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Reperfusion therapy guidelines

Amrou Sarraj, Navdeep Sangha, Muhammad Shazam Hussain, Dolora Wisco, Nirav Vora, Lucas Elijovich, Nitin Goyal, Michael Abraham, Manoj Mittal, Lei Feng, Abel Wu, Vallabh Janardhan, Suman Nalluri, Albert J Yoo, Megan George, Randall Edgell, Rutvij J Shah, Clark Sitton, Emilio Supsupin, Suhas Bajgur, M Carter Denny, Peng R Chen, Mark Dannenbaum, Sheryl Martin-Schild, Sean I Savitz, Rishi Gupta
Importance: Randomized clinical trials have shown the superiority of endovascular therapy (EVT) compared with best medical management for acute ischemic strokes with large vessel occlusion (LVO) in the anterior circulation. However, of 1287 patients enrolled in 5 trials, 94 with isolated second (M2) segment occlusions were randomized and 51 of these received EVT, thereby limiting evidence for treating isolated M2 segment occlusions as reflected in American Heart Association guidelines...
September 12, 2016: JAMA Neurology
T Viergutz, J Grüttner, T Walter, C Weiss, B Haaff, G Pollach, C Madler, T Luiz
BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians...
September 2016: Der Anaesthesist
Robert W Harrison, DaJuanicia Simon, Amy L Miller, James A de Lemos, Eric D Peterson, Tracy Y Wang
BACKGROUND: Adherence to guideline-based therapy improves patient outcomes after acute myocardial infarction (AMI) and hospital AMI volume is associated with reperfusion care, but the extent hospital AMI volume is associated with overall guideline adherence is unclear. METHODS AND RESULTS: We studied 486 hospitals treating 249,877 AMI patients in ACTION Registry-GWTG from January 1, 2007, to March 31, 2011. Hospital adherence to each American College of Cardiology/American Heart Association performance measure was compared between tertiles defined by hospital AMI volume: low (≤108 cases/y), middle (≥109 and ≤227 cases/y), and high (≥228 cases/y)...
August 2016: American Heart Journal
Anna Sina P Meyer, Sisse R Ostrowski, Jesper Kjaergaard, Pär I Johansson, Christian Hassager
BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery and AMI...
2016: Trials
Derek P Chew, Ian A Scott, Louise Cullen, John K French, Tom G Briffa, Philip A Tideman, Stephen Woodruffe, Alistair Kerr, Maree Branagan, Philip Eg Aylward
INTRODUCTION: The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations that have been graded on both the strength of evidence and the likely absolute benefit versus harm. Additional considerations influencing the delivery of specific therapies and management strategies are presented as practice points...
August 1, 2016: Medical Journal of Australia
Padmaa Venkatason, Yong Z Zubairi, Imran Hafidz, Wan Azman Wan, Ahmad S Zuhdi
BACKGROUND: The administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding. OBJECTIVES: To investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia. DESIGN: Retrospective analysis...
May 2016: Annals of Saudi Medicine
Yacov Shacham, Shafik Khoury, Nir Flint, Arie Steinvil, Ben Sadeh, Yaron Arbel, Yan Topilsky, Gad Keren
BACKGROUND: Acute myocardial infarction and remodeling of the left ventricle is associated with significant changes in systolic and diastolic echocardiographic derived indices. The investigators have tried to determine whether persistence of increased ratio of transmitral flow velocity (E) to early mitral annulus velocity (e'), signifying increased cardiac filling pressure, is associated with left ventricular (LV) remodeling and increased chamber size among patients presenting with ST-segment elevation myocardial infarction, who underwent successful reperfusion with primary percutaneous coronary intervention...
August 2016: Journal of the American Society of Echocardiography
Emily M Bucholz, Neel M Butala, Sharon-Lise T Normand, Yun Wang, Harlan M Krumholz
BACKGROUND: Guideline-based admission therapies for acute myocardial infarction (AMI) significantly improve 30-day survival, but little is known about their association with long-term outcomes. OBJECTIVES: This study evaluated the association of 5 AMI admission therapies (aspirin, beta-blockers, acute reperfusion therapy, door-to-balloon [D2B] time ≤90 min, and time to fibrinolysis ≤30 min) with life expectancy and years of life saved after AMI. METHODS: We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for AMI, with 17 years of follow-up...
May 24, 2016: Journal of the American College of Cardiology
Céline Rousseaux, Pierre Mols, Peter R Sinnaeve, Carl Convens, Philippe Dubois, Pascal Vranckx, Sofie Gevaert, Patrick Coussement, Ahmed Se Ramadan, Christophe Beauloye, Marc Renard, Patrick Evrard, Jean-François Argacha, Herbert De Raedt, Kristien Wouters, Marc J Claeys
OBJECTIVES: Emergency medical services play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates the effect of emergency medical services use on adherence to reperfusion therapy guidelines in Belgian STEMI patients and on in-hospital mortality. METHODS: The mode of admission with against without emergency medical services was associated with baseline risk profile, reperfusion modalities and in-hospital mortality in 5692 consecutive STEMI patients from 2012 to 2014...
September 2016: European Heart Journal. Acute Cardiovascular Care
J Li, X Li, S Hu, Y Yu, X F Yan, L X Jiang
OBJECTIVE: To assess trends in clinical characteristics, treatments, and outcomes for hospitalized patients with ST-segment elevation myocardial infarction(STEMI) in eastern urban China from 2001 to 2011. METHODS: The data were obtained from the China PEACE-retrospective acute myocardial infarction study. Patients admitted to hospital in the eastern urban China for STEMI were selected via two-stage random sampling. The first phase was to identify participating hospitals via a simple random-sampling procedure...
April 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
V V Kuz'kov, E V Fot, A A Smjotkin, K M Lebedinskij, M Yu Kirov
Current guidelines suggest that an early and aggressive fluid therapy is the best rescue approach to restore and preserve cardiac index, organ function and decrease the risk of multiple organ failure in shock of various origin. However, escala- tion of fluid resuscitation is a double-edged sword often associated with reperfusion, glicocalyx injury, capillary leakage, delayed weight gain and heperhydration. The body of evidences demons trates that an excessive fluid load in ICUpatient with global increased permeability syndrome, and, particularly, in ARDS and acute kidney injury can be devastating, particularly when guided with central venous pressure...
November 2015: Anesteziologiia i Reanimatologiia
Maurice Kakou-Guikahue, Roland N'Guetta, Jean-Baptiste Anzouan-Kacou, Euloge Kramoh, Raymond N'Dori, Serigne Abdou Ba, Maboury Diao, Moustapha Sarr, Abdoul Kane, Adama Kane, Findide Damorou, Dadhi Balde, Mamadou Bocary Diarra, Mohamed Djiddou, Gisèle Kimbally-Kaki, Patrice Zabsonre, Ibrahim Ali Toure, Martin Houénassi, Habib Gamra, Bachir Chajai, Benoit Gerardin, Rémy Pillière, Pierre Aubry, Marie-Christine Iliou, Richard Isnard, Pascal Leprince, Yves Cottin, Edmond Bertrand, Yves Juillière, Jean-Jacques Monsuez
BACKGROUND: Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM: To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS: The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities...
June 2016: Archives of Cardiovascular Diseases
G Ciliberti, M Del Pinto, F Notaristefano, G Zingarini, G Ambrosio, C Cavallini
Identification of acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) remains challenging. European guidelines recommend prompt reperfusion therapy in patients with suspected ongoing myocardial ischemia and new or presumably new LBBB, whereas AHA/ACC guidelines state that LBBB should not be considered diagnostic of AMI in isolation. Sgarbossa criteria and their recent modified version with the introduction of ST/S ratio can be helpful in this setting. A clinical-instrumental algorithm to manage suspected AMI in the presence of LBBB has been recently proposed...
July 2016: Journal of Electrocardiology
Jaime Masjuán, José Álvarez-Sabín, Susana Arias-Rivas, Miguel Blanco, Alicia de Felipe, Irene Escudero-Martínez, Blanca Fuentes, Jaime Gállego-Culleré, Francisco Moniche-Álvarez, Lucía Muñoz, Natalia Pérez de la Ossa-Herrero, Patricia Sahuquillo, Estevo Santamarina, Borja Sanz, José I Tembl, Beatriz Zandio
INTRODUCTION: A stroke is a time-dependent medical emergency. Swiftness in its recognition and in the care received by the patients plays a key role in the prognosis. AIMS: To analyse the medical intervention times, to evaluate possible areas where improvements can be made and to examine the allocation of resources in the centres. PATIENTS AND METHODS: The study was based on a prospective register of patients with suspected stroke and stroke code activation treated in eight experienced Spanish stroke units...
April 1, 2016: Revista de Neurologia
Eleanor R Joy, John Kurian, Chris P Gale
AIM: To compare the effectiveness of primary percutaneous coronary intervention (pPCI) and fibrinolytic therapy (FL) for the acute management of ST elevation myocardial infarction (STEMI). METHODS: A review of guidelines and PubMed literature comparing clinical outcomes of patients with STEMI treated with pPCI or FL. RESULTS: Earlier trials reported reduced mortality and reinfarction with pPCI. Recent randomized data suggest similar outcomes for delayed pPCI compared with FL, especially in geographically remote areas...
March 2016: Journal of Comparative Effectiveness Research
Peter R Sinnaeve, Thierry Danays, Kris Bogaerts, Frans Van de Werf, Paul W Armstrong
Elderly patients constitute a large and growing proportion of ST-elevation myocardial infarction (STEMI) patients, yet they have been under-represented or even excluded from reperfusion trials. Despite evidence that fibrinolysis improves outcomes irrespective of age, many elderly STEMI patients still remain undertreated or subject to major delays to primary percutaneous coronary intervention (PCI). The fear of an excessive risk of intracranial hemorrhage (ICH) in these patients can lead to avoidance of potentially life-saving reperfusion treatment, despite the fact that current STEMI guidelines do not exclude the elderly from a pharmaco-invasive strategy...
February 2016: Drugs & Aging
Keun-Sik Hong, Sang-Bae Ko, Kyung-Ho Yu, Cheolkyu Jung, Sukh Que Park, Byung Moon Kim, Chul-Hoon Chang, Hee-Joon Bae, Ji Hoe Heo, Chang Wan Oh, Byung-Chul Lee, Bum-Tae Kim, Bum-Soo Kim, Chin-Sang Chung, Byung-Woo Yoon, Joung-Ho Rha
Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or dead without timely reperfusion. Previously, intravenous tissue plasminogen activator (IV-TPA) within 4.5 hours after stroke onset was the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy, which enables more fast and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of endovascular recanalization therapy (ERT) when added to IV-TPA...
January 2016: Journal of Stroke
Lisa R Leffert, Caitlin R Clancy, Brian T Bateman, Margueritte Cox, Phillip J Schulte, Eric E Smith, Gregg C Fonarow, Elena V Kuklina, Mary G George, Lee H Schwamm
BACKGROUND: Stroke, which is a rare but devastating event during pregnancy, occurs in 34 of every 100,000 deliveries; obstetricians are often the first providers to be contacted by symptomatic patients. At least one-half of pregnancy-related strokes are likely to be of the ischemic stroke subtype. Most pregnant or newly postpartum women with ischemic stroke do not receive acute stroke reperfusion therapy, although this is the recommended treatment for adults. Little is known about these therapies in pregnant or postpartum women because pregnancy has been an exclusion criterion for all reperfusion trials...
June 2016: American Journal of Obstetrics and Gynecology
Constantinos Simillis, Francis P Robertson, Thalia Afxentiou, Brian R Davidson, Kurinchi S Gurusamy
OBJECTIVE: This study sought to compare the perioperative outcomes of interventions aiming to decrease ischemia-reperfusion (IR) injury during elective liver resection. METHOD: A comprehensive literature search was performed to identify randomized controlled trials. A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS following the guidelines of the National Institute for Health and Clinical Excellence Decision Support Unit...
April 2016: Surgery
Sebastian Hafner, François Beloncle, Andreas Koch, Peter Radermacher, Pierre Asfar
This review summarizes the (patho)-physiological effects of ventilation with high FiO2 (0.8-1.0), with a special focus on the most recent clinical evidence on its use for the management of circulatory shock and during medical emergencies. Hyperoxia is a cornerstone of the acute management of circulatory shock, a concept which is based on compelling experimental evidence that compensating the imbalance between O2 supply and requirements (i.e., the oxygen dept) is crucial for survival, at least after trauma. On the other hand, "oxygen toxicity" due to the increased formation of reactive oxygen species limits its use, because it may cause serious deleterious side effects, especially in conditions of ischemia/reperfusion...
December 2015: Annals of Intensive Care
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