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Isabella Possagnoli, Christian Bianchi, Jason Chiriano, Theodore Teruya, Vicki Bishop, Ahmed Abou-Zamzam
OBJECTIVE: To evaluate the long term outcome of patients presenting with PAD and tissue loss that were stratified in our limb preservation program to receive aggressive wound care without revascularization. METHODS: Veterans presenting with PAD and non-healing wounds were prospectively enrolled into our PAVE (Prevention of Amputation in Veterans Everywhere) program. Patients were stratified according to management strategies, which include: revascularization, primary amputation, palliative limb care and aggressive local wound care without revascularization (conservative group)...
August 18, 2016: Annals of Vascular Surgery
Robert Ward, Joie Dunn, Leonardo Clavijo, David Shavelle, Vincent Rowe, Karen Woo
OBJECTIVES: Patients presenting to a public hospital with critical limb ischemia (CLI) typically have advanced disease with significant co-morbidities. The purpose of this study was to assess the influence of revascularization on one year amputation rate of CLI patients presenting to Los Angeles County USC Medical Center, classified according to the SVS WIfI. METHODS: A retrospective review of patients who presented to a public hospital with CLI from February 2010 to July 2014 was performed...
August 18, 2016: Annals of Vascular Surgery
Wuyang Yang, Xiaoming Rong, Maria Braileanu, Bowen Jiang, Tomas Garzon-Muvdi, Justin M Caplan, Geoffrey P Colby, Alexander L Coon, Rafael J Tamargo, Judy Huang
OBJECTIVE: The safety of carotid revascularization in patients with concomitant extracranial carotid stenosis and cerebral aneurysm is rarely reported. We examine the risk of subarachnoid hemorrhage, aneurysm growth, ipsilateral transient ischemic attack, or stroke after revascularization in patients with both carotid stenosis and cerebral aneurysms. METHODS: A retrospective cohort study of patients with concomitant diagnosis of aneurysm and carotid stenosis evaluated in the neurosurgical department at our institution from 1990 to 2013 was carried out...
September 2016: World Neurosurgery
Yan-Fang Wan, Xiao-Li Ma, Chen Yuan, Ling Fei, Jing Yang, Jun Zhang
Limited data are available with regard to the impact of daily lifestyle choices in patients with coronary heart disease (CHD) who have undergone stent placement. Thus, the aim of the present study was to investigate the impact of daily lifestyle factors in patients with CHD following stent implantation. Between March 2005 and March 2006, 129 consecutive patients with CHD were admitted to Cangzhou Central Hospital at Hebei Medical University (Cangzhou, China). The patients underwent coronary stenting and participated in a 7-year clinical follow-up that analyzed the impact of their daily lifestyle choices on CHD following the stent placement...
September 2015: Experimental and Therapeutic Medicine
Lan Shen, Bimal R Shah, Shuang Li, Laine Thomas, Tracy Y Wang, Karen P Alexander, Eric D Peterson, Ben He, Matthew T Roe
BACKGROUND: Interhospital transfer invasive management patterns and implications for older non-ST-segment elevation myocardial infarction (NSTEMI) patients initially presenting to non-revascularization-capable hospitals have not been explored. HYPOTHESIS: Patients admitted to hospitals with a higher transfer proportion have lower risk of long-term mortality. METHODS: We linked CRUSADE Registry data on 5678 patients age ≥65 years from 65 United States non-revascularization-capable hospitals (2003-2006) with inpatient Medicare longitudinal claims...
December 2015: Clinical Cardiology
Alberto Bouzas-Mosquera, Jesús Peteiro, Francisco J Broullón, Ramón Calviño-Santos, Víctor X Mosquera, Cayetana Barbeito-Caamaño, José María Larrañaga-Moreira, Nicolás Maneiro-Melón, Nemesio Álvarez-García, José Manuel Vázquez-Rodríguez
INTRODUCTION: Scarce data are available on the temporal patterns in clinical characteristics and outcomes of elderly patients referred for exercise stress testing. We aimed to assess the trends in baseline characteristics, tests results, referrals for invasive management, and mortality in these patients. METHODS: We evaluated 11,192 patients aged ≥65years who were referred for exercise stress testing between January 1998 and December 2013. Calendar years were grouped into four quadrennia (1998-2001, 2002-2005, 2006-2009, and 2010-2013), and trends in clinical characteristics of the patients, type and results of the tests, referrals for invasive management, and mortality across the different periods were assessed...
December 2015: European Journal of Internal Medicine
Peter Clemmensen, Matthew T Roe, Judith S Hochman, Derek D Cyr, Megan L Neely, Darren K McGuire, Jan H Cornel, Kurt Huber, Dmitry Zamoryakhin, Harvey D White, Paul W Armstrong, Keith A A Fox, Dorairaj Prabhakaran, Erik Magnus Ohman
BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d...
October 2015: American Heart Journal
Melissa A Daubert, Joseph Massaro, Lawrence Liao, Ashish Pershad, Suresh Mulukutla, Erik Magnus Ohman, Jeffrey Popma, William W O'Neill, Pamela S Douglas
BACKGROUND: Therapies that reverse pathologic left ventricular (LV) remodeling are often associated with improved outcomes. The incidence and impact of reverse LV remodeling after high-risk percutaneous coronary intervention (PCI) are unknown. METHODS: The PROTECT II study was a multicenter trial in patients with complex, multivessel coronary artery disease and reduced ejection fraction (EF) that revealed an increase in visual EF after high-risk PCI. Among patients with quantitative echocardiography (LV volumes and biplane EF), we assessed the extent and predictors of reverse LV remodeling, defined as improved systolic function with an absolute increase in EF ≥5% and correlated these findings with clinical events...
September 2015: American Heart Journal
Felix Fleissner, Hendrick Engelke, Sebastian Rojas-Hernandez, Issam Ismail, Penelope Stiefel, Serghei Cebotari, Axel Haverich, Malakh Shrestha, Andreas Martens
OBJECTIVES: Coronary artery bypass grafting is the gold standard for the treatment of patients with multiple-vessel coronary artery disease. The long-term outcome can be improved using arterial grafts. We analysed the initial series of patients who underwent total arterial revascularization at our institute using left internal thoracic artery (LITA) and radial artery (RA) composite T-grafts and had a follow-up of >10 years. METHODS: We included all patients who received an isolated, non-emergent total arterial revascularization using LITA-RA T-grafts between September 1996 and August 2001 in our institution...
April 2016: European Journal of Cardio-thoracic Surgery
Joo Myung Lee, Ji-Hyun Jung, Kyung Woo Park, Eun-Seok Shin, Seok Kyu Oh, Jang-Whan Bae, Jay Young Rhew, Namho Lee, Dong-Bin Kim, Ung Kim, Jung-Kyu Han, Sang Eun Lee, Han-Mo Yang, Hyun-Jae Kang, Bon-Kwon Koo, Sanghyun Kim, Yun Kyeong Cho, Won-Yong Shin, Young-Hyo Lim, Seung-Woon Rha, Seok-Yeon Kim, Sung Yun Lee, Young-Dae Kim, In-Ho Chae, Kwang Soo Cha, Hyo-Soo Kim
BACKGROUND: Antiplatelet treatment is an important component in optimizing the clinical outcomes after percutaneous coronary intervention (PCI) especially in patients with acute coronary syndrome (ACS). Prasugrel, which is a new P2Y12 inhibitor, has been confirmed as efficacious in a large trial in Western countries, and a similar trial is also to be launched in Asian countries. Although a 60-mg loading dose of prasugrel followed by 10 mg per day should be acceptable, there have been no data regarding the optimal dose in Asian patients...
2015: Trials
Ismail Bolat, Ozgur Akgul, Huseyin Altug Cakmak, Hamdi Pusuroglu, Umut Somuncu, Sinem Ozbey, Vesile Ornek, Mehmet Erturk, Mehmet Gul
BACKGROUND: Mean platelet volume to platelet count (MPV/Plt) ratio has been demonstrated to be a good indicator of long-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). However, the prognostic value of MPV/Plt in ST-elevation myocardial infarction (STEMI) is not reported. AIM: To determine whether the MPV/Plt ratio on admission has any predictive value for major adverse cardiac events including short- and long-term mortality in STEMI...
2016: Kardiologia Polska
Jacek Gacoń, Anna Kabłak-Ziembicka, Ewa Stępień, Francisco J Enguita, Izabela Karch, Bogusław Derlaga, Krzysztof Żmudka, Tadeusz Przewłocki
BACKGROUND: Coronary artery occlusion does not always manifest with ST-elevation, and some patients can have patent coronary vessel. AIM: We evaluated circulating microRNA (miRNA) profiles to discriminate subjects with infarct-related artery (IRA) occlusion. METHODS AND RESULTS: Patients (n = 43) with uncomplicated acute coronary syndrome and positive troponins were classified with respect to patent vs. occluded IRA or ST-elevation vs. non-ST elevation MI (STEMI vs...
2016: Kardiologia Polska
Said Alsidawi, Mohamed Effat, Shahid Rahman, Mouhamad Abdallah, Massoud Leesar
BACKGROUND: The routine use of vascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in guiding percutaneous coronary interventions (PCI) is still controversial especially when using drug-eluting stents. A meta-analysis of trials using bare metal stents was previously published. METHODS: We conducted a meta-analysis of available published trials that compared imaging-guided PCI and angiography-guided PCI in patients undergoing routine PCI only...
December 2015: Cardiovascular Therapeutics
Alexander Weissgerber, Markus Scholz, Andrej Teren, Marcus Sandri, Daniel Teupser, Stephan Gielen, Joachim Thiery, Gerhard Schuler, Frank Beutner
BACKGROUND: Despite the widespread use of noninvasive testing prior to invasive coronary diagnostic the diagnostic yield of elective coronary angiography has been reported low in subjects with suspected obstructive CAD. OBJECTIVE: To determine the predictive value of noncoronary atherosclerosis (NCA) in subjects with suspected stable coronary artery disease (CAD) intended to invasive coronary angiography. METHODS: Ultrasound-based assessment of carotid artery plaque (CAP), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) was performed in 2216 subjects with suspected CAD prior to coronary angiography...
February 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Shu-Chun Huang, May-Kuen Wong, Pyng-Jing Lin, Feng-Chun Tsai, Ming-Shien Wen, Chi-Tai Kuo, Chih-Chin Hsu, Jong-Shyan Wang
Hemodynamic properties affected by the passive leg raise test (PLRT) reflect cardiac pumping efficiency. In the present study, we aimed to further explore whether PLRT predicts exercise intolerance/capacity following coronary revascularization. Following coronary bypass/percutaneous coronary intervention, 120 inpatients underwent a PLRT and a cardiopulmonary exercise test (CPET) 2-12 days during post-surgery hospitalization and 3-5 weeks after hospital discharge. The PLRT included head-up, leg raise, and supine rest postures...
2015: PloS One
Pedro A Lemos, Alexandre A C Abizaid, George C Meireles, Rogério Sarmento-Leite, Mauricio Prudente, Marcelo Cantarelli, Adriano D Dourado, Jose Mariani, Marco A Perin, Costantino Costantini, Ricardo A Costa, José Ribamar Costa, Daniel Chamie, Carlos A Campos, Expedito Ribeiro
AIMS: To evaluate the outcomes of patients treated with a new drug-eluting stent formulation with low doses of sirolimus, built in an ultra-thin-strut platform coated with biodegradable abluminal coating. METHODS: This study is a randomized trial that tested the main hypothesis that the angiographic late lumen loss of the novel sirolimus-eluting stent is noninferior compared with commercially available biolimus-eluting stent. A final study population comprising 170 patients with one or two de novo lesions was randomized in the ratio 2:1 for sirolimus-eluting stent or biolimus-eluting stent, respectively...
December 2015: Cardiovascular Therapeutics
Thomas Engstrøm, Henning Kelbæk, Steffen Helqvist, Dan Eik Høfsten, Lene Kløvgaard, Lene Holmvang, Erik Jørgensen, Frants Pedersen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Jan Ravkilde, Hans-Henrik Tilsted, Anton Boel Villadsen, Jens Aarøe, Svend Eggert Jensen, Bent Raungaard, Lars Køber
BACKGROUND: Patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease have a worse prognosis compared with individuals with single-vessel disease. We aimed to study the clinical outcome of patients with STEMI treated with fractional flow reserve (FFR)-guided complete revascularisation versus treatment of the infarct-related artery only. METHODS: We undertook an open-label, randomised controlled trial at two university hospitals in Denmark...
August 15, 2015: Lancet
Tomoaki Suzuki, Tohru Asai, Takeshi Kinoshita
OBJECTIVES: Diabetes mellitus is a strong risk factor that worsens the clinical outcome of patients undergoing coronary artery bypass grafting (CABG). With the development of the off-pump CABG technique, there is a current trend in revascularization strategies towards in situ all-arterial grafting. We were interested in whether total arterial off-pump CABG could improve the outcome for diabetic patients. METHODS: From January 2002 to December 2013, a total of 1064 patients underwent off-pump CABG at our institution, with total arterial reconstruction carried out in 775 cases...
December 2015: Interactive Cardiovascular and Thoracic Surgery
Stephen Worthley, Randall Hendriks, Matthew Worthley, Alan Whelan, Darren L Walters, Robert Whitbourn, Ian Meredith
BACKGROUND: Several studies investigated the combination of bare metal stents in the main branch and drug-eluting balloons in the side branch in bifurcation lesions, but data on the combination of drug-eluting stents and drug-eluting balloons are scarce. We aim to assess the feasibility of provisional stenting with an everolimus-eluting stent in the main branch and a paclitaxel-eluting balloon in the side branch. METHODS: In this prospective, multi-center study conducted in 5 Australian sites, 35 patients with bifurcation lesions were enrolled...
October 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Elisabetta Moscarella, Attilio Varricchio, Eugenio Stabile, Anna Franzone, Francesco Granata, Antonio Rapacciuolo, Gennaro Galasso, Claudia Capozzolo, Plinio Cirillo, Vittorio Monda, Ida Monterforte, Francesco Borgia, Orlando Piro, Giulio Bonzani, Bruno Trimarco, Giovanni Esposito
BACKGROUND/PURPOSE: Coronary in-stent restenosis (ISR) is a clinical problem for which a satisfactory solution has not been found yet. Bioabsorbable drug eluting vascular scaffolds (BVSs) provide transient vessel scaffolding combined with prolonged drug delivery capability. The aim of this study was to investigate the safety of BVS for the treatment of coronary ISR. METHODS/MATERIALS: Between January 2013 and June 2013, 27 patients (31 lesions), presenting with either stable or unstable angina due to coronary ISR, were enrolled in a single arm, prospective, open label registry...
October 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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