Background: Serum calcium and phosphate levels are controlled by a regulatory system, but their individual concentration tendencies and interactions may affect long-term vascular health. This study ...aimed to assess the effects of serum calcium and phosphate levels on incident ischemic heart disease (IHD) in a large-scale community-dwelling Korean cohort. Methods: We evaluated 15,259 non-diabetic individuals (median age, 45 years; range, 30-85) without previous IHD or ischemic stroke using the Korean National Health Insurance data. The study population was classified based on the calcium, phosphate, and calcium/ phosphate ratios. Using Cox proportional hazards regression models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD over 50 months after baseline enrolment. Results: The age- and sex-adjusted incidence of IHD gradually increased with serum calcium and phosphate quartiles and decreased with calcium/phosphate ratio quartiles, with an overall crude rate of 2.1% (315/15,259). After setting the lowest calcium, phosphate, and calcium/phosphate ratio quartiles as a reference group, the HRs (95% CIs) of the highest calcium, phosphate, and calcium/phosphate ratio quartiles for IHD were 1.77 (1.15-2.72), 1.73 (1.18-2.55), and 0.58 (0.39-0.87), respectively, after adjusting for potential confounding variables. Serum calcium and phosphate levels were positively associated with IHD incidence, while the serum calcium/phosphate ratio exhibited an inverse relationship. Conclusions: Serum calcium and phosphate homeostasis may merit serious consideration to understand the pathogenesis of coronary atherosclerosis as a risk modifier for IHD.
Background: Vasospasm occurs in up to 40% of aneurysmal subarachnoid hemorrhage (aSAH) cases, leading to delayed cerebral ischemia (DCI) in almost 30% of these episodes. Still, in underdeveloped ...countries, there is no consensual approach to its diagnosis, interventions and treatment, mostly because of the lack of resources. Our objectives were to compare the techniques employed in vasospasm management in both developed and underdeveloped countries, seeking for differences in treatments and their respective outcomes. Methods: We performed a comprehensive literature review using MEDLINE and SciELO databases. Data on locally widespread techniques were collected in a tertiary hospital of a city in the south of Brazil with 2 million inhabitants. Results: Although the most specific diagnosis method for DCI is based on clinical symptomatology, digital subtraction angiography (DSA) and transcranial pler have been widely used and recommended. DSA is considered the gold standard; however, TCD is regarded as highly specific and sensitive for observing the middle cerebral and internal carotid arteries. Whether having a clinical or imaging diagnosis, both DCI prophylaxis and treatment are based on a potent calcium channel blocker, nimodipine (high (high quality of evidence, strong recommendation). However, in Brazil, there is no such endovenous medication, leaving treatment options to oral nimodipine, surgical interventions and hypertensive drugs only. Also, the public health insurance does not cover TCD monitoring, narrowing the chances of adequate diagnosis and therapeutic procedures. Conclusion: In an underdeveloped country, low financial and technological resources impact doctors' and patients' daily lives. However, new, low-cost solutions can arise. More investment is needed in research toward budgetary and scientific accessibility.
PurposeThe outcomes of patients with large ischemic core who fail to recanalize with endovascular therapy (EVT) compared to medical management (MM) are uncertain. The objective was to evaluate the ...clinical and safety outcomes of patients who underwent EVT in patients with large ischemic core and unsuccessful recanalization.MethodsThis was a post hoc analysis of the ANGEL-ASPECT randomized trial. Unsuccessful recanalization was defined as patients who underwent EVT with eTICI 0–2a. The primary endpoint was 90-day very poor outcome (mRS 5–6). Multivariable logistic regression was conducted controlling for ASPECTS, occlusion location, intravenous thrombolysis, and time to treatment.ResultsOf 455 patients 225 were treated with MM. Of 230 treated with EVT, 43 (19%) patients had unsuccessful recanalization. There was no difference in 90-day very poor outcomes (39.5% vs. 40%, aOR 0.93, 95% confidence interval, CI 0.47–1.85, p = 0.95), sICH (7.0% vs. 2.7%, aOR 2.81, 95% CI 0.6–13.29, p = 0.19), or mortality (30% vs. 20%, aOR 1.65, 95% CI 0.89–3.06, p = 0.11) between the unsuccessful EVT and MM groups, respectively. There were higher rates of ICH (55.8% vs. 17.3%, p < 0.001), infarct core volume growth (142.7 ml vs. 90.5 ml, β = 47.77, 95% CI 20.97–74.57 ml, p < 0.001), and decompressive craniectomy (18.6% vs. 3.6%, p < 0.001) in the unsuccessful EVT versus MM groups.ConclusionIn a randomized trial of patients with large ischemic core undergoing EVT with unsuccessful recanalization, there was no difference in very poor outcomes, sICH or death versus medically managed patients. In the unsuccessful EVT group, there were higher rates of any ICH, volume of infarct core growth, and decompressive craniectomy.
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