Browsing by Author "Alasnag, Mirvat (24479281000)"

Background: The optimal duration of antiplatelet therapy (APT) after coronary stenting in patients at high bleeding risk (HBR) presenting with an acute coronary syndrome remains unclear. Objectives: The objective of this study was to investigate the safety and efficacy of an abbreviated APT regimen after coronary stenting in an HBR population presenting with acute or recent myocardial infarction. Methods: In the MASTER DAPT trial, 4,579 patients at HBR were randomized after 1 month of dual APT (DAPT) to abbreviated (DAPT stopped and 11 months single APT or 5 months in patients with oral anticoagulants) or nonabbreviated APT (DAPT for minimum 3 months) strategies. Randomization was stratified by acute or recent myocardial infarction at index procedure. Coprimary outcomes at 335 days after randomization were net adverse clinical outcomes events (NACE); major adverse cardiac and cerebral events (MACCE); and type 2, 3, or 5 Bleeding Academic Research Consortium bleeding. Results: NACE and MACCE did not differ with abbreviated vs nonabbreviated APT regimens in patients with an acute or recent myocardial infarction (n = 1,780; HR: 0.83; 95% CI: 0.61-1.12 and HR: 0.86; 95% CI: 0.62-1.19, respectively) or without an acute or recent myocardial infarction (n = 2,799; HR: 1.03; 95% CI: 0.77-1.38 and HR: 1.13; 95% CI: 0.80-1.59; Pinteraction = 0.31 and 0.25, respectively). Bleeding Academic Research Consortium 2, 3, or 5 bleeding was significantly reduced in patients with or without an acute or recent myocardial infarction (HR: 0.65; 95% CI: 0.46-0.91 and HR: 0.71; 95% CI: 0.54-0.92; Pinteraction = 0.72) with abbreviated APT. Conclusions: A 1-month DAPT strategy in patients with HBR presenting with an acute or recent myocardial infarction results in similar NACE and MACCE rates and reduces bleedings compared with a nonabbreviated DAPT strategy. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020) © 2022 The Authors

Cardiovascular diseases are the leading cause of death among women, and the incidence among younger women has shown the greatest increase over the last decades, in particular for acute myocardial infarction (AMI). Moreover, the prognosis of women post-AMI is poor when compared with men of similar ages. Since the 1990s, an abundant literature has highlighted the existing differences between sexes with regard to presentation, burden, and impact of traditional risk factors and of risk factors pertaining predominantly to women, the perception of risk by women and men, and the pathophysiological causations, their treatment, and prognosis. These data that have been accumulated over recent years highlight several targets for improvement. The objective of this collaborative work is to define the actions required to reverse the growing incidence of AMI in women and improve the patient pathway and care, as well as the prognosis. We aim to provide practical toolkits for different health professionals involved in the care of women, so that each step, from cardiovascular risk assessment to symptom recognition, to the AMI pathway and rehabilitation, thus facilitating that from prevention to intervention of AMI, can be optimized. © 2024 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.

Purpose of Review: Although simulation was adopted many years ago to complement training programs, more recently it has become an integral part of planning individual invasive procedures as well as understanding and developing new devices and techniques. Here, we review the different types of simulation and modeling and their impact on the field of interventional cardiology. Recent Findings: Three-dimensional model printing has been employed to strategize complex structural procedures for various congenital heart defects and valvular heart diseases. Ex vivo bench testing permitted understanding the relationship of new technologies with neighboring structures and enabled the refinement of the devices and procedural steps themselves. In vitro simulation and computational analyzes have enhanced our understanding of flow dynamics in bifurcation diseases, transcatheter therapies, congenital defects, and predicting outcomes for transcatheter valve technologies and techniques. Summary: Incorporating simulation, bench testing, computational analyzes, and three-dimensional modeling will enable the field of interventional cardiology to expand while optimizing techniques and maintaining best practices. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Purpose of Review: Although simulation was adopted many years ago to complement training programs, more recently it has become an integral part of planning individual invasive procedures as well as understanding and developing new devices and techniques. Here, we review the different types of simulation and modeling and their impact on the field of interventional cardiology. Recent Findings: Three-dimensional model printing has been employed to strategize complex structural procedures for various congenital heart defects and valvular heart diseases. Ex vivo bench testing permitted understanding the relationship of new technologies with neighboring structures and enabled the refinement of the devices and procedural steps themselves. In vitro simulation and computational analyzes have enhanced our understanding of flow dynamics in bifurcation diseases, transcatheter therapies, congenital defects, and predicting outcomes for transcatheter valve technologies and techniques. Summary: Incorporating simulation, bench testing, computational analyzes, and three-dimensional modeling will enable the field of interventional cardiology to expand while optimizing techniques and maintaining best practices. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

At the beginning of the SARS Co V2 (COVID-19) pandemic, women worldwide represented the majority of health care workers. As part of the fight against the pandemic, women health care workers became a part of the significant frontline response. This led to unique challenges that affected women physicians as well as the women patients they were taking care of. The American College of Cardiology Women in Cardiology International Working Group set up a webinar to discuss the challenges being faced by women physicians and women patients in various parts of the world and look towards finding possible solutions for these issues in a webinar themed “WIC Global Perspectives: COVID-19. © 2020, Serbia Medical Society. All rights reserved.

Background: The optimal duration of antiplatelet therapy in high–bleeding risk (HBR) patients with coronary artery disease treated with newer-generation drug-eluting bioresorbable polymer-coated stents remains unclear. Design: MASTER DAPT (clinicaltrial.gov NCT03023020) is an investigator-initiated, open-label, multicenter, randomized controlled trial comparing an abbreviated versus a standard duration of antiplatelet therapy after bioresorbable polymer-coated Ultimaster (TANSEI) sirolimus-eluting stent implantation in approximately 4,300 HBR patients recruited from ≥100 interventional cardiology centers globally. After a mandatory 30-day dual-antiplatelet therapy (DAPT) run-in phase, patients are randomized to (a) a single antiplatelet regimen until study completion or up to 5 months in patients with clinically indicated oral anticoagulation (experimental 1-month DAPT group) or (b) continue DAPT for at least 5 months in patients without or 2 in patients with concomitant indication to oral anticoagulation, followed by a single antiplatelet regimen (standard antiplatelet regimen). With a final sample size of 4,300 patients, this study is powered to assess the noninferiority of the abbreviated antiplatelet regimen with respect to the net adverse clinical and major adverse cardiac and cerebral events composite end points and if satisfied for the superiority of abbreviated as compared to standard antiplatelet therapy duration in terms of major or clinically relevant nonmajor bleeding. Study end points will be adjudicated by a blinded Clinical Events Committee. Conclusions: The MASTER DAPT study is the first randomized controlled trial aiming at ascertaining the optimal duration of antiplatelet therapy in HBR patients treated with sirolimus-eluting bioresorbable polymer-coated stent implantation. © 2018 Elsevier Inc.

Background: The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after the implantation of a drug-eluting coronary stent remains unclear. Methods: One month after they had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent, we randomly assigned patients at high bleeding risk to discontinue dual antiplatelet therapy immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy). The three ranked primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding; cumulative incidences were assessed at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population. Results: Among the 4434 patients in the per-protocol population, net adverse clinical events occurred in 165 patients (7.5%) in the abbreviated-therapy group and in 172 (7.7%) in the standard-therapy group (difference, -0.23 percentage points; 95% confidence interval [CI], -1.80 to 1.33; P<0.001 for noninferiority). A total of 133 patients (6.1%) in the abbreviated-therapy group and 132 patients (5.9%) in the standard-therapy group had a major adverse cardiac or cerebral event (difference, 0.11 percentage points; 95% CI, -1.29 to 1.51; P = 0.001 for noninferiority). Among the 4579 patients in the intention-to-treat population, major or clinically relevant nonmajor bleeding occurred in 148 patients (6.5%) in the abbreviated-therapy group and in 211 (9.4%) in the standard-therapy group (difference, -2.82 percentage points; 95% CI, -4.40 to -1.24; P<0.001 for superiority). Conclusions: One month of dual antiplatelet therapy was noninferior to the continuation of therapy for at least 2 additional months with regard to the occurrence of net adverse clinical events and major adverse cardiac or cerebral events; abbreviated therapy also resulted in a lower incidence of major or clinically relevant nonmajor bleeding. Conclusions: One month of dual antiplatelet therapy was noninferior to the continuation of therapy for at least 2 additional months with regard to the occurrence of net adverse clinical events and major adverse cardiac or cerebral events; abbreviated therapy also resulted in a lower incidence of major or clinically relevant nonmajor bleeding. (Funded by Terumo; MASTER DAPT ClinicalTrials.gov number, NCT03023020. opens in new tab.) Copyright © 2021 Massachusetts Medical Society.

The challenges to academic and professional development and career advancement of women in cardiology (WiC), imposed by the pandemic, not only impinge the female cardiologists’ “leaky pipeline” but also make the “leakiness” more obvious. This consensus document aims to highlight the pandemic challenges WIC face, raise awareness of the gender equity gap, and propose mitigating actionable solutions derived from the data and experiences of an international group of female cardiovascular clinicians and researchers. This changing landscape has led to the need for highly specialized cardiologists who may have additional training in critical care, imaging, advanced heart failure, or interventional cardiology. Although women account for most medical school graduates, the number of WIC, particularly in mentioned sub-specialties, remains low. Moreover, women have been more affected by systemic issues within these challenging work environments, limiting their professional progression, career advancement, and economic potential. Therefore, it is imperative that tangible action points be noted and undertaken to ensure the representation of women in leadership, advocacy, and decision-making, and increase diversity in academia. Strategies to mitigate the negative impacts of the pandemic need to be taken during this COVID-19 pandemic to ensure WIC have a place in the field of Cardiology. © 2022 Edizioni Minerva Medica.

Purpose of Review: The objective of this review is to summarize scientific statements on the diagnosis and management of myocardial infarction with no obstructive coronary artery disease (MINOCA); define the diagnostic role of optical coherence tomography (OCT), intravascular ultrasound (IVUS), and cardiac magnetic resonance imaging (CMR); and provide representative case examples. Recent Findings: The majority of patients with MINOCA are evaluated by conventional coronary angiography. However, intracoronary imaging using OCT or IVUS permits more accurate understanding of the underlying pathology. These and other imaging modalities provide significant diagnostic and prognostic value. Summary: Although nonobstructive disease is the hallmark of the disease, MINOCA is associated with significant morbidity and mortality. Every effort to define the underlying pathology is necessary and requires more standardized use of imaging in clinical practice. © 2020, The Author(s).

Purpose of Review: The objective of this review is to summarize scientific statements on the diagnosis and management of myocardial infarction with no obstructive coronary artery disease (MINOCA); define the diagnostic role of optical coherence tomography (OCT), intravascular ultrasound (IVUS), and cardiac magnetic resonance imaging (CMR); and provide representative case examples. Recent Findings: The majority of patients with MINOCA are evaluated by conventional coronary angiography. However, intracoronary imaging using OCT or IVUS permits more accurate understanding of the underlying pathology. These and other imaging modalities provide significant diagnostic and prognostic value. Summary: Although nonobstructive disease is the hallmark of the disease, MINOCA is associated with significant morbidity and mortality. Every effort to define the underlying pathology is necessary and requires more standardized use of imaging in clinical practice. © 2020, The Author(s).

The concept of diversity, equity, inclusion and belonging is essential for research and academic programs and institutions worldwide, but although women do not lag behind men at entry and graduation from Serbian universities, equitable leadership does and it further hinders outcomes in every way: from translational science via healthcare up to legislative efforts to protect children, women and elderly. Although all these may seem as l’art-pour-l’art issues when compared to mere survival in war zones on two continents and all issues women face under circumstances of displacement and bans on rights to education, healthcare and sounds of their own voices in public, still it is the ongoing fight for rights lost in silence and where one least expects it that has to push every human being to fight for the oppressed and underprivileged. © 2024, Serbia Medical Society. All rights reserved.

Cardiovascular and reproductive health of women have been going hand in hand since the dawn of time, however, their links have been poorly studied and once the basis of their connections started to be established in late 20th century, it depended on local regional abilities and the level of progressive thinking to afford comprehensive women’s care beyond the “bikini medicine”. Further research identified different associations rendering more conditions sex-specific and launching therefore a slow, yet initial turn around in clinical trials’ concept as the majority of global cardiovascular guidelines rely on the results of research conducted on a very modest percentage of women and even less on the women of color. Currently, the concept of women’s heart centers varies depending on the local demographics’ guided needs, available logistics driven by budgeting and societal support of a broad-minded thinking environment, free of bias for everyone: from young adults questioning their gender identity, via women of reproductive age both struggling to conceive or keep working part time when healthy and line of work permits it during pregnancy, up to aging and the elderly. Using “Investigate-Educate-Advocate-Legislate” as the four pillars of advancing cardiovascular care of women, we aimed to sum-marize standing of women’s health in Serbia, present ongoing projects and propose actionable solutions for the future. © 2021, Serbia Medical Society. All rights reserved.