bluuebunny/crossref_metadata_2025_split huggingface dataset:
26 CORONARY MICROVASCULAR DYSFUNCTION: IT COULD BE (ALSO) A MAN'S WORLD!
Authors: Persampieri Simone , Baluci Martino , Schaffer Alon , De Martino Leonardo , De Pace Doranna , Lupi Alessandro 
Published: December 2022

Abstract

Introduction
Coronary microvascular dysfunction (CMD) is one of the possible manifestation of ischaemic heart disease with signs and symptoms of myocardial ischaemia, but no obstructive coronary artery disease (CAD). CMD is defined by an impaired coronary flow reserve owing to functional and/or structural abnormalities of the microcirculation and it is associated with adverse cardiovascular prognosis. Women are known to be more likely than men to have angina in the absence of obstructive CAD and CMD has been proposed as one of the major reasons for this presentation. However, also in men, CMD should be recognized, in order to give the best treatment to relieve symptoms and improve patient prognosis.
Index of microvascular resistance (IMR) and coronary flow reserve (CFR) are needed to diagnose CMD and are now easily obtained with pressure wires measurement.

Methods
Since the adoption in our Cath Lab of the PressureWire™ X Guidewire with the Coroventis CoroFlow Cardiovascular System (Abbott) we started to study IMR and CFR in patients with no obstructive CAD and typical angina. No acute coronary syndromes have been studied in our Cath Lab so far. In this brief study we report a descriptive analysis of the first patients studied and of the first period of follow-up, focusing on men.

Results
From January 2022 (date when we received the new software) to April 2022 we studied 24 patients and 8 (33%) were men. Among men, mean age was 58±5 yo and two have been already treated with PCI during the previous 6 months. Mean ejection fraction was 57±2% and mean GFR was 76±20 ml/min/mq. 7 out of 8 patients were affected by dyslipidemia, 5 were smoker, 50% were affected by arterial hypertension and only 1 by diabetes. Mean RFR and FFR in left anterior descending artery were 0.92±0.02 and 0.92±0.03, respectively. In 6/8 (75%) patients IMR derived was &gt;25 and, among them 4 (66%) had CFR&lt;2. After coronary study we tried to optimize medical therapy in all these patients, adding or changing to Zofenopril previous ACE inhibitor therapy, adding or titrating Ranolazine and adding or titrating negative chronotropic therapy (beta blockers or calcium channel blockers). After therapy optimization none of the patients had resumption of symptoms (follow-up from 3 to 7 months).

Conclusions
Even if historically considered a women's disease, we should remember that CMD also affects men. New widespread technologies should be used systematically to rule out CMD and to define patients’ symptoms mechanisms. This would lead to targeted therapy that could improve patient's lives.
47 UNDER THE BRIDGE: OFF-LABEL CANGRELOR FOR PCI PATIENTS UNDERGOING NON CARDIAC SURGERY
Authors: Scalia Lorenzo , Calderone Dario , Agnello Federica , Legnazzi Marco , Mauro Maria Sara , Capranzano Piera , Greco Antonio , Capodanno Davide , Tamburino Corrado 
Published: December 2022

Abstract

Background
Dual antiplatelet therapy (DAPT) reduces the risk of stent thrombosis after percutaneous intervention (PCI), but it is estimated that approximately 5 to 10% of PCI patients undergo major noncardiac surgeries within 12 months from the procedure, which requires DAPT interruption. The interruption of DAPT reduces the risk of perioperative bleeding, but increases the risk of stent thrombosis. Peri-operative “bridge” therapy with cangrelor, a reversible and competitive intravenous P2Y12 receptor inhibitor with rapid on/offset of action, may offer a solution for high-risk patients undergoing major noncardiac surgery who require DAPT interruption. However, the use of cangrelor for this indication is currently off-label.

Clinical Scenario
A 58-year-old man was admitted to ER with increasing dyspnea and oppressive chest pain on exertion. A diagnosis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was made and PCI of the left main-left anterior descendent artery segment and the right coronary artery was performed with implantation of four drug-eluting stents. DAPT was prescribed for 12 months with acetylsalicylic acid 100 mg daily and ticagrelor 90 mg twice daily. The day after the procedure, due to gross hematuria with clots formation; the hemoglobin level fell to 8 g/dL and a transfusion was required. Subsequent abdominal echocardiography revealed two bladder neoformations that required further endoscopic evaluation and transurethral resection of bladder tumor (TURBT). In preparation for such invasive procedure, DAPT required interruption despite the high risk of catastrophic consequences.

Methods
After ticagrelor interruption, cangrelor was started intravenously at a rate of 0.6 mcg/Kg/min for 5 days and stopped 2 hours before the TURBT procedure, which was performed with minimal blood loss and no ischemic complications. Cangrelor infusion was re-started 2 hours after surgery at the same initial rate and planned for 12 hours if no sudden bleeding occurred. The day after the TURBT procedure cangrelor was stopped and DAPT was re-initiated with aspirin 100 mg daily and clopidogrel 75 mg daily (after a 600 mg loading dose). The patient was discharged 2 days later without any new bleeding or ischemic event.

Conclusions
Premature discontinuation of DAPT is a strong predictor of stent thrombosis in patients undergoing PCI who require major noncardiac surgery. Cangrelor represents a viable option for managing high-risk individuals who require prolonged P2Y12 receptor blockade with rapid onset and offset of action despite discontinuation of oral therapy. This use is currently off-label due to lack of well powered randomized clinical trials of bridge therapy.
122 A SWORD IN THE STONE - A STEMI AFTER MIAVR
Authors: Scalia Lorenzo , Francaviglia Bruno , Calderone Dario , Mauro Maria Sara , Capodanno Davide , Capranzano Piera , Tamburino Corrado 
Published: December 2022

Abstract

Background
Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions (mini-sternotomy and right anterior mini-thoracotomy approaches) and minimized degree of surgical intrusiveness. Compared with conventional surgery, it has been shown to reduce postoperative mortality, providing faster and shorter recovery, requires less rehabilitations resources and consequently cost reduction. Even though MIAVR has considered as a safe and acceptable surgical technique, higher learning curve and requirement for re-training should be endorsed as procedural limitations. Among procedural related complications, embolic events still remain the most serious.

Clinical case
A 70-year-old man, due to increasing dyspnea and chest pain came to emergency department. His medical history was notable for cigarettes smoke, dyslipidemia, non insuline dependent type 2 diabetes mellitus and hypertension. No abnormal electrocardiografic alterations. A transtoracic echocardiogram was performed showing, Left ventricular ejection fraction 50%, no wall motion abnormalities and thickened, ipomobil and calcified aortic valve cusps assessing a diagnosis of severe aortic stenosis. He was conducted to the cath-lab for a diagnostic coronary angiogram which showed a no-significant atherosclerotic disease. After Heart Team evaluation, MIAVR was the suitable and optimal management indicated for the patient.
Four hours after ending surgical procedure, ST segment elevation suddenly appears on DII, DIII and aVF leads. Emergency coronary angiogram showed an acute occlusion of the proximal circumflex artery.
After several unsuccessful attempts to cross the occlusion with different types of workhorse guidewires, we considered the cause of uncrossability was not a thrombus but a debris calcium embolus detached from valve apparatus.
After failed attempts using FineCross, SuperCross 90° provided adequate support to gaining access and enhancing the penetrating power of guidewire; we put the guidewire distally through the Mo2 with partial flow regain. Then we proceeded to modify the plaque geometry with a NC balloon to help crossing guidewire through distal Cx. So we’ve passed over the lesion gaining Cx periphery with a Fielder XT guidewire and we’ve proceeded to prepare the lesion thorugh progressive NC balloon dilatations. At the end we’ve implanted a 3.5/15 mm DES on mid Cx.

Conclusion
As MIAVR has being more common in the last twenty years, it is useful knowing how to manage any possible related peri-operative complications. Calcific valve is a very uncommon source of coronary debirs embolization. Coronary embolism is associated to worse outcomes: early diagnosis and revascularization must be required. Knowledge of CTO techniques and materials (guidewires, microcatheters) for a “non-CTO” dedicated operators could be useful in several scenarios, such as that encountered in the present case.
759 LEFT MAIN PERCUTANEOUS OR SURGICAL REVASCULARIZATION AND SUBSEQUENT RISK OF ACUTE KIDNEY INJURY: INSIGHTS FROM THE LUCKY REGISTRY
Authors: Terzi Riccardo , Chiarito Mauro , Oliva Angelo , Iaccarino Alessandra , Novelli Laura , Carnabuci Anna Giuli , Regazzoli Damiano , Mangieri Antonio , Sticchi Alessandro , Ferrante Giuseppe , Sturla Matteo , Gasparini Gabriele , Pagnotta Paolo , Colombo Antonio , Condorelli Gianluigi , Barbone Alessandro , Torracca Lucia , Reimers Bernhard , Mehran Roxana , Stefanini Giulio G 
Published: December 2022

Abstract

Background
Recent evidence has rendered percutaneous coronary intervention (PCI) a valuable alternative to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Nevertheless, the optimal management and patients selection is still subject to discussion

Methods
We retrospectively included 431 patients treated with PCI and 324 patients treated with CABG with the primary objective of comparing procedural failure according to revascularization strategy. Secondary endpoints were post procedural and clinically relevant myocardial infarction, in-hospital stroke, major bleeding defined according to the Bleeding Academic Research Consortium (BARC) criteria, death, and 1-year major adverse cardiac events (MACE).

Results
There was no observed difference in the rates of procedure failure in patients who received PCI compared to patients who received CABG (4.6% vs 3.7%, respectively) odds ratio [OR] 1.26; (95% confidence intervals [CI] 0.58-2.9, p= 0.52.) There was no significant difference in the defined ischemic outcome for PCI vs CABG (0.9% vs 2.4%, respectively) OR 0.37; (95% CI 0.08-1.4), P = 0.09. There was a mild increase in periprocedural myocardial infarction (MI) after PCI (4.2% vs 1.5%) compared to CABG; (OR = 2.8; 95% CI 0.99-9.8, P = 0.034). On the contrary there was a higher risk of major bleeding and transfusions in the patients who had been treated with CABG who has a clinical profile suited for PCI.

Conclusions
PCI did not significantly increase the risk for procedural failure or ischemic events compared to CABG in patients with LM CAD. The higher risk for post-procedural MI after PCI was offset by a higher risk for major bleeding events and transfusion requirements in those undergoing CABG, especially for those who were clinically suited for PCI.
760 IMPACT OF COMORBIDITIES AND PATIENTS PREFERENCE ON THE CHOICE BETWEEN PERCUTANEOUS OR SURGICAL REVASCULARIZATION FOR LEFT MAIN CORONARY ARTERY DISEASE
Authors: Chiarito Mauro , Oliva Angelo , Novelli Laura , Terzi Riccardo , Sturla Matteo , Lacevic Emir , Carnabuci Anna Giulia , Regazzoli Damiano , Mangieri Antonio , Sticchi Alessandro , Ferrante Giuseppe , Gasparini Gabriele , Pagnotta Paolo , Colombo Antonio , Mehran Roxana , Torracca Lucia , Condorelli Gianluigi , Reimers Bernhard , Stefanini Giulio G 
Published: December 2022

Abstract

Background
Recent evidence has rendered percutaneous coronary intervention (PCI) a valuable alternative to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Nevertheless, the optimal management and patients selection is still subject to discussion

Methods
We retrospectively included 431 patients treated with PCI and 324 patients treated with CABG with the primary objective of comparing procedural failure according to revascularization strategy. Secondary endpoints were post procedural and clinically relevant myocardial infarction, in-hospital stroke, major bleeding defined according to the Bleeding Academic Research Consortium (BARC) criteria, death, and 1-year major adverse cardiac events (MACE).

Results
There was no observed difference in the rates of procedure failure in patients who received PCI compared to patients who received CABG (4.6% vs 3.7%, respectively) odds ratio [OR] 1.26; (95% confidence intervals [CI] 0.58-2.9, p= 0.52.) There was no significant difference in the defined ischemic outcome for PCI vs CABG (0.9% vs 2.4%, respectively) OR 0.37; (95% CI 0.08-1.4), P = 0.09. There was a mild increase in periprocedural myocardial infarction (MI) after PCI (4.2% vs 1.5%) compared to CABG; (OR = 2.8; 95% CI 0.99-9.8, P = 0.034). On the contrary there was a higher risk of major bleeding and transfusions in the patients who had been treated with CABG who has a clinical profile suited for PCI.

Conclusions
PCI did not significantly increase the risk for procedural failure or ischemic events compared to CABG in patients with LM CAD. The higher risk for post-procedural MI after PCI was offset by a higher risk for major bleeding events and transfusion requirements in those undergoing CABG, especially for those who were clinically suited for PCI.
2 ABSENCE OF MAJOR CARDIOVASCULAR EVENT IN A GROUP OF PATIENTS FOLLOWED FOR MORE THAN ONE YEAR AFTER SEVERE COVID-19 PNEUMONIAE
Authors: Salvotti Francesca , Tosoni Federico , Borghi Erika , Fusco Elena Maria , Volpe Pietro , Zanotti Eros , Scipione Vittorio , Flamminio Gigliola , Pastori Antonella , Pedroni Leonardo , Napoli Federico , Santagiuliana Marzia , Turini Daniele , Leidi Francesca , Manzoni Francesca , Saottini Michele , Geroldi Veronica , De Ciuceis Carolina , Rosei Claudia Agabiti , Rizzoni Damiano , Boari Gianluca E m 
Published: December 2022

Abstract

Introduction
The Coronavirus disease 2019 (COVID-19), doesn't affect only respiratory system, but it also involves other organs including cardiovascular system, possibly causing acute or chronic cardiovascular events. Preexisting cardiovascular diseases enhance COVID-19 morbidity, as well.

Aim
In this retrospective analysis we investigated the onset of cardiovascular events during a time-span of more than one year since hospitalization (384 days).

Methods
The analysis included 43 patients, who were hospitalized in Internal Medicine Department of Montichiari Hospital (ASST Spedali Civili of Brescia) for moderate to severe SARS-CoV2 related pneumonia treated with high-flow oxygen support (ranging from 40% fraction of inspired oxygen to non-invasive ventilation)
Mean age was 63 years, 28% (12/43) were female and 72% (31/43) were male. Thirty-five percent of the patients suffered from heart diseases, 56% of them were hypertensives and 23% had type 2 diabetes; 12% had chronic kidney disease (CKD) and 5% an active neoplasm. 49% of the sample was obese. Nineteen percent took ACE inhibitors and 19% was on ARBs. Statins were taken by 37% of the patients; an antiaggregant by 21%, and an anticoagulant by 2% (see table)

Results
The follow-up visit included the evaluation of post-covid infection quality-of-life, standard laboratory tests, chest computed tomography, spirometry with evaluation of DLCO. The onset of cardiovascular events during the average period of 384 days was evaluated. None of the 43 patients had major cardiovascular events: coronary heart disease, cerebrovascular disease, peripheral arterial disease, deep vein thrombosis and pulmonary embolism.

Conclusions
Even if this study failed to demonstrate new-onset CV events, longer follow-up studies performed to evaluate cardiovascular risk following SARS-CoV1 infection showed persistent hyperlipidemia, cardiovascular system abnormalities, and glucose metabolism disorders in a very high number of patients. Further analyses are needed to further investigate longer term cardiovascular consequences of SARS-CoV2 infection.
293 IMPACT OF FEMALE GENDER ON ACUTE AND MID-TERM MORTALITY IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION DURING THE PANDEMIC ERA
Authors: Barbieri Lucia , Avallone Carlo , D´errico Andrea , Gentile Domitilla , Membo Dagnachew Cigno , Tumminello Gabriele , Carugo Stefano 
Published: December 2022

Abstract

Background
There is still much controversy concerning the impact of gender on mortality during ST-segment elevation myocardial infarction (STEMI). The COVID-19 pandemic deeply affected the clinical history of these patients, both in terms of presentation time and management. The aim of our study was to evaluate the impact of female gender on acute and mid-term mortality in STEMI patients hospitalized during the pandemic period.

Materials and Methods
Our study focuses on STEMI patients hospitalized during the darkest period of the pandemic. We retrospectively analyzed consecutive STEMI patients hospitalized from 15 March 2020 to 15 March 2021 in our Hub centre in Milan, Lombardy. All clinical, demographic, and procedural characteristics were collected in a dedicated database. Patient follow-up was carried out through clinical visits, telephone calls and remote monitoring through the “Lombardia Regional Registry”.

Results
From a total of 283 patients, women represented 26.8% of the population, with a mean age of 72 - 11.2 years vs. 64.7 - 12.6 years in men. Anterior STEMI was the most represented with a mildly reduced ejection fraction (EF 48.3 _ 11.8%) similar between genders. Coronary angiography showed more extensive disease in man, while women presented with a higher Killip class at admission and a more pronounced anemic status. In-hospital and 1-year mortality of the whole cohort were 11.4% and 7.5%, respectively, with no significant differences between genders (14.5% women vs. 10.6% men, p = ns; 9.2% women vs. 7% man, p = ns). EF resulted in being the only independent predictor of mortality in the short-term and at 1-year follow up in both genders. In the acute phase, the only other independent predictor of mortality was COVID-19 infection, secondary to the higher rate of respiratory omplications, without any difference in terms of major adverse cardiac events. The impact of COVID-19 infection on mortality was completely lost at 1-year follow up.

Conclusions
Our study has shown that female gender in STEMI patients does not represent an independent predictor of mortality both in the short- and in the mid-term follow up. Concomitant COVID-19 infection significantly influenced in-hospital mortality due to the higher rate of respiratory complications in both genders. The impact of COVID-19 on mortality was completely lost at follow-up, where age and a reduced EF remained the only independent predictors, regardless of gender.
382 IMPACT OF AGE ON MORTALITY IN STEMI PATIENTS DURING THE SARS-COV2 PANDEMIC:DATA FROM THE ISACS-STEMI COVID-19 REGISTRY
Authors: Ponti Enrico , Malivojevic Renata , Verdoia Monica , Nardin Matteo , Kedhi Elvin , Suryapranata Harry , Galasso Gennaro , De Luca Giuseppe 
Published: December 2022

Abstract

Background
Several reports have described the negative prognostic impact of ageing in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary angioplasty. During the COVID-19 pandemic, increased mortality was observed in patients admitted for STEMI. However, there are no data on the impact of ageing on the outcome of this high-risk patients during the pandemic.

Objectives
The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 11920 of March until June 30, 2019 and 2020). Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints was 30-day mortality.

Results
Our population is represented by 16083 STEMI patients undergoing mechanical reperfusion, who were divided according to age (&lt; 55 years, n = 4179 (25,98%); 55-65 years, n = 4814 (29,93%); 65-75 years, n = 4016 (24,97%); 75-65 years, n = 2226 (13,84%); &gt;85 years, n = 821 (5,10%). Ageing was linearly and independently associated with in-hospital (figure 1) and 30-day mortality (adjusted p &lt; 0.0001). The COVID pandemic had a significant impact on in-hospital and 30-day mortality (adjusted p &lt; 0.001), that was linearly related to age, particularly for in-hospital mortality (Figure 1).

Conclusions
Our study showed that among STEMI patients undergoing primary angioplasty, age was linearly associated to mortality in both precovid and covid era. The COVID-19 pandemic had a significant impact on mortality, especially in more advanced age.
637 PREVALENCE AND CLINICAL SIGNIFICANCE OF RELATIVE BRADYCARDIA IN COVID-19 INPATIENTS
Authors: Testa Sabrina , Molinari Lorenzo Vilhelm , De Luca Luigi , Pizzoferrato Giovanni , Falasca Katia , Vecchiet Jacopo , Gallina Sabina , Ricci Fabrizio , Renda Giulia 
Published: December 2022

Abstract

Background and aims
Relative Bradycardia (RB) is a poorly understood condition that refers to inappropriately low heart rate response to a given increase in body temperature. Dysfunctional crosstalk between the immune system and the autonomous nervous system has been advocated. It is most often observed in intracellular gram negative and parasitic infections, with a prevalence ranging between 15% and 20%. The aim of this study was to identify the prevalence, clinical determinants and significance of RB in patients hospitalized for SARS-CoV-2 infection and to evaluate its prognostic value for long-covid syndrome during follow-up.

Methods
We enrolled consecutive patients hospitalized for SARS-CoV-2 infection from March 2020 to April 2021. We collected clinical parameters including clinostatic and orthostatic blood pressure (BP) and heart rate (HR) at 1,3 and 5 minutes, oxygen saturation, body temperature (BT), routine blood tests, 12-lead ECG, and 48-h Holter ECG. At follow up, clinical symptoms were investigated by novel Malmo POTS Symptoms (MAPS) questionnaire.

Results
Total population included 269 inpatients (mean age 67±17 years, 59% male).Of these, 30 (11%) presented with sinus bradycardia and 37 (14%) RB. RB was more frequently observed in younger male patients with higher BT and heightened CRP levels. There were no significant correlations between BP and HR orthostatic changes and BR during hospital admission or during follow-up. No clinically relevant arrhythmias were revealed during 48-hour ECG monitoring. After mean16-month follow-up, MAPS score was higher in patients with RB (30±19) compared to those without RB (18±21, p=0.001) during index hospital admission. Dizziness, palpitations and fatigue were more frequently reported in patients with RB(p&lt;0.001).

Conclusions
RB is not an uncommon condition during acute COVID-19. SARS-CoV-2 inpatients who presented RB during index hospitalization showed a higher symptom burden during follow-up, as recorded by MAPS score. Further studies are needed to clarify the clinical significance of RB and its value to predict post-acute sequelae of COVID-19.
Spahic et Al., Malmö POTS symptom score: Assessing symptom burden in postural orthostatic tachycardia syndrome JIM 2022 (in press)