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Multivessel coronary artery disease

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https://www.readbyqxmd.com/read/28818317/reconsidering-the-gatekeeper-paradigm-for-percutaneous-coronary-intervention-in-stable-coronary-disease-management
#1
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/28798016/bayesian-analysis-a-practical-approach-to-interpret-clinical-trials-and-create-clinical-practice-guidelines
#2
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/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
#3
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/28795296/current-trends-in-selection-of-conduits-for-coronary-artery-bypass-grafting
#4
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/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
#5
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/28770213/positron-emission-tomography-determined-hyperemic-flow-myocardial-flow-reserve-and-flow-gradient-quo-vadis
#6
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/28759470/percutaneous-coronary-intervention-strategies-in-patients-with-st-segment-elevation-myocardial-infarction-and-multivessel-coronary-artery-disease
#7
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/28748523/management-and-prevention-of-saphenous-vein-graft-failure-a-review
#8
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
https://www.readbyqxmd.com/read/28748154/revascularization-strategies-in-patients-with-st-segment-elevation-myocardial-infarction-and-multivessel-coronary-artery-disease-urgent-or-staged
#9
EDITORIAL
Héctor Cubero-Gallego, Rafael Romaguera, Albert Ariza-Sole, Joan Antoni Gómez-Hospital, Angel Cequier
No abstract text is available yet for this article.
June 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28748153/prognostic-superiority-of-coronary-artery-bypass-grafting-to-percutaneous-coronary-intervention-in-non-diabetic-patients-with-anatomically-complex-multivessel-coronary-artery-disease
#10
EDITORIAL
Kenji Sakata, Takuya Nakahashi, Masa-Aki Kawashiri
No abstract text is available yet for this article.
June 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28748149/the-prognostic-value-of-residual-coronary-stenoses-after-functionally-complete-revascularisation
#11
EDITORIAL
Dennis T L Wong
Fractional flow reserve (FFR) has become the gold standard for functional assessment of coronary artery stenosis. Studies have confirmed the superiority of FFR guided percutaneous coronary intervention (PCI) compared to angiography guided PCI. Due to the high cost of FFR, it is not economically viable for FFR to be incorporated into every routine invasive coronary angiography. As a result, visual estimation of diameter stenosis on invasive coronary angiography still remains the cornerstone for decision making regarding revascularisation treatment for patients...
June 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28747945/the-impact-of-type-2-diabetes-mellitus-on-prognosis-in-patients-with-non-st-elevation-myocardial-infarction
#12
REVIEW
Katarzyna Birkner, Bartosz Hudzik, Mariusz Gąsior
Type 2 diabetes (T2D) is a recognized risk factor for acute coronary syndromes. There is currently no consensus concerning the intensification of antihyperglycemic treatment. According to the available guidelines, it seems that the goal is to achieve glycated hemoglobin (HbA1c) levels below 7% and avoid hypoglycemia. The choice of a revascularization method is influenced by many factors, such as the anatomy of the coronary arteries, severity of atherosclerosis, anatomical location of lesions, and presence of comorbidities...
June 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28728654/comparison-of-stenting-versus-bypass-surgery-according-to-the-completeness-of-revascularization-in-severe-coronary-artery-disease-patient-level-pooled-analysis-of-the-syntax-precombat-and-best-trials
#13
Jung-Min Ahn, Duk-Woo Park, Cheol Whan Lee, Mineok Chang, Rafael Cavalcante, Yohei Sotomi, Yoshinobu Onuma, Erhan Tenekecioglu, Minkyu Han, Pil Hyung Lee, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, Patrick W Serruys, Seung-Jung Park
OBJECTIVES: The aim of this study was to compare long-term survival between patients with severe coronary artery disease undergoing coronary artery bypass grafting (CABG) and those undergoing percutaneous coronary intervention (PCI) achieving complete revascularization (CR) or incomplete revascularization. BACKGROUND: The importance of CR in decision making regarding revascularization strategy in patients with severe coronary artery disease is unknown. METHODS: Data were pooled from the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trials...
July 24, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28723830/early-versus-delayed-coronary-artery-bypass-graft-surgery-for-patients-with-non-st-elevation-myocardial-infarction
#14
Le Dung Ha, Gbolahan Ogunbayo, Ayman Elbadawi, Odunayo Olorunfemi, Adrian Messerli
BACKGROUND: Although coronary artery bypass graft surgery (CABG) has been proven to have mortality and morbidity benefits in patients with non-ST elevation myocardial infarction and multivessel disease, the appropriate timing of this procedure remains unclear. Therefore, we proposed a propensity score-matched analysis comparing the clinical outcomes between patients who underwent CABG within the first 48 h of admission (early CABG) and patients who underwent CABG after 48 h of admission (delayed CABG)...
July 18, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28717115/coronary-artery-disease-and-type-2-diabetes-mellitus
#15
REVIEW
Ryo Naito, Katsumi Miyauchi
Type 2 diabetes mellitus (T2DM) is a major risk factor of coronary artery diseases (CAD). Clinical outcomes in CAD with T2DM are poor despite improvement in medications and intervention devices. Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) in treating diabetic patients with multivessel coronary artery diseases (MVD). However, selecting a revascularization strategy should depend not only on the lesion complexity but also on the patient's background and comorbidities...
August 3, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28706929/diabetes-mellitus-and-multivessel-coronary-artery-disease-an-ongoing-battle-for-an-ideal-treatment-strategy
#16
EDITORIAL
Laura S Kerkmeijer, Serdar Farhan, Roxana Mehran, George D Dangas
No abstract text is available yet for this article.
June 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28703046/multivessel-versus-culprit-lesion-only-percutaneous-coronary-intervention-in-cardiogenic-shock-complicating-acute-myocardial-infarction-a-systematic-review-and-meta-analysis
#17
Suzanne de Waha, Alexander Jobs, Ingo Eitel, Janine Pöss, Thomas Stiermaier, Roza Meyer-Saraei, Georg Fuernau, Uwe Zeymer, Steffen Desch, Holger Thiele
BACKGROUND: Early revascularisation of the culprit lesion is the therapeutic cornerstone in cardiogenic shock complicating acute myocardial infarction. The optimal management of additional non-culprit lesions is unclear. This systematic review and meta-analysis aims to summarise current evidence on the comparison of immediate multivessel percutaneous coronary intervention (MV-PCI) or culprit lesion only PCI with possible staged revascularisation (C-PCI) in patients with cardiogenic shock complicating acute myocardial infarction...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28701632/clinical-features-and-gaps-in-the-management-of-probable-familial-hypercholesterolemia-and-cardiovascular-disease
#18
Barak Zafrir, Ayman Jubran, Gil Lavie, David A Halon, Moshe Y Flugelman, Chen Shapira
BACKGROUND: Familial hypercholesterolemia (FH) is associated with premature atherosclerotic cardiovascular disease (ASCVD). The introduction of potent therapeutic agents underlies the importance of improving clinical diagnosis and treatment gaps in FH.Methods and Results:A regional database of 1,690 adult patients with high-probability FH based on age-dependent peak-low-density lipoprotein cholesterol (LDL-C) cut-offs and exclusion of secondary causes of severe hypercholesterolemia, was examined to explore the clinical manifestations and current needs in the management of ASCVD, which was present in 248 patients (15%), of whom 83% had coronary artery disease (CAD); 19%, stroke; and 13%, peripheral artery disease...
July 12, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28695977/quality-of-life-in-patients-with-coronary-artery-disease-treated-with-coronary-artery-bypass-grafting-and-hybrid-coronary-revascularization
#19
Karolina Gierszewska, Izabela Jaworska, Michał Skrzypek, Mariusz Gąsior, Robert Pudlo
BACKGROUND: Patients with stable coronary artery disease (CAD) have a worse quality of life (QoL) in comparison to patients without stable CAD. Standardized questionnaires are used in evaluation of QoL. Hybrid coronary revascularization (HCR) is a recently-introduced, minimally invasive option for patients requiring revascularization for coronary lesions. The aim of this study was to assess health-related quality of life (HRQoL) in patients with multivessel CAD (MVCAD), according to the mode of revascularization: coronary artery bypass grafting or HCR, using the generic SF-36 v...
July 11, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28695560/minimally-invasive-extracorporeal-circulation-excellent-outcome-and-life-expectancy-after-coronary-artery-bypass-grafting-surgery
#20
Bernhard Winkler, Paul Philipp Heinisch, Grzegorz Zuk, Katarzyna Zuk, Brigitta Gahl, Hans-Jörg Jenni, Alexander Kadner, Christoph Huber, Thierry Carrel
OBJECTIVE: Coronary artery bypass grafting (CABG) remains the gold standard for complex revascularisation in multivessel disease. The concept of the minimally invasive extracorporeal circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional extracorporeal circulation. This study presents early and long-term outcomes after CABG with use of MiECC in a single-centre consecutive patient cohort. METHODS: From 1 January 2005 to 31 December 2010, 2130 patients underwent isolated CABG with MiECC at our centre...
July 11, 2017: Swiss Medical Weekly
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