Background: Diabetes is a known risk factor of acute coronary syndrome (ACS). However, diabetes de novo and prediabetes are also common in ACS patients. This study explored the prevalence of prediabetes and diabetes de novo in ACS patients, glucose-mediating therapy at discharge, and compared the prevalence of 30-day major adverse cardiac and cerebrovascular events (MACCE) in patients with prediabetes and diabetes de novo with known diabetes. Methods: ACS patients with measured haemoglobin A1c (HbA1c) from the South-East Netherlands Heart Registry, a prospective, multicentre registry of patients undergoing percutaneous coronary intervention (PCI), were analysed. Patients were stratified into two groups: known diabetes, and prediabetes (HbA1c 39–47 mmol/mol) or diabetes de novo (HbA1c ≥ 48 mmol/mol). Outcomes were analysed at 30 days post-PCI. Results: HbA1c was available in 34.1% of ACS patients (n = 1836), of whom 526 (28.7%) had known diabetes, 619 (33.7%) prediabetes, and 180 (9.8%) diabetes de novo. Compared with patients with known diabetes, patients with prediabetes and diabetes de novo had a significantly higher risk of MACCE (HR = 1.81, 95% CI 1.12–2.93, p = 0.016) after multivariable adjustment. At discharge, 59% of patients with diabetes de novo received no insulin, metformin, nor sodium-glucose co-transporter-2 inhibitor, compared with 16% of patients with known diabetes (p < 0.001). Conclusions: Impaired glucose metabolism without known diabetes was observed in nearly 45% of ACS patients and they demonstrated a significantly higher risk of 30-day MACCE compared with patients with known diabetes. Despite clear guideline recommendations, routine screening for hyperglycaemia and the appropriate initiation of glucose-mediating therapy remain underutilised in clinical practice.

Background: Detecting and grading paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains challenging. Aims: We evaluated the prognostic value of algorithm-based invasively measured haemodynamic indices of PVR for all-cause mortality and heart failure (HF) rehospitalizations. Methods and Results: We included 727 patients who underwent TAVR with a self-expanding valve for severe native aortic stenosis between 2015 and 2021 at Radboudumc. Invasive left ventricular and aortic pressures were continuously measured and analysed offline using a validated algorithm for standardized computation of haemodynamic indices of PVR. The primary endpoint was an event-adjudicated composite of all-cause mortality and HF rehospitalization across 3-year follow-up. Algorithm-derived diastolic pressure–time index (DPTI) ≤58 and diastolic delta (DD) ≤32 mmHg were independently associated with the composite outcome (hazard ratio [HR] 1.64 [95% confidence interval (CI): 1.14, 2.37], HR 1.80 [95% CI: 1.21, 2.68], respectively). Following stratification for angiography-graded PVR, algorithm-derived invasive indices remained independently associated with the composite outcome in those with angiographic mild-moderate (HR DPTI ≤58 mmHg: 2.94, 95% CI: 1.68, 5.15) but not none/trace PVR (HR DPTI ≤58 mmHg: 0.91, 95% CI: 0.49, 1.69). Inferences remained consistent when considering only those with angiographic mild PVR (HR DPTI ≤58: 3.19, 95% CI: 1.62, 6.26). Conclusion: Algorithm-based invasive assessment of PVR showed independent prognostic value for the risk of all-cause mortality and HF rehospitalization across 3-year follow-up. Additionally, following stratification for angiography-graded PVR, haemodynamic indices remained independently associated with the composite outcome in those with angiographic mild PVR. Together, this highlights the potential of real-time automated assessment of invasive haemodynamics for risk stratification of patients undergoing TAVR.

Background/Objectives: Despite progress in secondary prevention, people with chronic coronary syndrome (CCS) still face a residual risk of ischemic events. Antithrombotic therapy reduces this risk and helps stabilize chronic cardiovascular disease. Studies have shown that combining low-dose rivaroxaban with aspirin—an approach called dual-pathway inhibition (DPI)—can lower this risk and reduce major adverse cardiovascular events (MACEs). However, researchers have not yet gathered enough real-world data to confirm the efficacy and safety of this strategy. The DUTCH CCS registry aims to collect real-world data on how effective and safe low-dose rivaroxaban combined with aspirin is for patients with CCS in The Netherlands. The study aims to provide insights into the outcomes, benefits, and risks of DPI in a real-world setting, beyond the scope of controlled clinical trials. Methods: The DUTCH CCS registry operates as a national, multicenter, prospective observational study. It enrolls 1000 patients with CCS who receive rivaroxaban (2.5 mg twice daily) and aspirin (80 mg or 100 mg once daily). The study targets individuals at high ischemic risk due to coronary artery disease (CAD) and follows a single-arm design. Researchers will measure the primary efficacy endpoint by tracking MACEs, clinically driven coronary, peripheral, or carotid revascularization, and stent thrombosis over one year. They will assess the primary safety endpoint by recording major bleeding events at one year. The team will collect data at both 3-month and 1-year follow-ups. Conclusions: As an observational study, this registry is not designed to establish causality. However, it seeks to improve our understanding of how DPI performs in real-world secondary prevention for CCS patients. The results may help update treatment guidelines and inform clinical decisions in everyday practice.