Cardiology

Myocardial injury and all MI types confer high MACE risk, with type 2 MI dominated by noncardiovascular death

This individual patient-level meta-analysis included 120,734 suspected ACS patients across nine countries with Universal Definition–adjudicated myocardial injury or infarction. Type 1 MI occurred in 9.4% and type 2 MI in 3.0%, while acute and chronic myocardial injury each occurred in about 5%. MACE rates were high across categories, around 45–55 per 1,000 patient-years, versus much lower rates without myocardial injury. Compared with no injury, subdistribution HRs for MACE were 4.82 for type 1 MI and 3.36 for type 2 MI, accounting for competing noncardiovascular death. 1

Sex-specific LVESVi thresholds improve risk stratification and surgical timing in chronic aortic regurgitation

This multicenter cohort followed 808 patients with at least moderate-severe aortic regurgitation and LVEF ≥50% for a median of 7 years. Women and men had similar LVESDi, but men had substantially larger LVESVi, highlighting sex differences in LV remodeling. Under medical management, adjusted 6-year survival was lower in women, 80% versus 89% in men. Mortality was associated with LVESDi ≥20 mm/m² for both sexes and LVESVi ≥40 mL/m² in women and ≥45 mL/m² in men. 2

In type 2 diabetes, higher BP monotonically worsens cardiovascular and renal outcomes without excess risk at low SBP

This dose-response meta-analysis pooled 89 cohorts with 5,875,364 participants with type 2 diabetes. J-shaped associations appeared between systolic blood pressure and all-cause mortality and cardiovascular events, and between diastolic pressure and mortality. However, risks flattened at lower blood pressures, and excluding cohorts with baseline cardiovascular disease or cancer removed apparent harm at low SBP. Lower SBP was then associated with significantly fewer cardiovascular events, while renal outcomes showed linear worsening with higher blood pressure. 3