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Background /objectives: Despite preoperative screening, technical improvements and increased patient monitoring, myocardial infarction remains the first cause of morbidity and mortality within 30 days after surgery. Moreover, the available evidence further indicates worrying elevation of risk in postoperative patients with only elevated troponins reflecting cardiac injury, but without a conventional clinical diagnosis of myocardial infarction according to current definition. We have defined MINS (myocardial injury after noncardiac surgery) as a prognostically relevant increase of a troponin T peak of 0.03 ng/ml or greater. Non-cardiac surgery patients suffer MINS frequently (8.0%) and the majority do not have fulfilled the universal definition of myocardial infarction. MINS patients rarely experience ischemic symptoms and the prognosis is very poor (1 out of 10 die at 30 days). Objectives: 1) To implement troponin monitoring as a routine perioperative care; 2) To determine the preoperative and postoperative hscTnT thresholds to predict death; 3) To evaluate the cost-effectiveness of troponin monitoring, and; 4) To elucidate the mechanisms of perioperative myocardial events. Methodology: We will include 2000 patients with high cardiovascular risk undergoing major non-cardiac surgery. Three determinations of hs-cTnT for each patient will be obtained. We will determine the proportion of patients with MINS and calculate the pre- and post-operative troponin thresholds. We will undertake a cost-effectiveness analysis of screening of troponins compared with usual care. Finally using coronary CT-angiography and magnetic resonance imaging we will determine whether MINS is due to plaque rupture, supply-demand mismatch, non-ischemic cardiac cause, non-cardiac cause. Expected results: Our study will evaluate the feasibility and impact of implementing a hs-cTnT monitoring program in our center and will evaluate its cost-effectiveness in Spain. We will produce new knowledge about hs-cTnT thresholds, and with minimally invasive diagnostic tools we will inform the perioperative field about the underlying mechanisms involved in perioperative ischemic events.
Assessment of Change in AtheROSclerotic Plaque by Serial CCTA (ACROSS) is designed as a prospective observational study which aim is to demonstrate the effect of statins on coronary atherosclerosis, assessed by quantitative analysis of CCTA.
To assess the relationship between serum endostatin (ES) and Coronary artery calcification (CAC) in type 2 diabetic (T2DM) patients.
The study will evaluate patients with, at least, one previous procedure of coronary revascularization (surgical, percutaneous or both), that are referred for a new, clinically indicated, diagnostic coronary angiography, to describe their clinical characteristics, management, and prognosis, and will propose a prognosis-oriented classification.
The purpose of the research project is to investigate the potential association of 6 genetic polymorphisms with the complexity and the severity of coronary artery disease (SYNTAX score). The aim of the study is to combine genetic, clinical and laboratory data in order to create a prognostic tool that will enable an individualized therapeutic patient approach.
ST elevation myocardial infarction (STEMI) patients affected by multivessels coronary artery stenosis, represent a clinical relevant problem. The management and prognosis of these patents are supported by few literature data. Therefore, in this study authors enrolled real world diabetic vs. non diabetic patients admitted for STEMI and associated to multi vessels coronary disease. Then these diabetics were divided in incretin users (6 months of incretin treatment before study enrollment) vs. never incretin users. In these patients authors studied all cause mortality, cardiac mortality, and major adverse cardiac events at 12 months follow up.
This translational study was designed to explore the association of the quantity and quality of epicardial adipose tissue (EAT) with coronary artery disease (CAD), left atrial remodeling and postoperative atrial fibrillation in a high cardiovascular disease-risk population. The investigators expect to identify new biochemical factors and biomarkers in the crosstalk between the epicardial adipocytes, coronary plaques and atrial cardiomyocytes that are involved in the pathogenesis of atherosclerosis and atrial fibrillation, respectively.
The aim of this study is to evaluate whether use of the echoclip device (an ultrasound transducer positioning device which can stabilize the involved part of the myocardium on the beating heart) facilitates imaging of coronary bypass anastomoses during coronary bypass surgery. A total of 100 low risk patients undergoing elective on-pump coronary bypass surgery will be included in the study in order to evaluate if the surgeons can visualize the coronary anastomoses before closure of the sternum. Ultrasonograpic pictures will be analyzed directly peroperatively and electronically post-operatively in order to evaluate if selected areas of the anastomoses can be visualized. Use of the echoclip devise will be considered a success if at least 80% of the anastomoses can be visualized.
Identifying patients who are at risk for a future myocardial infarction, is still one of the biggest challenges in cardiology. In this study the investigators will investigate culprit lesion in patients with NSTEMI and the ability of cardiac CT with dual energy computed tomography (DECT) scanning to describe and identify plaques that may be vulnerable. The investigators will also describe changes in characteristic in both stable and unstable plaques during 1 year follow up of NSTEMI and a matching group of stable angina pectoris (SAP) patients.
To evaluate the safety, efficacy and deliverability of the Combo bio-engineered sirolimus-eluting stent versus the Nano polymer-free sirolimus- eluting stents in the treatment of patients with de novo stenotic lesions of native coronary artery.