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1.
Interventional Neuroradiology ; 28(1 Supplement):240-241, 2022.
Article in English | EMBASE | ID: covidwho-2195322

ABSTRACT

Purpose: The ID NOW instrument is a genetic testing system that uses isothermal nucleic acid amplification and provides results in a short time. We use ID NOW to perform genetic testing for novel coronavirus (COVID-19) prior to endovascular treatment of acute ischemic stroke. The purpose of this study was to evaluate the extent to which ID NOW affected the time delay to initiation of therapy. Material(s) and Method(s): Patients underwent acute revascularization therapy at Nakamura Memorial South Hospital between January 2021, when ID NOW was introduced, and August 2021 were included;the control group before the introduction of ID NOW was patients in 2020. The time from arrival at the hospital to puncture was compared retrospectively before and after the introduction of ID NOW. We also retrospectively examined the results of ID NOW before treatment and whether COVID-19 infection developed after admission. Values are presented as medians (interquartile range). Result(s): 16 patients were included before and 17 patients after the introduction of ID NOW. The time from arrival to puncture was 72.5 (58.5-74.5) minutes before ID NOW introduction and 78.0 (71.5-84.0) minutes after, with a significant delay after introduction (p < 0.01). There were no cases of indeterminate ID NOW testing before treatment, and all cases were negative. No patient developed COVID-19 infection after admission. Conclusion(s): The introduction of ID NOW delayed the time from arrival to puncture approximately 10 min. There were no patients of COVID-19 infection after testing negative before treatment, which was considered useful for infection prevention and control.

2.
Rec-Interventional Cardiology ; 4(3):186-192, 2022.
Article in English | Web of Science | ID: covidwho-2205346

ABSTRACT

Introduction and objectives: During the lockdown due to the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a decrease in the number of admissions due to acute coronary syndrome (ACS) was observed. The objective of our study was to evaluate the impact lockdown had on the incidence, morbidity and mortality, and management of ACS. Methods: A retrospective and multicenter study was conducted including patients admitted due to ACS from February 14 through June 24, 2020. Patients with acute myocardial infarction and coronary arteries without significant lesions were excluded. The following groups were established based on the period of admission: a) 1 month before lockdown;b) during lockdown;and c) 1 month after lockdown. The differences in mortality seen among the 3 groups were evaluated, as well as the temporal differences reported between symptom onset and the first medical contact (FMC). Results: a total of 634 patients were included (group a, 205;group b, 303, and group c, 126). A 41% decrease in the number of admissions due to ACS was observed during the first month of lockdown compared to the previous month, as well as diagnostic delay during this same period (group a, 66 minutes (45-180), group b, 120 minutes (60-240), and group c, 120 minutes (60-240), P =.007). However, a higher mortality rate during confinement was not reported (RR, 1.26;95%CI, 0.53-2.97;P =.60). Conclusions: During lockdown, a remarkable decrease in the number of admissions due to ACS was observed, and although there was an increase in the time elapsed from symptom onset to the FCM in this period in patients with STEMI, the mortality rate was similar in the 3 groups studied.

3.
Annals of Vascular Surgery ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165092

ABSTRACT

Purpose The purpose of the study was to compare the clinical presentation, management and outcomes of surgical revascularization for acute limb ischemia (ALI) in two groups of patients – with and without SARS-CoV-2 infection. Methods During two years (01.01.2020-31.12.2021) all consecutive patients diagnosed with ALI and treated with urgent revascularization were prospectively enrolled. Based on the results of polymerase chain reaction swab for SARS-CoV-2 infection patients were allocated to: Group A – infected or Group B – non-infected. Demographic characteristics, clinical, imaging, laboratory data and details of treatment were collected prospectively. The composite endpoint of major amputation and/or death at 30 days after surgery was defined as main study outcome. The postoperative ABI value, reinterventions, complications and length of hospital stay were considered as secondary outcomes. Results Overall, 130 patients (139 limbs with ALI) were analyzed – 21 patients (23 limbs) in group A and 109 patients (116 limbs) in group B. The anatomical site of arterial occlusion, duration and severity of ischemia did not differ significantly between the groups. Patients with COVID-19 had significantly shorter time from ALI onset till administration of the first dose of anticoagulant: 8 (2.5-24) hours vs 15.7 (6-72) hours in group B, p = 0.02. Vascular imaging was performed before intervention only in 5 (23.8%) infected patients compared to 78 (71.5%) in group B, p < 0.001. The main outcome was registered in 38 (29.2%) patients, significantly more frequent in infected cohort: 12 (57.1%) patients in group A vs 26 (23.8%) in group B, p = 0.003. Difference was preponderantly caused by high mortality in group A – 9 (42.8%) patients, compared to 17 (15.5%) patients in group B, p = 0.01. The difference in the rate of limb loss was not statistically significant: 4 (17.3%) limbs were amputated in COVID-19 patients and 12 (10.3%) limbs – in non-infected patients (p = 0.3). Combination of ALI and COVID-19 resulted in increased 30-day mortality – RR 2.7 (95% CI 1.42 – 5.31), p = 0.002, but did not lead to significantly higher amputation rate – RR 1.6 (95% CI 0.59 – 4.75), p = 0.32. In group A initial admission of the patient in the intensive care unit was an independent risk factor for amputation / death. Excepting systemic complications which were more frequently registered among COVID-19 patients: 7 (33%) cases vs 14 (12.8%) in group B, p = 0.04;no differences in other secondary outcomes were observed between groups. Conclusion Study demonstrates the significant negative impact of COVID-19 upon the 30-day amputation free survival in patients undergoing urgent surgical revascularization for ALI. The difference in outcome is influenced by higher rate of mortality among infected patients, rather than by the rate of limb loss. Severity of COVID-19, namely requirement of intensive care, mostly determines the outcome of ALI treatment.

4.
Front Cardiovasc Med ; 9: 917250, 2022.
Article in English | MEDLINE | ID: covidwho-2065490

ABSTRACT

Background: The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI). Methods: There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained. Results: Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14-18) vs. 12 (12-14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79-18.14; p < 0.001). Conclusion: Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.

5.
Chest ; 162(4):A2065, 2022.
Article in English | EMBASE | ID: covidwho-2060893

ABSTRACT

SESSION TITLE: Etiologies of Cardiovascular Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Troponin level (Tnl) is usually used as confirmation of acute myocardial infarction (AMI) and is a sensitive marker. It is usually increased within 2-3 hours after AMI. In most cases, increased in Tnl is associated with symptomatic chest pain, cardiac ischemia, chronic coronary syndromes, etc. It can also be elevated in other conditions without cardiac injuries, like critical illness: COVID infection, septic shock, acute stroke and burns. CASE PRESENTATION: A 72 y/o man with history of b/l internal carotid artery (ICA) stenosis (70% in R-ICA and 80-90% in L-ICA) underwent elective left trans-carotid artery revascularization (TCAR). He was transferred to ICU after an uneventful procedure, for monitoring. His history was significant for HTN, HLD, Meniere's disease, gout, prior CVA of L-frontal lacunar and R-PICA (posterior inferior cerebellar artery). Postop vitals: BP 114/60 mmHg, HR 65, RR 16, O2 sat 98%. Tnl increased to 1.95 and then declined (normal 0 - 0.4 ng/ml). He was AAOx4, and asymptomatic. Post-op serial EKGs: normal sinus rhythm with no ST/T wave changes. Echo: EF 60%, normal biventricular size and function. LDL <70, A1C 5.9, normal TSH, no CPK elevation. Other labs: normal, No new neurological deficits. He was continued on ASA, clopidogrel, metoprolol, amlodipine and lisinopril. His hospital stay was uneventful, and he was discharged on post-op day 3. DISCUSSION: Cardiac troponin complex has its distinct subunits according to their functions: highly conserved Ca2+ binding subunit (cTnC);actomyosin ATPase inhibitory subunit and tropomyosin binding subunit. They play the pivotal role in regulating myocardial muscle contraction and relaxation and demonstrate as sensitive biomarkers for the myocardial injuries. Interestingly, there are many other causes that lead to increased cardiac troponin level without remarkable myocardial injuries or ischemia. Elevated Tnl after TCAR procedure can also be due to its surgical complication of a chance of hypoperfusion during the procedure. Our patient's surgery was uneventful. In one randomized controlled trial, it is stated that the risk of having CVA and AMI is higher in carotid endarterectomy compared to revascularization in patients with carotid artery stenosis. Our patient did not have any post-op complication, and only had an idiopathic elevation of troponin. CONCLUSIONS: The role of Tnl plays an important role in confirmation of myocardial infarction or ischemia but it can be idiopathic. Unpublished data from our institution revealed no increase in troponin s/p TCAR after uneventful procedures. This is the first reported case presenting with elevated troponin level without any pertinent positive findings (EKG changes/symptoms). Maybe in uneventful TCAR procedure troponin should not be ordered? Reference #1: Defilippi, C.R., Tocchi, M., Parmar, R.J., Rosanio, S., Abreo, G., Potter, M.A., Runge, M.S., & Uretsky, B.F. (2000). Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes: angiographic correlates and long-term clinical outcomes. Journal of the American College of Cardiology, 35 7, 1827-34. Reference #2: Gordon AM, Homsher E, Regnier M. Regulation of contraction in striated muscle. Physiol Rev. 2000 Apr;80(2):853-924. doi: 10.1152/physrev.2000.80.2.853. PMID: 10747208. Reference #3: Brott, T.G., Hobson, R.W., Howard, G., Roubin, G.S., Clark, W.M., Brooks, W., Mackey, A., Hill, M.D., Leimgruber, P.P., Sheffet, A.J., Howard, V.J., Moore, W.S., Voeks, J., Hopkins, L.N., Cutlip, D.E., Cohen, D.J., Popma, J.J., Ferguson, R.D., Cohen, S.N., Blackshear, J.L., Silver, F.L., Mohr, J.P., Lal, B.K., & Meschia, J.F. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England journal of medicine, 363 1, 11-23. DISCLOSURES: No relevant relationships by Moses Bachan No relevant relationships by Zin Min Htet No relevant relationships by Z nobia Khan No relevant relationships by Zin Oo

6.
Chest ; 162(4):A933-A934, 2022.
Article in English | EMBASE | ID: covidwho-2060732

ABSTRACT

SESSION TITLE: Extraordinary Cardiovascular Reports SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: The COVID-19 pandemic has reshaped modern history with an estimated death count over 6 million globally. Symptoms are primarily respiratory;however, COVID also confers an increased risk for hypercoagulability with the common presentations of venous and small vessel arterial thrombi (1). Acute mesenteric ischemia (AMI) is rare. We present a case of severe AMI with arterial and venous thrombi related to COVID. CASE PRESENTATION: A 50-year-old non-COVID-vaccinated male with a history of alcohol abuse presented with 1 day of emesis and abdominal pain and was found to be COVID-19 positive without respiratory symptoms. Computed tomography angiogram of the chest, abdomen and pelvis revealed normal lungs, extensive non-calcified thrombi in the abdominal aorta extending into the celiac artery causing severe stenosis, complete occlusion of the superior mesenteric, right portal, and splenic veins, partial occlusion of the extrahepatic portal vein, left lower pulmonary embolism, small bowel perfusion injury, and splenic and right hepatic lobe infarcts. He denied a personal or family history of hypercoagulability. The patient was placed on a heparin drip and underwent placement of a transjugular intrahepatic portosystemic shunt and an infusion catheter for administration of tissue plasminogen activator into the portal vein. He ultimately required a thrombectomy. Later imaging showed patency of previously occluded vessels and resolution of arterial thrombus. Over the course of his hospitalization, his respiratory status did decompensate, and he required 13 days of mechanical ventilation, after which he was extubated, transitioned to warfarin, and discharged. DISCUSSION: AMI in COVID has been identified as a rare but serious complication with a reported incidence of 3-4%, with a reported mortality of up to 47% in all-cause-related AMI(2,3). COVID causes a prothrombotic state due to its affinity to angiotensin-converting enzyme-2(ACE2) receptors on enterocytes and endothelium, allowing it to infect the cells and causing direct damage to bowel tissue and vessels. The binding of ACE2 also increases IL-6, inducing cytokine storm and hypercoagulability (1). While there are no clear guidelines, treatment mainly involves revascularization and removal of necrotic bowel. Anticoagulation generally has favorable results within 48 hours and invasive intervention is not required (1,4). Thus, early recognition of AMI as a potential complication of COVID is essential for early treatment and reduction of the staggering morbidity and mortality. CONCLUSIONS: While the incidence of AMI in COVID is low, it can have severe effects on patients and requires early recognition and treatment. Further studies are needed to develop awareness of the disease, therefore improving surveillance and standard of care to minimize the chances of these poor outcomes. Reference #1: Patel, Suyog et al. "Bowel ischemia in COVID-19: A systematic review.” International journal of clinical practice vol. 75,12 (2021): e14930. doi:10.1111/ijcp.14930 Reference #2: Kaafarani, Haytham M A et al. "Gastrointestinal Complications in Critically Ill Patients With COVID-19.” Annals of surgery vol. 272,2 (2020): e61-e62. doi:10.1097/SLA.0000000000004004 Reference #3: Cudnik, Michael T et al. "The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine vol. 20,11 (2013): 1087-100. doi:10.1111/acem.12254 Chen, Can et al. "Acute Mesenteric Ischemia in Patients with COVID-19: Review of the literature.” Journal of the National Medical Association vol. 114,1 (2022): 47-55. doi:10.1016/j.jnma.2021.12.003 DISCLOSURES: No relevant relationships by Mohamed Abdelhabib No relevant relationships by Naomi Habib No relevant relationships by Daniel Rabulinski No relevant relationships by Suresh Uppalapu

7.
Journal of the Formosan Medical Association ; 121(9):1617-1621, 2022.
Article in English | Scopus | ID: covidwho-2015654
8.
Journal of NeuroInterventional Surgery ; 14:A47-A48, 2022.
Article in English | EMBASE | ID: covidwho-2005437

ABSTRACT

Background The mechanisms and outcomes in COVID-19- associated stroke are unique from those of non-COVID-19 stroke. Objectives The purpose of this study is to describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. Methods We conducted an international multicenter retrospective study of consecutively admitted COVID-19 patients with concomitant acute large vessel occlusion (LVO) across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a MT between January 2018 to December 2020.Results: The total cohort was 575 patients with acute LVO, 194 had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs. 71.2;p<0.001), and lacked vascular risk factors (49, 25.3% vs. 54, 14.2%;p =0.001). mTICI 3 revascularization was less common in the COVID-19 group (74, 39.2% vs. 252, 67.2%;p < 0.001). Poor functional outcome at discharge (defined as mRS 3-6) was more common in the COVID-19 group (150, 79.8% vs.132, 66.7%;p =0.004). COVID-19 was independently associated with a lower likelihood of achieving mTICI 3 (OR: 0.4, 95% CI: 0.2 -0.7;p<0.001), and unfavorable outcomes (OR: 2.5, 95% CI: 1.4 - 4.5;p=0.002). Conclusion COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. COVID-19 patients with LVO patients were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates. (Figure Presented).

9.
EJVES Vascular Forum ; 54:e49-e50, 2022.
Article in English | EMBASE | ID: covidwho-2004043

ABSTRACT

Introduction: Aortic aneurysmal disease is an evolving pathology: when treating an aortic aneurysm, we must consider the possibility of a thoraco-abdominal evolution aneurysm, which might lead to further treatments. In case of challenging anatomies (narrow aortic lumen at the level of visceral arteries, aortic wall thrombus, true lumen in an aortic dissected aneurysm, and focal aortic narrow diameter), unfavourable both for fenestrated endovascular aneurysm repair (FEVAR) and branched endovascular aneurysm repair (BEVAR), an inner branched custom made device could represent a potential feasible solution. Inner branched endografts have a typical configuration that combines the advantageous characteristics of both fenestrated and side branched endografts, thus showing advantages over other custom made grafts. Our study aimed to investigate the potential role of this technique in a broad variety of aortic anatomies unfavourable for FEVAR and BEVAR, in patients who received different previous aortic treatments. Methods: In our institution, between July 2018 and July 2020, 20 consecutive patients underwent a FEVAR/BEVAR procedure to treat complex abdominal aortic aneurysm or thoracic aortic aneurysm. Nine patients who were deemed untreatable with a fenestrated/branched graft due to aortic anatomy and/or previous treatments were treated with a custom made, four inner branch E-xtra design endograft (I BEVAR). All patients were treated for a complex aortic abdominal and thoraco-abdominal aneurysm: two patients were previously treated with frozen elephant trunk and TEVAR;three patients were previously treated with TEVAR;and one with TEVAR + abdominal aortic surgical treatment. Two patients received abdominal aortic surgical treatment only. The last patient was previously treated with EVAR, which was then complicated with a type 1A endoleak (EL). Five of six TEVARs were placed before BEVAR as staged procedures, to decrease spinal cord ischaemia risk. All patients had a lumbar cerebrospinal fluid drainage during the BEVAR procedure. In total, the bridging stents placed included 43 balloon expandable and four self-expandable stents. Results: In our experience, all cases were treated with a four inner branch endograft with a total revascularisation of 36 target vessels. Technical success was achieved in all nine cases (100%), with precise deployment of the inner branched endograft and effective engagement and bridging of all branches. Major clinical complications occurred in three (33%) patients: one case of continuous veno-venous haemofiltration treatment for a transient acute renal failure in a chronic renal disease;one case of hepatic decompensation in patient with a chronic cirrhosis, which led to liver failure (Child Pugh C10, MELD 19, still under medical treatment);and one patient with a pulmonary infection disease (COVID-19 related), which then resolved. No patient suffered spinal cord ischaemia. The mean follow up was 12.8 months ± 6.79 months, with an estimated one year survival rate of 89%. One patient with a thrombophilic disorder died on postoperative day 48 as a result of multiple organ failure after acute four inner branches simultaneous occlusion. During follow up, the target vessel primary patency rate was 89%, associated with four (11%) bridging stent ELs. At 30 days, computed tomography angiography detected five BS ELs in four patients: one type III BS EL (2.7%), and four type I BS ELs (11%). Re-intervention was needed in one patient (11%) with a type III and I BS EL associated with an aneurysm sac enlargement treated with bridging stent relining in the left renal artery and superior mesenteric artery. Conclusion: Our experience shows the feasibility of treating complex aortic anatomies with an inner branched graft in patients which were anatomically unfit for FEVAR/BEVAR treatment, allowing complex visceral vessels recanalisation and an adequate sealing. When a re-intervention is needed, we have to consider that previous surgical and endovascular treatments modify the aortic anatomy, and the graft deploy ent may be tougher, with a higher risk of malrotation. Inner branched endograft could be a valid option in case of complex anatomies, but long term follow up is needed.

10.
Brazilian Neurosurgery ; 41(2):E192-E197, 2022.
Article in English | EMBASE | ID: covidwho-1996922

ABSTRACT

Intracranial cystic lesions are common findings in cerebral imaging and might represent a broad spectrum of conditions. These entities can be divided into nonneoplastic lesions, comprising Rathke cleft cyst, arachnoid cyst, and colloid cyst, as well as neoplastic lesions, including benign and malignant components of neoplasms such as pilocytic astrocytoma, hemangioblastoma, and ganglioglioma. Surgical resection and histological evaluation are currently the most effective methods to classify cysts of the central nervous system. The authors report two uncommon cases presenting as cystic lesions of the encephalic parenchyma-a enterogenous cyst and a glioblastoma-and discuss typical histological findings and differential diagnosis.

11.
Clin Res Cardiol ; 2022 Aug 17.
Article in English | MEDLINE | ID: covidwho-1990621

ABSTRACT

BACKGROUND: Reports about the influence of the COVID-19 pandemic on the number of hospital admissions and in-hospital mortality during the first wave between March and May 2020 showed conflicting results and are limited by single-center or limited regional multicenter datasets. Aim of this analysis covering all German federal states was the comprehensive description of hospital admissions and in-hospital mortality during the first wave of the COVID-19 pandemic. METHODS AND RESULTS: We conducted an observational study on hospital routine data (§21 KHEntgG) and included patients with the main diagnosis of acute myocardial infarction (ICD 21 and ICD 22). A total of 159 hospitals included 36,329 patients in the database, with 12,497 patients admitted with ST-elevation myocardial infarction (STEMI) and 23,832 admitted with non-ST-elevation myocardial infarction (NSTEMI). There was a significant reduction in the number of patients admitted with STEMI (3748 in 2020, 4263 in 2019 and 4486 in 2018; p < 0.01) and NSTEMI (6957 in 2020, 8437 in 2019 and 8438 in 2020; p < 0.01). These reductions were different between the Federal states of Germany. Percutaneous coronary intervention was performed more often in 2020 than in 2019 (odds ratio 1.13, 95% confidence interval [CI] 1.06-1.21) and 2018 (odds ratio 1.20, 95% CI 1.12-1.29) in NSTEMI and more often than in 2018 (odds ratio 1.26, 95% CI 1.10-1.43) in STEMI. The in-hospital mortality did not differ between the years for STEMI and NSTEMI, respectively. CONCLUSIONS: In this large representative sample size of hospitals in Germany, we observed significantly fewer admissions for NSTEMI and STEMI during the first COVID-19 wave, while quality of in-hospital care and in-hospital mortality were not affected. Admissions for STEMI and NSTEMI during the months March to May over 3 years and corresponding in-hospital mortality for patients with STEMI and NSTEMI in 159 German hospitals. (p-value for admissions 2020 versus 2019 and 2018: < 0.01; p-value for mortality: n.s.).

12.
Journal of Thoracic Disease ; 14(7):2451-2453, 2022.
Article in English | EMBASE | ID: covidwho-1988789
13.
Open Access Macedonian Journal of Medical Sciences ; 10:319-325, 2022.
Article in English | EMBASE | ID: covidwho-1939090

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a hypercoagulable state with a high incidence of thrombotic complications. Patients with a history of myocardial revascularization have more severe complications due to COVID-19. Coronary stent thrombosis has become significantly more common during the COVID-19 pandemic. AIM: The aim of our study is to analyze scientific information on the risks of stent thrombosis in patients who underwent COVID-19. METHODS: A search was made for scientific publications in evidence-based medicine databases and web resources: PubMed, MEDLINE, UpToDate, TripDatabase, ResearchGate, and Google Scholar. Inclusion criteria were: (1) Observational studies or case series involving patients with a confirmed diagnosis of COVID-19 and myocardial infarction requiring myocardial revascularization;(2) the division of the population into survivors and non-survivors;and (3) data on the presence of the previous myocardial revascularization. Exclusion criteria: Case description and editorials/bulletins. In all articles selected for further analysis, 49 sources were considered that met the inclusion criteria and excluded duplication or repetition of information. RESULTS: Coronavirus infection has contributed to the change in the course of myocardial infarction in patients undergoing myocardial revascularization. The incidence of stent thrombosis has a positive correlation with the severity of the coronavirus infection. The previous myocardial revascularization procedures significantly increase the risk of mortality in patients with coronavirus infection. This is especially actual for elderly patients. CONCLUSION: One of the most vulnerable groups is elderly patients who have undergone myocardial revascularization after myocardial infarction in the past and have concomitant diseases. An analysis of scientific publications has shown that further larger-scale clinical studies are needed to confirm the hypothesis about the negative impact of coronavirus infection on stent thrombosis in patients who have undergone COVID-19.

14.
European Stroke Journal ; 7(1 SUPPL):331, 2022.
Article in English | EMBASE | ID: covidwho-1928137

ABSTRACT

Background and aims: RES-Q Registry is the first stroke database in Romania. The aim is to map key performance indicators for quality of stroke care and to improve stroke management Methods: Each center registers all stroke patients hospitalized in march, yearly. Results: The number of participated centers has increased from 10 in 2017 to 36 in 2021. In five years we have registered 8467 patients. The median age was 71.46 years, median NIHSS at admittance 7.8 points, 82.8% ischemic strokes. Despite improvement in revascularization procedures (intravenous thrombolysis increased from 2.27% in 2017 to 10.56 in 2021, and mechanical thrombectomy from 0,1% to 1,7%) median Modified Rankin Score at discharge did not change significantly and mortality has increased (from 15.09% in 2017 to 19.03% in 2021). A reason for increased mortality is due to Covid-19 pandemic (poor access to primary care, more severely ill, increased door to needle time due to epidemiologic circuits), but beside this, there are unsolved problems, such as the very low percentage (below 1%) of decompressive hemicraniectomy, the reduced capacity to actively detect atrial fibrillation ( 36.9% of patients are still screened for AF only by repeated ECG), the low percentage of carotid imaging (56.7%) and revascularization procedures (less than 7% of symptomatic carotid stenosis). Conclusion: For a better prognosis of stroke we need to increase the number of properly financed stroke units, the educational activities, and to elaborate and implement a national stroke plan.

15.
European Stroke Journal ; 7(1 SUPPL):350-351, 2022.
Article in English | EMBASE | ID: covidwho-1928107

ABSTRACT

Background and aims: The Registry of Stroke Care Quality (RES-Q) is a tool for monitoring the quality of stroke care in hospitals throughout Europe. The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations and revascularization procedures. The aim was to compare results captured from RES-Q registry in Croatia in March 2019 and March 2020 and March 2021, before, during the first wave, and third wave of the COVID-19 pandemic in Croatia Patients and methods: Data on demographics, stroke care pathway, specific acute treatment, and prevention issues, in all acute stroke admissions in Croatia during March 2019 and March 2020, and March 2021 through the RES-Q registry were analyzed. Results: The study included 1 comprehensive stroke center and 7 primary stroke centers in Croatia, which captured data in all three periods. We have noted a reduction of stroke patients' admissions during the COVID-19 pandemic for 26.6% during the first wave and for 16.7% during the third wave. (Figure Presented) Conclusion: Our results showed a reduction of stroke patients' admissions in both periods;reduced numbers of female patients and patients with subarachnoid hemorrhage, and transfers among hospitals with prolonged door-to-needle time and door-to-groin time during the first wave of COVID-19 pandemic. The usage of revascularization therapies has shown a slight increase in the evaluated period.

16.
European Stroke Journal ; 7(1 SUPPL):102, 2022.
Article in English | EMBASE | ID: covidwho-1928106

ABSTRACT

Background and aims: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with ischemic stroke (IS). We aimed to evaluate the safety and disability outcomes of revascularization treatments in patients with IS and COVID-19. Methods: Retrospective multicenter cohort study of consecutive IS patients receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March-2020 and June-2021, tested for SARSCoV- 2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Study protocol was registered in ClinicalTrials.gov (NCT04895462). Results: Among 15128 revascularized patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT only, and 9280 (61.3%) EVT (+/- IVT). As shown in the Figure, treated patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH), symptomatic subarachnoid hemorrhage (sSAH), the combination thereof, higher mortality at 24 hours and 3 months, and worse 3-month modified Rankin score (mRS). Results for treatment subgroups were similar, except that in the IVT-only group only SICH, 3-month mRS and mortality were significantly increased. Conclusion: Ischemic stroke patients with COVID-19 showed higher rates of bleeding complications and worse clinical outcomes after acute revascularization treatments than contemporaneous non-COVID-19 treated patients. (Table Presented).

17.
Journal of Hypertension ; 40(SUPPL 2):e8-e9, 2022.
Article in English | EMBASE | ID: covidwho-1915860

ABSTRACT

Background: Coronary artery disease (CAD) patients with a history of hypertension and underlying comorbidities are at high risk of developing major adverse cardiac events (MACE) and increase the mortality of the patients. Objective: This study aims to determine the association of hypertension and MACE in CAD patients admitted to ICCU. Method: This research is an analytic study with a cross-sectional approach. The data used is secondary data from the records of patients who were admitted to ICCU at Sanglah Hospital on 1 January 2021- 31 December 2021 with total sampling technique. Result: There were 376 patients included in this study. The majority of patients were male (n=291,77.4%) with the median overall patient age of 58 years old. Most of MACE found in the patients were revascularization (n=113;30.1%). The prevalence of hypertension was 19.1%. There were significant differences in length of in hemoglobin (p=0.006), lymphocytes count (p=0.002), uric acid (p=0.032) and GFR (p=0.000) in the patients classified based on MACE. MACE was significantly associated with hypertension (PR=1.285;95%CI=1.102-1.498;p=0.006). Chisquare analysis showed that stroke (PR=2.386;95%CI=1.271-4.480;p=0.007), heart failure (PR=2.533;95%CI=1.574-4.078;p=0.000), and malignant arrhythmia (PR=1.820;95%CI=1.229-2.694;p=0.004) were significantly associated with hypertension. Association of hypertension and kidney disease were significantly associated with stroke (PR= 2.386;95%CI=1.271-4.480;p=0.007), malignant arrhythmia (PR=1.820;95%CI=1.229-2.694;p=0.004) and heart failure (PR=2.533;95%CI=1.574-4.078;p=0.000). Association of hypertension and COVID-19 were also significantly associated with malignant arrhythmia (PR= 2.253;95%CI=1.309-3.877;p=0.011). Conclusion: There were significant association between hypertension with MACE in the patients. Intervention on these factors can prevent further mortality.

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.
Khirurgiia (Mosk) ; (5): 126-134, 2022.
Article in Russian | MEDLINE | ID: covidwho-1863437

ABSTRACT

The authors report hybrid treatment of a patient with angina pectoris class II, multiple previous reconstructive interventions on the aortofemoral segment and chronic ischemia of the left lower limb stage IV and concomitant COVID-19. Coronary angiography was performed after regression of infectious disease under antiviral therapy. Occlusion of the left anterior descending artery was observed that required LAD stenting. On the next day, hybrid revascularization of the lower extremities was implemented: thrombectomy and endarterectomy from the branch of the aorto-femoral bypass graft and deep femoral artery at the first stage, stenting of the orifice of proximal branch of aorto-femoral bypass graft at the second stage, endarterectomy from superficial femoral artery, recanalization and stenting of superficial femoral artery and popliteal artery at the third stage and prosthetic- femoral bypass with autologous vein at the fourth stage. Postoperative angiography revealed patent stents and no residual stenoses. The choice in favor of these procedures and step-by-step approach has been substantiated. The authors emphasized effectiveness and safety of this treatment strategy.


Subject(s)
Arterial Occlusive Diseases , COVID-19 , Peripheral Vascular Diseases , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Ischemia/diagnosis , Ischemia/etiology , Ischemia/surgery , Popliteal Artery/surgery , Retrospective Studies , Stents , Treatment Outcome , Vascular Patency
20.
Hellenic Journal of Vascular and Endovascular Surgery ; 3(3):73-77, 2021.
Article in English | EMBASE | ID: covidwho-1849019

ABSTRACT

Although COVID-19 initially affects the respiratory system, several studies have drawn significant attention to the growing hypothesis that the infection is associated with direct and indirect cardiovascular complications that may negatively influence the outcome of diseased patients. We review the current literature to investigate the complications caused by COVID-19 in the heart and the vascular system. We also analyse the proposed mechanisms of cardiovascular involvement. The cardiovascular complications include myocarditis, myocardial injury, heart failure, arrhythmias as well as venous and arterial thrombosis, which are associated with elevated morbidity risk and adverse outcomes. The pathophysiological mechanisms that explain the cardiovascular complications include inflammation, endothelial dysfunction, an excessive storm cytokine release, coagulation disturbances, and cell hypoxia. Patients with underlying cardiovascular disease (CVD) tend to have worse outcomes compared to those without CVD. Arterial thrombosis seems to be associated with coagulopathy and increased D-dimer concentrations and can manifest in patients with no pre-existing comorbidities, atherosclerosis, or blood-clotting disorders. The rate of successful revascularization is lower than expected and is associated with a virus-related hypercoagulable state. Due to these adverse events critical diseased patients often require care from a multidisciplinary care team.

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