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Introduction: The USPSTF has recommended the use of preventive aspirin in all subjects aged 55-79 years without known heart disease when the potential benefit of a reduction in myocardial infarction outweighs the potential harm of bleeding. However, some studies have suggested that for women, the risks of aspirin may outweigh the benefit. Hypothesis: To investigate whether the risk of initial presentation of coronary heart disease with STEMI is lower in aspirin users and, if so, to assess the role of age and concomitant medications and procedures in the reduction of risk. Methods: We analyzed clinical characteristics and outcomes of patients without preexisting CVD that were enrolled in 41 hospitals referring data to the ISACS-TC registry (NCT01218776) from January 2010 to January 2018. Primary end points included rates of STEMI at clinical presentation and adjusted 30-day mortality. For the safety analysis, hemorrhagic events, consisting of gastrointestinal bleeding, hemorrhagic stroke, and bleeding from any other sites, were also analyzed. Estimates were obtained using logistic regression models. Results: There were 1098 subjects with a mean (SD) age of 66 (11.3) years in the aspirin group and 8978 subjects with a mean (SD) age of 60.3 (12.0) years in the no-aspirin group included in the study. After multivariable adjustment for age, sex, kidney function and risk factors, aspirin therapy reduced clinical presentation with STEMI in the protocol cohort (OR, 0.52; 95% CI, 0.46-0.60) with no heterogeneity of efficacy in subgroup analyses stratified by each of these factors (all interaction P>0.05). Similar treatment effects with aspirin therapy were found when concomitant medications were included as dummy variables in sequential logistic analyses (OR, 0.62 for statins, 0.59 for ACE inhibitors and 0.61 for beta-blockers) (Figure 1.). Bleeding events occurred in 8 patients (1.4%) in the aspirin group and 88 (2.4%) in the no-aspirin group (P=0.12), and the incidence of hemorrhagic stroke was not different between groups (P=0.28). Conclusions: Aspirin reduces the risk for STEMI without increasing risk for gastrointestinal bleeding in women and men in a primary prevention setting. These data support the routine use of aspirin as recommended by the USPSTF. [ABSTRACT FROM AUTHOR]

Introduction: Information on sex differences in clinical presentation and outcomes of STEMI with nonobstructive CAD is poor as prior studies have pooled together all patients with MI. STEMI and NSTEMI are clinical entities that differ considerably in the pathophysiology and management options Hypothesis: The current study aimed to determine the clinical characteristics, outcomes and predictors of STEMI by sex and CAD status Methods: We identified 5858 patients who underwent coronary angiography for STEMI in the ISACS-TC registry from 2010-2016. Patients with prior revascularization (n=797) and cardiomyopathies/myocarditis (n=12) were excluded, giving a final study population of 5049 STEMI patients. The primary outcome measure was all cause 30 day death. Secondary outcome was the incidence of severe left ventricular dysfunction at discharge (EF<30%). Risk factors, clinical history, presentation, and hospital treatments within 24 hours from admission were compared by sex and CAD status (obstructive vs nonobstructive) by multivariable logistic methods Results: Of the 5049 STEMI patients, 94.2% had significant CAD and 5.8% had nonobstructive CAD. Younger age (OR 1.19 CI 1.05- 1.35), prior MI (OR 1.66 CI 1.01-2.76) and prior heart failure (OR 2.09 CI 1.11-3.92) were independent determinants for clinical presentation with STEMI and nonobstructive CAD. There were no differences between men and women in rates of nonobstructive CAD (5.7% vs 5.9% P=0.77). The primary and secondary outcomes did not differ among men and women with nonobstructive CAD (OR 1.79 P=0.46 and OR 3.27 P=0.26 respectively). Sex specific regression models of obstructive versus nonobstructive CAD showed that older age (OR 1.20 CI 1.04-1.39) only predicts significant CAD in men whereas current smoking (OR 2.19 CI 1.15-4.17) and diabetes (OR 3.57 CI 1.49-8.53) were only significant predictors in women. The relative risk of hypercholesterolemia was similar in men (OR 2.01 CI 1.38-2.92) and women (OR 1.92 CI 1.05-3.51). The risk of death among women with obstructive CAD was most pronounced than their male counterpart (OR 1.45 CI 1.03-2.06) Conclusions: Women have a higher risk of death after STEMI in comparison with men only in patients with obstructive CAD. Development of obstructive CAD is, therefore, the most serious and life-threatening event in women. Diabetes and current smoking were found to have a greater impact on development of obstructive CAD in women compared with men. Prevention of traditional risk factors is a major need for improving cardiovascular health among women. [ABSTRACT FROM AUTHOR]

Background The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline pre-procedural treatment options may affect clinical outcomes. Methods Data were derived from the ISACS-TC registry ( NCT01218776 ) from October 2010 to January 2015. No-reflow was defined as post-PCI TIMI flow grades 0–1, in the absence of post-procedural significant (≥ 25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was in-hospital mortality. Results No-reflow was identified in 128 of 5997 patients who have undergone PCI (2.1%). On multivariate analysis, patients with no-reflow were more likely to be older (OR: 1.20, 95% CI: 1.01–1.44), to have a history of hypercholesterolemia (OR: 1.95, 95% CI: 1.31–2.91) and to be admitted with a diagnosis of STEMI (OR: 2.96, 95% CI: 1.85–4.72). Angiographic characteristics associated with no-reflow phenomenon were: stenosis ≥ 50% of the right coronary artery, presence of multivessel disease and pre-procedural TIMI blood flow grades 0–1. No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%; adjusted OR: 4.60, 95% CI: 2.61–8.09). Administration of pre-procedural unfractioned heparin or 600 mg clopidogrel loading dose was associated with less incidence of no-reflow (OR: 0.65, 95% CI: 0.43–0.99 and 0.61, 95% CI: 0.37–1.00, respectively). Aspirin, enoxaparin, and 300 mg clopidogrel loading dose, did not significantly impact the occurrence of the no-reflow. Conclusions We found that pre-procedural administration of 600 mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflow. [ABSTRACT FROM AUTHOR]

Introduction: Trans-radial access (TRA) for PCI has been consistently shown to reduce mortality and bleeding complications compared with trans-femoral access (TFA) in pts with STEMI. On the contrary the efficacy and the safety of TRA in NSTE-ACS is still matter of debate Hypothesis: The purpose of this study was to determine the potential clinical benefits of TRA in the NSTE-ACS patient population Methods: We compared outcomes of TRA versus TFA in a real world population of patients with NSTE-ACS drawn from the ISACS-TC registry (NCT01218776) The primary outcome was the incidence of all cause death and stroke at 30 days. The secondary outcome was the combined endpoint of periprocedural major complications (MI type 4, abrupt closure, loss of side branches, distal embolization and postPCI TIMI flow≤2). The incidence of nonCABG related major bleeding (TIMI definition) was also noted Results: Of 3127 NSTE ACS patients undergoing PCI 2047 (65.5%) underwent TRA, which was more likely to be employed among male sex and patients with lower-risk characteristics: patients were younger with a lower burden of risk factors. Patients undergoing TRA had significantly more periprocedural complications than those who received TFA (24.4% vs 8.6% p<0.001). The combined endpoint was driven mainly by the rate of noreflow phenomenon (24.4% vs 9.7%). After adjustment for baseline variables, the risk of periprocedural complications was attenuated but still remained significant between the radial and femoral groups (OR 3.63 CI: 2.52-5.22). There were significant differences in center experience: 1651 of the 2047 TRA procedures were performed by centers with high volume characteristics. There was heterogeneity in treatment effect in patients receiving TRA in centers with high versus medium/low volume characteristics. The risk of periprocedural complications was no longer significant after adjustment for center characteristics (OR 0.94 CI 0.52-1.68). The rate of the primary outcome was 1.6% in the TRA group compared with 2.2% in the TFA (adjusted OR 0.65 CI 0.33-1.29). The rate of nonCABG-related major bleeding at 30 days was 1.5% in the TRA group compared with 0.5% in the TFA group. Yet this rate was substantially lower in centers with high volume characteristics. (Adjusted for age and sex OR 0.25 CI 0.03-2.06). Conclusions: No significant differences in the combined outcome of 30 day mortality and ischemic stroke were seen between TRA and TFA approach in patients with NSTE-ACS undergoing PCI. TRA may be preferred in these patients only in centers with considerable experience. [ABSTRACT FROM AUTHOR]