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1.
Catheter Cardiovasc Interv ; 94(3): 446-447, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31670882

RESUMO

The clinical scenario of severe AS among patients with cancer diseases poses a growing clinical challenge. The current study indicates that patients with cancer and severe AS that underwent AVR (predominantly TAVR) survived longer than those without AVR, regardless of the cancer type or treatment. Patients can benefit from specialized management teams composed of cardiologists and oncologists that can navigate the crisis of severe symptomatic AS during oncology course.

2.
Am J Cardiol ; 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31653357

RESUMO

Although typical chest pain is an important clinical feature required for diagnosis of acute coronary syndrome (ACS), many patients present with atypical complaints. The full extent and implication of this presentation is largely unknown. The study aim was to evaluate possible relations and temporal trends between presenting symptoms and outcomes in patients with ACS. Data was obtained from the Acute Coronary Syndrome Israeli Survey on patients presenting with typical chest pain versus atypical complaints, including dyspnea, nonspecific chest pain, palpitations or other. Temporal trends analysis examined the early (2000 to 2006) versus the late (2008 to 2016) period. During 2000 to 2016, 14,722 patients with ACS were enrolled; 11,508 (79%) presented with typical chest pain and 3,214 (21%) with atypical complaints. Patients with atypical complaints were older, majority female, and had more co-morbidities (p <0.001 for each). The 30-day major adverse cardiac events, 30-day mortality, and 1-year mortality rate were significantly higher in patients presenting with atypical complaints, (18% vs 13.5%, 7.7% vs 3.6%, and 15.6% vs 7.5%, respectively, p <0.001 for each). Although 1-year mortality decreased significantly over the years in patients with typical chest pain, there were no significant changes in patients who presented with atypical complaints. These results were consistent in STEMI and non-STE-ACS patients. In conclusion, ACS patients who present with atypical complaints have a less favorable outcome compared with patients who present with typical chest pain, and failed to show an improvement in mortality over the past 2 decades. Identification and utilization of guideline-recommended therapies in these high-risk patients may improve their future outcome.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31566245

RESUMO

OBJECTIVES: In this study, we aimed to determine the comparative outcomes of patients supported with continuous-flow left ventricular assist devices (LVADs): HeartMate 2 (HM2), HeartWare (HW) and HeartMate 3 (HM3) in a real-world setting. METHODS: The study was an investigator-initiated comparative retrospective analysis of patients who underwent continuous-flow LVAD implantation at our institution between 2008 and 2017. The follow-up duration was 18 months after implantation. RESULTS: The study included 105 continuous-flow LVAD-supported patients of whom 51% (n = 54), 24% (25) and 25% (26) underwent implantation of HM2, HW and HM3, respectively. During follow-up, patients who were supported with HM3 versus either HM2 or HW LVADs demonstrated a lower risk of stroke (0% vs 26%, P < 0.001 and 0% vs 40%, P < 0.001, respectively) and lower rates of thrombosis (0% vs 31%, P < 0.001 and 0% vs 12%, P < 0.001, respectively), findings that were consistent with their calculated haemocompatibility scores (cumulative score 5, 89 and 56 for HM3, HM2 and HW, respectively, P < 0.001). Moreover, patients supported with HM3 versus HW had fewer unplanned hospitalizations [median 1 (25th-75th interquartile range 0-2) vs 3 (interquartile range 2-4), P = 0.012]. Importantly, survival free from stroke or device exchange was higher in patients supported with HM3 compared with either the HM2 or the HW LVADs [hazard ratio (HR) 2.77, confidence interval (CI) 1.13-6.78; P = 0.026 and HR 2.70, CI 1.01-7.20; P = 0.047, respectively]. CONCLUSIONS: HM3 device currently presents better prognostic and adverse events profiles when compared with the HM2 or the HW LVADs. A larger-scale head-to-head comparison between the devices is warranted in order to confirm our findings.

4.
EuroIntervention ; 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31566571

RESUMO

AIMS: Although transcatheter aortic valve replacement (TAVI) is officially indicated for severe aortic stenosis (AS) patients at intermediate or higher surgical risk, the procedure is increasingly being performed in patients who are at low surgical risk as well, data on the benefit of TAVI in this patient population is limited. METHODS AND RESULTS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) of TAVI vs. surgical aortic valve replacement (SAVR) in patients who are at low surgical risk (mean STS score <4% and/or logistic EuroScore <10%). The primary outcome was mortality (examined at 30 days, year and longest available follow up). The secondary outcomes included procedural complications. Nine studies (n=6,124) were included. TAVI was associated with a numerically, but not statistically significant reduced mortality at 30 days (1.45 vs. 2.1%, p=0.05), and similar mortality at 1 year (5.1% vs. 5.0%, p=0.74),and a median of 2 years (10.8% vs. 9.8%, p=0.15). For both time points, there was significant heterogeneity between RCT/PSM studies, with the former suggesting survival advantage for TAVI and the latter for SAVR. In terms of periprocedural complications, TAVI was associated with reduced risk for stroke, bleeding and renal failure and an increase in vascular complications and Pacemaker implantation. CONCLUSIONS: in patients who are at low surgical risk, TAVI seems to be associated with equivalent mortality up to a median follow up of 2 years compared to SAVR. More data is required before TAVI can be routinely considered as an alternative for SAVR in low risk patients.

6.
Int J Cardiol ; 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31629565
7.
J Cardiol ; 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31547947

RESUMO

BACKGROUND: Serum albumin (SA) is a powerful prognostic marker in patients with cardiovascular diseases. OBJECTIVES: To evaluate the prognostic significance of changes in SA levels among patients that underwent percutaneous coronary intervention (PCI). METHODS: Patients who underwent PCI in a tertiary medical center throughout 2004-2017 were considered for the study. Patients with missing SA values within the year before or 5 years after the PCI were excluded from the study as well as those for whom SA values were obtained throughout an acute infection. Changes in albumin were represented by Δalbumin: Albumin before PCI (closest) minus lowest albumin within the 5 years following the PCI. Δalbumin was categorized into 4 categories as follows: ≤0 g/dL, 0-0.5 g/dL, 0.5-1 g/dL, ≥1 g/dL. Primary outcome was major adverse cardiac events (MACE) that included all-cause mortality, non-fatal myocardial infarction, target vessel re-vascularization, and coronary artery bypass surgery. RESULTS: The study included 5449 out of 21,763 (25%) patients, mean age 66.8 ± 12 years, 26% women. Patients with greater Δalbumin were older with higher prevalence of most cardiovascular risk factors and comorbidity. The follow-up period was 7 years (median), with cumulative MACE rate of 49.5%. MACE rates and the rates of all the MACE components increased gradually with the increase in Δalbumin. Multivariate adjusted analysis showed that Δalbumin is an independent predictor of long-term MACE following PCI [HR = 1.4 (95%CI:1.3-1.6), HR = 2.2 (95%CI:1.9-2.5), HR = 3.8 (95%CI:3.3-4.35) for Δalbumin of 0-0.5 g/dL, 0.5-1 g/dL, ≥1 g/dL, respectivelyp < 0.001 for all]. CONCLUSIONS: A decrease in albumin levels following PCI is an independent prognostic marker of worse long-term outcomes.

8.
Heart Vessels ; 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529179

RESUMO

The Medina classification is the most widespread method to describe bifurcation lesions. However, little is known regarding its prognostic impact. Therefore, the aim of this study is to assess the prognostic significance of the Medina classification following percutaneous coronary intervention (PCI). From a prospective registry of 738 consecutive patients undergoing PCI for bifurcation lesions, 505 were treated with second-generation drug-eluting stents (DES). Of these, 407 (80.6%) presented with "true bifurcation" (TB) lesions (Medina class 1.0.1, 1.1.1, 0.1.1) and 98 (19.4%) in all other categories ("non-true bifurcation" = NTB). We compared rates of death and major adverse cardiac events (MACE: cardiac death, myocardial infarction, or target vessel revascularization) at 12 months and 3 years. Patients with TB had lower rates of previous bypass surgery (7.4% vs. 11.2%, p = 0.043). TB lesions were more likely to be calcified (33.9% vs. 28.6%, p = 0.003) and ulcerated (8.8% vs. 4.1%, p < 0.01). At 12 months, mortality was numerically higher for TB PCI (4.1% vs. 2.1%, p = 0.052) and MACE rates were higher (19.2% vs. 10.2%, p < 0.001). At 3 years, both all-cause death (10.1% vs. 5.1%, p = 0.002) and rates of MACE (37.2% vs. 17.6%, p < 0.001) were higher for TB PCI. After performing regression analysis, TB remained an independent predictor for poor outcomes (OR-2.28 at 12 months, CI 1.45-9.50, p = 0.007, OR-3.75 at 3 years, CI 1.52-6.77, p = 0.001 for MACE). In conclusion, TB lesions, according to the Medina classification, portend worse prognosis for patients undergoing bifurcation PCI. This may guide prognostication and decision-making in treatment.

9.
Isr Med Assoc J ; 21(9): 615-619, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542908

RESUMO

BACKGROUND: Aortic stenosis (AS) is a common valvular pathology and is increasing in prevalence. Severe symptomatic AS is associated with serious outcomes if left untreated. Transcatheter aortic valve implantation (TAVI) is an innovative modality, which has revolutionized the treatment of AS. With growing experience and technological upgrades, TAVI has become a valid alternative to surgical valve replacement. However, TAVI is associates with increase non-negligible risks of mortality, stroke, physical disability, and healthcare expenditures. Furthermore, imaging modalities have shown new ischemic lesions in most patients following TAVI (silent strokes), which might be related to worse subsequent neurocognitive function. Embolic protective devices are emerging as a safe, technically feasible implements to reduce the burden of periprocedural thromboembolism, and have shown promising results of improved clinical outcomes.


Assuntos
Estenose da Valva Aórtica/cirurgia , Dispositivos de Proteção Embólica , Complicações Pós-Operatórias/prevenção & controle , Substituição da Valva Aórtica Transcateter/métodos , Valva Aórtica/cirurgia , Humanos , Fatores de Risco , Resultado do Tratamento
10.
J Am Coll Cardiol ; 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31562908

RESUMO

BACKGROUND: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Females and males present with different baseline characteristics, which may influence procedural outcomes. OBJECTIVES: To evaluate differences between females and males undergoing transfemoral TAVR across the globe during the last decade. METHODS: The CENTER collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N= 12,381) from 2007-2018. In this retrospective analysis we examined differences in baseline patient characteristics, 30-day stroke and mortality and in-hospital outcomes between female and male patients. We also assessed for temporal changes in outcomes and predictors for mortality per gender. RESULTS: We included 58% (n=7,120) female and 42% (n=5,261) male patients. Females had higher prevalence of hypertension and glomerular filtration rate <30ml/min/m2, but lower prevalence of all other traditional cardiovascular comorbidities. Both genders had similar rates of 30-day stroke (2.3% vs 2.5%, p=0.53) and mortality (5.9% vs. 5.5%, p=0.17). In contrast, females had a 50% higher risk of life-threatening or major bleeding (6.7% vs 4.4%, p<0.01). Over the study period mortality rates decreased to a greater extent in males than in females (60% vs 50% reduction, both p<0.001), with no reductions in stroke rates over time. CONCLUSIONS: In this global collaboration females and males had similar rates of 30-day mortality and stroke. However, females had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018 mortality rates decreased to a greater extent in males than in females.

11.
N Engl J Med ; 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31556978

RESUMO

BACKGROUND: Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI). METHODS: In a double-blind trial, we examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone PCI. After 3 months of treatment with ticagrelor plus aspirin, patients who had not had a major bleeding event or ischemic event continued to take ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. We also evaluated the composite end point of death from any cause, nonfatal myocardial infarction, or nonfatal stroke, using a noninferiority hypothesis with an absolute margin of 1.6 percentage points. RESULTS: We enrolled 9006 patients, and 7119 underwent randomization after 3 months. Between randomization and 1 year, the incidence of the primary end point was 4.0% among patients randomly assigned to receive ticagrelor plus placebo and 7.1% among patients assigned to receive ticagrelor plus aspirin (hazard ratio, 0.56; 95% confidence interval [CI], 0.45 to 0.68; P<0.001). The difference in risk between the groups was similar for BARC type 3 or 5 bleeding (incidence, 1.0% among patients receiving ticagrelor plus placebo and 2.0% among patients receiving ticagrelor plus aspirin; hazard ratio, 0.49; 95% CI, 0.33 to 0.74). The incidence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke was 3.9% in both groups (difference, -0.06 percentage points; 95% CI, -0.97 to 0.84; hazard ratio, 0.99; 95% CI, 0.78 to 1.25; P<0.001 for noninferiority). CONCLUSIONS: Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke. (Funded by AstraZeneca; TWILIGHT ClinicalTrials.gov number, NCT02270242.).

12.
Int J Cardiol ; 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31474410

RESUMO

OBJECTIVES: To assess the external validity of the Dual Antiplatelet Therapy (DAPT) score decision tool in real world patients. METHODS AND RESULTS: Retrospective study using an all comers PCI registry. We compared the rates of myocardial infarction (MI) and actionable bleeding between 12 vs. 12+ months DAPT stratified by DAPT score category. Of 12,162 patients, 4471 (36.8%) completed a year of DAPT without events. The high DAPT score stratum patients were older and had a higher comorbidity burden. Overall, 12+ months DAPT duration was associated with reduced rates of MI (2.8% vs. 4.0%, p = 0.025) and similar rates of bleeding (2.6% vs. 1.9%, p = 0.281) compared to 12 months DAPT, but when stratified by DAPT score stratum, there was no difference in any of the outcomes in both high score group, (3.7% vs. 5.3%, p = 0.111 and 2.0% vs. 1.8%, p = 0.800, for MI and bleeding, respectively) and low score patients (2.7% vs. 3.1%, p = 0.656 and 2.8% vs. 2.0%, p = 0.308, for MI and bleeding, respectively). Overall clinical events (MI + bleeding) was again similar between patients treated with 12+ vs. 12 months DAPT (5.5% vs. 6.2%, p = 0.535 and 5.1% vs. 4.4%, p = 0.503 for high and low DAPT score, respectively). CONCLUSIONS: for real world patients completing 1 year of DAPT post PCI, rates of MI, actionable bleeding, and their combination did not differ between those treated with 12+ vs. 12 months DAPT stratified by DAPT score stratum. Clinicians should be aware of the DAPT score's limitations. Further studies examining the validity of the DAPT score in larger cohorts are required.

13.
Am J Cardiol ; 124(8): 1279-1285, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31439279

RESUMO

This study evaluated the prevalence, anatomical pattern, and prognostic implications of an intramural course of the coronary arteries in patients with hypertrophic cardiomyopathy (HC). The study population consisted of 92 patients with HC and 100 patients without HC. The presence of an intramural course of the coronary arteries was evaluated by coronary computed tomography angiography (CTA), and its length and depth were measured. During follow-up, the occurrence of unstable angina requiring hospitalization, myocardial infarction, and all-cause mortality was evaluated. An intramural course of the coronary arteries was more common in patients with HC than patients without HC (62% vs 25%, p <0.001). In the patients with an intramural coronary artery course, those with HC had a longer course (29.1 ± 15.3 mm vs 23.0 ± 13.0 mm; p = 0.037) with deeper penetration into the left ventricular myocardium (2.8 ± 1.2 mm vs 2.1 ± 0.8 mm; p = 0.007) and more involvement of multiple coronary arteries (38% vs 4%; p <0.001). During follow-up (mean 5.5 ± 3.5 years), cardiac events occurred in 17 of 57 patients (29.8%) with an intramural course and 11 of 35 (31.4%) without an intramural course (p = 0.87). On Kaplan-Meier survival analysis, there was no difference in cumulative event rate between HC patients with or without an intramural course (p = 0.89, log rank test). In conclusion, patients with HC have a high rate of an intramural course of the coronary arteries on CTA. The number of involved arteries and the length and depth of the intramural course differ between patients with and without HC, but apparently have no association with worse clinical outcomes.

14.
Future Cardiol ; 15(4): 255-258, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31290348
15.
Environ Res ; 176: 108560, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31295664

RESUMO

BACKGROUND: Moderate correlations were previously observed between individual estimates of traffic-related air pollution (TRAP) produced by different exposure modeling approaches. This induces exposure misclassification for a substantial fraction of subjects. AIM: We used an ensemble of well-established modeling approaches to increase certainty of exposure classification and reevaluated the association with cancers previously linked to TRAP (lung, breast and prostate), other cancers, and all-cause mortality in a cohort of coronary patients. METHODS: Patients undergoing percutaneous coronary interventions in a major Israeli medical center from 2004 to 2014 (n = 10,627) were followed for cancer (through 2015) and mortality (through 2017) via national registries. Residential exposure to nitrogen oxides (NOx) -a proxy for TRAP- was estimated by optimized dispersion model (ODM) and land use regression (LUR) (rPearson = 0.50). Mutually exclusive groups of subjects classified as exposed by none of the methods (high-certainty low-exposed), ODM alone, LUR alone, or both methods (high-certainty high-exposed) were created. Associations were examined using Cox regression models. RESULTS: During follow-up, 741 incident cancer cases were diagnosed and 3051 deaths occurred. Using a ≥25 ppb cutoff, compared with high-certainty low exposed, the multivariable-adjusted hazard ratios (95% confidence intervals) for lung, breast and prostate cancer were 1.56 (1.13-2.15) in high-certainty exposed, 1.27 (0.86-1.86) in LUR-exposed alone, and 1.13 (0.77-1.65) in ODM-exposed alone. The association of the former category was strengthened using more extreme NOx cutoffs. A similar pattern, albeit less strong, was observed for mortality, whereas no association was shown for cancers not previously linked to TRAP. CONCLUSIONS: Use of an ensemble of TRAP exposure estimates may improve classification, resulting in a stronger association with outcomes.

17.
Mayo Clin Proc ; 94(7): 1171-1179, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31272567

RESUMO

OBJECTIVE: To evaluate the association between bezafibrate, a drug used to treat hypertriglyceridemia, and long-term cancer incidence in patients with coronary artery disease (CAD). PATIENTS AND METHODS: The study comprised 2980 patients with CAD (mean age, 60 years; 2729 [91.6%] men) who were free of cancer and were enrolled in the Bezafibrate Infarction Prevention study, a double-blind trial conducted between May 1, 1990, and January 31, 1993, in 18 cardiology departments in Israel. Patients randomized to receive 400 mg of bezafibrate (n=1486) or placebo (n=1494) daily for a median of 6.2 years (range, 4.7-7.6 years) were followed up for incidence of cancer through the Israeli National Cancer Registry and all-cause death through the Population Registry of the State of Israel until December 31, 2013. Cox proportional hazards and Fine and Gray survival models were used to assess the bezafibrate-cancer association. RESULTS: Clinical characteristics and laboratory values were well balanced between the 2 groups at the study entry. Over a median follow-up of 22.5 years (range, 21.2-23.9 years), cancer developed in 753 patients. With death considered a competing event, the cumulative incidence of cancer at the end of the follow-up was lower in the bezafibrate vs the placebo group (23.9%; 95 CI, 21.9%-26.1% vs 27.2%; 95 CI, 25.1%-29.4%; P=.04). The hazard ratio for cancer in the bezafibrate vs placebo groups was 0.86 (95% CI, 0.74-0.99). In mediation analysis, the association between bezafibrate treatment and cancer incidence was not sensitive to adjustment for on-trial lipid levels but was attenuated on adjustment for on-trial fibrinogen levels. CONCLUSION: Bezafibrate treatment is associated with reduced risk of cancer among patients with CAD. Fibrinogen, but not lipid lowering, is linked to this association.

18.
Coron Artery Dis ; 2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31205054

RESUMO

OBJECTIVE: The transradial approach (TRA) has increasingly been adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. PATIENTS AND METHODS: From our large single-center PCI registry, we have analyzed 15 429 patients in two periods - 2008-2012 (period 1) and 2013-2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. RESULTS: The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus. Transfemoral artery (1.8 vs. 5.1%, overall, P<0.001), as were rates of additional bleeding events in the following 12 months (1.3 vs. 2.4%, P<0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery [at 4 years, hazard ratio (HR)=0.86; 95% confidence interval (CI): 0.77-0.96; P=0.007, during period 1 and HR=0.62; 95% CI 0.55-0.7; P<0.0001 during period 2]. Interaction analysis showed a stronger effect at the latter period (HR=0.69, 95% CI: 0.59-0.81, P<0.001). CONCLUSION: Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients - a course which is associated with consistent short and long-term clinical benefits.

20.
Cardiol J ; 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31225631

RESUMO

BACKGROUND: Acute idiopathic pericarditis (AIP) is frequently accompanied by myocardial involvement (AIPM). Although in acute myocarditis, the myocardial inflammation can lead to life-threatening complications, the outcome of patients with AIPM has been described as good. It remains unclear if a good prognosis of patients with AIPM reflects mild myocardial involvement or good medical management. METHODS: A retrospective analysis of life-threatening complications and life-saving interventions in a cohort of 248 consecutive patients admitted to a single medical center between 2006 and 2017 with AIP (n = 169) or AIPM (n = 79). Major adverse cardiac events (MACE)included cardiac tamponade, cardiogenic shock, ventricular tachycardia, pericardiocentesis, pericardiectomy, large pericardial effusion and death. RESULTS: Patients with AIPM were younger than patients with AIP (p < 0.001), and more often had left ventricular dysfunction, (31.6% vs. 1.2%, p < 0.001) and less often had large pericardial effusion (1.3% vs. 13.6%, p = 0.002), and MACE (5.1% vs. 14.8%, p = 0.014). Cardiac tamponade occurred in 5.3% of the patients with AIP as opposed to 1.3% of the patients with AIPM (p = 0.176). Severe left ventricular dysfunction with cardiogenic shock occurred exclusively among patients with AIPM but the rate was low (2.5%). Life-saving interventions were used in both groups at comparable rates (2.5% vs. 5.3%, p = 0.510). There were no in-hospital deaths. CONCLUSIONS: Myocardial involvement in acute pericarditis is associated with a low rate of severe left ventricular dysfunction and cardiogenic shock and a reduced rate of large pericardial effusion, resulting in a lower rate of MACE. Life-saving interventions were used at comparable rates in patients with and without myocardial involvement having excellent survival rates.

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