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The PRECISE-DAPT score predicts the bleeding risk in patients treated with dual antiplatelet treatment after PCI. We asess the prediction power of the score in patients suffering from non-ST elevation acute coronary syndromes. Our cohort included 862 patients from Buenos Aires 1 registry. The PRECISE-DAPT score was calculated upon admission and the follow up period was 15 months. The score as a continuous variable had low to moderate ability to predict bleeding events BARC 2, 3 or 5 (c-statistics 0.58 [95% CI, 0.52-0.61]); moderate at BARC 3 or 5 (c-statistics 0.72 [95% CI, 0.64-0.78]), and poor for MACE (c-statistics 0.49 [95% CI, 0,45-0.51]). PRECISE-DAPT score as a dichotomous variable (≥25, n= 210 [24%]) was associated with very high risk of bleeding (HR 2.1) and ischemic events (HR 1.9, 95% CI 1.8-2.1). As conclusion, PRECISE-DAPT score ≥25 was able to identify a subgroup of patients with high bleeding, and thrombotic events.

Atrial fibrillation (AF) has a strong impact on the quality of life (QOL) of patients and anticoagulation has a lot to do with it. We evaluated the QOL of patients with nonvalvular AF who start treatment with apixaban in Latin America. QOL was analyzed through a questionnaire developed to evaluate anticoagulated patients, which was completed by them 3 months after starting treatment. We included 521 patients from Uruguay, Bolivia, Ecuador, Paraguay, and Peru. A high index of general treatment satisfaction (5.34 ± 0.46) and self-efficacy (5.11 ± 0.68) were observed; the distress index was low (1.77 ± 0.88), as was the perception of daily hassles (1.35 ± 0.49) and strain social network related to medication (1.21 ± 0.34). Patients with AF who started treatment with apixaban has good satisfaction and self-efficacy scores with low index of stress, few daily limitations and social disruptions.

BACKGROUND Sarcopenia is a prevalent condition in elderly patients and has been associated with adverse outcomes following transcatheter aortic valve replacement (TAVR). The present study aimed to determine the predictive value of serum creatinine-cystatin C ratio, that is, "Sarcopenia Index" (SI) as a surrogate marker of sarcopenia, and investigate its association with clinical outcomes after TAVR. METHODS We conducted a retrospective observational study of patients undergoing TAVR between January, 2016 and December, 2018 at Hospital Italiano de Buenos Aires, Argentina. Patients were excluded if

Introduction: Sarcopenia, a marker of biological senescence, is a robust prognostic indicator of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM). The present study aimed to describe a new sarcopenia index (SI, serum creatinine value/cystatin C value x 100) and investigate its association with outcomes after TAVR. Methods: The study cohort comprised 100 patients ≥ 65 years of age (mean 83.9±5.7; 36% men) who underwent transfemoral TAVR at Hospital Italiano de Buenos Aires, Argentina from 2016 to 2018. The mean Society of Thoracic Surgeons (STS) score was 3.3±1.7. Sarcopenia was defined according to ROC curve for SI (AUC 0.731, CI 95% 0.599-0.863, p-value=0.001) for predicting the primary endpoint. Both all-cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint within the first year after TAVR. Results: According to SI cutoff, half of the study population (SI ≤66) was sarcopenic before TAVR. The 30-day mortality increased significantly in the lowest SI tertile (sarcopenia+) group (12, 3, and 0%, p=.05, respectively). SI strongly correlated with timed-up and go and gait speed but not with body mass index and baseline C-reactive protein levels. Overall survival was worse (Log-rank test= p=0.02) and CHF readmissions were more prevalent in the lowest SI tertile (Log-rank test=p=0.01). On Cox regression analysis, a low SI (SI ≤66) had a significantly higher risk of the primary endpoint (adjusted hazard ratio: 4.01, 95% CI: 1.31-12.27, p=.015). Conclusions: SI, a novel-non-invasive method for assessing SMM was able to predict mid-term mortality and CHF readmissions. We suggest careful consideration of sarcopenia prior to TAVR in order to decide the best treatment approaches.

Despite major advances in terms of prevention, diagnosis, risk-stratification, management and rehabilitation, atherosclerosis and atherothrombosis continue to have major morbidity and mortality implications worldwide. Since the unraveling of the pivotal role of inflammation in atherothrombosis pathophysiology, several focused treatments have been proposed with the ultimate goal of preventing or treating myocardial infarction, stroke, and peripheral artery disease. In particular, given the centrality of interleukin-1 (IL-1), targeted anti-IL-1 agents have attracted substantial attention and efforts. Yet, uncertainty persists on the real risk-benefit and cost-benefit balance of anti-IL-1 agents in patients with or at risk of atherothrombosis. Several trials have been recently completed on atherothrombosis prevention and treatment with anti-IL-1 agents, ranging, for instance, from the large Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) trial to the series of translational studies conducted within the Virginia Commonwealth University-Anakinra Remodeling Trial (VCU-ART) platform. In light of the present scoping umbrella review, it appears evident that anti-IL-1 agents can reduce systemic inflammation and improve surrogate markers of cardiac and vascular function, with potential benefits on the risk of new/worsening heart failure. One trial suggested an increased risk of major adverse events with anti-interleukin-1 agents, possibly due to a rebound phenomenon, but this was based on a post-hoc analysis of a small number of events, and it was not supported by all other pertinent trials. The CANTOS study showed a potential hazard due to an increased risk of fatal infections, but the effect size was rather small. In addition, cost issues limit the foreseeable scope of these treatment strategies in unselected patients, calling instead for more refined prescribing. The evidence base on the risk-benefit and cost-benefit profile of anti-IL-1 agents for atherothrombosis prevention and treatment has expanded substantially in the last decade. While largely dominated by the landmark CANTOS trial, effect estimates also including the VCU-ART trials suggest complex short- and long-term effects which may prove favorable in carefully selected patients with acute or chronically sustained inflammation. Conversely, more liberal use appears less promising, and further studies with currently available agents or novel ones are eagerly needed to better define their role in the era of precision molecular medicine.

The original version of this article unfortunately contained typo in the 2nd author’s family name. Instead of “Garmenda”, it should be “Garmendia”. The original version has been corrected.

Resumen es: La angiotensina II (Ang II) esta involucrada en diferentes procesos fisiopatologicos, particu- larmente actuando sobre los receptores AT-1 de Ang II (AT1...