SummaryElderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coronary syndrome (ACS) (63.8%). Non-STEMI accounted for two-thirds of the myocardial infarctions. We found higher prevalences of previous coronary artery disease (CAD) (38%), other atherosclerotic diseases (20.4%), cardiac risk factors such as hypertension (84.3%), diabetes (49.1%), hyperlipidemia (50.9%), heart failure (42.6%), atrial fibrillation (AF) (25.0%), severe aortic stenosis (13.0%), severe mitral regurgitation (3.7%), and implantable devices (25.0%), and co-morbidities such as renal impairment (48.1%), COPD (12.0%), and previous stroke (6.5%). Three-vessel disease was present in 34.6% of the patients. The left anterior descending artery (LAD) was the most affected coronary artery (67.6%). Percutaneous coronary intervention (PCI), mostly with bare metal stents (BMS), was used to manage 54.6% of the patients, and it failed in 4 of the patients. Conservative treatment was used in 39.8% of the patients and 15.7% had no significant CAD.The incidences of vascular complications, such as bleeding (6.5%), bleeding in other organs (6.5%), blood transfusion (6.5%), in-hospital paroxysmal atrial fibrillation (7.4%), in-hospital successful reanimation (2.8%), complete heart block (5.6%), acute renal impairment (23.1%), associated infection (25.9%), cardiogenic shock (14.8%), and death (15.7%) were high.Considering the more extensive risk factors, CAD and co-morbidities, acute presentation and age per se, we believe that the reported higher rates of complications and mortality are still acceptable. (Int Heart J 2017; 58: 180-184)

The use of ICDs is associated with lower all-cause mortality in observational studies of CKD patients. CRT use was also associated with lower all-cause mortality in CKD patients in comparison to ICDs. A randomized controlled trial is required to definitively define the role of ICDs/CRTs in CKD patients.

Background:The notion that women have better cardiovascular (CV) outcome than men is consolidated by strong evidence. However whether or not this sexspecific protection persists also in the presence of hypertensive target organ damage such as left ventricular (LV) hypertrophy (LVH) is unclear. Purpose: Our objective was to assess whether the presence of LVH alters the outcome difference between men and women with treated arterial hypertension. Methods: Clinical, echocardiographic and outcome data from 5,395 women and 6,937 men free from prevalent CV disease from the prospective Campania Salute Network registry were used. Median follow-up was 49 months. LVH was identified from prognostically validated sex-specific cut-off values of LV mass index (47 g/m 2.7 for women and 50 g/m 2.7 for men). The impact of sex on incident major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation) was assessed in the presence or absence of LVH, using Cox regression analysis and reported as hazard rates (HR) and 95% confidence intervals (CI). Results: Women were older, more obese, had higher systolic blood pressure (BP), total and high density lipoprotein cholesterol, and lower diastolic BP, serum triglycerides and glomerular filtration rate compared to men (all p<0.01), while the prevalence of smoking did not differ. LVH was more prevalent in women than men (43.2 vs. 32.4%, p<0.001). Incident MACE occurred in 3.5% of men and 2.8% of women during follow-up (p=0.040). In Cox regression analysis among subjects without LVH, adjusting for baseline differences in CV risk factors, women without LVH had a 32% lower HR for MACE (95% CI 0.49-0.95), p=0.025) than men without LVH ( Conclusions:In hypertension, presence of LVH attenuates the sex difference in CV risk. ICD INDICATIONS IN 20172920 | BEDSIDE Implantable cardioverter/defibrillators for primary prevention in dilated cardiomyopathy post-DANISH: an updated meta-analysis and systematic review of randomized controlled trials Background: Sudden cardiac death (SCD) is frequent in patients with heart failure due to dilated cardiomyopathy (DCM). Implantable cardioverter/defibrillator (ICD) device therapy is currently used for primary prevention. However, publication of the DANISH trial has recently given reason for doubt, showing no significant improvement in all-cause mortality in comparison to contemporary medical therapy (MT). Purpose and methods: To reassess the value of ICD therapy in this setting, we performed a meta-analysis of all randomized controlled trials comparing ICD therapy to MT for primary prevention in DCM. The primary outcome was all-cause mortality, secondary analyses were performed on sudden cardiac death, cardiovascular death and non-cardiac death. Results: Five trials including a total of 2,992 patients were included in the pooled meta-analysis. Compared to medical treatment there was a significant mortality reduction with ICD device therapy (odds ratio (OR) 0.77, confidence interv...