Relative telomere length impact on mortality of COVID-19: Sex differences.

Increasing age is associated with severity and higher mortality of COVID-19. Telomere shortening is associated with higher risk of infections and may be used to identify those patients who are more likely to die. We evaluated the association between relative telomere length (RTL) and COVID-19 mortality. RTL was measured in patients hospitalized because of COVID-19. We used Kaplan-Meier method to analyze survival probabilities, and Cox regression to investigate the association between RTL and mortality (30 and 90 days). Six hundred and eight patients were included in the analysis (mean age =72.5 years, 41.1% women, and 53.8% Caucasic). During the study period, 75 people died from COVID-19 and 533 survived. Lower RTL was associated with a higher risk of death in women either at 30 (adjusted hazard ratio [HR] (aHR) = 3.33; 95% confidence interval [CI] = 1.05-10.00; p = 0.040) and at 90 days (aHR = 3.57; 95%CI = 1.23-11.11; p = 0.019). Lower RTL was associated with a higher risk of dying of COVID-19 in women. This finding suggests that RTL has an essential role in the prognosis of this subset of the population.

Characteristics of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) from the ARIAM-SEMICYUC registry: development of a score for predicting MINOCA.

BACKGROUND: Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. PATIENTS AND METHODS: A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. RESULTS: A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer-Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. CONCLUSION: Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.

Insuficiencia ventricular izquierda precoz en pacientes con síndrome coronario agudo sin elevación persistente del segmento ST: primera descripción y evaluación de los factores asociados / Influence of the combination of antiplatelet agents on the occurrence of early left ventricular insufficiency in patients with acute coronary syndromes without persistent ST-segment elevation

Fundamento y objetivo: La frecuencia de la insuficiencia ventricular izquierda ( IVI ) en las fases precoces del síndrome coronario agudo sin elevación del segmento ST (SCASEST) no está descrita en la actualidad. El objetivo de este estudio es describir por vez primera la frecuencia de esta complicación en la evolución inicial del SCASEST y evaluar su asociación a otras intervenciones. Pacientes y método: Estudio observacional de cohortes prospectivo y multicéntrico realizado en unidades de cuidados intensivos y coronarios (UCIC). Se incluyeron pacientes con SCASEST ingresados en las primeras 24 h de evolución. El desenlace principal fue la aparición de IVI . Se evaluó la asociación entre esta y variables clínicas y terapéuticas. Resultados: Se produjo IVI en el 15,6% de los pacientes. La realización de angiografía coronaria (AC) durante el ingreso en la UCIC fue una variable protectora frente al desenlace principal, realizada tanto antes de las 72 horas (odds ratio [OR] 0,47; intervalo de confianza del 95% [IC 95%] 0,25-0,89; p = 0,022), como más tarde (OR 0,39; IC 95% 0,15-0,98; p = 0,044). La administración de betabloqueantes se mostró como variable protectora frente a la aparición de IVI (OR 0,54; IC 95% 0,32-0,87; p = 0,013). La toma de ácido acetilsalicílico antes del ingreso en la UCIC supuso un mayor riesgo de IVI (OR 1,74; IC 95% 1,06-2,86; p = 0,028). La edad fue factor de riesgo de presentar IVI (OR 1,02; IC 95% 1,00-1,05; p = 0,032). Conclusiones: La realización de AC precoz y la administración de betabloqueantes aparecen como capaces de disminuir la aparición de IVI . La toma previa de ácido acetilsalicílico y la edad se asociaron a la aparición de IVI , pudiendo reflejar enfermedad cardiovascular de larga evolución (AU)

Fundamento y objetivo: La frecuencia de insuficiencia ventricular izquierda (FVI) en las primeras etapas de la elevación del síndrome coronario agudo sin elevación del segmento ST (SCASEST) no se ha descrito hasta el momento. El objetivo de este estudio es describir por primera vez la frecuencia de LVF en el curso temprano de SCASEST y evaluar su asociación con otras intervenciones. Pacientes y método: Estudio multicéntrico observacional prospectivo de cohortes en las unidades de cuidados intensivos y coronarios (ICCU). Los pacientes con SCASEST ingresados dentro de las 24 horas después de la aparición se incluyeron. Resultado principal fue la aparición de LVF. Se evaluó la asociación entre la LVF y variables clínicas y terapéuticas. Resultados: LVF se produjo en el 15,6% de los pacientes. La angiografía coronaria (CA) durante el ingreso en la UCCI fue una variable protectora contra el resultado principal, realizado antes de las 72 h (odds ratio [OR] 0,47; intervalo de confianza del 95% [IC 95%] 0,25 hasta 0,89; P = 0.022) y más tarde (OR 0,39, IC 95% 0,15-0,98; P = 0,044). La administración de este tratamiento fue una variable protectora frente a la ocurrencia de LVF (OR 0,54, IC 95% 0,32-0,87; P = 0,013). Los pacientes que reciben ácido acetilsalicílico antes de su ingreso en la UCCI tenían un mayor riesgo de desarrollar LVF (OR 1.74, IC del 95%: 1,06 a 2,86; P = 0,028).La edad también fue un factor de riesgo para la LVF (OR 1.02, IC del 95%: 1,00 a 1,05; P = 0,032). Conclusiones: CA y beta-bloqueantes pueden disminuir la aparición de LVF. La asociación entre la anterior administración de ácido acetilsalicílico y la edad a la ocurrencia de LVF puede reflejar la enfermedad cardiovascular de larga data (AU)

[Influence of the combination of antiplatelet agents on the occurrence of early left ventricular insufficiency in patients with acute coronary syndromes without persistent ST-segment elevation]. / Insuficiencia ventricular izquierda precoz en pacientes con síndrome coronario agudo sin elevación persistente del segmento ST: primera descripción y evaluación de los factores asociados.

BACKGROUND AND OBJECTIVE: The frequency of left ventricular failure (LVF) in the early stages of non-ST-segment elevation acute coronary syndrome (NSTE ACS) has not been described so far. The objective of this study is to describe for the first time the frequency of LVF in the early course of NSTE ACS and to assess its association with other interventions. PATIENTS AND METHOD: Observational prospective cohort multicenter study in intensive and coronary care units (ICCU). Patients with NSTE ACS admitted within 24h after onset were included. Main outcome was the occurrence of LVF. We evaluated the association between LVF and clinical and therapeutic variables. RESULTS: LVF occurred in 15.6% of patients. Coronary angiography (CA) during admission to the ICCU was a protective variable against the main outcome, performed before 72h (odds ratio [OR] 0.47; 95% confidence interval [95% CI] 0.25-0.89; P=.022) and later (OR 0,39; 95% CI 0,15-0,98; P=.044). The administration of beta-blockers was a protective variable against the occurrence of LVF (OR 0,54; 95% CI 0,32-0,87; P=.013). Patients receiving acetylsalicylic acid before admission to the ICCU had a higher risk of developing LVF (OR 1.74; 95% CI 1.06-2.86; P=.028). Age was also a factor of risk for LVF (OR 1.02; 95% CI 1.00-1.05; P=.032). CONCLUSIONS: CA and beta-blockers can decrease the occurrence of LVF. The association between previous administration of acetylsalicylic acid and age with the occurrence of LVF may reflect long-standing cardiovascular disease.