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Background Patients with malignancies may have a high pro-thrombotic status as well as a high risk of hemorrhagic events either due to the tumor or its treatment. For this reason, these patients have always been excluded from randomized clinical trial on percutaneous coronary intervention (PCI). Aim To investigate the safety of PCI in patients with malignancies admitted for an AMI. Methods and results Retrospective analysis on an international European ACS registry. Primary endpoint: in-hospital mortality. Secondary endpoint: periprocedural-complications. There were 273 patients (35% women) with AMI and malignancies. Colon (19%), prostate (14%), breast (13%), lung (8%) and blood (8%) malignancies were the most frequents type of cancer. Women and men had similar age (68±11.5 vs 69.1±11.5, p=ns). STEMI was in 56% of patients (with no significant gender difference: 51% men vs 65% women, p=0.09). PCI was performed in 64% of patients (with primary PCI in 75% of STEMI). The rate of complications during cardiac catheterization and intervention was 6.5% (2.1% distal embolization, 2.1% no-reflow, 0.7% acute closure, 0.7% dissection, 0.7% perforation, none major bleeding). Nobody among patients that had cardiac catheterization and intervention complications died during hospital stay. In-hospital mortality was 5.9%. The group of patients treated with PCI had a significantly lower rate of death then that of those treated non invasively (1.7% vs 13.1%, p Conclusion These preliminary data from real word support the safety use of PCI in patients with malignancies and ACS, which have always been excluded from randomized clinical trial. Funding Acknowledgement Type of funding sources: None.

Background Obesity has been identified as the comorbidity more frequently associated with severe forms of COVID19. As the very elderly subjects are particularly prone to severe forms of the disease, but are less affected by obesity we specifically addressed the question on the influence of age on the relationship between BMI and COVID19 prognosis. Purpose To assess the relationship between obesity and early COVID-19 prognosis in octogenarians patients. Methods Patients were determined to have COVID-19 if they had a positive SARS-CoV-19 swab. We used logistic regression analyses to control for confounding by concomitant risk factors. Clinical characteristics and COVID-19 related outcomes (i.e. invasive mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analyzed according to BMI status and age (older vs younger than 80 years). Results Among 601 patients with COVID-19 confirmed disease there 514 (85.5%) normal weight and 87 (14.5%) obese subjects (BMI >30 kg/m2). In a multivariable adjusted model, the primary outcome (IMV and/or death by D7) was significantly associated with obesity in the overall population (OR 2.19; 95% CI: 1.26–3.8). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 80 years (OR 2.54; 95% CI: 1.38–4.68), while such an association was no longer found in those aged 80 years and older (OR 0.42; 95% CI: 0.05–3.33). Conclusions Obesity is associated with poor early prognosis in patients with confirmed COVID19 disease. The deleterious impact of obesity on COVID-19 prognosis is no longer observed in the elderly aged 80 years and older. Very advanced age by itself must be considered as a major risk for severe COVID-19 outcomes in all people irrespective of BMI status. Funding Acknowledgement Type of funding sources: None.

The human gut microbiota is the microbial ecosystem in the small and large intestines of humans. It has been naturally preserved and evolved to play an important role in the function of the gastrointestinal tract and the physiology of its host, protecting from pathogen colonization, and participating in vitamin synthesis, the functions of the immune system, as well as glucose homeostasis and lipid metabolism, among others. Mounting evidence from animal and human studies indicates that the composition and metabolic profiles of the gut microbiota are linked to the pathogenesis of cardiovascular disease, particularly arterial hypertension, atherosclerosis, and heart failure. In this review article, we provide an overview of the function of the human gut microbiota, summarize, and critically address the evidence linking compositional and functional alterations of the gut microbiota with atherosclerosis and coronary artery disease and discuss the potential of strategies for therapeutically targeting the gut microbiota through various interventions.

BACKGROUND There is uncertainty regarding the impact of statins on the risk of atherosclerotic cardiovascular disease (ASCVD) and its major complication, acute heart failure (AHF). OBJECTIVES The aim of this study was to investigate whether previous statin therapy translates into lower AHF events and improved survival from AHF among patients presenting with an acute coronary syndrome (ACS) as a first manifestation of ASCVD. METHODS Data were drawn from the International Survey of Acute Coronary Syndromes Archives. The study participants consisted of 14,542 Caucasian patients presenting with ACS without previous ASCVD events. Statin users before the index event were compared with nonusers by using inverse probability weighting models. Estimates were compared by test of interaction on the log scale. Main outcome measures were the incidence of AHF according to Killip class and the rate of 30-day all-cause mortality in patients presenting with AHF. RESULTS Previous statin therapy was associated with a significantly decreased rate of AHF on admission (4.3% absolute risk reduction; risk ratio [RR]: 0.72; 95% CI: 0.62-0.83) regardless of younger (40-75 years) or older age (interaction P = 0.27) and sex (interaction P = 0.22). Moreover, previous statin therapy predicted a lower risk of 30-day mortality in the subset of patients presenting with AHF on admission (5.2 % absolute risk reduction; RR: 0.71; 95% CI: 0.50-0.99). CONCLUSIONS Among adults presenting with ACS as a first manifestation of ASCVD, previous statin therapy is associated with a reduced risk of AHF and improved survival from AHF. (C) 2022 by the American College of Cardiology Foundation.

Background It remains uncertain whether female sex is itself a strong risk factor for worse outcomes in acute coronary syndromes (ACS). Purpose We hypothesized that sex differences in vulnerability to heart failure after ACS may modify the association between sex and outcomes. Methods Data were drawn from the ISACS-Archives network of registries. The study population consisted of 87,812 patients with known time from symptom onset to hospital presentation. Participants were stratified by ACS subtypes: STEMI and NSTE-ACS Data on presenting heart failure symptoms were collected from medical record abstraction. Heart failure was categorized as Killip class >2. Time from symptom onset to hospital presentation was categorized as early (≤120 minutes) or late (>120 minutes). Primary outcome measure was 30-day mortality. Estimates were performed using a parametric balancing strategy by weighting and compared by test of interaction on the log scale. Results Among the study sample, 30922 (35.2%) patients were women. Patient outcomes varied according to subtype of ACS. The mortality rates at 30-days were significantly higher among women vs men in STEMI (RR:1.65; 95% CI: 1.56–1.73) compared with NSTE-ACS (RR:1.18; 95% CI: 1.09–1.28; P interaction Conclusions Women exhibit substantially more vulnerability to heart failure in STEMI than men: a greater percentage of women have heart failure, and women with heart failure have higher 30-day mortality than men with heart failure. This finding was not seen in NSTE-ACS. heart failure on initial assessment is a key feature to explain the sex gap in mortality after ACS. Funding Acknowledgement Type of funding sources: None.

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Background: Although a family history (FHx) is an accepted risk factor for cardiovascular (CV) disease, few studies have examined the predictive strength of a positive FHx after adjusting for other conventional risk factors and medications Methods: We analyzed 12,922 patients with ACSs, without evidence of prior CV disease enrolled in the ISACS-TC registry between January 2010 to January 2021. Main outcome measures were the adjusted rates of STEMI and 30-day mortality from STEMI using multivariable logistic regression models Results: Overall, 3,147 patients (24,4%) self-reported an FHx of CV disease, defined as first-degree relative with premature CV events (men, age

The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction, and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular response to cytokine production and the interaction between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and angiotensin-converting enzyme 2 receptor may lead to a significant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. This conditions often referred to as 'post-acute COVID-19' may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic inflammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here, we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic continues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by integrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance.

Background Patients with diabetes and non-ST elevation acute coronary syndrome (NSTE-ACS) have an increased risk of mortality and adverse outcomes following percutaneous coronary intervention (PCI). Purpose We aimed to investigate the impact of early, within 24 hours PCI compared with only routine medical treatment on clinical outcomes in a large international cohort of patients with NSTE-ACS and diabetes. Methods We identified 1,250 patients with diabetes and NSTE-ACS from a registry-based population between October 2010 and April 2016. The primary endpoint was 30-day all-cause mortality. The secondary endpoint was the composite outcome of 30-day all-cause mortality and left ventricular dysfunction (ejection fraction

Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) complicated by symptoms of acute “de novo” heart failure is associated with excess mortality. Yet whether development of heart failure and its outcomes differ by sex is unknown Hypothesis: We postulated that men and women have distinct cardiovascular responses to acute myocardial ischemia and hypothesized that women are at higher risk to develop acute heart failure and carry a concomitant worse survival compared with their male counterparts Methods: We examined the relationship among sex, acute heart failure and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. Patients were recruited from a network of hospitals in the ISACS-TC registry (NCT01218776). Main outcome measures were incidence of Killip class 2 or higher at hospital presentation and risk-adjusted 30-day mortality rates estimated using inverse probability of weighting (IPW) and logistic regression models. Results: The study population consisted of 10,443 patients (3,112 women). After covariate adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity and delay to hospital presentation, the incidence of “de novo” heart failure at hospital presentation was significantly higher for women than for men (25.1% vs 20.0%, OR, 1.34; 95%CI: 1.21- 1.48). Women with “de novo” heart failure had higher 30-day mortality compared with their male counterparts (25.1% vs. 20.6%: OR, 1.29; 95%CI, 1.05 - 1.58). The sex-related difference in mortality rates were still apparent in patients with “de novo” heart failure undergoing reperfusion therapy after hospital presentation (21.3% vs.15.7%; OR, 1.45; 95% CI, 1.07 - 1.96). Conclusions: Women are at higher risk to develop “de novo” heart failure after STEMI and women with “de novo” heart failure have worse survival compared with their male counterparts. As so, “de novo” heart failure is a key feature to explain mortality gap after STEMI among women and men

Background Although guidelines from the European Society of Cardiology and American Heart Association/American College of Cardiology recommend early percutaneous coronary intervention (PCI) in all patients with non-ST-elevation myocardial infarction/ unstable angina (NSTE-ACS), in day-to-day practice persists uncertainty as to whether to follow guidelines in patients aged 75 years or older. Indeed, recommendations are based on large randomized trials where patients aged 75 years or older are under-represented. Purpose We aimed to investigate whether patients aged 75 years or older would benefit from an early invasive strategy versus a conservative strategy. We also analyzed the factors associated with the choice of an early PCI in this population. Methods The research was conducted on the population of the International Survey of Acute Coronary Syndromes (ISACS-TC) registry. The study population consisted of 6826 eligible patients with NSTE-ACS. Of these patients, 1496 were 75 years old or older and were included in the analysis. The primary outcome measure was 30-day mortality. Key secondary outcomes were bleeding complications during the index hospitalization. Multivariate logistic regression analyses were conducted to establish outcomes and factors associated with outcomes. We evaluated specific ranges of ages: 75–79 years, 80–84 years, and 85 years or over. Further, data were sorted by sex and diabetes mellitus status. Results The mean age of our study population was 80.0 (interquartile range: 77–82) years old. Elderly patients treated with early PCI and medical therapy were significantly younger than those treated with only medical therapy were (78.9 vs 80.5, p

Although myocardial ischaemia usually manifests as a consequence of atherosclerosis-dependent obstructive epicardial coronary artery disease, a significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Experimental and clinical evidence highlight the abnormalities of the coronary microcirculation as a main cause of myocardial ischaemia in patients with `normal or near normal' coronary arteries on angiography. Coronary microvascular disturbances have been associated with early stages of atherosclerosis even prior to any angiographic evidence of epicardial coronary stenosis, as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure. The main objectives of the manuscript are (i) to provide updated evidence in our current understanding of the pathophysiological consequences of microvascular dysfunction in the heart; (ii) to report on the current knowledge on the relevance of cardiovascular risk factors and comorbid conditions for microcirculatory dysfunction; and (iii) to evidence the relevance of the clinical consequences of microvascular dysfunction. Highlighting the clinical importance of coronary microvascular dysfunction will open the field for research and the development of novel strategies for intervention will encourage early detection of subclinical disease and will help in the stratification of cardiovascular risk in agreement with the new concept of precision medicine.

Background We hypothesized that female sex is a treatment effect modifier of blood flow and related 30‐day mortality after primary percutaneous coronary intervention ( PCI ) for ST ‐segment–elevation myocardial infarction and that the magnitude of the effect on outcomes differs depending on delay to hospital presentation. Methods and Results We identified 2596 patients enrolled in the ISACS ‐ TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry from 2010 to 2016. Primary outcome was the occurrence of 30‐day mortality. Key secondary outcome was the rate of suboptimal post‐ PCI Thrombolysis in Myocardial Infarction ( TIMI ; flow grade 0–2). Multivariate logistic regression and inverse probability of treatment weighted models were adjusted for baseline clinical covariates. We characterized patient outcomes associated with a delay from symptom onset to hospital presentation of ≤120 minutes. In multivariable regression models, female sex was associated with postprocedural TIMI flow grade 0 to 2 (odds ratio [ OR ], 1.68; 95% CI , 1.15–2.44) and higher mortality ( OR, 1.72; 95% CI , 1.02–2.90). Using inverse probability of treatment weighting, 30‐day mortality was higher in women compared with men (4.8% versus 2.5%; OR , 2.00; 95% CI , 1.27–3.15). Likewise, we found a significant sex difference in post‐ PCI TIMI flow grade 0 to 2 (8.8% versus 5.0%; OR , 1.83; 95% CI , 1.31–2.56). The sex gap in mortality was no longer significant for patients having hospital presentation of ≤120 minutes ( OR , 1.28; 95% CI , 0.35–4.69). Sex difference in post‐ PCI TIMI flow grade was consistent regardless of time to hospital presentation. Conclusions Delay to hospital presentation and suboptimal post‐ PCI TIMI flow grade are variables independently associated with excess mortality in women, suggesting complementary mechanisms of reduced survival. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01218776.

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Background: Limited data are available on the association between comorbidities and acute myocardial ischemia with atypical presentation. Purpose: The aim of this study was to investigate the impact of comorbidities on the management and outcomes of ACS patients with atypical presentation (i.e. ACS without chest pain). Methods: Between 2010 and 2016, 11458 ACS patients were admitted at 57 hospitals included in the network of the ISACS-TC registry (ClinicalTrials.gov, NCT01218776). There were 1394 (12.2%) patients with unstable angina, 2855 (24.9%) with NSTEMI, and 7203 (62.9%) with STEMI. Results: 995 (8.7%) ACS patients have atypical presentation at the initial evaluation, and the 40.2% of the overall study population have comorbidities (diabetes mellitus, heart failure, CKD, COPD, stroke, PAD, GERD or active cancer). Patients with comorbidities were not equally distributed: 38.7% were with typical presentation and 55.2% without typical presentation, (p

The aim of this study was to determine if earlier administration of oral blocker therapy in patients with acute coronary syndromes (ACSs) is associated with an increased short-term survival rate and improved left ventricular (LV) function. We studied 11,581 patients enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries registry from January 2010 to June 2014. Of these patients, 6,117 were excluded as they received intravenous beta blockers or remained free of any beta blocker treatment during hospital stay, 23 as timing of oral beta blocker administration was unknown, and 182 patients because they died before oral beta blockers could be given. The final study population comprised 5,259 patients. The primary outcome was the incidence of in-hospital mortality. The secondary outcome was the incidence of severe LV dysfunction defined as an ejection fraction 24 hours) during hospital stay in the remaining 3,882 patients. Early beta blocker therapy was significantly associated with reduced in-hospital mortality (odds ratio 0.41, 95% CI 0:21 to 0.80) and reduced incidence of severe LV dysfunction (odds ratio 0.57, 95% CI 0.42 to 0.78). Significant mortality benefits with early beta blocker therapy disappeared when patients with Killip class III/IV were included as dummy variables. The results were confirmed by propensity score matched analyses. In conclusion, in patients with ACSs, earlier administration of oral beta blocker therapy should be a priority with a greater probability of improving LV function and in-hospital survival rate. Patients presenting with acute pulmonary edema or cardiogenic shock should be excluded from this early treatment regimen. (C) 2016 Elsevier Inc. All rights reserved.

BACKGROUND: To evaluate the impact of comorbidities on the management and outcomes of acute coronary syndrome (ACS) patients without chest pain/discomfort (i.e. ACS without typical presentation). METHODS: Of the 11,458 ACS patients, enrolled by the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776), 8.7% did not have typical presentation at the initial evaluation, and 40.2% had comorbidities. The odds of atypical presentation increased proportionally with the number of comorbidities (odds ratio [OR]: 1, no-comorbid; OR: 1.64, 1 comorbidity; OR: 2.52, 2 comorbidities; OR: 4.57, =3 comorbidities). RESULTS: Stratifying the study population by the presence/absence of comorbidities and typical presentation, we found a decreasing trend for use of medications and percutaneous intervention (OR: 1, typical presentation and no-comorbidities; OR: 0.70, typical presentation and comorbidities; OR: 0.23, atypical presentation and no-comorbidities; OR: 0.18, atypical presentation and comorbidities). On the opposite, compared with patients with typical presentation and no-comorbidities (OR: 1, referent), there was an increasing trend (p

Background: Diabetic (DM) patients are at increased risk of cardiovascular events after an acute coronary syndrome, yet it remains unknown whether they derive enhanced benefit from an invasive strategy. Objective: We investigated the relation between coronary revascularization by percutaneus coronary intervention (PCI) and in-hospital survival of DM patients admitted to hospitals with a diagnosis of Unstable angina/ Non-ST-elevation myocardial infarction (UA/NSTEMI). Methods: This was a prospective cohort study using data from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACSTC, NCT01218776) registry on patients admitted to the coronary care units of 58 Eastern European hospitals from January 2010 to February 2015. A total of 4,996 first-day survivors who were admitted with a diagnosis of UA/NSTEMI were included. To avoid survival bias, a landmark time was set to 24 hours after hospital admission. Patients who died before the landmark time were excluded. Patients, who had undergone coronary artery bypass grafting, were also excluded leaving a final study population of 4,965 patients. Results: The study populations consisted of 4,965 NSTE-ACS patients. There were 1,381 patients (27.8%) with DM. Patients with DM were older and prevalently women, and had higher rates of hypercholesterolemia, hypertension, prior cardiovascular events and chronic kidney disease. They had more severe clinical presentation and higher rates of atypical chest pain. Patients with DM underwent less (p

Background: The impact of a mechanical reperfusion strategy beyond a 24-hour cut-off is still unsettled. Optimal management for these patients remains uncertain. Purpose: We sought to investigate the effect of delayed primary percutaneus coronary intervention (p-PCI) – 24 to 48 hours after symptom onset-for patients with ST-segment elevation myocardial infarction (STEMI) not undergoing timely reperfusion therapy. Methods: We conducted a cohort study of 1822 STEMI first-day survivors who were admitted with a diagnosis of STEMI, but did not receive any mechanical or pharmacological reperfusion therapy within 24 hours from symptom onset. We used multivariable logistic regression combined to landmark analysis to evaluate the effect of delayed p-PCI on in-hospital mortality and incidence of severe left ventricular dysfunction (LVD; ejection fraction

Purpose: We explored clinical characteristics and outcome associated with atypical chest pain (CP) in patients with diagnosis of ACS. Methods: Data of 8947 patients (32.4% women) from the International Survey of Acute Coronary Syndrome in Transitional Country (ISACS-TC) were reviewed in our comprehensive coordinating center. Only patients with admission and discharge diagnosis of ACS were considered. Results: There were 778 patients with atypical CP for the index event. These patients were significantly (p12 hrs to arrive to hospital; absence of typical CP doubled the probability (OR: 2.18; CI: 1.89–2.55) to late hospital presentation. Interestingly, patients without typical CP were significantly more likely to exhibit signs of heart faliure (42.8% vs. 22.1%), although they less frequently had STEMI as index even. In-hospital mortality rate was in the overall cohort 8.2% (STEMI: 9.1%, NSTEMI: 8.8%, UA: 2.1%). Yet, the mortality was significantly greater for patients with atypical CP (STEMI: 19.8%, NSTEMI: 19.3%) than for those with typical CP (STEMI: 6.7%, NSTEMI: 7.1%). It should be noted, however, that patients with atypical CP were less likely (p

We sought to investigate characteristics, treatment, and outcome of octogenarian patients during hospital stay for acute coronary syndrome (ACS) in a transitional country. This is a cohort study of 437 patients ≥ 80 years old, consecutively admitted with a diagnosis of ACS at 14 hospitals in 8 Eastern European countries reporting data to ISACS-TC registry. The primary endpoint was in-hospital mortality. The mean age of the study population was 83.5 years ; 50.1% of the patients were women. Females, less frequently than males, had a history of myocardial infarction, smoking habit, and episodes of typical chest pain. But they were more often admitted with left ventricular dysfunction. The rate of reperfusion treatment (29.5%) was very low in patients with ST-elevation myocardial infarction (STEMI). Also, most of the overall study population had a non-invasive approach (women, 79% vs. men, 70.6% ; P = 0.042). However, when the coronary anatomy was known, there were no differences in the rates of revascularization between genders. There was no difference in the rates of death between male (21%) and female (21.1%) patients. Univariate and multivariate analyses revealed that the independent predictors (P < 0.05) of death in octogenarians were systolic blood pressure

During the past 10 years, the health of people in Eastern Europe and the former Soviet Union has undergone changes very different from the health patterns seen in their Western counterparts. Mortality from cardiovascular disease has been decreasing continuously in the USA and many Western European countries, but it has increased or remained unchanged in many of the states of Eastern Europe. Analysis of this phenomenon has been hindered by insufficient information. The International Registry of Acute Coronary Syndromes registry study in Transitional Countries (ISACS-TC) is both a retrospective-over a 1-year period-and prospective study which was designed in order to obtain data of patients with acute coronary syndromes (ACSs) in countries with economy in transition in Central and Eastern Europe, and herewith control and optimize internationally guideline recommended therapies in these countries. Adhesion to the project was given by 112 Collaborating Centres in 17 countries with economy in transition (Albania, Bosnia and Herzegovina, Belarius, Bulgaria, Croatia, Hungary, Kosovo, Latvia, Lithuania, Macedonia, Moldova, Montenegro, Romania, Russian Federation, Serbia, Slovakia, Slovenia, and Ukraine). A total of 47 cluster sites in 11 countries in Central and Eastern Europe are currently collaborating in ISACS-TC. The registry encourages optimal individualization of evidence-based therapies and the international patient body ensures good representation of multiple practice patterns. It may help to make an additional improvement in clinical outcomes of countries with economy in transition.

Purpose: Patients with acute coronary syndrome (ACS) do not necessarily undergo coronary angiography and are managed acutely in a noninvasive manner. We investigate how soon evidence based secondary prevention therapies should be started after an ACS in this population. Methods: The study populations consisted of 8214 ACS patients, of these 4156 patients (42.0% non ST-elevation (STE) ACS and 58.0% STE-ACS patients) that did not received reperfusion treatment. Patients were admitted at 57 hospitals reporting data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (ClinicalTrials.gov, NCT01218776), from October 2010 to February 2014. We assessed the use of beta-blockers, statins and angiotensin-converting enzyme inhibitors in the emergency setting, (within 24 hrs since hospital admission) and their effects on in-hospital incidence of death. Results: There were 2451 patients that received all 3 drugs in the emergency setting (group 3), 982 patients with 2 medications (group 2), 384 patients with 1 medication (group 1) and 252 patients that did not receive any drugs (group 0). The mortality rate was 4.8%, 11.1%, 29.2% and 65.7% in group 3, 2, 1 and 0, respectively. Benefits were observed both in non STE-ACS (incidence of mortality: 3.0%, 9.0%, 19.7%, and 58.7%, in group 3, 2, 1 and 0, respectively) and in STE-ACS (incidence of mortality: 6.1%, 13.1%, 34.7%, and 68.8% in group 3, 2, 1 and 0, respectively). The advantage of multiple combination of prevention therapies was confirmed by multivariable analysis. The absolute risk reduction was of greater magnitude and statistical significance (p

Optical coherence tomography (OCT) is a recently developed technology capable of micron-scale imaging. Its high resolution (10-20 microm) makes intravascular OCT imaging the most interesting method for assessing atherosclerotic plaque microstructure in patients suffering from coronary artery disease. OCT allowed measurement of the thickness of the plaque fibrous cap, as well as identification of intima, media, and external elastic membrane in patients with normal coronary arteries. However, significant limitations still exist, including poor penetration in non-transparent tissue. The aim of this review is to give an update on OCT on the basis of the existing literature, with an overview of the strong and weak features of this technique.

Scientific interest in ischaemic heart disease (IHD) in women has grown considerably over the past 2 decades. A substantial amount of the literature on this subject is centred on sex differences in clinical aspects of IHD. Many reports have documented sex-related differences in presentation, risk profiles, and outcomes among patients with IHD, particularly acute myocardial infarction. Such differences have often been attributed to inequalities between men and women in the referral and treatment of IHD, but data are insufficient to support this assessment. The determinants of sex differences in presentation are unclear, and few clues are available as to why young, premenopausal women paradoxically have a greater incidence of adverse outcomes after acute myocardial infarction than men, despite having less-severe coronary artery disease. Although differential treatment on the basis of patient sex continues to be described, the extent to which such inequalities persist and whether they reflect true disparity is unclear. Additionally, much uncertainty surrounds possible sex-related differences in response to cardiovascular therapies, partly because of a persistent lack of female-specific data from cardiovascular clinical trials. In this Review, we assess the evidence for sex-related differences in the clinical presentation, treatment, and outcome of IHD, and identify gaps in the literature that need to be addressed in future research efforts.

It is well recognized that depression is independently associated with cardiovascular events. However, uncertainties remain on the pathophysiological pathways underlying the association between depression and coronary heart disease. In addition to the traditional cardiovascular risk factors, autonomic nervous system (ANS), low grade of inflammation, platelet and hypothalamic-pituitary-adrenal axis function and genetic factors may adversely impact the endothelium of the arterial wall. We provide an overview of the pathophysiological mechanisms and indices which seem to have a role in promoting and accelerating atherosclerosis and its complications due to plaque rupture and thrombosis. Given that the relationship between depression and atherosclerosis cannot be fully explained by single mechanisms, which seem at least partially interrelated, the depression-related dysfunctions in the ANS and hypothalamic-pituitary-adrenal axis seem to play a major role, promoting chronic inflammation, endothelial dysfunction and platelet activation and aggregation, which in turn are key steps in the development of atherosclerosis and its complications.