Gallbadder varices

Introduction: Gallbladder varices (GBV) are relatively rare ectopic varices in patients with portal hypertension (PH). The aim of the study is to investigate clinical, imagistic and endoscopic data of patients diagnosed with GBV. Material and Methods: Patients diagnosed with GBV over a period of 10 years were identified from the comprehensive database of our institution. Results: There were seven patients (F-4, M-3) with the mean age of 27.9 ± 5.2 (10 to 51) years. PH was caused by portal vein thrombosis (portal cavernoma): after splenectomy for trauma and hematologic disease (n=4), antithrombin III deficiency (n=2) and protein S deficiency (n=l). At time of presentation GBV (n=6) were associated with bleeding esophageal varices (F3, RCS++-i-, Li+m) managed by endoscopic band ligation MBL-6,10 (Wilson-Cook®, Winston-Salem, NC, SUA) and bleeding duodenal varices managed surgically (n=l). Doppler imaging showed the existence of portal cavernoma and GBV. After complete eradication of esophageal varices no GBV enlargement neither other related complications were noticed. Conclusion: Color Doppler sonography is a valuable noninvasive imaging technique for assessment of portal hemodynamic profile in patients with portal cavernoma as well as a useful technique to detect GBV. Preoperative correct diagnosis of GBV should increase the surgeon’s vigilance during biliary tract surgery in patients with PH in order to avoid hazardous complications

Management of bleeding ectopic varices

Introduction: Bleeding ectopic varices (EcV) are uncommon and a difficult conditions to manage. The clinical data of patients diagnosed and treated for bleeding EcV were reviewed to investigate the treatment strategy. Material and Methods: Patients diagnosed with bleeding EcV over a period of 10 years were identified from the comprehensive surgical database of our institution. Results: There were six patients (F-2, M-4) with the mean age of 46.8 ± 7.3 (20 to 76) years. The location of the EcV was: duodenal (DV, n=2), isolated gastric varices type 2 (IGV2) according Sarin classification (n=2), and rectal (RV, n=2). EcV were induced by liver cirrhosis (LC) - 2, posthrombotic portal cavernoma (PC) - 1, LC+PC - 1, hepatocelullar carcinoma (HCC) +PC-1 and left-sided portal hypertension -1. The EcV were managed as an emergency in 4 (DV-2, IGV2-2) and elective in 2 with RV. Bleeding EcV were managed by endoscopic ligation with HX-21L-1 (Olympus®, ET, Japan) device with mini-loop MAJ-339 (n=2, DV and IGV2) and endoscopic ligation with HMBL-4 (Wilson-Cook®, Winston-Salem, NC, SUA) (n=2, RV). Haemostatic efficacy was achieved in all cases. Surgery was performed in 2 pts: for IGV2 - stapling fundectomy with splenectomy and for DV - surgical ligation of affected vessels. Inhospital lethality was - 1/6 (16.6%). Conclusion: Bleeding EcV’s are a challenging emergency, haemostatic procedures depending on the site, bleeding activity and local expertise

P2652Seasonal influences on clinical features, comorbidities, and outcome in patients with ST-elevation myocardial infarction managed invasively

Abstract Background Outcome of STEMI patients has improved in the last years, with better survival due to an improved onset of symptoms to balloon time, and better pharmacological and nonpharmacological treatment. However, influences of seasonal differences are not studied yet. Purpose To identify differences in clinical features, associated comorbidities, and outcome of ST-elevation myocardial infarction (STEMI) patients, related to seasonal differences, in a temperate continental climate. Methods We examined data from the electronic STEMI registry from a high-volume PPCI center. We analyzed retrospectively data from 518 STEMI patients, managed invasively, admitted in the last year. We compared clinical features, comorbidities, and outcome, between winter months (December, January, and February) and summer months (June, July, and August). Results 269 (52%) patients (74% men, median age 61 years) were admitted during winter months, while 249 (48%) patients (80% men, median age 59 years) were admitted during summer months. Killip class at admission was higher during winter (χ2=10.2; p=0.017), with significant differences for all Killip classes (Killip I: 83% winter vs. 92% summer; Killip II: 8.6% winter vs. 4.4% summer; Killip III: 3.7% winter vs. 1.2% summer; Killip IV: 4.5% winter vs. 2.0% summer, p=0.04). Meanwhile, maximal Killip class anytime during hospitalization was higher during winter (χ2=9.7; p=0.021). In terms of comorbidities, a trend toward more frequent atrial fibrillation (AF) was recorded during winter (5.2% vs. 2,0%; χ2=3.7; p=0.053). Severe left ventricular dysfunction (LVEF&lt;30%) was more frequent among patients admitted in winter (9.7% vs. 4.4%; χ2=5.4, p=0.020). In-hospital mortality was higher during winter (9.7% vs. 4.4%; χ2=5.4; p=0,020). We computed a predictive model for in-hospital death for STEMI patients, using stepwise logistic regression analysis. Independent significant predictors were seasonal months, blood glycemia, and creatinine (χ2=53.3, p&lt;0.005). Patients with STEMI admitted during winter months had a 2.8-fold increase in probability of death during index hospitalization compared with summer months. Conclusions Winter months are associated with worse clinical features, more frequent AF, worse LV function, and higher risk of death of STEMI patients managed invasively than summer months. We consider temperature differences, changes in air pressure, decrease in physical activity, and increase in food intake as possible explanations for worse evolution of winter patients. A prospective dedicated research is necessary to provide detailed explanations. </jats:sec

Impact of chronic coronary syndromes on cardiovascular hospitalization and mortality: the ESC-EORP CICD-LT registry

Abstract Aims In Europe, global data on guideline adherence, geographic variations, and determinants of clinical events in patients with chronic coronary syndrome (CCS) remain suboptimal. The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease Long-Term (CICD-LT) registry is a prospective European registry, and was designed to describe the profile, management, and outcomes of patients with CCS across the ESC countries. Methods and results We aimed to investigate clinical events at 1-year follow-up from the ESC EORP CICD-LT registry. One-year outcomes of 6655 patients from the 9174 recruited in this European registry were analysed. Overall, 168 patients (2.5%) died, mostly from cardiovascular (CV) causes (n = 97, 1.5%). Northern Europe had the lowest CV mortality rate, while southern Europe had the highest (0.5 vs. 2.0%, P = 0.04). Women had a higher rate of CV mortality compared with men (2.0 vs. 1.3%, P = 0.02). During follow-up, 1606 patients (27.1%) were hospitalized at least once, predominantly for CV indications (n = 1220, 20.6%). Among the population with measured low-density lipoprotein-cholesterol level at 1 year, 1434 patients (66.5%) were above the recommended target. Age, history of atrial fibrillation, previous stroke, liver disease, chronic obstructive pulmonary disease or asthma, increased serum creatinine, and impaired left ventricular function were associated with an increased risk of CV death or hospitalization. Conclusion In the CICD registry, the majority of patients with CCS have uncontrolled CV-risk factors. The 1-year mortality rate is low, but these patients are frequently hospitalized for CV causes. Early identification of comorbidities may represent an opportunity for enhanced care and better outcomes. </jats:sec

Cohort profile. the ESC-EORP chronic ischemic cardiovascular disease long-term (CICD LT) registry

The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease registry Long Term (CICD) aims to study the clinical profile, treatment modalities and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid and long term outcomes and their determinants in this population

The ESC-EORP Chronic Ischaemic Cardiovascular Disease Long Term (CICD LT) registry

Abstract Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischaemic Cardiovascular Disease Long Term (CICD LT) registry aims to study the clinical profile, treatment modalities, and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular (CV) risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid- and long-term outcomes and their determinants in this population. Methods and results Nine thousand one hundred and seventy-four patients over 18 years with documented CICD defined by a history acute coronary syndrome with/without ST elevation, previous coronary revascularization, or stable coronary artery disease were enrolled between 1 May 2015 and 31 July 2018. Individual patient data on clinical profile, biology, and treatment modalities were collected across 154 centres from 20 ESC countries. Two years of follow-up is scheduled in order to determine the following clinical outcomes: all-cause and CV death, all-cause and CV hospitalizations, changes in medications, and quality of life using the EuroQol5D-5L score. Conclusion The CICD LT is an international registry of care and outcomes of patients hospitalized with CICD which will provide insights into the contemporary profile and management of patients with this common disease. </jats:sec

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events