Amyloidosis is an important cause of infiltrative cardiomyopathy and is often diagnosed lately in the course of the disease; radiolabeled bisphosphonates bone scan is highly sensitive in detecting transthyretin (TTR) cardiac amyloidosis; data on the true prevalence of cardiac involvement in TTR amyloidosis are lacking. The aim of the present retrospective observational, monocentric study was to estimate the prevalence of positive bone scan suspect for TTR cardiac amyloidosis in the population of Piedmont -a region in the north-west of Italy -retrospectively assessing unexpected cardiac emissions in bone scan scintigraphy among an all-comers population who underwent a bone scan at San Luigi Gonzaga University Hospital between January 2015 and May 2020. ECG, echocardiography and clinical status of patients with positive cardiac emission have been collected in order to better characterize their clinical features.Background. Amyloidosis is a group of diseases characterized by deposition in human tissues of protein aggregates [1]. A subtype of amyloidosis is characterized by accumulation of transtyretin (TTR), either in its natural (wild type ATTR amyloidosis, ATTRwt) or mutated (hereditary ATTR amyloidosis, hATTR) form. In this disease TTR tetramer, mutated or natural with age, becomes instable and dissociates into single monomers [2]. Clinically, the disease causes heart failure, orthostatic hypotension, neurological and autonomic dysfunctions, renal insufficiency, carpal tunnel syndrome and lumbar spinal stenosis [3].

Background Obesity has been described as a protective factor in cardiovascular and other diseases being expressed as ‘obesity paradox’. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI). Methods We retrospectively collected data up to May 31 st , 2020. 3635 patients were divided into three groups of BMI (<25 kg/m 2 ; n = 1110, 25-30 kg/m 2 ; n = 1464, and >30 kg/m 2 ; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed. Results The rate of respiratory insufficiency was more recorded in BMI 25-30 kg/m 2 as compared to BMI < 25 kg/m 2 (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m 2 than BMI < 25 kg/m 2 , respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25-30 kg/m 2 and BMI > 30 kg/m 2 as compared to BMI < 25 kg/m 2 , respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25-30 kg/m 2 and BMI > 30 kg/m 2 as compared to BMI < 25 kg/m 2 , respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m 2 and BMI > 30 kg/m 2 did not impact the mortality rate (HR 1.15, 95% CI: 0.889-1.508; p = 0.27) (HR 1.15, 95% CI: 0.893-1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m 2 is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538-1.004; p = 0.05). Conclusions HOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.

Introduction. The risk of recurrent ischemia and bleeding after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) may vary during the firstyear of follow-up according to clinical presentation, medical and interventional strategies.Methods. BleeMACS and Renami are two multicenter registries enrolling patients with ACS treated with PCI and clopidogrel, prasugrel or ticagrelor. The average daily ischemic and bleeding risks (ADIR and ADBR) in the first year after PCI were the primary endpoints. The difference between ADBR and ADIR was calculated to estimate the potential excess of bleeding/ischemic events in a given period or specific subgroup.Results. 19,826 patients were included. Overall, in the first year after PCI the ADBR was 0.008085%, while ADIR was 0.008017% (p=0.886). In the first 2 weeks ADIR was higher than ADBR (p=0.013), especially in patients with STEMI or incomplete revascularization. ADIR continued to be, albeit non-significantly, greater than ADBR up to the 3 rd month, while ADBR became higher, although not significantly, afterwards. Patients with incomplete revascularization had an excess in ischemic risk (p=0.003), while non-STelevation-ACS patients (NSTE-ACS) and those on ticagrelor had an excess of bleeding (p=0.012 and p=0.022 respectively). Conclusions.In unselected ACS patients, ADIR and ADBR occurred at similar rates within 1 year after PCI. ADIR was greater than ADBR in the first 2 weeks, especially in STEMI patients and those with incomplete revascularization. In the first year ADIR was higher than ADBR in patients with incomplete revascularization, while ADBR was higher in NSTE-ACS patients and in those discharged on ticagrelor.

Gender-related differences in COVID-19 clinical presentation, disease progression, and mortality have not been adequately explored. We analyzed the clinical profile, presentation, treatments, and outcomes of patients according to gender in the HOPE-COVID-19 International Registry. Among 2,798 enrolled patients, 1,111 were women (39.7%). Male patients had a higher prevalence of cardiovascular risk factors and more comorbidities at baseline. After propensity score matching, 876 men and 876 women were selected. Male patients more often reported fever, whereas female patients more often reported vomiting, diarrhea, and hyposmia/anosmia. Laboratory tests in men presented alterations consistent with a more severe COVID-19 infection (eg, significantly higher C-reactive protein, troponin, transaminases, lymphocytopenia, thrombocytopenia, and ferritin). Systemic inflammatory response syndrome, bilateral pneumonia, respiratory insufficiency, and renal failure were significantly more frequent in men. Men more often required pronation, corticosteroids, and tocilizumab administration. A significantly higher 30-day mortality was observed in men vs women (23.4% vs 19.2%; P = .039). Trial Numbers: NCT04334291/EUPAS34399.

Limited data are available concerning differences in clinical outcomes of real-life patients treated with Ticagrelor and Prasugrel after PCI. Objective: To determine and compare efficacy and safety of Ticagrelor and Prasugrel in a real-word population. Design: RENAMI is a retrospective, observational registry. Data and outcomes of patients with acute coronary syndrome who underwent PCI and discharged with DAPT between January 2012 and January 2016 were included. The mean follow-up period was of 17±9 months. Setting: 11 university hospitals from 6 European countries participated. Participants: Consecutive patients with ACS discharged with DAPT after primary PCI were enrolled. After propensity-score matching there were no substantial differences in the baseline clinical and interventional features. Exposures: All patients were treated with acetylsalicylic acid plus prasugrel (10 mg o.d.) or plus ticagrelor (90 mg b.d.). Mean duration of DAPT was 12.04±3.4 for patients treated with prasugrel and 11.90±4.1 months for ticagrelor (p 0.47). Main outcomes and measures: Long-term NACE was the primary end-point, while MACEs the secondary ones, along with their single components. Subgroup analysis for freedom from NACE and MACE were performed according to length of DAPT and to clinical presentation (STEMI-ACS) vs (NSTEMI-ACS). Results: 4244 patients (1699 in ticagrelor and 2275 in prasugrel group) were enrolled. After propensity-score matching 1290 patients of each cohort were included in the analysis. At 12 months, the incidence of NACE was lower in prasugrel patients (5.3% vs. 8.5%, p 0.0001), as that of MACE (6.05% vs. 8.1%, p 0.001), mainly driven by a reduction