Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead^® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65–75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data.

Patients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk of developing major adverse cardiovascular events (MACE). This is a multicenter, retrospective, and observational study performed in Spain aimed to characterize these patients in a real-world setting. Unstructured data from the Electronic Health Records were extracted by EHRead^®, a technology based on Natural Language Processing and machine learning. The association between new MACE and the variables of interest were investigated by univariable and multivariable analyses. From a source population of 2,184,662 patients, we identified 4072 adults diagnosed with T2DM and CAD (62.2% male, mean age 70 ± 11). The main comorbidities observed included arterial hypertension, hyperlipidemia, and obesity, with metformin and statins being the treatments most frequently prescribed. MACE development was associated with multivessel (Hazard Ratio (HR) = 2.49) and single coronary vessel disease (HR = 1.71), transient ischemic attack (HR = 2.01), heart failure (HR = 1.32), insulin treatment (HR = 1.40), and percutaneous coronary intervention (PCI) (HR = 2.27), whilst statins (HR = 0.73) were associated with a lower risk of MACE occurrence. In conclusion, we found six risk factors associated with the development of MACE which were related with cardiovascular diseases and T2DM severity, and treatment with statins was identified as a protective factor for new MACE in this study.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of cardiovascular mortality, yet significant gaps persist in understanding how contemporary management strategies influence long-term outcomes. We sought to provide novel insights into the characteristics, management variability, and 6-month outcomes of patients with OHCA admitted to eight intensive cardiovascular care units during a contemporary period. This was a prospective multicentre registry of patients with OHCA admitted to intensive cardiovascular care units from October 2020 to December 2021. Patients were categorised by prognosis as either favourable outcome (Cerebral Performance Category [CPC] 1-2) or non-favourable outcome, including death (CPC 3-5). A multinomial logistic regression identified independent predictors of CPC 3-5. Among 288 patients, only 17.36% were women. Most arrests (88.93%) were witnessed, yet bystander cardiopulmonary resuscitation was initiated in just 69.18% of cases. Despite 80% of patients presenting with a shockable rhythm, an automated external defibrillator was used in only 58%. Median time to return of spontaneous circulation (ROSC) was 28 minutes. Marked variability in post-resuscitation care was observed across centres in the use of targeted temperature management, emergent coronary angiography, and multimodal neuroprognostication. At 6 months, 49% of patients exhibited CPC 1-2. Ninety-three per cent of discharged patients maintained a favourable neurological outcome, and 15% improved their CPC score. Independent predictors of CPC 3-5 included older age (p=0.005), male sex (p=0.016), previous stroke (p=0.046), prolonged time to ROSC (p<0.001), and a non-shockable initial rhythm (p<0.001). Hypoxic-ischaemic brain injury was the leading cause of in-hospital death (72.90%). Nearly half of the patients with OHCA survived with a favourable neurological outcome, which persisted after 6 months. Despite significant in-hospital interventions, pre-hospital factors remained the strongest predictors of neurological outcome. The high degree of management variability suggests an urgent need for standardised protocols and supports the creation of cardiac arrest centres.

Background: D-Transposition of the great arteries (d-TGA) is characterized by the aorta positioned above the right ventricle and the pulmonary artery above the left ventricle. Acute pulmonary artery dissection (PAD) is a rare and often lethal condition. We present a case report of acute PAD in an adult with d-TGA and pulmonary hypertension. Case summary: A 49-year-old male with history of d-TGA palliated with an atrial switch (Mustard) operation, pulmonary venous baffle stenosis treated percutaneously, chronic pulmonary hypertension (mixed group 1 and 2), and severe dilatation of pulmonary arteries (pulmonary trunk of 75 mm) presented to the emergency department with chest pain and acute respiratory failure. Blood pressure was 106/78 mmHg, heart rate 93 b.p.m., and oxygen saturation 88% on room air. A computed tomography (CT) scan showed acute right PAD. He was not considered suitable for surgery nor percutaneous procedure. Epoprostenol was initiated to reduce parietal stress, but after initial stabilization, pulmonary venous stent baffle gradient increased and acute pulmonary oedema occurred. Epoprostenol was withdrawn, and furosemide was initiated, with good clinical response. A follow-up CT scan showed dissection morphological stabilization and false lumen thrombosis, and the patient was discharged. Discussion: Pulmonary hypertension and previous pulmonary artery dilatation are reported as the main underlying conditions leading to PAD. No previous cases of PAD are described in patients with history of d-TGA and atrial switch procedure. Evidence regarding the best treatment of PAD is lacking, but it seems reasonable to reduce parietal stress using pulmonary vasodilators. Nevertheless, in patients with post-capillary pulmonary hypertension, pulmonary vasodilatation may cause important pulmonary congestion.