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Alkhalaileh H, Wei R, Cordero Rivera A, Goksel M, Lee JKY, Mazzaferri, Jr. E, Jones J, Li J. Evaluation of Age and Sex Differences in Contemporary versus High-Sensitivity Troponin I Measurement in Hospitalized Patients. J Clin Med 2024; 13:2428. [PMID: 38673701 PMCID: PMC11051137 DOI: 10.3390/jcm13082428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: With the transition from the contemporary (cTnI) to high-sensitivity troponin assay (hs-cTnI), concerns have arisen regarding the diagnostic differences between these two assays due to analytical distinctions. This study aims to evaluate the age and sex differences between these two assays, as well as the differences resulting from using two different 99th percentile values of the high-sensitivity troponin assay. Method: A retrospective observational study was conducted at an academic medical center, encompassing a total of 449 lithium heparin plasma samples included in the dataset. Both contemporary and high-sensitivity troponin were simultaneously measured using Siemens ADVIA Centaur analyzers. Two sets of sex-specific 99th percentile URLs from the Siemens study (cutoff-1) and Universal Sample Bank data (cutoff-2) were used for the data analysis. Results: The use of cutoff-1 or cutoff-2 had a negligible impact on troponin classification. Troponin elevation significantly increased in individuals > 50 years old for males and >40 years old for females, with both troponin assays. A receiver operating characteristic analysis did not find significant differences between the two assays. The Kaplan-Meier curves showed no differences in survival in cTnI according to the non-sex-specific 99th URL or hs-cTnI (cutoff-2) but showed a slight difference in survival in hs-cTnI (cutoff-1). Conclusions: Overall, there were no significant differences in age and sex in the diagnostic performance between the contemporary and high-sensitivity troponin assays. Selection criteria for the establishment of the 99th percentile URL should be standardized to avoid the misinterpretation of the troponin results.
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Affiliation(s)
- Hussam Alkhalaileh
- The Ohio State College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
| | - Ruhan Wei
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Ashly Cordero Rivera
- Department of Pathology, Wexner Medical Center, The Ohio State University, 410 W 10th Ave., Columbus, OH 43210, USA; (A.C.R.); (M.G.); (J.J.)
| | - Mustafa Goksel
- Department of Pathology, Wexner Medical Center, The Ohio State University, 410 W 10th Ave., Columbus, OH 43210, USA; (A.C.R.); (M.G.); (J.J.)
| | - Jason K. Y. Lee
- Department of Clinical Laboratory, University Hospital, The Ohio State University, Columbus, OH 43210, USA;
| | - Ernest Mazzaferri, Jr.
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA;
| | - JoAnna Jones
- Department of Pathology, Wexner Medical Center, The Ohio State University, 410 W 10th Ave., Columbus, OH 43210, USA; (A.C.R.); (M.G.); (J.J.)
| | - Jieli Li
- Department of Pathology, Wexner Medical Center, The Ohio State University, 410 W 10th Ave., Columbus, OH 43210, USA; (A.C.R.); (M.G.); (J.J.)
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2
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Fezzi S, Malakouti S, Sivalingam J, Khater J, Ribichini F, Cortese B. Drug-Coated Balloon in Acute Coronary Syndromes: Ready for the Prime Time? Curr Cardiol Rep 2024:10.1007/s11886-024-02037-2. [PMID: 38619711 DOI: 10.1007/s11886-024-02037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW Acute coronary syndromes (ACS) are a major global health concern. Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) has been endorsed as safe and effective in the management of culprit and non-culprit lesions of ACS. However, permanent metallic implants may have drawbacks, including the need for prolonged dual antiplatelet therapy (DAPT) and the risk of long-term stent-related complications. An alternative approach using drug-coated balloons (DCBs) is gaining growing interest, having the potential of delivering therapy directly to vulnerable plaques, avoiding the need for permanent metallic implants, and potentially allowing for better long-term medical treatment. Despite limited evidence, DCB is being explored in several patients' subgroups. This review aims to discuss the existing evidence regarding DCB in ACS management. RECENT FINDINGS DCB appears to be a promising strategy in the management of ACS, showing comparable angiographic and clinical results as compared to new-generation DES in relatively small clinical trials or large prospective registries. The advantage of avoiding permanent implants is particularly appealing in this setting, where DCB has the potential of delivering anti-atherogenic local therapy directly to vulnerable plaques still amenable to atherogenic regression. This review seeks to underline the theoretical background of DCB use and reports the available evidence in its support in the specific setting of ACS. In the context of ACS, the use of DCB is highly attractive, offering a dedicated anti-atherogenic local therapy, capable of addressing a broad range of vulnerable plaques and patients.
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Affiliation(s)
- Simone Fezzi
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
- University of Verona, Verona, Italy
| | | | | | - Jacinthe Khater
- DCB Academy, Milan, Italy
- Faculty of Medical Sciences, Lebanese University Rafic Hariri University Campus, Hadath, Lebanon
| | | | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy.
- DCB Academy, Milan, Italy.
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3
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Silverio A, Bellino M, Scudiero F, Attisano T, Baldi C, Catalano A, Centore M, Cesaro A, Di Maio M, Esposito L, Granata G, Maiellaro F, Muraca I, Musumeci G, Parodi G, Personeni D, Valenti R, Vecchione C, Calabrò P, Galasso G. Intravenous antiplatelet therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention : A report from the INVEST-STEMI group. J Thromb Thrombolysis 2024:10.1007/s11239-024-02970-7. [PMID: 38615155 DOI: 10.1007/s11239-024-02970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/15/2024]
Abstract
The use of intravenous antiplatelet therapy during primary percutaneous coronary intervention (PPCI) is not fully standardized. The aim is to evaluate the effectiveness and safety of periprocedural intravenous administration of cangrelor or tirofiban in a contemporary ST-segment elevation myocardial infarction (STEMI) population undergoing PPCI. This was a multicenter prospective cohort study including consecutive STEMI patients who received cangrelor or tirofiban during PPCI at seven Italian centers. The primary effectiveness measure was the angiographic evidence of thrombolysis in myocardial infarction (TIMI) flow < 3 after PPCI. The primary safety outcome was the in-hospital occurrence of BARC (Bleeding Academic Research Consortium) 2-5 bleedings. The study included 627 patients (median age 63 years, 79% males): 312 received cangrelor, 315 tirofiban. The percentage of history of bleeding, pulmonary edema and cardiogenic shock at admission was comparable between groups. Patients receiving cangrelor had lower ischemia time compared to tirofiban. TIMI flow before PPCI and TIMI thrombus grade were comparable between groups. At propensity score-weighted regression analysis, the risk of TIMI flow < 3 was significantly lower in patients treated with cangrelor compared to tirofiban (adjusted OR: 0.40; 95% CI: 0.30-0.53). The risk of BARC 2-5 bleeding was comparable between groups (adjusted OR:1.35; 95% CI: 0.92-1.98). These results were consistent across multiple prespecified subgroups, including subjects stratified for different total ischemia time, with no statistical interaction. In this real-world multicenter STEMI population, the use of cangrelor was associated with improved myocardial perfusion assessed by coronary angiography after PPCI without increasing clinically-relevant bleedings compared to tirofiban.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy.
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Fernando Scudiero
- Cardiology Unit, Medical Sciences Departement, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Tiziana Attisano
- Interventional Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Cesare Baldi
- Interventional Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Catalano
- Cardiology Unit, Hospital Maria SS. Addolorata, Eboli, Italy
| | - Mario Centore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
- Cardiology Unit, Hospital Maria SS. Addolorata, Eboli, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giovanni Granata
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | | | - Iacopo Muraca
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | - Guido Parodi
- Cardiology Unit, Department of Medicine, Lavagna Hospital, Lavagna, Italy
| | - Davide Personeni
- Cardiology Unit, Medical Sciences Departement, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
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Kotanidis CP, Mills GB, Bendz B, Berg ES, Hildick-Smith D, Hirlekar G, Milasinovic D, Morici N, Myat A, Tegn N, Sanchis J, Savonitto S, De Servi S, Fox KAA, Pocock S, Kunadian V. Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis. Eur Heart J 2024:ehae151. [PMID: 38596853 DOI: 10.1093/eurheartj/ehae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/30/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND AIMS Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) are less likely to receive guideline-recommended care including coronary angiography and revascularization. Evidence-based recommendations regarding interventional management strategies in this patient cohort are scarce. This meta-analysis aimed to assess the impact of routine invasive vs. conservative management of NSTEACS by using individual patient data (IPD) from all available randomized controlled trials (RCTs) including older patients. METHODS MEDLINE, Web of Science and Scopus were searched between 1 January 2010 and 11 September 2023. RCTs investigating routine invasive and conservative strategies in persons >70 years old with NSTEACS were included. Observational studies or trials involving populations outside the target range were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction (MI) at 1 year. One-stage IPD meta-analyses were adopted by use of random-effects and fixed-effect Cox models. This meta-analysis is registered with PROSPERO (CRD42023379819). RESULTS Six eligible studies were identified including 1479 participants. The primary endpoint occurred in 181 of 736 (24.5%) participants in the invasive management group compared with 215 of 743 (28.9%) participants in the conservative management group with a hazard ratio (HR) from random-effects model of 0.87 (95% CI 0.63-1.22; P = .43). The hazard for MI at 1 year was significantly lower in the invasive group compared with the conservative group (HR from random-effects model 0.62, 95% CI 0.44-0.87; P = .006). Similar results were seen for urgent revascularization (HR from random-effects model 0.41, 95% CI 0.18-0.95; P = .037). There was no significant difference in mortality. CONCLUSIONS No evidence was found that routine invasive treatment for NSTEACS in older patients reduces the risk of a composite of all-cause mortality and MI within 1 year compared with conservative management. However, there is convincing evidence that invasive treatment significantly lowers the risk of repeat MI or urgent revascularisation. Further evidence is needed from ongoing larger clinical trials.
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Affiliation(s)
- Christos P Kotanidis
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom
| | - Gregory B Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend S Berg
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Hildick-Smith
- Sussex Cardiac Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Geir Hirlekar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | | | - Nicolai Tegn
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Juan Sanchis
- Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de Valencia, CIBER-Cardiovascular, Valencia, Spain
| | | | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom
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5
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Almansouri NE, Awe M, Rajavelu S, Jahnavi K, Shastry R, Hasan A, Hasan H, Lakkimsetti M, AlAbbasi RK, Gutiérrez BC, Haider A. Early Diagnosis of Cardiovascular Diseases in the Era of Artificial Intelligence: An In-Depth Review. Cureus 2024; 16:e55869. [PMID: 38595869 PMCID: PMC11002715 DOI: 10.7759/cureus.55869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
Cardiovascular diseases (CVDs) are significant health issues that result in high death rates globally. Early detection of cardiovascular events may lower the occurrence of acute myocardial infarction and reduce death rates in people with CVDs. Traditional data analysis is inadequate for managing multidimensional data related to the risk prediction of CVDs, heart attacks, medical image interpretations, therapeutic decision-making, and disease prognosis due to the complex pathological mechanisms and multiple factors involved. Artificial intelligence (AI) is a technology that utilizes advanced computer algorithms to extract information from large databases, and it has been integrated into the medical industry. AI methods have shown the ability to speed up the advancement of diagnosing and treating CVDs such as heart failure, atrial fibrillation, valvular heart disease, hypertrophic cardiomyopathy, congenital heart disease, and more. In clinical settings, AI has shown usefulness in diagnosing cardiovascular illness, improving the efficiency of supporting tools, stratifying and categorizing diseases, and predicting outcomes. Advanced AI algorithms have been intricately designed to analyze intricate relationships within extensive healthcare data, enabling them to tackle more intricate jobs compared to conventional approaches.
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Affiliation(s)
| | - Mishael Awe
- Internal Medicine, Crimea State Medical University named after S.I Georgievsky, Simferopol, UKR
| | - Selvambigay Rajavelu
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Kudapa Jahnavi
- Internal Medicine, Pondicherry Institute of Medical Sciences, Puducherry, IND
| | - Rohan Shastry
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, IND
| | - Ali Hasan
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Hadi Hasan
- Internal Medicine, University of Illinois, Chicago, USA
| | | | | | - Brian Criollo Gutiérrez
- Health Sciences, Instituto Colombiano de Estudios Superiores de Incolda (ICESI) University, Cali, COL
| | - Ali Haider
- Allied Health Sciences, The University of Lahore, Gujrat, PAK
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Masseli F, Veseli A, Pfohl M, Hoch J, Treede H, Schiller W. Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery. J Thromb Thrombolysis 2024; 57:512-519. [PMID: 38347373 PMCID: PMC10961287 DOI: 10.1007/s11239-023-02934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 03/26/2024]
Abstract
Patient blood group (BG) is predictive for von-Willebrand-factor (VWF) and Factor VIII variation. The clinical impact of this ABO-effect on blood loss, cardiovascular complications and outcome has been described for several patient cohorts. The aim of this study was to investigate the impact of patient BG on blood loss and outcome after coronary artery bypass surgery (CABG). Patient records, intraoperative data and perioperative transfusion records of 5713 patients receiving an on-pump CABG procedure between 05/2004 and 12/2018 were analyzed. A logistic regression model for death due to perioperative myocardial ischaemia (PMI) was developed from initially 24 variables by using an univariate and multivariate selection process. BG AB patients required less blood transfusions as compared to the other blood groups, especially in case of emergency operations. However, BG AB patients also had a higher mortality which was due to secondary cardiovascular complications. The impact of blood type on the rate of cardiovascular mortality was confirmed in the logistic regression model. BG AB patients have a worse outcome after CABG surgery due to an increased incidence of fatal cardiovascular complications. As perioperative myocardial ischemia due to graft occlusion appears to be the most likely explanation, stricter anticoagulation for BG AB patients should be discussed.
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Affiliation(s)
- Franz Masseli
- Department of Cardiac and Vascular Surgery, University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Arlinda Veseli
- Medical Faculty, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Marvin Pfohl
- Department of Cardiac and Vascular Surgery, University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Jochen Hoch
- Department for Experimental Hematology and Transfusion Medicine, University Clinic Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Wolfgang Schiller
- Department of Cardiac and Vascular Surgery, University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany
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Frișan AC, Mornoș C, Lazăr MA, Șoșdean R, Crișan S, Ionac I, Luca CT. Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus. Medicina (Kaunas) 2024; 60:199. [PMID: 38399487 PMCID: PMC10890444 DOI: 10.3390/medicina60020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Myocardial ischemia caused by coronary artery disease (CAD) and the presence of metabolic abnormalities and microvascular impairments detected in patients with diabetes mellitus (DM) are a common cause of left ventricular (LV) dysfunction. Transthoracic echocardiography is the most-used, non-invasive imaging method for the assessment of myocardial contractility. The accurate evaluation of LV function is crucial for identifying patients who are at high risk or may have worse outcomes. Myocardial work (MW) is emerging as an alternative tool for the evaluation of LV systolic function, providing additional information on cardiac performance when compared to conventional parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) because it incorporates deformation and load into its analysis. The potential of MW in various conditions is promising and it has gained increased attention. However, larger studies are necessary to further investigate its role and application before giving an answer to the question of whether it can have widespread implementation into clinical practice. The aim of this review is to summarize the actual knowledge of MW for the analysis of LV dysfunction caused by myocardial ischemia and hyperglycemia.
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Affiliation(s)
- Alexandra-Cătălina Frișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristian Mornoș
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Mihai-Andrei Lazăr
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Raluca Șoșdean
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Ioana Ionac
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (A.-C.F.); (R.Ș.); (S.C.); (I.I.); (C.-T.L.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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8
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Rohla M, Ye SX, Shibutani H, Bruno J, Otsuka T, Häner JD, Bär S, Temperli F, Kavaliauskaite R, Lanz J, Stortecky S, Praz F, Hunziker L, Pilgrim T, Siontis GC, Losdat S, Windecker S, Räber L. Pretreatment With P2Y 12 Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry. JACC Cardiovasc Interv 2024; 17:17-28. [PMID: 38199749 DOI: 10.1016/j.jcin.2023.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Evidence to support immediate P2Y12 inhibitor loading in ST-segment elevation myocardial infarction (STEMI) is limited. OBJECTIVES This study sought to compare outcomes of STEMI patients receiving immediate or delayed P2Y12 inhibitor treatment. METHODS Using data from the prospective Bern-PCI registry between 2016 and 2020, we stratified STEMI patients undergoing percutaneous coronary intervention according to time periods with different institutional recommendations regarding P2Y12 inhibitor pretreatment. In cohort 1 (October 2016-September 2018), immediate P2Y12 inhibitor treatment was recommended. In cohort 2 (October 2018-September 2020), P2Y12 inhibitor treatment was recommended after coronary anatomy was confirmed. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) defined as all-cause death, recurrent myocardial infarction, stroke, or definite stent thrombosis at 30 days. Sensitivity analysis included only patients in whom these recommendations were followed. RESULTS Cohort 1 included 1,116 patients; pretreatment was actually given in 708 (63.4%). Cohort 2 included 847 patients; pretreatment was withheld in 798 (94.2%). The mean age was 65 ± 13 years, and 24% were female. Baseline characteristics were well-balanced between groups. The median difference for P2Y12 loading to angiography was 52 minutes between cohort 1 and 2 and 100 minutes between patients receiving vs not receiving pretreatment. Rates of MACCEs were similar between cohort 1 and cohort 2 (10.1% vs 8.1%; adjusted HR: 0.91; 95% CI: 0.65-1.28; P = 0.59) and between patients receiving vs not receiving pretreatment (7.1% vs 8.4%; adjusted HR: 1.17; 95% CI: 0.78-1.74; P = 0.45). CONCLUSIONS In this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, P2Y12 inhibitor pretreatment was not associated with improved MACCEs.
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Affiliation(s)
- Miklos Rohla
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Shirley Xinyu Ye
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Jolie Bruno
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabrice Temperli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Raminta Kavaliauskaite
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - George Cm Siontis
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
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9
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Maqsood MH, Levine GN, Kleiman ND, Hasdai D, Uretsky BF, Birnbaum Y. Do We Still Need Aspirin in Coronary Artery Disease? J Clin Med 2023; 12:7534. [PMID: 38137601 PMCID: PMC10743767 DOI: 10.3390/jcm12247534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Aspirin has for some time been used as a first-line treatment for acute coronary syndromes, including ST-elevation myocardial infarction, for secondary prevention of established coronary disease, and for primary prevention in patients at risk of coronary artery disease. Although aspirin has been in use for decades, the available evidence for its efficacy largely predates the introduction of other drugs, such as statins and P2Y12 inhibitors. Based on recent trials, the recommendation for aspirin use as primary prevention has been downgraded. In addition, P2Y12 inhibitors given as a single antiplatelet therapy have been associated with a lower incidence of bleeding than dual antiplatelet therapy in combination with aspirin in patients with stable and unstable coronary artery disease. The aim of this review is to discuss the role of aspirin considering the available evidence for primary prevention, secondary prevention for stable coronary artery disease or acute coronary syndromes, and after percutaneous coronary intervention or coronary artery bypass revascularization.
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Affiliation(s)
- Muhammad Haisum Maqsood
- Department of Cardiology, DeBakey Heart and Vascular Center, Methodist Hospital, Houston, TX 77030, USA;
| | - Glenn N. Levine
- The Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Neal D. Kleiman
- Department of Cardiology, Section of Interventional Cardiology, Houston Methodist DeBakey Heart Center, Houston, TX 77030, USA;
| | - David Hasdai
- Department of Cardiology, Rabin Medical Center, Tel Aviv University, Petah Tikva 49200, Israel;
| | - Barry F. Uretsky
- Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Yochai Birnbaum
- The Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA;
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10
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Garcia-Garcia HM, De Maria GL. Bolus or Continuous Thermodilution: Which Is the Right Approach to Convert Assessment of CMD Into an "Atomic Habit"? JACC Cardiovasc Interv 2023; 16:2778-2781. [PMID: 38030362 DOI: 10.1016/j.jcin.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023]
Affiliation(s)
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
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11
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Savonitto S, De Luca G. Prehospital Care for ST-Segment Elevation Myocardial Infarction in Remote Areas: Lost in Translation. Am J Cardiol 2023; 207:509-510. [PMID: 37802699 DOI: 10.1016/j.amjcard.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Affiliation(s)
| | - Giuseppe De Luca
- Service of Cardiology, AOU "Policlinico G. Martino", University of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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12
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de Koning E, van der Haas Y, Saguna S, Stoop E, Bosch J, Beeres S, Schalij M, Boogers M. AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study. JMIR Cardio 2023; 7:e51375. [PMID: 37906226 PMCID: PMC10646678 DOI: 10.2196/51375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Overcrowding of hospitals and emergency departments (EDs) is a growing problem. However, not all ED consultations are necessary. For example, 80% of patients in the ED with chest pain do not have an acute coronary syndrome (ACS). Artificial intelligence (AI) is useful in analyzing (medical) data, and might aid health care workers in prehospital clinical decision-making before patients are presented to the hospital. OBJECTIVE The aim of this study was to develop an AI model which would be able to predict ACS before patients visit the ED. The model retrospectively analyzed prehospital data acquired by emergency medical services' nurse paramedics. METHODS Patients presenting to the emergency medical services with symptoms suggestive of ACS between September 2018 and September 2020 were included. An AI model using a supervised text classification algorithm was developed to analyze data. Data were analyzed for all 7458 patients (mean 68, SD 15 years, 54% men). Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for control and intervention groups. At first, a machine learning (ML) algorithm (or model) was chosen; afterward, the features needed were selected and then the model was tested and improved using iterative evaluation and in a further step through hyperparameter tuning. Finally, a method was selected to explain the final AI model. RESULTS The AI model had a specificity of 11% and a sensitivity of 99.5% whereas usual care had a specificity of 1% and a sensitivity of 99.5%. The PPV of the AI model was 15% and the NPV was 99%. The PPV of usual care was 13% and the NPV was 94%. CONCLUSIONS The AI model was able to predict ACS based on retrospective data from the prehospital setting. It led to an increase in specificity (from 1% to 11%) and NPV (from 94% to 99%) when compared to usual care, with a similar sensitivity. Due to the retrospective nature of this study and the singular focus on ACS it should be seen as a proof-of-concept. Other (possibly life-threatening) diagnoses were not analyzed. Future prospective validation is necessary before implementation.
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Affiliation(s)
- Enrico de Koning
- Cardiology Department, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Esmee Stoop
- Clinical AI and Research lab, Leiden University Medical Center, Leiden, Netherlands
| | - Jan Bosch
- Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, Netherlands
| | - Saskia Beeres
- Cardiology Department, Leiden University Medical Center, Leiden, Netherlands
| | - Martin Schalij
- Cardiology Department, Leiden University Medical Center, Leiden, Netherlands
| | - Mark Boogers
- Cardiology Department, Leiden University Medical Center, Leiden, Netherlands
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