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4.
J Am Coll Cardiol ; 72(8): 874-882, 2018 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-30115226

RESUMO

BACKGROUND: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).

5.
Curr Cardiol Rev ; 14(3): 213-216, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29788894

RESUMO

BACKGROUND: Calcified coronary lesions represent technical challenges during percutaneous coronary intervention and are associated with a high frequency of restenosis and target lesion revascularization. Rotational atherectomy has been shown to increase procedural success in severely calcified lesions, facilitate stent delivery in undilatable lesions and ensure complete stent expansion. However, rotational atherectomy in ST-elevation Myocardial Infarction (STEMI) is traditionally avoided given the concern for slow or no reflow and considered a contraindication in lesions with a visible thrombus by its manufacturer (Rotablator, Boston Scientific). CONCLUSION: This case demonstrates the successful use of rotational atherectomy to facilitate dilation and revascularization of a heavily calcified culprit lesions in a patient with acute anterior STEMI with ongoing chest pain.


Assuntos
Aterectomia Coronária/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Resultado do Tratamento
6.
EuroIntervention ; 12(11): e1428-e1434, 2016 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-26573974

RESUMO

AIMS: The aim of the study was to report preclinical safety and feasibility of a new transcatheter direct mitral annuloplasty intervention in an acute animal model. METHODS AND RESULTS: Twenty healthy pigs underwent Cardioband (Valtech Cardio, Or Yehuda, Israel) transcatheter implantation under intracardiac echocardiographic and fluoroscopic guidance. Through a neo inferior vena cava approach, transseptal access was arranged. The device was delivered into the left atrium using a multi-steerable catheter and fixed to the mitral annulus with multiple helix anchors. Following device cinching, reduction of annular size was evaluated. In all animals the device could be successfully implanted and displayed 100% function, with the average procedure duration and fluoroscopy times being 78±23 minutes and 27±9 minutes, respectively. In total, 246 anchors (average 12.3 per device) were delivered and optimal anchor placement was achieved in 95.1%, while inadequate anchor position (4%) and injury of the coronary sinus or atrium (0.8%) occurred in the rest. Following maximal cinching, diastolic transmitral flow velocity and coaptation lengths were markedly increased (p<0.001), whereas septolateral and intercommissural distances were significantly decreased (p<0.001), when compared to pre-contraction baseline, demonstrating efficient annular reduction by the device. CONCLUSIONS: Transcatheter direct annuloplasty with a surgical-like adjustable device is feasible in the porcine animal model. The humanised porcine model has been instrumental in demonstrating feasibility and in establishing the procedural steps.


Assuntos
Átrios do Coração/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Animais , Cateterismo Cardíaco , Seio Coronário/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/fisiopatologia , Modelos Animais , Suínos
7.
EuroIntervention ; 11(9): 989-95, 2016 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-25405656

RESUMO

AIMS: To report clinical outcomes in patients treated with drug-eluting balloon (DEB) versus second-generation drug-eluting stent (DES) for in-stent restenosis (ISR) involving a bifurcation lesion. METHODS AND RESULTS: Between February 2007 and November 2012, 167 bifurcation restenoses in 158 patients were treated with either DEB (n=73) or second-generation DES (n=85). The EuroSCORE was significantly higher in the DEB group (4.2±3.8 vs. 2.8±2.1, p=0.004). Regarding restenosed stent type, second-generation DES was more frequently seen in the DEB group (26.9% vs. 6.7%, p<0.001). In this group, there was also a trend towards more frequent stenting for a previous ISR (stent-in-stent) as compared with the DES group (25.6% vs. 15.6%, p=0.074). Over a median follow-up period of 701 days, there was no significant difference in major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction including periprocedural myocardial infarction, target vessel revascularisation, between the two groups (p=0.585). Independent predictors of MACE on multivariate Cox regression analysis included stent-in-stent (HR: 2.16; 95% CI: 1.11 to 4.20; p=0.023) and true bifurcation lesions (HR: 2.98; 95% CI: 1.45 to 6.14; p=0.001). CONCLUSIONS: DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been performed for the treatment of a previous restenosis.


Assuntos
Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Doença da Artéria Coronariana/terapia , Reestenose Coronária/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Dispositivos de Acesso Vascular , Idoso , Distribuição de Qui-Quadrado , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Reestenose Coronária/diagnóstico , Reestenose Coronária/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Modelos de Riscos Proporcionais , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
J Thorac Dis ; 7(9): 1536-42, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26543599

RESUMO

Transcatheter mitral valve therapies have emerged as an alternative option in high surgical risk or inoperable patients with severe and symptomatic mitral regurgitation (MR). As multiple technologies and different approaches will become available in the field of mitral valve interventions, different challenges are emerging, both patient- (clinical challenges) and procedure-related (technical challenges). This review will briefly explore the current open challenges in the evolving fields of interventional mitral valve treatment.

9.
Curr Heart Fail Rep ; 12(6): 379-88, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26472189

RESUMO

The feasibility, safety, and efficacy of transcatheter heart valve (THV) therapies such as MitraClip and transcatheter aortic valve implantation (TAVI) have made them valid therapeutic options in high-risk or inoperable patients with heart failure (HF). Randomized controlled trials (RCTs) demonstrated noninferiority and superiority in terms of efficacy for 12 months of TAVI versus surgical replacement and optimal medical therapy, respectively. With regard to MitraClip, noninferiority was first demonstrated in four subgroups at 12 months and then later at 4-year follow-up. This difference in clinical outcomes between the two therapies is consistent with the discrepancy in the level of recommendation and class of evidence for TAVI and MitraClip according to recent international guidelines (IB vs. IIbC, respectively). Data from ongoing RCTs and national registries will help establish the reciprocal role and hierarchy among THV therapies, surgery, and medical treatment in patients with HF.


Assuntos
Valva Aórtica/cirurgia , Insuficiência Cardíaca/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Instrumentos Cirúrgicos , Substituição da Valva Aórtica Transcateter , Ensaios Clínicos como Assunto , Insuficiência Cardíaca/etiologia , Doenças das Valvas Cardíacas/complicações , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Sistema de Registros , Resultado do Tratamento
10.
Cardiovasc Revasc Med ; 14(6): 311-5, 2013 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24157311

RESUMO

BACKGROUND: Randomized controlled trials have demonstrated that second-generation drug-eluting stents (DESs) for the treatment of obstructive coronary artery disease are associated with comparable, if not improved, clinical outcomes as compared to those of their first-generation counterparts. The aim of this study was to compare the long-term clinical outcomes associated with first- versus second-generation DESs for the treatment of coronary bifurcation lesions. METHODS AND MATERIALS: This was a retrospective study of consecutive de novo bifurcation lesions, excluding those at the left main, treated with either second-generation DES (everolimus-eluting or resolute zotarolimus-eluting stents) between October 2006 and October 2011 (199 bifurcation lesions in 192 patients) or first-generation DES (sirolimus-eluting or paclitaxel-eluting stents) between April 2002 and December 2005 (289 bifurcation lesions in 273 patients). RESULTS: Second-generation DES use in this setting was associated with less major adverse cardiac events (MACE) (23.1% vs. 14.4%, p=0.02) as well as lower target vessel revascularization (TVR) rates (15.5% vs. 8.3%, p=0.01) at 2-year follow-up. Target lesion revascularization, both per patient (12.6% vs. 7.4%, p=0.02) and per bifurcation (11.8% vs. 7.0%, p=0.03), was also improved with second-generation DES over the same follow-up period. Propensity-score adjusted analysis suggested that second-generation DES was associated with a lower incidence of MACE (HR, 0.53; 95% CI, 0.33-0.85; p=0.01) and TVR (HR, 0.44; 95% CI, 0.24-0.83; p=0.01). CONCLUSIONS: Our results suggest that the use of second-generation DES for the treatment of bifurcation lesions is associated with better clinical outcomes as compared to first-generation DES, largely due to a lower need for repeat revascularization.


Assuntos
Doença da Artéria Coronariana/cirurgia , Estenose Coronária/cirurgia , Reagentes para Ligações Cruzadas/uso terapêutico , Stents Farmacológicos , Infarto do Miocárdio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/tratamento farmacológico , Estenose Coronária/tratamento farmacológico , Stents Farmacológicos/efeitos adversos , Everolimo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Paclitaxel/uso terapêutico , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Sirolimo/análogos & derivados , Sirolimo/uso terapêutico , Resultado do Tratamento
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