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Reperfusion therapy guidelines

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https://www.readbyqxmd.com/read/29424346/emergency-thrombectomy-for-acute-ischaemic-stroke-current-evidence-international-guidelines-and-local-clinical-practice
#1
A Co Tsang, R Wl Yeung, M My Tse, R Lee, W M Lui
Acute ischaemic stroke due to large vessel occlusion leads to grave neurological morbidity and mortality. Conventional intravenous thrombolysis is ineffective in achieving timely reperfusion in this group of patients. The publication of five positive randomised controlled trials of emergency thrombectomy for acute ischaemic stroke in 2015 provided strong evidence to support endovascular reperfusion therapy and represented a paradigm shift in acute stroke management. In this article, we review the current evidence and international guidelines, and report on the findings of a survey study of the clinical practice and opinions of local neurologists, neurosurgeons, and interventional radiologists in emergency thrombectomy...
February 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29384058/inflammation-atrial-fibrillation-and-cardiac-surgery-current-medical-and-invasive-approaches-for-the-treatment-of-atrial-fibrillation
#2
Sahin Iscan, Bortecin Eygi, Yuksel Besir, Ismail Yurekli, Habib Cakir, Levent Yilik, Orhan Gokalp, Ali Gurbuz
Atrial fibrillation (AF) is a cardiac dysrhythmia commonly seen in clinical practice especially after cardiac surgery. It is associated with increased morbidity and mortality for the patients. The pathogenesis of AF is not exactly understood yet, but there is growing data about the relationship between AF and inflammation. Cardiac surgery itself is a big source for inflammation. It causes major surgical trauma, ischemia/reperfusion injury, hypothermia, low arterial pressure, and the equipment of cardiopulmonary bypass makes a large foreign surface thus it activates inflammatory response...
January 31, 2018: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29361856/catheterization-laboratory-activations-and-time-intervals-for-patients-with-pre-hospital-ecgs
#3
Josephine Muhrbeck, Jonas Persson, Claes Hofman-Bang
OBJECTIVE: The use of pre-hospital ECGs (PH-ECG) reduces time to reperfusion for patients with ST-segment elevation myocardial infarction (STEMI). The feasibility of reperfusion therapy within 60 minutes for hospitals with 24/7 PCI capability has been questioned, and current guidelines have set time targets to 90 minutes. Our primary objective was to investigate the proportion of false-positive catheterization laboratory activations by PH-ECG. Our secondary objective was to describe the time intervals from first medical contact to reperfusion and to establish the proportion of patients receiving reperfusion within 60 minutes...
January 23, 2018: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/29329796/the-evolving-face-of-myocardial-reperfusion-in-acute-coronary-syndromes-a-primer-for-the-internist
#4
REVIEW
R Jay Widmer, Peter M Pollak, Malcolm R Bell, Bernard J Gersh, Nandan S Anavekar
Acute coronary syndromes (ACSs) account for a large proportion of disease burden in the United States and worldwide, and our understanding of ACS management continues to evolve. In this review we take a practical approach to evaluating and treating a patient with ACS, focusing on the optimal timing and methods of coronary reperfusion. Beginning with initial assessment and risk stratification, a provider managing the patient with ACS must be able to expeditiously decide on and implement the correct guideline-directed pathway to optimize outcomes...
January 9, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29290368/effect-of-optimal-medical-therapy-at-discharge-in-patients-with-reperfused-st-segment-elevation-myocardial-infarction-on-1-year-mortality-from-the-regional-rescue-registry
#5
Danka Tomasevic, Carlos El Khoury, Fabien Subtil, Pierre-Yves Dubien, Thomas Bochaton, Patrice Serre, Pierre-Yves Gueugniaud, Eric Bonnefoy-Cudraz, Nathan Mewton
Several classes of medication improve survival in patients with ST-segment elevation myocardial infarction (STEMI). We sought to assess the frequency and effect of an optimal therapy upon discharge according to current international guidelines on 1-year all-cause mortality in a prospective cohort of reperfused patients with STEMI. Using data from the French Reseau Cardiologie Urgence (RESCUe) Network, we studied all patients with STEMI admitted and discharged alive from hospital between 2009 and 2013. Class I and II level guidelines were used to define the optimal therapy (OT) group...
November 22, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29262429/blood-pressure-management-for-acute-ischemic-and-hemorrhagic-stroke-the-evidence
#6
Sang-Bae Ko, Byung-Woo Yoon
Hypertension is the most common modifiable risk factor for stroke (both ischemic and hemorrhagic types). In the hyperacute phase, a majority of patients shows an elevated blood pressure (BP) at the time of presentation because of sympathetic hyperactivity or a physiological response to tissue ischemia. Therefore, BP may decrease spontaneously in a few hours and may drop further when complete recanalization is achieved. In stroke guidelines, an elevated BP is usually left untreated up to a systolic BP (SBP) of 220 mm Hg and a diastolic BP of 120 mm Hg...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29229321/the-role-of-aspirin-heparin-and-other-interventions-in-the-prevention-and-treatment-of-fetal-growth-restriction
#7
REVIEW
Katie M Groom, Anna L David
Fetal growth restriction and related placental pathologies such as preeclampsia, stillbirth, and placental abruption are believed to arise in early pregnancy when inadequate remodeling of the maternal spiral arteries leads to persistent high-resistance and low-flow uteroplacental circulation. The consequent placental ischaemia, reperfusion injury, and oxidative stress are associated with an imbalance in angiogenic/antiangiogenic factors. Many interventions have centered on the prevention and/or treatment of preeclampsia with results pertaining to fetal growth restriction and small-for-gestational-age pregnancy often included as secondary outcomes because of the common pathophysiology...
December 8, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29174258/the-design-and-rationale-of-the-primary-angioplasty-registry-of-kerala
#8
Jabir A, Anoop Mathew, Sunitha Viswanathan, Ashraf S M, Placid Sebastian, Prasannakumar C K, George Koshy A, Sunil Pisharody, Rony Mathew, L Jeyasheelan
BACKGROUND: ST-elevation myocardial infarction (STEMI) continues to be a major cause of cardiovascular mortality in Kerala, India. Timely primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy for STEMI. There is limited data on the safety, effectiveness, equity and efficiency of regional primary PCI services in India. METHODS/DESIGN: The primary angioplasty registry of Kerala is a clinician-initiated prospective state-wide longitudinal hospital-based registry of patients undergoing primary PCI for STEMI...
November 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/29120921/pregnancy-and-ischemic-stroke-a-practical-guide-to-management
#9
Mayte E van Alebeek, Roel de Heus, Anil M Tuladhar, Frank-Erik de Leeuw
PURPOSE OF REVIEW: Ischemic stroke during pregnancy or the puerperium is a devastating disease during a crucial period in life and warrants a specific approach. To date, current practice is mainly based on expert opinion because of a lack of randomized controlled trials and high-quality observational studies. The present review is intended as a practical guide to (acute) management of ischemic stroke during pregnancy and puerperium. RECENT FINDINGS: Recent findings showed that the incidence of stroke during pregnancy is rising...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29119223/-acute-myocardial-infarction-in-patients-with-st-segment-elevation-myocardial-infarction-esc-guidelines-2017
#10
REVIEW
H Thiele, S Desch, S de Waha
This article gives an update on the management of acute ST-segment elevation myocardial infarction (STEMI) according to the recently released European Society of Cardiology guidelines 2017 and the modifications are compared to the previous STEMI guidelines from 2012. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy. New guideline recommendations relate to the access site with a clear preference for the radial artery, use of drug-eluting stents over bare metal stents, complete revascularization during the index hospitalization, and avoidance of routine thrombus aspiration...
December 2017: Herz
https://www.readbyqxmd.com/read/29080984/benefit-risk-assessment-of-crataegus-extract-ws%C3%A2-1442-an-evidence-based-review
#11
REVIEW
Christian J F Holubarsch, Wilson S Colucci, Jaan Eha
Preparations from Crataegus (hawthorn) have a long history in the treatment of heart failure. WS 1442 is a dry extract from hawthorn leaves with flowers (4-6.6:1), extraction solvent of ethanol 45% (w/w), adjusted to 17.3-20.1% of oligomeric procyanidins. Nonclinical studies show that WS 1442 has positive inotropic and antiarrhythmic properties and protects the myocardium from ischemic damage, reperfusion injury, and hypertension-related hypertrophy, improves endothelial functions such as NO synthesis, and delays endothelial senescence...
October 28, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29066446/benefit-of-vasodilating-%C3%AE-blockers-in-patients-with-acute-myocardial-infarction-after-percutaneous-coronary-intervention-nationwide-multicenter-cohort-study
#12
Jaehoon Chung, Jung-Kyu Han, Young Jo Kim, Chong Jin Kim, Youngkeun Ahn, Myeong Chan Cho, Shung Chull Chae, In-Ho Chae, Jei Keon Chae, In-Whan Seong, Han-Mo Yang, Kyung-Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, Myung Ho Jeong, Hyo-Soo Kim
BACKGROUND: Although current guidelines recommend β-blocker after acute myocardial infarction (MI), the role of β-blocker has not been well investigated in the modern reperfusion era. In particular, the benefit of vasodilating β-blocker over conventional β-blocker is still unexplored. METHODS AND RESULTS: Using nation-wide multicenter Korean Acute Myocardial Infarction Registry data, we analyzed clinical outcomes of 7127 patients with acute MI who underwent successful percutaneous coronary intervention with stents and took β-blockers: vasodilating β-blocker (n=3482), and conventional β-blocker (n=3645)...
October 24, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28985560/ferroptosis-a-regulated-cell-death-nexus-linking-metabolism-redox-biology-and-disease
#13
REVIEW
Brent R Stockwell, José Pedro Friedmann Angeli, Hülya Bayir, Ashley I Bush, Marcus Conrad, Scott J Dixon, Simone Fulda, Sergio Gascón, Stavroula K Hatzios, Valerian E Kagan, Kay Noel, Xuejun Jiang, Andreas Linkermann, Maureen E Murphy, Michael Overholtzer, Atsushi Oyagi, Gabriela C Pagnussat, Jason Park, Qitao Ran, Craig S Rosenfeld, Konstantin Salnikow, Daolin Tang, Frank M Torti, Suzy V Torti, Shinya Toyokuni, K A Woerpel, Donna D Zhang
Ferroptosis is a form of regulated cell death characterized by the iron-dependent accumulation of lipid hydroperoxides to lethal levels. Emerging evidence suggests that ferroptosis represents an ancient vulnerability caused by the incorporation of polyunsaturated fatty acids into cellular membranes, and cells have developed complex systems that exploit and defend against this vulnerability in different contexts. The sensitivity to ferroptosis is tightly linked to numerous biological processes, including amino acid, iron, and polyunsaturated fatty acid metabolism, and the biosynthesis of glutathione, phospholipids, NADPH, and coenzyme Q 10 ...
October 5, 2017: Cell
https://www.readbyqxmd.com/read/28942971/survival-and-recurrence-after-acute-pulmonary-embolism-treated-with-pulmonary-embolectomy-in-thrombolysis-in-new-york-state-1999-to-2013
#14
Timothy Lee, Shinobu Itagaki, Yuting P Chiang, Natalia N Egorova, David H Adams, Joanna Chikwe
BACKGROUND: Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. METHODS: Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy...
August 31, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28844991/recalibrating-reperfusion-waypoints
#15
EDITORIAL
Paul W Armstrong, Robert C Welsh
No abstract text is available yet for this article.
October 17, 2017: Circulation
https://www.readbyqxmd.com/read/28794118/utilization-characteristics-and-in-hospital-outcomes-of-coronary-artery-bypass-grafting-in-patients-with-st-segment-elevation-myocardial-infarction-results-from-the-national-cardiovascular-data-registry-acute-coronary-treatment-and-intervention-outcomes-network
#16
Yi Pi, Matthew T Roe, DaJuanicia N Holmes, Karen Chiswell, J Lee Garvey, Gregg C Fonarow, James A de Lemos, Kirk N Garratt, Ying Xian
BACKGROUND: There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice. METHODS AND RESULTS: Using data from National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between 2007 and 2014, we analyzed trends in CABG utilization and hospital-level variation in CABG rates...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28749731/transfer-of-patients-in-a-telestroke-network-what-are-the-relevant-factors-for-making-this-decision
#17
Carsten M Klingner, Stefan Brodoehl, Laura Funck, Caroline C Klingner, Jörg Berrouschot, Otto W Witte, Albrecht Günther
Background/Introduction: Current telestroke network consultations are focused on decision-making in the hyperacute stage of stroke management. The two main questions in telestroke consultations are whether thrombolysis should be initiated and whether the patient should be transferred to a hub hospital. Although guidelines exist for initiating intravenous thrombolytic therapy, the question of whether patients should be transferred is far more elusive. MATERIALS AND METHODS: In this study, we investigated the factors involved in the decision to transfer stroke patients to a hub hospital...
July 27, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28706594/disparity-in-st-segment-elevation-myocardial-infarction-practices-and-outcomes-in-arabian-gulf-countries-gulf-coast-registry
#18
Mohammad Zubaid, Wafa Rashed, Alawi A Alsheikh-Ali, Taysir Garadah, Najib Alrawahi, Mustafa Ridha, Mousa Akbar, Fahad Alenezi, Rashed Alhamdan, Wael Almahmeed, Hussam Ouda, Arif Al-Mulla, Fahad Baslaib, Abdulla Shehab, Abdulla Alnuaimi, Haitham Amin
OBJECTIVES: The objective of this study is to describe contemporary management and 1-year outcomes of patients hospitalized with ST-segment elevation myocardial infarction (STEMI) in Arabian Gulf countries. METHODS: Data of patients admitted to 29 hospitals in four Gulf countries [Bahrain, Kuwait, Oman, United Arab Emirates (UAE)] with the diagnosis of STEMI were analyzed from Gulf locals with acute coronary syndrome (ACS) events (Gulf COAST) registry. This was a longitudinal, observational registry of consecutive citizens, admitted with ACS from January 2012 to January 2013...
April 2017: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/28596196/effect-of-retrievable-stent-size-on-endovascular-treatment-of-acute-ischemic-stroke-a-multicenter-study
#19
D Yang, Y Hao, W Zi, H Wang, D Zheng, H Li, M Tu, Y Wan, P Jin, G Xiao, Y Xiong, G Xu, X Liu
BACKGROUND AND PURPOSE: In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS: Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device...
August 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28522232/efficacy-of-new-measures-saving-time-in-acute-stroke-management-a-quantified-analysis
#20
Ana María Iglesias Mohedano, Andrés García Pastor, Fernando Díaz Otero, Pilar Vázquez Alen, Marta Vales Montero, Elisa Luque Buzo, Nuria Redondo Ráfales, Beatriz Chavarria Cano, Yolanda Fernández Bullido, Jose Antonio Villanueva Osorio, Antonio Gil Núñez
BACKGROUND: Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS: Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014...
May 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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