Archives of Cardiovascular Diseases最新文献

Background: Antithrombotic management in patients with chronic coronary syndrome and previous stent implantation who require long-term oral anticoagulation is highly challenging in daily practice, especially in those at high residual risk of coronary and vascular events. Dual therapy with oral anticoagulation and aspirin may lead to a higher risk of bleeding, whereas stopping aspirin in high-risk patients with coronary artery disease after percutaneous coronary intervention may lead to recurrent ischaemic events.

Aim: To assess the optimal antithrombotic regimen that should be pursued long term (often lifelong) in these patients.

Methods: The AQUATIC study is a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicentre study conducted in patients with chronic coronary syndrome at high risk of ischaemic events (i.e., stent implantation [> 6 months before inclusion] in a context of previous acute coronary syndrome and/or with high-risk features of ischaemic event recurrences) and requiring long-term oral anticoagulation. For superiority, we ensure 80% power at level α=0.05 to detect a 25% reduction in hazard in the experimental group relative to the control group. Overall, 2000 patients will be randomized in a 1:1 ratio to receive either oral anticoagulation and aspirin or oral anticoagulation and placebo. The primary efficacy endpoint is a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization and acute limb ischaemia. Major bleeding according to the International Society on Thrombosis and Haemostasis definition is a secondary safety endpoint that will be assessed as a priority.

Conclusion: The AQUATIC trial will test the efficacy and safety of adding aspirin to long-term oral anticoagulation in patients with chronic coronary syndrome and previous coronary stenting who are at high residual risk of recurrent ischaemic events and require oral anticoagulation.

Background: Three-dimensional electroanatomical mapping has become an essential tool in paediatric electrophysiology to precisely identify areas involved in arrhythmias. Anatomical variations in Koch's triangle, especially fluoroscopic enlargement of the coronary sinus ostium, have been found more frequently in patients with atrioventricular nodal reentrant tachycardia (AVNRT) than in those with atrioventricular reentrant tachycardia (AVRT). This finding is consistent with easier coronary sinus cannulation during electrophysiology procedures in patients with AVNRT.

Aim: To explore anatomical differences in the coronary sinus and Koch's triangle between children with AVNRT and AVRT using three-dimensional system acquisitions.

Methods: We conducted a single-centre retrospective study of paediatric patients undergoing a catheter ablation procedure for AVNRT or AVRT. Detailed anatomy of the coronary sinus ostium, global morphology and Koch's triangle properties was assessed via catheter-based intracardiac three-dimensional electroanatomical mapping, and compared.

Results: Forty-four children were enrolled (22 in each group). The median age was 14.6 (interquartile range [IQR] 10.9-16.2) years. The coronary sinus ostium area and diameter were similar in the AVNRT and AVRT groups: area, 1.0 (IQR 0.7-1.2) vs. 1.2 (IQR 0.5-1.6) cm/m², respectively (P=0.71; 95% confidence interval of median difference -0.3 to 0.3); diameter, 1.0 (IQR 0.8-1.5) vs. 1.1 (IQR 0.9-1.4) cm/m², respectively (P=0.56; 95% confidence interval of median difference -0.2 to 0.2). Five patients (22.7%) in each group had a coronary sinus with a windsock morphology. There was no difference in the Koch's triangle area between the AVNRT and AVRT groups: 1.4 (IQR 1.1-2.0) vs. 1.6 (IQR 1.3-1.9) cm²/m², respectively (P=0.37; 95% CI of median difference -0.2 to 0.5).

Conclusions: Our findings suggest no difference in coronary sinus anatomy between these two junctional tachycardias. A potential explanation is the limited ability of three-dimensional mapping technologies to accurately define complex intracardiac structures.

Background: In patients with acute coronary syndromes (ACS) requiring percutaneous coronary intervention (PCI), abnormally elevated platelet counts are often associated with an increased risk of stent thrombosis and bleeding.

Aims: To explore the associations between clinical benefits and PCI in patients with ACS and elevated platelet counts.

Methods: Between July 2017 and December 2019, 50,009 patients with ACS were enrolled in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. This study included patients with platelet count≥300×10⁹/L. The primary outcome was net adverse clinical events (NACE), including major adverse cardiovascular or cerebrovascular events (MACCE; all-cause death, myocardial infarction, ischaemic stroke and stent thrombosis) and major bleeding during the index hospitalization. The difference in the risk of NACE between PCI and non-PCI groups was analysed using multivariable analysis and inverse probability of treatment weighting.

Results: Among 4501 patients, PCI rates decreased as platelet count increased, with 3029 patients ultimately undergoing PCI. These patients exhibited a lower rate of NACE (adjusted odds ratio [OR]: 0.53, 95% confidence interval [95% CI]: 0.37-0.77; P=0.001) and a reduced risk of MACCE (OR: 0.44, 95% CI: 0.29-0.67; P<0.001). No significant differences in major bleeding were observed (adjusted OR: 1.40, 95% CI: 0.62-3.16; P=0.417). Inverse probability of treatment weighting confirmed these findings.

Conclusion: In patients with ACS and increased platelet counts who have more complex thrombohaemorrhagic profiles, PCI can effectively reduce the risk of ischaemic events without increasing the risk of bleeding.

Clinical trial registration: https://clinicaltrials.gov/study/NCT02306616.