MitraClip after heart transplantation: A case report

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The impact of COVID-19 on myocardial infarctions, strokes and out-of-hospital cardiopulmonary arrests: an observational retrospective study on time-sensitive disorders in the Friuli Venezia Giulia region (Italy)

The COVID-19 global pandemic has changed considerably the way time-sensitive disorders are treated. Home isolation, people's fear of contracting the virus and hospital reorganisation have led to a significant decrease in contacts between citizens and the healthcare system, with an expected decrease in calls to the Emergency Medical Services (EMS) of the Friuli-Venezia Giulia (FVG) region. However, mortality in clinical emergencies like acute ST-elevation myocardial infarction (STEMI), stroke and out-of-hospital cardiopulmonary arrest (OHCA) remained high. An observational retrospective cross-sectional study was carried out in FVG, taking into account the period between March 1, 2020, and May 31, 2020, the first wave of the COVID-19 pandemic, and comparing it with the same period in 2019. The flow of calls to the EMS was analysed and COVID-19 impact on time-sensitive disorders (STEMIs, ischemic strokes and OHCPAs) was measured in terms of hospitalisation, treatment and mortality. Despite a -8.01% decrease (p value ˂0.001) in emergency response, a 10.89% increase in calls to the EMS was observed. A lower number of advanced cardiopulmonary resuscitations (CPR) (75.8 vs 45.2%, p=0.000021 in April) and ROSC (39.1 vs 11.6%, p=0.0001 in April) was remarked, and survival rate dropped from 8.5 to 5%. There were less strokes (-27.5%, p value=0.002) despite a more severe onset of symptoms at hospitalisation with NHISS˃10 in 38.47% of cases. Acute myocardial infarctions decreased as well (-20%, p value=0.05), but statistical significances were not determined in the variables considered and in mortality. Despite a lower number of emergency responses, the number of calls to the EMS was considerably higher. The number of cardiac arrests treated with advanced CPR (ALS) was lower, but mortality was higher. The number of strokes decreased as well, but at the time of hospitalisation the clinical picture of the patient was more severe, thus affecting the outcome when the patient was discharged. Finally, STEMI patients decreased; however, no critical issues were observed in the variables taken into account, neither in terms of response times nor in terms of treatment times

Reversal of angiodysplasia-derived anemia after transcatheter aortic valve implantation

8no-nonenonePyxaras, Stylianos A; Santangelo, Sara; Perkan, Andrea; Vitrella, Giancarlo; Rakar, Serena; Grazia, Erica Della; Salvi, Alessandro; Sinagra, GianfrancoPyxaras, Stylianos A; Santangelo, Sara; Perkan, Andrea; Vitrella, Giancarlo; Rakar, Serena; Grazia, Erica Della; Salvi, Alessandro; Sinagra, Gianfranc

Arresto cardiaco extraospedaliero: le competenze degli studenti dell’Università degli Studi di Trieste sulle manovre rianimatorie e l’utilizzo del defibrillatore automatico esterno

Razionale. L’arresto cardiaco extraospedaliero è la terza principale causa di morte nei paesi industrializzati. Sebbene la maggior parte degli arresti cardiaci sia testimoniata, la sopravvivenza è solo del 2-10%, poiché gli astanti spesso non sono in grado di eseguire correttamente la rianimazione cardiopolmonare (RCP). Questo studio si propone di valutare le conoscenze teoriche e pratiche della RCP e dell’uso del defibrillatore automatico esterno negli studenti universitari. Materiali e metodi. Lo studio ha coinvolto 1686 studenti di 21 diverse facoltà dell’Università di Trieste, 662 studenti di facoltà sanitarie e 1024 di facoltà non sanitarie. I corsi di Basic Life Support e defibrillazione precoce (BLS-D) e di retraining ogni 2 anni, sono obbligatori per tutti gli studenti appartenente a facoltà sanitarie dell’Università di Trieste durante gli ultimi 2 anni di corso. Attraverso la piattaforma “EUSurvey” da marzo a giugno 2021 è stato loro somministrato un questionario online di 25 domande a scelta multipla per indagare le conoscenze del BLS-D. Risultati. Complessivamente dal campione emerso che il 68.7% sapeva come riconoscere un arresto cardiaco e il 47.5% conosceva il lasso di tempo che intercorre tra l’arresto cardiaco ed un danno cerebrale irreversibile. Le conoscenze pratiche sono state analizzate valutando le risposte corrette a tutte e quattro le domande sull’esecuzione della RCP (ovvero, posizione delle mani durante le compressioni, frequenza delle compressioni, profondità delle compressioni e rapporto ventilazioni-compressioni). È emerso che gli studenti delle facoltà sanitarie hanno una migliore conoscenza teorica e pratica della RCP rispetto ai loro colleghi delle facoltà non sanitarie, con una migliore conoscenza complessiva su tutte e quattro le domande pratiche (11.2% vs 4.3%; p<0.001). Gli studenti di medicina dell’ultimo anno dell’Università di Trieste, che hanno frequentato il corso BLS-D e si sono sottoposti a retraining dopo 2 anni, hanno ottenuto risultati migliori rispetto agli studenti di medicina del primo anno (non in possesso della certificazione BLS-D) (38.1% vs 2.7%; p<0.001). Conclusioni. L’obbligatorietà della formazione BLS-D e relativi retraining portano a una migliore conoscenza della gestione dell’arresto cardiaco e di conseguenza a un migliore esito per i pazienti. Per migliorare la sopravvivenza dei pazienti, la formazione (BLS-D per i laici) dovrebbe essere obbligatoria in tutti i corsi universitari

ANMCO/SICI-GISE paper on antiplatelet therapy in acute coronary syndromes

Antiplatelet therapy is the cornerstone of the pharmacologic management of patients with acute coronary syndrome (ACS). Over the last years, several studies have evaluated old and new oral or intravenous antiplatelet agents in ACS patients. In particular, research was focused on assessing superiority of two novel platelet ADP P2Y12 receptor antagonists (i.e., prasugrel and ticagrelor) over clopidogrel. Several large randomized controlled trials have been undertaken in this setting and a wide variety of prespecified and post-

Prognostic relevance of pericardial effusion in STEMI patients treated by primary percutaneous coronary intervention: a 10-year single-centre experience

Background: Pericardial effusion is frequent in the acute phase of ST-segment elevation myocardial infarction. However, its prognostic role in the era of primary percutaneous coronary intervention is not completely understood. Methods: We investigated the association between pericardial effusion, assessed by transthoracic echocardiography, and survival in a large cohort of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention, enrolled in the Trieste primary percutaneous coronary intervention registry from January 2007 to March 2017. Multivariable analysis and a propensity score approach were performed. Results: A total of 1732 ST-segment elevation myocardial infarction patients were included. Median follow-up was 45 (interquartile range 19-79) months. Pericardial effusion was present in 246 patients (14.2%). Thirty-day all-cause mortality was similar between patients with and without pericardial effusion (7.8% vs. 5.4%, P=0.15), whereas crude long-term survival was worse in patients with pericardial effusion (26.2% vs. 17.7%, P <= 0.01). However, at multivariable analyses the presence of pericardial effusion was not associated with long-term mortality (hazard ratio 1.26, 95% confidence interval 0.86-1.82, P=0.22). Matching based on propensity scores confirmed the lack of association between pericardial effusion and both 30-day (hazard ratio 1, 95% confidence interval 0.42-2.36, P=1) and long-term (hazard ratio 1.14, 95% confidence interval 0.74-1.78, P=0.53) all-cause mortality. Patients with pericardial effusion experienced a higher incidence of free wall rupture (2.8% vs. 0.5%, P<0.0001) independently of the entity of pericardial effusion. Conclusions: In acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, the onset of pericardial effusion after ST-segment elevation myocardial infarction is not independently associated with short and long-term higher mortality. Free wall rupture has to be considered rare compared to the fibrinolytic era and occurs more frequently in patients with pericardial effusion, suggesting a close monitoring of these patients in the early post-primary percutaneous coronary intervention phase