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https://www.readbyqxmd.com/read/28821512/protocol-for-an-economic-evaluation-of-the-randomised-controlled-trial-of-culprit-lesion-only-pci-versus-immediate-multivessel-pci-in-acute-myocardial-infarction-complicated-by-cardiogenic-shock-culprit-shock-trial
#1
Zahidul Quayyum, Andrew Briggs, Jose Robles-Zurita, Keith Oldroyd, Uwe Zeymer, Steffen Desch, Suzanne de Waha, Holger Thiele
INTRODUCTION: Emergency percutaneous coronary intervention (PCI) of the culprit lesion for patients with acute myocardial infarctions is an accepted practice. A majority of patients present with multivessel disease with additional relevant stenoses apart from the culprit lesion. In haemodynamically stable patients, there is increasing evidence from randomised trials to support the practice of immediate complete revascularisation. However, in the presence of cardiogenic shock, the optimal management strategy for additional non-culprit lesions is unknown...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28818317/reconsidering-the-gatekeeper-paradigm-for-percutaneous-coronary-intervention-in-stable-coronary-disease-management
#2
EDITORIAL
Joshua Schulman-Marcus, William S Weintraub, William E Boden
Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes...
July 24, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28804231/preliminary-report-on-the-safety-and-efficacy-of-staged-versus-complete-revascularization-in-patients-with-multivessel-disease-at-the-time-of-primary-percutaneous-coronary-intervention
#3
Marwan Saad, Ahmed Rashed, Wael El-Kilany, Mohamed El-Haddad, Islam Y Elgendy
This study aims to determine the safety and efficacy of complete versus staged-percutaneous coronary intervention (PCI) of nonculprit lesions at the time of primary PCI in patients with multivessel disease. Recent trials had suggested that revascularization of nonculprit lesions at the time of primary PCI is associated with better outcomes, however; the optimum timing and overall safety of this approach is not well known. An observational prospective study was conducted, including 50 patients who presented with ST-segment elevation myocardial infarction and found to have at least an additional nonculprit significant (> 70%) type A or B lesion...
September 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28798016/bayesian-analysis-a-practical-approach-to-interpret-clinical-trials-and-create-clinical-practice-guidelines
#4
John A Bittl, Yulei He
Bayesian analysis is firmly grounded in the science of probability and has been increasingly supplementing or replacing traditional approaches based on P values. In this review, we present gradually more complex examples, along with programming code and data sets, to show how Bayesian analysis takes evidence from randomized clinical trials to update what is already known about specific treatments in cardiovascular medicine. In the example of revascularization choices for diabetic patients who have multivessel coronary artery disease, we combine the results of the FREEDOM trial (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) with prior probability distributions to show how strongly we should believe in the new Class I recommendation ("should be done") for a preference of bypass surgery over percutaneous coronary intervention...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28798015/morbidity-and-mortality-conference-for-percutaneous-coronary-intervention
#5
Jacob A Doll, Robert Overton, Manesh R Patel, Sunil V Rao, Michael H Sketch, J Kevin Harrison, James E Tcheng
BACKGROUND: Morbidity and mortality conference is a common educational and quality improvement activity performed in cardiac catheterization laboratories, but best practices for case selection and for maximizing the effectiveness of peer review have not been determined. METHODS AND RESULTS: We reviewed the 10-year percutaneous coronary intervention morbidity and mortality conference experience of an academic medical center. Cases were triggered for review by the occurrence of prespecified procedural events...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28797425/differential-rates-and-clinical-significance-of-periprocedural-myocardial-infarction-after-stenting-or-bypass-surgery-for%C3%A2-multivessel-coronary-disease-according-to-various-definitions
#6
Min Soo Cho, Jung-Min Ahn, Cheol-Hyun Lee, Do-Yoon Kang, Jung-Bok Lee, Pil Hyung Lee, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Duk-Woo Park, Seung-Jung Park
OBJECTIVES: This study sought to estimate the differential incidence and prognostic significance of periprocedural myocardial infarction (MI) according to various definitions. BACKGROUND: In trials comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the primary composite endpoint is very sensitive to the definition of MI. Especially, the definition of periprocedural MI has considerably varied, and uniform criteria are still unsettled...
August 14, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28797161/masked-inherited-primary-arrhythmia-syndromes-in-sudden-cardiac-death-patients-accompanied-by-coronary-vasospasm
#7
Ki Hong Lee, Hyung Wook Park, Jeong Nam Eun, Jeong Gwan Cho, Nam Sik Yoon, Mi Ran Kim, Yo Han Ku, Hyukjin Park, Seung Hun Lee, Jeong Han Kim, Min Chul Kim, Woo Jin Kim, Hyun Kuk Kim, Jae Yeong Cho, Keun-Ho Park, Doo Sun Sim, Hyun Ju Yoon, Kye Hun Kim, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Jong Chun Park
Background/Aims: Coronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD. Methods: We analyzed 74 consecutive patients (3...
August 11, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28795296/current-trends-in-selection-of-conduits-for-coronary-artery-bypass-grafting
#8
REVIEW
Thierry Carrel, Bernhard Winkler
The procedure of coronary artery bypass grafting continues to be the "gold standard" for patients with multivessel coronary artery disease and left main stenosis due to favourable long-term and consistent outcomes despite the advent of new generations of stents. But the targeted better long-term outcome of surgical revascularization over percutaneous interventions depends on several variables and aspects; one of them is the choice of conduits used to bypass the stenosed arteries. Coronary artery bypass surgery has been studied and debated for decades and the same applies to the selection of grafts...
August 9, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28790165/prognostic-value-of-fractional-flow-reserve-measured-immediately-after-drug-eluting-stent-implantation
#9
Zsolt Piroth, Gabor G Toth, Pim A L Tonino, Emanuele Barbato, Soheila Aghlmandi, Nick Curzen, Gilles Rioufol, Nico H J Pijls, William F Fearon, Peter Jüni, Bernard De Bruyne
BACKGROUND: The predictive value of fractional flow reserve (FFR) measured immediately after percutaneous coronary intervention (PCI) with drug-eluting stent placement has not been prospectively investigated. We investigated the potential of post-PCI FFR measurements to predict clinical outcome in patients from FAME 1 and 2 trials (Fractional Flow Reserve or Angiography for Multivessel Evaluation). METHODS AND RESULTS: All patients of FAME 1 and FAME 2 who had post-PCI FFR measurement were included...
August 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28790123/prognostic-significance-of-nonobstructive-left-main-coronary-artery-disease-in-women-versus-men-long-term-outcomes-from-the-confirm-coronary-ct-angiography-evaluation-for-clinical-outcomes-an-international-multicenter-registry
#10
Joe X Xie, Parham Eshtehardi, Tina Varghese, Abhinav Goyal, Puja K Mehta, William Kang, Jonathon Leipsic, Bríain Ó Hartaigh, C Noel Bairey Merz, Daniel S Berman, Heidi Gransar, Matthew J Budoff, Stephan Achenbach, Tracy Q Callister, Hugo Marques, Ronen Rubinshtein, Mouaz H Al-Mallah, Daniele Andreini, Gianluca Pontone, Filippo Cademartiri, Erica Maffei, Kavitha Chinnaiyan, Gilbert Raff, Martin Hadamitzky, Joerg Hausleiter, Gudrun Feuchtner, Philipp A Kaufmann, Todd C Villines, Benjamin J W Chow, James K Min, Leslee J Shaw
BACKGROUND: Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for adverse events; prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, the prognostic significance of nonobstructive (1%-49% stenosis) LM CAD, including sex-specific differences, has not been previously examined. METHODS AND RESULTS: In the long-term CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) registry, patients underwent elective coronary computed tomographic angiography for suspected CAD and were followed for 5 years...
August 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28781251/the-compare-acute-trial-of-fractional-flow-reserve-guided-multivessel-angioplasty-in-myocardial-infarction
#11
Chee Tang Chin, Philippe L'Allier, Franz-Josef Neumann, Thomas Engstrøm, Peter Jüni, Goran K Olivecrona
No abstract text is available yet for this article.
August 4, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28780028/associations-between-chronic-kidney-disease-and-outcomes-with-use-of-prasugrel-versus-clopidogrel-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention-a-report-from-the-prometheus-study
#12
Usman Baber, Jaya Chandrasekhar, Samantha Sartori, Melissa Aquino, Annapoorna S Kini, Samir Kapadia, William Weintraub, Joseph B Muhlestein, Birgit Vogel, Michela Faggioni, Serdar Farhan, Sandra Weiss, Craig Strauss, Catalin Toma, Anthony DeFranco, Brian A Baker, Stuart Keller, Mark B Effron, Timothy D Henry, Sunil Rao, Stuart Pocock, George Dangas, Roxana Mehran
OBJECTIVES: The study sought to compare clinical outcomes in a contemporary acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) cohort stratified by chronic kidney disease (CKD) status. BACKGROUND: Patients with CKD exhibit high risks for both thrombotic and bleeding events, thus complicating decision making regarding antiplatelet therapy in the setting of ACS. METHODS: The PROMETHEUS study was a multicenter observational study comparing outcomes with prasugrel versus clopidogrel in ACS PCI patients...
July 27, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28770213/positron-emission-tomography-determined-hyperemic-flow-myocardial-flow-reserve-and-flow-gradient-quo-vadis
#13
REVIEW
Thorsten M Leucker, Ines Valenta, Thomas Hellmut Schindler
Positron emission tomography/computed tomography (PET/CT) applied with positron-emitting flow tracers such as (13)N-ammonia and (82)Rubidium enables the quantification of both myocardial perfusion and myocardial blood flow (MBF) in milliliters per gram per minute for coronary artery disease (CAD) detection and characterization. The detection of a regional myocardial perfusion defect during vasomotor stress commonly identifies the culprit lesion or most severe epicardial narrowing, whereas adding regional hyperemic MBFs, myocardial flow reserve (MFR), and/or longitudinal flow decrease may also signify less severe but flow-limiting stenosis in multivessel CAD...
2017: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28762932/-results-of-a-randomized-study-multivessel-stenting-and-staged-revascularization-in-patients-with-st-elevation-myocardial-infarction-using-second-generation-drug-covered-stents
#14
R S Tarasov, V I Ganyukov, A V Protopopov, O L Barbarash, L S Barbarash
Lack of evidence base on the use of 2-nd generation drug covered stents in patients with ST-elevation myocardial infarction (STEMI) with multivessel lesions in coronary vascular bed makes it important to conduct studies of new devices in a framework of multivessel stenting in primary percutaneous coronary intervention (PPCI) and staged revascularization. Controversial data on outcomes of the strategy of multiple revascularization in STEMI might be related to the use of previous generation coronary stents in this category of patients...
March 2017: Kardiologiia
https://www.readbyqxmd.com/read/28762902/-outcomes-of-various-revascularisation-strategies-in-the-elderly-stemi-patients-with-multi-vessel-coronary-pathology
#15
R S Tarasov, A M Kochergina, V I Ganyukov, V V Kashtalap, N A Kochergin, O L Barbarash
AIM: to assess safety and efficacy of single stage complete revascularization by multivessel stenting as primary percutaneous coronary intervention (pPCI) in elderly and middle aged patients with acute ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS: We included in this analysis data on 327 of 1690 STEMI patients who had undergone pPCI from 2009 to 2013. Age of 103 patients was more or equal 65 and of 224 less or equal 64 years. Multivessel stenting (MS) during pPCI was carried out in 26 and 65, while strategy of staged revascularization (SR) was implemented in 77 and 129 individuals among older and younger patients, respectively...
April 2017: Kardiologiia
https://www.readbyqxmd.com/read/28760476/continuous-procedural-full-lung-ventilation-during-minimally-invasive-coronary-bypass-grafting
#16
Stephan Sixt, Hug Aubin, Robert Kalb, Philipp Rellecke, Artur Lichtenberg, Alexander Albert
BACKGROUND: In the past, minimally invasive cardiac surgery (MICS)- coronary artery bypass graft surgery (CABG) alternatives have been introduced that dramatically reduce the invasiveness of standard operative procedures while still showing excellent clinical outcomes. However, in patients with high morbidity, reduced lung function impeding single-lung ventilation is one of the major concerns for MICS-CABG procedures, although those patients might reap the largest benefit from a procedure of reduced invasiveness...
July 28, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28759470/percutaneous-coronary-intervention-strategies-in-patients-with-st-segment-elevation-myocardial-infarction-and-multivessel-coronary-artery-disease
#17
Michael P Thomas, Eric R Bates
PURPOSE OF REVIEW: This review aims to summarize recent reports on percutaneous coronary intervention (PCI) strategies for patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). RECENT FINDINGS: Recent randomized clinical trials and meta-analyses have suggested that patients with STEMI and multivessel CAD may benefit more from multivessel PCI (either multivessel primary PCI or staged PCI before hospital discharge) than culprit vessel-only primary PCI...
July 29, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28754568/quantifying-ischemic-risk-after-percutaneous-coronary-intervention-attributable-to-high-platelet-reactivity-on-clopidogrel-from-the-assessment-of-dual-antiplatelet-therapy-with-drug-eluting-stents-study
#18
Björn Redfors, Ori Ben-Yehuda, Sheng-Hsuan Lin, Ariel Furer, Ajay J Kirtane, Bernhard Witzenbichler, Giora Weisz, Thomas D Stuckey, Akiko Maehara, Philippe Généreux, Gennaro Giustino, Michael J Rinaldi, Franz-Josef Neumann, D Christopher Metzger, Timothy D Henry, David A Cox, Peter L Duffy, Ernest L Mazzaferri, Girma Minalu Ayele, Roxana Mehran, Gary S Mintz, Gregg W Stone
Patients at high risk of thrombotic events after percutaneous coronary intervention (PCI) may potentially benefit from intensified antiplatelet therapy. However, more potent antiplatelet therapy would be expected to only overcome risk that is mediated by high platelet reactivity (PR). We used mediation analysis to determine the contribution of residual PR to the 2-year risk of major adverse cardiac events (MACE; the composite of cardiac death, myocardial infarction, or stent thrombosis) associated with clinical risk factors after PCI with drug-eluting stents (DES) in 8,374 patients from the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents (ADAPT-DES) registry...
June 28, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28750695/cost-effectiveness-of-long-term%C3%A2-ticagrelor-in-patients-with-prior-myocardial-infarction-results-from-the-pegasus-timi-54-trial
#19
Elizabeth A Magnuson, Haiyan Li, Kaijun Wang, Katherine Vilain, Ali Shafiq, Marc P Bonaca, Deepak L Bhatt, Marc Cohen, Philippe Gabriel Steg, Robert F Storey, Eugene Braunwald, Marc S Sabatine, David J Cohen
BACKGROUND: In patients with a myocardial infarction (MI) 1 to 3 years earlier, treatment with ticagrelor + low-dose aspirin (ASA) reduces the risk of cardiovascular (CV) death, MI, or stroke compared with low-dose aspirin alone, but at an increased risk of major bleeding. OBJECTIVES: The authors evaluated cost-effectiveness of ticagrelor + low-dose ASA in patients with prior MI within the prior 3 years. METHODS: The authors performed a prospective economic substudy alongside the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial, which randomized 21,162 patients to ASA alone, ticagrelor 60 mg twice daily + low-dose ASA, or ticagrelor 90 mg twice daily + low-dose ASA...
August 1, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28748523/management-and-prevention-of-saphenous-vein-graft-failure-a-review
#20
REVIEW
Peter McKavanagh, Bobby Yanagawa, George Zawadowski, Asim Cheema
Coronary artery bypass grafting (CABG) remains a vital treatment for patients with multivessel coronary artery disease (CAD), especially diabetics. The long-term benefit of the internal thoracic artery graft is well established and remains the gold standard for revascularization of severe CAD. It is not always possible to achieve complete revascularization through arterial grafts, necessitating the use of saphenous vein grafts (SVG). Unfortunately, SVGs do not have the same longevity, and their failure is associated with significant adverse cardiac outcomes and mortality...
July 26, 2017: Cardiology and Therapy
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