Risultati per: ESH: nuove linee guida complete per la gestione dell’ipertensione arteriosa

Cattani, ‘è emergenza di salute pubblica, non ci siamo arresi’

Oncologi, più vaccinazioni e screening. Parte una campagna di sensibilizzazione

Dagli anticorpi all’intelligenza artificiale, cosa sta cambiando la vita dei pazienti

New England Journal of Medicine, Volume 389, Issue 20, Page 1922-1924, November 2023.

Studio Usa, vale anche per i pazienti gia’ trattati

Fra questi il Semaglutide, usato anche per dimagrire

Circulation, Volume 148, Issue Suppl_1, Page A14388-A14388, November 6, 2023. Introduction:Complete revascularization with percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with acute coronary syndromes (ACS) and multivessel disease (MVD). In order to address the conflicting results reported with respect to the timing, we aimed to perform a meta-analysis of the available randomized controlled trials (RCTs).Methods:Online databases were searched for RCTs comparing immediate to staged complete PCI in patients presenting with ACS. The primary outcomes of interest were major adverse cardiovascular events (MACE), all cause death, myocardial infarction (MI), cardiovascular death, stent thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), cerebrovascular events and bleeding at the longest available follow up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model.Results:Three RCTs with a total of 2,261 patients, with 1,131 in the immediate PCI group and 1,130 in the staged PCI group were included. The mean age was 67 years, 79% of patients were men and the mean duration of follow up was 1 year. The immediate PCI group compared to staged complete PCI was associated with a significant reduction in MI (RR 0.50, 95% CI 0.31-0.83, p = 0.007) (Figure 1) and TVR (RR 0.58, 95% CI 0.41-0.80, p = 0.001). There were similar risks of cardiovascular death (RR 1.15, 95% CI 0.55-2.42, p = 0.71), TLR (RR 0.88, 95% CI 0.17-4.65, p = 0.88), cerebrovascular events (RR 0.87, 95% CI 0.41-1.82, p = 0.71), all-cause death (RR 1.30, 95% CI 0.48-3.50, p = 0.61), MACE (RR 0.70, 95% CI 0.48-1.02, p = 0.06), stent thrombosis (RR 0.89, 95% CI 0.36-2.22, p = 0.81) and bleeding (RR 0.65, 95% CI 0.18-2.41, p = 0.52) between the two groups.Conclusions:Complete PCI of the culprit and non-culprit vessels during the index procedure (immediate) significantly reduces the risk of MI and TVR when compared with staged PCI.

Circulation, Volume 148, Issue Suppl_1, Page A14394-A14394, November 6, 2023. Background:Atrioventricular block (AVB) in young adults is rare, and the etiologies and mechanisms in most cases remain uncertain. Alport syndrome is a heterogeneous, hereditary disorder characterized by nephropathy, hearing loss, and ocular abnormalities. Complete AVB has never been reported in Alport syndrome patients with normal kidney function.Case report:A 20-year-old male patient was admitted to hospital with “asymptomatic bradycardia for years”. On admission, the patient’s blood pressure was normal and electrocardiogram (ECG) showed third-degree AVB with atrial rate of 63 bpm and ventricular rate of 36 bpm. He was diagnosed with Alport syndrome at the age of 10. Genetic testing at that time showed single nucleotide variants (c.2372T >C, c.2072T >G) and deletion (c.1781-1949(Exon25)) inCOL4A5gene. During the subsequent 10-year follow-up, the patient was presented with consistent hematuria and proteinuria, but his renal function has never been found impaired. He denied other medical history as well as family history of arrhythmia. Laboratory tests indicated hypoproteinemia, hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. The 24-hour ambulatory ECG revealed a heart rhythm consisting of sinus rhythm with second-degree AVB (2:1 downward transmission) and complete AVB with junctional escape. The mean ventricular rate was 36 bpm (ranged 25-60 bpm). Neither echocardiography nor cardiac magnetic imaging with delayed gadolinium enhancement found any significant abnormality. We then did whole exome sequencing (WES), which did not identify specific pathogenic variant (Table1). 3mg atropine was admitted to the patient for an atropine test to rule out the possibility of vagally mediated AVB and the pacemaker implantation was then performed.Conclusion:We report a case of complete AVB with unknown etiology in a young patient with Alport syndrome.

Circulation, Volume 148, Issue Suppl_1, Page A18145-A18145, November 6, 2023. Background:Acute coronary syndrome (ACS) patients undergoing PCI often have severe non-culprit vessel involvement known as multivessel disease (MVD), which is linked to worse outcomes. While guidelines recommend complete revascularization, the optimal timing is unclear. Comparing immediate vs. staged approaches is crucial to identify the optimal approach to revascularization.Research question:Do outcomes differ between immediate complete revascularization (ICRV) and staged complete revascularization (SCRV) in patients with ACS and MVD?Methods:PubMed, Cochrane library and Web of Science were searched for studies comparing immediate vs. staged complete revascularization for ACS and MVD. Randomized controlled trials (RCTs) and prospective studies reporting all-cause mortality, major adverse cardiac events (MACE), myocardial infarction (MI), and revascularization were included. Thirty-day and extended-term outcomes were evaluated, and risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model.Results:The meta-analysis comprised 6 RCTs and 5 prospective studies, involving 3,631 patients (ICRV: 1,728; SCRV: 1,903) presenting with ACS (ST-elevation MI (STEMI)=9, NSTEMI=1; Mixed=2). The mean age was 62.4 ± 9.4 years, with 79.5% male. The ICRV group exhibited significantly higher 30-day mortality (RR: 2.19 [1.31-4.06], p=0.004), while the SCRV group had higher revascularization rates at 30 days and extended term (RR: 0.27 [0.10-0.69], p=0.007 and RR: 0.68 [0.48-0.96], p=0.03, respectively). No significant difference was found in 30-day and extended-term MACE and MI between the ICRV and SCRV groups.Conclusion:Although there was no significant difference in overall MACE between the two complete revascularization strategies for patients with ACS and MVD, the SCRV group showed lower 30-day all-cause mortality, while the ICRV group demonstrated a lower incidence of revascularization rates.

Circulation, Volume 148, Issue Suppl_1, Page A15023-A15023, November 6, 2023. Background:The benefit of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-culprit lesions with angiographically severe stenosis in patients with acute myocardial infarction (AMI) is unclearObjectivesWe evaluated the relationship between non-culprit lesion stenosis measured by quantitative coronary angiography (QCA) and the efficacy of FFR-guided PCIMethods:Severity of non-culprit lesion stenosis of 562 patients from FRAME-AMI (FFR vs. Angiography-Guided Strategy for Management of Non-Infarction Related Artery Stenosis in Patients with AMI) was measured using QCA in the core laboratory. The effect of FFR-guided versus angiography-guided PCI according to non-culprit lesion stenosis (QCA stenosis ≥70% or