Digimed Updates

Prateek Chopra | 15-Feb-2024

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.

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%).

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.

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.

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.

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.