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A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability.

Objectives Extracardiac vascular disease (ECVD) is increasingly recognized as a cardiovascular risk factor, but its association with outcomes after percutaneous coronary intervention (PCI) has not been well characterized. Methods Using the National Inpatient Sample database, all patients undergoing PCI between October 2015 and December 2018 were stratified by the presence and organ- specific extent of extracardiac vascular comorbidity (cerebrovascular disease (CeVD), renovascular, aortic and peripheral arterial disease (PAD)). Primary outcome was all-cause mortality and secondary outcomes were (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) acute ischemic stroke and (c) major bleeding. Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) and 95% confidence interval (95% CI). Results Of a total of 1, 403, 505 patients undergoing PCI during the study period, 199, 470 (14.2%) had ECVD. Patients with ECVD were older (median of 72 years vs. 70 years, p < 0.001) and had higher comorbidity burden that their counterparts. All cause-mortality was 22% higher in patients with any ECVD compared to those without ECVD. PAD patients had the highest odds of all-cause mortality (aOR 1.48, 95% CI 1.40-1.56), followed by those with CeVD (aOR 1.15, 95% CI 1.10-1.19). Patients with extracardiac disease had increased odds of MACCE, ischemic stroke and bleeding, irrespective of the nature or extent (p < 0.05), compared to patients without ECVD. Conclusion ECVD is associated with worse outcomes in patients undergoing PCI including significantly higher rates of death and stroke. These data should inform our shared decision-making process with our patients.

Background/purpose Rotational atherectomy (RA) plays a central role in the treatment of heavily calcified coronary artery lesions. Our aim was to compare periprocedural characteristics and outcomes of planned (PA) vs. bailout (BA) rotational atherectomy. Methods We conducted a systematic review and performed a meta-analysis on studies which compared PA vs. BA strategy. Results Five studies fulfilled the inclusion criteria, pooling a total of 2120 patients. There was no difference in procedural success, PA vs. BA risk ratio (RR) 1.03 and 95% confidence interval (95% CI) 0.99–1.07. Compared to BA, PA was associated with a shorter procedural time [mean difference (MD) -25.88 min, 95% CI -35.55 to −16.22], less contrast volume (MD -43.71 ml, 95% CI -69.17 to −18.25), less coronary dissections (RR 0.50, 95% CI 0.26–0.99), fewer stents (MD -0.20, 95% CI -0.29 to −0.11), and a trend favouring less periprocedural myocardial infarctions (MI) (RR 0.77, 95% CI 0.54–1.11). There was no difference in major adverse cardiovascular events on follow-up (RR 1.04, 95% CI 0.62–1.74), death (RR 0.98, 95% CI 0.59–1.64), MI (RR 1.16, 95% CI 0.62–2.18), target vessel revascularization (RR 1.40, 95% CI 0.83 to 2.36), stroke (RR 1.50, 95% CI 0.46–4.86) or stent thrombosis (RR 0.82, 95% CI 0.06–10.74); all PA vs. BA comparisons. Conclusions Compared to bailout RA, planned RA resulted in significantly shorter procedural times, less contrast use, lesser dissection rates and fewer stents used. The bailout RA approach appears to enhance periprocedural risk, but there is no difference on mid-term outcomes.

BACKGROUNDIn the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain.METHODSWe conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris.RESULTSAmong 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI), 0.46 to 1.07; P=0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48).CONCLUSIONSAmong patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy.

Zeyao Ye,&ast; Pengfei Yu,&ast; Yang Cao, Tengjiao Chai, Sha Huang, Xiangdong Cheng, Yian Du Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yian Du; Xiangdong ChengDepartment of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of ChinaTel +86-571-88128041Email duyajim@126.com; abdsurg@163.comObjective: The peritoneal cancer index (PCI) is used to evaluate the peritoneal metastasis of gastric cancer. A higher value indicates more widespread and/or larger tumors in the peritoneal cavity. The neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are representative blood markers of systemic inflammatory responses, and D-dimer (DDI) is the final stable product of fibrin. This study explores the association of NLR, PLR, and DDI with PCI and assesses the clinical utility of a new blood score combining the NLR, PLR, and DDI (NPD score) for PCI and the prognosis prediction of gastric cancer.Methods: This was a single-center, nonrandomized, retrospective, cohort study. We evaluated the risk factors for high PCI (≥ 15) using univariate and multivariate analyses. According to the findings of the ROC analysis, we determined the cut-off values of NLR, PLR and DDI and created the NPD score. The patients were grouped into high-risk and low-risk groups based on their NPD score (< 2 and ≥ 2, respectively).Results: Univariate and multivariate analysis demonstrated that the NLR, PLR, and DDI were independent risk factors for high PCI (P < 0.05). The NPD score of the high-risk group was ≥ 2, and the NPD score of the low-risk group was < 2. The median survival time was 14.2 in the high-risk group and 25.6 in the low-risk group. The NPD score was significantly higher in the high-PCI group than that in the low-PCI group. The survival of the high-risk group was significantly worse than that of the low-risk group (P = 0.003). NPD score decrease was an independent predictive factor for PCI decrease.Conclusion: NLR, PLR, and DDI are potential independent risk factors for high PCI in patients with peritoneal metastasis of gastric cancer. The NPD scoring system can help in predicting PCI and the prognosis of patients with peritoneal metastasis of gastric cancer.Keywords: gastric cancer, peritoneal metastasis, peritoneal cancer index, PCI, NLR-PLR-DDI score, prognosis

Objectives. To compare long-term angina pectoris relief of successful versus failed percutaneous coronary intervention of chronic total occlusions (CTO PCI). Background. Previous studies demonstrate better short-term angina pectoris relief of CTO PCI than with optimal medical treatment (OMT), however, data on the long-term effects are lacking. Methods. 295 patients undergoing CTO PCI were analyzed retrospectively, with a follow-up evaluation of symptoms of angina pectoris and all-cause death one to four years after the intervention. The primary outcome was long-term relief of symptoms of angina pectoris. Secondary outcomes included a composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and later target vessel revascularization (TVR). At follow-up, patients were interviewed for symptoms of angina pectoris at 1, 6, 12, and 22 to 48 months after the intervention. Results. CTO PCI was successful in 225 (76%) patients and failed in 70 (24%) patients. Short-term (six months) relief of angina pectoris was observed in both groups, but only the successful CTO PCI group showed long-term relief. The Kaplan–Meier curves of all-cause death did not differ between the groups (p = .715). The final follow-up was a mean (range) of 37 (25 to 44) months after the intervention in the successful CTO PCI group, and 33 (28 to 48) months in the failed CTO PCI group. Conclusions. Successful CTO PCI is associated with better long-term relief of symptoms of angina pectoris compared to failed CTO PCI.

Background Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularisation strategies. However, the potential predictors of outcomes on top of different revascularisation strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularisation strategies and the potential impact of medical therapy. Methods Using a propensity score approach, the impact of two treatment strategies was analysed –staged non-culprit revascularisation group vs culprit-lesion-only percutaneous coronary intervention (PCI) group -- on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularisation. Moreover, models were further adjusted for medication at discharge. Results Among 1,385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularisation group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; p=0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; p=0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; p=0.02). Use of renin-angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; p=0.03), and both renin-angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; p=0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; p=0.01) were associated with lower all-cause death. Conclusions In a real-word STEMI population with multivessel disease, staged non-culprit revascularisation was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularisation and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularisation.

In the present case report, we describe the management of severe coronary artery disease in a patient with Glanzmann thrombasthenia. To the best of our knowledge, there are no established guidelines for revascularization in this setting, and we pose novel discussion points regarding the nuanced care of this patient. (Level of Difficulty: Intermediate.), Central Illustration

Giriş ve Amaç: Literatürde yer alan birçok çalışmaya rağmen sol ana koroner arterde kritik darlık saptanan hastaların tedavisinde kesin olarak varılan bir karar bulunmamaktadır. Merkezimizde son beş yıl içerisinde sol ana koroner arter stent implantasyonu yapılan hastaları retrospektif olarak tarayarak koroner arter bypass greft uygulanan hastalar ile kıyaslayıp kendi merkezimizin sonuçlarını paylaşmayı hedefledik.Gereç ve Yöntemler: Koroner arter hastalığı şüphesiyle çeşitli testler sonucunda invaziv koroner anjiyografi uygulanıp sol ana koroner arter kritik darlığı nedeniyle stent implantasyonu (31 hasta) ve ana koroner darlığı ya da üç damar hastalığı nedeniyle bypass kararı verilen (34 hasta) hastalar çalışmaya dahil edildi. Ölüm, inme, miyokart enfarktüsü, tekrarlayan revaskülarizasyon açısından hastalar kıyaslandı.Bulgular: Perkutan koroner girişim grubunda ortalama yaş 68,77±11,46, koroner arter bypass greft grubunda ise 72,82±8,81 olarak izlenmişken p değeri 0,110 olarak saptanmıştır. İki grubun demografik verileri benzer olup gruplar arasında anlamlı fark saptanmamıştır. İki grup arasında kalsiyum kanal blokörü (p 0.049) ve klopidogrel (p 0.001) kullanımı açısından istatistiki anlamlı fark saptanmıştır. Gruplar arasında inme (P 0,981), tekrarlayan revaskülarizasyon ihtiyacı (0,614), ölüm (P 0,21) ve miyokart enfarktüsü (0,071) açısından istatistiki açıdan anlamlı bir fark gözlenmemiştir.Sonuç: Sol ana koroner arter lezyonu olan hastalarda perkutan koroner girişim ve koroner arter bypass greft uygulanmasında inme, tekrarlan revaskülarizasyon, ölüm ve miyokart enfarktüsü açısından fark yoktur., Objective: Despite many studies in the literature, there is no definite decision in the treatment of the patients who diagnosed critical stenosis in the left main coronary artery. We aimed to retrospectively scan the patients who underwent left main coronary artery stent implantation in our center in the last five years, compare them with the patients who underwent coronary artery bypass graft, and share the results of our own center.Materials and Methods: Patients with suspected coronary artery disease who underwent invasive coronary angiography as a result of various tests and underwent stent implantation due to left main coronary artery critical stenosis (31 patients) and coronary artery bypass graft, due to left main coronary stenosis or three-vessel disease (34 patients) were included in the study. Patients were compared in terms of death, stroke, myocardial infarction, and revascularization.Results: While the mean age was 68.77±11.46 years in the percutaneous coronary intervention group and 72.82±8.81 years in the coronary artery bypass graft group (p 0.110). Demographic data of the two groups were similar and no significant difference was found between the groups. A statistically significant difference was found between the two groups in terms of use calcium channel blockers (p 0.049) and clopidogrel (p 0.001). No statistically significant difference was observed between the groups in terms of stroke (P 0.981), need for revascularization (0.614), death (P 0.21), and myocardial infarction (0.071).Conclusion: There is no difference in the application of percutaneous coronary intervention and coronary artery bypass graft in patients with left main coronary artery lesions in terms of stroke, revascularization, death and myocardial infarction. Further studies with larger cohorts are needed for validation.

This investigation aimed to estimate reliability of the WHOQOL-BREF questionnaire and quality of life of patients after PCI or CABG surgery.In this cross-sectional study, 268 patients after PCI or CABG surgery were studied in East Kazakhstan and Pavlodar regions of Kazakhstan from September to December 2019. The Russian version of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) was used to measure their quality of life. Cronbach's alpha coefficient, Pearson's correlation coefficient, paired t-test, independent t-test, and linear regression model were used to analyze the data.The mean age of the participants was 60.8 ± 9.2 years, while most of them were male (75.0 %). The overall observed Cronbach's alpha coefficient for the WHOQOL-BREF was 0.842, ranging from 0.668 to 0.764 in its four domains. The total mean score of the respondents on the WHOQOL-BREF was 13.97. The highest and lowest mean scores were observed in the environmental domain (15.22) and the physical health domain (13.00), respectively.The WHOQOL-BREF questionnaire has a good reliability in characterizing the quality of life of patients after PCI or CABG surgery. Patients after PCI or CABG surgery had a relatively moderate quality of life (Tab. 6, Ref. 23).

The essay presents the debate between national PCI and Milan’s PCI about the building of a new popular culture after the fall of fascism. The philosopher Antonio Banfi and the writer Elio Vittorini were the protagonists of this period. Banfi had already analysed this issue in the “Fronte della cultura” and in the programmes of the “Casa della Cultura” of Milan, while Vittorini had intervened with some articles published in the Florentine periodical «Il Bargello» then recalled in «Il Politecnico». Their point of view would have been questioned by national PCI in which prevailed the cultural approach inspired by Gramsci’s «Quaderni del carcere» that came out in the same years

Questo articolo descrive le relazioni intercorse tra Alfonso Leonetti e il Pci dalla riammissione al partito (1962) alla sua morte (1984). Il nuovo tesseramento al partito da cui era stato espulso nel 1930 avvenne due anni dopo il suo ritorno in Italia, nel contesto della destalinizzazione, e fu il primo passo verso l'inizio di un intenso dialogo con i principali dirigenti del partito, un dialogo che fu collegato all'attività storiografica di Leonetti (incentrata sul movimento operaio italiano e sul suo ruolo nel partito negli anni Venti) e che riguardò anche temi più ampi quali lo stalinismo e la "svolta" del 1929-1930. Mentre il primo paragrafo di questo articolo fornisce una sintetica ricostruzione dell'attività politica di Leonetti negli anni Venti e Trenta, il secondo analizza il processo di riammissione, mentre il terzo si occupa della collaborazione intercorsa tra Leonetti e Palmiro Togliatti, anch'egli a quel tempo impegnato negli studi sulla figura di Antonio Gramsci e sul movimento operaio. Il quarto paragrafo, invece, si concentra sul dialogo tra Leonetti e alcuni dei principali dirigenti del Pci negli anni Sessanta-Ottanta quali Pietro Secchia, Giancarlo Pajetta, Giorgio Amendola, Enrico Berlinguer e Alessandro Natta.

Purpose Due to shared hepatic metabolism, concomitant medication with a proton pump inhibitor (PPI) and clopidogrel might reduce the effectiveness of clopidogrel in the prevention of cardiovascular events after percutaneous coronary intervention (PCI). We aimed to examine the risk of major cardiovascular events after PCI comparing patients who used clopidogrel together with PPI with those who used clopidogrel alone. Methods This Swedish nationwide cohort study included patients who received clopidogrel after primary PCI in 2005–2019. Patients were followed for up to 12 months after PCI. Data were retrieved from the Swedish Prescribed Drug Registry, Patient Registry, Cancer Registry, and Cause of Death Registry. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular events comparing PPI users (exposed) with non-users of PPI (non-exposed). The HRs were adjusted for sex, age, comorbidity, calendar period, obesity, diabetes, anti-diabetic medication, tobacco-related diseases, hypertension, and congestive heart failure. Results The cohort included 99,836 patients who received clopidogrel after primary PCI. Among these, 35,772 (35.8%) received concomitant PPI. Compared to non-users, PPI users had increased adjusted HRs of all study outcomes, i.e., the main outcome myocardial infarction (HR = 1.23, 95% CI 1.15–1.32) and the secondary outcomes coronary heart disease (HR = 1.28, 95% CI 1.24–1.33), stroke (HR = 1.21, 95% CI 1.05–1.40), and death due to coronary heart disease (HR = 1.52, 95% CI 1.37–1.69). The results were similar in analyses including both primary and secondary PCIs. Conclusions In patients who receive clopidogrel after PCI, concomitant use of PPI seems to increase the risk of major cardiovascular events.

Contexte : La Circonscription sanitaire du district d’Haliburton, Kawartha, Pine Ridge a étudié une exposition dans un établissement dentaire opérationnel de l’Ontario à une infection par le virus de l’hépatite C (VHC) nouvellement diagnostiquée causée par un virus ayant un génotype de l’hépatite C rare. Des lacunes dans la prévention et le contrôle des infections (PCI) et un deuxième cas lié de manière épidémiologique (avec le même génotype inhabituel de l’hépatite C) ont été identifiés, ce qui a entraîné une intervention plus large en santé publique et une enquête sur les éclosions. Objectifs : a) Décrire l’enquête sur un cas d’hépatite C nouvellement diagnostiqué; b) décrire l’intervention en santé publique dans son ensemble, et c) remédier à la pénurie de documentation sur le risque de transmission de la maladie dans les établissements dentaires en raison de lacunes de PCI. Méthodes : Une approche de collaboration avec deux cabinets dentaires, des partenaires en santé publique et des organismes de réglementation a été utilisée. Une inspection de PCI a été effectuée afin de déterminer et d’atténuer le risque de transmission d’infection par le sang dans les installations. Des protocoles appropriés ont été suivis pour l’enquête de PCI et l’intervention en santé publique. Résultats : L’enquête a révélé un risque de transmission potentielle du VHC entre deux cas liés à la même installation dentaire. Aucun autre cas de VHC lié à l’épidémiologie n’a été signalé. Les défis comprenaient le manque de respect des normes de PCI dans l’un des milieux dentaires et la sensibilisation de la communauté dentaire à la transmission du VHC, la coordination avec les organismes de réglementation et les experts en santé publique et la faible participation des patients aux tests de laboratoire. Conclusion : Malgré les défis uniques associés à l’enquête, la Circonscription sanitaire du district d’Haliburton, Kawartha, Pine Ridge a mené avec succès une enquête sur les lacunes de PCI et une intervention en santé publique. Les services de santé publique doivent maintenir des approches de collaboration avec les professionnels de la santé réglementés, leurs organismes de réglementation et les experts en santé publique.

Drug-eluting stents (DES) have been developed over recent decades and the implantation of DES is the standard of care in contemporary percutaneous coronary intervention for patients with coronary artery disease. The MiStent sirolimus-eluting stent has several unique features; ultra-thin (64 μm) struts, a bioresorbable polymer and a controlled drug release from microcrystalline sirolimus as a reservoir embedded in the vessel wall. Results of recent clinical trials demonstrated the potential performance of this state-of-the-art DES. In the present review, we provide an overview of the development of DES, in particular the design and performance of the novel MiStent sirolimus-eluting stent from technological and clinical points of view and discuss the potentials of this new type of DES.

Coronary artery obstruction (CAO) during transcatheter-aortic-valve replacement (TAVR) represents a main concern for TAVR safety in patients with low coronary take-off. To date, "snorkel" (also called chimney) technique, consisting of stent implantation from the coronary ostium to the aorta within the space between the valve frame and the aortic wall, is the most adopted strategy to prevent CAO. This technique is associated with the creation of complex valve/stent configuration that can hinder repeat coronary interventions. Due to this concern, we set up an original sequence for coronary protection aiming to ensure a more physiological TAVR frame/stent configuration. According to this technique, TAVR prosthesis is released with a "protection" system consisting of guiding catheter (GC), wire and stent inside the coronary artery with high CAO risk. In the case of CAO occurrence, the stent is released according to the snorkel technique. In the absence of complete CAO, a new GC is advanced inside the implanted TAVR prosthesis and the stent is deployed from the coronary artery up to the prosthesis. We herein report two cases of very high CAO risk where this technique was successfully used during last-generation self-expandable prostheses implantation (in a native aortic valve and in one prosthetic aortic valve). In conclusion, this "orthotopic snorkel-stenting in TAVR" (OST) technique represents a novel option for treating impeding CAO during TAVR. As compared with the "classic" snorkel technique, it allows avoiding stent implantation in some patients (who do not experience CAO) and may provide a more predictable and physiologic TAVR prosthesis/stent configuration in the case of stent implantation need.

This article investigates the effect of firm size on the performance of Vietnamese private enterprises. Based on the data from the Annual Enterprise Survey from 2009 to 2018, this study uses an ordinary least-squares regression model (OLS) to point out the effects of firm size (growth rate, total assets, and total labor) on the performance of Vietnamese private enterprises in both static and dynamic states. According to the results of the quantitative model, total assets are the biggest factor for determining firm performance, followed by total labor and growth rate. The results highlight the issue in Vietnamese private enterprises development in terms of scale, despite the fact that their number is growing, as the scale of enterprises decreases (the proportion of micro and small enterprises increases, but the proportion of medium and big enterprises decreases). Besides, the disadvantages of scale also negatively affect the development process of Vietnamese private enterprises, including accessing capital, increase in production or productivity, business expansion, and improving competitiveness. AcknowledgmentsThis research is supported by the National Science Project “Development of Private Enterprises in the Southwest Region in the new context” (KHCN-TNB/14-19/X15).

We present the case of a 16-year-old patient with anomalous left coronary artery from the left pulmonary artery requiring percutaneous coronary intervention in infancy who presented with ventricular fibrillation arrest. A coronary angiogram revealed 40% narrowing of the stent relative to the remainder of the left main coronary artery. Optical coherence tomography was performed and revealed an area stenosis of 70% relative to the native left main coronary artery. The patient had outgrown the stent. (Level of Difficulty: Advanced.), Central Illustration

The mechanisms behind very early statin use in ACS and their translation to clinical benefit are not fully elucidated, however, such effects could be explained by the multifactorial impact of statin treatment on molecular and cellular events that are fundamental to the pathogenesis of ACS. Such mechanisms, independent of the central action on atherogenic lipoproteins, include reduction of inflammation, modulation of thrombogenesis and thrombolysis, improvement of endothelial dysfunction, and amelioration of ischemia/reperfusion injury. It has been previously shown in clinical studies that statin preloading before percutaneous coronary intervention (PCI) can limit periprocedural microcirculatory damage, and significantly reduce the "no-reflow" phenomenon. It can elicit significant endothelial protection in chronic and acute coronary syndrome populations.

Data on left main (LM) percutaneous coronary interventions (PCI) have mostly been obtained in studies using drug-eluting stent (DES) platforms without dedicated large-vessel devices and with limited expansion capability.Our study aimed to investigate the safety and efficacy of LM PCI with the latest-generation Resolute Onyx DES.ROLEX (Revascularization Of LEft main with resolute onyX) is a prospective, multicentre study (ClinicalTrials.gov: NCT03316833) enrolling patients with unprotected LM coronary artery disease and a SYNTAX score33 undergoing PCI with the Resolute Onyx zotarolimus-eluting coronary stent, that includes dedicated extra-large vessel platforms. The primary endpoint (EP) was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR), at 1 year. All events were adjudicated by an independent clinical event committee. An independent core lab analysed all procedural angiograms.A total of 450 patients (mean age 71.8 years, SYNTAX score 24.5±7.2, acute coronary syndrome in 53%) were enrolled in 26 centres. Of these, 77% of subjects underwent PCI with a single-stent and 23% with a 2-stent technique (8% double kissing [DK] crush, 6% culotte, 9% T/T and small protrusion [TAP] stenting). Intravascular imaging guidance was used in 45% (42% intravascular ultrasound [IVUS], 3% optical coherence tomography [OCT]). At 1 year, the primary EP incidence was 5.1% (cardiac death 2.7%, TVMI 2.7%, ID-TLR 2.0%). The definite/probable stent thrombosis rate was 1.1%. In a prespecified adjusted subanalysis, the primary EP incidence was significantly lower in patients undergoing IVUS/OCT-guided versus angio-guided PCI (2.0 vs 7.6%; hazard ratio [HR] 0.28, 95% confidence interval [CI]: 0.13-0.58; p0.001).In this large, multicentre, prospective registry, LM PCI with the Resolute Onyx DES showed good safety and efficacy at 1 year, particularly when guided by intracoronary imaging.

Systematic review and meta-analysis with trial sequential analysis

The aim of this study was to compare the effect of a single high-dose rosuvastatin versus atorvastatin preloading in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI.) Methods: A total of 99 patients presented with STEMI and were randomly divided into three groups—a control group (n = 33) with no statin treatment, an atorvastatin group (n = 33) with a single 80 mg atorvastatin dose and the rosuvastatin group (n = 33) with a single 40 mg rosuvastatin dose in the emergency room (ER) prior to PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count (CTFC) were recorded, and ST-segment resolution was measured. Results: CTFC was significantly lower for the atorvastatin group (p-value < 0.01) than in the control group. A final TIMI flow grade 3 was achieved in 32 (97.0%) patients in the rosuvastatin group and 28 (84.8%) patients in the atorvastatin group compared with only 25 (75.8%) patients in the control group (p = 0.014). Peak CK-MB in the rosuvastatin group (263.2 [207.2–315.6]) and the atorvastatin group (208 [151.0–314.1]) was lower compared to that in the control group (398.4 [303.9–459.3]); p < 0.001. Conclusions: A single extensive dose of lipophilic atorvastatin prior to primary PCI in STEMI patients showed better improvement in microvascular myocardial perfusion compared to hydrophilic rosuvastatin.

BackgroundWhile the importance of invasive physiological assessment (IPA) to choose coronary lesions to be treated is ascertained, its role after PCI is less established. We evaluated feasibility and efficacy of Physiology-guided PCI in the everyday practice in a retrospective registry performed in a single high-volume and “physiology-believer” center.Materials and methodsThe PROPHET-FFR study (NCT05056662) patients undergoing an IPA in 2015–2020 were retrospectively enrolled in three groups: Control group comprising patients for whom PCI was deferred based on a IPA; Angiography-Guided PCI group comprising patients undergoing PCI based on an IPA but without a post-PCI IPA; Physiology-guided PCI group comprising patients undergoing PCI based on an IPA and an IPA after PCI, followed by a physiology-guided optimization, if indicated. Optimal result was defined by an FFR value ≥ 0.90.ResultsA total of 1,322 patients with 1,591 lesions were available for the analysis. 893 patients (67.5%) in Control Group, 249 patients (18.8%) in Angiography-guided PCI Group and 180 patients (13.6%) in Physiology-guided PCI group. In 89 patients a suboptimal functional result was achieved that was optimized in 22 cases leading to a “Final FFR” value of 0.90 ± 0.04 in Angiography-Guided PCI group. Procedural time, costs, and rate of complications were similar. At follow up the rate of MACEs for the Physiology-guided PCI group was similar to the Control Group (7.2% vs. 8.2%, p = 0.765) and significantly lower than the Angiography-guided PCI Group (14.9%, p < 0.001), mainly driven by a reduction in TVRs.Conclusion“Physiology-guided PCI” is a feasible strategy with a favorable impact on mid-term prognosis. Prospective studies using a standardized IPA are warrant to confirm these data.

The frequency of TAVI procedures worldwide is progressively increasing. The age of patients applying for TAVI is also declining, as a result of which life expectancy is increasing. Atherosclerotic disease (including ischemic heart disease) and aortic stenosis share some common risk factors and pathogenesis, which explains the frequent combination of diseases in the same patient. We present a clinical case of successful percutaneous coronary intervention in a patient presenting with acute coronary syndrome with a previously implanted TAVI prosthesis.

As the prevalence of asymptomatic COVID-19 continues to increase, there is an increasing possibility that patients with COVID-19 may presen with ST-segment elevation myocardial infarction (STEMI). With social distancing and restricted access to preventive healthcare and emergency services, the management of acute cardiac emergencies such as myocardial infarction has suffered collateral damage. Thus far, global trends suggest a decrease in STEMI activations with possible worse outcomes due to delayed presentation and management. In this review, we discuss the challenges to STEMI management in the COVID-19 era and provide potential solutions for adherence to evidence-based therapies as the pandemic progresses into the year 2021.

Diana Aurora Bordejevic,1 Tudor Pârvănescu,2 Lucian Petrescu,1 Cristian Mornoș,1 Ioan Olariu,1 Simina Crișan,1 Cristina Văcărescu,1 Mihai Lazăr,1 Vlad Ioan Morariu,2 Ioana Mihaela Citu,2 Mirela Cleopatra Tomescu,2 Dragoș Cozma1 1Cardiology Department, Institute of Cardiovascular Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 2Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Tudor Pârvănescu; Ioana Mihaela CituVictor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, Timișoara 300041, RomaniaTel +40 724 369729; +40 723 280 623Fax +40 256 220636Email tudorparvanescu@gmail.com; ioanamihaela2010@gmail.comBackground: Patients with acute myocardial infarction (AMI) are at high risk for left ventricular (LV) remodeling and heart failure. We aimed to study whether LV strains (S) and strain rates (SR) could predict cardiac remodeling in patients with AMI having a midrange or preserved LV ejection fraction (EF) following a percutaneous coronary intervention (PCI) within the first 12 hours from the onset of symptoms.Patients and Methods: This is a case-control observational study including patients admitted for their first AMI, either with ST-segment elevation (STEMI) or without ST elevation (NSTEMI), with an LVEF > 40% after a successful PCI. Echocardiography was repeated after 6 months, and the patients were divided into two groups, according to whether LV remodeling was determined on echocardiography.Results: Of the 253 AMI patients (mean 66 aged ± 13 years), including 185 males (73%), 61 (24%) presented signs of LV remodeling. In univariate logistic regression analysis, age, male sex, smoking history, hypertension, hypercholesterolemia, Killip class, renal function, peak creatine phosphokinase - MB level, 2- and 3-vessel coronary artery disease (CAD), and several echocardiographic parameters were significantly associated with LV remodeling (P< 0.05). In multivariate logistic regression analysis harmed (H) LS and SR, Killip class, 3-vessel CAD, and LV end-diastolic volume were outlined as independent predictors for LV remodeling. Receiver operating characteristic curve analyses showed that HLS and HLSR were the most powerful independent predictors for LV remodeling (P< 0.001), with an area under the curve (AUC) of 0.85 (sensitivity 83%; specificity 84%; p < 0.001) and 0.77 (sensitivity 93; specificity 61%; p < 0.001), respectively. The identified cut-off values for predictor variables were HLS< − 11%, and HLSR< − 0.65s− 1.Conclusion: We concluded that 2D-STE was the best method to evaluate LV remodeling in patients with AMI and midrange or preserved LVEF following myocardial revascularization by a PCI.Keywords: AMI, PCI, preserved LVEF, midrange LVEF, 2D speckle tracking echocardiography, LV remodeling

Sustainable maritime development needs coherent governance, particularly for the shipping sector, to ensure a stable maritime economy. However, maritime governance in Pakistan is considered inadequate and incoherent and thus poses a serious challenge to sustainability. The National Maritime Policy (NMP) was launched two decades ago, in 2002, to provide an overarching governance framework for long-term benefits, but it is now outdated. This study aimed at analyzing the extent to which the NMP of 2002 is coherent with provincial, national, and international obligations and addresses emerging requirements for the development of a sustainable shipping sector in Pakistan. An analytical framework based on three (03) guiding principles, seven (07) criteria, and twenty-eight (28) indicators was employed using a combination of qualitative and quantitative methods. Coherence across twenty-one (21) governing instruments was analyzed, scored (0–5), and rated on a ratio scale to represent the coherence index for each indicator. Thus, a matrix representing the coherence index score for each indicator individually and in pairwise comparison with the NMP was developed. An overall coherence index was calculated as 2.1, which shows poor coherence across governing instruments. This indicates that the NMP 2002 is unable to address emerging governance needs for sustainability issues such as climate response, pollution control, ballast water management, ecosystem conservation, social well-being, stakeholder engagement, and economic diversification, thus requiring revision to meet the challenges created by incoherent governing instruments at all levels and among segments of the maritime economy.

Pasados once meses del inicio de la pandemia de COVID-19, se han confirmado más de 103 millones de casos en 188 países y el número de muertes se acerca a los 2,5 millones. Uno de los efectos colaterales de la COVID-19 es el impacto en la salud no relacionada con el propio coronavirus y el aumento de las necesidades de salud. Este artículo aborda los principales vectores que están afectando a la provisión de servicios de salud y se centra en la explicación de la adaptación de la prevención y el tratamiento de la malaria en un entorno COVID-19 por Médicos Sin Fronteras, mediante un ejemplo de la estrategia realizada en la ciudad de Batangafo (República Centroafricana). El mantenimiento de la gestión de los casos de malaria en condiciones seguras ha sido esencial en un contexto de COVID-19, y hemos adaptado los procedimientos para mantener nuestras actividades en este ámbito; en especial, adaptando la estrategia de quimioprevención estacional de la malaria (SMC) y reforzando la gestión comunitaria, adaptada a las medidas de PCI contra la COVID-19. Se ha puesto especial atención a las medidas de prevención y control de infecciones (PCI) para identificar y aislar a las personas con síntomas compatibles con COVID-19, mantenido las acciones dirigidas al control y tratamiento de la malaria., After eleven months of the start of the COVID-19 pandemic, more than 103 million cases have been confirmed in 188 countries and the number of deaths is close to 2.5 million. One of the side effects of COVID-19 is the health impact unrelated to coronavirus itself and increased health needs. This article addresses the main vectors that are affecting the provision of health services and focuses on explaining the adaptation of malaria prevention and treatment in a COVID-19 environment by Doctors Without Borders, using an example of the strategy carried out in the city of Batangafo (Central African Republic). Maintaining the management of malaria cases in safe conditions has been essential in a coVID-19 context, and we have adapted procedures to maintain our activities in this area; in particular, adapting the strategy of seasonal chemoprevention of malaria (SMC) and strengthening community management, adapted to PCI measures against COVID-19. Particular attention has been paid to infection prevention and control (PCI) measures to identify and isolate people with COVID-19-compatible symptoms, with actions aimed at malaria control and treatment.

Introduction. Bifurcation lesions on venous Y grafts are rare. We present a case of a woman who developed non-ST segment elevation myocardial infarction complicated by cardiogenic shock due to a bifurcation lesion on the venous Y graft for left anterior descending artery (LAD) and ramus circumflex artery (RCX). Case outline. A 72-year-old woman was admitted to the coronary care unit as an emergency in September 2017 due to acute heart failure followed by the development of cardiogenic shock. Urgent coronarography revealed severe atherosclerotic disease of native coronary arteries with significant bifurcation lesion on venous Y graft for LAD and RCX (medina classification of 1,1,1) with thrombolysis in myocardial infarction (TIMI) grade 2 flow. According to the general condition of patient, a life-saving ad hoc percutaneous coronary intervention (PCI) was performed. Two stents were implanted in the Y graft with T and protrusion (TAP) technique achieving optimal result followed with patient stabilization. On one-year follow-up, the patient was without symptoms of angina, and computed tomography coronarography revealed patent both stents in the Y graft. To the best of our knowledge, this is the first described TAP technique used on the Y graft. Conclusion. The PCI on a vein graft is not uncommon either in elective cases or in cases with acute coronary syndrome due to the poorer persistence and more frequent progression of atherosclerotic disease in the venous grafts. The use of bifurcation techniques for the treatment of lesions on a vein graft and especially on the Y graft is rare, but it can be used the same way it is used in native vessels.

AIMS: The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium. METHODS AND RESULTS: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p 12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died. CONCLUSION: The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation. ispartof: ACTA CARDIOLOGICA vol:76 issue:8 pages:863-869 ispartof: location:England status: published

Background: Defining the optimal conduction of percutaneous-coronary-intervention (PCI) to treat bifurcation lesions has been the subject of many clinical studies showing that the applied stenting technique may influence clinical outcome. Accordingly, bifurcation stenting classifications and technical sequences should be standardized to allow proper reporting and comparison. Methods: The European Bifurcation Club (EBC) is a multidisciplinary group dedicated to optimize the treatment of bifurcations and previously created a classification of bifurcation stenting techniques that is based on the first stent implantation site. Since some techniques have been abandoned, others have been refined and dedicated devices became available, EBC promoted an international task force aimed at updating the classification of bifurcation stenting techniques as well as at highlighting the best practices for most popular techniques. Original descriptive images obtained by drawings, bench tests and micro-computed-tomographic reconstructions have been created in order to serve as tutorials in both procedure reporting and clinical practice. Results: An updated Main-Across-Distal-Side (MADS)-2, classification of bifurcation stenting techniques has been realized and is reported in the present article allowing standardized procedure reporting in both clinical practice and scientific studies. The EBC-promoted task force deeply discussed, agreed on and described (using original drawings and bench tests) the optimal steps for the following major bifurcation stenting techniques: (a) 1-stent techniques (“provisional” and “inverted provisional”) and (b) 2-stent techniques (“T/TAP,” “culotte,” and “DK-crush”). Conclusions: The present EBC-promoted paper is intended to facilitate technique selection, reporting and performance for PCI on bifurcated lesions during daily clinical practice.

The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures.

BackgroundSpontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term ‘SCAD’ is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient.Case summaryIn this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2.DiscussionA higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with ‘thrombolysis first’ for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.

Aims The optimal method of revascularization for patients with left main coronary artery disease (LMCAD) is controversial. Coronary artery bypass graft surgery (CABG) has traditionally been considered the gold standard therapy, and recent randomized trials comparing CABG with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have reported conflicting outcomes. We, therefore, performed a systematic review and updated meta-analysis comparing CABG to PCI with DES for the treatment of LMCAD. Methods and results We systematically identified all randomized trials comparing PCI with DES vs. CABG in patients with LMCAD. The primary efficacy endpoint was all-cause mortality. Secondary endpoints included cardiac death, myocardial infarction (MI), stroke, and unplanned revascularization. All analyses were by intention-to-treat. There were five eligible trials in which 4612 patients were randomized. The weighted mean follow-up duration was 67.1 months. There were no significant differences between PCI and CABG for the risk of all-cause mortality [relative risk (RR) 1.03, 95% confidence interval (CI) 0.81–1.32; P = 0.779] or cardiac death (RR 1.03, 95% CI 0.79–1.34; P = 0.817). There were also no significant differences in the risk of stroke (RR 0.74, 95% CI 0.35–1.50; P = 0.400) or MI (RR 1.22, 95% CI 0.96–1.56; P = 0.110). Percutaneous coronary intervention was associated with an increased risk of unplanned revascularization (RR 1.73, 95% CI 1.49–2.02; P Conclusion The totality of randomized clinical trial evidence demonstrated similar long-term mortality after PCI with DES compared with CABG in patients with LMCAD. Nor were there significant differences in cardiac death, stroke, or MI between PCI and CABG. Unplanned revascularization procedures were less common after CABG compared with PCI. These findings may inform clinical decision-making between cardiologists, surgeons, and patients with LMCAD.

Right ventricular involvement in inferior myocardial infarction (MI) was historically associated with a poor prognosis. However, few studies addressed the impact of right ventricular (RV) dysfunction in the primary percutaneous intervention (pPCI) era. Our aim was to assess the prognostic significance of RV dysfunction in right coronary artery (RCA) related MI treated with pPCI. Methods: A total of 298 patients with a RCA related MI undergone pPCI between January 2011 and June 2015 were included. RV dysfunction was defined by a RV-FAC

Yong Wang, Hong-wei Zhao, Cheng-fu Wang, Xiao-jiao Zhang, Jie Tao, Chun-sheng Cui, Qing-kun Meng, Yu Zhu, De-feng Luo, Ai-jie Hou, Bo Luan Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People’s Republic of ChinaCorrespondence: Ai-jie Hou; Bo LuanDepartment of Cardiology, The People’s Hospital of China Medical University, the People’s Hospital of Liaoning Province, No. 33, Wenyiroad, Shenhe District, Shenyang City, Liaoning Province 110016, People’s Republic of ChinaTel +86-17702488970Email 1758624242@qq.com; luanbo2016@163.comBackground: The incidence and prognosis of coronary slow-flow (CSF) and no-reflow phenomenon (NRP) in patients with coronary chronic total occlusion (CTO) who underwent percutaneous coronary intervention (PCI) remain unclear.Methods: This single-center prospective study aimed to investigate the incidence of CSF/NRP during CTO interventional therapy, determine predictors of CSF/NRP, and evaluate its effect on patient outcomes.Results: In this study, 552 patients with CTO who underwent PCI were included. CSF/NRP occurred in 16.1% of them. They had higher incidences of diabetes mellitus (53.9% vs 36.3%, p=0.002) and hypertension (50.6% vs 37.1%, p=0.018) and a lower incidence of retrograde filling grade > 2 (34.8% vs 47.1%, p=0.036). Patients with CSF/NRP had a higher neutrophil ratio (55.6± 19.4 vs 52.4± 18.3, p=0.038) and levels of low-density lipoprotein (LDL; 3.0± 0.8 vs 2.8± 0.6, p=0.029), fasting glucose (FG; 8.3± 1.3 vs 6.8± 1.1, p=0.005), uric acid (332.6± 82.9 vs 308.2± 62.8, p=0.045), and high-sensitivity C-reactive protein (Hs-CRP; 9.8± 4.8 vs 7.3± 3.9, p=0.036). A multivariate logistic regression analysis revealed that diabetes mellitus (odds ratio [OR], 1.962; 95% confidence interval [CI]: 1.198– 2.721; p=0.042), mean platelet volume (MPV; OR,1.284; 95% CI, 1.108– 1.895; p=0.046), LDL cholesterol (LDL-C; OR, 1.383; 95% CI, 1.105– 2.491; p=0.036), FG (OR, 2.095; 95% CI, 1.495– 2.899; p=0.018), Hs-CRP(OR, 2.218; 95% CI, 1.556– 3.519; p=0.029), and retrograde filling of grade > 2 (OR, 0.822; 95% CI, 0.622– 0.907; p=0.037) were independent predictors of CSF/NRP in CTO patients who underwent PCI. Kaplan-Meier analysis revealed that the patients in the CSF/NRP group had a significantly lower cumulative major cardiac and cerebrovascular events (MACCE)-free survival than those in the non-CSF/NRP group (p< 0.0001).Conclusion: Of the patients with CTO who underwent PCI, 16.1% developed CSF/NRP and had a significantly lower cumulative MACCE-free survival rate. Diabetes mellitus; higher levels of MPV, LDL-C, FG, and Hs-CRP; and a lower incidence of retrograde filling grade > 2 were independent predictors of CSF/NRP in CTO patients who underwent PCI. Thus, they can be used for risk stratification.Keywords: coronary slow-flow, no-reflow phenomenon, coronary chronic total occlusion, PCI, prognosis

Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.

The study aims to evaluate the short- and long-term outcomes of left main percutaneous coronary interventions (LM PCI) in patients disqualified from coronary artery bypass graft surgery (CABG). We included 459 patients (mean age: 68.4 ± 9.4 years, 24.4% females), with at least 1-year follow-up; 396 patients in whom PCI was offered as an alternative to CABG (Group 1); and 63 patients who were disqualified from CABG by the Heart Team (Group 2). The SYNTAX score (29.1 ± 9.5 vs. 23.2 ± 9.7; p < 0.001) and Euroscore II value (2.72 ± 2.01 vs. 2.15 ± 2.16; p = 0.007) were significantly higher and ejection fraction was significantly lower (46% vs. 51.4%; p < 0.001) in Group 2. Patients in Group 2 more often required complex stenting techniques (33.3% vs. 16.2%; p = 0.001). The procedure success rates were very high and did not differ between groups (100% vs. 99.2%; p = 0.882). We observed no difference in periprocedural complication rates (12.7% vs. 7.8%; p = 0.198), but the long-term all-cause mortality rate was higher in Group 2 (26% vs. 21%; p = 0.031). LM PCI in patients disqualified from CABG is an effective and safe procedure with a low in-hospital complication rate. Long-term results are satisfactory.

Introduction: Sudden cardiac arrest is one of the most common causes of death. In cases of shock-resistant ventricular fibrillation, immediate transport of patients to the hospital is essential and made possible with use of devices for mechanical chest compression. Objectives: The efficacy of AutoPulse in patients with shock-resistant ventricular fibrillation was studied. Methods: This is a multicentre observational study on a population of 480,000, with 192 reported cases of out-of-hospital cardiac arrest. The study included patients with shock-resistant ventricular fibrillation defined as cardiac arrest secondary to ventricular fibrillation requiring ≥3 consecutive shocks. Eventually, 18 patients met the study criteria. Results: The mean duration of resuscitation was 48.4±43 min, 55% of patients were handed over to the laboratory while still in cardiac arrest, 83.3% of them underwent angiography and, in 93.3% of them, infarction was confirmed. Coronary intervention was continued during mechanical resuscitation in 50.0% of patients, 60% of patients survived the procedure, and 27.8% of the patients survived. Conclusions: Resistant ventricular fibrillation suggests high likelihood of a coronary component to the cardiac arrest. AutoPulse is helpful in conducting resuscitation, allowing the time to arrival at hospital to be reduced.

El siguiente trabajo tiene como objetivo el desarrollo y documentación de alma, un kernel (núcleo) en C++ de funcionalidad muy reducida para manejar los recursos hardware de una máquina con arquitectura x86-64. En sus últimas versiones, alma puede ser arrancado en hardware real mediante un archivo iso, tanto en sistemas con UEFI como con BIOS. Al tratarse de un kernel no se dispone de biblioteca estándar, funciones base o llamadas a sistema (syscalls) sobre las que desarrollar. Cada píxel que aparece por pantalla, cada acción de los pistones del teclado, cada reserva de memoria: está todo gestionado exclusivamente por el kernel y plasmado en este trabajo. Para mejorar la calidad del software desarrollado se han implementado desde cero funciones conocidas como printf, malloc, scanf, etc. En conjunto con el kernel también se ha desarrollado un bootloader capaz de arrancar alma en máquinas que dispongan de UEFI. Se ha escrito en el lenguaje C junto con la librería de desarrollo posix-uefi [1] para comunicarnos con los servicios de UEFI mediante una interfaz POSIX. En las últimas versiones del proyecto, el desarrollo del bootloader ha sido reemplazado por la integración del protocolo de arranque stivale2 en el kernel. Ahora alma puede ser arrancado por cualquier bootloader que implemente el mismo protocolo. También se proporciona un sistema de construcción con cmake [2] capaz de compilar el proyecto de forma automatizada. Junto al sistema de construcción, se ha desarrollado un script capaz de construir gcc y otros programas de la toolchain del proyecto con las modificaciones necesarias para desarrollar un kernel. Puesto que construir alma es una tarea muy compleja, se ha configurado un entorno de desarrollo virtualizado preparado para construir el proyecto. El objetivo del proyecto no es desarrollar un kernel usable en hardware real ni útil para determinadas tareas. alma ha sido desarrollado con fines meramente académicos, al igual que otros proyectos similares desarrollados por otras universidades tales como xv6 [3] (Massachusetts Institute of Technology), OS/161 [4] (Harvard) y SWEB [5] (Graz University of Technology).

El treball de la tesi actual es tracta d'una anàlisi exhaustiva de la cohort de *ICPs sobre *OTCs del nostre centre al llarg de diversos anys des de l'establiment d'un programa dedicat a aquest camp. En el primer estudi s'ha estudiat la capacitat predictiva de J-*CTO *score en una cohort de més 500 pacients i s'ha investigat si el model pot predir adequadament l'èxit de procediment tenint en compte l'experiència progressiva del centro en aquest terreny. A ressaltar que J-*CTO *score va ser elaborat a partir d'una cohort de *ICPs sobre *CTOs dutes a terme per operadors experts. En el segon estudi hem analitzat les variables que millor prediuen les taxes d'èxit del procediment en la nostra cohort i hem inclòs la variable experiència de l'operador com un potencial factor influent, aspecte no quantificat en altres estudis. El tercer estudi analitza i compara aquelles *OTCs amb *ICP fallida i que van ser sotmeses a un segon intent amb les *ICPs de primer o de només un intent. Es fa una comparació del grau de complexitat i de les taxes d'èxit entre tots dos grups. Es busca i s'analitza específicament aquells possibles factors contribuents a l'èxit de procediment en el nou intent com a canvis *angiográficos en segon intent respecte al previ i la utilització de noves estratègies i tècniques en nous intents. El trabajo de la tesis actual se trata de un análisis exhaustivo de la cohorte de ICPs sobre OTCs de nuestro centro a lo largo de varios años desde el establecimiento de un programa dedicado a este campo. En el primer estudio se ha estudiado la capacidad predictiva de J-CTO score en una cohorte de más 500 pacientes y se ha investigado si el modelo puede predecir adecuadamente el éxito de procedimiento teniendo en cuenta la experiencia progresiva del centro en este terreno. A resaltar que J-CTO score fue elaborado a partir de una cohorte de ICPs sobre CTOs llevadas a cabo por operadores expertos. En el segundo estudio hemos analizado las variables que mejor predicen las tasas de éxito del procedimiento en nuestra cohorte y hemos incluido la variable experiencia del operador como un potencial factor influyente, aspecto no cuantificado en otros estudios. El tercer estudio analiza y compara aquellas OTCs con ICP fallida y que fueron sometidas a un segundo intento con las ICPs de primer o de sólo un intento. Se hace una comparación del grado de complejidad y de las tasas de éxito entre ambos grupos. Se busca y se analiza específicamente aquellos posibles factores contribuyentes al éxito de procedimiento en el nuevo intento como cambios angiográficos en segundo intento respecto al previo y la utilización de nuevas estrategias y técnicas en nuevos intentos. The work of the current thesis deals with an exhaustive analysis of the cohort of PCIs on OTCs of our center over several years since the establishment of a program dedicated to this field. In the first study, the predictive capacity of the J-CTO score was studied in a cohort of more than 500 patients and it was investigated whether the model can adequately predict the success of the procedure, taking into account the progressive experience of the center in this field. It should be noted that the J-CTO score was developed from a cohort of ICPs on CTOs carried out by expert operators. In the second study we have analyzed the variables that best predict the success rates of the procedure in our cohort and we have included the operator experience variable as a potential influencing factor, an aspect not quantified in other studies. The third study analyzes and compares those OTCs with failed PCI and who underwent a second attempt with the PCIs of the first or only one attempt. A comparison of the degree of complexity and the success rates between both groups is made. Those possible contributing factors to the success of the procedure in the new attempt are specifically sought and analyzed, such as angiographic changes in the second attempt compared to the previous one and the use of new strategies and techniques in new attempts.

Severe calcified coronary lesions are frequently encountered in today’s percutaneous coronary intervention practice and remain a challenging entity in complex and high-risk patients. The present case illustrates the contemporary approach to management of this coronary problem from hemodynamic support, optical coherence tomography assessment, and plaque modification technique. (Level of Difficulty: Advanced.), Graphical abstract, Severe calcified coronary lesions are frequently encountered in today’s percutaneous coronary intervention practice and remain a challenging entity in…