HED and cannabis use represent a public health problem due to their association with a variety of problems, including engagement in unsafe sex. Our results suggest that a significant proportion of unsafe sex could be avoided by reducing this consumption pattern of alcohol.

We can conclude that heavy drinking leads to an increase of alcohol-related injuries. This shows a new dimension on the consequences of this public concern already related with a variety of health and social problems. Furthermore, our results allow us to suggest that about half of alcohol-related injuries could be avoided by removing this consumption pattern.

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Background: Leadless pacemakers (L-PM) are an emerging effective and safe technology that offer an alternative to conventional pacemakers (C-PM) for right ventricular stimulation. However, there is little information about their potential benefits for quality of life (QoL) in patients with L-PM. We compared QoL between patients with L-PM and C-PM. Methods:The study population comprised patients undergoing single chamber pacemaker implantation from December 2016 to March 2018. The SF-36 questionnaire was used to evaluate QoL at baseline and at 6 months of followup.We also used a questionnaire consisted of 10 specific questions related to the implant procedure.Results: A total of 106 patients (64 C-PM; 42 L-PM) were included. There were no differences in baseline characteristics between the groups (C-PM vs L-PM), except for age (81.5 vs 77.3 years; P = .012) and diabetes (38% vs 17%; P = .021). Baseline SF-36 scores did not differ between the groups. At 6 months followup, patients in the L-PM group scored significantly higher on physical function (63 vs 42; P < .001), physical role (64 vs 36; P = .004), and mental health (75 vs 65; P = .017), even after adjusting for covariates. Pacemaker-related discomfort and physical restrictions were significantly lower for the L-PM group.

IntroductionTranscatheter aortic valve implantation (TAVI) as a treatment in severe aortic stenosis (AS) is an excellent alternative to conventional surgical replacement. However, long-term outcomes are not benign. Renin-angiotensin system (RAS) blockade has shown benefit in terms of adverse remodelling in severe AS and after surgical replacement.Methods and analysisThe RAS blockade after TAVI (RASTAVI) trial aims to detect if there is a benefit in clinical outcomes and ventricular remodelling with this therapeutic strategy following the TAVI procedure. The study has been designed as a randomised 1:1 open-label study that will be undertaken in 8 centres including 336 TAVI recipients. All patients will receive the standard treatment. The active treatment group will receive ramipril as well. Randomisation will be done before discharge, after signing informed consent. All patients will be followed up for 3 years. A cardiac magnetic resonance will be performed initially and at 1 year to assess ventricular remodelling, defined as ventricular dimensions, ejection fraction, ventricular mass and fibrosis. Recorded events will include cardiac death, admission due to heart failure and stroke. The RASTAVI Study will improve the management of patients after TAVI and may help to increase their quality of life, reduce readmissions and improve long-term survival in this scenario.Ethics and disseminationAll authors and local ethics committees have approved the study design. All patients will provide informed consent. Results will be published irrespective of whether the findings are positive or negative.Trial registration numberNCT03201185.

Coronary artery disease (CAD) is a common chronic condition in the elderly. However, the earlier CAD begins, the stronger its impact on lifestyle and costs of health and social care. The present study analyzes clinical and angiographic features and the outcome of very young patients undergoing coronary angiography due to suspected CAD, including a nested case-control study of ≤40-year-old patients referred for coronary angiography. Patients were divided into two groups: cases with significant angiographic stenosis, and controls with non-significant stenosis. Of the 19,321 coronary angiographies performed in our center in a period of 10 years, 504 (2.6%) were in patients ≤40 years. The most common cardiovascular risk factors for significant CAD were smoking (OR 2.96; 95% CI 1.65–5.37), dyslipidemia (OR 2.18; 95% CI 1.27–3.82), and family history of CAD (OR 1.95; 95% CI 1.05–3.75). The incidence of major adverse cardiovascular events (MACE) at follow-up was significantly higher in the cases compared to controls (HR 2.71; 95% CI 1.44–5.11). Three conventional coronary risk factors were directly related to the early signs of CAD. MACE in the long-term follow-up is associated to dyslipidaemia and hypertriglyceridemia. Focusing efforts for the adequate control of CAD in young patients is a priority given the high socio-medical cost that this disease entails to society.

A 58-year-old patient presented to our hospital with an anterior ST-segment-elevation myocardial infarction. His medical history included placement of 2 overlapped stents in the left anterior descending coronary artery, and 1 in the first diagonal branch (DG) 3 years before. Current coronary angiography revealed thrombotic occlusion of the first DG stent, patency of the remaining stents, and absence of de novo lesions ( Figure 1A, 1, asterisk; Movie I in the Data Supplement). Thromboaspiration with Pronto thrombectomy catheter (Vascular Solutions, Inc, Minneapolis, MN) was attempted with no success because of inability of passing the device through the proximal portion of first DG. During its removal, the thrombectomy catheter was hooked with the endothelized left anterior descending stent, inadvertently dislodging and extracting it entirely (Movie II in the Data Supplement). Tissue prolapse ( Figure 1A, 2), a large coronary dissection ( Figure 1A, 3, yellow asterisk), stent struts (blue arrowheads), and neointimal dissected tissue floating within the lumen (red asterisk) was suspected by angiography (Movie III in the Data Supplement) and confirmed by optical coherence tomography. A drug-eluting stent was implanted in the left anterior descending covering the dissected endothelium, remaining a small proximal edge dissection ( Figure 1B, 1-3), and balloon-angioplasty was performed in first DG, achieving excellent immediate results (Movie IV in the Data Supplement). Clinical evaluation at 6 months was unremarkable, but still incomplete stent endothelialization was noticed ( Figure 1C; Movie V in the Data Supplement). Partial coverage of first DG by the left anterior descending stent (not visible by fluoroscopy) was identified in the postprocedural 3-dimensional optical coherence tomography reconstruction ( Figure 1D; Movie VI in the Data Supplement). Tissue trapped within the extracted stent (Figure 2) was analyzed. Besides thromboaspiration, other techniques must be considered to prevent this complication, like during directional coronary atherectomy, passage of imaging devices throughout underexpanded/malpositioned stents, crossing jailed side-branches or bifurcations, or in-stent restenosis treatment with cutting balloon. To achieve correct wiring through the previously stented segment or bifurcation, creating a loop in the tip of the guidewire as it passes through the old stent, and then straightening it to advance to the distal vessel, decreases the possibility that the wire has passed through a cell of a stent that lies proximal to the ostium of the side branch. DisclosuresNone.

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