Hemodynamic comparison of transcatheter aortic valve replacement with theSAPIEN3 Ultra versusSAPIEN3 : TheHomoSAPIENregistry

Objectives The study aims to compare the hemodynamic and clinical outcomes of the SAPIEN 3 Ultra (S3-Ultra) with the SAPIEN 3 (S3) system in patients who underwent transfemoral transcatheter aortic valve replacement (TF-TAVR). Background The new balloon-expandable S3-Ultra system incorporates new features to reduce paravalvular leakage (PVL). However, the data after the S3-Ultra implantation is very limited. Methods A total of 282 consecutive patients who underwent TF-TAVR with the S3-Ultra and the S3 were evaluated. The primary outcome of this study was to compare the incidence of >= mild PVL after the S3-Ultra and S3 implantation. Results Between June 2017 and November 2019, 141 patients with the S3-Ultra and 141 patients with the S3 were identified with similar baseline and preprocedural imaging characteristics (mean age: 79.6 +/- 6.7 years and mean aortic annulus area: 492.5 +/- 91.2 mm(2)). In total, 83 patients (29.4%) were treated with 29-mm valve. Predischarge echocardiography demonstrated a significantly lower incidence of >= mild PVL (the total cohort: 7.2 vs. 22.3%,p = mild PVL compared with the S3 system in multivariate analysis. There were no significant differences in clinical outcomes at 30-day between these groups, except for the lower incidence of major vascular complication (4.5 vs. 11.4%,p= .05) in patients with the S3-Ultra. Conclusions In this registry, the S3-Ultra system performed superiorly to the S3, as demonstrated by reduced >= mild PVL, with comparable safety.Peer reviewe

Hemodynamic comparison of transcatheter aortic valve replacement with theSAPIEN3 Ultra versusSAPIEN3 : TheHomoSAPIENregistry

Objectives The study aims to compare the hemodynamic and clinical outcomes of the SAPIEN 3 Ultra (S3-Ultra) with the SAPIEN 3 (S3) system in patients who underwent transfemoral transcatheter aortic valve replacement (TF-TAVR). Background The new balloon-expandable S3-Ultra system incorporates new features to reduce paravalvular leakage (PVL). However, the data after the S3-Ultra implantation is very limited. Methods A total of 282 consecutive patients who underwent TF-TAVR with the S3-Ultra and the S3 were evaluated. The primary outcome of this study was to compare the incidence of >= mild PVL after the S3-Ultra and S3 implantation. Results Between June 2017 and November 2019, 141 patients with the S3-Ultra and 141 patients with the S3 were identified with similar baseline and preprocedural imaging characteristics (mean age: 79.6 +/- 6.7 years and mean aortic annulus area: 492.5 +/- 91.2 mm(2)). In total, 83 patients (29.4%) were treated with 29-mm valve. Predischarge echocardiography demonstrated a significantly lower incidence of >= mild PVL (the total cohort: 7.2 vs. 22.3%,p = mild PVL compared with the S3 system in multivariate analysis. There were no significant differences in clinical outcomes at 30-day between these groups, except for the lower incidence of major vascular complication (4.5 vs. 11.4%,p= .05) in patients with the S3-Ultra. Conclusions In this registry, the S3-Ultra system performed superiorly to the S3, as demonstrated by reduced >= mild PVL, with comparable safety.Peer reviewe

B-type natriuretic peptide ability to predict mortality after transcatheter aortic valve replacement

Peer reviewe

Device Failure in Bicuspid Aortic Stenosis Following Transcatheter Aortic Valve Implantation

Recent studies showed the favorable outcomes of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis. However, data on the rela-tion between BAV morphology and optimal transcatheter heart valve (THV) selection are limited. This study sought to evaluate the determinants of device performance in patients with BAV who underwent TAVI. Consecutive patients with BAV who under-went TAVI with the SAPIEN 3 from multicenters were evaluated. Outcomes were the incidence and predictors of device failure. Device failure was defined as peak aortic velocity > 3.0 m/s, mean pressure gradient > 20 mm Hg, moderate or severe paravalvular leakage and/or procedure mortality. A total of 187 patients with BAV were identified, aged 77 years, and 38.0% were women. A total of 37 patients (19.8%) were treated with 23-mm valve, 58 (31.0%) with 26-mm valve, and 92 (49.2%) with 29-mm valve. Predis -charge echocardiogram demonstrated 37 patients (19.8%) with device failure. BAV with excessive leaflet calcification plus calcified raphe (EC-BAV) (OR 16.7, 95% CI 1.99 to 39.6) and smaller THV (OR 4.41, 95% CI 1.43 to 13.6) were independently associated with increased risk of device failure. In addition, 4.0%, 5.1%, and 11.1% of device fail-ures were observed in patients without EC-BAV who underwent TAVI with 23-, 26-and 29-mm THV (p = 0.47), respectively, and 91.7%, 31.6% and 23.2% in those with EC-BAV, respectively (p < 0.001). In conclusion, EC-BAV morphology was the major deter-minant of a device failure after TAVI. Moreover, TAVI in patients with EC-BAV requir-ing small SAPIEN 3 could be challenging. Further data on device and treatment selection in patients with BAV are still warranted. (C) 2022 The Author(s). Published by Elsevier Inc.Peer reviewe

Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion : Insight from an international STEMI registry

Background: Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study. Methods: STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission. Results: Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51 & ndash;0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33 & ndash;0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084 & ndash;0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect. Conclusions: This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.Peer reviewe

Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry

Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658-1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620-1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020)

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Background. Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry. Methods. This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March–June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality. Results. We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825–0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31–2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96–1.34], p = 0.12). Conclusions. The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655

Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI : Insights from the ISACS–STEMI COVID-19 Registry

The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS– STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with nonsmokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking histor

Results of the ISACS-STEMI COVID-19 Registry

Publisher Copyright: © 2023 by the authors.Background. Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry. Methods. This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March–June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality. Results. We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825–0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31–2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96–1.34], p = 0.12). Conclusions. The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655.publishersversionpublishe

"Me ei olla pelkkiä vankeja vaan myös hyviä isiä" : Vanhemmuusteemaisen isäryhmän arviointi Riihimäen vankilassa

Opinnäytetyön tarkoituksena on arvioida Riihimäen vankilassa syksyn 2012 aikana toteutettua vanhemmuusteemaista isäryhmää. Tavoitteena on kartoittaa isäryhmän toteutukseen liittyneitä haasteita ja kohokohtia sekä kehittämistarpeita. Tavoitteena on myös tuoda esiin sekä isäryhmään osallistuneiden että ryhmän ohjaajien kokemuksia isäryhmästä. Tutkimustuloksia voidaan hyödyntää vankilan perhetyön kehittämisessä. Opinnäytetyö on tehty yhteistyössä Kriminaalihuollon tukisäätiön Ehjä perhe –toiminnan ja Riihimäen vankilan kanssa. Riihimäen vankilassa järjestettiin vanhemmuusteemainen isäryhmä vapausrangaistustaan suorittaville vangeille, joilla on alaikäisiä lapsia. Ryhmän tavoitteena oli antaa isille tukea vanhemmuuteensa vankeusaikana. Ryhmä kokoontui yhteensä kahdeksan kertaa, minkä lisäksi ryhmäläisille ja heidän lapsilleen järjestettiin kaksi yhteistapaamista. Ryhmän ohjaajina toimivat Kriminaalihuollon tukisäätiön lapsi- ja perhetyön koordinaattori, Helsingin seurakuntayhtymän erityisnuorisotyön keskuksen Snellun erityisnuorisotyöntekijä sekä Riihimäen vankilan sosiaalityöntekijä. Osallistujia isäryhmässä oli seitsemän ja heidät valittiin ryhmään haastattelujen pohjalta alkusyksystä 2012. Kaikki osallistujat olivat mukana ryhmässä sen alusta loppuun saakka. Opinnäytetyö on arviointitutkimus, joka on pääasiassa toteutettu laadullisin menetelmin, mutta pientä osaa arviointiaineistosta on käsitelty myös tilastollisin menetelmin. Arviointiaineistoa on kerätty sekä kyselylomakkeilla että teemahaastatteluilla. Opinnäytetyön teoreettisessa viitekehyksessä tarkastellaan vankeuden vaikutusta vanhemmuuteen, vankilan perhetyötä sekä vankilan kuntouttavaa toimintaa erityisesti sosiaalisesta näkökulmasta. Kaikki nämä osa-alueet ja näkökulmat muodostavat yhdessä vankiperhetyön kokonaisuuden. Sekä osallistujat ja ohjaajat että vankilan toiminnasta ja toiminnoista vastaava apulaisjohtaja kokivat vanhemmuusteemaisen isäryhmätoiminnan tarpeelliseksi ja hyödylliseksi. Isäryhmän prosessi sujui pääasiassa hyvin alkuhaastatteluista ryhmän päättämiseen saakka. Isäryhmä-toiminnan kehittämisehdotukset koskivat pääasiassa ryhmäkertojen pituutta ja lapsitapaamisten määrää. Arvioinnissa käy ilmi, että vanhemmuusteemaiselle isäryhmätoiminnalle on tarvetta ja sen järjestäminen on mahdollista suljetussa vankilassa. Arviointiaineistosta on nähtävissä, että perhetyötä ja lapsen näkökulman huomioimista tulisi lisätä vankiloissa. Sekä ryhmään osallis-tuneiden vanki-isien että ryhmän ohjaajien asettamat tavoitteet saavutettiin ryhmätoiminnan aikana. Vanki-isät kokivat saaneensa ryhmästä tukea vanhemmuuteensa, ja tämä välittyi myös ryhmän ohjaajille.“We’re not just convicts but also good fathers” ― Evaluation of a parenting-themed group for fathers in Riihimäki prison The purpose of this thesis was to evaluate a parenting-themed group meant for fathers in prison. The group gathered eight times in Riihimäki Prison during the fall of 2012. The goal of this thesis was to survey the challenges and highlights involved in the group’s activity as well as the group’s development requirements. Another goal of this thesis was to gather and present both the group’s members as well as the counselors’ experiences regarding the group. The results of the evaluation can be used in the developing of family work in Finnish prisons. This thesis was made in cooperation with Probation Foundation’s Child and Family Action or Sound Family Action and Riihimäki Prison. A parenting-themed group was arranged in Riihimäki Prison in order to provide help and support for convicts who are fathers to under-aged children. The goal of the group was to support the convicts’ parenting-skills during their time in prison. In addition to the eight group-meetings, two father and child –meetings were arranged. There were three counselors in the group, one of them being the Probation Foundation’s Child and Family Work Coordinator. The other two counselors were Riihimäki Prison’s social worker and a youth worker from the Special Youth Work Centre of the Parish Union of Helsinki. In the group there were seven convicts who were selected as group participants based on their interviews with the counselors in the beginning of autumn in 2012. All of the seven participants took part in the group from the first meeting to the last. This thesis is an evaluative survey and has been made mainly with qualitative methods, though quantitative methods have been used to gather a small part of the evaluation material as well. The evaluation material was gathered with both questionnaires and themed interviews. Imprisonment’s influences on parenting and family work in prison as well as social rehabilitation in prison are examined in the theoretical portion of this thesis. All of these areas together form the body of family work in prison. The parenting-themed group for fathers was considered necessary and useful for the participants by the convicts, the counselors and Riihimäki Prison's Deputy Director of Operations. The process of the group was successful for the most part since the beginning of the group until the end of the process. The development proposals regarding the group were mostly about the length of the meetings and the amount of father-child-meetings. This evaluation clearly presents the need for this kind of activity. It is shown that this kind of activity can be arranged in a closed prison with high safety standards. The evaluation material also shows that the amount of family work and also the consideration of convicts’ children in prison should be increased. Both the group’s participants’ and counselors’ goals were achieved during the group-process. Both the convicts as well as the group counselors felt that the fathers benefited from the supporting of their parenting abilities