Risultati per: Terapia antibiotica: breve durata vs. lunga durata

Circulation, Volume 150, Issue Suppl_1, Page A4139378-A4139378, November 12, 2024. Introduction:The potential benefits and risks of paclitaxel-coated balloon (PCB) angioplasty over uncoated balloon (UB) angioplasty in the management of coronary in-stent restenosis (ISR) is not well established.Hypothesis/Aims:This study aims to determine whether PCB angioplasty is superior to UB angioplasty in patients with coronary ISR in terms of target lesion revascularization (TLR), myocardial infarction (MI), and all-cause mortality rates.Methods:PubMed, Embase and Cochrane Central databases were systematically searched for randomized clinical trials (RCT) comparing PCB with UB angioplasty in patients with coronary ISR. Statistical analyses were performed using Review Manager version 5.4.1. Risk Ratios (RR) with 95% confidence intervals (CI) for dichotomous endpoints were computed with the use of a Mantel-Haenszel random effects model.Results:A total of 1,407 patients from 7 randomized clinical trials were included. Follow-up periods in the included studies ranged from 6 months to 1 year. PCB angioplasty significantly reduced TLR (RR 0.28; 95% CI 0.16-0.48; p

Circulation, Volume 150, Issue Suppl_1, Page A4117180-A4117180, November 12, 2024. Introduction:Patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi) are at increased risk of developing hyperkalemia (HK). Sodium zirconium cyclosilicate (SZC) is used to treat HK, but the impact of duration of SZC on healthcare resource utilization (HRU) in RAASi users is unknown. The GALVANIZE Outcome study compared HK-related HRU among RAASi users between long-term and short-term SZC users.Methods:Adults with ≥1 outpatient prescription for SZC (index date) and ≥1 RAASi prescription spanning the index date were identified from a large US insurance claims database (7/2018-12/2022) and were stratified based on duration of SZC use. Long-term SZC users ( >90 days) and short-term SZC users (≤30 days) were exactly and propensity score matched on key baseline characteristics. Rates of HK-related hospitalizations or emergency department (ED) visits, HK-related ED visits, and HK-related hospitalizations were compared during follow-up from index to the earliest of 6 months post-index, end of data availability, other potassium binder use, or re-initiation of SZC post-discontinuation.Results:Among 1,586 matched pairs, the mean age was 65.5 years, 41.0% of patients were female, and most patients had any stage chronic kidney disease (91.9%), hypertension (90.8%), and diabetes (73.4%). Also, 30.0% of patients had heart failure. The most used RAASi therapies at index were angiotensin-converting enzyme inhibitors (57.3%) and angiotensin-receptor blockers (56.3%). Patients with long-term SZC use had a 44% lower rate of HK-related hospitalizations or ED visits, a 41% lower rate of HK-related hospitalizations and a 52% lower rate of HK-related ED visits than patients with short-term SZC use during follow-up (all p

Circulation, Volume 150, Issue Suppl_1, Page A4142085-A4142085, November 12, 2024. Background:Highly precise definition of high-risk features associated with HFpEF may guide targeted treatments and inform biological studies. The aim of this two-step study is to 1) define a high risk HFpEF cluster with unsupervised machine learning approach using cardiac magnetic resonance (CMR), 2) define novel pulmonary vascular mechanics at rest and with exercise in low- vs. high-risk phenotypes. Vascular mechanics defines vessel- and cardiac cycle-specific flow dynamics in pulmonary circulation.Methods:48 HFpEF participants underwent CMR and invasive cardiopulmonary exercise testing. With unsupervised K-means clustering analyses using CMR data, two specific clusters were identified with different survival outcomes at 12-months (mortality and heart failure hospitalizations): HR=5.4 (CI:1.7-17.4), log-rank p

Circulation, Volume 150, Issue Suppl_1, Page A4135723-A4135723, November 12, 2024. Background:Dual antiplatelet therapy (DAPT) consisting of ticagrelor, a P2Y12inhibitor, and aspirin, is the recommended treatment of acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI). However, recently ticagrelor monotherapy has been shown to preserve ischemic protection while reducing bleeding risk in ACS patients. We aimed to compare the clinical outcomes of DAPT and ticagrelor monotherapy in ACS patients undergoing PCI.Methods:MEDLINE, Scopus, and EMBASE were queried up to May 2024 for randomized controlled trials (RCTs) comparing ticagrelor monotherapy after 1 to 3 months of DAPT versus continued DAPT for 12 months in ACS patients. The primary outcomes were all-cause death, net adverse clinical events (NACE) and Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. Key secondary endpoints included BARC 3 or 5 bleeding, myocardial infarction (MI), hemorrhagic and ischemic stroke, and target vessel revascularization (TVR). A random-effects meta-analysis was performed to derive risk ratios (RR) and corresponding 95% confidence intervals (CI).Results:Six RCTs including 28,526 patients, with a mean age of 63.5 years, were included. DAPT was associated with a significantly higher risk of all-cause death (RR: 1.32, 95% CI: 1.05-1.64, P=0.02), NACE (RR: 1.20, 95% CI: 1.01-1.42, P=0.04), and BARC 2, 3, or 5 bleeding (RR: 1.96, 95% CI: 1.71-2.26, P

Circulation, Volume 150, Issue Suppl_1, Page A4125334-A4125334, November 12, 2024. Background:Limited knowledge exists regarding non-acute myocardial infarction-associated cardiogenic shock (nACS-CS) and its associated outcomes within the African American population.Aim:This investigation aimed to examine the clinical outcomes of nACS-CS in the African American population compared to the non-African-American population in the United States.Methods:The National Inpatient Sample (NIS) database was employed to identify hospitalizations with nACS-CS from 2018 to 2020. Patients were categorized as either African Americans or non-African Americans. Statistical analyses, including Chi-square and t-tests, were conducted using STATA version 18.Results:Out of 8,607 nACS-CS hospitalizations, 1,325 (15.4%) involved African Americans between 2018 and 2020 (Figure 1a). African American patients with nACS-CS tended to be younger (60.9±16.6 vs. 65.8±16.7 years; p < 0.05). Moreover, the length of stay for this cohort was notably longer (16.2±0.75 vs. 14.8±0.32 days; p < 0.05). The demographic age group affected by cardiogenic shock exhibited a decreasing trend as time progressed up to 2020 (p-trend

Circulation, Volume 150, Issue Suppl_1, Page A4139258-A4139258, November 12, 2024. Introduction:Antiplatelet therapy plays a significant role in the management of patients with coronary artery disease (CAD) to prevent cardiovascular events. Current guidelines recommend 6-12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) followed by either aspirin or clopidogrel monotherapy indefinitely. Previous meta-analyses have suggested a potential superiority of clopidogrel over aspirin. However, given the evolving landscape of cardiovascular medicine, there is a need for updated evidence to inform clinical practice.Hypothesis:This systematic review and meta-analysis, to our knowledge the most up-to-date, aims to compare the effectiveness and safety of aspirin versus clopidogrel as monotherapy in patients with coronary artery disease (CAD).Methods:We searched PubMed, Embase, and Cochrane Library databases for relevant randomized controlled trials (RCTs) and Non (RCTs) Studies published up to April 2024. The primary outcomes were Major Adverse Cardiovascular and Cerebrovascular Events, myocardial infarction, stroke, and Death, while secondary outcomes included major bleeding events, target vessel revascularization, repeated revascularization, and stent thrombosis. heterogeneity analysis, and pooled analysis conducted by RevMan 5.3 software.Results:A total of eleven (11) studies involving 26324 patients, of whom 11435 (43.4%) received clopidogrel met the inclusion criteria. Mean follow-up was 12-36 months. Duration of DAPT before antiplatelet monotherapy was 1-18 months. The meta-analysis revealed a significant reduction with Clopidogrel monotherapy in all the following compared to Aspirin monotherapy; myocardial infarction [ 0.77 -95%CI -(0.64 – 0.93)], stroke [ 0.59 -95%CI- (0.48 – 0.74)], major bleeding events [ 0.66 -95%CI- (0.53 – 0.84)], and repeated revascularization [ 0.88 – 95% CI ( 0.77 – 0.99 )]. There was no significant difference in the risk of major adverse cardiovascular and cerebrovascular events, death and cardiac death.Conclusion:Clopidogrel monotherapy may be associated with a lower risk of major bleeding, MI, stroke and repeated revascularization compared to aspirin monotherapy in patients with CAD. This supports the use of clopidogrel over aspirin in patients with CAD who require secondary prevention with long-term antiplatelet monotherapy.

Circulation, Volume 150, Issue Suppl_1, Page A4139940-A4139940, November 12, 2024. Background:There are two approved methods for transcatheter aortic valve replacement (TAVR) namely balloon-expandable valves (BEV) and self-expanding valves (SEV). While several randomized controlled trials (RCTs) have compared the efficacy of SEV and BEV, the generalizability of their findings is questioned. Therefore, to generate concrete evidence regarding the superiority between the two, we conducted this real-world meta-analysis to compare the clinical efficacy and safety outcomes of SEV vs BEV in patients undergoing TAVR for aortic stenosis (AS).Methods:MEDLINE, EMBASE, and Scopus were queried to shortlist studies including AS patients undergoing TAVR. Primary outcomes included 30-day and 1-year all-cause and cardiac mortality. Secondary outcomes were permanent pacemaker implantation (PPI), paravalvular leak (PVL), aortic regurgitation (AR), stroke, major vascular complications (MVC), major bleeding (MB), acute kidney injury (AKI), myocardial infarction (MI), length of stay (LOS), patient prosthesis mismatch (PPM), and atrial fibrillation (AF). A random effects meta-analysis was conducted to derive risk ratios and mean differences with corresponding 95% confidence intervals (CI).Results:Our meta-analysis included 38 real-world studies. No significant association was seen in 30-day (RR=1.13, P=0.15) and 1-year all-cause mortality (RR=1.04, P=0.55), and cardiac mortality (RR=1.28, P=0.12). SEV was associated with a higher risk of 30-day PPI (RR=1.61, 95% CI 1.28-2.02, I2 = 88%, P

Circulation, Volume 150, Issue Suppl_1, Page A4144488-A4144488, November 12, 2024. Background:Oral anticoagulants (OAC) including Vitamin K antagonists such as warfarin and direct oral anticoagulants like Apixaban, Rivaroxaban, and Edoxaban, have long been the standard treatment for stroke prevention in patients with atrial fibrillation (AF). However, they increase the risk of bleeding, making them unsuitable for certain patient populations, particularly those with a personal history of bleeding, elderly individuals prone to falls or those with high-risk occupation with safety hazards. In cases of non-valvular AF, where thrombi typically form in the left atrial appendage, mechanical left atrial appendage closure (LAAC) has come out as an alternative for selected patients. Numerous studies have shown that LAAC is comparable to OAC in preventing strokes while significantly reducing major bleeding events. This meta-analysis aims to compare the 4–5-year outcomes of these two treatment strategies in non-valvular AF.Methods:4 studies (3 randomized controlled trials and 1 observational study) comparing the 4–5-year outcomes of LAAC versus OAC in patients with AF were included in this meta-analysis. These studies were identified after a thorough search of PUBMED, COCHRANE, and MEDLINE databases from inception till May 2024. The outcomes of interest were MACE (composite of stroke, embolism, and death), ischemic stroke, major bleeding episodes, cardiovascular (CV) deaths, and all-cause death. The results were reported as Risk Ratio (RR) with 95% confidence intervals (CI), using a random effects model.Results:6,012 patients were identified from the 4 studies. After a median follow-up of 4–5 years, LAAC was associated with a clinically significant reduction in MACE (RR: 0.76, 95% CI: 0.61-0.94, p=0.01), all-cause mortality (RR: 0.77, 95% CI: 0.62-0.96, p=0.02), and CV mortality (RR: 0.64, 95% CI: 0.45-0.90, p=0.01). Additionally, a significant reduction in major bleeding episodes (RR: 0.63, 95% CI: 0.44-0.91, p=0.01) was also noted between the two treatment strategies favoring LAAC treatment group. There was no significant difference in the incidence of ischemic stroke (RR: 1.07, 95% CI: 0.62-1.85, p=0.80) between the two groups.Conclusion:Over a median follow-up of 4-5 years, LAAC was found to be as effective as OAC in preventing ischemic strokes, while also showing lower incidence of MACE, all-cause, CV mortality and major bleeding episodes. More RCTs are needed to further assess the long-term outcomes between the two strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4145424-A4145424, November 12, 2024. Introduction:Dual therapy with clopidogrel and an anticoagulant has become the standard of care for patients on long-term anticoagulation following PCI. However, the impact of initial triple therapy and the selection of optimal P2Y12 inhibitor on ischemic and bleeding events is ambiguous during the first 30 days after PCI.Aim:Explore prescribing patterns and outcomes of patients discharged on dual therapy versus triple therapy post PCI.Methods:We performed a retrospective chart review of all patients receiving PCI at a single institution over a 12-month time frame who were discharged on an anticoagulant. The exposure variable was type of therapy (dual vs. triple) prescribed at discharge as well as anticoagulants and P2Y12 inhibitors prescribed. The outcome was any 30-day event defined as death, stent thrombosis, major bleeding events, and composites of ischemic and bleeding events. Differences were explored using Fisher’s exact test due to the low number of types of events.Results:The study included 124 patients. 41% patients were treated with immediate dual therapy, and 59% were discharged on triple therapy. A greater proportion of patients undergoing non-elective PCI received triple combination therapy (58% vs 31%; P=0.004; Table 1). There was no statistically significant difference in death or composite outcomes between groups (Table 2). Two stent thrombosis events occurred, both in patients receiving dual antithrombotic therapy with clopidogrel (P=0.09). No stent thrombosis events occurred in patients initially started on triple therapy or in patients receiving dual therapy utilizing a more potent P2Y12 inhibitor. Four major bleeding events were noted in patients on triple therapy, and 1 major bleeding event occurred in a patient on dual therapy (P=0.31; Table 2).Conclusion:In this retrospective analysis of patients, a trend toward higher albeit not statistically significant 30-day stent thrombosis event rate was noted in patients started on dual therapy using clopidogrel for P2Y12 inhibition. These findings should be cautiously interpreted, and analysis is ongoing in a larger dataset to better define the relationship between type of therapy and ischemic and bleeding events.

Circulation, Volume 150, Issue Suppl_1, Page A4147215-A4147215, November 12, 2024. Background:Patients with ischemic heart failure (IHF) often undergo myocardial viability assessment to help determine the appropriate treatment strategy, whether revascularization or medical therapy. However, there is a lack of evidence regarding the optimal imaging modality for this purpose. The present study aimed to compare the clinical outcomes of IHF patients undergoing cardiac magnetic resonance (CMR) versus positron emission tomography (PET) for myocardial viability assessment.Methods:We enrolled patients >18 years with IHF and ejection fraction (EF)

Circulation, Volume 150, Issue Suppl_1, Page A4146939-A4146939, November 12, 2024. Background:New onset AF during acute illness has a high rate of AF recurrence within 5-yr. However, little is known about AF progression in patients with new onset AF during COVID illness. It is also unknown whether the time of COVID diagnosis (early vs late) impacts AF progression. More specifically, did the potentially different immune and inflammatory responses during early vs late COVID produce structural and electrical cardiac remodeling that would increase the likelihood of AF progression.Objective:We sought to compare AF progression in patients with new onset AF during early vs late COVID and hypothesized that early COVID was associated with increased AF progression compared to late COVID.Methods:From Apr 2020 to Feb 2024, patients receiving a SARS-2-CoV test without a history of AF with new onset AF and at least 3-mo of follow up were included (N=11,767). Patients were subdivided based on pos vs neg SARS-2-CoV test and time of diagnosis. Early COVID diagnosis (n=3052) included Apr 2020-Aug 2021 and late COVID (n=8715) included Sep 2021-Feb 2024. AF progression endpoints at 3-, 6- and 12-mo included AF hospitalization, AF emergency department (ED) visit, cardioversion and AF ablation.Results:Patients with late COVID were more likely females with hypertension, coronary artery disease and hyperlipidemia compared to early COVID patients. At 3- and 6-mo follow-up there was no difference in AF progression between the early and late COVID groups for any endpoint. In contrast, at 12-mo follow up there was in increase in late diagnosis group AF ED visits (11% vs 7.6%,p

Circulation, Volume 150, Issue Suppl_1, Page A4140562-A4140562, November 12, 2024. Background:E-cigarettes may be less harmful than combustible cigarettes, though results from research with objective outcomes are limited. Comparisons of the cardiopulmonary effects of e-cigarettes and combustible cigarettes in controlled settings are necessary.Aims:Examine cardiopulmonary effects of combustible cigarettes vs. e-cigarettes using a within-subjects design in individuals with chronic obstructive pulmonary disease (COPD) who smoke.Hypothesis:Cardiopulmonary measures will improve following e-cigarette use compared to combustible cigarette use.Methods:Twenty-one individuals ≥40 years old who smoke (≥5 cigarettes/day for ≥1 year) while diagnosed with COPD underwent two consecutive randomly ordered 2-week phases: a cigarette phase (usual-brand cigarettes) and nicotine-containing e-cigarette phase (combustible-cigarette abstinence with 3% and/or 5% nicotine tobacco-flavored JUUL available). During the e-cigarette phase, participants earned monetary incentives for CO readings ≤6ppm to promote cigarette abstinence. Pulmonary (spirometry, oscillometry, COPD Assessment Test [CAT], Saint George’s Respiratory Questionnaire for COPD [SGRQ-C]) and cardiac (heart rate, blood pressure) measures were completed at baseline and after each phase. Changes in pulmonary and cardiac measures across assessments were analyzed using a mixed-model repeated-measures ANOVA.Results:Fourteen participants (66.66%) maintained cigarette abstinence during the e-ciguarette condition. There were no significant differences in objective (spirometry, oscillometry) or self-reported (CAT, SGRQ-C) by condition. Of the cardiac measures, diastolic blood pressure significantly differed by condition (F(2,40) = 3.87,p< 0.05), with higher measures after the completion of the cigarette phase (p= 0.02).Conclusions:Participants were largely able to conform to the study conditions. However, cardiopulmonary changes were minimal with only diastolic blood pressure differing by condition. Nonetheless, the absence of impairments in pulmonary and cardiac health during this 2-week e-cigarette phase suggests evaluations of longer durations of e-cigarette exposure, with concurrent cigarette abstinence, are warranted to determine the safety of e-cigarettes as a potential replacement for combustible-cigarettes.

Circulation, Volume 150, Issue Suppl_1, Page A4132909-A4132909, November 12, 2024. Background:While the critical role of right ventricular dysfunction (RVD) in heart failure (HF) is increasingly recognized, the prevalence and prognostic impact of RVD across HF subtypes is poorly understood.Research Questions/Aims:We aimed to characterize differences in hemodynamic indices of RV function among patients with HF with preserved vs reduced ejection fraction (HFpEF, EF≥50% vs HFrEF, EF

Circulation, Volume 150, Issue Suppl_1, Page A4140462-A4140462, November 12, 2024. Background:Right ventricular pacing (RVP) can have adverse cardiac effects and cause pacing induced cardiomyopathy (PiCM). His bundle pacing (HBP)&Left Bundle Branch area pacing (LBBAP) mimic physiologic conduction (PhysioP) and maintain biventricular synchrony.Hypothesis and Aims:Reduced left ventricular (LV) systolic function reserve in the presence of normal baseline LV ejection fraction (EF) could precede development of RV PiCM. Our aim was to compare the effects of RVP vs. PhysioP on bicycle exercise cardiopulmonary performance in patients with normal LVEF who required pacing for bradyarrhythmias.Methods:Patients with sinus rhythm and RVP or PhysioP&ventricular pacing burden of >70% who completed cardiopulmonary exercise test and simultaneous stress echocardiography (SE) were included. Pulmonary gas exchange was calculated using Ventilation/CO2 production at rest and during exercise. Changes in LV size, EF, longitudinal strain and diastolic function and gas exchange parameters were compared post and pre exercise in the 2 groups.Results:25 of 29 patients completed the study [68 ± 23 yrs, 48% M; LVEF 56±5%, 11 RVP, 14 PhysioP]. There was no difference in baseline demographic&clinical variables, exercise duration, rest and peak heart rate and blood pressure between 2 groups. Pacing duration was 2.61±1.48 yrs in RVP vs. 0.84±0.67 yrs (p=0.003) in the Physio group. Resting echocardiographic parameters (Table 1A)were comparable. Compared to RVP, reduction in LV end-diastolic volume (EDV) 3.4±14.1 ml vs. -23.1±18.1ml, p=0.006)&LV end-systolic volume (ESV -5.7±11.6 ml vs. -18.0±9.5ml, p=0.01) was more pronounced in the PhysioP group. Changes in LVEF, LV strain&diastolic function were not different between the 2 groups (Table 1B). There were no significant differences in changes in pulmonary gas exchange parameters in the 2 groups.Conclusions:In patients with normal LVEF and pacemaker dependent, RVP is associated with impaired but PhysioP with preserved LV systolic function reserve, which can be detected by exercise SE. SE may help identify patients at risk for RV PiCM. Benefit of PhysioP needs to be determined by larger studies with longer follow-up.

Circulation, Volume 150, Issue Suppl_1, Page A4144881-A4144881, November 12, 2024. Introduction:Metabolic equivalents (METs), a measure of energy use during a specified exercise intensity, and volume of oxygen consumed (VO2) are key measurements in cardiopulmonary exercise tests (CPETs). METs are traditionally converted to VO2 via multiplying METs by 3.5 ml/kg/min when VO2 data is not available, due to the fact that the latter requires more-expensive, accurate measurements of volume of inspired and expired oxygen and CO2. However, it is unclear which populations have significant variation between peak METs and peak VO2.Research Question:In a general cardiology population, do older women have a weaker relationship between peak METs and peak VO2?Methods:We present a retrospective study analyzing the relationship of peak METs and peak VO2 achieved on a CPET. Patients presenting to the cardiology clinic who received a CPET from 2017-2022 were included. Patients with severe valvular dysfunction, congenital heart disease, prior coronary artery bypass grafting, or ejection fraction < 50% were removed to limit confounding. A Spearman correlation coefficient was calculated for the whole sample comparing peak METs and peak VO2. Subsequently, a subgroup of women age 65 or greater were compared to the general sample by a fisher’s z transformation.Results:1907 patients were included. There was a strong positive correlation between peak VO2 and peak METs in the whole sample (r(1860) = 0.914), p

Circulation, Volume 150, Issue Suppl_1, Page A4146155-A4146155, November 12, 2024. Importance:Despite the increasing use of intra-aortic balloon pumps (IABP) and Impella bridge to heart transplant (HTx), there is a paucity of comparative data on their use as bridges to heart transplantation.Objective:To compare the efficacy of IABP vs Impella (5.5 and 5.0) devices as a bridge to HTx in a cohort transplanted under the current UNOS heart allocation system.Design, Setting, and Participants:A retrospective longitudinal study of the United Network for Organ Sharing (UNOS) registry included adult patients listed for HTx between Oct 2018 and April 2022 as status 2, who were supported by IABP or Impella (5.5 and 5.0) and had a complete set of demographics, hemodynamics, medical comorbidities, inotrope requirements, and biochemical variables. The primary endpoint was a successful bridging to HTx as status 2. IABP and Impella groups were propensity-matched at a 3:1 ratio for demographics, UNOS region, baseline hemodynamics, and liver and kidney function.Results:Of 32,806 HTx during the study period, 991 patients met the inclusion criteria (Impella n=88, IABP n=903). Post-matching, there were no differences between the IABP and Impella groups in any baseline characteristic. The primary outcome occurred in 89.5% of the pre-matched population (IABP 90.1% vs Impella 83%, P = 0.055). In the matched cohort, the primary outcome occurred in 85.2% (IABP 86%, Impella 83%, P = 0.603); there was no difference in the listing by exception, multiorgan transplantation, waitlist time, waitlist mortality, or delisting. Post-transplant graft survival, infection, and renal failure were not different. Impella was associated with a lower rehospitalization rate (OR 0.54, 95% CI 0.33–0.9, P = 0.02), coronary allograft vasculopathy (OR 0.23, 95% CI 0.05–1, P = 0.05), and rejection requiring hospitalization (OR 0.13, 95% CI 0.02–1, P = 0.05).Conclusions:IABP and Impella (5.5 and 5.0) devices are equally effective as bridge-to-transplant platforms with a high transplantation rate as status 2. Additionally, Impella was associated with lower post-HTx events.