Changes in the Biomarkers of Oxidative/Nitrosative Stress and Endothelial Dysfunction Are Associated with Cardiovascular Risk in Periodontitis Patients.

Patients with cardiovascular disease (CVD) and periodontitis (PT) show shared risk factors as result of the altered molecular mechanisms associated with pathological conditions. The aim of our study was to evaluate if the plasma biomarkers associated with endothelial dysfunction may also be related to alterations in the inflammatory status in peripheral blood mononuclear cells (PBMC). Patients with PT, coronary heart disease (CHD), or both diseases as well as controls were enrolled. Plasma levels of coenzyme Q10 (CoQ10), 3-nitrotyrosine (NT), and asymmetric dimethylarginine (ADMA) were assessed using HPLC. mRNA levels of caspase-1 (CASP1), NLR family pyrin domain containing 3 (NLRP3), and tumor necrosis factor-α (TNF-α) in PBMC from the recruited subjects were quantified using real-time PCR. Patients with PT + CHD showed lower CoQ10 plasma levels and increased concentrations of NT in comparison to healthy subjects. ADMA levels were higher in CHD and PT + CHD patients compared to controls. Transcript levels of CASP1, NLRP3, and TNF-α were up-regulated in PBMC from all patient groups when compared to healthy subjects. Our results suggest a possible causal link between oxidative stress, high levels of NT and ADMA, and inflammasome activation, which may be involved in the endothelial inflammatory dysfunction leading to the pathogenesis and progression of CHD in PT patients.

Invasive strategy for COVID patients presenting with acute coronary syndrome: The first multicenter Italian experience.

OBJECTIVE: To report our initial experience of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/acute coronary syndrome (ACS) patients undergoing standard of care invasive management. BACKGROUND: The rapid diffusion of the SARS-CoV-2 together with the need for isolation for infected patients might be responsible for a suboptimal treatment for SARS-CoV-2 ACS patients. Recently, the group of Sichuan published a protocol for COVID/ACS infected patients that see the thrombolysis as the gold standard of care. METHODS: We enrolled 31 consecutive patients affected by SARS-COV-2 admitted to our emergencies room for suspected ACS. RESULTS: All patients underwent urgent coronary angiography and percutaneous coronary intervention (PCI) when required except two patients with severe hypoxemia and unstable hemodynamic condition that were conservatively treated. Twenty-one cases presented diffuse ST-segment depression while in the remaining cases anterior and inferior ST-elevation was present in four and six cases, respectively. PCI was performed in all cases expect two that were diagnosed as suspected myocarditis because of the absence of severe coronary disease and three with apical ballooning at ventriculography diagnostic for Tako-Tsubo syndromes. Two patients conservatively treated died. The remaining patients undergoing PCI survived except one that required endotracheal intubation (ETI) and died at Day 6. ETI was required in five more patients while in the remaining cases CPAP was used for respiratory support. CONCLUSIONS: Urgent PCI for ACS is often required in SARS-CoV-2 patients improving the prognosis in all but the most advanced patients. Complete patient history and examination, routine ECG monitoring, echocardiography, and careful evaluation of changes in cardiac enzymes should be part of the regular assessment procedures also in dedicated COVID positive units.

Decrease and Delay in Hospitalization for Acute Coronary Syndromes During the 2020 SARS-CoV-2 Pandemic.

The diffusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) forced the Italian population to restrictive measures that modified patients' responses to non-SARS-CoV-2 medical conditions. We evaluated all patients with acute coronary syndromes admitted in 3 high-volume hospitals during the first month of SARS-CoV-2 Italian-outbreak and compared them with patients with ACS admitted during the same period 1 year before. Hospitalization for ACS decreased from 162 patients in 2019 to 84 patients in 2020. In 2020, both door-to-balloon and symptoms-to-percutaneous coronary intervention were longer, and admission levels of high-sensitive cardiac troponin I were higher. They had a lower discharged residual left-ventricular function and an increased predicted late cardiovascular mortality based on their Global Registry of Acute Coronary Events (GRACE) scores.

Preventive left main and right coronary artery stenting to avoid coronary ostia occlusion in high-risk stentless valve-in-valve transcatheter aortic valve implantation.

Transcatheter aortic valve implantation is becoming an attractive and promising alternative to redo surgery for aortic bioprosthetic valves degeneration, especially in high-risk patients. However, valve-in-valve transcatheter aortic valve implantation itself carries some procedural risks and potential challenges that interventionists must be aware of. An accurate preprocedural planning is fundamental for the prevention of potentially fatal complications. This case describes a novel strategy of simultaneous right and left coronary artery stenting preventing bilateral coronary obstruction in a patient with a stentless surgical aortic valve and extremely low origin of the 2 coronary arteries.

Immediate and long-term clinical performance of bioresorbable vascular scaffolds in a real world population.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of bioresorbable vascular scaffolds (BVS) in terms of acute success and long-term clinical events in a real world population according to the most updated technical recommendations. METHODS: Perspective, single-center registry involving symptomatic patients treated with BVS from February 2013 to January 2016. Primary end-point was the occurrence of MACCEs at one year: death, target vessel related myocardial infarction, target vessel revascularization, stroke, major bleeding. Secondary endpoints were acute device and procedural clinical success, and occurrence of MACCEs at long-term follow-up. RESULTS: In total, 112 patients were treated on 173 lesions. Average age was 55.53±12.4 years and acute coronary syndrome was the admission diagnosis for 79.5% patients. Nine patients presented cardiac allograft vasculopathy after cardiac transplantation. Multi-vessel disease was treated in 50% of cases. Predilatation and post-dilatation were performed respectively in 96% and 88.4% of lesions. Intravascular imaging was used in 41 patients (37%). Angiographic success rate and procedural success rate were 100% and 97.3% respectively. Clinical follow-up was completed in 100 patients with an average follow-up of 10.5±8.3 months. Including peri-procedural and in-hospital MACCEs, target vessel failure was noticed in 7% of patients in the first year of follow up and in 11% of patients at long-term follow-up. Two cases of target lesion revascularization occurred 25 and 26 months after the index procedure. No cases of definite stent thrombosis were reported. CONCLUSIONS: Strict adherence to expert recommendation for BVS placement may minimize device related peri-procedural and mid-to-long term MACCEs in a real world population.

[An unusual case of transient ST-segment elevation during hypertensive crisis in a patient with left ventricular hypertrophy]. / Sopraslivellamento transitorio del tratto ST durante crisi ipertensiva in paziente con severa ipertrofia ventricolare sinistra.

We report the case of a 73-year-old patient with severe left ventricular hypertrophy presenting with acute ST-segment elevation mimicking acute myocardial infarction on ECG during a hypertensive crisis. Unexpectedly, emergency coronary angiography showed no evidence of coronary thrombosis or spasm. Electrocardiographic alterations gradually resolved after lowering blood pressure.