Abstract Introduction Atherosclerosis vascular disease is one of the main causes of morbidity and mortality in the world. We aimed to evaluate the prognostic impact of a history of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery (CABG). Methods Single-center, observational and retrospective study including all patients undergoing CABG in our center between 2010 and 2018. Electronic health records were used to record clinical characteristics to identify patients with a history of peripheral vascular disease. This one was defined as having a history of stroke or transient ischemic attack (TIA), intermittent claudication, or previous percutaneous or surgical arterial procedure. Patients were followed until December 2019. The primary endpoint (PE) was the composite of stroke, TIA, myocardial infarction, new coronary revascularization, inferior limb vascular or aortic aneurysm intervention, and death. Results We included 567 patients, 138 (24.3%) with a history of peripheral vascular disease (stroke/TIA 34.1%; carotid surgery 6.5%; inferior limb surgery 12.3%; abdominal aortic aneurysm surgery 8.7% and intermittent claudication 38.4%). Baseline characteristics of the overall cohort and different subgroups (with and without peripheral vascular disease) can be seen in the table. The group with peripheral vascular disease had a worse clinical profile. They were significantly older, more frequently males, and smokers. They also had a higher prevalence of hypertension, diabetes, dyslipidemia, chronic kidney disease, and neoplasms. In addition, the preoperative status was less favorable, left ventricular ejection fraction and hemoglobin were lower, and renal function was worse than the group without peripheral vascular disease. The median follow-up was 4.2 years. During the study period, 55 patients (40%) with peripheral vascular disease and 80 patients (18.6%) without peripheral vascular disease reached the PE. After multivariate Cox modeling, variables independently related to PE were diabetes (HR=1.65 (1.17–2.33); p=0.004), creatinine levels (HR= 1.32 (1.19–1.47); p≤0.001) and peripheral vascular disease (HR= 2.28 (1.60–3.25); p≤0.001) (figure, panel A). Kaplan-Meier survival curves of PE according to the presence of peripheral vascular disease prior to CABG are shown in panel B of the figure. Conclusion According to our results, patients with peripheral vascular disease have approximately double the risk of suffering a major complication after CABG. Larger studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied population.HR and Kaplan-Meier curves
Abstract Background On January 2020, the first patient with coronavirus 2 (SARS-CoV-2) was detected in Spain. Since then, 3 280 000 cases have been confirmed and 75.305 people have died. We aimed to clarify the epidemiological and clinical characteristics related with poor short-term prognosis in patients diagnosed with SARS-CoV-2. Methods Observational, retrospective single-center study including consecutive patients (≥40yo) diagnosed with SARS-CoV-2 through PCR, since March 2nd to 20th 2020 in our center in Spain. The primary endpoint (PE) was the combined of all-cause death or need for orotracheal intubation within the first 30 days of infection symptoms. Results 704 patients were included (table). A follow-up period of thirty-days was fully completed in 692 of 704 patients (98.3%). At the end of this period, 148 patients (21.4%) met the PE; they were older, more frequently male, obese and smokers. Patients who met the PE had a higher prevalence of hypertension, diabetes, dyslipidemia, ischemic heart disease, heart failure, peripheral and cerebrovascular disease, cancer and lung pathologies. They received more frequently therapies with renin-angiotensin system inhibitors, betablockers, calcium channel blockers and statins, as well as antiplatelet and anticoagulant therapies Multivariate analysis showed that age (OR 1.99 for every 10 years, 95% CI [1.637–2.4], p<0.001), female sex (OR 0.49, [0.30–0.80], p=0.004), diabetes (OR 2.09, [1.17–3.71], p=0.012), lung disease (OR 1.99, [1.14–3.44], p=0.014) and body mass index (OR 1.33 for each 5 kg/m2 increased, [1.05–1.68], p=0.017) were predictors of the PE. Hypertension was not significantly related to the PE (OR 1.55, [0.93–2.60], p=0.09) Conclusion In our group of patients with SARS-CoV-2, age, male sex, diabetes, lung disease and obesity were found to be independent predictors of the combined of all case death or need for orotracheal intubation within the first 30 days of infection symptoms. Larger studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied populationOdds-ratio and CI for the combined PE
Several studies suggest that statins, besides reducing cardiovascular disease, have anti-inflammatory properties which might provide a benefit in downregulating the immune response after a respiratory viral infection (RVI) and, hence, decreasing subsequent complications. We aim to analyse the effect of statins on mortality after RVI.A single-centre, observational and retrospective study was carried out including all adult patients with a RVI confirmed by PCR tests from October 2, 2017 to May 20, 2018. Patients were divided between statin users and non-statin users and followed-up for 1 year, and all causes of death were recorded. In order to analyse the effect of statin treatment on mortality after RVI we planned two different approaches, a multivariate Cox regression model with the overall population and a univariate Cox model with a propensity-score matched population.We included 448 patients, 154 (34.4%) of whom were under statin treatment. Statin users had a worse clinical profile (older population with more comorbidities). During the 1-year follow-up, 67 patients died, 17 (11.0%) in the statin group and 50 (17.1%) in the non-statin group. Multivariate Cox analysis showed that statins were associated with mortality benefit (HR 0.47, 95% CI 0.26-0.83; p=0.01). In a matched population (101 statins users and 101 non-statins users) statins also remained associated with mortality benefit (HR 0.32, 95% CI 0.14-0.72; p=0.006). Differences were mainly driven by non-cardiovascular mortality (HR 0.31, 95% CI 0.13-0.73; p=0.004).Chronic statin treatment was associated with reduced 1-year mortality in patients with laboratory-confirmed RVI. Further studies are needed to determine the exact role of statin therapy after RVI.
Proton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD.We followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death.Patients on PPIs were older [62.0 (53.0-73.0) vs. 58.0 (50.0-70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244-4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628-20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results.In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings.
Abstract Objective There has been a great interest in knowing the factors associated with progression of aortic stenosis to try to slow down this evolution. Methods We studied 283 patients with chronic ischemic heart disease recording a broad number of clinical, therapeutic and analytical variables including inflammation and mineral metabolism biomarkers. We analyzed if any of these factors is a determinant of progression to aortic stenosis, defined as an increase in maximum flow speed across the aortic valve of at least 0.5 m/s. Results 20 patients (7%) progressed to aortic stenosis in 72.4 months of follow-up. Among the patients who developed aortic stenosis, a greater age, greater percentage of peripheral arterial disease (PAD), lower treatment with beta-blockers, estimated Glomerular Filtration Rate (eGFR), total cholesterol, LDL, High-sensitivity C-reactive protein (HS-CRP), high-sensitivity troponin, N-terminal pro b-type natriuretic peptide and galectin 3 were found. The results of the multivariate analysis showed that plasma levels of Proprotein convertase subtilisin/kexin type 9 (PCSK9) [OR: 0.668 per every increase in 100.000 μg/ml CI (0.457–0.977); p=0.038], HS-CRP [OR: 1.034 per every increase in 1 mg/dl CI (1.005–1.063); p=0.022], dyslipidemia [OR: 4.622 CI (1.285–16.618); p=0.019], PAD [OR: 9.453 CI (1.703–52.452); p=0.010], and eGFR [OR: 0.962 CI (0.939–0.986); p=0.002], remained a parameter with the ability to independently predict the progression of aortic stenosis Conclusions In patients with chronic ischemic heart disease, low PCSK9 and high HS-CRP plasmatic levels, low eFGR, PAD and dyslipidemia were independent predictors of progression of aortic stenosis. More studies are needed to investigate the relationships between the progression of aortic stenosis PCSK9 and inflammation.
Introduction The presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG). Materials and methods This is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery. Results One-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27–2.69], age (HR = 1.35, 95% CI 1.09–1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05–2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80–0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15–0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001). Conclusions Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.
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