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

Circulation, Volume 150, Issue Suppl_1, Page A4147463-A4147463, November 12, 2024. Introduction:American guidelines recommend rescue PCI within 3 to 24 hours after failed fibrinolysis in patients with ongoing ischemia, hemodynamic instability, or other high-risk features. Given the large areas covered by relatively few centers, rescue PCI can be delayed.Aims:This abstract aims to compare complications in patients undergoing early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis).Methods:A prospective registry was conducted, patients over 18 years with diagnosis of STEMI undergoing rescue PCI (reperfusion therapy when thrombolysis has failed) in a tertiary cardiology center in Mexico from august of 2023 to april of 2024 were included. We divided patients into two groups, the ones who received early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis).Results:109 patients who received late Rescue PCI and 56 patients who received early Rescue PCI were included. Baseline characteristics in patients undergoing Rescue PCI before and after 6 hours are presented in table 1. Patients who underwent late rescue PCI showed worsening heart failure (KK: Killip Kimball IV) 14.2% vs 9.1% (p= 0.319.). The Major adverse cardiovascular events (MACE) reported with statistical significance are angina (p value 0.048) and especially renal failure (p= 0.016). The survival rate was significantly higher when the patient entered rescue PCI after 6 hours 95.4% vs 89.2% (p = 0.023).Conclusion:Although no specific time frame has been set for rescue PCI, patients who underwent to rescue PCI within six hours showed worsening outcomes such as angina and renal failure, possibly due to higher KK grades, the onset of cardiogenic shock, and lower survival rates. A major limitation of our study was the small sample size, which restricted comparisons of MACE with other outcomes. This limitation is expected to improve as our database expands. Despite these findings, it is essential to base the decision to perform a rescue PCI on the patient’s initial condition upon arrival at a capable PCI center.

Circulation, Volume 150, Issue Suppl_1, Page A4137019-A4137019, November 12, 2024. Background:Despite the effectiveness of drug-eluting stents (DES) in preventing restenosis, many patients still experience DES restenosis. Neointimal hyperplasia and neoatherosclerosis can develop within these stents, leading to recurrent coronary syndromes.Hypothesis:Repeated stenting with DES is limited by additional metal layers, the need for prolonged dual antiplatelet therapy, and heightened risks of stent thrombosis. Locally acting drugs with sustained efficacy may prevent this progression. Paclitaxel delivery via contrast medium or drug-coated balloon catheters could exert antiproliferative effects, reducing neointimal proliferation.Aims:To synthesize existing evidence on the efficacy and safety of Paclitaxel-Coated Balloons versus Uncoated Balloons in coronary in-stent restenosis.Methods:Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to March 23, 2024. Using R version 4.4.0, we reported outcomes as risk ratios (RRs) or mean differences (MD) and confidence intervals (CIs). This review has been registered and published in PROSPERO (CRD42024527412).Results:The meta-analysis included a total of six trials with 1,541 patients. PCB significantly reduced the incidence of myocardial infarction (RR 0.65, 95% CI [0.42, 1.00], p = 0.052), stent thrombosis (RR 0.26, 95% CI 0.08, to 0.83], p = 0.023), major adverse cardiac events (RR 0.32, 95% CI 0.25, to 0.42], P < 0.001), target lesion revascularization (RR 0.34, 95% CI [0.14, 0.84], p < 0.001). No significant differences were observed between PCB and UCB regarding cardiac-related mortality, target vessel revascularization, percutaneous coronary intervention, all-cause death, Q wave and non-Q wave myocardial infarction, coronary artery bypass grafting, and target vessel failure.Conclusion:PCB for ISR significantly reduced the incidence of myocardial infarction, MACE, and stent thrombosis compared to UCB.

Circulation, Volume 150, Issue Suppl_1, Page A4135905-A4135905, November 12, 2024. Background:Atrial fibrillation (AF) and heart failure (HF) are associated with an increased risk of adverse events, with their diagnoses often coexisting. The impact of AF in HF needs additional study, with further delineation among HF type. Therefore, this study sought to determine the degree of AF burden among newly diagnosed HF patients and whether differences in risk exist between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) patients.Methods:Patients with new-onset HF between 2000-2019 were studied. To be included, patients had to have 1-year of follow-up, an ejection fraction (EF) measurement within 30 days of HF diagnosis, and no history of cancer. EF was used to define HFrEF (EF 40%). Multivariable Cox hazard regression was used to evaluate the risk of death and HF hospitalization at 1- and 3-years.Results:A total of 21,925 patients were studied with HFrEF (n=7931 [36.2%]) and HFpEF (n=13,994 [63.8%]). HFpEF patients were older (74 vs. 65 years) and more often female (53.7% vs. 33.1%). Prevalent AF was 40.5% (n=8879), being more common in HFpEF compared to HFrEF (65.2% vs. 34.8%). Among AF patients, HFpEF patients were also older (76 vs. 72 years) and more often female (52.7% vs. 30.8%) compared to HFrEF. The presence of AF was associated with an increased risk of HFpEF (OR=1.11, p=0.001). Prevalent AF was associated with an increased risk of death and follow-up HF hospitalization (Table). Death at 1-year and 3-years were similar between the HF groups (Table). However, the risk of HF hospitalization was greater among HFrEF patients (Table). Similar associations persisted when AF patients were propensity matched (Table).Conclusions:Among a newly diagnosed HF population, AF was common (40%) and was associated with an increased risk of HFpEF, death, and HF hospitalization. These results provide a rationale for aggressive management of HF and AF patients and the need for a randomized clinical trial to determine optimal therapy by ablation and 4-pillar HF therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4140642-A4140642, November 12, 2024. Background:The diagnosis of VVS largely relies on clinical history and simple diagnostic tools (e.g., electrocardiogram) to rule out dangerous differential diagnoses. However, using the head-up tilt test (HUTT) has become controversial among clinicians. This retrospective study aims to evaluate whether the prodromal symptoms experienced during HUTT are consistent with those experienced during spontaneous syncope.Methods:This study utilized data from the HUTT registry at the Syncope Unit of the tertiary Heart Center, focusing on adults aged 18 and older diagnosed with VVS. Diagnoses were based on clinical histories, physical examinations, and the latest syncope guidelines. Out of 1914 patients with HUTT results, 764 patients with positive tests were analyzed for mutual prodromal symptoms during HUTT and spontaneous syncope.Results:The McNemar test revealed significant differences for several symptoms, including palpitation (X2 = 30.59, P < 0.001), nausea (X2 = 16.13, P < 0.001), chest pain (X2 = 24.32, P < 0.001), abdominal discomfort (X2 = 22.33, P < 0.001), flushing (X2 = 10.87, P < 0.001), and aura (X2 = 19.86, P < 0.001), indicating discrepancies in the occurrence of these symptoms. Cohen's Kappa values ranged from 0.06 to 0.32, signifying slight to fair agreement. Specifically, diaphoresis (k = 0.32), palpitation (k = 0.27), and vertigo (k = 0.25) demonstrated fair agreement, whereas nausea, aura, chest pain, abdominal discomfort, and flushing exhibited slight agreement. Among the 640 patients who experienced prodrome during spontaneous syncope, 110 (17.19%) had no symptoms. Conversely, among the 123 patients who did not experience prodrome, 96 (78.05%) experienced at least one symptom during the tilt test (Figure).Conclusion:The assessment of prodromal symptoms during HUTT compared to spontaneous syncope showed significant differences for several symptoms and overall low levels of agreement. Also, tilt cannot differentiate patients with or without prodrome during their spontaneous spells.

Circulation, Volume 150, Issue Suppl_1, Page A4145520-A4145520, November 12, 2024. Background:The previous literature reports similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD) in such patients. Thus, our aim is to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG.Methods:A comprehensive search of electronic databases, PubMed, SCOPUS, and Cochrane Central was conducted from their inception till May 2024. Outcomes of interest included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), Myocardial Infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data were pooled and analyzed using a random effects model and presented as hazard ratios (HR) along with their 95% confidence intervals (CI). Heterogeneity was quantified using the I(2) index.Results:We included three studies in our analysis (n = 5,732). Our analysis demonstrated that in patients with prior CEVD, PCI lead to significantly increased risk of MACCE (HR = 2.56, 95% CI:[1.23, 5.37], p = 0.01] and MI (HR = 2.97, 95% CI: [1.72, 5.13], p< 0.01). While an elevated risk of all-cause mortality (HR: 1.35, 95% CI: [0.92, 1.98]; p = 0.12) and repeat stroke (HR: 1.67, 95% CI: [0.81, 3.42], p = 0.16) was observed, these were comparable across procedures. Similarly, an elevated but comparable risk of repeat revascularization was observed between the two procedures (HR: 3.44, 95% CI: [0.50, 23.60]; p = 0.21).Conclusion:Our results show that PCI significantly elevates the risk of MACCE and MI in patients with prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were comparable. The increased risk of adverse CV events in CEVD patients may be due to co-morbidities like hypertension, smoking, diabetes, peripheral vascular disease, renal insufficiency, inflammation, and hypercoagulability. We recommend including prior CEVD in pre-operative assessments for revascularization and developing novel strategies for patients with LMCAD and prior CEVD.

Circulation, Volume 150, Issue Suppl_1, Page A4143918-A4143918, November 12, 2024. Background:Spontaneous coronary artery dissection (SCAD) is a non-iatrogenic dissection in the epicardial coronary arteries, not related to trauma or atherosclerosis. In SCAD, myocardial injury occurs due to luminal obstruction following intimal disruption or intramural hematoma. We aimed to determine the differences in outcomes associated with SCAD compared to Type 1 myocardial infarction (MI) in the Aurora Health Care community.Methods:A retrospective, matched cohort, multicenter community study was carried out on adult patients aged >18 years admitted to all Aurora Hospitals from January 2012 to December 2022. A total of 57 patients were diagnosed with SCAD during that period. The SCAD and Type 1 MI groups were matched by age and gender at a 1:5 ratio using a propensity score-based matching. Outcomes between the SCAD and Type 1 MI groups were compared using chi-squared tests or Fisher’s exact tests, and t-tests or nonparametric equivalents (Wilcoxon), and a time-to-event analysis.Results:SCAD patients who underwent conservative therapy were 87.7%. There were no significant differences in in-hospital outcomes between SCAD and Type 1 MI in measures such as cardiogenic shock, mortality rate, sudden cardiac death, ischemic stroke, hospital length of stay, and arrhythmias (AF, atrial flutter, supraventricular tachycardia, and ventricular fibrillation). In the long term, SCAD patients required less repeat coronary catheterization (7% vs. 24.6%, p=0.003) and PCI (1.8% vs. 11.2%, p=0.027) compared to the Type 1 MI group. Type 1 MI patients had a higher incidence of AF, atrial flutter, death, readmissions for heart failure, and diastolic and systolic function in the long term, but this was not statistically significant. Type 1 MI patients required loop diuretics in the long term (24.6% vs 10.5%, p 0.02).Conclusion:Type 1 MI patients exhibited poorer long-term prognoses characterized by a higher risk of heart failure, which likely increased the necessity for diuretics. Additionally, Type 1 MI patients showed a higher need for repeat coronary catheterization and PCI. Although SCAD and Type 1 MI present similarly as acute coronary syndrome, it is important to understand the differences in outcomes as the management of these two populations differ.

Circulation, Volume 150, Issue Suppl_1, Page A4147358-A4147358, November 12, 2024. Introduction:Heart transplantation (HT) is the gold standard for end-stage heart failure, but limited donor availability and increasing disease prevalence have necessitated the use of mechanical circulatory support (MCS) devices. There is a rising trend of MCS devices used as a bridge to transplant with variable outcomes. This study examines trends and outcomes of MCS devices, specifically Extracorporeal Membrane Oxygenation (ECMO) and Impella, used as bridges to HT.Hypothesis:Impella support leads to better survival and post-transplant outcomes than ECMO.Methods:A retrospective cross-sectional study was conducted using National Inpatient Sample data from 2016-2021. Trends in utilization and patient outcomes were compared for those who received ECMO and Impella as bridges to HT. International classification of disease (ICD-10) codes were used to extract the data.Results:During the study period, 17,570 HTs were performed, with a rising trend in using MCS devices as a bridge to transplant, especially Impella. ECMO was used in 1,635 patients and Impella in 755 patients. The mean age of the study population was 52.5 years and 610 (25.5%) were female. Cardiogenic shock was more common among patients with Impella (94.04% vs. 67.28%, p

Circulation, Volume 150, Issue Suppl_1, Page A4142506-A4142506, November 12, 2024. Introduction:Myocarditis has been reported after mRNA-based COVID-19 vaccination, but the immune mechanisms remain unclear. This study aimed to identify the proteome-based immunopathogenesis of post-vaccination myocarditis compared to viral myocarditis in the pre-COVID-19 era.Methods:Proteomic analysis of right ventricle (RV) biopsy specimens was performed in myocarditis patients (pre-pandemic viral myocarditis: n=3, post-vaccination myocarditis: n=3) and controls (normal endomyocardial biopsy specimens of heart transplant recipients, n=4) using mass spectrometry. Differentially expressed proteins were analyzed with CIBERSORTx, Gene Ontology (GO) analysis, and Ingenuity Pathway Analysis (IPA). To examine the relationship between the SARS-CoV-2 spike protein and post-vaccination myocarditis, immunohistochemistry (IHC), mass spectrometry analysis of spike protein, and activation-induced marker (AIM) assay in T cells from RV samples were conducted.Results:In the proteomic analysis, 6,861 proteins were identified. Post-vaccination myocarditis showed increased extracellular matrix formation and cardiac fibrosis. Both pre-pandemic and post-vaccination myocarditis had elevated pro-inflammatory cytokine activities. However, post-vaccination myocarditis exhibited higher expression of interferon-alpha (IFNα) and pattern recognition receptor activation, including TLR3 and TLR7. Pre-pandemic myocarditis showed higher activation of the complement system, neutrophils, and NK cells, whereas post-vaccination myocarditis showed increased Th2 cell activation and classical macrophage activation. Spike protein and related T-cell activation were not detected.Conclusion:The immune activation in myocarditis after COVID-19 mRNA vaccination may be triggered by the mRNA in the vaccine via an IFNα-driven immune response, leading to autoimmune-like features. Further studies are necessary to validate whether these proteins correlate with clinical characteristics.

Circulation, Volume 150, Issue Suppl_1, Page A4135270-A4135270, November 12, 2024. Introduction:A growing body of evidence from randomized controlled trials (RCTs) has demonstrated the superiority of transcatheter aortic valve replacement (TAVR) over surgical aortic valve replacement (SAVR) irrespective of surgical risk in patients with severe aortic stenosis (SAS). Given the rise in TAVR procedures, analyzing trends in outcomes over time is critical to aid clinical decision-making. Hence, we pooled RCT data for a robust assessment of clinical and procedural outcomes in SAS patients undergoing TAVR and SAVR.Methods:PUBMED and SCOPUS were queried until April 2024. Trials were classified into high and low-risk groups based on surgical risk. The outcomes were analyzed at 30 days (short-term), 1 year (mid-term), and 5 years (long-term). Estimates were calculated as random effects risk ratios (RRs) with 95% confidence intervals (CI).Results:10 RCTs with a total of 10,252 patients were included. There was no significant association between TAVR and SAVR in reducing all-cause mortality at 30 days (RR: 0.84 [0.64, 1.10]; Figure 1a). While TAVR was associated with a significantly lower all-cause mortality at 1 year (RR: 0.82 [0.68-0.97]; Figure 1b), it was linked with a significantly higher all-cause mortality at 5 years (RR: 1.14 [1.07-1.21]; Figure 1c). Myocardial infarction and stroke were similar in both groups up to 5 years. TAVR was associated with a lower risk of acute kidney injury for up to 1 year and atrial fibrillation for up to 5 years but a higher risk of new permanent pacemaker implantation and aortic valve re-intervention for up to 5 years. In low-risk patients, TAVR showed no significant differences from SAVR for all-cause mortality at 30 days and 5 years, but it was significant at 1 year. In high-surgical-risk patients, all-cause mortality was comparable between TAVR AND SAVR at 30 days and 1 year, with a higher rate observed with TAVR at 5 years.Conclusion:Compared with SAVR, TAVR was superior in reducing all-cause mortality at 1 year in low-risk patients and inferior in reducing all-cause mortality at 5 years in high-risk patients. A thorough evaluation of anatomical, clinical, and procedural factors is crucial to tailor the optimal intervention for each patient.

Circulation, Volume 150, Issue Suppl_1, Page A4145685-A4145685, November 12, 2024. Introduction:Cardiogenic shock (CS), with a mortality rate of 30% to 50%, is a severe condition marked by the heart’s inability to supply sufficient blood to meet the body’s needs, which demands timely and effective intervention. Historically, the intra-aortic balloon pump (IABP) was the primary support device, but the use of left ventricular assist devices (LVADs) has increased. This study compared outcomes between CS patients treated with newer LVADs (CSLVAD) and older IABPs (CSIABP).Methods:This retrospective cohort study used the 2020 National Inpatient Sample (NIS) database to identify cardiogenic shock (CS) hospitalizations using ICD–10 codes. Our primary outcomes were in-hospital mortality, length of stay (LOS), total hospital charges (TOTCHG), and postprocedural complications among patients treated with LVADs and IABPs.Results:Out of 195,254 patients with cardiogenic shock, 2,609 received LVADs, and 21,169 received IABPs. The average age was 64.8 years for CSIABP patients and 54.8 years for CSLVAD patients. Males predominated in both groups (70.5% CSIABP, 75% CSLVAD). More Black patients received LVADs (33%) compared to IABPs (13%).Mortality was 23% in the CSIABP group versus 8% in the CSLVAD group. After adjusting for confounders, the CSLVAD group had statistically significant 62% lower odds of mortality (P=0.00, CL=0.25–0.57). The average LOS was longer in the CSLVAD group (39.4 days) compared to the CSIABP group (13.4 days), with a statistically adjusted increase of 20.1 days in the CSLVAD group (P=0.00, CL=17.6-22.6). The average TOTCHG was higher in the CSLVAD group ($1,265,731) compared to the CSIABP group ($399,160), with a statistically significant increase of $869,550 (P=0.00, CL=732,536-1,006,564).For cardiovascular outcomes, there was a 79% and 40% decrease in the odds of hypertension and CAD in the CSLVAD group(P=

Circulation, Volume 150, Issue Suppl_1, Page A4144067-A4144067, November 12, 2024. Background:Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston score which is used for coronary artery disease prediction only. We have previously reported AI-enabled cardiac chambers volumetry in CAC scans (AI-CAC) predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). Here we compare the distribution of cardiac chambers volumes vs. risk categories of ASCVD pooled cohorts’ equation (PCE) and PREVENTTMrisk scores.Methods:We applied the AutoChamberTMcomponent of AI-CAC to 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at the baseline examination of MESA. We calculated 10-year estimated risk from the PCE and PREVENT Risk Scores based on 4 categories of risk: 20% using baseline risk factors. The PREVENT total CVD base model was used in analysis, which excludes urinary albumin to creatinine ratio and social depravity index. We compared the distribution of the quartiles of left atrial (LA) and left ventricle (LV) volumes to categories of both risk scores. We defined enlarged cardiac chambers as the top quartile of LA ( >82.7 cc) and LV ( >136.5 cc) volume, which corresponded to 33% and 21.1% incidence of all-CVD events over 10 years (CHD, HF, AF, stroke, CVD deaths), respectively. LA and LV volumes were standardized by adjusting for body surface area (BSA).Results:A substantial portion of cases categorized by PREVENT as low risk (10-year risk

Introduction
Buprenorphine is a highly effective treatment for opioid use disorder (OUD). However, provider observations and preliminary research suggest that the current standard maintenance dose may be insufficient for suppressing withdrawal and preventing cravings among people who use or have used fentanyl. Buprenorphine dosing guidelines were based on studies among people who use heroin and have not been formally re-evaluated since fentanyl became predominant in the unregulated drug supply. We aim to compare the effectiveness of a high (24 mg) vs standard (16 mg) maintenance daily dose of buprenorphine for improving retention in treatment, decreasing the use of non-prescribed opioids, preventing cravings and reducing opioid overdose risk in patients.

Methods and analysis
Adults who are initiating or continuing buprenorphine for moderate to severe OUD and have a recent history of fentanyl use (n=250) will be recruited at four outpatient substance use treatment clinics in Rhode Island. Patients continuing buprenorphine must be on doses of 16 mg or less and have ongoing fentanyl use to be eligible. Participants will be randomly assigned 1:1 to receive either a high (24 mg) or standard (16 mg) maintenance daily dose, each with usual care, and followed for 12 months to evaluate outcomes. Providers will determine the buprenorphine initiation strategy, with the requirement that participants reach the study maintenance dose within 7 days of randomisation. Providers may adjust the maintenance dose, if clinically needed, for participant safety. The primary study outcome is retention in buprenorphine treatment at 6 months postrandomisation, measured using clinical and statewide administrative data. Other outcomes include non-prescribed opioid use and opioid cravings (secondary), as well as non-fatal or fatal opioid overdose (exploratory).

Ethics and dissemination
This protocol was approved by the Brown Institutional Review Board (STUDY00000075). Results will be presented at conferences and published in peer-reviewed journals.

Trial registration number
NCT06316830.

In this observational study, rosuvastatin was associated with lower 6-year mortality but interpreting and applying the results is not straightforward.

Total hip arthroplasty was superior to resistance training, with some caveats.