Background and Aims. Heart rate (HR) and hypertension are both important risk factors for adverse cardiovascular (CV) events in patients with established coronary artery disease (CAD). We sought to evaluate whether hypertension can modify the effect of admission HR on adverse CV events in patients with acute coronary syndrome (ACS). Methods. A total of 1056 patients with ACS undergoing percutaneous coronary intervention (PCI) were analyzed. All patients were classified into three groups according to the tertiles of admission HR (T1: ≤66 bpm, n = 369; T2: 67–73 bpm, n = 322; and T3: ≥74 bpm, n = 365). The primary endpoint was defined as major adverse CV events (MACEs), including all-cause death, stroke, myocardial infarction, or unplanned repeat revascularization. The multivariate Cox regression model was performed to evaluate the association of admission HR with MACE stratified by hypertension. Results. During the median follow-up of 30 months, a total of 232 patients developed at least one event. After adjusting for other covariates, elevated admission HR was significantly associated with an increased risk of MACE only in patients with hypertension (when T1 was taken as a reference, the adjusted HR of T2 was 1.143 [95% CI: 0.700–1.864] and that of T3 was 2.062 [95% CI: 1.300–3.270]); however, in patients without hypertension, admission HR was not associated with the risk of MACE (when T1 was taken as a reference, the adjusted HR of T2 was 0.744 [0.406–1.364] and that of T3 was 0.614 [0.342–1.101]) ( for interaction). Conclusions. In patients with ACS undergoing PCI, the association of elevated admission HR with an increased risk of MACE was present in individuals with hypertension but not in those without hypertension. This finding suggests a potential benefit of HR control for ACS patients when they concomitantly have hypertension.

Elevated stress hyperglycemia ratio (SHR) is a putative risk indicator for acute myocardial infarction (AMI). However, the relationship between SHR, albumin, and subsequent cardiovascular adverse outcomes is less well-established. We consecutively included patients from a multi-center, prospective registry (NCT05337319) from January 2022 to October 2023 and analyzed their baseline SHR and albumin levels. Low and high SHR were determined using the optimal cutoff value. The primary outcome was in-hospital major adverse cardiovascular events, which were composed of all-cause mortality, cardiac shock, acute congestive heart failure (ACHF), reinfarction, and stroke. Multivariable logistic regression models were used to estimate albumin-stratified associations between SHR and outcomes. A total of 5269 patients presenting with AMI were included, of which 27.7% were high-SHR and 19.5% had hypoalbuminemia. Low-SHR normalbuminemia had the lowest in-hospital MACEs (1.4%), with which as the reference, high-SHR hypoalbuminemia had the highest increase in MACEs (adjusted OR, 6.800; 95% CI, 3.883–11.907; P < 0.001), followed by low-SHR hypoalbuminemia (adjusted OR, 3.033; 95% CI, 1.775–5.182, P < 0.001), and high-SHR normalbuminemia (adjusted OR, 2.375; 95% CI, 1.335–4.226, P = 0.003). High-SHR was associated with increased cardiovascular risk regardless of baseline albumin level for MACEs (normalbuminemia: adjusted OR, 2.325; 95% CI, 1.307–4.136, P = 0.004; hypoalbuminemia: adjusted OR, 2.213; 95% CI, 1.343–3.647, P = 0.002; P = 0.866 for interaction), and cardiac shock or ACHF. Higher SHR is prevalent among patients with AMI, especially in those with hypoalbuminemia. Higher SHR was consistently associated with a more unfavorable in-hospital prognosis, regardless of their baseline albumin value.

Background and aims: although an association between metabolic syndrome (MS) and cardiovascular disease risk has been documented, the relationship in patients with complex calcified coronary lesions undergoing rotational atherectomy (RA) and drug-eluting stent(DES) insertion remains controversial. Here, the influence of MS on outcomes was assessed. Methods and results: we retrospectively included 398 patients who underwent RA and DES insertion for complex calcified coronary lesions in our institution between June 2015 and January 2019. The modified Adult Treatment Plan III was used to diagnose MS. The endpoint was major adverse cardiovascular events (MACEs), comprising mortality from all causes, myocardial infarction, and target vessel revascularization (TVR). In all, 173 (43.5%) patients had MS. MS was significantly associated with MACE over the 28.32 ± 6.79-month follow-up period (HR 1.783, 95% CI from 1.122 to 2.833) even after adjustment for other possible confounders. Conclusion: MS was frequently observed in patients treated with RA with DES insertion for complex calcified coronary lesions. MS independently predicted MACE in these patients.