The ACEF score: a simple but powerful predictor of short-term mortality in patients with ST-elevation myocardial infarction

Background: several clinical risk scores are available for the risk stratification of patients with ST-elevation myocardial infarction (STEMI), such as the CADILLAC, GRACE, PAMI, TIMI, and Zwolle, but all are complex to use and there is uncertainty on the best one. The age-creatinine-ejection fraction (ACEF) score, has been recently proven effective and proficient as a risk score in cardiac surgery despite its user-friendliness. We thus aimed to compare the performance of the ACEF score in comparison to the other available risk scores in patient with STEMI. Methods: subjects with STEMI undergoing primary percutaneous coronary intervention at our Institution from 2001 to 2009 were enrolled. The primary end-point was in-hospital all-cause death, whereas long-term all-cause death, long-term cardiac death were appraised as secondary outcomes. ACEF, CADILLAC, GRACE, PAMI, TIMI, and Zwolle risk scores were compared with receiver-operating characteristics (ROC) curves with areas under the curve (AUC), and binary multivariable logistic regression analysis with odds ratios (OR), plus 95% confidence intervals

COMPARISON OF RENALGUARD SYSTEM, CONTINUOUS VENOVENOUS HEMOFILTRATION AND HYDRATION IN HIGH-RISK PATIENTS FOR CONTRAST-INDUCED NEPHROPATHY

Contrast-induced nephropathy (CIN) is a relatively frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in-hospital and long term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system (RG), continuous veno-venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N-acetylcysteine in patients with severe renal failure

Renalguard, hemofiltration and hydration in prevention of contrast induced nephropathy in patients with severe chronic kidney disease undergoing percutaneous vascular interventions

Contrast-induced nephropathy (CIN) is a frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in-hospital and long-term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system(RG), continuous veno-venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N-acetylcysteine in patients with severe renal failure

Adjusted indirect meta-analysis of Aspirin plus Warfarin at international normalized ratios 2 to 3 versus Aspirin plus Clopidogrel after acute coronary syndromes

After acute coronary syndromes,the beneficial effect of aspirin plus clopidogrel (A + C) or aspirin plus dose-adjusted warfarin (A + W) compared with aspirin alone is well established. However, these regimens were never compared. To compare the risk-benefit profile of A + C versus A + W after acute coronary syndromes, major medical databases for randomized controlled trials comparing 1 of these combined approaches versus aspirin alone after an acute coronary. syndrome (updated June 2006) were searched. Evaluated end points were major adverse events [MAEs: all-cause death, acute myocardial infarction [AMI], thromboembolic stroke, major bleeds, and overall risk of stroke [hemorrhagic or ischemic]). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for (1) A + W versus aspirin alone, (2) A + C versus aspirin alone, and (3) A + W versus A + C using adjusted indirect meta-analysis. Thirteen studies were included, totaling 69,741 patients. Ten compared A + W versus aspirin alone and 3 compared A + C versus aspirin alone. Each combined approach yielded a significantly lower risk of MAEs, albeit an increased risk of major bleeds, compared with aspirin alone. No significant difference was found for A + W versus A + C for risk of overall MAEs, death, or AMI. However, A + W versus A + C was associated with a significantly lower risk of thromboembolic stroke (OR 0.53, 95% CI 0.31 to 0.88, number needed to treat 60) and all types of stroke (OR 0.58, 95% CI 0.35 to 0.94, p = 0.038), but also with increased risk of major bleeds (OR 1.9, 95% CI 1.2 to 2.8, number needed to harm 300). In conclusion, after an acute coronary syndrome, A + W and A + C are comparable in the prevention of MAEs, death, and AMI compared with aspirin alone. Allocating 100 patients to A + W (at international normalized ratio 2 to 3) with respect to A + C could prevent 17 thromboembolic strokes while causing 3 major bleeds. (c) 2007 Elsevier Inc. All rights reserved

Coronary calcification identifies the vulnerable patient rather than the vulnerable Plaque

Presence of coronary artery calcium (CAC) is associated with a high risk of adverse cardiovascular outcomes. Nevertheless, although CAC is a marker of atherosclerosis it is still uncertain whether CAC is a marker of plaque vulnerability. Therefore, the aim of this study was to verify if calcification identifies a vulnerable patient rather than the vulnerable plaque

Effects of glycoprotein IIb/IIIa antagonists: Anti platelet aggregation and beyond

Background: The use of inhibitors of glycoprotein IIb/IIIa (GPIIb/IIIa) has provided dramatic results in terms of the prevention of acute stent thrombosis and a reduction in major adverse coronary events in patients subjected to percutaneous coronary intervention. GPIIb/IIIa or αIIbβ3 is a member of the β3 subfamily of integrins, which also includes αVβ3. GPIIb/IIIa functions as a receptor for fibrinogen and several adhesion proteins sharing an arginine-glycine-aspartic acid (RGD) sequence. GPIIb/IIIa antagonists, through blockade of the receptor, prevent platelet aggregation. Among the three GPIIb/IIIa antagonists used in therapy, abciximab is an anti-β3 monoclonal antibody, while tirofiban and eptifibatide mimic the binding sequence of the fibrinogen ligand. Although antiplatelet aggregation represents the central function of GPIIb/IIIa inhibitors, further actions have been documented for these compounds. Objective: The aim of the present article is to review the structures and functions of GPIIb/IIIa antagonists and to highlight the clinical outcomes and results of randomized trials with these compounds. Hypotheses on the unexplored potential of GPIIb/IIIa antagonists will be put forward. Conclusion: GPIIb/IIIa inhibitors were developed to prevent platelet aggregation, however, these compounds can exert further biological functions, both platelet- and non-platelet-related. Large-scale studies comparing the efficacy and safety of GPIIb/IIIa antagonists are lacking. More insights into the functions of these compounds may lead to generation of novel small molecules able to antagonize platelet aggregation while promoting vascular repair

Mid-term outcomes of iodixanol versus iomeprol contrast medium after primary angioplasty for st elevation myocardial infarction

Mid-term outcomes of iodixanol versus iomeprol contrast medium after primary angioplasty for st elevation myocardial infarctio

Impact of pre-existing vascular disease on clinical outcomes in patients with non-ST-segment myocardial infarction: a nationwide cohort study.

AIMS: Little is known about the outcomes and processes of care of patients with non ST-segment myocardial infarction (NSTEMI) who present with 'polyvascular' disease. METHODS AND RESULTS: We analysed 287,279 NSTEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed; coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD), with comparison to a historically disease-free control group; comprising 167,947 patients (59%). After adjusting for demographics and management, polyvascular disease was associated with increased likelihood of major adverse cardiovascular events (MACE) (CAD OR: 1.06, 95% CI: 1.01-1.12, P = 0.02) (CeVD OR: 1.19, 95% CI: 1.12-1.27, P<0.001) (PVD OR: 1.22, 95% CI: 1.13-1.33, P<0.001) and in-hospital mortality (CeVD OR: 1.24, 95% CI: 1.16-1.32, P<0.001) (PVD OR: 1.33, 95% CI: 1.21-1.46, P<0.001). Patients without vascular disease were less frequently discharged on statins (PVD 88%, CeVD 86%, CAD 90% and control 78%), and those with moderate (ejection fraction (EF) 30-49%) or severe left ventricular systolic dysfunction (LVSD) (EF<30%), were less frequently discharged on angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (CAD 82%, CeVD 77%, PVD 77%, control 74%). Patients with polyvascular disease were less likely to be discharged on dual antiplatelet therapy (DAPT) (PVD 78%, CeVD 77%, CAD 80%, control 87%). CONCLUSION: Polyvascular disease patients had a higher incidence of in-hospital mortality and MACE. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT

Efficacy and Saftey of 38 mm Long Stent Treatment for Diffuse Coronary Disease: A Multicenter Evaluation by Angiography and OCT Analysis at One Year After Implantation

Background: Very long lesions treatment usually contemplates the use of DES but the implantation of multiple overlapping DES for diffuse disease increases the risk of restenosis and stent thrombosis. Methods: We prospectively evaluated the performance of 38mm-long DES in terms of feasibility, efficacy and safety in elective patients undergoing stent implantation for de novo diffuse (>33 mm) coronary disease. Endpoint of the study was the occurrence of MACE (cardiac death, myocardial infarction, TLR and stent thrombosis at one year FU). Secondary endpoints were OCT struts coverage, and malapposed struts at followup. Results: 68 pts with 79 lesions were enrolled, 83.8% male, mean age of 67.2 ±10 yrs. All 79 lesions were type C, 23.5% C3. Lesions were treated with Taxus Libertè®, 14 with Endeavor Resolute®, and 10 with Xience® stents all post-dilated at high atmosphere (>20 atm) with NC balloons. Mean stent size was 3.0±0.2, mean stent per lesion was 1.1, mean stent length was 42.18 mm. No adverse in-hospital events were observed. Mean follow-up of 8.2±3.7 months was done for all pts. No MACE but 2 not cardiac deaths (2.9%) occurred, no TLR detected. OCT was randomly performed in 5 patients of each group at 8 mo FU angiography. Mean neointimal thickness was 140±72 μm, 223±107 μm and 254.5±82.5 μm and percentage of neointimal hyperplasia was 15.7±9.4%, 20.7±11.9%, and 30.7±9.4% for the Resolute®, Taxus Libertè®, and Xience® groups respectively, with a significant difference between Resolute® and the other 2 groups (P= 0.0001 with Taxus®, P=0.024 with Xience®). Percentage of IIIb+IV stent struts were 15.7%, 9.89%, and 0.87% of total struts analysed. Frames with RUTTS > 30% were 23.1%, 16.2%, and 1.3% of total analyzed for Resolute®, Taxus Libertè®, and Xience® groups respectively with a significant difference between Xience® and the other 2 groups (P=0.0001 for both Resolute® and Taxus®) Conclusion: Dedicated 38mm-long DES for treatment of complex diffuse disease can be achieved with high success rate and excellent mid term safety profile. OCT analysis revealed that second generation stents may perform significantly better than first generation in terms of safety parameters