Search Results (3,172)

Despite the implementation of safety-engineered devices (SEDs) in Germany, percutaneous sharps injuries (PSIs) caused by medical devices remain a major occupational risk for healthcare workers. The aim of this study was to analyze the frequency of PSIs and the circumstances of SED-associated PSIs in hospitals, medical practices, and nursing homes. Routine data from a statutory accident insurance provider for 2015–2024 were used to analyze PSI trends (n = 481,575), and survey data from online questionnaires were used to analyze circumstances of PSIs (n = 791). Routine data showed a slight decline (6.1%) in PSIs over the past 10 years across all sectors. Hospitals and medical practices had the highest rates (30.2 and 21.6 PSIs per 1000 full-time equivalents, respectively). The devices most frequently involved were blood collection needles in hospitals and medical practices and insulin pens in nursing homes. Overall, 43.1% of PSIs were related to the improper disposal of used devices. Around 31.1% of PSIs were associated with SEDs. Around 33% of SED-related injuries occurred during disposal. High workload and distraction were the most frequently reported causes of injuries. Regular training should be provided to raise staff awareness of the proper handling and disposal of used devices. Full article

Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research Network. Adults (≥18 years) with diabetes mellitus and gastroparesis were identified and divided into two cohorts based on GLP-1 RA exposure. Propensity score matching (1:1) balanced demographics, comorbidities, and antidiabetic medications, yielding 23,371 patients per cohort. Outcomes, assessed from 180 days after index, included pneumonia, pneumonitis, mechanical ventilation, ventilator-associated pneumonia, sepsis, bacteremia, empyema, lung abscess, acute respiratory distress syndrome (ARDS), and need for enteral feeding. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Results: Compared with GLP-1 users, non-GLP-1 patients had higher incidences of pneumonitis (3.6% vs. 2.5%; HR 1.76, 95% CI 1.58–1.95), pneumonia (13.2% vs. 12.2%; HR 1.34, 95% CI 1.27–1.41), mechanical ventilation (4.4% vs. 3.3%; HR 1.63, 95% CI 1.49–1.79), sepsis (12.8% vs. 11.1%; HR 1.44, 95% CI 1.37–1.52), and bacteremia (5.2% vs. 4.4%; HR 1.46, 95% CI 1.35–1.59) (all p < 0.001). Empyema and ARDS were also numerically lower among GLP-1 users, while ventilator-associated pneumonia and lung abscess were rare and similar between groups. No patients required percutaneous endoscopic gastrostomy or nasal enteral feeding. Conclusions: In patients with diabetes and gastroparesis, GLP-1 RA therapy was associated with significantly fewer pulmonary and systemic infectious complications. These data suggest that the systemic benefits of GLP-1 RAs may outweigh concerns regarding delayed gastric emptying in this high-risk population. Full article

Background/Objectives: Coronary bifurcation lesions (CBLs) are common, and the treatments remain nuanced. Side branch (SB) patency is a key determinant of clinical success in CBL intervention. In this paper, data exploring the routine use of drug-coated balloons (DCBs) in the SB is presented as an alternative to standard plain old balloon angioplasty (POBA). Methods: A meta-analysis was performed comparing DCBs in the SB to POBA after drug-eluting stent (DES) implantation in the main vessel (MV) of a true CBL. Outcomes including myocardial infarction (MI), target lesion revascularisation (TLR), cardiac death, and late lumen loss (LLL) up to 1 year post-procedure are reported. Results: Six studies comprising of 1982 patients were included in the analyses. Patients were predominantly male, and the mean age was >60 years. Four studies included patients with acute coronary syndrome. The primary outcomes were a statistically significant reduction in MI rate (OR 0.38, 95% CI 0.19–0.76, p = 0.006), and in the TLR rate (OR 0.45, 95% CI 0.23–0.87, p = 0.02) in the DCB group compared to the control. There was no significant difference in cardiac death. Furthermore, there was a significant reduction in SB LLL in the DCB group (Mean difference −0.22mm, 95% CI −0.33–−0.11mm, p = 0.0001). Conclusions: Following DES implantation in the MV of a true CBL, this analysis demonstrated that DCBs in the SB is superior to POBA in reducing MI, TLR, and LLL of the SB. Large, randomized trials are required to consolidate the role of DCB in the treatment of CBL. Full article

For nearly two decades, 12 months of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) has been the standard recommendation. Recent evidence suggests that abbreviated DAPT durations may reduce bleeding without compromising ischemic protection in selected patients. This review synthesizes randomized controlled trials, meta-analyses, and guideline updates published between 2023 and 2025, evaluating abbreviated DAPT strategies after ACS with percutaneous coronary intervention. Immediate aspirin withdrawal after PCI increased early stent thrombosis in NEO-MINDSET and STOPDAPT-3. One-month DAPT followed by ticagrelor monotherapy reduced bleeding without increasing ischemic events in ULTIMATE-DAPT and T-PASS. Three-month strategies demonstrated the most consistent safety profile, with TWILIGHT showing 50% bleeding reduction without increased death, myocardial infarction, or stroke (noting that TWILIGHT included 35% chronic coronary syndrome patients). Clopidogrel monotherapy after abbreviated DAPT increased myocardial infarction in STOPDAPT-2 ACS, highlighting the importance of potent P2Y12 inhibition. Meta-analyses confirmed bleeding reductions with early P2Y12 inhibitor monotherapy across broader populations, though benefits were more pronounced in East Asian cohorts. Abbreviated DAPT strategies offer personalized alternatives to standard 12-month therapy. Three-month DAPT followed by ticagrelor monotherapy represents a reasonable and evidence-supported strategy in selected patients with ACS. Risk stratification tools and individual patient factors should guide therapy duration decisions. Full article

Malignant biliary obstruction is commonly treated with biliary stenting either endoscopically or percutaneously; however, tumor ingrowth might occlude the stent, often leading to recurrent jaundice and repeat interventions. Endobiliary microwave ablation (MWA) is an emerging adjunct intended to devitalize intraductal tumors and potentially prolong stent patency. This review assesses the state of the art of endobiliary ablation for malignant biliary obstruction, focusing on the technique and safety of percutaneous procedures, as well as patient outcomes. It also discusses the use of flexible endobiliary MWA for hilar cholangiocarcinoma. The review covers ablation methods such as radiofrequency and MWA, which can be performed endoscopically or percutaneously. Research indicates that endobiliary thermal ablation is technically feasible and can be safely combined with stenting. Some studies suggest it may prolong stent patency and decrease the necessity for repeat procedures compared with stenting alone. Percutaneous techniques may be particularly helpful in complex hilar cases, allowing accurate energy delivery, protection of secondary bile ducts, and tailored stent placement. New microwave systems can heat tissue more deeply and evenly than radiofrequency ablation, which may improve local tumor control. Endobiliary thermal ablation appears to be a useful supplement to stenting, especially for patients with unresectable hilar cholangiocarcinoma. Flexible percutaneous MWA probes could make this treatment more widely available. Still, more high-quality studies are needed to find optimal ablation settings, identify which patients benefit most, and compare this method with standard stenting. Full article

Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral amyloid angiopathy (CAA), or neuroimaging markers of cerebral small vessel disease (SVD). Left atrial appendage occlusion (LAAO) has emerged as an alternative stroke prevention strategy for patients with contraindications to anticoagulation; however, optimal patient selection and post-procedural antithrombotic management remain uncertain, largely because existing bleeding risk scores inadequately capture ICH risk. Most hemorrhagic risk scores were designed to estimate systemic bleeding and demonstrate limited ability to predict ICH, as they do not incorporate hemorrhage etiology or neuroimaging features. Importantly, ICH recurrence risk varies substantially by subtype, with the highest risk observed in CAA-related hemorrhage, the lowest in hypertensive SVD, and intermediate risk in mixed or secondary etiologies. These distinctions have direct implications for anticoagulation decisions and consideration of LAAO. Finally, we synthesize contemporary evidence on ICH risk stratification, neuroimaging biomarkers, and antithrombotic strategies following LAAO. We propose a multidisciplinary, evidence-based decision-making framework integrating clinical risk scores, neuroimaging findings, and hemorrhage phenotype to support individualized stroke prevention strategies in high-risk patients with AF. Full article

Background/Objectives: Contrast-associated acute kidney injury (CA-AKI) remains an important cause of morbidity and mortality in patients undergoing procedures that require intravascular contrast administration. Therefore, the early identification of high-risk individuals is paramount, above all for ST-segment elevation myocardial infarction (STEMI) patients in need of urgent percutaneous coronary intervention (PCI). Methods: This retrospective study evaluated the prognostic value of the Pan-Immune-Inflammation Value (PIV), a composite inflammatory index, in predicting CA-AKI among patients presenting with STEMI who received urgent PCI within a 12 h window from the onset of symptoms. Results: This study recruited 2325 patient. CA-AKI was defined as a >25% or ≥0.5 mg/dL increase in serum creatinine within 48–72 h after the procedure. Patients were categorized into CA-AKI (+) and CA-AKI (−) groups. PIV levels were significantly higher in patients who developed CA-AKI (502.5 ± 324.5 vs. 264.7 ± 165.8; p < 0.001). ROC analysis identified a PIV cutoff value of >320, yielding an AUC of 0.753 (95% CI: 0.740–0.787; p < 0.001), with 67% sensitivity and 66.9% specificity. Multivariate logistic regression confirmed that PIV > 320 independently predicted CA-AKI (OR 2.118; 95% CI: 1.329–3.790; p < 0.001). In multivariable analysis, age, Killip class, contrast volume, and PIV > 320 were identified as independent predictors of CA-AKI. Conclusions: Elevated admission PIV serves as an independent and practical biomarker for predicting CA-AKI in STEMI patients undergoing PCI. Full article

Background: Red blood cell distribution width (RDW) is an accessible prognostic biomarker in cardiovascular disease, but its independent association with clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) remains incompletely characterized, particularly regarding its prognostic value independent of anemia status. Methods: Using the TriNetX US Collaborative Network (70 healthcare organizations; >105 million patients), we identified 84,811 adult AMI patients who underwent PCI between January 2019 and December 2023 and had RDW measured on the index date. Patients were stratified by RDW ≥ 13.5% (high) versus <13.5% (low) and matched 1:1 using propensity scores based on 38 baseline characteristics. The primary outcome was 1-year all-cause mortality, assessed using a 30-day landmark approach. Secondary outcomes included major adverse cardiovascular events (MACE), heart failure, cardiogenic shock, recurrent AMI, cerebrovascular accident, ventricular tachycardia/fibrillation, and cardiac arrhythmia. Results: After matching (32,010 pairs), high RDW was significantly associated with increased 1-year all-cause mortality (HR 1.77, 95% CI 1.62–1.93, p < 0.001). High RDW was also associated with greater risks of MACE (HR 1.12), heart failure (HR 1.24), cardiogenic shock (HR 1.26), recurrent AMI (HR 1.11), cerebrovascular accident (HR 1.16), and cardiac arrhythmia (HR 1.14; all p < 0.01). Findings remained consistent across serial sensitivity analyses and subgroup analyses. Among non-anemic patients, high RDW remained strongly associated with mortality (HR 1.67, 95% CI 1.50–1.85, p < 0.001). Conclusions: Elevated RDW at the time of AMI is independently associated with mortality and adverse cardiovascular outcomes after PCI, including among non-anemic patients. RDW may serve as a readily available tool to support early risk stratification in this population. Full article

Background: Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), has been associated with elevated cardiovascular risks. However, the impact of IBD on outcomes following percutaneous coronary intervention (PCI) remains underexplored. We aimed to evaluate the clinical and procedural outcomes of PCI in patients with concurrent IBD. Methods: This study utilized the National Readmission Database from 2016 to 2020 to evaluate outcomes such as all-cause mortality and post-PCI complications, including various cardiovascular and gastrointestinal (GI) complications in IBD patients undergoing PCI. Patients with concurrent IBD and PCI were compared to non-IBD controls via multivariable logistic regression. Results: On propensity-score-matching analysis, IBD patients undergoing PCI had a higher prevalence of GI complications, including acute liver failure (Odds ratio (OR) 1.48, 95% confidence interval (CI) 1.13–1.93, p = 0.004), mesenteric ischemia (OR 5.34, 95% CI 1.56–18.40, p = 0.007), and need for blood transfusion (OR 1.74, 95% CI 1.46–2.08, p < 0.001). There was also a higher rate of cardiac complications (OR 1.31, 95% CI 1.05–1.64, p = 0.017). No significant difference in all-cause mortality (OR 0.86, 95% CI 0.72–1.04, p = 0.113) was observed. Conclusions: IBD patients undergoing PCI face increased GI and cardiovascular complications without a significant mortality difference. These findings highlight the complex interplay between systemic inflammation, vascular integrity, and procedural outcomes in IBD patients. Full article

Background: Theoretical frameworks are essential for understanding and predicting medication adherence behaviours. The Theory of Planned Behaviour (TPB) posits that behavioural intentions, shaped by attitudes, subjective norms, and perceived behavioural control, are the proximal determinants of behaviour. This cross-sectional study examined associations between TPB constructs and antiplatelet medication adherence among Saudi patients following percutaneous coronary intervention (PCI). Methods: A cross-sectional survey was conducted among 236 Saudi adults post-PCI at two tertiary cardiac centres in Riyadh. TPB constructs (attitude, subjective norms, perceived behavioural control, intention) were assessed using a validated questionnaire. Adherence was measured via the Morisky Medication Adherence Scale-8 (MMAS-8). Hierarchical multiple regression examined associations between TPB constructs and adherence, controlling for demographic and clinical variables. Results: The results demonstrated significant associations with adherence. In the final regression model, intention (β = 0.273, p < 0.001), perceived behavioural control (β = 0.189, p = 0.007), and subjective norms (β = 0.142, p = 0.038) were significantly associated with adherence. Attitude was not significantly associated (β = 0.087, p = 0.194). The TPB constructs explained an additional 18.7% of variance in adherence beyond demographic and clinical factors. Conclusions: The TPB provides a useful framework for understanding antiplatelet adherence patterns in Saudi post-PCI patients. These findings suggest that interventions addressing behavioural intentions, perceived control over medication-taking, and normative influences from significant others may potentially enhance adherence outcomes. Theory-informed nurse-led interventions incorporating strategies such as implementation intentions and family involvement are recommended. Full article

Echocardiographic assessment is essential for evaluating patients with cardiogenic shock (CS) and determining their potential need for mechanical circulatory support (MCS) implantation. The use of Impella devices has increased significantly in recent years, paralleling the growing recognition of their hemodynamic benefits in selected patient populations. As the clinical experience with these devices has expanded, the need for a more standardized imaging approach has emerged. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) play complementary roles in guiding the pre-implantation evaluation, placement procedure, and post-implantation management of Impella devices. Currently, no comprehensive guidelines exist concerning the echocardiographic evaluation of Impella devices throughout their entire clinical course, from initial patient selection and device implantation to ongoing monitoring and eventual weaning. This gap in standardized guidance has led to significant variability in clinical practice across different institutions and healthcare systems. This comprehensive review examines the role of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in managing patients on Impella support across five distinct phases: candidate identification and pre-implantation assessment, intraoperative procedural guidance and device positioning, postoperative monitoring and haemodynamic optimisation, complication detection and troubleshooting, and weaning strategies with post-explantation surveillance. Both left-sided devices (Impella CP, CP Smart Assist, and Impella 5.5) and right-sided support (Impella RP) are covered, including combined configurations with VA-ECMO (ECPella). For each phase, we detail the recommended echocardiographic views, essential measurements and their evidence-based thresholds, signs of device malposition, and practical corrective strategies. A level-of-evidence approach is adopted throughout, specifying whether proposed thresholds derive from randomised trials, observational studies, expert consensus, or manufacturer recommendations. Summary tables and a bedside workflow are provided to facilitate immediate clinical application. Full article

Mechanical complications after acute myocardial infarction (MI)—ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR)—have become uncommon in the primary percutaneous coronary intervention (PCI) era, yet remain among the most lethal cardiovascular emergencies, with contemporary mortality largely driven by cardiogenic shock and delays to definitive treatment. Although major society documents agree on urgent imaging, early mechanical circulatory support when shock is present, and multidisciplinary decision-making, important transatlantic differences persist, particularly regarding timing of intervention in ventricular septal rupture. This review synthesises current surgical and transcatheter evidence and proposes a unified, physiology-centred framework integrating shock staging, anatomical feasibility, and response to mechanical support. We also introduce STABLE, a structured bedside checklist designed to support consistent daily triage across all three lesions and to align timing decisions with haemodynamic stabilisation rather than centre-specific habit. Full article

Interventional treatment of very elderly patients with severe coronary artery disease is currently one of the central topics in interventional cardiology. Technological progress and increased life expectancy have made these patients appropriate candidates for contemporary standards of care, especially those with an active lifestyle. We hereby report the case of a 95-year-old patient hospitalized for acute myocardial infarction, who underwent a complex percutaneous coronary intervention with mechanical circulatory support. A literature review on mechanical circulatory support devices in older adults is also provided. Full article

Background: Although survival in coronary artery disease (CAD) has improved with modern therapies, quality of life (QoL) remains an important clinical concern. Our study aimed to evaluate QoL, life satisfaction, and disease acceptance in CAD patients and to identify their clinical and lifestyle determinants. Methods: This single-center, prospective study included patients undergoing percutaneous coronary intervention for myocardial infarction (MI) or chronic coronary syndrome (CCS). QoL was assessed using validated questionnaires (WHOQOL-BREF, SWLS, AIS). Comparative analyses between the MI and CCS groups were performed, and the determinants of the outcomes were evaluated using regression models. Results: The study included 220 patients (110 MI and 110 CCS) with a median age of 64 years (IQR 54–70); 30% were women. The WHOQOL-BREF-assessed QoL was comparable between MI and CCS patients, whereas MI patients reported higher life satisfaction (SWLS 24 vs. 20, p = 0.003). Smoking was the strongest determinant of poorer QoL, associated with lower SWLS (β = −2.75; p < 0.001) and WHOQOL-BREF (β = −4.46; p = 0.014). Alcohol consumption (β = −6.22; p = 0.008), hypertension (β = −7.10; p < 0.001), and chronic obstructive pulmonary disease (β = −9.84; p < 0.001) were also independently associated with lower WHOQOL-BREF scores. Subgroup analyses showed heterogeneity between MI and CCS patients. Conclusions: QoL in CAD patients might be influenced more by lifestyle factors and multimorbidity than by CAD phenotype. Smoking, alcohol, and cardiopulmonary comorbidities might have the most consistent adverse associations with QoL. These findings highlight the potential importance of integrating lifestyle and comorbidity management to improve QoL and patient-reported outcomes in CAD care. Full article

Background and Clinical Significance: Polycythemia vera is a myeloproliferative neoplasm associated with a high thrombotic risk. Although this association is well recognized, acute coronary syndrome as the initial manifestation of polycythemia vera is rare. Case Presentation: We report the case of a previously healthy 57-year-old male with no conventional cardiovascular risk factors who presented with an anterior ST-elevation myocardial infarction. Coronary angiography revealed a subocclusive lesion in the left anterior descending artery, which was successfully treated with primary percutaneous coronary intervention. Initial laboratory testing showed markedly elevated hemoglobin (209 g/L) and hematocrit (64.9%), together with thrombocytosis (438 × 10⁹/L). In the absence of conventional risk factors, the combination of a single-vessel coronary lesion and marked hematologic abnormalities raised suspicion for polycythemia vera as a major contributor to coronary thrombosis. Subsequent work-up confirmed polycythemia vera based on the presence of a JAK2 V617F mutation and suppressed erythropoietin levels. The patient underwent therapeutic phlebotomy shortly after angioplasty and was subsequently started on hydroxyurea to maintain a hematocrit below 45%, together with dual antiplatelet therapy. Conclusions: This case highlights acute myocardial infarction as a rare initial presentation of polycythemia vera. It underscores the importance of considering polycythemia vera in patients presenting with acute coronary syndrome and unexplained erythrocytosis, while acknowledging that, in the absence of intracoronary imaging, a definitive causal link between PV and the coronary event cannot be established. Full article