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3.
JACC Case Rep ; 4(1): 31-35, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-35036940

RESUMO

This case series shows how the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization can be used to decide between revascularization or optimal medical therapy to reduce mortality or cardiovascular events in selected subsets of patients with stable ischemic heart disease and complex coronary disease with or without left ventricular dysfunction. (Level of Difficulty: Advanced.).

5.
J Am Coll Cardiol ; 79(2): e21-e129, 2022 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-34895950

RESUMO

AIM: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.


Assuntos
Cardiologia/normas , Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/normas , American Heart Association , Humanos , Revascularização Miocárdica/métodos , Estados Unidos
6.
J Am Coll Cardiol ; 79(2): 197-215, 2022 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-34895951

RESUMO

AIM: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. METHODS: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.


Assuntos
Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/normas , Algoritmos , American Heart Association , Tomada de Decisão Compartilhada , Diabetes Mellitus , Terapia Antiplaquetária Dupla , Humanos , Revascularização Miocárdica/métodos , Equipe de Assistência ao Paciente , Medição de Risco , Estados Unidos
8.
Circulation ; 145(3): e4-e17, 2022 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-34882436

RESUMO

AIM: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. METHODS: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.


Assuntos
Cardiologia/normas , Ponte de Artéria Coronária/normas , Revascularização Miocárdica/normas , Intervenção Coronária Percutânea/normas , Procedimentos Cirúrgicos Vasculares/normas , American Heart Association/organização & administração , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/cirurgia , Humanos , Estados Unidos , Procedimentos Cirúrgicos Vasculares/métodos
11.
J Am Coll Cardiol ; 77(10): 1287-1289, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33706869
12.
Prog Cardiovasc Dis ; 65: 84-88, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33587962

RESUMO

Interventional cardiologists who treat malfunctioning hemodialysis accesses play an important role in the life of patients with end-stage kidney disease (ESKD). By collaborating with interventional nephrologists who currently perform the bulk of routine access angiographic procedures, interventional cardiologists can fill an important gap in the care of ESKD patients by performing urgent or emergent procedures that fall outside the schedule of an outpatient interventional nephrology laboratory to ensure that hemodialysis patients will not miss a hemodialysis session or get a temporary catheter. This paper reviews the pathophysiology of dialysis access failure and illustrates the catheter-based approaches used by interventional cardiologists to treat malfunctioning dialysis accesses.


Assuntos
Angiografia , Derivação Arteriovenosa Cirúrgica , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/terapia , Falência Renal Crônica/terapia , Radiografia Intervencionista , Diálise Renal , Trombectomia , Trombose/terapia , Angiografia/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Valor Preditivo dos Testes , Radiografia Intervencionista/efeitos adversos , Trombectomia/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
JACC Cardiovasc Interv ; 12(24): 2528-2537, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31857023

RESUMO

OBJECTIVES: The aim of the present study was to quantify the probability of increased mortality with paclitaxel compared with control in a dataset of 28 randomized controlled trials. BACKGROUND: Analysis of data from 28 randomized controlled trials using conventional null-hypothesis statistical testing has produced the unexpected finding of a 68% increase in mortality at 2 years and a 93% increase at 3 to 5 years after using paclitaxel-eluting balloons and stents to treat femoropopliteal arterial disease, but no biologic explanation for increased mortality has been identified. METHODS: A Bayesian sequential model was developed to quantify the probability of increased mortality 1, 2, and 3 to 5 years after treatment, and p values were replaced with meta-analytic Bayes factors (BFs), which provide decisive evidence at values >100 and very strong evidence at values of 32 to 100. RESULTS: The evidence for increased mortality at 1 year (BF = 0.02), 2 years (BF = 8.5), and 3 to 5 years (BF = 14.6) was less than conclusive. All-cause mortality at 1 year was similar between the paclitaxel and control arms at 1 year (odds ratio: 0.92; 95% Bayesian credible interval: 0.53 to 1.53) and 2 years (odds ratio: 1.23; 95% Bayesian credible interval: 0.84 to 1.71) but was increased at 3 to 5 years (odds ratio: 1.43; 95% Bayesian credible interval: 1.01 to 1.90). CONCLUSIONS: This study finds some support for increased mortality after using paclitaxel-eluting devices in femoropopliteal arterial disease, but the evidence is not unequivocal and may not sway skeptical investigators concerned about causation, unreported studies, or the post hoc analysis of trials underpowered for mortality.


Assuntos
Angioplastia com Balão/instrumentação , Angioplastia com Balão/mortalidade , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Stents Farmacológicos , Paclitaxel/administração & dosagem , Doença Arterial Periférica/terapia , Dispositivos de Acesso Vascular , Angioplastia com Balão/efeitos adversos , Teorema de Bayes , Fármacos Cardiovasculares/efeitos adversos , Humanos , Paclitaxel/efeitos adversos , Doença Arterial Periférica/mortalidade , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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