774 Young adults with acute coronary syndrome: still a long road ahead

Aims Acute coronary syndrome (ACS) are a leading cause for mortality and morbility worldwide. Despite ACS usually affects the older population, it also occurs in younger individuals. Young ACS patients (YACS) have a significantly worse prognosis compared to their age-mates in the general population. Despite YACS are characterized by a different risk profiles compared to their older mates, many aspects still remain elusive. Aim of this study was to describe the clinical profile of young adults with Acute Coronary Syndrome. Methods and results Young patients (≤50 years) with the first diagnose of Acute Coronary Syndrome admitted to the Magna Graecia University Hospital were enrolled in the ongoing GENEPAMY registry. Over 7 years, a total of 675 eligible patients with Acute Coronary Syndrome aged 44 ± 8 years were included. Men accounted for 84.9% of all patients. Overall, 11.9% of patients had diabetes, 69.1% hypertension, 17.6% obesity, 93.6% dyslipidemia, while 75.5% were smokers. In the overall cohort, 44.1% were first diagnosed with STEMI, 45.9% with NSTEMI, while the remaining had been admitted for Unstable Angina. Cardiogenic shock was present at admission in 2.7% of cases. Multivessel disease was present in 39% of cases and was significantly less frequent in women (P < 0.001). Thrombolysis was administered as the initial treatment in 15.1% of cases but was ineffective in 66.7% of patients. Percutaneous coronary angioplasty was performed in 79.1% of patients, while 1.9% of patients underwent surgical myocardial revascularization. Spontaneous coronary dissection was present in 0.7% of men and 17.2% of women (P < 0.001). At admission, 98.9% of patients had been treated with ASA, 17.9% with clopidogrel, 49.1% with ticagrelor and 28.4% with prasugrel. A complete revascularization was achieved in 81.6% during the index hospitalization but was significantly more frequent in women compared to men (86.3% vs. 80.8; P < 0.001). Conclusions Our data highlight that YACS present a peculiar clinical profile. In particular, the high cardiovascular risk profile demands attention. Finally, despite most patients were men, young women with ACS present several relevant differences compared to men, needing a more careful clinical management.

The Effects of PCSK9 and Apolipoprotein E Functional Gene Variations On Hypercholesterolemia and Clinical Phenotype in Restenosis Patients After Percutaneous Coronary Angioplasty

Background: In-stent-restenosis is a case restricting the benefits of percutaneous-transluminal coronary angioplasty (PTCA). PCSK9 controls LDLR levels, and variations in PCSK9, ApoE and ApoER genes may affect the development of restenosis. The aim of this study was to assess the effects of genetic variants on restenosis risk after PTCA.Methods and Results: The study groups include 109 CAD-patients with restenosis (S-CAD) and 82 CAD-patients without restenosis (open-stent,OS-CAD). SNPs were analyzed by RT- PCR. PCSK9 levels were detected via ELISA method. The distributions of ApoE Epsilon, APOER (rs5174), PCSK9 rs2182833 and rs11206510 polymorphisms were found similar between study groups while the frequency of the PCSK9 E670G G allele in S-CAD group was found significantly higher than OS-CAD patients (p= 0.015). No difference was found between study groups in terms of the serum levels of PCSK9. LDL-C was found lower and HDL-C was found higher in OS-CAD group comparing with S-CAD group (p=0.042, p=0.008, respectively). Frequencies of Type 2 DM and hyperlipidemia were also found higher in S-CAD group than OS-CAD group (p=0.007, p=0.001, respectively) while EF% was found lower in S-CAD group than OS-CAD group (p=0.007).Conclusions: Our findings indicate that although ApoE Epsilon, APOER (rs5174), PCSK9 rs2182833, rs11206510 and E670G polymorphisms has no effect on serum PCSK9 levels, PCSK9-rs505151G-allele and hyperlipidemia may be risk factors in the development of restenosis.

Neglected cardiovascular risk factors: Relationship of anxiety and depression with percutaneous coronary angioplasty

Introduction: Coronary artery disease (CAD) is the leading cause of mortality in Malaysia. Psychological risk factors are associated with detrimental outcomes in CAD. Our study aimed to evaluate procedural anxiety and depression levels among subjects who underwent coronary angioplasty. Methods: A single-centre prospective cohort study was conducted on patients electively admitted to a tertiary hospital in Malaysia for percutaneous coronary intervention (PCI) over a half-year period. The Hospital Anxiety and Depression Scale (HADS) and the EuroQol-5 Dimension (EQ5D) Health Questionnaire were used to evaluate subjects’ psychological statuses. The EQ Visual Analogue Scale was used for the global assessment of their health. Results: The analysis included 65 patients with a mean age of 63 years from a predominately educated population ( n=54; 83.1%). Before the PCI procedure, female sex was found to be protective against depression, with an odds ratio (ORs) of 0.29 (95% confidence interval (CI) 0.08–1.03). A high level of education was protective against anxiety (OR=0.21; 95% CI 0.06–0.83). After the PCI, females were more likely to be depressed (OR=3.89; 95% CI 1.13–13.37), and those of Malay ethnicity were more likely to be anxious (OR=4.2; 95% CI 1.03–17.07). Using the HADS, subjects were significantly less anxious and depressed (pre-PCI: median (IQR) score=4 (7.0)); post-PCI: median (IQR) score=3 (5.0), p=0.02), measured by the HADS. Using the EQ5D, subjects had an improved mean VAS score (post-PCI: 75±14.9; pre-PCI: 68±12.6; p<0.05). Conclusions: PCI may predispose patients with CAD to psychological stressors. Female patients and those of Malay ethnicity are more likely to experience psychological stress. Being highly educated is protective against such stress.

Assessment of no-reflow phenomenon by non-constrast computed tomography in patients with acute myocardial infarction undergoing primary percutaneous coronary angioplasty

Funding Acknowledgements Type of funding sources: None. Background Coronary no-reflow phenomenon after primary percutaneous coronary angioplasty (pPCI) is an independent predictor of adverse clinical outcomes after AMI regardless of infarct size. The incidence of no-reflow varies widely depending on the diagnostic methods used. Purpose Showing whether non-contrast CT performed after pPCI might be usefull as a diagnosis of no-reflow phenomenon. Methods Six STEMI patients (mean age = 68.3 y/o) underwent revascularization by pPCI and stent placement within 6 hours after onset of angina and within less than 90 minutes of door-to-balloon time. Due to the outbreak of SARS-Cov-2, chest CT scanning was indicated in all patients before coronary unit admission (192 ± 102 mins after pPCI). Results Three patients with a higher time than the mean angina time and than the mean door-to-ballon time (190 ± 149.3 versus 170 ± 107.5 and 63 ± 6.08 vs 56 ± 11.5, respectively) developed an interventional type of no-reflow phenomenon (Table 1) and CT scanning showed regional myocardial contrast retention related to the culprit coronary artery (Figure 1). On the other hand, three patients with a lower time than the mean angina time and than the mean door-to-ballon time showed TIMI III flow after pPCI (Table 1) and CT scanning showed no regional myocardial contrast retention (Figure 2). Conclusion Myocardial regional contrast retention, evaluated by non-contrast and non-ECG-gated computed tomography after pPCI, might be usefull for no-reflow diagnosis. TABLE 1 AGE ANGINA-TIME DOOR-TO-BALLON-TIME BASAL/cTnT POST-pPCI/cTnT CHANGE/cTnT PTS 68 ± 17y/o 170 ± 107mins 56 ± 11mins 1635 ± 2549ng/L 9621 ± 4586ng/L 588% (N = 6) NO-REFLOW PATS 65 ± 25y/o 190 ± 149mins 63 ± 6mins 761 ± 837ng/L 11151 ± 2787ng/L 1465% (N = 3) TIMI-III FLOW PTS 72 ± 9y/o 117 ± 76mins 49 ± 12mins 2219 ± 3653ng/L 18091 ± 6148ng/L 364% (N = 3)

Periodontitis Is Associated With Risk of Conventional Stent Restenosis: Pilot Case-Control Study

Objectives: Percutaneous coronary angioplasty with stent implantation has been established as the main form of treatment of atherosclerosis. However, 16 to 44% of patients may evolve with stent restenosis. Periodontitis is an inflammatory condition associated with bacterial infection, that may lead to periodontal tissue destruction and tooth loss. This study aimed to evaluate the association between stent restenosis and periodontitis.Materials and Methods: Coronary angiography exams presenting stent imaging with and without restenosis were analyzed. Patients meeting the inclusion and exclusion criteria were selected and allocated in 2 groups: case (restenosis) and control (without restenosis). We evaluated if systemic and periodontal variables were predictors of restenosis (primary outcome) using a multivariable stepwise logistic regression. Additionally, we compared clinical and periodontal conditions between the control and case groups (secondary outcomes) using Chi-square test and ANOVA test.Results: Data from 49 patients (case n = 15; control n = 34) were analyzed. The results showed that stages III and IV periodontitis and lack of physical activity were significant predictors of stent restenosis (OR 5.82 and 5.98, respectively). Comparisons regarding the diagnosis of periodontal conditions between control and case groups did not present significant differences in the incidence of periodontitis and alveolar bone loss.Conclusion: Stages III and IV periodontitis increased the incidence of stent restenosis. These findings suggest that advanced stages of periodontal disease might lead to the occurrence of negative outcomes after coronary angioplasty with stent placement.

A Challenging Case of Critical Coronary Trifurcation Disease–Managed Successfully with Percutaneous Coronary Angioplasty

Coronary trifurcation lesions are a complex group of lesions. Percutaneous intervention of such trifurcation lesions which involve left anterior descending artery, left circumflex artery and RAMUS artery is difficult task. Trifurcating coronary artery disease is a complex atherosclerotic process involving the origin of one or more of three side branches arising from a main trunk. The approach to treat trifurcation lesions has not been standardized. We describe a technique to percutaneously treat this lesion using routine day-to-day hardware and a unique two guide catheter technique. We present a case admitted in our hospital with unstable angina. CAG done suggestive of triple vessel disease and later PTCA was done. Staged PTCA was planned Initially RCA and subsequently Trifurcation PTCA was done for left system.No postprocedural complication was observed and then patient was discharged on third day.

Post-angioplasty aneurysm of right coronary artery

Coronary artery aneurysms are an uncommon disease whose incidence ranges from 0.3% to 5.3%. The right coronary artery is affected in 40-70% of cases. Percutaneous coronary angioplasty is among causative factors, in particular with stent implantation. We present a case of large post-angioplasty aneurysm of the right coronary artery requiring surgical correction.

Cardiovascular complications according to severity of renal artery stenosis based on Doppler ultrasound

IntroductionThe interactions between atherosclerotic renal artery stenosis, independently of severity, and cardiovascular risk, and mortality, are complex and have not been fully researched. The aim of this study was the assessment of the risk of cardiovascular events and mortality in patients with haemodynamically non-significant (NS-RAS) and significant renal artery stenosis (S-RAS) diagnosed with ultrasonography.Material and methodsThe study group consisted of all consecutive patients (n = 2059) who underwent Doppler ultrasound of the renal arteries during a 4-year period. The patients were divided, according to the renal aortic ratio (RAR), into the following groups: S-RAS (RAR ≥ 3.5), NS-RAS (1 < RAR < 3.5), and normal RAR (control group; RAR ≤ 1). The risk of cardiovascular events and death was estimated using Cox’s proportional hazard model, including severity of RAS, age, and gender, based on the data from the National Health Fund on causes of hospitalization, deaths, and statistics on percutaneous coronary angioplasty procedures.ResultsSignificant renal artery stenosis was found in 112 patients (5.4%), NS-RAS in 313 patients (15.2%), and 1634 patients (79.4%) were qualified to the control group. The NS-RAS group had an increased risk of stroke (7.0% vs. 3.0%, HR = 1.77, p = 0.032); S-RAS patients were at increased risk of heart failure (16.1% vs. 5.2%, HR = 2.19, p = 0.002) and death (19.6% vs. 4.3%, HR = 3.08, p < 0.001).ConclusionsThe presence of haemodynamically non-significant renal artery stenosis is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor for stroke.