Subject(s)
Coronary Artery Disease , Age Factors , Aged , Coronary Artery Disease/diagnosis , HumansABSTRACT
The efficacy of COVID-19 convalescent plasma (CCP) as a treatment for hospitalized patients with COVID-19 remains somewhat controversial; however, many studies have not evaluated CCP documented to have high neutralizing antibody titer by a highly accurate assay. To evaluate the correlation of the administration of CCP with titer determined by a live viral neutralization assay with 7- and 28-day death rates during hospitalization, a total of 23 118 patients receiving a single unit of CCP were stratified into two groups: those receiving high titer CCP (>250 50% inhibitory dilution, ID50; n = 13 636) or low titer CCP (≤250 ID50; n = 9482). Multivariable Cox regression was performed to assess risk factors. Non-intubated patients who were transfused with high titer CCP showed 1.1% and 1.7% absolute reductions in overall 7- and 28-day death rates, respectively, compared to those non-intubated patients receiving low titer CCP. No benefit of CCP was observed in intubated patients. The relative benefit of high titer CCP was confirmed in multivariable Cox regression. Administration of CCP with high titer antibody content determined by live viral neutralization assay to non-intubated patients is associated with modest clinical efficacy. Although shown to be only of modest clinical benefit, CCP may play a role in the future should viral variants develop that are not neutralized by other available therapeutics.
Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Neutralizing , Antibodies, Viral , COVID-19/therapy , Humans , Immunization, Passive , Treatment Outcome , COVID-19 SerotherapyABSTRACT
OBJECTIVES: The study aimed to evaluate inclacumab for the reduction of myocardial damage during a percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction. BACKGROUND: P-selectin is an adhesion molecule involved in interactions between endothelial cells, platelets, and leukocytes. Inclacumab is a recombinant monoclonal antibody against P-selectin, with potential anti-inflammatory, antithrombotic, and antiatherogenic properties. METHODS: Patients (N = 544) with non-ST-segment elevation myocardial infarction scheduled for coronary angiography and possible ad hoc PCI were randomized to receive 1 pre-procedural infusion of inclacumab 5 or 20 mg/kg or placebo. The primary endpoint, evaluated in patients who underwent PCI, received study medication, and had available efficacy data (n = 322), was the change in troponin I from baseline at 16 and 24 h after PCI. RESULTS: There was no effect of inclacumab 5 mg/kg. Placebo-adjusted geometric mean percent changes in troponin I with inclacumab 20 mg/kg were -24.4% at 24 h (p = 0.05) and -22.4% at 16 h (p = 0.07). Peak troponin I was reduced by 23.8% (p = 0.05) and area under the curve over 24 h by 33.9% (p = 0.08). Creatine kinase-myocardial band yielded similar results, with changes of -17.4% at 24 h (p = 0.06) and -16.3% at 16 h (p = 0.09). The incidence of creatine kinase-myocardial band increases >3 times the upper limit of normal within 24 h was 18.3% and 8.9% in the placebo and inclacumab 20-mg/kg groups, respectively (p = 0.05). Placebo-adjusted changes in soluble P-selectin level were -9.5% (p = 0.25) and -22.0% (p < 0.01) with inclacumab 5 and 20 mg/kg. There was no significant difference in adverse events between groups. CONCLUSIONS: Inclacumab appears to reduce myocardial damage after PCI in patients with non-ST-segment elevation myocardial infarction. (A Study of RO4905417 in Patients With Non ST-Elevation Myocardial Infarction [Non-STEMI] Undergoing Percutaneous Coronary Intervention; NCT01327183).
Subject(s)
Antibodies, Monoclonal/therapeutic use , Immunologic Factors/therapeutic use , Myocardial Infarction/therapy , P-Selectin/antagonists & inhibitors , Percutaneous Coronary Intervention/adverse effects , Premedication , Aged , Antibodies, Monoclonal/administration & dosage , Creatine Kinase, MB Form/metabolism , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Immunologic Factors/administration & dosage , Male , Middle Aged , Myocardial Infarction/metabolism , Myocardial Infarction/pathology , Prospective Studies , Recombinant Proteins/therapeutic use , Treatment Outcome , Troponin I/metabolismSubject(s)
Cardiomyopathy, Hypertrophic/complications , Ventricular Dysfunction, Left/etiology , Ventricular Outflow Obstruction/etiology , Aged , Cardiac Surgical Procedures , Cardiomyopathy, Hypertrophic/diagnosis , Echocardiography , Echocardiography, Doppler, Color , Electrocardiography , Female , Fibrosis , Humans , Myocardium/pathology , Ventricular Dysfunction, Left/diagnosis , Ventricular Outflow Obstruction/diagnosis , Ventricular Outflow Obstruction/surgeryABSTRACT
The aim of the present study was to determine whether body mass index (BMI) influences survival and recurrent cardiovascular events in a cardiac rehabilitation population. We followed 389 consecutive entrants to cardiac rehabilitation for 6.4 +/- 1.8 years. Patients were stratified into 3 groups: normal (BMI 18 to 24.9 kg/m(2)), overweight (BMI 25 to 29.9 kg/m(2)), and obese (BMI > or =30 kg/m(2)). Total and cardiovascular mortality were inversely associated with BMI category in bivariate models. However, only cardiovascular mortality was significant after adjustment for age and gender (p < 0.044), with cardiovascular death rates of 10% in normal, 8% in overweight, and 2% in obese patients. The rates of nonfatal recurrent events were 10% in normal, 24% in overweight, and 25% in obese patients. Our data indicate that BMI is inversely related to cardiovascular mortality but positively related to the risk of nonfatal recurrent events.