RESUMO
[Figure: see text].
Assuntos
Síndrome Coronariana Aguda/enzimologia , Aorta/enzimologia , Aterosclerose/prevenção & controle , Doença da Artéria Coronariana/enzimologia , Colágenos Fibrilares/metabolismo , Metaloproteinase 1 da Matriz/deficiência , Metaloproteinase 1 da Matriz/metabolismo , Monócitos/enzimologia , Síndrome Coronariana Aguda/patologia , Síndrome Coronariana Aguda/terapia , Animais , Aorta/patologia , Aterosclerose/enzimologia , Aterosclerose/genética , Aterosclerose/patologia , Cateterismo Cardíaco/efeitos adversos , Peptídeos Penetradores de Células/uso terapêutico , Células Cultivadas , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/terapia , Modelos Animais de Doenças , Feminino , Fibrose , Humanos , Lipopeptídeos/uso terapêutico , Masculino , Metaloproteinase 1 da Matriz/genética , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , Monócitos/efeitos dos fármacos , Monócitos/patologia , Intervenção Coronária Percutânea/efeitos adversos , Placa Aterosclerótica , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Aim This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. Methods A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Structure Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
Assuntos
Técnicas de Imagem Cardíaca/normas , Cardiologia/normas , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/terapia , Algoritmos , American Heart Association , Consenso , Técnicas de Apoio para a Decisão , Medicina Baseada em Evidências/normas , Humanos , Valor Preditivo dos Testes , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Bleeding complications and acute limb ischemia (ALI) are devastating vascular complications in patients with ST-segment elevation myocardial infarction (STEMI). Cardiogenic shock (CS) can further increase this risk due to multiorgan failure. In the contemporary era, percutaneous mechanical circulatory support is commonly used for management of CS. We hypothesized that vascular complications may be an important determinant of clinical outcomes for CS due to STEMI (CS-STEMI). OBJECTIVE: We evaluated 10-year national trends, resource utilization and outcomes of bleeding complications, and ALI in CS-STEMI. METHODS: We performed a retrospective cohort study of CS-STEMI patients from a large U.S. national database (National Inpatient Sample) between 2005 and 2014. Events were then divided into four different groups: no MCS, with intra-aortic balloon pump, percutaneous ventricular assist device includes Impella or Tandem Heart or extracorporeal membrane oxygenation. RESULTS: Bleeding complications and ALI were observed in 31,389 (18.2%) and 1,628 (0.9%) out of 172,491 admissions with CS-STEMI, respectively. Between 2005 and 2014, overall trends increased for ALI; however, the number of bleeding events decreased. ALI was associated with increased in-hospital mortality in comparison to those without any ALI. However, bleeding complications were not associated with increased in-hospital mortality. Compared to patients without complications, both bleeding and ALI were associated with increased length of stay (LOS) and hospitalization costs. CONCLUSIONS: Bleeding and ALI are common complications associated with CS-STEMI in the contemporary era. Both complications are associated with increased hospital costs and LOS. These findings highlight the need to develop algorithms focused on vascular safety in CS-STEMI.
Assuntos
Coração Auxiliar , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Mortalidade Hospitalar , Humanos , Incidência , Balão Intra-Aórtico/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: The authors sought to evaluate 10-year national trends, incidence and clinical outcomes of stroke in CS-STEMI. BACKGROUND: Stroke is a devastating complication among patients with ST-elevation myocardial infarction (STEMI). Concomitant cardiogenic shock (CS) may further increase the risk of stroke. Use of percutaneous mechanical circulatory support (pMCS) devices may further increase stroke risk in CS-STEMI. No studies have evaluated the risk of stroke in contemporary CS-STEMI. METHODS: We performed a retrospective cohort study of CS-STEMI patients from a large U.S. national database between 2005 and 2014. Previously validated codes for stroke were used to identify events of ischemic or hemorrhagic stroke. They were then divided into different groups: without MCS, with intra-aortic balloon pump, percutaneous ventricular assist device (PVAD, includes Impella or TandemHeart devices), or extracorporeal membrane oxygenation. RESULTS: In 172,491 admissions, stroke was noted in 5,613 (3.2%). Between 2005 and 2014, we observed an increase in the events of overall stroke from 3.1% in 2005 to 5.0% in 2014 (p for the trend <.001). The number of ischemic stroke events (2.4%) was higher than hemorrhagic stroke (0.1%) during the study period. Presence of stroke was associated with higher in-hospital mortality (40.6 vs. 29.8%, 95% CI adjusted odds ratio: 1.57, 1.44-1.67; p < .0001 among stroke vs. without stroke). CONCLUSIONS: The incidence of stroke events in CS-STEMI patients increased between 2005 and 2014, and is associated with higher in-hospital mortality, length of stay, and cost of hospitalization. The incidence of both hemorrhagic and ischemic stroke was higher with pMCS device use. Stroke prevention is a priority for CS-STEMI patients.
Assuntos
Coração Auxiliar , Infarto do Miocárdio com Supradesnível do Segmento ST , Acidente Vascular Cerebral , Coração Auxiliar/efeitos adversos , Mortalidade Hospitalar , Humanos , Incidência , Balão Intra-Aórtico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: Arterial thrombosis leading to ischemic injury worsens the prognosis of many patients with cardiovascular disease. PZ-128 is a first-in-class pepducin that reversibly inhibits PAR1 (protease-activated receptor 1) on platelets and other vascular cells by targeting the intracellular surface of the receptor. The TRIP-PCI (Thrombin Receptor Inhibitory Pepducin in Percutaneous Coronary Intervention) trial was conducted to assess the safety and efficacy of PZ-128 in patients undergoing cardiac catheterization with intent to perform percutaneous coronary intervention. Approach and Results: In this randomized, double-blind, placebo-controlled, phase 2 trial, 100 patients were randomly assigned (2:1) to receive PZ-128 (0.3 or 0.5 mg/kg), or placebo in a 2-hour infusion initiated just before the start of cardiac catheterization, on top of standard oral antiplatelet therapy. Rates of the primary end point of bleeding were not different between the combined PZ-128 doses (1.6%, 1/62) and placebo group (0%, 0/35). The secondary end points of major adverse coronary events at 30 and 90 days did not significantly differ but were numerically lower in the PZ-128 groups (0% and 2% in the PZ-128 groups, 6% and 6% with placebo, p=0.13, p=0.29, respectively). In the subgroup of patients with elevated baseline cardiac troponin I, the exploratory end point of 30-day major adverse coronary events + myocardial injury showed 83% events in the placebo group versus 31% events in the combined PZ-128 drug groups, an adjusted relative risk of 0.14 (95% CI, 0.02-0.75); P=0.02. CONCLUSIONS: In this first-in-patient experience, PZ-128 added to standard antiplatelet therapy appeared to be safe, well tolerated, and potentially reduced periprocedural myonecrosis, thus providing the basis for further clinical trials. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02561000.
Assuntos
Síndrome Coronariana Aguda/terapia , Plaquetas/efeitos dos fármacos , Cateterismo Cardíaco , Peptídeos Penetradores de Células/administração & dosagem , Doença da Artéria Coronariana/terapia , Lipopeptídeos/administração & dosagem , Miocárdio/patologia , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/administração & dosagem , Receptor PAR-1/agonistas , Trombose/prevenção & controle , Síndrome Coronariana Aguda/diagnóstico por imagem , Idoso , Plaquetas/metabolismo , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Peptídeos Penetradores de Células/efeitos adversos , Peptídeos Penetradores de Células/farmacocinética , Doença da Artéria Coronariana/diagnóstico por imagem , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Lipopeptídeos/efeitos adversos , Lipopeptídeos/farmacocinética , Masculino , Pessoa de Meia-Idade , Necrose , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/farmacocinética , Estudo de Prova de Conceito , Estudos Prospectivos , Receptor PAR-1/metabolismo , Recidiva , Stents , Trombose/sangue , Trombose/etiologia , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation or, in some patients, as a bridge to recovery. LVAD withdrawal with ventricular recovery represents the optimal outcome for patients previously implanted with an LVAD. In this E-Challenge, the authors present a case of percutaneous decommissioning of an LVAD, in which TEE provided critical, real-time perioperative evaluation. The authors also review the current perspectives on LVAD decommissioning in terms of patient selection and surgical techniques.
Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , HumanosRESUMO
BACKGROUND: In ST-segment-elevation myocardial infarction (STEMI), infarct size correlates directly with heart failure and mortality. Preclinical testing has shown that, in comparison with reperfusion alone, mechanically unloading the left ventricle (LV) before reperfusion reduces infarct size and that 30 minutes of unloading activates a cardioprotective program that limits reperfusion injury. The DTU-STEMI pilot trial (Door-To-Unload in STEMI Pilot Trial) represents the first exploratory study testing whether LV unloading and delayed reperfusion in patients with STEMI without cardiogenic shock is safe and feasible. METHODS: In a multicenter, prospective, randomized exploratory safety and feasibility trial, we assigned 50 patients with anterior STEMI to LV unloading by using the Impella CP followed by immediate reperfusion (U-IR) versus delayed reperfusion after 30 minutes of unloading (U-DR). The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events at 30 days. Efficacy parameters included the assessment of infarct size by using cardiac magnetic resonance imaging. RESULTS: All patients completed the U-IR (n=25) or U-DR (n=25) protocols with respective mean door-to-balloon times of 72 versus 97 minutes. Major adverse cardiovascular and cerebrovascular event rates were not statistically different between the U-IR versus U-DR groups (8% versus 12%, respectively, P=0.99). In comparison with the U-IR group, delaying reperfusion in the U-DR group did not affect 30-day mean infarct size measured as a percentage of LV mass (15±12% versus 13±11%, U-IR versus U-DR, P=0.53). CONCLUSIONS: We report that LV unloading using the Impella CP device with a 30-minute delay before reperfusion is feasible within a relatively short time period in anterior STEMI. The DTU-STEMI pilot trial did not identify prohibitive safety signals that would preclude proceeding to a larger pivotal study of LV unloading before reperfusion. An appropriately powered pivotal trial comparing LV unloading before reperfusion to the current standard of care is required. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03000270.
Assuntos
Infarto Miocárdico de Parede Anterior/terapia , Coração Auxiliar , Reperfusão Miocárdica/métodos , Implantação de Prótese/instrumentação , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Função Ventricular Esquerda , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Infarto Miocárdico de Parede Anterior/fisiopatologia , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/prevenção & controle , Estudos de Viabilidade , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Projetos Piloto , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
The clinical impact of concurrently administered morphine and P2Y12 inhibitors in primary percutaneous coronary intervention (PCI) is not well understood. Large, randomized clinical trials are required to assess clinical outcomes with concurrent morphine and P2Y12 inhibitor use in ST-segment elevation myocardial infarction patients undergoing PCI. Based on the currently available pharmacologic data, cautious use of morphine in primary PCI would seem prudent.
Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Morfina/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Resultado do TratamentoRESUMO
Alcohol volume is positively correlated with mortality following alcohol septal ablation (ASA). Over time, there has been a trend to use lower volumes of alcohol for ASA. Most cases can and should be performed using 1-2 cc of alcohol. The volume of alcohol utilized during septal ablation should be determined by anatomic and clinical features of the individual patient.
Assuntos
Técnicas de Ablação , Cardiomiopatia Hipertrófica , Etanol , Septos Cardíacos , Humanos , Pacientes , Padrões de Referência , Segurança , Resultado do TratamentoRESUMO
Evaluation of the severity of aortic stenosis in the presence of dynamic left ventricular outflow (LVOT) obstruction is challenging. Invasive hemodynamic assessment with provocative maneuvers can be useful to differentiate of the relative components of obstruction. In patients with both dynamic LVOT obstruction and aortic stenosis, surgical myectomy and concurrent surgical aortic valve replacement is the optimal treatment strategy; combined alcohol septal ablation and transcatheter aortic valve replacement should only be considered for very high surgical risk patients.
Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Obstrução do Fluxo Ventricular Externo/cirurgia , Valva Aórtica , Constrição Patológica , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: The ION Study assessed clinical outcomes for the thin-strut, ION™ (TAXUS Element) Paclitaxel-Eluting Platinum Chromium Coronary Stent System (Boston Scientific, Marlborough, MA) in unselected patients. METHODS: This prospective, open-label registry enrolled the first 1,120 consenting patients treated with the ION stent without clinical or angiographic inclusion criteria at 40 clinical sites. Follow-up was at discharge, 30 days, 180 days, 1 and 2 years. The primary endpoint, the 1-year rate of cardiac death or MI (CD/MI) in PERSEUS-like patients (i.e., patients similar to those enrolled in PERSEUS, the pivotal approval trial), was tested in patients pooled from the ION study (N = 316), the European TAXUS Element post-approval registry (TE-PROVE; N = 306 PERSEUS-like patients), and the PERSEUS WH/SV populations (N = 1,166); and then compared with a prespecified performance goal. Additional outcomes were examined in the overall ION patient population. RESULTS: A total of 1,111 (out of 1,120) enrolled patients received a study stent. Most patients were male (70%) and mean age was 64 years. At 1 year, the primary endpoint of CD/MI occurred in 2.1% (6/292) of PERSEUS-like patients in ION, and 2.3% (40/1,729) of patients in the combined analysis. The upper one-sided 95% confidence interval for the combined analysis was 2.9%, which was significantly less than the performance goal of 7.6% (P < 0.001). Within patients enrolled in the ION study (N = 1,111), the rate of CD/MI was 4.5% at 1 year and 7.5% at 2 years. Definite/probable stent thrombosis occurred in 2.1% of patients at 1 year and 2.5% at 2 years. CONCLUSIONS: The results of the ION Study confirm the mid-term safety and effectiveness of the ION stent for the treatment of coronary artery disease in everyday clinical practice.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Cromo , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Paclitaxel/administração & dosagem , Platina , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Fármacos Cardiovasculares/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Vigilância de Produtos Comercializados , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Acutely decompensated heart failure remains a major clinical problem. Volume overload promotes cardiac and renal dysfunction and is associated with increased morbidity and mortality in heart failure. We hypothesized that transient occlusion of the superior vena cava (SVC) will reduce cardiac filling pressures without reducing cardiac output or systemic blood pressure. The objective of this proof of concept study was to provide initial evidence of safety and feasibility of transient SVC occlusion in patients with acutely decompensated heart failure and reduced ejection fraction. METHODS AND RESULTS: In eight patients with systolic heart failure, SVC occlusion was performed using a commercially available occlusion balloon. Five minutes of SVC occlusion reduced biventricular filling pressures without decreasing systemic blood pressure or total cardiac output. In three of the eight patients, a second 10-minutes occlusion had similar hemodynamic effects. SVC occlusion was well-tolerated without development of new symptoms, new neurologic deficits, or any adverse events including stroke, heart attack, or reported SVC injury or thrombosis at 7 days of follow up. CONCLUSION: We report the first clinical experience with transient SVC occlusion as a potentially new therapeutic approach to rapidly reduce cardiac filling pressures in heart failure. No prohibitive safety signal was identified and further testing to establish the clinical utility of transient SVC occlusion for acute decompensated heart failure is justified.
Assuntos
Oclusão com Balão , Insuficiência Cardíaca/terapia , Veia Cava Superior/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita , Pressão Ventricular , Idoso , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudo de Prova de Conceito , Recuperação de Função Fisiológica , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Dispositivos de Acesso Vascular , Veia Cava Superior/diagnóstico por imagemRESUMO
OBJECTIVE: Protease-activated receptor-1 (PAR1) is classically activated by thrombin and is critical in controlling the balance of hemostasis and thrombosis. More recently, it has been shown that noncanonical activation of PAR1 by matrix metalloprotease-1 (MMP1) contributes to arterial thrombosis. However, the role of PAR1 in long-term development of atherosclerosis is unknown, regardless of the protease agonist. APPROACH AND RESULTS: We found that plasma MMP1 was significantly correlated (R=0.33; P=0.0015) with coronary atherosclerotic burden as determined by angiography in 91 patients with coronary artery disease and acute coronary syndrome undergoing cardiac catheterization or percutaneous coronary intervention. A cell-penetrating PAR1 pepducin, PZ-128, currently being tested as an antithrombotic agent in the acute setting in the TRIP-PCI study (Thrombin Receptor Inhibitory Pepducin-Percutaneous Coronary Intervention), caused a significant decrease in total atherosclerotic burden by 58% to 70% (P<0.05) and reduced plaque macrophage content by 54% (P<0.05) in apolipoprotein E-deficient mice. An MMP1 inhibitor gave similar beneficial effects, in contrast to the thrombin inhibitor bivalirudin that gave no improvement on atherosclerosis end points. Mechanistic studies revealed that inflammatory signaling mediated by MMP1-PAR1 plays a critical role in amplifying tumor necrosis factor α signaling in endothelial cells. CONCLUSIONS: These data suggest that targeting the MMP1-PAR1 system may be effective in tamping down chronic inflammatory signaling in plaques and halting the progression of atherosclerosis.
Assuntos
Doenças da Aorta/enzimologia , Aterosclerose/enzimologia , Doenças das Artérias Carótidas/enzimologia , Doença da Artéria Coronariana/enzimologia , Metaloproteinase 13 da Matriz/metabolismo , Metaloproteinase 1 da Matriz/metabolismo , Receptor PAR-1/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Doenças da Aorta/patologia , Doenças da Aorta/prevenção & controle , Aterosclerose/patologia , Aterosclerose/prevenção & controle , Biomarcadores/sangue , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/prevenção & controle , Linhagem Celular , Peptídeos Penetradores de Células/farmacologia , Ensaios Clínicos Fase II como Assunto , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/patologia , Modelos Animais de Doenças , Progressão da Doença , Feminino , Fibrinolíticos/farmacologia , Células Endoteliais da Veia Umbilical Humana/enzimologia , Humanos , Ácidos Hidroxâmicos/farmacologia , Lipopeptídeos/farmacologia , Masculino , Metaloproteinase 1 da Matriz/sangue , Inibidores de Metaloproteinases de Matriz/farmacologia , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Oligopeptídeos/farmacologia , Placa Aterosclerótica , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptor PAR-1/antagonistas & inibidores , Receptor PAR-1/sangue , Transdução de Sinais , Fator de Necrose Tumoral alfa/sangue , Estados UnidosRESUMO
Stent thrombosis and clinically driven restenosis are rare in the era of newer generation DES. The Synergy bioresorbable polymer DES appears to be comparable to other durable polymer and other bioabsorbable polymer DES in terms of safety and efficacy at 1-year post implantation. Further long-term study is needed to determine the specific role of the Synergy stent and other DES with bioabsorbable polymers.
Assuntos
Implantes Absorvíveis , Stents Farmacológicos , Everolimo/farmacologia , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Angiografia Coronária , Humanos , Imunossupressores/farmacologia , Incidência , Polímeros , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Taxa de Sobrevida/tendências , Suécia/epidemiologiaRESUMO
Procedural cost control will continue to be increasingly important to the bottom line of health care institutions. Reducing cost in PCI need not compromise clinical outcomes. Cost awareness can alter physician behavior, enabling monetary savings.
Assuntos
Intervenção Coronária Percutânea , Médicos , Conscientização , Custos e Análise de CustoRESUMO
The debate regarding the choice of heparin or bivalirudin as the preferred anticoagulant in PCI is still ongoing Nonrandomized registry data are severely limited for comparative analyses and should therefore always be interpreted with caution Clinicians should resist simplistic data interpretations or populist cries relating to cost, but rather focus on valid benefit:risk analyses for their clinical decision making.
Assuntos
Heparina , Intervenção Coronária Percutânea , Anticoagulantes , Hemorragia , Hirudinas , Humanos , Fragmentos de Peptídeos , Proteínas RecombinantesAssuntos
Técnicas de Imagem Cardíaca/normas , Cardiologia/normas , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/terapia , Algoritmos , American Heart Association , Consenso , Técnicas de Apoio para a Decisão , Medicina Baseada em Evidências/normas , Humanos , Valor Preditivo dos Testes , Resultado do Tratamento , Estados UnidosRESUMO
In this retrospective analysis, CHF patients undergoing PCI had a decrease in mortality, bleeding, and transfusion as well as decreased length of stay and hospital cost when bivalirudin was used when compared to heparin. This study suggests bivalirudin may be the preferred anticoagulant for patients with CHF undergoing PCI. Confirmation of these data might entail analysis of patient-level, pooled data from randomized controlled trials comparing bivalirudin to heparin in PCI patients with pre-existing CHF.