Is cytisine contraindicated in smoking patients with coronary artery disease after percutaneous coronary intervention?

Background: Cytisine is contraindicated, and its effects have not been evaluated in patients with coronary artery disease (CAD).Aims: The safety, feasibility, and short-term efficacy of cytisine for smoking cessation were evaluated in active smokers with CAD after percutaneous coronary interventions (PCI).Methods: Patients with stable CAD and acute coronary syndromes (ACS), who smoked at least 10 cigarettes per day, were included 30 days post PCI and offered cytisine therapy. Adverse events, smoking activity, and drug adherence were assessed after 30 days.Results: 117 patients participated (mean standard deviation [SD] age, 60.8 [7.7] years; men, 73.6%, median and interquartile range [IQR] of the number of pack-years, 40 [30–46.5]). Overall, 79 patients consented (study group) and 38 declined (control group) to use cytisine. At the follow-up visit, the incidence of adverse events did not differ between groups (17.7% vs 21%; P = 0.67). The groups had a similar success rate of smoking cessation in the intention-to-treat analysis (41.8% vs 36.8%; P = 0.61). In the as-treated analysis, patients who completed the therapy achieved a higher success rate than those who declined (69.7% vs 36.9%; P = 0.006) or did not complete therapy (69.7% vs 34.8%; P = 0.01). In the multivariable analysis, complete cytisine therapy and ACS at admission were associated with an increased and male sex with a decreased chance of smoking cessation.Conclusions: Cytisine therapy is not associated with an increase in adverse events in patients with CAD after PCI. Cytisine is tolerable but effective in short-term follow-up only when the treatment is completed

Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus

Background: Many patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF.Methods: Sixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S’) were measured and Tei index was calculated before and 3 months after PCI.Results: Before PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (D) of LVEF, GLS, S’, and Tei index. LV function improvement expressed as DGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (b = 0.003, 95% confidence interval: 0.0004–0.005; p = 0.02).Conclusions: Percutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function

Dwukierunkowe hamowanie w miażdżycy układu sercowo-naczyniowego — ostatnie postępy

Choroba układu sercowo-naczyniowego o podłożu miażdżycy (ASCVD, atherosclerotic cardiovascular disease), która obejmuje chorobę wieńcową (CAD, coronary artery disease), chorobę naczyń mózgowych oraz chorobę tętnic obwodowych (PAD, peripheral arterial disease), wiąże się z dużą zachorowalnością, śmiertelnością i kosztami opieki zdrowotnej. Terapia przeciwpłytkowa była od dawna podstawą leczenia przeciwzakrzepowego w profilaktyce pierwszych i ponownych incydentów ASCVD. Jednak ostatnie randomizowane badania pokazały zalety i efektywność kosztową strategii dwukierunkowego hamowania (DPI, dual pathway inhibition) w ostrej i przewlekłej ASCVD. Kwas acetylosalicylowy stosowany w skojarzeniu z małą dawką rywaroksabanu działają synergistycznie, hamując aktywację płytek krwi i generację trombiny, tym samym zapobiegając powstawaniu skrzepliny. Wśród pacjentów z niedawnym ostrym zespołem wieńcowym (ACS, acute coronary syndrome), ci z dodatnimi biomarkerami sercowymi, zawałem serca z uniesieniem odcinka ST lub historią niewydolności serca odnoszą największe bezwzględne korzyści. Wśród pacjentów z przewlekłą ASCVD, ci z zajęciem dwóch lub więcej łożysk naczyniowych, niewydolnością serca, przewlekłą chorobą nerek lub cukrzycą odnoszą największe bezwzględne korzyści. Dodatkowe badania są w trakcie realizacji, celem oceny wpływu terapii DPI w innych interesujących populacjach, w tym pacjentów z ACS z dużym ryzykiem powstania skrzepliny w lewej komorze, wewnątrzczaszkową miażdżycą tętnic po niedawno przebytym przemijającym napadzie niedokrwienia mózgu lub udarze, chorobą tętnic obwodowych z chromaniem przestankowym lub po rewaskularyzacji kończyn dolnych i zaawansowaną przewlekłą chorobą nerek z ASCVD lub czynnikami ryzyka ASCVD. Dalsze badania są potrzebne w celu oceny możliwych dodatkowych korzyści z łączenia rywaroksabanu z klopidogrelem lub tikagrelorem zamiast kwasu acetylosalicylowego

Dual pathway inhibition for atherosclerotic cardiovascular disease: Recent advances

Atherosclerotic cardiovascular disease (ASCVD), which includes coronary artery disease (CAD), cerebrovascular disease, and peripheral arterial disease (PAD) is associated with significant morbidity, mortality, and healthcare costs. Antiplatelet therapy has long been the mainstay of antithrombotic therapy for the prevention of first-ever and recurrent ASCVD events. More recently, however, randomized trials have demonstrated the benefits and cost-effectiveness of a dual pathway inhibition (DPI) strategy in acute and chronic ASCVD. When used in combination, aspirin and low-dose rivaroxaban work synergistically to inhibit platelet activation and thrombin generation, thereby preventing thrombus formation. Among patients with recent acute coronary syndrome (ACS), those with positive cardiac biomarkers or ST-segment elevation myocardial infarction, or a history of heart failure derive the greatest absolute benefits. Among patients with chronic ASCVD, those with involvement of two or more vascular beds, heart failure, chronic kidney disease, or diabetes derive the greatest absolute benefits. Additional trials are underway to assess the impact of DPI therapy in other populations of interest, including patients with ACS at high risk of left ventricular thrombus formation, intracranial atherosclerotic disease with recent transient ischemic attack or stroke, peripheral arterial disease with limiting claudication or post lower extremity revascularization, and advanced chronic kidney disease with ASCVD or risk factors for ASCVD. Further work is required to assess the possible added benefit of combining rivaroxaban with clopidogrel or ticagrelor instead of aspirin

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry.

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.Since the start of EORP, the following companies have supported the programme: Abbott Vascular Inc. (2011–20), Amgen Cardiovascular (2009–18), AstraZeneca (2014–21), Bayer AG (2009–18), Boehringer Ingelheim (2009–19), Boston Scientific (2009–12), Bristol Myers Squibb and Pfizer Alliance (2011–19), Daiichi Sankyo Europe GmbH (2011–20), the Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–17), Edwards (2016–19), Gedeon Richter Plc. (2014–16), Menarini Int. Op. (2009–12), MSD-Merck & Co. (2011–14), Novartis Pharma AG (2014–20), ResMed (2014–16), Sanofi (2009–11), Servier (2009–21), and Vifor (2019–22).S

Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology

BACKGROUND: The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care, and outcomes of NSTEMI by country income classification. METHODS AND RESULTS: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack, and death, and 30-day mortality. Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared with patients in HICs, were younger, more commonly diabetic, and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; P < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; P = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; P < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; P < 0.001) exhibited an inverse economic gradient. CONCLUSION: Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries