Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Doença da Artéria Coronariana/mortalidade , Humanos , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Intervenção Coronária Percutânea , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/epidemiologiaRESUMO
Percutaneous coronary intervention (PCI) remains the mainstay management of symptomatic obstructive stable coronary artery disease (despite optimal medical treatment) and acute coronary syndrome. Intravascular ultrasound (IVUS) has emerged as an adjunct to angiography, permitting better assessment of the coronary lesion and stent apposition. Data from multiple studies have demonstrated improved clinical and procedural outcomes with IVUS-guided PCI. This review discusses the use of IVUS, with emphasis on technique, parameters, and applications during coronary interventions. In addition, the clinical outcomes data are highlighted with IVUS compared with conventional angiography-guided PCI.
Assuntos
Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Métodos Epidemiológicos , Humanos , Implantação de Prótese/métodos , Stents , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/cirurgiaRESUMO
OBJECTIVES: This study sought to determine the incidence, predictors, and prognostic implications of early post-lung transplant atrial arrhythmias (AAs). BACKGROUND: Although frequently encountered, the prognostic implications of early AAs after lung transplant remain uncertain. METHODS: A systematic review of MEDLINE and the Cochrane Library was conducted for all studies that reported early post-lung transplant AAs. Random-effects DerSimonian-Laird risk ratios (RRs) were calculated for categorical variables and standardized mean difference (SMD) for continuous variables. RESULTS: A total of 12 studies with 3,203 patients (mean age 57 ± 3 years; 52% males) were included. The incidence of early post-lung transplant AAs during hospitalization was 26.6% at mean follow-up duration of 6.7 days. Predictors of post-lung transplant AAs included advanced age (SMD: 0.50; 95% confidence interval [CI]: 0.35 to 0.64), male gender (RR: 1.37; 95% CI: 1.28 to 1.47), history of smoking (RR: 1.23; 95% CI: 1.05 to 1.46), hypertension (RR: 1.35; 95% CI: 1.13 to 1.59), hyperlipidemia (RR: 1.39; 95% CI: 1.18 to 1.63), coronary artery disease (RR: 1.40; 95% CI: 1.12 to 1.7), left atrial diameter (SMD: 0.25; 95% CI: 0.07 to 0.44), and restrictive lung disease (RR: 1.34; 95% CI: 1.13 to 1.59). Post-lung transplant AAs were associated with increased all-cause mortality (adjusted RR: 1.63; 95% CI: 1.22 to 2.19) at mean follow-up of 27.8 months and length of hospital stay (36.5 ± 16.5 days vs. 26.1 ± 14.3 days; p < 0.001). CONCLUSIONS: Early AAs post-lung transplant are associated with increased mortality and length of hospital stay. Advanced age, male sex, smoking, hypertension, hyperlipidemia, coronary artery disease, increased left atrial diameter, and restrictive lung disease are independent predictors of early AAs in post-lung transplant patients.