scholarly journals 659 Myocardial infarcion and ischaemic stroke in a COVID-19 patient: nothing happens by chance

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Antonio Ianniciello ◽  
Emilio Attena ◽  
Ambra Uccello ◽  
Valentina Maria Caso ◽  
Paolo Golino ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Treatment Pathways ◽  
Acute Dyspnoea ◽  
Appropriate Treatment ◽  
Laboratory Examinations ◽  
Ischaemic Lesion ◽  
Obtuse Marginal ◽  
Correct Application

Abstract A 68-years-old man, affected by arterial hypertension in treatment with angiotensin-receptor blocker (cardesartan 32 mg), was admitted to emergency department for fever and dyspnoea. The molecular swab for SARS-CoV-2 was positive. Chest CT showed bilateral interstitial pneumonia with Chung severity score index 15/20. The laboratory examinations showed: PCR 21 mg/dl, IL-6 17 pg/ml, d-dimer 374 ng/ml, lymphopenia, glycaemia 218 mg/dl, total cholesterol 245 mg/dl. At COVID-19 diagnosis he started the following therapy: Azithromycin 500 mg once a day, Methylprednisolone 20 mg twice a day, Remdesivir 200 mg once a day, Enoxaparin 6000 UI twice a day, Insulin Lispro 6/8/8 UI three times a day, High FlowNasal Cannula (FiO2 45%). No lipid-lowering therapy was prescribed. During the hospitalization, the patient experienced a progressive improvement in clinical and laboratory parameters. On the 28th day, there was a sudden worsening of dyspnoea with evidence of ST-elevation in DI, aVL, V2–V6 leads. A primary percutaneous coronary intervention at COVID-19 HUB hospital (2.9 km away) was required. Because of massive demand for emergency vehicles, the patient was admitted to the Chat Lab 3 h and 23 min later. Due to evidence of critical stenosis of the proximal and intermediate left anterior descending artery, a PTCA with stenting was performed. 12 h later, the patient developed left hemiplegia (NIHSS score: 7). The brain CT revealed an acute right frontal ischaemic lesion; no indication to fibrinolysis was given by the consultant neurologist. Our case report describes the rare concomitance of two thrombotic events in a COVID-19 patient with many cardiovascular risk factors, offering the opportunity to underline the need of their appropriate treatment during the hospitalization for SARS-CoV-2 infection. Moreover, a dedicated treatment pathways should be provided for COVID-19 patients in order to ensure the timely and correct application of the protocols suggested by the international guidelines. 659 Figure 1ECG performed at the onset of acute dyspnoea.659 Figure 2Critical stenosis on LAD and subcritical stenosis on first and second obtuse marginal arteries.

Abstract 111: Assessing Statin Therapy and Lipid Profile Goals 6 Months After Percutaneous Coronary Intervention at a Veterans Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Dmitry Blumenkrants ◽  
Saifullah M Siddiqui ◽  
Karthik Challa ◽  
Amit Ladani ◽  
Adhir Shroff
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Statin Therapy ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Percutaneous Coronary ◽  
Core Measure ◽  
Study Population ◽  
Artery Disease

Background: Patients undergoing percutaneous coronary intervention (PCI) represent a high-risk cohort for cardiovascular events. Lipid lowering therapy is an established core measure of secondary prevention in coronary artery disease management. The NCEP-ATPIII advises a minimum LDL level < 100 mg/dL in patients with coronary heart disease (CHD). However, further research suggests that an LDL < 70 is more desirable in this population to further reduce adverse CHD endpoints. Methods: We conducted a retrospective, observational study on all patients undergoing PCI at an urban Veterans Hospital from September 2004 to December 2011. Statin use and lipid profiles at 6 months post-PCI were compared to pre-PCI values. Results: A total of 1052 unique patients had PCI during the study period. Approximately 70% of patients were on statins at baseline, which improved to 88% at 6 months post-PCI (p < 0.0001). LDL levels improved significantly when compared to pre-PCI levels, from a mean of 97.2 to 85.1 (p < 0.0001). With regards to NCEP-ATPIII guidelines, the proportion of the study population that met minimum LDL goals (<100) post-PCI increased from 59% to 76% (p < 0.0001). The percentage of patients meeting ideal goals for LDL (<70) increased from 23% to 33% (p < 0.0001). Conclusion: In patients who have undergone PCI, there was significant improvement in LDL levels. At six months, there was an increase in usage of statin therapy. Furthermore there was a statistically significant increase in adherence to NCEP-ATIII guidelines at both the minimum and ideal LDL levels on follow-up after PCI.

Abstract 436: Assessing Statin Therapy and Lipid Profile Goals 6 Months After Percutaneous Coronary Intervention at a Veterans Hospital

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Amit Ladani ◽  
Karthik Challa ◽  
Sloane McGraw ◽  
Anupama Shivaraju ◽  
Adhir Shroff
Keyword(s):  
Total Cholesterol ◽  
Statin Therapy ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Percutaneous Coronary ◽  
Risk Patients ◽  
Core Measure ◽  
The Mean ◽  
Artery Disease

Background: Lipid lowering therapy is an established core measure of secondary prevention in coronary artery disease (CAD) management. The National Cholesterol Education Program - Adult treatment panel III (NCEP-ATP III) advises a minimum LDL level less than 100 mg/dL in patients with CAD and a recommended LDL less than 70 mg/dL for high risk patients. Statins remain the preferred agent for LDL reduction. Methods: We conducted a retrospective, observational study on all patients undergoing PCI at an urban Veterans Hospital from September 2004 to January 2011. Statin use and lipid profiles at 6 months post-PCI were compared to pre-PCI values. Results: A total of 933 unique patients had PCI during the study period. The mean total cholesterol decreased 18 mg/dL and the mean LDL decreased 15 mg/dL during 6 months follow-up (p< 0.001) (refer to table). The mean HDL did not differ significantly. The percent of patients at NCEP-ATP III guideline’s goal of LDL < 100 mg/dL increased from 58% pre-PCI to 74% post-PCI. Goal LDL < 70 mg/dL increased from 22 to 31% at 6 months. The use of statins increased from 69% to 89%. Conclusion: There were significant improvements in total cholesterol and LDL values at six months post-PCI, as well as the percentage of patients who met the NCEP-ATP III recommended goal of LDL cholesterol less than 100 mg/dL and the suggested goal of 70 mg/dL. At six months, there was an increase usage of statin therapy.

Prevalence of Smoking and Adherence to Lipid-lowering Therapy in Patients Following Percutaneous Coronary Intervention

2008 ◽  
Vol 17 ◽  
pp. S111
Author(s):  
William Chan ◽  
Angela Brennan ◽  
Michelle J. Butler ◽  
Nick Andrianopoulos ◽  
David J. Clark ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Percutaneous Coronary

scholarly journals Impact of a stent-less percutaneous coronary intervention strategy using directional coronary atherectomy and a drug coated balloon for left main and ostial lesions

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Nakamura ◽  
T Rokutanda ◽  
H Kurokawa ◽  
Y Onoue
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Balloon Angioplasty ◽  
Chronic Phase ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Directional Coronary Atherectomy

Abstract Background With the advent of drug eluting stents (DESs), the restenosis rate has markedly decreased. However, even with DESs, problems remain unsolved for bifurcated lesions including left main trunk (LMT) and right coronary artery (RCA) ostial lesions. In the era of directional coronary atherectomy (DCA) alone, an optimal DCA provides a significantly lower residual stenosis and lower angiographic restenosis than conventional balloon angioplasty, despite failing to reach a statistical significance for reducing late clinical events as compared to balloon angioplasty (Circulation 1998; 97:322–31.). Purpose This study aimed to examine the safety and effectiveness of stent-less percutaneous coronary intervention (PCI) using DCA and drug coated balloons (DCBs). Methods From November 2017 to June 2019, a stent-less PCI for LMT and ostial lesions was performed in 32 consecutive cases (male 24/female 8; mean age 70.9±9.8). A stent-less PCI was performed using SeQuent Please™ DCB after an ATHEROCUT™ DCA, and procedural success was obtained in all cases (6 cases with LMT, 18 with left anterior descending ostial, 6 with left circumflex ostial, and 2 with RCA ostial lesions). Results The percent plaque area (%PA) decreased from 70.0±7.7% at baseline to 51.6±8.1% after the DCA and to 46.1±9.0% after the DCBs. All patients completed a follow up coronary angiography after 6 months and no restenosis was observed. No major adverse cardiac events occurred in any cases including target lesion revascularizations. In 29 cases that the lumen was confirmed with IVUS at 6 months of follow-up, the lumen area (LA) had expanded significantly from 8.0±2.3 mm2 at baseline (post DCBs) to 8.9±2.7 mm2 at 6 months (P=0.023, Figure 1A). Local paclitaxel may induce late lumen enlargement (LLE) after a DCA/DCB. The group in which the LA increased during the chronic phase was defined as the Increased group and the group in which the LA decreased during the chronic phase was defined as the Decreased group. When comparing the LDL-Cho level pre DCA between the two groups, the LDL-Cho level in the Increased group was significantly low (74.0±25.8 mg/dl vs. 101.0±33.6 mg/dl, P=0.050, Figure 1B). Conclusions Stent-less PCI using DCA and DCBs for bifurcated lesions including LMT and RCA ostial lesions was effective, safe, and useful. Furthermore, a chronic LLE effect by DCBs is expected. In addition, intensive lipid-lowering therapy may also contribute to the chronic outcome after DCA/DCBs. Funding Acknowledgement Type of funding source: None

scholarly journals Achievement of European guideline-recommended lipid levels post-percutaneous coronary intervention: A population-level observational cohort study

2020 ◽  
pp. 204748732091411
Author(s):  
Daniel E Harris ◽  
Arron Lacey ◽  
Ashley Akbari ◽  
Fatemeh Torabi ◽  
Dave Smith ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
European Society ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
European Atherosclerosis Society ◽  
Lowering Therapy ◽  
Percutaneous Coronary ◽  
European Society Of Cardiology

Aims European Society of Cardiology/European Atherosclerosis Society 2019 guidelines recommend more aggressive lipid targets in high- and very high-risk patients and the addition of adjuvant treatments to statins in uncontrolled patients. We aimed to assess (a) achievement of prior and new European Society of Cardiology/European Atherosclerosis Society lipid targets and (b) lipid-lowering therapy prescribing in a nationwide cohort of very high-risk patients. Methods We conducted a retrospective observational population study using linked health data in patients undergoing percutaneous coronary intervention (2012–2017). Follow-up was for one-year post-discharge. Results Altogether, 10,071 patients had a documented LDL-C level, of whom 48% had low-density lipoprotein cholesterol (LDL-C)<1.8 mmol/l (2016 target) and (23%) <1.4 mmol/l (2019 target). Five thousand three hundred and forty patients had non-high-density lipoprotein cholesterol (non-HDL-C) documented with 57% <2.6 mmol/l (2016) and 37% <2.2 mmol/l (2019). In patients with recurrent vascular events, fewer than 6% of the patients achieved the 2019 LDL-C target of <1.0 mmol/l. A total of 10,592 patients had triglyceride (TG) levels documented, of whom 14% were ≥2.3 mmol/l and 41% ≥1.5 mmol/l (2019). High-intensity statins were prescribed in 56.4% of the cohort, only 3% were prescribed ezetimibe, fibrates or prescription-grade N-3 fatty acids. Prescribing of these agents was lower amongst patients above target LDL-C, non-HDL-C and triglyceride levels. Females were more likely to have LDL-C, non-HDL-C and triglyceride levels above target. Conclusion There was a low rate of achievement of the new European Society of Cardiology/European Atherosclerosis Society lipid targets in this large post-percutaneous coronary intervention population and relatively low rates of intensive lipid-lowering therapy prescribing in those with uncontrolled lipids. There is considerable potential to optimise lipid-lowering therapy further through statin intensification and appropriate use of novel lipid-lowering therapy, especially in women.

scholarly journals In-Hospital Initiation of Lipid-Lowering Therapy After Coronary Intervention as a Predictor of Long-term Utilization

2003 ◽  
Vol 163 (21) ◽  
pp. 2576 ◽  
Author(s):  
Herbert D. Aronow ◽  
Gian M. Novaro ◽  
Michael S. Lauer ◽  
Danielle M. Brennan ◽  
A. Michael Lincoff ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

Insufficient lipid lowering therapy could not bring favorable prognostic effect in high risk patients who were functionally deferred percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Abe ◽  
K Jujo ◽  
T Moriyama ◽  
Y Iwanami ◽  
K Shimazaki ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Endpoint ◽  
Coronary Stenosis ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Close Monitoring ◽  
Fractional Flow ◽  
Lowering Therapy ◽  
Percutaneous Coronary

Abstract Introduction Deferral of percutaneous coronary intervention (PCI) of a functionally insignificant stenosis is associated with favorable long-term prognoses. However, previous reports revealed that patients with fractional flow reserve (FFR) 0.81–0.85 had higher cardiovascular adverse event rates than those with FFR &gt;0.85. Numbers of large clinical trials established the lower, the better strategy for low-density lipoprotein cholesterol (LDL-C) management for patients after PCI. However, in the real clinical practice, the achievement rate of target LDL-C is often insufficient in patients with atherosclerotic risk factors who were functionally deferred PCI. Purpose We aimed to examine optimal LDL-C management for patients with intermediate coronary stenosis deferred PCI by FFR measurement. Methods This observational study included 293 consecutive patients with coronary stenosis deferred PCI due to greater FFR than 0.80. We separately analyzed 90 patients with 0.81–0.85 of FFR and 203 patients with &gt;0.85. Patients in each group were further classified into 2 groups based on LDL-C level at one year after FFR measurement; the Lower LDL-C group (&lt;100 mg/dL) and the Higher LDL-C group (&gt;100 mg/dL). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, non-fatal myocardial infarction, ischemic stroke, heart failure hospitalization and unplanned revascularization. Results Patients with FFR 0.81–0.85 had a significantly higher MACCE rate than those with FFR &gt;0.85 (hazard ratio (HR): 1.77, 95% confidence interval (CI): 1.02–3.07, p=0.043). In patients with FFR 0.81–0.85, the Lower LDL-C group (n-=53) had a significantly lower rate of the primary endpoint than the Higher LDL-C group (HR: 0.41, 95% CI: 0.18–0.97, Log-rank p=0.036, Figure A). Whereas, there was no significant difference in the event rate between 2 groups in patients with FFR &gt;0.85 (Log-rank p=0.42, Figure B). Conclusion Uncontrolled LDL-C level was associated with higher MACCE rate in patients who were deferred PCI due to FFR 0.81–0.85. These results suggested that even in patients who were deferred PCI, those with coronary artery stenosis of lower FFR value should receive strict LDL-C lowering therapy with close monitoring. Figure 1 Funding Acknowledgement Type of funding source: None

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