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1.
J Clin Med ; 12(23)2023 Nov 28.
Article in English | MEDLINE | ID: mdl-38068419

ABSTRACT

Over the past four decades, percutaneous coronary intervention (PCI) safety and efficacy have significantly improved, particularly with the advent of the drug-eluting stent (DES). First-generation DESs reduced in-stent restenosis rates and targeted lesion revascularization; however, safety issues emerged, due to high incidences of stent thrombosis (ST) linked to death, myocardial infarction, and repeat revascularization. Second-generation DESs were developed to overcome these issues, reducing late-thrombotic-event risk while maintaining anti-restenosis efficacy. Nevertheless, ST still occurs with second-generation DES use. Stent thrombosis etiology is multifaceted, encompassing lesion-, patient-, procedural-, and stent-related factors. Overall, most early-stent-thrombosis cases are linked to procedural and patient-related aspects. Factors like premature discontinuation of dual antiplatelet therapy, resistance to clopidogrel, smoking, diabetes mellitus, malignancy, reduced ejection fraction or undertaking coronary angioplasty for an acute coronary syndrome can increase the risk of stent thrombosis. The aim of this study is to assess patient-related factors that potentially heighten the risk of stent thrombosis, with the objective of pinpointing and addressing modifiable contributors to this risk. By focusing on both patient- and procedure-related factors, a multifaceted approach to coronary revascularization can help minimize complications and maximize long-term benefits in managing ST.

2.
Int J Mol Sci ; 24(6)2023 Mar 21.
Article in English | MEDLINE | ID: mdl-36983001

ABSTRACT

The presence of a myocardial infarction at a younger age is of special interest, considering the psychological and socioeconomic impact, as well as long-term morbidity and mortality. However, this group has a unique risk profile, with less traditional cardiovascular risk factors that are not well studied. This systematic review aims to evaluate traditional risk factors of myocardial infarction in the "young", highlighting the clinical implications of lipoprotein (a). We performed a comprehensive search using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards; we systematically searched the PubMed, EMBASE, and Science Direct Scopus databases, using the terms: "myocardial infarction", "young", "lipoprotein (a)", "low-density lipoprotein", "risk factors". The search identified 334 articles which were screened, and, at the end, 9 original research articles regarding the implications of lipoprotein (a) in myocardial infarction in the "young" were included in the qualitative synthesis. Elevated lipoprotein (a) levels were independently associated with an increased risk of coronary artery disease, especially in young patients, where this risk increased by threefold. Thus, it is recommended to measure the lipoprotein (a) levels in individuals with suspected familial hypercholesterolaemia or with premature atherosclerotic cardiovascular disease and no other identifiable risk factors, in order to identify patients who might benefit from a more intensive therapeutic approach and follow-up.


Subject(s)
Coronary Artery Disease , Hyperlipoproteinemia Type II , Myocardial Infarction , Humans , Lipoprotein(a) , Myocardial Infarction/etiology , Risk Factors
3.
Int J Mol Sci ; 23(9)2022 Apr 30.
Article in English | MEDLINE | ID: mdl-35563387

ABSTRACT

The atherosclerotic vascular disease is a cardiovascular continuum in which the main role is attributed to atherosclerosis, from its appearance to its associated complications. The increasing prevalence of cardiovascular risk factors, population ageing, and burden on both the economy and the healthcare system have led to the development of new diagnostic and therapeutic strategies in the field. The better understanding or discovery of new pathophysiological mechanisms and molecules modulating various signaling pathways involved in atherosclerosis have led to the development of potential new biomarkers, with key role in early, subclinical diagnosis. The evolution of technological processes in medicine has shifted the attention of researchers from the profiling of classical risk factors to the identification of new biomarkers such as midregional pro-adrenomedullin, midkine, stromelysin-2, pentraxin 3, inflammasomes, or endothelial cell-derived extracellular vesicles. These molecules are seen as future therapeutic targets associated with decreased morbidity and mortality through early diagnosis of atherosclerotic lesions and future research directions.


Subject(s)
Atherosclerosis , Extracellular Vesicles , Atherosclerosis/metabolism , Biomarkers/metabolism , Extracellular Vesicles/metabolism , Heart Disease Risk Factors , Humans , Inflammasomes/metabolism
4.
Nutrients ; 13(6)2021 May 22.
Article in English | MEDLINE | ID: mdl-34067469

ABSTRACT

While targeting elevated serum levels of low-density lipoprotein cholesterol has been the mainstay of atherosclerosis prevention and treatment for decades, the evidence regarding the atherogenic role of hypertriglyceridemia is still controversial. Various epidemiological population-based studies on statin-treated subjects nominated triglycerides, triglyceride-rich lipoproteins (namely, chylomicrons and very-low-density lipoprotein particles), and their remnants as major determinants of the substantial residual cardiovascular risk. With the triglyceride-glucose index and triglyceride to high-density lipoprotein ratio emerging as surrogate indicators of peripheral artery disease and atherosclerotic cerebrovascular disease, one can conclude that further research addressing the intricate relationship between triglycerides and atherosclerosis is warranted. Therefore, this review aims to provide insight into the current clinical and epidemiological state of knowledge on the relationship between triglycerides and atherosclerotic cardiovascular disease. It also intends to highlight the connection between triglycerides and other metabolic disorders, including diabetes mellitus, and the potential benefits of triglyceride-lowering agents on cardiovascular outcomes and all-cause mortality.


Subject(s)
Atherosclerosis/epidemiology , Lipoproteins/blood , Metabolic Diseases/epidemiology , Triglycerides/blood , Adult , Atherosclerosis/blood , Atherosclerosis/drug therapy , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Cerebrovascular Disorders/epidemiology , Cholesterol, LDL/blood , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Female , Heart Disease Risk Factors , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypertriglyceridemia/drug therapy , Hypertriglyceridemia/epidemiology , Hypolipidemic Agents/therapeutic use , Male , Metabolic Diseases/blood , Middle Aged , Young Adult
5.
Rev Cardiovasc Med ; 21(1): 65-73, 2020 Mar 30.
Article in English | MEDLINE | ID: mdl-32259905

ABSTRACT

Critical lesion of the unprotected left main coronary disease carries a tremendous mortality burden, often associated with a diabetes status or multivessel disease, with coronary artery bypass grafting being the standard treatment for over 40 years. Percutaneous coronary intervention with drug eluting stents should be taken into consideration and could be a better option for patients with low SYNTAX score as validated by the recently published studies. This review summarizes the major randomized clinical trials and meta-analyses concerning the debate regarding percutaneous coronary intervention with drug eluting stents versus coronary artery bypass grafting for unprotected left main coronary disease, along with the latest European and American revascularization guidelines and tries to shed light on this matter. The most results advocate that there is no convincing difference in survival rate for both therapies, especially in patients with isolated left main disease but with fewer major ischemic events for coronary artery bypass grafting when compared with percutaneous coronary intervention in multivessel coronary artery disease, at the rate of a higher stroke incidence. The gaps in evidence are also highlighted, especially the lack of randomized clinical trials with new generation drug eluting stents versus coronary artery bypass grafting or those regarding the best revascularization strategy for an acute coronary syndrome when unprotected left main coronary disease is involved.


Subject(s)
Coronary Artery Bypass , Coronary Artery Disease/therapy , Percutaneous Coronary Intervention , Clinical Decision-Making , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Evidence-Based Medicine , Humans , Patient Selection , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Risk Assessment , Risk Factors , Treatment Outcome
6.
Nat Commun ; 6: 6583, 2015 Mar 11.
Article in English | MEDLINE | ID: mdl-25758945

ABSTRACT

Thermoplastic polyurethane elastomers enjoy an exceptionally wide range of applications due to their remarkable versatility. These block co-polymers are used here as an example of a structurally inhomogeneous composite containing nano-scale gradients, whose internal strain differs depending on the length scale of consideration. Here we present a combined experimental and modelling approach to the hierarchical characterization of block co-polymer deformation. Synchrotron-based small- and wide-angle X-ray scattering and radiography are used for strain evaluation across the scales. Transmission electron microscopy image-based finite element modelling and fast Fourier transform analysis are used to develop a multi-phase numerical model that achieves agreement with the combined experimental data using a minimal number of adjustable structural parameters. The results highlight the importance of fuzzy interfaces, that is, regions of nanometre-scale structure and property gradients, in determining the mechanical properties of hierarchical composites across the scales.

7.
Rev Med Chir Soc Med Nat Iasi ; 109(4): 743-5, 2005.
Article in Romanian | MEDLINE | ID: mdl-16610170

ABSTRACT

Endocarditis due to Pasteurella pneumotropica are very rarely described. We report a new case of bacterial endocarditis in a 43 years-old patient with mitral stenosis. The patient was admitted to the hospital for lethargy, malaise and hemiparesis. On physical examination, a new systolic murmur was found. Transthoracic echocardiography revealed a vegetation on the mitral valve. Three blood culture sets were drawn and after 24 hours of incubation, the last two sets yielded Pasteurella pneumotropica and cell wall deficient forms (L-forms). The patient was successfully treated with gentamicin and ceftriaxone and underwent mitral valve replacement.


Subject(s)
Endocarditis, Subacute Bacterial/microbiology , Pasteurella Infections/microbiology , Pasteurella pneumotropica/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Drug Therapy, Combination , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/therapy , Female , Gentamicins/therapeutic use , Humans , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/microbiology , Mitral Valve Stenosis/therapy , Pasteurella Infections/complications , Pasteurella Infections/therapy , Treatment Outcome
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