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Diabetes mellitus, cardiovascular disease and heart failure are interacting dynamically. Patients being diagnosed with cardiovascular disease should be screened for diabetes mellitus. Enhanced cardiovascular risk stratification based on biomarkers, symptoms and classical risk factors should be performed in patients with preexisting diabetes mellitus. In patients with previously diagnosed arterosclerotic cardiovascular disease an agent proven to reduce major adverse cardiovascular events or cardiovascular mortality is recommended., (© 2023. The Author(s).)

Objectives: We aimed to investigate the prognostic utility of the anatomical CABG SYNTAX and logistic clinical SYNTAX scores for mortality after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafts (CABG)., Background: The anatomical SYNTAX score evaluated the anatomical complexity of coronary artery disease and helped predict the prognosis of patients undergoing PCI. The anatomical CABG SYNTAX score was derived from the anatomical SYNTAX score in patients with prior CABG, whilst the logistic clinical SYNTAX score was developed by incorporating clinical factors into the anatomical SYNTAX score., Methods: We calculated the anatomical CABG SYNTAX score and logistic clinical SYNTAX score in 205 patients in the GLOBAL LEADERS trial. The predictive abilities of these scores for 2-year all-cause mortality were evaluated., Results: Using the median scores as categorical thresholds between low and high score groups, the logistic clinical SYNTAX score was able to discriminate the risk of 2-year mortality, unlike the anatomical CABG SYNTAX score. The logistic clinical SYNTAX was significantly better at predicting 2-year mortality, compared to the anatomical CABG SYNTAX score, as evidenced by AUC values in receiver-operating characteristic curve analysis (0.806 vs. 0.582, p < .001) and integrated discrimination improvement (0.121, p < .001)., Conclusions: The logistic clinical SYNTAX score was superior to the anatomical CABG SYNTAX score in predicting 2-year mortality., (© 2020 Wiley Periodicals, Inc.)

Diabetes mellitus, cardiovascular disease and heart failure are interacting dynamically. Patients being diagnosed with cardiovascular disease should be screened for diabetes mellitus. Enhanced cardiovascular risk stratification based on biomarkers, symptoms and classical risk factors should be performed in patients with pre-existing diabetes mellitus. In patients with previously diagnosed arterosclerotic cardiovascular disease an agent proven to reduce major adverse cardiovascular events or cardiovascular mortality is recommended after therapy failure of metformin.

Background: There is still limited data on the very long term clinical outcomes after ABSORB BRS in daily practice. We sought to evaluate the 3 year-performance of the Absorb bioresorbable vascular scaffolds for the treatment of low/moderate complexity patients enrolled in the ABSORB EXTEND trial., Methods: ABSORB EXTEND is a prospective, single-arm, open-label clinical study in which 812 patients were enrolled at 56 sites. This study allowed the treatment of lesions ≤28 mm in length and reference vessel diameter of 2.0-3.8 mm (as assessed by on-line QCA). To determine the independent predictors of MACE, a multivariable logistic regression model was built using a stepwise (forward/backward) procedure., Results: Average population age was 61 years and 26.5% had diabetes. Most patients had single target lesion (92.4%). Adequate scaffold deployment (PSP) was achieved in 14.2% of the cases. At three years, the composite endpoints of MACE and ischemia-driven target vessel failure were 9.2% and 10.6%, respectively. The cumulative rate of ARC definite/probable thrombosis was 2.2%, with 1.2% of the cases occurring after the 1st year. Independent predictors of MACE were hypertension and the need for "bail out" stent., Conclusion: At three-year follow-up, the use of ABSORB in low/moderate complex PCI was associated with low and acceptable rates of major adverse clinical events, despite the infrequent use of the recommended contemporary scaffold deployment technique. However, scaffold thrombosis rate was higher than reported with current generation of metallic DES. The study is registered on clinicaltrials.gov (unique identifier NCT01023789)., (© 2018 Wiley Periodicals, Inc.)

Diabetes mellitus, cardiovascular disease and heart failure are interacting dynamically. Patients being diagnosed with cardiovascular disease should be screened for diabetes mellitus. Enhanced cardiovascular risk stratification based on biomarkers, symptoms and classical risk factors should be performed in patients with pre-existing diabetes mellitus.

Background: Periprocedural outcome has been extensively investigated in patients undergoing carotid artery stenting. However, risk factors contributing to long-term mortality have not been comprehensively assessed. We aimed to establish a validated clinical risk score for long-term mortality in patients after carotid artery stenting., Methods and Results: Two independent cohorts after successful carotid artery stenting (602 and 552 patients) were prospectively investigated. Multivariable Cox regression and bootstrap variable selection were used to select the best-fitting multivariable model. The mortality rate was 35% in the derivation and 39% in the validation cohort during a median follow-up of 6.5 and 7.4 years, respectively. The following variables were identified as most robust risk factors in the derivation cohort: age, heart failure, diabetes mellitus, relative lymphocyte count, prothrombin time, peripheral artery disease, and contralateral carotid occlusion. A weighted multimarker risk score yielded an area under the receiver operating characteristic curve of 0.79 in the derivation (P<0.001) and of 0.69 (P<0.001) in the validation cohort. In comparison, the best area under the receiver operating characteristic curves for single risk factors were 0.67 and 0.63, respectively. For optimal clinical use, a simplified risk score was also developed, which discriminated very well from very low to very high risk. The risk of all-cause mortality ranged from 8% for a score of 1 to 93% for a score of 7 (P<0.001) in the derivation and from 11% to 100% in the validation cohort (P<0.001)., Conclusions: A multimarker risk score outperformed the prognostic value of single risk factors for the prediction of long-term mortality.

Aims: This study sought to investigate the incidence of stent thrombosis (ST) in patients treated with drug-eluting stents (DES) and clearly defined short-term dual antiplatelet therapy (DAT) for three or six months for sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES), respectively., Methods and Results: A series of 1023 consecutive patients with 1,414 stented lesions and prescribed short-term DAT were followed for at least two years after DES implantation. The individual durations of DAT, the rate of ischaemic events, and survival status were assessed. Follow-up was completed for 1017 patients (99.4%) with a mean follow-up of 3.0 +/- 0.7 years. DAT duration was 2.8 +/- 0.4 and 5.9 +/- 0.8 months in patients with SES and PES, respectively. Adherence to continued single antiplatelet therapy was 98.4%. We identified 14 patients with definite ST (1.4%) and no patients with probable ST with a cumulative incidence of 0.6% at 30 days, of 0.8% at one year, of 1.2% at 2 years, and of 1.4% at three years., Conclusions: Definite or probable ST after DES implantation and short DAT occurs with a cumulative incidence of 1.4% at 3 years if excellent patient adherence to the continued single antiplatelet therapy can be achieved.

Background: Longer-term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events., Aim: To assess the longer-term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting., Method: In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long-term follow-up., Results: Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all-cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all-cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups., Conclusions: In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all-cause mortality depending on a significant coronary artery stenosis.

Introduction: Atherosclerosis is looked upon as an inflammatory disease. The production of proinflammatory markers may indicate activity in this inflammatory state., Methods: We prospectively evaluated a range of proinflammatory serum parameters in 136 cardiac patients who had previously undergone percutaneous coronary intervention (PCI)., Results: By means of myocardial scintigraphy, an ischemia group (A; n=49) and a group with stable cardiovascular disease without exercise induced ischemia (B; n=87) were distinguished. Risk factors and lipoprotein profile of both groups were comparable. Serum levels of serum C-reactive protein (CRP), IL-6, sTNF-RI, IGF-I, neopterin, serotonin and prolactin did not present any significant difference between the two groups., Conclusions: We conclude that measurement of these (inflammatory) parameters does not help to delineate post-PCI cardiac patients with and without exercise-induced ischemia.

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Summary: Background: An early diagnosis of acute coronary syndrome (ACS) is crucial for treatment and prognosis. The aim of this study was to evaluate the Manchester triage system (MTS) for patients with ACS, e.g. ST-segment elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (N-STEMI) and unstable angina pectoris (UAP). Methods: Retrospective analysis of patients diagnosed with ACS (STEMI, N‑STEMI and UAP) who were triaged in the emergency department (ED) with the MTS. Results: In this study 282 patients with ACS (STEMI: 34.0%, N‑STEMI: 61.7%, UAP: 4.3%) were triaged as MTS level 1 (immediate assessment): 0.4%, MTS level 2 (very urgent): 51.4%, MTS level 3 (urgent): 41.5%, MTS level 4 (standard): 6.7%, MTS level 5 (non-urgent): 0%. We observed significantly lower mean MTS levels in males (male: 2.48 ± 0.59, female: 2.68 ± 0.68, p = 0.02) and in patients younger than 80 years (age <80 years: 2.50 ± 0.61, age ≥80 years: 2.70 ± 0.67, p = 0.03). We did not find a significant difference of mean MTS levels in different types of ACS (STEMI: 2.46 ± 0.6, N‑STEMI: 2.59 ± 0.64, STEMI vs N‑STEMI: p = 0.11, UAP: 2.67 ± 0.65, STEMI vs UAP: p = 0.26) and with respect to diabetes (diabetic: 2.47 ± 0.57, non-diabetic: 2.58 ± 0.65, p = 0.13). The in-hospital mortality was 2.5% (MTS level 2: n = 3, MTS level 3: n = 3, MTS level 4: n = 1). Conclusion: The majority of patients with ACS were classified as MTS levels 2 and 3. There was no significant difference of mean MTS levels in patients with STEMI, NSTEMI and UAP. In order to assure an early diagnosis of STEMI, an electrocardiogram (ECG) should be carried out immediately or at least within 10 min after first medical contact in the ED in all patients suspected for ACS, irrespective of the assigned MTS level. [ABSTRACT FROM AUTHOR]

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Copyright of Wiener Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)