Archives of cardiovascular diseases
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Arch Cardiovasc Dis · May 2012
Multicenter StudyCompliance with guidelines in patients with ST-segment elevation myocardial infarction after implementation of specific guidelines for emergency care: results of RESCA+31 registry.
Guidelines emphasize the implementation of local networks with prehospital emergency medical systems to improve the management of patients with ST-segment elevation myocardial infarction (STEMI); they also define the choice of reperfusion strategies and adjunctive treatments. ⋯ Despite the implementation of a network, compliance with guidelines for reperfusion strategies and adjunctive treatments was insufficient in our area. However, very few patients did not receive reperfusion therapy and the mortality rate was low. Efforts should be made to improve the estimation of delay before primary percutaneous coronary intervention.
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Arch Cardiovasc Dis · Apr 2012
Review Meta AnalysisRate versus rhythm control in atrial fibrillation and clinical outcomes: updated systematic review and meta-analysis of randomized controlled trials.
Atrial fibrillation is the most frequently occurring sustained cardiac arrhythmia and is associated with a significantly increased risk of thromboembolic events and death. We sought to compare the clinical efficacy of rate and rhythm control strategies in patients with non-postoperative atrial fibrillation. We searched the PubMed database and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing rate versus rhythm control in patients with atrial fibrillation. ⋯ There were no significant differences in the effects of rate and rhythm control on any outcome: all-cause mortality (RR: 0.95; CI: 0.86-1.05), cardiovascular mortality (RR: 0.99; CI: 0.87-1.13), arrhythmic/sudden death (RR: 1.12; CI: 0.91-1.38), ischaemic stroke (RR: 0.89; CI: 0.52-1.53), systemic embolism (RR: 0.89; CI: 0.69-1.14) and major bleeding (RR: 1.10; CI: 0.89-1.36). Updated data pooled from a large population of patients with atrial fibrillation suggests that rate and rhythm control strategies have similar effects on major clinical outcomes. Other factors, including individual preferences, comorbidities, drug tolerance and cost issues, should be considered when choosing the approach for these patients.
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Arch Cardiovasc Dis · Mar 2012
Comparative StudyTransapical aortic valve implantation in Rouen: four years' experience with the Edwards transcatheter prosthesis.
The first French transapical transcatheter aortic valve implantation (TAVI) was performed in July 2007 in our department. ⋯ Our series of 61 patients who underwent transapical implantation of the Edwards transcatheter bioprosthesis shows satisfactory results, similar to other reports, considering the high level of severity of patients referred for this method. Transapical access is a reliable alternative method for patients that cannot benefit from a transfemoral approach.
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Data supporting epidemiological transition from a predominant burden of infectious diseases to one of chronic diseases in Africa result mostly from hospital surveys. ⋯ Our findings provide strong evidence of ongoing epidemiological transition in Gabon, where CVD prevalence rates increase mainly with hypertension, affecting about one in six individuals aged over 40 years.