Potential explanations may include reduction of STEMI due to physical inactivity, reluctance of patients for seeking medical assistance due to the possibility of SARS-CoV-2 contamination, attribution ...of symptoms to COVID-19 infection, health system failures and diagnostic errors in attending patients with chest pain, delay in diagnosis losing the benefit of early coronary reperfusion, increased use of thrombolysis, and cardiac death before medical attendance. Mean age was not statistically different in both periods (63.4 ± 13.4 before, and 65.1 ± 13.1 during pandemic, p = 0.3769). ...the reduction in the number of patients with STEMI attended in tertiary hospitals only was found in men. ...men have higher treatment-seeking threshold than women, some studies having pointed towards men's sense of stoicism and self-reliance. Because of these reasons, COVID-19 pandemic might have impacted clearly on STEMI treatment only in male patients, and counterbalanced the classical advantage of more typical symptoms in male gender.
The aim of this prospective multinational registry is to assess and identify predictors of in-hospital outcome and complications of contemporary TAVI practice.
The Transcatheter Valve Treatment ...Sentinel Pilot Registry is a prospective independent consecutive collection of individual patient data entered into a web-based case record form (CRF) or transferred from compatible national registries. A total of 4,571 patients underwent TAVI between January 2011 and May 2012 in 137 centres of 10 European countries. Average age was 81.4±7.1 years with equal representation of the two sexes. Logistic EuroSCORE (20.2±13.3), access site (femoral approach: 74.2%), type of anaesthesia and duration of hospital stay (9.3±8.1 days) showed wide variations among the participating countries. In-hospital mortality (7.4%), stroke (1.8%), myocardial infarction (0.9%), major vascular complications (3.1%) were similar in the SAPIEN XT and CoreValve (p=0.15). Mortality was lower in transfemoral (5.9%) than in transapical (12.8%) and other access routes (9.7%; p<0.01). Advanced age, high logistic EuroSCORE, pre-procedural ≥grade 2 mitral regurgitation and deployment failure predicted higher mortality at multivariate analysis.
Increased operator experience and the refinement of valve types and delivery catheters may explain the lower rate of mortality, stroke and vascular complications than in historical studies and registries.
Abstract Background There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional ...differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome. Methods Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%). Results A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p < 0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p = 0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan–Meier analysis, was similar between groups (log-rank: p = 0.1505). Conclusions Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
The aim of this study was to assess the ability of optical coherence tomography (OCT) to guide recrossing during percutaneous coronary interventions in bifurcations and to reduce strut malapposition.
...Fifty-two patients undergoing elective treatment of bifurcation lesions using provisional stenting as default strategy were included in the study. Patients were divided into two groups: OCT-guided stent recrossing (group 1, n=12), and angiography-guided recrossing (group 2, n=40). Malapposition in the various bifurcation segments was compared in the two groups, using propensity score analysis to correct for confounders. In 4/12 patients (33%) of the OCT-guided group after the first attempt to recross the stent towards the SB the wire was found to have crossed in a proximal cell, requiring a second and in one case a third attempt to successfully cross through a distal cell. Patients who were treated using OCT-guided recrossing had a significantly lower number of malapposed stent struts, especially in the quadrants towards the SB ostium (9.5%7.5-17.4% vs 42.3%31.2-54.7% in the angiography-guided group, p<0.0001).
The rate of strut malapposition was significantly reduced when OCT was used to confirm that wire recrossing was performed in a distal cell of the SB ostium.
Background
During COVID‐19 pandemic in Spain, elective procedures were canceled or postponed, mainly due to health care systems overwhelming.
Objective
The objective of this study was to evaluate the ...consequences of interrupting invasive procedures in patients with chronic cardiac diseases due to the COVID‐19 outbreak in Spain.
Methods
The study population is comprised of 2,158 patients that were pending on elective cardiac invasive procedures in 37 hospitals in Spain on the 14th of March 2020, when a state of alarm and subsequent lockdown was declared in Spain due to the COVID‐19 pandemic. These patients were followed‐up until April 31th.
Results
Out of the 2,158 patients, 36 (1.7%) died. Mortality was significantly higher in patients pending on structural procedures (4.5% vs. 0.8%, respectively; p < .001), in those >80 year‐old (5.1% vs. 0.7%, p < .001), and in presence of diabetes (2.7% vs. 0.9%, p = .001), hypertension (2.0% vs. 0.6%, p = .014), hypercholesterolemia (2.0% vs. 0.9%, p = .026) Correction added on December 23, 2020, after first online publication: as per Dr. Moreno's request changes in p‐values were made after original publication in ., chronic renal failure (6.0% vs. 1.2%, p < .001), NYHA > II (3.8% vs. 1.2%, p = .001), and CCS > II (4.2% vs. 1.4%, p = .013), whereas was it was significantly lower in smokers (0.5% vs. 1.9%, p = .013). Multivariable analysis identified age > 80, diabetes, renal failure and CCS > II as independent predictors for mortality.
Conclusion
Mortality at 45 days during COVID‐19 outbreak in patients with chronic cardiovascular diseases included in a waiting list due to cancellation of invasive elective procedures was 1.7%. Some clinical characteristics may be of help in patient selection for being promptly treated when similar situations happen in the future.
Optical coherence tomography: from research to practice Gutiérrez-Chico, Juan Luis; Alegría-Barrero, Eduardo; Teijeiro-Mestre, Rodrigo ...
European heart journal cardiovascular imaging,
05/2012, Letnik:
13, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Optical coherence tomography (OCT) is a high-resolution imaging technique with great versatility of applications. In cardiology, OCT has remained hitherto as a research tool for characterization of ...vulnerable plaques and evaluation of neointimal healing after stenting. However, OCT is now successfully applied in different clinical scenarios, and the introduction of frequency domain analysis simplified its application to the point it can be considered a potential alternative to intravascular ultrasound for clinical decision-making in some cases. This article reviews the use of OCT for assessment of lesion severity, characterization of acute coronary syndromes, guidance of intracoronary stenting, and evaluation of long-term results.
Background: Percutaneous edge-to-edge mitral valve repair with the MitraClip® was shown to be a safe and feasible alternative compared to conventional surgical mitral valve repair. Herein is reported ...our experience on MitraClip® for high-risk surgical candidates with severe mitral regurgitation (MR). Methods and Results: Patients with severe MR (3 or 4+) and high operative risk were considered for MitraClip® implantation. Device success was defined as placement of 1 or more MitraClips® with reduction of MR to ≤2+. Patients were followed up clinically and with echocardiography at 1 year. A total of 27 patients with severe MR (age, 74±12 years; 17 male; logistic EuroSCORE, 27±12; left ventricular ejection fraction, 40±17%) were treated. Fifty-six percent of MR was degenerative and 44% was functional. Device success was 93% with 14 patients receiving 2 clips. MR severity was reduced from 3.5±0.5 to 1.7±0.8 (P<0.001); New York Heart Association class improved from 3.1±0.4 to 2.0±0.8 (P<0.001). In 45% of functional and in 29% of degenerative MR patients, to avoid mitral stenosis, additional MitraClip® implantation was not attempted, with resultant transmitral mean gradient of 4.9±1.6mmHg vs. 3.1±1.4mmHg, respectively (P=0.01). Conclusions: MitraClip® was shown to be an effective and safe treatment for patients with both functional and degenerative MR. Inability to obtain a greater reduction of MR was the consequence of borderline transmitral gradient requiring a compromise to avoid mitral stenosis, particularly in the functional MR patients. (Circ J 2012; 76: 2488–2493)
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