Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation.

BACKGROUND: There are indications that viral myocarditis, demand ischemia, and renin-angiotensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019 (COVID-19) patients. Antiviral medications and steroids are used to treat viral myocarditis, but their effect in patients with elevated troponin, possibly from myocarditis, has not been studied. AIM: To evaluate the effect of dexamethasone, remdesivir, and angiotensin-converting enzyme (ACE) inhibitors (ACEI) on mortality in COVID-19 patients with elevated troponin. METHODS: Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California, United States. We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population. Additionally, we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin, comparing survival in patients that received dexamethasone, remdesivir, and ACEI with those that did not. RESULTS: The mean age was 66 years (range 20-110), troponin elevation was noted in 11.5% of the patients, and 29.9% expired. The patients' age [hazard ratio (HR) = 1.02, P < 0.001], intensive care unit admission (HR = 5.07, P < 0.001), and ventilator use (HR = 0.68, P = 0.02) were significantly associated with mortality. In the subset of patients with elevated troponin, there was no statistically significant difference in survival in those that received remdesivir (0.07), dexamethasone (P = 0.63), or ACEI (P = 0.8) and those that did not. CONCLUSION: Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors, conventional viral myocarditis treatment, including antiviral and steroids, and ACEI did not show any effect on mortality in these patients.

Use of intravascular lithotripsy in non-coronary artery lesions.

BACKGROUND: Intravascular lithotripsy (IVL) is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease. However, much of the available literature on IVL is focused on its use in coronary arteries, with relatively limited data on non-coronary artery use. AIM: To analyze the safety and efficacy of current IVL use in non-coronary artery lesions, as reported in case reports and case series. METHODS: We searched EMBASE, PubMed, and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease. We then extracted variables of interest and calculated the mean and proportions of these variables. RESULTS: We included 60 patients from 33 case reports/case series. Ninety-eight percent of the cases had IVL usage in only one blood vessel, while four had the IVL used in two vessels (2.0%), resulting in 64 Lesions treated with IVL. The mean age of the patients was 73.7 (SD 10.9). IVL was successfully used in severe iliofemoral artery stenosis (51.6%), severe innominate, subclavian, and carotid artery stenosis (26.7% combined), and severe mesenteric vessel stenosis (9.4%). Additionally, IVL was successfully used in severe renal (7.8%) and aortic artery (4.7%) stenosis. There were complications in 12% of the cases, with dissection being the commonest. CONCLUSION: IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral, carotid, subclavian, aorta, renal, and mesenteric vessels. The most severe but transient complications were with IVL use in the aortic arch and neck arteries.