401
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Bridgewater B. Almanac 2012: Adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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402
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Abstract
OPINION STATEMENT Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Percutaneous coronary intervention has been shown to be an effective treatment for angina pectoris, although it does not provide any prognostic benefit in stable patients. Drug-eluting stents (DES) have revolutionised the practice of interventional cardiology by permitting the percutaneous treatment of increasingly complex coronary artery lesions, which historically would have only been treated with surgery. There have been concerns with their long-term safety; however, the most recent large meta-analysis appears to suggest that these concerns are no longer a pertinent issue with the newest generation of stents. Consequently, DES are being used in complex patients and lesion types, and clinical data and guideline recommendations support this. New stent designs are also continually being developed, with the aim to further improve the safety profile of these devices. It must, however, be kept in mind that complacency following the impressive result from initial DES studies lead to, amongst others things, sub-optimal and careless stent deployment, and inappropriate patient selection, which may have ultimately contributed to the prior safety concerns. It is vital, therefore, that this is not repeated in light of the reassuring data, or with newer devices. Finally, as stent design improves, it is becoming increasingly difficult to identify meaningful and clinically relevant differences in stent performance without the requirement of a very large, expensive, randomised trial.
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403
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Federspiel JJ, Stearns SC, D'Arcy LP, Geissler KH, Beadles CA, Crespin DJ, Carey TS, Rossi JS, Sheridan BC. Resource use trajectories for aged medicare beneficiaries with complex coronary conditions. Health Serv Res 2013; 48:753-72. [PMID: 23347002 DOI: 10.1111/1475-6773.12028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use. DATA SOURCES Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003-2004. STUDY DESIGN This retrospective cohort study of 102,877 beneficiaries assessed survival, days in institutional settings, and Medicare payments for up to 6 years following receipt of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). METHODS A three-part estimator designed to provide robust estimates of a treatment's effect in the setting of mortality and censored follow-up was used. The estimator decomposes the treatment effect into effects attributable to survival differences versus treatment-related intensity of resource use. PRINCIPAL FINDINGS After adjustment, on average CABG recipients survived 23 days longer, spent an 11 additional days in institutional settings, and had cumulative Medicare payments that were $12,834 higher than PCI recipients. The majority of the differences in institutional days and payments were due to intensity rather than survival effects. CONCLUSIONS In this example, the survival benefit from CABG was modest and the resource implications were substantial, although further adjustments for treatment selection are needed.
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Affiliation(s)
- Jerome J Federspiel
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA
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404
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Update on ischemic heart disease and critical care cardiology. ACTA ACUST UNITED AC 2013; 66:198-204. [PMID: 24775454 DOI: 10.1016/j.rec.2012.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients.
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Affiliation(s)
- Javier Jiménez-Candil
- Servicio de Cardiología, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca, Spain.
| | - Óscar Díaz-Castro
- Servicio de Cardiología, Complejo Hospitalario Universitario do Mexoeiro, Vigo, Pontevedra, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Vicente Bodí Peris
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Ramón López Palop
- Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea de Madrid, Madrid, Spain
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405
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Shahian DM, Jacobs JP, Edwards FH, Brennan JM, Dokholyan RS, Prager RL, Wright CD, Peterson ED, McDonald DE, Grover FL. The society of thoracic surgeons national database. Heart 2013; 99:1494-501. [PMID: 23335498 DOI: 10.1136/heartjnl-2012-303456] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The Society of Thoracic Surgeons (STS) National Database collects detailed clinical information on patients undergoing adult cardiac, paediatric and congenital cardiac, and general thoracic surgical operations. These data are used to support risk-adjusted, nationally benchmarked performance assessment and feedback; voluntary public reporting; quality improvement initiatives; guideline development; appropriateness determination; shared decision making; research using cross-sectional and longitudinal registry linkages; comparative effectiveness studies; government collaborations including postmarket surveillance; regulatory compliance and reimbursement strategies. INTERVENTIONS All database participants receive feedback reports which they may voluntarily share with their hospitals or payers, or publicly report. STS analyses are regularly used as the basis for local, regional and national quality improvement efforts. POPULATION More than 90% of adult cardiac programmes in the USA participate, as do the majority of paediatric cardiac programmes, and general thoracic participation continues to increase. Since the inception of the Database in 1989, more than 5 million patient records have been submitted. BASELINE DATA Each of the three subspecialty databases includes several hundred variables that characterise patient demographics, diagnosis, medical history, clinical risk factors and urgency of presentation, operative details and postoperative course including adverse outcomes. DATA CAPTURE Data are entered by trained data abstractors and by the care team, using detailed data specifications for each element. DATA QUALITY Quality and consistency checks assure accurate and complete data, missing data are rare, and audits are performed annually of selected participant sites. ENDPOINTS All major outcomes are reported including complications, status at discharge and mortality. DATA ACCESS Applications for STS Database participants to use aggregate national data for research are available at http://www.sts.org/quality-research-patient-safety/research/publications-and-research/access-data-sts-national-database.
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Affiliation(s)
- David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, , Boston, Massachusetts, USA
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406
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Efird JT, O'Neal WT, Davies SW, Kennedy WL, Alger LN, O'Neal JB, Ferguson TB, Kypson AP. Long-Term Mortality of 306,868 Patients with Multi-Vessel Coronary Artery Disease: CABG versus PCI. ACTA ACUST UNITED AC 2013; 3:1248-1257. [PMID: 24611133 PMCID: PMC3942885 DOI: 10.9734/bjmmr/2013/3380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Several randomized controlled trials (RCT) have reported no difference in long-term mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The purpose of this pooled observational analysis was to compare recent retrospective studies examining long-term survival of patients with multi-vessel coronary artery disease undergoing CABG and PCI. Methodology We searched Medline for observational studies comparing long-term (>1 year) survival between CABG and PCI for the treatment of multi-vessel coronary artery disease over the past 10 years. Results Eight studies met inclusion criteria. A total of 306,868 patients (155,502 CABG; 151,366 PCI) were identified. Follow-up ranged from 1 to 8 years. Mantel-Haenszel combined hazard ratios (HR) for mortality demonstrated a protective benefit of CABG compared with PCI (HR=0.77, 95%CI=0.75–0.79). Conclusion These findings suggest a long-term survival advantage for CABG compared with PCI in patients with multi-vessel coronary artery disease.
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Affiliation(s)
- Jimmy T Efird
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Departmentof Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Center for Health Disparities Research, Brody School of Medicine, Greenville, NC, USA
| | - Wesley T O'Neal
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Departmentof Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Center for Health Disparities Research, Brody School of Medicine, Greenville, NC, USA
| | - Stephen W Davies
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Departmentof Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Departmentof General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Whitney L Kennedy
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Center for Health Disparities Research, Brody School of Medicine, Greenville, NC, USA
| | - Lada N Alger
- Departmentof Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Jason B O'Neal
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - T Bruce Ferguson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Alan P Kypson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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407
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Redwood SR. The Year in Cardiology 2012: coronary intervention. Eur Heart J 2013; 34:338-44. [PMID: 23284091 DOI: 10.1093/eurheartj/ehs452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Simon R Redwood
- BHF Centre of Excellence, King's College London, St Thomas' Campus, Westminster Bridge Road, London SE1 7EH, UK.
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408
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Hayward PA, Zhu YY, Nguyen TT, Hare DL, Buxton BF. Should all moderate coronary lesions be grafted during primary coronary bypass surgery? An analysis of progression of native vessel disease during a randomized trial of conduits. J Thorac Cardiovasc Surg 2013; 145:140-8; discussion 148-9. [DOI: 10.1016/j.jtcvs.2012.09.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/03/2012] [Accepted: 09/20/2012] [Indexed: 02/08/2023]
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409
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Stein AJ. Superioridad de la cirugía coronaria versus intervencionismo coronario en el paciente diabético. CIRUGIA CARDIOVASCULAR 2013. [DOI: 10.1016/s1134-0096(13)70002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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410
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127:e6-e245. [PMID: 23239837 PMCID: PMC5408511 DOI: 10.1161/cir.0b013e31828124ad] [Citation(s) in RCA: 3357] [Impact Index Per Article: 305.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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411
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Goldenberg G, Kornowski R. Coronary bypass surgery versus percutaneous coronary intervention: the saga continues. Interv Cardiol 2012. [DOI: 10.2217/ica.12.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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412
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Anaortic, total-arterial, off-pump coronary artery bypass surgery: why bother? Heart Lung Circ 2012; 22:161-70. [PMID: 23102694 DOI: 10.1016/j.hlc.2012.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 09/14/2012] [Accepted: 09/17/2012] [Indexed: 11/20/2022]
Abstract
Coronary artery bypass grafting (CABG) remains the standard of care for multi-vessel coronary disease. However, the increased rate of peri-operative stroke reported after surgery compared to percutaneous coronary intervention (PCI) remains of concern. Anaortic, total-arterial, off-pump coronary artery bypass (OPCAB) grafting is a technique that offers the main advantages of surgical revascularisation with a rate of stroke that is equivalent to that of PCI. Some recent trials comparing conventional on-pump CABG with OPCAB have questioned the efficacy of the off-pump technique - these are most often performed with manipulation of the ascending aorta. We review the potential benefits of the anaortic, total-arterial OPCAB technique to explain why it is being employed by an increasing number of surgeons.
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413
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Dehmer GJ, Weaver D, Roe MT, Milford-Beland S, Fitzgerald S, Hermann A, Messenger J, Moussa I, Garratt K, Rumsfeld J, Brindis RG. A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011. J Am Coll Cardiol 2012; 60:2017-31. [PMID: 23083784 DOI: 10.1016/j.jacc.2012.08.966] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/25/2012] [Accepted: 08/13/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study sought to provide a report to the public of data from the CathPCI Registry of the National Cardiovascular Data Registry. BACKGROUND The CathPCI Registry collects data from approximately 85% of the cardiac catheterization laboratories in the United States. METHODS Data were summarized for 6 consecutive calendar quarters beginning January 1, 2010, and ending June 30, 2011. This report includes 1,110,150 patients undergoing only diagnostic cardiac catheterization and 941,248 undergoing percutaneous coronary intervention (PCI). RESULTS Some notable findings include, for example, that on-site cardiac surgery was not available in 83% of facilities performing fewer than 200 PCIs annually, with these facilities representing 32.6% of the facilities reporting, but performing only 12.4% of the PCIs in this data sample. Patients 65 years of age or older represented 38.7% of those undergoing PCI, with 12.3% being 80 years of age or older. Almost 80% of PCI patients were overweight (body mass index ≥25 kg/m(2)), 80% had dyslipidemia, and 27.6% were current or recent smokers. Among patients undergoing elective PCI, 52% underwent a stress study before the procedure, with stress myocardial perfusion being used most frequently. Calcium scores and coronary computed tomography angiography were used very infrequently (<3%) before diagnostic or PCI procedures. Radial artery access was used in 8.3% of diagnostic and 6.9% of PCI procedures. Primary PCI was performed with a median door-to-balloon time of 64.5 min for nontransfer patients and 121 min for transfer patients. In-hospital risk-adjusted mortality in ST-segment elevation myocardial infarction patients was 5.2% in this sample. CONCLUSIONS Data from the CathPCI Registry provide a contemporary view of the current practice of invasive cardiology in the United States.
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Affiliation(s)
- Gregory J Dehmer
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA.
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414
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Edelman JJB, Wilson MK, Bannon PG, Vallely MP. Cardiac surgery versus stenting: what is better for the patient? ANZ J Surg 2012; 82:792-8. [DOI: 10.1111/j.1445-2197.2012.06262.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/30/2022]
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415
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Greenfield S, Kaplan SH. Observational studies versus randomized trials: squaring off. J Comp Eff Res 2012; 1:385-6. [PMID: 24236414 DOI: 10.2217/cer.12.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sheldon Greenfield
- Health Policy Research Institute, University of California, Irvine, 100 Theory Ste 110 Irvine, CA 92697-5800, USA
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416
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Rezende PC, Hueb W, Garzillo CL, Lima EG, Hueb AC, Ramires JAF, Kalil Filho R. Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: effect of age in the Medicine, Angioplasty, or Surgery Study II trial. J Thorac Cardiovasc Surg 2012; 146:1105-12. [PMID: 22944095 DOI: 10.1016/j.jtcvs.2012.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/19/2012] [Accepted: 08/01/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE With progressive aging, coronary artery disease has been diagnosed at more advanced ages. Although patients aged 65 years or more have been referred to surgical or percutaneous coronary interventions, the best option for coronary artery disease treatment remains uncertain. The current study compared the 3 treatment options for coronary artery disease in patients aged 65 years or more and analyzed the impact of age in treatment options. METHODS Patients were separated according to age: 65 years or more (n = 200) and less than 65 years (n = 411). All patients were followed for 10 years. The rates of overall mortality, acute myocardial infarction, and new revascularizations were analyzed. RESULTS Of 200 patients aged 65 years or more, 68 were randomized to medical therapy, 68 were randomized to percutaneous coronary intervention, and 64 were randomized to coronary artery bypass grafting. At 10 years, overall survival was 63% (medical therapy), 69% (percutaneous coronary intervention), and 66% (coronary artery bypass grafting) (P = .93). The survival free of combined events was 43% (medical therapy), 38% (percutaneous coronary intervention ), and 66% (coronary artery bypass grafting) (P = .007). The survival free of myocardial infarction was 82% (medical therapy), 77% (percutaneous coronary intervention), and 90% (coronary artery bypass grafting) (P = .17), and survival free of new revascularizations was 59% (medical therapy), 58% (percutaneous coronary intervention ), and 91% (coronary artery bypass grafting) (P = .0003). When the 2 age groups were compared, survival free of myocardial infarction for patients treated by percutaneous coronary intervention was 77% (older patients) and 92% (younger patients) (P = .004). CONCLUSIONS In this analysis, treatment options for patients aged 65 years or more who have coronary artery disease yield similar overall survival. However, coronary artery bypass grafting was associated with fewer coronary events, and percutaneous coronary intervention was associated with a higher incidence of myocardial infarction.
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Affiliation(s)
- Paulo Cury Rezende
- Department of Atherosclerosis, Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil
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417
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Rodríguez AE, Fernández-Pereira C, Rodríguez-Granillo AM. Changes in the safety paradigm with percutaneous coronary interventions in the modern era: Lessons learned from the ASCERT registry. World J Cardiol 2012; 4:242-9. [PMID: 22953021 PMCID: PMC3432881 DOI: 10.4330/wjc.v4.i8.242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/17/2012] [Accepted: 07/24/2012] [Indexed: 02/06/2023] Open
Abstract
In the past, comparative effectiveness trials evaluating percutaneous coronary interventions (PCI), using either balloon angioplasty or bare metal stent (BMS) implantation, versus coronary artery bypass surgery (CABG) found similar survival rates at long-term follow-up with both revascularization strategies. Two major meta-analyses of these trials reported 5- and 6-year comparative effectiveness between PCI and CABG: one included only four trials that compared PCI with BMS implantation versus CABG whereas the largest one also included trials using balloon angioplasty. In these studies, the authors observed no survival differences between groups although a significant survival advantage was seen in diabetics treated with CABG and this benefit was also perceived in elderly patients. In both reports, number of involved vessels, presence of left anterior descending artery stenosis or poor left ventricular ejection fraction were no predictors of poor survival with PCI. Therefore, extent of the coronary artery disease (CAD) was not associated with poor outcome after PCI in the pre-drug eluting stent (DES) era. Recently, the ASCERT (Database Collaboration on the Comparative Effectiveness of Revascularization Strategies) registry found higher mortality rate with PCI in patients ≥ 65 years old in comparison with CABG, and advantages of surgery were seen in all subgroups including those at low risk. In this registry, PCI was accomplished by implantation of the first type of DES designs in 78% of cases. The intriguing observation of high mortality rate with PCI, including for non-diabetics and patients with two-vessel CAD, meaning a lack of clinical benefit with DES implantation, had not been seen previously. The study was not randomized, although its results are largely strengthened by its sample size. In this manuscript, the authors describe other registries and randomized trials reporting similar results supporting the findings of the aforementioned study and explore the reasons for these results, while also searching for potential solutions.
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Affiliation(s)
- Alfredo E Rodríguez
- Alfredo E Rodríguez, Carlos Fernández-Pereira, Alfredo M Rodríguez-Granillo, Cardiovascular Research Center, Cardiac Unit Otamendi Hospital, Azcuenga 870, 1072 Buenos Aires, Argentina
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418
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Kirtane AJ, Pinto DS, Moses JW. Comparative effectiveness of revascularization strategies. N Engl J Med 2012; 367:476-7; author reply 477. [PMID: 22853023 DOI: 10.1056/nejmc1206011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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419
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Should Ischemia Guide Revascularization? J Am Coll Cardiol 2012; 60:191-2. [DOI: 10.1016/j.jacc.2012.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 03/28/2012] [Accepted: 04/04/2012] [Indexed: 11/21/2022]
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420
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Kolh P, Sousa Uva M, Wijns W. The new 2011 ACCF/AHA Guidelines on Coronary Artery Bypass Grafting Surgery: are they different from the 2010 ESC/EACTS Guidelines on Myocardial Revascularisation? EUROINTERVENTION 2012; 8:33-4. [PMID: 22580246 DOI: 10.4244/eijv8i1a6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Philippe Kolh
- Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liège, Liège, Belgium.
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421
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422
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Park SJ, Lee CW. Coronary artery disease: Risk models for revascularization--the search continues. Nat Rev Cardiol 2012; 9:316-8. [PMID: 22507970 DOI: 10.1038/nrcardio.2012.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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423
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Taggart DP. CABG in 2012: Evidence, practice and the evolution of guidelines. Glob Cardiol Sci Pract 2012; 2012:21-8. [PMID: 24688987 PMCID: PMC3963716 DOI: 10.5339/gcsp.2012.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 11/04/2012] [Indexed: 11/09/2022] Open
Abstract
Abstract: In the management of coronary artery disease (CAD) it is important to ensure that all patients are receiving optimal medical therapy irrespective of whether any intervention, by stents or surgery, is planned. Furthermore it is important to establish if a proposed intervention is for symptomatic and/or prognostic reasons. The latter can only be justified if there is demonstration of a significant volume of ischaemia (>10% of myocardial mass). Taking together evidence from the most definitive randomized trial and its registry component (SYNTAX), almost 79% of patients with three vessel CAD and almost two thirds of patients with LMS disease have a survival benefit and marked reduction in the need for repeat revascularisation with CABG in comparison to stents, implying that CABG is still the treatment of choice for most of these patients. This conclusion which is apparently at odds with the results of most previous trials of stenting and surgery but entirely consistent with the findings of large propensity matched registries can be explained by the fact that SYNTAX enrolled ‘real life’ patients rather than the highly select patients usually enrolled in previous trials. SYNTAX also shows that for patients with less severe coronary artery disease there is no difference in survival between CABG and stents but a lower incidence of repeat revascularisation with CABG. At three years, SYNTAX shows no difference in stroke between CABG and stents for three-vessel disease but a higher incidence of stroke with CABG in patients with left main stem disease. In contrast the PRECOMBAT trial of stents and CABG in patients with left main stem disease showed no excess of mortality or stroke with CABG in comparison to stents in relatively low risk patients. Finally the importance of guidelines and multidisciplinary/heart teams in making recommendations for interventions is emphasised.
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Affiliation(s)
- David P Taggart
- Nuffield Dept of Surgery, Oxford University NHS Hospitals, Oxford OX3 9DU, England, UK
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424
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Holtermann M. Revaskularisering ved koronarsykdom. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012. [DOI: 10.4045/tidsskr.12.0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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425
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Marini I, Moschini R, Corso AD, Mura U. Alpha-crystallin: an ATP-independent complete molecular chaperone toward sorbitol dehydrogenase. Cell Mol Life Sci 2005; 62:599-605. [PMID: 15747064 PMCID: PMC11365903 DOI: 10.1007/s00018-005-4474-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
alpha-Crystallin, the major component of the vertebrate lens, is known to interact with proteins undergoing denaturation and to protect them from aggregation phenomena. Bovine lens sorbitol dehydrogenase (SDH) was previously shown to be completely protected by alpha-crystallin from thermally induced aggregation and inactivation. Here we report that alpha-crystallin, in the presence of the SDH pyridine cofactor NAD(H), can exert a remarkable chaperone action by favoring the recovery of the enzyme activity from chemically denaturated SDH up to 77%. Indeed, even in the absence of the cofactor, alpha-crystallin present at a ratio with SDH of 20:1 (w:w) allows a recovery of 35% of the enzyme activity. The effect of ATP in enhancing alpha-crystallin-promoted SDH renaturation appears to be both nonspecific and to not involve hydrolysis phenomena, thus confirming that the chaperone action of alpha-crystallin is not dependent on ATP as energy donor.
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Affiliation(s)
- I. Marini
- Dipartimento di Fisiologia e Biochimica, Sezione di Biochimica, Università di Pisa, Via S. Zeno, 51, 56100 Pisa, Italy
| | - R. Moschini
- Dipartimento di Fisiologia e Biochimica, Sezione di Biochimica, Università di Pisa, Via S. Zeno, 51, 56100 Pisa, Italy
| | - A. Del Corso
- Dipartimento di Fisiologia e Biochimica, Sezione di Biochimica, Università di Pisa, Via S. Zeno, 51, 56100 Pisa, Italy
| | - U. Mura
- Dipartimento di Fisiologia e Biochimica, Sezione di Biochimica, Università di Pisa, Via S. Zeno, 51, 56100 Pisa, Italy
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