bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood iron level and vulnerable coronary atherosclerotic plaques
Authors: Oleksiak A , Kruk M , Rucinska KI , Marcinkiewicz K , Demkow M , Kepka C
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Centre, Poland

BACKGROUND

Vulnerable plaque rupture is one of the causes of acute coronary syndromes. Preliminary research indicate that iron might accelerate the oxidation of low density lipoproteins (LDL) which can then be taken up by the LDL receptor on macrophages leading to their development into foam cells. Foam cell infiltration and necrotic core expansion are key events in atherogenesis and vulnerable plaque formation. However, the potential pathophysiological roles of iron in plaque development remain uncertain.

PURPOSE

The aim of the study was to investigate the relationship between iron and the type and composition of atherosclerotic plaques in the coronary arteries.

METHODS

In 200 patients with ≥1 stenosis ≥50% in computed tomography coronary angiography (CTCA) made for clinical indications we assessed: free iron level, the presence of high-risk plaque features: low-attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcium (SC) (CT Coronary, Syngo, Siemens), type of plaque (calcified, mixed, non-calcified) and their composition (calcified, fibrous, fibro-fatty, necrotic core) (QAngioCT, Medis). Fibro-fatty and necrotic core were analyzed together as vulnerable plaque component. The study was financed by the National Science Centre (2016/21/N/NZ5/01450).

RESULTS

Of 200 patients (125 men, 66 ± 10 years), the mean iron level (µg/dl) was 91 ±30 for women and 103 ±33 for men (p = 0.5). 3 patients had iron deficiency and 2 patients had iron overload. In CTCA analysis there were 815 calcified, 344 non-calcified and 438 mixed plaques. There was a trend in correlation between iron level and non-calcified plaque presence (p = 0.06). LAP was detected in 56 patients, NRS in 83, PR in 132, and SC in 125. Patients with LAP had higher iron levels (113 vs 93 µg/dl; p < 0.001). There was no association between iron and NRS, PR or SC (p > 0.05). In univariate regression analysis, the predictors of LAP were iron (p < 0.001) and male gender (p = 0.01). In multivariate regression analysis, iron was an independent predictor of LAP (p < 0.001; OR 1.02; 95%CI 1.01-1.03). Higher iron levels correlated with more fibro-fatty (p = 0.009) and necrotic core (p = 0.02); less calcified (p = 0.04); and with no relation to fibrous (p = 0.9), thus higher iron levels were associated with greater vulnerable plaque component (p = 0.003).

CONCLUSIONS

Higher iron levels are more likely to be associated with low-attenuation plaque and a greater vulnerable component of atherosclerotic plaques.
Impact of coronavirus disease 19 (COVID 19) pandemic on acute coronary syndrome (ACS) hospitalizations, and related invasive procedures
Authors: Simoni L , Alimehmeti I , Ceka A , Tafaj E , Gina M , Dibra A , Goda A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

  Reports from countries affected by the COVID 19 pandemic demonstrate a reduction in ACS hospitalizations and invasive procedures.

Purpose

We aimed to investigate the impact of the COVID 19 pandemic on ACS patient hospitalizations and related invasive procedures in a country with low COVID 19 incidence and without changes in Cardiology hospital services.

Methods

We conducted a retrograde study collecting data for ACS hospitalizations including ST elevation myocardial infarction (STEMI), non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) and related invasive and revascularization procedures from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center.

Results

Hospital admissions for ACS declined during 2020 (COVID 19 period) from a total of 550 patients in 2019 to 321 patients hospitalization in 2020 representing a 41.6% reduction (p < 0.001). The reduction was observed for all types of ACS, the greatest reduction was for UA 58% (p < 0.001) followed by NSTEMI 32% (p < 0.001) and for STEMI 28% reduction (p < 0.009). Compared to 2019 the proportion of patients presented with STEMI was higher in 2020 (48.6% vs 39.5% p = 0.01) and lower with UA (43.3% vs 31.5% p = 0.0002)

Reduction was observed also in coronary angiography by 43% (p < 0.001) and in percutaneous coronary interventions with 42% (p < 0.001). Compared to 2019 the proportion of patients with 3 vessels coronary disease(CAD)and left main (LM) was higher during COVID 19 pandemic,  respectively 33% vs 40% p = 0.032 and 8% vs 13% p = 0.046

Conclusions

Hospitalizations and related invasive procedures for ACS significantly dropped during COVID 19 pandemic.  Patients admitted to hospital during pandemic presented more with STEMI and had more 3 vessels CAD and LM. Measures should be taken to ensure patients for the safety of health services and encouraged not to neglect cardiac consultations and treatments.
The profile of T-cells (CD4 +, CD8 +) and natural killer cells (CD16 / 56+) in STEMI patients with poor prognosis
Authors: Dovhan O , Parkhomenko A , Talayeva T , Shumakov O , Tretyak I
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Institute of Cardiology, Kyiv, Ukraine

The role of lymphocytes in  the progression of atherosclerosis is still unclear. T-cells helper (CD4+) and suppressor (CD8+) subtypes are activated in acute cardiac injury and myocardial infarction (AMI),including cytotoxicity mediated by CD8+ T-cells and immunoregulatory activity mediated by CD4+ T-cells (which can also enhance the CD8+ T-cell cytotoxicity). The natural killer (NK) cells are important in the infarcted myocardium, where it affects heart remodeling.

The aim of the study was to identify the difference in the dynamic profile of T-cells (CD4 +, CD8 +) and NK cells (CD16 / 56+) in STEMI patients with and without complications during 1-year follow-up.

Methods

The composition of individual subtypes of T-cells (CD4 +, CD8 +) and NK cells (CD16 / 56+) in the venous blood was evaluated retrospectively in 60 pts with STEMI, treated with primary PCI, at admission and on day 7. The following cardiovascular events were considered as the end point in remote (1 year) observation: death, AMI, stroke, revascularization, development/decompensation of heart failure and cardiac ischemia. All patients were divided into 2 groups depending on the presence (1st group - 35 pts) and absence of endpoint (2nd group - 25 pts). Both groups were comparable by the clinical profile. Results: There were lower number of T-suppressor on day 7 in patients with cardiovascular events during long-term follow-up (357.4 ± 36.2 /μl in group 1 vs 779.7 ± 222.8 /μl in group 2, p <0,01) with the trend in their percentage (23.6 ± 1.5% vs. 27.6 ± 2.3% in group 2, p <0.1). In pts with poor prognosis NK cells number and percentage has tendency to increase at the admission– 45,6% vs 37,3% in the group 2. Tab 1

Conclusion

We can assume that the initial tendency to increase in the number and percentage of NK cells (CD16 / 56 +) followed by a decrease in the number and percentage of T cells suppressor (CD8+) on STEMI day 7 are associates with an undesirable 1-year prognosis. Dynamics of T-cells subtypes in STEMI pGroup 1 (n = 35)Group 2 (n = 25)Р group 1 vs group 2Day1Day 7Day 1Day7T-cells suppressor (CD8+) %20,9 ± 1,623,6 ± 1,524,2 ± 2,127,6 ± 2,3<0.1 on day 7T-cells suppressor (CD8+) /μl341,4 ± 40,1357,4 ± 36,2338,4 ± 46,8779,7 ± 222,8<0.02 on day 7T-cells helper (CD4+) %42,0 ± 1,948,0 ± 1,345,3 ± 2,248,0 ± 2,1>0.1T-cells helper (CD8+) /μl671,9 ± 72,9771,7 ± 68,0666,6 ± 94,2900,9 ± 115,8>0.1Natural killer (CD16 / 56+) %18,4 ± 1,912,5 ± 1,413,4 ± 2,09,73 ± 0,96<0.1 on day 1Natural killer (CD16 / 56+) /μl263,7 ± 31,9219,7 ± 33,8181,1 ± 26,7170,6 ± 25,9<0.1 on day 1
Budget impact analysis of antiplatelet therapy with cangrelor in patients with acute coronary artery disease undergoing percutaneous coronary intervention in Portugal
Authors: Lizano-Diez I , Paz S
Published: April 2021

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Ferrer, Barcelona, Spain

Background

Cangrelor is a novel, intravenous, potent, fast onset, direct-acting, P2Y12 receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation with a half-life of 3-6 min. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) (ST-elevation myocardial infarction (STEMI), non-STEMI, stable CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) prior to PCI procedure and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable.

Purpose

To assess the economic implications of incorporating cangrelor into the hospital formulary for the acute care of CAD patients undergoing PCI in Portugal.

Methods

A budget impact model (BIM) was developed. The 3-year pharmacological and clinical event costs of two hypothetical scenarios, without and with cangrelor in the formulary for the total PCI population (base case) in Portugal were compared. Also, the primary PCI (STEMI) and a PCI population with special needs (ie. unable to swallow) were assessed as complementary setups. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on clinical trials, meta-analyses and on Portuguese registries. Only the costs of pre-treatment with oral P2Y12 inhibitors and glycoprotein IIb-IIIa inhibitors (GPI) for bail-out were considered. One-way sensitivity analysis established the effect of uncertainty on BIM results.

Results

The model assumes that the total PCI population grows from 13,422 to 14,370 adults (age 65 years, mean) over three years in Portugal. Pre-treatment with oral P2Y12 inhibitors increases from 9,932 to 10,634 patients, and uptake of cangrelor rises from 0.80% to 1.40% in the same period. The number of total PCI patients receiving cangrelor grows from 79 to 149. At current usage of antithrombotics and at existing pharmacological and management costs, adding cangrelor into the hospital formulary represents 115 thousand € over 3 years in Portugal. Results are most sensible to the percentage of patients on GPI bail-out.

Conclusions

Under BIM assumptions, introducing cangrelor for the acute care of CAD patients undergoing PCI represents a safe and affordable option in Portugal, particularly when the required control of thrombosis is not certain with oral pre-treatment.
Bioabsorbable magnesium scaffold implantation in acute coronary syndromes: profit and medium-term results
Authors: Noval Morillas I , Gutierrez Barrios A , Gheorghe L , Bretones Del Pino T , Camacho S , Calle Perez G , Canadas Pruano D , Vazquez Garcia R
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Puerta del Mar

OBJECTIVES AND METHODS

We aim to evaluate the long-term clinical and intravascular outcomes inACS patients treated with Magnesium-Based Bioresorbable Scaffold(MgBRS).Exclusion criteria:left main disease,bifurcations,ostial lesions,severe tortuosity and calcification,long lesions,high thrombus burden,haemodynamic instability,oral anticoagulants,contraindication to dual-antiplatelet therapy.Primary endpoint was the device-oriented composite end-point(DOCE):cardiac death,target vessel myocardial infarction,and target lesion revascularization(TLR).RESULTS:Between Dec2016 to Dec2018,90patients with ACS underwent PCI with MgBRS.46%patients presented with STEMI.Mean age55.9 ± 9.9,75.6%males and64.4%smokers.OCT was performed in 62patients.Mean scaffold length21.27 ± 7.7mm,mean diameter3.31 ± 0.24mm.15 patients required a second overlapped stent.There were 7complications:5edge dissection;1catheter-induced ostial dissection and 1case of slow-flow.Post-PCI OCT showed in-scaffold area stenosis of3.49 ± 21.29%.At 15months,diameter stenosis was31.95 ± 26.14%and restenosis was observed in 10cases(21.7%).Mean scaffold area shrinked from baseline(7.57 ± 1.77mm2)to15-month follow-up(6.13 ± 2.20mm2).The main mechanism of restenosis was scaffold collapse.DOCE was observed in 13.3%of patients.2patients with target-vessel myocardial infarction due to stent thrombosis.1case had recurrent angina at2weeks because of stent fracture and proximal edge dissection.9cases presented restenosis at different time-points.CONCLUSIONS:MgBRS is feasible in patients presenting ACS.At long-term follow-up,further development is needed to help to resolve these drawbacks
Efficacy of thrombolytics in patients with acute coronary syndrome
Authors: Vasin A , Mironova O , Fomin V
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: The optimal choice of the thrombolytic drug for emergency revascularization in patients with acute coronary syndrome (ACS) still remains to be defined. Percutaneous coronary intervention is a more safe and effective method of reperfusion compared with thrombolytic therapy, that’s why the last is relatively not common nowadays. But in the COVID-19 era in a number of cases some patients with ACS can’t be quickly hospitalized due to different reasons like the absence of the nearest available cardiovascular center, or lack of an ambulance. A long period of chest pain forces the doctors to use systemic thrombolytic therapy.

Purpose

This study investigates the efficacy and safety of Alteplase, Prourokinase, Tenecteplase, and Streptokinase in patients with acute coronary syndrome.

Methods

A retrospective, open, non-randomized cohort study was conducted. We have analysed 600 patients with ACS, who underwent systemic thrombolytic therapy at the prehospital and in-hospital stages from 2009 to 2011. Patients were divided into several groups according to the thrombolytic agent administered: Alteplase (254 patients), Prourokinase (309 patients), Tenecteplase (6 patients), Streptokinase (31 patients). Treatments were to be given as soon as possible. The ECG reperfusion criterion was a decrease in the ST segment by 50% or more from the initial elevation.

Results

 Among 600 patients (mean age, 61 years (SD = 20); 119 women [19.7%]), 440 had successful reperfusion. The median time from chest pain onset to the start of treatment was 3 hours (P < 0.001). The percentages of successful thrombolysis for each agent were similar: Alteplase 74,4% Prourokinase 71,2%, Tenecteplase 83%, Streptokinase 74,2%. No statistical differences were observed in thrombolytic results among these groups (OR: 0.60, 95% CI: 0,2868 to 1,217; P = 0.17). At the same time, the hospital treatment with prourokinase was more effective than prehospital care with prourokinase: 110 successful reperfusions in 138 patients (79.7%) and 110 successful reperfusions in 171 patients (64.3%), respectively. Regardless of the onset of the attack (OR: 0.45, 95% CI: 0,2004 to 0,9913; P = 0.05). The effectiveness of the other thrombolytics cannot be compared between prehospital care and hospital treatment due to the rare use at the hospital stage in our cases. In the study, there was also no statistical difference in complication rates among the treatment groups. Among all patients, there were 9 fatal outcomes (1.5%): Alteplase 3,15% Prourokinase 1,9%, Streptokinase 3,22%.

Conclusion(s): In patients with ACS, all thrombolytic drugs showed similar effectiveness. There is no difference in the safety and efficacy among the agents in our study, but there is a difference in cost and route of administration. However, upcoming prospective trials with long follow-up periods might be expected to determine the most appropriate systemic thrombolytic drug.
Midventricular takotsubo syndrome: different dyskinesia location leading to a different electrocardiogram?
Authors: Padilla Lopez M , Duran Cambra A , Vidal Burdeus M , Rodriguez Sotelo L , Sanchez Vega J , Carreras Mora J , Del Castillo P , Sans Rosello J , Vila Perales M , Sionis A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Takotsubo syndrome (TKS) is characterized by the appearance of apical reversible dyskinesia in its typical form. Electrocardiogram (ECG) in the acute phase (<12 from symptom onset) generally shows anterior ST segment elevation. Nonetheless, other atypical forms of TKS have been described depending on the location of the dyskinetic segments, such as, mid-ventricular, basal and focal forms. Considering the different segments involved in these atypical forms, it seems reasonable to consider that ST changes in acute phase ECG could be different.

Purpose

To compare ECG in the acute phase of typical TKS versus mid-ventricular TKS, as it was the more frequent form of atypical TKS in our registry.

Methods

Patients included in the prospective TKS registry of our center according to the Mayo Clinic diagnostic criteria, with the first ECG performed less than 12 hours from the symptoms onset were reviewed. All cardiac left ventriculographies were reviewed to ensure a correct classification of the different types of TKS.

Results

A total of 297 patients were included in our local registry. 80 patients met our study inclusion criteria. 56 ECGs of typical apical TKS were compared to 24 ECGs of atypical midventricular TKS. There were no differences between the baseline characteristics in both groups, except for mid-ventricular TKS, that was more frequently triggered by physical stressor.

Regarding the ECG analysis, the main difference found in our serie was related to ST-segment deviation (Table 1). While ST-segment elevation was more common in typical TKS than in atypical TKS (73% vs 50%), ST-segment depression (generally in inferior leads) was observed in 54% of patients with atypical TKS and in no patient with typical TKS (figure 1).

Conclusion

The different location of dyskinesia between typical TKS and mid-ventricular TKS is associated to significant differences in the ECG obtained in the first hours after the onset of the clinical symptoms. The presence of ST-segment depression is highly suggestive of mid-ventricular TKS. ECG characteristicsTypical (n = 56)Midventricular (n = 24)pSTe > 1mm, no (%)41 (73)12 (50)0,044STd >0,5 mm, no (%)013 (54)< 0,001T wave inversion, no (%)12 (21)4 (17)0,626Q wave, no (%)22 ( 39)12 (50)0,374cQT, mean (SD)445 (54)438 (37)0,578QRS low voltages*, n (%)9 ( 16)1 (4)0,328STe ST-segment elevation, STd: ST-segment depression, cQT: corrected QT interval *Voltages <5mm in all limb leads or <10mm in all precordial leads Abstract Figure. 12-lead ECG and left ventriculography
Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study
Authors: Laimoud M , Saad E , Koussayer S
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Backgroud

Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in  ipsilateral limb ischemia due to  reduced distal  blood flow below the insertion point of the cannula .We retrospectively studied  adult patients supported with femoral VA-ECMO for cardiogenic shock between  2015 and 2019 at our tertiary care hospital. 

Results : the study included 65 adult patients supported on femoral VA-ECMO  for refractory cardiogenic shock . The studied patients had  a mean age of 37.9 ± 14.87 years , mostly males (70.8%) , a mean  BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four  (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients ,  femoral arteriovenous fistula in one patient and  large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute  limb ischemia had significantly frequent AKI (<0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%)  patients  without significant difference between the patients with and without acute limb ischemia.  The  occurrence of acute  limb ischemia was significantly  correlated with failed percutaneous femoral cannulation (p = 0.039 )  while there was no significant statistical correlation between the  cut-down technique and occurrence of limb ischemia(p = 0.053).  The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001 ) and cut-down technique (p = 0.001) . 

Conclusion :  Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .
ADP-induced platelet reactivity and bleeding events in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Scherer C , Luesebrink E , Massberg S , Sibbing D , Orban M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

While previous reports showed ADP-induced platelet reactivity to be an independent predictor of bleeding after PCI in stable patients, this has never been investigated in patients with cardiogenic shock (CS).

Methods

The association of bleeding events with respect to ADP-induced platelet aggregation was investigated in patients undergoing primary PCI for acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and with available on-treatment ADP-induced platelet aggregation measurements.

Results

Out of 233 patients, 74 suffered from a severe BARC 3 or higher bleed. ADP-induced platelet aggregation was significantly lower in patients with BARC≥3 bleedings (10 AU [IQR 3 - 13] vs. 15 AU [IQR 9 - 25], p < 0.001). Multivariate analysis identified on-treatment ADP-induced platelet aggregation as an independent risk factor for bleeding (HR = 0.968 per AU, 95% confidence interval (CI) 0.942-0.994). An optimal cut-off value of <12 AU for ADP-induced platelet aggregation to predict BARC≥3 bleedings was identified via ROC analysis. Moreover, use of VA-ECMO (HR 1.972, 95% CI 1.003-3.879) or coaxial left ventricular pump (HR 2.593, 95% CI 1.509-4.455), first lactate (HR 1.093 per mmol/l, 95% CI 1.037-1.152) and thrombocyte count (HR 0.994 per G/l, 95% CI 0.990-0.998) were independent predictors of BARC≥3 bleedings. There was no significant difference in survival nor ischemic events between patients with low and high on-treatment platelet reactivity. Conclusion: Lower on-treatment ADP-induced platelet aggregation was independently associated with severe bleeding events in patients with AMI-CS. The value of platelet function testing for bleeding risk prediction and guidance of anti-thrombotic treatment in CS warrants further investigation.
Anticoagulation after VA-ECMO decannulation, providing new insights
Authors: Maestro-Benedicto A , Duran-Cambra A , Vila-Perales M , Sans-Rosello J , Carreras-Mora J , Vidal-Burdeus M , Bragagnini W , Tauron-Ferrer M , Rossello E , Koller-Bernhard T , Cegarra V , Pastor-Del Amo A , Sobre-Lacaya C , Mirabet S , Sionis A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol. 

AIM

The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation.

METHODS

We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after).

RESULTS

Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%.

CONCLUSIONS

This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis
The impact of kids save lives program on Knowledge, skills and attitude of Greek students. Final results from 2 years of implementation
Authors: Parisis C , Bouletis A , Chatzidimitriou K , Palla DD , Makri P , Ntaliani M , Economou K , Aggelosopoulou M , Papa E , Triantafyllou TH
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of "Kids Save Lives" project in schools can change this situation. The Kids Save Lives initiative, endorsed by the World Health Organization in 2015, is teaching school children worldwide about the importance of CPR and how to perform it. In Greece this project is a suggestion of Ministry of Education to schools.

Purpose

Τo evaluate the level of theoretical knowledge, willingness to perform Cardiopulmonary resuscitation (CPR) and active skills of Greek secondary school students on the subject of Basic life Support before and after a "Kids Save Lives" program.

Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools of Thessaly’s region. A total of 5092 students (51,9% female, mean age 14.2 years) participated on the "Kids save Lives" program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. A 12 point questionnaire was answered by the students before and after completing the "kid saves lives" program, while practical skills were evaluated on manikins by experienced ERC Basic Life Support (BLS) Instructors.

Results

The training improves significantly the theoretical knowledge regarding Cardiopulmonary resuscitation (CPR), with the percentage of correct answers being 48,4% and 82,8%,before and after the course respectively (p < 0.001). The participants willingness to perform bystander CPR significantly increased after the completion of the course (93,7% before to 97,4% after, p < 0.001). Almost all of the participants (98.9%) could recognize the correct position near the victim and 91% performed chin lift maneuver and recognized cardiac arrest. More than 90% of the students performed chest compressions with the correct rate and placing their hands on the center of the chest (90,1% and 93.4%, respectively), whereas only 76.1% of the participants achieved the desired compression depth of 5 to 6 cm.

Conclusions

The overall results strongly recommend that the "Kids Save Lives" program can boost prospects for bystander CPR and indicate the necessity of implementation in a greater scale nationwide.
The impact of kids save lives program on knowledge of students after the first and second year of implementation in Thessaly region of greece
Authors: Parisis C , Bouletis A , Chatzidimitriou K , Palla D-D , Papa E , Makri P , Aggelosopoulou M , Economou K , Ntaliani M , Triantafyllou TH
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of "Kids Save Lives" project in schools can change this situation. The World Health Organization endorsed the ‘Kids Save Lives’ project in 2015 in order to reduce mortality, while in countries, where children were taught cardiopulmonary resuscitation (CPR) in schools, have higher rates of bystander CPR and higher survival rates. In Greece, this project is a suggestion from  Ministry of Education  to schools.

Purpose

Τo evaluate the level of theoretical knowledge of secondary school students on the subject of Basic life Support before and after a "Kids Save Lives" program and to compare the results after the first and second year of implementation.

Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools. A total of 691 students participated on the "Kids save Lives" program in both academic periods according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. A 12-point questionnaire was answered by the students before and after the "kids saves lives" program. The same program was performed one year later and the same questionnaire was given to students in order to fill it again before and just after the course

Results

The training improves significantly the theoretical knowledge regarding Cardiopulmonary resuscitation (CPR), with the percentage of correct answers being 48,4% and 82,8%,before and after the first year course respectively (p < 0.001). One year later, students retain a big part of their knowledge before the course (64,1% correct answers), and also improve their performance (87,5% correct answers, p < 0,001) after the course.

Conclusions

The overall results strongly depict the benefits of "Kids Save Lives" program by improving the theoretical knowledge. The course should performed for at least 2 years in order to attain optimal results of theoretical knowledge. Further research is needed to identify the times a student must follow the program to maximize its effectiveness
Tocilizumab reduces cardiac injury after out-of-hospital cardiac arrest primarily in patients without acute revascularization - Results from a randomized trial, The IMICA trial
Authors: Meyer M , Wiberg S , Grand J , Meyer ASP , Obling L , Kjaergaard J , Hassager C
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation (Reference no. 19-R135-A9302-22125) Lundbeck Foundation (Reference no. R186-2015-2132)

BACKGROUND

Patients remaining comatose after the initial resuscitation from out-of-hospital cardiac arrest (OHCA) have a high risk of morbidity and mortality as part of the ensuing post cardiac arrest syndrome (PCAS). Systemic inflammation and myocardial dysfunction are constituents of PCAS. The cytokine Interleukin-6 (IL-6) is associated with PCAS severity and poor outcome. Also, the extend of cardiac injury is a prognostic marker. We have recently shown that the IL-6 receptor antagonist tocilizumab dampens systemic inflammation and cardiac injury after cardiac arrest.

PURPOSE

To investigate if the reduction in cardiac injury by tocilizumab is differentiated in patients undergoing acute coronary revascularization compared to those who do not.

METHODS

Eighty comatose OHCA patients were randomized 1:1 in a double-blinded placebo-controlled trial to a single infusion of tocilizumab or placebo in addition to standard of care including targeted temperature management. Trial registration: Clinicaltrials.gov NCT03863015. Blood samples were sequentially drawn for biomarker analysis. Endpoints were markers of cardiac injury and inflammation:  Troponin T (TnT), N-terminal pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP). Continuous variables were log2 transformed and analyzed using mixed models; values shown as geometric mean with 95%-confidence limits [95%CL] after back-transformation.

RESULTS

Thirty-nine patients were randomized to treatment with tocilizumab and 41 to placebo. In the tocilizumab group 15 (39%) patients underwent acute revascularization (all PCI), and this was 22 (54%) for placebo. Patients not undergoing acute revascularization had a marked reduction by treatment with tocilizumab in TnT at 6h, as well as NT-proBNP at 48h (Figure). For patients treated with acute revascularization there was no significant group difference in TnT at 6h, whereas there was a marked reduction in NT-proBNP at 48h. There was a substantial reduction in CRP by treatment with tocilizumab irrespective of whether acute revascularization was performed.

CONCLUSION

Treatment with tocilizumab resulted in a significant reduction in myocardial injury as measured by TnT primarily in patients not undergoing acute revascularization, whereas the reduction in NT-proBNP, as well as CRP, was seen irrespective of whether acute revascularization was performed. Abstract Figure. Acute vs. NO acute revascularization
The impact of kids save lives program on knowledge and skills of Greek students, subgroup analysis on recognition of cardiac arrest
Authors: Parisis C , Bouletis A , Chatzidimitriou K , Palla D-D , Makri P , Economou K , Ntaliani M , Aggelosopoulou M , Triantafyllou TH
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Sudden cardiac death is one of the main issues worldwide, with more than 700.000 deaths annually. It is strongly believed that the implementation of "Kids Save Lives" project in schools can change this situation. The World Health Organization endorsed the ‘Kids Save Lives’ project in 2015 in order to reduce mortality. The first chain of survival concerns the recognition of cardiac arrest with chin lift and head tilt manoeuvre of the victim and the feel- look- listen approach.

Purpose

Τo evaluate the level of theoretical knowledge, as far the recognition of cardiac arrest is concerned in Greek secondary school students before and after the "Kids Save Lives" program.

Material – Method: Data collection took place on the academic periods of 2017-2018 and 2018-2019 and was performed in secondary schools of Thessaly’s region. A total of 4922 students (51,9% female, mean age 14.2 years) participated on the "Kids save Lives" program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. A 12-point questionnaire was answered by the students before and after the "kid saves lives" program, while practical skills were evaluated on manikins by experienced ERC Basic Life Support (BLS) Instructors. The knowledge of the recognition of cardiac arrest is investigated in this subgroup analysis

Results

The training improves significantly the theoretical knowledge regarding the recognition of cardiac arrest, with the percentage of correct answers being 58,3% and 96,1%,before and after the course respectively (p < 0.001). In the practical part of the program, almost all of the participants (98.9%) could recognize the correct position near the victim and 91% perform chin lift manoeuvre and recognize cardiac arrest.

Conclusions

The overall results reveal that the "Kids Save Lives" program can play a important role in improving the theoretical knowledge and  the practical skills of Greek students towards towards the recognition of cardiac arrest and indicate the necessity of implementation in a greater scale nationwide.
Acute myocarditis in COVID19 patients. Clinical features, severity and outcomes. Results from Spanish multicenter registry Car-COVID19
Authors: Abellas Sequeiros M , Sanmartin Fernandez M , Cosin Sales J , Corbi Pascual M , Escudier Villa JM , Ortiz Cortes C , Baron Esquivas G , Gomez Doblas JJ , Barge Caballero E , Garcia Del Egido A , Barrios Alonso V , Gonzalez Juanatey C , Anguita Sanchez M , Zamorano JL
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Fundacion del Corazon

Introduction

COVID19 has emerged as a new disease, spreading around the world, leading to a complete lockdown. It is known that other infectious diseases can affect the heart inducing myocarditis. As a new entity, it was unknown if SARS-COV2 could provoke that cardiovascular manifestation. This national registry was created to describe COVID19 cardiac affection and its severity.

Methods and results

A multicenter registry was conducted, including 28 centers in Spain. Patients with COVID19 diagnosis presenting an acute cardiovascular event between March 1st and May 30th were included. Eighty-two patients were included. Of them, 9 (14,1%, excluding missing data) presented with acute myocarditis; the rest were diagnosed of acute myocardial infarction or stress cardiomyopathy. Baseline characteristics of these patients are summarised in Table 1. The 83,3% of patients with myocarditis presented with heart failure and 25% simulating an acute coronary syndrome.

According to severity, 5 patients (62,5%) were admitted in the Intensive Care Unit, requiring orotracheal intubation 4 patients (57,1%). Left ventricle was affected in 66,7% of patients, whereas the remaining 33,3% presented biventricular failure. Mean left ventricle ejection fraction was 46% [30,0%-52%]. One patient developed refractory cardiogenic shock requiring implantation of both intra-aortic balloon pump and VA- ECMO. Three patients died during hospitalization.

Cardiac magnetic resonance was conducted in 2 patients (28,6%), showing oedema and subepicardial enhacement in postero-lateral segments. Cardiac biopsy was performed in one patient showing significant lymphoid infiltration and intersticial oedema.

Conclusions

Patients with COVID 19 who develop acute myocarditis usually present with heart failure secondary to ventricular failure. This entity has a bad prognosis with high in-hospital mortality rate. Table 1. Baseline characteristics.n (%)Age65,0[47,0-77,0]Sex (female)3 (42,9%)Hypertension3 (42,9%)Dyslipidemia3 (42,9%)Diabetes mellitus2 (28,6%)Chronic coronary disease1 (14,3%)Previous stroke1 (14,3%)Cancer1 (14,3%)
Catheter-directed low-dose fibrinolysis infusion for treat acute intermediate-high risk pulmonary embolism
Authors: Martin Cabeza MM , Garcia Gonzalez MJ , Jorge Perez P , Sanchez-Grande Flecha A , Munoz Rodriguez R , Igareta Herraiz AT , Leiva Gordillo M , Mendez Vargas C , Yanes Bowden G , Bosa Ojeda F
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND 

Intermediate-high risk  (IHR) Pulmonary Embolism (PE) are a common disease witch could have a high mortality. Anticoagulation remains the first therapeutic option, but Catheter-directed therapies are being investigated as a safe and effective treatment option.

PURPOSE

To evaluate the safety and efficacy of Catheter-directed low-dose fibrinolysis infusion to treat IHR-PE.

METHODS

Retrospective analysis of 16 patients IHR-PE treated. After performing Right catheterization (RC) and angiogram, Pigtail catheters were located for intrapulmonary infusion of Alteplase 1mg/h/catheter for 24 h (25-30mg/day). Baseline and clinical characteristics, inicial and evolutive echocardiography, also clinical evaluation and echocardiography 6 months after discharge were evaluated.  

RESULTS

The majority were women (11) and obese (93.8%), aged 22-74 years with cardiovascular risk factors: 5 hypertension, 3 Dyslipidemia, 2 smokers and 3 severe CKD . At admission 11 patients consulted for dyspnea and 5 for syncope; all were hemodynamic stable. 68.8% presented respiratory failure. All had bilateral PE (angiography) and elevation of Nt-proBNP and troponins. The echocardiographic at admission, and its evolution are shown in Table 1.  The invasive measurement of pulmonary hypertension (PH) reflected greater severity than the estimated by echo:  5 (31.3%) Severe PH, 5 (31.3%) Moderate PH and 2 (12.5%) mild PH.

At discharge all presented a decrease in PH and 15 (93.8%) improved RV function. 2 patients suffered bleeding complications (relation with femoral access): 1 not severe, 1 severe without mortality; none suffered intracranial hemorrhage.

In the evaluation at 6-months: 13 patients (81.3%) where on functional Class I and without PH, 3 patients (18.8%) where in Class II and with mild-PH.

CONCLUSION

In short-term follow-up, intrapulmonary low-dose fibrinolysis reduces PA pressures and improves RV function, without an increased bleeding complications, especially if femoral access is avoided. However impact on long-term remains unclear. Table 1: Echocardiography evolution.RV function admissionNormal Function1 (6.3%)Mild Dysfunction9 (56.3%)Moderate Dysfunction6 (37.5%)RV Dilatation admissionDilatation 16 (100%)Not dilatation 0 (0%)PH Degree admissionMild PH6 (37.5%)Moderate PH5 (31.3%)Severe PH5 (31.3%)PH Degree 24h-postNot PH1 (6.3%)Mild PH10 (62.5%)Moderate/severe PH5 (31.3%)Improvement RV 24h-postYes14 (87.5%)Not2 (12.5%)RV function dischargeNormal Function16 (100%)Mild Dysfunction0 (0%)Moderate Dysfunction0 (0%)RV Dilatation dischargeDilatation 5 (31.3%)Not dilatation 11 (68.8%)PH Degree dischargeNot PH 9 (56.3%)Mild PH7 (43.8%)Moderate/severe PH0 (0%)RV Right Ventricular; PH: Pulmonary Hypertension,
Impact of ESC-endorsed high ischemic risk features and ARC-high bleeding risk criteria on clinical outcomes in all-comer patients undergoing PCI
Authors: Wang HY , Yin D , Yang YJ , Xu B , Dou KF
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Beijing Municipal Health Commission (Grant number: 2020-1-4032).

Background

Whether the underlying risk of high bleeding risk (HBR) influences the relationship of high ischemic risk (HIR) features with adverse events after drug-eluting stent implantation remains unclear. The purpose of this study was to evaluate (1) the prognostic effect of ESC guideline-endorsed HIR features on long-term clinical outcomes and (2) whether the outcomes of HIR versus non-HIR features vary by HBR status.

Methods

Ten thousand one hundred sixty-seven consecutive patients who underwent percutaneous coronary intervention between January 2013 and December 2013 were prospectively enrolled in Fuwai PCI Registry. Patients who are at HIR were defined as: diffuse multivessel disease in diabetic patients, chronic kidney disease, at least three stents implanted, at least three stents lesions treated, bifurcation with two stents implanted, total stent length > 60 mm, or treatment of chronic total occlusion. The definition of HBR was based on the Academic Research Consortium (ARC) for HBR criteria. The primary ischemic outcome was major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis. The primary bleeding outcome was clinically relevant bleeding, defined according to Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding.

Results

With a 2.4-year median follow-up, 4430 patients (43.6%) having HIR experienced a significantly higher risk of MACE (hazard ratio [HR] adjust : 1.56, 95% confidence interval [CI]: 1.34–1.82; P < 0.001) and device-oriented composite endpoint (composite of cardiac death, target-vessel MI, and target lesion revascularization) (HRadjust : 1.52 [1.27–1.83]; P < 0.001), compared to those having non-HIR. The risk of clinically relevant bleeding did not differ between groups (HRadjust : 0.85 [0.66–1.08]; P = 0.174). Associations between HIR and adverse events were similar in HBR and non-HBR groups, without evidence of interaction (all P interaction > 0.05); however, adverse event rates were highest among subjects with both HIR and HBR.

Conclusions

ESC guideline-endorsed HIR was associated with significantly increased risk of MACE without any significant differences in clinically relevant bleeding. The presence of ARC-HBR does not emerge as a modifier of cardiovascular risk for patients at HIR, suggesting more potent and longer antiplatelet therapy may be beneficial for this patient population.
The radioprotective effect of the cathpax air cabin during interventional cardiology procedures
Authors: Noval Morillas I , Gutierrez Barrios A , Angulo Pain E , Gheorghe L , Alarcon De La Lastra I , Canadas Pruano D
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Puerta del Mar

BACKGROUND

 The use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and the medical staff.  Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has demonstrated to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. 

METHODS AND RESULTS

 In this non-randomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n = 59) and the non-RPC group (n = 60). No significant changes in patients and procedures characteristics, average contrast volume, air kerma (AK), dose area-product (PDA) and fluoroscopy time between both groups were apparent.

In RPC group, the first operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures.

CONCLUSIONS

 Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting. Table 3.Comparison of radiation exposureStructural (n = 12)Coronary (n = 107)pPrimary outcomesFirst operator relative exposure at chest*6.8 ± 33 ± 0.60.06First operator relative exposure at left wrist*19.3 ± 104 ± 1.50.01Secondary outcomesSecond operator relative exposure at chest*2.5 ± 1.21.2 ± 0.20.06First operator dose at chest (E in µSv)59.2 ± 4317.2 ± 50.08First operator dose at left wrist (E in µSv)134.1 ± 9623.4 ± 90.04Second operator dose at chest (E in µSv)19 ± 165.7 ± 20.1Patient exposure (DAP in mGy·cm2)62651 ± 2618059682 ± 142860.8Fluoroscopy time, min (±SD)24.2 ± 715.7 ± 40.2Abstract Figures 1 and 2