ABSTRACT
Background: Coronary in-stent restenosis (ISR) is a major clinical challenge of contemporary percutaneous revascularization and portends adverse cardiovascular outcomes. Objectives: We aimed to evaluate gender, race, and ethnicity related outcomes in acute coronary syndromes (ACS) with ISR. Methods: Primary hospitalizations for ACS and ISR in the National Inpatient Sample database from 2016 to 2019 were included. Patients were stratified by gender, race, and ethnicity. The primary end points were all cause in-hospital mortality and coronary revascularization defined as composite of percutaneous coronary intervention (PCI), balloon angioplasty and/or coronary artery bypass grafting (CABG). Results: During the study period, a nationally weighted total of 97,680 patients with ACS and ISR were included. There was substantial variation in comorbidities, with greatest burden among Black and Hispanic women. All-cause in-hospital mortality was 2.4 % in the study cohort, but significantly higher in women (2.1 % vs. 2.1 %; aOR: 1.282, 95 % CI: 1.174-1.4; p < 0.001) and revascularization rates were significantly lower in women (77 % vs 80.2 %; aOR: 0.891, 95 % CI: 0.862-0.921; p < 0.001). Compared to White men, all women except Hispanic women, had significantly higher likelihood of in-hospital mortality, while White women, Black men and women, and Hispanic men had lower odds of revascularization. Conclusions: There are significant gender, racial, and ethnic related differences in revascularization practices and clinical outcomes in patients with ACS and ISR with an adverse impact on women, racial and ethnic minorities in the U.S.
ABSTRACT
Valvular heart disease, including calcific or degenerative aortic stenosis (AS), is increasingly prevalent among the older adult population. Over the last few decades, treatment of severe AS has been revolutionised following the development of transcatheter aortic valve replacement (TAVR). Despite improvements in outcomes, older adults with competing comorbidities and geriatric syndromes have suboptimal quality of life outcomes, highlighting the cumulative vulnerability that persists despite valve replacement. Sarcopenia, characterised by loss of muscle strength, mass and function, affects 21%-70% of older adults with AS. Sarcopenia is an independent predictor of short-term and long-term outcomes after TAVR and should be incorporated as a prognostic marker in preprocedural planning. Early diagnosis and treatment of sarcopenia may reduce morbidity and mortality and improve quality of life following TAVR. The adverse effects of sarcopenia can be mitigated through resistance training and optimisation of nutritional status. This is most efficacious when administered before sarcopenia has progressed to advanced stages. Management should be individualised based on the patient's wishes/preferences, care goals and physical capability. Exercise during the preoperative waiting period may be safe and effective in most patients with severe AS. However, future studies are needed to establish the benefits of prehabilitation in improving quality of life outcomes after TAVR procedures.
Subject(s)
Sarcopenia , Transcatheter Aortic Valve Replacement , Humans , Sarcopenia/diagnosis , Sarcopenia/therapy , Sarcopenia/physiopathology , Sarcopenia/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/methods , Quality of Life , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/physiopathology , Aortic Valve/surgery , Risk Factors , Aged , Aortic Valve Disease/surgery , Aortic Valve Disease/therapy , Treatment OutcomeABSTRACT
Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) has resulted in a global health crisis. Prior to the arrival of this viral pandemic, the world was already plagued with a significant burden of cardiovascular disease. With the introduction of the novel virus, the world now faces a double jeapordy. Early reports have suggested an increased risk of death in individuals with underlying cardio-metabolic disorders. The exact effects of COVID-19 on the cardiovascular system are not well determined, however lessons from prior viral epidemics suggest that such infections can trigger acute coronary syndromes, arrhythmias and heart failure via direct and indirect mechanisms. In this article, we aimed to discuss the effects and potential underlying mechanisms of COVID -19 as well as potential implications of treatments targeted against this virus on the cardiovascular system.
Resumen El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) que causa la enfermedad por coronavirus (COVID-19) ha provocado una crisis en la salud global. Antes de la llegada de esta pandemia, se tenia una carga importante de enfermedad cardiovascular a nivel mundial. Con la introducción del nuevo virus, el mundo ahora se enfrenta a un doble peligro. Los primeros informes han sugerido un mayor riesgo de muerte en personas con trastornos cardio-metabólicos de base. Los efectos causados por el COVID-19, en el sistema cardiovascular aun no están bien determinados, sin embargo, el conocimiento sobre otras epidemias virales previamente ocurridas en el mundo, sugieren que estas infecciones pueden desencadenar síndromes coronarios agudos, arritmias e insuficiencia cardíaca a través de mecanismos directos e indirectos. En este artículo, nuestro objetivo fue analizar los efectos y los posibles mecanismos subyacentes de COVID -19, así como las posibles implicaciones de los tratamientos dirigidos contra este virus en el sistema cardiovascular.