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Gresnigt F, Heikamp L, van Essen J, Walraven L, van Ofwegen-Hanekamp C, Mollink S, Franssen E, de Lange D, Riezebos R. Application of European Society of Cardiology guidelines for evaluating acute coronary syndrome risk in low-risk patients with cocaine-associated chest pain: Findings from the RISK study - An observational analysis. Toxicol Rep 2024; 13:101680. [PMID: 39006369 PMCID: PMC11245997 DOI: 10.1016/j.toxrep.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 07/16/2024] Open
Abstract
Background Cocaine was the drug of choice in 4.7 % of all recreational drug-related emergency department visits. Of these patients, 40 % present with cocaine-associated chest pain, of whom 4.7 % develop an acute coronary syndrome. The American Heart Association recommends a 12-hour observation period for these patients. Objective This study primarily aimed to ascertain whether the European Society of Cardiology non-ST-elevation myocardial infarction guidelines can be safely applied to rule-out acute coronary syndrome in low-risk patients with cocaine-associated chest pain. Methods For this prospective observational cohort study, patients, aged 18-45 years old, who presented with cocaine-associated chest pain and were risk stratified as low risk according to the European Society of Cardiology non-ST-elevation myocardial infarction guidelines and therefore discharged home without prolonged observation period, were included. They were followed to assess major adverse cardiac events four weeks after presentation to the emergency department or chest pain unit. Cocaine use was confirmed with urine toxicology screening. Results A total of 107 patients were included and analysed. The accuracy of the self-reported history of recent cocaine use was 94 %. Post-discharge cocaine use persisted among 32 % of patients. None of the included 107 patients died and major adverse cardiac event within four weeks did not occur among 97 patients with available data regarding MACE. Conclusion Ruling out an acute coronary syndrome using the European Society of Cardiology non-ST-elevation myocardial infarction guidelines is likely to be safe for patients with cocaine-associated chest pain, however this study was underpowered to reach definitive conclusions.
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Affiliation(s)
- F.M.J. Gresnigt
- Emergency Department, OLVG Hospital, Oosterpark 9, Amsterdam 1091 AC, the Netherlands
- Dutch Poison Information Center (DPIC), UMC Utrecht, University Utrecht, Utrecht 3508 GA, the Netherlands
| | - L.K. Heikamp
- Emergency Department, OLVG Hospital, Oosterpark 9, Amsterdam 1091 AC, the Netherlands
| | - J.J.W. van Essen
- Emergency Department, OLVG Hospital, Oosterpark 9, Amsterdam 1091 AC, the Netherlands
| | - L.F.J. Walraven
- Emergency Department, Diakonessenhuis Utrecht, Bosboomstraat 1, Utrecht 3582KE, the Netherlands
| | | | - S. Mollink
- Emergency Department, Haaglanden Medical Centre, Lijnbaan 32, the Hague 2512VA, the Netherlands
| | - E.J.F. Franssen
- Hospital pharmacy department, OLVG Amsterdam, Oosterpark 9, Amsterdam 1091 AC, the Netherlands
| | - D.W. de Lange
- Dutch Poison Information Center (DPIC), UMC Utrecht, University Utrecht, Utrecht 3508 GA, the Netherlands
| | - R.K. Riezebos
- Heartcenter, OLVG Amsterdam, Oosterpark 9, Amsterdam 1091 AC, the Netherlands
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Yan K, Li J, Li Y, Zhu P, Tang X, Yuan D, Yang Y, Gao R, Yuan J, Zhao X. Inflammation modifies the platelet reactivity among thrombocytopenia patients undergoing percutaneous coronary intervention. Platelets 2024; 35:2327835. [PMID: 38655673 DOI: 10.1080/09537104.2024.2327835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
Percutaneous coronary intervention (PCI) patients combined with thrombocytopenia (TP) are usually considered to be at low ischemic risk, receiving less proper antiplatelet therapy. However, recent studies reported a paradoxical phenomenon that PCI patients with TP were prone to experience thrombotic events, while the mechanisms and future treatment remain unclear. We aim to investigate whether inflammation modifies platelet reactivity among these patients. Consecutive 10 724 patients undergoing PCI in Fuwai Hospital were enrolled throughout 2013. High-sensitivity C-reactive protein (hsCRP) ≥2 mg/L was considered inflammatory status. TP was defined as platelet count <150×109/L. High on-treatment platelet reactivity (HTPR) was defined as adenosine diphosphate-induced platelet maximum amplitude of thromboelastogram >47mm. Among 6617 patients finally included, 879 (13.3%) presented with TP. Multivariate logistic regression demonstrated that patients with TP were associated with a lower risk of HTPR (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.53-0.76) than those without TP in the overall cohort. In further analysis, among hsCRP <2 mg/L group, patients with TP exhibited a decreased risk of HTPR (OR 0.53, 95% CI 0.41-0.68); however, in hsCRP ≥2mg/L group, TP patients had a similar risk of HTPR as those without TP (OR 0.83, 95% CI 0.63-1.08). Additionally, these results remain consistent across subgroups, including patients presenting with acute coronary syndrome and chronic coronary syndrome. Inflammation modified the platelet reactivity of PCI patients with TP, providing new insights into the mechanisms of the increased thrombotic risk. Future management for this special population should pay more attention to inflammation status and timely adjustment of antiplatelet therapy in TP patients with inflammation.
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Affiliation(s)
- Kailun Yan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiawen Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yulong Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Zhu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Tang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Deshan Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wu XD, Ye XY, Liu XY, Lin Y, Lin X, Li YY, Ye BH, Sun JC. Benefits of intensive lipid-lowering therapies in patients with acute coronary syndrome: a systematic review and meta-analysis. Ann Med 2024; 56:2389470. [PMID: 39126262 PMCID: PMC11318487 DOI: 10.1080/07853890.2024.2389470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/23/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Previous meta-analyses have investigated the efficacy of lipid-lowering therapies for atherosclerotic cardiovascular disease; however, few have focused on patients with acute coronary syndrome (ACS). This meta-analysis aimed to compare the benefits of intensive lipid-lowering therapy with those of background statin therapy in patients with ACS. METHODS Searches were performed on PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for articles published until April 13, 2023. Randomized controlled trials that compared intensive lipid-lowering therapies and background statin therapies in patients with prior ACS and recorded the outcome of three-point major cardiovascular events (MACE) were included. The risk ratio (RR) with 95% confidence interval (CI) was used as a measure of primary and secondary outcomes. RESULTS Nine trials involving 38,640 patients with ACS were identified. Pooled results suggested that intensive lipid-lowering therapies are associated with a reduction in the risk of three-point MACE (RR, 0.88; 95% CI, 0.83-0.94; p < 0.001), recurrent ACS (RR, 0.82; 95% CI, 0.71-0.96; p = 0.013), nonfatal myocardial infarction (MI) (RR, 0.87; 95% CI, 0.81-0.93; p < 0.001), stroke (RR, 0.83; 95% CI, 0.73-0.94; p = 0.003), and unstable angina-related hospitalization (RR, 0.57; 95% CI, 0.33-0.99; p = 0.046), but not all-cause mortality (RR, 0.94; 95% CI, 0.82-1.07; p = 0.329), cardiovascular disease-related mortality (RR, 0.96; 95% CI, 0.88-1.06; p = 0.457) or coronary revascularization (RR, 0.89; 95% CI, 0.79-1.00; p = 0.057). CONCLUSIONS Intensive lipid-lowering therapies may reduce the risk of three-point MACE, recurrent ACS, nonfatal MI, stroke, and hospitalization for unstable angina in patients with ACS undergoing background statin therapy. These results may assist in clinical decision-making for the secondary prevention of cardiovascular events to initiate intensive lipid-lowering therapies immediately after ACS.
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Affiliation(s)
- Xian-Dan Wu
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Xin-Yue Ye
- Shanghai Jiao Tong University, Shanghai, China
| | - Xuan-Yan Liu
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Yue Lin
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Xian Lin
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Yan-Yan Li
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Bin-Hua Ye
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Jing-Chao Sun
- Department of Cardiology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
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Ayayo SA, Kontopantelis E, Martin GP, Zghebi SS, Taxiarchi VP, Mamas MA. Temporal trends of in-hospital mortality and its determinants following percutaneous coronary intervention in patients with acute coronary syndrome in England and Wales: A population-based study between 2006 and 2021. Int J Cardiol 2024; 412:132334. [PMID: 38964546 DOI: 10.1016/j.ijcard.2024.132334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND There is limited data around drivers of changes in mortality over time. We aimed to examine the temporal changes in mortality and understand its determinants over time. METHODS 743,149 PCI procedures for patients from the British Cardiovascular Intervention Society (BCIS) database who were aged between 18 and 100 years and underwent Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) in England and Wales between 2006 and 2021 were included. We decomposed the contributing factors to the difference in the observed mortality proportions between 2006 and 2021 using Fairlie decomposition method. Multiple imputation was used to address missing data. RESULTS Overall, there was an increase in the mortality proportion over time, from 1.7% (95% CI: 1.5% to 1.9%) in 2006 to 3.1% (95% CI: 3.0% to 3.2%) in 2021. 61.2% of this difference was explained by the variables included in the model. ACS subtypes (percentage contribution: 14.67%; 95% CI: 5.76% to 23.59%) and medical history (percentage contribution: 13.50%; 95% CI: 4.33% to 22.67%) were the strongest contributors to the difference in the observed mortality proportions between 2006 and 2021. Also, there were different drivers to mortality changes between different time periods. Specifically, ACS subtypes and severity of presentation were amongst the strongest contributors between 2006 and 2012 while access site and demographics were the strongest contributors between 2012 and 2021. CONCLUSIONS Patient factors and the move towards ST-elevated myocardial infarction (STEMI) PCI have driven the short-term mortality changes following PCI for ACS the most.
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Affiliation(s)
- Sharon A Ayayo
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK.
| | | | - Glen P Martin
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK.
| | - Salwa S Zghebi
- Division of Population Health, Health Services Research and Primary care, The University of Manchester, UK.
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, The University of Manchester, UK.
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, UK.
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Matetic A, Kyriacou T, Mamas MA. Machine-learning clustering analysis identifies novel phenogroups in patients with ST-elevation acute myocardial infarction. Int J Cardiol 2024; 411:132272. [PMID: 38880421 DOI: 10.1016/j.ijcard.2024.132272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Machine learning clustering of patients with ST-elevation acute myocardial infarction (STEMI) may provide important insights into their risk profile, management and prognosis. METHODS All adult discharges for STEMI in the National Inpatient Sample (October 2015 to December 2019) were included, excluding patients with prior myocardial infarction. Machine-learning clustering analysis was used to define clusters based on 21 clinical attributes of interest. Main outcomes of the study were cluster-based comparison of risk profile, in-hospital clinical outcomes and utilization of invasive management. Binomial hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) was used to detect the between-cluster differences. RESULTS Out of overall 470,960 STEMI cases, the machine-learning analysis revealed 4 different clusters with 205,640 (cluster 0: 'behavioural risk cluster'), 146,400 (cluster 1: 'least comorbidity cluster'), 45,100 (cluster 2: 'diabetes with end-organ damage cluster') and 73,820 (cluster 3: 'cardiometabolic cluster') cases. Attributes with the highest importance for clustering were hypertension and diabetes. After multivariable adjustment, patients from 'diabetes with end-organ damage cluster' exhibited the worst mortality, MACCE and ischemic stroke (p < 0.001 for all), as well as the lowest utilization of invasive management (p < 0.001 for all), in comparison to other clusters. Patients from 'behavioural risk cluster' exhibited the best in-hospital prognosis and the highest utilization of invasive management, compared to other clusters (p < 0.001 for all). CONCLUSIONS Machine learning driven clustering of inpatients with STEMI reveals important population subgroups with distinct prevalence, risk profile, prognosis and management. Data driven approaches may identify high risk phenogroups and warrants further study.
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Affiliation(s)
- Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom
| | - Theocharis Kyriacou
- School of Computer Science and Mathematics, Keele University, Keele, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom; National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, United Kingdom.
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6
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Fan T, Li Y, Li M, Zhu N, Zhang C, Wang X. The correlation between subendocardial viability ratio and the degree of coronary artery stenosis in patients with coronary heart disease and its predictive value for the incidence of short-term cardiovascular events. Coron Artery Dis 2024; 35:451-458. [PMID: 38595165 DOI: 10.1097/mca.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study aimed to analyze the ability of subendocardial viability ratio (SEVR) to predict the degree of coronary artery stenosis and the relationship between SEVR and the incidence of short-term cardiovascular endpoint events. METHOD The indexes of 243 patients with chest pain were collected.. Binary logistic regression analyses were performed using the dichotomous outcome of high and non-high SYNTAX scores. Receiver operating characteristic curves were employed to comparatively analyze the diagnostic efficiencies of the indices and models. A survival analysis combined with the Cox regression analysis was performed using the Kaplan-Meier method to understand the relationship between the SEVR and the incidence of cardiovascular events within 1 year in patients with coronary heart disease (CHD). RESULTS SEVR was significantly lower ( P < 0.05) in the high-stenosis group than control and low-stenosis groups. The diagnostic efficacy of SEVR [area under the curve (AUC) = 0.861] was better than those of age (AUC = 0.745), ABI (AUC = 0.739), and AIx@HR75 (AUC = 0.659). The cutoff SEVR was 1.105. In patients with confirmed CHD who had been discharged from the hospital for 1 year, only SEVR affected survival outcomes (hazard ratio = 0.010; 95% confidence interval: 0.001-0.418; P = 0.016). CONCLUSION A significant decrease in SEVR predicted severe coronary artery stenosis, with a cutoff value of 1.105 and an accuracy of 0.861. In patients with CHD, the lower the SEVR, the higher was the rate of cardiovascular events at 1 year after hospital discharge.
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Affiliation(s)
- Tingting Fan
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Bruno F, Wenzl FA, De Filippo O, Kraler S, Giacobbe F, Roffi M, Muller O, Räber L, Templin C, De Ferrari GM, D'Ascenzo F, Lüscher TF. Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:391-402. [PMID: 38604747 DOI: 10.1093/ehjcvp/pvae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 04/13/2024]
Abstract
AIMS Data on glycoprotein IIb/IIIa inhibitor (GPI) use in real-world acute coronary syndrome (ACS) patients following the introduction of potent P2Y12 inhibitors and newer-generation stents are scant. Here, we aimed to assess the utilization, effectiveness, and safety of GPI in a large prospective multicentre cohort of contemporary ACS patients. METHODS AND RESULTS SPUM-ACS prospectively recruited patients presenting with ACS between 2009 and 2017. The primary endpoint of the present study was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke at 1 year. Secondary endpoints were defined as any bleeding events, Bleeding Academic Research Consortium (BARC) 3-5 bleeding, and net adverse cardiovascular events (NACE). A total of 4395 ACS patients were included in the analysis. GPI-treated patients had more total coronary artery occlusion (56% vs. 35%, P < 0.001) and thrombus (60% vs. 35%, P < 0.001) at angiography. Among the propensity score-matched (PSM) population (1992 patients equally split into two groups), GPI-treated patients showed lower risk of MACE [PSM adjusted hazard ratio (HR) 0.70, 95% CI 0.49-0.99], but a higher risk of any (PSM adjusted HR 1.46, 95% CI 1.06-1.99) and major bleedings (PSM adjusted HR 1.73, 95% CI 1.09-2.76), resulting in a neutral effect on NACE (PSM adjusted HR 0.87, 95% CI 0.65-1.17). These results remained consistent across all subgroups. CONCLUSIONS In patients with ACS undergoing percutaneous coronary intervention and receiving potent P2Y12 inhibitors, we observed a reduced risk of MACE and an increased risk of major bleedings at 1 year in patients treated with GPI. Although the routine use of GPI is currently not recommended, they might be considered in selected patients following a personalized balancing between ischaemic and bleeding risks.
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Affiliation(s)
- Francesco Bruno
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin 10126, Italy; Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin 10126, Italy; Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Federico Giacobbe
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin 10126, Italy; Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Marco Roffi
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, 1011 Lausanne, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin 10126, Italy; Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin 10126, Italy; Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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Hixson R, Jensen KS, Melamed KH, Qadir N. Device associated complications in the intensive care unit. BMJ 2024; 386:e077318. [PMID: 39137947 DOI: 10.1136/bmj-2023-077318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Invasive devices are routinely used in the care of critically ill patients. Although they are often essential components of patient care, devices such as intravascular catheters, endotracheal tubes, and ventilators are a common source of complications in the intensive care unit. Critical care practitioners who use these devices need to use strategies for risk reduction and understand approaches to management when adverse events occur. This review discusses the identification, prevention, and management of complications of vascular, airway, and mechanical support devices commonly used in the intensive care unit.
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Affiliation(s)
- Roxana Hixson
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kristin Schwab Jensen
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kathryn H Melamed
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Nida Qadir
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
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9
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Abusharekh M, Kampf J, Dykun I, Souri K, Backmann V, Al-Rashid F, Jánosi RA, Totzeck M, Lawo T, Rassaf T, Mahabadi AA. Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:402-410. [PMID: 38192031 DOI: 10.1093/ehjqcco/qcae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Acute total occlusion (ATO) is diagnosed in a substantial proportion of patients with non-ST-elevation myocardial infarction (NSTEMI). We compared procedural outcomes and long-term mortality in patients with STEMI with NSTEMI with vs. without ATO. METHODS AND RESULTS We included patients with acute myocardial infarction (AMI) undergoing invasive coronary angiography between 2004 and 2019 at our centre. Acute total occlusion was defined as thrombolysis in myocardial infarction (TIMI) 0-1 flow in the infarct-related artery or TIMI 2-3 flow with highly elevated peak troponin (>100-folds the upper reference limit). Association between presentation and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. From 2269 AMI patients (mean age 66 ± 13.2 years, 74% male), 664 patients with STEMI and 1605 patients with NSTEMI (471 [29.3%] with ATO) were included. ATO(+)NSTEMI patients had a higher frequency of cardiogenic shock and no reflow than ATO(-)NSTEMI with similar rates compared with STEMI patients (cardiogenic shock: 2.76 vs. 0.27 vs. 2.86%, P < 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P < 0.0001, P = 0.54). ATO(+)NSTEMI and STEMI were associated with 60 and 55% increased incident mortality, respectively, as compared with ATO(-)NSTEMI (ATO(+)NSTEMI: 1.60 [1.27-2.02], P < 0.0001, STEMI: 1.55 [1.24-1.94], P < 0.0001). Likewise, left ventricular ejection fraction (48.5 ± 12.7 vs. 49.1±11 vs. 50.6 ± 11.8%, P = 0.5, P = 0.018) and global longitudinal strain (-15.2 ± -5.74 vs. -15.5 ± -4.84 vs. -16.3 ± -5.30%, P = 0.48, P = 0.016) in ATO(+)NSTEMI were comparable to STEMI but significantly worse than in ATO(-)NSTEMI. CONCLUSION Non-ST-elevation myocardial infarction patients with ATO have unfavourable procedural outcomes, resulting in increased long-term mortality, resembling STEMI. Our findings suggest that the occlusion perspective provides a more appropriate classification of AMI than differentiation into STEMI vs. NSTEMI.
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Affiliation(s)
- Mohammed Abusharekh
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Jürgen Kampf
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Iryna Dykun
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Kashif Souri
- Department of Cardiology, The Elisabeth Hospital Recklinghausen, Röntgen Street 10, 45661 Recklinghausen, Germany
| | - Viktoria Backmann
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Thomas Lawo
- Department of Cardiology, The Elisabeth Hospital Recklinghausen, Röntgen Street 10, 45661 Recklinghausen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen, Hufeland Street 55, 45147 Essen, Germany
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10
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Goyal A, Tariq MD, Singh A, Thakkar KU, Brateanu A, Mahalwar G. Systematic Review and Meta-Analysis Comparing Complete Versus Incomplete or Culprit-only Revascularization by Percutaneous Coronary Intervention in Elderly Patients with Acute Coronary Syndrome. Curr Probl Cardiol 2024:102790. [PMID: 39127434 DOI: 10.1016/j.cpcardiol.2024.102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Complete revascularization (CR) is favored over culprit-only or incomplete revascularization (IR) for patients with acute coronary syndrome (ACS) and multi-vessel disease (MVD) due to better long-term outcomes. However, the optimal revascularization strategy is currently uncertain in elderly patients, where frailty, polypharmacy, multi-morbidity, inherent bleeding risk and presumed cognitive decline can often burden the decision-making process. METHODS We searched Medline, PubMed, and Google Scholar from inception to April 2024. The search of databases identified relevant studies that reported the comparative effects of CR and IR in the elderly population undergoing percutaneous coronary intervention (PCI). Data was pooled for individual studies using random-effects models on Comprehensive Meta-Analysis software, with statistical significance set at p<0.05. RESULTS The meta-analysis included 14 studies and 62577 patients. CR demonstrated a significant reduction in all-cause mortality [RR: 0.680; 95% CI: 0.57-0.82; p=<0.001], cardiovascular-related mortality [RR: 0.620; 95% CI: 0.478-0.805; p=<0.001], and myocardial infarction [RR: 0.675; 95% CI: 0.553-0.823; p=<0.001] rates. There was no difference between the risk of stroke [RR: 1.044; 95% CI: 0.733-1.486; p=0.81], major bleeding [RR: 1.001; 95% CI: 0.787-1.274; p=0.991], stent thrombosis [RR: 1.015; 95% CI: 0.538-1.916; p=0.936], and contrast-induced acute kidney injury [RR: 1.187; 95% CI: 0.963-1.464; p=0.109]. CONCLUSION The meta-analysis suggests that CR may be a favorable revascularization strategy for elderly patients undergoing PCI, displaying a significant decrease in mortality and repeat myocardial infarction risk.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India.
| | - Muhammad Daoud Tariq
- Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan.
| | - Ajeet Singh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Kamya Uday Thakkar
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India.
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
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11
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Pereira NL, Cresci S, Angiolillo DJ, Batchelor W, Capers Q, Cavallari LH, Leifer D, Luzum JA, Roden DM, Stellos K, Turrise SL, Tuteja S. CYP2C19 Genetic Testing for Oral P2Y12 Inhibitor Therapy: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e129-e150. [PMID: 38899464 PMCID: PMC11300169 DOI: 10.1161/cir.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
There is significant variability in the efficacy and safety of oral P2Y12 inhibitors, which are used to prevent ischemic outcomes in common diseases such as coronary and peripheral arterial disease and stroke. Clopidogrel, a prodrug, is the most used oral P2Y12 inhibitor and is activated primarily after being metabolized by a highly polymorphic hepatic cytochrome CYP2C219 enzyme. Loss-of-function genetic variants in CYP2C219 are common, can result in decreased active metabolite levels and increased on-treatment platelet aggregation, and are associated with increased ischemic events on clopidogrel therapy. Such patients can be identified by CYP2C19 genetic testing and can be treated with alternative therapy. Conversely, universal use of potent oral P2Y12 inhibitors such as ticagrelor or prasugrel, which are not dependent on CYP2C19 for activation, has been recommended but can result in increased bleeding. Recent clinical trials and meta-analyses have demonstrated that a precision medicine approach in which loss-of-function carriers are prescribed ticagrelor or prasugrel and noncarriers are prescribed clopidogrel results in reducing ischemic events without increasing bleeding risk. The evidence to date supports CYP2C19 genetic testing before oral P2Y12 inhibitors are prescribed in patients with acute coronary syndromes or percutaneous coronary intervention. Clinical implementation of such genetic testing will depend on among multiple factors: rapid availability of results or adoption of the concept of performing preemptive genetic testing, provision of easy-to-understand results with therapeutic recommendations, and seamless integration in the electronic health record.
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12
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Azazy A, Farid WA, Ibrahim WA, El Shafey WELDH. Survival benefit of IABP in pre- versus post-primary percutaneous coronary intervention in patients with cardiogenic shock. Egypt Heart J 2024; 76:99. [PMID: 39107654 PMCID: PMC11303647 DOI: 10.1186/s43044-024-00527-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). However, little evidence is available regarding the optimal order of intra-aortic balloon counter-pulsation (IABP) insertion and primary percutaneous coronary intervention (PPCI). The aim of this study was to assess the hospital and short-term survival benefits of two different IABP insertion approaches, before versus after PPCI in patients with acute myocardial infarction and cardiogenic shock. RESULTS Total mortality was 80 patients representing 48.4% of the total 165 studied patients; 60 patients died during the hospital admission period, while the remaining 20 patients died post-discharge. In-hospital mortality was significantly higher in Post-PPCI-IABP group 40 (49.4%) versus Pre-PPCI-IABP group 20 (23.8%) (P = 0.001). Moreover, the mortality difference between the two groups was sustained over six-month follow-up period, where 15 patients (18.5%) died in the Post-PPCI-IABP group, while only 5 patients 6.0% died in the Pre-PPCI-IABP (P = 0.001). CONCLUSIONS Early IABP insertion before PPCI is associated with improved in-hospital and long-term survival when used for patients presenting with AMI complicated by hemodynamic instability.
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Affiliation(s)
- Ahmed Azazy
- Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Walaa Abdaziz Farid
- Department of Cardiology, Menofiya University Hospital, Shebin El Kom, Egypt
| | - Walid Abdu Ibrahim
- Department of Cardiology, Menofiya University Hospital, Shebin El Kom, Egypt
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13
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Sundermeyer J, Schock A, Kellner C, Haller PM, Lehmacher J, Thießen N, Toprak B, Scharlemann L, Twerenbold R, Sörensen NA, Clemmensen P, Neumann JT. Pre-hospital admission of heparin in patients with suspected non-ST segment elevation acute coronary syndrome. Clin Res Cardiol 2024:10.1007/s00392-024-02507-1. [PMID: 39102002 DOI: 10.1007/s00392-024-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/25/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Evidence supporting pre-hospital heparin administration in patients with suspected non-ST segment elevation acute coronary syndrome (NSTE-ACS) is lacking. We aim to evaluate if pre-hospital heparin administration by emergency medical service improves clinical outcome in patients with suspected NSTE-ACS. METHODS Patients with suspected myocardial infarction (MI) presenting to the emergency department were prospectively enrolled from 2013 to 2021, excluding those with ST segment elevation MI. Patients with and without prehospital heparin administration were compared using propensity score matching. To assess the association between pre-hospital heparin loading, 30-day and 1-year mortality, Kaplan-Meier estimations and Cox regression models were used. RESULTS Among 1,234 patients, median age was 69 years, 755 (61.2%) were male, 867 (70.5%) with known hypertension, 177 (14.4%) had diabetes, 280 (23.1%) were current smokers, and 444 (36.0%) had a history of CAD. Compared to patients without pre-hospital heparin administration, heparin pre-treated patients were more often active smokers (26.5% vs. 20.8%). After propensity matching, 475 patients with vs. without pre-hospital heparin administration were compared, with no significant difference in 30-day mortality (no-heparin 1.3% vs. heparin 0.4%) and 1-year mortality (no-heparin 7.2% vs. heparin 5.5%, adjusted HR 0.98, CI 0.95-1.01, p = 0.22). Bleeding events occurred at a low frequency (< 2%) and did not differ between groups. CONCLUSIONS In this study, pre-hospital heparin administration was not associated with improved clinical outcome in patients with suspected NSTE-ACS. These findings question pre-hospital heparin therapy in this patient population and might potentially warrant a more restricted utilization pending in-hospital risk assessment.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Alina Schock
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Paul M Haller
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Jonas Lehmacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Niklas Thießen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Betül Toprak
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Lea Scharlemann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Nils Arne Sörensen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Peter Clemmensen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), Hamburg, Germany
| | - Johannes T Neumann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
- Center for Population Health Innovation (POINT), Hamburg, Germany.
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14
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Pepe M, Addabbo F, Cecere A, Tritto R, Napoli G, Nestola PL, Cirillo P, Biondi-Zoccai G, Giordano S, Ciccone MM. Acute Hyperglycemia-Induced Injury in Myocardial Infarction. Int J Mol Sci 2024; 25:8504. [PMID: 39126075 PMCID: PMC11313474 DOI: 10.3390/ijms25158504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Acute hyperglycemia is a transient increase in plasma glucose level (PGL) frequently observed in patients with ST-elevation myocardial infarction (STEMI). The aim of this review is to clarify the molecular mechanisms whereby acute hyperglycemia impacts coronary flow and myocardial perfusion in patients with acute myocardial infarction (AMI) and to discuss the consequent clinical and prognostic implications. We conducted a comprehensive literature review on the molecular causes of myocardial damage driven by acute hyperglycemia in the context of AMI. The negative impact of high PGL on admission recognizes a multifactorial etiology involving endothelial function, oxidative stress, production of leukocyte adhesion molecules, platelet aggregation, and activation of the coagulation cascade. The current evidence suggests that all these pathophysiological mechanisms compromise myocardial perfusion as a whole and not only in the culprit coronary artery. Acute hyperglycemia on admission, regardless of whether or not in the context of a diabetes mellitus history, could be, thus, identified as a predictor of worse myocardial reperfusion and poorer prognosis in patients with AMI. In order to reduce hyperglycemia-related complications, it seems rational to pursue in these patients an adequate and quick control of PGL, despite the best pharmacological treatment for acute hyperglycemia still remaining a matter of debate.
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Affiliation(s)
- Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
| | - Francesco Addabbo
- ASL Taranto, Local Health Authority of Taranto, Statistics and Epidemiology Unit, 74100 Taranto, Italy;
| | - Annagrazia Cecere
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy;
| | - Rocco Tritto
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
| | - Gianluigi Napoli
- Division of Cardiology, Villa Verde Clinic, 74121 Taranto, Italy;
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy;
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Maria Cecilia Hospital, GVM Care & Research, 48032 Cotignola, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Marco Matteo Ciccone
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
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15
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Toprak K, Kaplangöray M, Karataş M, Dursun A, Arğa Y, Tascanov MB, Biçer A, Demirbağ R. Atherogenic Combined Index: Validation of a Novel Predictive Lipid Biomarker for the Presence and Severity of Coronary Artery Disease. Arch Med Res 2024; 55:103065. [PMID: 39098112 DOI: 10.1016/j.arcmed.2024.103065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/06/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND/AIM The balance between atherogenic and antiatherogenic lipid particles significantly influences coronary artery disease (CAD), as an imbalance may contribute to the development and progression of atherosclerosis, which affects the risk and severity of CAD. This study aims to introduce and validate the atherogenic combined index (ACI) as a novel lipid biomarker that, comprehensively assesses the balance between atherogenic and antiatherogenic particles in the blood to effectively reflect the cumulative atherogenic effect and its association with the presence and severity of CAD. MATERIAL AND METHODS In this cross-sectional study, 1,830 patients diagnosed with CAD and a total of 650 patients without CAD were included in the study cohort for comprehensive analysis and comparison. Based on the tertiles of the SYNTAX score (SS), three subgroups of patients with CAD were identified. ACI and other atherogenic indices were compared to predict the presence and severity of CAD. RESULTS The levels of ACI and other non-traditional lipid markers levels were higher in the CAD group compared to the non-CAD group (p <0.05, for all). ACI showed a good linear association with the SYNTAX score (r = 0.527; p <0.001). The multivariate logistic regression model showed that ACI was an independent predictor of the presence (OR: 1.602, 95% CI: 1.509-1.701, p <0.001) and severity (OR: 1.296, 95% CI: 1.243-1.351, p <0.001) of CAD after adjustment for various confounders. CONCLUSION The results suggest that ACI may serve as a promising and stronger tool for predicting the presence and severity of CAD.
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Affiliation(s)
- Kenan Toprak
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, Turkey.
| | - Mustafa Kaplangöray
- Şeyh Edebali University, Medical Faculty, Department of Cardiology, Bilecik, Turkey
| | - Mesut Karataş
- Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Ayten Dursun
- Şanlıurfa Provincial Health Directorate, Nursing Department, Sanliurfa, Turkey
| | - Yakup Arğa
- Viranşehir State Hospital, Department of Cardiology, Sanliurfa, Turkey
| | | | - Asuman Biçer
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, Turkey
| | - Recep Demirbağ
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, Turkey
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16
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Corballis N, Bhalraam U, Merinopoulos I, Gunawardena T, Tsampasian V, Wickramarachchi U, Eccleshall S, Vassiliou VS. One-Month Duration Compared with Twelve-Month Duration of Dual Antiplatelet Therapy in Elective Angioplasty for Coronary Artery Disease: Bleeding and Ischaemic Outcomes. J Clin Med 2024; 13:4521. [PMID: 39124787 PMCID: PMC11312761 DOI: 10.3390/jcm13154521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: The need to determine the safest duration of dual antiplatelet therapy duration after elective angioplasty to reduce bleeding events without an adverse effect on major adverse cardiovascular events (MACE) remains a challenge. Methods: In this investigator-initiated, single-centre cohort study, we identified all patients who underwent PCI for de novo coronary disease for stable angina between January 2015 and November 2019. We compared 1-month and 12-month durations of dual antiplatelet therapy (DAPT) to determine if there was any difference in the primary outcome of major bleeding. The secondary outcome was a patient-oriented composite endpoint of all-cause mortality; any myocardial infarction, stroke, or revascularisation; and the individual components of this composite endpoint. Data were analysed using Cox regression models and cumulative hazard plots. Results: A total of 1025 patients were analysed, of which 340 received 1 month of DAPT and 685 received 12 months of DAPT. There was no difference in major bleeding between the two groups (2.6% vs. 2.5% respectively). On univariable cox regression analysis, no characteristics were predictors of major bleeding. A proportion of 99.7% of patients in the 1-month DAPT arm were treated with a DCB strategy, whilst 93% in the 12-month DAPT group were treated with a DES. There was no difference between the two groups with regards to the composite patient-oriented MACE (11% vs. 12%, respectively) or any individual component of this. These results were unchanged after propensity score matched analysis. Conclusions: A 1-month duration of DAPT, for which 99.7% of patients were treated with a DCB strategy, appears safe and effective when compared with a 12-month duration of DAPT with no difference in major bleeding or MACE.
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Affiliation(s)
- Natasha Corballis
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - U. Bhalraam
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - Ioannis Merinopoulos
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - Tharusha Gunawardena
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - Vasiliki Tsampasian
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - Upul Wickramarachchi
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
| | - Vassilios S. Vassiliou
- Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK (I.M.)
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK;
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17
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Kiliç R, Güzel T, Aktan A, Güzel H, Kaya AF, Çankaya Y. The effectiveness of HALP score in predicting mortality in non-ST-elevation myocardial infarction patients. Coron Artery Dis 2024:00019501-990000000-00257. [PMID: 39087643 DOI: 10.1097/mca.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND The HALP score, measured based on hemoglobin, albumin, lymphocyte, and platelet levels, is regarded as a novel scoring system that indicates the status of systemic inflammation and nutritional health. Our study aimed to evaluate the relationship between HALP score and prognosis in non-ST-elevation myocardial infarction (NSTEMI) patients. METHODS Between 1 January 2020 and 1 January 2022, 568 consecutive patients diagnosed with NSTEMI from a single center were included in the study retrospectively. The patients were divided into two equal groups according to the median HALP cutoff value of 44.05. Patients were followed for at least 1 year from the date of admission. RESULTS The average age of the patients was 62.3 ± 10.6 years and 43.7% were female. In-hospital and 1-year mortality were found to be significantly higher in the group with low HALP scores (6.0 vs. 2.1%, P = 0.019 and 22.5 vs. 9.9%, P < 0.001, respectively). In receiver operating characteristic curve analysis, a cutoff level of 34.6 of the HALP score predicted 1-year mortality with 71% sensitivity and 65% specificity (area under the curve: 0.707, 95% confidence interval: 0.651-0.762, P < 0.001). In Kaplan-Meier analysis, higher mortality rates were observed over time in the group with lower HALP scores (log-rank test=16.767, P < 0.001). In Cox regression analysis, the HALP score was found to be an independent predictor of 1-year mortality (odds ratio: 0.969, 95% confidence interval: 0.958-0.981, P < 0.001). CONCLUSION We found that a low HALP score could predict in-hospital and 1-year mortality in patients admitted to the hospital with a diagnosis of NSTEMI.
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Affiliation(s)
- Raif Kiliç
- Department of Cardiology, Çermik State Hospital
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital, Diyarbakir
| | - Adem Aktan
- Department of Cardiology, Mardin Artuklu University Medical Faculty, Mardin
| | - Hamdullah Güzel
- Department of Cardiology, Düzce University Faculty of Medicine, Düzce
| | | | - Yusuf Çankaya
- Department of Emergency Medicine, Çermik State Hospital
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18
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Scala A, Marchini F, Meossi S, Zanarelli L, Sanguettoli F, Frascaro F, Bianchi N, Cocco M, Erriquez A, Tonet E, Campo G, Pavasini R. Future of invasive and non-invasive hemodynamic assessment for coronary artery disease management. Minerva Cardiol Angiol 2024; 72:385-404. [PMID: 38934267 DOI: 10.23736/s2724-5683.23.06461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Coronary artery disease represents a global health challenge. Accurate diagnosis and evaluation of hemodynamic parameters are crucial for optimizing patient management and outcomes. Nowadays a wide range of both non-invasive and invasive methods are available to assess the hemodynamic impact of both epicardial coronary stenosis and vasomotor disorders. In fact, over the years, important developments have reshaped the nature of both invasive and non-invasive diagnostic techniques, and the future holds promises for further innovation and integration. Non-invasive techniques have progressively evolved and currently a broad spectrum of methods are available, from cardiac magnetic resonance imaging with pharmacological stress and coronary computed tomography (CT) to the newer application of FFR-CT and perfusion CT. Invasive methods, on the contrary, have developed to a full-physiology approach, able not only to identify functionally significant lesions but also to evaluate microcirculation and vasospastic disease. The aim of this review is to summarize the current state-of-the-art of invasive and non-invasive hemodynamic assessment for CAD management.
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Affiliation(s)
- Antonella Scala
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Sofia Meossi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Luca Zanarelli
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | | | - Federica Frascaro
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Nicola Bianchi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Marta Cocco
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy -
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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19
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Cau R, Palmisano A, Suri JS, Pisu F, Esposito A, Saba L. Prognostic role of cardiovascular magnetic resonance in Takotsubo syndrome: A systematic review. Eur J Radiol 2024; 177:111576. [PMID: 38897052 DOI: 10.1016/j.ejrad.2024.111576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Takotsubo syndrome (TS) is characterized by transient myocardial dysfunction with outcomes ranging from favorable to life-threatening. Cardiovascular magnetic resonance (CMR) has emerged as an essential tool in its diagnosis and management and is consistently recommended by current guidelines in the diagnostic work-up. However, the prognostic value of CMR in patients with TS remains undetermined. The aim of this study was to assess the prognostic value of CMR in managing patients with TS. METHOD PubMed, MEDLINE via Ovid, Scopus, and the Cochrane Library were searched to identify studies reporting the prognostic role of multiparameteric CMR in patients with TS with a follow-up ≥ 12 months. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, cardiac death, heart failure, sudden cardiac death, recurrence of TS, and cerebrovascular events. RESULTS Five studies with 564 patients were included for reporting correlation of CMR parameters with MACCE. Primary endpoint occurred in 69 (12%) patients. Among the CMR parameters assessed, myocardial strain parameters (including measurements of the left atrium, left and right ventricle), right ventricle involvement, and a CMR-based radiomics model demonstrated correlations with MACCE. Additionally, one study showed the predictive ability of a CMR score. CONCLUSION The current systematic review suggests that CMR may offer prognostic insights in TS patients, underscoring its potential clinical utility for integration into clinical practice. However, scarce data are currently available; hence, further research is needed.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60 20132, Milan, Italy
| | - Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, Atheropoint, Roseville, CA, USA
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60 20132, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy.
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20
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Alexandre A, Campinas A, Brochado B, Braga M, Sá‐Couto D, Santos M, Ribeiro D, Brandão M, Silva MP, de Morais GP, Calvão J, Silva JC, Baggen‐Santos R, Luz A, Silveira J, Torres S. Twelve-year trends in unprotected left main coronary artery occlusion: insights from a real-world multicentre study. ESC Heart Fail 2024; 11:1981-1994. [PMID: 38549183 PMCID: PMC11287319 DOI: 10.1002/ehf2.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 07/31/2024] Open
Abstract
AIMS Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12 year period. METHODS AND RESULTS This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%. CONCLUSIONS In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.
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Affiliation(s)
- André Alexandre
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Andreia Campinas
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Bruno Brochado
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Marta Braga
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - David Sá‐Couto
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Mariana Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Diana Ribeiro
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
| | - Mariana Brandão
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Marisa Passos Silva
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - Gustavo Pires de Morais
- Department of CardiologyCentro Hospitalar de Vila Nova de Gaia e Espinho (CHVNGE)Vila Nova de GaiaPortugal
| | - João Calvão
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - João Carlos Silva
- Department of CardiologyCentro Hospitalar Universitário de São João (CHUSJ)PortoPortugal
| | - Raquel Baggen‐Santos
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - André Luz
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
- Cardiovascular Research Group, UMIB – Unit for Multidisciplinary Research in Biomedicine, ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - João Silveira
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
| | - Severo Torres
- Department of CardiologyCentro Hospitalar Universitário de Santo António (CHUdSA)Largo do Prof. Abel Salazar4099‐001PortoPortugal
- ICBAS – School of Medicine and Biomedical SciencesUniversity of PortoPortoPortugal
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21
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Wira CR, Kearns T, Fleming-Nouri A, Tyrrell JD, Wira CM, Aydin A. Considering Adverse Effects of Common Antihypertensive Medications in the ED. Curr Hypertens Rep 2024; 26:355-368. [PMID: 38687403 DOI: 10.1007/s11906-024-01304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW To evaluate the adverse effects of common antihypertensive agents utilized or encountered in the Emergency Department. RECENT FINDINGS All categories of antihypertensive agents may manifest adverse effects, inclusive of adverse drug reactions (ADRs), drug-to-drug interactions, or accidental overdose. Adverse effects, and specifically ADRs, may be stratified into the organ systems affected, might require specific time-sensitive interventions, could pose particular risks to vulnerable populations, and may result in significant morbidity, and potential mortality. Adverse effects of common antihypertensive agents may be encountered in the ED, necessitating that ED systems of care are poised to prevent, recognize, and intervene when adverse effects arise.
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Affiliation(s)
- Charles R Wira
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA.
- Yale Acute Stroke Program, Section of Vascular Neurology, Department of Neurology, New Haven, CT, USA.
| | - Thomas Kearns
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - Alex Fleming-Nouri
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - John D Tyrrell
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Section of Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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22
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Romagnoli E, Aurigemma C, Biondi-Zoccai G, Burzotta F. John Steinbeck in cardiology: of guidelines and giants. Minerva Cardiol Angiol 2024; 72:311-312. [PMID: 38934265 DOI: 10.23736/s2724-5683.24.06635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Unit of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
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23
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Nowak W, Kowalik I, Stępińska J. 'Evaluation of beta-2-microglobulin and neuron-specific enolase as prognostic factors in patients over 65 years of age with frailty syndrome hospitalized for acute coronary syndrome'. Coron Artery Dis 2024; 35:353-359. [PMID: 38411209 DOI: 10.1097/mca.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND The aim of the study is to assess the value of beta-2-microglobulin (B2M) and neuron-specific enolase (NSE) as prognostic factors in the population of patients over 65 years of age with frailty hospitalized due to acute coronary syndrome (ACS). METHODS Patients aged ≥65 years with ACS were included. Assessment of frailty was carried out using the FRAIL scale. The measurement of NSE and B2M was carried out three times during hospitalization: (1) at the time of admission, (2) on the second day of hospitalization, (3) on the seventh day of hospitalization, or the day of discharge if it was before the seventh day. The primary endpoint was all-cause mortality, and the secondary endpoint was unscheduled rehospitalization. RESULTS Of the 127 patients, frailty was identified in 39.3%. Multivariate analysis of variance showed significantly higher levels of NSE ( P = 0.012) and B2M ( P < 0.001) in patients with frailty compared to the nonfrail group and significant changes in marker levels during hospitalization - decreased NSE ( P < 0.001) and increased B2M levels ( P < 0.001). Elevated B2M-1 level was an independent marker of the occurrence of frailty [odds ratio (OR), 1.98 (1.09-4.00); P = 0.044], and the optimal cutoff point for the diagnosis of frailty was 2.85 mg/l [area under the curve (AUC), 0.718 (0.632-0.795)] with sensitivity 52% and specificity 84.4% ( P < 0.001). Elevated NSE-3 level was associated with all-cause mortality, and each 1 ng/ml increase in NSE-3 increased the risk of death by 1.07-fold [OR, 1.07 (1.03-1.10]). Meanwhile, elevated B2M-3 level was associated with unscheduled rehospitalization, and each 1 mg/l increase in B2M-3 increased the risk of unscheduled rehospitalization by 1.21-fold [OR, 1.21 (1.03-1.42)]. The Harrell's C-index for all-cause mortality was higher for NSE-3 [0.820 (95% confidence interval {CI}, 0.706-0.934)] compared to frailty assessed by the FRAIL scale [0.715 (95% CI, 0.580-0.850)], which means that additional NSE-3 assessment may improve the prediction of all-cause mortality. However, Uno's C-Statistic analysis showed that the difference was not statistically significant (Pr>chi-square 0.556). Harrell's C-index for unscheduled rehospitalization was higher for frailty assessed by the FRAIL scale compared to B2M-3. CONCLUSION Monitoring NSE and B2M marker levels in patients over 65 years of age with frailty and ACS does not provide additional benefits in terms of prognostic ability compared to tests assessing frailty. B2M, assessed upon hospital admission and monitoring NSE and B2M levels during hospitalization may be considered in the diagnosis of frailty and risk stratification in a group of patients for whom currently available frailty diagnostic tools cannot be used.
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Affiliation(s)
- Wojciech Nowak
- Department of Intensive Cardiac Therapy, National Institute of Cardiology
| | - Ilona Kowalik
- Clinical Research Support Center, National Institute of Cardiology, Warsaw, Poland
| | - Janina Stępińska
- Department of Intensive Cardiac Therapy, National Institute of Cardiology
- Department of Medical Communication, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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24
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Hoenicka M, Vokshi A, Zhou S, Liebold A, Mayer B. Feasibility of aligning creatine kinase MB activity and mass data in multicentre trials using generalized additive modelling. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae138. [PMID: 39041604 PMCID: PMC11298413 DOI: 10.1093/icvts/ivae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/21/2024] [Accepted: 07/22/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES Elevated serum creatine kinase isoenzyme MB (CK-MB) levels indicate myocardial ischaemia and periprocedural myocardial injury during treatment of heart diseases. We established a method to predict CK-MB mass from activity data based on a prospective pilot study in order to simplify multicentre trials. METHODS 38 elective cardiac surgery patients without acute myocardial ischaemia and terminal renal failure were recruited. CK-MB mass and activity were determined in venous blood samples drawn preoperatively, postoperatively, 6 h post-op, and 12 h post-op. Linear regression and generalized additive models (GAMs) were applied to describe the relationship of mass and activity. Influences of demographic and perioperative factors on the fit of GAMs was evaluated. The agreement of predicted and measured CK-MB masses was assessed by Bland-Altman analyses. RESULTS Linear regression provided an acceptable overall fit (r2 = 0.834) but showed deviances at low CK-MB levels. GAMs did not benefit from the inclusion of age, body mass index and surgical times. The minimal adequate model predicted CK-MB masses from activities, sex and sampling time with an r2 of 0.981. Bland-Altman analyses confirmed narrow limits of agreement (spread: 8.87 µg/l) and the absence of fixed (P = 0.41) and proportional (P = 0.21) biases. CONCLUSIONS GAM-based modelling of CK-MB data in a representative patient cohort allowed to predict CK-MB masses from activities, sex and sampling time. This approach simplifies the integration of study centres with incompatible CK-MB data into multicentre trials in order to facilitate inclusion of CK-MB levels in statistical models.
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Affiliation(s)
- Markus Hoenicka
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Arbresha Vokshi
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Shaoxia Zhou
- Department of Clinical Chemistry, Ulm University Medical Center, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Almalki A, Arjun S, Harding I, Jasem H, Kolatsi-Joannou M, Jafree DJ, Pomeranz G, Long DA, Yellon DM, Bell RM. SGLT1 contributes to glucose-mediated exacerbation of ischemia-reperfusion injury in ex vivo rat heart. Basic Res Cardiol 2024:10.1007/s00395-024-01071-z. [PMID: 39088085 DOI: 10.1007/s00395-024-01071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
Hyperglycaemia is common during acute coronary syndromes (ACS) irrespective of diabetic status and portends excess infarct size and mortality, but the mechanisms underlying this effect are poorly understood. We hypothesized that sodium/glucose linked transporter-1 (SGLT1) might contribute to the effect of high-glucose during ACS and examined this using an ex-vivo rodent heart model of ischaemia-reperfusion injury. Langendorff-perfused rat hearts were subjected to 35 min ischemia and 2 h reperfusion, with variable glucose and reciprocal mannitol given during reperfusion in the presence of pharmacological inhibitors of SGLT1. Myocardial SGLT1 expression was determined in rat by rtPCR, RNAscope and immunohistochemistry, as well as in human by single-cell transcriptomic analysis. High glucose in non-diabetic rat heart exacerbated reperfusion injury, significantly increasing infarct size from 45 ± 3 to 65 ± 4% at 11-22 mmol/L glucose, respectively (p < 0.01), an association absent in diabetic heart (32 ± 1-37 ± 5%, p = NS). Rat heart expressed SGLT1 RNA and protein in vascular endothelium and cardiomyocytes, with similar expression found in human myocardium by single-nucleus RNA-sequencing. Rat SGLT1 expression was significantly reduced in diabetic versus non-diabetic heart (0.608 ± 0.08 compared with 1.116 ± 0.13 probe/nuclei, p < 0.01). Pharmacological inhibitors phlorizin, canagliflozin or mizagliflozoin in non-diabetic heart revealed that blockade of SGLT1 but not SGLT2, abrogated glucose-mediated excess reperfusion injury. Elevated glucose is injurious to the rat heart during reperfusion, exacerbating myocardial infarction in non-diabetic heart, whereas the diabetic heart is resistant to raised glucose, a finding which may be explained by lower myocardial SGLT1 expression. SGLT1 is expressed in vascular endothelium and cardiomyocytes and inhibiting SGLT1 abrogates excess glucose-mediated infarction. These data highlight SGLT1 as a potential clinical translational target to improve morbidity/mortality outcomes in hyperglycemic ACS patients.
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Affiliation(s)
- Alhanoof Almalki
- Hatter Cardiovascular Institute, Institute for Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Sapna Arjun
- Hatter Cardiovascular Institute, Institute for Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Idris Harding
- Hatter Cardiovascular Institute, Institute for Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Hussain Jasem
- Hatter Cardiovascular Institute, Institute for Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Maria Kolatsi-Joannou
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Daniyal J Jafree
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- UCL Centre for Kidney and Bladder Health, London, UK
- UCL MB/PhD Programme, Faculty of Medical Sciences, University College London, London, UK
| | - Gideon Pomeranz
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- UCL Centre for Kidney and Bladder Health, London, UK
| | - David A Long
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- UCL Centre for Kidney and Bladder Health, London, UK
| | - Derek M Yellon
- Hatter Cardiovascular Institute, Institute for Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Robert M Bell
- Hatter Cardiovascular Institute, Institute for Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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26
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Demandt JPA, El Farissi M, de Vos A, Eerdekens R, Teeuwen K, Brueren G, Zimmermann FM, Tonino PAL, Pijls NHJ, Vlaar PJ. Continuous thermodilution and microvascular resistance reserve during the index procedure in acute coronary syndrome without obstructive coronary artery disease: A pilot study. Catheter Cardiovasc Interv 2024; 104:241-246. [PMID: 38895766 DOI: 10.1002/ccd.31122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/07/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND In 5%-25% of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients, coronary angiography reveals no obstructive coronary arteries (MINOCA). Coronary microvascular disease (CMD) is a potential causal pathophysiological mechanism in these patients and can be diagnosed by continuous thermodilution assessment. Recently, the microvascular resistance reserve (MRR) has been introduced as a novel index to assess the vasodilatory capacity of the microcirculation. However, continuous thermodilution and MRR have never been investigated in the acute setting in MINOCA patients and invasive assessment of the microcirculation in these patients are currently lacking. AIMS The objectives of the study were to investigate the incidence of CMD (MRR ≤ 2.7) in patients with MINOCA and to evaluate the feasibility and safety of continuous thermodilution-based assessment during index coronary angiography in the acute setting. METHODS This study was a prospective, observational, pilot study investigating coronary physiology in the acute setting in MINOCA patients. Patients admitted with a diagnosis of NSTE-ACS were eligible for inclusion. RESULTS In total, 19 MINOCA patients were included in this analysis; the mean age was 70 ± 9 years, and 79% were females. CMD was present in 6 patients (32%). Qrest was significantly higher in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (0.076 [0.057-0.100] vs. 0.049 [0.044-0.071] L/min, p = 0.03). Rµ,rest was significantly lower in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (1083 [710-1510] vs. 1563 [1298-1970] WU, p = 0.04). No periprocedural complications or hemodynamic instability have occurred during continuous thermodilution assessment during the index coronary angiography. CONCLUSION In patients admitted for MINOCA undergoing immediate coronary angiography, continuous thermodilution assessment and MRR are feasible and safe in the acute setting, and evidence of functional CMD could be observed in one-third of the MINOCA patients.
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Affiliation(s)
- Jesse P A Demandt
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Annemiek de Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Rob Eerdekens
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Guus Brueren
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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27
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Mason F, Pandey AC, Gadaleta M, Topol EJ, Muse ED, Quer G. AI-enhanced reconstruction of the 12-lead electrocardiogram via 3-leads with accurate clinical assessment. NPJ Digit Med 2024; 7:201. [PMID: 39090394 PMCID: PMC11294561 DOI: 10.1038/s41746-024-01193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
The 12-lead electrocardiogram (ECG) is an integral component to the diagnosis of a multitude of cardiovascular conditions. It is performed using a complex set of skin surface electrodes, limiting its use outside traditional clinical settings. We developed an artificial intelligence algorithm, trained over 600,000 clinically acquired ECGs, to explore whether fewer leads as input are sufficient to reconstruct a 12-lead ECG. Two limb leads (I and II) and one precordial lead (V3) were required to generate a reconstructed 12-lead ECG highly correlated with the original ECG. An automatic algorithm for detection of ECG features consistent with acute myocardial infarction (MI) performed similarly for original and reconstructed ECGs (AUC = 0.95). When interpreted by cardiologists, reconstructed ECGs achieved an accuracy of 81.4 ± 5.0% in identifying ECG features of ST-segment elevation MI, comparable with the original 12-lead ECGs (accuracy 84.6 ± 4.6%). These results will impact development efforts to innovate ECG acquisition methods with simplified tools in non-specialized settings.
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Affiliation(s)
- Federico Mason
- Scripps Research Translational Institute, La Jolla, 92037, CA, USA
- Department of Information Engineering, University of Padova, Padova, 35131, Italy
| | - Amitabh C Pandey
- Scripps Research Translational Institute, La Jolla, 92037, CA, USA
- Scripps Clinic, La Jolla, 92037, CA, USA
- Tulane University School of Medicine, New Orleans, 70122, LA, USA
| | - Matteo Gadaleta
- Scripps Research Translational Institute, La Jolla, 92037, CA, USA
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, 92037, CA, USA
- Scripps Clinic, La Jolla, 92037, CA, USA
| | - Evan D Muse
- Scripps Research Translational Institute, La Jolla, 92037, CA, USA.
- Scripps Clinic, La Jolla, 92037, CA, USA.
| | - Giorgio Quer
- Scripps Research Translational Institute, La Jolla, 92037, CA, USA.
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Wenger NK. What US Cardiology Can Learn From the 2023 ESC Guidelines for the Management of Acute Coronary Syndromes. Clin Cardiol 2024; 47:e24329. [PMID: 39129714 PMCID: PMC11317809 DOI: 10.1002/clc.24329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024] Open
Affiliation(s)
- Nanette K. Wenger
- Consultant, Emory Heart and Vascular Center, Founding Consultant, Emory Women's Heart CenterEmory University School of MedicineAtlantaGeorgiaUSA
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29
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Sabouret P, Barbato E, Montalescot G, Biondi-Zoccai G, Manzo-Silberman S. Remembering our friend Jean-Philippe Collet: a giant in cardiology, a gentleman in life. Minerva Cardiol Angiol 2024; 72:329-331. [PMID: 38535986 DOI: 10.23736/s2724-5683.24.06559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
- Pierre Sabouret
- Heart Institute and Action Group, Pitié-Salpétrière Hospital, Sorbonne University, Paris, France
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Gilles Montalescot
- ACTION Group, Sorbonne University, Institute of Cardiology (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy
| | - Stéphane Manzo-Silberman
- Heart Institute and Action Group, Pitié-Salpétrière Hospital, Sorbonne University, Paris, France
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30
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Akyuz S, Calik AN, Onuk T, Yaylak B, Kolak Z, Eren S, Mollaalioglu F, Durak F, Cetin M, Tanboga IH. The predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock. Herz 2024; 49:302-308. [PMID: 38172314 DOI: 10.1007/s00059-023-05231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/25/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS. METHODS The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno's C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R2] and likelihood ratio χ2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death. RESULTS All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59-3.68], R2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased. CONCLUSION The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.
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Affiliation(s)
- Sukru Akyuz
- Department of Cardiology, Faculty of Medicine, Okan University, Acibadem Mahallesi, Elysium Elit Kosuyolu A Blok D.1, Kadikoy, Istanbul, Turkey.
| | - Ali Nazmi Calik
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tolga Onuk
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Baris Yaylak
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Kolak
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Feyza Mollaalioglu
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Furkan Durak
- Department of Cardiology, Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Ibrahim Halil Tanboga
- Department of Biostatistics, Nisantasi University Medical School, Istanbul, Turkey
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
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31
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Chaturvedi A, Haberman D, Waksman R, Bernardo NL. Percutaneous intervention of a giant native coronary artery aneurysm using self-expanding stents. Catheter Cardiovasc Interv 2024; 104:247-251. [PMID: 38860616 DOI: 10.1002/ccd.31112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/30/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
In the absence of standardized management guidelines, coronary artery aneurysms (CAAs) present therapeutic challenges. Percutaneous coronary intervention (PCI) is rarely explored, especially in giant aneurysms with persistent angina, where surgery might be presumed as a preferred option. We describe the technical aspects and feasibility of PCI using Gore Viabahn expanded polytetrafluoroethylene (ePTFE)-covered nitinol self-expanding stents in a 66-year-old woman with a complex medical history and an enlarging, symptomatic right coronary artery aneurysm. The case was complicated by endoleak after the first stent, but intravascular ultrasound guidance enabled the precise deployment of additional stents, resulting in the successful exclusion of the aneurysm. This case demonstrates steps to successful CAA PCI with Gore Viabahn ePTFE-covered nitinol self-expanding stents and emphasizes that in unsuitable surgical candidates, PCI might be a potential alternative for symptomatic CAAs.
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Affiliation(s)
- Abhishek Chaturvedi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Dan Haberman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Mital P, Forrester J, Abecassis S, Haverty J, Arata X, Gorlin M, Perera T. Delta troponin does not distinguish acute coronary syndrome in emergency department patients with renal impairment and an initial positive troponin. J Am Coll Emerg Physicians Open 2024; 5:e13228. [PMID: 38975017 PMCID: PMC11224499 DOI: 10.1002/emp2.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 05/01/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background In emergency department (ED) patients with renal impairment, troponin concentrations can be positive without myocardial ischemia. When there is clinical concern for acute coronary syndrome (ACS), guidelines recommend obtaining a delta troponin measurement to identify acute myocardial injury. However, evidence supporting the use of delta troponin to rule in or out ACS in patients with renal impairment and initial elevated troponin levels is limited. Methods This retrospective, observational study assessed the diagnostic value of a 20% delta troponin cutoff in the prediction of ACS events in ED patients (estimated glomerular filtration rate [eGFR] <60 mL/min/1.72 m2) with renal impairment, clinical concern for ACS, and an initial positive troponin concentration using either conventional troponin (cTnT) or high-sensitivity troponin (hsTnT). Clinical concern for ACS was based on initial ED physician-reported diagnoses. Patients with an initial diagnosis of ST-elevation myocardial infarction were not included. A positive initial troponin was identified at a threshold of ≥0.06 ng/mL for cTnT and ≥52 ng/L for hsTnT, and delta troponin measurements were obtained within 24 h of the initial troponin. The primary composite outcome, termed ACS event, included (1) cardiac-related mortality, (2) coronary revascularization (or its recommendation), or a (3) clinically diagnosed type-1 myocardial infarction within 6 weeks of the ED presentation. Sensitivities, specificities, negative predictive values, positive predictive values, and negative and positive likelihood ratios were calculated for these 6-week ACS events. Results A total of 608 ED patients with renal impairment, an initial positive troponin, and clinical concern for ACS were included in the study. Of these patients, 234 had an initial positive cTnT (median eGFR 18 mL/min/1.72 m2) and 374 had an initial positive hsTnT (median eGFR 25 mL/min/1.72 m2). The overall ACS event rate was 38% in the cTnT group and 33% in the hsTnT group. In those with a negative delta, the 6-week ACS event rate was 32% when using cTnT, compared to 24% using hsTnT. Conversely, a positive delta was associated with an ACS event rate of 47% when cTnT was utilized versus 61% when hsTnT was utilized. Conclusion In this study, approximately one-third of ED patients with renal impairment who had an initial positive troponin and clinical concern for ACS developed ACS events at 6 weeks. A delta troponin did not appear to provide clinically meaningful assistance in the prediction or exclusion of 6-week ACS events in this cohort.
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Affiliation(s)
- Praveen Mital
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
| | - John Forrester
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
| | - Samuel Abecassis
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
| | - John Haverty
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
| | - Ximena Arata
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
| | - Margaret Gorlin
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
| | - Thomas Perera
- Department of Emergency MedicineNorth Shore University HospitalNorthwell HealthManhassetNew YorkUSA
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33
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Kemp BJ, Thompson DR, Coates V, Bond S, Ski CF, Monaghan M, McGuigan K. International guideline comparison of lifestyle management for acute coronary syndrome and type 2 diabetes mellitus: A rapid review. Health Policy 2024; 146:105116. [PMID: 38943831 DOI: 10.1016/j.healthpol.2024.105116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/07/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.
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Affiliation(s)
- Bridie J Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Vivien Coates
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Sarah Bond
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; Australian Centre for Heart Health, Deakin University, Melbourne, Australia
| | | | - Karen McGuigan
- Queen's Communities and Place, Queen's University Belfast, Belfast, UK.
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34
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Triska J, Maitra N, Deshotels MR, Haddadin F, Angiolillo DJ, Vilahur G, Jneid H, Atar D, Birnbaum Y. A Comprehensive Review of the Pleiotropic Effects of Ticagrelor. Cardiovasc Drugs Ther 2024; 38:775-797. [PMID: 36001200 DOI: 10.1007/s10557-022-07373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
AIMS This review summarizes the findings of preclinical studies evaluating the pleiotropic effects of ticagrelor. These include attenuation of ischemia-reperfusion injury (IRI), inflammation, adverse cardiac remodeling, and atherosclerosis. In doing so, it aims to provide novel insights into ticagrelor's mechanisms and benefits over other P2Y12 inhibitors. It also generates viable hypotheses for the results of seminal clinical trials assessing ticagrelor use in acute and chronic coronary syndromes. METHODS AND RESULTS A comprehensive review of the preclinical literature demonstrates that ticagrelor protects against IRI in the setting of both an acute myocardial infarction (MI), and when MI occurs while on chronic treatment. Maintenance therapy with ticagrelor also likely mitigates adverse inflammation, cardiac remodeling, and atherosclerosis, while improving stem cell recruitment. These effects are probably mediated by ticagrelor's ability to increase local interstitial adenosine levels which activate downstream cardio-protective molecules. Attenuation and augmentation of these pleiotropic effects by high-dose aspirin and caffeine, and statins respectively may help explain variable outcomes in PLATO and subsequent randomized controlled trials (RCTs). CONCLUSION Most RCTs and meta-analyses have not evaluated the pleiotropic effects of ticagrelor. We need further studies comparing cardiovascular outcomes in patients treated with ticagrelor versus other P2Y12 inhibitors that are mindful of the unique pleiotropic advantages afforded by ticagrelor, as well as possible interactions with other therapies (e.g., aspirin, statins, caffeine).
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Affiliation(s)
- Jeffrey Triska
- The Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Neil Maitra
- The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Faris Haddadin
- The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Gemma Vilahur
- Cardiovascular Program, Research Institute Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain
- CiberCV, Institute Carlos III, Madrid, Spain
| | - Hani Jneid
- Department of Medicine, Section of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Dan Atar
- The Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Yochai Birnbaum
- The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
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35
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Zhang Y, Feng Y, Sun J, Zhang L, Ding Z, Wang L, Zhao K, Pan Z, Li Q, Guo N, Xie X. Fully automated artificial intelligence-based coronary CT angiography image processing: efficiency, diagnostic capability, and risk stratification. Eur Radiol 2024; 34:4909-4919. [PMID: 38193925 DOI: 10.1007/s00330-023-10494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/10/2023] [Accepted: 10/16/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To prospectively investigate whether fully automated artificial intelligence (FAAI)-based coronary CT angiography (CCTA) image processing is non-inferior to semi-automated mode in efficiency, diagnostic ability, and risk stratification of coronary artery disease (CAD). MATERIALS AND METHODS Adults with indications for CCTA were prospectively and consecutively enrolled at two hospitals and randomly assigned to either FAAI-based or semi-automated image processing using equipment workstations. Outcome measures were workflow efficiency, diagnostic accuracy for obstructive CAD (≥ 50% stenosis), and cardiovascular events at 2-year follow-up. The endpoints included major adverse cardiovascular events, hospitalization for unstable angina, and recurrence of cardiac symptoms. The non-inferiority margin was 3 percentage difference in diagnostic accuracy and C-index. RESULTS In total, 1801 subjects (62.7 ± 11.1 years) were included, of whom 893 and 908 were assigned to the FAAI-based and semi-automated modes, respectively. Image processing times were 121.0 ± 18.6 and 433.5 ± 68.4 s, respectively (p <0.001). Scan-to-report release times were 6.4 ± 2.7 and 10.5 ± 3.8 h, respectively (p < 0.001). Of all subjects, 152 and 159 in the FAAI-based and semi-automated modes, respectively, subsequently underwent invasive coronary angiography. The diagnostic accuracies for obstructive CAD were 94.7% (89.9-97.7%) and 94.3% (89.5-97.4%), respectively (difference 0.4%). Of all subjects, 779 and 784 in the FAAI-based and semi-automated modes were followed for 589 ± 182 days, respectively, and the C-statistic for cardiovascular events were 0.75 (0.67 to 0.83) and 0.74 (0.66 to 0.82) (difference 1%). CONCLUSIONS FAAI-based CCTA image processing significantly improves workflow efficiency than semi-automated mode, and is non-inferior in diagnosing obstructive CAD and risk stratification for cardiovascular events. CLINICAL RELEVANCE STATEMENT Conventional coronary CT angiography image processing is semi-automated. This observation shows that fully automated artificial intelligence-based image processing greatly improves efficiency, and maintains high diagnostic accuracy and the effectiveness in stratifying patients for cardiovascular events. KEY POINTS • Coronary CT angiography (CCTA) relies heavily on high-quality and fast image processing. • Full-automation CCTA image processing is clinically non-inferior to the semi-automated mode. • Full automation can facilitate the application of CCTA in early detection of coronary artery disease.
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Affiliation(s)
- Yaping Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Yan Feng
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Jianqing Sun
- Shukun (Beijing) Technology Co, Ltd, Jinhui Bd, Qiyang Rd, Beijing, 100102, China
| | - Lu Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Zhenhong Ding
- Shukun (Beijing) Technology Co, Ltd, Jinhui Bd, Qiyang Rd, Beijing, 100102, China
| | - Lingyun Wang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Keke Zhao
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Zhijie Pan
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Qingyao Li
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
- Radiology Department, Shanghai General Hospital, University of Shanghai for Science and Technology, Haining Rd.100, Shanghai, 200080, China
| | - Ning Guo
- Shukun (Beijing) Technology Co, Ltd, Jinhui Bd, Qiyang Rd, Beijing, 100102, China
| | - Xueqian Xie
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China.
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36
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Özkan C, Karayiğit O. Relationship Between High Sensitivity C-reactive Protein to Albumin Ratio With Infarct-related Artery Patency in Patients With Non-ST-segment Elevation Myocardial Infarction. Angiology 2024; 75:682-688. [PMID: 37236654 DOI: 10.1177/00033197231176983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The C-reactive protein/albumin ratio (CAR) has recently emerged as a marker for poor prognosis or mortality in various patient groups. This study aimed to examine the relationship between serum CAR and infarct-related artery (IRA) patency in 700 consecutive non-ST-segment elevation myocardial infarction (NSTEMI) patients prior to percutaneous coronary intervention. The study population was separated into 2 different groups according to preprocedural IRA patency as assessed by the degree of Thrombolysis in Myocardial Infarction (TIMI) flow. As a result, occluded IRA was defined as TIMI grade 0-1, while patent IRA was defined as TIMI grade 2-3. High CAR (Odds Ratio: 3.153 (1.249-8.022); P < .001) was found to be an independent predictor of occluded IRA. Additionally, CAR was positively correlated with the SYNTAX score, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio; CAR was negatively correlated with left ventricular ejection fraction. The highest cut-off value of CAR predicting occluded IRA was found to be .18 with 68.3% sensitivity and 67.9% specificity. The area under the curve for CAR was .744 (95% CI: .706-.781) after the receiver-operating characteristic curve assessment.
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Affiliation(s)
- Can Özkan
- Bursa City Hospital, Department of Cardiology, Bursa, Turkey
| | - Orhan Karayiğit
- Yozgat State Hospital, Department of Cardiology, Yozgat, Turkey
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37
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Becker L, Alonso A, Kruska M, Baumann S, Grassl N, Lesch H, Eisele P, Sieburg T, Behnes M, Schupp T, Kayed H, Platten M, Duerschmied D, Szabo K, Akin I, Fastner C. [Acute ischemic stroke and troponin elevation: update of the Mannheim clinical algorithm]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:830-839. [PMID: 38831047 PMCID: PMC11269393 DOI: 10.1007/s00108-024-01719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 06/05/2024]
Abstract
Elevated high-sensitivity cardiac troponin (hs-cTn) levels should be expected in about half of all patients with acute ischemic stroke (AIS). Since those patients are at risk of increased morbidity and mortality, often attributable to cardiac causes, an adequate work-up of the underlying etiology is required. This can only be achieved by a team of cardiologists and neurologists. Since underlying causes of hs-cTn elevation in AIS patients are diverse, often atypical or silent in their clinical presentation and some, such as an accompanying myocardial infarction, can be acutely life-threatening, the work-up should follow a standardized clinical algorithm. The vast majority of hs-cTn elevations are caused by non-ischemic myocardial injury associated with AIS. This work presents a practice-oriented approach to differential diagnosis with the update of the Mannheim clinical algorithm for acute ischemic stroke and troponin elevation.
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Affiliation(s)
- Louisa Becker
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Angelika Alonso
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Mathieu Kruska
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Stefan Baumann
- Innere Medizin II, Abteilung für Kardiologie, Kreiskrankenhaus Bergstraße, Heppenheim, Deutschland
| | - Niklas Grassl
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Hendrik Lesch
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Philipp Eisele
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Tina Sieburg
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Michael Behnes
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Tobias Schupp
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Hany Kayed
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Michael Platten
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Daniel Duerschmied
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Kristina Szabo
- Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Christian Fastner
- I. Medizinische Klinik, Schwerpunkte: Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, European Center for AngioScience (ECAS) und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Anguita-Gámez M, Vivas D, Ferrandis R, Esteve-Pastor MA, Marín F, Anguita Sánchez M. Periprocedural use of antithrombotic therapy in interventional cardiology in Spain: are we doing better than other specialties? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:701-703. [PMID: 38580142 DOI: 10.1016/j.rec.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 04/07/2024]
Affiliation(s)
| | - David Vivas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Raquel Ferrandis
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Asunción Esteve-Pastor
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco Marín
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Anguita Sánchez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Gestión Clínica (UGC) de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides para la Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain.
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García-Delgado M, Rodríguez-García R, Ochagavía A, Rodríguez-Esteban MDLÁ. The medical treatment of cardiogenic shock. Med Intensiva 2024; 48:477-486. [PMID: 38834498 DOI: 10.1016/j.medine.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 06/06/2024]
Abstract
Cardiogenic shock is characterized by tissue hypoperfusion due to the inadequate cardiac output to maintain the tissue oxygen demand. Despite some advances in cardiogenic shock management, extremely high mortality is still associated with this clinical syndrome. Its management is based on the immediate stabilization of hemodynamic parameters through medical care and the use of mechanical circulatory supports in specialized centers. This review aims to understand the cardiogenic shock current medical treatment, consisting mainly of inotropic drugs, vasopressors and coronary revascularization. In addition, we highlight the relevance of applying measures to other organ levels based on the optimization of mechanical ventilation and the appropriate initiation of renal replacement therapy.
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Affiliation(s)
- Manuel García-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain.
| | - Ana Ochagavía
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Fu B, Zeng Y, Wang M, Zhao L, Sun L, Wang T, Dong J, Yang W, Hua W. The triglyceride-glucose index is a predictor of major adverse cardiovascular events in patients with coronary artery disease and psoriasis: a retrospective cohort study. Diabetol Metab Syndr 2024; 16:184. [PMID: 39085887 PMCID: PMC11290256 DOI: 10.1186/s13098-024-01423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The association between the triglyceride-glucose (TyG) index and clinical outcomes in patients with both coronary artery disease (CAD) and psoriasis is unclear. This study investigated the association between the TyG index and major adverse cardiovascular events (MACE) in patients with both CAD and psoriasis. METHODS This retrospective cohort study included patients diagnosed with both CAD and psoriasis who underwent coronary angiography at the Fuwai Hospital, Beijing, China, between January 2017 and May 2022. The study endpoint was the occurrence of MACE or end of follow-up time. Multivariate Cox proportional analysis and restricted cubic splines (RCS) were used to determine the association between the TyG index and MACE. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold value of the TyG index for predicting MACE. RESULTS This study enrolled 293 patients with both CAD and psoriasis, including 258 (88.1%) males with a mean age of 58.89 ± 9.61 years. Patients were divided into four groups based on the TyG quartiles: Q1 (N = 74), Q2 (N = 73), Q3 (N = 73), and Q4 (N = 73). After adjusting for the potential confounders, the TyG index was independently associated with MACE, both as a continuous variable (HR = 1.53, 95% CI = 1.03-2.28, P = 0.035) and as a categorical variable (Q1: reference; Q2: HR = 1.85, 95% CI = 0.88-3.87, P = 0.105; Q3: HR = 2.39, 95% CI = 1.14-5.00, P = 0.021; Q4: HR = 2.19, 95% CI = 1.001-4.81, P = 0.0497; P for trend = 0.039). RCS analysis showed an linear association between the TyG index and MACE (P-overall = 0.027, P-non-linear = 0.589). ROC curve analysis showed that the TyG index of ≥ 8.73 was the optimal threshold value (area under the ROC curve = 0.60, 95% CI 0.53-0.67). TyG index ≥ 8.73 was significantly associated with MACE (HR = 2.10, 95% CI = 1.32-3.34, P = 0.002). After adjustment for confounders, the TyG index showed independent association with MACE (HR = 2.00, 95% CI = 1.17-3.42, P = 0.011). CONCLUSIONS The TyG index showed a positive linear correlation with MACE in patients with both CAD and psoriasis. The TyG index of ≥ 8.73 might be the optimal threshold for predicting MACE.
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Affiliation(s)
- Bingqi Fu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Yan Zeng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Man Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Lin Zhao
- Department of Integrative Medicine Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lin Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Tianjie Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Junle Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China.
| | - Wei Hua
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Beijing, 100037, China.
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Hosseini K, Soleimani H, Maleki S, Nasrollahizadeh A, Tayebi S, Nelson J, Heffron SP. Early administration of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in patients with acute coronary syndrome: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:395. [PMID: 39080549 PMCID: PMC11287928 DOI: 10.1186/s12872-024-04057-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/16/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND High-intensity statin therapy is currently recommended initial guideline therapy in ACS treatment. However, only a minority of patients are achieving LDL-C attainment goal at 6 months. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are on recommended guideline therapy post-ACS if LDL-C goal attainment is not achieved after high-intensity statin (4-6 weeks) and after the addition of ezetimibe if guideline goal attainment is not achieved after an additional 4-6 weeks. Thus, it has been recommended that PCSK9 inhibitors be considered earlier post-ACS. However, the efficacy of early PCSK9 inhibitors initiation in ACS patients remains uncertain. METHODS This systematic review and meta-analysis was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies involving ACS patients who received PCSK9 inhibitors within 48 h of hospitalization were included. Common and random effects models were used to evaluate the pooled effect of early PCSK9 inhibitor administration. Nine RCTs and three cohort studies were included. RESULTS Early PCSK9 inhibitor administration reduced the incidence of MI, ACS hospitalization, and revascularization at 6-18 months post-ACS. Although there was a drift towards reduced stroke, all-cause mortality, and cardiovascular death, no statistically significant reduction was observed. Additionally, PCSK9 inhibitors significantly enhanced lipid control at 4-12 weeks after index hospitalization. CONCLUSION Early PCSK9 inhibitors initiation in ACS patients reduces MACE and improves lipid profiles. While the results propose promising benefits in terms of stroke and mortality, further research with longer follow-up is required for more decisive evidence.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, 1411713139, Iran.
| | - Saba Maleki
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- School of Medicine, Guilan University of Medical Sciences (GUMS), Rasht, Guilan Province, Iran
| | - Amir Nasrollahizadeh
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Sima Tayebi
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, SE, Sweden
| | - John Nelson
- California Cardiovascular Institute, Fresno, CA, USA
| | - Sean P Heffron
- Center for the Prevention of Cardiovascular Disease, Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, USA
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Tan MC, Dinh D, Gayed D, Liang D, Brennan A, Duffy SJ, Clark D, Ajani A, Oqueli E, Roberts L, Reid C, Freeman M, Chandrasekhar J. Associations between Dual Anti-Platelet Therapy score and long-term mortality after percutaneous coronary intervention: Analysis of >27,000 patients. Can J Cardiol 2024:S0828-282X(24)00582-8. [PMID: 39084254 DOI: 10.1016/j.cjca.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/12/2024] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The dual antiplatelet therapy (DAPT) score was developed to identify patients undergoing percutaneous coronary intervention (PCI) who are likely to derive benefit (score ≥2) or harm (score <2) from extended DAPT beyond 1-year post-PCI with respect to ischaemic and bleeding outcomes. We examined the associations between DAPT score at index PCI and long-term mortality from an all-comers PCI registry in patients receiving DAPT as per the standard of care. METHODS We retrospectively examined prospectively collected data from the Melbourne Interventional Group PCI database (2005- 2018) and grouped patients as having DAPT score ≥2 or <2. Long-term mortality was assessed from the Australian National Death Index linkage. The primary endpoint was long-term mortality using survival analysis. Secondary endpoints included in-hospital events and 30-day major adverse cardiac events (MACE), a composite of death, myocardial infarction, or target vessel revascularization. RESULTS Of 27,740 study patients, 9,402 (33.9%) had DAPT score ≥2. Patients with DAPT score ≥2 were younger and included more females with higher prevalence of cardiovascular risk factors. Patients with DAPT score ≥2 had higher in-hospital mortality (3.0% vs. 1.0%) and major bleeding (2.3% vs. 1.6%), 30-day MACE (7.1% vs. 3.1%), and long-term mortality at a median follow-up of 5.17 years (21.9% vs. 16.5%), p<0.001 for all. CONCLUSION A third of all-comer patients undergoing PCI had a DAPT score ≥2 with greater short-term ischaemic and bleeding risk, and higher long-term mortality. Risk assessment using the DAPT score may guide the duration and intensity of DAPT beyond the early post-PCI period.
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Affiliation(s)
- Mae Chyi Tan
- Department of Cardiology, Eastern Health, Box Hill, VIC, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Daniel Gayed
- Department of Cardiology, Eastern Health, Box Hill, VIC, Australia
| | - Danlu Liang
- Department of Cardiology, Eastern Health, Box Hill, VIC, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | | | - David Clark
- University of Melbourne, Melbourne, VIC, Australia; Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
| | - Andrew Ajani
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Grampians Health Ballarat, Ballarat, VIC, Australia
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Box Hill, VIC, Australia; Eastern Health Clinical School, Monash University, Clayton, VIC, Australia
| | - Christopher Reid
- University of Melbourne, Melbourne, VIC, Australia; Curtin University, Perth, WA, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Box Hill, VIC, Australia
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern Health, Box Hill, VIC, Australia; Eastern Health Clinical School, Monash University, Clayton, VIC, Australia.
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Matetic A, Kuchtaruk A, Siudak Z, Ullah W, Elbadawi A, Elgendy IY, Zaman S, Bang V, Rao S, Bagur R, Mamas MA. 30-Day unplanned readmission rates, causes and outcomes of patients hospitalized for acute coronary syndrome based on the trial participation status. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00607-9. [PMID: 39095290 DOI: 10.1016/j.carrev.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND This study aimed to investigate the association between index trial participation status and 30-day unplanned readmission rates, causes, and outcomes in acute coronary syndrome (ACS) patients. METHODS The National Readmission Database was analysed for all index hospitalizations with a principal diagnosis of ACS between October 2015 to November 2019, stratified by index trial participation status (International Classification of Diseases - 10th edition code: Z00.6). The 30-day unplanned readmission rates, causes and outcomes were analysed, including the assessment of factors associated with readmission. Multivariable regression analyses were reported as adjusted odds ratios (aOR) with 95 % confidence intervals (95 % CI). All analyses were weighted and utilized hierarchical multi-level organization. RESULTS A total of 2,066,328 cases with a principal diagnosis of ACS were included in the study, of which there were 4061 trial participants (0.2 %) and 189,240 (9.2 %) cases experienced unplanned 30-day readmission. Rates of unplanned 30-day readmission were similar between trial participants and non-participants (9.8 % vs. 9.2 %, p = 0.16). Consistently, after multivariable adjustment, there was no significant association between trial participation and unplanned 30-day readmissions (aOR 0.96, 95 % CI 0.86-1.07, p = 0.45). Compared with trial participants, the majority of readmissions in non-participants were related to cardiovascular conditions (55.2 % vs. 46.7 %, p = 0.005, respectively). There was no significant difference in all-cause mortality (5.5 % vs. 4.6 %, p = 0.368, respectively), but trial participants were more likely to develop major bleeding (3.5 % vs. 2.1 %, p = 0.044), ischemic stroke (4.0 % vs. 2.1 %, p = 0.008) and haemorrhagic stroke (2.0 % vs. 0.6 %, p < 0.001) at readmissions. CONCLUSION Overall rates of unplanned 30-day readmissions after ACS are similar between trial participants and non-participants, but non-participation in trials was associated with a higher likelihood of cardiovascular readmission.
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Affiliation(s)
- Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom
| | - Adrian Kuchtaruk
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, United States of America
| | - Sarah Zaman
- Westmead Applied Research Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Vijay Bang
- Lilavati Hospital and Research Center, Mumbai, India
| | - Sarita Rao
- Department of Cardiology, Apollo Hospitals, Indore, India
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom; National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, United Kingdom.
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Neppala S, Chigurupati HD, Chauhan S, Chinthapalli MT, Desai R. Impact of depression on in-hospital outcomes for adults with type 2 myocardial infarction: A United States population-based analysis. World J Cardiol 2024; 16:412-421. [PMID: 39086894 PMCID: PMC11287453 DOI: 10.4330/wjc.v16.i7.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/30/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. However, though there is a rising prevalence of depression and its potential association with type 1 myocardial infarction (T1MI), data remains non-existent to evaluate the association with T2MI. AIM To identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes. METHODS We queried the National Inpatient Sample (2019) to identify T2MI hospitalizations using Internal Classification of Diseases-10 codes in hospitalized adults (≥ 18 years). In addition, we compared sociodemographic and comorbidities in the T2MI cohort with vs without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with vs without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke), adjusting for confounders. Statistical significance was achieved with a P value of < 0.05. RESULTS There were 331145 adult T2MI hospitalizations after excluding T1MI (median age: 73 years, 52.8% male, 69.9% white); 41405 (12.5%) had depression, the remainder; 289740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression vs without [adjusted odds ratio (aOR) = 0.88, 95% confidence interval (CI): 0.86-0.90, P = 0.001]. There was the equal prevalence of prior MI with any revascularization and a similar prevalence of peripheral vascular disease in the cohorts with depression vs without depression. There is a greater prevalence of stroke in patients with depression (10.1%) vs those without (8.6%). There was a slightly higher prevalence of hyperlipidemia in patients with depression vs without depression (56.5% vs 48.9%), as well as obesity (21.3% vs 17.9%). There was generally equal prevalence of hypertension and type 2 diabetes mellitus in both cohorts. There was no significant difference in elective and non-elective admissions frequency between cohorts. Patients with depression vs without depression also showed a lower risk of all-cause mortality (aOR = 0.75, 95%CI: 0.67-0.83, P = 0.001), cardiogenic shock (aOR = 0.65, 95%CI: 0.56-0.76, P = 0.001), cardiac arrest (aOR = 0.77, 95%CI: 0.67-0.89, P = 0.001) as well as stroke (aOR = 0.79, 95%CI: 0.70-0.89, P = 0.001). CONCLUSION This study revealed a significantly lower risk of T2MI in patients with depression compared to patients without depression by decreasing adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest, and stroke in patients with depression.
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Affiliation(s)
- Sivaram Neppala
- Department of Internal Medicine, University of Texas at San Antonio, San Antonio, TX 78249, United States
| | - Himaja Dutt Chigurupati
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ 07102, United States
| | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States.
| | | | - Rupak Desai
- Independent Researcher, Atlanta, GA 30079, United States
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Billig H, Al Zaidi M, Quacken F, Görtzen-Patin J, Goody PR, Gräff I, Nickenig G, Zimmer S, Aksoy A. Blood glucose and lactate levels as early predictive markers in patients presenting with cardiogenic shock: A retrospective cohort study. PLoS One 2024; 19:e0306107. [PMID: 39052641 PMCID: PMC11271948 DOI: 10.1371/journal.pone.0306107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/11/2024] [Indexed: 07/27/2024] Open
Abstract
Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.
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Affiliation(s)
- Hannah Billig
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | | | - Florian Quacken
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | | | | | - Ingo Gräff
- Department of clinical acute- and emergency medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Department of Cardiology—University Hospital Bonn, Bonn, Germany
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Peng D, Wang A, Shi W, Lin L. Pentacyclic triterpenes, potential novel therapeutic approaches for cardiovascular diseases. Arch Pharm Res 2024:10.1007/s12272-024-01510-4. [PMID: 39048758 DOI: 10.1007/s12272-024-01510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
Cardiovascular diseases (CVDs) involve dysfunction of the heart and blood vessels and have become major health concerns worldwide. Multiple mechanisms may be involved in the occurrence and development of CVDs. Although therapies for CVDs are constantly being developed and applied, the incidence and mortality of CVDs remain high. The roles of natural compounds in CVD treatment are being explored, providing new approaches for the treatment of CVD. Pentacyclic triterpenes are natural compounds with a basic nucleus of 30 carbon atoms, and they have been widely studied for their potential applications in the treatment of CVDs, to which various pharmacological activities contribute, including anti-inflammatory, antioxidant, and antitumor effects. This review introduces the roles of triterpenoids in the prevention and treatment of CVDs, summarizes their potential underlying mechanisms, and provides a comprehensive overview of the therapeutic potential of triterpenoids in the management of CVDs.
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Affiliation(s)
- Dewei Peng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Aizan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Wei Shi
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
| | - Li Lin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
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Zeymer U, Goss F, Kunadt M, Oldenburg S, Hochadel M, Thiele H, Werdan K. Patient knowledge about risk factors, achievement of target values, and guideline-adherent secondary prevention therapies 12 months after acute myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:537-545. [PMID: 38768234 DOI: 10.1093/ehjacc/zuae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/22/2024]
Abstract
AIMS The prospective GULLIVE-R study aimed to evaluate adherence to guideline-recommended secondary prevention, physicians' and patients' estimation of cardiac risk, and patients' knowledge about target values of risk factors after acute myocardial infarction (AMI). METHODS AND RESULTS We performed a prospective study enrolling patients 9-12 months after AMI. Guideline-recommended secondary prevention therapies and physicians as well as patients' estimation about their risk and patients' knowledge about target values were prospectively collected. Between July 2019 and June 2021, a total of 2509 outpatients were enrolled in 150 German centres 10 months after AMI. The mean age was 66 years, 26.4% were women, 45.3% had ST elevation myocardial infarction, 54.7% had non-ST elevation myocardial infarction, and 93.6% had revascularization (84.0% percutaneous coronary intervention, 7.4% coronary artery bypass graft, 1.8% both). Guideline-recommended secondary drug therapies were prescribed in over 80% of patients, while only about 50% received all five recommended drugs (aspirin, P2Y12 inhibitors, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors), and regular exercise was performed by only one-third. About 90% of patients felt well informed about secondary prevention, but the correct target value for blood pressure was known in only 37.9% and for LDL-cholesterol in only 8.2%. Both physicians and patients underestimated the objective risk of future AMIs as determined by the thormbolysis in myocardial infarction (TIMI) risk score for secondary prevention. CONCLUSION There is still room for improvement in patient education and implementation of guideline-recommended non-pharmacological and pharmacological secondary prevention therapies in patients in the chronic phase after AMI.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Medizinische Klinik B, Bremserstasse 79, 67063 Ludwigshafen, Germany
- Institut für Herzinfarktforschung, Bremserstasse 79, 67063 Ludwigshafen, Germany
- Center for Health Services Research of the German Cardiac Society (DGK-ZfKVF), German Cardiac Society (DGK), Düsseldorf, Germany
| | - Franz Goss
- Center for Health Services Research of the German Cardiac Society (DGK-ZfKVF), German Cardiac Society (DGK), Düsseldorf, Germany
- Herzzentrum Alter Hof, München, Germany
- BNK Service GmbH, München, Germany
| | - Marcel Kunadt
- Institut für Herzinfarktforschung, Bremserstasse 79, 67063 Ludwigshafen, Germany
| | | | - Mathias Hochadel
- Institut für Herzinfarktforschung, Bremserstasse 79, 67063 Ludwigshafen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- German Cardiac Society (DGK), Düsseldorf, Germany
| | - Karl Werdan
- Center for Health Services Research of the German Cardiac Society (DGK-ZfKVF), German Cardiac Society (DGK), Düsseldorf, Germany
- German Cardiac Society (DGK), Düsseldorf, Germany
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
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Hong D, Choi KH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Gwon HC, Yang JH. Clinical significance of residual ischaemia in acute myocardial infarction complicated by cardiogenic shock undergoing venoarterial-extracorporeal membrane oxygenation. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:525-534. [PMID: 38701179 DOI: 10.1093/ehjacc/zuae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
AIMS Although culprit-only revascularization during the index procedure has been recommended in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS), the reduction in residual ischaemia is also emphasized to improve clinical outcomes. However, few data are available about the significance of residual ischaemia in patients undergoing mechanical circulatory supports. This study aimed to evaluate the effects of residual ischaemia on clinical outcomes in patients with AMI undergoing venoarterial-extracorporeal membrane oxygenation (VA-ECMO). METHODS AND RESULTS Patients with AMI with multivessel disease who underwent VA-ECMO due to refractory CS were pooled from the RESCUE and SMC-ECMO registries. The included patients were classified into three groups according to residual ischaemia evaluated using the residual Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score (rSS): rSS = 0, 0 < rSS ≤ 8, and rSS > 8. The primary outcome was 1-year all-cause death. A total of 408 patients were classified into the rSS = 0 (n = 100, 24.5%), 0 < rSS ≤ 8 (n = 136, 33.3%), and rSS > 8 (n = 172, 42.2%) groups. The cumulative incidence of the primary outcome differed significantly according to rSS (33.9 vs. 55.4 vs. 66.1% for rSS = 0, 0 < rSS ≤ 8, and rSS > 8, respectively, overall P < 0.001). In a multivariable model, rSS was independently associated with the risk of 1-year all-cause death (adjusted hazard ratio 1.03, 95% confidence interval 1.01-1.05, P = 0.003). Conversely, the baseline SYNTAX score was not associated with the risk of the primary outcome. Furthermore, when patients were stratified by rSS, the primary outcome did not differ significantly between the high and low delta SYNTAX score groups. CONCLUSION In patients with AMI with refractory CS who underwent VA-ECMO, residual ischaemia was associated with an increased risk of 1-year mortality. Future studies are needed to evaluate the efficacy and safety of revascularization strategies to minimize residual ischaemia in patients with CS supported with VA-ECMO. CLINICAL TRIAL REGISTRATION REtrospective and Prospective Observational Study to Investigate Clinical oUtcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock (RESCUE), NCT02985008.
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Affiliation(s)
- David Hong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Woo Jin Jang
- Department of Cardiology, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Valgimigli M, Landi A, Angiolillo DJ, Baber U, Bhatt DL, Bonaca MP, Capodanno D, Cohen DJ, Gibson CM, James S, Kimura T, Lopes RD, Mehta SR, Montalescot G, Sibbing D, Steg PG, Stone GW, Storey RF, Vranckx P, Windecker S, Mehran R. Demystifying the Contemporary Role of 12-Month Dual Antiplatelet Therapy After Acute Coronary Syndrome. Circulation 2024; 150:317-335. [PMID: 39038086 DOI: 10.1161/circulationaha.124.069012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/26/2024] [Indexed: 07/24/2024]
Abstract
For almost two decades, 12-month dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) has been the only class I recommendation on DAPT in American and European guidelines, which has resulted in 12-month durations of DAPT therapy being the most frequently implemented in ACS patients undergoing percutaneous coronary intervention (PCI) across the globe. Twelve-month DAPT was initially grounded in the results of the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial, which, by design, studied DAPT versus no DAPT rather than the optimal DAPT duration. The average DAPT duration in this study was 9 months, not 12 months. Subsequent ACS studies, which were not designed to assess DAPT duration, rather its composition (aspirin with prasugrel or ticagrelor compared with clopidogrel) were further interpreted as supportive evidence for 12-month DAPT duration. In these studies, the median DAPT duration was 9 or 15 months for ticagrelor and prasugrel, respectively. Several subsequent studies questioned the 12-month regimen and suggested that DAPT duration should either be fewer than 12 months in patients at high bleeding risk or more than 12 months in patients at high ischemic risk who can safely tolerate the treatment. Bleeding, rather than ischemic risk assessment, has emerged as a treatment modifier for maximizing the net clinical benefit of DAPT, due to excessive bleeding and no clear benefit of prolonged treatment regimens in high bleeding risk patients. Multiple DAPT de-escalation treatment strategies, including switching from prasugrel or ticagrelor to clopidogrel, reducing the dose of prasugrel or ticagrelor, and shortening DAPT duration while maintaining monotherapy with ticagrelor, have been consistently shown to reduce bleeding without increasing fatal or nonfatal cardiovascular or cerebral ischemic risks compared with 12-month DAPT. However, 12-month DAPT remains the only class-I DAPT recommendation for patients with ACS despite the lack of prospectively established evidence, leading to unnecessary and potentially harmful overtreatment in many patients. It is time for clinical practice and guideline recommendations to be updated to reflect the totality of the evidence regarding the optimal DAPT duration in ACS.
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V., A.L.)
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland (M.V., A.L.)
- Department of Cardiology, Inselspital (S.W.), University of Bern, Switzerland (M.V.)
| | - Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V., A.L.)
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland (M.V., A.L.)
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.)
| | - Usman Baber
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City (U.B.)
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York (D.L.B.)
| | - Marc P Bonaca
- Colorado Prevention Center Clinical Research, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (M.B.)
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - David J Cohen
- St Francis Hospital, Roslyn, NY (D.J.C.)
- Cardiovascular Research Foundation, New York (D.J.C.)
| | - C Michael Gibson
- Baim Institute for Clinical Research, Harvard Medical School, Harvard University, Boston, MA (C.M.G.)
| | - Stefan James
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden (S.J.)
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Japan (T.K.)
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.D.L.)
| | | | - Gilles Montalescot
- ACTION Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, France (G.M.)
| | - Dirk Sibbing
- Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance; Ludwig-Maximilians University München, Munich, Germany; and Privatklinik Lauterbacher Mühle am Ostsee, Seeshaupt, Germany (D.S.)
| | - P Gabriel Steg
- Paris Cité University, Public Hospitals of Paris (AP-HP), Bichat Hospital, France (P.G.S.)
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S., R.M.)
| | - Robert F Storey
- Cardiovascular Research Unit, Division of Clinical Medicine, University of Sheffield, UK (R.F.S.)
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, and Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.W.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital (S.W.), University of Bern, Switzerland (M.V.)
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S., R.M.)
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50
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Wang YF, Kong XH, Tao HM, Tao L. Triglyceride-Glucose Index as a Predictor of Major Adverse Cardiovascular Events in Post-PCI Patients Diagnosed with In-Stent Restenosis. Diabetes Metab Syndr Obes 2024; 17:2737-2746. [PMID: 39072346 PMCID: PMC11283261 DOI: 10.2147/dmso.s464490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024] Open
Abstract
Background The triglyceride-glucose index (TyG) is a reliable indicator for predicting the prognosis of patients with coronary heart disease (CAD) after percutaneous coronary intervention (PCI). However, its influence on patients with in-stent restenosis (ISR) is unclear. This study was designed to evaluate the association between the TyG index and the occurrence of major adverse cardiovascular events (MACEs) after PCI in patients with ISR. Methods This retrospective study included 1654 patients who underwent PCI between 2016 and 2022 at Nanjing First Hospital. Patients were stratified into three groups based on the quantile level of the TyG index. The TyG index was determined as Ln (triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2). Results Individuals with the highest TyG index showed an increased risk of MACEs compared to those with the lowest level of the TyG index (HR 1.60; 95% CI 1.11-2.30; P = 0.01). When analyzing the TyG index as a continuous variable, each standard deviation increase was associated with an HR of 1.51 (95% CI: 1.11-2.05; P = 0.01). For the male subgroup and the diabetes subgroup, this trend was even more pronounced (HR 1.269; 95% CI 1.055-1.527; P = 0.011; HR 1.385; 95% CI 1.125-1.706; P = 0.002). Additionally, the landmark analysis showed that patients with the highest level of TyG had an increased risk of MACEs 6 months after the PCI (P = 0.019). Conclusion Elevated TyG index is associated with increased risk of adverse cardiovascular events in patients with ISR, and the extent of increase in the risk is more significant in male patients with diabetes.
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Affiliation(s)
- Yi-fei Wang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210000, People’s Republic of China
| | - Xiao-han Kong
- Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210000, People’s Republic of China
| | - Hui-min Tao
- Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210000, People’s Republic of China
| | - Li Tao
- Nanjing Medical University, Nanjing, Jiangsu, 210000, People’s Republic of China
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