Need For Percutaneous Coronary Intervention Research Articles

Validity of TIMI Risk Score and HEART Score for Risk Assessment of Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction Presented to an Emergency Department in Jordan.

To examine the validity and predictability of thrombolysis in myocardial infarction (TIMI) risk and HEART scores in patients presenting to the emergency department (ED) with chest pain in Jordan (representative of the Middle East and North Africa Region, MENA). Risk scores were calculated for 237 patients presenting to the ED with chest pain. Patients were followed-up prospectively for the need for percutaneous coronary intervention, major adverse cardiovascular events, and all-cause mortality, looking for correlation and accuracy between the predicted cardiovascular risk from TIMI risk score and HEART score and the clinical outcome. Of the 237 patients, approximately 77% were diagnosed with unstable angina and 23% diagnosed with non-ST elevation myocardial infarction (NSTEMI). about two thirds of the study population were smokers and known to have hypertension and dyslipidaemia. In 50 patients, the primary outcome (need for percutaneous coronary intervention (PCI) and/or major adverse cardiovascular events (MACE) at days 14 and 40, all-cause mortality) was observed. Regarding the predictability of the TIMI score, a larger number of events were observed in the study population than predicted. Patients with TIMI scores of 3 to 5 have about a 5-8% higher event rate than predicted. Both TIMI and HEART risk scores were able to predict an elevated risk of major cardiovascular adverse events (MACE). The overall impression was that the TIMI risk score tended to underestimate risk in the study population.

Impact of Chronic Coronary Artery Disease and Revascularization Strategy in Patients with Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Implantation

The prognostic impact of coronary artery disease (CAD) after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study is to investigate the impact of CAD and different revascularization strategies on clinical outcomes in patients who underwent TAVI with third generation devices. Patients enrolled in the national observational Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment II study were stratified according to the presence of CAD (CAD+, n=1,130) versus no CAD (CAD-, n=1,505), and compared using a propensity matched analysis. CAD+ group was further stratified according to the revascularization strategy: no revascularization (n=331), revascularization performed >90days before index-TAVI (n=417) and coronary revascularization performed <90days before index-TAVI or during TAVI (n=382). In-hospital, 30-day and 1-year clinical outcomes were estimated. The mean age of the overall population was 81.8years; 54.9% of patients were female. Propensity score matching yielded 813 pairs and their 30-day all-cause mortality was comparable (p=0.480). Major periprocedural adverse events were also similar between the groups. At 1-year follow-up, the rate of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause mortality were similar between the groups (p=0.732 and p=0.633, respectively). Conversely, patients with CAD experienced more often myocardial infarction and need for percutaneous coronary intervention at 1year (p=0.007 and p=0.001, respectively). Neither CAD nor revascularization strategy were independent predictors of 1-year MACCE. About 40% of patients presenting with severe AS and who underwent TAVI had concomitant CAD. The presence of CAD had no impact on all-cause mortality and MACCE 1-year after TAVR. However, CAD carries a higher risk for acute myocardial infarction and need of percutaneous coronary intervention during follow-up.

Evaluating Plasma Galectin-3 Levels in Patients With an Increased Risk of Atherosclerotic Cardiovascular Disease Who Underwent Coronary Artery Revascularization

Coronary artery disease (CAD) is a common atherosclerotic cardiovascular disease (ASCVD) associated with significant mortality. Galectin-3 is a novel inflammatory factor implicated in the initiation and progression of atherosclerosis. We aimed to evaluate the association of plasma galectin-3 with the risk of ASCVD and the need for coronary artery revascularization. Patients with angina who underwent coronary angiography were divided into groups per their risk of ASCVD. Patients (n=385) were stratified into having low (n=21), moderate (n=40), high (n=41), and very high risk (n=283) for ASCVD. The mean age ± standard error of the mean was 53.9 ± 0.5years and 73% of patients were men. Plasma galectin-3 levels were higher in patients with CAD than non-CAD primarily in patients with stable and unstable angina. Patients with stable CAD had higher levels of galectin-3 relative to acute coronary syndrome patients. Increased plasma galectin-3 level was associated with increased risk of ASCVD and degree of coronary stenosis. By multivariate analysis, the plasma galectin-3 level was independently associated with increased ASCVD risk and body mass index. Plasma galectin-3 levels were independently higher in patients who underwent percutaneous coronary intervention (PCI) than medically treated patients. In addition, age, male gender, smoking, and diabetes mellitus were associated with PCI. In conclusion, plasma galectin-3 levels are elevated in patients with CAD and associated with increased risk of ASCVD and the need for PCI. Plasma galectin-3 could be used as a potential improving predictor of ASCVD risk and when making therapeutic guidance or selecting patients who underwent PCI when the decision is difficult.

IN-HOSPITAL OUTCOMES OF BILATERAL INTERNAL MAMMARY ARTERY GRAFTING

HighlightsThe present study was conducted to evaluate in-hospital outcomes of one of the most effective and simultaneously controversial surgical techniques for myocardial revascularization using two internal thoracic arteries (ITA).To this date, this is the most complete analysis that has been carried out at the Research Institute on the topic of studying bilateral internal thoracic artery grafting (BITA). The results obtained are of great importance for the subsequent evaluation of long-term results. AbstractAim. To analyze in-hospital outcomes of BITA.Methods. The study included 232 patients who were admitted to the Cardiac Surgery Department for coronary artery bypass grafting (CABG). All patients were divided into 2 groups depending on the use of either single or bilateral ITA conduits. Both groups included equal number of patients – 116. In-hospital outcomes were analyzed.Results. BITA and CABG with single ITA were proven to be comparable regarding myocardial infarction, stroke, the need for percutaneous coronary intervention, death, and composite endpoint. At the same time BITA patients significantly more often had longer hospital stay and required inotropic drugs.Conclusion. BITA is a safe procedure comparable to classic CABG in terms of in-hospital complications, but at the same time, this intervention is associated with longer hospital stay, and extended inotropic drugs use.

Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis.

Colchicine has anti-inflammatory properties, but its utility in improving cardiovascular outcomes has been disputed. Here, we study the impact of colchicine on cardiovascular outcomes in patients with gout with and without coronary artery disease (CAD). Medline, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Primary outcomes included myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Secondary outcomes included stroke and all-cause mortality. We included 4 observational studies comprising 10,026 patients with gout on treatment with colchicine. There was no significant difference in the risk of myocardial infarction (risk ratio [RR] 0.71; 95% confidence interval [CI], 0.36-1.39), need for PCI, or need for CABG, between patients on colchicine and those not receiving colchicine. Colchicine was associated with a significantly lower risk of all-cause mortality (RR 0.58; 95% CI 0.43-0.79). Non-randomized studies suggest that risk of MI, stroke and revascularization is not higher in gout patients treated with colchicine compared to gout patients without colchicine treatment.

Safety and Feasibility of Staged Versus Concomitant Transcatheter Edge-to-Edge Mitral Valve Repair After Transcatheter Aortic Valve Implantation

The data on the safety and feasibility of performing concomitant or staged transcatheter edge-to-edge repair (TEER) of the mitral valve with transcatheter aortic valve implantation (TAVI) remains limited. The Nationwide Readmission Database was used to identify TEER and TAVI procedures from October 1, 2015 to December 31, 2019, using the International Classification of Diseases, Tenth Revision, Clinical Modification administrative data. A total of 627 weighted cases of TEER and TAVI procedures were included in the analysis. Of those cases, 453 underwent staged TEER after TAVI, whereas 174 had concomitant TAVI and TEER during the same admission. Patients who underwent staged procedures were mostly men (64.8%, p=0.02) and had a higher median age of 85years (interquartile range 79 to 88) versus 82years (interquartile range 72 to 86) in the concomitant procedure group. The adjusted propensity-matched mortality rate was similar for staged versus same-admission procedures (6.1% vs 7.0%, p=0.79). In-hospital complication rates, including acute kidney injury, vascular complications, need for percutaneous coronary intervention, mechanical support, and pacemaker implantation, were higher for the same-admission TEER and TAVI group than TEER performed as a staged procedure. Nonhome facility discharges and length of hospital stay (15 vs 4days) were also significantly higher for the concomitant same-admission TEER and TAVI groups. In conclusion, there was no difference in in-hospital mortality rate between patients who underwent concomitant or staged TEER and TAVI procedures, whereas complication rates were significantly higher in the concomitant group.

Development of a risk score model for the prediction of patients needing percutaneous coronary intervention.

The incidence of coronary heart disease (CHD) is increasing worldwide. The need for percutaneous coronary intervention (PCI) is determined by coronary angiography (CAG). As coronary angiography is an invasive and risky test for patients, it will be of great help to develop a predicting model for the assessment of the probability of PCI in patients with CHD using the test indexes and clinical characteristics. A total of 454 patients with CHD were admitted to the cardiovascular medicine department of a hospital from January 2016 to December 2021, including 286 patients who underwent CAG and were treated with PCI, and 168 patients who only underwent CAG to confirm the diagnosis of CHD were set as the control group. Clinical data and laboratory indexes were collected. According to the clinical symptoms and the examination signs, the patients in the PCI therapy group were further split into three subgroups: chronic coronary syndrome (CCS), unstable angina pectoris (UAP), and acute myocardial infarction (AMI). The significant indicators were extracted by comparing the differences among the groups. A nomogram was drawn based on the logistic regression model, and predicted probabilities were performed using R software (version 4.1.3). Twelve risk factors were selected by regression analysis; the nomogram was successfully constructed to predict the probability of needing PCI in patients with CHD. The calibration curve shows that the predicted probability is in good agreement with the actual probability (C-index=0.84, 95% CI=0.79-0.89). According to the results of the fitted model, the ROC curve was plotted, and the area under the curve was 0.801. Among the three subgroups of the treatment group, 17 indexes were statistically different, and the results of the univariable and multivariable logistic regression analysis revealed that cTnI and ALB were the two most important independent impact factors. cTnI and ALB are independent factors for the classification of CHD. A nomogram with 12 risk factors can be used to predict the probability of requiring PCI in patients with suspected CHD, which provided a favorable and discriminative model for clinical diagnosis and treatment.

Prevalence and Prognostic Relevance of Modifying Anatomical Features Influencing the Measurement of Fractional Flow Reserve in Complex Situations in Daily Practice

Fractional low reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to reduce the need for PCI and to improve clinical outcome. Several anatomical features and hemodynamic parameters are well known to influence FFR determination. We evaluated the prevalence and prognostic impact of modifying anatomical features influencing the FFR- measurement on survival, myocardial infarction and the need of recurrent coronary revascularization.

Patient experience of informed consent for diagnostic coronary angiogram and follow-on treatments

Background/Aims Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results Female participants reported greater difficulty in recalling treatment information (P&lt;0.03), found discussions about alternative treatments more confusing (P&lt;0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P&lt;0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P&lt;0.002). Conclusions Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent.

Differential diagnosis of angina pectoris in the practice of the regional vascular center: a clinical observation

The leading cause of myocardial ischemia in case of coronary atherosclerosis and coronary vasospasm combination in one patient is difficult to establish. However, it is important to know for optimal treatment strategy: choosing between beta-blockers and calcium channel blockers as a preferred treatment, need for percutaneous coronary intervention. We present a case of a 56-yearold patient who was admitted with acute coronary syndrome without ST-segment elevation, low Killip class, and low GRACE score. Stress echocardiography revealed inducible transmural myocardial ischemia (regional wall motion abnormalities and ST segment elevation on the ECG) accompanied by polymorphic ventricular tachycardia. The coronary angiography showed single-vessel moderate stenosis in the left anterior descending artery. There were no changes in comparison with previous angiography. The patient was considered to have vasospastic angina. A probable mechanism is coronary artery spasm at the site of the atherosclerotic plaque. The article is discussed the difficulties in diagnosing vasospastic angina, especially in the presence of borderline stenosis in the coronary artery. We reviewed similar cases and discussed the difficulties of a vasospastic angina diagnosis especially in the presence of moderate coronary artery stenosis, the role of the provocative tests, and the pharmacological management. Demonstrating, discussing and analyzing cases of patients with a combined mechanism of myocardial ischemia is substantiated for further improving their diagnosis and treatment.

Revascularization of significant coronary artery disease in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract Background The prevalence of coronary artery disease (CAD) in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI) is high. However, the importance of a percutaneous coronary intervention (PCI) prior to TAVI has been matter of debate. Importantly, patients undergoing TAVI are characterized by high age often accompanied by highly calcified coronary arteries, increasing the risk of severe periprocedural complications. Moreover, patients with a severe aortic valve stenosis are limited in their ability to compensate for these life-threatening complications. Together with the necessity of dual antiplatelet therapy after PCI, this may explain a possible negative effect of PCI in this patient population. However, there is still insufficient evidence regarding the importance of PCI in patients undergoing TAVI. Purpose The aim of this systematic review and meta-analysis was to assess the need for PCI in patients with significant CAD undergoing TAVI. Methods A systematic search was conducted to identify studies comparing optimal medical treatment only versus PCI in patients with significant CAD undergoing TAVI. Endpoints were all-cause mortality, cardiac death, stroke, myocardial infarction, and major bleeding which were assessed at 30 days, one year, and beyond one year following TAVI. Results A total of 14 studies was included in this meta-analysis, including 3838 patients of which 1806 patients (47.1%) underwent PCI before TAVI. All-cause mortality was not significantly different between optimal medical treatment only and PCI at 30 days (OR: 1.27; 95% CI, 0.91–1.77; p=0.17; I2=0%), at one year (OR: 0.91; 95% CI, 0.64–1.29; p=0.59; I2=45%), and beyond one year (OR 0.68; 95% CI, 0.42–1.08; p=0.10; I2=49%). Cardiac death and myocardial infarction was similar across the groups at 30 days (OR cardiac death: 1.94; 95% CI, 0.36–10.56; p=0.45; I2=28%; OR myocardial infarction: 0.50; 95% CI, 0.13–1.91; p=0.31; I2=0%), and at one year (OR cardiac death: 0.77; 95% CI, 0.19–3.13; p=0.72; I2=84%; OR myocardial infarction: 0.74; 95% CI, 0.21–2.66; p=0.64; I2=18%). Stroke did not significantly differ between PCI and optimal medical treatment groups at 30 days (OR: 0.77; 95% CI, 0.31–1.92; p=0.57; I2=0%). However, patients that underwent TAVI without preceding PCI had significantly lower risk of major bleeding at 30 days (OR: 0.66; 95% CI, 0.46–0.94; p=0.022; I2=0%). Conclusion This systematic review and meta-analysis showed no significant differences in clinical outcomes between patients with and without PCI prior to TAVI at both short- and long-term follow-up, apart from a higher risk of major bleeding within 30 days in patients undergoing PCI before TAVI. Funding Acknowledgement Type of funding sources: None.

Comparison of trans-radial access and femoral access in cardiogenic shock patient who had undergone primary percutaneous coronary intervention from SMART RESCUE trial

Abstract Introduction Throughout the years of percutaneous coronary intervention (PCI), the debate regarding access route, whether it being trasns-radial or femoral, is an ongoing agenda yet to be solved. Recent guidelines suggest trans-radial approach as an option to be considered in acute coronary syndrome (ACS). However, data on cardiogenic shock patients undergoing PCI is relatively sparse. Purpose Compare the clinical implication of trans-radial and femoral approach in cardiogenic shock patients who had undergone PCI. Method Cardiogenic shock patients who had undergone PCI from January 2014 to December of 2018 were enrolled. Patients were divided according to their access route respectfully. Primary outcome was composite endpoints including all-cause death, re-admission due to heart failure, myocardial infarction (MI) and cerebrovascular accident. Result A total of 694 (572 via femoral approach, 122 via radial approach) cardiogenic shock patients who received PCI were enrolled. Mean age femoral and radial groups was 66.59±12.51 and 66.66±12.8 respectfully. Disease severity was higher for femoral patients compared to radial patients as represented by their LM involvement, mechanical organ support (extracorporeal membrane oxygenation, continuous renal replacement therapy, mechanical ventilation), left ventricular ejection fraction (LVEF) and vasoactive inotropic score. Cox regression analysis after adjusting for conventional risk factors showed that femoral route was a poor prognosticator with respect to composite endpoints (HR=2.059, 95% CI 1.249–3.397, p value = 0.005). Radial approach patients had higher survival probability compared to femoral approach patients (Figure 1). Conclusion Radial approach in cardiogenic shock patients who are in need for PCI with relatively less severe clinical condition could be a reasonable option for access route. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): Inha University Hospital

64-Year-Old Woman With Aphasia and Troponin Elevation

64-Year-Old Woman With Aphasia and Troponin Elevation

The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence

BackgroundThe prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for low-income patients, the high cost of post-PCI treatment, especially Dual Antiplatelet Therapy (DAPT), still caused many patients to prematurely discontinue the secondary prevention. Our study aimed to investigate the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence in India.MethodWe collected clinical data of 4,595 patients undergoing PCI in 110 participating medical centers in Maharashtra, India from 2012 to 2015 by electronic medical records. We surveyed 2527 adult patients who were under the insurance scheme by telephone interview, usually between 6 to 12 months after their revascularization. Patients reporting DAPT continuation in the telephone survey were categorized as DAPT adherence. The outcome of the interest was all-cause mortality within 1 year after the index procedure. Multivariate Cox proportional hazard (PH) model with adjustment of potential confounders and standardization were used to explore the effects of DAPT adherence on all-cause mortality. We further used a multivariate logistic model to investigate the potential determinants of DAPT adherence.ResultsOut of the 2527 patients interviewed, 2064 patients were included in the analysis, of whom 470 (22.8%) discontinued DAPT prematurely within a year. After adjustment for baseline confounders, DAPT adherence was associated with lower one-year all-cause mortality compared to premature discontinuation (less than 6-month), with an adjusted hazard ratio (HR) of 0.52 (95% Confidence Interval (CI) = (0.36, 0.67)). We also found younger patients (OR per year was 0.99 (0.97, 1.00)) and male (vs. female, OR of 1.30 (0.99, 1.70)) had higher adherence to DAPT at one year as did patients taking antihypertensive medications (vs. non medication, OR of 1.57 (1.25, 1.95)).ConclusionThese findings suggest the protective effects of DAPT adherence on 1-year mortality among post-PCI patients in a low-income setting and indicate younger age, male sex and use of other preventive treatments were predictors of higher DAPT adherence.

Moderately elevated lipoprotein (a) levels are associated with an earlier need for percutaneous coronary intervention in recurrent cardiovascular disease.

A significant number of cardiovascular disease (CVD) patients, with the target lipid levels, as set by the guidelines, achieved, continue to remain at risk. In this setting, lipoprotein (Lp) a role in CVD prognosis is regaining interest. Although Lp(a) is related to the arteriosclerotic process, there is not currently an adequate amount of data for the inclusion of Lp(a) levels as a primary therapeutic target in the treatment of coronary artery disease (CAD) patients. In this framework, the current retrospective study aims to investigate the association of Lp(a) levels with the adverse cardiovascular (CV) events presented in a 10 year follow-up of CVD patients with dyslipidemia and its association with the major CV risk factors. A statistically significant reduction in Lp(a) levels was observed during the follow-up period (72.8±45.6 vs. 68.3±41.8 mg/dl; McNemar test; P<0.001). The vast majority of patients who suffered a new acute myocardial infarction during the follow up period had Lp(a) levels >30 mg/dl (24/28 patients, mean ± standard deviation Lp(a), 83.1±36.6 mg/dl, P=0.001). Kaplan-Meier survival analysis did not find statistically significant differences in a percutaneous coronary intervention (PCI) time occurrence during the follow-up period between patients with low (≤30 mg/dl) and high (>30 mg/dl) Lp(a) levels (log-rank P=0.305). On the other hand, when a second and third PCI conducted during the monitoring period were included in the Kaplan Meier analysis as events, the mean time for a PCI was significantly shorter (7.2%; P=0.01) for patients with Lp(a) levels >30 mg/dl. In conclusion, the current study reported that patients with high Lp(a) values are more prone to the occurrence of new myocardial infarction, while the Lp(a) cut-off value of 30 mg/dl was linked in CVD patients to an earlier need for PCI, especially in the most vulnerable group of patients with more than one (recurrent) revascularizations.

Patient experience of informed consent for diagnostic coronary angiogram and follow-on treatments

Background/AimsCoronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter.MethodsA descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography.ResultsFemale participants reported greater difficulty in recalling treatment information (P&lt;0.03), found discussions about alternative treatments more confusing (P&lt;0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P&lt;0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P&lt;0.002).ConclusionsPatients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent.

Cardiac disease and prognosis associated with ventricular tachyarrhythmias in young adults and adults

BackgroundThis study evaluates cardiac diseases and prognosis in young adults and adults presenting with ventricular tachyarrhythmias (VTA).MethodsThe present longitudinal, observational, registry-based, monocentric cohort study includes all consecutive patients 45 years old or younger presenting with VTA at admission from 2002 to 2016. Rates of coronary angiography, coronary artery disease (CAD) and need for percutaneous coronary intervention (PCI), cardiac diseases associated with VTA, and differences in long-term prognostic endpoints for young adults (20–34 years old) were analyzed and compared to those of adults (35–45 years old), for whom multivariable risk prediction models were developed. Kaplan–Meier analyses were performed according to age and type of VTA.ResultsA total of 259 consecutive patients were included in the study (36% young adults and 64% adults). At admission, 38% of young adults had VTA due to CAD that required PCI. Furthermore, VTA in young adults was commonly idiopathic (27%), or had underlying channelopathies (18%), primary cardiomyopathies (13%) or acute myocardial infarction (AMI, 11%). In adults, VTA was mostly associated with AMI (28%), though the rate of idiopathy was still high (20%). A total 41% of all patients received cardiopulmonary resuscitation (CPR), for whom AMI (STEMI 17%, NSTEMI 24%) was most frequently observed. Irrespective of the type of VTA, all-cause mortality was similar for young adults and adults. In young adults, left ventricular ejection fraction (LVEF) < 35% (HR = 33.590) was associated with increased long-term all-cause mortality.ConclusionDespite high rates of idiopathic ventricular tachyarrhythmias, CAD and AMI are common causes of VTA and CPR in adults 45 years old and younger. Young adults and adults had comparable survival at index hospitalization and after 2.5 years irrespective of the type of VTA.Clinical trial registration clinicaltrials.gov identifier: NCT02982473.

Influence of time on the predictive value of the post-resuscitation ECG

Background: The reliability of the electrocardiogram (ECG) after return of spontaneous circulation (ROSC) is unclear. While its predictive value has previously been described, no studies have looked at the influence of time on the post-ROSC ECG. Aim: This study aimed to evaluate the predictive value of the ECG immediately after ROSC and between 1 and 5 hours later to assess whether time influences its ability to accurately predict the need for percutaneous coronary intervention. Methods: A single-centre, retrospective, observational 1-year analysis examined the records of post-ROSC patients who underwent coronary angiography and for whom prehospital and delayed post-ROSC ECGs were available for analysis. Findings: Forty-two post-ROSC ECGs were reviewed alongside angiographic findings. Sensitivities of 25% and 69%, specificities of 60% and 100% and an accuracies of 33% and 76% were calculated for the prehospital and delayed hospital ECGs respectively. A chi-squared value of 7.78 (P=0.0053) suggests there is statistical significance between the two. Conclusions: The delayed post-ROSC ECG is statistically significantly more accurate, suggesting that time influences the reliability of the post-ROSC ECG.

Possi bilities and perspectives of colchicine application in complex therapy in patients with COVID-19

The new coronavirus infection, which has become a pandemic, is greatly increasing interest in the search for new pharmacological drugs with antiviral and anti-infl ammatory properties. Colchicine, which has been used in medicine for centuries and has been mainly known as arthrifuge, has come to be unexpectedly considered as a drug aff ecting the cumulative endpoint in outpatients, including death and hospitalization requirement in a recent large, well-planned, randomized controlled trial. The article provides data on the pharmacodynamics of the drug, which consists in blockade of infl ammasome activation in patients with COVID-19, and an eff ective impact on the mechanisms of “cytokine storm” — a predictor of acute respiratory distress syndrome and sepsis as a major cause of multi-organ lesions and death. The information that its spectrum of anti-infl ammatory activity may explain the vasoprotective eff ects in patients with coronary heart disease (CHD) who underwent acute infarction in the COLCOT study, is particularly attractive from the point of view of the perspectives for the oral colchicine application in COVID-19. High tolerability of the drug, the absence of severe adverse reactions, simple dosing regimen, low cost of colchicine, the absence of signifi cant drug interactions are additional advantages. The authors of this article believe that this information is suffi cient for planning a study of the eff ectiveness of colchicine as an element of complex therapy in hospitalized patients with COVID-19 in combination with acute coronary syndrome, including the need for percutaneous coronary intervention. Early anti-infl ammatory therapy in patients with COVID-19 is still not recommended, despi te th e fact t h at there comes an understanding of its necessity. And in this situation, colchicine has the potential to challenge.

The Impact of Atrial Fibrillation on hospitalization Outcomes for Patients With Chronic Lymphocytic Leukemia Using the National Inpatient Sample Database

BackgroundThe incidence of atrial fibrillation (AF) in patients with chronic lymphocytic leukemia (CLL) has been on the rise. However, the excess burden added by AF to the morbidity and mortality of CLL patients especially in the hospitalized setting is undetermined. MethodsThe National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2009 to 2018. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while the secondary outcomes included acute coronary syndrome (ACS), acute myocardial infarction (AMI), and the need for percutaneous coronary intervention (PCI), acute heart failure (AHF), acute hypoxic respiratory failure (AHRF), cardiac arrest (CA), cardiogenic shock (CS), stroke, and the total cost of hospitalization. ResultsCLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; odds ratio [OR] 1.39, 95% confidence interval [CI] 1.19-1.61; P =< .001). All other secondary outcomes including ACS, AMI, PCI, AHRF, CA, CS, and stroke were observed at a significantly higher rate in the AF group as well. The median total hospital cost was also higher in the AF group ($9097 vs. $7646; P value < .0001) ConclusionCLL patients with AF are at a significantly increased risk of all-cause mortality, cardiac-related mortality, and stroke. For this population, a multidisciplinary approach should be orchestrated for better management and outcomes.