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Journal of Cardiovascular Computed... Apr 2024
PubMed: 38688783
DOI: 10.1016/j.jcct.2024.04.003 -
BMC Medicine Apr 2024Little is known about the safety and efficacy of discontinuing antiplatelet therapy via LMWH bridging therapy in elderly patients with coronary stents implanted for > 12... (Randomized Controlled Trial)
Randomized Controlled Trial
Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior coronary stents implanted > 12 months undergoing non-cardiac surgery: a randomized, placebo-controlled trial.
BACKGROUND
Little is known about the safety and efficacy of discontinuing antiplatelet therapy via LMWH bridging therapy in elderly patients with coronary stents implanted for > 12 months undergoing non-cardiac surgery. This randomized trial was designed to compare the clinical benefits and risks of antiplatelet drug discontinuation via LMWH bridging therapy.
METHODS
Patients were randomized 1:1 to receive subcutaneous injections of either dalteparin sodium or placebo. The primary efficacy endpoint was cardiac or cerebrovascular events. The primary safety endpoint was major bleeding.
RESULTS
Among 2476 randomized patients, the variables (sex, age, body mass index, comorbidities, medications, and procedural characteristics) and percutaneous coronary intervention information were not significantly different between the bridging and non-bridging groups. During the follow-up period, the rate of the combined endpoint in the bridging group was significantly lower than in the non-bridging group (5.79% vs. 8.42%, p = 0.012). The incidence of myocardial injury in the bridging group was significantly lower than in the non-bridging group (3.14% vs. 5.19%, p = 0.011). Deep vein thrombosis occurred more frequently in the non-bridging group (1.21% vs. 0.4%, p = 0.024), and there was a trend toward a higher rate of pulmonary embolism (0.32% vs. 0.08%, p = 0.177). There was no significant difference between the groups in the rates of acute myocardial infarction (0.81% vs. 1.38%), cardiac death (0.24% vs. 0.41%), stroke (0.16% vs. 0.24%), or major bleeding (1.22% vs. 1.45%). Multivariable analysis showed that LMWH bridging, creatinine clearance < 30 mL/min, preoperative hemoglobin < 10 g/dL, and diabetes mellitus were independent predictors of ischemic events. LMWH bridging and a preoperative platelet count of < 70 × 10/L were independent predictors of minor bleeding events.
CONCLUSIONS
This study showed the safety and efficacy of perioperative LMWH bridging therapy in elderly patients with coronary stents implanted > 12 months undergoing non-cardiac surgery. An alternative approach might be the use of bridging therapy with half-dose LMWH.
TRIAL REGISTRATION
ISRCTN65203415.
Topics: Humans; Male; Female; Aged; Stents; Aged, 80 and over; Anticoagulants; Platelet Aggregation Inhibitors; Heparin, Low-Molecular-Weight; Dalteparin; Treatment Outcome; Surgical Procedures, Operative; Hemorrhage; Placebos; Perioperative Care
PubMed: 38649992
DOI: 10.1186/s12916-024-03391-2 -
Cureus Mar 2024Myocardial bridging is an under-recognized cause of angina. This congenital anomaly occurs when a segment of the epicardial coronary artery has a short intra-myocardial...
Myocardial bridging is an under-recognized cause of angina. This congenital anomaly occurs when a segment of the epicardial coronary artery has a short intra-myocardial course. A significant intra-myocardial course may lead to ischemia, causing anginal symptoms. In this case report, we discuss a rare presentation of myocardial bridging with symptoms of heart failure. The pathology led to a marked degree of ventricular dysfunction and a significant drop in cardiac output (CO), and the patient had severe exertional dyspnea and functional limitations. The ischemic workup with diagnostic imaging and angiograms failed to explain the severity of symptoms, which were only evident in hemodynamic studies and cardiopulmonary exercise testing.
PubMed: 38638725
DOI: 10.7759/cureus.56462 -
Journal of Neurological Surgery. Part... Apr 2024Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary...
Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.
PubMed: 38621711
DOI: 10.1055/s-0044-1785649 -
Trends in Cardiovascular Medicine May 2024
PubMed: 38584067
DOI: 10.1016/j.tcm.2024.03.005 -
International Journal of Cardiology Jul 2024Myocardial bridging (MB) is a frequent congenital anomaly of the epicardial coronary arteries commonly considered a benign condition. However, in some cases a complex...
AIMS
Myocardial bridging (MB) is a frequent congenital anomaly of the epicardial coronary arteries commonly considered a benign condition. However, in some cases a complex interplay between anatomical, clinical and physiology factors may lead to adverse events, including sudden cardiac death. Coronary CT angiography (CCTA) emerged as the gold standard noninvasive imaging technique for the evaluation of MB. Aim of the study was to evaluate MB prevalence and anatomical features in a large population of patients who underwent CCTA for suspected CAD and to identify potential anatomical and clinical predictors of adverse cardiac events at long-term follow-up.
METHODS AND RESULTS
Two-hundred and six patients (mean age 60.3 ± 11.8 years, 128 male) with MB diagnosed at CCTA were considered. A long MB was defined as ≥25 mm of overlying myocardium, whereas a deep MB as ≥2 mm of overlying myocardium. The study endpoint was the sum of the following adverse events: cardiac death, bridge-related acute coronary syndrome, hospitalization for angina or bridge-related ventricular arrhythmias and MB surgical treatment. Of the 206 patients enrolled in the study, 9 were lost to follow-up, whereas 197 (95.6%) had complete follow-up (mean 7.01 ± 3.0 years) and formed the analytic population. Nineteen bridge-related events occurred in 18 patients (acute coronary syndrome in 7, MB surgical treatment in 2 and hospitalization for bridge-related events in 10). Typical angina at the time of diagnosis and long MB resulted as significant independent predictors of adverse outcome.
CONCLUSIONS
Typical angina and MB length ≥ 25 mm were independent predictors of cardiac events.
Topics: Humans; Male; Myocardial Bridging; Female; Middle Aged; Computed Tomography Angiography; Aged; Follow-Up Studies; Coronary Angiography; Predictive Value of Tests; Retrospective Studies
PubMed: 38556216
DOI: 10.1016/j.ijcard.2024.131997 -
Cureus Feb 2024Typical takotsubo cardiomyopathy (TCM) is a reversible form of myocardial injury that presents with a characteristic ballooning abnormality of the left ventricular apex....
Typical takotsubo cardiomyopathy (TCM) is a reversible form of myocardial injury that presents with a characteristic ballooning abnormality of the left ventricular apex. Typical TCM has been associated with myocardial bridging; however, mid-ventricular variant TCM has not. We describe a rare case of mid-ventricular variant TCM with a coexisting left anterior descending artery myocardial bridge and discuss management strategies. Furthermore, we propose potential pathophysiological mechanisms that may contribute to the symptomatic presentation of both conditions as a manifestation of common etiological factors.
PubMed: 38533150
DOI: 10.7759/cureus.54868 -
European Journal of Heart Failure Mar 2024
Temporary mechanical circulatory support for cardiogenic shock: Definitive intervention or ancillary bridging therapy? Letter regarding the article 'What about current recommendations for extracorporeal life support in acute myocardial infarction-associated cardiogenic shock: Stay or go? or time to...
PubMed: 38528821
DOI: 10.1002/ejhf.3216 -
Cureus Feb 2024Transient left bundle branch block occurring during a nuclear stress test in the setting of myocardial bridging is a relatively rare finding. We report a case of a...
Transient left bundle branch block occurring during a nuclear stress test in the setting of myocardial bridging is a relatively rare finding. We report a case of a 75-year-old male who presented with typical stable angina. Serial troponins were negative, and the electrocardiogram revealed normal sinus rhythm with left ventricular hypertrophy and T-wave inversions in the lateral leads. The nuclear stress test was non-ischemic but showed a transient left bundle branch block associated with chest pain and shortness of breath that occurred right after the administration of regadenoson. Coronary angiography revealed non-obstructive coronary artery disease and a mid-LAD myocardial bridge.
PubMed: 38523980
DOI: 10.7759/cureus.54654 -
Scientific Reports Mar 2024We performed this cohort study to investigate whether the myocardial bridge (MB) affects the fat attenuation index (FAI) and to determine the optimal cardiac phase to...
We performed this cohort study to investigate whether the myocardial bridge (MB) affects the fat attenuation index (FAI) and to determine the optimal cardiac phase to measure the volume and the FAI of pericoronary adipose tissue (PCAT). The data of 300 patients who were diagnosed with MB of the left anterior descending (LAD) coronary artery were retrospectively analyzed. All of patients were divided into the MB group and the MB with atherosclerosis group. In addition, 104 patients with negative CCTA results were enrolled as the control group. There was no significant difference between FAI values measured in systole and diastole (P > 0.05). There was no significant difference in FAI among the MB group, the MB with atherosclerosis group, and the control group (P > 0.05). In MB with atherosclerosis group, LAD stenosis degree (< 50%) (OR = 0.186, 95% CI 0.036-0.960; P = 0.045) and MB located in the distal part of LAD opening (OR = 0.880, 95% CI 0.789-0.980; P = 0.020) were protective factors of FAI value. A distance (from the LAD opening to the proximal point of the MB) of 29.85 mm had the highest predictive value for abnormal FAI [area under the curve (AUC), 0.798], with a sensitivity of 81.1% and a specificity of 74.6%.
Topics: Humans; Coronary Angiography; Cohort Studies; Retrospective Studies; Myocardial Bridging; Tomography, X-Ray Computed; Atherosclerosis; Coronary Vessels; Coronary Artery Disease; Adipose Tissue
PubMed: 38472256
DOI: 10.1038/s41598-024-55005-9