Background Dual antiplatelet therapy (DAPT) is the treatment of choice for patients with acute and chronic coronary syndromes as it reduces mortality and prevents recurrent thrombotic complications. The assessment of both ischaemic burden and bleeding risk is crucial in deciding which DAPT to choose and how long it should be continued. Objectives The aim of our study was to perform prospective clinical follow-up of patients receiving fixed-dose combination therapy (ASA 75 mg + clopidogrel 75 mg). Our study is a multicentric, cross-sectional, observational, cohort study. Methods A total of 1500 patients who were started on fixed-dose combination DAPT for acute or chronic coronary syndrome were included in the study. Primary endpoints were hospitalization for any reason, hospitalization for cardiovascular cause, acute myocardial infarction, stent thrombosis, target vessel revascularization and bleeding; the secondary endpoints were death for any reason or cardiovascular cause and stroke. The significance level adopted in the statistical analysis was 5%. Results Median age was 63 years; 78.5% of the patients were receiving DAPT treatment for acute coronary syndrome. The rates of hospitalization for cardiovascular reasons, acute myocardial infartion, stent thrombosis and target-vessel revascularization were 7.9%, 2.3%, 1.3% and 4.2%, respectively. While the rate of BARC type 1 bleeding was 3.3%, the rate of BARC type 5, 3, or 2 bleeding was 0.6%. The secondary endpoints which were death from any cause, cardiovascular death and stroke were 0.5%, 0.3% and 0.3%, respectively. Conclusion: Our study shows that fixed-dose combination therapy is effective and safe in appropriately selected patients with acute or chronic coronary syndromes.

Unknown incidence, isolated right ventricular thrombus is a very uncommon disorder. It has frequently been claimed to be linked to right ventricular infarction, deep vein thrombosis, or pulmonary embolism. There have been cases of severe chronic obstructive pulmonary disease and profound hypoxia, which may lead to right ventricular dysfunction and thrombus in the isolated right ventricle. An 80-year-old man with acute respiratory failure was hospitalized to our emergency room. He also had Alzheimer's, COPD, diabetes mellitus, and atherosclerotic heart disease. The patient wasn't consistently using his prescription drugs and oxygen therapy. His lungs were examined, and wheezing or a drawn-out expiration was found. S1 and S2 were normal on cardiac auscultation, and there was no S3, S4, or murmur. Similar to earlier ECGs, the electrocardiogram displayed T wave inversion in leads V1-V5 and D2-D3-AVF. No pulmonary embolism was observed with computed tomography. A 1.5x2.8 cm mass was discovered between the right ventricular trabeculae during routine echocardiography, which was used to assess heart function. Moreover, there was middle tricuspid regurgitation, right ventricular dilatation, and an 8 mm tricuspid annular plane systolic extension (TAPSE). To make the diagnosis clearer, cardiac magnetic resonance imaging was carried out. Nodular forms between the trabeculations in the right ventricle were seen using cardiac resonance imaging and were considered to be thrombi because they appeared hypointense on late contrast images. Treatment with apixaban and an inhaler were both initiated. A control examination was scheduled for the patient. Transthoracic echocardiography, transesophageal echocardiography, and cardiac magnetic resonance imaging can all identify RV thrombus. Although transthoracic surgery is the procedure of choice in clinical practice, right ventricular thrombus diagnosis is not usually as straightforward as left ventricular thrombus diagnosis. According to recent studies, the most precise method for detecting myocardial thrombus is cardiac MRI. While being more expensive than transthoracic echocardiography, cardiac MRI can be utilized to differentiate between different types of heart masses or to rule out fatal conditions such right ventricular thrombus.

Background: Stent overlapping serves as a crucial strategy in achieving complete coverage of diffuse coronary artery lesions, plaque shifts, and edge dissections. Objectives: We aimed to evaluate the long-term clinical outcomes of overlapping heterogeneous drug-eluting stents (DES) in comparison to homogeneous DES. Methods: A total of 421 patients treated with overlapping DES were included in the study. The study patients were stratified into two groups according to the type of overlap: homogeneous (same antiproliferative drug and stent platform) and heterogeneous (different drug and/or platform). The primary endpoint was a device-oriented composite of cardiac death, target-vessel myocardial infarction and target lesion revascularization; a broader composite of all-cause death, any repeat revascularization, stent thrombosis, in-stent restenosis and cerebrovascular events (MACE) and its components were secondary endpoints. Propensity-score analysis with inverse probability of treatment weighting (IPTW) was used to account for treatment-selection bias. Results: The device-oriented composite endpoint occurred in 9.3% and 7.1% (p = 0.60), and MACE in 17.6% and 14.7% (p = 0.56) of patients with homogeneous and heterogeneous DES, respectively, with no significant difference in any individual component. After IPTW adjustment, heterogeneous overlap was not associated with an increased risk of MACE (odds ratio: 0.45, 95% confidence interval: 0.23–0.86) or of the device-oriented composite endpoint (0.52, 0.22–1.23). In a multivariable model with clinically prespecified covariates, lower left ventricular ejection fraction and greater total stent length, but not HbA1c, were independently associated with MACE. Conclusions: In this retrospective cohort, overlapping heterogeneous DES was not associated with an increased risk of adverse events compared with homogeneous DES, including in patients presenting with acute coronary syndromes; however, the modest sample size and the low number of events preclude conclusions of equivalence, and clinically relevant differences cannot be excluded.