Paclitaxel in endovascular devices. Identikit of a “serial killer”?

Recent developments in the management of peripheral artery disease have been momentous, and a key advance has been the introduction of drug-coated balloons, which capitalise on the mechanical effects of angioplasty balloons, and on the pharmacologic effects of anti-restenotic drugs [1,2]. Indeed, single reports from randomized trials and pooled estimates from meta-analyses have clearly showed that paclitaxel-coated balloons reduce the risk of restenosis and repeat revascularization, while improving patency, limb salvage, and freedom from claudication

Veneto's successful lesson for a world shocked by COVID-19: think globally and act locally

Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) infection has wreaked havoc globally, with an ominous morbidity and mortality impact.1,2 Indeed, croronavirus disease 2019 (COVID-19) still represents a formidable challenge for pathophysiology, prognostication, management, and rehabilitation. This holds even truer given the conflicting reports accrued so far for several purportedly effective interventions.1,3,4 Although substantial steps have been accomplished in terms of diagnostic yield, even recognizing early infection is still quite challenging. Each country has addressed COVID-19 in its own way, with variable results. Perusing data on China’s experience with the virus brings forward several questions in terms of completeness and truthfulness of reporting, with substantial skepticism despite several authoritative reports.5 For instance, to date, China has reported fewer COVID-19-related deaths than many smaller countries where COVID-19 spread much later (eg, The Netherlands). Countries and healthcare systems that have acted with a global vision, but also with a firm and proactive local hand, have seen the best results in terms of deaths and system derangement. Conversely, countries with a loose policy (either initially such as the United Kingdom or throughout such as Sweden) have already paid an enormous toll of life and pain, and hypothetically will continue to do so

SARS-CoV-2 and COVID-19. Facing the pandemic together as citizens and cardiovascular practitioners

Despite their highbrow name, coronarvirus have proved eminently disruptive in recent years. Since the epidemic of severe respiratory distress syndrome (SARS) due to the SARS-related coronavirus (SARS-CoV) infection and the Middle East respiratory syndrome (MER S) due to the MER S-related coronavirus (MER S-CoV), several experts could expect the advent of additional epidemics due to coronaviruses. Yet, the ongoing pandemic of coronavirus-associated disease 2019 (COVID -2019) due to the infection from SARS-CoV-2 (also known as 2019-nCoV) has wreaked havoc worldwide (Figure 1). As Italian citizens and cardiovascular practitioners, we are now facing this storm, with a mix of incredulity, fear, boldness, and sense of duty

Interpersonal violence. Serious sequelae for heart disease in women

Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease, both shortly after the event and during follow-up, particularly in women. The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women, possibly due to several contributing factors, ranging from lockdown, stay at home regulations, job losses, anxiety, and stress. Accordingly, it remains paramount to enforce proactive preventive strategies, at both the family and individual level, maintain a high level of attention to recognize all forms of violence or abuse, and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical, sexual, and emotional domains and offer a personalized care

Relationship between angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and SARS-CoV-2 infection. Where are we?

In recent months SARS-CoV-2 has spread rapidly throughout the world. The case fatality rate is higher in cardiovascular disease and hypertension. Other comorbidities do not seem to confer the same risk, therefore the understanding of the relationship between infection and cardiovascular system could be a crucial point for the fight against the virus. A great interest is directed towards the angiotensin 2 converting enzyme (ACE 2) which is the SARS-CoV-2 receptor and creates important connections between the virus replication pathway, the cardiovascular system and blood pressure. All cardiovascular conditions share an imbalance of the renin angiotensin system in which ACE 2 plays a central role. In the early pandemic period, much confusion has appeared about the management of therapy with angiotensin converting enzyme inhibitors and angiotensin receptor blockers especially in infected patients and in those at risk of critical illness in case of infection. In this article we will try to reorder the major opinions currently emerging on this topic

Optimal stent design for high bleeding risk patients: Evidence from a network meta-analysis

Objective. To determine the best stent design for high bleeding risk (HBR) patients. Background. Polymer-free (PF) drug eluting stent (DES) devices have a proven benefit over bare-metal stent (BMS) devices in previous trials. It is unknown, however, whether polymer-based (PB)-DES devices are as safe as PF-DES devices. Methods. A network meta-analysis including all randomized controlled trials (RCTs) that compared different stent technology in HBR patients with a 1-month course of dual-antiplatelet therapy (DAPT) was performed. The main efficacy outcome was major adverse cardiac event (MACE) rate, defined as the composite of all-cause mortality, myocardial infarction (MI), and target-lesion revascularization (TLR). Secondary efficacy events included all-cause and cardiac mortality, MI, stroke, TLR, and target-vessel revascularization (TVR). Safety outcomes included all bleeding, major bleeding, and stent thrombosis (ST). Results. A total of 4 RCTs with 6456 patients were included. PF-DES and PB-DES yielded a reduced rate of MACE, MI, TLR, and TVR events compared with BMS (all P<.05). ST events were reduced in PB-DES compared with BMS (P=.01). No differences were found in all-cause death, cardiac death, or stroke events in PF-DES and PB-DES compared with BMS. Furthermore, no differences were found between PF-DES and PB-DES regarding any of the outcomes. Conclusion. DES devices were associated with lower MACE and TVR rates compared with BMS, whereas there were no statistical differences in other efficacy endpoints. Also, PB-DES were associated with fewer ST events compared with BMS. There were no statistical differences between PB-DES and PF-DES with regard to any of the endpoints. t 2021 HMP Comm Personal Use Onl

Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection : a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO

Introduction: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI.Methods: CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus (updated 2 January 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods.Results: From 1,196 initial citations, 8 studies were selected, including 1,357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median Sequential Organ Failure Assessment (SOFA) score of 9, and had received mechanical ventilation before ECMO implementation for a median of two days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18% to 37%; I2= 64%).Conclusions: ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (more than one week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death

Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients

BACKGROUND: Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures. METHODS: Pertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals). RESULTS: A total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access. CONCLUSIONS: Right and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs