Explore the vast range of titles available.

During the Covid-19 outbreak in northern Italy, the daily rate of admissions for acute coronary syndrome at 15 hospitals was significantly lower than the rate during two control intervals (13.3 admissions vs. 18.0 and 18.9 admissions for the two control periods).

The accuracy of current prediction tools for ischaemic and bleeding events after an acute coronary syndrome (ACS) remains insufficient for individualised patient management strategies. We developed a machine learning-based risk stratification model to predict all-cause death, recurrent acute myocardial infarction, and major bleeding after ACS. Different machine learning models for the prediction of 1-year post-discharge all-cause death, myocardial infarction, and major bleeding (defined as Bleeding Academic Research Consortium type 3 or 5) were trained on a cohort of 19 826 adult patients with ACS (split into a training cohort [80%] and internal validation cohort [20%]) from the BleeMACS and RENAMI registries, which included patients across several continents. 25 clinical features routinely assessed at discharge were used to inform the models. The best-performing model for each study outcome (the PRAISE score) was tested in an external validation cohort of 3444 patients with ACS pooled from a randomised controlled trial and three prospective registries. Model performance was assessed according to a range of learning metrics including area under the receiver operating characteristic curve (AUC). The PRAISE score showed an AUC of 0·82 (95% CI 0·78–0·85) in the internal validation cohort and 0·92 (0·90–0·93) in the external validation cohort for 1-year all-cause death; an AUC of 0·74 (0·70–0·78) in the internal validation cohort and 0·81 (0·76–0·85) in the external validation cohort for 1-year myocardial infarction; and an AUC of 0·70 (0·66–0·75) in the internal validation cohort and 0·86 (0·82–0·89) in the external validation cohort for 1-year major bleeding. A machine learning-based approach for the identification of predictors of events after an ACS is feasible and effective. The PRAISE score showed accurate discriminative capabilities for the prediction of all-cause death, myocardial infarction, and major bleeding, and might be useful to guide clinical decision making. None.

The optimal strategy for patients with an acute myocardial infarction (MI) and multivessel (MV) coronary artery disease complicated by cardiogenic shock (CS) remains unknown. We conducted a meta-analysis of all randomized controlled trials and observational studies that reported adjusted effect measures to evaluate the association of MV-PCI (percutaneous coronary intervention), compared with culprit only (C)-PCI, with cardiovascular events in patients admitted for CS and MV disease. We identified 12 studies (n = 1 randomized controlled trials, n = 11 observational) that included 7,417 patients (n = 1,809 treated with MV-PCI and n = 5,608 with C-PCI). When compared with C-PCI, MV-PCI was not associated with an increased risk of short-term death (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.87 to 1.48, p = 0.35 and adjusted OR [ORadj] 1.00, 95% CI 0.70 to 1.43, p = 1.00). In-hospital and/or short-term mortality tended to be higher with MV-PCI, when compared with C-PCI, for CS patients needing dialysis (ß 0.12, 95% CI from 0.049 to 0.198; p= 0.001), whereas MV-PCI was associated with lower in-hospital and/or short-term mortality in patients with an anterior MI (ß −0.022, 95% CI −0.03 to −0.01; p <0.001). MV-PCI strategy was associated with a more frequent need for dialysis or contrast-induced nephropathy after revascularization (OR 1.36, 95% CI 1.06 to 1.75, p = 0.02). In conclusion, MV-PCI seems not to increase risk of death during short- or long-term follow-up when compared with C-PCI in patients admitted for MV coronary artery disease and MI complicated by CS. Furthermore, it appears a more favorable strategy in patients with anterior MI, whereas the increased risk for AKI and its negative prognostic impact should be considered in decision-making process. Further studies are needed to confirm our hypothesis on in these subpopulations of CS patients.

Abstract Aims A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined. Methods and results Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial’s subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71–1.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60–0.79), mainly driven by MI (OR 0.48, 95% CI 0.36–0.65) and revascularization (OR 0.53, 95% CI 0.45–0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59–0.97 for values < 32 and OR 0.63, 95% CI 0.47–0.84 for values ≥ 33) while was not evident for ‘younger’ patients (OR 0.83, 95% CI 0.65–1.07 vs. OR 0.65, 95% CI 0.51–0.84 for ‘older’ patients). Conclusion For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score.

Same-day discharge after coronary angiography or percutaneous coronary interventions (PCI) is safe. It allows a decrease in length of hospital stay, waiting list and operating expenses with increased patient satisfaction. The aim of this study was to evaluate the feasibility and safety of this approach in our center. 798 selected patients considered suitable for same-day discharge were enrolled in our study and underwent coronary angiography and/or PCI procedures over a period of 5 years. All procedures were performed by femoral approach using the 6-8F AngioSeal closure device. A follow-up telephone interview was carried out in all patients after 7-10 days from discharge with particular regard to bleeding/vascular complications. After PCI procedures, 738 patients (92.4%) were discharged as day cases. The remaining 60 patients (7.6%) were kept in hospital for longer observation. Procedural success was achieved in 100% of patients. Hemostasis with the AngioSeal closure device was successfully obtained in 98.4% of cases. At follow-up, 6 patients developed mild size hematoma on femoral access site, without any other vascular complications or major bleeding needing blood transfusion. In our experience same-day discharge after coronary angiography or PCI was found to be feasible and safe in selected patients undergoing uncomplicated procedures performed by femoral approach using a closure device.

Razionale. La dimissione in regime di day-surgery dopo procedure coronariche diagnostico-interventistiche si configura oggi come una valida e sicura possibilità che permette la riduzione di tempi di ricovero, liste d’attesa e costi ospedalieri e contestuale aumento del gradimento da parte dei pazienti. Scopo del nostro studio è stato valutare la fattibilità e la sicurezza dell’uso di tale approccio presso il nostro centro.Materiali e metodi. Nell’arco di 5 anni, 798 pazienti selezionati sono stati inseriti in regime di day-surgery e sottoposti a manovre diagnostico-interventistiche coronariche presso il nostro centro. In tutte le procedure sono stati utilizzati l’accesso vascolare femorale e il dispositivo di chiusura AngioSeal 6-8F. La dimissione è avvenuta nella stessa giornata della procedura in caso di sola coronarografia, la mattina del giorno successivo in caso di angioplastica. Per tutti i pazienti è stato eseguito un follow-up telefonico a 7-10 giorni dalla dimissione. Risultati. La dimissione in regime di day-surgery è stata possibile per 738 pazienti (92.4%). Nei restanti 60 casi (7.6%) la degenza è stata convertita in ricovero ordinario. Il successo procedurale è stato ottenuto nel 100% dei casi; l’emostasi del vaso mediante dispositivo è avvenuta con successo nel 98.4% dei casi. Al follow-up è stato necessario richiamare i pazienti presso la nostra struttura in soli 6 casi (0.8%) per il riscontro di ematomi risultati di modesta entità e mai accompagnati da calo significativo dell’emoglobina o necessità di trasfusioni. Conclusioni. Nella nostra esperienza la dimissione in regime di day-surgery è emersa come una possibilità fattibile e sicura in pazienti selezionati, sottoposti a coronarografia e/o angioplastica non complicate, effettuate per via femorale, con sistema di emostasi meccanico.

Background. Same-day discharge after coronary angiography or percutaneous coronary interventions (PCI) is safe. It allows a decrease in length of hospital stay, waiting list and operating expenses with increased patient satisfaction. The aim of this study was to evaluate the feasibility and safety of this approach in our center.Methods. 798 selected patients considered suitable for same-day discharge were enrolled in our study and underwent coronary angiography and/or PCI procedures over a period of 5 years. All procedures were performed by femoral approach using the 6-8F AngioSeal closure device. A follow-up telephone interview was carried out in all patients after 7-10 days from discharge with particular regard to bleeding/vascular complications.Results. After PCI procedures, 738 patients (92.4%) were discharged as day cases. The remaining 60 patients (7.6%) were kept in hospital for longer observation. Procedural success was achieved in 100% of patients. Hemostasis with the AngioSeal closure device was successfully obtained in 98.4% of cases. At follow-up, 6 patients developed mild size hematoma on femoral access site, without any other vascular complications or major bleeding needing blood transfusion. Conclusions. In our experience same-day discharge after coronary angiography or PCI was found to be feasible and safe in selected patients undergoing uncomplicated procedures performed by femoral approach using a closure device.