Background: Mean platelet volume (MPV) is a simple and reliable indicator of platelet size that correlates with platelet activation and their ability to aggregate. We studied the predictive value of MPV in patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated with percutaneous coronary intervention (PCI). Methods: We analyzed the consecutive records of 1001 patients who were hospitalized due to NSTEMI at our center. The primary end point was a composite end point that included the rates of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) driven revascularization at 12 months. The enrolled patients were stratified according to the quartile of the MPV level at admission. Results: Along with the increasing quartile of MPV, the 12-month composite end point increased significantly (p = 0.010), and this association remained significant after the risk-adjusted analyses (per 1 fL higher MPV; adjusted hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.02–1.27; p = 0.026). In the multivariate analysis, the MPV was also an independent factor of all-cause mortality (per 1 fL increase; adjusted HR 1.34; 95% CI 1.12–1.61; p = 0.0014) and death or non-fatal myocardial infarction (per 1 fL increase; adjusted HR 1.16; 95% CI 1.03–1.31; p = 0.017). Conclusion: In patients with NSTEMI treated with PCI, a high MPV value was associated with a significantly increased incidence of long-term adverse events, particularly for all-cause mortality.

Background: There is paucity of data concerning the optimal revascularization in patients with multivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. Methods: 3,166 patients with NSTE-ACS hospitalized between 2006–2014 were screened. After exclusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their management after coronary angiography; the medical-only therapy group (n = 91), the PCI group (n = 1,122), the CABG group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. Results: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20–0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31–0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortality (HR 0.37; 95% CI 0.19–0.69; p = 0.0020). Conclusions: In patients with multivessel CAD presenting with NSTE-ACS, medical-only management is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis. Background: There is paucity of data concerning the optimal revascularization in patients with multivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. Methods: 3,166 patients with NSTE-ACS hospitalized between 2006–2014 were screened. After exclusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their management after coronary angiography; the medical-only therapy group (n = 91), the PCI group (n = 1,122), the CABG group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics. Results: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20–0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31–0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortality (HR 0.37; 95% CI 0.19–0.69; p = 0.0020). Conclusions: In patients with multivessel CAD presenting with NSTE-ACS, medical-only management is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.

INTRODUCTION The positive outcomes of the COMPASS trial raise questions about the proportion of patients who could benefit from additional therapy with rivaroxaban in real-world practice. OBJECTIVES We aimed to identify the proportion of patients from the TERCET registry with significant coronary artery disease (TERCET-CAD) who could benefit from the use of rivaroxaban and to assess their clinical characteristics and long-term prognosis in comparison with the corresponding measures in the COMPASS trial. PATIENTS AND METHODS he COMPASS criteria were applied in the TERCET-CAD population. Patients who met the criteria of the COMPASS trial were included in the COMPASS-like group. The baseline characteristics and long-term outcomes of the COMPASS-like group were compared with the corresponding measures in the acetylsalicylic acid (ASA)-alone arm from the COMPASS trial. RESULTS The COMPASS-like group included 3884 patients (31.6%) out of the 12286 patients constituting the TERCET-CAD population. Patients in the COMPASS-like group were characterized by older age (P < 0 .001) and a more frequent occurrence of risk factors for CAD than those in the ASA-alone arm of the COMPASS trial. The rate of a composite endpoint in the COMPASS-like group was 9%, and in the ASA-alone arm of the COMPASS trial, it was 6% (P <0 .001) . CONCLUSIONS Less than one-third of the TERCET-CAD population met the COMPASS criteria and could potentially benefit from low-dose rivaroxaban therapy. Unfavorable clinical profiles and higher rates of adverse events in the TERCET registry compared with those in the COMPASS trial may predict greater benefits from the implementation of low-dose rivaroxaban in the real-world population.

Second-generation drug-eluting stents (DESs) have shown higher safety and efficacy compared with first-generation DESs. This effect was achieved by improving biocompatibility using an interalia cobalt-chromium construction, thinner stent struts and biodegradable polymers.To assess clinical and angiographic outcomes of patients receiving a novel second-generation cobalt-chromium sirolimus-eluting stent.A total of 424 consecutive patients who received an Alex stent were enrolled in the registry from January to December 2012. The primary outcome measure was the occurrence of 12-month major cardiac adverse events, defined as cases of death, nonfatal myocardial infarction and target lesion revascularization. Quantitative coronary angiography for 240 randomly selected patients was performed by an independent Corelab.The primary endpoint occurred in 31 of 424 patients (7.3%). The rates of death, nonfatal myocardial infarction and target lesion revascularization were 3.3, 2.6 and 3.5%, respectively. According to the definition established by the Academic Research Foundation, definitive and probable stent thrombosis (ST) occurred in 1.6% (7/424) of patients, including six cases of early ST and one case of late ST. The acute device success rate was 98.5%.The ALEX Registry provides evidence for the safety and effectiveness of the study device in a relevant population. Quantitative analysis showed a satisfactory performance of the study device for complex coronary lesions. The 12-month rates of major cardiac adverse event and ST were similar to those of other second-generation DES registries.

Background: There are no clinical trials comparing multivessel percutaneous coronary intervention (MV PCI) with coronary artery bypass grafting (CABG) in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) population. Aim: We sought to compare long-term outcomes of MV PCI and CABG in patients with severe coronary artery disease (CAD) presenting with NS TE-ACS. Methods: A total of 3166 consecutive patients with NSTE-ACS hospitalised between 2006 and 2014 were analysed. Patients with left main, proximal left anterior descending artery, or triple-vessel CAD were included in further analysis. Finally, 455 patients were enrolled and divided into two groups (MV PCI or CABG group). The Cox proportional hazards model and propensity score analysis were used to assess the effects of the treatment on 36-month outcomes. Results: MV PCI was performed in 335 patients, the remaining 120 patients underwent CABG. After propensity score analysis, 99 well-matched pairs were chosen. At 36 months MV PCI was associated with similar incidence of the composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven, revascularisation, or stroke) in both Cox proportional hazards model (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.75-2.11; p = 0.39) and propensity matched analysis (HR 1.28; 95% CI 0.75-2.21; p = 0.36). Rates of 36-month mortality were also comparable before (HR 0.90; 95% CI 0.46-1.75; p = 0.76) and after matching (HR 0.94; 95% CI 0.47-1.89; p = 0.87). Rates of MI and ACS-driven revascularisation were independently higher in MV PCI than in CABG groups (17.8% vs. 5.5%, p = 0.01, and 20.6% vs. 4.4%, p = 0.003, respectively). Conclusions: It seems that MV PCI is comparable to CABG in terms of long-term combined endpoint and mortality in patients with severe CAD and NSTE-ACS. However, higher rates of MI and ACS-driven revascularisation were observed in the MV PCI group.