Editorial: Short and long-term treatment options in patients with acute coronary syndrome DOI Creative Commons
Antonio Landi, Albert Varga, Verena Veulemans

et al.

Frontiers in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 12

Published: Feb. 4, 2025

Coronary artery disease (CAD) and acute coronary syndromes (ACS) remain the leading causes of mortality in Western countries (1). In last decades, technological advancements optimization pharmacological interventional strategies led to a substantial reduction ACS-associated morbidity (2). However, not negligible proportion post-ACS patients are still exposed higher risks fatal non-fatal adverse events, including re-admission due myocardial infarction (MI) or heart failure (HF), unplanned revascularization, stroke bleeding.Percutaneous intervention (PCI) represents revascularization modality choice ACS (3). The wide adoption radial access (4,5), newer-generation drug-eluting stents, intravascular imaging-guidance (6), optimized periprocedural antithrombotic treatments (7-9) novel mechanical thrombectomy devices (10,11) paved way treatment even "complex, high-risk indicated patients" (CHIP). spite these advancements, uncertainties exist both management specific subjects, such as following out-of-hospital cardiac arrest (OHCA) those with diabetes, on optimal medical therapy ACS.The papers published this research topic shed interesting insights crucial aspects.The safety effectiveness immediate versus delayed invasive angiography (CAG) without persistent ST-segment elevation after OHCA have been investigated three recent randomized clinical trials (RCTs). TOMAHAWK trial, 554 post-OHCA elevation, there were no significant differences primary endpoint allcause death at 30 days between two (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.00 1.63; P=0.06) (12). COACT (13) EMERGE ( 14) yelded similar results 90 180 days, respectively. Ahmed et al. summarize all available evidence by performing systematic review meta-analysis observational studies (n=9) RCT (n=7) encompassing total 4,737 elevation. authors found that, compared CAG, early CAG was associated lower long-term (odd [OR], 0.66; CI, 0.51-0.85) increased favorable cerebral performance discharge (OR, 1.49; 1.09-2.03). benefit mainly accrued from studies, while when RCTs separately appraised. Therefore, should be interpreted caution different timeframes for early/delayed (ranging < 2 6 hours CAG) potential unmeasured confounders studies.Diabetes mellitus (DM) is an impaired prognosis (15). large retrospective analysis FAST-MI program (n=9,181 MI whom 22% had DM), Bouisset prognostic impact DM survival. After propensity score matching, per se 30% risk (HR, 1.30; 1.17-1.45; p 0.001). As correctly pointed out authors, DM-associated microvascular damage dysfunction (not captured study dataset) could potentially explain excess.Patients undergoing PCI require combination agents reduce events. cornerstones include agents, lipid-lowering treatments, anti-RAAS (renin-angiotensin-aldosterone system), β-blockers metabolic-acting (if clinically indicated). Current European Society Cardiology (ESC) guidelines provide framework tailored implementation options (3).Among indication oral anticoagulation, dual antiplatelet (DAPT) consisting aspirin P2Y12 inhibitor recommended 12 months unless high bleeding (3,16). DAPT de-escalation repeteadly shown ischemic harm (17)(18)(19)(20)(21) current provides value sodium-glucose cotransporter (SGLT)-2 inhibitors ACS. CCC-ACS project (n=113,650 patients), Zhang concomitant chronic obstructive pulmonary (COPD). Of 1,084 COPD, 540 received β-blocker (within 24 hospital admission), whereas 544 did not. adjustment, that 77% relative all-cause 0.33; 0.12-0.92; P = 0.035) 37% HF 0.63; 0.41-0.94; 0.025). These data confirm efficacy subpopulation dispel concerns effect β -blocker induced bronchospasm COPD patients. another 465 diabetic complicated HF, Rahhal SGLT-2 short outcomes. composite ACS, hospitalization 1 discharge. 0.20; 0.04-0.94; 0.041) 0.46; 0.22-0.99; 0.046), hospitalization. lend support use HF. Further larger, needed findings.In conclusion, despite notable improvements, remains Importantly, outline mitigate "residual risk"

Language: Английский

Percutaneous Revascularization of Thrombotic and Calcified Coronary Lesions DOI Open Access
Andrea Milzi, Federico Simonetto, Antonio Landi

et al.

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(3), P. 692 - 692

Published: Jan. 22, 2025

Percutaneous coronary intervention (PCI) for thrombotic and heavily calcified artery lesions occlusions is often hampered by difficulty in wiring the occlusions, restoring antegrade flow, proceeding to successful stent implantation. Characterization of dynamic anatomical features such as thrombi calcium distribution key prevent periprocedural complications long-term adverse events, which are mainly driven underexpansion malapposition may prompt in-stent restenosis or thrombosis. Therefore, multimodal imaging a critical step during PCI better characterize these high-risk select those careful preparation with debulking devices needed guide optimization aim improving procedural clinical outcomes. Hence, obtaining understanding underlying cause thrombus formation, distribution, thorough planning remain crucial steps selecting optimal revascularization strategy an individual patient. In this review, we summarize current evidence about prevalence, predictors, outcomes “hard-rock” treated PCI, focusing on value physiological assessments performed interventions. Furthermore, provide overview cutting-edge technologies facilitating use according specific features.

Language: Английский

Citations

2
Editorial: Short and long-term treatment options in patients with acute coronary syndrome DOI Creative Commons
Antonio Landi, Albert Varga, Verena Veulemans

et al.

Frontiers in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 12

Published: Feb. 4, 2025

Coronary artery disease (CAD) and acute coronary syndromes (ACS) remain the leading causes of mortality in Western countries (1). In last decades, technological advancements optimization pharmacological interventional strategies led to a substantial reduction ACS-associated morbidity (2). However, not negligible proportion post-ACS patients are still exposed higher risks fatal non-fatal adverse events, including re-admission due myocardial infarction (MI) or heart failure (HF), unplanned revascularization, stroke bleeding.Percutaneous intervention (PCI) represents revascularization modality choice ACS (3). The wide adoption radial access (4,5), newer-generation drug-eluting stents, intravascular imaging-guidance (6), optimized periprocedural antithrombotic treatments (7-9) novel mechanical thrombectomy devices (10,11) paved way treatment even "complex, high-risk indicated patients" (CHIP). spite these advancements, uncertainties exist both management specific subjects, such as following out-of-hospital cardiac arrest (OHCA) those with diabetes, on optimal medical therapy ACS.The papers published this research topic shed interesting insights crucial aspects.The safety effectiveness immediate versus delayed invasive angiography (CAG) without persistent ST-segment elevation after OHCA have been investigated three recent randomized clinical trials (RCTs). TOMAHAWK trial, 554 post-OHCA elevation, there were no significant differences primary endpoint allcause death at 30 days between two (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.00 1.63; P=0.06) (12). COACT (13) EMERGE ( 14) yelded similar results 90 180 days, respectively. Ahmed et al. summarize all available evidence by performing systematic review meta-analysis observational studies (n=9) RCT (n=7) encompassing total 4,737 elevation. authors found that, compared CAG, early CAG was associated lower long-term (odd [OR], 0.66; CI, 0.51-0.85) increased favorable cerebral performance discharge (OR, 1.49; 1.09-2.03). benefit mainly accrued from studies, while when RCTs separately appraised. Therefore, should be interpreted caution different timeframes for early/delayed (ranging < 2 6 hours CAG) potential unmeasured confounders studies.Diabetes mellitus (DM) is an impaired prognosis (15). large retrospective analysis FAST-MI program (n=9,181 MI whom 22% had DM), Bouisset prognostic impact DM survival. After propensity score matching, per se 30% risk (HR, 1.30; 1.17-1.45; p 0.001). As correctly pointed out authors, DM-associated microvascular damage dysfunction (not captured study dataset) could potentially explain excess.Patients undergoing PCI require combination agents reduce events. cornerstones include agents, lipid-lowering treatments, anti-RAAS (renin-angiotensin-aldosterone system), β-blockers metabolic-acting (if clinically indicated). Current European Society Cardiology (ESC) guidelines provide framework tailored implementation options (3).Among indication oral anticoagulation, dual antiplatelet (DAPT) consisting aspirin P2Y12 inhibitor recommended 12 months unless high bleeding (3,16). DAPT de-escalation repeteadly shown ischemic harm (17)(18)(19)(20)(21) current provides value sodium-glucose cotransporter (SGLT)-2 inhibitors ACS. CCC-ACS project (n=113,650 patients), Zhang concomitant chronic obstructive pulmonary (COPD). Of 1,084 COPD, 540 received β-blocker (within 24 hospital admission), whereas 544 did not. adjustment, that 77% relative all-cause 0.33; 0.12-0.92; P = 0.035) 37% HF 0.63; 0.41-0.94; 0.025). These data confirm efficacy subpopulation dispel concerns effect β -blocker induced bronchospasm COPD patients. another 465 diabetic complicated HF, Rahhal SGLT-2 short outcomes. composite ACS, hospitalization 1 discharge. 0.20; 0.04-0.94; 0.041) 0.46; 0.22-0.99; 0.046), hospitalization. lend support use HF. Further larger, needed findings.In conclusion, despite notable improvements, remains Importantly, outline mitigate "residual risk"

Language: Английский

Citations

0