RESUMO
As the prevalence of asymptomatic COVID-19 continues to increase, there is an increasing possibility that patients with COVID-19 may presen with ST-segment elevation myocardial infarction (STEMI). With social distancing and restricted access to preventive healthcare and emergency services, the management of acute cardiac emergencies such as myocardial infarction has suffered collateral damage. Thus far, global trends suggest a decrease in STEMI activations with possible worse outcomes due to delayed presentation and management. In this review, we discuss the challenges to STEMI management in the COVID-19 era and provide potential solutions for adherence to evidence-based therapies as the pandemic progresses into the year 2021.
Assuntos
COVID-19/complicações , Controle de Infecções/organização & administração , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologiaRESUMO
There does not appear to be a difference in patient outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis whether using first- or second-generation drug elutting stent. This is despite increase in patients having more adjunctive procedures such as intravascular imaging and newer generation antiplatelet agents. This single-center study provokes questions as to why there has not been improvement in outcomes.
Assuntos
Estenose Coronária , Stents Farmacológicos , Intervenção Coronária Percutânea , Características da Família , Humanos , Pacientes , Stents , Resultado do TratamentoAssuntos
Valva Aórtica/cirurgia , Medicina Baseada em Evidências/normas , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/normas , Padrões de Prática Médica/normas , Substituição da Valva Aórtica Transcateter/normas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Técnicas de Imagem Cardíaca/normas , Competência Clínica/normas , Tomada de Decisão Clínica , Consenso , Credenciamento/normas , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Curva de Aprendizado , Seleção de Pacientes , Valor Preditivo dos Testes , Desenho de Prótese/normas , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento , Carga de Trabalho/normasRESUMO
The use of mechanical thrombectomy in STEMI with large amount of jeopardized myocardium may preserve regional wall motion When appropriate and done with proper removal technique, there does not appear to be any increased incidence of neurologic complications The guideline recommendation that mechanical thrombectomy should not be done routinely is supported by these authors.
Assuntos
Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Miocárdio , Sistema de Registros , TrombectomiaRESUMO
The learning curve for TAVR is determined based on technical (procedural) data from PARTNER-1 Trial The number of cases needed to reach a learning curve for TAVR in PARTNER-1 was 50 for original sites and fell to 25 for late entering sites Analyses such as this is important in developing guidelines for other emerging technologies.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Educação de Pós-Graduação em Medicina/normas , Próteses Valvulares Cardíacas , Curva de Aprendizado , Ensino/normas , Substituição da Valva Aórtica Transcateter/educação , Artéria Femoral , Humanos , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodosRESUMO
Current guidelines indicate that routine aspiration thrombectomy (AT) has a level III indication and AT is only indicated for "bail-out" indications. "Bail-out" situations are not well defined. The AT catheter may still be necessary and have other uses such as distal contrast or drug delivery.
Assuntos
Sucção , Trombectomia , Catéteres , Humanos , Resultado do TratamentoAssuntos
American Heart Association , Cardiologia/normas , Angiografia Coronária/normas , Intervenção Coronária Percutânea/normas , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Sociedades Médicas , Humanos , Estados UnidosAssuntos
Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Eletrocardiografia , Medicina Baseada em Evidências , Humanos , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombectomia/métodos , Resultado do TratamentoRESUMO
With the evolution of transcatheter valve replacement, an important opportunity has arisen for cardiologists and surgeons to collaborate in identifying the criteria for performing these procedures. Therefore, The Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), and The Society of Thoracic Surgeons (STS) have partnered to provide recommendations for institutions to assess their potential for instituting and/or maintaining a transcatheter valve program. This article concerns transcatheter pulmonic valve replacement (tPVR). tPVR procedures are in their infancy with few reports available on which to base an expert consensus statement. Therefore, many of these recommendations are based on expert consensus and the few reports available. As the procedures evolve, technology advances, experience grows, and more data accumulate, there will certainly be a need to update this consensus statement. The writing committee and participating societies believe that the recommendations in this report serve as appropriate requisites. In some ways, these recommendations apply to institutions more than to individuals. There is a strong consensus that these new valve therapies are best performed using a Heart Team approach; thus, these credentialing criteria should be applied at the institutional level. Partnering societies used the ACC's policy on relationships with industry (RWI) and other entities to author this document (http://www.acc.org/guidelines/about-guidelines-and-clinical-documents). To avoid actual, potential, or perceived conflicts of interest due to industry relationships or personal interests, all members of the writing committee, as well as peer reviewers of the document, were asked to disclose all current healthcare-related relationships including those existing 12 months before the initiation of the writing effort. A committee of interventional cardiologists and surgeons was formed to include a majority of members with no relevant RWI and to be led by an interventional cardiology cochair and a surgical cochair with no relevant RWI. Authors with relevant RWI were not permitted to draft or vote on text or recommendations pertaining to their RWI. RWI were reviewed on all conference calls and updated as changes occurred. Author and peer reviewer RWI pertinent to this document are disclosed in the Appendices. In addition, to ensure complete transparency, authors' comprehensive disclosure information (including RWI not pertinent to this document) is available in Appendix AII. The work of the writing committee was supported exclusively by the partnering societies without commercial support. SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chances that these therapies will become a successful part of the armamentarium for treating valvular heart disease in the United States. In addition, these recommendations will hopefully facilitate optimum quality during the delivery of this therapy, which will be important to the development and successful implementation of future, less invasive approaches to structural heart disease.