The use of intravenous antiplatelet therapy during primary percutaneous coronary intervention (PPCI) is not fully standardized. The aim is to evaluate the effectiveness and safety of periprocedural ...intravenous administration of cangrelor or tirofiban in a contemporary ST-segment elevation myocardial infarction (STEMI) population undergoing PPCI. This was a multicenter prospective cohort study including consecutive STEMI patients who received cangrelor or tirofiban during PPCI at seven Italian centers. The primary effectiveness measure was the angiographic evidence of thrombolysis in myocardial infarction (TIMI) flow < 3 after PPCI. The primary safety outcome was the in-hospital occurrence of BARC (Bleeding Academic Research Consortium) 2–5 bleedings. The study included 627 patients (median age 63 years, 79% males): 312 received cangrelor, 315 tirofiban. The percentage of history of bleeding, pulmonary edema and cardiogenic shock at admission was comparable between groups. Patients receiving cangrelor had lower ischemia time compared to tirofiban. TIMI flow before PPCI and TIMI thrombus grade were comparable between groups. At propensity score-weighted regression analysis, the risk of TIMI flow < 3 was significantly lower in patients treated with cangrelor compared to tirofiban (adjusted OR: 0.40; 95% CI: 0.30–0.53). The risk of BARC 2–5 bleeding was comparable between groups (adjusted OR:1.35; 95% CI: 0.92–1.98). These results were consistent across multiple prespecified subgroups, including subjects stratified for different total ischemia time, with no statistical interaction. In this real-world multicenter STEMI population, the use of cangrelor was associated with improved myocardial perfusion assessed by coronary angiography after PPCI without increasing clinically-relevant bleedings compared to tirofiban.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Serial pharmacokinetic (PK) sampling in 1159 patients from TRITON‐TIMI 38 was undertaken. A multilinear regression model was used to quantitatively predict prasugrel's active metabolite (Pras‐AM) ...concentrations from its 2 downstream inactive metabolites. Population‐based methods were then applied to Pras‐AM concentration data to characterize the PK. The potential influence of body weight, body mass index, age, sex, renal function, diabetes, tobacco use, and other disease status on Bayesian estimates of Pras‐AM exposures was assessed. The PK of Pras‐AM was adequately described by a multicompartmental model and consistent with results from previous studies. The systemic exposure of prasugrel was not appreciably affected by body mass index, gender, diabetes, smoking, and renal impairment. Pras‐AM mean exposure in patients weighing <60 kg (4.1%) was 30% (90% confidence interval CI 1.16–1.45) higher than exposure in patients ≥60 kg. Mean Pras‐AM exposures for patients ≥75 years (10.5%) were 19% (90% CI: 1.11–1.28) higher compared with patients <75 years.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The involvement of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-2 (IGFBP-2) following acute coronary syndrome (ACS) is rarely studied in clinical practice. ...Therefore, we sought to evaluate the relationship between IGF-1 and IGFBP-2 concentrations at admission and risk stratification based on the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients with ACS.
In all, 304 patients diagnosed with ACS were included in this study. Plasma IGF-1 and IGFBP-2 were measured using commercially available ELISA kits. The TIMI risk score was calculated and the study population was stratified into high (n = 65), medium (n = 138), and low (n = 101) risk groups. Levels of IGF-1 and IGFBP-2 were analyzed for their predictive ability of risk stratification based on the TIMI risk scores. Correlation analysis showed that IGF-1 levels were negatively correlated with TIMI risk levels (r = −0.144, p = 0.012), while IGFBP-2 levels were significantly and positively correlated with TIMI risk levels (r = 0.309, p < 0.001). In multivariate logistic regression analysis, IGF-1 (odds ratio OR: 0.995; 95% confidence interval CI: 0.990–1.000; p = 0.043) and IGFBP-2 (OR: 1.002; 95%CI: 1.001–1.003; p < 0.001) were independent predictors of high TIMI risk levels. In receiver operating characteristic curves, the area under the curve values for IGF-1 and IGFBP-2 in the prediction of high TIMI risk levels were 0.605 and 0.723, respectively.
IGF-1 and IGFBP-2 levels are excellent biomarkers for risk stratification in patients with ACS, which provides further guidance for clinicians to identify patients at high risk and to lower their risk.
•Plasma of IGF-1 was lower, while IGFBP-2 was higher in AMI than in UA group.•IGF-1 levels were negatively correlated with TIMI risk levels.•IGFBP-2 levels were significantly and positively correlated with TIMI risk levels.•IGF-1 and IGFBP-2 were independent predictors of high TIMI risk levels.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In this article, we study the case of the linguistic combination
ch ́timi - french in Bienvenue chez les Ch ́tis and the linguistic and social debe lopment of the main character during the film. We ...analyse the linguistic and social inequality, a term coined by Hudson (1981: 205), because this film shows how common is to have a preconceived idea of a person only from their way of speaking or their acce nt. In order to achieve this goal, we focus on Philippe Abrams, the main character of the film and the head of the post office in the south of France, who is transferred to the north, to Bergues (Nord - Pas de Calais, France), where he arrives without speaking a word of the ch ́timi dialect.
Finally, we study the translation of the script of the original film into Spanish and Italian, that is characterized by the presence of a dialect and cultural references.
En este trabajo analizamos el caso de la combinación lingüística ch´timi-francés presentado en la película Bienvenue chez les Ch´tis y la evolución lingüística y social del personaje principal en el transcurso del filme. Tratamos el tema de la desigualdad social lingüística, concepto acuñado por Hudson (1981:205), pues el filme objeto de estudio refleja cuán común es tener una idea preconcebida de una persona únicamente por su manera de expresarse y su acento, esto es, lo que se dice, cómo se dice y lo que implica. Para ello, nos centramos en el personaje de Philippe Abrams, director de una oficina de correos del sur de Francia que es trasladado al norte, en concreto a Bergues (Nord-Pas de Calais, Francia), ciudad en la que desembarca sin conocer el dialecto ch´timi.
Para finalizar, estudiamos cómo se ha afrontado el proyecto de traducción al español y al italiano de un texto marcado por la variedad lingüística y las referencias culturales.
Background and Aim:The systemic immune-inflammation index (SII) has been identified as a novel prognostic marker in various illnesses. We investigated the relationship between SII and mortality in ...patients undergoing primary percutaneous coronary intervention (pPCI). In addition, we planned to examine how SII correlated with SYNTAX II and thrombolysis in myocardial infarction (TIMI) risk scores in this population.Materials and Methods:This retrospective observational study included patients with ST-segment elevation myocardial infarction who underwent pPCI. The endpoint was 1 year all-cause mortality. SII (neutrophil x platelet)/lymphocyte was calculated from admission blood samples. Besides clinical and laboratory findings, SII, Syntax II and TIMI risk scores were compared between survivors and non-survivors. The correlation between SII and Syntax II and TIMI risk scores was also evaluated.Results:The study included 334 patients (82.3% male). In the 1 year follow-up, 18 patients (5.4%) died. The SII, Syntax II, and TIMI risk scores were significantly higher in non-survivors than in survivors mean (standard deviation: SD), 2423 (2005) vs 1686 (998), P = 0.005; median (interquartile range) 43 (35-53) vs 30 (25-37), P < 0.001; and 4 (2-5) vs 2 (1-3), P = 0.005, respectively. Furthermore, the Syntax II score, TIMI risk score, and SII was independent predictors of 1 year all-cause mortality. SII showed a significant correlation with Syntax II and TIMI risk scores (R2 = 0.28, P = 0.001 and R2 = 0.37, P < 0.001, respectively).Conclusion:SII might provide additional prognostic data alongside Syntax II and TIMI risk scores in patients undergoing pPCI.
Background Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC)
27, can diagnose coronary microvascular ...dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED. Methods and Results Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, adenosine-mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve <2.5) and CED in response to acetylcholine (acetylcholine flow reserve ≤1.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty-six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5
6.9 versus 20.2
6.9 cm/s;
=0.001 and 6.26
1.83 versus 5.36
1.83 mm Hg/cm/s;
=0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 95% CI, 0.32%-0.50% and 0.36 95% CI, 0.23%-0.49%, respectively). Conclusions In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited.
Better early than later Yildiz, Mehmet; Henry, Timothy D.
Catheterization and cardiovascular interventions,
April 1, 2022, 2022-04-00, 20220401, Volume:
99, Issue:
5
Journal Article
Peer reviewed
Key Points
Timing to administer antiplatelet and antithrombin inhibitor in ST‐segment elevation myocardial infarction (STEMI) patients remains a matter of debate despite the guideline's ...recommendation of “as early as possible.”
This pre–post study with heparin and ticagrelor pretreatment in STEMI patients improved pre‐PCI TIMI flow grade with lower peak cardiac troponin levels and higher left ventricular ejection fraction without any difference in bleeding risk.
The results provide further support for the use of standardized STEMI protocols, including pretreatment with aspirin, heparin bolus, and P2Y12 inhibitor at the first‐medical contact in an effort to improve infarct‐related artery patency without risk of bleeding.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Large-scale outcome trials of sodium glucose co-transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes have identified consistent effects on major adverse cardiovascular events, heart ...failure, and progression of kidney disease. However, the magnitude of effects on cardiovascular and all-cause death appeared to vary between some of the studies.
We explored the impact of differences in trial methodologies, participant characteristics, types of deaths, follow-up duration, effects on intermediate markers of risk, and drug selectivity for SGLT2 on the magnitude of the protective effect against fatal events achieved in the 4 trials.
The trial populations differed substantively in the proportions with baseline atherosclerotic cardiovascular disease history (99.2% in EMPA-REG OUTCOME to 40.6% in DECLARE-TIMI 58), and macroalbuminuria (88.0% in CREDENCE to 7.6% in the CANVAS Program). Meta-regression analyses identified no clear effect of these (both P > 0.09) or other participant characteristics on mortality benefits (all P > 0.55). Other differences between the trials (duration, selectivity of the SGLT2 inhibitor, or effects on intermediate markers of risk) also did not explain the heterogeneity in effects on mortality observed (all P > 0.30).
No clear explanation for the statistical evidence of heterogeneity in effects of SGLT2 inhibition on fatal outcomes between the trials could be identified. While the analyses had limited statistical power, these results raise the possibility that the observed variations in treatment effects on fatal outcomes between trials may be at least partly due to chance.
•Heterogeneity in mortality was observed in large-scale trials of SGLT2 inhibitors.•Meta-regression analyses found no explanation for variations in fatal outcomes.•Variations in SGLT2 inhibitor effects on fatal outcomes may be partly due to chance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
OBJECTIVES
This study sought to analyze the impact of the preprocedural thrombolysis in myocardial infarction (TIMI) flow on clinical outcome in patients with ST‐elevation myocardial infarction ...(STEMI).
BACKGROUND
Previous studies have shown that the TIMI flow 0/1 prior to primary percutaneous coronary intervention (PCI) is associated with a poor clinical outcome. However, it is unclear whether the same is true in patients with ongoing STEMI of less than 6 hr duration, rapid reperfusion, and modern guideline‐adherent therapy.
METHODS
The ATLANTIC study compared prehospital versus inhospital treatment with ticagrelor in patients with acute STEMI. For this analysis, patients were divided into three groups according to the preprocedural TIMI flow grade of the infarct vessel: TIMI 0/1, TIMI 2, and TIMI 3.
RESULTS
From a total of 1,680 patients, 1,113 had TIMI 0/1, 279 TIMI 2, and 288 TIMI 3 flow before primary PCI. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p < .05) and all‐cause death (3.0, 1.4, and 2.1%, p = .30) were highest in patients with TIMI flow 0/1. After adjustment, preprocedural TIMI flow <3 (versus 3) was not an independent predictor of major adverse ischemic events within 30 days (odds ratio 1.89, 95% confidence interval 0.74–4.85). However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. 1.3%, p < .05).
CONCLUSION
In this post‐hoc analysis, preprocedural TIMI flow was not independently associated with a higher rate of adverse ischemic events.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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