Coronary angioplasty was first introduced in 1977. From plain old balloon angioplasty to the introduction of bare metal stents in 1986 and dual antiplatelet therapy in 1992 to much more later on. Due ...to the unacceptable rate of stent restenosis, drug eluting stents (DES) were introduced in 2000. The first generation showed an increase in late stent thrombosis which led to the introduction of the second generation DES with biocompatible or biodegradable polymers and thinner platforms. However very late stent thrombosis and late restenosis might still pose problems in the latter. Furthermore, there has been major debate regarding the impact of long-term vessel caging on normal vasomotricity and long-term positive remodeling. To resolve these issues, the bioresorbable vascular scaffolds (BVS) were launched into the real world in 2011, showing promising initial results. Multiple randomized trials, meta-analyses, and registries were performed, mainly with the Absorb Bioresorbable Vascular Scaffold System (Abbott Vascular, Chicago, IL, USA). This new technology is hindered by certain features, such as the BVS radial strength, its strut thickness, and the inflammatory process related to scaffold degradation. Moreover, there is known data indicating higher thrombosis rate with the Absorb BVS compared with the new generation of DES, despite similar cardiovascular death. In this review, we discuss the clinical procedural and technical evidence on BVS, with emphasis on their clinical impact. We finally tackle the future directions on device and procedural improvement while asking: is the bioresorbable technology still the way to the future?
In optimizing anticoagulation therapy, it is essential to balance treatment efficacy with the major adverse effect of anticoagulant treatment, bleeding risk. This narrative review examines the ...efficacy and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban compared with standard anticoagulation or placebo. NOAC therapies provide equivalent to superior protection versus standard therapy, with similar or superior safety, and potential benefits in convenience. We will review the phase III evidence for each of the available NOACs in different antithrombotic indications, including atrial fibrillation (in the absence of significant mitral stenosis or mechanical heart valves); prophylaxis of venous thromboembolism (VTE) in patients undergoing orthopedic surgery; and acute and long-term treatment of VTE. Further, we will illustrate scenarios in which the evidence is stronger for a particular agent in the context of the overall positive safety and efficacy profile of NOACs in general. Limitations of the factor Xa inhibitors include the lack of a specific antidote in case of a bleeding emergency (an approved agent is available for reversing the effect of the direct thrombin inhibitor). We discuss the options for mitigating bleeding and describe the ongoing developments towards specific reversal agents. In conclusion, the available data for efficacy and safety, together with reliable pharmacokinetics obviating the need for regular monitoring, indicate that NOACs may offer substantial benefits for patients with nonvalvular atrial fibrillation or VTE.
Thyroid storm is a life-threatening condition characterized by a high level of circulating thyroid hormones and harbors high mortality and morbidity, even if diagnosed and treated early. The ...condition is frequently overlooked and under-recognized in emergency departments owing to its rarity. Here, we present a case of a 24-year-old male patient, previously healthy, who presented with cardiac arrest and was found to have heart failure and high thyroid hormone levels after investigations. Consequently, the presentation was attributed to thyroid storm. His clinical status and cardiac function improved after treatment of the hyperthyroidism.
Background There is no universally accepted algorithm for identifying atrial fibrillation (AF) patients and stroke risk using electronic data for use in performance measures. Methods Patients with AF ...seen in clinic were identified based on International Classification of Diseases, Ninth Revision (ICD-9) codes. CHADS2 and CHA2 DSs -Vasc scores were derived from a broad, 10-year algorithm using IICD-9 codes dating back 10 years and a restrictive, 1-year algorithm that required a diagnosis within the past year. Accuracy of claims-based AF diagnoses and of each stroke risk classification algorithm were evaluated using chart reviews for 300 patients. These algorithms were applied to assess system-wide anticoagulation rates. Results Between 6/1/2011, and 5/31/2012, we identified 6,397 patients with AF. Chart reviews confirmed AF or atrial flutter in 95.7%. A 1-year algorithm using CHA2 DS2 -Vasc score ≥2 to identify patients at risk for stroke maximized positive predictive value (97.5% negative predictive value 65.1%). The PPV of the 10-year algorithm using CHADS2 was 88.0%; 12% those identified as high-risk had CHADS2 scores <2. Anticoagulation rates were identical using 1-year and 10-year algorithms for patients with CHADS2 scores ≥2 (58.5% on anticoagulation) and CHA2 DS2 -Vasc scores ≥2 (56.0% on anticoagulation). Conclusions Automated methods can be used to identify patients with prevalent AF indicated for anticoagulation but may have misclassification up to 12%, which limits the utility of relying on administrative data alone for quality assessment. Misclassification is minimized by requiring comorbidity diagnoses within the prior year and using a CHA2 DS2-Vasc based algorithm. Despite differences in accuracy between algorithms, system-wide anticoagulation rates assessed were similar regardless of algorithm used.
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Patients with COVID-19 typically present with symptoms and signs related to respiratory ...tract infection. However, a broad spectrum of cardiac manifestations including myocarditis has been reported as complications of this virus. Nevertheless, focal myocarditis as the first clinical manifestation of COVID-19 infection has not been reported before.Thus, we herein present the case of a 56-year-old male patient previously healthy and presented to the emergency department with chest pain. The clinical picture was compatible with inferior ST-elevation myocardial infarction (STEMI). Initial COVID-19 polymerase chain reaction (PCR) was negative, as well for its classic symptoms. Thereafter, further investigations suggested the diagnosis of focal myocarditis. Later on, the patient started to have a fever and repeated COVID-19 PCR that returned positive.
Two patients with history of cardiac ablation presented with massive hemoptysis secondary to pulmonary vein stenosis. They underwent successful pulmonary vein angioplasty and stenting. Although the ...second patient ended up having a lobectomy, the successful opening of the Left Superior Pulmonary Vein helped sparing the superior lobe and lingula.
A low threshold should be kept for pulmonary vein stenosis as considerable etiology of hemoptysis episodes, including the massive ones. Previous cardiac ablation is the key to the diagnosis, even if it was performed several years earlier.
Key Points
Thoracic aortic disease has usually been treated with surgery.
Thoracic endovascular aortic repair is challenging if supra‐aortic vessels are involved.
In situ fenestration of the main ...graft from a retrograde approach while using bare‐metal stents as bridge stents appears to be a safe and practical technique.
Transcatheter aortic valve implantation: Do leaks matter? Shatila, Wassim; Krajcer, Zvonimir
Catheterization and cardiovascular interventions,
April 1, 2020, 2020-Apr-01, 2020-04-00, 20200401, Letnik:
95, Številka:
5
Journal Article
Recenzirano
Key Points
Transcatheter aortic valve implantation (TAVI) has become more prevalent and is now performed in moderate‐ and low‐surgical‐risk patients.
Moderate‐to‐severe postoperative aortic ...regurgitation (AR) confers greater mortality risk and worse cardiovascular outcomes.
Mild postoperative AR confers higher heart failure readmission rates without affecting mortality.
Key Points
Type A aortic dissection has been treated classically with surgical repair.
Endovascular therapy provides an acceptable alternative, especially for high‐surgical‐risk patients.
Dedicated ...systems are needed to help improve outcomes and decrease both short‐ and long‐term complications.
PDF
