation were limited by small subgroup sizes.

In this retrospective matched cohort, TyG and AIP provided incremental discriminatory information for angiographically detected ISR beyond conventional clinical and procedural factors, whereas METS-IR provided little additional value. Evidence regarding angiographic severity was less robust, and findings across sex and clinical-presentation subgroups should be considered exploratory. Prospective external validation is required before these indices can be considered for clinical risk stratification.

Early prediction of acute pancreatitis (AP) severity is essential for timely intervention and improved outcomes. The C-reactive protein-triglyceride-glucose index (CTI) is a simple, routine laboratory-derived biomarker. It integrates signals of inflammation and insulin resistance (IR) and has demonstrated predictive value in cardiovascular and metabolic diseases. However, its association with AP severity remains unknown.

This retrospective cross-sectional study included AP patients admitted between January 2019 and January 2026. CTI was calculated as 0.412 × ln (CRP, mg/L) + ln [triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. We assessed the association between CTI and AP severity using Spearman's correlation, logistic regression, and receiver operating characteristic (ROC) curve analysis. Severity was graded according to both the revised Atlanta criteria (RAC) and the modified computed tomography severity index (MCTSI).

A total of 567 patients with AP were included in this study. The high CTI group had significantly more severe AP than the low CTI group under both the RAC and MCTSI grading systems (both P < 0.001). Spearman's rank correlation confirmed a positive monotonic association (P < 0.001). In multivariate models, CTI independently predicted severity under the RAC (odds ratio [OR] 1.180, 95% confidence interval [CI] 1.027-1.357, P = 0.019) and MCTSI (OR 1.436, 95% CI 1.237-1.667, P < 0.001). For MCTSI ≥ 8, the area under the ROC curve (AUC) reached 0.763 (95% CI 0.681-0.845, P < 0.001). The combined model of CTI + white blood cell (WBC) + lactate dehydrogenase (LDH) yielded the highest AUCs across all endpoints (range 0.697-0.795).

CTI independently predicts AP severity with moderate discriminative accuracy. Its routine availability and low cost support its potential as an adjunct for early risk stratification. Adding WBC and LDH further improved predictive performance, though the incremental benefit was modest.

To investigate whether early estimated glomerular filtration rate (eGFR) fluctuation is associated with 180-day functional outcome in patients with large-artery atherosclerotic stroke undergoing endovascular thrombectomy.

We conducted a multicenter retrospective cohort study of consecutive patients with acute ischemic stroke attributed to large-artery atherosclerosis who underwent endovascular thrombectomy between January 1, 2024 and December 31, 2024. Among 108 patients with 180-day follow-up, 93 had at least two actual eGFR measurements within the first 7 days and comprised the primary complete-case cohort; the full 108-patient cohort after multiple imputation was examined in a sensitivity analysis. Early eGFR fluctuation was defined as the absolute difference between the maximum and minimum eGFR values within 7 days after admission. Poor functional outcome was defined as a modified Rankin Scale score of 3-6 at 180 days.

In the primary cohort of 93 patients, 54 had poor functional outcomes. Greater early eGFR fluctuation was associated with poor 180-day functional outcome (adjusted OR per 1 mL/min/1.73 m2 increase, 1.078; 95% CI, 1.019-1.139; p = 0.008). The association was consistent in Firth penalized regression (OR, 1.068; 95% CI, 1.020-1.134; p = 0.002) and bootstrap internal validation. It remained significant after adjustment for the number of eGFR measurements (adjusted OR, 1.065; 95% CI, 1.006-1.127; p = 0.029) and in the 108-patient post-imputation sensitivity cohort (adjusted OR, 1.089; 95% CI, 1.030-1.151; p = 0.003). Restricted cubic spline analysis showed an overall association (p = 0.012) without evidence of nonlinearity (p = 0.471).

Greater early eGFR fluctuation was associated with poor 180-day functional outcome after thrombectomy in patients with large-artery atherosclerotic stroke. Early eGFR fluctuation may represent an exploratory prognostic marker that requires prospective external validation.

To analyze mortality from acute myocardial infarction in Brazil according to temporal trends, sociodemographic characteristics, and regional disparities from 2015 to 2024.

A time series study using annual aggregated data from the Mortality Information System (Sistema de Informações sobre Mortalidade, SIM). Unadjusted mortality rates, age-standardized mortality rates, and sex-specific rate ratios were calculated. Temporal trends were assessed using log-linear regression to estimate the annual percent change (APC), and reestimated using the Prais-Winsten method as a complementary analysis.

A total of 938,997 deaths were recorded during the study period. The absolute number of deaths remained stable, with a 3.8% increase between 2015 and 2024. Age-standardized mortality rates declined throughout the study period (annual percent change: -2.6%; p-value<0.001). Mortality was higher among males, with a mean rate ratio of 1.53 over the study period, reaching 1.58 in 2024, and was concentrated among older adults. The Southeast and Northeast regions had the highest unadjusted mortality rates.

Age-standardized mortality rates declined over the study period, although the high burden of deaths associated with population aging and regional disparities persisted. These findings reinforce the need to strengthen cardiovascular disease prevention strategies, timely diagnosis, and the organization of the healthcare network for cardiovascular diseases within the Brazilian Unified Health System (Sistema Único de Saúde, SUS).

Patient and Public Involvement (PPI) aims to embed patient perspectives in all aspects of health research. In stroke, where diverse impairments affect communication, cognition, and mobility, inclusive PPI is particularly critical yet challenging. Little is known about how stroke PPI is currently practised or what barriers researchers face in supporting the participation of stroke survivors with complex needs.

To understand how stroke PPI is currently structured and practised, what resources it requires, how research teams support stroke survivors with diverse impairments and what barriers exist to more inclusive practice.

We conducted a national questionnaire with Principal Investigators of NIHR, UKRI and Stroke Association-funded stroke research projects active between October 2019 and January 2025 (31 responses representing 104/185 eligible projects). Open-ended questions elicited detailed accounts of PPI practices, resource requirements, adaptations to support diverse participation and barriers to inclusion. Data were analysed using qualitative description and thematic analysis, drawing on concepts of infrastructure to examine how the way PPI is organised shapes participation.

Four interconnected themes were identified. Despite considerable variation in scale and sophistication, the group meeting dominated PPI practice, functioning as taken-for-granted infrastructure through which involvement happens. Resource constraints, particularly unfunded coordination time and absent specialist communication support, limited what was viable. Researchers consistently reported lacking expertise to support stroke survivors with severe impairments, relying heavily on carers whose involvement sometimes functioned as proxy representation. While participants demonstrated creativity and commitment, PPI groups remained predominantly 'white, middle class, and [with] minor stroke severity', with innovation not leading to more inclusive participation.

Group meetings dominate stroke PPI, but they systematically exclude stroke survivors whose impairments make participating in meetings difficult. Achieving inclusive stroke PPI requires not merely adapting meetings but reimagining participation infrastructure, adequately resourcing diversity work and addressing expertise gaps through multidisciplinary support.

This research was informed by prior workshops with stroke survivors and carers from two PPI groups, who identified barriers to PPI participation and emphasised the need for methods to support more severely affected stroke survivors. Stroke survivors shaped questionnaire content and helped refine the findings and themes.

Patients undergoing transcatheter aortic valve implantation (TAVI) remain at risk of adverse cardiovascular and renal outcomes despite procedural advancements. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular and renal benefits across various patient populations; however, their role in patients undergoing TAVI remains unclear. This study is aimed at evaluating the association between SGLT2 inhibitor use and clinical outcomes in this population.

We conducted a systematic review and meta-analysis comparing SGLT2 inhibitors versus non-SGLT2 inhibitors or standard care in patients undergoing TAVI. Major databases were searched through March 2026, with Embase updated through June 2026. Pooled analyses were performed using random-effects models to calculate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Five studies involving 6111 patients (SGLT2 inhibitors: n = 2933; control: n = 3178) were included. In primary random-effects models, SGLT2 inhibitors were associated with lower all-cause mortality (RR 0.68, 95% CI 0.48-0.97, p = 0.03), heart failure (HF) hospitalization (RR 0.62, 95% CI 0.42-0.90, p = 0.01), and major adverse cardiovascular events (RR 0.68, 95% CI 0.48-0.96, p = 0.03). However, in REML/Hartung-Knapp sensitivity analyses, CIs crossed the null for all-cause mortality, HF hospitalization, MACE, and pooled hazard ratios. Mortality benefits were absent at 6 and 12 months and in the randomized trial but persisted in low left ventricular ejection fraction (RR 0.56, 95% CI 0.35-0.89, p = 0.01). No significant differences occurred in acute kidney injury, urinary tract infections, or echocardiographic parameters.

SGLT2 inhibitor use was associated with lower all-cause mortality and HF hospitalization after TAVI, but the evidence is limited by observational designs, heterogeneity, and low certainty for several outcomes. Further randomized trials are required.

Chronic venous diseases (CVD), including venous leg ulcers (VLU), represent a significant health burden. Despite the central role of compression therapy in current treatment guidelines, recent evidence suggests substantial gaps in provision. A retrospective cohort study was conducted using anonymized claims data from 3.35 million insured individuals. Persons with VLU or CVD in 2017 were observed over 5 years. Compression therapy, comorbidities, antibiotic prescriptions, and physician contacts were analysed. The prevalence was 0.50% for VLU (n = 16 615) and 7.27% for CVD (n = 243 681). Across 5 years, 75.85% (VLU) and 53.10% (CVD) received compression therapy. However, 24.15% of persons with VLU were not treated with compression therapy. Persons receiving compression were predominantly female and older (VLU: 74.13 years, 59.56% women; CVD: 68.55 years, 70.86% women), exhibited a higher mean Charlson Comorbidity Index (CCI [95% CI]: VLU 4.09 [4.03-4.15], CVD 2.67 [2.65-2.68] vs. VLU 3.14 [3.05-3.23], CVD 2.12 [2.11-2.14] without compression). In the first year post-diagnosis, 51.43% VLU persons with compression received antibacterials (vs. 36.28%). The data confirm prior estimates of disease prevalence and highlight a substantial gap in the documented use of guideline-compliant compression therapy, especially in VLU. High multimorbidity and care intensity underscore the need for better integration of compression therapy in routine practice.

Dual antiplatelet therapy (DAPT) was noninferior to alteplase in nondisabling minor stroke (NIHSS 0 to 5). Given potential benefit of DAPT in minor stroke with large artery atherosclerosis (LAA) and of alteplase in stroke with NIHSS 4-5, we hypothesize that neurological deficit and LAA may affect efficacy of DAPT versus alteplase in minor stroke.

This analysis included patients from the ARAMIS trial with minor stroke who underwent vessel imaging assessment. Participants were stratified into NIHSS 0-3 with LAA, NIHSS 0-3 with Non-LAA, NIHSS 4-5 with LAA, and NIHSS 4-5 with Non-LAA. Outcomes were compared between those receiving DAPT versus alteplase. Primary outcome was an excellent functional outcome (mRS 0 to 1) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and bleeding events. Primary analysis employed adjusted models, with sensitivity analysis conducted using inverse probability of treatment weighting.

Among 478 included patients, including 388 in NIHSS 0-3 group and 90 in NIHSS 4-5 group. In NIHSS 0-3 group, a numerically higher rates of excellent functional outcome was found in patients with LAA who received DAPT versus alteplase (97.3% vs. 85.1%; adjusted OR, 6.45 [0.68 to 60.81]; p = 0.10), which was obviously attenuated in patients with Non-LAA (96.5% vs. 94.4%; adjusted OR, 1.67 [0.50 to 5.59]; p = 0.41). This phenomenon was not observed in NIHSS 4-5 group, and the test for interaction was not statistically significant (p-interaction = 0.36). Notably, sensitivity analysis revealed that DAPT significantly increased the likelihood of excellent functional outcome in the NIHSS 0-3 with LAA subgroup (adjusted OR, 6.49 [1.54 to 27.39]; p = 0.01), but not in NIHSS 0-3 with Non-LAA subgroup (adjusted OR, 2.51 [0.58 to 10.90]; p = 0.22). Safety outcomes were comparable across treatments.

Neurological deficit and LAA may affect efficacy of DAPT versus alteplase in acute minor nondisabling stroke. In patients with NIHSS scores of 0 to 3 due to LAA, DAPT may be associated with numerically higher odds of 90-day functional outcomes compared to alteplase. Given the exploratory nature of this subgroup analysis and no formal adjustment for multiple comparisons was applied, these results should be interpreted as hypothesis-generating and require confirmation.

The 2024 European Society of Cardiology (ESC) guidelines retained the diagnostic threshold for hypertension (≥ 140/90 mmHg) but revised the classification of office blood pressure (BP) values below this threshold and introduced a risk-based management strategy. However, there are limited data regarding the impact of these changes on primary care practice.

The aim of this study was to evaluate the reclassification of office BP categories among primary care patients according to the 2024 ESC guidelines for elevated BP and hypertension, and to assess achievement of target BP based on these revised targets.

This retrospective cross-sectional study included 882 individuals aged 18 years or older registered at a family health center (FHC) in Izmir. Participants were classified according to the 2018 ESC/European Society of Hypertension (ESH) and 2024 ESC criteria. Cardiovascular risk was determined using the Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (SCORE2-OP) algorithms. The primary endpoint was the change in office BP classification, and the secondary endpoint was the proportion of patients achieving the BP target.

Overall, 29.5% of the participants had hypertension. Under the 2018 ESC/ESH guidelines, 70.5% of individuals had optimal, normal, or high-normal office BP, whereas under the 2024 ESC guidelines, only 17.1% had non-elevated BP. Applying the 2024 criteria, 53.4% of all participants were placed in the elevated BP group, with 75.7% of individuals previously considered below the hypertension threshold reclassified into this group. The proportion of treated patients achieving the prespecified BP target decreased from 53.5% under the 2018 ESC/ESH criteria to 30.8% under the 2024 ESC framework.

Applying the 2024 ESC office BP criteria reclassified more than half of our participants into the newly defined "elevated BP" group. This update could influence daily clinical practice by changing how clinicians determine which patients require closer assessment, ongoing follow-up, and treatment to achieve target BP.

Constrictive pericarditis (CP) remains a challenging disease with evolving etiological patterns and increasing emphasis on phenotype-based management. Pericardiectomy is the definitive treatment for CP. However, contemporary data on the etiological spectrum and the clinical relevance of inflammatory phenotypes in patients undergoing pericardiectomy are limited. We report the etiological spectrum, clinical phenotypes, and short- and long-term outcomes of pericardiectomy at a single center and explore whether a preoperative inflammatory phenotype is associated with adverse perioperative outcomes.

We retrospectively analyzed 36 consecutive patients who underwent pericardiectomy for CP between 2007 and 2024. A study-defined inflammatory phenotype-preoperative pericardial effusion plus C-reactive protein > 10 mg/L (n = 16)-was compared with all remaining patients (n = 20). Patients were evaluated according to etiology, radiologic morphology, inflammatory status, perioperative outcomes, and long-term survival. Survival was estimated by the Kaplan-Meier method.

The mean age was 46.1 ± 17.6 years and 69.4% were male. Idiopathic disease was the most common etiology (44.4%), followed by tuberculosis (22.2%), while several uncommon causes, including familial Mediterranean fever, post-transplantation, sarcoidosis, Erdheim-Chester disease and post-COVID pericarditis, were identified. Hypoalbuminemia was more frequent in the inflammatory phenotype group (62.5% vs. 20.0%; p = 0.016). The inflammatory phenotype was also associated with a higher incidence of postoperative LCOS (p = 0.038). In-hospital mortality was observed in two patients (5.6%). After a median follow-up of 86.8 months, overall survival was 94.4%, 87.4% and 82.0% at 1, 5, and 10 years, respectively.

Pericardiectomy for constrictive pericarditis provided favorable short- and long-term outcomes in this single-center cohort. A study-defined preoperative inflammatory phenotype was associated with higher perioperative risk in this exploratory cohort. These preliminary findings highlight the potential role of perioperative inflammatory assessment in surgical patients, though validation in larger prospective registries is required.