Background: The prognostic implication of mildly reduced ejection fraction (mrEF) after acute myocardial infarction has not been clearly demonstrated. We investigated the long‐term risk of cardiovascular death and its predictors in patients with mrEF following acute myocardial infarction. Methods and Results: A total of 18 668 patients who presented with acute myocardial infarction were included in 2 prospective, multicenter registries. The incidence of adverse cardiovascular events according to the left ventricular ejection fraction (EF) strata at index admission were evaluated. A score system consisting of clinical variables were developed to predict long‐term cardiovascular death in the mrEF group. There were 2548 patients with reduced EF (EF ≤40%), 4266 patients with mrEF (EF 41%–49%), and 11 854 patients with preserved EF (EF ≥50%). During a median follow‐up period of 37.9 months, the cardiovascular death rate was 22.3% in the reduced EF group, 10.3% in the mrEF group, and 7.3% in the preserved EF group ( P 65 years, hypertension, stroke, severe renal insufficiency, and Killip class ≥3 were independent predictors for cardiovascular death. Presence of >2 predictors best discriminated the high‐risk patients for cardiovascular death with an area under the curve of 0.746. Incidence of cardiovascular death in the high‐risk mrEF group was comparable with the rEF group, while it was lower in the low‐risk mrEF group than in the pEF group. Conclusions: Patients with mrEF after acute myocardial infarction had a modest risk of cardiovascular death. Clinical predictors could help discriminate a high‐risk subpopulation with cardiovascular death risks comparable with those in the reduced EF group.

Aims: Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) are recommended to receive double antithrombotic therapy including an antiplatelet agent and direct anticoagulants (DOAC). The efficacy and safety of aspirin versus clopidogrel as a combination therapy with DOAC were compared in the present study. Methods: Patient data from the Korea National Health Insurance Service from 2013 to 2020 were analyzed. A total of 9,157 patients with AF who received double antithrombotic therapy consisting of an antiplatelet agent and a DOAC after PCI were included. Patients were classified into the clopidogrel or aspirin group and 1:1 propensity score (PS) matching was performed. The major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, ischemic stroke, or systemic thromboembolism. Results: After PS matching, the clopidogrel and aspirin groups consisted of 2,882 patients each. During a median follow-up of 20.1 months, the incidence of MACE was not significantly different between the two groups (hazard ratio [HR] for clopidogrel group 0.91, 95% confidence interval [CI] 0.81–1.02). The incidence of ischemic endpoints did not significantly differ between the two groups. A significant difference was not observed in the incidence of major bleeding events (HR 0.94, 95% CI 0.78–1.12) and net adverse clinical events (HR 0.93, 95% CI 0.84–1.03). Conclusion: In patients with AF receiving double antithrombotic therapy after PCI, aspirin and clopidogrel showed similar efficacy and safety when used in combination with DOAC.

Accurate assessment of the response to the antiarrhythmic drug (AAD) in atrial fibrillation (AF) is crucial to achieve adequate rhythm control. We evaluated the effectiveness of extended cardiac monitoring using an adhesive ECG patch in the detection of drug-refractory paroxysmal AF. Patients diagnosed with paroxysmal AF and receiving AAD therapy were enrolled. The subjects simultaneously underwent 11-day adhesive ECG patch monitoring and a 24-h Holter test. The primary study outcome was a detection rate of drug-refractory AF or atrial tachycardia (AT) lasting ≥30 s. A total of 59 patients were enrolled and completed the study examinations. AF or AT was detected in 28 (47.5%) patients by an 11-day ECG patch monitor and in 8 (13.6%) patients by a 24-h Holter test (p < 0.001). The 11-day ECG patch monitor identified an additional 20 patients (33.8%) with drug-refractory AF not detected by the 24-h Holter, and as a result, the treatment plan was changed in 11 patients (10 catheter ablations, one medication change). In conclusion, extended cardiac rhythm monitoring using an adhesive ECG patch in patients with paroxysmal AF under AAD therapy led to over a threefold higher detection of drug-refractory AF episodes, compared to the 24-h Holter test.

Lee D, et al. J Korean Med Sci. 2022 Dec;38(2):e5. https://doi.org/10.3346/jkms.2023.38.e5

Park S, et al. J Korean Med Sci. 2026 Feb;41(7):e80. https://doi.org/10.3346/jkms.2026.41.e80

Background: Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) are recommended to receive dual antithrombotic therapy including an antiplatelet agent and direct anticoagulants (DOAC). We compared the effectiveness between aspirin and clopidodgrel for a combination therapy with DOAC in this population. Methods: We analyzed patient data from the Korea National Health Insurance Service. A total of 9,157 patients with AF who received dual antithrombotic therapy after PCI were included. Patients were classified into the aspirin group and clopidogrel group, and 1:1 propensity score matching (PSM) was performed. The primary ischemic endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or systemic thromboembolism. A major bleeding event was defined as a bleeding event requiring hospitalization. Results: After PSM, there were each 2,882 patients each in the aspirin and clopidogrel group. The incidence of the primary ischemic endpoint was similar in the two groups (22.8% vs. 21.8%, in the aspirin and clopidogrel group, hazard ratio [HR] for clopidogrel group: 0.909, 95% confidence interval [CI] 0.815 – 1.014). The incidence of each component of ischemic endpoint did not differ significantly between the two groups. All-cause mortality was increased in the clopidogrel group (HR 1.301, 95% CI 1.000 – 1.692). There was no significant difference in major bleeding events (HR 0.942, 95% CI 0.789 – 1.126). Conclusions: For a dual antithrombotic therapy in patients with AF who had undergone PCI, aspirin and clopidogrel did not differ in terms of ischemic outcomes, but the use of aspirin was associated with slightly lower all-cause mortality.