Risk Stratification and Treatment Options in Chronic Coronary Syndrome

  • A 3-Year Analysis of differences in Outcomes of Patients Undergoing PCI for Premature vs. Non-Premature Coronary Artery Disease
  • Patients with premature CAD (CAD in men <50 years and women <55 years) had lower rates of diabetes, hypertension, hypercholesterolemia, and peripheral arterial disease, but they were more often overweight, smokers, and had a family history of CAD. The incidence of acute ST-segment elevation MI was high and the frequency of treatment for calcified or bifurcated lesions was less.
  • At 3-year follow-up, patients with premature CAD had lower all-cause mortality but higher risks for repeated target vessel revascularization and stent thrombosis compared to patients with non-premature CAD.
  • In patients with premature CAD, long-term outcome after PCI can be improved by treating modifiable risk factors such as increased body weight and smoking.


Heart Failure Outcomes: Effects of Phenotypes and Comorbidities

  • Impact of Ischemic Etiology in Heart Failure with reduced left ventricular ejection fraction
  • Patients with ischemic etiology were older, more frequently male, and had higher prevalence of comorbidities such as arterial hypertension, diabetes, dyslipemia, chronic kidney disease, anemia, and vascular comorbidity.
  • Ischemic etiology patients had longer HF evolution times, lower rates of LVEF improvement (21.1% vs. 51.6%), and higher baseline NTproBNP concentration. They also had poor prognosis.
  • Over a 60-month follow-up, ischemic etiology patients exhibited higher rates of hospital readmissions (50.3% vs. 39%) and HF-related mortality (41% vs. 26.8%).


Imaging in Chronic Coronary Syndrome

  • Prognostic value of transthoracic echocardiography in the evaluation of suspected myocardial infarction
  • Transthoracic bedside echocardiography (TTE) could serve as a reliable risk stratification tool in patients presenting with suspected myocardial infarction (MI).
  • 5% showed pathological TTE findings, including reduced systolic left ventricular function, regional wall motion abnormalities (akinesia and hypokinesia), and severe valvular defects.
  • Patients with any pathological TTE findings exhibited significantly higher rates of major adverse cardiac events (MACE) and overall mortality compared to those with normal TTE results
  • Patients with TTE-detected pathologies, particularly those showing regional akinesia, highly reduced LV function, and severe valvular defects, were associated with a significantly higher cardiovascular risk over a 5-year period.


Hypertension in High-Risk Populations

  • The reduction in BP obtained in ED was significantly greater in 2017 than in 2019 (44.7±31.4 vs 35.4±24.5 mmHg, p = 0.011) with a lower target reaching in 2019 (28.9 vs 51.4%, p<0.001)
  • ED clinicians continue to adhere to previous guidelines for blood pressure reduction in cardiological hypertensive emergencies, rather than adopting the recommendation for a more intense and rapid approach.


Hypertension Management and Risk Factors

  • The percentage of patients on monotherapy decreased from 56.7% to 42.6% (years 1 to 5), and the percentage of patients on DCT increased from 14.9% to 25.5% (years 1 to 5)
  • The findings indicate an opportunity for substantial improvement in BP control and CV risk reduction in this population, by ensuring appropriate guideline-based initiation, of dual combination BP-lowering therapy.


Pharmacological Therapy in Heart Failure

  • Nine RCTs comprising 8270 patients with HF, of whom 2529 (30%) were randomized to torsemide. Mean follow-up ranged from 32 weeks to 17.4 years.
  • In the pooled analysis, there was no significant difference between groups in terms of all-cause mortality (OR 0.98; 95% CI 0.85–1.13; p=0.77; I2=0), hospitalizations for HF (OR 0.78; 95% CI 0.48–1.27; p=0.32; I2=48), or improvement in NYHA class (OR 1.39; 95% CI 0.91–2.12; p=0.13; I2=0)
  • In this meta-analysis, no significant difference was observed between torsemide and furosemide in managing HF with regards to all-cause mortality, hospitalizations for HF, or NYHA class improvement.