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1.
Eur Heart J ; 40(26): 2142-2151, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31098611

RESUMO

AIMS: We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS: We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS: Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

2.
Eur Heart J ; 40(32): 2700-2709, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31049589

RESUMO

AIMS : Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS). METHODS AND RESULTS : Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N = 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04-3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15-3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50-4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06-9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with 'negative' high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N = 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28-5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04-2.31; P < 0.05). CONCLUSION : Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.

3.
Int J Cardiovasc Imaging ; 35(9): 1557-1561, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31044328

RESUMO

Right ventricular systolic dysfunction is prognostic in various cardiovascular diseases. Right ventricular systolic function is not commonly assessed in the catheterization laboratory. Therefore, we developed a novel, reproducible method to measure right ventricular systolic function during selective coronary angiography. We analyzed the angiographic systolic translational motion and maximum speed of the right coronary artery (RCA) in 97 consecutive patients and compared it to the tricuspid annular plane systolic excursion (TAPSE) as measured by echocardiography. All measurements were performed by two independent operators on two occasions. Inter-observer variability and intra-observer variability were excellent for RCA motion distance and for RCA maximum speed. There was a significant correlation of the RCA motion distance and RCA maximum speed with the TAPSE measured by echocardiography (Pearson's correlation for RCA distance: r = 0.59, p < 0.001, r2 = 0.35; for RCA speed: r = 0.40, p < 0.001, r2 = 0.16). The area under the receiver operating curve for the RCA motion distance was 0.88 (95% CI 0.80-0.96) for discrimination of normal and abnormal right ventricular systolic function. A cut-off value less than 22.3 mm systolic RCA motion had a specificity of 93.3% and a sensitivity of 75.6% for identifying an abnormal right ventricular systolic function. Analysis of the RCA motion is a reproducible and reliable method to measure right ventricular systolic function during selective coronary angiography. It is a simple and useful tool to assess right ventricular function in the catheterization laboratory and may serve for risk assessment for right ventricular failure. CLINICAL TRIAL REGISTRATION: Data for this study was collected retrospectively from Swiss Transcatheter Aortic Valve Implantation Registry (NCT01368250). https://clinicaltrials.gov/show/NCT01368250 .


Assuntos
Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Movimentos dos Órgãos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sístole , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia
4.
Anatol J Cardiol ; 21(3): 142-149, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30821714

RESUMO

OBJECTIVE: The aim of the present study was to assess the predictive value of the CHADS2, CHA2DS2-VASc, R2CHADS2, and APPLE scores for rhythm outcome in patients with atrial fibrillation (AF) after catheter ablation. METHODS: The cohort of the present study consisted of 192 patients with AF who underwent a total of 265 ablations. Rhythm outcome was documented between 3 and 24 month after ablation. The mentioned scores were calculated for every patient. RESULTS: Of the patients, 139 (72%) were successfully treated having freedom of any atrial tachyarrhythmia, whereas 21 (11%) had partial success, and 32 (17%) had failure. For univariate analysis, the APPLE score was the only significant predictor of outcome after ablation with an odds ratio (OR) of 1.485 [95% confidence interval (CI) 1.075-2.052, p-value 0.017]. A multivariate binary regression corrected for possible confounders showed that the APPLE score (OR 1.527, 95% CI 1.082-2.153, p-value 0.016) along with the number of previous ablations (OR 5.831, 95% CI 1.356-25.066, p-value 0.018) is a significant predictor of outcome. A novel score (SUCCESS) was created by adding one point to the APPLE score for each previously performed ablation. This novel score demonstrated an improvement in receiver operating characteristic curve analysis (area under the curve 0.657 vs. 0.620). However, these findings were not significant in our study (p-value 0.219). CONCLUSION: Both the APPLE and the novel SUCCESS scores are superior to the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores in predicting AF recurrence after catheter ablation. The SUCCESS score appears to have a higher predictive value than the APPLE score and might be a valuable tool to estimate the risk of AF recurrence in patients eligible for catheter ablation.


Assuntos
Fibrilação Atrial/cirurgia , Frequência Cardíaca/fisiologia , Idoso , Ablação por Cateter , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Curva ROC , Índice de Gravidade de Doença
5.
Int J Cardiol ; 275: 171-178, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30344063

RESUMO

BACKGROUND: Influence of pre-existing treatment with aspirin and/or statins prior to a first acute coronary syndrome (ACS) on clinical presentation, infarct size and inflammation markers. We analyzed patients from the Swiss Program University Medicine ACS-cohort (SPUM-ACS; ClinicalTrials.govnumber:NCT01075867). METHODS: 1639 patients were categorized into 4 groups: (1) patients without either drug (n = 1181); (2) patients only on aspirin (n = 157); (3) patients only on statins (n = 133) and (4) patients on both drugs (n = 168). Clinical features, electrocardiogram (ECG), creatinine kinase (CK, U/l), high-sensitivity troponin T (hsTNT, µg/l), N-terminal brain natriuretic peptide (NT-proBNP, ng/l), leucocytes (Lc, G/l), neutrophils (Nc, G/l), C-reactive protein (CRP, mg/l) and angiographic features were documented at baseline. RESULTS: Incidences of ST-elevation myocardial infarction (STEMI) were 64% in group 1, 45% in group 2, 52% in group 3 and 40% in group 4 (p < 0.0001). Those with both drugs had significantly lower CK (median 145 U/l, interquartile range (IQR) 89-297), hsTNT (median 0.13 µg/l, IQR 0.03-0.52) and higher left ventricular ejection fraction values (LVEF) (mean 55 ±â€¯12%) compared to untreated patients (median CK 273 U/l, IQR 128-638; median hsTNT 0.26 µg/l, IQR 0.08-0.85; mean LVEF 51 ±â€¯11%) (p < 0.0001, p = 0.001, p = 0.028, respectively). Co-medicated groups matched for high risk factors presented less frequently as STEMIs (p < 0.0001), had significantly smaller infarcts determined by CK and hsTNT (both p < 0.0001) and lower CRP levels (p = 0.01) compared to patients without pre-existing treatment with either drug. CONCLUSION: Pre-existing treatment with aspirin and/or statins and particularly with their combination changes the clinical presentation, infarct size, inflammation markers and LVEF in patients suffering their first ACS.


Assuntos
Síndrome Coronariana Aguda/complicações , Aspirina/uso terapêutico , Eletrocardiografia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inflamação/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Angiografia Coronária , Feminino , Seguimentos , Humanos , Inflamação/diagnóstico , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Inibidores da Agregação de Plaquetas/uso terapêutico , Prognóstico , Estudos Prospectivos , Volume Sistólico/fisiologia , Troponina T/sangue , Função Ventricular Esquerda/fisiologia
6.
Curr Cardiol Rev ; 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30520380

RESUMO

BACKGROUND: Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and re-openening symptomatic occluded CAF is ongoing. CASE SUMMARY: We are reporting a 30-year-old male patient with no previous medical history presented as non-ST segment elevation myocardial Infarction. Coronary angiography showed an entirely thrombosed ectatic circumflex artery with a suspicion of thrombosed coronary arterial fistula. In view of ongoing ischemia in the setting of acute coronary syndrome; we tried to open percutaneously but all efforts were to no avail. DISCUSSION: In this case report, we are sharing our experience in management of this challenging case in view of the rarity of such peculiar clinical condition and the unfavourable presentation along with the lack of clear-cut Guideline and Consensus whether to/not to open such huge and immensely thrombosed symptomatic coronary artery fistula as well as the dilemma of choosing the best long-term medical treatment between antiplatelets vs anticoagulants in such young patient.

7.
J Clin Med ; 7(12)2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-30486335

RESUMO

Several studies have shown site-specific differences in colorectal cancer (CRC) with respect to the risk factors. CRC was shown to be associated with cardiovascular risk (CVR) factors, but site-specific variations have not been investigated so far. This study aimed to assess the associations between the prevalence and subsite-specific differences of colorectal neoplasia and established CVR scores or known coronary artery disease (CAD) in a large asymptomatic European screening cohort (N = 2098). Participants underwent simultaneous screening colonoscopy and CVR evaluation, using the Framingham Risk Score and Heart Score. Lesions found in the colonoscopy were classified by location (proximal/distal colon or rectum). More neoplasias were found in the proximal versus the distal colon (p < 0.001). The Framingham Risk Score and Heart Score showed incremental risk for colorectal adenoma, across the tertiles in the proximal and the distal colon (p < 0.001). The prevalence of adenomas in the rectum was much lower, but also here, incremental risk could be shown for the Framingham Risk but not the Heart Risk Score tertiles. Prevalence of adenomas in the proximal colon was higher in subjects with type 2 diabetes (T2DM) (p = 0.006), but no association was found between adenomas and T2DM in the distal colon (p = 0.618) and the rectum (p = 0.071). Males had a higher CVR and more findings, in the screening colonoscopy, as compared to females, however, no site-specific differences were noted. Patients with known CAD and high CVR have an increased risk of colorectal neoplasia in both the proximal and distal colon. Patients with T2DM have a higher risk for neoplasia in the proximal colon.

8.
Artigo em Inglês | MEDLINE | ID: mdl-30291678

RESUMO

OBJECTIVES: The number of elderly patients undergoing coronary revascularization is steadily increasing, and data on the impact of gender on outcomes are scarce. This study sought to assess gender-related differences in outcomes in elderly patients with acute coronary syndromes (ACS). METHODS: We investigated outcomes in elderly ACS patients referred for coronary angiography and prospectively enrolled in the Swiss ACS Cohort between December 2009 and October 2012. Adjudicated major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke. RESULTS: Among 2,168 patients recruited, 481 (22%) patients were >75 years of age (37% women). In patients >75 years, 1-year MACCE rates were 15% and 23% in women and men (OR 0.59, 95% CI 0.36-0.97, P = 0.04), respectively, and differences remained significant after adjustments for baseline variables (adjusted OR 0.48, 95% CI 0.26-0.90, P = 0.02). Women >75 years had a lower cardiovascular mortality (6% versus 12%, adjusted OR 0.31, 95% CI 0.12-0.81, P = 0.02). In patients ≤75 years, 1-year MACCE rates did not differ between gender (10% and 8% for women and men, adjusted OR 1.28, 95% CI 0.77-2.14, P = 0.34). Rates of TIMI major bleeding for women and men were 4% and 4% in patients >75 years (P = 0.96), and 5% and 3% in those ≤75 years (P = 0.11). CONCLUSIONS: The low rates of MACCE observed in elderly women in this patient cohort suggest that with current interventional strategies the gender gap in ACS management has been attenuated.

10.
Catheter Cardiovasc Interv ; : e27806, 2018 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-30269398

RESUMO

BACKGROUND: Post-procedural risk stratification based on renal function after trans aortic valve implantation (TAVI) was assessed by means of a modified age, creatinine, and ejection fraction (ACEF) score using the lowest glomerular filtration rate (GFR), obtained within 1 week after valve implantation. We refer to the score as ACEF-7 score. METHODS: The Zurich- and Cardiocentro Ticino TAVI-Cohorts comprised of 424, and 137 patients, who were not on hemodialysis and had already survived the first post-procedural week. Zurich patients were stratified into tertiles of ACEF-7 score (ACEF-7Low ≤ 2.45 (n = 138), ACEF-7Mid 2.46-4.38 (n = 142), and ACEF-7High ≥ 4.39 (n = 144) and compared for survival using KM curves. Euroscore II, Society of Thoracic Surgeons (STS), and ACEF were also calculated at baseline in all patients and assessed for prognostic significance in predicting the primary outcome of 1-year all-cause mortality using univariate and multivariate Cox regression models. Results were then confirmed in the Cardiocentro cohort. RESULTS: Six months (18.1% vs. 6.3% vs. 2.9% P < 0.001) and 1-year all-cause mortality (24.3% vs. 12.7% % vs. 5.8%, P < 0.001), as well as the composite of death or rehospitalization (35% vs. 20% vs. 11% P < 0.001) occurred significantly more frequently in the ACEF-7High compared to the other groups. Both Euroscore II and STS score were not predictors of mortality in our cohort. In a multivariate Cox regression model corrected for gender, Acute Kidney Injury, and baseline ACEF score, the ACEF-7 score was an independent predictor of 1-year all-cause mortality as a per point increment HR 1.512 [95% CI 1.227-1.862, P < 0.001] and as ACEF-7High (≥4.39); HR 5.541 [1.694-18.120]). In addition, the ACEF-7 tertiles showed a significant (P = 0.02) net reclassification improvement of 16% when compared to baseline tertiles of ACEF score, when assessing 1-year all-cause mortality. CONCLUSION: Post-procedural risk stratification using the simple ACEF-7 score significantly better predicted long-term outcome than commonly used risk-scores. Practical implications could include contrast sparing and renal protection in high-risk patients, emphasizing the importance of preventative measures.

11.
Cardiol Res Pract ; 2018: 9762176, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30356345

RESUMO

Aims: To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention. Methods and results: SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSIILow ≤21.5 (n=245), SxSIIMid 21.5-30.6 (n=245), and SxSIIHigh ≥30.6 (n=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77-0.84, p < 0.001 versus 0.67, 95% CI 0.63-0.72, p=0.007 versus 0.69, 95% CI 0.6-0.8, p=0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96-1.07), p=0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06-1.11), p < 0.001). This was also true for the prediction of both secondary outcomes MACE (n=60) and MACCE (n=70) with an adjusted HR = 1.055, 95% CI (1.03-1.08), p < 0.001, and HR = 1.065, 95% CI (1.04-1.09), p < 0.001. Conclusion: In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.

12.
J Geriatr Cardiol ; 15(6): 394-400, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30108610

RESUMO

Backgound: The influence of gender on clinical outcomes following transcatheter aortic valve implantation (TAVI) was considerably discrepant in previous studies. We aimed to investigate the impact of gender in our registry. Methods: The study is a retrospective observational analysis of a prospectively designed cohort (546 consecutive patients treated at the University Hospital Zurich who were enrolled in Swiss TAVI Cohort from May 2008 to April 2014). The Study took place in University Heart Centre at University Hospital Zurich, Switzerland. Results: Both genders were equally represented with 51.5 % (n = 281) of the populations being females, who were significantly older and had a more pronounced history of hypertension (P < 0.001). Males on the other hand showed a higher incidence of diabetes (P = 0.004), coronary artery disease (P < 0.001), chronic obstructive pulmonary disease (P < 0.001) and renal failure requiring renal replacement therapy (P = 0.018). Patients were followed up for a median of 391 days with a 100% complete follow-up at one year. The primary outcome (all-cause mortality) occurred in 6.8% (n = 37) and 15% (n = 82) of patients at 30 days and one year, respectively. The 30-day all-cause mortality outcome did not significantly differ between females (7.5%) and males (6.0%) (P = 0.619), but one year all-cause mortality occurred significantly more in males than in females (18.7% vs. 11.7%, P < 0.037). Conclusion: After TAVI implantation for severe aortic stenosis, males have a less favorable long-term (one year) mortality outcome than females.

13.
Artigo em Inglês | MEDLINE | ID: mdl-30124159

RESUMO

BACKGROUND: Although not well established; gender may play a role in the incidence, clinical manifestations, and atherosclerotic burden of coronary artery anomalies (CAAS). Our aim is to investigate the impact of gender on coronary artery anomalies Methods: All coronary angiograms performed at the University Heart Center Zurich, Switzerland, between January 2000 and December 2016 were investigated. Those of anomalous origin, course and termination (fistula) were included in the analysis with the exclusion of coronary artery aneurysms and myocardial bridges. RESULTS: Out of the original 39577 angiographic studies that included 28550 males and 11026 females, coronary artery anomalies (CAAS) were documented in 130 (0.32%) patients of whom 69.2% (n=90) and 30.8%(n=40) were males and females respectively. However, the overall prevalence of coronary anomalies amongst both genders did not differ (0.32% vs 0.36%, P = 1) and so were the basic characteristics except for hypertension, which was more prevalent in females (P = 0.03644). The most prevalent anomaly overall was (left circumflex artery from right coronary artery/sinus), which was present in (n=47, 36.2%). No impact of gender on the incidence of individual anomalies except for right coronary artery (RCA) originating from left circumflex artery (LCX), which was only documented in men (P = 0.0000116). On the other hand malignant CAAS presented equally with a proportion of 10% for both genders (P = 1). Although males outnumbered females in terms of atherosclerotic burden in CAAS this was statistically not significant (P = 0.331). CONCLUSION: Both genders have similar impact on the overall prevalence, clinical manifestations and atherosclerotic burden of CAAs. Anomaly of RCA originating from LCX occurred more frequently in males than females.

14.
Int J Cardiol ; 270: 7-13, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29885826

RESUMO

BACKGROUND: This study sought to investigate the predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes (ACS). The ACEF score (age/left ventricular ejection fraction +1 [if creatinine > 176 µmol/L]) has been established in patients evaluated for coronary artery bypass surgery. Data on its predictive value in all-comer ACS patients undergoing percutaneous coronary intervention are scarce. METHODS: A total of 1901 patients prospectively enrolled in the Swiss ACS Cohort were included in the analysis. Optimal ACEF score cut-off values were calculated by decision tree analysis, and patients divided into low-risk (≤1.45), intermediate-risk (>1.45 and ≤2.0), and high-risk groups (>2.0). The primary endpoint was all-cause mortality. Major adverse cardiac and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke. RESULTS: One-year rates of all-cause death increased across ACEF score groups (1.6% versus 5.6% versus 23.0%, p < 0.001). In multivariate analysis, the ACEF score was related with an increased risk of all-cause mortality (adjusted HR 3.53, 95% CI 2.90-4.31, p < 0.001), MACCE (adjusted HR 2.23, 95% CI 1.88-2.65, p < 0.001), and transient ischemic attack/stroke (adjusted HR 2.58, 95% CI 1.71-3.89, p < 0.001) at 1 year. Rates of Thrombolysis in Myocardial Infarction (TIMI) major and Global use of Strategies to Open Occluded Coronary Arteries (GUSTO) severe bleeding paralleled the increased ischemic risk across the groups (p < 0.001). CONCLUSIONS: The ACEF score is a simple and useful risk stratification tool in patients with ACS referred for coronary revascularization.

15.
JCI Insight ; 3(6)2018 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-29563342

RESUMO

Using an untargeted metabolomics approach in initial (N = 99 subjects) and replication cohorts (N = 1,162), we discovered and structurally identified a plasma metabolite associated with cardiovascular disease (CVD) risks, N6,N6,N6-trimethyl-L-lysine (trimethyllysine, TML). Stable-isotope-dilution tandem mass spectrometry analyses of an independent validation cohort (N = 2,140) confirmed TML levels are independently associated with incident (3-year) major adverse cardiovascular event risks (hazards ratio [HR], 2.4; 95% CI, 1.7-3.4) and incident (5-year) mortality risk (HR, 2.9; 95% CI, 2.0-4.2). Genome-wide association studies identified several suggestive loci for TML levels, but none reached genome-wide significance; and d9(trimethyl)-TML isotope tracer studies confirmed TML can serve as a nutrient precursor for gut microbiota-dependent generation of trimethylamine (TMA) and the atherogenic metabolite trimethylamine N-oxide (TMAO). Although TML was shown to be abundant in both plant- and animal-derived foods, mouse and human fecal cultures (omnivores and vegans) showed slow conversion of TML to TMA. Furthermore, unlike chronic dietary choline, TML supplementation in mice failed to elevate plasma TMAO or heighten thrombosis potential in vivo. Thus, TML is identified as a strong predictor of incident CVD risks in subjects and to serve as a dietary precursor for gut microbiota-dependent generation of TMAO; however, TML does not appear to be a major microbial source for TMAO generation in vivo.

17.
J Invasive Cardiol ; 30(3): 98-104, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29493510

RESUMO

OBJECTIVE: To assess the efficacy and safety of coronary left main (LM) disease interventions in patients with acute coronary syndromes (ACS) as compared to those without LM coronary artery disease. METHODS: A total of 2899 patients with ACS, enrolled in the prospective Swiss Program University Medicine ACS (SPUM-ACS) cohort, were included. The primary endpoints of independently adjudicated major adverse cardiovascular and cerebrovascular event (MACCE) and net adverse clinical event (NACE) were determined at 30-day follow-up. RESULTS: Seventy-one (2.0%) of the 2899 ACS patients had significant LM disease. At 30-day follow-up, the primary outcomes of MACCE and NACE occurred in 140 patients (4.8%) and 272 patients (9.4%), respectively. Compared to those without LM disease, patients in the LM group were significantly older (P<.001), had a higher incidence of hypertension (P<.001) and diabetes (P=.013), and more often had a history of coronary artery bypass graft (CABG) surgery (P<.001). Analyses on non-matched populations showed a nearly significant trend toward a higher incidence of MACCE (P=.06) and NACE (P=.10) in patients with LM disease compared to those without LM disease. This trend, however, disappeared after matching the populations for all significant confounding variables on a 3:1 basis. This subanalysis showed MACCE rates of 10.0% in the LM group and 7.3% in the non-LM group (P=.61). Notably, the matched patients with LM disease treated with percutaneous coronary intervention had a lower NACE incidence when compared to those undergoing urgent CABG surgery (P<.01). CONCLUSIONS: In ACS patients with LM disease, revascularization with PCI is feasible and safe, with short-term outcomes comparable to ACS patients without significant LM disease.


Assuntos
Síndrome Coronariana Aguda , Vasos Coronários , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Suíça/epidemiologia
18.
Int J Cardiol ; 253: 40-44, 2018 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29153460

RESUMO

BACKGROUND: Published procedural and short-term outcome of the Portico valve for Transcatheter Aortic Valve Implantation (TAVI) is limited. We report a single-center patient series assessing procedural and 30-day outcome of this device. METHODS AND RESULTS: Procedural and 30-day follow-up data were prospectively collected from a consecutive series of 73 patients (80.7±6.9years, 45% male, mean STS score: 4.8±3.9) with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Transfemoral access was used in 69 patients (94.5%), whereas in the remainder subclavian access was used. Concomitant interventions were performed in 30% of the patients. At 30days, all-cause mortality and the rate of neurological events were both 2.7%. The rates of non-minor bleeding and major vascular complications were 8.2% and 4.1%, respectively. Clinically significant aortic regurgitation was limited to a single case (1.4%) of moderate regurgitation at discharge, which was reduced to mild at 30days. Overall pacemaker rate after TAVI was 12% and the transprosthetic gradient was 6.9±3.2mmHg. CONCLUSIONS: TAVI using the Portico system was associated with low mortality and a low rate of neurological events at 30days and excellent hemodynamic outcome with no more than mild residual aortic regurgitation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Desenho de Prótese , Substituição da Valva Aórtica Transcateter/tendências , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Estudos de Coortes , Feminino , Humanos , Masculino , Mortalidade/tendências , Estudos Prospectivos , Desenho de Prótese/métodos , Estudos Retrospectivos , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
19.
Cardiol Res ; 8(5): 190-198, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29118880

RESUMO

Background: The aim of the study was to evaluate the occurrence, duration and impact of time delays to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI). Methods: A total of 357 consecutive STEMI patients enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. In order to identify the causes behind a possible treatment delay, we constructed four different time points which included: 1) symptom onset to hospital arrival, 2) hospital arrival to arrival in the catheterization laboratory, 3) hospital arrival to first balloon inflation, and 4) time from arrival in the catheterization laboratory to first balloon inflation in addition to total ischemic time. Patients were stratified according to a delay > 3 h, > 30 min, > 90 min and > 1 h, respectively and major adverse events at 0, 30 and 365 days were analyzed. Results: Resuscitated STEMI patients (23 patients) and STEMI patients presenting at weekends (101 patients) and to lesser extent at night hours (100 patients) experienced more time delays than stable patients and those presenting at office hours. Median door-to-balloon time averaged 93 min in resuscitated, but 65 min in stable patients. Median door-to-balloon time at weekends and public holidays was 89 min, but 68 min at office hours. Median time from hospital arrival to cathlab arrival at weekends and public holidays was 30 min, but 15 min during office hours. Corresponding times for resuscitated patients was 45 and 15 min in stable patients. Of note, resuscitated patients were late presenters as regards time from symptoms onset to hospital arrival with a median time of 180 min compared to 155 min in stable patients. Median total ischemic time was 225 min for all patients, 223 min at day hours, 239 at night hours, 244 min at weekends, 233 min at office days, 220 min in stable patients and 273 min in resuscitated patients. Patients with STEMI who arrived > 3 h after symptom onset had a higher rate of myocardial infarction (MI) at 1 year (1.6% vs. 9% in < 3 h; P = 0.008). Furthermore, STEMI patients who had a delay of > 1 h from cathlab arrival to first balloon inflation had a higher rate of in hospital reinfarction at 0 day (0.6% vs. 0% in < 1 h; P = 0.007), MI at 30 days (0.8% vs. 0% in < 1 h; P = 0.001) and MI at 1 year (1.4% vs. 1.1% in < 1 h; P = 0.012). Similarly, in these patients, cardiac deaths at 0 day (0.8% vs. 0.6% in < 1 h; P = 0.035) and at 30 days (0.8% vs. 0.6% in < 1 h; P = 0.035) were higher as were major adverse cardiovascular events (MACCE) at 0 day (1.4% vs. 0.8% in < 1 h; P = 0.004). Conclusion: Resuscitated STEMI patients and those presenting at weekends and to lesser extent at night hours experienced more time delays and longer ischemic time than stable patients and those presenting at office hours. In STEMI patients, any delay in treatment increased their risk of MACCE. Efforts should focus on improving patient's awareness along with minimizing in-hospital transfer to the catheterization laboratory especially at weekends and in resuscitated patients.

20.
Eur Heart J ; 38(41): 3066-3069, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29040468
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