Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 177
Filter
1.
Int J Cardiol ; 2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2105050

ABSTRACT

INTRODUCTION: We sought to assess the clinical impact of Covid-19 infection on mortality in patients with Non-ST elevation myocardial infarction (NSTEMI) admitted during the national outbreak in Italy. METHODS: We analysed a nationwide, comprehensive, and universal administrative database of consecutive NSTEMI patients admitted during lockdown for Covid-19 infection (March,11st - May 3rd, 2020) and the equivalent periods of the previous 5 years in Italy. The observed rate of 30-day and 6-month all-cause mortality of NSTEMI patients with and without Covid-19 infection during the lockdown was compared with the expected rate of death according to the trend of the previous 5 years. RESULTS: During the period of observation, 48.447 NSTEMI hospitalizations occurred in Italy. Among these, 4981 NSTEMI patients were admitted during the 2020 outbreak: 173 (3.5%) with and 4808 (96.5%) without a Covid-19 diagnosis. According to the 5-year trend, the 2020 expected rate of 30-day and 6-month all-cause mortality was 6.5% and 12.2%, while the observed incidence of death was 8.3% (p = 0.001) and 13.6% (p = 0.041), respectively. Excluding NSTEMI patients with a Covid-19 diagnosis, the 6-month mortality rate resulted in accordance with the prior 5-year trend. After multiple corrections, the presence of Covid-19 diagnosis resulted one of the independent predictors of all-cause mortality at 30 days [adjusted odds ratio (OR) 4.3; 95% confidence intervals (CI) 2.90-6.23; p < 0.0001] and 6 months (adjusted OR 3.5; 95% CI: 2.43-5.03; p < 0.0001). CONCLUSIONS: During the 2020 national outbreak in Italy, a concomitant diagnosis of Covid-19 in NSTEMI was associated with a significantly higher rate of mortality.

2.
J Atheroscler Thromb ; 29(11): 1571-1587, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2100246

ABSTRACT

AIMS: Declines in cardiovascular diseases during the first surge of coronavirus disease 2019 (COVID-19) have been reported. With the repeating surges of COVID-19, we aim to investigate the medium-term impact of the COVID-19 pandemic on the practice of percutaneous coronary interventions (PCIs). METHODS: We performed a descriptive analysis of rates of PCIs, utilizing administrative data in Japan. Changes in the proportion of severe cases and in-hospital mortality since the start of the COVID-19 pandemic were investigated using interrupted time series (ITS) analyses. RESULTS: From April 2018 to February 2021, 38,696 and 28,585 cases of elective and emergency PCIs, respectively, were identified. The rates of PCIs decreased during the first and third COVID-19 surges. The ratios of monthly rates of elective PCIs to that in the corresponding months during the previous 2 years were 50.3% in May 2020 and 76.1% in January 2021. The decrease in rates of emergency PCIs was smaller than that of elective PCIs. The ITS analyses did not identify any significant changes in the proportion of severe cases and in-hospital mortality. CONCLUSIONS: We found that the impacts of COVID-19 on PCIs were larger in the first surge than in the subsequent and larger in the elective than in the emergency; this continued over the medium-term. During the COVID-19 pandemic, in-hospital mortality of cases undertaking emergency PCIs did not change.


Subject(s)
COVID-19 , Percutaneous Coronary Intervention , Humans , Pandemics , COVID-19/epidemiology , Japan/epidemiology , Hospital Mortality
3.
Revista Espanola de Cardiologia ; 2022.
Article in English | EMBASE | ID: covidwho-2061809

ABSTRACT

Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2021. Methods: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. Results: A total of 121 centers participated (83 public and 38 private). Compared to 2020, both diagnostic coronary angiograms and percutaneous coronary interventions (PCI) increased by 11,4% and 10,3%, respectively. The radial approach was the most used access (92,8%). Primary PCI also increased by 6.2% whereas rescue PCI (1,8%) and facilitated PCI (2,4%) were less frequently conducted. Transcatheter aortic valve implantation was one of the interventions with the most relevant increase. A total of 5720 transcatheter aortic valve implantation procedures were conducted with an increase of 34,9% compared to 2020 (120 per million in 2021 and 89,4 per million in 2020). Other structural interventions like transcatheter mitral or tricuspid repair, left atrial appendage occlusion and patent foramen oval closure also experienced a significant increase. Conclusions: The 2021 registry demonstrates a clear recovery of the activity both in coronary and structural interventions showing a relevant increase compared to 2020, the year of the COVID-19 pandemic.

4.
Chest ; 162(4):A283, 2022.
Article in English | EMBASE | ID: covidwho-2060549

ABSTRACT

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a rare cardiac phenomenon associated with autoimmune and inflammatory conditions seen often in young women with few conventional atherosclerotic risk factors. The presentation is indistinguishable from acute coronary syndrome and can lead to acute myocardial infarction, arrhythmias, and sudden death. We share a thought-provoking case of SCAD in a COVID-19 positive patient. CASE PRESENTATION: 51-year-old physically fit female with BMI of 22.46kg/m2, non-diabetic with recent unremarkable lipid panel and history of anxiety, postpartum cardiomyopathy 15 years prior with recovered ejection fraction presented with complaints of midsternal chest pain at rest, 9/10 intensity, radiating to the right shoulder associated with dyspnea, lasting for 3 hours until relieved by nitroglycerine patch. Initial workup revealed troponin of 3.08 and EKG consistent with acute ischemic changes without STEMI. She was incidentally found positive for SARS-CoV-2. Echocardiogram showed dyskinetic apex with normal ejection fraction. The following day, while she was on aspirin and heparin drip, she developed chest discomfort with EKG revealing dynamic T wave inversions and troponin trending up to 14.79. The patient was taken for an emergent cardiac catheterization which revealed patent coronaries with concern for distal left anterior descending artery dissection. Subsequently, the patient was continued on a heparin drip with an improvement of her symptoms. Troponin declined to 7.97 with no other COVID-19 related concerns. She was deemed medically stable and discharged home after completing her isolation. Furthermore, she underwent a cardiac and coronary artery CT angiogram 2 weeks later, showing patent coronaries and a calcium score of 0 and no findings of coronary artery disease. DISCUSSION: SCAD is an emergent condition closely associated with inflammatory conditions, systemic arteriopathy, emotional stress triggers, fibromuscular dysplasia, and pregnancy. It is not iatrogenic, traumatic or associated with atherosclerosis. The mainstay of detection of SCAD is coronary angiography. In our patient, since it was a distal LAD disease, the echo findings of dyskinetic apex helped established the diagnosis of SCAD. Management is mainly supportive usually carrying a good prognosis. In our case report, the connecting factor to SCAD was the presence of SARS-CoV-2. Our patient was without traditional risk factors for coronary artery disease, which reinforced the likelihood of SCAD instead of acute coronary syndrome. CONCLUSIONS: Thus, as the manifestations, complications, and sequelae of COVID-19 continue to emerge, we believe SCAD needs to remain a top differential in COVID -19 positive patients presenting with symptoms of the acute coronary syndrome. To better elucidate the pathophysiology of SCAD in SARS-CoV-2 patients, we encourage further vigilance of this phenomenon. Reference #1: Hayes, S. N. et al (2018, February 22). Spontaneous coronary artery dissection: Current state of the science: A scientific statement from the American Heart Association. Circulation. Retrieved April 1, 2022, from https://www.ahajournals.org/doi/10.1161/cir.0000000000000564 Reference #2: Ahmed, T., Jeudy, J., & Srivastava, M. C. (2020). Imaging modalities to delineate sequelae of spontaneous coronary artery dissection managed with percutaneous coronary intervention. Cureus. https://doi.org/10.7759/cureus.7591 DISCLOSURES: No relevant relationships by Hareesh Lal No relevant relationships by Jennaire Lewars No relevant relationships by Avani Mohta

5.
Journal of Tehran University Heart Center ; 17(3):103-111, 2022.
Article in English | EMBASE | ID: covidwho-2057796

ABSTRACT

Background: Limited data exist on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) presenting with ST-segment-elevation myocardial infarction (STEMI). Method(s): This multicenter study, conducted in 6 centers in Iran, aimed to compare baseline clinical and procedural data between a case group, comprising STEMI patients with COVID-19, and a control group, comprising STEMI patients before the COVID-19 pandemic, and to determine in-hospital infarct-related artery thrombus grades and major adverse cardio-cerebrovascular events (MACCEs), defined as a composite of deaths from any cause (cardiovascular and noncardiovascular), nonfatal strokes, and stent thrombosis. Result(s): No significant differences were observed between the 2 groups regarding baseline characteristics. Primary percutaneous coronary intervention (PPCI) was performed in 72.9% of the cases and 98.5% of the controls (P=0.043), and primary coronary artery bypass grafting was performed in 6.2% of the cases and 1.4% of the controls (P=0.048). Successful PPCI procedures (final TIMI flow grade III) were significantly fewer in the case group (66.5% vs 93.5%;P=0.001). The baseline thrombus grade before wire crossing was not statistically significantly different between the 2 groups. The summation of thrombus grades IV and V was 75% in the case group and 82% in the control group (P=0.432). The rate of MACCEs was 14.5% and 2.1% in the case and control groups, respectively (P=0.002). Conclusion(s): In our study, the thrombus grade had no significant differences between the case and control groups;however, the in-hospital rates of the no-reflow phenomenon, periprocedural MI, mechanical complications, and MACCEs were statistically significantly higher in the case group. Copyright © 2022 Tehran University of Medical Sciences.

6.
Journal of Cardiac Failure ; 28:12, 2022.
Article in English | EMBASE | ID: covidwho-2031176

ABSTRACT

Although cardiac rehabilitation (CR) is a cost-effective and evidence-based therapy for patients with acute myocardial infarction, heart failure, after percutaneous coronary intervention and bypass surgery, the major challenge remains to be suboptimal referral, uptake and compliance[1]. The remarkably lower density of CR programs relative to population is an additional unfavourable characteristic in Asia and other low and middle-income countries[2]. During the COVID-19 pandemic, inequality in access to CR service among different countries has been further aggravated[1]. Different barriers have been identified to explain the underuse of CR in different countries in Asia. In China, there is a lack of staff with interest, inadequate experience and training, financial limitation, space limitation and lack of patient awareness[3]. In India, patient disinterests and socioeconomic factors have been identified to be the barriers to referral for CR[4].With advancement in wearable, smartphone and communication technology, novel models of delivery of CR service have been implemented and studied[1]. In Hong Kong, community-based and home-based tele-cardiac rehabilitation programs have been conducted with preliminarily encouraging results.

7.
Clin Cardiol ; 45(10): 1070-1078, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2013438

ABSTRACT

BACKGROUND: The implications of coronavirus disease 2019 (COVID-19) infection on outcomes after invasive therapeutic strategies among patients presenting with acute myocardial infarction (AMI) are not well studied. HYPOTHESIS: To assess the outcomes of COVID-19 patients presenting with AMI undergoing an early invasive treatment strategy. METHODS: This study was a cross-sectional, retrospective analysis of the National COVID Cohort Collaborative database including all patients presenting with a recorded diagnosis of AMI (ST-elevation myocardial infarction (MI) and non-ST elevation MI). COVID-19 positive patients with AMI were stratified into one of four groups: (1a) patients who had a coronary angiogram with percutaneous coronary intervention (PCI) within 3 days of their AMI; (1b) PCI within 3 days of AMI with coronary artery bypass graft (CABG) within 30 days; (2a) coronary angiogram without PCI and without CABG within 30 days; and (2b) coronary angiogram with CABG within 30 days. The main outcomes were respiratory failure, cardiogenic shock, prolonged length of stay, rehospitalization, and death. RESULTS: There were 10 506 COVID-19 positive patients with a diagnosis of AMI. COVID-19 positive patients with PCI had 8.2 times higher odds of respiratory failure than COVID-19 negative patients (p = .001). The odds of prolonged length of stay were 1.7 times higher in COVID-19 patients who underwent PCI (p = .024) and 1.9 times higher in patients who underwent coronary angiogram followed by CABG (p = .001). CONCLUSION: These data demonstrate that COVID-19 positive patients with AMI undergoing early invasive coronary angiography had worse outcomes than COVID-19 negative patients.


Subject(s)
COVID-19 , Myocardial Infarction , Percutaneous Coronary Intervention , Respiratory Insufficiency , Cross-Sectional Studies , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/adverse effects , Retrospective Studies , Treatment Outcome
8.
Rev Port Cardiol ; 2022 Aug 26.
Article in Portuguese | MEDLINE | ID: covidwho-2004452

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. OBJECTIVES: To quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. METHODS: Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017-2019). RESULTS: The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (-36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, -25% (p<0.019), -20% (p<0.068) and -59% (p<0.001). CONCLUSIONS: Compared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.

9.
Journal of Thoracic Disease ; 14(7):2451-2453, 2022.
Article in English | EMBASE | ID: covidwho-1988789
10.
JMIR Res Protoc ; 11(8): e24595, 2022 Aug 05.
Article in English | MEDLINE | ID: covidwho-1987312

ABSTRACT

BACKGROUND: Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. OBJECTIVE: The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. METHODS: We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. RESULTS: In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. CONCLUSIONS: This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. TRIAL REGISTRATION: Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/24595.

11.
Cardiol Res ; 13(3): 172-176, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1957607

ABSTRACT

Bradyarrhythmia commonly occurs because of degenerative fibrosis in the conductive system. Ischemic disease is a rare etiology and limited cases have demonstrated direct evidence of ischemia to the sinus node vessels. We report a 62-year-old Hispanic male with a significant medical history of diabetes mellitus type II (DM II), hypertension, and dyslipidemia who was admitted to our hospital for symptomatic sinoatrial (SA) exit block. Patient had no electrolyte abnormalities and our differential included ischemic vs. fibrotic or infiltrative pathologies, giving symptomatic bradycardia, cardiac chest pain, and high-risk factors for coronary artery disease. We decided to take him for cardiac catheterization which revealed sluggish, pulsatile flow into the SA nodal artery due to severe stenosis of the ostial right coronary along with sever distal left circumflex (LCX) lesion. The flow into the sinus nodal artery (SNA) markedly improved post percutaneous coronary intervention (PCI) of the right coronary artery (RCA) and distal LCX and restoration of flow into SNA. Resolution of his bradyarrhythmia and symptoms post intervention confirmed our suspicious for reversible ischemic sinus node dysfunctions. Therefore, ischemic pathologies should be thought of when other common etiologies are less likely. Coronary angiogram should be considered prior to pacemaker evaluation in these setting to avoid missing reversible causes of bradyarrhythmia.

12.
Cardiol Clin ; 40(3): 345-353, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1944428

ABSTRACT

The global health crisis caused by the COVID-19 pandemic has evolved rapidly to overburden health care organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes and percutaneous coronary intervention. The reasons for such abrupt changes in health care delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted during the pandemic. This review discusses the impact of COVID-19 on important aspects of acute MI care.


Subject(s)
COVID-19 , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Communicable Disease Control , Humans , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Pandemics
13.
J Soc Cardiovasc Angiogr Interv ; 1(5): 100404, 2022.
Article in English | MEDLINE | ID: covidwho-1936877

ABSTRACT

Background: In-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI. Methods: Baseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient. Results: In-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 â€‹years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P â€‹< â€‹.001), and the model demonstrated good discriminative power (c-statistic â€‹= â€‹0.81) and calibration (Hosmer-Lemeshow, P â€‹= â€‹.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high-risk score categories, respectively). Conclusions: The risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

14.
Korean J Intern Med ; 37(4): 786-799, 2022 07.
Article in English | MEDLINE | ID: covidwho-1934302

ABSTRACT

BACKGROUND/AIMS: Little is known about the clinical characteristics and treatment outcomes of ST-segment elevation myocardial infarction (STEMI) in Korea during the coronavirus disease 2019 (COVID-19) era. We aimed to evaluate the clinical characteristics and treatment outcomes of patients with STEMI in the COVID-19 era. METHODS: A total of 588 consecutive patients with STEMI who underwent primary percutaneous coronary intervention were included in this study. The patients were categorized into the COVID-19 (from January 20, 2020 to December 31, 2020) and control groups (from January 20, 2019 to December 31, 2019). RESULTS: The COVID-19 group showed pre-hospital and in-hospital delays than the control group. The control group underwent more thrombus aspiration and had a higher proportion of left main coronary artery diseases, while the COVID-19 group had a higher proportion of multivessel diseases with a marked increase in the number and total length of stents than the control group. As for the prescribed medications, the COVID-19 group was administered more beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins than the control group. The clinical outcomes were comparable between the groups, except for higher incidences of atrioventricular block and temporary pacemaker implantation in the COVID-19 group. CONCLUSION: Reperfusion after STEMI treatment during the COVID-19 period was delayed; therefore, efforts should be made to improve on reperfusion.


Subject(s)
COVID-19 , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Humans , Percutaneous Coronary Intervention/adverse effects , ST Elevation Myocardial Infarction/drug therapy , Time-to-Treatment , Treatment Outcome
15.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i391, 2022.
Article in English | EMBASE | ID: covidwho-1915603

ABSTRACT

Background: Underlying mechanisms for sport-related acute myocardial infarction (SR-AMI) are only poorly understood. Moreover, their coronary artery disease (CAD) characteristics and lesion complexity are poorly described. Purpose: To characterize coronary angiographic feature of patients with SR-AMI Methods: From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were retrospectively analysed. SR-MI was defined as MI occurring during sport activity or within the first hour of recovery. Results: Among the 174 patients included, most were male (n=157(91%)). Median (IQR) age was 59 y (48-66), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The SR-MI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced pre-hospital (PH) sudden cardiac arrest (SCA) (17%). Atherothrombotic risk factors were dyslipidaemia (32%), current smoking (31%) or hypertension (28%). A history of CAD was documented in 31 (18%) patients. Most (n=156(91%)) had significant lesions, of whom 140 (81%) were considered as culprit. Culprit lesions were located on left anterior descending (39%), circumflex (14%) and right coronary artery (33%). Median (IQR) Syntax score was 10.5 (6-15). The vast majority of patients (n=152 (87%)) had at least one complex lesion;114 of them had several characteristics of complex lesion. Lesions were eccentric in 68 (39%) patients;an intraluminal thrombus was documented in 85 patients (49%), in 55% of STEMI and 37% of non-STEMI (p =0.027). However, 18 subjects (10%) had optically normal coronary angiogram or non-significant lesions, suggesting alternative mechanism such as type 2 MI. Treatment of the lesions was mainly achieved by PCI and/or stenting (n=132(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 11 patients (6%), of whom 10 experienced a PH-SCA and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Among the 5 patients treated with extracorporeal membrane oxygenator, only one survived. Conclusion: In our large retrospective study, SR-MI was commonly associated with complex coronary lesions, often characterized by intraluminal thrombus. Our findings suggest that the mechanisms of these events could be mainly related to type 1 MI patterns Moreover, PH-SCA was frequent, thus justifying mass-education to basic life support and deployment of automated external defibrillators, especially in the sport settings.

16.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i314, 2022.
Article in English | EMBASE | ID: covidwho-1915591

ABSTRACT

Background/Introduction: Building confidence to exercise regularly (exercise self-efficacy (ESE)) in the face of constraints and barriers, is a key goal of cardiac rehabilitation (CR) because such self-efficacy beliefs are predictors of sustained exercise behaviours. Therefore, identifying patient subgroups at risk of poor ESE enables tailoring of CR and appropriate targeting of support interventions. Purpose: To identify independent predictors of poor ESE and poor improvements in ESE in CR participants. Methods: The study used a prospective observational cohort design and recruited patients with coronary heart disease at CR entry across four sites in Metropolitan Sydney, Australia (2019-2020). Data were also compared for traditional in-person and remote-delivered CR during COVID-19 pandemic restrictions. The Exercise Self Efficacy Scale was used to measure ESE at CR entry and completion, and General Linear Models were used for analyses. Results: Participants (n=194) had a mean age of 65.94 (SD 10.46) years, with 80.9% males;and 80.0% were married or partnered, with 23.6% from an ethnic minority background. Referral diagnosis included elective percutaneous coronary intervention (PCI) (40.2%), coronary artery bypass surgery (26.3%), and myocardial infarction with or without PCI (33.5%). At CR entry, the mean ESE score was 24.93 (SD 5.99) points, which improved significantly by completion (p=.027). The GLM of ESE change (Adjusted R2=.247) identified that predictors of less change in ESE scores by CR completion included ethnic minorities (β=2.96, p=.003), not having a spouse or an intimate partner (β=-2.42, p=.023), and attending in-person CR (β=1.75, p=.036). Having higher ESE scores at entry was also associated with less ESE change on completion, such that for every point increase in ESE at entry, there was a reduction of .37 points in change (p<.001). These variables were also the same predictors of poor ESE at CR completion. Conclusions: Confidence to exercise improves in CR, and screening for ESE at CR entry enables identification of patients at-risk of poor improvements. Tailoring of interventions to provide appropriate support such as extending CR should be considered for patients from ethnic minorities and those who are single/widowed. Exploring the reasons for differences in outcomes from in-person and remote-delivered CR using appropriate methods should be the focus of future research.

17.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i308, 2022.
Article in English | EMBASE | ID: covidwho-1915589

ABSTRACT

Background: As COVID-19 pandemic continues, using technologies within cardiac rehabilitation facilitates access to care and reduces the frequency of direct contact with vulnerable cardiac patients. We aimed to assess the feasibility of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR) and preliminarily evaluate its effects on patients with coronary heart disease (CHD). Methods: Between February 2021 to May 2021, a total of 28 patients with CHD were recruited and randomised to receive a 12-week TecHCR programme (n = 14) or a 12-week conventional, centre-based programme (n = 14). The TecHCR group received three center-based, supervised exercise training sessions. Participants were instructed to wear a fitness tracker watch for exercise self-monitoring at home environment, and the exercise data were shared through a web-based application for remote monitoring by the intervener. Participants received six audio-visual educational videos via a messaging application and a weekly video/telephone call follow-up. Self- Efficacy for Exercise (ESE), Health Promoting Lifestyle Profile II (HPLP II), Hospital Anxiety and Depression Scale (HADS), exercise capacity and cardiovascular health outcomes were assessed at baseline and at 12th week on completion of the programme. Generalised estimating equations analysis was conducted to compare the outcomes between groups. Results: Out of 28 participants (56.46±12.98 years old;1 female), 67.9% had percutaneous coronary intervention and 28.6% had coronary bypass grafting surgery. Among 14 participants in the TecHCR group, three dropped out due to: 1) fear to attend face-to-face supervised exercise training during high daily COVID-19 cases;2) infected with COVID-19 and 3) found a job in overseas. Eleven participants in the TecHCR group attended all video/telephone call sessions, nine participants completed 3 supervised exercise training sessions and nine participants adhered to the weekly exercise recommendations. No treatment-related adverse events were reported. TecHCR was non-inferior to conventional, centre-based program on exercise self-efficacy, exercise capacity and cardiovascular health outcomes. TecHCR group showed significantly greater improvement in health-promoting behavior when compared with the control group (p =0.013) at post-intervention. Conclusion: This pilot study demonstrated the feasibility in recruitment and implementation of TecHCR as an alternative delivery mode and could enhance health-promoting behavior among patients with CHD. Implications: The TecHCR program provides accessible interventions to patients without frequent visits to the outpatient centre. A full-scale randomised controlled trial is needed to confirm the effectiveness of TecHCR.

18.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i80, 2022.
Article in English | EMBASE | ID: covidwho-1915576

ABSTRACT

Background: Low-density lipoprotein-cholesterol (LDL-C) is a well-accepted causal risk factor for atherothrombotic cardiovascular disease. Several randomized controlled trials and meta-analyses have shown that lipid-lowering therapies reduce cardiovascular events and have a positive effect in reducing vulnerable plaques. In particular, the recommended target for LDL-C has become more and more stringent, moving to 1.4 mmol/l (55 mg/dl) for very high-risk patients. According to the 2019 ESC/EAS Guidelines, the current paradigm for lipid management favors a stepwise approach consisting of early initiation of high-intensity statin, followed by subsequent addition of ezetimibe, and ultimately a consideration of PCSK9 inhibitor treatment if LDL-C levels remain elevated. Methods: We recruited 307 patients admitted for acute coronary syndrome (ACS) during the COVID-19 pandemic from March 2020 to December 2020. Baseline LDL-C concentration and prescribed hypolipemiant treatment at hospital admission and discharge were registered. Therefore, we included all consecutive patients identified as very-high cardiovascular risk, according to 2019 ESC guidelines. We stratified our population through variables independently associated with non-attainment of LDL-cholesterol such as hypertension, diabetes, peripheral arterial disease, clinical manifestations of ACS, number of main vessels treated, and complexity of the atherosclerotic disease. Results: 274 patients were included. Mean age was 69,9 years (SD 11,4), 20,8%were women, 23,7%had diabetes, 16,4%had PAD and 32,1 % suffered from valvular disease, mainly with mitral regurgitation or aortic stenosis no more than mild or moderate. Of 25.1% with a previous history of acute myocardial infarction, the 33,3% of whom didn't have statin therapy pre-ACS index (p =0,001). At admission, medium cholesterol levels of patients that underwent previous coronary revascularization (25,5% of the total population) were 84,21 ± 31,2 mg/dL, not in range according to both 2016 and 2019 ESC guidelines. At discharge, 77,37 % of all the patients included received only statin therapy VS 22,63% with statin plus ezetimibe. In the subpopulation of patients with recurring ACS events with LDL pre-admission > 100 mg/dL,despite high dose statin, only 25% of this population were discharged adding ezetimibe (VS 75% who kept on the treatment of high dose statin without up-titration). Conclusions: Management of dyslipidemia is frequently suboptimal and the gap between guidelines and clinical practice for lipid management across Europe has been exacerbated by the 2019 guidelines. A greater utilization of non-statin lipid-lowering therapies is likely needed to reach the LDL-C optimal target. A correct stratification of the risk class would help to identify, in a personalized perspective of treatment, patients at very high risk that would take advantage of more aggressive therapy to reach the lowest target of LDL-C ('the lower is better'). (Figure Presented).

19.
European Heart Journal, Supplement ; 24(SUPPL C):C60, 2022.
Article in English | EMBASE | ID: covidwho-1915556

ABSTRACT

Development of endomyocardial biopsy for acute rejection monitoring in the early Seventies, and above all use of cyclosporine in the clinical practice starting from 1980, introduced the modern era of heart transplantation. Following the initial positive outcomes, the first Italian transplant was performed in Padua by V.Gallucci on November 15th 1985. This pioneering success was rapidly repeated in Pavia, where M.Viganò performed the second transplant on Novembre 17th. Recipient was 20 years old man, suffering from dilated cardiomyopathy, on urgent transplant list. Cardiac index was 1.38 l/min/m2 and pulmonary vascular resistance 1.6 WU. Donor was a 14 years old boy died of brain injury. Total ischemic time was 125 minutes. Induction immunosuppression consisted of horse anti-lymphocyte immunoglobulins, whereas maintenance therapy included cyclosporine, azathioprine and steroids. Postoperative course was complicated by pericardial effusion and cholestatic jaundice. Later pulmonary aspergillosis occurred and due to the profound immunodepression was complicated by fungal localization at L2 vertebral body. The infection was treated with surgical removal of the secondary localization and amphotericin B administration. On December 6th severe acute rejection was found at biopsy and treated with i.v. steroid pulse. Length of ICU and hospital stay was 28 and 72 days, respectively. In 1998 HCV infection was detected and eradicated in 2017 with elbasvir/grazoprevir therapy. Complications of long term immunosuppressive treatment included dyslipidemia, myeloma and basal cell carcinoma. Due to long-term calcineurin inhibitors therapy progressive chronic renal failure occurred, leading to replacement therapy in 2015 and kidney transplantation in 2016. In 2015 the patient underwent percutaneous coronary intervention with stents implantation in two marginal branches and in the anterior descending artery in 2021. Everolimus was introduced to slow down progression of cardiac allograft vasculopathy. In 2020 he suffered from Covid-19, but the course of infection was uneventful being cough the only symptom. We report the eldest survivor after heart transplant in Europe. Our case demonstrates that despite early and long-term complications of immunosuppressive therapy, a careful and patient tailored management allowed an amazing outcome. Nowadays heart transplant remains the best treatment for end stage heart failure and allows to resume a nearly normal quality of life.

20.
Russian Journal of Cardiology ; 27(3):26-31, 2022.
Article in Russian | EMBASE | ID: covidwho-1897225

ABSTRACT

Aim. To assess the clinical performance and factors associated with inhospital mortality in patients with coronavirus disease 2019 (COVID-19). Material and methods. Our results are based on data from hospital charts of inpatients hospitalized in the Asinovskaya District Hospital in the period from March 11, 2020 to December 31, 2020, with a verified COVID-19 by polymerase chain reaction. The study included 151 patients, the median age of which was 66,2 (5092) years (women, 91;60,3%). The study endpoints were following hospitalization outcomes: Discharge or death. Depending on the outcomes, the patients were divided into 2 groups: The 1st group included 138 patients (survivors), while the 2nd one included 13 patients (death). To objectify the severity of multimorbidity status, the Charlson comorbidity index was used. The final value was estimated taking into account the patient age by summing the points assigned to a certain nosological entity using a calculator table. Results. Hypertension was recorded in the majority of patients — 79,5%, chronic kidney disease — in 61,1%. The prevalence of type 2 diabetes and coronary artery disease was high — 31,8% each. Prior myocardial infarction was diagnosed in 11,3% of cases. The prevalence of percutaneous coronary intervention and coronary bypass surgery was 5,3% and 3,3%, respectively. Stroke was detected in 9,3% of participants. Prior chronic pulmonary pathologies in COVID-19 patients were rare (asthma — 3,3%, chronic obstructive pulmonary disease — 2,0%). In order to predict the death risk in COVID-19 patients, a logistic regression analysis was performed, which showed that age and Charlson comorbidity index were the most significant predictors. Conclusion. Independent factors of inhospital mortality were age and Charlson’s comorbidity index. The risk assessment model will allow clinicians to identify patients with a poor prognosis at an earlier disease stage, thereby reducing mortality by implementing more effective COVID-19 treatment strategies in conditions with limited medical resources.

SELECTION OF CITATIONS
SEARCH DETAIL