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https://www.readbyqxmd.com/read/28942880/predictors-of-high-killip-class-after-st-segment-elevation-myocardial-infarction-in-the-era-of-primary-reperfusion
#1
Lourdes Vicent, Jesús Velásquez-Rodríguez, María Jesús Valero-Masa, Felipe Díez-Delhoyo, Hugo González-Saldívar, Vanessa Bruña, Carolina Devesa, Miriam Juárez, Iago Sousa-Casasnovas, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND/INTRODUCTION: Outcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥II need a closer monitoring in a specialized cardiac care unit. PURPOSE: We aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI. METHODS: Non-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28919628/coronary-artery-bypass-graft-with-endarterectomy-and-stent-removal-in-patient-with-multivessel-in-stent-restenosis
#2
S S Husain, C M Ahmed, A B Adhikary, S A Sunny, M N Hasan
In the age of stent deployment after balloon angioplasty. In stent restenosis (ISR) has become a major concern. Various coronary interventional measures and coronary artery bypass graft (CABG) has employed to manage the ISR. Although CABG seems to offer advantages over other coronary intervention methods in patients with multi vessel ISR; lack of appropriate graftable vessels often make the surgery difficult and end up with incomplete revascularization. Coronary endarterectomy with stent removal mitigated some of the limitations of CABG but initial results of this surgical measure were not favorable...
July 2017: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/28917022/epidemiology-pathogenesis-and-management-of-takotsubo-syndrome
#3
REVIEW
Shams Y-Hassan, Per Tornvall
Takotsubo syndrome is a recently recognized acute cardiac disease entity with a clinical presentation resembling that of an acute coronary syndrome. The typical takotsubo syndrome patient has a unique circumferential left (bi-) ventricular contraction abnormality profile that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation. The syndrome predominantly affects postmenopausal women and is often preceded by emotional or physical stress. Patients with predisposing factors such as malignancy and other chronic comorbidities are more prone to suffer from takotsubo syndrome...
September 15, 2017: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
https://www.readbyqxmd.com/read/28903139/percutaneous-coronary-intervention-vs-coronary-artery-bypass-grafting-in-patients-with-left-main-coronary-artery-stenosis-a-systematic-review-and-meta-analysis
#4
Daniele Giacoppo, Roisin Colleran, Salvatore Cassese, Antonio H Frangieh, Jens Wiebe, Michael Joner, Heribert Schunkert, Adnan Kastrati, Robert A Byrne
Importance: In patients with left main coronary artery (LMCA) stenosis, coronary artery bypass grafting (CABG) has been the standard therapy for several decades. However, some studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative. Objective: To compare the long-term safety of PCI with drug-eluting stent vs CABG in patients with LMCA stenosis. Data Sources: PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect databases were searched from December 18, 2001, to February 1, 2017...
September 13, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28889210/ketamine-and-midazolam-differently-impact-post-intubation-hemodynamic-profile-when-used-as-induction-agents-during-emergency-airway-management-in-hemodynamically-stable-patients-with-st-elevation-myocardial-infarction
#5
Marco Zuin, Gianluca Rigatelli, Fabio Dell'Avvocata, Giuseppe Faggian, Luca Conte, Sara Giatti, Flavio Michielan, Loris Roncon
We investigated the incidence of post-intubation hypotension (PIH) in hemodynamically stable patients with STEMI requiring rapid sequences intubation (RSI) and medicated with ketamine or midazolam as induction agent. STEMI patients admitted between 1st January 2009 and 1st January 2017 who did not receive any type of inotropic support before the endotracheal intubation (ETI) was reviewed. PIH was defined as a reduction greater than 20% or a drop of systolic blood pressure (SBP) below 90 mmHg within 10 min from the administration of the induction agent [ketamine (1 mg/kg) or midazolam (0...
September 9, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28887316/prognostic-value-of-aortic-stiffness-in-patients-after-st-elevation-myocardial-infarction
#6
Hans-Josef Feistritzer, Gert Klug, Sebastian J Reinstadler, Martin Reindl, Lea Niess, Timo Nalbach, Christian Kremser, Agnes Mayr, Bernhard Metzler
BACKGROUND: High aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST-elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. METHODS AND RESULTS: This prospective observational study included 160 consecutive patients with first acute ST-elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2-4 days) days after infarction using cardiac magnetic resonance imaging...
September 8, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28883734/prognostic-impact-of-blood-pressure-and-heart-rate-at-admission-on-in-hospital-mortality-after-primary-percutaneous-intervention-for-acute-myocardial-infarction-with-st-segment-elevation-in-western-romania
#7
Diana Aurora Bordejevic, Florina Caruntu, Cristian Mornos, Ioan Olariu, Lucian Petrescu, Mirela Cleopatra Tomescu, Ioana Citu, Adelina Mavrea, Sorin Pescariu
BACKGROUND: The purpose of this retrospective study was to evaluate the prognostic impact of systolic blood pressure (SBP) and heart rate (HR) on in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) patients, after primary percutaneous intervention (PCI). PATIENTS AND METHODS: The study included 294 patients admitted for STEMI. They were divided into five groups according to the SBP at admission: group I, <105 mmHg; group II, 105-125 mmHg; group III, 126-140 mmHg; group IV, 141-158 mmHg; and group V, ≥159 mmHg...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28874027/coronary-artery-bypass-surgery-is-superior-to-second-generation-drug-eluting-stents-in-three-vessel-coronary-artery-disease-a-propensity-score-matched-analysis
#8
Hiroshi Tsuneyoshi, Tatsuhiko Komiya, Kazushige Kadota, Takeshi Shimamoto, Jiro Sakai, Toshifumi Hiraoka, Kenji Wada, Hiroyuki Kaneko, Yuka Fujimoto, Yoshimasa Furuichi, Reo Hata, Taiyo Jinno, Osamu Tominaga
OBJECTIVES: Compared with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) appears to be a promising revascularization strategy for multivessel coronary disease. Trials comparing these treatments have not used second-generation drug-eluting stents (2nd DES). We conducted a retrospective evaluation of both treatments using a propensity score-matched analysis (PSMA). METHODS: A total of 537 patients with three-vessel with/without left-main-trunk coronary artery disease underwent CABG (n = 239) or primary PCI using 2nd DES (298) at a single institution...
September 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28851544/pci-versus-cabg-in-patients-with-type%C3%A2-1%C3%A2-diabetes-and-multivessel-disease
#9
Thomas Nyström, Ulrik Sartipy, Stefan Franzén, Björn Eliasson, Soffia Gudbjörnsdottir, Mervete Miftaraj, Bo Lagerqvist, Ann-Marie Svensson, Martin J Holzmann
BACKGROUND: It is unknown if coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) may offer a survival benefit in patients with type 1 diabetes (T1D) in need of multivessel revascularization. OBJECTIVES: This study sought to determine if patients with T1D and multivessel disease may benefit from CABG compared with PCI. METHODS: In an observational cohort study, the authors included all patients with T1D who underwent a first multivessel revascularization in Sweden from 1995 to 2013...
August 23, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28844517/coronary-computed-tomographic-angiography-derived-fractional-flow-reserve-based-on-machine-learning-for-risk-stratification-of-non-culprit-coronary-narrowings-in-patients-with-acute-coronary-syndrome
#10
Taylor M Duguay, Christian Tesche, Rozemarijn Vliegenthart, Carlo N De Cecco, Han Lin, Moritz H Albrecht, Akos Varga-Szemes, Domenico De Santis, Ullrich Ebersberger, Richard R Bayer, Sheldon E Litwin, Ellen Hoffmann, Daniel H Steinberg, U Joseph Schoepf
This study investigated the prognostic value of coronary computed tomography angiography (cCTA)-derived fractional flow reserve (CT-FFR) in patients with acute coronary syndrome (ACS) and multivessel disease to gauge significance and guide management of non-culprit lesions. We retrospectively analyzed data of 48 patients (56 ± 10 years, 60% men) who were admitted for symptoms suggestive of ACS and underwent dual-source cCTA followed by invasive coronary angiography with culprit lesion intervention. Culprit lesions were retrospectively identified on cCTA using images obtained during invasive coronary angiography...
July 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28840487/revascularization-strategies-in-stemi-with-multivessel-disease-deciding-on-culprit-versus-complete-ad-hoc-or-staged
#11
REVIEW
Shalin Patel, Steven R Bailey
PURPOSE OF REVIEW: This review will address the clinical conundrum of those who may derive clinical benefit from complete revascularization of coronary stenosis that are discovered at the time of ST segment elevation myocardial infarction (STEMI). The decision to revascularize additional vessels with angiographic stenosis beyond the culprit lesion remains controversial, as does the timing of revascularization. RECENT FINDINGS: STEMI patients represent a high-risk patient population that have up to a 50% prevalence of multivessel disease...
August 24, 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28840017/complete-versus-culprit-only-revascularization-in-st-elevation-myocardial-infarction-a-perspective-on-recent-trials-and-recommendations
#12
REVIEW
Gabriela Andries, Sahil Khera, Robert J Timmermans, Wilbert S Aronow
The presence of multivessel coronary artery disease (CAD) is strongly associated with higher 30-day mortality, reduced myocardial reperfusion success, reinfarction, and occurrence of major adverse cardiac events (MACE) at 1 year compared with single-vessel CAD. Despite higher morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI) and coexistent multivessel CAD, major guidelines recommended against percutaneous coronary intervention (PCI) on non-culprit lesions at the time of primary PCI in patients with STEMI who are hemodynamically stable...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28838087/quality-of-life-following-coronary-artery-bypass-graft-surgery-vs-percutaneous-coronary-intervention-in-diabetics-with-multivessel-disease-a-five-year-registry-study
#13
Brent M McGrath, Colleen M Norris, Emeleigh Hardwicke-Brown, Robert C Welsh, Kevin R Bainey
Aims: The aim of this study is to investigate the long-term relationship between revascularization technique and health status in diabetics with multivessel disease. Methods and results: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, we captured 1319 diabetics with multivessel disease requiring revascularization for an acute coronary syndrome (January 2009-December 2012) and reported health status using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 3 and 5-years [599 underwent coronary artery bypass grafting (CABG); 720 underwent percutaneous coronary intervention (PCI)]...
July 1, 2017: European Heart Journal. Quality of Care & Clinical Outcomes
https://www.readbyqxmd.com/read/28834794/quality-of-life-after-coronary-artery-bypass-graft-surgery-versus-percutaneous-coronary-intervention-what-do-the-trials-tell-us
#14
Alexander Kulik
PURPOSE OF REVIEW: With an ever-aging population, the treatment of multi-vessel coronary artery disease (CAD) has increasingly become focused not only on mortality, but on symptom relief and improving quality of life (QOL). The purpose of this review is to present a summary on the subject of QOL after percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), highlighting the latest comparative trials in the field. RECENT FINDINGS: About 1 month after revascularization, patients recovering from either PCI or CABG report improvements in angina frequency...
August 22, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28825567/cardiogenic-shock-with-st-segment-elevation-acute-coronary-syndrome-rena-shock-st
#15
Yanina Castillo Costa, Víctor M Mauro, Mauro García Aurelio, Carlos Barrero, Adrián Charask, Juan A Gagliardi
Cardiogenic shock (CS) in the setting of an ST-segment elevation myocardial infarction (STEMI) is a severe complication and constitutes one of the principal causes of death associated with this condition. The aim of this study was to describe the clinical characteristics, treatment strategies and hospital outcome of CS associated with STEMI in Argentina. The Argentine Registry of Cardiogenic Shock (ReNA-Shock) was a prospective and multicenter registry of consecutive patients with CS hospitalized in 64 centers in Argentina between July 2013 and May 2015...
2017: Medicina
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
#16
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
#17
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
#18
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
#19
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
#20
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
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