Cancer has a non-negligible prevalence in patients with acute coronary syndrome undergoing percutaneous coronary intervention, with a major risk of cardiovascular events and bleedings. Moreover, these patients are often undertreated from clinical despite medical therapy seems to be protective. Registration:The BleeMACS project (NCT02466854).

Introduction The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.

Different vascular devices for closure of femoral access did not results superior to manual compression to reduce complications, whereas offered a shorted time to hemostasis. StarClose was the device with the highest probability to perform best in terms of complication, whereas Angioseal was superior in terms of reduction of time to hemostasis.

In the last years, the intravascular ultrasound study (IVUS) and further the optical coherence tomography (OCT) became two helpful tools to characterize of the atherosclerotic plaque.These new technologies made possible to analyse in vivo the pathophysiologic mechanisms that previously were just speculated or observed post-mortem (1). Recently Dr. Higum and Prof. Jang published an interesting article named "A combined OCT and IVUS on plaque rupture, plaque erosion and calcified nodule in patients with STEMI", useful to describe the different presentation of culprit lesions in STelevation myocardial infarction (2).In this paper the authors describe the findings about 112 STEMI patients who underwent to OCT and IVUS. Incidence of plaque rupture (PR) was 64.3%, plaque erosion (PE) 26.8% and calcified nodule (CN) 8%. The highlight hallmarks of PR were a higher lipid content inside the plaque, major thin-cap fibroatheroma (TCFA) and more numerous microchannels, with a trend toward a positive remodelling of plaque. PE showed less "vulnerable" morphology of plaque because of lower degree of TCFA, lipid content of plaque and microchannels. The structure of lesion with PE was more eccentric than PR and this was observed better through IVUS rather than OCT. CN lesions demonstrated higher amount of calcium compared to the other lesions, arranged like a "calcium sheet" along with negative remodelling of plaque. After primary Percutaneous Coronary Intervention (PCI) PR was associated with higher rate of myocardial blush grade ≤1 and consequently with a larger incidence of no reflow because of elevated thrombogenic burden enhancing in situ-thrombosis and distal embolization, confirmed by the higher creatinine kinase (CK) peak in PR lesions respect to the others kinds.The population was rather homogeneous, apart from difference in ages. Patients with CN were of older age with a larger significative incidence of diabetes mellitus, that was a factor causing increased degree of vessel calcification as already shown in different setting of patients (3). Unfortunately, the incidence of another factor of progressive and widespread calcification like chronic kidney disease (CKD) wasn't reported.Patients with culprit lesions characterized by PE were younger that those with PR, without relationship with gender. However, OCT and IVUS have showed some discrepancy due to its unclear definition and morphological criteria, so much that it in this study was just considered as a diagnosis of exclusion (4).The results of this study confirmed the prevalence of PR in patients with STEMI and the elevated incidence of TCFA as risk factor of evolution toward myocardial infarction. A meta-analysis recently published by of our group (5) including 23 studies and 2,711 culprit lesions attested that at the observation through OCT the presence of PR and TCFA at 70.4% and 76.6% respectively, in STEMI patients (Figure 1). On the other side, in the others subsets of coronary artery disease the incidence of both these parameters resulted to be less importan...