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Introduction The association between alcohol consumption and the occurrence of coronary heart disease is well described in literature. Data regarding the impact of regular alcohol consumption on in-hospital outcomes in the setting of acute coronary syndrome (ACS) are lacking. Purpose We aimed to evaluate the impact of self-reported alcohol consumption on in-hospital outcomes in patients with ACS. Methods Data derived from patients enrolled between 2007 and 2019 in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry were retrospectively analyzed. The primary endpoint was all-cause in-hospital mortality, while secondary endpoints were set as incidence of major adverse cardiac and cerebrovascular events (MACCEs). Outcomes comparisons according to quantity of daily alcohol intake were also performed. Results Records concerning alcohol consumption were available in 25707 patients; 5298 of them (21%) fulfilled the criteria of regular alcohol consumption. Daily alcohol intake was reported in 4059 (77%), of these patients (regular drinkers) with 2640 light drinkers (≤2 drinks/day) and 1419 heavy drinkers (>2 drinks/day). Regular drinkers were predominantly male, younger, smokers, more comorbid and with a worse clinical presentation as compared to abstainers/occasional drinkers. In-hospital mortality and MACCEs of heavy drinkers were significantly higher compared to light drinkers (5.4% vs. 3.3% and 7.0% vs. 4.4%, both p=0.001). When tested together with GRACE risk score parameters, heavy alcohol consumption was independently associated to in-hospital mortality (p=0.004). Conclusions Heavy alcohol consumption is an additional independent predictor of in-hospital mortality in patients presenting with ACS. Figure 1. Study flowchart. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Swiss Heart Foundation

Introduction Percutaneous treatment of functional mitral regurgitation (FMR) with MitraClip (MC) has led to discordant results in recent randomized clinical trials. We aimed at estimating excess mortality (EM) and to evaluate its predictors in a large Swiss FMR population treated with MC. Methods FMR patients enrolled in the MitraSwiss Registry (479 pts) with a mean age of 74.7±9.42 years were evaluated. We computed and plotted EM up to 5 years after implant using the Swiss 2008–20013 mortality tables, stratified by age and sex. A Poisson regression was used to model EM as a function of age, sex, pre-implant RV/RA gradient, calendar period (2011–2013; 2014–2015,2016–2017), ischemic vs non ischemic aetiology, acute procedural success and residual MR. Results Patient's survival at 1,2,3,4 and 5 years were respectively 0.84, 0.72, 0.59, 0.53 and 0.48. FMR patients treated with MC showed excess mortality of +13% (95% CI,10%-18%), +22% (95% CI,17%-28%), +34% (95% CI,27%-41%), +37% (95% CI,28%-46%) and +39% (95% CI,28%-50%) at each time point as compared to the Swiss population, with not differences over the entire follow up (p=0.481). Age group, sex, RV/RA gradient calendar period, ischemic vs non ischemic and residual MR were not associated with excess mortality while a clear association was recognized with acute procedural success (p=0.011). Conclusions In FMR patients treated with MC a persistent EM was observed at a 5 years follow up. Acute procedural success is the only determinant of EM with a 65% lower EM as compared to procedural failures.

Background Myocardial infarction (MI) is associated with significant loss of cardiomyocytes (CM), which are replaced by a fibrotic scar. Necrotic CM release damage-associated proteins that stimulate innate immune pathways and macrophages (MΦ) tissue infiltration, which drives to the progression of inflammation and myocardial remodeling process. Both, loss of CM and inflammatory response are determinants of the long term ventricle remodeling and heart failure. Circulating inflammatory extracellular vesicles (EV) play a crucial role in the acute and chronic phases of MI, in terms of inflammatory progression. In this study we examined whether reducing the generation of inflammatory EV within few hours from the ischemic event may ameliorate cardiac outcome at short and long time-point in LAD rat model. Methods Before coronary artery ligation, rats were injected IP with a chemical inhibitor of neutral sphingomyelinase (nSMase) which is essential for the biogenesis and release of EVs. The number and size profile of plasma-derived EV was assessed by NTA analysis at baseline and 24hrs after MI. Multiple EV cytokine levels were simultaneously determined using enzyme-linked immunosorbent assay (ELISA)-based protein array technology. Heart global function was assessed by echocardiography and hemodynamic analysis performed at 7, 14 and 28 days after MI. Cytotoxic effects of circulating EV were evaluated ex-vivo in a Langedorff, system by measuring the level of cardiac troponin I (cTnI) in the perfusate. Mechanisms undergoing cytotoxic effects of EV derived from pro-inflammatory MΦ (MΦM1) were studied in vitro into primary rat neonatal CM. Results The induction of MI and the consequent inflammation, dramatically increase the number of circulating EV carrying inflammatory cytokines such as IL1α, ILβ and Rantes. Preventive inhibition nSMase significantly reduced the boost of inflammatory EV and cytokines in treated group as compared to control animals. The reduction of circulating EV post MI results in preserved LV ejection fraction at 7 and 28 days post-MI as compared to control group. Hemodynamic analysis confirmed functional recovery by displaying a higher velocity of LV relaxation and an improved contractility capacity in treated versus control group. The number of infiltrating CD68+ monocytes/macrophages in the infarct area was significantly reduced. Post-MI circulating EV induce cell death in adult CM when added to the perfusate of Langendorff, as assessed by the incresed level of cTnI into media. In vitro MΦM1-EV activated nuclear translocation of NF-kB. Specific inhibition of TLR4 receptor activity abrogated NF-kB translocation and reduced cell death. Indicating that the axis TRL4-NF-kB is essential in EV-mediated CM death. Conclusions Systemic inhibition of EV release during the acute phase of MI preserves heart function in an animal model of LAD. These findings suggest detrimental effects of exosomes in the acute phase of MI.

Background It is uncertain if the obesity paradox still exists in contemporary PCI practice. Purposes We aimed to assess an association between baseline BMI and clinical outcomes at 2 years after PCI and to determine if the outcomes between two antiplatelet strategies depend on baseline BMI. Methods Global Leaders study compared 23-month ticagrelor monotherapy after 1 month of dual antiplatelet therapy (experimental strategy) with 12-month aspirin monotherapy after 12 months of conventional DAPT (reference strategy) in patients undergoing PCI with biolimus-A9 eluting stent. Primary outcome of current study was 2-year all-cause mortality after PCI. Secondary outcomes were net adverse clinical event (NACE) and individual components of the composite endpoint. Association between baseline BMI and outcomes were determined in the Cox model. Non-linearity was assessed using restrict cubic spline function. Patients were categorized according to WHO BMI categories; underweight (BMI Results BMI was available in 15,966 out of 15,968 patients with a median of 27.7 kg/m2 (IQR 25.0–30.7). Baseline BMI had a reverse J-shaped association with 2-year all-cause mortality. 3901 patients (24.4%) were in the group of healthy weight, 79 patients (0.5%) were under-weight, 7220 patients (45.2%) were pre-obese and 4766 patients (29.8%) were obese. Due to small number of underweight patients, outcomes after PCI were compared among three groups; healthy weight, overweight, and obesity. Pre-obese and obese patients had lower risk of 2-year all-cause mortality than healthy-weight patients (HR pre-obesity vs. healthy-weight 0.71, 95% CI 0.58–0.88, HR obesity vs. healthy-weight 0.69, 95% CI 0.54–0.87). The risk of 2-year NACE was similar among three groups (healthy weight vs. pre-obesity; HR 1.04, 95% CI 0.94–1.16, healthy weight vs. obesity; HR 1.04, 95% CI 0.93–1.16). No significant difference in risk of any stroke, any MI, and BARC3 or 5 bleeding was found among three groups. Pre-obese patients had higher risk of revascularization than patients with healthy weight (HR 1.19, 95% CI 1.04–1.35). The risk of revascularization in obese patients was numerically higher than healthy-weight patients (HR 1.14, 95% CI 0.99–1.31). For BARC 3 or 5 bleeding at 2 years, ticagrelor monotherapy was more favorable in obese patients (HR reference/experimental 1.63, 95% CI 1.06–2.52) while conventional DAPT strategy was more favorable in pre-obese patients (HR experimental/reference 0.76, 95% CI 0.55–1.05) (P interaction 0.02). No interaction between treatment strategy, BMI, and other outcomes was seen. BMI and all-cause mortality and NACE Conclusions An obesity paradox, an association between elevated BMI and lower mortality, is still evident in this large PCI population. Effect of two antiplatelet strategies on bleeding may depend on baseline BMI.

Background Oral P2Y12 receptor antagonists exhibit a delayed onset of platelet inhibition in patients experiencing acute myocardial infarction (AMI). Selatogrel is a potent, reversible, and highly selective P2Y12 receptor antagonist with a rapid onset and offset of action when administered subcutaneously. Purpose To assess inhibition of platelet aggregation (IPA) after subcutaneous (s.c.) single-dose administration of selatogrel in patients with AMI receiving standard concomitant therapy. Methods Male and postmenopausal female adults (≤85 years) presenting with type 1 AMI (ST-elevation MI [STEMI] or non-STEMI [NSTEMI]) and onset of AMI symptoms >30 min to Results Forty-seven patients (median age 69 y; 72% male; 62% STEMI; 94% Killip class 1) received 8 mg (N=24) or 16 mg (N=23) selatogrel. Study-treatment concomitant medications included acetylsalicylic acid (98%), P2Y12 inhibitors (96%), heparins (94%), statins (94%), nitrates (68%) and morphine (38%). Oral ticagrelor (92%) with corresponding loading doses was only administered after selatogrel. The proportion of patients meeting the primary endpoint (responders) 30 min post-dose was 91% (95% CI: 72, 99) and 95% (95% CI: 77, 100) with 8 and 16 mg, respectively (p Conclusion Single-dose administration of s.c. selatogrel (8 mg and 16 mg) induced a rapid IPA response in patients with AMI at 30 min (as early as 15 min and maintained at 60 min post-dose) and was well-tolerated with no major bleeding events. Acknowledgement/Funding Fully funded by Idorsia Pharmaceuticals Ltd

A young cardiology centre with an ambitious agenda in basic and clinical research Created 16 years ago with the support of a private donation, the Cardiocentro Ticino is located in Lugano, a small town in the Italian speaking region of Switzerland, south of the Alps, 80 km north of Milan. The Cardiocentro Ticino is a non-profit medical centre for the treatment of patients with heart disease. It is the only existing centre of interventional cardiology and cardiac surgery in the region. The Cardiocentro currently has 400 collaborators. Since 2012, it has been an associate institute of the department of cardiology of the University Hospital of Zurich. Prof. Tiziano Moccetti the medical director of Cardiocentro Ticino also leads the department of cardiology together with Dr Giovanni Pedrazzini. Prof. Stefanos Demertzis is head of the department of cardiac surgery and Dr Tiziano Cassina is head of the department of cardiac anaesthesiology and intensive care unit. Dr Marco Moccetti leads the Division of Interventional Cardiology. Beyond percutaneous coronary interventions, this team routinely performs percutaneous heart valve procedures including transcatheter aortic valve implantation (TAVI) and the Mitra-Clip device implantation for severe mitral valve regurgitation, as well as percutaneous closure of patent foramen ovale, and hybrid interventions involving both interventional cardiology and cardiac surgery teams. The recent opening of a ‘radial lounge’ has increased the rate of coronary angiography procedures using a radial arterial approach up to 50%. ![Graphic][1] ![Graphic][2] ![Graphic][3] Dr Francesco F. Faletra leads the Division of cardiac imaging which … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif

We report the case of a 65-year-old female without history of significant cardiovascular diseases, referred to our institution because of sudden cardiac arrest due to ventricular fibrillation. At the time of admission, no structural abnormality or coronary artery disease was documented. Her baseline ECG showed normal PR, QRS, and QT interval ( Panel A ) and signs of early repolarization …

An 84-year-old woman with symptomatic aortic stenosis underwent transfemoral aortic revalving (CoreValve 26 mm). Nine months later, after an uneventful period, she was admitted because of acute coronary syndrome and ECG signs of anterior wall ischaemia ( Panel A , …

Exosomes are extracellular vesicles of endosomal origin which have emerged as key mediators of intercellular communication. All major cardiac cell types-including cardiomyocytes, endothelial cells, and fibroblasts-release exosomes that modulate cellular functions. Exosomes released from human cardiac progenitor cells (CPCs) are cardioprotective and improve cardiac function after myocardial infarction to an extent comparable with that achieved by their parent cells. Cardiac progenitor cell-derived exosomes are enriched in cardioprotective microRNAs, particularly miR-146a-3p. Circulating exosomes mediate remote ischaemic preconditioning. Moreover, they currently are being investigated as diagnostic markers. The discovery that cell-derived extracellular signalling organelles mediate the paracrine effects of stem cells suggests that cell-free strategies could supplant cell transplantation. This review discusses emerging roles of exosomes in cardiovascular physiology, with a focus on cardioprotective activities of CPC-derived exosomes.

Aims We assessed the relationship between cardiac resynchronization therapy (CRT)-induced reverse remodelling and mortality during a long-term follow-up in a prospective observational study. Methods and results We analyzed data from a prospective registry including 398 consecutive patients who underwent CRT between September 1998 and September 2007. Left ventricular ejection fraction (LVEF) was assessed before CRT and in the period between 3 and 6 months following implant. All-cause mortality, urgent transplantation and implantation of left ventricular assist device were all considered relevant events. A total of 398 (179 non-ischaemic and 219 ischaemic) patients were analysed. Overall, the increase of LVEF was statistically significant and was computed with 7.0 points (95% CI 5.8–8.3, P < 0.001). Non-ischaemic patients had a larger increase [9.2 points (95% CI 7.0–11.1), P < 0.001] of their LVEF from baseline, when compared with the ischaemic group. The median duration of follow-up was 4.4 years. The cumulative incidence of all events at the end of the 96 months period of follow-up was 55% and it was 34% (95% CI 29–40) at 5 years. At the multivariable analysis of the event-free survival, aetiology lost its predictive value (HR 0.92, P = 0.47), while a change in LVEF ≥6 points still significantly decreased the risk of event during the follow-up (HR 0.30, P = 0.001). Conclusion Reverse remodelling measured by LVEF after 3 months is a good predictor of long-term outcome. Patients with an increase in LVEF ≥6 points have an excellent event-free survival approaching 66% at 5 years of follow-up.

An 80-year-old man admitted to the emergency department with chest pain (lasting for at least 36 h) presented with severe dyspnea, low blood pressure (80/60 mmHg), third heart sound, 3/6 systolic murmur at Erb point, and right-sided inspiratory crackles. ECG revealed sinus tachycardia, low-amplitude R-waves in limb leads, and ST elevation in V1–V5 ( Panel A ). Transthoracic echocardiogram …

A 76-year-old Caucasian woman known for hypertension and former cigarette smoking was admitted for acute dyspnoea and chest pain with 12-lead ECG highly evocative for sub-acute anterior myocardial infarction ( Panel A ). Based on the urgent coronary angiogram showing a complex left anterior descending (LAD) artery proximal bifurcation lesion (Medina 1/1/1) with preserved peripheral flow ( Panels B and …

An 81-year-old man, known for valvular cardiomyopathy, was admitted to our emergency department for increasing haemodynamic instability, fever, and progressive asthenia 6 weeks after transfemoral aortic revalving with Corevalve 29 mm complicated by large retroperitoneal haematoma requiring urgent surgery. Main findings were an extended anterior hypokinesia at the transthoracic echocardiogram with elevated troponin 20.47 …

An 83-year-old man, known for previous coronary bypass surgery, was admitted to the emergency department with acute chest pain, poor haemodynamic stability, and superior vena cava syndrome. The CT angiography ( Panel A ) showed a rupture of the aortic root, 10 cm above the aortic valve, with the development of a large mediastinal haematoma …

A surgical technique, called edge-to-edge technique or Alfieri's stitch, approximating the middle scallops of the mitral leaflets to create a double orifice with improved leaflet coaptation was introduced in the early 1990s. Recently, a percutaneous method to create the same type of repair was developed. Real-time 3D transoesophageal echocardiography …

A 55-year-old woman with a past (about 5 years ago) aortic replacement due to ascending aorta aneurysm and, more recently (about 4 months ago), replacement of aortic valve, implantation of tube graft, and native coronary arteries due to Type I aortic dissection presented with new onset, crescendo typical angina. Physical examination was normal …