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1.
Medicine (Baltimore) ; 100(6): e24366, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578533

RESUMO

BACKGROUND: Pharmacokinetic and pharmacodynamic study showed a lower clopidogrel response when coprescribed with proton pump inhibitors (PPIs). Despite this, PPIs is necessary for patients treated with long term dual antiplatelet therapy (DAPT). Ethnic variance also played a different effect on clopidogrel response. Our study evaluated the effect of concomitant use of DAPT and PPIs and assessed whether ethnic variance exert different effect on clinical outcomes. METHODS: We carefully searched EMBASE, PubMed/Medline databases, and the Cochrane library in April 2019. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) and individual endpoints reported. We also focused on bleeding events. Studies were excluded if the follow-up were <12 months and patients were not treated with clopidogrel after stent implantation. RESULTS: A total of 18 studies were included in the systematic review (involving 79,670 patients). No randomized controlled trials (RCTs) were included. PPIs comedication were associated with increased MACCE (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.28-1.49) while not associated with decreased bleeding risks, such as gastrointestinal bleeding (OR = 1.05; 95% CI = 0.53-2.11). PPIs comedication were associated with increased risk for all endpoints among Caucasian population while not with increased risk for MACE (OR = 1.20; 95% CI = 0.99-1.39), all-cause death (OR = 1.24; 95% CI = 0.74-2.06), cardiac-death (OR = 1.29; 95% CI = 0.64-2.57) among Asian population. CONCLUSION: PPIs comedication were associated with adverse clinical outcomes, and ethnic variance may exert different effect on clinical outcomes. Subgroup analysis indicated that concomitant use of PPI might be suitable for Asian patients after stent implantation.


Assuntos
Implante de Prótese Vascular , Prótese Vascular , Clopidogrel/uso terapêutico , Grupos de Populações Continentais , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Stents , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Clopidogrel/administração & dosagem , Grupos de Populações Continentais/estatística & dados numéricos , Oclusão Coronária/prevenção & controle , Oclusão Coronária/terapia , Quimioterapia Combinada , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Resultado do Tratamento
2.
Angiology ; 72(1): 44-49, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32799665

RESUMO

Coronary chronic total occlusions (CTOs) are characterized by a high incidence of severe plaque calcifications, which are associated with a high use of the retrograde approach and a low success rate of percutaneous coronary intervention (PCI). However, the feasibility of rotational atherectomy (RA) in retrograde CTO-PCI remains unknown. The aim of the present study is to examine the safety and efficacy of RA in retrograde CTO-PCI. Consecutive patients (n = 129) who underwent RA during CTO-PCI were categorized into anterograde and retrograde groups according to the CTO crossing approach. The distributions of the baseline characteristics were similar in the 2 groups, but the lesion type was more complex (P = .001), and the starting burr size was smaller (P = .003) in the retrograde group than in the anterograde group. There was a trend of a higher incidence of procedural complications in the retrograde group than in the anterograde group (P = .054). Technical and procedural success and in-hospital outcomes were not significantly different between the 2 groups. In conclusion, RA was feasible in retrograde CTO PCI, but some specific precautions are required before and during the procedure. In addition, further investigation of the long-term outcomes of RA in retrograde CTO PCI is necessary.


Assuntos
Aterectomia Coronária/métodos , Oclusão Coronária/terapia , Aterectomia Coronária/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Estudos Retrospectivos , Stents
3.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933911

RESUMO

A 50-year-old woman presented with history of intermittent angina for 2 days and signs of extensive anterior wall myocardial infarction. An urgent coronary angiogram showed a large proximally occluded left anterior descending (LAD) artery with no distal vessel opacification. After one attempt of thrombus aspiration, there was no improvement in Thrombolysis in Myocardial Infarction (TIMI) flow. The aspiration catheter was then parked in the distal vessel beyond the thrombotic lesion and 2 mg of intravenous nicorandil drug mixed with 10 mL of 50% dilute iodinated contrast media was infused slowly. A comparison was made to proximal vessel angiogram and the angioplasty procedure was then completed with a right size stent, restoring TIMI 3 flow in the LAD. This method minimises clot manipulations by avoiding repeated balloon predilatations or thrombus aspiration attempts and thus prevents the occurrence of no-reflow in lesions with large thrombus burden.


Assuntos
Angioplastia , Meios de Contraste/administração & dosagem , Oclusão Coronária/terapia , Nicorandil/administração & dosagem , Trombose/terapia , Vasos Coronários , Combinação de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade
4.
PLoS One ; 15(8): e0238048, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845908

RESUMO

INTRODUCTION: Non-primary percutaneous coronary intervention (non-PPCI) recently received certificate of need approval in the state of Michigan at sites without cardiac surgery on-site (cSoS). This requires quality oversight through participation in the BMC2 registry. While previous studies have indicated the safety of this practice, real-world comprehensive outcomes, case volume changes, economic impacts, and readmission rates at diverse healthcare centers with and without cSoS remain poorly understood. METHODS: Consecutive patients undergoing non-PPCI at 47 hospitals (33 cSoS and 14 non-cSoS) in Michigan from April 2016 to March 2018 were included. Using propensity-matching, patients were analyzed to assess outcomes and trends in non-PPCI performance at sites with and without cSOS. RESULTS: Of 61,864 PCI's performed, 50,817 were non-PPCI, with 46,096 (90.7%) performed at sites with cSoS and 4,721 (9.3%) at sites without cSoS. From this cohort, 4,643 propensity-matched patients were analyzed. Rates of major adverse cardiac events (2.6% vs. 2.8%; p = 0.443), in-hospital mortality (0.6% vs. 0.5%; p = 0.465), and several secondary clinical and quality outcomes showed no clinically significant differences. Among a small subset with available post-discharge data, there were no differences in 90-day readmission rates, standardized episode costs, or post-discharge mortality. Overall PCI volume remained stable, with a near three-fold rise in non-PPCI at sites without cSoS. CONCLUSIONS: Non-PPCI at centers without cardiac SoS was associated with similar comprehensive outcomes, quality of care, 90-day episode costs, and post-discharge mortality compared with surgical sites. Mandatory quality oversight serves to maintain appropriate equivalent outcomes and may be considered for other programs, including the performance of non-PPCI at ambulatory surgical centers in the near future.


Assuntos
Oclusão Coronária/cirurgia , Intervenção Coronária Percutânea , Idoso , Oclusão Coronária/terapia , Feminino , Mortalidade Hospitalar/tendências , Hospitais , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente/tendências , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/economia , Pontuação de Propensão , Sistema de Registros , Resultado do Tratamento
5.
Am J Cardiol ; 132: 44-51, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762964

RESUMO

The optimal duration of dual antiplatelet therapy (DAPT) after treatment of chronic total occlusions (CTO) with percutaneous coronary intervention (PCI) is unknown. We aimed to determine if extended (> 12 months) DAPT was associated with a net clinical benefit. The study population included patients who underwent successful CTO PCI within Kaiser Permanente Northern California between 2009 and 2016. Baseline demographic, clinical, and procedural characteristics were compared for patients on DAPT ≤ versus > 12 months. Clinical outcomes (death, myocardial infarction (MI), and ≥ Academic Research Consortium type 3a bleeding) were compared beginning 12 months after PCI using Cox proportional hazards models. We also adjudicated individual causes of death. 1,069 patients were followed for a median of 3.6 years (Interquartile Range = 2.2 to 5.5) following CTO PCI. Patients on DAPT ≤ 12 months (n = 597, 56%) were more likely to have anemia, end stage renal disease, and previous MI. After adjustment for between group differences, > 12 months of DAPT was associated with lower death or MI (hazard ratio [HR]: 0.66; 95% confidence interval [CI]: 0.47 to 0.93) and lower death (HR: 0.54; 95% CI: 0.36 to 0.82). There were no associations with MI (HR: 0.91; 95% CI: 0.55 to 1.5) or bleeding (HR 1.1; 95% CI: 0.50 to 2.4), but a numerically higher proportion of patients on shorter v. longer DAPT died of a cardiovascular cause (37% vs 20%, p = 0.10). In conclusion, > 12 months of DAPT was associated with lower death or MI, without an increase in bleeding. Prospective studies are needed to evaluate the optimal duration of DAPT in this unique subgroup.


Assuntos
Oclusão Coronária/terapia , Terapia Antiplaquetária Dupla/métodos , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , California/epidemiologia , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/mortalidade , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
6.
Cardiovasc Diabetol ; 19(1): 100, 2020 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-32622353

RESUMO

BACKGROUND: In this study, we compared the outcomes of medical therapy (MT) with successful percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) patients with and without type 2 diabetes mellitus. METHODS: A total of 2015 patients with CTOs were stratified. Diabetic patients (n = 755, 37.5%) and non-diabetic patients (n = 1260, 62.5%) were subjected to medical therapy or successful CTO-PCI. We performed a propensity score matching (PSM) to balance the baseline characteristics. A comparison of the major adverse cardiac events (MACE) was done to evaluate long-term outcomes. RESULTS: The median follow-up duration was 2.6 years. Through multivariate analysis, the incidence of MACE was significantly higher among diabetic patients compared to the non-diabetic patients (adjusted hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.09-1.61, p = 0.005). Among the diabetic group, the rate of MACE (adjusted HR 0.61, 95% CI 0.42-0.87, p = 0.006) was significantly lower in the successful CTO-PCI group than in the MT group. Besides, in the non-diabetic group, the prevalence of MACE (adjusted HR 0.85, 95% CI 0.64-1.15, p = 0.294) and cardiac death (adjusted HR 0.94, 95% CI 0.51-1.70, p = 0.825) were comparable between the two groups. Similar results as with the early detection were obtained in propensity-matched diabetic and non-diabetic patients. Notably, there was a significant interaction between diabetic or non-diabetic with the therapeutic strategy on MACE (p for interaction = 0.036). CONCLUSIONS: For treatment of CTO, successful CTO-PCI highly reduces the risk of MACE in diabetic patients when compared with medical therapy. However, this does not apply to non-diabetic patients.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Oclusão Coronária/terapia , Diabetes Mellitus Tipo 2/epidemiologia , Intervenção Coronária Percutânea , Idoso , Fármacos Cardiovasculares/efeitos adversos , China/epidemiologia , Doença Crônica , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/mortalidade , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Int J Cardiovasc Imaging ; 36(11): 2107-2113, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32681317

RESUMO

Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12 h after the interventions. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.


Assuntos
Infarto Cerebral/etiologia , Doença da Artéria Coronariana/terapia , Oclusão Coronária/terapia , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Estudos de Casos e Controles , Infarto Cerebral/sangue , Doença Crônica , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 40(7): 919-921, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32701236

RESUMO

de Winter syndrome is a special equivalent of anterior ST-segment elevation myocardial infarction (STEMI) characterized by the absence of overt ST-elevation with upsloping ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often associated with total occlusion of the proximal left anterior descending coronary artery. Herein we present a case of de Winter syndrome in a 63-year-old man, whose initial ECG showed no ST-segment elevation, but subsequent coronary angiography confirmed total occlusion of the proximal LAD coronary artery. The patient was successfully treated via mechanical reperfusion therapy and stenting through percutaneous coronary intervention (PCI). de Winter syndrome is associated with a high mortality often due to insufficient awareness of this condition by clinicians. Immediate reperfusion therapy by PCI is the life-saving treatment for the patients diagnosed with this syndrome, and prompt recognition of the ECG pattern is critical to ensure the timely administration of the therapy.


Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/terapia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica , Stents , Resultado do Tratamento
9.
J Interv Cardiol ; 2020: 7432831, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32547329

RESUMO

Interventional treatment of chronic total occlusions (CTOs) is nowadays counting on a wide span of procedural possibilities, and retrograde approaches are becoming more and more frequent as they warrant high success rates at the cost of a slightly higher incidence of donor vessel damage. Retrograde lesion crossing needs to be followed by procedural conversion to an antegrade approach to dilate and stent the lesion, and new techniques are being proposed to address this issue and achieve a safer recanalization of the vessel. In this context, we propose novel and simple techniques to antegrade guiding catheter engagement by the retrograde wire, enhancing the chances for procedural success.


Assuntos
Cateterismo Cardíaco/métodos , Oclusão Coronária/terapia , Intervenção Coronária Percutânea/métodos , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Humanos , Stents , Resultado do Tratamento
10.
Expert Rev Cardiovasc Ther ; 18(7): 415-426, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32594784

RESUMO

INTRODUCTION: Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI) is now performed with high success rates and acceptable complication rates. AREAS COVERED: We describe recent clinical and technological developments in CTO PCI from 2018 to 2020. EXPERT OPINION: After publication of six randomized controlled trials, improving patient symptoms remains the principal indication for CTO PCI. Although good outcomes can be achieved with CTO PCI at experienced centers, success rates are significantly lower at less experienced centers, despite increased use in CTO crossing algorithms and development of novel and improved equipment and techniques.


Assuntos
Oclusão Coronária/terapia , Intervenção Coronária Percutânea/métodos , Doença Crônica , Angiografia Coronária/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Cardiovasc Diabetol ; 19(1): 59, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393276

RESUMO

BACKGROUND: To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHODS: Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up. RESULTS: Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p = 0.008). At 13.5 ± 4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p = 0.034) and repeat revascularization (15.2% vs 25.5%, p = 0.026) was lower and the increase in LVEF (3.10% vs 1.80%, p = 0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p = 0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155,95% CI 1.290-3.599, p = 0.003) and repeat revascularization (HR 2.326, 95% CI 1.357-3.986, p = 0.002) in non-diabetic patients, but did not enter the model in those with T2DM. CONCLUSIONS: T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.


Assuntos
Circulação Colateral , Circulação Coronária , Oclusão Coronária/terapia , Diabetes Mellitus Tipo 2/fisiopatologia , Intervenção Coronária Percutânea , Idoso , Doença Crônica , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Oclusão Coronária/fisiopatologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Prospectivos , Recuperação de Função Fisiológica , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
13.
Cardiovasc Drugs Ther ; 34(5): 697-706, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32472238

RESUMO

Dual antiplatelet therapy (DAPT) duration in patients undergoing percutaneous coronary intervention (PCI) has long been considered a matter of controversy. Complex-PCI (C-PCI) is considered to be associated with an increased ischemic risk that tends to be greater with progressively higher procedural complexity. Thus, with a view to balance ischemic versus bleeding risks, high complexity of PCI intuitively represents an advocate of prolonged DAPT duration. However, the optimal DAPT strategy in this high ischemic risk subset of patients remains unclear, a fact that is exacerbated by the absence of a universal definition of C-PCI, resulting in a significant between-study heterogeneity. The aim of this review is to highlight the increased risks associated with C-PCI, compare long- versus short-term DAPT regimens regarding safety and efficacy endpoints as well as investigate outcomes in special C-PCI cohorts, such as patients with bifurcation, left main or chronic total occlusion lesions. Furthermore, controversial issues, such as antithrombotic regimens in C-PCI patients with atrial fibrillation, and future perspectives are addressed.


Assuntos
Doença da Artéria Coronariana/terapia , Oclusão Coronária/terapia , Terapia Antiplaquetária Dupla , Fibrinolíticos/administração & dosagem , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/administração & dosagem , Anticoagulantes/administração & dosagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Esquema de Medicação , Terapia Antiplaquetária Dupla/efeitos adversos , Fibrinolíticos/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Inibidores da Agregação de Plaquetas/efeitos adversos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
15.
Expert Rev Cardiovasc Ther ; 18(5): 269-275, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32345070

RESUMO

INTRODUCTION: Angina refractory to medical therapy and providing complete revascularization (after acute coronary syndrome or in patients with ischemic cardiomyopathy) are common indications for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Unfortunately, CTO PCI is associated with higher rates of complications when compared with non-CTO PCI. AREAS COVERED: In this article, we review available studies on risk prediction in CTO PCI and outline strategies to avoid complications. EXPERT OPINION: Identifying patients at increased risk of periprocedural major adverse cardiovascular events (MACE) is of great importance. It enhances the conversations about the risk and benefits of CTO PCI and it allows for shared decision making when deciding to undergo or forego such procedures.


Assuntos
Angina Pectoris/terapia , Oclusão Coronária/terapia , Intervenção Coronária Percutânea/métodos , Doença Crônica , Oclusão Coronária/etiologia , Humanos , Fatores de Risco , Resultado do Tratamento
16.
Circ Cardiovasc Interv ; 13(5): e008900, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32338524

RESUMO

The retrograde approach has increased the success rate of chronic total occlusion percutaneous coronary intervention but has also been associated with a higher risk of complications. The retrograde approach is usually performed in complex lesions, in which the antegrade approach is not feasible or has failed previously. Using a systematic 10-step approach can maximize the likelihood of success and minimize the risks of retrograde chronic total occlusion interventions.


Assuntos
Oclusão Coronária/terapia , Intervenção Coronária Percutânea , Doença Crônica , Circulação Colateral , Circulação Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Fatores de Risco , Resultado do Tratamento
17.
JACC Cardiovasc Interv ; 13(6): 751-761, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32192695

RESUMO

OBJECTIVES: The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO). BACKGROUND: CAO during transcatheter aortic valve replacement (TAVR) is a rare but often fatal complication. METHODS: In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR. RESULTS: To date, 16 centers have contributed 60 cases among 12,800 TAVR procedures (0.5%). Chimney stenting was performed for 2 reasons: 1) due to the development of an established CAO (n = 25 [41.6%]); or 2) due to an impending CAO (n = 35 [58.3%]). The majority of cases (92.9%) had 1 or more classical risk factors for CAO. Upfront coronary protection was performed in 44 patients (73.3%). Procedural and in-hospital mortality occurred in 1 and 2 patients, respectively. Myocardial infarction (52.0% vs. 0.0%; p < 0.01), cardiogenic shock (52.0% vs. 2.9%; p < 0.01), and resuscitation (44.0% vs. 2.9%; p < 0.01) all occurred more frequently in patients with established CAO compared with those with impending CAO. The absence of upfront coronary protection was the sole independent risk factor for the combined endpoint of death, cardiogenic shock, or myocardial infarction. During a median follow-up time of 612 days (interquartile range: 405 to 842 days), 2 cases of stent failure were reported (1 in-stent restenosis, 1 possible late stent thrombosis) after 157 and 374 days. CONCLUSIONS: Chimney stenting appears to be an acceptable bailout technique for CAO, with higher event rates among those with established CAO and among those without upfront coronary protection.


Assuntos
Valva Aórtica/cirurgia , Oclusão Coronária/terapia , Próteses Valvulares Cardíacas , Intervenção Coronária Percutânea/instrumentação , Stents , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Oclusão Coronária/mortalidade , Reestenose Coronária/etiologia , Trombose Coronária/etiologia , Europa (Continente) , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Oriente Médio , América do Norte , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
19.
BMC Cardiovasc Disord ; 20(1): 109, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138662

RESUMO

BACKGROUND: Patients with coronary chronic total occlusion (CTO) require effective antiplatelet therapy after percutaneous coronary intervention (PCI). Ticagrelor has more pronounced platelet inhibition than clopidogrel. However, the most appropriate dose of ticagrelor in East Asian populations remains unclear. METHOD: We compared ticagrelor (180 mg loading dose, 90 mg twice daily thereafter and 120 mg loading dose, 60 mg twice daily thereafter) and clopidogrel (300 mg loading dose, 75 mg daily thereafter) for prevention of cardiovascular events in 525patients with CTO undergoing PCI. RESULTS: The rate of in-hospital major adverse cardiac and cerebral events (MACCE) was not different between the groups. At 1-year follow-up, target vessel revascularization (TVR) in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.047); TVR was significantly decreased in 60 mg ticagrelor compared to standard dose clopidogrel (p = 0.046). At 1-year follow-up, overall MACCE in both ticagrelor groups were significantly lower than that in the clopidogrel group (p = 0.023). Kaplan-Meier analysis showed MACCE-free survival was significantly higher in both ticagrelor groups than in the clopidogrel group (p = 0.024). During hospitalization, minor bleeding was significant increased in the 90 mg ticagrelor group (p = 0.021). At 1-year follow-up, risk of major and minor bleeding were significantly increased in the 90 mg ticagrelor group. CONCLUSION: In East Asian patients with CTO undergoing PCI, 60 mg ticagrelor was as effective as 90 mg, at the same time significantly reduced risk of bleeding.


Assuntos
Clopidogrel/administração & dosagem , Oclusão Coronária/terapia , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/administração & dosagem , Ticagrelor/administração & dosagem , Idoso , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Doença Crônica , Clopidogrel/efeitos adversos , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etnologia , Oclusão Coronária/mortalidade , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Inibidores da Agregação de Plaquetas/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Ticagrelor/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
20.
BMC Cardiovasc Disord ; 20(1): 108, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131738

RESUMO

BACKGROUND: The management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI). METHODS: Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI) at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed. RESULTS: A total of 392 patients (mean age of 63.9 years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n = 69) and no loss (TIMI grade2-3, n = 323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p = 0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p < 0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI. CONCLUSION: Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.


Assuntos
Infarto Miocárdico de Parede Anterior/terapia , Oclusão Coronária/terapia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Infarto Miocárdico de Parede Anterior/mortalidade , Infarto Miocárdico de Parede Anterior/fisiopatologia , Circulação Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Oclusão Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
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