No abstract

To determine the prevalence of allergic sensitization in patients with vernal keratoconjunctivitis (VKC) and to provide an overview of published studies on this topic. We systematically searched 11 literature databases on 24 May 2021, for studies with cross‐sectional data on the prevalence of positive allergy tests in patients with VKC. Our main outcome of interest was the prevalence of allergic sensitization and the allergens involved. Prevalence meta‐analyses were made to provide summary estimates. We identified 33 eligible studies for qualitative review with 2122 patients with VKC. Studies were predominantly based on patients seen in ophthalmology clinics. Overall, studies reported that the most prevalent positive allergen tests were the inhaled allergens house dust mites and pollen. Twenty‐nine studies were eligible for the quantitative analysis. Here, we calculated the prevalence of allergen‐positive patients to 57.7% (95% confidence interval: 52.5%–62.8%). Subgroup analyses of pooled estimates on sensitization based on specific testing methods found prevalence estimates of 51.4% for conjunctival provocation test, 68.7% for total tear IgE, 58.9% for specific tear IgE, and 58.2% for skin prick test. The prevalence of allergic sensitization in patients with VKC is 57.7%, and mostly towards inhaled allergens. The most frequent positive allergens are house dust mites and pollen. Identifying possible clinically relevant allergens provide information that may aid in managing VKC, such as environmental allergy‐avoidance or allergy‐specific treatment.

ST-segment-elevation myocardial infarction (STEMI) is treated with timely primary percutaneous coronary intervention (PCI) to improve the prognosis by reducing final infarct size and improving myocardial salvage. 1 In STEMI patients, cardiac magnetic resonance (CMR) has become an important method to quantify area at risk, 2-5 infarct size, 5,6 and myocardial salvage index.2,5,7 CMR does also allow for assessment of microvascular damage (microvascular obstruction [MVO]) within the infarct area. 8,9 Myocardial salvage index and MVO are both predictors for outcome in STEMI patients treated with primary PCI and therefore considered markers of successful reperfusion. 10A pathological Q wave (QW) in the ECG before reperfusion (early QW) is a frequent observation in patients presenting with STEMI. 11 The presence of QW is considered a surrogate for transmural infarction, whereas the absence of QW is interpreted as a sign of subendocardial infarction.12-15 However, previous studies have found transmural infarction in some patients Background-Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI. Methods and Results-The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients.The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR,(89)(90)(91)(92)(93)(94)(95)(96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index ( and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI. 16,18,19 Furthermore, the presence of early QW in patients with STEMI treated with reperfusion (thrombolysis or primary PCI) is related to worse clinical outcome. 11,[20][21][22][23] Interestingly, the benefit from reperfusion with primary PCI compared with thrombolysis seems to be attenuated in patients with early QW. 24 It may therefore be speculated that patients with QW STEMI benefit to a lesser extent from primary PCI than non-QW. Evaluating the association between QW and myocardial salvage index and MVO may help to clarify the benefit from primary PCI in STEMI patients with baseline QW. However, to the best of our knowledge, there exist no data on the association between early QW and myocardial salvage index and MVO after primary PCI. Thus, the aim of this study was to evaluate the association between early QW and myocar...

Background Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort. Methods Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years. Results Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001). Conclusion Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.