Double Antiplatelet Therapy Research Articles

Dual anti-platelet therapy with colchicine after PCI for acute coronary syndrome: A literature review

Colchicine, one of the oldest medications still in use, is a relatively inexpensive and well-tolerated agent with a documented role in a range of inflammatory diseases, such as gout, Behchet’s disease and pericarditis. In recent years, different clinical trials also tested colchicine in the management of cardiovascular conditions and demonstrated favorable results. The aim of this literature review is to evaluate the prospective use of colchicine instead of aspirin as double-antiplatelet therapy (DAPT) after percutaneous coronary interventions in patients with acute coronary syndrome.

Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair

Despite the increasing number of fenestrated/branched endovascular aortic repair (f/bEVAR) procedures, evidence on post-operative antiplatelet therapy is lacking. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after f/bEVAR on 30 day and follow up outcomes. A multicentre retrospective analysis was conducted, including f/bEVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six months. Primary outcomes were 30 day death, and cardiovascular ischaemic and major haemorrhagic events. Secondary outcomes were survival and target vessel (TV) patency during follow up. A total of 1 430 patients were included: 955 under SAPT and 475 under DAPT. The 30 day mortality was similar (SAPT 2.1% vs. DAPT 1.5%; p = .42). Cardiovascular ischaemic events were lower in the DAPT group (SAPT 11.9% vs. DAPT 8.2%; p = .040), with DAPT being an independent protector for acute mesenteric (p = .009) and lower limb ischaemia (p = .020). No difference was found in 30 day major haemorrhagic events (SAPT 7.5% vs. DAPT 6.3%; p = .40). The mean follow up was 21.8 ± 2.9 months. Cox regression showed no cofounders on survival, with similar rates between groups (log rank p = .71). DAPT patients presented higher TV patency (SAPT 93.4%, standard error [SE] 0.7% vs. DAPT 96.6%, SE 0.7%; log rank p = .007) at thirty six months. Cox regression revealed bEVAR as a predictor of worse TV patency (hazard ratio 2.03, 95% confidence interval 1.36 - 3.03; p < .001). DAPT was related to higher patency within bEVAR patients (SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p < .001). DAPT after f/bEVAR was associated with lower risk of cardiovascular ischaemic events and higher TV patency, especially in bEVAR cases. No difference in major haemorrhagic events was observed at 30 days.

Evaluating the Efficacy of Venous versus Arterial Grafts in CABG: A Cross-Sectional Retrospective Study

Background: Angiography of the coronary arteries is the most noninvasive advanced method of establishing graft patency post-coronary artery bypass grafting. The emergence of multi-slice computed tomography has opened a wide avenue for fast imaging around coronary angiography, with a featured scan time of 0.25 seconds, up to 32-slice detection, and multirow detector arrays, which are very important for quick evaluation. Methods and Results: This study was a retrospective cross-sectional case series that involved 56 individual patients who underwent CABG in the Erbil Cardiac Center. Clinical and radiological evaluations were carried out to evaluate arterial and venous grafts' patency, considering the sociocultural pattern of the individual, type of conduits used, and patency in relation to multiple risk factors. The patency of arterial grafts was 84.9%, while that of venous was 61.9%. Features like hypertension, diabetes mellitus, exercise, and dietary restriction were shown to have a significantly associated vessel occlusion with a P-value of less than 0.05%. Conclusion: The results of our study also confirm that arterial grafts have far better patency rates than saphenous vein grafts (SVG) in coronary artery bypass grafts. Contributory factors for graft occlusion are diabetes mellitus, hypertension, double antiplatelet therapy, and smoking habits. There is also suggestive evidence that dietary and exercise modification in the patient orientation program would improve the long-term outcome of patients after CABG.

Clinical features in patients with non-ST-segment elevation myocardial infarction with nonobstructive coronary arteries

Estimation of the rate of non-ST-segment elevation myocardial infarction with non-obstructive coronary arteries (NSTE-MINOCA) and comparative analysis of clinical and management data with non-ST-segment elevation myocardial infarction with obstructive coronary arteries (NSTEMI-CAD). Material and methods: 494 patients diagnosed with NSTEMI were included in the study. The patients were divided into 2 research groups according to the presence of obstruction in the coronary arteries: group I - 35 patients with MINOCA and group II - 459 MI-CAD. Results: The MINOCA rate in the NSTEMI group was 7.08%. The risk factors: smoking, diabetes mellitus and hypertension was higher in the MI-CAD vs. MINOCA group. The concentrations of myocardial necrosis markers was higher in MI-CAD vs MINOCA: troponin - 8.58±0.89 vs 2.8±1.3, CK-MB 20.7±1.78 vs 13.97±2.6 ng/L, p&lt;0.05 and high-sensitivity troponin - 767.4 vs 8248 ng/L, p&lt;0.001. Patients with MINOCA had higher levels of C-reactive protein (CRP (36.62±16.27) vs MI-CAD (22.16±2.39), p&lt;0.05. Regarding the treatment, the study highlighted that patients with MINOCA used less the double antiplatelet therapy (28.6 vs 89.2%), statins (45.7 vs 83.1%) and ACEI/BRA (90.4 vs 57.1%) than MI-CAD patients (p&lt;0.001). Conclusions: The NSTE- MINOCA rate was 7,08%. MINOCA patients have a lower rate of risk factors. In MINOCA there are lower concentrations of myocardial necrosis markers and increased values of inflammatory markers compared to MI-CAD.

Characteristics, management and prognosis of patients with coronary artery disease undergoing coronary intervention and atrial fibrillation

Abstract Funding Acknowledgements None. Introduction The selection of antithrombotic treatment in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF) represents a challenge when trying to balance ischaemic and haemorrhagic risk. However, there is little "real-life" data on the selected antithrombotic treatment and its short and long-term prognosis. Methods A Prospective multicentre study that includes patients with IHD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] and AF admitted to 13 Spanish centres. The objective is to describe the characteristics, antithrombotic treatment and prognosis of patients undergoing PCI and AF. Results 373 patients were included. The average age was 77.6 ± 9.8 years (28% women). Patients had a high ischaemic and haemorrhagic risk [CHA2DS2VASc 4 (2-5) and HASBLED 3 (2-4)], with 25.5% being frail according to the Clinical Frailty Scale. The main reason for admission was ACS (44.8% NSTEMI, 22.2% STEMI and 33% CCS ), and 49.8% of patients had multivessel disease. 70.3% of patients underwent revascularisation, mainly percutaneously (92.2%). Among those percutaneously revascularised, the most used antithrombotic treatment was triple therapy with double antiplatelet therapy (DAPT) + oral anticoagulant (OAC) (62.5%), followed by double therapy with monoantiplatelet therapy + OAC (29.2%). In revascularised patients over 80, the most selected antithrombotic therapy was similar: 60.5% and 28.9%, respectively. The most used OAC was apixaban (42.3%), followed by vitamin K antagonists (17.3%). One-year survival was 88.5%. 2.6% of patients presented an ischemic stroke, and 4.8% suffered a new ACS. At the same time, haemorrhagic events (BARC ≥2) were 8.9%. Conclusions A high ischaemic and haemorrhagic risk co-exists in patients with IHD and AF. In our setting, triple therapy, mainly with the use of DOACs over VKA, is the preferred therapy. The long-term mortality of this subgroup of patients with IHD is high (&amp;gt;10%), with a rate of haemorrhagic events (8.9%) higher than ischaemic events (4.8%).Characteristics of patients

Long-term combined antiplatelet therapy for secondary prevention of noncardioembolic stroke

Introduction. The high risk of recurrent ischemic events after non-cardioembolic ischemic stroke(IS), the prevalence of which is 25% of all strokes in the Russian Federation, determines the need to search for effective and safe secondary prevention strategies.Аim. The study was to evaluate the efficacy and safety of a combination of ADP receptor inhibitors (dipyridamole) with acetylsalicylic acid in patients with ischemic stroke (IS) in the secondary prevention of noncardioembolic stroke.Materials and methods. 229 patients in the early recovery period of noncardioembolic IS (139 women, 90 men), with an average age of 59.0 ± 5.7 years were included in the study. The duration of IS was 54.4 ± 6.1 days. All patients received a multimodal medical rehabilitation (MMR) program. Long-term double antiplatelet therapy with acetylsalicylic acid (ASA) 75 mg per day and dipyridamole at a daily dose of 225 mg divided into 3 doses were prescribed to all the patients. The neurological and neuropsychological status of the patient, quality of life and hemorheological parameters were assessed initially (T0), after MMR (T1, 6 weeks) and 12 months after IS(T2).Results. Motor and coordination indicators of patients as well as the cognitive and emotional parameters were significantly (p &lt; 0,05) improved due to MMR technology. These were confirmed by the dynamics of the corresponding scales. The prescribed double antiplatelet therapy did not cause significant adverse events and worsening of the patients’ well-being both during the MMR process and during the observation period. The combination of ASA with dipyridamole was well tolerated. At the end of the study, recurrent IS, myocardial infarctions, and fatal bleeding were not recorded. In 5.2% patients with severe risks of cardiovascular complications there was occurred TIA. The effectiveness of the dual antiplatelet therapy was confirmed by a decrease in the level of platelet aggregation (p &lt; 0,05).Conclusions. The high effectiveness of secondary prevention of IS with a combination of ASA and dipyridamole with good tolerability and safety in patients after IS has been shown.

Abstract WMP6: Dual Antiplatelet Therapy versus Alteplase in Patients With Minor Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Background: Minor stroke, defined as a National Institutes of Health Stroke Scale (NIHSS), score of less than or equal to 5, accountedfor half of Acute Ischemic Stroke (AIS) patients in 2019 . Given the low impairment on function, there is a debate about which therapy is better for these patients: intravenous alteplase or double antiplatelet therapy (DAPT).Research question: For patients with minor AIS who can be treated within 24 hours after symptom onset, is alteplase associated with better outcomes and a good safety profile? Methods: We systematically searched PubMed, Web of Science, and EMBASE. Outcomes of interest included: Modified Rankin Scale (mRS) 0-1, symptomatic intracranial hemorrhage (sICH) and stroke recurrence. Heterogeneity was examined with I2 statistics, and a random-effects model was used for all of the outcomes due to expected high heterogeneity. Results: We included 1 randomized controlled trial and 3 observational cohorts, comprising 2,224 patients. DAPT was administered to 1,395 (62.7%) patients. DAPT was associated with a significantly lower incidence of sICH (OR 0.21; 95% CI 0.05-0.83; P=0.03; Fig 1A). There was no significant difference between DAPT and alteplase in good clinical outcome (mRS 0-1) at 90 days (OR 1.19; 95% CI 0.67-2.11; P=0.55; Fig 1B) or stroke recurrence (OR 0.87; 95% CI 0.51-1.48; P=0.61; Fig 1C). Conclusion: In this systematic review and meta-analysis comparing alteplase and DAPT in patients with minor non-disabling acute stroke, DAPT was associated with lower risk of sICH and there was nodifference in excellent clinical outcome or stroke recurrence at 90 days.

His bundle pacing in a patient with atrioventricular conduction abnormalities, persistent atrial flutter at high thromboembolic and bleeding risk after hybrid coronary revascularization and left atrial appendage closure - case report

We present a case of a 78-year-old patient with persistent atrial &amp;#64258; utter, history of atrial &amp;#64257; brillation and atrioventricular conduction disturbances, including &amp;#64257; rst-degree atrioventricular block (AVB) and paroxysmal complete AVB. Echocardiography revealed mildly reduced left ventricular ejection fraction (LVEF, 44%). The patient had high thromboembolic risk, had previous ischemic stroke, suffered from chronic coronary artery disease treated with hybrid coronary revascularization (minimally invasive direct coronary artery bypass grafting and subsequent percutaneous coronary intervention) as well as left atrial appendage closure. Because of high bleeding risk, double antiplatelet therapy (acetylsalicylic acid and clopidogrel) combined with low dose of low-molecular-weight heparin after cardiac surgery were introduced. Due to persistent atrial &amp;#64258; utter, complete AVB, lack of intraventricular conduction abnormalities, mildly reduced LVEF and expected high right ventricle pacing burden, the patient was referred for dual-chamber pacemaker implantation using conduction system pacing (CSP), preferentially His bundle pacing (HBP). The procedure was performed with good outcome and CSP was utilized via HBP. After reassessment of thromboembolic and bleeding risk, the patient was discharged home on reduced dose of dabigatran. Short-term follow-up showed stable HBP parameters along with no additional symptoms. Despite good short-term outcomes and no complications in studied patient, large randomized controlled trials are needed to verify long-term safety and ef&amp;#64257; cacy of HBP to optimize clinical care of patients with atrioventricular conduction abnormalities using a personalized approach.&amp;nbsp;

Antithrombotic Management and Outcomes of Anterior ST-Elevation Myocardial Infarction With New-Onset Wall Motion Abnormalities in Men and Women

BackgroundIn patients with anterior ST-elevation myocardial infarction (STEMI) and new-onset antero-apical wall motion abnormalities (WMAs), whether the rate of prophylaxis against left ventricular thrombus and outcomes differ between men and women is unknown. MethodsA multicentre retrospective cohort study of patients with STEMI and new-onset antero-apical WMAs treated with primary percutaneous coronary intervention was conducted. Patients with an established indication of oral anticoagulation (OAC) were excluded. The rates of triple therapy (double antiplatelet therapy + OAC) at discharge were compared for women vs men. The rates of net adverse clinical events, a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 6 months were compared across sex using a multivariate logistic regression model. ResultsA total of 1664 patients were included in the primary analysis, of whom 402 (24.2%) were women and 1262 (75.8%) were men. A total of 138 women (34.3%) and 489 men (38.7%) received a triple therapy prescription at discharge (P = 0.11). At 6 months, 33 women (8.2%) and 96 men (7.6%) experienced a net adverse clinical event (adjusted odds ratio 0.82; 95% confidence interval 0.49-1.37). No difference occurred in the risk of bleeding events and ischemic events between men and women, when these were analyzed separately. ConclusionsThe rates of OAC prescription for left ventricular thrombus prophylaxis and clinical outcomes at 6 months were similar in women and men following anterior STEMI with new-onset antero-apical WMAs.

Comparison of clinical outcomes with short-term and long-term DAPT after PCI using second-generation drug-eluting stents in high bleeding risk patient : a systematic review and meta-analysis

Abstract Background Now that second-generation drug-eluting stents (DES) are available in almost every hospital in the world, it is unknown whether reducing the duration of double antiplatelet therapy (DAPT) following percutaneous coronary intervention in high-bleeding-risk (HBR) populations is beneficial and safe. Purpose This systematic review and meta-analysis aims to determine the safety, efficacy, and advantages of shortening the duration of DAPT (&amp;lt;6 months) in HBR patients with second-generation DES implantation. Methods We searched Ebsco, PubMed, Web of Science, Scopus, and Google scholar databases from inception to December 2022 for papers comparing short-term DAPT (6 months) followed by aspirin or P2Y 12 inhibitor monotherapy with long-term DAPT (6 months) in HBR patients after PCI with second generation DES. The primary objectives are major bleeding, definite or probable stent thrombosis (ST), and myocardial infarction (MI), while the secondary endpoint is mortality from any cause. Random-effect models were used to assess the relative risk and 95% confidence interval. Results This study included 9,789 HBR patients from three observational studies and one randomized controlled trial (Figure 1). Short DAPT for HBR patients undergoing PCI with second generation DES had a tendency of lower incidence of major bleeding in comparison with standard (6 months) DAPT, even though statistically non-significant (2.33% vs. 3.36%, RR 0.66 [95% CI 0.39 – 1.10], p = 0.11). Short-term DAPT was also found to be comparable and non-inferior to standard DAPT with in term of stent thrombosis (0.251% vs. 0.252%, RR 1.00 [95% CI 0.46-2.17], p = 0.99), Myocardial Infarction (2.08% vs. 1.85%, RR 1.09 [95% CI 0.82-1.44], p = 0.57), and All cause of death (3.01% vs. 2.56%, RR 1.17 [95% CI 0.93-1.49], p = 0.18) (Figure 2). Conclusions Among HBR patients implanted with second-generation DES, short DAPT was associated with slightly lower but comparable risk of major bleeding and non-inferior to reduce stent thrombosis, myocardial infarction, and all cause of death compared to standard DAPT.

Dynamics of Prescribing Antithrombotic Therapy to Patients with Atrial Fibrillation Hospitalized for Myocardial Infarction in 2016–2021

INTRODUCTION: At present, the issue of optimal antithrombotic therapy (ATT) in patients with myocardial infarction (MI) and atrial fibrillation (AF) has not been finally resolved, it requires an individual approach and is of interest for study.&#x0D; AIM: To study the dynamics of prescribing ATT to patients with AF of non-valvular etiology hospitalized in cardiology hospital in 20162021 for MI.&#x0D; MATERIALS AND METHODS: The study included 599 patients with MI and AF: in 20162017 104 patients, in 20182019 256 patients, in 20202021 239 patients. The median and interquartile range of age of patients hospitalized in 20162017 were 70 (61.0; 78.0) years, in 20182019 71 (65.0; 79.3) years, in 20202021 72 (65.0; 80.0) years, p = 0.09.&#x0D; RESULTS: In 20162017, 76.9% of patients with MI and AF were prescribed double antiplatelet therapy (DAPT) from the first day of hospitalization; 16.3% of patients were prescribed therapy with oral anticoagulants (OACs), here, in 6.7% as part of triple ATT, in 8.7% as part of double ATT (OACs + antiplatelet agent), in 1.0% as monotherapy with OACs; in 3.8% monotherapy with an antiplatelet agent was prescribed; in 2.9% of cases ATT was not prescribed. In 20182019, DAPT was used in 37.9% of cases; therapy with OACs in 54.7% of cases: in 44.9% cases as part of triple ATT, in 9.8% as part of double therapy; in 7.4% of cases monotherapy with antiplatelet agent was prescribed. In 20202021, DAPT was prescribed in 15.9% of cases; therapy with OACs in 74.5%, of them in 59.8% triple АТТ, in 14.2% double АТТ; monotherapy with an antiplatelet agent - in 7.5%; in 1.7% АТТ was not prescribed.&#x0D; CONCLUSION: In the study, the frequency of prescription of triple ATT to patients with AF and MI in 20202021 increased 1.3 times as compared to 20182019, and 8.9 times as compared to 20162017 and made 59.8% (p 0.001 for all periods). The frequency of OAC also increased 1.3 times as compared to 20182019 and 4.6 times as compared to 20162017 and made 74.5% (p 0.001 for all periods). This dynamics of increase in the frequency of prescription of oral anticoagulants to patients with a combination of AF and MI should be considered a positive result of introduction of the Clinical recommendations in the treatment of cardiologic patients.

Hemostasiological Aspects of PCI: Periprocedural Changes in the Activity of the Platelet Link of Hemocoagulation on the Background of Prior Double Antiplatelet Therapy in Patients with Chronic Coronary Syndrome

The aim. To analyze changes in the activity of the platelet link of hemocoagulation in patients with chronic coronary syndrome before and after percutaneous coronary intervention (PCI) against the background of prior antiplatelet therapy.&#x0D; Materials and methods. We examined 67 patients (mean age 65.2±8.6 years) who were undergoing inpatient treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Patients with different regimens of antiplatelet therapy were compared before and after PCI. At the time of hospitalization, patients were receiving both monotherapy and dual antiplatelet therapy (those with a history of myocardial infarction up to 12 months) in standard doses. The control group consisted of 25 people of similar age (62.7±6.5 years). The activity of platelet hemostasis was evaluated by the turbidimetric method and the light transmission fluctuation method. Statistical processing was carried out using the MedStat v.5.2 and Statistica 8.0 software.&#x0D; Results. Before PCI, dual antiplatelet therapy using aspirin and ticagrelor suppressed the activity of platelet hemostasis, compared to dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Patients receiving monotherapy did not achieve the desired effect. After PCI, the group of patients who took the combination of aspirin and ticagrelor responded better to the therapy than those who received aspirin and clopidogrel.&#x0D; Conclusions. The use of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor reduced both spontaneous and induced aggregation.

Acute myocardial infarction complicated by sudden out-of-hospital cardiac arrest: a clinical case

Justification. One of the serious complications of acute myocardial infarction (AMI) is out-of-hospital cardiac arrest, which is associated with electrical instability of the myocardium, ventricular arrhythmias. The development of a complication in the presence of an emergency medical team requires immediate resuscitation measures, including basic resuscitation measures and defibrillation.Aim: To present a clinical case of a patient with AMI with ST segment elevation complicated by recurrent ventricular fibrillation, hospitalized in an emergency hospital with the possibility of performing invasive interventions.Methodology and methods of research. The analysis of anamnesis, electrocardiographic data of the patient, the results of coronary angiography and stenting of the coronary artery, echocardiography examination, Holter monitoring, laboratory studies was carried out.Results. Patient P., female, 81 years old, was taken to the emergency hospital 2 hours and 15 minutes after the start of the clinic. At the prehospital stage, recurrent ventricular fibrillation, stopped by repeated three defibrillations. Non-contact, twice bouts of motor arousal. The council decided to conduct coronary angiography with possible stenting of the coronary arteries immediately. It was performed by femoral access on the right in 30 minutes after hospitalization. Complete occlusion of the anterior interventricular artery was revealed. Conductor recanalization and stenting of permanent residence was performed using a drug-coated stent. In the intensive care unit, drip administration of dopamine, noninvasive ventilation of the lungs, heparin administration were continued; double antiplatelet therapy, atorvastatin, amiodarone were prescribed. Since the fourth day, a beta-blocker has been added to therapy. Physical and psychological rehabilitation was carried out. She was discharged on the 15th day in a satisfactory condition.Conclusion. Out-of-hospital cardiac death requires urgent resuscitation measures, among which defibrillation occupies a special place, as well as immediate hospitalization to a cardiology center with the possibility of performing invasive interventions. Early rehabilitation plays an important role in the treatment of patients.

Predictors of ischemic and hemorrhagic complications in patients with myocardial infarction at 18-month follow-up: a single-center registry study

Aim. To identify predictors of ischemic and hemorrhagic events in patients with myocardial infarction (MI) after 18 months of follow-up.Material and Methods. The single-center prospective study included 478 patients with MI. The exclusion criteria were as follows: age &lt; 18 years; MI as a complication of myocardial revascularization; atrial fibrillation; intake of anticoagulants after MI. During inpatient treatment, the risk of ischemic and hemorrhagic events was calculated according to the PRECISE-DAPT score, GRACE hospital discharge risk score, CRUSADE bleeding score. After 18 months, we evaluated the rate of ischemic (cardiovascular death, unstable angina, life-threatening arrhythmia, non-fatal MI and stroke, acute decompensated heart failure, elective repeated and/ or emergency revascularization) and haemorrhagic events and the amount of corresponding therapy.Results. At 18 months post-MI, patients were at high risk of developing both ischemic events (cardiovascular death: 32.0%; recurrent MI: 16.3%; repeated myocardial revascularization: 18.5%; unstable angina: 13.8%; stroke: 3.6%) and hemorrhagic events (bleeding rate of 39.7% according to the TIMI score), most of which occurred during the first 12 months post-MI. Double antiplatelet therapy (DAPT) was prescribed to 86.5% patients upon discharge (including a triple antithrombotic therapy in 8.6% patients). Patient adherence to treatment was 66.7% and 60.6% at 6 and 12 months of follow-up, respectively. After 18 months, DAPT was prescribed exclusively to patients suffered from recurrent ischemic events or those who underwent repeated myocardial revascularization (17.4% patients in total). The main reason to cancel DAPT was bleeding, although it was minor in most cases. Predictors of ischemic events (fatal and non-fatal) at 18 months of follow-up were PRECISE- DAPT score (odds ratio (OR) = 1.108, 95% confidence interval (CI) = 1.054-1.164, р &lt; 0.001), GRACE score (OR = 1.032, 95% CI = 1.016-1.048, р &lt; 0.001), left ventricular ejection fraction (LVEF) &lt; 40% (OR = 4.256, 95% CI = 1.510-12.001, р = 0.006). Predictors of hemorrhagic events at 18-month follow-up were PRECISE-DAPT score (OR = 1.025, 95% CI = 1.009-1.041, р = 0.002), peripheral artery disease (PAD) (OR = 2.459, 95% CI = 1.365-4.428, р = 0.003), intake of sulfonylurea for diabetes mellitus (OR = 2.523, 95% CI = 1.266-5.028; р = 0.009), unsuccessful percutaneous coronary intervention (PCI) or conservative treatment of MI (OR = 3.792, 95% CI = 1.799-7.996, р &lt; 0.001).Conclusion. Predictors of ischemic events (fatal and non-fatal) in the long-term period after MI include PRECISE-DAPT and GRACE scores, and LVEF below 40%. Predictors of hemorrhagic events at 18-month follow-up were PRECISE- DAPT scores, PAD, taking sulfonylurea for diabetes mellitus, unsuccessful PCI or conservative treatment of MI.

Clinical case of a 29 weeks pregnant patient with ST-segment elevation myocardial infarction

HighlightsThis clinical case describes the management of a 29 weeks pregnant patient with myocardial infarction. The material will be useful for cardiologists, physicians, obstetricians and gynecologists, and endovascular surgeons. AbstractUnavoidable drastic changes in lifestyle due childbirth are pushing women to postpone it to an older age, thus increasing the risk of coronary artery disease (CAD) in pregnant women. This can be a problem not only for patients, but also for specialists. Currently there are 3-6 cases of acute coronary syndrome (ACS) per 100 thousand pregnancies, meaning such cases occur rarely in real clinical practice. Discomfort in the chest area does not directly indicate cardiac problem, so women do not visit cardiologist right away, and thus ACS remains undiagnosed. Besides traditional risk factors for CAD (age, dyslipidemia, smoking, physical inactivity), there are some additional obstetric factors: preeclampsia, thrombophilia and postpartum bleeding. About 40% of patients have myocardial infarction in the third trimester. Atherosclerosis is the most common cause of ACS, with coronary artery spasms, coronary artery dissection and thrombosis following behind. Currently the maternal mortality due to MI has decreased from 20% to 5% due to introduction of the percutaneous coronary intervention (PCI) into the treatment of ACS. There are not enough data on the use of thrombolytics and other medicine in the treatment of CAD, because pharmacological therapy can be dangerous in the early pregnancy at the peak of organogenesis. Moreover, PCI should be used with caution due to harmful effects of radiation on the pregnant woman and the fetus. The main task in later stages of pregnancy is to balance out the risk of stent thrombosis upon discontinuing double antiplatelet therapy and bleeding during childbirth and in the postpartum period. This article describes a clinical case of a 29 weeks pregnant patient with myocardial infarction.

Spontaneous coronary artery dissection: the role of Coronary CT angiography in the follow-up management

Abstract Funding Acknowledgements Type of funding sources: None. Background Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS), myocardial infarction (MI) and sudden death (SD). Diagnosis is done with coronary angiography (CA); nevertheless, coronary computed tomography angiography (CCTA) is a new useful tool in the acute diagnosis and at follow-up. Treatment could involve a conservative approach or an invasive approach with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Purpose 1) analyze the clinical and CCTA features at baseline of patients with a SCAD diagnosis; 2) evaluate the clinical and anatomic outcome at follow-up of patients with a SCAD diagnosis treated with a conservative or invasive approach; 3) evaluate in the conservative approach treated patients the clinical and anatomic outcome of those dismissed with single or double antiplatelet therapy. Methods A retrospective analysis of 57 patients affected by SCAD followed up with Coronary CT angiography (CCTA) between 2010 and 2022. Clinical and anatomic data were collected at baseline and at the follow-up (FU). The clinical endpoints evaluated were: all cause mortality, hospitalization for cardiovascular cause, SCAD or PCI ex-novo and MI; the anatomic endpoints were: patency of coronary artery and/or stents and length dissection changing from baseline. Results 57 patients were divided in 2 groups: 46 (80,7%) patients underwent a conservative treatment and 11 (19,3%) patients a PCI treatment. Patients treated with PCI has a significative incidence of smokers (45,5% vs 15,2%; p = 0,042), peripherical arteriopathy (18,2% vs 0%; p = 0,034), higher troponin peak (40425,8 vs 13436; p = 0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p = 0,050). Moreover the PCI population has a significant involvement of more than one coronary artery (72,7% vs 6,5%; p&amp;lt;0,001), of the proximal tracts of the coronary arteries (22,8% vs 13 %; p = 0,001) and of the truncus communis (45,4% vs 0%; p&amp;lt;0,001). At the follow up, there were no statistical differences for the clinical and anatomic endpoints between the conservative and invasive treated patients (p&amp;gt;0,05). Among patients treated with conservative therapy, there were a significant recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p = 0,033). Conclusions patients with SCAD managed with PCI have more cardiovascular risk factors, a major myocardial infarction extension and a more complex coronary arteries involvement; conservative management is comparable to the PCI treatment for the clinical and anatomic endpoints evaluated; DAPT at discharge was associated with a higher rate of SCAD recurrence at follow-up.

Bleeding events occurring in patients sdminitering double antiplatelet therapy (aspirin + P2Y12 inhibitor – clopidogrel)

In patients with coronary artery disease, percutaneous coronary interventions (PCI) are the mainstay of treatment for those presenting with acute coronary syndrome (ACS); PCI has also been widely adopted in patients with chronic coronary syndromes. Adjuvant pharmacotherapy, especially antithrombotic therapy, is the key to reducing local thrombotic complications and systemic ischemic events among patients undergoing percutaneous coronary interventions, but is inevitably associated with the occurrence of bleeding events. Prasugrel and ticagrelor are preferred over clopidogrel in patients with ACS in the absence of contraindications. Despite this, clopidogrel remains the most widely used. In this article, the bleeding events that occurred during 6-12 months of dual antiplatelet therapy (aspirin + P2Y12 inhibitor - clopidogrel) in patients who underwent myocardial revascularization by PCI, the factors that favored their occurrence and the use of the prediction score were studied.

Early and Mid-Term Outcomes of Females Treated with t-Branch off the Shelf Device

Female sex has been characterized as a risk factor of increased mortality in patients managed for complex aortic aneurysm using endovascular means. This study aimed to present the perioperative and follow-up outcomes of females managed electively or urgently with the t-Branch device and investigate factors affecting the early outcomes. A 2-center retrospective observational study was conducted including elective and urgent female patients managed with the t-Branch device (Cook Medical, Bjaeverskov, Denmark) for thoracoabdominal and pararenal aneurysms between January 1, 2018 and September 30, 2020. Primary early outcomes included technical success and 30-day mortality and morbidity [spinal cord ischemia (SCI) and acute kidney injury]. Follow-up survival and freedom from reintervention rates were assessed using Kaplan-Meier estimates. In total, 153 females were included; 81 (52.9%) treated urgently. Urgent patients were older (73.2±8.6 vs. 68.5±6.8years; P<0.001) and presented higher previous coronary angioplasty/stenting (16.0% vs. 5.6%, P=0.005) and lower double antiplatelet therapy (DAPT, 46.3% vs. 53.7%, P=0.04) rates. Technical success was 97.4%. Early mortality was 16.3% (22% in urgent; 12% in elective; P=0.2) and SCI and acute kidney injury were diagnosed in 13.7% (11% in urgent; 16% in elective; P=0.2) and 18.3% (22.2% in urgent; 13.9% in elective; P=0.18), respectively. Multivariate regression analyses showed that DAPT and b-blockers were related to lower 30-day mortality. DAPT was also preventive for SCI. Survival rates were 68.4% [standard error (SE) 0.07] at 12months for the urgent and 75.6% (SE 0.09) at 24months for the elective group (P=0.14). Freedom from reintervention rates were 81.4% (SE 0.06) at 6months and 64.7% (SE 0.09) at 18months for the urgent and 81.7% (SE 0.06) at 6months and 75.4% (SE 0.081) at 18months for the elective group (P=0.94). Female patients managed with the t-Branch device for thoracoabdominal and pararenal aneurysms in elective and urgent setting presented similar 30-day mortality and SCI rates.

The study of platelet microparticles and P-selectin expression in patients with the peripheral arterial diseases

BACKGROUND: High platelet reactivity leads to the progression of atherosclerosis and its complications. Activated platelets adhere to the site of endothelium damage on the vessel wall and initiate the formation of an arterial thrombus, followed by acute ischemia of the organ. Biochemical and cellular marker such as platelet microvesicles and P-selectin can be analyzed using flow cytometry, which is based on a specific antigen-antibody interaction. Patients with peripheral arterial disease are at significantly greater risk of cardiovascular and cerebrovascular complications than individuals of the same age and sex. The use of antiplatelet agents is an important part of pathogenetic therapy and prevention of cardiovascular diseases and their complications.&#x0D; AIM: This study was to evaluate the level of platelet microparticles and P-selectin expression in patients with peripheral arterial disease receiving antiplatelet therapy.&#x0D; MATERIALS AND METHODS: The study included 49 people, which included three study groups: patients with obliterating disease of the arteries of the lower extremities (n = 14) on the background of long-term use (more than 14 days) of double (75 mg clopidogrel and 100 mg Acetylsalicylic acid) antiplatelet therapy, patients with COVID-19 (n = 15), who made up the positive control group in the determination of microparticles of platelet origin, and healthy volunteers (n = 20) without signs of acute respiratory disease, without a history of cardiovascular and thromboembolic episodes, not taking antiplatelet drugs. The functional activity of platelets was assessed by two methods: using light aggregometry and analysis of P-selectin expression on platelet surface by flow cytometry. The number of platelets microparticles in blood plasma was also determined using flow cytometry.&#x0D; RESULTS: A significant decrease in platelet aggregation was found in patients with peripheral arterial disease taking antiplatelet agents, compared with controls by used light aggregometry. Similar changes were obtained when analyzing the expression of P-selectin on platelets. A higher percentage of platelets microparticles with the CD9+CD41+ phenotype was found in patients with severe inflammation compared with peripheral arterial disease patients treated with antiplatelet agents and compared with the healthy controls.&#x0D; CONCLUSIONS: Thus, our study reflects the consistency of the results of three different laboratory tests in assessing the platelets reactivity in patients with the peripheral arterial diseases taking antiplatelet drugs.

P65 A STRANGE CASE OF ACUTE CORONARY SYNDROME WITH VESSEL SQUEEZING AND INTRAMURAL HEMATOMA

Abstract A 53–year–old woman presented herself at our center for the appearance of oppressive chest pain radiating to the upper limbs associated with cold sweat, which arose in resting conditions. The patient had as cardiovascular risk factors tobacco habits and an important family history of cardiovascular diseases (father died of AMI at a young age) and had entered menopause for some months. The ECG showed signs of anterior transmural ischemia (Figure 1a) with corresponding echocardiographic kinetic abnormalities of the cardiac apex (EF 40%). The patient underwent an emergency coronary angiography documenting an intramyocardial bridge with evident systolic squeezing of the vessel in the proximal–middle section of the anterior descending artery and normal appearance of the remaining coronary tree (Figure 2). She was subjected to infusion of intracoronary nitrates with improvement of the instrumental picture and on that occasion it was opted for medical therapy alone with double antiplatelet therapy and low–dose calcium antagonist. On the second day after the diagnostic procedure, there was a recurrence of anginal symptoms with evidence on the ECG of anterolaterally reversed T waves (figure 1b). The patient underwent a new coronary angiography, IVUS–guided, with documentation of probable intramural hematoma in the absence of non–flow–limiting dissection image with an area of 7 mm² (Figure 3). During the subsequent hospitalization, the patient remained asymptomatic with stable ECG tracing, but telemetry revealed ventricular tachyarrhythmias for which beta–blocker therapy was optimized with improvement of the arrhythmic burden. The pre–discharge echocardiogram showed improvement of cardiac kinesis with resumption of systolic function (EF 48%). The patient was discharged stable and asymptomatic with follow–up at our dedicated ischemic heart disease clinic. This case report is an example of an infrequent cause of acute coronary syndrome, of non–atherosclerotic origin, to be considered in clinical practice.