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Inflammation plays a central role in coronary artery disease (CAD), and recent data have shown that anti-inflammatory drugs have the potential to reduce ischemic events in CAD patients. Colchicine is an ancient anti-inflammatory drug that targets neutrophil and inflammasome activities. It has been prescribed for decades for different rheumatological conditions. Given the important role of inflammation in the development of cardiovascular disease, there has been considerable interest in studying colchicine's potential to limit the progression of atherosclerosis among afflicted patients. In fact, there is a growing body of randomized data suggesting that use of low-dose colchicine reduces the risk of ischemic events in patients with CAD, particularly repeated revascularizations, new myocardial infarctions and strokes. This review article summarizes background information-including possible side effects and contraindications-as well as the current evidence backing up the use of colchicine in patients with established CAD.
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Antiinflamatorios , Colchicina , Enfermedad de la Arteria Coronaria , Colchicina/uso terapéutico , Colchicina/efectos adversos , Humanos , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Antiinflamatorios/uso terapéutico , Antiinflamatorios/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad Crónica , Inflamación/tratamiento farmacológico , Infarto del Miocardio/tratamiento farmacológico , Enfermedad AgudaRESUMEN
Current guidelines recommend vitamin K antagonists (VKAs) for the treatment of a left ventricular thrombus (LVT). However, direct oral anticoagulants (DOACs) show superior safety and efficacy compared with VKAs in most thromboembolic disorders. Nevertheless, DOACs remain poorly investigated for the treatment of LVT. To describe the thrombus resolution rate and clinical efficacy of DOACs versus VKAs in patients with LVT, we analyzed consecutive patients with confirmed LVT from a multicenter echocardiography database. Echocardiograms and clinical end points were evaluated independently. The thrombus resolution rate and clinical outcomes were compared according to the underlying anticoagulation regimen. In total, 101 patients were included (17.8% women, mean age 63.3 ± 13.2 years), 50.5% had recently experienced a myocardial infarction. The mean left ventricular ejection fraction was 36.6 ± 12.2%. DOACs versus VKAs were used in 48 and 53 patients, respectively. The median follow-up was 26.6 (interquartile range 11.8;41.2) months. Among patients receiving VKAs compared with DOACs, the thrombus resolved more rapidly within the first month in those taking VKAs (p = 0.049). No differences were seen between the 2 groups with respect to major bleedings, strokes, and other thromboembolic events. In each group, LVT recurred in 3 of the subjects (a total of 6) after discontinuation of anticoagulation. In conclusion, DOACs appear to be a safe and effective alternative to VKAs for the treatment of LVTs, but the rate of thrombus dissolution within 1 month after initiation of anticoagulation appears to be higher with VKAs. A sufficiently powered randomized trial is required to definitively define the role of DOACs in the treatment of LVT.
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Tromboembolia , Trombosis , Humanos , Femenino , Persona de Mediana Edad , Anciano , Masculino , Volumen Sistólico , Suiza , Función Ventricular Izquierda , Anticoagulantes/uso terapéutico , Trombosis/tratamiento farmacológico , Tromboembolia/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Vitamina K , Sistema de Registros , Administración OralRESUMEN
BACKGROUND: Patients with supraventricular tachycardia (SVT) and patients with coronary artery disease (CAD) often present with similar symptoms (chest pain, shortness of breath), similar electrocar¬diographic changes and elevated high-sensitivity troponin (Tn). It is not clear whether troponin reflects critical CAD or is elevated due to other causes in patients presenting with SVT. The aim of this study was to assess the role of elevated troponin in patients presenting with SVT. METHODS: Patients undergoing radiofrequency ablation (RFA) for SVT and simultaneous coronary an¬giography at the Heart Centre Lucerne, Switzerland between January 2010 and October 2014 were in¬cluded in this analysis. Significant CAD was defined as diameter-stenosis ≥ 75% in vessels > 2.0 mm. The level of Tn was compared between patients with the presence or absence of CAD on coronary angi¬ography. A Tn value of ≥ 0.014 µg/L was considered as elevated. RESULTS: During the study period a total of 473 patients underwent RFA for SVT. The study population consisted of 326 patients (69%, mean age 60 ± 12 years) who underwent invasive coronary angiogra¬phy during the same session. The prevalence of significant CAD was 14% (45/326 patients). The highest prevalence of CAD was found in patients with atrial flutter (35%, 18/45 patients). Tn was elevated in 83% (10/12 patients) with significant CAD and in 47% (26/55 patients) without CAD. CONCLUSIONS: The prevalence of CAD is low in patients with SVT, which questions the role of routine invasive coronary angiography during RFA. Tn measurement did not reliably exclude or confirm CAD in these patients.
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Enfermedad de la Arteria Coronaria/sangre , Taquicardia Supraventricular/diagnóstico , Troponina/sangre , Ablación por Catéter , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Diagnóstico Diferencial , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Suiza/epidemiología , Taquicardia Supraventricular/sangre , Taquicardia Supraventricular/cirugíaRESUMEN
INTRODUCTION: Drug-coated balloons (DCB) are being increasingly used in interventional cardiology. The effect of DCB on acute changes of coronary flow reserve (CFR) has never been reported. METHODS: Patients with in-stent restenosis or with contraindication for use of clopidogrel were included in this study. The FloWire was used to assess CFR before and immediately after conventional balloon angioplasty and after the use of In.Pact, a paclitaxel-coated balloon. In a sub-selection of patients, CFR was measured immediately and then 2, 5, and 10 min post-DCB. RESULTS: Thirty patients (18 males, 60%) with a total of 32 lesions were studied. Comparison of CFR pre- and post-conventional balloon angioplasty was not statistically significant (P = 0.95). CFR dropped significantly after the use of In.Pact (n = 32, 1.59 ± 0.49 vs. 1.22 ± 0.28, P < 0.0001) and showed a statistically significant improvement over 10 min in a subset of patients (n = 6, P = 0.01). Implantation of a coronary stent after the use of In.Pact rapidly improved CFR (n = 10, P = 0.0004). CONCLUSIONS: We describe a novel phenomenon of acute decrease in CFR after the use of DCB. This phenomenon is temporary and spontaneously improves after approximately 10 min. The exact pathophysiological mechanism remains unclear and further studies are warranted to study the long-term effects of acute CFR drop after use of DCB.
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Angioplastia Coronaria con Balón/instrumentación , Cateterismo Cardíaco , Fármacos Cardiovasculares/administración & dosificación , Materiales Biocompatibles Revestidos , Reestenosis Coronaria/terapia , Reserva del Flujo Fraccional Miocárdico , Paclitaxel/administración & dosificación , Anciano , Análisis de Varianza , Angioplastia Coronaria con Balón/efectos adversos , Reestenosis Coronaria/fisiopatología , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Stents , Suiza , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Drug-coated balloons (DCBs) are increasingly used in percutaneous coronary intervention (PCI). The sequential use of DCB and bare-metal stent (BMS) represents a novel approach and results of pilot studies have been encouraging. The aim of this study was to assess long-term outcomes of patients who received treatment with DCB and BMS and additionally study whether the order (BMS or DCB first) affected outcomes. METHODS: This is a single-center, non-randomized, prospective study of patients who underwent PCI between July 2009 and July 2011. Two groups were defined: DCB followed by BMS (DCBâBMS) or BMS followed by DCB (BMSâDCB). Our primary outcome was target lesion revascularization (TLR) at 7 months. RESULTS: A total of 128 patients (173 lesions) with a mean age of 67 years were included. The BMSâDCB group consisted of 53 patients (78 lesions) and the DCBâBMS group consisted of 75 patients (95 lesions). The mean follow-up was 7.4 months. The TLR rate was 4/76 (5%) in the BMSâDCB group and 3/90 (3%) in the DCBâBMS group (P=.83). CONCLUSION: Our study demonstrates good results of sequential BMS and DCB use in an all-comers population. If confirmed by larger studies, this could be a valuable approach in patients with contraindications to drug-eluting stent implantation.
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Angioplastia Coronaria con Balón/instrumentación , Estenosis Coronaria/terapia , Paclitaxel , Stents , Anciano , Angioplastia Coronaria con Balón/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: To validate the sleep-disordered breathing components of a portable electrocardiography and hemodynamic monitor to be used for sleep apnea screening. METHODS: Sleep-disordered breathing (SDB) is associated with cardiovascular disease. Patients with existing cardiovascular disease may have unrecognized SDB or may develop SDB while under the care of a cardiologist. A screening device for SDB, easy to use and appealing to cardiologists, would assist in referral of appropriate patients for full polysomnography (PSG). A cardiac and respiratory monitor (CPAM) was attached to patients undergoing PSG and an apnea/hypopnea index (AHI) generated. The CPAM device produced respiration rate, snoring rate, individual apnea/hypopnea events and an SDB severity score (SDBSS). In addition to AHI, an expert over-reader annotated individual breaths, snores and SDB breathing events to which the automated algorithms were compared. RESULTS: The test set consisted of data from 85 patients (age: 50.5 ± 12.4 years). Of these, 57 had a positive PSG defined as AHI ≥ 5.0 (mean: 30.0 ± 29.8, negative group mean: 1.5 ± 1.2). The sensitivity and specificity of the SDBSS compared to AHI was 57.9% and 89.3%, respectively. The correlation of snoring rate by CPAM compared to the expert over-reader was r = 0.58 (mean error: 1.52 snores/min), while the automated respiration rate had a correlation of r = 0.90 (mean error: 0.70 breaths/min). CONCLUSION: This performance assessment shows that CPAM can be a useful portable monitor for screening and follow-up of subjects for SDB.
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INTRODUCTION: Drug-coated balloons (DCB) are being increasingly used in interventional cardiology and are established for the treatment of in-stent restenosis (ISR). It is unclear how effective they are in patients with de novo lesions. METHODS: A prospective registry of patients treated with the In.Pact DCB at our institution was conducted. Patients with ISR and those with planned surgery or contraindication to long-term use of double-antiplatelet therapy were included. OUTCOME MEASURES: 12-month rates of clinically driven target-lesion revascularization (TLR). The efficacy of DCB was compared between patients with ISR and de novo lesions and in those with reference vessel diameter (RVD) < and > 2.75 mm. RESULTS: A total of 139 patients (222 lesions) were followed up for 12 months. The mean age was 69 ± 10 years. Ninety-five patients (68%) had stable angina and 44 patients (32%) had acute coronary syndrome. Clinically driven TLR was performed in 6/126 lesions (4.8%) in the de novo group and in 5/92 lesions (5.4 %) in the ISR group (P=1.0). In the de novo group, TLR rate was 1/45 (2.2%) in patients with vessel diameter >2.75 mm and 5/81 (6.2%) in those with diameter <2.75 (P=.42). In the ISR group, TLR was 3/71 (4.2%) in patients with vessel diameter >2.75 mm and 2/21 (9.5%) in those with diameter <2.75 mm (P=.32). CONCLUSIONS: DCB are a valuable treatment option for patients with ISR offering good rates of TLR. Additionally, DCB can be an alternative to drug-eluting stents, if the use of long-term double antiplatelet medications is not desired.