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

86 STEMI and multivessel disease: medical therapy amplifies the benefit of complete myocardial revascularization

Abstract Aims Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularization strategies. However, the potential predictors of outcomes on top of different revascularization strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularization strategies and the potential impact of medical therapy. Methods and results Using a propensity score approach, the impact of two treatment strategies was analysed—staged non-culprit revascularization group vs. culprit-lesion-only percutaneous coronary intervention (PCI) group—on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularization. Moreover, models were further adjusted for medication at discharge. Among 1385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularization group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; P = 0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; P = 0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; P = 0.02). Use of renin–angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; P = 0.03), and both renin–angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; P = 0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; P = 0.01) were associated with lower all-cause death. Conclusions In a real-word STEMI population with multivessel disease, staged non-culprit revascularization was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularization and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularization

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

ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis

11noPrimary percutaneous coronary intervention (pPCI) largely reduced the rate of left ventricular (LV) dysfunction after ST-segment elevation acute myocardial infarction (STEMI). Though LV recovery begins early following revascularization, the optimal timing for re-assessment of LV function is still unclear. We sought to assess the proportion and timing of LV recovery in STEMI patients presenting with LV dysfunction treated by pPCI and to identify possible early predictors of adverse LV remodeling. STEMI patients with LV ejection fraction (LVEF ≤40%) at presentation treated by pPCI from 2007 to 2013 were included whether they had an available 3-step LVEF assessment (35%, p<0.001). Independent predictors of 3-months LVEF ≤35% were creatinine at admission, peak troponin I and LVEF. Of note, LVEF re-assessment at discharge (median time 6days, IQR 4-9) showed an increased accuracy to predict 3-months LV dysfunction compared to LVEF at admission (AUC 0.80, 95% CI 0.72-0.88 vs AUC 0.69, 95% CI 0.58-0.79 respectively, p=0.03). In most of patients presenting with STEMI and LV dysfunction, a significant LV recovery can be observed early following pPCI. LVEF measurement at discharge indeed emerged as the best indicator of late persistence of severe LV dysfunction.reservedmixedStolfo, Davide; Cinquetti, Martino; Merlo, Marco; Santangelo, Sara; Barbati, Giulia; Alonge, Marco; Vitrella, Giancarlo; Rakar, Serena; Salvi, Alessandro; Perkan, Andrea; Sinagra, GianfrancoStolfo, Davide; Cinquetti, Martino; Merlo, Marco; Santangelo, Sara; Barbati, Giulia; Alonge, Marco; Vitrella, Giancarlo; Rakar, Serena; Salvi, Alessandro; Perkan, Andrea; Sinagra, Gianfranc

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-