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1. Underlying heart diseases and acute COVID-19 outcomes

Author

Universitat Rovira i Virgili, Nunez-Gil, Ivan J.; Fernandez-Ortiz, Antonio; Maroud Eid, Charbel; Huang, Jia; Romero, Rodolfo; Manuel Becerra-Munoz, Victor; Uribarri, Aitor; Feltes, Gisela; Trabatoni, Daniela; Fernandez-Rozas, Inmaculada; Viana-Llamas, Maria C.; Pepe, Martino; Cerrato, Enrico; Bertaina, Maurizio; Astrua, Thamar Capel; Alfonso, Emilio; Castro-Mejia, Alex F.; Raposeiras-Roubin, Sergio; D'Ascenzo, Fabrizio; Espejo Paeres, Carolina; Signes-Costa, Jaime; Bardaji, Alfredo; Fernandez-Perez, Cristina; Marin, Francisco; Fabregat-Andres, Oscar; Akin, Ibrahim; Estrada, Vicente; Macaya, Carlos;Hope COVID-19 Investigators, Universitat Rovira i Virgili, and Nunez-Gil, Ivan J.; Fernandez-Ortiz, Antonio; Maroud Eid, Charbel; Huang, Jia; Romero, Rodolfo; Manuel Becerra-Munoz, Victor; Uribarri, Aitor; Feltes, Gisela; Trabatoni, Daniela; Fernandez-Rozas, Inmaculada; Viana-Llamas, Maria C.; Pepe, Martino; Cerrato, Enrico; Bertaina, Maurizio; Astrua, Thamar Capel; Alfonso, Emilio; Castro-Mejia, Alex F.; Raposeiras-Roubin, Sergio; D'Ascenzo, Fabrizio; Espejo Paeres, Carolina; Signes-Costa, Jaime; Bardaji, Alfredo; Fernandez-Perez, Cristina; Marin, Francisco; Fabregat-Andres, Oscar; Akin, Ibrahim; Estrada, Vicente; Macaya, Carlos;Hope COVID-19 Investigators

Abstract

Background: The presence of any underlying heart condition could influence outcomes during the coronavirus disease 2019 (COVID-19). Methods: The registry HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19, NCT04334291) is an international ambispective study, enrolling COVID-19 patients discharged from hospital, dead or alive. Results: HOPE enrolled 2798 patients from 35 centers in 7 countries. Median age was 67 years (IQR: 53.0-78.0), and most were male (59.5%). A relevant heart disease was present in 682 (24%) cases. These were older, more frequently male, with higher overall burden of cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, smoking habit, obesity) and other comorbidities such renal failure, lung, cerebrovascular disease and oncologic antecedents (p < 0.01, for all). The heart cohort received more corticoids (28.9% vs. 20.4%, p < 0.001), antibiotics, but less hydroxychloroquine, antivirals or tocilizumab. Considering the epidemiologic profile, a previous heart condition was independently related with short-term mortality in the Cox multivariate analysis (1.62; 95% CI 1.29-2.03; p < 0.001). Moreover, heart patients needed more respiratory, circulatory support, and presented more in-hospital events, such heart failure, renal failure, respiratory insufficiency, sepsis, systemic infammatory response syndrome and clinically relevant bleedings (all, p < 0.001), and mortality (39.7% vs. 15.5%; p < 0.001). Conclusions: An underlying heart disease is an adverse prognostic factor for patients suffering COVID-19. Its presence could be related with different clinical drug management and would benefit from maintaining treatment with angiotensin converting enzyme inhibitors or angiotensin receptor blockers during in-hospital stay.

Published
2021

2. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

Author

D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., Templin, Christian, D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., and Templin, Christian

Abstract

AimsThe aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). Methods and resultsPatients from the International Takotsubo (InterTAK) Registry were categorized into two groups based on aspirin prescription at discharge. A comparison of clinical outcomes between groups was performed using an adjusted analysis with propensity score (PS) stratification; results from the unadjusted analysis were also reported to note the effect of the PS adjustment. Major adverse cardiac and cerebrovascular events (MACCE: a composite of death, myocardial infarction, TTS recurrence, stroke or transient ischaemic attack) were assessed at 30-day and 5-year follow-up. A total of 1533 TTS patients with known status regarding aspirin prescription at discharge were included. According to the adjusted analysis based on PS stratification, aspirin was not associated with a lower hazard of MACCE at 30-day [hazard ratio (HR) 1.24, 95% confidence interval (CI) 0.50-3.04, P = 0.64] or 5-year follow-up (HR 1.11, 95% CI 0.78-1.58, P = 0.58). These results were confirmed by sensitivity analyses performed with alternative PS-based methods, i.e. covariate adjustment and inverse probability of treatment weighting. ConclusionIn the present study, no association was found between aspirin use in TTS patients and a reduced risk of MACCE at 30-day and 5-year follow-up. These findings should be confirmed in adequately powered randomized controlled trials. Identifier: NCT01947621.

Published
2020

3. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

Author

D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., Templin, Christian, D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., and Templin, Christian

Abstract

AimsThe aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). Methods and resultsPatients from the International Takotsubo (InterTAK) Registry were categorized into two groups based on aspirin prescription at discharge. A comparison of clinical outcomes between groups was performed using an adjusted analysis with propensity score (PS) stratification; results from the unadjusted analysis were also reported to note the effect of the PS adjustment. Major adverse cardiac and cerebrovascular events (MACCE: a composite of death, myocardial infarction, TTS recurrence, stroke or transient ischaemic attack) were assessed at 30-day and 5-year follow-up. A total of 1533 TTS patients with known status regarding aspirin prescription at discharge were included. According to the adjusted analysis based on PS stratification, aspirin was not associated with a lower hazard of MACCE at 30-day [hazard ratio (HR) 1.24, 95% confidence interval (CI) 0.50-3.04, P = 0.64] or 5-year follow-up (HR 1.11, 95% CI 0.78-1.58, P = 0.58). These results were confirmed by sensitivity analyses performed with alternative PS-based methods, i.e. covariate adjustment and inverse probability of treatment weighting. ConclusionIn the present study, no association was found between aspirin use in TTS patients and a reduced risk of MACCE at 30-day and 5-year follow-up. These findings should be confirmed in adequately powered randomized controlled trials. Identifier: NCT01947621.

Published
2020

4. Percutaneous coronary intervention or coronary artery bypass graft in left main coronary artery disease: a comprehensive meta-analysis of adjusted observational studies and randomized controlled trials

Author

Bertaina, Maurizio, De Filippo, Ovidio, Iannaccone, Mario, et al, Templin, Christian, Bertaina, Maurizio, De Filippo, Ovidio, Iannaccone, Mario, et al, and Templin, Christian

Abstract

BACKGROUND Treatment of patients with ULMCA (unprotected left main coronary artery disease) with percutaneous coronary intervention (PCI) has been compared with coronary artery bypass graft (CABG), without conclusive results. METHODS All randomized controlled trials (RCTs) and observational studies with multivariate analysis comparing PCI and CABG for ULMCA were included. Major cardiovascular events (MACEs, composite of all-cause death, MI, definite or probable ST, target vessel revascularization and stroke) were the primary end points, whereas its single components were the secondary ones, along with stent thrombosis, graft occlusion and in-hospital death and stroke. Subgroup analyses were performed according to Syntax score. RESULTS Six RCTs (4717 patients) and 20 observational studies with multivariate adjustment (14 597 patients) were included. After 5 (3-5.5) years, MACE rate was higher for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07-1.14], without difference in death, whereas more relevant risk of MI was because of observational studies. Coronary stenting increased risk of revascularization (OR 1.52; 95% CI 1.34-1.72). At meta-regression, performance of PCI was improved by use of intra-coronary imaging and worsened by first generation stents, whereas two arterial grafts increased benefit of CABG. For patients with Syntax score less than 22, MACE rates did not differ, whereas for higher values, CABG reduced MACE because of lower risk of revascularization. Incidence of graft occlusion was 3.24% (2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced stent thrombosis. CONCLUSION Surgical revascularization reduces risk of revascularization for ULMCA patients, especially for those with Syntax score greater than 22, with a higher risk of in-hospital death. Intra-coronary imaging and use of arterial grafts improved performance of revascularization strategies.

Published
2018

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