2026年 · 第06卷第02期

Since the 2016 release of the China Guidelines for Percutaneous Coronary Intervention (PCI), the procedure has become a foundational therapeutic modality for coronary heart disease, undergoing widespread adoption and significant refinement. In light of the emergence of substantial global clinical evidence and subsequent updates to European and American guidelines, the Chinese Society of Cardiology, in collaboration with the Editorial Board of the Chinese Journal of Cardiology, has convened an expert panel to update the national guideline. This revision synthesizes the latest domestic and international clinical evidence with insights from China’s unique clinical practice, aiming to standardize PCI indications and implementation to ensure patient safety.

Objective: Heart failure (HF) is a major complication of myocardial infarction (MI) that contributes to increased morbidity and mortality. Although previous studies have reported the incidence of HF following acute MI, comprehensive epidemiological and clinical data on the Korean population are lacking. This study aimed to evaluate the incidence, risk factors, and long-term outcomes of HF after MI using nationwide data. Methods: A retrospective cohort study was conducted using data from the Korean National Health Insurance Database. A total of 258,916 patients aged ≥ 18 years who were newly hospitalized for MI between 2010 and 2021 were included, excluding those with a history of MI or HF within the previous 3 years. The incidence of HF and all-cause mortality were measured. Cox proportional hazard models were used to identify the independent risk factors for HF development. Results: Among the study participants, 36,538 (14.1%) developed HF during follow-up. The cumulative incidence of HF were 7.2%, 10.2%, and 12.3% at 1, 2, and 3 years after MI, respectively. The median time of admission for HF was 431 d after MI. Older age, female sex, lower socioeconomic status, and comorbidities (such as hypertension, diabetes mellitus, dyslipidemia, stroke, and end-stage renal disease) were identified as independent risk factors for HF development (all P < 0.001). Patients who developed HF exhibited a remarkably poor prognosis, with a 3-year cumulative probability of all-cause mortality of 37.8% compared to 21.9% in those without HF. Conclusion: HF is a frequent and critical consequence of MI and contributes to a poor long-term prognosis. Identifying patients who are at high risk and then implementing targeted interventions are essential to reduce the HF burden and improve long-term outcomes.

It remains uncertain whether combined pulmonary artery denervation (PADN) and guideline-directed medical therapy (GDMT) can effectively reduce clinical worsening in patients with heart failure (HF) and pulmonary hypertension (PH) associated with left heart disease. The PADN-HF-PH is a prospective, multicenter, randomized, controlled trial designed to assess the superiority of PADN for the treatment of patients with PH secondary to left-sided HF despite GDMT. A total of 264 subjects with PH secondary to left-sided HF who meet the inclusion criteria and none of the exclusion criteria will be dynamically randomized (at a 1:1 ratio) to the PADN plus GDMT group or the GDMT alone group, stratified by PH secondary to left-sided HF phenotypes and participating sites. The GDMT strategy is based on the 2023 European Society of Cardiology Guidelines for HF. The primary endpoint is the composite of all-cause death, rehospitalization due to HF, requirement for intravenous medication (inotropes, diuretics, or vasodilators) due to worsening of HF, referral for heart/lung transplantation, or 6-minute walk distance decreased by >10% or >30 m compared with baseline when the last enrolled subject has at least 6 months of follow-up. The safety endpoint is the incidence of adverse events of special interest, defined as complications occurring within 30 d after the PADN procedure. The PADN-HF-PH trial is specifically designed to evaluate the effectiveness and safety of adding PADN to GDMT in patients with PH associated with left heart disease who are experiencing HF. The primary objective of this study is to generate new evidence regarding the potential benefits of combining PADN with GDMT in reducing clinical worsening events among these patients (NCT05824923).

Atrial fibrillation (AF) is one of the most commonly sustained cardiac arrhythmias, which increases the risk of ischemic stroke, heart failure, and death. Although great progress has been achieved in the treatment of AF, a proportion of patients are refractory to treatment with anti-arrhythmics or experience AF recurrence and progression. Accumulating evidence identifies diabetes mellitus (DM) as an independent risk factor for AF, indicating that glucose-lowering medications may be effective for the treatment of AF. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), a relatively new class of anti-diabetes agents, may therefore offer an alternative therapeutic strategy for AF. While several reviews support the cardiovascular benefits of SGLT2i, few publications have specifically focused on their effects on AF. This review comprehensively summarizes existing clinical studies valuating the impact of SGLT2i on new-onset AF in DM patients without AF, AF recurrence risk in DM patients with AF, and associated poor prognosis. In addition, data derived from animal models exploring the influence of SGLT2i on the inducibility, incidence, and duration of AF, as well as the underlying molecular mechanisms, are summarized. The cumulative evidence suggests that the use of SGLT2i considerably reduces the risk of new-onset AF, AF recurrence, and AF-related complications. The potential underlying mechanisms involve regulation of ion exchange channels and energy metabolism, and inhibition of oxidative stress, mitochondrial dysfunction, inflammation, apoptosis, and fibrosis. Further studies should be carried out to verify these beneficial effects by integrating the studies with negative results and to further explore other mechanisms that explain the benefits of SGLT2i.

Globally, around 1 in 2 patients with left heart disease (LHD) has pulmonary hypertension (PH). The prevalence of PH associated with heart failure, mitral regurgitation, aortic valve disease, hypertrophic cardiomyopathy, and cardiac amyloidosis has mainly been investigated in high-income countries, especially the United States and Europe, by transthoracic echocardiography without right heart catheterization confirmation. It is estimated that around 80% of patients with hypertrophic cardiomyopathy or cardiac amyloidosis, around 65% of patients with heart failure or mitral regurgitation, and around 40% of patients with aortic valve disease have PH. In contrast, data about PH associated with mitral stenosis and rheumatic heart disease are primarily from low-income countries. The prevalence is around 80% in mitral stenosis—as determined by right heart catheterization in candidates for surgery or balloon valvuloplasty—and around 45% in rheumatic heart disease based on transthoracic echocardiography screening. PH associated with LHD (PH-LHD) clinical trials have focused on PH secondary to heart failure and have most often been performed in the United States and Europe (sites from these countries in 53.3% and 43.3% of the trials, respectively). The heterogeneous epidemiology of PH-LHD may reflect actual differences in the frequency of the underlying types of LHD, but it may also be the consequence of detection and reporting biases. Regional health authority choices, diagnostic capacity, and socio-economic factors likely influence the selection of the sites of PH-LHD trials. Efforts are needed to better characterize the worldwide burden of PH-LHD and to conduct truly global clinical trials.

Atrial fibrillation (AF) and heart failure (HF) are major public health issues and are linked by a complex, bidirectional relationship. AF can contribute to the development of HF through diverse mechanisms, including tachycardia, irregular ventricular rhythm, impaired atrial contraction, and atrioventricular dyssynchronization. In patients with AF-mediated cardiomyopathy (AF-CM), these effects may be reversible with effective rate control or restoration of sinus rhythm. Early diagnosis and intervention offer the potential for the recovery of cardiac function, highlighting the importance of understanding the underlying mechanisms, clinical features, and management strategies for AF-CM. Cardiac imaging, biomarker profiling, continuous rhythm monitoring, and the identification of specific clinical features may facilitate the diagnosis of AF-CM. Catheter ablation has been established as an effective treatment for patients with AF and HF. However, considerable controversy persists regarding the necessity for long-term HF pharmacological therapy following successful ablation. In this review, the current understanding of AF-CM is summarized, with a focus on its mechanisms, clinical features, and management. The role of guideline-directed medical therapy for HF in the long-term management of patients with AF-CM is further discussed.

Anomalous origin of the coronary arteries refers to abnormalities in the number, location, or orientation of the coronary artery ostia. This condition is associated with an increased risk of misdiagnosis and sudden cardiac death. An 18-year-old male with no known cardiovascular risk factors who developed cardiogenic shock during exercise is presented. Diagnostic evaluation using cardiac ultrasound, coronary computed tomography angiography, and coronary angiography revealed that the left coronary artery originated high in the supra-sinus region on the anterior wall of the ascending aorta. The anomalous origin was close to the pulmonary trunk, resulting in compression and stenosis of the left main coronary artery. Surgery should be performed as soon as possible in those with ischemic symptoms such as syncope, angina, or potential risk factors for origin or route. Therefore, left coronary reshaping was performed using a surgical unroofing technique. The patient achieved a favorable long-term prognosis at 9-month follow-up, with normalization of left ventricular wall thickness, stable coronary ostial patency, and no recurrence of symptoms. This case indicates that timely surgical intervention can be a safe and effective option in the management of high-risk intramural anomalous left coronary artery, which may help lower the risk of sudden cardiac death and optimize clinical outcomes.