Patient preferences prompt a peek at priorities Blankenship, James C.
Catheterization and cardiovascular interventions,
September 1, 2017, 2017-09-01, 2017-09-00, 20170901, Volume:
90, Issue:
3
Journal Article
Peer reviewed
Key Points
Patients rate the downsides of bare metal stents (higher restenosis rates) as being of similar magnitude to the downsides of drug eluting stents (longer dual anti‐platelet therapy).
...Patient preferences regarding choice of bare metal versus drug eluting stents should be elicited before coronary stenting.
This article does not study actual patient preferences for stent type. Future studies should assess how personalized discussions of trade‐offs of stent types affect patient preferences.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
To assess whether the use of the femoral or radial approach for percutaneous coronary intervention (PCI) interacted with the efficacy and safety of cangrelor, an intravenous P2Y12 inhibitor, in ...CHAMPION PHOENIX.
A total of 11 145 patients were randomly assigned in a double-dummy, double-blind manner either to a cangrelor bolus and 2-h infusion or to clopidogrel at the time of PCI. The primary endpoint, a composite of death, myocardial infarction, ischaemia-driven revascularization, or stent thrombosis, and the primary safety endpoint, Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) defined severe bleeding, were evaluated at 48 h. Of the patients undergoing PCI and receiving study drug treatment, a total of 8064 (74%) and 2855 (26%) patients underwent femoral or radial PCI, respectively. Among the femoral cohort, the primary endpoint rate was 4.8% with cangrelor vs. 6.0% with clopidogrel (odds ratio, OR 95% confidence interval, CI = 0.79 0.65-0.96); among the radial cohort, the primary endpoint was 4.4% with cangrelor vs. 5.7% with clopidogrel (OR 95% CI = 0.76 0.54-1.06), P-interaction 0.83. The rate of GUSTO severe bleeding in the femoral cohort was 0.2% with cangrelor vs. 0.1% with clopidogrel (OR 95% CI = 1.73 0.51-5.93). Among the radial cohort, the rate of GUSTO severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR 95% CI = 1.02 0.14-7.28), P-interaction 0.65. The evaluation of safety endpoints with the more sensitive ACUITY-defined bleeding found major bleeding in the femoral cohort to be 5.2% with cangrelor vs. 3.1% with clopidogrel (OR 95% CI = 1.69 1.35-2.12); among the radial cohort the rate of ACUITY major bleeding was 1.5% with cangrelor vs. 0.7% with clopidogrel (OR 95% CI = 2.17 1.02-4.62, P-interaction 0.54).
In CHAMPION PHOENIX, cangrelor reduced ischaemic events with no significant increase in GUSTO-defined severe bleeding. The absolute rates of bleeding, regardless of the definition, tended to be lower when PCI was performed via the radial artery.
http://www.clinicaltrials.gov identifier: NCT01156571.
Coronary thrombus aspiration was developed to remove thrombus, prevent distal embolization, and prepare the vessel for definitive intervention. However, its use is now limited by the risk of stroke. ...We describe a case where appropriate aspiration technique likely prevented central embolization of a coronary thrombus. (Level of Difficulty: Beginner.)
Display omitted
Coronary thrombus aspiration was developed to remove thrombus, prevent distal embolization, and prepare the vessel for definitive intervention. However…
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Slow and Steady May Win This Race Blankenship, James C.
Catheterization and cardiovascular interventions,
August 1, 2017, 2017-08-01, 2017-08-00, 20170801, Volume:
90, Issue:
2
Journal Article
Peer reviewed
Key Points
This retrospective cohort study compares two strategies of stent delivery balloon inflation: inflation for 30 sec and longer as needed to stabilize the balloon pressure for 30 sec at the ...desired pressure, versus conventional fast inflation/fast deflation of the stent balloon
The experimental technique decreased target vessel revascularization by about 50% as assessed by logistic regression and propensity analyses
The investigators’ recommendation to routinely use their prolonged inflation protocol is supported by six other studies over the past decade demonstrating that long stent balloon inflation produces better outcomes than does short inflation
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
BACKGROUND—Myocardial salvage is often suboptimal after percutaneous coronary intervention in ST-segment elevation myocardial infarction. Posthoc subgroup analysis from a previous trial (AMIHOT I) ...suggested that intracoronary delivery of supersaturated oxygen (SSO2) may reduce infarct size in patients with large ST-segment elevation myocardial infarction treated early.
METHODS AND RESULTS—A prospective, multicenter trial was performed in which 301 patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset were randomized to a 90-minute intracoronary SSO2 infusion in the left anterior descending artery infarct territory (n=222) or control (n=79). The primary efficacy measure was infarct size in the intention-to-treat population (powered for superiority), and the primary safety measure was composite major adverse cardiovascular events at 30 days in the intention-to-treat and per-protocol populations (powered for noninferiority), with Bayesian hierarchical modeling used to allow partial pooling of evidence from AMIHOT I. Among 281 randomized patients with tc-99m-sestamibi single-photon emission computed tomography data in AMIHOT II, median (interquartile range) infarct size was 26.5% (8.5%, 44%) with control compared with 20% (6%, 37%) after SSO2. The pooled adjusted infarct size was 25% (7%, 42%) with control compared with 18.5% (3.5%, 34.5%) after SSO2 (PWilcoxon=0.02; Bayesian posterior probability of superiority, 96.9%). The Bayesian pooled 30-day mean (±SE) rates of major adverse cardiovascular events were 5.0±1.4% for control and 5.9±1.4% for SSO2 by intention-to-treat, and 5.1±1.5% for control and 4.7±1.5% for SSO2 by per-protocol analysis (posterior probability of noninferiority, 99.5% and 99.9%, respectively).
CONCLUSIONS—Among patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset, infusion of SSO2 into the left anterior descending artery infarct territory results in a significant reduction in infarct size with noninferior rates of major adverse cardiovascular events at 30 days.
CLINICAL TRIAL REGISTRATION—clinicaltrials.gov IdentifierNCT00175058
The National Cardiovascular Data Registry is a group of registries maintained by the American College of Cardiology Foundation. These registries are used by a diverse constituency to improve the ...quality and outcomes of cardiovascular care, to assess the safety and effectiveness of new therapies, and for research. To achieve these goals, registry data must be complete and reliable. In this article, we review the process of National Cardiovascular Data Registry data collection, assess data completeness and integrity, and report on the current state of the data. Registry data are complete. Accuracy is very good but variable, and there is room for improvement. Knowledge of the quality of data is essential to ensuring its appropriate use.
Display omitted
•The National Cardiovascular Data Registry is used by a diverse constituency to improve the quality and outcomes of cardiovascular care, to assess the safety and effectiveness of new therapies, and for research.•Registry data are complete, and accuracy is very good but variable, and there is room for improvement.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives We sought to compare outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with or without previous coronary ...artery bypass grafts (CABG). Background Limited information exists regarding procedural success and clinical outcomes of STEMI patients with CABG undergoing primary PCI. Methods The APEX-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial was a randomized, placebo-controlled trial of pexelizumab in STEMI patients with planned primary PCI: 128 of 5,745 (2.2%) patients had prior CABG. Clinical/procedural characteristics, culprit vessel (infarct-related artery IRA), and 90-day clinical outcomes were compared. Results Patients with previous CABG were more frequently men, older, had a higher incidence of comorbidities and multivessel disease. In patients with versus without prior CABG, PCI was performed less frequently, that is, 78.9% versus 93.9%; of those with prior CABG receiving PCI, Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was also restored less often, that is, 82.5% versus 91.6% (both p < 0.001). In prior CABG, there was a nearly even designation of the IRA as a bypass graft (n = 63) versus a native vessel (n = 55): IRA post-PCI TIMI flow grade 3 was achieved in 66.7% versus 88.0%, respectively (p = 0.043). Prior CABG patients had increased 90-day death and composite 90-day death/congestive heart failure/shock. Excess death remained significant after multivariable adjustment (hazard ratio: 1.9, 95% confidence interval: 1.08 to 3.33, p = 0.025). When prior CABG patients were stratified by the type of IRA, there was further discrimination of the increased 90-day death, that is, 19% bypass graft (n = 63) versus 5.7% native vessel (n = 55, p = 0.05), respectively. Conclusions Prior CABG patients with STEMI are less likely to undergo acute reperfusion, have worse angiographic outcomes following primary PCI, and higher 90-day mortality. These findings are especially applicable when the IRA was a bypass graft.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
General Considerations...e70 Risk Assessment Using Clinical Parameters...e71 Advanced Testing: Resting and Stress Noninvasive Testing...e72 Resting Imaging to Assess Cardiac Structure and Function: ...Recommendations...e72 Stress Testing and Advanced Imaging in Patients With Known SIHD Who Require Noninvasive Testing for Risk Assessment: Recommendations...e74 Risk Assessment in Patients Able to Exercise...e74 Risk Assessment in Patients Unable to Exercise...e74 Risk Assessment Regardless of Patients' Ability to Exercise...e74 Exercise ECG...e75 Exercise Echocardiography and Exercise Nuclear MPI...e76 Dobutamine Stress Echocardiography and Pharmacological Stress Nuclear MPI...e77 Pharmacological Stress CMR Imaging...e77 Special Patient Group: Risk Assessment in Patients Who Have an Uninterpretable ECG Because of LBBB or Ventricular Pacing...e77 Prognostic Accuracy of Anatomic Testing to Assess Risk in Patients With Known CAD...e78 Coronary CT Angiography...e78 Coronary Angiography...e78 Coronary Angiography as an Initial Testing Strategy to Assess Risk: Recommendations...e78 Coronary Angiography to Assess Risk After Initial Workup With Noninvasive Testing: Recommendations...e78 Treatment...e80 Definition of Successful Treatment...e80 General Approach to Therapy...e82 Factors That Should Not Influence Treatment Decisions...e83 Assessing Patients' Quality of Life...e84 Patient Education: Recommendations...e84 Guideline-Directed Medical Therapy...e86 Risk Factor Modification: Recommendations...e86 Lipid Management...e86 Blood Pressure Management...e88 Diabetes Management...e89 Physical Activity...e91 Weight Management...e92 Smoking Cessation Counseling...e92 Management of Psychological Factors...e93 Alcohol Consumption...e94 Avoiding Exposure to Air Pollution...e94 Additional Medical Therapy to Prevent MI and Death: Recommendations...e95 Antiplatelet Therapy...e95 Beta-Blocker Therapy...e96 Renin-Angiotensin-Aldosterone Blocker Therapy...e97 Influenza Vaccination...e98 Additional Therapy to Reduce Risk of MI and Death...e99 Medical Therapy for Relief of Symptoms...e100 Use of Anti-ischemic Medications: Recommendations...e100 Alternative Therapies for Relief of Symptoms in Patients With Refractory Angina: Recommendations...e104 Enhanced External Counterpulsation...e104 Spinal Cord Stimulation...e105 Acupuncture...e105 CAD Revascularization...e106 Heart Team Approach to Revascularization Decisions: Recommendations...e106 Revascularization to Improve Survival: Recommendations...e108 Revascularization to Improve Symptoms: Recommendations...e109 CABG Versus Contemporaneous Medical Therapy...e109 PCI Versus Medical Therapy...e110 CABG Versus PCI...e110 CABG Versus Balloon Angioplasty or BMS...e110 CABG Versus DES...e111 Left Main CAD...e111 CABG or PCI Versus Medical Therapy for Left Main CAD...e111 Studies Comparing PCI Versus CABG for Left Main CAD...e111 Revascularization Considerations for Left Main CAD...e112 Proximal LAD Artery Disease...e112 Clinical Factors That May Influence the Choice of Revascularization...e113 Completeness of Revascularization...e113 LV Systolic Dysfunction...e113 Previous CABG...e113 Unstable Angina/Non-ST-Elevation Myocardial Infarction...e113 DAPT Compliance and Stent Thrombosis: Recommendation...e113 Transmyocardial Revascularization...e114 Hybrid Coronary Revascularization: Recommendations...e114 Special Considerations...e114 Women...e115 Older Adults...e115 Diabetes Mellitus...e116 Obesity...e117 Chronic Kidney Disease...e118 HIV Infection and SIHD...e118 Autoimmune Disorders...e119 Socioeconomic Factors...e119 Special Occupations...e119 Patient Follow-Up: Monitoring of Symptoms and Antianginal Therapy...e119 Clinical Evaluation, Echocardiography During Routine, Periodic Follow-Up: Recommendations...e120 Follow-Up of Patients With SIHD...e121 Focused Follow-Up Visit: Frequency...e121 Focused Follow-Up Visit: Interval History and Coexisting Conditions...e121 Focused Follow-Up Visit: Physical Examination...e122 Focused Follow-Up Visit: Resting 12-Lead ECG...e122 Focused Follow-Up Visit: Laboratory Examination...e122 Noninvasive Testing in Known SIHD...e122 Follow-Up Noninvasive Testing in Patients With Known SIHD:
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
