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https://www.readbyqxmd.com/read/27923461/impact-of-patient-and-lesion-complexity-on-long-term-outcomes-following-coronary-revascularization-with-new-generation-drug-eluting-stents
#1
Konstantinos C Koskinas, Masanori Taniwaki, Fabio Rigamonti, Dik Heg, Marco Roffi, David Tüller, Olivier Muller, Andre Vuillomenet, Stephane Cook, Daniel Weilenmann, Christopher Kaiser, Peiman Jamshidi, Peter Jüni, Stephan Windecker, Thomas Pilgrim
Long-term clinical outcomes of new-generation drug-eluting stents in complex anatomic and clinical settings are not well defined. This study assessed the impact of patient and lesion complexity on 2-year outcomes after coronary revascularization with ultrathin strut biodegradable-polymer (BP) sirolimus-eluting stents (SES) versus durable-polymer (DP) everolimus-eluting stents (EES). In a prespecified analysis of the BIOSCIENCE randomized trial (NCT01443104), complex patients (911 of 2,119; 43%) were defined by the presence of acute ST-elevation myocardial infarction (MI); left ventricular ejection fraction ≤30%; renal dysfunction; insulin-treated diabetes; treatment of ostial lesion, bypass graft, unprotected left main lesion; or 3-vessel intervention...
November 16, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27891384/bioresorbable-scaffolds-current-evidences-in-the-treatment-of-coronary-artery-disease
#2
REVIEW
Bhargav Dave
Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex Coronary Artery Disease (CAD)...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27878548/contemporary-use-of-arterial-and-venous-conduits-in-coronary-artery-bypass-grafting-anatomical-functional-and-clinical-aspects
#3
REVIEW
G Cuminetti, S Gelsomino, S Curello, R Lorusso, J G Maessen, J C A Hoorntje
Although the benefits of using the left internal mammary artery to bypass the left anterior descending artery (LAD) have been extensively ascertained, freedom from major cardiovascular events and survival after coronary artery bypass grafting (CABG) also correlate with the completeness of revascularisation. Hence, careful selection of the second-best graft conduit is crucial for CABG success. The more widespread use of saphenous vein grafts contrasts with the well-known long-term efficacy of multiple arterial grafting, which struggles to emerge as the procedure of choice due to concerns over increased technical difficulties and higher risk of postoperative complications...
November 22, 2016: Netherlands Heart Journal
https://www.readbyqxmd.com/read/27869561/successful-drug-coated-balloon-angioplasty-and-single-anti-platelet-therapy-to-treat-an-ischaemic-stroke-patient-with-haemorrhage-and-acute-coronary-syndrome
#4
Hee Hwa Ho, Kwang How Mok
A 55-year-old male presented with two challenging problems, i.e. acute coronary syndrome (ACS) and a major bleeding episode. He first presented with ischaemic stroke and was treated with thrombolysis. However this was complicated by haemorrhagic transformation. He subsequently developed ACS with urgent coronary angiography demonstrating a critical stenosis in the proximal left anterior descending artery. Percutaneous coronary intervention (PCI) was deemed necessary but we were mindful of causing bleeding complications from the use of anti-thrombotic therapy...
November 21, 2016: Acute Cardiac Care
https://www.readbyqxmd.com/read/27863695/analysis-of-a-low-dose-protocol-to-reduce-patient-radiation-exposure-during-percutaneous-coronary-interventions
#5
Davide Maccagni, Cosmo Godino, Azeem Latib, Lorenzo Azzalini, Vittorio Pazzanese, Alaide Chieffo, Alberto Margonato, Antonio Colombo
The cardiac catheterization laboratory is an important source of radiation for patients and operators and it is good practice to limit exposure as much as possible. The purpose of this study was to evaluate the effectiveness and impact of a radiological low dose protocol (LDP) in terms of reduction in patient radiation exposure during percutaneous coronary interventions (PCIs). From November 2014 to October 2015, 906 consecutive patients who underwent PCI were evaluated. Of these, 571 patients (63%) were treated with the standard dose protocol (SDP) of 15 frames per second for cine acquisition and standard settings for fluoroscopy, and 335 patients (37%) with the LDP of 7...
October 8, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27862875/cost-awareness-decreases-total-percutaneous-coronary-intervention-procedural-cost-the-shopping-show-how-options-in-price-for-procedures-can-be-influenced-greatly-trial
#6
Elad Asher, John Mansour, Adam Wheeler, Daniel Kendrick, Michael Cunningham, Sahil Parikh, David Zidar, Todd Harford, Daniel I Simon, Vikram S Kashyap
OBJECTIVES: We initiated the SHOPPING Trial (Show How Options in Price for Procedures can be InflueNced Greatly) to see if percutaneous coronary intervention (PCI) procedures can be performed at a lower cost in a single institution. BACKGROUND: Procedural practice variability is associated with inefficiency and increased cost. We hypothesized that announcing costs for all supplies during a catheterization procedure and reporting individual operator cost relative to peers would spur cost reduction without affecting clinical outcomes...
November 10, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27862338/efficacy-and-safety-of-the-guideliner-mother-in-child-guide-catheter-extension-in-percutaneous-coronary-intervention
#7
Divyesh Sharma, Ashish Shah, Mark Osten, Douglas Ing, Alan Barolet, Christopher B Overgaard, Vladimír Džavík, Peter H Seidelin
BACKGROUND: Percutaneous coronary intervention (PCI) procedures are increasingly performed on complex tortuous and heavily calcified coronary lesions. The GuideLiner® catheter (Vascular Solutions, Inc. Minneapolis, MN) is a rapid exchange guide catheter extension system. There is paucity of data about the efficacy of this device in complex PCI. Therefore, we aim to report the indications, success, and efficacy of GuideLiner use in treating complex lesion subset in the present study. METHODS: We collected data from all patients in whom the GuideLiner was used to facilitate PCI between April 1, 2011 and December 31, 2014 at a tertiary referral center in Toronto, Canada...
November 14, 2016: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/27860277/comparison-of-transradial-and-transfemoral-access-in-patients-undergoing-percutaneous-coronary-intervention-for-complex-coronary-lesions
#8
Edward Koifman, Michael A Gaglia, Ricardo O Escarcega, Nelson L Bernardo, Robert A Lager, Robert A Gallino, Itsik Ben-Dor, Augusto D Pichard, Nevin C Baker, Michael J Lipinski, Sarkis Kiramijyan, Smita I Negi, Rebecca Torguson, Jiaxiang Gai, William O Suddath, Lowell F Satler, Ron Waksman
OBJECTIVE: Comparison of transradial versus transfemoral access for complex percutaneous coronary intervention (PCI) with regard to both complications and long-term outcomes. BACKGROUND: Radial access has been shown to confer superior results in patients undergoing PCI, especially in patients with acute coronary syndromes. However, radial access has limitations of sheath and device size, which may increase procedure time and result in inferior outcomes. METHODS: Patients undergoing PCI for complex lesions, defined as type C according the ACC/AHA classification system, were included in this study...
November 10, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27860111/coronary-artery-spatial-distribution-of-chronic-total-occlusions-insights-from-a-large-us-registry
#9
Santiago Garcia, M Chadi Alraies, Aris Karatasakis, Demetris Yannopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Robert W Yeh, Mitul P Patel, John Bahadorani, Judit Karacsonyi, Pratik Kalsaria, Barbara Danek, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVE: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI). BACKGROUND: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery. METHODS: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree...
November 10, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27845507/updates-on-radial-approach-for-percutaneous-coronary-intervention-in-patients-with-chronic-total-occlusion
#10
Lazzaro Paraggio, Francesco Burzotta, Cristina Aurigemma, Carlo Trani
INTRODUCTION: Radial approach is the emerging arterial access for percutaneous coronary interventions (PCIs) in patients with coronary artery disease. EVIDENCE ACQUISITION: Among the different subset of complex targets for PCI, chronic total occlusion (CTO) still represent a challenge for the interventional cardiologist. Is radial approach suitable for PCI on CTO? A series of data collected in selected centres with high volume of transradial procedures supported the change from elective transfemoral approach to systematic transradial approach...
November 15, 2016: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/27843802/coronary-ectasia-in-a-man-on-breast-cancer-therapy-presenting-with-acute-coronary-syndrome
#11
Dana C Johnson, Luay Rifai, Parag V Patel
Limited data exist on the association between breast cancer treatments and coronary artery disease anatomy, particularly in males. We describe an unusual case of diffuse coronary ectasia in a man with breast cancer presenting with acute coronary syndrome (ACS). A 66-year-old man with breast cancer on paclitaxel, tamoxifen, and carboplatin chemotherapy regimen, presents with new onset chest pain. Electrocardiogram reveals anterolateral ST-segment depressions and elevated troponin I level. Emergent angiography revealed grossly ectatic coronary arteries with a total thrombotic occlusion of the mid right coronary artery...
October 2016: Avicenna Journal of Medicine
https://www.readbyqxmd.com/read/27825727/appropriateness-of-myocardial-revascularization-assessed-by-the-syntax-score-ii-in-a-country-without-cardiac-surgery-facilities-proust-study
#12
Bojan M Stanetic, Miodrag Ostojic, Carlos M Campos, Jelena Marinkovic, Vasim Farooq, Tamara Kovacevic-Preradovic, Kurt Huber, Patrick W Serruys
BACKGROUND/OBJECTIVES: The SYNTAX Score II (SSII) was proposed as a novel approach for objective individualized decision-making for optimal myocardial revascularization i.e. percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. We sought to investigate how many lives may be saved by SSII use. METHODS: A total number of 651 consecutive SSII-naive-patients with complex coronary artery disease who were treated with PCI (n=409) or referred to other institutions for CABG (n=242) were included...
November 3, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27825685/pericardiectomy-after-previous-bypass-grafting-analyzing-risk-and-effectiveness-in-this-rare-clinical-entity
#13
Erin A Gillaspie, Joseph A Dearani, Richard C Daly, Kevin L Greason, Lyle D Joyce, Jae Oh, Hartzell V Schaff, John M Stulak
BACKGROUND: Historically the most common causes of pericarditis necessitating pericardiectomy are infection, radiation, idiopathic causes, and inflammation. More recently, there has been a rise in iatrogenic pericardial constriction, with most cases occurring after coronary artery bypass grafting (CABG). To date, there has been no large series evaluating the incidence, presentation, and effectiveness of surgical intervention. We review our 20-year experience managing this special subset of patients...
November 5, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27818146/spanish-cardiac-catheterization-and-coronary-intervention-registry-25th-official-report-of-the-spanish-society-of-cardiology-working-group-on-cardiac-catheterization-and-interventional-cardiology-1990-2015
#14
Pilar Jiménez-Quevedo, Ana Serrador, Armando Pérez de Prado, Manuel Pan
INTRODUCTION AND OBJECTIVES: The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in 2015. METHODS: All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and analyzed mostly by an independent company. RESULTS: In 2015, 106 centers participated in the national register; 73 of these centers are public...
November 3, 2016: Revista Española de Cardiología
https://www.readbyqxmd.com/read/27810964/comparison-between-1-and-2-stent-strategies-in-unprotected-distal-left-main-disease-the-milan-and-new-tokyo-registry
#15
Kensuke Takagi, Toru Naganuma, Alaide Chieffo, Yusuke Fujino, Azeem Latib, Satoko Tahara, Hisaaki Ishiguro, Matteo Montorfano, Mauro Carlino, Hiroyoshi Kawamoto, Naoyuki Kurita, Koji Hozawa, Shotaro Nakamura, Sunao Nakamura, Antonio Colombo
BACKGROUND: There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease. METHODS AND RESULTS: Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days...
November 2016: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27803362/toward-optimal-decision-making-among-vulnerable-patients-referred-for-cardiac-surgery-a-qualitative-analysis-of-patient-and-provider-perspectives
#16
Ryan A Gainer, Janet Curran, Karen J Buth, Jennie G David, Jean-Francois Légaré, Gregory M Hirsch
OBJECTIVES: Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population...
November 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27801655/gender-based-differences-in-outcomes-after-orbital-atherectomy-for-the-treatment-of-de-novo-severely-calcified-coronary-lesions
#17
Michael S Lee, Evan Shlofmitz, Pejman Mansourian, Sanjum Sethi, Richard A Shlofmitz
OBJECTIVES: We evaluated the relationship between gender and angiographic and clinical outcomes in patients with severely calcified lesions who underwent orbital atherectomy. BACKGROUND: Female gender is associated with increased risk of adverse clinical events after percutaneous coronary intervention (PCI). Severe coronary artery calcification increases the complexity of PCI and increases the risk of adverse cardiac events. Orbital atherectomy is effective in plaque modification, which facilitates stent delivery and expansion...
November 2016: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/27799743/the-clinical-outcomes-of-triple-antiplatelet-therapy-versus-dual-antiplatelet-therapy-for-high-risk-patients-after-coronary-stent-implantation-a-meta-analysis-of-11-clinical-trials-and-9-553-patients
#18
Zhong-Guo Fan, Guo-Bin Ding, Xiao-Bo Li, Xiao-Fei Gao, Ya-Li Gao, Nai-Liang Tian
BACKGROUND: The optimal antiplatelet regimen after in-coronary intervention among patients presenting with complex coronary artery lesions or acute coronary syndrome (ACS) has remained unclear. This study sought to evaluate the clinical outcomes of triple antiplatelet treatment (TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients. METHODS: The PubMed, EMBASE, MEDLINE, and other Internet sources were searched for relevant articles. The primary end point was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target vessel revascularization...
2016: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/27797291/everolimus-eluting-stents-or-bypass-surgery-for-left-main-coronary-artery-disease
#19
Gregg W Stone, Joseph F Sabik, Patrick W Serruys, Charles A Simonton, Philippe Généreux, John Puskas, David E Kandzari, Marie-Claude Morice, Nicholas Lembo, W Morris Brown, David P Taggart, Adrian Banning, Béla Merkely, Ferenc Horkay, Piet W Boonstra, Ad J van Boven, Imre Ungi, Gabor Bogáts, Samer Mansour, Nicolas Noiseux, Manel Sabaté, José Pomar, Mark Hickey, Anthony Gershlick, Pawel Buszman, Andrzej Bochenek, Erick Schampaert, Pierre Pagé, Ovidiu Dressler, Ioanna Kosmidou, Roxana Mehran, Stuart J Pocock, A Pieter Kappetein
Background Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. Methods We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients)...
October 31, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27794429/alternative-complement-pathway-activation-during-invasive-coronary-procedures-in-acute-myocardial-infarction-and-stable-angina-pectoris
#20
Zsófia Horváth, Dorottya Csuka, Katarina Vargova, Andrea Kovács, Sarolta Leé, Lilian Varga, István Préda, Emese Tóth Zsámboki, Zoltán Prohászka, Róbert Gábor Kiss
The effect of invasive percutaneous coronary procedures on complement activation has not been elucidated. We enrolled stable angina patients with elective percutaneous coronary intervention (SA-PCI, n=24), diagnostic coronary angiography (CA, n=52) and 23 patients with ST segment elevation myocardial infarction and primary PCI (STEMI-PCI). Complement activation products (C1rC1sC1inh, C3bBbP and SC5b-9) were measured on admission, 6 and 24h after coronary procedures. The alternative pathway product, C3bBbP significantly and reversibly increased 6h after elective PCI (baseline: 7...
December 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
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