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2.
Artigo em Inglês | MEDLINE | ID: mdl-32061033

RESUMO

Evidence-based recommendations for clinical practice are intended to help health care providers and patients make decisions, minimize inappropriate practice variation, promote effective resource use, improve clinical outcomes, and direct future research. The Society for Cardiovascular Angiography and Interventions (SCAI) has been engaged in the creation and dissemination of clinical guidance documents since the 1990s. These documents are a cornerstone of the society's education, advocacy, and quality improvement initiatives. The publications committee is charged with oversight of SCAI's clinical documents program and has created this manual of standard operating procedures to ensure consistency, methodological rigor, and transparency in the development and endorsement of the society's documents. The manual is intended for use by the publications committee, document writing groups, external collaborators, SCAI representatives, peer reviewers, and anyone seeking information about the SCAI documents program.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32013839

RESUMO

Cryptogenic stroke and its relation to the Patent foramen ovale (PFO) is a long debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between right and left atria in approximately 25-27% of adults [1, 2]. In this review we examine the clinical relevance of the PFO with analysis of latest trials evaluating catheter-based closure of PFO's for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients' with PFO who do not qualify for closure per current guidelines.

4.
Cardiovasc Hematol Agents Med Chem ; 17(2): 144-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31629400

RESUMO

INTRODUCTION: Recent findings have shown that in Acute Ischemic Stroke (AIS) patients, elevated troponin is associated with increased mortality. However, due to concerns of cerebral hypoperfusion and hemorrhagic transformation, current practice has been slow to apply proven cardiac therapies to these patients. This study aims to determine this rate of utilization. MATERIALS AND METHODS: A single-center review of 83 patients with AIS and measured troponin was conducted. Patients were stratified based on elevated and non-elevated troponin. Between groups, we measured the utilization of evidence-based cardiac therapies and used a univariate logistic regression to compare outcomes of mortality, re-hospitalization, recurrent acute ischemic stroke, recurrent acute myocardial infarction, and a composite of these outcomes. RESULTS: Of 83 patients, 25 had elevated troponin and 58 had non-elevated troponin. There was no statistical difference in the use of cardiac therapies between the two groups. Adenosine diphosphate P2Y12 antagonists were infrequently used in both elevated and non-elevated troponin groups at 32% vs. 24% (p = 0.64), as were Angiotensin-Converting Enzyme Inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) at 56% vs. 69% (p = 0.38). Those in the elevated troponin group encountered a statistically significant increase in composite endpoint 64% vs. 33% (Odds Ratio [OR] 7.28, 95% Confidence interval [CI] 2.19-28.88, p<0.01). CONCLUSION: Cardiac therapies are underutilized in patients with acute ischemic stroke and elevated troponin levels. In turn, this low usage may explain the increase in morbidity and mortality seen in these patients and the use of such therapies should be considered when treating this subset of patients as the cardio protective nature of these therapies may outweigh the risks associated with them in AIS patients.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Acidente Vascular Cerebral/sangue , Troponina/sangue , Idoso , Isquemia Encefálica/sangue , Isquemia Encefálica/complicações , Feminino , Humanos , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações
5.
Arch Med Res ; 50(5): 257-258, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593849

RESUMO

Acute pulmonary embolism remains a catastrophic acute cardiovascular event, and it is the leading cause of preventable mortality among hospitalized patients. Pulmonary embolism response teams have been designed to facilitate efficiency, streamline and improve quality of care in a timely manner for complex pulmonary embolism case scenarios with a multidisciplinary approach. Herein, we briefly describe and delineate the main goals and strategies on how to leverage the strengths from such pulmonary embolism response teams, with the aim to be adopted worldwide, improve survival, and change the paradigm in the care of a potentially deadly disease.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31483237

RESUMO

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.


Assuntos
Nicotina/efeitos adversos , Fumar Cachimbo de Água/efeitos adversos , Animais , Doenças Cardiovasculares/etiologia , Política de Saúde , Humanos , Pneumopatias/etiologia , Neoplasias/etiologia , Estresse Oxidativo , Cachimbos de Água , Abandono do Uso de Tabaco , Fumar Cachimbo de Água/epidemiologia , Fumar Cachimbo de Água/legislação & jurisprudência , Fumar Cachimbo de Água/terapia
11.
J Am Heart Assoc ; 8(14): e013361, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31284819

RESUMO

See Article Choo et al.

12.
Catheter Cardiovasc Interv ; 94(7): 905-914, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31165573

RESUMO

BACKGROUND: Recent trials have shown benefits with percutaneous coronary intervention (PCI) on nonculprit coronary vessels in select ST-elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (CAD). However, readmission rates and causes in this high-risk group are unknown. Objective of this study is to explore pattern, causes and factors associated with 30-day readmission after multivessel PCI in STEMI patients. METHODS AND RESULTS: Nationwide Readmissions Data (NRD) between 2010 and 2014 was utilized to identify multivessel PCI cases in STEMI patients using appropriate ICD-9 codes. We evaluated 30-day readmission rate and factors associated with 30-day readmission. Hierarchical logistic regression model was used to identify factors associated with 30-day readmission. Among 22,257 STEMI patients who survived to discharge after multivessel PCI, 2,302 (10.3%) were readmitted within 30-days. Subsequent unresolved/aggravated cardiac issues most commonly triggered readmission (62.66%). Among cardiac causes, heart failure and ischemic heart disease were most frequent etiologies. Advancing age (OR: 1.073, 95%CI: 1.026 to 1.122, p = .002), female sex (OR: 1.36, 95%CI: 1.23 to 1.50, p < .001), comorbid conditions like chronic kidney disease (CKD; OR: 1.35, 95%CI: 1.17 to 1.57, p = .001), congestive heart failure (CHF; OR: 1.40, 95%CI: 1.24 to 1.57, p = .04), anemia (OR: 1.16, 95%CI: 1.002 to 1.34, p = .04), and utilization of a mechanical circulatory support (MCS) device (OR: 1.45, 95%CI: 1.19 to 1.77, p < .001) during the index procedure were predictive of subsequent readmission within 30 days. CONCLUSION: In this large nationally representative study, nearly one in 10 patients were readmitted within 30 days from discharge after index admission for multivessel PCI in STEMI, most commonly for cardiac causes.

13.
Artigo em Inglês | MEDLINE | ID: mdl-31241442

RESUMO

INTRODUCTION: Bivalirudin and heparin are the two most commonly used anticoagulants used during percutaneous coronary intervention (PCI). The results of randomized controlled trials (RCTs) comparing bivalirudin versus heparin monotherapy in the era of radial access are controversial, questioning the positive impact of bivalirudin on bleeding. The purpose of this systematic review is to summarize the results of RCTs comparing the efficacy and safety of bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors (GPI). METHODS: This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements for reporting systematic reviews. We searched the National Library of Medicine PubMed, Clinicaltrial.gov and the Cochrane Central Register of Controlled Trials to include clinical studies comparing bivalirudin with heparin in patients undergoing PCI. Sixteen studies met inclusion criteria and were reviewed for summary. FINDINGS: Several RCTs and meta-analyses have demonstrated the superiority of bivalirudin over heparin plus routine GPI use in terms of preventing bleeding complications but at the expense of increased risk of ischemic complications such as stent thrombosis (ST). The hypothesis of post- PCI bivalirudin infusion to mitigate the risk of acute ST have been tested in various RCTs with conflicting results. In comparison, heparin offers advantage of availability of reversible agent, less cost and reduced incidence of ischemic complications. CONCLUSION: Bivalirudin demonstrates its superiority over heparin plus GPI with better clinical outcomes in terms of preventing bleeding complications, thus making it as an anticoagulation of choice particularly in patients at high risk of bleeding. Further studies are warranted for head to head comparison of bivalirudin to heparin monotherapy to establish an optimal heparin dosing regimen and post-PCI bivalirudin infusion to affirm its beneficial effect in reducing acute ST.

14.
Catheter Cardiovasc Interv ; 94(1): 123-135, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31104353

RESUMO

This article is intended for any physician, administrator, or cardiovascular catheterization laboratory (CCL) staff member who desires a fundamental understanding of finances and economics of CCLs in the United States. The authors' goal is to illuminate general economic principles of CCL operations and provide details that can be used immediately by CCL leaders. Any article on economics in medicine should start by acknowledging the primacy of the principles of medical ethics. While physicians have been trained to act in the best interests of their patients and avoid actions that would harm patients it is vitally important that all professionals in the CCL focus on patients' needs. Caregivers both at the bedside and in the office must consider how their actions will affect not only the patient they are treating at the time, but others as well. If the best interests of a patient were to conflict with any recommendation in this article, the former should prevail. KEY POINTS: To be successful and financially viable under current payment systems, CCL physicians, and managers must optimize the outcomes and efficiency of care by aligning CCL leadership, strategy, organization, processes, personnel, and culture. Optimizing a CCL's operating margin (profitability) requires maximizing revenues and minimizing expenses. CCL managers often focus on expense reduction; they should also pay attention to revenue generation. Expense reduction depends on efficiency (on-time starts, short turn-over time, smooth day-to-day schedules), identifying cost-effective materials, and negotiating their price downward. Revenue optimization requires accurate documentation and coding of procedures, comorbidities, and complications. In fee-for-service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues. New procedures that improve patient care but are expensive can usually be justified by negotiating with vendors for lower prices and including the "halo effect" of collateral services that accompany the new procedure. Fiscal considerations should never eclipse quality concerns. High quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.

15.
Prog Cardiovasc Dis ; 62(4): 315-326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30922976

RESUMO

Diabetes causes cardiomyopathy and increases the risk of heart failure independent of hypertension and coronary heart disease. This condition called "Diabetic Cardiomyopathy" (DCM) is becoming a well- known clinical entity. Recently, there has been substantial research exploring its molecular mechanisms, structural and functional changes, and possible development of therapeutic approaches for the prevention and treatment of DCM. This review summarizes the recent advancements to better understand fundamental molecular abnormalities that promote this cardiomyopathy and novel therapies for future research. Additionally, different diagnostic modalities, up to date screening tests to guide clinicians with early diagnosis and available current treatment options has been outlined.


Assuntos
Diabetes Mellitus/epidemiologia , Cardiomiopatias Diabéticas/epidemiologia , Insuficiência Cardíaca/epidemiologia , Programas de Rastreamento/métodos , Biomarcadores/sangue , Técnicas de Imagem Cardíaca/métodos , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Cardiomiopatias Diabéticas/diagnóstico por imagem , Cardiomiopatias Diabéticas/terapia , Diagnóstico Precoce , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Humanos , Masculino , Prognóstico , Medição de Risco , Análise de Sobrevida
16.
J Invasive Cardiol ; 31(6): 187-194, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30865914

RESUMO

OBJECTIVES: We evaluated the efficacy of low-dose (LD) radiation (≤7.5 frames/second [f/s]) compared with standard-dose (SD) radiation (≥10 f/s) in cardiac catheterization (CC) and percutaneous coronary intervention (PCI). Patients undergoing CC with LD vs SD radiation have not been previously studied. METHODS: We performed an observational study of 452 consecutive patients (61 ± 12 years) who had coronary angiography or PCI from September 2016 to September 2017. Patients were divided into an LD radiation group (n = 136) consisting of 0.5 f/s and 1 f/s (n = 73), 4 f/s (n = 40), or 7.5 f/s fluoroscopy (n = 23) with 7.5 f/s cine angiography vs an SD group (n = 316) consisting of 10 f/s (n = 250), 15 f/s (n = 64), or 30 f/s fluoroscopy (n = 2) and 10-30 f/s cine angiography. Primary endpoints included air kerma, dose area product (DAP), fluoroscopy time, and contrast use. RESULTS: Compared with SD radiation, LD radiation was associated with a significant reduction in air kerma (100.70 mGy [IQR, 46.42-233.35 mGy] vs 660.96 mGy [IQR, 362.78-1373.65 mGy]; P<.001), DAP (723.60 µGy•m² [IQR, 313.09-2328.22 µGy•m²] vs 5203.40 µGy•m² [IQR, 2743.55-10064.71 µGy•m²]; P<.001), and contrast use (100 mL [IQR, 60-150 mL] vs 115 mL [IQR, 80-180 mL]; P<.03). No difference in fluoroscopy time was noted (13.33 min [IQR, 6.93-25.55 min] vs 12.75 min [IQR, 7.75-22.55 min]; P=.95). CONCLUSIONS: LD radiation in CC was efficacious, with significant radiation reduction and without an increase in fluoroscopy time or contrast utilization. All patients underwent successful LD radiation catheterization without conversion to SD.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Cateterismo Cardíaco/métodos , Angiografia Coronária/métodos , Fluoroscopia/métodos , Intervenção Coronária Percutânea/métodos , Cirurgia Assistida por Computador/métodos , Síndrome Coronariana Aguda/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial , Doses de Radiação , Estudos Retrospectivos , Fatores de Risco
18.
Chem Commun (Camb) ; 55(22): 3199-3202, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30801600

RESUMO

A magnesium hydride cation [(L)MgH]+ supported by a macrocyclic ligand (L = Me4TACD; 1,4,7,10-tetramethyl-1,4,7,10-tetraazacyclododecane) has been prepared by partial protonolysis of a mixed amide hydride [(L)MgH2Mg{N(SiMe3)2}2] and shown to undergo a variety of reactions with unsaturated substrates, including pyridine.

19.
Cardiovasc Revasc Med ; 20(11): 956-964, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30638891

RESUMO

BACKGROUND: Previous studies comparing outcomes between culprit vessel only percutaneous coronary intervention (CV-PCI) versus multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock in the setting of acute myocardial infarction have shown conflicting results. This meta-analysis investigates the optimal approach for management of these patients considering recently published data. METHODS: Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all clinical studies published until May 1, 2018, which compared outcomes in patients presenting with acute myocardial infarction and cardiogenic shock. Studies comparing CV-PCI versus MV-PCI in patients with multivessel coronary artery disease were screened for inclusion in final analysis. The primary end point was in-hospital/30 day mortality. Secondary endpoints included long term (>6 months) mortality, renal failure requiring renal replacement therapy, stroke, bleeding, and recurrent myocardial infarction. Odds ratio (OR) with 95% of confidence interval (CI) were computed and p values <0.05 were considered significant. RESULTS: Patient who underwent CV-PCI had significantly lower short-term mortality (in-hospital or 30-day mortality) (OR: 0.73, CI: 0.61-0.87, p = 0.0005), and lower odds of severe renal failure requiring renal replacement therapy (OR: 0.76, CI: 0.59-0.98, p = 0.03). There was no statistically significant difference in long-term mortality, stroke, bleeding, and recurrent myocardial infarction between two groups. CONCLUSION: This meta-analysis showed lower short-term mortality and decreased odds of renal failure requiring renal replacement therapy with CV-PCI compared to MV-PCI. However, subgroup analysis including studies exclusively assessing STEMI patients revealed no statistically significant difference in outcomes. Further randomized trials are needed to confirm these findings and evaluate long term results.

20.
Circ Cardiovasc Interv ; 12(1): e007244, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30608884

RESUMO

BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.


Assuntos
American Heart Association , Procedimentos Endovasculares/normas , Medicina Baseada em Evidências/normas , Doenças Vasculares Periféricas/terapia , Guias de Prática Clínica como Assunto/normas , Procedimentos Cirúrgicos Vasculares/normas , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Humanos , Doenças Vasculares Periféricas/diagnóstico , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversos
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