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Aspirin Combined With Ticagrelor or Clopidogrel in STEMI Patients With Diabetes Mellitus and Poor Glycemic Control Undergoing Primary PCI: A Multicenter Retrospective Cohort StudyDOI: 10.1002/ccd.70503   Abstract Background: The safety and efficacy of aspirin combined with ticagrelor or clopidogrel remain unclear in ST-segment elevation myocardial infarction (STEMI) patients with Diabetes mellitus (DM) and poor glycemic control. Aims: This study aims to assess the efficacy and safety of ticagrelor versus clopidogrel-based dual antiplatelet therapy in STEMI patients with DM and poor glycemic control undergoing pPCI. Methods: We evaluated 2732 STEMI patients with DM and poor glycemic control who underwent primary percutaneous coronary intervention (pPCI) and were registered in the "Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS)" program between November 2014 and December 2019. Using propensity score matching (PSM) and cox proportional hazards regression, we compared the in-hospital risk of major adverse cardiovascular events (MACCE), TIMI bleeding events, and net adverse clinical events (NACE) between patients receiving aspirin combined with either ticagrelor or clopidogrel. Results: After PSM, the risk of in-hospital MACCE (HR = 0.545, 95% CI: 0.321-0.926, p = 0.025), Cardiac death (HR = 0.380, 95% CI: 0.149-0.971, p = 0.043) and NACE (HR = 0.728, 95% CI: 0.560-0.947, p = 0.018) was significantly lower in the ticagrelor group compared with the clopidogrel group(p 0.05). Conclusion: Among STEMI patients with DM and poor glycemic control undergoing pPCI, ticagrelor use was associated with a low rate of MACCE, without an excessive risk of bleeding. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysisof randomised controlled trialsLancet-2025 Sep 13;406(10508):1128-1137.doi: 10.1016/S0140-6736(25)01592-2. Epub 2025 Aug 30. Abstract Background: The effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40-49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trialstested the efficacy of β blockers after a recent myocardial infarction in patients without reduced LVEF (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reducedLVEF. We aimed to assess the efficacy of β blockers in patients with myocardial infarction and mildly reduced LVEF during the index hospitalisation. Methods: We conducted an individual patient-level meta-analysis of patients with mildly reduced LVEF and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlledtrials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction (randomisation within 14 days) and had mildly reduced LVEF. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025). A one-stage,fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heart failure. All endpointswere independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480). Findings: 1885 patients with myocardial infarction and mildly reduced LVEF were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in theβ-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI0·58-0·97]; p=0·031). No heterogeneity between the trials (trial-by-treatment pinteraction=0·95) or between countries of enrolment was observed (pinteraction=0·98). Interpretation: In patients with acute myocardial infarction with mildly reduced LVEF without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardialinfarction, or heart failure. These results extend the known benefits of these agents in patients with myocardial infarction with reduced LVEF to the subgroup with mildly reduced LVEF. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Heart Failure Outcomes with SGLT2 Inhibitors in Adults with Type 2 Diabetes: A Systematic Review and Meta-AnalysisDOI: https://doi.org/10.3390/medicina62010069 Abstract Background and Objectives: Type 2 diabetes mellitus (T2DM) substantially increases the risk of heart failure (HF) and worsens its prognosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for glycemic control, have shown important cardiovascular benefits. This systematic review and meta-analysisevaluated the effects of SGLT2i on HF hospitalizations, cardiovascular (CV) death, and renal outcomes, as well as their safety profile, in patients with T2DM and established HF.  Materials and Methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) comparing SGLT2i with placebo in adults with T2DM and HF. Data on HF hospitalizations, CV death, other clinical outcomes, and adverse events were extracted. Risk of bias was assessed using the Cochrane RoB2 tool, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using RevMan 5.4.1.  Results: Ten RCTs including more than 21,000 participants met the inclusion criteria. Most were large, international, double-blind trials with overall low risk of bias. SGLT2i reduced the composite of worsening HF or CV death by about 21% (pooled HR 0.79, 95% CI 0.69–0.89), mainly driven by a consistent reduction in HF hospitalizations across trials. Effects on CV death alone were directionallyfavorable but not uniformly significant. Furthermore, SGLT2i were associated with beneficial effects on cardiac function and patient-reported health status and showed consistent renoprotective effects. The safety profile was favorable, with a small increase in genital infections and no excess of hypoglycemia or other serious adverse events.  Conclusions: In patients with T2DM and HF, SGLT2i meaningfully reduce HF events and provide additional renal benefits with good tolerability. Our findings consolidate and update the current evidence by focusing specifically on RCTs enrolling patients with both T2DM and established HF across the spectrum of ejection fraction, thereby reinforcing the role of SGLT2i as a key component of guideline-directedtherapy in this high-risk population. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Potent P2Y12 Inhibitor Monotherapy Versus Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Systematic Review and Meta-AnalysisDOI: 10.1177/10760296261422490 Abstract BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) remains debated. While DAPT with aspirin and a P2Y12 inhibitor prevents ischemic events, it increases bleeding risk. This meta-analysis evaluates whether early aspirin discontinuation with P2Y12 inhibitor monotherapy offers comparable efficacy andimproved safety versus standard long-term DAPT. MethodsThis review, conducted according to PRISMA guidelines, searched PubMed, Cochrane Central and Clinicaltrials.gov up to September 2025 for RCTs comparing short-term DAPT (≤3 months) followed by P2Y12 inhibitor monotherapy with standard-duration DAPT (≥6-12 months). Outcomes included NACE, MACE, all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis,and BARC 3 or 5 bleeding. Random-effects models were applied to estimate pooled risk ratios and 95% CIs. ResultsTen RCTs involving 35,277 patients were included. Compared with standard DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR = 0.80, 95% CI0.71-0.90; p = 0.0002; I2 = 38%), and BARC type 3 or 5 bleeding (RR = 0.48, 95% CI 0.40-0.58; p 0.001; I2 = 0%), without significant differences in MACE (RR: 1.01 [0.86, 1.19]; p = 0.87; I2 = 41%) or all-cause mortality (RR: 0.96 [0.80, 1.16]; p = 0.69; I2 = 4%). ConclusionEarly transition to P2Y12 inhibitor monotherapy after 1-3 months of DAPT in ACS patients undergoing PCI significantly reduces bleeding without increasing ischemic events. Ticagrelor- or prasugrel-based monotherapy represents a safe and effective alternative to conventional 12-month DAPT. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Circadian variation in ST-segment elevation myocardial infarction: a nationwide analysis of onset, treatmentdelays, and culprit artery patterns Pol Arch Intern Med. 2026 Jan 7:17188. doi: 10.20452/pamw.17188 Abstract Introduction: ST-segment elevation myocardialinfarction (STEMI) onset follows a circadian rhythm, yet data from large contemporary national registries remain limited, particularly regarding how onset time influences treatment delays and coronary pathology. Objectives: To examine circadian patterns of ST-segmentelevation myocardial infarction onset and their impact on treatment delays, culprit vessel involvement, and periprocedural mortality. Patients and methods: We retrospectively analyzed 1,53,543ST-segment elevation myocardial infarction patients from the Polish National PCI Registry (ORPKI) between 2014 and 2022. We examined the hourly distribution of symptom onset and its associations with patient characteristics, treatmentdelays, and infarct-related artery location. Results: ST-segment elevation myocardial infarctiononset showed pronounced circadian variation, peaking at 8:00 AM. Although the overall pattern was similar between sexes (P for interaction = 0.15), median onset timeoccurred significantly earlier in males than females (10:00 AM vs. 11:00 AM, P = 0.007). Nocturnal onset (e.g., 3:00 AM) was associated with substantially longer median pain-to-first-medical-contact times compared with daytime onset (180 vs. 90 minutes at 1:00 PM; P 0.001). We identified a novel opposing circadian rhythm for the infarct-related artery location: left anterior descending (LAD) artery identified as the infarct-related artery peaked during nocturnal hours with a nadir at noon, while right coronary artery (RCA) involvement demonstrated the inverse pattern (P 0.001). Despite delayed presentation, periprocedural mortality did not vary significantly by onset time. Conclusions: This large nationwide cohort demonstrates that ST-segment elevation myocardial infarction onset follows arobust circadian pattern significantly affecting system delays. The discovery of opposing circadian rhythms for left anterior descending versus right coronary artery involvement suggests that time of day influences not only ST-segmentelevation myocardial infarction triggering but also its pathophysiological manifestation.   Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Initiation of SGLT2 inhibitors versus mineralocorticoid receptor antagonists as third-line therapy in heart failurewith reduced ejection fraction: a nationwide cohort study Lancet Reg Health Eur . 2025 Oct 27:60:101510. doi:10.1016/j.lanepe.2025.101510. Abstract Background: Heart failure with reduced ejection fraction (HFrEF) guidelines recommend early initiation of four foundational therapies-renin-angiotensin system inhibitors (RASI), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 (SGLT2) inhibitors. In clinical practice, these drugs are usually introduced sequentially, and optimal sequencing remains uncertain. This study investigated the effectiveness of initiating sodium-glucose co-transporter 2  inhibitors versus mineralocorticoid receptor antagonists as the third foundational therapy following RASI and beta-blockers. Methods: This was a nationwide non-interventional study in Denmark, July 2020-2023. Patients with HFrEF (leftventricular ejection fraction ≤40%) aged ≥45 years on background RASI and beta-blockers were included. An active-comparator new-user design was used to emulatea trial-like comparison. Baseline characteristics were balanced using inverse-probability of treatment weighting based on propensity scores. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death, heart failure hospitalization, and their composite.Weighted hazard ratios (wHRs) were estimated using proportional hazards regression. Findings: The study included 4185 new mineralocorticoidreceptor antagonists users (63% spironolactone, 37% eplerenone) and 2565 new sodium-glucose co-transporter 2 inhibitor users (74% dapagliflozin, 26% empagliflozin). All-cause mortality occurred in 423 mineralocorticoid receptor antagonists users (unweighted rate 6.3 per 100 person-years) and 155 sodium-glucose co-transporter 2  inhibitor users (5.8 per 100 person-years). In weighted analysis comparing sodium-glucose co-transporter 2 inhibitors to mineralocorticoid receptor antagonists, the wHR was 0.70 (95% CI 0.57-0.86; absolute risk difference -2.1 per 100person-years, 95% CI -0.9 to -3.2). For the composite secondary outcome, the wHR was 0.83 (95% CI 0.71-0.97); for cardiovascular death, 0.65 (95% CI 0.49-0.87); and for heart failure hospitalization, 0.89 (95% CI 0.74-1.07). Interpretation: Initiating sodium-glucose co-transporter 2 inhibitors as the third foundational therapy after RASI andbeta-blockers was associated with significantly lower risk of all-cause mortality compared to mineralocorticoid receptor antagonists. These findings support the prioritization of sodium-glucose co-transporter 2 inhibitors in treatment sequencing for Heart failure with reduced ejection fraction. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Lower Ticagrelor Dosing in the Dual Antiplatelet Regimen for Neurointerventional Procedures https://doi.org/10.1136/jnis-2024-022536  Abstract Background Ticagrelor, a P2Y12 inhibitor, offersa rapid onset and consistent platelet inhibition, making it a viable alternative for dual antiplatelet therapy (DAPT). The optimal ticagrelor dose for neurointerventional procedures, however, remains unclear. We report our experience with ticagrelor 60 mg twice daily plus aspirin 81 mg daily compared with the standard aspirin and clopidogrel regimen forintracranial stenting. Methods We conducted a retrospective analysis ofa prospectively maintained database, identifying consecutive patients who underwent intracranial stenting for aneurysm treatment or intracranial atherosclerosis. Patients received either ticagrelor 60 mg with aspirin or aspirin with clopidogrel 75 mg daily. Primary outcomes included peri-procedural ischemic and/or hemorrhagic events within 30 days.Secondary outcomes were the median P2Y12 reaction unit and in-stent stenosis rates at 6-month follow-up. Results Among 119 patients, 59 received ticagrelor and 60 (50.4%) received clopidogrel. Baseline characteristics including age and gender were comparable between the two groups, although the ticagrelor group had a higher proportion of African-American patients. The majority of patients underwent aneurysm treatment (n=105; 88.23%), while the remainder received stenting for intracranial atherosclerosis (n=14; 11.77%). No ischemic events occurred in either group and intracranial hemorrhage rates were comparable (1.7% in both groups). The median P2Y12 reaction unit was significantly lower in the ticagrelor group (69 vs 126, P0.001).In-stent stenosis rates were lower with ticagrelor (5% vs 21%). Conclusion Ticagrelor 60 mg for dual antiplatelet therapy in intracranial stenting is safe and effective. Larger prospective studies may be required to validate these findings. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Impact of Early Percutaneous Coronary Intervention on Long-Term Survival in Patients With Acute Myocardial InfarctionCureus 18(1): e101145. DOI 10.7759/cureus.101145  Abstract Background: Early percutaneous coronary intervention(PCI) is the recommended standard of care for acute myocardial infarction (AMI), but long-term outcomes in mixed real-world cohorts remain underreported. This study evaluated the effects of early percutaneous coronary intervention (≤24 hours) compared with delayed or no percutaneous coronary intervention on short- and long-term clinical outcomes. Materials and methods: A five-year mixed cohort studywas conducted and included 891 consecutive acute myocardial infarction patients (early PCI, n = 446;delayed/no PCI, n = 445). Demographics, clinical characteristics, procedural data, and in-hospital outcomes were collected. Long-term outcomes, such as all-cause mortality, cardiovascular mortality, recurrent myocardialinfarction (MI), heart failure (HF) hospitalization, and major adverse cardiovascular events (MACE), were assessed over a median follow-up of 48 months. Propensity score matching and Cox proportional hazards models were usedto adjust for confounding. Statistical analyses were done in the IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY, USA). Results: Early percutaneous coronary intervention wasassociated with lower in-hospital mortality (18/446, 4.0% vs 35/445, 7.9%; p = 0.01), shorter door-to-balloon time (median65 vs 210 minutes; p 0.001), and better left ventricular function (mean left ventricular ejection fraction (LVEF) 48.7% vs 46.2%; p 0.001). Over a median follow-upof 48 months, early percutaneous coronary intervention significantly reduced all-cause mortality (62/446,13.9% vs 112/445, 25.2%; adjusted hazard ratio (HR) 0.54, 95% CI 0.40-0.73, p 0.001), cardiovascular mortality (44/446, 9.9% vs 82/445, 18.4%; adjusted HR 0.53, 95% CI 0.37-0.77, p = 0.001), heart failure hospitalization (56/446, 12.6% vs 84/445, 18.9%; adjusted HR 0.66, 95% CI 0.47-0.93, p = 0.02), and major adverse cardiovascular events (92/446,20.6% vs 138/445, 31.0%; adjusted HR 0.63, 95% CI 0.49-0.82, p 0.001). Recurrent myocardial infarction was slightly lower with early percutaneous coronary intervention (38/446,8.5% vs 49/445, 11.0%; adjusted HR 0.78, 95% CI 0.52-1.16, p = 0.21) but did not reach statistical significance.  Conclusion:Early percutaneous coronary intervention confers substantial short- and long-term survival benefits in acute myocardial infarction patients, with significant reductions in all-cause and cardiovascular mortality, heart failure hospitalization, and major adverse cardiovascular events. These findingsunderscore the critical importance of timely reperfusion, supporting guideline-driven early percutaneous coronary intervention strategies in real-world practice. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Incidence and In-Hospital Outcomes of Bradycardia or Atrioventricular Conduction Disorder in Patients With Type 2Myocardial Infarction: A Nationwide Inpatient Analysis https://doi.org/10.1002/joa3.70243 ABSTRACT Background Type 2 myocardial infarction (T2MI), caused by an imbalancebetween oxygen supply and demand without significant coronary obstruction, is increasingly recognized yet remains underexplored, particularly regarding conduction abnormalities. Methods We conducted a retrospective cohort study using the NationalInpatient Sample from 2017 to 2022. Adult patients hospitalized with Type 2 myocardial infarction were identified by ICD-10-CM code. Bradycardia or atrioventricular (AV) conduction delay was defined using diagnostic codes forbradycardia and all degrees of atrioventricular block. We compared baseline characteristics, comorbidities, and causes of Type 2 myocardial infarction, and used multivariable logistic regression to evaluate associations with in-hospitalmortality and cardiogenic shock. Results Among 1 960 410 patients with Type 2 myocardial infarction, 118 025 (6.0%) had bradycardia or atrioventricular conduction delay. These patients were older, more often male, and had higher rates of hypertension, heart failure, chronic kidney disease, and diabetes. The pacemaker implantation wassignificantly more prevalent (8.7% vs. 0.3%, p  0.01). They also showed an increase in in-hospital mortality (10.4% vs. 9.8%, p  0.01), cardiogenic shock (5.1% vs. 3.2%, p  0.01), and AKI (47.9% vs. 46.3%, p  0.01). After adjustment, conduction disorders remained associated with higher odds of mortality (aOR 1.09, 95% CI 1.04–1.14) and cardiogenic shock (aOR 1.71, 95% CI 1.61–1.83).  Conclusions Bradycardia or atrioventricular conduction delay occurred in6% of Type 2 myocardial infarction hospitalizations and wasindependently linked to worse in-hospital outcomes, underscoring the need for close monitoring in this population.  Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Pharmacological Evaluation of Ticagrelor and Aspirin Versus Clopidogrel and Aspirin Pretreatment on Infarct Artery Flowin Patients with Acute STEMI  Pharmaceuticals 2025, 18(12), 1856; https://doi.org/10.3390/ph18121856 Abstract Background and Objectives: Dual antiplatelet therapy(DAPT) with aspirin and a P2Y12 inhibitor is standard in ST-segment elevation myocardial infarction (STEMI). Guidelines favor ticagrelor over clopidogrel, but their effect on infarct artery flow prior to percutaneous coronary intervention(PCI) remains debated. Objective was to compare the effects of aspirin + clopidogrel versus aspirin + ticagrelor pretreatment on infarct arteryThrombolysis in Myocardial Infarction (TIMI) flow in ST-segment elevation myocardial infarction patients. Materials and Methods: This retrospective cohortstudy included first-time ST-segment elevation myocardial infarction patients ≥ 18 years admitted to the Military Medical Academy, Belgrade (January 2016–January 2022), who received pretreatment with aspirin + clopidogrel or aspirin + ticagrelor and underwent percutaneous coronary intervention. Thrombolysis in Myocardial Infarction flow was graded  before and after percutaneous coronary intervention. Primary outcomes were pre- and post- percutaneous coronary intervention Thrombolysis in Myocardial Infarctionflow; secondary outcome was in-hospital mortality. Results: Of 299 ST-segment elevation myocardialinfarction patients, 174 received aspirin + ticagrelor and 125 received aspirin + clopidogrel. Pre- percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow was significantly higher in the ticagrelor group (p 0.001), whilepost- percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow (p = 0.056) and in-hospital mortality (p = 0.083) did not significantly differ between groups. After exclusion of patients receiving glycoprotein IIb/IIIa  inhibitors, the difference in percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow grade after percutaneous coronary intervention becamestatistically significant (p = 0.007), favoring the aspirin + ticagrelor group. In multivariate analysis, male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitor use were independently associated with reduced in-hospitalmortality. Conclusions: In ST-segment elevation myocardial infarction patients, ticagrelor-based Dual antiplatelet therapy was associated with better initial coronary flow compared to clopidogrel. However, this advantage was not evident after percutaneous coronary intervention. Male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitoruse were associated with improved survival. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

β-blocker and clinical outcomes in patients after myocardial infarction: a systematic review and meta-analysis Eur J Clin Pharmacol. 2025 Dec;81(12):1807-1817. Abstract Background and objective: While current clinicalguidelines generally advocate for beta-blocker therapy following acute myocardial infarction (AMI), conflicting findings have surfaced through large-scale observational studies and meta-analyses. We conducted this systematic review and meta-analysis of published observational studies to quantify the long-term therapeutic impact of beta-blocker across heterogeneous acutemyocardial infarction populations. Methods: We conducted comprehensive searches ofthe PubMed, Embase, Cochrane, and Web of Science databases for articles published from 2000 to 2025 that examine the link between beta-blocker therapy and clinical outcomes (last search update: March 1, 2025). We used the odds ratio (OR) with its 95% confidence interval (95% CI) to evaluate the effect of beta-blocker therapy on all-cause mortality, cardiac death, or major adverse cardiac events (MACE) in acute myocardial infarction patients. Our analysisstratified these effects by study type, ejection fraction (EF), sample size, follow-up duration, and patient characteristics including primary coronary revascularization, ST segmentelevation status, and comorbidities. Results: This meta-analysis incorporated 34 observational studies covering 233,303  acute myocardial infarction patients. Our results showed beta-blockers reducedall-cause (OR = 0.73, 95% CI = 0.64-0.82) and cardiac mortality (OR = 0.79, 95% CI = 0.70-0.89) in post- acute myocardial infarction patients, with no significant effect on major adversecardiac events. In these patients, post-PCI and STEMI patients, beta-blockers lowered all-cause mortality but not MACE risk. Subgroup analysis revealed that beta-blockers decreased all-cause death in post- acute myocardial infarction patients with diabetes and COPD, but not in those with hypertension and AF. Stratified by EF, beta-blockers were beneficial for all-cause death (OR = 0.75, 95% CI = 0.60-0.93),cardiac death (OR = 0.72, 95% CI = 0.56-0.92), and MACE (OR = 0.85, 95% CI = 0.76-0.96) in post- acute myocardialinfarction patients with reduced ejection fraction and only decreased all-cause death in those with preserved ejection fraction. Conclusions: Our meta-analysis suggests beta-blockers may offer long-term clinical benefits to acute myocardialinfarction patients, particularly those with reduced ejection fraction. However, this is not conclusive for acute myocardial infarction patients with comorbidities or preserved ejection fraction. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Intravascular imaging-guided percutaneous coronary intervention for acute myocardial infarction according to ACC/AHA lesion classification https://doi.org/10.1016/j.rec.2025.12.001 Abstract Introduction and objectives: Despite the favorableprognosis associated with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) for complex coronary lesions, it is still unclear whether intravascular imaging -guided percutaneous coronary intervention forsuch lesions provides clinical benefit in patients with acute myocardial infarction (AMI) according to the ACC/AHA lesion classification. Methods: This study was a patient-level pooled analysis of 2 nationwide Korean acute myocardial infarction registries. We identified 23 051 patients from KAMIR-V and KAMIR-NIH who underwent successful percutaneous coronary intervention for an infarct-related artery and stratified them by the ACC/AHAlesion classification. Clinical outcomes were compared between intravascular imaging -guided and angiography-guided percutaneous coronary intervention. Theprimary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, acute myocardial infarction, repeat revascularization, and stent thrombosis, at 3 years. Results: intravascular imaging -guided percutaneouscoronary intervention demonstrated a lower incidence of MACE compared with angiography-guided percutaneous coronary intervention in patients with type B2/C lesions (adjusted HR, 0.78; 95%CI, 0.70-0.88; P  .001), but not inpatients with type A/B1 lesions (adjusted HR, 0.81, 95%CI, 0.60-1.11; P = .190). In both non–ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction, a significantly lower risk of major adversecardiac events following intravascular imaging -guided percutaneous coronary intervention than angiography-guided percutaneous coronary intervention was observed in patients with type B2/C lesions (non–ST-segment elevation myocardial infarction: adjusted HR, 0.73; 95%CI, 0.63-0.84; P  .001; ST-segment elevation myocardial infarction: adjusted HR, 0.86, 95%CI, 0.75-0.98; P = .027), but not in those with type A/B1 lesions. Conclusions: Among patients with acute myocardialinfarction, intravascular imaging -guided percutaneous coronary intervention was associated with a significantly lower risk of major adverse cardiac events in those with type B2/C lesions, but not in those with type A/B1 lesions. Theprognostic benefit of intravascular imaging -guided percutaneous coronary intervention increased with greater lesion complexity in the infarct-related artery. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Beta-Blockers after Myocardial Infarction in Patients without Heart Failure N Engl J Med . 2025 Nov 13;393(19):1901-1911. doi: 10.1056/NEJMoa2505985  Abstract Background: The evidence supporting beta-blockertherapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies. Methods: In an open-label, randomized trial withblinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventriculararrhythmias). Results: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6%and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observedbetween the groups. Conclusions: Among patients with a myocardialinfarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy.  Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Differential Impact of Metoprolol Formulations on Heart Failure Outcomes: A Multi-center Study https://doi.org/10.1016/j.yjcafi.2025.10.010  ABSTRACT  Background  Despite widespread use of metoprolol formulations in heart failure (HF), direct comparative evidence of theirclinical outcomes remains limited.   Methods In this retrospective cohort study using the TriNetX Research Network (2010-2024), we compared outcomes between metoprolol succinate and tartrate in heart failure withreduced ejection fraction HFrEF (EF ≤40%) and HFmrEF HeartFailure with Mid-range Ejection Fraction (EF 41-49%) patients. After propensity score matching (761 pairs for HFrEF, 732 pairs for HFmrEF), we evaluated a primary composite outcome of hospitalizations and all-cause mortality, and secondary outcomes of individual components over one year follow-up.  Results Baseline characteristics were well-balanced between cohorts in both HF populations. For the primary composite outcome, both heart failure with reduced ejection fraction and Heart Failure with Mid-range Ejection Fraction patients receiving succinate formulation demonstrated significantly betterevent-free survival compared to tartrate (HFrEF: 64.12% vs 51.22%, log-rank p0.001; HFmrEF: 67.57% vs 56.04%, log-rank p0.001). Secondary analysis revealed these benefits were driven by improvements in both hospitalizations andall-cause mortality.  Conclusions Metoprolol succinate was associated with significantly improved event-free survival compared to tartrate in Kaplan-Meier analyses for both heart failure with reduced ejectionfraction and Heart Failure with Mid-range Ejection Fraction populations, despite modest differences in crude event rates. These findings suggest that formulation-specific pharmacokinetics influence long-term outcomes in heartfailure management, supporting current guidelines favoring succinate over tartrate. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Efficacy and safety of ticagrelor versus clopidogrel in acute myocardial infarction-associated cardiogenic shock: apropensity score-matched analysis https://doi.org/10.1093/eurheartj/ehaf784.2070  Abstract Background Cardiogenic shock secondary to acute myocardial infarction (AMICS) is a critical condition with significant hemostatic challenges. Despite the widespread use of P2Y12 inhibitors, current evidence comes primarily from stable populations. This study aimed to compare the efficacy and safety of ticagrelor versus clopidogrel in a propensity-matched cohort of acute myocardial infarction patients.  Methods We conducted a single-center retrospective study to evaluate the impact of ticagrelor versus clopidogrel in acutemyocardial infarction patients receiving dual antiplatelet therapy (DAPT), hospitalized between 2016 and 2024. Propensity score matching was performed on a cohort of 151 patients (103 on clopidogrel; 48 on ticagrelor) using a 1:1matching protocol without replacement (matching tolerance 20%). Matching variables included age, sex, chronic kidney disease (CKD), peak troponin levels (pTn), occurrence of cardiac arrest, and initial SCAI shock classification. Theprimary endpoint was 30-day all-cause mortality. Secondary endpoints included major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial reinfarction, stroke or transient ischemicattack, and embolic events, as well as major bleeding events, defined as BARC ≥3.  Results A total of 88 patients were included, 44 within each group, with a mean age of 60.5 ± 11 years, 71.6% male, 44.3%presenting in SCAI-C, and 47.7% on mechanical circulatory support (MCS), including IABP, VA-ECMO, and/or Impella. At 30-day follow-up, 39 patients (44.3%) had died. Baseline characteristics were well balanced between groups,including age (p=0.138), sex (p=0.813) and SCAI shock classification (p=0.910)–Table 1. Although not statistically significant, other antithrombotic therapies showed numerical variations between groups. Anticoagulation was morecommon in clopidogrel-treated patients (70.5% vs. 56.8%), whereas Gp IIb/IIIa antagonists were more frequent in those receiving ticagrelor (20.5% vs. 11.4%). Ticagrelor was associated with a significantly lower 30-day mortality rate (34.1% vs. 54.6%; Log-rank p=0.018) -Figure 1, and reduced major adverse cardiovascular events incidence (34.1% vs 56.8%; Log-rank p=0.018) -Figure 2. In the subgroup with MCS the magnitude of benefit was similar (OR 0.419 [95% CI=0.159-1.101]; p=0.078), despite not reaching statistical significance. No significant differences were observed between groups regarding the incidence of major bleeding events (63.6% vs.59.1%; OR 1.212 [95% CI=0.513 - 2.861]; p=0.662).  Conclusions In this propensity score-matched analysis of acutemyocardial infarction patients receiving dual antiplatelet therapy, ticagrelor was associated with significantly lower 30-day mortality and major adverse cardiovascular events rates compared to clopidogrel, without a correspondingincrease in major bleeding risk. These findings may suggest a potential benefit of ticagrelor in this high-risk population; however, further prospective studies are needed. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.