AIMS:This study aims to assess pharmacological treatment patterns and outcomes according to the coexistence of heart failure (HF) and Type 2 diabetes (T2DM). METHODS AND RESULTS:Two cohorts were derived: HF patients with/without T2DM and T2DM patients with/without HF, by linking the Swedish HF Registry, the National Diabetes Registry, and other national registries in 2017-2021. In 37 903 patients with HF (35% females, median age 74), T2DM was independently associated with a 10-fold higher use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and less likely use of mineralocorticoid receptor antagonists (MRAs) irrespective of ejection fraction (EF), and of renin-angiotensin inhibitors (RASis)/angiotensin receptor-neprilysin inhibitors (ARNis) in HF with reduced and mildly reduced EF. Over a median follow-up of 1.8 years, T2DM was independently associated with higher risk of first HF hospitalization (HHF)/cardiovascular (CV) death, first HHF, and all-cause death, but not with CV death alone. In 16 266 patients with T2DM (29% females, median age 76), HF was independently associated with more likely use of SGLT2i but less likely use of metformin. Over a median follow-up of 2.2 years, HF was independently associated with higher risk of CV death, all-cause death, and myocardial infarction. CONCLUSION:In HF, T2DM was associated with higher use of SGLT2i and lower use of MRA and RASi/ARNI despite being linked with a higher risk of death and HHF. In T2DM, presence of HF was linked with higher SGLT2i use and an independent higher risk of death and myocardial infarction. Heart failure was associated with comparatively greater risk increase than T2DM.

Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.

AIMSPatients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment.METHODS AND RESULTSWe assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients with ACS enrolled in the prospective, multicentre, nationwide EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) registry. Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P < 0.0001 and 50 vs. 33, P < 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively).CONCLUSIONAlmost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did.CLINICAL TRIAL REGISTRATIONUnique identifier: NCT02015624, http://www.clinicaltrials.gov.

Background: Several new antithrombotic therapies have emerged for the treatment of acute coronary syndrome (ACS). We sought to assess contemporary patterns of antithrombotic therapies use in patients with ACS. Methods and results: EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in patients admitted to intensive cardiac care units (CCUs) for an ACS in Italy. Over a three-week period, 203 CCUs enrolled 2585 consecutive patients: 41.2% with ST-elevation myocardial infarction (STEMI) and 58.8% with non-ST elevation ACS (NSTE-ACS). During hospitalisation, low-molecular-weight heparins, aspirin, and clopidogrel were the most commonly used antithrombotic therapies. Among patients treated with percutaneous coronary intervention (PCI, n=1755), any crossover of heparin therapy occurred in 30.8% of cases, while switching from one P2Y12 inhibitor to another occurred in 3.6% of cases in the CathLab and in 14.2% before discharge. Of the 790 patients who did not receive revascularisation, switching of a P2Y12 inhibitor occurred in 5.7% of cases. At discharge, a new P2Y12 inhibitor (ticagrelor or prasugrel) in association with aspirin was prescribed in 59.5% of STEMI and 33.9% of NSTE-ACS patients: the most powerful predictor for prescription was PCI (odds ratio (OR) 6.18; 95% confidence interval (CI) 4.76–8.01; p<0.0001), whereas age ≥75 years was strongly associated with clopidogrel use (OR 0.28; 95% CI 0.22–0.36; p<0.0001). Conclusions: The EYESHOT registry shows the current pattern of antithrombotic treatments for ACS patients admitted to Italian CCUs and provides insights which may help to improve the clinical care of such patients.

In this paper we describe an experience of multi UAS civil mission management derived from our participation to the Industrial Research Project SMAT-F1, which focused on UAV missions for monitoring the territory for civil purposes. After describing the operational framework and the system architecture, we present in some detail the computer-supported design of a Mission Plan. The main focus of the article is on the flight experience made; in particular, we discuss the capabilities of the system to supply clear situation comprehension to the operators, the operation coordination issues and the operational results achieved during the mission. Finally, future extensions of mission planning support capabilities are discussed.

Background - Volume supplementation by saline infusion combined with N-acetylcysteine (NAC) represents an effective strategy to prevent contrast agent - induced nephrotoxicity (CIN). Preliminary data support the concept that sodium bicarbonate and ascorbic acid also may be effective in preventing CIN.Methods and Results - Three hundred twenty-six consecutive patients with chronic kidney disease, referred to our institutions for coronary and/or peripheral procedures, were randomly assigned to prophylactic administration of 0.9% saline infusion plus NAC (n = 111), sodium bicarbonate infusion plus NAC (n = 108), and 0.9% saline plus ascorbic acid plus NAC (n = 107). All enrolled patients had serum creatinine >= 2.0 mg/dL and/or estimated glomerular filtration rate < 40 mL center dot min(-1) center dot 1.73 m(-2). Contrast nephropathy risk score was calculated in each patient. In all cases, iodixanol (an iso-osmolar, nonionic contrast agent) was administered. The primary end point was an increase of >= 25% in the creatinine concentration 48 hours after the procedure (CIN). The amount of contrast media administered (179 +/- 102, 169 +/- 92, and 169 +/- 94 mL, respectively; P = 0.69) and risk scores (9.1 +/- 3.4, 9.5 +/- 3.6, and 9.3 +/- 3.6; P = 0.21) were similar in the 3 groups. CIN occurred in 11 of 111 patients (9.9%) in the saline plus NAC group, in 2 of 108 (1.9%) in the bicarbonate plus NAC group (P = 0.019 by Fisher exact test versus saline plus NAC group), and in 11 of 107 (10.3%) in the saline plus ascorbic acid plus NAC group (P = 1.00 versus saline plus NAC group).Conclusions - The strategy of volume supplementation by sodium bicarbonate plus NAC seems to be superior to the combination of normal saline with NAC alone or with the addition of ascorbic acid in preventing CIN in patients at medium to high risk.

BACKGROUND Recent data support that iodixanol, an iso-osmolality contrast agent, is less nephrotoxic than low-osmolality contrast agents when hydration is the only prophylactic strategy used. We evaluated the nephrotoxicity of iso- and low-osmolality contrast agents with prophylactic administration of N-acetylcysteine (NAC) along with hydration. METHODS Two hundred and twenty-five patients with chronic renal insufficiency (serum creatinine >1.5 mg/dL or an estimated glomerular filtration rate <60 mL/min/1.73 m(2)), referred to our institution for coronary and/or peripheral procedures, were assigned to receive low-osmolality (iobitridol group; N = 115) or iso-osmolality (iodixanol group; N = 110) contrast dye. In all cases prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. RESULTS Baseline creatinine levels were similar in the 2 groups [iobitridol group = 1.70 (IQR: 1.54-1.98) mg/dL; iodixanol group = 1.73 (IQR: 1.56-2.00) mg/dL, P = 0.33]. The risk score for contrast nephrotoxicity was 5.0 +/- 1.6 in the iobitridol group versus 5.0 +/- 1.8 in the iodixanol group (P = 0.44). Increase of at least 0.5 mg/dL of the creatinine concentration 48 hours after the procedure occurred in 4/115 patients (3.5%) in the iobitridol group and 3/110 patients (2.7%) in the iodixanol group (P = 1.00; OR 0.78; 95% CI 0.17-3.56). Amount of contrast media administration was similar in the 2 groups (iobitridol group = 167 +/- 90 mL; iodixanol group = 164 +/- 82 mL; P = 0.61). CONCLUSION Nephrotoxicity of iso-osmolality and low-osmolality contrast agents was similar when a prophylactic strategy of hydration plus NAC was utilized.

Diagnostic angiography is a routine diagnostic procedure in modern day cardiological practice. However, there are potential life threatening complications which can occasionally occur. We describe one such complication and detail the management and clinical outcome.

Clinical outcome after percutaneous coronary intervention (PCI) is significantly worse in diabetic patients in comparison to nondiabetic patients. The subset of diabetic patients in the ARTS trial treated with multivessel stenting had the lowest 1-year event-free survival. We examined our experience of multivessel PCI in diabetics to assess clinical outcome outside clinical trials and to determine if repeat revascularizations are the result of restenosis or the progression of nontreated disease. Between January 2000 and December 2001, we performed multivessel PCI in 99 diabetic patients. Our group was well matched with those in the ARTS trial, with mean age of 69+/-8 years, male sex 70%, hypertension 68%, hypercholesterolemia 51%, and mean LV ejection fraction 60%. The mean number of diseased segments treated was 2.8+/-0.9 and 56% of the patients had three-vessel disease. There were 2.3+/-0.6 stents implanted per patient. Target vessels included the LAD in 90%, LCx in 77%, and the RCA in 87% of cases. The in-hospital MACE rate was 8%, which included eight nonfatal MI but no deaths or repeat revascularizations. After a mean follow-up of 14+/-8 months, there were 4 deaths (4%), no further MIs, and 21 (21%) repeat revascularizations (2 CABG; 19 PCI), giving a 1-year event-free survival of 67%. There were 18 repeat revascularizations (2 CABG; 16 PCI) for restenosis, but in 9 of the 18 (50%) patients treatment was also required for progression of disease. Three further patients had PCI for symptomatic disease progression without restenosis. Thus, disease progression contributed to 57% of repeat revascularization procedures. The medium- and longer-term success of multivessel PCI in diabetic patients is limited principally by the need for repeat revascularization. However, it is important to realize that these revascularizations are performed not only for restenosis but also for disease progression in more than 50% of patients. Consequently, even if drug-eluting stent technology can eliminate restenosis, disease progression will continue to impact the clinical outcome of diabetic patients after PCI.

Coronary artery perforation is a life-threatening complication of percutaneous interventional procedures.' Angiographic evidence for perforation has been reported in 0.1% of patients treated with percutaneous transluminal coronary angioplasty alone. The incidence of this complication increases to 0.5% to 3.0% in treating more complex lesion subsets with more aggressive interventional techniques, including rotational atherectomy, directional coronary atherectomy, and excimer laser coronary angioplasty. Surgical intervention has been required in a high proportion of cases because of persistent coronary leak or ongoing ischemia. The premounted polytetrafluoroethylene (PTFE)-covered stent offers the potential for rapid percutaneous sealing of coronary perforations and offers a realistic alternative to high-risk emergency coronary surgery. We outline our experience using this new device to treat this potentially catastrophic complication of percutaneous intervention.