[A rare case of myocarditis and pulmonary embolism after BNT162b2 mRNA vaccine]. / Raro caso di miocardite ed embolia polmonare dopo vaccino a mRNA BNT162b2.

In the clinical research arsenal, the COVID-19 vaccines are the strongest weapons against the most important worldwide sanitary crisis of the last centuries. Even if vaccine adverse events have mild clinical relevance, several thromboembolic events occurring after adenoviral recombinant vaccine administration have been reported. Cases of myocarditis and pericarditis after administration of mRNA vaccines have also recently been described. We report the case of a patient who suffered from two rare adverse events after BNT162b2 mRNA vaccine administration (Pfizer-BioNTech): acute myocarditis and pulmonary embolism. Although the temporal consequentiality does not demonstrate a causal link, the strong analogies emerging in the latest clinical reports suggest a possible relation. Further studies are needed to understand the potential mechanisms of myocardial damage and atypical thrombosis. Despite the favorable and self-limiting clinical course of post-vaccinal myocarditis, in these cases a tight follow-up is advisable and vaccine adverse event reporting remains mandatory, especially if not described during pivotal clinical trials.

[ANMCO Position paper: Hospital discharge planning]. / Position paper ANMCO: Gestione della dimissione ospedaliera.

Hospital discharge is often poorly standardized and is characterized by discontinuity and fragmentation of care, putting patients at high risk of post-discharge adverse events and early readmission. The present ANMCO position paper reviews the modifiable components of the hospital discharge process related to adverse events or rehospitalizations and suggests the optimal methods for redesign the whole discharge process. The key principles for proper hospital discharge or transfer of care acknowledge that hospital discharge:- is not an isolated event, but a process that has to be planned immediately after admission, ensuring that the patient and the caregiver understand and contribute to the planned decisions as equal partners;- is facilitated by a comprehensive systemic approach that begins with a multidimensional evaluation process;- must be organized by an operator who is responsible for the coordination of all phases of the hospital patient pathway, involving afterwards the physician and transferring to them the information and responsibility;- is the result of an integrated multidisciplinary team approach;- uses appropriately the transitional and intermediate care services;- is carried out in an organized system of care and continuum of services;- programs the passage of information to after-discharge services.

[Nutrition and malnutrition in the intensive coronary care unit. Fundamentals for the clinical cardiologist]. / Nutrizione e malnutrizione in terapia intensiva cardiologica. Nozioni di base per il cardiologo clinico.

Patients admitted to coronary care units (CCU) have largely changed in the last decades. As observed in national and international registries, they are older, with different degrees of disability and several comorbidities. Moreover, they often undergo complex procedures. In this scenario, the cardiologist of the CCU has to deal with multidisciplinarity that should involve physiology and pathophysiology of nutrition. Despite the lack of specific data about our CCUs, hospital malnutrition is indeed a common entity that can reach a prevalence of 50% in elderly patients aged more than 75 years old. Malnutrition has several consequences in CCU patients since it involves respiratory drive, immune system and, clinically, patients have longer CCU stay and more complications. Briefly, malnutrition has a significant impact on their final outcome. In the clinical arena, the main issues for CCU physicians are the nutritional screening tools to promote an early recognition of patients with malnutrition, the pathophysiological knowledge of nutrition for a correct interaction with nutritionists, and the way of administration with its major complications. The changes in the population within CCUs are relatively recent and, although specific data in the cardiology setting are still scarce, nutrition science has reached a high level of knowledge to understand and plan tailored nutritional schemes based on the clinical and demographic features of our sick patients.

Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.

AIMS: Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS. METHODS AND RESULTS: We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29-51]. In-hospital mortality of CS patients decreased from 68% (95% CI 59-76) in 2001 to 38% (95% CI 29-47) in 2014 (percentage change -30, 95% CI -41 to -18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%. CONCLUSIONS: Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate.

Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: insights from the EYESHOT study.

AIMS: Patients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. METHODS AND RESULTS: We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients with ACS enrolled in the prospective, multicentre, nationwide EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) registry. Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P < 0.0001 and 50 vs. 33, P < 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). CONCLUSION: Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did. CLINICAL TRIAL REGISTRATION: Unique identifier: NCT02015624, http://www.clinicaltrials.gov.

[Role of adherence to long-term drug therapy in patients with cardiovascular disease: an Italian intersocietary consensus document]. / Il ruolo dell'aderenza al trattamento farmacologico nella terapia cronica delle malattie cardiovascolari: documento intersocietario di consenso.

Chronic therapy with statins, antihypertensive and antiplatelet drugs is one of the most important interventions for primary and secondary prevention of cardiovascular disease. Adherence to drug treatment is key to successful therapeutic intervention, especially in chronic conditions. This holds particularly true in the setting of cardiovascular diseases, because poor adherence may have serious adverse effects in terms of morbidity and mortality. Many factors may contribute to poor adherence, which can be either patient-related or dependent on the healthcare system, the physician and the environment. The identification and appropriate correction of these factors may result in both clinical and economic benefits. In this setting it is also important to assess the implications of the increasing use of generic or equivalent drugs on adherence to pharmacological therapy.

[ANMCO/SICI-GISE document on antiplatelet therapy in patients with acute coronary syndrome]. / Documento ANMCO/SICI-GISE sulla terapia antiaggregante nelle sindromi coronariche acute.

Antiplatelet therapy is the cornerstone of the pharmacologic management of patients with acute coronary syndrome (ACS). Over the last years, several studies have evaluated old and new oral or intravenous antiplatelet agents in ACS patients. In particular, research was focused on assessing superiority of two novel platelet ADP P2Y12 receptor antagonists (i.e., prasugrel and ticagrelor) over clopidogrel. Several large randomized controlled trials have been undertaken in this setting and a wide variety of prespecified and post-hoc analyses are available that evaluated the potential benefits of novel antiplatelet therapies in different subsets of patients with ACS. The aim of this document is to review recent data on the use of current antiplatelet agents for in-hospital treatment of ACS patients. For each drug or class of drugs, strong evidence and/or areas of uncertainty that warrant further research are highlighted by examining 10 subgroups of patients with ACS.

[Transradial access for percutaneous coronary and non-coronary interventions]. / Accesso radiale per la diagnostica e l'interventistica coronarica e non coronarica.

The transfemoral access is still the most widely used approach for percutaneous coronary and non-coronary interventions. However, the transradial access has been increasingly used, mostly because it is associated with less hemorrhagic complications. The present review is aimed at evaluating the use of the transradial access for percutaneous vascular interventions. In many institutions, the radial artery is already the preferred vascular access for coronary procedures for routine coronary angiography but also for complex interventions such as primary angioplasty and angioplasty for stenosis at coronary bifurcations or coronary bypass grafts, or for treating chronic coronary occlusions. The radial artery can be used also as a vascular access for percutaneous peripheral interventions. Supra-aortic vessels (carotid, subclavian and vertebral arteries) can be treated via the radial route when obstructions of the femoro-iliac tract preclude groin access or also to circumvent anatomic variations such as bovine aortic arch. For renal artery angioplasty, the transradial access can be considered ideal for anatomic reasons, at least for those operators who use this access routinely for coronary interventions. At present, the transradial access can also be used, although in specific cases, to treat stenosis of the lower limb arteries in above the knee segments.

Early left ventricular structural myocardial alterations and their relationship with functional and electrical properties of the heart in myotonic dystrophy type 1.

BACKGROUND: Conduction disturbances and arrhythmias characterize the cardiac feature of myotonic dystrophy type 1 (MD1), and a myocardial involvement has been suggested as part of the cardiac disease. The aim of the study was to investigate the role of novel ultrasonic techniques, such as integrated backscatter (IBS) and color Doppler myocardial imaging (CDMI), in the assessment of the subclinical functional and structural myocardial involvement in patients with MD1. METHODS: Thirty-one patients with MD1 (MD1 group) without known heart failure were evaluated and compared with 31 healthy, age-matched controls. In all patients, 19 conventional and 28 new echocardiographic parameters (14 tissue Doppler, 10 CDMI, and 4 IBS indexes) were analyzed. RESULTS: In regard to ultrastructural left ventricular (LV) properties, a significantly higher IBS echointensity was found at the septum level in the MD1 group, with a statistically significant correlation with MPI (myocardial performance index) (r = 0.34; P = .05) and PR interval duration (r = 0.40; P = .05). In regard to LV systolic function, the MD1 group showed an early alteration of systolic function compared with controls, evidenced by a significant higher MPI and lower peak strain, strain rate, and cyclic variation index (CVI). In regard to LV diastolic function, the MD1 group showed an early alteration of diastolic function compared with controls, evidenced by lower tissue Doppler imaging, E/A, and E/A strain rate, with a statistically significant inverse correlation to the muscular disability rating scale. On receiver operating characteristic curve analysis, MPI and CVI showed the highest discriminating ability to differentiate the hearts of patients with MD1 from healthy subjects. CONCLUSION: Highly sensitive ultrasonic techniques can detect early functional and structural alterations of the LV myocardium in patients with MD1.