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Early menopause is associated with an increased risk of cardiovascular diseases, including aortic stenosis (AS). We sought to investigate the prevalence and impact of early menopause on clinical outcomes in patients who underwent transcatheter aortic valve implantation (TAVI) for severe symptomatic AS. Women's International TAVI is a multinational, prospective, observational registry of women who underwent TAVI for severe symptomatic AS (n = 1,019). Patients were divided into 2 groups based on age of menopause: early menopause (age ≤45 years) and regular menopause (age >45 years). The primary outcome of interest was Valve Academic Research Consortium 2 efficacy end point, a composite of mortality, stroke, myocardial infarction, hospitalization for valve-related symptoms, or heart failure or valve-related dysfunction at 1-year follow-up. Of 732 patients with available data on menopause age, 173 (23.6%) were classified as having early menopause. These patients presented for TAVI at a younger age (81.6 ± 6.9 vs 82.7 ± 5.9, p = 0.05) and had a significantly lower Society of Thoracic Surgeons score (6.6 ± 4.8 vs 8.2 ± 7.1, p = 0.03) than those with regular menopause. However, the total valve calcium volume was smaller among patients with early versus regular menopause (731.8 ± 850.9 mm3 vs 807.6 ± 633.8 mm3, p = 0.002). Other co-morbidities were similar between the 2 groups. At 1-year follow-up, there were no significant differences in clinical outcomes between patients with early versus regular menopause (hazard ratio 1.00, 95% confidence interval 0.61 to 1.63, p = 1.00). In conclusion, despite presenting for TAVI at a younger age, patients with early menopause had a similar risk of adverse events as patients with regular menopause at 1 year after TAVI.

Antithrombotic therapy is the cornerstone of secondary cardiovascular prevention after percutaneous coronary intervention (PCI). Improvements in drug-eluting stent (DES) design and materials over the last 2 decades have prompted the development of new antithrombotic strategies. Current guidelines recommend to tailor dual antiplatelet therapy (DAPT) according to clinical presentation and individual ischemic and bleeding risk. Given the growing number of complex PCI procedures performed nowadays, it is a priority to define the optimal antithrombotic treatment in this challenging patient subset. In this review article, we sought to summarize and discuss the current evidence on antiplatelet therapy in patients undergoing complex PCI.

The optimal perioperative management of antiplatelet therapy (APT) therapy in patients undergoing noncardiac surgery (NCS) following percutaneous coronary intervention (PCI) is unclear. We sought to identify predictors of APT cessation in a real-world cohort of patients undergoing NCS within 1 year of PCI.Consecutive patients undergoing PCI at a tertiary center between 2011 and 2018 were prospectively enrolled. Perioperative interruption of APT was defined as cessation of either aspirin or P2YA total of 1092 surgeries corresponding to 747 patients were identified. Overall, there were 487 (44.6%) preoperative antiplatelet interruptions: discontinuation of either P2YIn this contemporary cohort of post-PCI patients undergoing NCS, patient-, angiographic- and surgery-specific factors all affected decision-making regarding APT cessation. Our findings reflective of real-world practice, highlight the importance of a multidisciplinary team approach to individualize decision making in these patients.

There is a paucity of data on the prognostic value of high-sensitivity C-reactive protein (hsCRP) levels in diabetic and nondiabetic patients undergoing percutaneous coronary intervention (PCI).All patients with known baseline hsCRP undergoing PCI at a single tertiary care centre from 2010 to 2017 were included. High hsCRP was defined as3 mg/L. Known causes of elevated hsCRP levels and hsCRP10 mg/L represented exclusion criteria. The 1-year primary outcome was major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularisation (TVR).Among a total of 11,979 patients included, high hsCRP levels were observed in 24.7% of patients without diabetes and 29.8% of patients with diabetes (P0.001). Both diabetics and nondiabetics with high hsCRP levels had increased rates of MACE compared with their counterparts with low hsCRP (diabetics: adjusted hazard ratio [aHR] 1.58, 95% CI 1.27-1.96; nondiabetics: aHR 1.45, 95% CI 1.13-1.86; P interaction = 0.981) primarily driven by increased rates all-cause deaths (diabetics: aHR 2.32, 95% CI 1.42-3.80; nondiabetics: aHR 3.14, 95% CI 1.74-5.65; P interaction = 0.415). Although high hsCRP levels were associated with increased rates of TVR (aHR 1.35, 95% CI 1.04-1.75) and MI (aHR 1.86, 95% CI 1.18-2.93) only in patients with diabetes, no significant interactions were observed between inflammation and diabetes (P interaction = 0.749 and 0.602, respectively).Patients undergoing PCI with high levels of hsCRP, defined as3 mg/L, have worse ischemic outcomes regardless of diabetes status.

Low levels of high-density lipoprotein (HDL) have been associated with adverse cardiovascular events in epidemiologic studies. Evidence regarding its role in patients who underwent percutaneous coronary intervention (PCI) is scarce. We evaluated consecutive patients who underwent PCI with drug-eluting stents from 2012 to 2017, excluding those with unavailable baseline HDL, age18 years, presentation with ST-segment elevation myocardial infarction (MI) or shock, and coexisting neoplastic disease. The final population was stratified according to baseline HDL levels into reduced and nonreduced HDL cohorts, with cut-off value 40 mg/dl in males and 50 mg/dl in females. The primary end point was 1-year major adverse cardiovascular events (MACE), defined as the composite of death, MI, or target vessel revascularization (TVR). Among 10,843 patients included, 6,511 (60%) had reduced HDL, and 4,332 (40%) nonreduced HDL. The rate of 1-year MACE was similar between the 2 groups (7.5% vs 6.6%; p = 0.14). Although mortality and MI rates were comparable, reduced HDL was associated with significantly higher TVR 5.2% vs 4.0%; p = 0.02, a finding that attenuated after multivariable adjustment (adjusted hazard ratio 1.18, p = 0.14). Sex subgroup analysis included 7,718 (71.2%) males and 3,125 (28.8%) females. Among men, there was a trend toward higher MACE in those with reduced HDL (7.4% vs 6.0%; p = 0.08) mostly driven by TVR (5.4% vs 3.7%; p = 0.005). No association between HDL and 1-year outcomes was evident in females. Assessment for interaction between sex and reduced HDL did not reach statistical significance. In conclusion, reduced baseline HDL was not associated with increased risk of MACE in a contemporary PCI population.

Cardiovascular and renal diseases share common pathophysiological grounds, risk factors, and therapies. The 2 entities are closely interlinked and often coexist. The prevalence of kidney disease among cardiac patients is increasing. Patients have an atypical clinical presentation and variable disease manifestation versus the general population. Renal impairment limits therapeutic options and worsens prognosis. Meticulous treatment and close monitoring are required to ensure safety and avoid deterioration of kidney and heart functions. This review highlights recent advances in the diagnosis and treatment of cardiac pathologies, including coronary artery disease, arrhythmia, and heart failure, in patients with decreased renal function.

Objective The objective of this study was to assess and to investigate the reasons for the variations between the results of meta-analyses addressing the same question. Study Design and Setting We included systematic reviews, and the trials that they included, on the use of implantable cardiac defibrillator (ICD) in patients with nonischemic cardiomyopathy. We assessed the variation between meta-analyses pooled effect estimates by calculating the percentage of absolute difference. We developed a list of 10 reasons for variations between the results of the meta-analyses clustered in four overarching categories. Results We identified 21 systematic reviews including six trials and reporting on 22 eligible meta-analyses. The percentage of absolute difference between each of the 22 pooled effect estimates (included odds ratio, risk ratio, hazard ratio) and their median value had an average of 3.2%. The number of trials for which the following categories of reasons for variations applied were as follows: (1) different decision to include or exclude trials ( n = 3); (2) differences in analytical approaches ( n = 6); (3) errors in conducting meta-analyses ( n = 5); and (4) unclear reason ( n = 1). Conclusion Few of the observed variations between the results of the 22 meta-analyses could lead clinicians or guideline development organizations to adopt different courses of actions. Variations were most frequently related to both errors and variations in trial eligibility and analytical approaches.

Purpose The prevalence of seizures in the elderly will increase as populations age. Data is currently limited regarding treatment and especially tolerability of newer antiseizure medications (ASMs). In the current study we aimed to investigate the tolerability of lacosamide (LCS) and zonisamide (ZNS). Method We performed a retrospective chart review of patients with seizures older than 60 treated with LCS or ZNS in the outpatient setting. We examined seizure variables, medical comorbidities, and concomitant medications. Primary outcomes were the retention rates at last follow up, and the discontinuation rate due to side effects. Results Seventy-one (71) LCS and 39 ZNS patients were identified. Average age at LCS initiation was 71.0±7.0 years and 49% were medically refractory. Average duration of follow up was 23.1±21.2 months. At last follow up, the retention rate was 60% and seizure freedom rate 52%. Of the 19 discontinuations due to side effects, 7 (37%) were due to dizziness/gait instability. No predictors of discontinuation were identified. Average age at ZNS initiation was 69.7±6.9 years and 51% were medically refractory. Average duration of follow up was 46.3±38.3 months. At last follow up, the retention rate was 64% and seizure freedom rate was 67%. Of the 12 discontinuations due to side effects, 4 (33%) were due to cognitive or behavioral side effects. Predictors of discontinuation included a lower starting dose. Conclusions Lacosamide and zonisamide are viable options for the treatment of epilepsy in the elderly and have similar retention rates.

Among patients undergoing cardiac surgery, those with a history of recent percutaneous coronary intervention (PCI) are at increased risk of perioperative complications. We sought to examine the predictors of adverse events in this vulnerable population. The institutional PCI registry and the

Distribution of high bleeding risk (HBR) factors varies widely in the population. Consequently, the interplay between race, bleeding risk and outcomes remains unclear. The Academic Research Consortium (ARC) recently provided a definition of HBR expected to capture a >4% risk of major bleeding at 1