Diffused coronary involvement in Takayasu arteritis with concomitant malignancy.

Large vessel vasculitis (LVV) is composed of conditions in which inflammation of blood vessel walls affects mainly large arteries, such as the aorta and its main branches, and in some cases the coronary arteries. Coronary artery involvement in systemic vasculitis is associated with significant morbidity and mortality. We present a case of a young patient diagnosed with extensive coronary disease diagnosed as Takayasu arteritis, when whom a concomitant diagnosis of Hodgkin's lymphoma was made. The literature review revealed ten cases of malignancies associated with Takayasu arteritis. We discuss the complexity of the management of concurrent hematological malignancy with TAK and extensive coronary arteritis. This complicated and cross-disciplinary case also represents the pivotal importance of multi-disciplinary team decision in order to achieve the best clinical outcome of both disorders.

Worse outcomes of ACS patients without versus with traditional cardiovascular risk factors.

INTRODUCTION: Up to 20% of patients presenting with acute coronary syndrome (ACS) have no traditional cardiovascular risk-factors (RFs). Data regarding the determinants, management, and outcomes of these patients are scarce. OBJECTIVES: To evaluate the management, outcomes, and time-dependent changes of ACS patients without RFs. METHODS: Evaluation of clinical characteristics, management strategies, and outcomes as well as time-dependent changes [by 3 time periods: early (2000-2006), mid (2008-2013), and late (2016-2018)] of ACS patients without RFs (diabetes mellitus, hypertension, dyslipidemia, family history of ischemic heart disease, and smoking) or known coronary artery disease, enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. We compared ACS patients without RFs (no-RF group) to those with ≥1 RFs (RF group). RESULTS: Overall, 554/9,683 (5.7%) eligible ACS patients did not have any RFs [median age 63 (IQR 52-76) years, 25% females]. The no-RF group were older, with lower body mass index and prevalence of other cardiovascular comorbidity and chronic kidney disease compared with the RF group. The in-hospital percutaneous coronary intervention rates were lower among the no-RF vs. the RF group (55% vs. 66%, respectively p<0.001). Furthermore, lower rate of guideline-recommended medical therapy upon discharge was prescribed in the no-RF group. The rate of in-hospital complications was greater in the no-RF vs. RF group (31.6% vs. 26.1%, respectively p=0.005). The rates of 30-day major adverse cardiovascular events (MACE; 17.6% vs.12.8%, respectively, p=0.002) and of 30-day and 1-year all-cause mortality (8.4% vs. 4.2%, p<0.001 and 11.4% vs. 7.7%, p=0.003 respectively) were higher among patients with no-RF vs. RF. Following propensity score matching 30-day MACE, 30-day and 1-year mortality risk remained higher in the no-RF group. The rate of 30-day MACE decreased between the early and the late study period in the no-RF group (21.5% vs. 10.5%, p=0.003, respectively). CONCLUSIONS: ACS patients without traditional cardiovascular risk-factors comprise a unique group with reduced prevalence of comorbidities yet significantly worse outcomes. Additional research to identify unique risk-factors and targets for interventions to improve outcomes of this group of patients is warranted.

Report from a large and comprehensive single-center Women's Health Cardiology Clinic.

OBJECTIVE: This article describes the women population and work at a unique Women's Health Cardiology Clinic in order to raise cardiovascular disease awareness with an emphasis on women-specific risk factors, and thus to improve women's clinical outcomes. This expectantly will aid in opening similar centers allowing more women to get superior care. METHODS: Electronic medical records of women referred to the Women's Health Cardiology Clinic were analyzed. The statistical analysis is descriptive in nature. Women's Health Cardiology Clinic personnel work as a multidisciplinary team, and patients receive specialized diagnostic tests and treatments. Referrals are by physicians according to traditional and women's specific risk factors for cardiovascular disease. RESULTS: 985 women visited the Women's Health Cardiology Clinic, accumulating 2062 visits. Median age was 57.5 years. The majority of the women were menopausal (575 women, 58%), 62 pregnant with complications and 25 oncology patients. At least, 30% of women had diabetes/hypertension/or dyslipidemia. 72 women had a history of either cerebrovascular event or acute coronary syndrome, and 139 women had evidence of atherosclerosis. Overall, 388 women underwent endothelial function test, 40% of these women had a score indicating endothelial dysfunction. 277 women underwent a psychological intervention. CONCLUSION: Described here are the experiences from a multidisciplinary Women's Health Cardiology Clinic using a gender-specific cardiovascular care approach for women geared toward improved health and wellbeing. It is of utmost importance that this report will raise women-specific cardiovascular disease risk factors awareness in order to promote women's cardiovascular and overall health.

Characteristics and outcomes of patients with cancer presenting with acute myocardial infarction.

BACKGROUND: Limited data are available regarding the optimal management of patients with cancer in the acute myocardial infarction (AMI) setting. PATIENTS AND METHODS: We studied consecutive patients with AMI included in a national registry (years 2010, 2016) with the diagnosis of past or active malignancy and followed them for 1 year. RESULTS: Our cohort consisted of 2937 cancer-naive patients and 152 patients with cancer, of whom 35% presented with active malignancies. Compared with cancer-naive patients, patients with cancer were older, with female predominance, and presented more often with a history of hypertension and chronic kidney disease (P<0.001 for all comparisons). The rate of ST-elevation AMI was comparable (P=0.067). GRACE score more than 140 was more common in the cancer group (P<0.001). Most patients with cancer were referred to coronary angiography, though less than cancer-naive patients (87 vs. 93%; P=0.004). The rate of percutaneous coronary intervention was similar (P=0.265). Propensity score matching demonstrated similar rates of in-hospital complications between groups, and no mortality or major cardiac adverse event differences were noted at 30 days. Moreover, short-term mortality was similar between patients with active versus past malignancies, and between patients with solid and nonsolid tumors. However, cancer in patients with AMI was found to predict an increased mortality risk at 1 year by multivariable analysis (hazard ratio=2.52; P<0.001). CONCLUSION: Patients with cancer and AMI have a more complicated clinical presentation, yet their short-term prognosis is similar to cancer-naive patients. Nevertheless, 1-year outcome is worse.

Impact of female sex on long-term acute coronary syndrome outcomes.

OBJECTIVES: Recent literature shows a greater risk for adverse clinical outcomes following acute coronary syndrome (ACS) events in women undergoing a percutaneous coronary intervention (PCI), especially in young and diabetic patients. We aimed to assess the impact of sex on clinical results following ACS. METHODS: From our database of all-comer PCI patients, between 1 April 2004 and 31 December 2011, the procedural and angiographic results and clinical outcomes up to 5 years of 5819 patients with ACS undergoing emergent PCI were analyzed and compared according to sex. RESULTS: A total of 1425 (24.5%) of the patients were women. They presented at an older age (72.7±11.3 vs. 65.2±12.3 years, P<0.001), and more had diabetes mellitus (46.7 vs. 40.0%, P<0.001) and previous heart failure (12.1 vs. 7.26%, P=0.001). Mortality (21.63 vs. 13.22% at 5 years, P<0.001) and combined endpoints of death, myocardial infarction, and target-vessel revascularization (30.72 vs. 24.65% at 5 years, P<0.001) were higher in women. In a multivariate analysis using age, previous diabetes, heart failure, coronary artery bypass graft surgery, baseline glomerular filtration rate, presentation with ST-elevation myocardial infarction, and proximal left anterior descending artery disease, female sex was no longer an independent predictor of outcomes. No sex differences in mortality or major adverse cardiac events were observed in young or diabetic patients. CONCLUSION: Our results show no sex differences in clinical endpoints among ACS patients undergoing PCI after correction for advanced age and comorbidities. Importantly, no differences were found in patients with diabetes mellitus or those younger than 60 years of age. This may reflect the importance of the administration of evidence-based therapeutics in women.

Gender-related differences in hospitalized heart failure patients.

AIMS: The burden of heart failure (HF)-related hospitalization and mortality of female patients with HF is substantial. Currently, several gender-specific distinctions have been recognized amongst HF patients, but their relationships to outcomes have not been fully elucidated. Accordingly, in the current work, we aimed to explore gender-specific clinical and echocardiographic measures and to assess their potential impact on outcome. METHODS AND RESULTS: We studied all consecutive HF patients, aged 50 or older, who had been hospitalized between January 2000 and December 2009, and had undergone at least one echocardiography study. A comparative analysis of clinical and echocardiographic findings was performed between 5228 males and 4107 females. Patients were followed for a mean of 2.8 ± 2.6 years. Females compared with males had less ischaemic heart disease, prior stroke, chronic renal failure, and COPD, and higher rates of hypertension, AF, obesity, valvular abnormalities, and pulmonary hypertension. Unadjusted 30-day and 1-year mortality rates were higher among women, while age-adjusted rates were similar. Predictors of outcomes varied between genders. Female-specific predictors of mortality included aortic stenosis, pulmonary hypertension, and malignancy, whereas diastolic dysfunction and chronic renal failure were found to be male-specific predictors. CONCLUSIONS: Age-adjusted mortality rates of male and female hospitalized HF patients are similarly high. Predictors of mortality, however, are gender distinctive, and these measures may allow a better identification of high-risk HF patients.

A comparative analysis of major clinical outcomes with drug-eluting stents versus bare metal stents in male versus female patients.

AIMS: To conduct a risk-adjusted gender-based analysis of clinical outcomes following drug-eluting stent (DES) versus bare metal stent (BMS) implantation in patients with coronary artery disease. METHODS AND RESULTS: We compared risk-adjusted total mortality rate, myocardial infarction, and event-free survival (defined as freedom from death, myocardial infarction and/or repeat revascularisation) in a consecutive cohort of 7,662 patients undergoing percutaneous coronary intervention at our institution, including 1,835 (25.4%) women. Follow-up was six months to 6.2 years (mean: 3.5 years; median: 3.6 years). The women were older than men and more likely to suffer from diabetes, hypertension or congestive heart failure. Smokers were more often men, and men were more likely to have had prior coronary bypass surgery compared to women. A DES was used in 39.9% of males and 39.5% of females. Both genders derived a significant long-term clinical benefit from DES compared to BMS; advantages were observed for mortality (men: HR=0.78, 95% CI: 0.64-0.96, p=0.016; women: HR=0.62, 95% CI: 0.45-0.85, p=0.003) and major adverse cardiac events (men: HR=0.73, 95% CI: 0.63-0.84, p<0.001; women: HR=0.76, 95% CI: 0.52-0.84, p=0.001). Among BMS-treated patients, women had worse cumulative clinical outcomes than men. DES eliminated the gender differences in cardiac prognosis. CONCLUSIONS: Our analysis indicated a profound prognostic advantage for DES versus BMS among both genders, though female patients appeared to derive the greatest benefit.

[The importance of preventive medicine in women's health].

The concept of preventive health care screening has been developed over the last 30 years through cLinical trials of screening maneuvers, as well as a theoretical statistical Literature. Screening is used in general medical practice in two distinct ways: to screen for early disease, and to screen for risk factors for disease or injury. Since medical problems can affect women and men differently, some serious medical issues may be overlooked because symptoms in many women are not clear-cut. Moreover, many research studies in the past did not include women participants; therefore, conclusions from those studies may not be valid for making health care decisions about women. Health care for women includes the entire spectrum of a woman's life. At each stage of a woman's Life, there are important preventive health care steps to follow in order to provide early detection of medical problems, or to prevent them.

Acute coronary syndromes in patients with prosthetic heart valves-a case-series.

BACKGROUND: There are few reports regarding acute coronary syndromes (ACS) in patients with prosthetic heart valves (PHV), mostly attributing the ACS to a PHV-derived coronary embolus. OBJECTIVE: To characterize a case-series of ACS patients with PHV. METHODS: All patients in our institution with previous PHV surgery and ACS during 1996-2005 were retrospectively analysed. RESULTS: We identified 40 patients from the 15,878 patient database, whose mean age was 72.5 +/- 12.5 years and of whom 21 were male. The majority (n=28) had mechanical valves; 24 patients (60%) had an aortic prosthetic valve, 9 patients (22.5%) had a mitral valve prosthesis and 7 patients (17.5%) had both. The majority of patients had > or = 2 risk factors for atherosclerotic disease. The median time from the PHV implantation to the subsequent ACS was 8.0 (4.7-12.1) years. Most patients had non-ST-segment elevation ACS rather than ST-segment elevation ACS (32 patients versus 8 patients). 12 patients (30%) had moderate to severe left ventricular dysfunction and 2 of them presented with cardiogenic shock. Atrial fibrillation on hospital admission was noted in 13 patients (32.5%). ACS management included coronary angiography in 32 patients (80%) which revealed coronary disease in 93%. Only 2 patients had normal coronary arteries and PHV-derived coronary emboli. The most frequent in-hospital complication was heart failure (n=11, 27.5%). CONCLUSIONS: Patients with PHV and ACS are a rare subgroup, more likely to be elderly with risk factors for atherosclerotic disease and to present with non-ST-segment-elevation ACS. The pathogenesis for ACS is commonly coronary atherosclerotic disease rather than PHV-derived emboli.