Episode Of Acute Coronary Syndrome Research Articles

IMPACT OF POLYVASCULAR DISEASE ON LONG–TERM PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME. A PROSPECTIVE COHORT STUDY IN ITALY

Abstract Background Atherothrombosis should be considered a systemic disease that may involve one or more than one vascular beds. Data on the impact of polyvascular disease on long–term prognosis in patients with acute coronary syndrome (ACS) are still scarce. Aim To assess the prevalence of symptomatic polyvascular disease in a cohort of patients with ACS and to investigate the impact on long–term outcomes of single versus multiple vascular beds involvement. Methods We analyzed a nationwide, comprehensive, and universal administrative database of consecutive patients older than 40 years admitted for a new episode of ACS in 2013–14 in Italy. Patients with ACS were stratified according to the presence of Peripheral Arterial Disease (PAD) only, Cerebrovascular Disease (CeVD) only, PAD and CeVD (PAD+CeVD) or neither (noPAD/noCeVD). A Cox proportional hazard multivariate model was used to evaluate the impact of PAD only, CeVD only and PAD+CeVD on 5–year MACCE. Results 331320 new episode of ACS were identified. Among them, 24491 (7.4%) were patients with PAD only, 16269 (4.9%) with CeVD only and 4710 (1.4%) with PAD+CeVD. The 5 years MACCE was 42.6%, 64.7%, 66.1 and 72.2 (p<0.001) for noPAD/noCeVD, PAD only, CeVD only and PAD+CeVD, respectivelly. After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 5–year MACCE was 1.30 (p<0.0001), 1.39 (p<0.0001), and 1.46 (p<0.0001) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, as compared with patients without PAD and CeVD. Conclusion Polyvascular disease represents a major risk factor in patients with ACS. The simultaneous involvement of three vascular beds further increases the risk of long–term outcomes. Greater effort should be directed toward identification of subclinical/clinical atherosclerosis of beds different from coronary for a better risk stratification.

CARDIAC REHABILITATION AND PSYCHOLOGICAL TREATMENT: CONTRASTS IN ANXIETY, DEPRESSION AND ILLNESS PERCEPTION LEVELS

Abstract Background Investigating the relationship between psychological factors and cardiovascular diseases (CVD) has long been a focal point of previous research. Researchers have primarily focused on identifying possible predictive factors for CVD’s development and examining patients’ responses during acute or chronic phases, but less is known about the role of cardiac rehabilitation and the types of psychological treatments on patients’ psychological status. Aims The aim of this study is to compare anxiety, depression, and illness perception levels of patients affected by different cardiovascular diseases at the beginning (t0), at the end (t1), and three months after a cardiac rehabilitation program (t2) in which patients were involved in three different types of psychological treatments: psychoeducational intervention group, progressive muscle relaxation training integrated with Jacobson‘s technique and imaginative stabilization techniques, individual counseling. Methods In this study were involved patients with recent episodes of Acute Coronary Syndrome (ACS), heart failure (HF) or cardiac surgery undergoing cardiac rehabilitation between January 2023 and August 2023 at ASST Bergamo Est. To assess anxiety, depression and illness perception levels of participants we used self–report questionnaires that included the Hospital Anxiety and Depression Scale (HADS) and the Brief Illness Perception Questionnaire (Brief–IPQ). Patients could be assigned to different psychological treatments based on their clinical condition. Results The study involved 181 participants, namely N=36 ACS cases (19.9%), N=25 CHF (13.8%), and N=120 cardiac surgery (66.3%). As shown in Table 1, males were 71.3% (N=129) and the average age was 65.96 years old (SD=11.904). One hundred–sixty einght patients participated in psychoeducational intervention group, 120 in relaxation training, and 35 in individual counseling. Statistically significant differences in anxiety, depression, and illness perception levels were observed at the program‘s initiation (t0) and upon completion (t1 and t2) in relation to the psychological treatments: individual counseling had a better impact on levels of anxiety and depression and on the development of a more adequate perception of illness. Conclusions The type of psychological treatment during cardiac rehabilitation appears to give different results in terms of psychological status, self–care and disease management of patients.

Work stress and changes in heart rate variability among employees after first acute coronary syndrome: a hospital-based longitudinal cohort study.

Work stress is considered as a risk factor for coronary heart disease, but its link with heart rate variability (HRV) among heart attack survivors is unknown yet. The aim of this study was to investigate associations between baseline work stress and the changes of HRV over one-year after onset of acute coronary syndrome (ACS). Hundred and twenty-two patients with regular paid work before their first ACS episode were recruited into this hospital-based longitudinal cohort study. During hospitalization (baseline), all patients underwent assessments of work stress by job strain (JS) and effort-reward imbalance (ERI) models, and were assigned into low or high groups; simultaneously, sociodemographic and clinical data, as well depression, anxiety, and job burnout, were collected. Patients were followed up 1, 6, and 12 months after discharge, with HRV measurements at baseline and each follow-up point. Generalized estimating equations were used to analyze the effects of baseline work stress on HRV over the following 1 year. After adjusting for baseline characteristics and clinical data, anxiety, depression, and burnout scores, high JS was not associated with any HRV measures during follow-up (all p > 0.10), whereas high ERI was significantly related to slower recovery of 5 frequency domain HRV measures (TP, HF, LF, VLF, and ULF) (all p < 0.001), and marginally associated with one time domain measure (SDNN) (p = 0.069). When mutually adjusting for both work stress models, results of ERI remained nearly unchanged. Work stress in terms of ERI predicted lower HRV during the one-year period after ACS, especially frequency domain measures.

The glycosylated hemoglobin level and the severity of cardiovascular involvement in patients with the first episode of acute coronary syndrome.

The current study was carried out aiming at investigating the relationship between glycosylated hemoglobin level and coronary atherosclerosis in patients with the first episode of acute coronary syndrome. This case-control study evaluated 450 patients with the first episode of acute coronary syndrome in Ayatollah Rouhani Hospital in Babol (Iran) from 2011 to 2018. Based on glycosylated hemoglobin, patients were divided into three groups of non-diabetic, pre-diabetic, and diabetic (n=150 in each group). Since SYNTAX score and Gensini score are employed to evaluate the extent of cardiovascular disease and predict CVD in patients with CAD over long-term follow-up, we calculated SYNTAX score and Gensini score based on angiographic results. Concerning the factors related to the severity of cardiovascular involvement, the results revealed no significant difference between the diabetic and pre-diabetic groups in terms of the frequency of patients in terms of SYNTAX score, Gensini score, and the number of vessels involved (0.142 and 87, respectively, and P=0.102). However, this difference between the diabetic and non-diabetic groups, as well as between the pre-diabetic and non-diabetic groups was statistically significant (respectively for SYNTAX score, p< 0.001 and P=0.001; for Gensini score, P=0.013 and P=0.019; and for the number of vessels involved P=0.001and p<0.001). According to the findings of the current study, since there was no significant difference between diabetic and pre-diabetic patients in terms of the components indicating the severity of cardiovascular involvement, pre-diabetes itself may be associated with the severity of cardiovascular involvement as a predisposing factor.

Vehicular homicide or cardiovascular event? The importance of the autopsy findings

We present the case of a 61 years old woman who was hit by a car, resulting in fractures of the pubic bone, left ischium-pubis ramus and right femur, with need of hip replacement surgery. In the next days she was affected by two episodes of acute coronary syndrome, treated with coronary angioplasty surgery. After undergoing total hip replacement surgery an episode of asystole caused her death. A full autopsy showed coronary stenosis and chronic ischemic heart disease associated with a recent myocardial infarction. The pre-existing condition of T.L. could not be ignored but the initial traumatic event and the subsequent fractures played a further co-occurrent causal role. The initial trauma represented the first step of the phenomenological chain that led to a series of adverse cardiological events and to an irreversible asystole, so that the car driver should be partly considered accountable for the death of the woman.

Comparison of SCORE and SCORE2 in determination rates with very high cardiovascular risks

Abstract Background Appropriate risk stratification is fundamental for cardiovascular disease (CVD) prevention. The European Society of Cardiology recently updated the Systematic Coronary Risk Estimation (SCORE) algorithm to SCORE2 for estimating the 10-year risk of first-onset CVD among Europeans. However, the performance of SCORE2 has not been examined in the non-European population. Purpose This study aimed to compare the results of CVD risk assessments between the SCORE and SCORE2 algorithms. Methods A total of 1089 non-diabetic patients who experienced their first episode of acute coronary syndrome (ACS) were included in the study. CVD risks were evaluated according to the SCORE charts based on age, sex, smoking status, blood pressure, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and non-HDL levels. Results The SCORE2 algorithm identified 58.8% (n=640) of patients as very high risk, whereas the SCORE algorithm identified only 22.5% (n=245) of patients as such, demonstrating a statistically significant difference (p &amp;lt; 0.001). Furthermore, there was a noticeable sex disparity in very high-risk classification between the two algorithms. Specifically, the SCORE algorithm identified a considerably higher proportion of males (25.7%; n=233) as very high risk compared to females (4.9%; n=12) (p &amp;lt; 0.001). In contrast, the SCORE2 algorithm demonstrated a relatively smaller difference in the very high-risk category between males (59.7%; n=540) and females (54.3%; n=100) (p=0.181). A lower proportion of patients were classified as low to intermediate risk by the SCORE2 algorithm compared to the SCORE algorithm (3.9 % vs. 49.7%; p &amp;lt; 0.001). On the other hand seven patients (0.6 %) aged between 70 to 73 years were reclassified from the very high-risk category by SCORE to the very high-risk category by SCORE2. Conclusion The study suggests that the SCORE2 algorithm is superior to the SCORE algorithm in classifying patients who developed first-onset ACS as very high risk. In the very high-risk category, the sex gap was less prominent using the SCORE2 algorithm than the SCORE algorithm. However, the SCORE2 algorithm may underestimate CVD risk levels among patients aged between 70 to 73 years.General characteristics of the patientsThe Comparison of CV risk levels

Recurrence of acute coronary syndrome in the elderly: predictors and prognosis - insights from a multicentre national registry

Abstract The burden of cardiovascular (CV) disease remains at the top of society's health problems, with acute coronary syndromes (ACS) undoubtedly being one of the major causes. Patients with a known history of CVD are at increased risk of recurrent events. However, this recurrence's incidence rate and clinical impact vary between populations. Elderly patients represent a large proportion of patients admitted for a second ACS. The decision on its management lacks support in clinical guidelines, as studies generally exclude patients with significant comorbidities and tend to underrepresent this group. This study aimed to analyse the characteristics and outcomes of elderly patients admitted with ACS with a previous history of myocardial infarction (MI) versus those who did not. The authors performed a retrospective analysis of patients older than 75 years included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between 2010 and 2022. Comparison tests were performed. A COX proportional hazard regression method was applied to generate the proposed risk models. A p-value less than 0.05 was considered statistically significant. A total of 8658 patients older than 75 years admitted for ACS were analysed, 6630 (76.6%) without a history of MI (group 1) and 2028 (23.4%) with a previous MI. Table 1 shows the most important baseline characteristics and differences between groups. Table 2 demonstrates the group differences regarding admission diagnosis, complementary study results and treatment. Table 3 represents in-hospital complications. At discharge, 16.5% of group 1 and 21.2% of group 2 had a planned cardiac rehabilitation program (CRP) (p-value=0.01). At 1-year follow-up, 15,6% of patients with more than 75 years admitted for ACS died and 17.4% were re-hospitalized by a CV cause. COX-regression analysis identified the history of MI as a predictor factor of CV re-hospitalization (HR 1,43; 95%CI [1.10;1.86], p-value&amp;lt;0.01) and of the composite of mortality and CV re-hospitalization (HR 1,37; 95%CI [1.10;1.71], p-value&amp;lt;0.01). In conclusion, the elderly with a second episode of ACS tends to have more CV risk factors and comorbidities than those without a MI history. Furthermore, the recurrence of MI seems to be an independent predictor of 1-year re-hospitalization and the composite of mortality and CV re-hospitalization. Then, these results should increase the awareness of this group of patients.Table 1Table 2 (incomplete) and Table 3

Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome.

Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for the detection of ischemic myocardial dysfunction. The aim of this study was to evaluate the accuracy of myocardial deformation parameters measured by speckle tracking echocardiography (STE) in predicting culprit coronary artery lesions in patients with prior revascularization and acute coronary syndrome (ACS). We prospectively studied 33 patients with ischemic heart disease, a history of at least one episode of ACS and prior revascularization. All patients underwent a complete stress Doppler echocardiographic examination, including the myocardial deformation parameters of peak systolic strain (PSS), peak systolic strain rate (SR) and wall motion score index (WMSI). The regional PSS and SR were analyzed for different culprit lesions. The mean age of patients was 59 ± 11 years and 72.7% were males. At peak dobutamine stress, the change in regional PSS and SR in territories supplied by the LAD showed smaller increases compared to those in patients without culprit LAD lesions (p < 0.05 for all). Likewise, the regional parameters of myocardial deformation were reduced in patients with culprit LCx lesions compared to those with non-culprit LCx lesions and in patients with culprit RCA legions compared to those with non-culprit RCA lesions (p < 0.05 for all). In the multivariate analysis, the △ regional PSS (1.134 (CI = 1.059-3.315, p = 0.02)) and the △ regional SR (1.566 (CI = 1.191-9.013, p = 0.001)) for LAD territories predicted the presence of LAD lesions. Similarly, in a multivariable analysis, the △ regional PSS and the △SR predicted LCx culprit lesions and RCA culprit lesions (p < 0.05 for all). In an ROC analysis, the PSS and SR had higher accuracies compared to the regional WMSI in predicting culprit lesions. A △ regional SR of -0.24 for the LAD territories was 88% sensitive and 76% specific (AUC = 0.75; p < 0.001), a △ regional PSS of -1.20 was 78% sensitive and 71% specific (AUC = 0.76, p < 0.001) and a △ WMSI of -0.35 was 67% sensitive and 68% specific (AUC = 0.68, p = 0.02) in predicting LAD culprit lesions. Similarly, the △ SR for LCx and RCA territories had higher accuracies in predicting LCx and RCA culprit lesions. The myocardial deformation parameters, particularly the change in regional strain rate, are the most powerful predictors of culprit lesions. These findings strengthen the role of myocardial deformation in increasing the accuracy of DSE analyses in patients with prior cardiac events and revascularization.

Impact of Mean Platelet Volume on Outcomes among Patients under 45 Years Presenting with First Episode of Acute Coronary Syndrome

Impact of Mean Platelet Volume on Outcomes among Patients under 45 Years Presenting with First Episode of Acute Coronary Syndrome

Antitachycardic Therapy of ICD in Patients with Multiple Morphologies of Monomorphous Ventricular Tachycardia Refractory to Therapy

The article presents a description of a clinical case of a patient with structural myocardial pathology (postinfarction cardiosclerosis) with recurrent paroxysmal sustained monomorphic ventricular tachycardia (VT) refractory to the nominal recommended ICD (implantable cardioverter defibrillator) settings; as well as discusses the shortcomings of existing standard algorithms for antitachycardia pacing (ATP) of implantable cardioverter defibrillators and potential ways to increase its efficiency. The refractoriness of recurrent paroxysms of ventricular tachycardia to ATP therapy increases the risk of repeated ICD shocks.&#x0D; Despite the existence of universal recommendations for ICD programming and ATP therapy, there is a need in clinical practice for individualized ATP programming in patients refractory to nominal settings. Increasing the number of ATP series and changing algorithms enables to increase the efficiency of ATP up to 8089%. Refractoriness to standard ATP settings may be also overcome by using alternative ATP pacing algorithms (Ramp, Burst-plus, or Ramp-plus instead of Burst), changing the pacing interval, ATP sequence duration, pacing type, and even adding 12 extra stimuli, as well as using data from the previous intracardiac electrophysiological heart test.&#x0D; The presented clinical case of a patient with postinfarction cardiosclerosis and paroxysmal stable monomorphic VT (SM-VT) of several morphologies demonstrates that the arrhythmogenic substrate after myocardial infarction changes for a long time without new stenoses in large coronary arteries and without new episodes of acute coronary syndrome, as well as generates several different morphologies of VT from one scar (with different heart rates) and the effect on hemodynamics. The efficiency of early ATP pacing may differ for VT of various morphologies, which makes it reasonable to use alternative pacing algorithms (in addition to the standard Burst sequences recommended by the 2019 Consensus on ICD programming) and testing possible ATP algorithms during ablation of monomorphic VT, including during preventive VT ablation before ICD implantation.

Quality of life assessment in the first episode of acute coronary syndrome

Quality of life assessment in the first episode of acute coronary syndrome

Longitudinal Associations of Work Stress with Changes in Quality of Life among Patients after Acute Coronary Syndrome: A Hospital-Based Study

(1) Background: Targeting a sample of Chinese employees in this study, the correlation of work stress with changes in quality of life (QoL) was explored subsequent to acute coronary syndrome (ACS). (2) Methods: Patients suffering from the first ACS episode, with regular paid work before ACS, were eligible for this one-year longitudinal study. Effort-reward imbalance (ERI), together with job strain (JS) models, were employed to evaluate work stress before discharge, and QoL prior to discharge (baseline), as well as at 1, 6, and 12 months following discharge, were measured using the 8-Items Short Form (SF-8), in addition to the Seattle Angina Questionnaire (SAQ). Moreover, generalized estimating equations were used to determine the relationship of work stress to longitudinal QoL variations. (3) Results: After adjusting for covariates, high work stress at the baseline measured by JS was associated with the slow recovery of both mental health (p < 0.01) and physical health (p < 0.05) in SF-8, while ERI-measured work stress was related to slower improvement in SF-8 physical health (p < 0.001), SAQ-angina stability (AS) (p < 0.05), SF-8 mental health (p < 0.001), and SAQ-angina frequency (AF) (p < 0.05). After mutual adjustment for JS and ERI, high work stress as assessed by JS displayed no correlation with any QoL alteration (all p > 0.05), whereas ERI-determined work stress at a high level still presented a relationship to slow improvement in SF-8 physical health, SAQ-AS, SF-8 mental health, and SAQ-AF (all p < 0.05). (4) Conclusion: Work stress was associated with slow recovery of QoL in patients with ACS across one year. For ACS patients, ERI was a stronger predictor of QoL variations than JS.

Clinical consequences of the lipid-lowering treatment in patients with acute coronary syndrome: real-world retrospective study (LipidACS study)

Abstract Background The reduction of low-density lipoprotein cholesterol (LDLc) levels is Key for improving the prognosis of patiens with acute coronary syndrome (ACS). Purpose To estimate the clinical characteristics and treatments of patients with a first episode of ACS in real world in a large database in Spain. Methods An observational and retrospective study was carried out based on electronic medical records of primary care centers and hospitals including 969.587 spanish patients aged &amp;gt;18 years.From these, we selected the ones with a first episode of ACS between 01/07/2016 and 30/06/2018, with a follow-up period of 18 months. Patients were divided according to the intensity of their lipid-lowering treatments: low, moderate, high (high intensity statin/moderate plus ezetimibe), very high (high intensity statin plus ezetimibe) and extreme (IPCSK added) and those on treatment with lipid-lowering drugs other than statins. The incidence of new cardiovascular events, the reduction of LDLc levels, the persistence rates at 9 and 18 months, and the mortality rates were estimated. The concomitant treatments prescribed at the start of the study were registered. Results A first episode of ACS was detected in 7,150 patients (mean age: 70 years [SD: 9.6]; males: 62.2%). The intensity of their lipid-lowering treatments: low [n=172 (2.4%)], moderate [n=370 (5.2%)], high [n=3,751 (52.5%)], very high [n=2,457 (34.4%)], extreme [n=67 (0.9%)])and non-statins lipid-lowering treatments (n=333 [4.7%]). Patients with lipid-lowering treatments other than statins had the highest incidence rate of cardiovascular events (33.0%), followed by those on treatment with low intensity treatments (32.0%): acute myocardial infarction and angina were the most frequent cardiovascular events. The deepest reductions of LDLc levels at 18 months were reported in patients with extreme intensity and very-high intensity treatments (−60.5 mg/dL [42.9%] and −31.6 mg/dL [24.3%], respectively). The persistence rates at 9 and 18 months were higher in patients with extreme intensity and very high intensity lipid-lowering treatments. The highest mortality rate was observed in patients with lipid-lowering treatments other than statins (12.6%), with the median time to death being 221 days (P25–P75: 116–327). The lowest mortality rate was registered in patients with extreme intensity lipid-lowering treatments, who showed a median time to death of 405 days (P25–P75: 396–0).Overall, referral to Cardiac Rehabilitation in ACS is less than 20% in Spain. Conclusion Patients with ACS who received lipid-lowering treatments other than statins and low intensity treatments had the highest incidence of cardiovascular events and mortality rates.The reduction of LDLc levels increased with the intensity of the lipid-lowering treatments, which may lead to a reduced risk of cardiovascular events and death. More referral to Cardiac Rehabilitation could also improve these results Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): SANOFI

Remote monitoring of outpatients discharged from the emergency cardiac care department

The coronavirus disease 2019 (COVID-19) pandemic has shown the need for the development of telemedicine technologies, especially remote follow-up using vital sign telemonitoring. In the Russian Federation, this approach is also justified by the remoteness factor with a shortage of medical workers in distant areas of the country.Aim. To study the potential of remote monitoring in outpatients discharged after acute decompensated heart failure and acute coronary syndrome.Material and methods. The study included 392 patients randomized to active follow-up groups with remote blood pressure (BP) monitoring (group 1, n=197) and standard management (group 2, n=195). The follow-up period lasted 3 months.Results. During the follow-up period, patients managed with BP and heart rate telemonitoring tended to decrease in systolic BP from 132 (interquartile range (IQR), 121-139) mm Hg up to 125 (IQR, 115-130) mm Hg (p=ns). On the contrary, the 2nd group patients had a slight increase in systolic BP from 127 (IQR, 115-137) mm Hg up to 132 (IQR, 124-142) mm Hg (p=ns).The patients of group 2 were more likely to receive diuretics and nitrates after 3-month follow-up, which can be considered a negative factor. This may indicate no improvement in the course of heart failure and chronic coronary artery disease with the absence of therapy correction over time.During follow-up, four patients from group 1 were hospitalized due to decompensated heart failure or an episode of acute coronary syndrome with a total duration of 30 days, compared with 13 hospitalizations for the same reasons in group 2 (p=0,027; OR 3,4; 95% CI 1,1-10,8). In total, six patients died during the follow-up period in group 1, and eleven patients died in group 2 (p=0,226; OR 1,9; 95% CI 0,7-5,3). At the same time, three patients in the 1st group and one patient from the 2nd group died during the follow-up period due to COVID-19. Thus, cardiovascular mortality consisted of 3 and 10 patients in groups 1 and 2, respectively (p=0,052; OR 3,5; 95% CI 0,9-12,9).Conclusion. Three-month remote management of patients after decompensated heart failure or acute coronary syndrome, including BP monitoring, showed a significant reduction in the hospitalization rate and a trend towards a decrease in cardiovascular mortality.

Thromboembolic Complications in COVID-19 Patients Hospitalized in Italian Ordinary Wards: Data from the Multicenter Observational START-COVID Register.

Background Coronavirus disease 2019 (COVID-19) infection causes acute respiratory insufficiency with severe interstitial pneumonia and extrapulmonary complications; in particular, it may predispose to thromboembolic disease. The reported incidence of thromboembolic complications varies from 5 to 30% of cases. Aim We conducted a multicenter, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe the clinical characteristics of patients at admission and bleeding and thrombotic events occurring during the hospital stay. Results The number of hospitalized patients included in the START-COVID-19 Register was 1,135, and the number of hospitalized patients in ordinary wards included in the study was 1,091, with 653 (59.9%) being males and 71 years (interquartile range 59–82 years) being the median age. During the observation, two (0.2%) patients had acute coronary syndrome episodes and one patient (0.1%) had an ischemic stroke; no other arterial thrombotic events were recorded. Fifty-nine patients had symptomatic venous thromboembolism (VTE) (5.4%) events, 18 (30.5%) deep vein thrombosis (DVT), 39 (66.1%) pulmonary embolism (PE), and 2 (3.4%) DVT+PE. Among patients with DVT, eight (44.4%) were isolated distal DVT and two cases were jugular thrombosis. Among patients with PE, seven (17.9%) events were limited to subsegmental arteries. No fatal PE was recorded. Major bleeding events occurred in nine (1.2%) patients and clinically relevant nonmajor bleeding events in nine (1.2%) patients. All bleeding events occurred among patients receiving thromboprophylaxis, more frequently when treated with subtherapeutic or therapeutic dosages. Conclusion Our findings confirm that patients admitted to ordinary wards for COVID-19 infection are at high risk for thromboembolic events. VTE recorded among these patients is mainly isolated PE, suggesting a peculiar characteristic of VTE in these patients.

Cost-Effectiveness, Burden of Disease and Budget Impact of Inclisiran: Dynamic Cohort Modelling of a Real-World Population with Cardiovascular Disease.

ObjectiveWe aimed to estimate the cost-effectiveness, burden of disease and budget impact of inclisiran added to standard-of-care lipid-lowering therapy in the real-world secondary cardiovascular prevention population in Switzerland.MethodsAn open-cohort Markov model captured event risks by sex, age and low-density lipoprotein cholesterol based on epidemiological and real-world data. Low-density lipoprotein cholesterol reduction with add-on inclisiran was based on trial results and translated to meta-analysis-based relative risks of cardiovascular events. Unit costs for 2018 were based on publicly available sources, adopting a Swiss healthcare system perspective. Price assumptions of Swiss francs (CHF) 500 and CHF 3,000 per dose of inclisiran were evaluated, combined with uptake assumptions for burden of disease and budget impact. The assessment of cost-effectiveness used a discount rate of 3% per year. We performed deterministic and probabilistic sensitivity analyses, and extensive scenario analyses.ResultsPatients treated with inclisiran gained a 0.291 qualityadjusted life-year at an incremental cost per QALY gained of CHF 21,107/228,040 (life-long time horizon, discount rate 3%) under the lower/higher price. Inclisiran prevented 1025 cardiovascular deaths, 3425 acute coronary syndrome episodes, and 1961 strokes in 48,823 patients ever treated during 10 years; the 5-year budget impact was CHF 49.3/573.4 million under the lower/higher price. Estimates were sensitive to calibration targets and treatment eligibility; burden of disease/budget impact results also to uptake. Limitations included uncertainties about model assumptions and the size and characteristics of the population modelled.ConclusionsInclisiran may be cost-effective at a willingness to pay of CHF 30,000 if priced at CHF 500; a threshold upwards of CHF 250,000 will be required if priced at CHF 3000. Inclisiran could enable important reductions in cardiovascular burden particularly under broader eligibility with a budget impact range from moderate to high depending on price.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-022-01152-8.

Clinical case of coronary artery aneurysm

An aneurysm of a coronary artery is considered to be its expansion by 1.5 times or more over a short distance. The relevance of this pathology is determined by the severity of complications, mainly thrombotic. According to autopsies, it is detected in approximately 1.5% of all autopsies. In the majority of cases, coronary artery aneurysms are asymptomatic, but they also can cause symptoms similar to acute coronary syndrome. A rupture of the aneurysm is a rare but potentially dangerous complication of coronary artery aneurysm. The tactics of managing patients is determined by the severity of symptoms, aneurysm localization, the dynamics of the aneurysm, the presence of myocardial infarction in the area of the altered artery blood supply, the risk of surgical intervention, the distribution and degree of atherosclerotic changes in the coronary vessels, and the possibilities of drug therapy. Reliable diagnostic methods are coronary angiography and multidetector computed tomography. The paper describes a clinical case with patient G., aged 50, who was admitted to the emergency cardiology department with a typical picture of acute coronary syndrome, with stable hemodynamics and without echocardiographic signs of ischemia or infarction. An in-depth study of the coronary system was carried out in order to determine the prospects and the need for planned percutaneous coronary intervention. Computed tomography was performed for this purpose and revealed not only high degrees of stenosis in several coronary arteries, but also structural changes in the coronary system in the form of an aneurysm of the proximal segment of the anterior interventricular branch. The results obtained with computed tomography determined the need for coronary angiography. Its data made it possible to clarify the number, location and severity of stenotic changes in the coronary arteries, as well as to determine other localizations of aneurysms of the coronary system. The summary data of the two studies made it possible to establish that the patient had both stenosing atherosclerosis of the coronary arteries and multiple aneurysms of some arteries at the same time. It was deemed appropriate to continue conservative treatment aimed at preventing recurrence of acute coronary syndrome and thrombosis of coronary artery aneurysm, treatment of hypertension and secondary prevention of atherosclerosis. This clinical case demonstrates that the combined pathology of the coronary arteries can have clinical manifestations in the form of a single episode of acute coronary syndrome.

ACUTE CORONARY SYNDROME AND COVID 19 ARDS: A RARE CASE REPORT OF REFRACTORY HYPERCOAGULOPATHY.

Novel coronavirus disease 2019 (COVID-19) is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS), it is also presenting as severe hypercoagulable state, leading to serious complications such as pulmonary embolism (PE),[4] cerebral infarction,[5,6] or venous thromboembolism (VTE).[7]Less common manifestations include renal artery thrombosis,[8] acute myocardial injury,[9] and mesenteric ischemia.[10,11] Here we present a case of 40 year old non diabetic patient came with chief complaints of fever,dry cough and generalized bodyache which was diagnosed as having covid 19 pneumonia by RTPCR testing the next day. Patient had recurrent fever spikes, desaturation, tachycardia, Raised HbA1c on the third day. He was started on T. Favipinavir, followed by Inj.Remdesivir. Patient had worsening symptoms and landed up in cytokine storm on the 7th day. After giving 2 injections of Tocilizumab and 2 Convalescent plasma transfusions patient improved but had complications of fungal infections, post covid coagulopathy avascular necrosis of Femur Head and new onset diabetes mellitus. After being asymptomatic for 1 year patient had episode of Acute coronary syndrome. Patient was managed with Inj.Tenecteplase and underwent Coronary angiography which was suggestive of Thrombotic single vessel coronary artery disease of left anterior descending artery (LAD). As Pharmacoinvasive approach patient underwent percutaneous transluminal coronary angioplasty to LAD and was discharged asymptomatic. Patient had no cardiac or respiratory complaints on follow up.

Depression after a first coronary acute syndrome: Prevalence and predictive factors

Post Acute Coronary Syndrome (ACS) depression is a common manifestation that can interfere with the management of ACS. The identification of patients at risk of developing this disorder will ensure overall management of coronary artery disease. Estimate the prevalence of post ACS depression following a first episode of ACS and identify predictive factors for the onset of this disorder. We conducted a prospective, multicentric study across four cardiology departments from June to December 2018. We included hospitalized patients for a first episode of ACS. A screening of depressive symptoms was performed using the Hospital Anxiety and Depression Scale, in two stages, in-hospital (T0) and between 30 and 59 days after hospital discharge (T1). We enrolled 110 patients. The prevalence of depressive symptomatology at T0 and T1 was respectively 19.1% and 12.7%. At T0, drinking alcohol was the only independent predictor of depression ( P = 0.01; adjusted OR = 4.68; CI 95% :1.449-15.107). At T1, depression was significantly associated with drinking alcohol, non performining coronary angiography and a high risk for mortality assessed by the GRACE score. No factor was linked to depression in multivariate study. The high prevalence of post ACS depressive symptomatology reflects the importance of mental health of coronary patients. A collaboration between cardiologists and psychiatrists is needed to improve the quality of life of coronary patients.

Assessment of Metabolic Risk Factors and Heart-Healthy Lifestyle in Atherosclerotic Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention after a 6-Month Follow-Up.

Background:Mortality due to acute coronary syndrome (ACS) has dramatically diminished because of performing life-saving interventions. This study aims to assess the metabolic risk factors and heart healthy lifestyle following the first episode of ACS under percutaneous coronary intervention (PCI) treatment after the 6-month follow-up.Materials and Methods:This is a longitudinal study conducted on 40 patients who underwent PCI because of the first episode of ACS. The patients' information including age, weight, abdominal circumference, smoking, functional capacity, patients' metabolic equivalent of task (METS), and laboratory tests including triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine, fasting blood sugar (FBS), and hemoglobin A1C were recorded before discharge and reassessed after 6-month follow-up.Results:The patients were dominantly male (92.5%) with an average age of 56.8 ± 7.11 years. Physical activity and functional capacity (METS) significantly improved within 6 months (P = 0.019). BMI significantly improved; however, although the abdominal circumference decreased, it was not significant (P = 0.28). The number of smokers (P = 0.12) and the daily number of smoked cigarettes (P = 0.37) nonsignificantly decreased within 6 months. However, HDL-C (P = 0.013) and LDL-C (P = 0.027) changes were not desirable. TG, FBS, and blood pressure did not statistically significant change (P > 0.05).Conclusion:Although BMI, physical activity, and METS remarkably improved, waist circumference decreased nonsignificantly and lipid profile got worse paradoxically. Although this population is limited for generalization, this study shows that we require further schedules to improve ACS secondary prevention practice in our community.