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1.
N Engl J Med ; 382(17): 1608-1618, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32227756

RESUMO

BACKGROUND: Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS: We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS: At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03). CONCLUSIONS: Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).


Assuntos
Angiografia Coronária , Ponte de Artéria Coronária , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea , Insuficiência Renal Crônica/complicações , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Bloqueadores dos Canais de Cálcio/uso terapêutico , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , Fatores de Risco
2.
Kardiol Pol ; 77(11): 1094-1105, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31723115

RESUMO

The presence of patent foramen ovale (PFO) was found to be associated with a number of medical conditions, including embolic stroke and recurrent transient neurological defects. The closure of PFO remains controversial; however, in recently published guidelines from the European Association of Percutaneous Cardiovascular Interventions in collaboration with 7 other European societies, which extensively refer to the latest randomized clinical trials, it is explicitly recommended to perform percutaneous PFO closure in the prevention of recurrent thromboembolic events. In connection with the above facts and expected increasing number of PFO closure procedures, the joint expert group of the Association of Cardiovascular Interventions and the Grown­Up Congenital Heart Disease Section of the Polish Cardiac Society developed the following consensus opinion in order to standardize the principles of diagnosis, indications, methods of performing procedures, and postoperative care in relation to Polish conditions and experiences.

6.
Kardiol Pol ; 76(3): 677-697, 2018.
Artigo em Polonês | MEDLINE | ID: mdl-29441512

RESUMO

Left atrial appendage (LAA) occlusion devices have the potential to influence the clinical approach to stroke prevention in patients with atrial fibrillation. A number of percutaneous techniques have been proposed, including various intracardiac plugs and also external ligation. Several devices have been already used in Poland. One of them has been evaluated in randomised controlled trials compared with the current standard of care. Others are less well studied but quite commonly used in Eu-rope. It is anticipated that the use of LAA occlusion technologies in clinical practice will expand. This Consensus Document prepared jointly by Association of Cardiovascular Interventions (AISN) and Heart Rhythm Section (HRS) of Polish Cardiac Society seeks to highlight the critical issues surrounding LAA occlusion therapies and to facilitate the alignment of multiple interests, including those of primary care physicians, general cardiologists and procedural specialists (electrophysiologists and interventional cardiologists) but also other medical professionals. The article summarises current evidence and provides spe-cific recommendations on organisation and conduct of LAA therapy in patients with atrial fibrillation in Poland and defines also operator and institutional requirements fundamental to the establishment of successful LAA occlusion programmme.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/instrumentação , Cardiologia , Sociedades Médicas , Fibrilação Atrial/complicações , Humanos , Polônia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
7.
Circ Cardiovasc Interv ; 11(3): e005997, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29463510

RESUMO

BACKGROUND: Device-related thrombus (DRT) after left atrial appendage occlusion is a worrisome finding with little knowledge about when to expect it and how to prevent it. This study sought to investigate correlates of DRT after left atrial appendage occlusion, its time of diagnosis, and particularly, association with postimplantation dual antiplatelet therapy duration. METHODS AND RESULTS: Consecutive patients (n=102) after left atrial appendage occlusion with AMPLATZER Cardiac Plug/Amulet (n=59) or WATCHMAN (n=43) were included in a prospective registry (October 2011-May 2016). Follow-up was done at 1.5, 3 to 6, and 12 months postimplantation. DRT was classified as early (at 1.5 month), late (at 3-6 month), or very late (at 12-month follow-up). Postimplantation dual antiplatelet therapy was recommended for 30 to 180 days and decided independently by attending physicians. Final analysis included 99 patients, 42 (42.4%) females, with median CHA2DS2-VASc of 4.0 (interquartile range [IQR], 3.0-5.0) and median HAS-BLED score of 2.0 (IQR, 1.0-3.0). DRTs were observed in 7 (7.1%) patients: 2 (28.6%) early, 2 (28.6%) late, and 3 (42.9%) very late. When compared with patients without DRT, those with DRT presented more often with a history of prior thromboembolism (5 [71.4%] versus 28 [30.4%]; P=0.04), had lower left ventricular ejection fraction (50.0 [IQR, 35.0-55.0] versus 60.0 [IQR, 55.0-66.0]; P<0.01), and had greater proportion of patients with deep device implantation (6 [85.7%] versus 36 [39.1%]; P=0.04) and with larger devices implanted (30.0 mm [IQR, 27.0-33.0] versus 25.0 mm [IQR, 24.0-28.0]; P<0.01). Postimplantation dual antiplatelet therapy duration was not different between the 2 groups (12.4 weeks [IQR, 6.0-49.7] with DRT versus 13.0 weeks [IQR, 7.3-26.0] without DRT; P=0.77). CONCLUSIONS: In this real-world series, DRT was observed early, late, and very late after left atrial appendage occlusion. It was related to patient and procedural characteristics but not to postimplantation dual antiplatelet therapy duration.


Assuntos
Apêndice Atrial , Fibrilação Atrial/terapia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Inibidores da Agregação de Plaquetas/administração & dosagem , Dispositivo para Oclusão Septal , Trombose/epidemiologia , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Esquema de Medicação , Quimioterapia Combinada , Ecocardiografia Transesofagiana , Humanos , Incidência , Inibidores da Agregação de Plaquetas/efeitos adversos , Polônia/epidemiologia , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Medição de Risco , Fatores de Risco , Trombose/diagnóstico , Trombose/prevenção & controle , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
J Comput Assist Tomogr ; 42(2): 263-268, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29189397

RESUMO

OBJECTIVE: Despite coronary calcifications being a major factor affecting the diagnostic accuracy of coronary computed tomography angiography (CTA), there is a lack of established criteria for categorizing calcifications. We aimed to evaluate patterns of coronary calcification based on quantitative radiodensity and size parameters to provide coronary calcium categories and assess their impact on the accuracy of coronary CTA. METHODS AND RESULTS: We analyzed length, maximum thickness, volume, mean density, and maximum density of coronary calcium and divided each of these parameters into tertiles. Subsequently, we summarized the tertiles for each individual calcification and divided them into 3 equal groups of: mild, moderate, and severe calcification. The accuracy of coronary CTA was defined as the difference between the measurements obtained on coronary CTA versus the reference of intravascular ultrasound (IVUS). We evaluated 252 coronary calcifications within 97 arteries of 60 patients. There was an expected increase in size and density values for mild versus moderate versus severe calcifications, but there was no difference in IVUS measured minimum lumen area among the 3 groups. Of note, coronary CTA significantly underestimated IVUS minimum lumen area measurement by 1.2 ± 1.6 mm (14.6 ± 23.1%, P < 0.001) for severe calcifications and by 0.5 ± 2.0 mm (3.7 ± 32.1%, P = 0.021) for moderate calcifications. Within mild calcifications, the difference was not significant. CONCLUSION: Based on their dimensional and radiodensity characteristics, our analysis revealed patterns of individual coronary artery calcifications that affected the accuracy of coronary CTA measurements; coronary CTA inaccuracy was associated with the presence of moderate or severe calcifications, but not mild calcifications.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Ultrassonografia de Intervenção
9.
Menopause ; 25(4): 408-414, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29206775

RESUMO

OBJECTIVE: Menopause, particularly its early stage (≤3 years from onset), may be an important risk factor for premature coronary artery disease. The objective of the study was to assess whether the addition of the presence of menopause in women with premature coronary artery disease could improve the predictive value of the Atherosclerotic Cardiovascular Disease risk estimator and the Systematic COronary Risk Evaluation model. METHODS: The case-control study included 307 women with coronary artery disease aged 55 or less, and 347 age-matched controls without coronary artery disease. Diagnostic accuracy parameters were evaluated for traditional risk models versus those enriched with menopausal status. Early and late postmenopausal periods were defined as ≤3 and >3 years from the onset of menopause, respectively. RESULTS: Only the addition of the presence of the early postmenopausal stage to the 10-year Atherosclerotic Cardiovascular Disease risk classes resulted in significantly increased c-statistics from 0.66 (95% confidence interval [CI] 0.62-0.7) to 0.705 (95%CI 0.66-0.75) (P = 0.0003) and an increase of accuracy from 61.3% to 63.8% (P = 0.0025).Adding the presence of early postmenopause to the Systematic COronary Risk Evaluation risk classes also resulted in significantly increased c-statistics from 0.59 (95% CI 0.55-0.63) to 0.641 (95%CI 0.6-0.68) (P = 0.0024) and an increase of accuracy from 64.1% versus 57.5% (P = 0.001). CONCLUSION: Adding the early menopausal period may significantly improve the predictive value of the 10-year Atherosclerotic Cardiovascular Disease risk score and the Systematic COronary Risk Evaluation model in women with premature coronary artery disease.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Nível de Saúde , Menopausa , Fatores Etários , Idade de Início , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
10.
Catheter Cardiovasc Interv ; 91(1): 105-112, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28303670

RESUMO

OBJECTIVES: To compare subcutaneous "Z"-stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency. BACKGROUND: Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. "Z"-stitch has been introduced for this purpose in some centers but systematic data on its performance is limited. METHODS: This single center study randomized consecutive patients with femoral venous access sites requiring ≥10F sheaths to the "Z"-stitch or manual compression for hemostasis in a 2:1 fashion. There were three co-primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler-Duplex was performed with the stitch in place and after its removal. RESULTS: 86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 ± 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10-22 F). Patients randomized to "Z"-stitch achieved hemostasis quicker [<1 min vs. 12.0 (IQR 10.0-15.0) min, P < 0.001] and ambulated sooner [7.0 (IQR 4.0-12.0) vs. 16.0 (IQR 11.8-20.3) hr post procedure, P < 0.001] when compared with manual compression alone. The "Z"-stitch reduced rates of access site complications (OR = 0.27, 95%CI 0.09-0.76, P = 0.01). All imaged veins were patent before and after stitch removal. CONCLUSIONS: The "Z"-stitch is a safe and effective method of achieving hemostasis after large bore femoral venous sheath removal and results in faster hemostasis, early patient ambulation and less access site complications, without compromising vein patency when compared with manual compression alone. © 2017 Wiley Periodicals, Inc.


Assuntos
Cateterismo Periférico/instrumentação , Veia Femoral , Hemorragia/prevenção & controle , Técnicas Hemostáticas , Técnicas de Sutura , Dispositivos de Acesso Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Pesquisa Comparativa da Efetividade , Desenho de Equipamento , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Pressão , Estudos Prospectivos , Punções , Técnicas de Sutura/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
J Invasive Cardiol ; 30(1): 10-17, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28915510

RESUMO

BACKGROUND: Most drug-eluting stent (DES) trials have excluded patients with chronic kidney disease (CKD). The efficacy of DES implantation in patients with CKD is therefore not known. OBJECTIVES: To evaluate the outcomes with DES vs bare-metal stent (BMS) implantation in patients with CKD. METHODS AND RESULTS: MEDLINE, EMBASE, and CENTRAL were searched for studies including at least 100 patients with CKD (estimated glomerular filtration rate ≤60 mL/min/1.73 m² or on dialysis) treated with DES or BMS and followed for at least 1 month and reporting outcomes of all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), target-vessel revascularization (TVR), and stent thrombosis (ST). Thirty-one studies (5 randomized) with 91,817 participants (49,081 DES and 42,736 BMS) fulfilled the inclusion criteria. DES was associated with lower all-cause mortality (relative risk [RR], 0.77; 95% confidence interval [CI], 0.71-0.84), CV mortality (RR, 0.51; 95% CI, 0.38-0.70), MI (RR, 0.90; 95% CI, 0.86-0.95), TVR (RR, 0.61; 95% CI, 0.47-0.80), and numerically lower ST (RR, 0.75; 95% CI, 0.55-1.01) when compared with BMS. Analysis by study type (RCTs vs non-RCTs) showed similar results for most outcomes (Pinteraction>.05) except all-cause mortality, where there was no difference between DES vs BMS in RCTs (Pinteraction=.04). The effects were greater with 2nd-generation DES vs BMS (for example, ST: RR, 0.38; 95% CI, 0.20-0.72). CONCLUSIONS: In patients with CKD, the available evidence, largely from observational studies, suggests significantly fewer events with DES vs BMS with even a lower ST rate with 2nd-generation DES. These findings should be tested in large, randomized trials.


Assuntos
Doença da Artéria Coronariana , Reestenose Coronária , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Insuficiência Renal Crônica/complicações , Stents , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/epidemiologia , Reestenose Coronária/etiologia , Reestenose Coronária/mortalidade , Humanos , Estudos Observacionais como Assunto , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos
12.
Am Heart J ; 190: 135-139, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28760208

RESUMO

BACKGROUND: The Universal Definition of Myocardial Infarction recommends the 99th percentile concentration of cardiac troponin in a normal reference population as part of the decision threshold to diagnose type 1 spontaneous myocardial infarction. Adoption of this recommendation in contemporary worldwide practice is not well known. METHODS: We performed a cohort study of 276 hospital laboratories in 31 countries participating in the National Heart, Lung, and Blood Institute-sponsored International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial. Each hospital laboratory's troponin assay manufacturer and model, the recommended assay's 99th percentile upper reference limit (URL) from the manufacturer's package insert, and the troponin concentration used locally as the decision level to diagnose myocardial infarction were ascertained. RESULTS: Twenty-one unique troponin assays from 9 manufacturers were used by the surveyed hospital laboratories. The ratio of the troponin concentration used locally to diagnose myocardial infarction to the assay manufacturer-determined 99th percentile URL was <1 at 19 (6.6%) laboratories, equal to 1 at 91 (31.6%) laboratories, >1 to ≤5 at 101 (35.1%) laboratories, >5 to ≤10 at 34 (11.8%) laboratories, and >10 at 43 (14.9%) laboratories. The variability in troponin decision level for myocardial infarction relative to the assay 99th percentile URL was present for laboratories in and outside of the United States, as well as for high- and standard-sensitivity assays. CONCLUSIONS: There is substantial hospital-level variation in the troponin threshold used to diagnose myocardial infarction; only one-third of hospital laboratories currently follow the Universal Definition of Myocardial Infarction consensus recommendation for use of troponin concentration at the 99th percentile of a normal reference population as the decision level to diagnose myocardial infarction. This variability across laboratories has important implications for both the diagnosis of myocardial infarction in clinical practice as well as adjudication of myocardial infarction in clinical trials.


Assuntos
Infarto do Miocárdio/diagnóstico , Troponina/sangue , Biomarcadores/sangue , Humanos , Infarto do Miocárdio/sangue , Estudos Retrospectivos , Estados Unidos
14.
Postepy Kardiol Interwencyjnej ; 12(2): 135-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27279873

RESUMO

INTRODUCTION: The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2-17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage - pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices. AIM: To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization. MATERIAL AND METHODS: In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology. RESULTS: We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood. CONCLUSIONS: Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.

17.
Am Heart J ; 169(1): 6-16.e6, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25497242

RESUMO

BACKGROUND: Multiple studies have evaluated the diagnostic and prognostic performance of conventional troponin (cTn) and high-sensitivity troponin (hs-cTn). We performed a collaborative meta-analysis comparing cTn and hs-cTn for diagnosis of acute myocardial infarction (AMI) and assessment of prognosis in patients with chest pain. METHODS: MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing both cTn and hs-cTn in patients with chest pain. Study authors were contacted and many provided previously unpublished data. RESULTS: From 17 included studies, there were 8,644 patients. Compared with baseline cTn, baseline hs-cTn had significantly greater sensitivity (0.884 vs 0.749, P < .001) and negative predictive value (NPV; 0.964 vs 0.935, P < .001), whereas specificity (0.816 vs 0.938, P < .001) and positive predictive value (0.558 vs 0.759, P < .001) were significantly reduced. Based on summary receiver operating characteristic curves, test performance for the diagnosis of AMI was not significantly different between baseline cTn and hs-cTn (0.90 [95% CI 0.85-0.95] vs 0.92 [95% CI 0.90-0.94]). In a subanalysis of 6 studies that alternatively defined AMI based on hs-cTn, cTn had lower sensitivity (0.666, P < .001) and NPV (0.906, P < .001). Elevation of baseline hs-cTn, but negative baseline cTn, was associated with increased risk of death or nonfatal myocardial infarction during follow-up (P < .001) compared with both negative. CONCLUSION: High-sensitivity troponin has significantly greater early sensitivity and NPV for the diagnosis of AMI at the cost of specificity and positive predictive value, which may enable early rule in/out of AMI in patients with chest pain. Baseline hs-cTn elevation in the setting of negative cTn is also associated with increased nonfatal myocardial infarction or death during follow-up.


Assuntos
Dor no Peito/sangue , Infarto do Miocárdio/diagnóstico , Troponina/sangue , Dor no Peito/etiologia , Humanos , Infarto do Miocárdio/mortalidade , Prognóstico , Curva ROC , Sensibilidade e Especificidade
18.
J Invasive Cardiol ; 26(10): 501-11, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25274860

RESUMO

AIMS: Non-uniform distribution of drug-eluting stent struts may cause uneven drug deposition associated with an adverse neointimal response and clinical events. This study assesses circumferential stent strut distribution in bare-metal (BMS) and paclitaxel-eluting (Taxus) stents post implantation and at 9-month follow-up, as well as its impact on intimal hyperplasia (IH). METHODS AND RESULTS: In the current analysis, intravascular ultrasound (IVUS) substudies of the Taxus IV, V, and VI trials were combined. Among them, 242 stents (117 BMS and 125 Taxus) had paired IVUS images post procedure and at 9-month follow-up that were reassessed at 1 mm intervals. Post implantation, the maximum interstrut angle (71.5 ± 17.7° vs 70.0 ± 19.6°; P=.53) and minimum number of stent struts (7.1 ± 1.0 vs 7.2 ± 0.8; P=.32) were similar in Taxus vs BMS subgroups, respectively. At 9-month follow-up, the maximum angle increased (92.8 ± 22.1° and 81.7 ± 20.6°) and stent strut numbers decreased (6.1 ± 0.9 and 6.5 ± 1.0) for both Taxus and BMS, respectively, as compared to immediately post implantation (all P<.001). The increased stent angle was more pronounced for Taxus compared with BMS (P<.01). Non-uniform strut distribution did not affect IH pattern or clinical outcomes in either stent population. No complete stent fractures were identified. CONCLUSION: Stent strut distribution changed from implantation to follow-up with an increased interstrut angle and fewer visible stent struts. These changes were more pronounced for Taxus as compared to BMS; however, non-uniform strut distribution was unrelated to increased IH or clinical outcomes.


Assuntos
Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Stents Farmacológicos , Falha de Equipamento , Neointima/diagnóstico por imagem , Paclitaxel/administração & dosagem , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Estudos de Coortes , Angiografia Coronária , Método Duplo-Cego , Seguimentos , Humanos , Hiperplasia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Túnica Íntima/patologia
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