Andrea Baldo

Prognostic Impact of in-Hospital-Bleeding in Patients With ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Several studies established a link between bleeding and mortality in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI); however, it is unclear whether bleeding has a direct role in worsening the prognosis or if it is simply a marker of patient frailty. We investigated whether bleeding is an independent predictor of mortality in patients with STEMI treated with pPCI. The relationship between the presence of heart failure on presentation (Killip classification), bleeding occurrence, and outcome was also assessed. Bleeding was defined as the combination of Thrombolysis in Myocardial Infarction major and minor bleeding. Short- and long-term mortalities were estimated using the Kaplan-Meyer analysis. Multivariable analysis was performed by the Cox regression model. As an alternative method to address the potential confounding factors, we performed a propensity-matched analysis adjusted for all variables included in the CRUSADE score. In the 1,911 consecutive patients with STEMI considered, bleeding (observed in 11.4% of patients) was an independent predictor of 30-day (hazard ratio 2.61, 95% confidence interval 1.30 to 5.25, p = 0.007) and 1-year mortality (hazard ratio 1.98, 95% confidence interval 1.13 to 3.47, p = 0.017) but not in a landmark analysis starting from 30 days to 1 year. Bleeding was significantly associated with higher 30-day and 1-year mortality in patients with Killip class ≥II, but not in patients with Killip class I. In conclusion, in-hospital bleeding is independently associated with increased mortality in the early period after STEMI, also after adjusting for variables associated with the risk of bleeding. Bleeding was associated with increased mortality in patients with signs of heart failure at admission, whereas it had no effects in patients with Killip class I.

Neoatherosclerosis and plaque rupture as triggers for very late stent thrombosis in a bare-metal stent

Very late stent thrombosis has been increasingly described in the drug eluting stent era. A 56-year-old male presented with anterior ST-elevation myocardial infarction, he received a bare-metal stent in the left anterior descending artery in 2010. We obtained an optical coherence tomography scan, showing ruptured neoatherosclerotic plaque with thrombus.

PLATELET TO LYMPHOCYTE RATIO IS AN INDEPENDENT RISK FACTOR OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

The development of contrast induced nephropathy (CIN) after primary percutaneous coronary intervention (pPCI) is associated with increased mortality and morbidity. The aim of this study was to investigate whether the platelet to lymphocyte ratio (PLR), an aspecific inflammatory marker associated in

INTRA-AORTIC BALLOON PUMP DOES NOT IMPROVE SURVIVAL IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK: DATA FROM A LARGE SINGLE CENTER REGISTRY

Recent evidence from a randomized clinical trial has re-evaluated the benefit of intra-aortic balloon pump (IABP) in patients with STEMI complicated by cardiogenic shock, leading to a downgrading of the recommendation level in the international guidelines. The aim of our study was to evaluate the