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Calogiuri G, Mandurino-Mirizzi A, Parlangeli C, Macchia L, Foti C, Savage MP. Comparing Allergist and Cardiologist Considerations for the Optimal Management of Thienopyridines Hypersensitivity. Endocr Metab Immune Disord Drug Targets 2018; 19:2-12. [PMID: 30215337 DOI: 10.2174/1871530318666180914121758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/30/2018] [Accepted: 06/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity seems to be best done as an interdisciplinary collaboration between the allergist and cardiologist. METHOD The present study investigates the management of thienopyridines hypersensitivity on the basis of published case reports and studies, comparing the pro and contro of pharmacological treatments, different desensitization protocols to thienopyridines and substitution of antiplatelet agents eaches others, according to the point of view of cardiologist and allergist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropriateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization, or switching to an alternative agent. RESULTS AND CONCLUSION All the data seem to suggest that only working together, a cardio-allergy team of specialists may evaluate and offer the best approach to clinical decision-making for the individual patient.
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Affiliation(s)
- Gianfanco Calogiuri
- Pneumology and Allergy Department - Civil Hospital "Sacro Cuore" Gallipoli, Lecce, Italy.,Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Claudio Parlangeli
- Cardiology Intensive Care Unit - Civil Hospital San Giuseppe da Copertino - Copertino Lecce, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy
| | - Michael P Savage
- Department of Medicine, Jefferson Angioplasty Center, Thomas Jefferson University Hospital, Philadelphia, United States
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2
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Yilmaz S, Akboga MK, Aras D, Topaloglu S. Evaluation of the Predictive Value of CHA2DS2-VASc Score for In-Stent Restenosis. Angiology 2017; 69:38-42. [DOI: 10.1177/0003319717700746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Its usefulness in predicting in-stent restenosis (ISR) is unknown. We evaluated the predictive value of the CHA2DS2-VASc score in AF-free patients who have undergone stent implantation. A total of 1350 patients who underwent coronary angiography and successful bare-metal stent implantation were analyzed. The CHA2DS2-VASc score was calculated before percutaneous coronary intervention, and the association between the score and ISR was investigated. Patients (n = 700; mean age: 61.4 [8.7] years, 63% men) were divided in 2 subgroups according to the presence of ISR; 265 of 700 patients had ISR. Mean CHA2DS2-VASc score was significantly higher in the ISR (+) group than the ISR (−) group (3.7 [1.8] vs 2.1 [1.4], P < .001). According to multivariate logistic regression analysis, diabetes, hyperlipidemia, smoking, stent length, and CHA2DS2-VASc score were independent predictors of ISR. In conclusion, the CHA2DS2-VASc score may be useful as a new and simple tool to predict ISR.
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Affiliation(s)
- Samet Yilmaz
- Cardiology Clinic, Yozgat State Hospital, Yozgat, Turkey
| | - Mehmet Kadri Akboga
- Cardiology Clinic, Turkey Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Cardiology Clinic, Turkey Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Cardiology Clinic, Turkey Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Kundi H, Korkmaz A, Balun A, Cicekcioglu H, Kiziltunc E, Gursel K, Cetin M, Ornek E, Ileri M. Is In-Stent Restenosis After a Successful Coronary Stent Implantation Due to Stable Angina Associated With TG/HDL-C Ratio? Angiology 2017; 68:816-822. [PMID: 28068799 DOI: 10.1177/0003319716689366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the impact of the preprocedural triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio on risk of in-stent restenosis (ISR). Patients with typical anginal symptoms and/or positive treadmill or myocardial perfusion scintigraphy test results who underwent successful coronary stent implantation due to stable angina were examined; 1341 patients were enrolled. The hospital files of the patients were used to gather data. Cox regression analysis showed that the TG/HDL-C ratio was independently associated with the presence of ISR ( P < .001). Moreover, diabetes mellitus ( P = .007), smaller stent diameter ( P = .046), and smoking status ( P = .001) were also independently associated with the presence of ISR. Using a cutoff of 3.8, the TG/HDL-C ratio predicted the presence of ISR with a sensitivity of 71% and a specificity of 68%. Also, the highest quartile of TG/HDL-C ratio had the highest rate of ISR ( P < .001). Measuring preprocedural TG/HDL-C ratio, in fasting or nonfasting samples, could be beneficial for the risk assessment of ISR. However, further large-scale prospective studies are required to establish the exact role of this simple, easily calculated, and reproducible parameter in the pathogenesis of ISR.
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Affiliation(s)
- Harun Kundi
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ahmet Balun
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Hulya Cicekcioglu
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Emrullah Kiziltunc
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Koray Gursel
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ender Ornek
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mehmet Ileri
- 1 Cardiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
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4
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Ye Z, Lu H, Guo W, Dai W, Li H, Yang H, Li L. The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e5306. [PMID: 27861357 PMCID: PMC5120914 DOI: 10.1097/md.0000000000005306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At present, there are a lot of research about the effect of Alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention (PCI) in diabetic patients, but the clinical efficacy is not consistent, so we conduct this study and therefore determine the dominant strategy for the treatment of PCI in diabetic patients based on the best evidence currently. METHODS An electronic database search was conducted in MEDLINE, Embase, Cochrane library, CBM, CNKI, VIP, and WanFang to retrieve randomized controlled trial (RCT) comparing Alprostadil versus hydration on preventing CIN for PCI in diabetic patients. Reference lists of relevant articles were also screened manually to retrieve additional ones. Two investigators independently assessed the eligibility of retrieved articles using predefined inclusion and exclusion criteria. All characteristics as well as outcome variables including incidence of CIN, blood urea nitrogen (BUN), cystatin C (CysC), glomerular filtration rate (GFR), serum creatinine (Scr), serum beta 2-microspheres (β2-MG) presented in each included study were extracted. Heterogeneity was thought to be significant when I > 50%. All of the meta-analytic procedures were performed by using Review Manager software, version 5.3. RESULTS Finally, data from 8 articles including 969 patients were included into this meta-analysis, among them, 487 patients in the experience group, and 482 patients in the control group. Meta analysis showed that the incidence of CIN in the experimental group was significantly lower than that in the control group (OR = 0.28,95%CI[0.18,0.42]). The incidence of adverse reactions in the experimental group was significantly lower than that in the control group (OR = 0.46,95%CI[0.24,0.85]). The BUN of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -0.77, 95%CI [-1.22, -0.32]; MD = -1.38, 95%CI [-1.83,-0.92]; MD = -2.43, 95%CI [-2.68,-2.19], respectively). The CysC of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -0.30, 95%CI [-0.40, -0.21]; MD = -0.54, 95%CI [-0.68,-0.41]; MD = -0.49, 95%CI [-0.63, -0.35], respectively). The GFR of 24 hours, 48 hours, and 72 hours in the experimental group were significantly higher than that of control group (MD = 7.86, 95%CI [4.44, 11.29], MD = 18.23, 95%CI [13.76,22.69], MD = 12.81, 95%CI [8.51,17.11], respectively). The Scr of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -9.09, 95%CI [-12.67, -5.51], MD = -19.14, 95%CI [-23.61, -14.66], MD = -6.50, 95%CI [-8.29, -4.71], respectively). The β2-MG of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = -0.12, 95%CI [-0.27, 0.03], MD = -0.55, 95%CI [-0.71, -0.39], MD = -0.50, 95%CI [-0.60, -0.39], respectively). CONCLUSION Our result suggested that comparing with conventional Hydration, Alprostadil can significantly reduce the incidence of CIN, adverse reaction, and protect renal function in PCI in diabetic patients. Due to the limitations of the quality and quantity of the articles, this conclusion still needs further research to confirm.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Haili Lu
- Department of Orthodontic, The Affiliated Dental Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wenqin Guo
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Weiran Dai
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Hongqing Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Huafeng Yang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
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5
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Okmen E, Sanli A, Uyarel H, Dayi S, Tartan Z, Cam N. Impacts of Glycoprotein IIb/IIIa Inhibition on QT Dispersion After Successful Percutaneous Coronary Intervention. Angiology 2016; 57:273-81. [PMID: 16703187 DOI: 10.1177/000331970605700303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coronary ischemia augments inhomogeneity in ventricular repolarization. Decrease in the QT dispersion (QTd) following restoration of coronary blood flow to the ischemic myocardium by successful percutaneous coronary intervention (PCI) is an expected outcome. The purpose of the study was to seek whether glycoprotein IIb/IIIa (GP IIb/IIIa) inhibition has additional beneficial effects on QT dispersion after angiographically successful PCI. The study involved 111 consecutive patients scheduled for elective coronary balloon angioplasty with or without stent implantation. Sixty patients (mean age 58 ±9) were randomized to receive standard therapy including preprocedural aspirin, ticlopidine, and IV heparin, and 51 patients (mean age 54 ±10) were randomized to receive additional IV tirofiban infusion before the lesion was crossed with the guidewire. Standard 12-lead simultaneous ECG recordings for the measurement of QTd and corrected QTd (QTcd) (calculated by using Bazett’s formula) were obtained before and immediately after the procedure, and at the 6th, and 24th hours. Blood samples for detection of postprocedural myocardial damage (CK-MB and cTn-I) were taken before and immediately after the procedure, at the 6th, 12th, and 24th hours. In total, 128 stenoses were treated with PCI. Seventy of these lesions were in the standard therapy group and 58 in the tirofiban group. QTd and QTcd were not statistically different between the 2 groups before and immediately after the procedure and at the 6th hours, but at the 24th hour QTd and QTcd were significantly longer in the standard therapy group (p=0.047 and p=0.001, respectively). Postprocedural troponin-I elevation (B=0.692, p=0.037), maximum inflation pressure (B=0.182, p=0.001), and previous myocardial infarction (MI) (B=0.885, p=0.004) were defined as the predictors of the final QT dispersion at the 24th hour. QT dispersion significantly decreased after successful percutaneous coronary intervention. GP IIb/IIIa inhibition therapy was not superior by means of recovery of increased QT dispersion during the early hours of the intervention, but it prevented minor myocardial necrosis and provided more long-lasting recovery in QT dispersion as compared with heparin therapy. This impact of GP IIb/IIIa receptor inhibition on QTd may be a possible mechanism by which these drugs reduce cardiovascular events after PCI.
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Affiliation(s)
- Ertan Okmen
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
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6
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Ahmed W, Zafar S, Alam AY, Ahktar N, Shah MA, Alpert MA. Plasma Levels of B-Type Natriuretic Peptide in Patients With Unstable Angina Pectoris or Acute Myocardial Infarction: Prognostic Significance and Therapeutic Implications. Angiology 2016; 58:269-74. [PMID: 17626979 DOI: 10.1177/0003319707302543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Plasma B-type natriuretic peptide (BNP) levels were obtained from 146 patients with unstable angina pectoris, non—ST-segment elevation myocardial infarction (MI), or ST-segment elevation MI to determine their value in predicting the presence of new heart failure, recurrent MI or ischemia, or death 1 month after the index event. Patients with elevated plasma BNP levels (>80 pg/mL) had a significantly higher incidence of new heart failure and all-cause mortality than those with a normal plasma BNP level (≤80 pg/mL). Early revascularization with percutaneous intervention or coronary artery bypass grafting significantly reduced the incidence of new heart failure and all-cause mortality in patients with an elevated plasma BNP level, but had no effect on individual outcomes in the normal plasma BNP subgroup.
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MESH Headings
- Adult
- Aged
- Angina, Unstable/blood
- Angina, Unstable/complications
- Angina, Unstable/diagnosis
- Angina, Unstable/mortality
- Angina, Unstable/therapy
- Angioplasty, Balloon, Coronary
- Biomarkers/blood
- Cardiac Output, Low/blood
- Cardiac Output, Low/etiology
- Cardiac Output, Low/mortality
- Coronary Angiography
- Coronary Artery Bypass
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Myocardial Infarction/blood
- Myocardial Infarction/complications
- Myocardial Infarction/diagnosis
- Myocardial Infarction/mortality
- Myocardial Infarction/therapy
- Myocardial Ischemia/blood
- Myocardial Ischemia/etiology
- Myocardial Ischemia/mortality
- Natriuretic Peptide, Brain/blood
- Predictive Value of Tests
- Prospective Studies
- Recurrence
- Risk Assessment
- Time Factors
- Treatment Outcome
- Troponin T/blood
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Affiliation(s)
- Waqas Ahmed
- Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan
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7
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Okmen E, Cam N, Sanli A, Yapici F, Uyarel H, Vural M, Ozturk R. Effects of Direct Stent Implantation and Conventional Stent Implantation on Minor Myocardial Injury. Angiology 2016; 55:485-91. [PMID: 15378110 DOI: 10.1177/000331970405500503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Direct coronary stenting without balloon predilation has the potential benefits of a reduced risk of extended dissections, reduced fluoroscopy exposure, reduced procedural time, and potential cost savings. The purpose of the study was to compare the effects of angiographically successful direct stent implantation and conventional stent implantation (stent implantation following predilation) on minor myocardial injury characterized by cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) elevation. The authors prospectively studied 42 patients who had successful direct stent implantation, and 49 patients who had successful conventional stent implantation. Blood samples for measurement of cTn-I and cTn-T were taken before, and immediately after the procedure, and every 6 hours for the first 24 hours. cTn-T elevation was observed in 6 patients (14.3%) in the direct stent implantation group, and in 16 patients (32.6%) in the conventional stent implantation group (p: 0.03). Similarly cTn-I elevation was more frequent in the conventional stent implantation group (20 patients, 40.8%) than direct stent implantation group (7 patients, 16.7%, p: 0.02). Stent implantation following predilation is more frequently associated with postprocedural minor myocardial injury than direct stent implantation.
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Affiliation(s)
- Ertan Okmen
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
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8
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Yilmaz S, Akboga MK, Sen F, Balcı KG, Aras D, Temizhan A, Aydogdu S. Usefulness of the monocyte-to-high-density lipoprotein cholesterol ratio to predict bare metal stent restenosis. Biomark Med 2016; 10:959-66. [DOI: 10.2217/bmm-2016-0069] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: The aim of the present study was to investigate the predictive value of preprocedural monocyte count-to-high-density lipoprotein cholesterol ratio (MHR) on development of in-stent restenosis in patients undergoing coronary bare-metal stent (BMS) implantation. Patients & methods: Data from 705 patients who had undergone BMS implantation and additional control coronary angiography were analyzed. Results: Patients were divided into three tertiles based on preprocedural MHR. Restenosis occurred in 59 patients (25%) in the lowest tertile, 84 (35%) in the middle tertile and 117 (50%) in the highest MHR tertile (p < 0.001). Using multiple logistic regression analysis, smoking, diabetes mellitus, stent length, preprocedural MHR and C-reactive protein levels emerged as independent predictors of in-stent restenosis. Conclusion: High preprocedural MHR is related to BMS restenosis.
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Affiliation(s)
- Samet Yilmaz
- Cardiovascular Department, Yozgat State Hospital, 66200 Yozgat, Turkey
| | - Mehmet K Akboga
- Cardiology Clinic, Turkey Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey
| | - Fatih Sen
- Cardiology Clinic, Turkey Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey
| | - Kevser G Balcı
- Cardiology Clinic, Turkey Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey
| | - Dursun Aras
- Cardiology Clinic, Turkey Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey
| | - Ahmet Temizhan
- Cardiology Clinic, Turkey Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey
| | - Sinan Aydogdu
- Cardiology Clinic, Turkey Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey
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9
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Araki T, Banchhor SK, Londhe ND, Ikeda N, Radeva P, Shukla D, Saba L, Balestrieri A, Nicolaides A, Shafique S, Laird JR, Suri JS. Reliable and Accurate Calcium Volume Measurement in Coronary Artery Using Intravascular Ultrasound Videos. J Med Syst 2015; 40:51. [PMID: 26643081 DOI: 10.1007/s10916-015-0407-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
Quantitative assessment of calcified atherosclerotic volume within the coronary artery wall is vital for cardiac interventional procedures. The goal of this study is to automatically measure the calcium volume, given the borders of coronary vessel wall for all the frames of the intravascular ultrasound (IVUS) video. Three soft computing fuzzy classification techniques were adapted namely Fuzzy c-Means (FCM), K-means, and Hidden Markov Random Field (HMRF) for automated segmentation of calcium regions and volume computation. These methods were benchmarked against previously developed threshold-based method. IVUS image data sets (around 30,600 IVUS frames) from 15 patients were collected using 40 MHz IVUS catheter (Atlantis® SR Pro, Boston Scientific®, pullback speed of 0.5 mm/s). Calcium mean volume for FCM, K-means, HMRF and threshold-based method were 37.84 ± 17.38 mm(3), 27.79 ± 10.94 mm(3), 46.44 ± 19.13 mm(3) and 35.92 ± 16.44 mm(3) respectively. Cross-correlation, Jaccard Index and Dice Similarity were highest between FCM and threshold-based method: 0.99, 0.92 ± 0.02 and 0.95 + 0.02 respectively. Student's t-test, z-test and Wilcoxon-test are also performed to demonstrate consistency, reliability and accuracy of the results. Given the vessel wall region, the system reliably and automatically measures the calcium volume in IVUS videos. Further, we validated our system against a trained expert using scoring: K-means showed the best performance with an accuracy of 92.80%. Out procedure and protocol is along the line with method previously published clinically.
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Affiliation(s)
- Tadashi Araki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Sumit K Banchhor
- Department of Electrical Engineering, NIT Raipur, Chhattisgarh, India.,Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Narendra D Londhe
- Department of Electrical Engineering, NIT Raipur, Chhattisgarh, India.,Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Nobutaka Ikeda
- Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Petia Radeva
- Department MAIA, Computer Vision Centre, Cerdanyola del Vallés, University of Barcelona, Barcelona, Spain
| | - Devarshi Shukla
- Department of Electrical Engineering, NIT Raipur, Chhattisgarh, India.,Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, London, UK.,Vascular Diagnostic Centre, University of Cyprus, Nicosia, Cyprus
| | - Shoaib Shafique
- CorVasc Vascular Laboratory, 8433 Harcourt Rd #100, Indianapolis, IN, USA
| | - John R Laird
- UC Davis Vascular Centre, University of California, Davis, CA, USA
| | - Jasjit S Suri
- Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA. .,Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA. .,Department of Electrical Engineering, University of Idaho (Affl.), Moscow, ID, USA.
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10
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Bonow RO. Guidelines for revascularization: The evidence base matures. Glob Cardiol Sci Pract 2013; 2012:29-35. [PMID: 24688988 PMCID: PMC3963719 DOI: 10.5339/gcsp.2012.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 11/27/2012] [Indexed: 11/03/2022] Open
Affiliation(s)
- Robert O Bonow
- Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
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12
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Abstract
OBJECTIVES This article reviews adverse influences of for-profit enterprises on health care and public health, and examines significance for public policy. RESEARCH DESIGN Narrative review. RESULTS For-profit health-care industries may increase costs and reduce quality, leading to market failure and contributing to the USA's unflattering position in international comparisons of health-care efficiency. Drug and device corporations use strategies such as making biased inferences, influencing scientists and physicians, marketing rather than informing the public, and lobbying to control their own industry regulations to create market advantage. Successful marketing leads to the increased use of costly profit-making drugs and procedures over cheaper, nonpatented therapies. Because resources are limited, the overuse of costly modalities contributes to expensive health care, which presents a challenge to universal coverage. The free market also fosters the proliferation of industries, such as tobacco, food, and chemicals, which externalize costs to maximize profits, seek to unduly influence research by paying experts and universities, and attempt to control the media and regulatory agencies. Most vulnerable to the cumulative harm of these tactics are children, the poor, the sick, and the least educated. CONCLUSIONS The free market can harm health and health care. The corporate obligation to increase profits and ensure a return to shareholders affects public health. Such excesses of capitalism pose formidable challenges to social justice and public health. The recognition of the health risks entailed by corporation-controlled markets has important implications for public policy. Reforms are required to limit the power of corporations.
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Eles GR, Fisher DL, Khalil R, Dajani Z, Spotti JP, Lasorda D. Balloon aortic valvuloplasty for aortic stenosis using a novel percutaneous dilation catheter and power injector. J Interv Cardiol 2010; 24:92-8. [PMID: 20738729 DOI: 10.1111/j.1540-8183.2010.00594.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Calcific aortic stenosis is the most common valvular heart disease in the Western world. Although definitive treatment is valve replacement, many patients are not replacement candidates due to high surgical risk from older age and comorbid illness or lack of desire for a surgical or replacement procedure. Percutaneous balloon aortic valvuloplasty (BAV) is an option for palliative treatment in nonsurgical patients, although this procedure is complicated during the immediate postprocedure period by bleeding requiring transfusion for about 1 in 5 patients and subsequent restenosis. This report describes BAV using a smaller profile balloon designed to withstand higher pressures, rapidly inflated with a power injector. Twenty consecutive high-risk patients with severe aortic stenosis were treated. In all cases, New York Heart Association (NYHA) class improved from IV before BAV to I or II at 30 days follow-up. Six-month posttreatment follow-up data were available for 19 of 20 patients: 15 patients were either NYHA class I or II, 1 patient was class III, and 3 deaths occurred unrelated to aortic stenosis. One patient was lost to follow-up. Average systolic gradient peak-to-peak pressure decreased by 40.0% (range 18.0-70.0%) and mean gradient decreased by 30.0% (range 13.7-70.8%). Aortic valve area increased from 0.59 ± 0.16 cm(2) to 0.92 ± 0.23 cm(2), representing a mean increase of 30.0% (range 7.8%-58.2%). There were no significant bleeding complications. The only procedural complication was a single case of pericardial tamponade. There were no other complications during the first 24 hours post-BAV. These data support that the reported BAV technique may offer an effective alternative for patients with severe aortic stenosis who are not surgical candidates or prefer to avoid aortic valve replacement.
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Affiliation(s)
- Gustav R Eles
- Division of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
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15
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Morrison DA. Stent thrombosis: the effect of intention on perception. J Am Coll Cardiol 2010; 55:1943-4. [PMID: 20430266 DOI: 10.1016/j.jacc.2009.11.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 11/03/2009] [Accepted: 11/11/2009] [Indexed: 02/02/2023]
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Schiks IEJM, Schoonhoven L, Aengevaeren WRM, Nogarede-Hoekstra C, van Achterberg T, Verheugt FWA. Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation. J Clin Nurs 2009; 18:1862-70. [DOI: 10.1111/j.1365-2702.2008.02587.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pohlen M, Bunzemeier H, Husemann W, Roeder N, Breithardt G, Reinecke H. Risk predictors for adverse outcomes after percutaneous coronary interventions and their related costs. Clin Res Cardiol 2008; 97:441-8. [DOI: 10.1007/s00392-008-0647-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 01/24/2008] [Indexed: 12/01/2022]
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Lippi Bruni M, Nobilio L, Ugolini C. The analysis of a cardiological network in a regulated setting: a spatial interaction approach. HEALTH ECONOMICS 2008; 17:221-33. [PMID: 17575558 DOI: 10.1002/hec.1255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We analyse referral patterns for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in the Emilia Romagna region of Italy, a procedure for which the assumption of a negative association between volume and adverse outcomes is used to justify its territorial concentration. Nevertheless, recent clinical evidence shows PTCA superiority for immediate treatment of acute myocardial infarction, which advises an increase in the number of points of delivery. Our paper aims to develop analytical tools designed to provide support to policy makers when they are asked to evaluate the spatial distribution of catheterisation laboratories that perform PTCA. Information is drawn from the regional administrative hospital discharge data (SDO) for the year 2002. We first use entropy indexes to investigate the spatial accessibility of the cardiological network. Secondly, by means of a gravity model estimated using Bayesian techniques we identify the determinants of patient flows in terms of demand and supply factors. Our results suggest that information on destinations is processed hierarchically and that agglomeration-like forces are dominant. Furthermore, although self-sufficiency of provision at the provincial level has been achieved to a large extent, there is still scope to improve the organisational efficiency of the network.
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Rogers AM, Ramanath VS, Grzybowski M, Riba AL, Jani SM, Mehta R, De Franco AC, Parrish R, Skorcz S, Baker PL, Faul J, Chen B, Roychoudhury C, Elma MAC, Mitchell KR, Froehlich JB, Montoye C, Eagle KA. The association between guideline-based treatment instructions at the point of discharge and lower 1-year mortality in Medicare patients after acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) initiative in Michigan. Am Heart J 2007; 154:461-9. [PMID: 17719291 DOI: 10.1016/j.ahj.2007.05.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 05/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative for acute myocardial infarction (AMI) has been shown to increase the use of guideline-based therapies and improve outcomes in patients with AMI. It is unknown whether hospitals that are more successful in using the standard discharge contract--a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning--experience a proportionally greater improvement in patient outcomes. METHODS Medicare patients treated for AMI in all 33 participating GAP hospitals in Michigan were enrolled. We aggregated the hospitals into 3 tertiles based on the rates of discharge contract use: 0% to 8.4% (tertile 1), >8.4% to 38.0% (tertile 2), and >38.0% to 61.1% (tertile 3). We analyzed 1-year follow-up mortality both pre- and post-GAP and compared the mortality decline post-GAP with discharge contract use according to tertile. RESULTS There were 1368 patients in the baseline (pre-GAP) cohort and 1489 patients in the post-GAP cohort. After GAP implementation, mortality at 1 year decreased by 1.2% (P = .71), 1.2% (P = .68), and 6.0% (P = .03) for tertiles 1, 2, and 3, respectively. After multivariate adjustment, discharge contract use was significantly associated with decreased 1-year mortality in tertile 2 (odds ratio 0.43, 95% CI 0.22-0.84) and tertile 3 (odds ratio 0.45, 95% CI 0.27-0.75). CONCLUSIONS Increased hospital utilization of the standard discharge contract as part of the GAP program is associated with decreased 1-year mortality in Medicare patient populations with AMI. Hospital efforts to promote adherence to guideline-based care tools such as the discharge contract used in GAP may result in mortality reductions for their patient populations at 1 year.
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Affiliation(s)
- Adam M Rogers
- Department of Medicine, University of California, San Francisco, CA, USA
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Sheth TN, Rieber J, Mooyaart EAQ, Pena A, Abbara S, Cury RC, Brady T, Hoffmann U. Usefulness of coronary computed tomographic angiography to assess suitability for revascularization in patients with significant coronary artery disease and angina pectoris. Am J Cardiol 2006; 98:1198-201. [PMID: 17056327 DOI: 10.1016/j.amjcard.2006.05.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/13/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
Coronary computed tomographic angiography (CTA) accurately excludes the presence of coronary stenoses in selected patient populations. However, it remains unclear whether coronary CTA has the potential to replace invasive coronary angiography as a tool to assess a patient's suitability for revascularization as determined by the characterization of lesion morphology in patients with significant coronary artery disease. Coronary CTA (64-slice computed tomography) was performed before invasive coronary angiography in 29 patients. We evaluated the accuracy of CTA for the detection of complex lesion morphology, including the presence of severe calcium, total occlusions, and ostial or bifurcation location, and compared the results with those of invasive angiography. On CTA, 10 of 69 lesions (15%) were not evaluable for any feature of complex lesion morphology. Of the evaluable lesions, CTA detected >or=1 feature of complexity in 58% of lesions, corresponding to a sensitivity of 88% (23 of 26) and a specificity of 83% (24 of 29). For those single features, the sensitivity of CTA was 100% for the presence of severe calcium, 93% for total occlusions, and 60% and 80% for the detection of ostial and bifurcation lesions, respectively. The specificity was high for total occlusions (97%), ostial lesions (97%), and bifurcations (100%). It was moderate (85%) for severe calcium. Severe calcium precluded the evaluation of other features of complex lesion morphology in 6 lesions (11%). In conclusion, invasive selective coronary angiography remains the cornerstone to assess a patient's suitability for revascularization given the high proportion of unevaluable segments and segments with severe calcium that precluded adequate revascularization planning on CTA.
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Affiliation(s)
- Tej N Sheth
- Cardiac MR PETCT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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22
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Daemen J, Ong ATL, Stefanini GG, Tsuchida K, Spindler H, Sianos G, de Jaegere PPT, van Domburg RT, Serruys PW. Three-year clinical follow-up of the unrestricted use of sirolimus-eluting stents as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry. Am J Cardiol 2006; 98:895-901. [PMID: 16996869 DOI: 10.1016/j.amjcard.2006.04.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 04/25/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
Sirolimus-eluting stents (SESs) have been shown to decrease restenosis compared with bare metal stents (BMSs). Currently, there are limited data on the long-term efficacy of these devices in a real-world patient population. Furthermore, the potential of a late restenotic phenomenon has not yet been excluded. From April to October 2002, 508 consecutive patients with de novo lesions exclusively treated with SESs were enrolled and compared with 450 patients treated with BMSs in the preceding 6 months (control group). Patients in the SES group more frequently had multivessel disease and type C lesions, received more stents, and had more bifurcation stenting. After 3 years, the cumulative incidence of major adverse cardiac events (comprising death, myocardial infarction, and target vessel revascularization) was significantly lower in the SES group compared with the pre-SES group (18.9% vs 24.7%, hazards ratio 0.73, 95% confidence interval 0.56 to 0.96, p = 0.026). The 3-year risk of target lesion revascularization was 7.5% in the SES group versus 12.6% in the pre-SES group (hazards ratio 0.57, 95% confidence interval 0.38 to 0.87, p = 0.01). In conclusion, the unrestricted use of SESs is safe and superior to the use of BMSs. The beneficial effects, reported after 1 and 2 years in reducing major adverse cardiac events, persisted with no evidence of a clinical late restenotic "catch-up" phenomenon.
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Affiliation(s)
- Joost Daemen
- The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Valencia J, Berenguer A, Mainar V, Bordes P, Gómez S, Tello A, López-Aranda MA, Caturla J. Two-year follow-up of sirolimus-eluting stents for the treatment of proximal left anterior descending coronary artery stenosis. J Interv Cardiol 2006; 19:126-34. [PMID: 16650240 DOI: 10.1111/j.1540-8183.2006.00119.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Sirolimus-eluting stents (SES) have demonstrated low target vessel revascularizations and low incidence of angiographic restenosis in several clinical scenarios. The aim of the present study was to assess the efficacy and safety of SES for the treatment of proximal left anterior descending coronary artery (pLAD) lesions. METHODS Ninety-six patients with severe pLAD stenosis were enrolled. Angiographic and clinical follow-up were performed at 6 and 24 months, respectively. Death, myocardial infarction (MI), new target lesion revascularization (TLR), and target vessel failure (TVF) were registered. Clinical, angiographic, and procedural variables were analyzed to identify predictors of restenosis. RESULTS Mean clinical follow-up was 858+/-158 days (26.5+/-8.3 months). Angiographic procedural success was 100%. Angiographic follow-up showed 8.4% of binary restenosis without edge-restenosis phenomenon. Late loss was 0.15+/-0.65 mm; 15.6% of patients had an adverse cardiac event, with 1% of death, 5.2% of MI, 6.3% of TLR, and 9.4% of TVF. At 2 years, the probabilities of cumulative TVF- and TLR-free survival were 90.6% and 93.7%, respectively. Interestingly, no adverse cardiac events were registered between the first and second years. Female gender (OR 10.7 CI 95%[1.7-66.7]) and in-stent restenosis (OR 8.2, CI 95%[1.2-56.4]) were found as independent predictors of binary restenosis. Advanced chronic renal failure showed a strong trend toward worse outcome in terms of binary restenosis (P=0.063). CONCLUSIONS SES for the treatment of pLAD stenosis proved safe and effective in a long-term follow-up with low incidence of adverse cardiac events and restenosis. Female gender and in-stent restenosis were predictors of binary restenosis.
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Affiliation(s)
- José Valencia
- Laboratorio de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain.
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Hecht HS, Budoff MJ, Berman DS, Ehrlich J, Rumberger JA. Coronary artery calcium scanning: Clinical paradigms for cardiac risk assessment and treatment. Am Heart J 2006; 151:1139-46. [PMID: 16781212 DOI: 10.1016/j.ahj.2005.07.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 07/12/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) scanning is being increasingly used for cardiac risk assessment in asymptomatic patients, particularly in those with a Framingham 10-year risk of 10% to 20%. Physician awareness of this technology and its appropriate uses and limitations is crucial to appropriate use. METHODS With the goal of establishing clinical paradigms, this document integrates the results of key published articles, Framingham Risk Score, National Cholesterol Education Program Adult Treatment Plan III guidelines, American College of Cardiology/American Heart Association exercise testing and angiographic guidelines, and the authors' extensive clinical experience. RESULTS Coronary artery calcium scanning is best used in the asymptomatic population with a 10% to 20% risk of cardiac events over 10 years, with selected application in higher and lower risk categories. In the 10%-20% risk patient, coronary artery calcium scores >100 or >75th percentile for age and sex transform the moderately high-risk patient to higher risk status with the attendant recommendation for more aggressive therapy; scores from 11 to 100 and <75th percentile are consistent with the 10%-20% 10-year risk status and scores from 0 to 10 and <75th percentile convert the patient to lesser risk categories. If stress testing is planned in the asymptomatic patient, it should be preceded by coronary artery calcium scanning and performed only for scores >400; it should always precede coronary angiography in these patients. CONCLUSIONS Coronary artery calcium scanning is an important risk assessment tool with direct clinical applications; it is of particular utility in the Framingham 10%-20% 10-year risk population.
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Affiliation(s)
- Harvey S Hecht
- Lenox Hill Heart and Vascular Institute, New York, NY 10021, USA.
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Ong ATL, Serruys PW, Mohr FW, Morice MC, Kappetein AP, Holmes DR, Mack MJ, van den Brand M, Morel MA, van Es GA, Kleijne J, Koglin J, Russell ME. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J 2006; 151:1194-204. [PMID: 16781219 DOI: 10.1016/j.ahj.2005.07.017] [Citation(s) in RCA: 221] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Accepted: 07/12/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Changes in the treatment of coronary artery disease both surgically and percutaneously have rendered the major randomized trials historical. Furthermore, the restrictive criteria of previous trials excluded most patients treated in daily practice. Although coronary surgery is still considered the current, evidence-based, gold-standard treatment of left main (LM) and 3-vessel coronary disease, the added benefit of drug-eluting stents has further expanded the use of percutaneous coronary intervention (PCI) beyond less complex populations in daily practice. STUDY DESIGN The 1500-patient, prospective, multicenter, multinational (European and North American), randomized SYNTAX study with nested registries will enroll "all-comers." Consecutive patients with de novo 3-vessel disease (3VD) and/or LM disease will be screened for eligibility by the Heart Team (composed of an interventionalist, a cardiac surgeon, and the study coordinator) at each site and then allocated to either (1) the randomized cohort, if comparable revascularization can be achieved by either PCI or coronary artery bypass surgery (CABG), or (2) to one of the nested registries for CABG-ineligible patients (PCI registry) or for PCI-ineligible patients (CABG registry). Randomized patients will be stratified based on LM disease and diabetes by site. The primary end point for the randomized comparison is noninferiority of major adverse cardiac and cerebral events between the 2 groups at 1 year. To adequately project the expected enrollment rate per site, a run-in phase was mandated for each site interested in participating in the trial. Both cardiothoracic and interventional cardiology departments within the same institution were asked to complete a questionnaire regarding their frequency of treatment of LM and 3VD over a retrospective 3-month period. IMPLICATIONS By replacing most traditional inclusion and exclusion criteria with the real-world decision between the cardiothoracic surgeon and the interventionalist, this study will define the roles of CABG and PCI using drug-eluting stents in the contemporary management of LM and 3VD. Results of the run-in phase were used by the steering committee to determine eligibility and to project enrollment for each site.
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Affiliation(s)
- Andrew T L Ong
- Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands
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Dumont CJP, Keeling AW, Bourguignon C, Sarembock IJ, Turner M. Predictors of Vascular Complications Post Diagnostic Cardiac Catheterization and Percutaneous Coronary Interventions. Dimens Crit Care Nurs 2006; 25:137-42. [PMID: 16721193 DOI: 10.1097/00003465-200605000-00016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Care of patients after cardiac catheterization and/or percutaneous coronary intervention is largely the responsibility of nurses. The identification of risk factors for vascular complications from these procedures is important for the development of protocols to prevent complications. This article describes a retrospective, descriptive, and correlational study of 11,119 patients who underwent cardiac catheterization and/or percutaneous intervention, with femoral artery access, in the years 2001 to 2003. Increased risk for vascular complications was found in patients who were older than 70 years, were female, had renal failure, underwent percutaneous intervention, and had a venous sheath.
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Morrison DA, Thai H, Goldman S, Felix E, Hernandez J. Percutaneous coronary intervention of or through saphenous vein grafts or internal mammary arteries: the impact of stents, adjunctive pharmacology, and multicomponent distal protection. Catheter Cardiovasc Interv 2006; 67:571-9. [PMID: 16547927 DOI: 10.1002/ccd.20641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We hypothesized that the use of stents and aggressive adjunctive pharmacotherapies has been associated with lower rates of complicating myocardial infarction (MI) and improved long-term outcomes compared to either previous balloon-only percutaneous coronary intervention (PCI) or atheroablative intervention for lesions of or through saphenous vein grafts (SVGs) and/or internal mammary arteries (IMAs). PCI of SVG has been complicated by relatively high rates of procedural MI and less favorable long-term outcomes than native vessel PCI, stimulating the development and application of an array of technologies. This study was based on retrospective review of stent-era (1999-2004) 5-year experience of a single center with 95 SVG procedures in 85 patients and 20 IMA procedures in 20 patients. These cases were compared with the previously published experience of one of the operators during the balloon-only period and literature review of the application of multiple technologies to SVG intervention, as well as consideration of the reoperation alternative. There was one in-hospital death each in the SVG cohort (1%) and in the IMA cohort (5%). There were SIX procedural MIs (6%), defined by total CK > normal, and 19 procedural MIs (20%) based on troponin-I > 1.0. Follow-up has been from 4 months to 5 years (average, 2.5 years), with 91% survival and one late CABG in the IMA group. SVG PCI with stents and adjunctive pharmacotherapies is associated with relatively low rates of procedural MI and favorable long-term outcomes.
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Affiliation(s)
- Douglass A Morrison
- Section of Cardiology, Department of Internal Medicine, SAVAHCS, and the University of Arizona, Sarver Heart Center, Tucson, 85723, USA.
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Strausbaugh LJ, Siegel JD, Weinstein RA. Preventing Transmission of Multidrug-Resistant Bacteria in Health Care Settings: A Tale of Two Guidelines. Clin Infect Dis 2006; 42:828-35. [PMID: 16477561 DOI: 10.1086/500408] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Accepted: 12/08/2005] [Indexed: 12/29/2022] Open
Abstract
Two guidelines for the control of multidrug-resistant organisms in health care facilities have appeared during the past 3 years--one from the Society for Healthcare Epidemiology of America and one, in draft form, from the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention. These guidelines reflect universal concern in the infection-control community about today's unprecedented levels of activity of multidrug-resistant organisms and about inadequate or inconsistent application of potentially effective control measures. The 2 guidelines provide detailed reviews of pertinent issues and evidence-based, rated recommendations, which overlap considerably. Recommendations regarding indications for active surveillance cultures and the extent of their use constitute the major divergence. Although implementation of comprehensive control plans for multidrug-resistant organisms advocated by both guidelines will require health care facilities to confront difficult programmatic issues, aggressive and widespread adoption of control measures for multidrug-resistant organisms is urgently needed.
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Affiliation(s)
- Larry J Strausbaugh
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, OR, USA.
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Affiliation(s)
- Ullamari Pesonen
- Dept. of Pharmacology and Clinical Pharmacology, University of Turku, Itäinen Pitkäkatu 4B, FIN-20520, Turku, Finland.
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Blackman DJ, Pinto R, Ross JR, Seidelin PH, Ing D, Jackevicius C, Mackie K, Chan C, Dzavik V. Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention. Am Heart J 2006; 151:146-52. [PMID: 16368308 DOI: 10.1016/j.ahj.2005.03.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 03/15/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND End-stage renal failure is associated with poor outcomes, including increased mortality, after percutaneous coronary intervention (PCI). The effect of milder degrees of renal insufficiency (RI) is less clear, especially with routine stenting and glycoprotein IIb/IIIa inhibitor therapy, which may be of particular benefit in patients with RI. METHODS Clinical, angiographic, procedural, and outcome variables of 7769 consecutive patients who underwent PCI between April 2000 and July 2004 were entered into a prospective database. Inhospital mortality and morbidity were calculated according to baseline creatinine clearance. Simple and multiple logistic regression analyses were performed to determine independent predictors of mortality. RESULTS Baseline creatinine clearance was available in 6840 patients. It was normal (> 80 mL/min) in 3474; 1670 had mild RI (61-80 mL/min), 1111 moderate RI (41-60 mL/min), and 585 severe RI (< or = 40 mL/min). Major adverse cardiac events (MACE) (death/myocardial infarction/revascularization) increased substantially with worsening renal function (2.4% vs 3.0% vs 4.8% vs 9.7%, P < .0001), as did mortality (0.3% vs 0.7% vs 1.5% vs 6.0%, P < .0001). Multiple logistic regression analysis identified moderate RI and severe RI as independent predictors of mortality (odds ratio [OR] 3.9, P < .001; OR 12.7, P < .0001, respectively) and morbidity (MACE) (OR 1.5, P < .05; OR 2.5, P < .0001, respectively). Mild RI trended to increase the risk of mortality but did not reach statistical significance as an independent predictor of inhospital death on multiple regression analysis (OR 2.1, P = .1) and did not increase the risk of MACE (OR 1.1, P = .6). CONCLUSIONS Despite routine stenting and glycoprotein IIb/IIIa inhibitor therapy, RI remains an independent predictor of increased morbidity, and particularly mortality, after PCI. However, the adverse effect of truly mild RI on outcome is limited.
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Affiliation(s)
- Daniel J Blackman
- Interventional Cardiology Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Kaul P, Lytle BL, Spertus JA, DeLong ER, Peterson ED. Influence of racial disparities in procedure use on functional status outcomes among patients with coronary artery disease. Circulation 2005; 111:1284-90. [PMID: 15769770 DOI: 10.1161/01.cir.0000157731.66268.e1] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although black cardiac patients receive fewer revascularization procedures than whites, it is unclear whether this has a detrimental impact on outcomes. The objective of our study was to compare 6-month functional status and angina outcomes among blacks and whites with documented coronary disease and to assess whether differential use of revascularization procedures affects these outcomes. METHODS AND RESULTS We identified a prospective cohort of 1534 white and 337 black patients undergoing cardiac catheterization between August 1998 and April 2001. Health status was assessed at baseline and 6 months with the Short-Form 36 (SF-36) Health Survey and the Seattle Angina Questionnaire (SAQ) Angina Frequency Scale. Compared with whites, blacks received fewer coronary revascularization procedures (52.5% versus 66.0%; P<0.01). By 6 months, blacks had similar mortality (odds ratio, 1.03; 95% CI, 0.57 to 1.9) but worse scores in 5 SF-36 domains (physical, social, role physical, role emotional, and mental health function). Blacks also reported higher rates of angina at 6 months than whites (34.2% versus 24.6%; P<0.01). After adjustment for baseline functional status and clinical and demographic variables, blacks had significantly worse summary physical component scores, summary mental component scores, and SAQ Angina Frequency Scale scores. However, differences in physical component summary scores and SAQ scores between blacks and whites were no longer significant after adjustment for revascularization status. CONCLUSIONS Our study is among the first to document greater symptoms and functional impairment among black cardiac patients relative to whites. Differential use of coronary revascularization may contribute to the poorer functional outcomes observed among black patients with documented coronary disease.
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Affiliation(s)
- Padma Kaul
- University of Alberta, Edmonton, Alberta, Canada
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32
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 SW First Street, Rochester, MN 55905, USA.
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Rothman MT. Drug Insight: bleeding after percutaneous coronary intervention-risks, measures and impact of anticoagulant treatment options. ACTA ACUST UNITED AC 2005; 2:465-74. [PMID: 16265587 DOI: 10.1038/ncpcardio0311] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 07/22/2005] [Indexed: 11/10/2022]
Abstract
In Europe, the use of interventional cardiology, including percutaneous coronary intervention (PCI), is increasing rapidly. The use of anticoagulation agents in PCI procedures is essential, but despite technical improvements, a significant associated bleeding risk still exists: more than 5% of patients are estimated to require transfusion, and around a further 13% experience minor bleeding. The methods used to detect and measure blood loss following PCI, however, vary widely between institutions and clinical trials. The risk of bleeding is influenced by therapeutic options and patient-specific characteristics, such as age, anemia and previous exposure to anticoagulants. Bleeding is associated with death, and also with less severe conditions such as thrombocytopenia, anemia, and hematoma, which have major impacts on patients' welfare and length of hospital stay, and on hospital budgets. Unfractionated heparin is the most widely used anticoagulant during PCI. Heparin, antiplatelet agents and other anticoagulants, however, have limitations that make it difficult to achieve a level of anticoagulation that prevents ischemic events without promoting bleeding. The use of low-molecular-weight heparin and the addition of glycoprotein IIb/IIIa inhibitors offer improved outcomes, but safer and more effective therapeutic agents are still required. New anticoagulants, including direct thrombin inhibitors such as bivalirudin, show similar levels of efficacy to heparin plus glycoprotein IIb/IIIa inhibitors, but with fewer hemorrhagic complications, and might advance clinical practice. This review evaluates the impact of PCI-related bleeding on patients' outcomes and hospital resources, examines methods for the detection and measurement of bleeding, and appraises the therapeutic options--particularly the newer agents--available to minimize hemorrhagic complications.
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Chee KH, Siaw FS, Chan CG, Chong WP, Imran ZA, Haizal HK, Azman W, Tan KH. Clinical experience in coronary stenting with the Vivant Z Stent. Int J Clin Pract 2005; 59:628-31. [PMID: 15924588 DOI: 10.1111/j.1742-1241.2005.00514.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This single centre study was designed to demonstrate feasibility, safety and efficacy of the Vivant Z stent (PFM AG, Cologne, Germany). Patients with de novo lesion were recruited. Coronary angioplasty was performed with either direct stenting or after balloon predilatation. Repeated angiogram was performed 6 months later or earlier if clinically indicated. Between January to June 2003, a total of 50 patients were recruited (mean age 55.8 +/- 9 years). A total of 52 lesions were stented successfully. Mean reference diameter was 2.77 mm (+/-0.59 SD, range 2.05-4.39 mm) with mean target lesion stenosis of 65.5% (+/-11.6 SD, range 50.1-93.3%). Forty-six lesions (88.5%) were American College of Cardiologist/American Heart Association class B/C types. Direct stenting was performed in 18 (34.6%) lesions. Mean stent diameter was 3.18 mm (+/-0.41 SD, range 2.5-4 mm), and mean stent length was 14.86 mm (+/-2.72 SD, range 9-18 mm). The procedure was complicated in only one case which involved the loss of side branch with no clinical sequelae. All treated lesions achieved Thrombolysis In Myocardial Infarction 3 flow. Mean residual diameter stenosis was 12.2% (+/-7.55 SD, range 0-22.6%) with acute gain of 1.72 mm (+/-0.50 SD, range 0.5-2.8). At 6 months, there was no major adverse cardiovascular event. Repeated angiography after 6 months showed a restenosis rate of 17% (defined as >50% diameter restenosis). Mean late loss was 0.96 mm (+/-0.48 SD) with loss index of 0.61 (+/-0.38 SD). The restenosis rate of those lesions less than 3.0 mm in diameter was 22.2% compared with 6.25% in those lesions more than 3.0 mm in diameter. The Vivant Z stent was shown to be safe and efficacious with low restenosis rate in de novo coronary artery lesion.
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Affiliation(s)
- K H Chee
- Cardiology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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35
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Reinecke H, Matzkies F, Fobker M, Breithardt G, Schaefer RM. Diabetic nephropathy, percutaneous coronary interventions, and blockade of the renin-angiotensin system. Cardiology 2005; 104:24-30. [PMID: 15942180 DOI: 10.1159/000086050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Accepted: 11/29/2004] [Indexed: 11/19/2022]
Abstract
Since recent studies demonstrated an impaired outcome after percutaneous coronary interventions (PCI) in patients with chronic renal failure but did not address the aetiology of renal failure, we now analysed the outcome of patients with diabetic nephropathy in 721 consecutive patients undergoing PCI. Diabetic nephropathy was present in 37 patients (5.1%), and diabetes alone in 126 patients (17.5%); 178 patients (24.7%) suffered from renal insufficiency of other causes; the other 380 patients (52.7%) were used as controls. Although angiographic success rates were similar in the subgroups (94-97%), 30-day and long-term mortality after 4 years was significantly higher in patients with diabetic nephropathy (8.1 and 27%, respectively) than in diabetics (1.6 and 8.7%, respectively), patients with renal insufficiency (3.9 and 16.8%, respectively), or controls (2.4 and 5.0%, respectively, each p<0.001, log-rank test). Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a marked decrease in 2-year mortality in patients with diabetic nephropathy (19.4 vs. 33.3%, respectively, p=0.02, log-rank test).
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Affiliation(s)
- Holger Reinecke
- Department of Cardiology and Angiology, Medical Clinic and Policlinic C, University Hospital of Munster, Munster, Germany.
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Abstract
Myocardial revascularization in patients with multi-vessel coronary artery disease may be accomplished, by percutaneous interventions or surgery, either on all diseased lesions or directed to selectively targeted coronary segments. The extent of planned revascularization is often a major determinant of treatment strategy. Revascularization of all diseased coronary segments-complete myocardial revascularization-has a potential long-term benefit, but is more complex and may increase in-hospital untoward events. Revascularization may otherwise be incomplete, either because of the operator's inability to treat all diseased coronary segments or by choice of deciding to selectively revascularize only large areas of myocardium at risk. Although incomplete revascularization may negatively affect long-term outcomes, it may be, when wisely chosen, the preferred treatment strategy in selected patient categories because of its lower immediate risks. The patient's clinical status, ventricular function, and the presence of co-morbidities may orient clinical decisions in favour of incomplete revascularization.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Centre of Excellence on Aging, 'G. d'Annunzio' University, Ospedale S. Camillo de Lellis, Via Forlanini, 50, 66100 Chieti, Italy.
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Ong ATL, Serruys PW, Aoki J, Hoye A, van Mieghem CAG, Rodriguez-Granillo GA, Valgimigli M, Sonnenschein K, Regar E, van der Ent M, de Jaegere PPT, McFadden EP, Sianos G, van der Giessen WJ, de Feyter PJ, van Domburg RT. The unrestricted use of paclitaxel- versus sirolimus-eluting stents for coronary artery disease in an unselected population. J Am Coll Cardiol 2005; 45:1135-41. [PMID: 15808774 DOI: 10.1016/j.jacc.2005.01.008] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 01/10/2005] [Accepted: 01/18/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We investigated the efficacy of paclitaxel-eluting stents (PES) compared to sirolimus-eluting stents (SES) when used without restriction in unselected patients. BACKGROUND Both SES and PES have been separately shown to be efficacious when compared to bare stents. In unselected patients, no direct comparison between the two devices has been performed. METHODS Paclitaxel-eluting stents have been used as the stent of choice for all percutaneous coronary interventions in the prospective Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) registry. A total of 576 consecutive patients with de novo coronary artery disease exclusively treated with PES were compared with 508 patients treated with SES from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. RESULTS The PES patients were more frequently male, more frequently treated for acute myocardial infarction, had longer total stent lengths, and more frequently received glycoprotein IIb/IIIa inhibitors. At one year, the raw cumulative incidence of major adverse cardiac events was 13.9% in the PES group and 10.5% in the SES group (unadjusted hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.95 to 1.88, p = 0.1). Correction for differences in the two groups resulted in an adjusted HR of 1.16 (95% CI 0.81 to 1.64, p = 0.4, using significant univariate variables) and an adjusted HR of 1.20 (95% CI 0.85 to 1.70, p = 0.3, using independent predictors). The one-year cumulative incidence of clinically driven target vessel revascularization was 5.4% versus 3.7%, respectively (HR 1.38, 95% CI 0.79 to 2.43, p = 0.3). CONCLUSIONS The universal use of PES in an unrestricted setting is safe and is associated with a similar adjusted outcome compared to SES. The inferior trend in crude outcome seen in PES was due to its higher-risk population. A larger, randomized study enrolling an unselected population may assist in determining the relative superiority of either device.
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Affiliation(s)
- Andrew T L Ong
- Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands
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38
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Mehta SR, Steg PG, Granger CB, Bassand JP, Faxon DP, Weitz JI, Afzal R, Rush B, Peters RJG, Natarajan MK, Velianou JL, Goodhart DM, Labinaz M, Tanguay JF, Fox KAA, Yusuf S. Randomized, Blinded Trial Comparing Fondaparinux With Unfractionated Heparin in Patients Undergoing Contemporary Percutaneous Coronary Intervention. Circulation 2005; 111:1390-7. [PMID: 15781750 DOI: 10.1161/01.cir.0000158485.70761.67] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Factor Xa plays a central role in the generation of thrombin, making it a novel target for treatment of arterial thrombosis. Fondaparinux is a synthetic factor Xa inhibitor that has been shown to be superior to standard therapies for the prevention of venous thrombosis. We performed a randomized trial to determine the safety and feasibility of fondaparinux in the percutaneous coronary intervention (PCI) setting.
Methods and Results—
A total of 350 patients undergoing elective or urgent PCI were randomized in a blinded manner to receive unfractionated heparin (UFH), 2.5 mg fondaparinux IV, or 5.0 mg fondaparinux IV. Randomization was stratified for planned or no planned use of glycoprotein (GP) IIb/IIIa antagonists. The primary safety outcome was total bleeding, which was a combination of major and minor bleeding events. The incidence of total bleeding was 7.7% in the UFH group and 6.4% in the combined fondaparinux groups (hazard ratio, 0.81; 95% confidence interval, 0.35 to 1.84;
P
=0.61). Bleeding was less common in the 2.5-mg fondaparinux group compared with the 5-mg fondaparinux group (3.4% versus 9.6%,
P
=0.06). The composite efficacy outcome of all-cause mortality, myocardial infarction, urgent revascularization, or need for a bailout GPIIb/IIIa antagonist was 6.0% in the UFH group and 6.0% in the fondaparinux group, with no significant difference in efficacy among the fondaparinux doses compared with UFH. Coagulation marker analysis at 6 and 12 hours after PCI demonstrated that fondaparinux was superior to UFH in inducing a sustained reduction in markers of thrombin generation, as measured by prothrombin fragment F1.2 (
P
=0.02).
Conclusions—
In this pilot study of patients undergoing contemporary PCI, factor Xa inhibition with the synthetic anticoagulant fondaparinux in doses of 2.5 and 5.0 mg was comparable to UFH for clinical safety and efficacy outcomes. These data form the basis for further evaluation of fondaparinux in arterial thrombosis.
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Affiliation(s)
- Shamir R Mehta
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, General Division, 237 Barton St E, Hamilton, Ontario, Canada L6K 1B8.
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Jones SO, Eckart RE, Shry EA, Simpson DE. Review of Subacute Stent Thrombosis Following Percutaneous Coronary Intervention at a Low‐Volume Catheterization Laboratory. J Interv Cardiol 2005; 18:11-5. [PMID: 15788048 DOI: 10.1111/j.1540-8183.2005.04044.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The frequency of coronary stent subacute thrombosis (SAT) following percutaneous coronary intervention (PCI) with uncoated stents in recent studies is 0.5%-0.9%. Prior studies have indicated that complication rates are significantly higher when performed in low-volume centers. We sought to determine the incidence and outcomes of SAT following PCI with stent placement at a low-volume catheterization laboratory. METHODS We reviewed the Brooke Army Medical Center Interventional Database for all consecutive PCIs with stent implantation performed from January 1998 to December 2002. Clinical outcomes were obtained primarily through hospitalization records and clinic follow-up visits. RESULTS There were 789 interventions with stenting on 750 patients over the specified time period, for an average of 158 procedures on 150 patients per year. There were seven cases of SAT, representing a rate of 0.89%. There was no difference in the clinical characteristics, procedural technique, or postprocedural antithrombotic therapy of the subjects with and without SAT. Of those with SAT, there were no subjects requiring surgical revascularization during index hospitalization, and all survived to index hospital discharge. Six of these seven subjects with SAT (85.7%) were alive at one year, with the single death noncardiovascular related. CONCLUSIONS The incidence of thrombosis occurring within 30 days of intracoronary stent implantation is similar in low- and high-volume catheterization laboratories. In our low-volume laboratory experience, these events were not associated with significantly increased adverse outcomes.
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Affiliation(s)
- Samuel O Jones
- Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
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40
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Lemos PA, de Feyter PJ, Serruys PW, Saia F, Arampatzis CA, Disco C, Mercado N, Mainar V, Morís C, van den Bos AA, Berghoefer G. Fluvastatin reduces the 4-year cardiac risk in patients with multivessel disease. Int J Cardiol 2005; 98:479-86. [PMID: 15708183 DOI: 10.1016/j.ijcard.2003.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate the impact of the extent of coronary disease (single- or multivessel) and of fluvastatin treatment on the incidence of long-term cardiac atherosclerotic complications in the Lescol Intervention Prevention Study (LIPS). METHODS A total of 1063 patients with single-vessel disease and 614 patients with multivessel disease were randomized to receive fluvastatin (40 mg bid) or placebo for at least 3 years following a first successful percutaneous coronary intervention. The incidence of cardiac atherosclerotic events (cardiac death, non-fatal myocardial infarction, and coronary re-interventions not related to restenosis) was evaluated. RESULTS Patients with multivessel disease tended to be older and presented a higher prevalence of associated risk factors and cardiovascular antecedents. The presence of multivessel disease markedly increased the risk of cardiac atherosclerotic events compared with single-vessel disease among patients allocated to placebo (RR 1.67 [95% CI: 1.24-2.25]; p<0.001). In patients treated with fluvastatin, however, no significant differences in long-term outcomes were observed between patients with multivessel disease and patients single-vessel disease (RR 1.28 [95% CI: 0.90-1.81]; p=0.2). CONCLUSIONS Multivessel coronary disease impaired the 4-year outcomes after percutaneous intervention. However, the hazardous effect of multivessel disease was significantly reduced by long-term fluvastatin treatment.
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Affiliation(s)
- Pedro A Lemos
- Erasmus Medical Center, Thoraxcenter, Rotterdam, Netherlands
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41
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Bottner RK, Klein LW. Society news page: Do the Current ACC/AHA guidelines correctly reflect the attitudes and utilization of PCI in patients with unprotected left main coronary artery stenosis? Catheter Cardiovasc Interv 2005; 64:402-5. [PMID: 15736261 DOI: 10.1002/ccd.20309] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Waters RE, Kandzari DE, Phillips HR, Crawford LE, Sketch MH. Late thrombosis following treatment of in-stent restenosis with drug-eluting stents after discontinuation of antiplatelet therapy. Catheter Cardiovasc Interv 2005; 65:520-4. [PMID: 15973673 DOI: 10.1002/ccd.20428] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Drug-eluting stent usage has become commonplace for the percutaneous treatment of de novo coronary lesions, but the safety and efficacy profile for their evolving usage in restenotic lesions is largely unknown. We report three cases of angiographically confirmed drug-eluting stent thrombosis following treatment of restenotic lesions that occurred late (193, 237, and 535 days) and shortly after interruption of antiplatelet therapy. All three patients suffered ST elevation myocardial infarction, and there was one death. Further studies are necessary to better define the associated risk and ideal duration of antiplatelet therapy necessary in this cohort of patients with restenotic lesions.
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Affiliation(s)
- Richard E Waters
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA
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43
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Thomas GS. Should We Screen Asymptomatic Individuals for Coronary Artery Disease or Implement Universal Lipid-Lowering Therapy? Cardiol Rev 2005; 13:40-5. [PMID: 15596028 DOI: 10.1097/01.crd.0000134646.52262.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The lifetime risk of developing coronary heart disease after age 40 has been estimated to be 49% and 32% in men and women, respectively. Including other diseases secondary to atherosclerosis makes the likelihood of developing cardiovascular disease even greater. Lacking an adequate screening test for subclinical cardiovascular disease, or for those in whom it will develop, our current national prevention and treatment strategy is to screen for risk factors of coronary artery disease (CAD), treating only those at greatest risk. Although pharmacologic lipid-lowering therapy has proven to be effective at reducing the development and manifestations of CAD, as well as remarkably safe, our current strategy withholds treatment of many in whom cardiovascular disease will ultimately develop. An alternate strategy is to implement universal lipid-lowering therapy, initiated in men at age 30 and at the time of menopause in women. Such a policy would not limit effective treatment to only those at greatest risk. While the cost of such a program would be substantial, although decreasing with the increasing availability of generic agents, this must be weighed against the direct and indirect costs of cardiovascular disease, estimated to be $368 billion in 2004. If such a strategy were implemented, the goal of screening would shift from CAD detection to detection of a disease burden such that therapies shown to decrease events among those with manifest CAD would be expected to benefit. Such treatments currently include aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and revascularization.
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Affiliation(s)
- Gregory S Thomas
- Mission Internal Medical Group, and the Division of Cardiology, University of California-Irvine, Mission Viejo, CA 92691, USA.
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Karmpaliotis D, Turakhia MP, Kirtane AJ, Murphy SA, Kosmidou I, Morrow DA, Giugliano RP, Cannon CP, Antman EM, Braunwald E, Gibson CM. Sequential risk stratification using TIMI risk score and TIMI flow grade among patients treated with fibrinolytic therapy for ST-segment elevation acute myocardial infarction. Am J Cardiol 2004; 94:1113-7. [PMID: 15518603 DOI: 10.1016/j.amjcard.2004.07.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 07/09/2004] [Accepted: 07/09/2004] [Indexed: 11/26/2022]
Abstract
In the setting of ST-segment elevation myocardial infarction (STEMI), the Thrombolysis In Myocardial Infarction (TIMI) risk score (TRS) and indexes of epicardial and myocardial perfusion are associated with mortality. The association between TRS at presentation and angiographic indexes of epicardial and myocardial perfusion after reperfusion therapy has not been investigated. We hypothesized that TRS, TIMI flow grade (TFG), and TIMI myocardial perfusion grade (TMPG) would provide independent prognostic information and that angiographic indexes of poor flow and perfusion would be associated with a higher TRS. TRS and angiographic data were evaluated in 3,801 patients from the TIMI 4, 10A, 10B, 14, 20, 23, and 24 trials. Within each TRS stratum (TRS 0 to 2, 3 to 4, >/=5), 30-day mortality increased stepwise among patients with impaired TFG at 60 minutes after fibrinolytic administration. In a multivariate model adjusting for the TRS strata, impaired TMPG (0/1) was independently associated with higher mortality (odds ratio 2.28, p = 0.018). In a multivariate model adjusting for the TFG and infarct location, the likelihood of impaired TMPG (0/1) was greater among intermediate-risk (TRS 3 to 4) and high-risk (TRS >/=5) patients than among low-risk (TRS 0 to 2) patients (odds ratio 1.43, p = 0.019 and 1.50, p = 0.055, respectively). Thus, impaired epicardial flow and myocardial perfusion are independently associated with increased 30-day mortality among patients identified by TRS as high risk, although there is no synergism between either TFG or TMPG and TRS. High TRS at presentation is associated with abnormal myocardial perfusion, even after adjusting for possible confounders.
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Affiliation(s)
- Dimitrios Karmpaliotis
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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45
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Vogt A, Strasser RH. Positionspapier zur Qualit�tssicherung in der invasiven Kardiologie. ACTA ACUST UNITED AC 2004; 93:829-33. [PMID: 15492900 DOI: 10.1007/s00392-004-0154-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A Vogt
- Medizinische Klinik II, Klinikum Kassel, Mönchebergstrasse 41-43, 34125 Kassel, Germany
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46
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Latsch A, Suselbeck T, Muth N, Poerner T, Baumbach A, Pfleger S, Borggrefe M, Haase KK. Utilization of eptifibatide for treatment of severe dissections as a bail-out procedure. Int J Cardiol 2004; 96:229-33. [PMID: 15262038 DOI: 10.1016/j.ijcard.2003.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2003] [Revised: 06/25/2003] [Accepted: 07/25/2003] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has been shown in several large trials that the inhibition of glycoprotein (GP) IIb/IIIa receptors of platelets can reduce the rate of ischemic complications following percutaneous transluminal coronary angioplasty (PTCA). We sought to determine the efficacy of eptifibatide in patients with severe dissections or threatened vessel closure after PTCA in small coronary arteries (< 2.5 mm). METHODS Eptifibatide was used in 51 patients after conventional balloon angioplasty complicated by severe dissections with or without threatened vessel occlusion. Eptifibatide was administered as a double-bolus of 180 microg/kg bodyweight, followed by a continuous infusion at a dosage of 2.0 microg/kg min over a time period of 20 h. In this situation, the implantation of a coronary stent was avoided if a prompt antegrade flow of contrast dye could be maintained. RESULTS Using the GP IIb/IIIa antagonist eptifibatide, it was possible to increase or to maintain antegrade blood flow in 28 (55%) patients. In 45% of the patient population, however, repeat PTCA was needed, and in four patients (7.8%) an intracoronary stent had to be implanted. During hospitalization three (6%) patients underwent target lesion revascularization (two Re-PTCAs, one coronary bypass graft operation). There were no myocardial infarctions and there was no intrahospital death. The cumulative event rate including acute and long term events was 25%. CONCLUSIONS The findings of our study indicate that eptifibatide is able to prevent vessel occlusion after PTCA complicated by severe dissections with or without threatened vessel occlusion associated with a low-in-hospital complication rate.
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Affiliation(s)
- Asvin Latsch
- I. Department of Medicine, University Hospital of Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
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47
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Stadius ML. Diminishing returns …and too many choices …the saga of pharmacologic therapy to reduce the complications of percutaneous coronary intervention**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2004; 44:25-7. [PMID: 15234400 DOI: 10.1016/j.jacc.2004.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Greenlund KJ, Keenan NL, Giles WH, Zheng ZJ, Neff LJ, Croft JB, Mensah GA. Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001. Am Heart J 2004; 147:1010-6. [PMID: 15199349 DOI: 10.1016/j.ahj.2003.12.036] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Timely access to emergency cardiac care and survival is partly dependent on early recognition of heart attack symptoms and immediate action by calling emergency services. We assessed public recognition of major heart attack symptoms and knowledge to call 9-1-1 for an acute event. METHODS Data are from the 2001 Behavioral Risk Factor Surveillance System, a state-based telephone survey. Participants (n = 61,018) in 17 states and the U.S. Virgin Islands indicated whether the following were heart attack symptoms: pain or discomfort in the jaw, neck, back; feeling weak, lightheaded, faint; chest pain or discomfort; sudden trouble seeing in 1 or both eyes (false symptom); pain or discomfort in the arms or shoulder; shortness of breath. Participants also indicated their first action if someone was having a heart attack. RESULTS Most persons (95%) recognized chest pain as a heart attack symptom. However, only 11% correctly classified all symptoms and knew to call 9-1-1 when someone was having a heart attack. Symptom recognition and the need to call 9-1-1 was lower among men than women, persons of various ethnic groups than whites, younger and older persons than middle-aged persons, and persons with less education. Persons with high blood pressure, high cholesterol, diabetes mellitus, or prior heart attack or stroke were not appreciably more likely to recognize heart attack symptoms than were persons without these conditions. CONCLUSIONS Public health efforts are needed to increase recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute event.
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Affiliation(s)
- Kurt J Greenlund
- Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga 30341, USA.
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Sicari R. Perioperative risk stratification in non cardiac surgery: role of pharmacological stress echocardiography. Cardiovasc Ultrasound 2004; 2:4. [PMID: 15140258 PMCID: PMC419977 DOI: 10.1186/1476-7120-2-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 05/12/2004] [Indexed: 11/30/2022] Open
Abstract
Perioperative ischemia is a frequent event in patients undergoing major non-cardiac vascular or general surgery. This is in agreement with clinical, pathophysiological, and epidemiological evidence and constitutes an additional diagnostic therapeutic factor in the assessment of these patients. Form a clinical standpoint, it is well known that multidistrict disease, especially at the coronary level, is a severe aggravation of the operative risk. From a pathophysiological point of view, however, surgery creates conditions able to unmask coronary artery disease. Prolonged hypotension, hemorrhages, and haemodynamic stresses caused by aortic clamping and unclamping during major vascular surgery are the most relevant factors endangering the coronary circulation with critical stenoses. From the epidemiological standpoint, coronary disease is known to be the leading cause of perioperative mortality and morbidity following vascular and general surgery: The diagnostic therapeutic corollary of these considerations is that coronary artery disease - and therefore the perioperative risk - in these patients has to be identified in an effective way preoperatively.
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Affiliation(s)
- Rosa Sicari
- CNR Institute of Clinical Physiology, Via G, Moruzzi, 1 56124 Pisa, Italy.
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Zimarino M, De Caterina R. Glycoprotein IIb-IIIa antagonists in non-ST elevation acute coronary syndromes and percutaneous interventions: from pharmacology to individual patient's therapy: part 1: the evidence of benefit. J Cardiovasc Pharmacol 2004; 43:325-32. [PMID: 15076214 DOI: 10.1097/00005344-200403000-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Antagonists of platelet glycoprotein IIb/IIIa (abciximab, tirofiban, eptifibatide) have now an approved role in reducing the extent of thrombotic complications leading to myocardial damage during percutaneous coronary interventions (PCI). This effect likely here translates into a long-term survival benefit. However, the question of their usefulness in different clinical scenarios (stable or unstable coronary disease, without PCI) has not been fully answered on the basis of considerations of dosing and cost-effectiveness. These agents seem most useful in high-risk patients with unstable coronary syndromes especially in the presence of co-morbidities such as diabetes or renal insufficiency. This article summarizes reasons for the ongoing debate on their efficacy and highlights areas of uncertainty.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio University, Chieti, Italy.
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