European Heart Journal

Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

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The year in cardiovascular medicine 2020: interventional cardiology

Fernando Alfonso, Nieves Gonzalo, Fernando Rivero, Javier Escaned

doi : 10.1093/eurheartj/ehaa1096

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 985–1003

The year in coronary interventions. ACS, acute coronary syndrome; CCS, chronic coronary syndrome; COVID-19: coronavirus disease-19; DEB, drug-eluting balloon; DAPT, dual antiplatelet therapy; ISR, in-stent restenosis.

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Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

Kei Woldendorp, Ben Indja, Paul G Bannon, Jonathon P Fanning, Brian T Plunkett

doi : 10.1093/eurheartj/ehab002

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 1004–1015

Silent brain infarcts (SBIs) are frequently identified after transcatheter aortic valve implantation (TAVI), when patients are screened with diffusion-weighted magnetic resonance imaging (DW-MRI). Outside the cardiac literature, SBIs have been correlated with progressive cognitive dysfunction; however, their prognostic utility after TAVI remains uncertain. This study’s main goals were to explore (i) the incidence of and potential risk factors for SBI after TAVI; and (ii) the effect of SBI on early post-procedural cognitive dysfunction (PCD).

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Silent brain infarction after TAVR: common but of unclear significance

Grant W Reed, Amar Krishnaswamy, Samir R Kapadia

doi : 10.1093/eurheartj/ehaa1110

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 1016–1018

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Percutaneous coronary intervention in patients with cancer and readmissions within 90 days for acute myocardial infarction and bleeding in the USA

Chun Shing Kwok, Chun Wai Wong, Evangelos Kontopantelis, Ana Barac, Sherry-Ann Brown

doi : 10.1093/eurheartj/ehaa1032

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 1019–1034

The post-discharge outcomes of patients with cancer who undergo PCI are not well understood. This study evaluates the rates of readmissions within 90?days for acute myocardial infarction (AMI) and bleeding among patients with cancer who undergo percutaneous coronary intervention (PCI).

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Ischaemic and bleeding risk in cancer patients undergoing PCI: another brick in the wall

Giancarlo Marenzi, Nicola Cosentino, Daniela Cardinale

doi : 10.1093/eurheartj/ehaa1109

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 1035–1037

Issues to consider in the evaluation of post-discharge ischaemic and bleeding risk in cancer patients undergoing percutaneous coronary intervention (PCI) and possible therapeutic implications. ACS, acute coronary syndrome; ASA, acetylsalicylic acid; DAPT, dual antiplatelet therapy; TAT, triple antithrombotic therapy. *Factors to consider in cancer patients in addition to those suggested by the international guidelines for all patients undergoing PCI.

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Patient-tailored antithrombotic therapy following percutaneous coronary intervention

Niels M R van der Sangen, Rik Rozemeijer, Dean R P P Chan Pin Yin, Marco Valgimigli, Stephan Windecker

doi : 10.1093/eurheartj/ehaa1097

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 1038–1046

Dual antiplatelet therapy has long been the standard of care in preventing coronary and cerebrovascular thrombotic events in patients with chronic coronary syndrome and acute coronary syndrome undergoing percutaneous coronary intervention, but choosing the optimal treatment duration and composition has become a major challenge. Numerous studies have shown that certain patients benefit from either shortened or extended treatment duration. Furthermore, trials evaluating novel antithrombotic strategies, such as P2Y12 inhibitor monotherapy, low-dose factor Xa inhibitors on top of antiplatelet therapy, and platelet function- or genotype-guided (de-)escalation of treatment, have shown promising results. Current guidelines recommend risk stratification for tailoring treatment duration and composition. Although several risk stratification methods evaluating ischaemic and bleeding risk are available to clinicians, such as the use of risk scores, platelet function testing , and genotyping, risk stratification has not been broadly adopted in clinical practice. Multiple risk scores have been developed to determine the optimal treatment duration, but external validation studies have yielded conflicting results in terms of calibration and discrimination and there is limited evidence that their adoption improves clinical outcomes. Likewise, platelet function testing and genotyping can provide useful prognostic insights, but trials evaluating treatment strategies guided by these stratification methods have produced mixed results. This review critically appraises the currently available antithrombotic strategies and provides a viewpoint on the use of different risk stratification methods alongside clinical judgement in current clinical practice.

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Association between device-related thrombus and the neo-appendage with left-atrial appendage occlusion devices

Hashrul N Rashid, Jamie Layland

doi : 10.1093/eurheartj/ehaa803

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Pages 1047–1048

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Left atrial appendage occlusion and device-related thrombus: keeping a lid on it

David Hildick-Smith, the Amplatzer Amulet Global Observational Study Investigators

doi : 10.1093/eurheartj/ehaa806

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Page 1049

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Late device-related thrombus after left atrial appendage closure: never let your guard down

Xavier Iriart, Alexandre Metras, Alain Coiffic, Jean-Benoit Thambo

doi : 10.1093/eurheartj/ehaa907

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Page 1050

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Chimney technique in a TAVR-in-TAVR procedure with high risk of left main artery ostium occlusion

Alain Dibie, Quentin Landolff, Aurélie Veugeois, Nicolas Amabile

doi : 10.1093/eurheartj/ehaa817

European Heart Journal, Volume 42, Issue 10, 7 March 2021, Page 1051

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