RESUMO
Contrast-induced nephropathy (CIN) is a major cause of morbidity and mortality among patients undergoing angiographic procedures. Limiting contrast dose and administration of intravenous normal saline appear to be the best approaches to reducing CIN, but the timing, dose, and duration of optimal hydration is poorly understood. The REMEDIAL III trial protocol outlines two different targeted hydration regimens (guided either by continuous measurement of urine output or by initial left ventricular end diastolic pressure (LVEDP), and 700 patients at high risk of CIN will be randomized.
Assuntos
Injúria Renal Aguda , Meios de Contraste , Pressão Sanguínea , Hidratação , Humanos , Estudos Prospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Poor outcomes observed in cancer patients who sustain STEMI are due, in part, to advanced age, comorbidities, and underutilization of guidelines-based therapies. Coronary angiography in the cancer patient is more likely to demonstrate MINOCA, but the majority have critical disease and PCI success is similar to noncancer patients. We recommend primary PCI with stenting as the default strategy in STEMI patients with cancer.
Assuntos
Infarto do Miocárdio , Neoplasias , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angioplastia , Angiografia Coronária , Humanos , Resultado do TratamentoAssuntos
Aterectomia Coronária , Doença da Artéria Coronariana , Aterectomia Coronária/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Recidiva , Resultado do TratamentoAssuntos
Diabetes Mellitus , Stents Farmacológicos , Humanos , Itália , Polímeros , Sistema de Registros , Sirolimo , Stents , Resultado do TratamentoRESUMO
OBJECTIVES: The objectives of this study were to evaluate the ability of interventional cardiologists to accurately measure lesion length and select appropriate stents. BACKGROUND: Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis. METHODS: Interventional cardiologists (n = 40) evaluated 25 matched orthogonal angiographic images that were prescored using quantitative coronary angiography (QCA) by a core laboratory. Visual estimates of lesion length and stent length selection were compared to the maximum QCA value. A 2-4 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. Based on optimal stent overlap, accurate lesion lengths were those measured from -1 to +4 mm from the QCA. Likewise, appropriate stent lengths were those that measured between +4 mm to +8 mm from the QCA value. Five images were repeated to assess intrarater variability. RESULTS: Lesion length measurements were short and long for 51.1% (95% CI 47.6-54.6%) and 19.0% (95% CI 16.3-21.9%) of the images, respectively. Stent length selections that were short and long were recorded for 55.0% (95% CI 51.5-58.5%) and 22.8% (95% CI 19.9-25.8%) of the images, respectively. Intrarater variability evaluation indicated that 38.5% (95% CI 31.7-45.6%) of lesion length measurements and 37.5% (95% CI 30.8-44.6%) of stent length selections were >3 mm different between the first and second evaluation of repeated images. CONCLUSIONS: Visual estimation of coronary lesion length has a high degree of variability, which may lead to inappropriate stent selection. Improving the accuracy of lesion length measurement may improve patient outcomes.
Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/instrumentação , Stents , Percepção Visual , Adulto , Idoso , Competência Clínica , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Julgamento , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Reprodutibilidade dos TestesRESUMO
Percutaneous coronary intervention (PCI) decreases ischemic complications of acute coronary syndromes. The benefits of PCI in stable ischemic heart disease (SIHD) depend on its effect on quality of life (QoL), including angina, physical activity, and emotional well-being. PCI decreases angina and the need for anti-anginal medications, and increases exercise capacity and QoL, compared with baseline status and compared with medical therapy without PCI. These benefits are greater when QOL is markedly impaired by severe angina before the procedure. When considering treatment options for symptomatic SIHD, physicians should consider and provide objective data regarding QoL effects for each treatment strategy. QoL outcomes should be considered in clinical trials, appropriate use criteria, practice guidelines, and reimbursement policies for PCI.
Assuntos
Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea/normas , Qualidade de Vida , Angina Pectoris/psicologia , Angina Pectoris/terapia , Fármacos Cardiovasculares/uso terapêutico , Consenso , Ponte de Artéria Coronária , Emoções , Tolerância ao Exercício , Nível de Saúde , Humanos , Saúde Mental , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/psicologia , Seleção de Pacientes , Resultado do TratamentoRESUMO
Following primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction, microvascular perfusion is often impaired secondary to thrombotic embolization. Intracoronary (IC) fibrinolytic administration may reduce thrombotic burden and distal embolization. The ICE-T-TIMI-49 study evaluated the feasibility and safety of low-dose IC tenecteplase (TNK) during PPCI. The study randomized 40 PPCI patients to a volume matched bolus of IC TNK (4 mg) (nâ¯=â¯20) or IC saline placebo (nâ¯=â¯20) before and following PPCI. The primary end point was percent diameter stenosis of the culprit lesion following first bolus. The primary end point did not differ between IC placebo (median 100%, interquartile range [IQR] 83.0,100.0) and IC TNK (median 100% stenosis, IQR 91.0,100.0; pâ¯=â¯0.522). However, the proportion of patients with reduction in thrombus following first bolus tended to be greater with IC TNK (placebo: 12.5% vs IC TNK: 40.0%, pâ¯=â¯0.133). Following PPCI, the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC) was lower (faster) with placebo (16.0 frames [IQR 12.0,24.0] vs 24.0 frames [22.0,32.0], pâ¯=â¯0.045) due to a trend towards greater frequency of hyperemia (cTFC <14), a marker of distal embolization (50.0% vs 8.3%, pâ¯=â¯0.056). There was no difference in TIMI major bleeds and no intracranial hemorrhage. In conclusion, treatment with low-dose IC TNK appears safe and well tolerated during PPCI. Although IC TNK administration did not improve percent stenosis, a trend towards reduced thrombus burden was demonstrated with less hyperemia (a marker of distal embolization). Our findings provide support for a large randomized study.
Assuntos
Fibrinolíticos/administração & dosagem , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tenecteplase/administração & dosagem , Aspirina/administração & dosagem , Clopidogrel/administração & dosagem , Terapia Combinada , Angiografia Coronária , Quimioterapia Combinada , Estudos de Viabilidade , Feminino , Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inibidores da Agregação Plaquetária/administração & dosagemRESUMO
The International Andreas Gruentzig Society is an educational society of physicians and scientists interested in cardiovascular and related fields. Members cooperate in the advancement of knowledge and education through research, publication, study, and teaching in the fields of cardiovascular disease. This summary reflects the proceedings from the recent scientific meeting to assess current clinical problems and propose future directions and possible solutions.