Minerva cardiology and angiology最新文献

Background: The aim of this study is to investigate the effect of hyperuricemia on prognosis of drug-eluting stent implantation for coronary bifurcated lesions and the value of uric acid levels in predicting the prognosis.

Methods: Patients with coronary bifurcation lesions treated with drug-eluting stent implantation were retrospectively enrolled. The clinical, interventional and follow-up data were analyzed.

Results: Totally, 308 patients were enrolled and were divided into three groups according to the uric acid levels: group Q1 (N.=105), Q2 (N.=101), and Q3 (N.=102). Before PCI, the stenosis rate was 0.85 (0.80, 0.90) for the main coronary artery and 0.50 (0.50, 0.50) for the branch artery. After PCI and stent deployment, the arterial stenosis rate was 0.20 (0.20, 0.20) for the main coronary artery and 0.50 (0.50, 0.50) for the branch artery. At 36-month follow-up, seven patients died of different reasons, with five patients in group Q1, one in group Q2, and one in group Q3, 96 patients were readmitted for treatment of angina pectoris, with 18 in Q1 group, 29 in Q2 group, and 49 in Q3 group. Twenty-seven patients experienced revascularization because of deterioration of the condition, including six patients in group Q1, seven in group Q2, and 14 in group Q3. After correction of the confounding factors, the readmission rate of angina pectoris was significantly (P<0.001) increased with the increase of the uric acid level: Q3 vs. Q1 (220.47/1000 vs. 66.69/1000 person years, HR 3.65, 95% CI 1.92-6.96) and Q2 vs. Q1 (113.76/1000 vs. 66.69/1000 person years, HR 2.20,95% CI 1.16-4.18).

Conclusions: Increased uric acid level is an independent risk factor for cardiogenic readmission rather than for all-cause mortality and revascularization after drug-eluting stent implantation for patients with coronary bifurcation lesions.

Background: Cardiovascular (CV) disease is a significant risk even among seemingly healthier populations like master athletes, who face unique CV challenges due to their advanced age and high-intensity physical activities. Exercise stress echocardiography (ESE) has emerged as a valuable diagnostic tool to detect exercise-induced coronary artery disease (CAD), offering advantages over traditional exercise stress testing (EST) by integrating echocardiographic imaging. This article aimed to assess the diagnostic value and efficacy of ESE for detecting CAD in master athletes who exhibit exercise-induced alterations during pre-participation screening (PPS) EST.

Methods: This retrospective study analyzed 521 master athletes (aged 35 years and older) who underwent annual CV assessments including EST as part of their PPS at Noale Hospital, Venice, Italy, from September 2020 to August 2023. Participants who showed exercise-induced alterations suspicious for CAD on EST were further evaluated using ESE.

Results: Of the 521 athletes screened, 58 (11.1%) exhibited suspicious alterations for CAD during EST. ESE further identified 13 athletes with wall motion abnormalities (WMA), of whom 10 were subsequently diagnosed with critical CAD and received appropriate interventions. The positive predictive value of ESE was 0.77. Comparatively, athletes with WMA had significantly higher CV risk scores. No major adverse CV events (MACE) were reported during the 43.9-month follow-up.

Conclusions: ESE is an effective third-line diagnostic tool in master athletes, demonstrating a high diagnostic yield for identifying significant CAD. Its integration into routine CV screening for master athletes can enhance the detection of underlying pathologies, potentially leading to timely and life-saving interventions.

Background: Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS), disproportionately affecting women. Data on the management and outcomes of these patients remain limited, especially regarding the overall risk of major adverse cardiovascular events (MACE) and arrhythmic complications. This study aimed to investigate the incidence and independent predictors of MACE in SCAD patients.

Methods: In this single-center, prospective observational study, 76 patients with SCAD were enrolled. Clinical follow-up (mean duration: 4.03±3.4 years) was conducted through in-hospital visits and electronic database monitoring. The primary composite endpoint included MACE, defined as cardiovascular (CV) rehospitalization and death, the secondary endpoint included supraventricular and ventricular arrhythmias.

Results: All the patients enrolled were characterized by their clinical presentation, underlying risk factors, and triggers for SCAD. Of the 76 patients, 45 (59.2%) received medical therapy alone, 27 (35.5%) underwent percutaneous coronary intervention (PCI), and four (5.2%) had coronary artery bypass grafting (CABG). During the follow-up period, the primary endpoint occurred in 34 patients (44.7%), with CV rehospitalization as the main cause of MACE (31 patients, 40.8%). Coronary revascularization emerged as the only independent predictor of MACE (HR=1.92, 95% CI 1.13-3.21, P=0.035). The secondary endpoint occurred in 13 patients (17.1%).

Conclusions: Although SCAD is often considered a rare and relatively benign cause of ACS, our findings reveal a high rate of CV rehospitalization and mortality. Furthermore, mid-term follow-up indicates that SCAD is associated with supraventricular and non-sustained ventricular arrhythmias, with limited impact on prognosis and generally requiring pharmacological optimization.

Introduction: Whilst aortic stenosis remains the most prevalent valvular abnormality, the management of asymptomatic severe aortic stenosis remains a clinical challenge. Recently, two randomised-controlled trials (RCTs) - EVOLVED (Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis) and Early TAVR (Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis) - have been published, alongside an extended follow-up from the AVATAR (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) study.

Evidence acquisition: In response, we conducted a systematic review of PubMed, Ovid, and Cochrane databases, identifying RCTs up to October 29, 2024, that compared early intervention with conventional management.

Evidence synthesis: Four studies met the inclusion criteria, with a combined total of 1427 patients across the trials. Meta-analysis of the primary endpoints across these studies demonstrated a benefit with early intervention (HR=0.50, 95% CI: 0.35-0.73). However, we did not find mortality and cardiac mortality to show significant reductions (HR=0.68, 95% CI: 0.40-1.18 and HR=0.66, 95% CI: 0.33-1.29, respectively). Crucially, stroke outcomes were improved with early intervention (HR=0.60, 95% CI: 0.38-0.95), as were unplanned hospitalizations (HR=0.40, 95% CI: 0.30-0.53).

Conclusions: These findings confirm the safety of early intervention and suggest a reduction in stroke incidence, although no significant benefits were observed in overall or cardiac mortality; results which can help to guide shared decision-making with patients and prevent adverse health outcomes.

Background: Previous studies have highlighted the role of inflammatory and nutritional markers in predicting outcomes in cardiovascular diseases. However, to our knowledge, no study has explored the impact of the combination of these two aspects on outcome of patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to assess the predictive value of the pre-procedural platelet-to-lymphocyte ratio (PLR)/albumin ratio on one-year mortality in this population METHODS: This retrospective observational study screened 867 patients who underwent TAVI between December 2018 and September 2023 at our tertiary center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy. After excluding patients with systemic inflammatory or autoimmune diseases (223), cancer (257), acute or chronic infections (22), and those with missing data (77), the final cohort comprised 288 patients. PLR and albumin levels were calculated from pre-procedural blood samples, and the PLR/albumin ratio was subsequently derived. The prognostic discriminatory capacity and cutoff value of the PLR/albumin ratio were assessed using multivariate Cox regression and ROC analysis, respectively.

Results: Individually both PLR and albumin were confirmed as independent predictors of post-TAVI 1-year mortality (odds ratios: 1.01 and 0.83, respectively), but their association with outcome was sensibly increased when considered together as PLR/albumin ratio (odds ratio: 1.33 [95% CI: 1.1-1.6, P=0.007]). In particular, PLR/albumin ratio >4.69 showed the best predictive capacity (AUC 0.69, sensitivity 56.25%, specificity 83.27%) for patients at higher risk of mortality in the first year after TAVI. No other clinical covariate demonstrated such comparable outcome predictive strength.

Conclusions: A high PLR/albumin ratio resulted as independent one-year mortality predictor in patients undergoing TAVI procedure. The proposed combination of inflammatory and nutritional markers outperformed the value of single parameters. Its integration into pre-procedural TAVI work-out could be represent a further improvement of individualized risk stratification.

Background: Prolonged dual antiplatelet therapy (DAPT) with ticagrelor 60 mg is recommended in post-myocardial infarction (MI) patients at moderate to high ischemic risk. Beyond physician-led discontinuation, persistence with therapy in real-world settings may be limited due to adverse effects and patient choices. The aim of this study is to assess the real-world incidence of non-compliance with prolonged DAPT and to elucidate reasons for discontinuation.

Methods: A retrospective observational study was conducted in three high-volume Italian PCI centers, involving patients with prior MI (1-3 years before) prescribed with ticagrelor 60 mg twice daily. Demographic, clinical, and procedural data were collected, with follow-up to determine therapy discontinuation and reasons for it.

Results: Among 244 enrolled patients, mean age was 66 years, and 83.6% were male. During follow-up (mean duration: 27.6 months), 10.2% (95% CI: 6.7% to 14.8%) discontinued ticagrelor. Key reasons included voluntary decision (40.0% [21.1% to 61.3%]) and bleeding events (40.0% [21.1% to 61.3%]), with some switching to high-dose regimens post-revascularization. In univariate analysis, ticagrelor discontinuation was significantly associated with female sex, higher BMI, prior PCI or CABG, high bleeding risk, and the absence of multivessel disease or primary PCI. However, in multivariable analysis, only multivessel disease remained independently associated with a lower likelihood of discontinuation (P<0.001).

Conclusions: Real-world persistence with prolonged DAPT remains a challenge, often hindered by patient-driven discontinuation and adverse events. Enhanced patient education on therapy benefits and adherence may improve long-term outcomes.