Abstract Recent randomized controlled trials have suggested that patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease may benefit more from multivessel ...percutaneous coronary intervention (PCI) compared with culprit vessel-only primary PCI. The American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions recently published an updated recommendation on this topic. The purpose of this State-of-the-Art Review is to accurately document existing published reports, describe their limitations, and establish a base for future studies.
More than 1 in 1,000 patients in the U.S. has end-stage renal disease, and most patients who require renal-replacement therapy undergo hemodialysis. By the year 2020, more than 750,000 patients are ...expected to have end-stage renal disease, and over 500,000 will require hemodialysis. The greatest limitation of hemodialysis is the finite durability of hemodialysis accesses, which on average remain patent for <3 years but are the lifeline for hemodialysis patients. Catheter-based interventions are successful in restoring flow in more than 80% of hemodialysis accesses that undergo thrombosis and have replaced surgical revision as the treatment of choice for failing or thrombosed accesses. Catheter-based interventions have improved the quality of life for hemodialysis patients by reducing the need for temporary hemodialysis catheters and have prolonged total survival time by preserving existing access sites and by saving venous segments for future access creation. This review discusses the pathophysiology of dialysis access failure, presents the success rates of catheter-based treatments, and illustrates the interventional approaches for treating failing and thrombosed fistulas and grafts.
An organized and directed approach to a thorough review of evidence has resulted in the production of clinical practice guidelines that assist physicians in selecting the best management strategy for ...an individual patient. ...clinical practice guidelines can provide a foundation for other applications, such as performance measures, appropriate use criteria, and both quality improvement and clinical decision support tools. For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C.\n ACS = acute coronary syndromes AKI = acute kidney injury BMS = bare-metal stent(s) CABG = coronary artery bypass graft surgery CAD = coronary artery disease CKD = chronic kidney disease CTO = chronic total occlusion DAPT = dual antiplatelet therapy DES = drug-eluting stent(s) ECG = electrocardiogram EF = ejection fraction EPD = embolic protection device FDA = U.S. Food and Drug Administration FFR = fractional flow reserve GDMT = guideline-directed medical therapy GI = gastrointestinal GP = glycoprotein IABP = intra-aortic balloon pump IV = intravenous IVUS = intravascular ultrasound LAD = left anterior descending LIMA = left internal mammary artery LV = left ventricular LVEF = left ventricular ejection fraction MACE = major adverse cardiac event MI = myocardial infarction MRI = magnetic resonance imaging NCDR = National Cardiovascular Data Registry PCI = percutaneous coronary intervention PPI = proton pump inhibitor RCT = randomized controlled trial SIHD = stable ischemic heart disease STEMI = ST-elevation myocardial infarction SVG = saphenous vein graft TIMI = Thrombolysis In Myocardial Infarction TMR = transmyocardial laser revascularization UA/NSTEMI = unstable angina/non-ST-elevation myocardial infarction UFH = unfractionated heparin * This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review and determined to be relevant.
Because the ACC/AHA practice guidelines address patient populations (and healthcare providers) residing in North America, drugs that are currently unavailable in North America are discussed in the ...text without a specific COR. For studies performed in large numbers of subjects outside North America, a writing committee reviews the potential impact of different practice patterns and patient populations on the treatment effect and relevance to the ACC/AHA target population to determine whether the findings should inform a specific recommendation.\n Sabik Content Reviewer--ACC Surgeons' Scientific Council Cleveland Clinic--Department Chair, Thoracic and Cardiovascular Surgery Edwards Lifesciences Medtronic None Abbott Laboratoriesdagger Edwards Lifesciencesdagger None Vikas Saini Content Reviewer The Lown Institute--President None None None None Frank W. Sellke Content Reviewer--ACC/AHA Task Force on Practice Guidelines Brown Medical School and Lifespan--Chief of Cardiothoracic Surgery None None The Medicines Company None William S. Weintraub Content Reviewer Christiana Care Health System--Section Chief, Cardiology Bristol-Myers Squibb Daiichi-Sankyo Eli Lilly None None None Christopher J. White Content Reviewer Ochsner Health System--Director, John Ochsner Heart and Vascular Institute None None None St. Jude Medical (DSMB) Sankey V. Williams Content Reviewer--ACP University of Pennsylvania Health System--Professor of General Medicine None None None None Poh Shuan Daniel Yeo Content Reviewer--AIG Tan Tock Seng Hospital, Department of Cardiology--Cardiologist None None None Boston Scientificdagger Merckdagger Schering-Ploughdagger * No reviewer had a relevant ownership, partnership, or principal position to report.
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