Incidence Of Composite Endpoint Research Articles

The prevalence and prognostic impact of low voltage zone in patients with cardiomyopathy after catheter ablation for atrial fibrillation

Abstract Background The low voltage zone (LVZ) in left atrium (LA) was observed in 20-30% of patients undergoing catheter ablation of atrial fibrillation (AF). Furthermore, LVZ was associated with not only AF recurrence but also prognosis. However, the prevalence and prognostic impact of LVZ in patients diagnosed with cardiomyopathy remained unclear. Purpose In this study, we focused on the patients with cardiomyopathy after AF ablation and investigated the prevalence and prognostic impact of LVZ after AF ablation. Methods This study is a single-center retrospective observational study. We enrolled 125 patients diagnosed with cardiomyopathy. All patients underwent voltage mapping after pulmonary vein isolation. LVZ was defined as regions where bipolar peak-to-peak voltage was <0.5mV. We set 5 cm² as the cutoff of the presence of LVZ. The etiology of cardiomyopathy was divided into arrhythmia-induced cardiomyopathy (AICM) and non-AICM consisting of idiopathic dilated cardiomyopathy (iDCM), hypertrophic cardiomyopathy (HCM), ischemic cardiomyopathy (ICM), transthyretin amyloidosis wild type (ATTRwt) and others (1 Fabry disease, 1 cardiac sarcoidosis, 1 restrictive cardiomyopathy). AICM was defined as patient whose LVEF was recovered above 50% after maintenance of sinus rhythm. We investigated the proportion of LVZ by etiology, and the association between LVZ and the composite endpoint consisting of all cause death, heart failure hospitalization, ventricular assisting device implantation, ventricular arrhythmia and stroke. Results Out of 125 patients [age 68 (58-73), female 32 (25%), LVEF 34.0 (25-43)], 51 (41%) had LVZ. Sixty-four patients were AICM etiology (LVEF pre to post: 30.7±10.7% to 61.1±6.7% ) and 61 was Non-AICM etiology (LVEF: 40.7 ± 18.1 to 44.7±15.7, P=0.0062). The presence of LVZ was lower in AICM than in non-AICM group (20.3% vs. 62.3%, P<0.0001). The etiology of non-AICM was consisting of 26 iDCM, 18 HCM, 7 ICM, 7 ATRRwt and 3 other etiology. The prevalence of LVZ was lower in AICM than in non-AICM (20.3 vs. 62.3%, P<0.0001). Detail is shown in Figure 1. Next, the incidence of composite endpoint was higher in patients with LVZ than in those without (HR 4.6, 95%CI 2.1-10.0, P=0.0001) (Figure 2A). Among 4 groups stratified by AICM/non-AICM and with/without LVZ, there was significant difference in the incidence of the composite endpoint (Figure 2B, P<0.0001). After adjusted with age, gender, Non-AICM, LVZ, LVZ tended to have association with composite endpoint (2.21, 0.87-5.65, P=0.097) and Non-AICM showed strong association (5.58, 1.55-20.12, P=0.0086). LVZ was associated with HF hospitalization (4.35, 1.21-15.61, P=0.024). Conclusions The prevalence of LVZ was 60% in Non-AICM, while it was 20% in AICM. LVZ tended to be associated with poor prognosis of cardiomyopathy after AF ablation. LVZ was associated with HF hospitalization in patients with cardiomyopathy. LVZ might be the marker for poor prognosis in cardiomyopathy cohort.

The dynamics of urine sodium concentration after intra-venous furosemide in patients with acute heart failure

Abstract Background The urine sodium concentration measured at 2 hours after the administration of intravenous (IV) furosemide in patients with acute heart failure (AHF) is recommended as a marker to assess the responsiveness to IV furosemide. However, little is known regarding the dynamics of natriuresis in the very acute phase after IV furosemide and its association with prognosis in patients with AHF. Purpose The aim of this study is to investigate the dynamics of natriuresis in the very acute phase after IV furosemide and its prognostic implication in patients with AHF. Methods DIURESIS-AHF (Diuretic Resistance Measured by Sodium Excretion and Urine Output in Acute Heart Failure) is a multicenter, prospective, and observational study that evaluated the urine samples at the time of 0h, 1h, 2h, 6h, and 24h after the first administration of IV furosemide in hospitalized patients with AHF. Results After excluding 20 patients who needed additional IV furosemide within the first 6 hours, and 9 patients with missing data about 1h-spot urine sample, 84 patients with AHF (79±8 years, 55% men) were analyzed. Median N-terminal pro-brain natriuretic peptide levels at admission were 4722 [interquartile: 2616-8095] pg/mL, and median first IV furosemide doses were 20 [interquartile:20-20] mg. 29 combined event of all-cause death and heart failure rehospitalization were observed during a 1-year follow-up after registration. Urine sodium concentration corrected for urine creatinine concentration peaked 1 hour and decreased at 2 hours after IV furosemide. Kaplan-Meier curve analysis indicated that 1h urine sodium concentration below 50 mEq/L was significantly associated with a high incidence of composite endpoint (Log-rank P=0.033), and this association was retained even after adjusting for age and sex (hazard ratio, 2.37 [95% CI, 1.03-5.45]; P=0.042), but 2h urine sodium below 50 mEq/L was not associated with a poor prognosis (Log-rank; P=0.630). Conclusions Urinary sodium excretion after IV furosemide administration peaked at 1 hour after IV furosemide and decreased at 2 hours in patients with AHF. The urine sodium concentration below 50 mEq/L at 1 hour, but not 2 hours, was associated with adverse events.Urine Na trajectoriesKaplan Meier curves

A comparison of the management and five-year outcomes of patients treated for chronic coronary syndrome between 2006-2007 and 2015-2016 - insights from the PRESAGE registry.

Changes in the management of patients with chronic coronary syndromes (CCS) require continuous monitoring of results of treatment in daily clinical practice. The present study contains a comparison of the clinical characteristics, management, and in-hospital and five-year outcomes of patients with CCS enrolled on the Prospective REgistry of Stable AnGina management and trEatment (PRESAGE). A group of 3475 patients with CCS were selected who underwent coronary angiography and were divided into two groups who were treated in the years 2006-2007 (1300 [37.4%]) - group I, and during 2015-2016 (2175 [62.6%] - group II). The composite endpoints involved death, non-fatal myocardial infarction (MI), and acute coronary syndrome-driven revascularization. Comparing patients from group I to those from group II, group I were younger; 61.8 (54.9-68.5) vs. 66.1 (59.7-72.7) years respectively, with a higher incidence of previous MI and percutaneous intervention. Patients from the group II had a higher incidence of hypertension, diabetes, obesity, atrial fibrillation, New York Heart Association class III or more. The incidence of the composite endpoints did not vary significantly between the two groups during the entire period after the index hospitalization, but patients from the group I had a lower mortality rate both within three and five years after discharge (8.5% vs. 10.7, p = 0.03 and 13.2% vs. 17.9%, p < 0.001, respectively). Patients treated during 2006-2007 and 2015-2016 differed in age, clinical characteristics, and comorbidities. The composite endpoint incidence was similar in both groups,butlong-term mortality rates werehigherin the 2015-2016 cohort.

The Effect of Teleprehabilitation on Adverse Events After Elective Cardiac Surgery: A Randomized Controlled Trial

BackgroundPatients scheduled for cardiac surgery and procedures often present with modifiable risk factors for adverse perioperative outcomes. Prehabilitation has shown potential to enhance mental and physical fitness; however, its effect on clinical cardiovascular endpoints in this population has not been studied. ObjectivesThe current trial was designed to evaluate the effect of a personalized multimodal teleprehabilitation on the incidence of composite endpoint on major adverse cardiovascular events in patients scheduled for elective cardiac surgery. MethodsIn a multicenter randomized controlled trial, 394 patients awaiting elective cardiac surgery and procedures were enrolled. Of these, 197 patients were randomized to an online multimodal personalized teleprehabilitation program through shared decision-making by a multidisciplinary team, and 197 were assigned to a control group. The primary outcome was major adverse cardiovascular events (ie, cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure or other life-threatening cardiac events, and earlier or repeated intervention), as measured from the randomization until 1-year postoperatively. All events were adjudicated by a blinded event committee. Secondary outcomes included length of hospital stay, postoperative complications, quality of life, adherence to the program, and effect on the incidence of modifiable risk factors. Sensitivity analyses of the primary outcome were conducted adjusting for baseline characteristics to evaluate the consistency of treatment effects. ResultsFrom randomization until 1 year postoperatively, the primary endpoint occurred in 33 patients (16.8%) in the teleprehabilitation group and 50 patients (25.5%) in the control group (difference 8.8%; 95% CI: 0.7%-16.8%; P = 0.032). This difference was primarily driven by a reduction in hospitalizations, and the sensitivity analyses showed that treatment effect was mainly in the patients undergoing a cardiac surgery rather than transcatheter procedures with adjusted OR of 0.54 (95% CI: 0.30-0.96; P = 0.035). Teleprehabilitation also reduced the incidence of active smokers, elevated pulmonary risk scores, and elevated depression scores. There was no significant difference in postoperative length of hospital stay, occurrence of postoperative complications, physical fitness, incidence of obesity, or malnutrition. ConclusionsMultimodal personalized teleprehabilitation resulted in a clinically relevant and statistically significant reduction of the primary endpoint in patients undergoing cardiac surgery. (Digital Cardiac Counseling Trial: DCC Trial [DCC]; NCT04393636)

Neutrophil-to-lymphocyte ratio and prognostic nutritional index in predicting composite endpoint of early safety following transcatheter aortic valve replacement.

The incidence of composite endpoint of early safety (CEES) after transcatheter aortic valve replacement (TAVR) has been a topic of focus within the cardiovascular field due to its impact on long-term patient outcomes. Timely prophylactic interventions are crucial for patients identified as high risk for CEES through preoperative risk stratification. This study aimed to explore the connection between inflammatory and nutritional markers, specifically the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI), and CEES occurrence. A cohort of 134 patients undergoing TAVR in a single center was studied. The study endpoint was the occurrence of CEES, which was defined according to the Valve Academic Research Consortium 3. The CEES was reached in 25.4% of patients at 30 days. A high NLR was associated with a 5.55-fold increased risk of CEES (95% confidence interval (95% CI): 1.52-20.29; p < 0.05), while a low PNI was linked to a 4.43-fold increased risk (95% CI: 1.55-12.65; p < 0.01). Combining NLR and PNI provided additional risk stratification for high-risk patients (hazard ratio (HR), 95% CI: 2.24-43.37; p < 0.005). A high NLR and low PNI were shown to be significant predictors of CEES following TAVR. These findings underscore the significance of NLR and PNI in the risk assessment of TAVR patients, offering valuable insights for preventive measures.

Incidence and Predictors for Recurrence of Ventricular Arrhythmia Presenting During Acute Myocarditis: A Multicenter Study

BackgroundManagement of acute myocarditis (AM) patients experiencing ventricular arrhythmia (VA) during acute illness is controversial, especially regarding early implantable cardioverter-defibrillator (ICD) implantation. ObjectivesThe purpose of this study was to evaluate the prevalence of and find predictors for long-term sustained VA recurrence and overall mortality among AM patients with VA. MethodsThis was a multicenter retrospective analysis of AM patients (verified by cardiac magnetic resonance imaging or myocardial biopsy) with documented VA during the acute illness (“initial VA”). Patients with history of myocardial infarction, heart failure, or VA were excluded. The study endpoint was a composite of sustained VA and overall mortality during follow-up. ResultsThe study included 69 AM patients with initial VA: sustained monomorphic ventricular tachycardia (MMVT) (n = 25), sustained polymorphic ventricular tachycardia (VT)/ventricular fibrillation (n = 13), and nonsustained VT (n = 31). Age was 44 ± 13 years, and 23 of 69 (33.3%) were women. During median follow-up of 5.5 years, 27 of 69 (39%) patients reached the composite endpoint including sustained VA (n = 24) and death (n = 11). Initial MMVT, predischarge left ventricular dysfunction (left ventricular ejection fraction <50%), and anteroseptal delayed enhancement on cardiac magnetic resonance imaging were significantly associated with the composite endpoint. On multivariable analysis, initial MMVT (HR: 5.17; 95% CI: 1.81-14.6; P = 0.001) and predischarge LV dysfunction (HR: 4.57; 95% CI: 1.83-11.5; P = 0.005) were independently associated with the composite endpoint. Using these 2 predictors, we could delineate subgroups with low (∼4%), medium (∼42%), and high (∼82%) 10-year incidence of composite endpoint. ConclusionsAM patients presenting with VA have high incidence of sustained VA recurrence and mortality posthospitalization. Initial MMVT and predischarge LV dysfunction are independently associated with VA recurrence and mortality. Implantable cardioverter-defibrillator implantation may be considered in such high-risk patients.

Prognostic value of noninvasive programmed stimulation in primary prevention implantable cardioverter‐defibrillator recipients

AbstractBackgroundImplantable cardioverter‐defibrillator (ICD) offers an opportunity to study inducibility of ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing noninvasive programmed ventricular stimulation (NIPS). Whether NIPS can predict future arrhythmic events or mortality in patients with primary prevention ICD, has not yet been examined.MethodsFrom the NIPS‐ICD study (ClinicalTrials ID: NCT02373306) 41 consecutive patients (34 males, age 64 ± 11 years, 76% ischemic cardiomyopathy [ICM]) had ICD for primary prevention indication. Patients underwent NIPS using a standardized protocol of up to three premature extrastimuli at 600, 500 and 400 ms drive cycle lengths. NIPS was classified as positive if sustained VT or VF was induced. The study endpoint was occurrence of sustained VT/VF during the follow‐up.ResultsAt baseline NIPS, VT/VF was induced in 8 (20%) ICM patients. During the 5‐year follow‐up, the VT/VF occurred in 7 (17%) patients, all with ICM. The difference between NIPS‐inducible versus NIPS‐noninducible patients regarding VT/VF occurrence did not meet statistical significance (38% vs. 12%, log rank test p = .11). After a 5‐year follow‐up, the mortality rate was significantly higher in patients who had VT/VF induced at NIPS versus no VT/VF at NIPS (38% vs. 12%, p = .043). The occurrence of a composite endpoint consisting of VT/VF recurrence or death in patients with ICM was also most frequent in the NIPS‐inducible group (75% vs. 35%, p = .037).ConclusionsInducibility of VT/VF during NIPS in ICM patients with primary prevention ICD is associated with higher mortality and higher incidence of composite endpoint consisting of death or VT/VF during a long‐term observation.

Catheter ablation of atrial fibrillation in patients with left bundle branch block.

Left bundle branch block (LBBB) and atrial fibrillation (AF) are commonly coexisting conditions. The impact of LBBB on catheter ablation of AF has not been well determined. This study aims to explore the long-term outcomes of patients with AF and LBBB after catheter ablation. Forty-two patients with LBBB of 11,752 patients who underwent catheter ablation of AF from 2011 to 2020 were enrolled as LBBB group. After propensity score matching in a 1:4 ratio, 168 AF patients without LBBB were enrolled as non-LBBB group. Late recurrence and a composite endpoint of stroke, all-cause mortality, and cardiovascular hospitalization were compared between the two groups. Late recurrence rate was significantly higher in the LBBB group than that in the non-LBBB group (54.8%vs. 31.5%, p=.034). Multivariate analysis showed that LBBB was an independent risk factor for late recurrence after catheter ablation of AF (hazard ratio [HR] 2.19, 95% confidence interval [CI] 1.09-4.40, p=.031). LBBB group was also associated with a significantly higher incidence of the composite endpoint (21.4%vs. 6.5%, HR 3.98, 95% CI 1.64-9.64, p=.002). LBBB was associated with a higher risk for late recurrence and a higher incidence of composite endpoint in the patients underwent catheter ablation.

Sex-specific impact of mild obesity on the prognosis of ST-segment elevation myocardial infarction

This study aimed to clarify the existence of the mild obesity paradox in patients with ST-segment elevation myocardial infarction (STEMI) and assess the impact of mild obesity on the prognosis of STEMI. A retrospective cohort study was conducted on STEMI patients who underwent percutaneous coronary intervention at Xiangtan Central Hospital from January 1, 2020 to July 31, 2022. After excluding individuals with a body mass index (BMI) of no less than 35 kg/m2, subjects were divided into the mildly obese group (BMI, 30–35 kg/m2) and non-obese group (BMI < 30 kg/m2). The cardiovascular events and death were deemed the composite endpoints and were employed as the outcome event. The study recruited 664 patients with STEMI, including 515 males and 149 females. The mildly obese group of male patients exhibited a lower incidence of composite endpoints than the non-obese group (22.4% vs. 41.3%, P < 0.001). For female patients, no significant difference was observed in the incidence of composite endpoints between the two groups (43.6% vs. 43.8%, P = 0.987). After adjusting for confounding factors, the multivariable Cox regression analysis revealed mild obesity as an independent protective factor for male patients [hazard ratio (HR) 0.47; 95% confidence interval (CI) 0.32–0.69; P < 0.001]. Nevertheless, mild obesity was not associated with the prognosis of female patients (HR 0.96; 95% CI 0.47–1.94; P = 0.9). In male STEMI patients, mild obesity presented a paradoxical effect in improving the prognosis and functioned as an independent protective factor for the prognosis of STEMI. However, no association between mild obesity and prognosis was found in female patients, possibly due to distinct physiological and metabolic characteristics between male and female patients, which deserved further investigation and validation.

Prognostic impact of atrial cardiomyopathy: Long-term follow-up of patients with and without low-voltage areas following atrial fibrillation ablation

BackgroundAtrial cardiomyopathy is known as an underlying pathophysiological factor in the majority of patients with atrial fibrillation (AF). Left atrial low-voltage areas (LVAs) are reported to coincide with fibrosis and likely represent atrial cardiomyopathy. ObjectiveThe purpose of this study was to delineate differences in the long-term prognosis of patients stratified by the size of LVAs. MethodsThis observational study included 1488 consecutive patients undergoing initial ablation for AF. LVAs were defined as regions with a bipolar peak-to-peak voltage <0.50 mV. The total study population was divided into 3 groups stratified by LVA size: patients with no LVAs (n = 1136); those with small (<20 cm2) LVAs (n = 250) LVAs; and those with extensive (≥20 cm2) LVAs (n = 102). Composite endpoints of death, heart failure, and stroke were followed for up to 5 years. ResultsComposite endpoints developed in 105 of 1488 patients (7.1%), and AF recurrence occurred in 410 (27.6%). Composite endpoints developed more frequently in the order of patients with extensive LVAs (19.1%), small LVAs (10.8%), and no LVAs (5.1%) (P for trend <.0001). Multivariable analysis revealed that LVA presence was independently associated with higher incidence of composite endpoints, irrespective of AF recurrence (modified hazard ratio 1.73; 95% confidence interval 1.13–2.64; P = .011) ConclusionLVA presence and its extent both were associated with poor long-term composite endpoints of death, heart failure, and stroke, irrespective of AF recurrence or other confounders. Underlying atrial cardiomyopathy seems to define a poor prognosis after AF ablation.

Abstract 15085: Analysis of the Composite of Death and Stroke at Follow-Up Among Risk Profiles in Trials Comparing Transcatheter and Surgical Aortic Valve Implantation. A Systematic Review and Meta-Analysis

Introduction: To compare the effectiveness of transcatheter vs surgical aortic valve implantation on mid-term composite of death for any cause or stroke within high, intermediate and low-risk profiles. Methods: We performed a systematic review of the literature between 2007 and 2023 including randomized controlled trials comparing a composite of all-cause mortality or stroke of transcatheter vs surgical aortic valve replacement. Hazard ratios (HRs) and restricted mean survival time (RMST) differences within high, intermediate and low-risk profiles were estimated by reconstructing time-to-event data from Kaplan-Meier curves. Results: Seven trials were included (8418 participants). The incidence of composite endpoint increases concordantly with higher risk profiles for both treatments. A time variant effect unites all the risk profiles with transcathteter superior to surgery early and a trend toward HR reversal after 24 months, also supported by an cumulative additional time-to-event of 0.57 months at 3 years driven by high risk (95%CI 0.19 - 0.9) that is reabsorbed at 60 months, The benefit of transcatheter approach increased over time till 5 years in high risk, while intermediate and low risk showed a similar quadratic association (a parameter -0.0004, 95%CI -0.0008 - 0, p-value 0.05; b parameter 0.029, 95%CI 0.012 - 0.046, p-value 0.001), with a smaller increase of the transcatheter that is reabsorbed after a nadir at 36 months. Conclusions: There is a different trend of benefit of transcatheter approach within risks. TAVI maintains a benefit over surgery at 5-years in high risk, while its advantage is smaller and runs out at 5 years in the low-mid risk groups.

Prevalence and Clinical Outcomes of Noncardiac Surgery After Transcatheter Aortic Valve Replacement

BackgroundAortic stenosis (AS) is a prevalent valvular heart disease, especially among the elderly. They often coexist with other comorbidities, and noncardiac surgery carries a higher risk due to the underlying valve condition. Despite the growing concern about the safety and optimal management of non-cardiac surgery post-transcatheter aortic valve replacement (TAVR), there is limited evidence on this matter. This study aims to assess the clinical outcomes of non-cardiac surgeries following TAVR. Methods and ResultsThis retrospective study included 718 patients who underwent TAVR. Of these, 36 patients underwent non-cardiac surgery after TAVR. The primary endpoint was the incidence of cardiovascular adverse events post-TAVR and the secondary endpoint was the incidence of structural valve deterioration (SVD). Composite endpoints included disabling stroke, heart failure requiring hospitalization, and cardiac death as defined by VARC3. Most of these surgeries were orthopedic and classified as intermediate risk. All non-cardiac surgeries were performed without perioperative adverse events. There was no observed SVD, and the incidence of composite endpoints did not significantly differ between the surgical and non-surgical groups during the follow-up period. ConclusionNon-cardiac surgery after TAVR can be performed safely and does not have a negative impact on prognosis. Further studies are warranted to determine the optimal strategy for non-cardiac surgery post-TAVR.

Prognostic impact of remote dielectric sensing value following TAVR.

Remote dielectric sensing (ReDS) system non-invasively quantifies pulmonary congestion. Re-admission following trans-catheter aortic valve replacement (TAVR) remains an unsolved matter. Residual pulmonary congestion is a strong risk factor of worse clinical outcomes in patients with heart failure. ReDS system may have a prognostic impact in patients undergoing TAVR. Patients who received TAVR and ReDS measurements during index hospitalization between 2021 and 2022 were included. The prognostic impact of ReDS value on the composite endpoint of death or re-admission following index discharge was investigated. Totally, 42 patients (median 84years, 14 men) were included. Median ReDS value at index discharge was 27% (24%, 30%) and 10 patients had ReDS values > 30%. During a median of 316 (282, 354) days following index discharge, a higher ReDS value at baseline was independently associated with the incidence of composite endpoint with an adjusted hazard ratio of 1.32 (95% confidence interval between 1.10 and 1.58) with a calculated cutoff of 30%, which significantly stratified the cumulative incidence of the composite endpoint (78% in the high ReDS group [N = 10] and 36% in the normal ReDS group [N = 32], p = 0.002). ReDS technology may be a promising tool to predict future clinical outcomes following TAVR by quantifying residual pulmonary congestion. The clinical implication of ReDS-guided aggressive intervention following TAVR remains the next concern.

Prevalence and clinical implications of polypharmacy and potentially inappropriate medication in elderly patients with heart failure: results of six months' follow-up.

To investigate the prevalence of polypharmacy and potentially inappropriate medication (PIM) in elderly patients with heart failure (HF) and their impact on readmission and mortality. We conducted a study of 274 participants aged 60 years or older with HF. The prevalence of polypharmacy (defined as the use of five or more medications) was calculated, and the 2019 American Geriatrics Society Beers criteria were applied to access PIMs. Medications and PIMs were characterized at admission and discharge, and changes in prescriptions during hospitalization were compared. The impact of polypharmacy and PIM on readmission and mortality were investigated. The median age of this study population was 68 years old. The median number of prescribed drugs was 7 at admission and 10 at discharge. At discharge, 99.27% of all patients were taking five or more drugs. The incidence of composite endpoint and cardiovascular readmission increased with the number of polypharmacy within 6 months. The use of guideline-directed medical therapy reduced the incidence of composite endpoint events and cardiovascular readmission, while the use of non-cardiovascular medications increased the composite endpoint events. The frequency of PIMs was 93.79% at discharge. The incidence of composite endpoint events increased with the number of PIMs. "PIMs in older adults with caution" increased cardiovascular readmission and "PIMs based on kidney function" increased cardiovascular mortality. Several comorbidities were associated with cardiovascular mortality or non-cardiovascular readmission. Polypharmacy and PIM were highly prevalent in elderly patients with HF, and their use was associated with an increased risk of composite endpoint events, readmission and mortality. Non-cardiovascular medications, "PIMs in older adults with caution", "PIMs based on kidney function" and several comorbidities were important factors associated with hospital readmission and mortality. Our findings highlight the importance of medication optimization in the management of HF in elderly patients.

Efficacy and safety of Ginkgo biloba dropping pills in the treatment of coronary heart disease with stable angina pectoris and depression: study protocol for a randomised, placebo-controlled, parallel-group, double-blind and multicentre clinical trial

BackgroundCoronary heart disease(CHD) with stable angina pectoris is a common cardiovascular disease. It has been reported that 10%–81.4% of these patients suffer from psychological conditions,such as depression, which has been...

Clinical Outcomes of Unprotected Left Main Stem Stenting: An Observational Single-Centre Study

Objectives: To know the clinical outcomes of percutaneous intervention (PCI) with drug eluting stents (DES) in patients with unprotected left main stem disease. Materials and Methods: This single-centre, prospective, observational study was conducted on 133 patients, who underwent PCI using DES to an unprotected LMS at Kuwait teaching Hospital Peshawar, between 2018 to 2022. Patients were followed in OPD and clinics or they were traced through calls at monthly and yearly intervals, after the procedure. A team, which comprised of a cardiac interventionist and a cardiac surgeon, scrutinised patients for the eligibility of either procedure. Ethical Committee approval was granted by the Institutional Ethics committee. Results: At 1month follow up, the composite end point occurred in 13 (11.58%) patients, whereas individual secondary end points including death from all-cause mortality was reported in 5 (4.7%), stroke in 1 (0.9 %), MI in 4 (3.73 %) and repeat vascularisation in 3 (2.25%) patients. The annual incidence of composite end point occurred in 27.58%patients, whereas individual secondary end points including death from all-cause mortality was reported in 10 (8.27%), stroke in 3 (2.25 %), MI in 09 (6.76%) and repeat vascularisation in 11 (10.3%) patients, Conclusion: PCI to LMS can be performed safely in centres having no cardiac surgery backup and newer imaging modalities with results comparable to the centres having the luxury of such facilities, provided that operators are skilled enough with sufficient expertise and knowledge.

Abstract 9964: Clinical Impact of Handgrip Strength on Prognosis After Percutaneous Coronary Intervention

Introduction: Sarcopenia is defined as age-related loss of skeletal muscle mass and strength, and has been reportedly associated with cardiovascular disease. However, the impact of handgrip strength (HGS) on clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery disease has not been well investigated. Methods: This was a retrospective, single center, observational study. A total of 469 patients who underwent PCI were included. Periprocedural HGS of both hands were measured and of which better value was used for assessment. Patients were divided into 2 groups, low HGS group (men;&lt;28kg, women;&lt;18kg) and high HGS group (men;≥28kg, women;≥18kg) according to the consensus of Asian Working Group for Sarcopenia. The primary outcome was the composite endpoint of all-cause death, myocardial infarction, and heart failure readmission. Results: There were 151 patients in the low HGS group and 318 patients in the high HGS group. The age of patients in the low HGS group was significantly higher (78 [71-82] vs. 70 [61-75] years, p&lt;0.001), while the body mass index and serum albumin level were significantly lower than those in the high HGS group. During the median follow-up period of 778 days, composite endpoint occurred in 35 patients with low HGS and 29 patients with high HGS. The low HGS group had a higher incidence of composite endpoint than the high HGS group (p&lt;0.001) (Figure). The low HGS group had a higher risk of individuals of all-cause, cardiac, and non-cardiac death (p&lt;0.001, respectively). Multivariate Cox proportional hazards analysis showed that low HGS was an independent predictor for the composite endpoint (HR 1.86, 95% CI 1.04-3.33, p=0.04). Conclusions: Low HGS was independently related with long-term cardiac events after PCI.

Impact of &lt;i&gt;CYP2C19&lt;/i&gt; gene polymorphisms on clinical outcomes in patients with myocardial infarction during 12-month follow-up

Highlights. CYP2C19 gene polymorphisms in patients with acute myocardial infarction are common in clinical practice. The article assesses the role of genetic predisposition in the development of ischemic and hemorrhagic events during dual antiplatelet therapy (aspirin and clopidogrel) within the first 12 months after revascularization for acute myocardial infarction.Aim. To evaluate the impact of CYP2C19 gene *1, *2, *3, *17 alleles polymorphism on 12-month clinical outcomes in patients who underwent coronary revascularization due to acute myocardial infarction and took clopidogrel.Methods. 363 patients with acute myocardial infarction undergoing percutaneous coronary intervention were enrolled in the prospectively study in 2010–2012. CYP2C19 gene *1, *2, *3, *17 alleles polymorphism analysis was performed in all study participants. Dual antiplatelet therapy, consisting of aspirin and clopidogrel, was prescribed for 12 months. The follow-up period was 12 months, the incidence of cardiovascular death, non-fatal myocardial infarction, stroke and bleeding was assessed.Results. 12 months after inclusion in the study, the incidence of composite endpoint (defined as cardiovascular death, non-fatal myocardial infarction and stroke) was observed in 18 patients (7% [5%; 11%]; 95% CI) with wild-type CYP2C19 gene and in 12 patients (11% [6%; 18%]; 95% CI) with lost-of-function *2+*3 alleles, with no statistical difference (OR = 1.6 [0.7; 3.6], 95% CI; p = 0.301). Presence of any LOF-alleles did not predict composite endpoint events (OR = 1.56 [0.71; 3.34], 95% CI, p&lt;0.253). Multivariable logistic regression analysis revealed that CYP2C19*2 homozygotes have higher risk of composite endpoint (OR = 6.34, 95% CI [1.57; 22.23], p&lt;0.005) and myocardial infarction (OR = 5.45, 95% CI [1.14; 19.97], p&lt;0.016) compared to *2 heterozygotes and wild-type carriers. 14 patients had major bleedings, required blood transfusion or hospitalization. Patient’s age, increase in creatinine level and gain-of-function (GOF) CYP2C19*17 homozygotic carriage were identified as the predictors of major bleeding during follow-up period.Conclusion. In this study CYP2C19 LOF alleles polymorphism except the CYP2C19*2 homozygotic carriage demonstrated no impact on the incidence of ischemic events during 12-month follow-up in patients with acute MI who underwent successful revascularization. CYP2C19*17 homozygotes demonstrated increased risk of major bleeding only in young individuals with elevated blood creatinine levels.

Prognostic value of apical rocking and septal flash after cardiac resynchronization

Introduction and objectivesApical rocking (ApR) and septal flash (SF) evaluated using echocardiography are mechanical consequences of left bundle branch block. Their presence is associated with effectiveness after cardiac resynchronization therapy (CRT) and better prognosis. The aim was to analyze the relationship between ApR and SF before CRT and the outcomes. MethodsRetrospective observational registry of 96 patients treated with CRT. ApR and SF were visually assessed by readers blinded to the CRT outcomes. The primary endpoint was a composite of all-cause death and heart failure hospitalization. ResultsApR or SF were present in 55% of the patients before CRT. At baseline, patients with ApR or SF were younger and had lower hemoglobin levels. The median follow-up was of 42 months. Composite endpoint incidence rate of the was 1.22 for 100 patients/year. The composite endpoint was significantly lower in the ApR or SF group as well as the heart failure hospitalization (17 vs 49%; P=.001). This group also improved the number of meters walked at the six-minute walking test (median [p25–p75] 61m (0–101) vs 6 (−11–37); P=.054) and the rate of CRT echocardiographic super-responders (26.5% vs 5.4%; P=.009). In multivariate analysis, the presence of Ap-Rock or SF (hazard ratio, 0.36; 95%CI, 0.15-0.86; P=.019), female sex, hemoglobin, and logarithm N-terminal pro B-type natriuretic peptide (logNT-proBNP) were associated with the composite endpoint. ConclusionsSF or ApR were present before the biventricular pacemaker implantation in more than half of the patients with CRT indication and were associated with lower all-cause mortality and heart failure hospitalization and improved functional status and left ventricle ejection fraction at follow-up.

Invasive versus conservative strategy in the very elderly with non-ST-elevation acute coronary syndrome: A meta-analysis of randomized controlled trials.

To investigate the optimal treatment strategy in patients older than 80 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). All published randomized, placebo-controlled trials (RCTs) reporting on comparisons between invasive and conservative strategies for patients aged 80 years or older with NSTE-ACS were identified. The literature search was performed using PubMed, EMBASE, Cochrane Library, and the ISI Web of Science, from their establishment to July 2021 with no language restriction. The pooled risk ratios (RRs) with 95% confidence intervals (CI) for dichotomous outcomes were calculated. Three RCTs involving a total of 893 cases met the inclusion criteria. Compared with the conservative group, the invasive strategy could significantly improve the incidence rate of composite endpoint (I2 = 21.9%; RR 0.727, 95% CI 0.619 to 0.855, P < 0.001), recurrent myocardial infarction (MI) (I2 = 0.0%; RR 0.585, 95% CI 0.441 to 0.776, P < 0.001) and revascularization (I2 = 0.0%; RR 0.239, 95% CI 0.126 to 0.455, P < 0.001). However, no benefits were observed on outcomes of all-cause death (I2 = 0.0%; RR 0.888, 95% CI 0.681 to 1.160, P=0.384), cardiac death (I2 = 0.0%; RR 0.769, 95% CI 0.412 to 1.433, P=0.408) and stroke (I2 = 0.0%; RR 0.778, 95% CI 0.392 to 1.543, P=0.473). The major bleeding events were comparable between the two groups (I2 = 0.0%; RR 1.582, 95% CI 0.622 to 4.025, P=0.336). Compared with a conservative strategy, the invasive treatment could reduce the incidence of composite endpoint, recurrent MI, and revascularization in the very elderly with NSTE-ACS. However, no benefits were observed on mortality. Geriatr Gerontol Int 2022; 22: 36-41.