1,721,025 research outputs found
Early Percutaneous Coronary Intervention: Risks and Outcomes in Patients With Cancer
No full textBackground: Patients with malignancies may have high pro-thrombotic status as well as a high risk of hemorrhagic events either due to the tumor or its treatment.For this reason, these patients have always been excluded from randomized clinical trials on percutaneous coronary intervention (PCI).
Aim: To investigate the safety of PCI in patients with malignancies admitted for an AMI.
Methods and Results: Retrospective analysis on an international European ACS registry. Primary endpoint: 30-day mortality. Secondary endpoint: periprocedural complications. There were 273 patients (35% women) with AMI and malignancies. Colon (19%), prostate (14%), breast (13%), lung (8%) and blood (8%) malignancies were the most frequent type of cancer. Women and men had similar age (68 ±11.5 vs 69.1 ±11.5, p=ns). STEMI was in 56% of patients (with no significant gender difference: 51% men vs 65% women, p=0.09). PCI was performed in 64% of patients (with primary PCI in 75% of STEMI). The rate of complications during cardiac catheterization and intervention was 6.5% (2.1% distal embolization, 2.1% no-reflow, 0.7% acute closure, 0.7% dissection, 0.7% perforation, none major bleeding). Nobody among patients that had cardiac catheterization and intervention complications died during hospital stay. In-hospital mortality was 5.9%. The group of patients treated with PCI had a significantly lower rate of death then that of those treated non invasively (1.7% vs 13.1%, p<0.00001). Factors associated with lower probability to receive cardiac catheterization were older age (OR 0.94, 95% CI 0.92-0.97) and absence of typical chest pain at admission (OR: 0.38; 95%CI:0.18-0.81), but the type of malignancy and gender were not. On multivariable model, age (OR 1.1, 95%CI 1.03-1.17) and PCI (OR 0.16 95%CI, 0.04-0.59) were independently associated with the risk of death for ACS (increased and decreased risk, respectively).
Conclusion: These preliminary data from the real world support the safety use of PCI in patients with malignancies and ACS, which have always been excluded from randomized clinical trial
Reperfusion Therapy for ST-Elevation Acute Myocardial Infarction in Eastern Europe: The ISACS-TC Registry
No full textEARLY VERSUS DELAYED USE OF BETA-BLOCKERS IN ACUTE CORONARY SYNDROMES: A LANDMARK ANALYSIS. FROM THE ISACS-TC STUDY
No full text"DE NOVO" HEART FAILURE: A MECHANISM UNDERSCORING SEX DIFFERENCES IN OUTCOMES AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
No full textBackground: ST-Segment Elevation Myocardial Infarction (STEMI) complicated by symptoms of acute heart failure (HF) is associated with excess mortality. Yet the relative contribution of sex to the development of acute HF and its related outcomes remains controversial. We aimed to compare the incidence and outcomes of patients with HF during index admission for STEMI according to sex and prior HF status: pre-existing diagnosis of HF, as assessed by past medical history, or no prior HF.
Methods: Cohort study using a population-based registry consisting of 8,409 STEMI patients with acute HF status recorded at baseline. Adjusted 30-day mortality and HF rates at index admission were estimated using inverse probability of weighting and logistic regression models. HF was defined as Killip class 2 or higher and classified according to prior medical history as acute “de novo” or decompensated HF.
Results: A total of 2,526 women and 5,883 men had HF status recorded at baseline and were included in the analysis. Of these patients, 2,403 (95.1%) women and 5,664 (96.3%) men have never experienced HF before index admission. After adjustment for baseline clinical covariates, the incidence of “de novo” HF was significantly higher for women than for men (29.4% vs 21.9 %, OR 1.23; 95%CI 1.10-1.38). For “de novo” HF presentations women have higher 30-day mortality than men (9.5% vs 6.2%: OR 1.58; 95%CI 1.33-1.88). After adjusting for potential confounders, a history of pre-existing HF was strongly associated with increased risk of acute decompensated HF at index admission (OR 3.89; 95%CI, 3.02-5.01). Nevertheless, when women and men presented with acute decompensated HF their outcomes are equally negative with a 30-day mortality of 11.3% vs 12.9%, respectively (OR 0.86; 95%CI 0.43-1.70).
Conclusion: Female sex has differing effects among patients with STEMI according to prior medical history of HF. It worsens outcomes in patients with acute “de novo” HF but has neutral effects in those with acute decompensated HF. “De novo” HF is a key feature to explain mortality difference between sexes
Sex Differences in Mortality in Women and Men with Obstructive Coronary Artery Disease and Acute Coronary Syndrome
No full textEffects of High Intensity Statin Therapy in the Treatment of Diabetic Dyslipidemia in Patients with Coronary Artery Disease
No full text
Background:
Diabetic dyslipidemia has specifics that differ from dyslipidemia in patients without
diabetes, which contributes to accelerated atherosclerosis equally as dysglycemia. The aim of this study was to
deduce the interdependence of diabetic dyslipidemia and cardiovascular diseases (CVD), therapeutic strategies
and the risk of diabetes development with statin therapy.
Method:
We conducted a literature review of English articles through PubMed, PubMed Central and Cochrane,
on the role of diabetic dyslipidemia in atherosclerosis, the antilipemic treatment with statins, and the role of statin
therapy in newly developed diabetes, by using key words: atherosclerosis, diabetes mellitus, diabetic dyslipidemia,
CVD, statins, nicotinic acid, fibrates, PCSK9 inhibitors.
Results:
hyperglycemia and dyslipidemia cannot be treated separately in patients with diabetes. It seems that
dyslipidemia plays one of the key roles in the development of atherosclerosis. High levels of TG, decreased levels
of HDL-C and increased levels of small dense LDL- C particles in the systemic circulation are the most specific
attributes of diabetic dyslipidemia, all of which originate from an inflated flux of free fatty acids occurring due to
the preceding resistance to insulin, and exacerbated by elevated levels of inflammatory adipokines. Statins are a
fundamental treatment for diabetic dyslipidemia, both for dyslipidemia and for CVD prevention. The use of statin
treatment with high intensity is endorsed for all diabetes-and-CVD patients, while a moderate - intensity treatment
can be applied to patients with diabetes, having additional risk factors for CVD. Statins alone are thought to
possess a small, although of statistical significance, risk of incident diabetes, outweighed by their benefits.
Conclusion:
As important as hyperglycemia and glycoregulation are in CVD development in patients with diabetes,
diabetic dyslipidemia plays an even more important role. Statins remain the cornerstone of antilipemic treatment
in diabetic dyslipidemia, and their protective effects in CVD progression overcome the risk of statin- associated
incident diabetes.
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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