(1) Shorter-duration dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy has been shown to significantly reduce bleeding events while preserving anti-ischemic effects in patients undergoing conventional percutaneous coronary interventions (PCI). Whether this strategy is also safe and effective in complex PCI remains elusive; (2) A systematic search of randomized controlled trials comparing a short course of ticagrelor-based DAPT versus standard DAPT in patients undergoing complex PCI was performed; (3) Of 10,689 studies screened, 3 were identified for a total of 4176 participants on ticagrelor monotherapy after a short course of ticagrelor-based DAPT, and 4209 on standard DAPT. The pooled analysis revealed no difference in the outcomes of major bleeding, myocardial infarction, definite or probable stent thrombosis and ischemic stroke. A significant reduction in the risk of cardiovascular death (incidence rate ratio (IRR) 0.52; 95% CI 0.28–0.96; p = 0.04), all-cause death (IRR 0.65; 95% CI 0.49–0.86; p = 0.003), and any bleeding events (IRR 0.62; 95% CI 0.47–0.81; p < 0.001) was seen in the shorter DAPT group; (4) Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischemic risk. More data are needed to definitively explain mortality benefits.
Background: Simultaneous ulnar and radial artery compression (SURC) has emerged as a strategy to increase radial artery flow and mitigate radial artery occlusion (RAO) while achieving adequate hemostasis after transradial access (TRA), though its technical adoption has been limited worldwide. Methods: A systematic search of studies comparing SURC versus isolated radial artery compression after TRA for coronary angiography and/or intervention was performed. Data were pooled by meta-analysis using random-effects models. Odds ratios (OR) with relative 95% confidence intervals (CI) and standardized mean difference were used as measures of effect estimates. The primary endpoint was the occurrence of overall RAO. Results: A total of 6 studies and 6793 patients were included. SURC method as compared to isolated radial artery compression was associated with a lower risk of RAO both overall (OR 0.29; 95% CI, 0.13–0.61, p < 0.001; number needed to treat to benefit [NNTB] =38) and in-hospital (OR 0.28; 95% CI: 0.10 to 0.75; p = 0.01, NNTB = 36), with a reduced risk of unsuccessful patent hemostasis (OR: 0.13; 95% CI: 0.02 to 0.85; p = 0.03, NNT = 5) and upper extremity pain (OR: 0.48; 95% CI: 0.24 to 0.95; p = 0.04, NNTB = 124). No significant difference was observed in hemostasis time and in the risk of hematoma. Conclusion: Compared to isolated radial artery compression, SURC is associated with lower risk of RAO, unsuccessful patent hemostasis, and reported upper limb pain, without any trade-off in safety outcomes. With further development of dedicated dual compression devices, the proposed technique should be freed from usage constraints.
Despite large-scale randomized clinical trials (RCTs) highlighting a consistent prognostic benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2is) both in diabetic patients at high cardiovascular risk and in those with heart failure, there is relative paucity of data on their biochemical effects in a real-world setting. We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral center and completed at least 1 year of treatment. Changes in glycated hemoglobin, weight, and hematocrit were compared across 2 cardiovascular risk categories, defined through the inclusion criteria of 3 large RCTs. Of the 459 patients screened, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%), and 55 were lost to follow-up (12.0%). The most common cause of drug discontinuation was genital or urinary tract infections (9.4%). At 1 year, reduction in glycated hemoglobin concentration (20.7 6 1.5%, P , 0.001) and body weight (2.4 6 4.6 kg, P , 0.001) was comparable between patients at high versus low cardiovascular risk, while hematocrit increase (2.3 6 3.3%, P , 0.001) was more marked in patients with high cardiovascular risk and low baseline hematocrit. In a real-world population of diabetic patients, SGLT2is were well-tolerated at 1 year and led to improved glycemic control and weight loss. Hematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating euvolemic restoration as a potential cardioprotective mechanism mediated by these compounds.
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Background Recent evidence has rendered percutaneous coronary intervention (PCI) a valuable alternative to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Nevertheless, the optimal management and patients selection is still subject to discussion Methods We retrospectively included 431 patients treated with PCI and 324 patients treated with CABG with the primary objective of comparing procedural failure according to revascularization strategy. Secondary endpoints were post procedural and clinically relevant myocardial infarction, in-hospital stroke, major bleeding defined according to the Bleeding Academic Research Consortium (BARC) criteria, death, and 1-year major adverse cardiac events (MACE). Results There was no observed difference in the rates of procedure failure in patients who received PCI compared to patients who received CABG (4.6% vs 3.7%, respectively) odds ratio [OR] 1.26; (95% confidence intervals [CI] 0.58-2.9, p= 0.52.) There was no significant difference in the defined ischemic outcome for PCI vs CABG (0.9% vs 2.4%, respectively) OR 0.37; (95% CI 0.08-1.4), P = 0.09. There was a mild increase in periprocedural myocardial infarction (MI) after PCI (4.2% vs 1.5%) compared to CABG; (OR = 2.8; 95% CI 0.99-9.8, P = 0.034). On the contrary there was a higher risk of major bleeding and transfusions in the patients who had been treated with CABG who has a clinical profile suited for PCI. Conclusions PCI did not significantly increase the risk for procedural failure or ischemic events compared to CABG in patients with LM CAD. The higher risk for post-procedural MI after PCI was offset by a higher risk for major bleeding events and transfusion requirements in those undergoing CABG, especially for those who were clinically suited for PCI.
Introduction Recent published ESC guidelines on non-cardiac surgery suggest the use of imaging stress test in patients with poor functional capacity and high likelihood of coronary artery disease or high clinical risk (class I, level B), while the use of coronary computed tomography has lower evidence (class IIa, level B). Witch test has the best performance in the clinical contest of pre-operative risk assessment is a matter of debate. Aim The aim of our single centre, retrospective study was to compare the prognostic role of the three main cardiac imaging modalities (CCT: Cardiac computed tomography, sCMR: stress cardiac magnetic resonance, SPECT MPI:single photon emission computed tomography myocardial perfusion imaging) in relation to 30 days post-surgery cardiac events (composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema, life threatening cardiac arrythmias). Method Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Recorded data included demographic characteristics, clinical risk factors, results from laboratory tests, results from cardiac imaging tests, pharmacological therapy, type of intervention, cardiac complication within 30 days after surgery. Results Eight-hundred eighty-three patients were included (287 sCMR, 382 SPECT-MPI, 214 CCT). Rate of 30-days myocardial infarction was not significantly different between different modalities (CMR 1.1%, SPECT 1.3%; CT 0.5%; CMR vs SPECT p 0.998; sCMR vs CT p 0.639; SPECT vs CT 0.427); while planned invasive coronary angiography (ICA) was more common in CT group (CT 34%, CMR 16%, SPECT 10%, p<0,001). Absence of ischemia on stress test and absence of relevant coronary artery disease on CT are associate to lower cardiac events at follow-up (0.67%). Conclusions The use of imaging stress test and coronary CT are both associated to low incidence of cardiac events and should be recommended in risk assessment before non-cardiac surgery, in the appropriate clinical context.
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