Cardiovascular revascularization medicine : including molecular interventions
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Cardiovasc Revasc Med · Nov 2014
Meta AnalysisMulti-vessel versus culprit-vessel and staged percutaneous coronary intervention in STEMI patients with multivessel disease: a meta-analysis of randomized controlled trials.
Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD. ⋯ MV-PCI compared to CV-PCI resulted in lower risks of MACE driven by lower MI and revascularization in patients with STEMI and multi-vessel disease.
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Cardiovasc Revasc Med · Sep 2014
Meta Analysis Comparative StudyBivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials.
Given controversy over anticoagulation regimens for percutaneous coronary intervention (PCI), we performed an updated meta-analysis of randomized controlled trials (RCTs) to compare bivalirudin versus heparin. ⋯ Meta-analysis of 14 RCTs with 30,446 patients demonstrated that bivalirudin is associated with higher risk of stent thrombosis but lower risk of major bleeding compared with heparin.
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Cardiovasc Revasc Med · Jul 2014
Case ReportsBail-out transcatheter aortic valve implantation to reduce severe acute aortic regurgitation in a failing homograft secondary to HeartMate II ventricular assistance device.
Left ventricular assistance with surgically implanted pump devices like the HeartMate may be crucial in selected patient with end-stage heart failure. However, mainly due to its high aortic output, the pump itself may induce severe aortic regurgitation that could result in paradoxycal worsening of the anterograde perfusion after the initiation of the support. Surgical or percutaneous occlusion of the aortic valve has proved useful in these kinds of patients. Here we present a successful case of bail-out CoreValve implantation after HeartMate II positioning complicated by acute severe aortic regurgitation in a patient with a failing homograft and end-stage ventricular dysfunction, ineligible for heart transplanation.
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Cardiovasc Revasc Med · Jul 2014
Real-time, two-way interaction during ST-segment elevation myocardial infarction management improves door-to-balloon times.
The study aimed to determine if utilization of the CodeHeart application (CHap) reduces door-to-balloon (DTB) times of ST-segment elevation myocardial infarction (STEMI) patients. ⋯ The implementation of a two-way telecommunications system allowing real-time interactions between interventional cardiologists and referring practitioners improves overall DTB time. In addition, it has the potential to decrease the frequency of false activations, thereby improving the cost efficiency of a network's STEMI system.
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Cardiovasc Revasc Med · Jun 2014
Comparative StudyUse of emergency medical services expedites in-hospital care processes in patients presenting with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
To determine whether door-to-balloon (DTB) times of patients presenting with ST-elevation myocardial infarction (STEMI) were reduced in patients transported by emergency medical services (EMS) compared to those who were self-transported. DTB time is an important measure of hospital care processes in STEMI. Use of EMS may expedite in-hospital processing and reduce DTB times. ⋯ Independent correlates of DTB times >90 minutes were self-transport (odds ratio 5.32, 95% CI 2.65-10.70; p<0.001) and off-hours presentation (odds ratio 2.89, 95% CI 1.60-5.22; p<0.001). Use of EMS transport in STEMI patients significantly shortens time to reperfusion, primarily by expediting emergency department processes. Community education efforts should focus not only on the importance of recognizing symptoms of myocardial infarction, but also taking early action by calling the EMS.