Balancing thrombosis and bleeding after out-of-hospital cardiac arrest related to acute coronary syndrome: A literature review

Central illustration. Balance between thrombosis and bleeding risks after out-of-hospital cardiac arrest related to acute coronary syndrome.

     

Intracoronary imaging in addition to coronary angiography for patients with out-of-hospital cardiac arrest: More information for better care?

About 70% of out-of-hospital cardiac arrests are related to an ischaemic heart disease in Western countries. Percutaneous coronary intervention has been shown to improve the prognosis of survivors when an unstable coronary lesion is identified as the potential cause of the cardiac arrest. Acute complete coronary occlusion is often demonstrated among patients with ST-segment elevation on electrocardiogram after the return of spontaneous circulation. In patients without ST-segment elevation, routine coronary angiography has been shown to be not superior to conservative management. However, an electrocardiogram-based decision to perform immediate coronary angiography could be insufficient to identify unstable coronary lesions, which are frequently associated with intermediate coronary stenosis. Intracoronary imaging can be helpful to detect plaque rupture or erosion and intracoronary thrombus, but could also lead to better stent implantation, and help to reduce the risk of stent thrombosis. In patients with coronary lesions without the instability characteristic, conservative management should be the default strategy, and a search for another cause of the cardiac arrest should be systematic. In the present review, we sought to describe the potential benefit of intracoronary imaging in patients with out-of-hospital cardiac arrest.     

Mid-term clinical outcomes of out-of-hospital cardiac arrest patients treated with targeted temperature management at 34–36°C versus 32–34°C

BackgroundTargeted temperature management (TTM) in comatose survivors of out-of-hospital cardiac arrest has been associated with improved neurological outcomes. However, the optimal temperature target for TTM remains unclear.ObjectivesTo compare a TTM protocol targeted at 34–36°C with a protocol targeted at 32–34°C with reference to both clinical outcomes and acute complications.MethodsWe analyzed a prospective registry of consecutive out-of-hospital cardiac arrest survivors who underwent TTM. We compared patients on a TTM protocol targeted at 34–36°C (n = 59) with a historical cohort of patients treated at 32–34°C (n = 116) according to the following parameters: six-month survival, cerebral performance category (CPC) scores, and acute complications.ResultsSurvival and favorable neurological outcomes (CPC ≤ 2) at six months were 56% and 49%, respectively, in the higher target temperature group vs. 66% and 61%, respectively, in the lower target temperature group (p = 0.18 and 0.13). Acute clinical complications occurred in 1.5% vs. 12% of patients treated at the higher vs. the lower temperature range (p = 0.02).ConclusionsPatients treated with TTM at 34–36°C had similar mid-term survival and neurological outcomes as patients treated with TTM at 32–34°C. However, patients treated within the higher temperature range had fewer acute complications.     

The difficult balance between thrombosis and bleeding after transcatheter aortic valve replacement: A translational review

The difficult balance between thrombosis and bleeding after transcatheter aortic valve replacement. TAVR: transcatheter aortic valve replacement.

     

Gastrointestinal bleeding in patients admitted to cardiology: risk factors and a new risk score

ObjectiveAlthough the early use of a risk stratification score in gastrointestinal bleeding (GIB) is recommended, so far there has been no risk score for GIB in patients admitted to the cardiology department. To describe the risk factors of GIB and develop a new risk score model in patients admitted to the cardiology department.MethodsA total of 633 inpatients with GIB from January 2014 to December 2018 were recruited, 4,231 inpatients with non-GIB were recruited as the control group. Multivariate logistic regression was used to describe the risk factors of GIB. A new risk score model was developed in the derivation cohort. Accuracy to predict GIB was assessed by the area under the receiver operating characteristic (AUROC) curve in the validation cohort.ResultsMale, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and alanine aminotransferase (ALT) were associated with GIB. The model had a high predictive accuracy (AUROC 0.816 and 95% CI, 0.792-0.839), which was supported by the validation cohort (AUROC 0.841 and 95% CI, 0.807~0.874). Besides, the prediction of the model was better than HAS-BLED score (AUROC 0.557; 95% CI, 0.513~0.602) and CRUSADE score (AUROC 0.791; 95%CI, 0.757~0.825), respectively. Among the inpatients with a score of 0-3, 4-7, and ≥8 points, the incidence of GIB, the proportion of inpatients requiring suspended red blood cells transfusion, length of stay, and in-hospital mortality all increased gradually (P< 0.001).ConclusionsMale, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin, and ALT are associated with GIB. The new risk score model is an accurate risk score that predicts GIB in patients admitted to the cardiology department.     

Adolescent cardiometabolic risk scores: A scoping review

AimsClustering of cardiometabolic risk factors (CMRFs) indicates cardiometabolic risk (CMR), a key driver of cardiovascular disease. Early detection and treatment of CMR are important to decrease this risk. To facilitate the identification of individuals at risk, CMRFs are commonly combined into a CMR Score. This scoping review aims to identify CMRFs and methods used to calculate adolescent CMR Scores.Data synthesisSystematic searches were executed in Child Development and Adolescent Studies, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO CINAHL, Scopus Elsevier, Cochrane CENTRAL, and Nursing and Allied Health. No limits were placed on publication date or geographic location. Studies were included if participants were 10–19 years and the study reported CMRFs in a composite score. Key extracted information included participant characteristics, CMRFs comprising the scores, and methods of score calculation. CMRFs were categorized and data were reported as frequencies. This study identified 170 studies representing 189 CMR Scores. The most common CMRF categories were related to lipids, blood pressure, and adiposity. The most frequent CMRFs were triglyceride z-score, systolic blood pressure z-score, and inverse high-density lipoproteins z-score. Scores were mostly calculated by summing CMRF z-scores without weighting.ConclusionsThe range of CMRFs and Scores identified in adolescent CMR literature limits their use and interpretation. Published CMR Scores commonly contain two main limitations: (a) use of an internal cohort as the z-score reference population, and (b) Scores relying on adiposity measures. We highlight the need for a standard set of CMRFs and a consensus for a CMR Score for adolescents.     

Deleterious synergistic effects of acute heart failure and diabetes mellitus in patients with acute coronary syndrome: Data from the FAST-MI Registries

Central Illustration: Characteristics of the study population and 5-year survival according to the presence or absence of DM and/or early AHF.

     

Antithrombotic strategies in elderly patients with acute coronary syndrome

Central illustration. Anti-thrombotic strategies in patients with acute coronary syndrome. ACS: acute coronary syndrome; ADP: adenosine diphosphate; CAD: coronary artery disease; CRP: C-reactive protein; IL-6; interleukin-6; DAPT: dual antiplatelet therapy; GRACE: Global Registry of Acute Coronary Events; NSTEMI: non-ST-segment elevation myocardial infarction; PAI-1: plasminogen activator inhibitor-1; PCI: percutaneous coronary intervention; PG12: prostaglandin 12; PPI: proton pump inhibitor; PRECISE-DAPT: PREdicting bleeding Complications in patients undergoing stent Implantation and SubsequEnt Dual AntiPlatelet Therapy; REACH: REduction of Atherothrombosis for Continued Health; STEMI: ST-segment elevation myocardial infarction; TIMI: Thrombolysis In Myocardial Infarction; Vwf: von Willebrand factor.

     

Malnutrition-associated high bleeding risk with low thrombogenicity in patients undergoing percutaneous coronary intervention

Background and aimsAlthough antithrombotic treatments are established for coronary artery disease (CAD), they increase the bleeding risk, especially in malnourished patients. The total thrombus-formation analysis system (T-TAS) is useful for the assessment of thrombogenicity in CAD patients. Here, we examined the relationships among malnutrition, thrombogenicity and 1-year bleeding events in patients undergoing percutaneous coronary intervention (PCI).Methods and resultsThis was a retrospective analysis of 300 consecutive CAD patients undergoing PCI. Blood samples obtained on the day of PCI were used in the T-TAS to compute the thrombus formation area under the curve. We assigned patients to two groups based on the geriatric nutritional risk index (GNRI): 102 patients to the lower GNRI group (≤98), 198 patients to the higher GNRI group (98<). The primary endpoint was the incidence of 1-year bleeding events defined by Bleeding Academic Research Consortium criteria types 2, 3, or 5. The T-TAS levels were lower in the lower GNRI group than in the higher GNRI group. Kaplan-Meier analysis showed worse 1-year bleeding event-free survival in the lower GNRI group compared with the higher GNRI group. The combined model of the GNRI and the Academic Research Consortium for High Bleeding Risk (ARC-HBR) had good calibration and discrimination for bleeding risk prediction. In addition, having a lower GNRI and ARC-HBR positivity was associated with 1-year bleeding events.ConclusionA lower GNRI could reflect low thrombogenicity evaluated by the T-TAS and determine bleeding risk in combination with ARC-HBR positivity.     

Thromboembolic events in atrial fibrillation: Different level of risk and pattern between peripheral artery disease and coronary artery disease

A. Clinical outcomes (ischaemic stroke, ischaemic stroke/systemic thromboembolism and systemic thromboembolism) among patients with atrial fibrillation (AF) without coronary artery disease (CAD) or peripheral artery disease (PAD). B. Clinical outcomes among patients with AF and only CAD. C. Clinical outcomes among patients with AF and only PAD. D. Clinical outcomes among patients with AF and both CAD and PAD.

     

Prevalence of familial hypercholesterolaemia in patients presenting with premature acute coronary syndrome

Central illustration. Prevalence of familial hypercholesterolaemia (FH) among young adults with myocardial infarction (MI) (n = 457) and in the general control population (CARVAR 92 cohort) (n = 9900), and cardiovascular risk factors associated with premature acute MI.

     

New insights into cardiogenic shock and coronary revascularization after acute myocardial infarction

Cardiogenic shock management and guidelines. The green boxes represent class I recommendations and the orange boxes represent class II recommendations from the European Society of Cardiology guidelines; the grey boxes represent management suggestions from the authors based on data presented in this review. ACS: acute coronary syndrome; LVEF: left ventricular ejection fraction; NSTEMI: non-ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction; UFH: unfractionated heparin.