Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.

Background and Objectives: Cachexia is a systemic wasting syndrome associated with poor outcomes in chronic diseases, including heart failure (HF). Although the cachexia index (CXI), which integrates skeletal muscle mass, serum albumin, and the neutrophil-to-lymphocyte ratio, has shown prognostic value in oncology, its clinical significance in HF remains poorly defined. Materials and Methods: This retrospective single-center cohort study evaluated a selected subgroup of adults hospitalized with decompensated heart failure between January 2020 and January 2025 who had undergone abdominal computed tomography within the preceding 6 months, enabling CT-based body composition assessment. Skeletal muscle index was measured at the L3 vertebral level, and CXI was calculated as (SMI × serum albumin)/neutrophil-to-lymphocyte ratio. Patients were followed for all-cause mortality and HF-related rehospitalizations. Results: A total of 127 patients were included (mean age 70.45 ± 12.73 years; 51.2% male). CXI showed excellent discrimination for mortality (AUC 0.951; 95% CI 0.905–0.996), with an optimal cut-off value of <20.87. Patients with low CXI had significantly higher all-cause mortality (80.5% vs. 4.7%, p < 0.001) and more HF-related hospitalizations [4 (3–5) vs. 0.5 (0–1), p < 0.001] than those with high CXI. Conclusions: In patients hospitalized with decompensated HF, low CXI was strongly associated with all-cause mortality and recurrent hospitalization, suggesting that CXI may serve as an integrative prognostic marker in this population.

Background: Optimal stenting for distal unprotected left main coronary artery (LMCA) bifurcation disease remains uncertain. We evaluated long-term outcomes by initially intended strategy. Methods: This retrospective, single-centre cohort included 234 consecutive patients undergoing percutaneous coronary intervention (PCI) without acute coronary syndrome, classified by intended strategy irrespective of crossover. Cox models for all-cause mortality were adjusted for strategy, age, left ventricular ejection fraction, SYNTAX score, and diabetes, with anatomical and propensity-score sensitivity analyses. Secondary and subgroup analyses were exploratory. Results: Provisional and upfront two-stent strategies were intended in 145 and 89 patients. Two-stent patients had greater anatomical complexity. During median 49-month follow-up, mortality did not differ significantly (two-stent versus provisional: 16.9% versus 21.4%; p = 0.499; adjusted hazard ratio, 0.83; 95% confidence interval, 0.43–1.60; p = 0.579), with consistent sensitivity analyses. Older age, lower ejection fraction, and higher SYNTAX score were associated with mortality. Target-lesion revascularisation (7.8% versus 2.1%; p = 0.033) and in-hospital stroke (5.6% versus 0.7%; p = 0.031) were more frequent with intended two-stent PCI; other secondary outcomes did not differ significantly. Exploratory unadjusted comparisons showed lower target-lesion and target-vessel revascularisation with double-kissing crush (n = 74) versus conventional culotte (n = 15), limited by small samples and selection bias. Intravascular ultrasound was associated with lower mortality in exploratory adjusted analyses. Mortality was numerically lower with elective intra-aortic balloon pump support at ejection fraction ≤40%, without statistical significance. Conclusions: No, statistically significant association between initially intended bifurcation strategy and long-term all-cause mortality was observed. Limited precision precludes an inference of equivalence, and exploratory differences in target-lesion revascularisation and in-hospital stroke warrant caution. These findings provide a long-term real-world perspective on individualised distal LMCA PCI, integrating lesion complexity, ventricular reserve, procedural technique, and intravascular imaging.

Background/Objectives: Patients receiving a cardiac implantable electronic device (CIED) for conduction disease may remain at substantial long-term risk despite preserved systolic function at implantation. The prognostic association of sodium–glucose cotransporter-2 (SGLT2) inhibitor use in this population is uncertain. We therefore examined the relationship between early documented SGLT2 inhibitor use and subsequent all-cause mortality in patients with preserved left ventricular ejection fraction (LVEF) undergoing CIED implantation for conduction disease. Methods: In this retrospective single-center cohort study, we screened consecutive adults who underwent CIED implantation for conduction disease between January 2018 and June 2024. Patients with LVEF ≥ 50% and complete clinical, laboratory, electrocardiographic, and echocardiographic data were included. SGLT2 inhibitor exposure was defined as documented initiation or active use within 3 months after implantation. The primary endpoint was all-cause mortality. Associations were evaluated using multivariable Cox proportional-hazards regression and Kaplan–Meier analyses. Results: Among 2176 screened patients, 540 fulfilled the eligibility criteria, of whom 206 (38.1%) had documented SGLT2 inhibitor exposure. During a median observation period of 64.2 months (range, 7–90 months), 185 deaths occurred. SGLT2 inhibitor exposure was associated with a lower adjusted hazard of death (HR, 0.48; 95% CI, 0.38–0.69; p < 0.001). Survival also differed between exposure groups in the overall cohort (log-rank p = 0.006) and in patients without either heart failure or diabetes mellitus (log-rank p = 0.020). Conclusions: In patients with preserved LVEF undergoing CIED implantation for conduction disease, documented SGLT2 inhibitor use was independently associated with lower all-cause mortality. These observational findings are hypothesis-generating and warrant confirmation in prospective studies.