Panminerva medica
-
Despite advancement of therapeutic approaches to recurrent pericarditis, it poses notable challenges to its' management. As per the current guidelines, colchicine is the first line therapy, although, non-conventional treatments like interleukin-1 (IL-1) antagonists (rilonacept, anakinra, goflikicept) are progressively utilized for refractory cases. ⋯ IL-1 antagonists significantly reduce recurrent pericarditis episodes compared to colchicine, with anakinra, rilonacept, and goflikicept demonstrating high efficacy and acceptable safety profiles. These findings support their consideration as alternative therapies in colchicine-refractory cases of recurrent pericarditis. Further studies are warranted to refine treatment guidelines and optimize patient outcomes.
-
Prompt reperfusion is critical for patients with ST-segment elevation myocardial infarction (STEMI) to improve outcomes. Yet, variability in regional healthcare delivery may influence treatment times and patient outcomes. We thus aimed at evaluating differences in management and outcomes of STEMI patients across Northern, Central, and Southern Italy, focusing on time-dependent reperfusion and in-hospital logistics. ⋯ This comprehensive nationwide analysis highlights significant regional disparities in the management and treatment timelines of STEMI patients in Italy. Despite these differences, in-hospital care was consistently timely across regions, suggesting that pre-hospital logistics critically influence overall treatment times. Enhanced pre-hospital ECG teletransmission could further optimize reperfusion times, potentially improving patient outcomes.
-
Observational Study
Psychosocial and psychopathological dimensions of patients with Takotsubo Syndrome.
Takotsubo syndrome (TTS) is an acute reversible heart dysfunction affecting mostly post-menopausal women, frequently precipitated by a significant stressful event, presenting as an acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The pathogenesis is not fully understood, but a close relationship between individual's mind, brain, neuroendocrine system and the heart may be involved in a mind-heart axis. The purpose of this study was to compare the prevalence of psychopathological findings in TTS patients as compared to healthy subjects, patients affected by psychiatric diseases and patients affected by ACS. ⋯ Psychosocial and psychopathological dimensions of TTS patients have been explored and analyzed in a cohort of TTS patients vs. ACS, healthy subjects and psychiatric patients, showing statistically significant differences among the various groups. Psychopathological symptoms were more frequent in TTS patients, suggesting an evident involvement of mind-heart axis in this disease. Future studies are needed to investigate the cause-effect relationship between psychopathological features and the occurrence of TTS.
-
Recently, the FFR-Guidance for Complete Nonculprit Revascularization (FULL REVASC) trial in ST elevation myocardial infarction (STEMI) patients with multiple vessel disease (MVD) did not show differences in the composite endpoint of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only percutaneous coronary intervention (PCI) at 4.8 years, although complete revascularization is a recommendation IA in current guidelines. We want to determine through an updated meta-analysis whether complete revascularization is associated with decreased mortality and hard clinical endpoints compared to culprit lesion only PCI. ⋯ In patients with STEMI and MVD without cardiogenic shock, our metanalysis showed that complete revascularization with PCI significantly reduced the risk of non-fatal myocardial reinfarction and ischemic-driven revascularization compared to culprit vessel-only revascularization, without differences in overall mortality.