Bilateral trans-radial approach in stenting of occluded right axillary artery

With recent advancement in percutaneous endovascular interventions, angioplasty and stenting of axillary artery lesions could become the treatment of choice vs. surgical intervention owing to its lower complication and mortality rates and shorter hospital stay. We report a Caucasian female case with axillary artery chronic total occlusion (CTO) with dual etiology (atherosclerotic and radiation induced), which was successfully managed with stent angioplasty. The strategy used was right radial retrograde approach with contralateral injections from left radial catheter. Two year follow-up revealed widely patent axillary stents. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13019-014-0138-0) contains supplementary material, which is available to authorized users

Distribucija rizičnih čimbenika i dugoročni ishodi u mladih bolesnika podvrgnutih perkutanoj koronarnoj intervenciji u Makedoniji

The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.Cilj istraživanja bio je procijeniti distribuciju rizičnih čimbenika za koronarnu arterijsku bolest (KAB) i dugoročne ishode kod mladih bolesnika podvrgnutih perkutanoj koronarnoj intervenciji (PKI) u Makedoniji. U istraživanje je bilo uključeno ukupno 12.361 bolesnika podvrgnutih PKI (od ožujka 2011. do prosinca 2017. godine). Skupina 1. obuhvatila je 309 mladih bolesnika u dobi od ≤40 godina kao glavna ispitna skupina koja je tijekom istraživanja uspoređena sa skupinom 2. koja je uključivala 12.052 starijih bolesnika. Uspoređivali smo distribuciju rizičnih čimbenika za KAB te kliničke osobine i značajke zahvata. Uz to, u skupini 1. analizirani su angiografski podaci, dugoročni teži štetni srčani i cerebrovaskularni događaji (major adverse cardiac and cerebrovascular events, MACCE) i smrtnost. Medijan dobi bio je 36±4 godine u skupini 1. i 62±11 godine u skupini 2. Pozitivna obiteljska anamneza za KAB, pušenje i pretilost bili su znatno češći u mladoj skupini (p<0,0001). Primarna PKI zbog STEMI bila je također češća s 48% PKI u mladoj skupini (p<0,0001). KAB višestrukih krvnih žila i intervencije zbog kronične potpune okluzije bile su češće u starijoj skupini (51% odnosno 28%; p<0,0001). Trajanje zahvata (31±0,4 prema 35±22 min) i fluoroskopije (9±4 prema 9±12 min) bilo je slično u objema skupinama. Nije bilo razlike u krvarenju na ulaznom mjestu (4,8% prema 4,3%). Tijekom medijana praćenja od 3,5 godine MACCE su zabilježeni u 1,9% mladih bolesnika. U zaključku, najčešći čimbenik rizika u populaciji mladih bolesnika podvrgnutih PKI bila je pozitivna obiteljska anamneza za KAB, pretilost i pušenje. Mladi bolesnici uglavnom su imali KAB jedne krvne žile i podvrgnuti su primarnoj PKI zbog STEMI. Dugoročno godišnje preživljenje bilo je više od 99% u ovih bolesnika s izvrsnom prognozom nakon PKI

Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis. CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies. CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score &lt;3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score &lt;3 (mean 1.7), and 82 had score ≥3 (mean 3.5), p&gt;0.001. Patients with ST-segment elevation MI had OR 2.1 (p&gt;0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p &gt; 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after MI

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score <3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score 0.001. Patients with ST-segment elevation MI had OR 2.1 (p>0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p > 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after M

Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome

BACKGROUND: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predictors of major adverse cardiac events (MACE) following discharge still remains limited. Assessment of left ventricular (LV) function, combined with the use of cardiac biomarkers, such as NT-proBNP can help in the early identification of patients at risk of developing heart failure and/or other MACE in acute MI (AMI) survivors. AIM: The aim of the study was to identify early predictors of MACE in MI patients, that underwent primary percutaneous coronary intervention, with special emphasis on cardiac biomarkers. MATERIALS AND METHODS: We analyzed clinical, LV functional, angiographic variables, as well cardiac troponin (hsTn), a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study was designed as longitudinal, prospective observational cohort study undertaken on 150 AMI patients hospitalized at University Clinic of Cardiology over the period of September 2018 to March 2019. Inclusion criteria: All incomers hospitalized for AMI over the aforementioned period who were willing to participate in the study and gave signed informed consent. Exclusion criteria: Patients who were not consented to participate in the study, patients who suffered in-hospital mortality over the index hospitalization and those with the previous HF and/or AMI. IBM SPSS statistical software version 22 was used for statistical analysis. Descriptive and comparative statistical methods were applied. Continuous variables were presented as means, while categorical as frequencies and percentages. Comparative statistic tests: Chi-square test, for variables with dichotomous distribution, t-test and one-way ANOVA for continuous variables with two or more categories were applied. Risk ratios with 95% confidence intervals were calculated, and the significance was determined using Cochran and Mantel-Haenszel test (at the level of <0.05). Receiver operator characteristic curves (ROC) were used for prediction capability. Correlations, uni- and multivariate linear, and logistic regression analysis were undertaken to identify significantly associated variables. RESULTS: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p = 0.007), number of diseased vessels (p = 0.027), and need for loop diuretic therapy (p = 0.050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve 0.640, and 0.658, p = 0.025 and 0.011, respectively). CONCLUSION: The combination of biomarkers for myocardial stress and inflammation improves the prediction of MACE in MI survivors

Sex Differences in Heart Failure Following Acute Coronary Syndromes

Background: There have been conflicting reports regarding outcomes in women presenting with an acute coronary syndrome (ACS). Objectives: The objective of the study was to examine sex-specific differences in 30-day mortality in patients with ACS and acute heart failure (HF) at the time of presentation. Methods: This was a retrospective study of patients included in the International Survey of Acute Coronary Syndromes-ARCHIVES (ISACS-ARCHIVES; NCT04008173). Acute HF was defined as Killip classes ≥2. Participants were stratified according to ACS presentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). Differences in 30-day mortality and acute HF presentation at admission between sexes were examined using inverse propensity weighting based on the propensity score. Estimates were compared by test of interaction on the log scale. Results: A total of 87,812 patients were included, of whom 30,922 (35.2%) were women. Mortality was higher in women compared with men in those presenting with STEMI (risk ratio [RR]: 1.65; 95% CI: 1.56-1.73) and NSTE-ACS (RR: 1.18; 95% CI: 1.09-1.28; Pinteraction &lt;0.001). Acute HF was more common in women when compared to men with STEMI (RR: 1.24; 95% CI: 1.20-1.29) but not in those with NSTE-ACS (RR: 1.02; 95% CI: 0.97-1.08) (Pinteraction &lt;0.001). The presence of acute HF increased the risk of mortality for both sexes (odds ratio: 6.60; 95% CI: 6.25-6.98)

Statins for primary prevention among elderly men and women.

We undertook a propensity match-weighted cohort study to investigate whether statin treatment recommendations for statins translate into improved cardiovascular (CV) outcomes in the current routine clinical care of the elderly. We included in our analysis (ISACS Archives -NCT04008173) a total of 5619 Caucasian patients with no known prior history of CV disease who presented to hospital with a first manifestation of CV disease with age of 65 years or older. The risk of ST-segment elevation myocardial infarction (STEMI) was much lower in statin users than in non-users in both patients aged 65-75 years [14.7% absolute risk reduction; relative risk (RR): 0.55, 95% CI 0.45-0.66] and those aged 76 years and older (13.3% absolute risk reduction; RR: 0.58, 95% CI 0.46-0.72). Estimates were similar in patients with and without history of hypercholesterolaemia (interaction test; P-values = 0.24 and 0.35). Proportional reductions in STEMI diminished with female sex in the old (P for interaction = 0.002), but not in the very old age (P for interaction = 0.26). We also observed a remarkable reduction in the risk of 30 day mortality from STEMI with statin therapy in both age groups (10.2% absolute risk reduction; RR: 0.39; 95% CI 0.23-0.68 for patients aged 76 or over and 3.8% absolute risk reduction; RR 0.37; 95% CI 0.17-0.82 for patients aged 65-75 years old; interaction test, P-value = 0.46). Preventive statin therapy in the elderly reduces the risk of STEMI with benefits in mortality from STEMI, irrespective of the presence of a history of hypercholesterolaemia. This effect persists after the age of 76 years. Benefits are less pronounced in women. Randomized clinical trials may contribute to more definitively determine the role of statin therapy in the elderly.EMMACE was funded by the National Institute for Health Research and the British Heart Foundation.S