1,721,293 research outputs found
European Heart Journal – Acute Cardiovascular Care moving onwards and upwards
No full textI feel honoured to have been chosen to become Editor-in-Chief of European Heart Journal-Acute Cardiovascular Care (EHJ-ACVC). I realise that I have been charged with piloting an ACVC (Association for Acute CardioVascular Care)-charged super engine along the acute cardiovascular care highway that plunges through the medical publishing galaxy. The ambition for EHJ-ACVC is to best represent our community and to foster and disseminate our research. Despite being the official journal of the ESC-ACVC association, EHJ-ACVC indisputably needs to become truly global. The ESC-ACVC association has grown in size, scientific diversity, and cultural wealth. So must the EHJ-ACVC! The numbers of accessed and downloaded articles need to increase further, as do the citations. EHJ-ACVC needs to compete on impact factor in the intensive care and cardiology arenas. Over the last decade, EHJ-ACVC profoundly improved its profile and metrics. However, EHJ-ACVC has not yet fulfilled its full potential. The journal must therefore continue onwards and upwards. Our success can only be built on a foundation of brilliant authors striving to address relevant clinical questions by applying appropriate methods, skilled reviewers intent on guiding authors towards improving their work, and gifted editors dedicating their valuable time to share their hard-earned wisdom. Quality editors attract quality papers! One obvious area for improvement is identification of the best work among the many excellent submissions via initial manuscript selection, peer review, and internal discussion. Another task consists in offering editing and rewriting of accepted manuscripts by professionals with expertise in science, the English language, and EHJ-ACVC style. We target both substance and form! Speed of the review and publication process should become our hallmark for all articles, not only those designated for 10-day profile submissions. Decisions are needed within 3 days when manuscripts are not sent out for review, within 3 weeks overall for 85% of submissions and within 7 days on average for 10-day profile submissions. Key performance indicators for the peer review process (i.e. time from submission to reviewer assignment or initial rejection, time to first review, and time to publication) will be featured online on the journal website. We will ask for extraordinary efforts from editors and reviewers to shorten the submission turnover time. A speedy review process relies heavily on high quality reviewers. EHJ-ACVC will acknowledge its ten top-ranking reviewers in the journal and on the website. These reviewers will also receive a certificate from the journal to recognize review effort. Medical journals are often perceived as working behind closed doors to apply enigmatic procedures that they have no wish to disclose. The Editor-in-Chief is thus seen as holding the keys to the mystery of how to get published. This should be different for EHJ-ACVC: the goals developed by the editorial board must be broadcast clearly and regularly to ensure a harmonious channelling of energies. The editorial line defined in the last few years by the Editorial Board will be refined, but the principles in place will remain. As indicated , the journal should breathe the ESC-ACVC association, and reflect current and future trends in the field of intensive and acute cardiovascular care. EHJ-ACVC aims for high quality original papers that include critically ill cardiovascular patients with clear messages for all physicians working in the field. Manuscripts providing new findings from large interventional studies can be submitted as 10-day profile publications, allowing important data to be rapidly available in the public domain. The methodology and the content of original articles, review articles, systematic reviews, and meta-analyses will be evaluated closely for application of high-level methodological standards. EHJ-ACVC welcomes transfers from other journals and will consider manuscripts in their original format for quality and content, but only when the remarks of the initial reviewers are addressed. Only upon acceptance ('as it is', or 'minor review') will we ask the authors to reformat the manuscript according to our journal instructions for authors. It goes without saying, de novo submissions should comply with the instructions to authors issued by our journal. We endorse the concept of visual learning. A central illustration or visual abstract will be required for all original investigations, editorials , and state-of-the art reviews. The editors and editorial staff of EHJ-ACVC want to help authors disseminate their important findings worldwide to as many people as possible via our website and Published on behalf of theVranckx, P (corresponding author), Jessa Ziekenhuis, Dept Cardiol & Crit Care Med, Hasselt, Belgium ; Univ Hasselt, Fac Med & Life Sci, Hasselt, Belgium ; Hasselt Univ, Hasselt, Belgium
Comparison of 1-month vs. 12-month dual antiplatelet therapy after implantation of drug-eluting stents in patients with acute coronary syndrome: the ULTIMATE-DAPT trial
No full textThe 2023 ESC guidelines assigned to 12-month dual antiplatelet therapy (DAPT) the single class I recommendation on DAPT in patients with acute coronary syndrome (ACS) after drug-eluting stent (DES) im-plantation. However, evidence exists that various DAPT de-escalation strategies are preferable to 12-month DAPT, which has sparked ongoing debate. 1,2 Several randomized clinical trials (RCTs) and individual patient data (IPD) meta-analysis investigated the efficacy and safety of P2Y 12 inhibitor monotherapy after 1-3 months of DAPT. The GLOBAL LEADERS trial, encompassing all-comer patients, found no clear superiority on death or Q-wave myocardial infarction (MI) between a 1-month DAPT followed by ticagrelor monotherapy and standard 12-month DAPT followed by aspirin after DES implant-ation. The bleeding risk was reduced in ACS (1.95% vs. 2.68%) but not chronic coronary syndrome patients (2.13% vs. 1.62%) with 1-month DAPT, 3,4 which contributed to foster additional research efforts with P2Y 12 inhibitor monotherapy. The GLOBAL LEADERS Adjudication Sub-StudY (GLASSY), which, unlike the parent trial, implemented a central adjudication of events, confirmed the potential of lower bleeding and similar fatal or non-fatal ischaemic risks with ticagrelor monotherapy than standard DAPT. 5 The TWILIGHT study, which included selected high-risk patients including ACS, showed that after 3 months of DAPT, ticagrelor monother-apy was safer [Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding 1% vs. 2%] and similarly effective [major adverse cardiovascular events (MACE) endpoint: a composite of all-cause death, non-fatal MI, or non-fatal stroke; P for non-inferiority <0.001] compared with standard additional 12-month DAPT. 6 The SIDNEY-2 Collaboration, involving over 38,000 patients, supported P2Y 12 inhibitor monotherapy for reducing BARC type 3 or 5 bleeding events by 44% [hazard ratio (HR) 0.56; 95% confidence interval (CI): 0.41-0.75] and demonstrated its non-inferiority for MACE compared to standard DAPT, with notable benefits for bleeding in ACS patients (P for interaction 0.51) 7 and those undergoing complex percutaneous coronary intervention (PCI). 8 While these findings hold true for ticagrelor in ACS patients in a more recent IPD analysis, they may not be applicable when clopidogrel is used. 9 Trial description The ULTIMATE-DAPT trial was designed to test whether antiplatelet monotherapy with ticagrelor alone vs. ticagrelor plus aspirin reduces the incidence of clinically relevant bleeding without increasing the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in ACS patients following DES who have completed a 1-month course of DAPT with aspirin plus ticagrelor. The ULTIMATE-DAPT was a prospective, multicentre, randomized, controlled trial. Patients were initially randomized to intravascular ultrasound (IVUS)-guided (n = 1753) or angiography-guided (n = 1752) PCI for index ACS event and received DAPT with ticagrelor (90 mg b.i.d.) and aspirin (100 mg q.d.) for 30 days. If they had no ischaemic or bleeding events at the end of 30 days, they were randomized to continuing DAPT for 12 months total (n = 1700) or stopping aspirin and switching to tica-grelor + placebo (n = 1700). 10 Patient population In total, 3400 patients were randomized. Their median age was 63, 26% of the patients were females, 31.6% had diabetes, and 7% had chronic kidney disease (CKD), whereas severe CKD was an exclusion criterion, together with chronic oral anticoagulation, stroke within 3 months or any permanent neurologic deficit, and prior intracranial bleed, previous coronary artery bypass graft (CABG), or any planned surgery within 90 days. Overall, 40% of patients had unstable angina, European Heart Journal: Acute Cardiovascular Care (2024) 13, 368-369 https://doi
Cracking the clot: the RIVAWAR trial challenges warfarin's reign in left ventricular thrombus post-acute coronary syndrome
No full textEvidence before this study Left ventricular thrombosis (LVT) is a severe complication that often arises in patients with left ventricular systolic dysfunction, particularly within 1-14 days after a ST-segment elevation myocardial infarction (STEMI), and is associated with increased risks of stroke, embolization, and mortality. (1,2) Despite modern reperfusion therapy, the prevalence of LVT remains notable, ranging from 2-22%.(3,4) It is more frequent in patients with anterior STEMI and in patients with severe ventricular dysfunction and varies based on the imaging modality employed for detection.(5-7) Vitamin K antagonists (VKAs), such as warfarin, have been the standard treatment for LVT, though they require monitoring and have dietary interactions. (8)In contrast, direct oral anticoagulants (DOACs), including rivaroxaban, have gained attention as alternatives, offering advantages such as fewer food and drug interactions, a lower risk of bleeding, and no requirement for routine laboratory monitoring. (9) The 2023 ESC guidelines for management of acute coronary syndromes (ACS) recommend that oral anticoagulation therapy (warfarin or NOAC) should be considered for 3-6 months in patients with confirmed LVT (class IIa, level of evidence C). (10) Nonetheless, the evidence supporting NOAC use for LVT, particularly in the context of acute coronary syndrome (ACS), remains limited. (11,12) Contribution To Clinical Practice The RIVAWAR trial supports the use of rivaroxaban as a non-inferior alternative to warfarin for LV thrombus management, offering similar efficacy and safety with potential advantages in clinical practice
BIOVASC trial in perspective: complete revascularization strategies in patients presenting with acute coronary syndromes and multi-vessel coronary disease
No full textIn patients hospitalized with acute myocardial infarction, multi-vessel coronary artery disease (MVD) is common (50-60%) and is associated with an increased risk of post-discharge mortality and recurrent myo-cardial infarction. 1,2 Multiple randomized controlled trials (PRAMI, DANAMI-3-PRIMULTI, CvLPRIT, Compare-Acute, and COMPLETE) have demonstrated that complete revascularization (CR) is superior to culprit-only recalculation in patients presenting with stent thrombosis (ST)-segment elevation myocardial infarction (STEMI). 3-6 The largest study (COMPLETE trial) randomized n = 4041 patients presenting with STEMI and MVD to culprit-only or separate staged CR procedure with 45 days of randomization. 7 It found that CR reduced death or myocardial infarction [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.60-0.91]. As of today, the optimal timing of CR in this population remains unclear with studies have protocolized immediate, in-hospital staged, or post-discharged staged CR. 3,4,7 Contribution to the literature Data considering the optimal timing in CR of the non-culprit lesion(s) are scarce or conflicting. Aim of the study The goal of the Percutaneous Complete Revascularization Strategies Using Sirolimus-Eluting Biodegradable Polymer-Coated Stents in Patients Prenting with Acute Coronary Syndrome and Multivessel Disease (BIOVASC) trial was to evaluate the optimal timing for a CR strategy in patients with acute coronary syndromes (ACS) and MVD. Study design The BIOVASC trial was a prospective, investigator-initiated, multi-center, open label, randomized non-inferiority trial that randomized patients to either (i) immediate complete revascularization (ICR) at the time of the index-PCI or (ii) staged complete revascularization (SCR) with PCI of the non-infarct related lesions within 6 weeks of the index procedure. 8 Coronary physiological assessment was used at the discretion of the operator. The primary end point was a composite of all-cause mortality, non-fatal myocardial infarction, unplanned ischaemia-driven revasculariza-tion, and cerebrovascular events (MACCE) through 1-year post-index procedure. The study planned to enrol 1525 patients at 30 sites in Belgium, Italy, Netherlands, and Spain. It had an 80% power with a non-inferiority α of 0.5 assuming an event rate of 10.5% in the immediate CR and 11% in the staged arm. Study patients The study included patients 18-85 years with ST-segment elevation and non-ST-segment elevation ACS with MVD with identifiable culprit le-sion and aimable for PCI using the Orsiro platform (Biotronik AG, Bűlach, Switzerland) stent platform. The significant coronary disease was defined as a 70% stenosis in a vessel ≥ 2.5 mm by visual estimation or positive coronary physiological testing. Selected exclusion criteria included cardiogenic shock, PCI within 30 days, presence of a chronic total occlusion, and previous coronary artery bypass grafting. Principle findings The study enrolled 1525 patients (764 in the ICR-arm and 761 in the SCR-arm) at 29 sites. The mean patient age was 65 years, 22% female, 21% with diabetes, and 40% presented with a STEMI. 9 The 1-year primary outcome The 1-year primary MACCE outcome occurred in 7.6% of the ICR-arm and 9.4% in the SCR-arm (HR 0.78, 95% CI 0.55-1.11, P = 0.001 for non-inferiority; P = 0.166 for superiority)
How should I treat this unusual anterolateral ST-elevation myocardial infarction with recurrent ventricular fibrillation and cardiac arrest? How would I treat?
No full textThe European Heart Journal Acute Cardiovascular Care (EHJ ACVC) 2022: message from the editorial board
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How should I treat this unusual anterolateral ST-elevation myocardial infarction with recurrent ventricular fibrillation and cardiac arrest? How would I treat?
No full textAntithrombotic therapy in patients with atrial fibrillation undergoing PCI remains a moving target, yet with a clearer direction!
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