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BACKGROUND: Community-based interventions may promote awareness and adherence to atrial fibrillation (AF)-related therapies, potentially reducing adverse events. The ARENA project investigated the health status, therapies and events in AF patients in the Rhein-Neckar Region, Germany. The subproject "ARENA intervention" studied the effect of community-based interventions on AF-associated outcomes. METHODS: From 2016 onward, patients with diagnosed AF were recruited for the observational ARENA registry. In 2018, an intervention period was initiated involving population-based information campaigns on AF diagnosis and therapies. The "control group" was recruited prior to initiation, and the "intervention group" afterward. Patients underwent standardized follow-up > 1 year after recruitment. Clinical outcomes, therapy and quality of life were compared between the two groups. RESULTS: A total of 2769 patients were included. This real-world cohort showed high adherence to oral anticoagulation therapy (OAC) and an increased use of NOACs over vitamin K antagonists over time. In the intervention group (n = 1362), more patients continued OAC at follow-up (87.1% vs. 81.5%, P = 0.002). However, this difference was not significant in the patient subgroup with class I/IIa indications for OAC (90.1% vs. 87.5%, P = 0.11). AF-related re-hospitalization was lower in the intervention group (6.8% vs. 12.3%, P < 0.001). There was no significant difference in quality of life. AF-related anxiety was reduced at follow-up. Of note, nearly a quarter of all patients stated that ARENA had influenced their health perception. CONCLUSION: Tailored community-based campaigns may raise awareness for AF-related health issues, supporting therapy adherence. Future public strategies to improve quality of life in AF patients should be investigated, as the ARENA project hints at a potential benefit of population-based campaigns. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT02978248).
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BACKGROUND: The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO2peak when compared with no CR. OBJECTIVE: To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. METHODS: Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. RESULTS: The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO2peak at 6 months was 1085 per 1-unit [ml/kg/min] improvement in change VO2peak and at 12 months it was 1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. CONCLUSION: From a health-economic point of view the home-based mobile CR programme is an effective and cost-effective alternative for elderly cardiac patients who are not willing to participate in a regular rehabilitation programme to improve cardiorespiratory fitness. The change of QoL between the mobile CR was similar for both groups. Adherence to the mobile CR programme plays a significant role in the cost-effectiveness of the intervention. Future research should focus on the determinants of adherence, on increasing the adherence of patients and the implementation of comprehensive home-based mobile CR programmes in standard care.
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Reabilitação Cardíaca , Telerreabilitação , Idoso , Análise Custo-Benefício , Exercício Físico , Humanos , Qualidade de VidaRESUMO
BACKGROUND: The present guidelines ( http://leitlinien.net ) focus exclusively on cardiogenic shock due to myocardial infarction (infarction-related cardiogenic shock, ICS). The cardiological/cardiac surgical and the intensive care medicine strategies dealt with in these guidelines are essential to the successful treatment and survival of patients with ICS; however, both European and American guidelines on myocardial infarction and heart failure and also position papers on cardiogenic shock focused mainly on cardiological aspects. METHODS: Evidence on the diagnosis, monitoring and treatment of ICS was collected and recommendations compiled in a nominal group process by delegates of the German Cardiac Society (DGK), the German Society for Medical Intensive Care Medicine and Emergency Medicine (DGIIN), the German Society for Thoracic and Cardiovascular Surgery (DGTHG), the German Society for Anaesthesiology and Intensive Care Medicine (DGAI), the Austrian Society for Internal and General Intensive Care Medicine (ÖGIAIM), the Austrian Cardiology Society (ÖKG), the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), under the auspices of the Working Group of the Association of Medical Scientific Societies in Germany (AWMF). If only poor evidence on ICS was available, general study results on intensive care patients were inspected and presented in order to enable analogue conclusions. RESULTS: A total of 95 recommendations, including 2 statements were compiled and based on these 7 algorithms with defined instructions on the course of treatment.
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Procedimentos Cirúrgicos Cardíacos , Infarto do Miocárdio , Áustria , Cuidados Críticos , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapiaAssuntos
Síndrome Coronariana Aguda/terapia , Angina Instável/terapia , COVID-19/prevenção & controle , Serviço Hospitalar de Cardiologia/tendências , Serviço Hospitalar de Emergência/tendências , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Admissão do Paciente/tendências , Isolamento Social , Síndrome Coronariana Aguda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Angina Instável/diagnóstico , COVID-19/transmissão , Feminino , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Fatores de TempoRESUMO
Atrial fibrillation (AF) is the most common form of cardiac tachyarrhythmia. It is estimated that in the Rhein-Neckar region approximately 40,000-50,000 out of 2â¯million people are affected. Due to demographic changes in the near future there will be a significant increase in the prevalence of AF within the next decades. The ARENA project was initiated by the Foundation Institute for Cardiac Infarction Research (IHF) Ludwigshafen in cooperation with cardiological and neurological departments of neighboring hospitals, resident doctors and pharmacies to improve the awareness and care of patients with AF. The particular aim is the prevention of stroke as one of the most dreaded complications. The project focusses on the following three subtopics: interventions, medication, migration. The aim of the intervention project is to raise awareness of AF as a risk factor for stroke and to improve the diagnostic work-up and care for patients with diagnosed or unknown AF. The subproject medication focusses on the adherence of patients with AF to the prescribed antithrombotic medication. To evaluate differences concerning patients with and without a migration background the subproject migration was initiated.
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Fibrilação Atrial , Acidente Vascular Cerebral , Antraquinonas , Anticoagulantes , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Humanos , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
Current guidelines generally recommend continuation of blood thinning drugs in dermatologic surgery and the previously used "bridging" with subcutaneous or intravenous heparin is obsolete. While the guidelines are increasingly implemented in daily practice, there is still uncertainty concerning the use of the novel direct oral anticoagulants (NOACâ¯= DOAC). In this review, we analyze current developments and formulate concise recommendations for continuation during skin surgery under consideration of individual risk.
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Anticoagulantes/administração & dosagem , Dabigatrana/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos/métodos , Hemorragia Pós-Operatória/induzido quimicamente , Guias de Prática Clínica como Assunto , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Rivaroxabana/administração & dosagem , Administração Oral , Anticoagulantes/uso terapêutico , Humanos , Hemorragia Pós-Operatória/terapia , Medição de RiscoRESUMO
Frailty is increasingly seen among patients with acute cardiovascular disease. A combination of an ageing population, improved disease survival, treatable long-term conditions as well as a greater recognition of the syndrome has accelerated the prevalence of frailty in the modern world. Yet, this has not been matched by an expansion of research. National and international bodies have identified acute cardiovascular disease in the frail as a priority area for care and an entity that requires careful clinical decisions, but there remains a paucity of guidance on treatment efficacy and safety, and how to manage this complex group. This position paper from the Acute Cardiovascular Care Association presents the latest evidence about frailty and the management of frail patients with acute cardiovascular disease, and suggests avenues for future research.
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Doenças Cardiovasculares/terapia , Cuidados Críticos/organização & administração , Fragilidade , Doença Aguda , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: The multifactorial origin of cardiovascular diseases has led to polypharmacy in primary and secondary prophylaxis with evidence-based medications, such as statins, antihypertensive drugs and platelet aggregation inhibitors. The number of prescribed drugs correlates inversely to adherence and can lead to treatment failure. Fixed-dose combination drugs (polypills) could increase the medication adherence of patients, reduce risks and prevent cardiovascular events. METHODS: This review is based on publications that were retrieved from Medline (via PubMed) and The Cochrane Library. The clinical database ClinicalTrials.gov. was also considered. RESULTS: In the studies on primary prevention conducted to date, fixed-dose combinations showed a superior control of risk factors, e.g. hypertension and low-density lipoprotein (LDL) cholesterol compared to placebo and at least non-inferiority compared to usual care. In secondary prevention, the effect of the polypill is mostly on the reduction of blood pressure and LDL cholesterol in non-adherent patients; however, evidence that fixed-drug combinations reduce cardiovascular morbidity and mortality compared to standard therapy is lacking. CONCLUSION: The polypill can be considered as an alternative to polypharmacy after a risk-benefit assessment, especially in non-adherent patients. Ongoing studies are investigating the effect of the polypill on cardiovascular events. Current polypills are limited by the lack of sufficient dosages of the individual components to avoid overtreatment and undertreatment at the individual treatment level.
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Fármacos Cardiovasculares , Doenças Cardiovasculares , Combinação de Medicamentos , Inibidores de Hidroximetilglutaril-CoA Redutases , Anti-Hipertensivos , Humanos , Fatores de Risco , ComprimidosRESUMO
Approximately 50 % of hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and up to 80 % of patients with infarction-related cardiogenic shock have multivessel coronary artery disease. The optimal revascularization strategy in these patients has still not been defined. Following successful percutaneous coronary intervention (PCI) of the culprit lesion, immediate PCI of all additional lesions or staged PCI, after invasive or non-invasive proof of ischemia or conservative therapy can be considered. Randomized studies have demonstrated a clinical benefit of immediate or staged multivessel PCI compared to a conservative approach. So far there are no randomized studies available comparing immediate versus staged PCI. The data regarding the optimal strategy in patients with cardiogenic shock show low concordance. The currently running CULPRIT shock study will help to define the optimal strategy in shock patients. This manuscript summarizes the current knowledge and data and provides recommendations for the clinical practice.
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Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/cirurgia , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/estatística & dados numéricos , Adulto , Idoso , Comorbidade , Vasos Coronários/cirurgia , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Prevalência , Fatores de Risco , Taxa de Sobrevida , Resultado do TratamentoRESUMO
For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Premature discontinuation of dual antiplatelet therapy is associated with an increased risk of ischaemic events. However, antiplatelet therapy is also associated with an increased risk of bleeding that should not be under- or overestimated. To ensure an optimal care of patients receiving dual antiplatelet therapy after an acute coronary syndrome, an interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology gathered bleeding-related information and developed recommendations relevant to daily clinical practice. These include the significance of bleeding events in the course of treatment, measures for bleeding prevention and the adequate care of patients with bleedings.
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Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/tratamento farmacológico , Hemorragia/etiologia , Hemorragia/terapia , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Medicina Baseada em Evidências , Humanos , Equipe de Assistência ao Paciente/organização & administração , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and associated with a high risk of stroke, heart failure and hospitalization. This study examines the indication-specific costs of illness of AF patients in Germany. METHODS: The study was conducted nationwide with 54 general practitioners and internists, as well as 12 practicing cardiologists. The observational period per patient was one year. Costs were calculated from the perspective of the German statutory health insurance. The study collected the annual direct indication-specific costs and additional patient relevant outcomes. RESULTS: Indication-specific services of 361 patients (age: 75, male: 55%) documented by general practitioners and internists cause average costs of 582 per patient. The highest cost are caused by hospitalization (289 ), followed by outpatient treatment costs (151 ) and costs of anticoagulation with 52 per patient. Additional consulting of a cardiologist (115 patients) causes average costs of 81 . Assuming that a patient with AF is treated once a year by a resident cardiologist, the average annual cost amounted to 664 . CONCLUSION: The results of this prospectively cost of illness analysis for AF patients under real life conditions in Germany indicate a high socio-economic burden of AF.
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Assistência Ambulatorial/economia , Anticoagulantes/economia , Fibrilação Atrial/economia , Fibrilação Atrial/epidemiologia , Efeitos Psicossociais da Doença , Hospitalização/economia , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/terapia , Feminino , Alemanha/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Prevalência , Estudos ProspectivosRESUMO
BACKGROUND: Representative data on the current management of patients with acute coronary syndromes (ACS) are of high interest. The EPICOR registry aimed to prospectively collect such real-life data with particular focus on antithrombotic drug utilization and outcomes. METHODS: As part of the international prospective EPICOR registry, 29 hospitals in Germany documented 296 patients with ST-elevation myocardial infarction (STEMI)-ACS and 333 with unstable angina or non-STEMI (NSTEMI)-ACS surviving the hospital phase. The statistical analysis was performed in a descriptive manner. The ClinicalTrials.gov identifier is NCT01171404. RESULTS: The mean age of patients was 62 ± 13 years, and 77.4 % were men. Treatment with antithrombotic agents was initiated in the prehospital phase in 50.7 % of STEMI and 33.3 % of NSTEMI patients. During the hospital stay (median 7.0 days), cardiac catheterization was performed in 97.6 %, percutaneous coronary intervention in 85.6 %, thrombolysis in 4.6 %, and coronary bypass surgery in 2.7 % patients. The use of acetylic salicylic acid (ASA) was reported in 95.6 % vs. 96.1 %, clopidogrel in 60.8 % vs. 73.0 %, prasugrel in 45.6 % vs. 22.5 %, any GP IIb/IIIa inhibitor in 52.4 % vs. 18.9 % [any dual combination of ASA+(clopidogrel/prasugrel)in 94.0 vs. 91.0 %], statins in 94.6 % vs. 92.2 %, beta blockers in 96.3 % vs. 94.6 %, and ACE-I/ARB in 91.6 % vs. 87.7 % of STEMI vs. NSTEMI patients, respectively. Combined use of the five drug classes recommended in the guidelines-ASA, P2Y12 antagonists, statin, beta blocker, and ACE-I/ARB-was reported in 81.1 % vs. 69.4 % of STEMI vs. NSTEMI patients, respectively. CONCLUSION: In Germany a high proportion of patients with ACS are treated according to current guidelines, receiving primary revascularization as well as antithrombotic drugs and other agents for prevention of secondary events; associated bleeding complications were less frequent as compared with published registries.
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Síndrome Coronariana Aguda/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Fidelidade a Diretrizes/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Sistema de Registros , Síndrome Coronariana Aguda/epidemiologia , Cardiologia/normas , Feminino , Alemanha/epidemiologia , Humanos , Internacionalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/normasRESUMO
We aimed to analyze benefits and risks of aliskiren treatment in older adults (⩾ 65 years) in clinical practice. Patients (n = 14,986) were assigned to either aliskiren (ALIS), an angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB), or an agent not blocking the renin-angiotensin system (non-RAS). Older adults (n = 7396) had a longer history of hypertension (8.7 vs 4.7 years; P < 0.0001), lower mean diastolic blood pressure (DBP; 87.7 ± 11.0 vs 92.1 ± 11.0 mm Hg) and more renal (12.0 vs 5.6%; P < 0.0001) or cardiovascular disease (44.0 vs 18.9%; P < 0.0001); 4548 received aliskiren (68.8%), 1215 ACEi/ARBs (18.4%) and 850 non-RAS treatments (12.9%). Office BP at 1 year was reduced by 18.4 ± 21.5/7.2 ± 12.0 mm Hg. BP reductions were greater (19.5 ± 21.7/7.6 ± 12.1 mm Hg) in the aliskiren group than in the ACEi/ARB (15.6 ± 20.9/6.4 ± 11.9) and non-RAS groups (16.1 ± 20.7/6.5 ± 11.7 mm Hg), respectively (P<0.0001 for systolic BP (SBP) and <0.01 for DBP). After multivariable adjustment, differences in SBP reductions were clinically irrelevant and no differences were noted for DBP. Adverse effects were higher in older adults with no differences between treatment groups. In conclusion, the present analysis of a large, unselected cohort of patients in clinical practice from the 3A study, offers real-life evidence of the effectiveness and safety of aliskiren for the treatment of hypertension in older adults.
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Amidas , Fumaratos , Hipertensão , Fatores Etários , Idoso , Amidas/administração & dosagem , Amidas/efeitos adversos , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Fumaratos/administração & dosagem , Fumaratos/efeitos adversos , Alemanha/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/metabolismo , Masculino , Pessoa de Meia-Idade , Renina/antagonistas & inibidores , Sistema Renina-Angiotensina/efeitos dos fármacos , Medição de Risco , Resultado do TratamentoRESUMO
Current guidelines recommend dual antiplatelet therapy preferably with prasugrel or ticagrelor for 12 months in patients after acute coronary syndrome with stent implantation. Problems occur in patients with a need for oral anticoagulation, such as patients with atrial fibrillation. In these patients a combination of oral anticoagulation and platelet inhibitors is necessary. Antithrombotic combination therapy is known to increase bleeding complications. In a small randomized trial the combination of a vitamin K antagonist (VKA) and clopidogrel decreased bleeding compared to triple therapy with VKA, clopidogrel and aspirin. The new oral anticoagulants have consistently been shown to decrease bleeding complications compared to VKAs regardless of additional antiplatelet therapy. Because of the lack of randomized trials the individual decision about the intensity and duration of antithrombotic combination therapy should be based on the bleeding and ischemic risk in the individual patient. However, in most patients in addition to oral anticoagulation, antiplatelet monotherapy preferably with clopidogrel seems necessary only for 3-6 months.
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Síndrome Coronariana Aguda/tratamento farmacológico , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Inibidores da Agregação Plaquetária/administração & dosagem , Stents/efeitos adversos , Trombose/prevenção & controle , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/cirurgia , Administração Oral , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Esquema de Medicação , Quimioterapia Combinada/métodos , Medicina Baseada em Evidências , Humanos , Trombose/etiologia , Resultado do TratamentoAssuntos
Povo Asiático/etnologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etnologia , Paclitaxel/administração & dosagem , Sistema de Registros , População Branca/etnologia , Idoso , Angiografia Coronária/tendências , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/tendências , Feminino , França/etnologia , Alemanha/etnologia , Humanos , Internacionalidade , Itália/etnologia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/tendências , Estudos ProspectivosRESUMO
BACKGROUND: Drug-eluting stents (DES) have substantially reduced target vessel revascularization (TVR) after percutaneous coronary interventions. Risk factors for clinical events need to be redefined with this treatment option. METHODS AND RESULTS: In the prospective DES.DE registry, baseline clinical and angiographic characteristics as well as in-hospital and follow-up events were recorded for all enrolled patients. Between October 2005 and May 2009, 21,774 patients receiving DES were enrolled at 98 DES.DE sites. The composite of death, myocardial infarction (MI) and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and TVR were predefined as primary endpoints. At 1-year follow-up rates for overall death, MI, stroke, MACCE, TVR and definite stent thrombosis were 2.7, 3.1, 1.4, 7.1, 11.5 and 0.6 %, respectively. Aside from well-known risk factors like age, diabetes mellitus and triple-vessel disease, stratification in patients with or without MACCE revealed atrial fibrillation, non-ST-segment elevation myocardial infarction, renal failure, impaired ejection fraction and peripheral vascular disease as strong predictors of MACCE at 1 year. CONCLUSION: Data collected in the DES.DE registry, reflecting the clinical practice in Germany, revealed favorable clinical outcomes after DES implantation in a real world setting but also identifying several high-risk populations.
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Angioplastia Coronária com Balão/instrumentação , Estenose Coronária/terapia , Stents Farmacológicos , Oclusão de Enxerto Vascular/epidemiologia , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Feminino , Seguimentos , Alemanha , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Falha de Prótese , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. We therefore analyzed data from the German ALKK registry (Arbeitsgemeinschaft Leitende Krankenhausärzte; Working Group of Hospital Cardiologists) to determine differences in procedural features, antithrombotic treatment, and in-hospital outcome in patients with coronary artery disease (CAD) according to age in a large series of patients. METHODS AND RESULTS: The present analysis was based on the data of 35,534 consecutive patients undergoing elective PCI who were enrolled in the ALKK registry. Of these 27,145 (76.4 %) were younger than 75 years, 7,645 (21.5 %) were aged between 75 and 84 years, and 744 (2.1 %) patients were older than 85 years. Mean age was 68.5 years (60.9-74.5 years), and 25,784 patients (72.6 %) were male. Overall intraprocedural events were very low (1.1 %) and there was no significant difference between the three age groups [< 75 years (1.1 %); 75-< 85 years (1.2 %); ≥ 85 years (0.5 %) (p = not significant)]. Rates of in-hospital death, stroke and transient ischemic attack (TIA), as well as the combined endpoint in-hospital major adverse cardiac and cerebrovascular events (MACCE) were also very low (0.6 % vs. 0.9 % vs. 0.9 %; p < 0.001) but significantly higher in elderly patients with no further increase in the very elderly patient group. CONCLUSION: We found no differences in this registry in intraprocedural complications during elective PCI between younger and elderly patients. Although in-hospital MACCE were somewhat higher in the elderly, the overall event rate was low and thus elderly patients should not be deprived from this therapy because of age alone.
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Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/mortalidade , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Trombose/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Fatores de Risco , Distribuição por Sexo , Taxa de Sobrevida , Trombose/prevenção & controle , Resultado do TratamentoRESUMO
BACKGROUND: This prospective registry assessed the safety and efficacy of paclitaxel coated balloon (PCB) angioplasty for small vessel coronary artery disease in Europe and Asia with the intention to treat lesions without additional stenting. The use of PCBs in small vessels seems to be associated with favourable outcomes; however, prospective data for the use of PCBs without stenting are limited. METHODS: The SeQuent Please Small Vessel 'PCB only' Registry was an international, prospective, multicentre registry enrolling patients with de novo lesions of small reference diameters (≥ 2.0 mm, ≤ 2.75 mm). The primary end point was clinically driven target lesion revascularisation (TLR) at 9 months. Secondary end points were acute technical success, in-hospital outcomes, 9-month major adverse cardiac events (MACE) (death, myocardial infarction, or TLR), and the occurrence of definite lesion and vessel thrombosis. RESULTS: A total of 479 patients (66.1 ± 10.9 years, 36.7% diabetics) were enrolled, 105 (23.5%) with an acute coronary syndrome, 41 (9.2%) with ST elevation myocardial infarction (STEMI), and 60 (14.8%) with non-STEMI. The initial procedural success rate was 99.0%; 27 patients (6%) needed additional bare metal stent implantation. TLR at 9.4±1.7 months occurred in 14 patients (3.6%), while three patients (0.6%) had vessel thrombosis in non-target lesions. There was no cardiac death or coronary artery bypass graft surgery. CONCLUSIONS: To date, this is the largest prospective study with PCBs in small vessel de novo lesions in unselected patients. Rates of TLR and MACE were low, suggesting the use of PCBs may be an attractive alternative treatment option to drug eluting stents in small vessels.
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Angioplastia Coronária com Balão/instrumentação , Materiais Revestidos Biocompatíveis , Doença da Artéria Coronariana/terapia , Fidelidade a Diretrizes , Paclitaxel/farmacologia , Idoso , Antineoplásicos Fitogênicos/farmacologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoAssuntos
Cardiologia/organização & administração , Cardiologia/tendências , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/tendências , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Sociedades Médicas , Pesquisa Biomédica/organização & administração , Pesquisa Biomédica/tendências , Cardiologia/educação , Educação Médica Continuada/tendências , Previsões , Alemanha , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Pesquisa Translacional Biomédica/organização & administração , Pesquisa Translacional Biomédica/tendênciasRESUMO
BACKGROUND AND OBJECTIVE: The goal of treatment of patients with ST-segment elevation acute myocardial infarction (STEMI) is to restore perfusion as soon as possible, preferably by primary percutaneous coronary intervention (PCI). The aim of this study of the German Myocardial Infarction Registry (DHR) was to document acute care and in-hospital course of STEMI patients in Germany. METHODS: Over three months patients with STEMI were consecutively included and their basic data, treatments and in-hospital complications were centrally recorded using an internet-based standardized questionnaire. RESULTS: Included were 6,330 patients from 243 hospitals, in group 1 (primary admission in 136 hospitals with cath lab) 4,656 patients (74%) and in group 2 (primary admission in 107 hospitals without cath lab) 1,674 (26%). Reperfusion therapy was performed more frequently in patients of group 1 (91.1% PCI, 2.7% fibrinolysis) than in group 2 (80.7% PCI after transfer, 6.4% fibrinolysis). In-hospital mortality was 7.3% in all patients, 7.0% in group 1 and 8.3% in group 2. CONCLUSION: The DHR data show that about three quarters of patients with STEMI are primarily admitted to hospitals with cath labs. Primary PCI is the preferred treatment option both in hospitals with and without cath labs (in the latter after transfer); it is performed in about 85% of STEMI patients. In-hospital mortality is with over 7% higher in real-life than in randomized studies.