Red cell distribution width is an inflammatory predictor marker of contrast induced nephropathy in patients undergoing percutaneous coronary intervention.

Red blood cell distribution width (RDW) is an inflammatory biomarker reported in complete blood cell (CBC) counts. High RDW defines a proinflammatory state. Contrast-induced nephropathy (CIN) is an important and common complication in percutaneous coronary intervention (PCI) treated patients. The current study was conducted to evaluate the role of RDW as a simple predictive inflammatory marker of CIN in PCI treated patients. The current prospective study enrolled 126 PCI treated patients. Laboratory investigations included CBC, liver function test, (HbA1C), lipid profile and serological tests. Serum urea and creatinine levels were obtained at baseline and 48 to 72 hours after PCI procedure, used to categorize for CIN. Diabetes mellitus, hypertension, and ischemic heart disease were present in 39 (31%), 44 (34.9%), and 23 (18.3%) patients, respectively. Of the studied patients, only 19 (15.1%) patients developed CIN. The hemoglobin level was significantly higher in the non-CIN group (13.49 ± 1.63 vs. CIN group 12.56 ± 1.62 mg/dl; p= 0.02). RDW was significantly higher among CIN group than non-CIN group (16.20 ± 2.60 vs. 13.83 ± 2.19 % (p < 0.001). Delta creatinine (% change in creatinine level after 48 hour) was significantly higher in patients with CIN (59.17 ± 28.89 vs. non-CIN 33.62 ± 9.76; p < 0.001). Predictors for CIN in patients who underwent PCI were old age high RDW high delta creatinine and amount of dye. At cut off > 14.5%, RDW had 79% sensitivity, 70% specificity and 71.3% overall accuracy at AUC of 0.76. In conclusion, RDW may be simple and immediately available inflammatory biomarker and predictor for development of CIN in patients undergoing PCI.

Results of penicillin skin testing in patients with suspected penicillin allergy - the Qatar experience.

BACKGROUND: Unverified penicillin allergy has been linked to adverse patient events and increased healthcare expenditure owing to the usage of broad-spectrum, expensive antibiotics. Penicillin allergy test is the gold standard to diagnose penicillin allergy; and in this study, we present data from Qatar which have not been published before. METHODS: Patients with a history of penicillin allergy who underwent penicillin allergy testing between January 2015 and December 2020 at the Allergy Division of the Hamad General Hospital were retrospectively reviewed from the division registry. Benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM) kit DAP-penicillin (0.04 mg +0.5 mg)/vial) (penicillin G, amoxicillin (20 mg/vial), and lately clavulanic acid (20 mg/vial) (DAP, Diater, Madrid, Spain) were used for skin and intradermal testing according to published guidelines. Patients with negative skin tests were administered direct oral challenge with amoxicillin/clavulanate (500/125 mg) and observed for 2 hours. RESULTS: Of the 189 charts reviewed, 183 patients had a complete data set for analysis. Patients were predominantly women (n = 132, 72%) with an average age of 42 years. Of these patients, 149 (81.4%) had a history of an immediate allergic reaction to penicillin, 10 had a history of delayed reactions, and 24 had other or undefined reactions. A total of 39 (21.3%) patients were diagnosed with penicillin allergy (30 patients with positive skin test results and 9 using a direct oral challenge). Of the 30 patients with positive skin testing, 5 reacted to PPL, 8 to MDM, 13 to amoxicillin, and 4 to clavulanic acid. CONCLUSION: Previous studies indicate that 90% patients with a history of penicillin allergy were able to tolerate the drug (10% were truly allergic). Our data showed that 21% were truly allergic to penicillin. This high positive rate can be attributed to the high pretest probability based on the detailed history obtained before the test, which led to the exclusion of patients with symptoms incompatible with penicillin allergy from the test.

Severity and outcome of COVID-19 disease in patients with allergic rhinitis during the pandemic in Qatar - A preliminary report.

BACKGROUND: Allergic rhinitis and asthma exacerbation are strongly linked to respiratory viral and bacterial infections. COVID-19 pandemic has raised concerns about the risk of infection and the severity of COVID-19 infection in patients with asthma and allergic rhinitis. However, increasing evidence suggests that atopic disease protects against severe COVID-19 illness owing to the underlying type 2 inflammatory process. Many studies have reported the impact of asthma on COVID-19 disease; however, data on allergic rhinitis are scarce. In this study, we aimed to investigate the severity and outcome of COVID-19 disease in adult patients with allergic rhinitis in Qatar during the first pandemic wave. METHODS: We conducted a retrospective chart review of adult patients with a confirmed diagnosis of asthma and/or allergic rhinitis who had a positive COVID-19 RT-PCR between February 01, 2020, and December 01, 2020. Parameters evaluated included the WHO classification of COVID-19 disease severity as mild, moderate, severe, and critical; COVID-19 disease outcome; and mortality. Patients with allergic rhinitis were defined as those with typical allergic rhinitis symptoms and positive skin prick test or specific IgE to perennial or seasonal inhaled allergens. Only data about patients with allergic rhinitis has been presented in this report. RESULTS: We screened 97 EMR Cerner records of patients who had the diagnosis code for allergic rhinitis. Nine patients met the inclusion criteria of allergic rhinitis diagnosis; the remaining either had no allergy testing or had negative allergy tests. Seven (77.7%) patients had mild COVID-19, whereas only one (11.1%) patient each had moderate and severe disease. The length of hospital stays for 6 patients ranged from 5-13 days, and the remaining 3 patients were quarantined at home. No reports of critical cases or death were identified. All the patients recovered from COVID-19 with a favorable outcome. CONCLUSION: This preliminary data showed that most patients with allergic rhinitis had mild COVID-19 disease. Furthermore, all of them recovered well, similar to the available data from previous studies. A limitation of this study is the small population size.

Correlation between skin test results and historical manifestations in patients with suspected lidocaine hypersensitivity.

BACKGROUND: Adverse reactions to local anesthetics (LA) are relatively common; however, true IgE-mediated allergy is extremely rare, estimated to occur in less than 1%. Investigating patients with suspected allergy to LA should begin with a detailed history to exclude other more common operation theater related culprit medications, followed by skin testing. The subcutaneous challenge is considered the gold standard for confirming true IgE-mediated allergy to LA. In this study, we have described the skin prick test results of patients with suspected lidocaine allergy who had historical reaction symptoms typical to IgE-mediated allergic reactions. METHODS: The data were retrieved from the allergy procedure log registry for patients who were referred to the allergy clinic with a suspected allergic reaction to lidocaine at the Hamad Medical Corporation between 2016 and 2020. These patients' symptoms of historical reactions to lidocaine were compared to their skin test results. RESULT: A total of 7 patients were identified. The skin test result for lidocaine was positive in only 1 patient; his historical reaction was anaphylaxis (urticaria/angioedema and shortness of breath). The remaining 6 patients had a negative result for skin and challenge tests. Of these 6 patients with negative results, 4 had only urticaria/angioedema as historical reactions; 1 had systematic manifestation (tachycardia) along with urticaria/angioedema, and 1 experienced systemic symptoms (shortness of breath, chest pain, and palpitation) with no skin or mucous membrane involvement (Table 1). CONCLUSION: Negative skin test and subcutaneous challenge with a history of generalized cutaneous symptoms and/or systemic symptoms during the reaction to LA can be attributed to many causes, such as an IgE-mediated reaction against a component other than lidocaine (e.g., latex), medication side effects (adrenaline in combined preparations), and/or symptoms of primary disease (chronic spontaneous urticaria/angioedema).

Aspirin challenge and desensitization in patients with suspected AERD in Qatar.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is a chronic disease characterized by chronic rhinosinusitis, nasal polyposis, asthma, and intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin challenge is considered the gold standard for diagnosing AERD. Many patients with AERD have reported clinical benefits when desensitized to aspirin and maintained on daily aspirin therapy. In this study, we have summarized aspirin challenges and aspirin desensitization in our division during the past ten years. METHODS: We reviewed aspirin challenges and desensitization procedures performed in the Allergy and Immunology Division at the Hamad Medical Corporation, Doha, Qatar, between 2010 and 2020 from our procedures log registry and reported the results of the procedures. RESULTS: The procedures were performed for patients with chronic rhinosinusitis, nasal polyposis, and bronchial asthma with a historical reaction to NSAIDs or those never exposed to NSAIDs. The challenge and desensitization procedure protocol is outlined in table.1. Of the 45 procedures performed, 36 (80%) patients reacted during aspirin desensitization; and their characteristics, historical reaction to NSAIDs, provoking dose, length of desensitization, and types of reactions were reviewed. Of the reactors, 32 (88%) patients completed aspirin desensitization successfully. The mean ( ± SD) age of patients was 46 ( ± 11.6) years, and 51% were women. The historical symptoms were asthma symptoms (56%) and naso-ocular (21%). The common (71%) reaction during the procedure was asthma symptoms, and 29% had naso-ocular symptoms. The provoking dose was 50-75 mg in most patients. The desensitization procedure was carried out over 2 days in most patients; however, 29% of the patients needed more than 2 days to complete the desensitization. None of the reactors needed emergency epinephrine use or hospital admission. CONCLUSION: In our review, desensitization was successful in all the patients who reacted to aspirin, and it was the only therapeutic choice for patients with AERD before the era of biologics. The procedure was well tolerated in most patients. Aspirin challenge was positive in 80% of our patients with suspected AERD, and this has an important diagnostic value that may help in choosing the proper biologic, such as dupilumab, for these patients.

Electrocardiographic Changes and Serum Troponin Levels in Patients with Acute Stroke: A Prospective Cross-Sectional Study.

Background: Electrocardiographic changes and elevated serum troponin are frequent findings in acute stroke. They may reflect what is known as the neurogenic myocardial injury. The aim of this study is to determine the electrocardiographic changes and serum troponin level in acute stroke patients and to correlate these changes to the anatomical location and pathological type of the stroke. Methods: A prospective cross-sectional study was conducted at the National Center of Neurological Science, from January to December 2019. Non-probability sampling with total coverage was considered. 50 patients with acute stroke were included in the study. Data were analyzed by using (SPSS) version 25. Standardized ECG was performed in the first hours of admission. 2 samples from each patient were obtained for serum troponin with at least 8 hours apart. Results: All patients had wide variants of ECG changes. But tachycardia was the most frequent one identified in 54% of patients (n=50). Half of them were found to have an anterior circulation stroke. 14% of patients (n=50) have positive troponin; ECG changes are identified in all patients who represent positive troponin 100% (7 patients). Moreover, anterior circulation stroke was recognized in all patients with a positive troponin I marker. Conclusion: This study suggests that ECG abnormalities in patients with acute stroke are very common, especially tachycardia. The site of the lesion appears to play a major factor as a cause of the genesis of arrhythmia. Serum troponin elevation may play a role in diagnosing neurocardiogenic injury; nevertheless, ECG appears to be more sensitive and familial.

In vitro Interleukin-7 treatment partially rescues MAIT cell dysfunction caused by SARS-CoV-2 infection.

MAIT cells have been shown to be activated upon several viral infections in a TCR-independent manner by responding to inflammatory cytokines secreted by antigen-presenting cells. Recently, a few studies have shown a similar activation of MAIT cells in response to severe acute respiratory coronavirus 2 (SARS-CoV-2) infection. In this study, we investigate the effect of SARS-CoV-2 infection on the frequency and phenotype of MAIT cells by flow cytometry, and we test in vitro stimulation conditions on the capacity to enhance or rescue the antiviral function of MAIT cells from patients with coronavirus disease 2019 (COVID-19). Our study, in agreement with recently published studies, confirmed the decline in MAIT cell frequency of hospitalized donors in comparison to healthy donors. MAIT cells of COVID-19 patients also had lower expression levels of TNF-alpha, perforin and granzyme B upon stimulation with IL-12 + IL-18. 24 h' incubation with IL-7 successfully restored perforin expression levels in COVID-19 patients. Combined, our findings support the growing evidence that SARS-CoV-2 is dysregulating MAIT cells and that IL-7 treatment might improve their function, rendering them more effective in protecting the body against the virus.

Ticagrelor versus prasugrel in acute coronary syndrome: sex-specific analysis from the RENAMI Registry.

BACKGROUND: The use of potent P2Y12 inhibitors (ticagrelor & prasugrel) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary interventions (PCI) is a class I recommendation. We performed a sex-specific analysis comparing the difference in efficacy and safety outcomes between ticagrelor and prasugrel in a real-world ACS population. METHODS: Data from the multicenter REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) for 4424 ACS patients who underwent PCI and were treated with ticagrelor or prasugrel between 2012 to 2016 were analyzed. Mean follow-up was 17±9 months. RESULTS: After propensity score matching, there was no significant difference in the occurrence of primary endpoint of net adverse cardiac events between ticagrelor and prasugrel in men (HR: 0.94; 95% CI: 0.69-1.29; P=0.71), or women (HR: 1.17; 95% CI: 0.63-2.20; P=0.62; P interaction [sex] = 0.40). Similarly, no differences were found in the occurrence of any of the secondary endpoints (MACE, all cause death, re-infarction, stent thrombosis, BARC major bleeding and BARC any bleeding) between the two P2Y12 groups between men and women. CONCLUSIONS: In this real-world ACS population, no relative difference in efficacy or safety outcomes were found between ticagrelor and prasugrel between sexes.

The association between airborne pollen monitoring and sensitization in the hot desert climate.

BACKGROUND: Pollen is a major cause of allergic respiratory diseases. In Qatar, data on the presence and prevalence of allergenic airborne types of pollen is quite limited. METHODS: The study aimed to determine and correlate the most frequently implicated airborne pollen detected by aerobiological monitoring samplers in respiratory allergy symptoms. An aerobiological survey was started on May 8, 2017. Airborne pollen was collected using two Hirst type seven-day recorder volumetric traps. Skin prick test in patients attending allergy clinics in Doha using commercial extracts was conducted. RESULTS: Twenty-five pollen types representing the native, as well as the introduced plants, with a relatively low daily mean concentration were observed from May 2017 to May 2019. The highest pollen concentrations were reached by Amaranthaceae (58.9%), followed by Poaceae (21.7%). SPT revealed a comparatively higher degree of sensitization to pollen. Among 940 patients, 204 were sensitized to pollen (54% female) with 135 (66.2%) and 114 (55.8%) to Amaranthaceae and Poaceae, respectively. Some patients had polysensitization. There was a statistically significant association between Amaranthaceae, and asthma (r = 0.169, P = 0.016) and allergic rhinitis (r = 0.177, P = 0.012). CONCLUSIONS: This is the first study to monitor airborne pollen in the state of Qatar. The main pollen detected were Amaranthaceae and Poaceae. Pollen may represent a possible exacerbating factor in adult patients with allergic diseases such as asthma and allergic rhinitis.

Inhibition of endoplasmic reticulum stress ameliorates cardiovascular injury in a rat model of metabolic syndrome.

Metabolic (Met) syndrome is characterized by hypertension, insulin resistance and dyslipidaemia with high risk of cardiovascular disease. Endoplasmic reticulum (ER) stress is a key contributor in the pathogenesis of Met syndrome. The current study investigates the effect of Tauroursodeoxycholate (TUDCA), an ER stress inhibitor, on Met syndrome-induced cardiovascular complications and the possible underlying signalling mechanisms. Met syndrome was induced in rats, which were then treated with TUDCA. Body weight, blood pressure, glucose tolerance and insulin tolerance tests were performed. ER stress, survival and oxidative stress markers were measured in heart and aorta tissue. The results showed that TUDCA improved metabolic parameters in rats with Met syndrome. Treatment mitigated the Met syndrome-induced cardiovascular complications through upregulating survival markers and downregulating ER and oxidative stress markers. These results highlight the protective effect of ER stress inhibition as a potential target in the management of cardiovascular complications associated with Met syndrome.

Long versus short dual antiplatelet therapy in acute coronary syndrome patients treated with prasugrel or ticagrelor and coronary revascularization: Insights from the RENAMI registry.

INTRODUCTION: The benefits of short versus long-term dual antiplatelet therapy (DAPT) based on the third generation P2Y12 antagonists prasugrel or ticagrelor, in patients with acute coronary syndromes treated with percutaneous coronary intervention remain to be clearly defined due to current evidences limited to patients treated with clopidogrel. METHODS: All acute coronary syndrome patients from the REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) undergoing percutaneous coronary intervention and treated with aspirin, prasugrel or ticagrelor were stratified according to DAPT duration, that is, shorter than 12 months (D1 group), 12 months (D2 group) and longer than 12 months (D3 group). The three groups were compared before and after propensity score matching. Net adverse clinical events (NACEs), defined as a combination of major adverse cardiac events (MACEs) and major bleedings (including therefore all cause death, myocardial infarction and Bleeding Academic Research Consortium (BARC) 3-5 bleeding), were the primary end points, MACEs (a composite of all cause death and myocardial infarction) the secondary one. Single components of NACEs were co-secondary end points, along with BARC 2-5 bleeding, cardiovascular death and stent thrombosis. RESULTS: A total of 4424 patients from the RENAMI registry with available data on DAPT duration were included in the model. After propensity score matching, 628 patients from each group were selected. After 20 months of follow up, DAPT for 12 months and DAPT for longer than 12 months significantly reduced the risk of NACE (D1 11.6% vs. D2 6.7% vs. D3 7.2%, p = 0.003) and MACE (10% vs. 6.2% vs. 2.4%, p < 0.001) compared with DAPT for less than 12 months. These differences were driven by a reduced risk of all cause death (7.8% vs. 1.3% vs. 1.6%, p < 0.001), cardiovascular death (5.1% vs. 1.0% vs. 1.2%, p < 0.0001) and recurrent myocardial infarction (8.3% vs. 5.2% vs. 3.5%, p = 0.002). NACEs were lower with longer DAPT despite a higher risk of BARC 2-5 bleedings (4.6% vs. 5.7% vs. 6.2%, p = 0.04) and a trend towards a higher risk of BARC 3-5 bleedings (2.4% vs. 3.3% vs. 3.9%, p = 0.06). These results were not consistent for female patients and those older than 75 years old, due to an increased risk of bleedings which exceeded the reduction in myocardial infarction. CONCLUSION: In unselected real world acute coronary syndrome patients treated with percutaneous coronary intervention, DAPT with prasugrel or ticagrelor prolonged beyond 12 months markedly reduces fatal and non-fatal ischaemic events, offsetting the increased risk deriving from the higher bleeding risk. On the contrary, patients >75 years old and female ones showed a less favourable risk-benefit ratio for longer DAPT due to excess of bleedings.

P2Y12 inhibitors in acute coronary syndrome patients with renal dysfunction: an analysis from the RENAMI and BleeMACS projects.

AIMS: The aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction. METHODS AND RESULTS: All consecutive patients from RENAMI (REgistry of New Antiplatelets in patients with Myocardial Infarction) and BLEEMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60 mL/min/1.73 m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MBs), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint. A total of 19 255 patients were enrolled. Mean age was 63 ± 12; 14 892 (77.3%) were males. A total of 2490 (12.9%) patients had chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2. Mean follow-up was 13 ± 5 months. Mortality was significantly higher in CKD patients (9.4% vs. 2.6%, P < 0.0001), as well as the incidence of reinfarction (5.8% vs. 2.9%, P < 0.0001) and MB (5.7% vs. 3%, P < 0.0001). At Cox multivariable analysis, potent P2Y12 inhibitors significantly reduced the mortality rate [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.54-0.96; P = 0.006] and the risk of reinfarction (HR 0.53, 95% CI 0.30-0.95; P = 0.033) in CKD patients as compared to clopidogrel. The reduction of risk of reinfarction was confirmed in patients with preserved renal function. Potent P2Y12 inhibitors did not increase the risk of MB in CKD patients (HR 1.00, 95% CI 0.59-1.68; P = 0.985). CONCLUSION: In ACS patients with CKD, prasugrel and ticagrelor are associated with lower risk of death and recurrent MI without increasing the risk of MB.

Average daily ischemic versus bleeding risk in patients with ACS undergoing PCI: Insights from the BleeMACS and RENAMI registries.

BACKGROUND: The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the first year of follow-up according to clinical presentation, and medical and interventional strategies. METHODS: BleeMACS and RENAMI are 2 multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel, or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary end points. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup. RESULTS: A total of 19,826 patients were included. Overall, in the first year after PCI, the ADBR was 0.008085%, whereas ADIR was 0.008017% (P = .886). In the first 2 weeks ADIR was higher than ADBR (P = .013), especially in patients with ST-segment elevation myocardial infarction or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the third month, whereas ADBR became higher, although not significantly, afterward. Patients with incomplete revascularization had an excess in ischemic risk (P = .003), whereas non-ST-segment elevation ACS patients and those on ticagrelor had an excess of bleeding (P = .012 and P = .022, respectively). CONCLUSIONS: In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in ST-segment elevation myocardial infarction patients and those with incomplete revascularization. In the first year, ADIR was higher than ADBR in patients with incomplete revascularization, whereas ADBR was higher in non-ST-segment elevation ACS patients and in those discharged on ticagrelor.

Efficacy and Safety of Clopidogrel, Prasugrel and Ticagrelor in ACS Patients Treated with PCI: A Propensity Score Analysis of the RENAMI and BleeMACS Registries.

INTRODUCTION: Real-life data comparing clopidogrel, prasugrel, and ticagrelor for unselected patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are lacking, as are data for the temporal distribution of ischemic and bleeding risks. METHODS: A total of 19,825 patients were enrolled from the RENAMI and BleeMACS registries. Both were multicenter, retrospective, observational registries including the data and outcomes of consecutive patients with ACS who underwent primary PCI and were discharged with dual antiplatelet therapy (DAPT). We evaluated the long-term outcome stratified by the different antiplatelet agents. RESULTS: A total of 14,105 patients (71.2%) were treated with clopidogrel, 2364 patients (11.9%) with prasugrel and 3356 patients (16.9%) with ticagrelor. After propensity score matching, at 1 year, prasugrel reduced the incidence of net adverse clinical events (NACE; a composite endpoint of all-cause death, myocardial infarction [MI] and Bleeding Academic Research Consortium [BARC] 3-5 bleeding) (4.2% vs.7.6%, p = 0.002) and of major adverse cardiovascular events (MACE; a composite endpoint of death and MI) compared with clopidogrel (2.6% vs. 5.2%, p = 0.007). Ticagrelor decreased rates of MACE compared with clopidogrel (2.7% vs. 6.2%, p < 0.001), but not of NACE (6.6% vs. 8.7%, p = 0.07). Ticagrelor presented similar performance in terms of MACE compared with prasugrel (2.8% vs. 2.4%, p = 0.56), with a trend towards a reduction in MI (0.2% vs. 0.4%, p = 0.56), but with higher risk of BARC 3-5 bleedings (3.8% vs. 1.7%, p = 0.04). In the daily risk analysis, clopidogrel presented a binomial distribution with a peak of ischemic risk at 3 months, which decreased towards bleedings; prasugrel had a constant equivalence between opposite risks; and ticagrelor constantly reduced recurrent MIs despite higher risk of BARC 3-5 events. CONCLUSION: In real life, ticagrelor is more effective in reducing ischemic events during the first year after ACS, despite an increased risk of major bleedings, while prasugrel assures a better balance between ischemic and bleeding recurrent events.

Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor.

BACKGROUND: The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicians at individualizing the optimal dual antiplatelet therapy duration (DAPT) after percutaneous coronary intervention (PCI). Nevertheless, external validation of these RSs it has not yet been performed in ACS (acute coronary syndrome) patients treated with prasugrel or ticagrelor in a real- world scenario. METHODS: 4424 ACS patients who underwent PCI and survived to hospital discharge, from January 2012 to December 2016 at 12 European centers, were included. PRECISE-DAPT and PARIS bleeding RS, as well as PARIS ischemic RS, were computed, and their performance at predicting major bleeding (MB; BARC type 3 or 5) and ischemic events (MI and stent thrombosis) during follow up was compared. RESULTS: After a median follow-up of 14 (interquartile range 12-20.9) months, 83 (1.88%) patients developed MB and 133 (3.0%) suffered an ischemic episode. PRECISE-DAPT performed better than PARIS bleeding RS (c-statistic = 0.653 vs. 0.593; p = .01 for comparison) in predicting MB. The RSs performance for MB prediction remained consistent in STEMI patients (c-statistic = 0.632 vs 0.575) or in those treated with prasugrel (c-statistic = 0.623 vs 0.586). PARIS ischemic RS exhibited superior discrimination in predicting ischemic complications compared to PRECISE-DAPT (c-statistic = 0.604 vs 0.568 p = .05 for comparison). CONCLUSION: Our data provide support to the use of PRECISE-DAPT in MB risk stratification for patients receiving DAPT in form of aspirin and prasugrel or ticagrelor whereas the PARIS ischemic RS has potential to complement the risk prediction with respect to ischemic events.

In vivo measurement of stent length by using intravascular ultrasound.

BACKGROUND: What happens to stent length when deployed in a coronary artery? It is the aim of this study. RESULTS: Consecutive 95 balloon-expandable stents (BES) were studied by intravascular ultrasound (IVUS) imaging. The stent length was measured from the longitudinal view in two ways: (1) edge-to-edge length (E-E) measured between distal and proximal stent frames located at one IVUS quadrant and (2) area-to-area length (A-A) measured between distal and proximal stent frames located at two or more IVUS quadrants. IVUS measurements were compared with the manufacturer-stated length (M-L). The median E-E length was significantly longer than M-L, 18.76 mm [interquartile range (IQR) 15.65-23.60] versus 18.00 mm (IQR 15.00-23.00), respectively, p < 0.0001. Also, the median A-A length was significantly longer, 18.36 mm (IQR 15.19-23.47), p < 0.0001, than M-L. Moreover, the E-E length was significantly different from A-A length, p < 0.0001. Among the stent groups, the differences were significantly present in all drug-eluting stent and bare metal stent (BMS) comparisons, p < 0.0001, except the A-A length versus M-L in BMS only. By multivariate analysis, the predictors of difference in stent length were as follows: lesion length, p = 0.01; pre-intervention minimal diameter of the external elastic membrane (EEM), p = 0.03; lesions present in the left anterior descending branch, p = 0.03; and M-L, p = 0.04. CONCLUSIONS: In the present study, the length of BES measured by IVUS was significantly different from the manufacturer-stated length. In addition to the manufacturer length, other important factors such as lesion length, pre-intervention diameter of EEM, and affected vessel determine the stent length.

Correction to: Real-World Data of Prasugrel vs. Ticagrelor in Acute Myocardial Infarction: Results from the RENAMI Registry.

The first author's name which previously read.

Real-World Data of Prasugrel vs. Ticagrelor in Acute Myocardial Infarction: Results from the RENAMI Registry.

BACKGROUND: Limited data are available concerning differences in clinical outcomes for real-life patients treated with ticagrelor versus prasugrel after percutaneous coronary intervention (PCI). OBJECTIVE: Our objective was to determine and compare the efficacy and safety of ticagrelor and prasugrel in a real-world population. METHODS: RENAMI was a retrospective, observational registry including the data and outcomes of consecutive patients with acute coronary syndrome (ACS) who underwent primary PCI and were discharged with dual antiplatelet therapy (DAPT) between January 2012 and January 2016. The mean follow-up period was 17 ± 9 months. In total, 11 university hospitals from six European countries participated. After propensity-score matching, there were no substantial differences in the baseline clinical and interventional features. All patients were treated with acetylsalicylic acid plus prasugrel 10 mg once daily or acetylsalicylic acid plus ticagrelor 90 mg twice daily. Mean duration of DAPT was 12.04 ± 3.4 months with prasugrel and 11.90 ± 4.1 months with ticagrelor (p = 0.47). The primary and secondary endpoints were long-term net adverse clinical events (NACE) and major adverse cardiovascular events (MACE), respectively, along with their single components. Subgroup analysis for freedom from NACE and MACE was performed according to length of DAPT and clinical presentation [ST-elevation myocardial infarction (STEMI)-ACS versus non-ST-elevation myocardial infarction (NSTEMI)-ACS]. RESULTS: In total, 4424 patients (2725 ticagrelor, 1699 prasugrel) were enrolled. After propensity-score matching, 1290 patients in each cohort were included in the analysis. At 12 months, the incidence of both NACE and MACE was lower with prasugrel (NACE: 5.3% vs. 8.5% [p = 0.001]; MACE: 5% vs. 8.1% [p =  0.001]) mainly driven by a reduction in recurrent myocardial infarction (MI) (2.4 vs. 4.0%; p = 0.029) and a lower rate of Bleeding Academic Research Consortium (BARC) 3-5 bleeding (1.5 vs. 2.9%; p = 0.011). The benefit of prasugrel was confirmed for patients with NSTEMI and for those discharged with a DAPT regimen of ≤ 12 months. Only a trend in the reduction of NACE and MACE was noted for STEMI or for those treated with longer DAPT. CONCLUSIONS: Comparison of these drugs suggested that prasugrel is safer and more efficacious than ticagrelor in combination with aspirin after NSTEMI but not STEMI. No differences were found for events occurring after 12 months. The nonrandomized design of the present research means further studies are required to support these findings.