Background: The prevalence of coronary artery disease (CAD) considerably varies by ethnicity. High-risk populations include patients from Eastern Europe (EEP), the Middle East and North Africa (MENAP) and South Asia (SAP). Methods: This retrospective study aims to highlight cardiovascular risk factors and specific coronary findings in high-risk immigrant groups. We examined the medical records and coronary angiographies of 220 patients from the above-mentioned high-risk ethnic groups referred for Acute Coronary Syndrome (ACS) and compared them with 90 Italian patients (IP) from 2016 to 2021. In the context of high-risk immigrant populations, this retrospective study aims to shed light on cardiovascular risk factors and particular coronary findings. We analyzed the medical records of 220 patients from the high-risk ethnic groups described above referred for ACS and compared them with 90 IPs between 2016 and 2021. In addition, we assessed coronary angiographies with a focus on the culprit lesion, mainly evaluating multi-vessel and left main disease. Results: The mean age at the first event was 65.4 ± 10.2 years for IP, 49.8 ± 8.5 years for SAP (Relative Reduction (ReR) 30.7%), 51.9 ± 10.2 years for EEP (ReR 26%) and 56.7 ± 11.4 years for MENAP (ReR 15.3%); p < 0.0001. The IP group had a significantly higher prevalence of hypertension. EEP and MENAP had a lower prevalence of diabetes. EEP and MENAP had a higher prevalence of STEMI events; SAP showed a significant prevalence of left main artery disease (p = 0.026) and left anterior descending artery disease (p = 0.033) compared with other groups. In SAP, we detected a higher prevalence of three-vessel coronary artery disease in the age group 40–50. Conclusions: Our data suggest the existence of a potential coronary phenotype in several ethnicities, especially SAP, and understate the frequency of CV risk factors in other high-risk groups, supporting the role of a genetic influence in these communities.
Introduction Coronary artery disease (CAD) is a major cause of morbidity and mortality in the world and its prevalence varies considerably by ethnicity, as shown by the SCORE2 and SCORE2- OP risk tables calibrated to four country groups (low, moderate, high and very high risk). High risk and very high risk regions include Eastern European countries. Previous studies have shown that risk factors such as smoking, excessive alcohol consumption, obesity, hypercholesterolaemia and type 2 diabetes are more prevalent in this population. However, mortality in Eastern European countries is higher than wealth levels would suggest, implying that Eastern European ethnicity may be an independent risk factor. Methods In this retrospective observational study at a single centre, we selected patients from Eastern Europe who underwent coronary angiography. We compared 106 Eastern European patients with 100 Italian patients as a control group. All Eastern European patients were consecutively selected from our registry from 2016 to 2021. Patients who had not undergone coronary angiography in our centre were excluded from the study. We recorded medical history, age, sex, cardiovascular risk factors, number of previous cardiovascular events (STEMI, NSTEMI and UA) and age of first cardiovascular event. Using the coronary angiography reports, we analysed the site of the lesions (RCA, LAD, LCX and LMA). We then used χ square test to compare the two populations. Results We observed a lower mean age at first cardiovascular event in Eastern European patients (p value < 0.0001) with a relative reduction of 30.5% in the general population (ReR 30.5%, t167 = 10.6, p < 0.0001, 95% CI 12.8 - 18.6). The incidence of STEMI events was twice as high in Eastern Europe (OR 2.73, CI 1.3-5.98, p-value 0.006). Regarding coronary anatomy, Eastern Europeans had a higher incidence of significant lesions on the artery LAD with an increase of 31.1% (OR 2.73, p-value 0.0006). When comparing the number of risk factors in the two ethnic groups, the prevalence of multiple risk factors was significantly lower in Eastern Europe than in Italy, with the population with two or fewer risk factors being twice as high as the Italian population (OR 2.26, CI 1.2- 4.3, p-value 0.01). Discussion Our study showed an early and more aggressive CAD in Eastern European patients while adding previously unknown data on coronary anatomy, with Eastern Europeans having 30% more significant stenoses on LAD than Italians. Surprisingly, the Eastern European population had a lower incidence of multiple risk factors compared to Italian patients, refuting the findings of previous studies on this topic and the common misconception that the incidence of CAD in Eastern Europe is due to an unhealthy lifestyle. Conclusion The present study confirms that Eastern European ethnicity is an independent risk factor for CAD and, in accordance with the principles of personalised cardiovascular medicine, elaborates on the coronary lesions associated with it.
Background Transcatheter edge-to-edge repair (TEER) with the MitraClip system is an alternative procedure for the treatment of severe mitral regurgitation (MR) in high-risk patients who are not suitable for conventional surgery and is usually performed under general anaesthesia (GA). GA may be associated with potential haemodynamic complications. A new alternative approach is deep sedation (DS) with spontaneous breathing using a target-controlled infusion (TCI). The aim of this study is to compare TCI during DS with manual administration of total intravenous anaesthesia (TIVA) during GA in patients undergoing TEER evaluating the impact of these approaches on anaesthesia time, remifentanil dose administered, haemodynamic profile, vasopressor requirements, adverse events and postoperative hospital stay. Methods The study population included 90 consecutive patients treated with MitraClip (mean age 73.5 ± 9.54 years). 65 patients (72%) suffered from functional MR. Mean LVEF was 35 ± 13% and logistic EuroSCORE was 23 ± 19%. 24 patients received GA and TIVA; 66 patients underwent DS and TCI, consisting of administration of midazolam and fentanyl citrate as induction of anaesthesia followed by continuous infusion of remifentanil hydrochloride. Results Acute procedural success was 100%, with no major complications during the procedure. No statistical differences were found between the GA-TIVA and the DS-TCI group in terms of demographics and surgical risk profile. Anaesthesia time was significantly shorter in the DS-TCI group (71 ± 30 vs. 118 ± 35 minutes; p < 0.0001), as was procedure duration (54 ± 29 vs. 99 ± 74 minutes; p = 0.00007). In addition, there was a significant reduction in the remifentanil dose administered (249 µg vs. 2865 µg, p < 0.01), the incidence of hypotension (p = 0.08) and the need for vasopressors (29.6% vs. 63%, p = 0.03) in the DS-TCI group. There were no differences in days of hospital stay after the procedure (5.4 days vs. 5.8 days, p = 0.4). Conclusions DS with spontaneous breathing using TCI could be a valid alternative during TEER which can ensure stable anaesthetic conditions, less drug administration, higher haemodynamic stability and fewer side effects, with particular advantages in patients at high risk for general anaesthesia.
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