Long-term outcomes after percutaneous revascularization of complex coronary bifurcation lesions using a dedicated self-expanding biolimus-eluting stent system

Background: To evaluate long-term clinical outcomes after treatment of complex bifurcation lesions with the AXXESS dedicated self-expanding biolimus A9-eluting bifurcation stent.Methods: Between 2004 and 2013, 123 patients with complex bifurcation lesions were treated in a single-center with the AXXESS stent in the proximal main vessel (MV) and additional drug-eluting stents in branches when required. Median follow-up was 5 years. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included MACE components (cardiac death, non-periprocedural clinical myocardial infarction [MI], target lesion revascularization [TLR] and definite/probable stent thrombosis [ST]) as well as all-cause death, target vessel revascularization (TVR) and non-TVR.Results: During follow-up, 11 (8.9%) patients experienced a MACE, of whom 2 (1.6%) suffered cardiac death, 2 (1.6%) had a non-periprocedural clinical MI requiring TLR, and 7 (5.7%) underwent elective TLR. No definite/probable ST was observed. All-cause death occurred in 9 (7.3%) patients, TVR in 11 (8.9%) and non-TVR in 11 (8.9%). Patients treated for left main (LM) bifurcation lesions were more likely to experience MACE than non-LM bifurcation lesions (25% vs. 6.5%, p = 0.04).Conclusions: Percutaneous revascularization of complex bifurcation lesions with the AXXESS stent is safe and provides excellent long-term results, especially in non-LM lesions

Age and gender effects on the association of sleep insufficiency with hypertension among adults in Greece

Background: We aimed to investigate the relationship between sleep characteristics with hypertension using self-reported questionnaires. Material & methods: A total of 957 adults were classified into three groups (short [<6 h], normal [6-8 h] and long [>8 h] sleepers). Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or use of antihypertensive medication at the time of interview. Results: Overall prevalence of hypertension was 34.3%. Association between short sleep duration and hypertension that was age-specific, present only among younger and middle aged individuals and sparing the elderly, but not gender-specific, as no discrepancies existed between males and females in all age groups, was evident. Conclusion: This study promotes early pharmacological or cognitive behavioral interventions on sleep disturbances in order to reduce hypertension burden

Summarising data and factors associated with COVID‑19 related conspiracy theories in the first year of the pandemic:a systematic review and narrative synthesis

Conspiracy theories can have particularly harmful effects by negatively shaping health-related behaviours. A significant number of COVID-19 specific conspiracy theories emerged in the immediate aftermath of the pandemic outbreak. The aim of this study was to systematically review the literature on conspiracy theories related to COVID-19 during the first year of the pandemic (2020), to identify their prevalence, their determinants and their public health consequences. A comprehensive literature search was carried out in PubMed and PsycINFO to detect all studies examining any conspiracy theory related to COVID-19 between January 1st 2020, and January 10th 2021. Forty-three studies were included with a total of 61,809 participants. Between 0.4 and 82.7% of participants agreed with at least one conspiracy belief. Certain sociodemographic factors (young age, female gender, being non-white, lower socioeconomic status), psychological aspects (pessimism, blaming others, anger) and other qualities (political conservatism, religiosity, mistrust in science and using social media as source of information) were associated with increased acceptance of conspiracy theories. Conspiracy beliefs led to harmful health-related behaviours and posed a serious public health threat. Large-scale collaborations between governments and healthcare organizations are needed to curb the spread of conspiracy theories and their adverse consequences

The role of intravascular imaging in chronic total occlusion percutaneous coronary intervention

Chronic total occlusions (CTOs) represent the most complex subset of coronary artery disease and therefore careful planning of CTO percutaneous coronary recanalization (PCI) strategy is of paramount importance aiming to achieve procedural success, and improve patient's safety and post CTO PCI outcomes. Intravascular imaging has an essential role in facilitating CTO PCΙ. First, intravascular ultrasound (IVUS), due to its higher penetration depth compared to optical coherence tomography (OCT), and the additional capacity of real-time imaging without need for contrast injection is considered the preferred imaging modality for CTO PCI. Secondly, IVUS can be used to resolve proximal cap ambiguity, facilitate wire re-entry when dissection and re-entry strategies are applied and most importantly to guide stent deployment and optimization post implantation. The role of OCT during CTO PCI is currently limited to stent sizing and optimization, however, due to its high spatial resolution, OCT is ideal for detecting stent edge dissections and strut malapposition. In this review, we describe the use of intravascular imaging for lesion crossing, plaque characterization and wire tracking, extra- or intra-plaque, and stent sizing and optimization during CTO PCI and summarize the findings of the major studies in this field

Sleep insufficiency and incident diabetes mellitus among indigenous and minority populations in Greece

Objective: To investigate the potential association between sleep pathology and diabetes mellitus (DM) using self-reported questionnaires. Material and Methods: 957 adults aged between 19 and 86 years old were enrolled in this cross-sectional study. Multistage stratified cluster sampling was used and subjects were classified into three groups [short (8h) sleep duration]. Individuals were classified as diabetics if they responded positively to the questions: “Have you ever been told that you are diabetic or have high blood sugar by a health professional?” or “Are you on antidiabetic medication?”. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results: DM prevalence was higher among expatriated and Muslim Greeks (23.1% and 18.7%, respectively) compared to indigenous Greek Christians (4.4%). DM prevalence was significantly associated with short sleep duration (aOR=2.82, p<0.001), excessive daytime sleepiness (aOR=2.09, p=0.019) and poor sleep quality (aOR=2.56, p<0.001), while its relation with insomnia (aOR=1.63, p=0.065) and risk for obstructive sleep apnea (aOR=1.53, p=0.080) were of marginal statistical significance. Conclusion: This study indicates an association between sleep quantity, quality and DM and supports early pharmacological and cognitive behavioral interventions on sleep disturbances in order to reduce the burden of DM with increased focus on minority population needs

Association between sleep insufficiency and dyslipidemia: a cross-sectional study among Greek adults in the primary care setting

Objective: To investigate the potential association between sleep insufficiency and dyslipidemia (DL) in the primary care setting using self-reported questionnaires. Material and Methods: 957 adults aged between 19 and 86 years old from the rural area of Thrace, Greece were enrolled in this cross-sectional study. Multistage stratifed cluster sampling was used and the subjects were classifed into three groups according to sleep duration [short (8h) sleep duration]. DL was defined by a positive response to the question “Have you ever been told by a doctor or health professional that your blood cholesterol or triglyceride levels were high?”, or if they were currently taking antilipidemic agents. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results: DL prevalence was significantly associated with short sleep duration (aOR=2.18, p<0.001) and insomnia (aOR=1.43, p=0.050), while its relation with poor sleep quality (aOR=1.31, p=0.094) and risk for obstructive sleep apnea (aOR=1.32, p=0.097) were of marginal statistical significance. Concerning insomnia subtypes, DL was significantly associated with difficulties maintaining sleep (aOR=2.99, p<0.001) and early morning awakenings (aOR=1.38, p=0.050), but not difficulties initiating sleep (aOR=1.18, p=0.328). Conclusion: This study reveals an association between sleep pathology and DL. Thus, early pharmacological and cognitive or behavioral interventions that improve sleep are deemed necessary in order to decrease DL burden

Coronary artery ectasia and it's relation with inflammatory markers in patients with or without colonary artery disease

T-helper (Th) lymphocytes are present in significant numbers in the atherosclerotic plaque. Even though coronary artery ectasia (CAE), a variant of coronary atherosclerosis, has been associated with increased levels of inflammatory markers, the underlying mechanism that determines the role of inflammation in CAE remains controversial.We evaluated the hypothesis that CAE might be associated with a specific pattern of Th-lymphocyte activation by measuring the Th-1 cytokine, interleukin-2 (IL-2) and the Th-2 cytokines, interleukin-4 (IL-4) and interleukin-6 (IL-6) in patients with CAE, obstructive coronary artery disease (CAD) and normal individuals.Plasma levels of IL-2, IL-4 and IL-6 were measured in 74 patients undergoing an elective cardiac catheterization due to symptoms of chest pain and positive or equivocal results during non-invasive screening for cardiac ischemia: 34 patients had CAE and non-obstructive CAD (group A), 22 had obstructive CAD without CAE (group B) and 18 had normal coronary arteries (group C). Group A had significantly higher levels of IL-4 compared to group B and group C (p<0,001 and p=0,006, respectively). In contrast, Group A had markedly lower levels of IL-2 compared to group B and group C (p<0,001 for both comparisons). Serum IL-4 was higher in group C compared to group B, whereas group B had higher IL-2 levels than group C (p<0,001 for both comparisons). Serum levels of IL-6 were significantly higher in group A and B compared to group C (p<0,001 for both comparisons), whilst they were comparable between group A and B. Multivariate logistic regression analysis showed that higher levels of IL-4 and lower levels of IL-2 were the strongest independent predictors associated with the incidence of CAE whilst IL-6 depicted a weaker positive relation (OR: 3,846, CI: 1,677-8,822, p=0,001, OR: 0,567, CI: 0,387-0,831, p=0,004 and OR: 1,481 CI: 1,036-2,033, p=0,03, respectively).Our data demonstrates for the first time that Th-2 inflammatory response exhibited through increased serum levels of IL-4 and low serum IL-2 constitutes a fundamental feature of CAE phenotype. The above findings may be interpreted, apart from their pathophysiologic significance, towards the effort of discovering a novel approach in the diagnosis, prognosis and therapy of patients with coronary artery ectasia.Τα Τ-βοηθητικά λεμφοκύτταρα (Th) είναι παρόντα σε σημαντικές συγκεντρώσεις στις αθηρωματικές πλάκες. Η εκτασία των στεφανιαίων αρτηριών, μια μορφή στεφανιαίας αθηρωμάτωσης, έχει συσχετισθεί με την αυξημένη φλεγμονώδη απάντηση. Ωστόσο, οι ακριβείς παθογενετικοί μηχανισμοί που καθορίζουν το ρόλο της φλεγμονής στην δημιουργία εκτασίας παραμένουν ασαφείς.Διερευνήσαμε την υπόθεση πως η εκτασία των στεφανιαίων αρτηριών είναι δυνατόν να συνδέεται με συγκεκριμένα πρότυπα φλεγμονώδους ενεργοποίησης μέσω Th-λεμφοκυττάρων. Συνεπώς προσδιορίστηκαν τα επίπεδα της Th-1 κυτταροκίνης ιντερλευκίνης-2 (IL-2) και των Th-2 κυτταροκινών ιντερλευκίνης-4 (IL-4) και ιντερλευκίνης-6 (IL-6) στον ορό ασθενών με εκτασία των στεφανιαίων αρτηριών, αποφρακτική στεφανιαία νόσο και φυσιολογικές στεφανιαίες αρτηρίες.Τα επίπεδα των IL-2, IL-4, IL-6 ορού μετρήθηκαν σε 74 ασθενείς οι οποίοι υπεβλήθησαν σε εκλεκτική στεφανιογραφία λόγω κλινικού συνδρόμου στηθάγχης και θετικών αναίμακτων δοκιμασιών μυοκαρδιακής ισχαιμίας. Οι ασθενείς ταξινομήθηκαν σε τρεις ομάδες με βάση αγγειογραφικά δεδομένα. Η πρώτη ομάδα (ομάδα A, n=34) αποτελείται από ασθενείς με εκτασία των στεφανιαίων αρτηριών χωρίς αποφρακτική στεφανιαία νόσο. Η δεύτερη ομάδα (ομάδα B, n=22) αποτελείται από ασθενείς με αποφρακτική στεφανιαία νόσο χωρίς εκτασία. Τέλος, η τρίτη ομάδα (ομάδα Γ, n=18) αποτελείται από ασθενείς με αγγειογραφικά φυσιολογικές στεφανιαίες αρτηρίες.Η ομάδα Α εμφάνισε σημαντικά υψηλότερα επίπεδα IL-4 ορού σε σύγκριση με τους ασθενείς της ομάδας Β και της ομάδας Γ (p<0,001 και p=0,006, αντίστοιχα). Αντίθετα, η ομάδα Α παρουσίασε σημαντικά χαμηλότερα επίπεδα IL-2 ορού σε σχέση με την ομάδα Β και την ομάδα Γ (p<0,001 και για τις δύο συγκρίσεις). Τα επίπεδα IL-4 ορού ήταν σημαντικά υψηλότερα στην ομάδα Γ σε σχέση με την ομάδα Β, ενώ η ομάδα Β εμφάνισε υψηλότερα επίπεδα IL-2 σε σχέση με την ομάδα Γ (p<0,001 και για τις δύο συγκρίσεις). Τα επίπεδα της IL-6 ορού ήταν σημαντικά υψηλότερα στις ομάδες Α και B όταν αυτές συγκρίθηκαν με την ομάδα Γ (p<0,001 και για τις δύο συγκρίσεις). Ωστόσο, οι ομάδες Α και B παρουσίαζαν συγκρίσιμα επίπεδα IL-6 ορού. Η πολυπαραγοντική λογιστική ανάλυση παλινδρόμησης αποκάλυψε πως τα υψηλότερα επίπεδα IL-4 ορού και τα χαμηλότερα επίπεδα IL-2 ορού αποτελούσαν τους ισχυρότερους ανεξάρτητους παράγοντες που συσχετίστηκαν με την παρουσία εκτασίας των στεφανιαίων αρτηριών ενώ η IL-6 παρουσίασε ασθενέστερη θετική συσχέτιση (OR: 3,846, CI: 1,677-8,822, p=0,001, OR: 0,567, CI: 0,387-0,831, p=0,004 και OR: 1,481 CI: 1,036-2,033, p=0,03, αντίστοιχα).Τα δεδομένα της παρούσας μελέτης καταδεικνύουν για πρώτη φορά στη βιβλιογραφία πως η Th-2 φλεγμονώδης απάντηση η οποία διαμεσολαβείται μέσω των αυξημένων επιπέδων IL-4 ορού και των ελαττωμένων επιπέδων IL-2 ορού συνιστά κομβικό χαρακτηριστικό του φαινότυπου της εκτασίας των στεφανιαίων αρτηριών. Τα ευρήματα αυτά μπορούν να αξιολογηθούν, εκτός της παθοφυσιολογικής τους χρήσης, στη συνισταμένη προσπάθεια για νέες προσεγγίσεις στη διάγνωση, πρόγνωση και θεραπεία των ασθενών με στεφανιαία εκτασία