Coronary artery disease
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Coronary artery disease · Jan 2014
ReviewDual antiplatelet therapy after drug-eluting stents: defining the proper duration.
As compared with bare-metal stents, drug-eluting stents (DESs) reduce restenosis in every clinical situation and every type of lesion studied. Therefore, DESs have been in widespread use for more than a decade and are used in the majority of patients receiving intracoronary stents. However, several studies have suggested that early discontinuation of dual antiplatelet therapy (DAPT; the combination of aspirin and an inhibitor of platelet P2Y12) is associated with a greater risk for 'late' stent thrombosis in patients with DESs. ⋯ On the basis of recent clinical studies, a shorter course of DAPT than recommended by the guidelines (at least 12 months in the ACCF/AHA/SCAI guideline and 6-12 months in the European Society of Cardiology guidelines) may be considered, especially with second-generation or newer-generation DESs being associated with a significant reduction in stent thrombosis compared with first-generation DES. However, as these trials also had insufficient statistical power to allow for a firm decision with regard to the optimal DAPT duration after DES implantation, the results of larger ongoing clinical trials are necessary to resolve this issue before changing the practice. This article systematically reviews the cumulative evidence from key clinical studies and tries to help guide the physician in making informed decisions on the optimal duration of DAPT for patients who are undergoing DES implantation.
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Coronary artery disease · Jan 2014
Relationship between obstructive sleep apnea and coronary microcirculatory function among patients with cardiac syndrome X.
Obstructive sleep apnea (OSA) is an emerging risk factor for cardiovascular disease. Microcirculatory dysfunction has been proposed as a potential mechanism in the pathogenesis of cardiovascular disease in OSA. This study aims to investigate the relationship between OSA and coronary microcirculatory function. ⋯ As compared with having no sleep apnea, categories with higher AHI were associated with increased odds of lower coronary flow reserve. The data suggested a close relationship between OSA and coronary microcirculatory function in atherosclerosis.
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Coronary artery disease · Dec 2013
Comparative StudyQuality of life 12 years after on-pump and off-pump coronary artery bypass grafting.
To assess whether the use of either the on-pump or the off-pump method affects changes in health-related quality of life (QOL) in the long term after coronary artery bypass graft (CABG) surgery. ⋯ A majority of patients experience significant improvement in health-related QOL in the long term after CABG. Cardiopulmonary bypass has no impact on patients' subsequent health-related QOL.
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Coronary artery disease · Nov 2013
Multicenter Study Observational StudyPrevalence and prognosis of congestive heart failure in Saudi patients admitted with acute coronary syndrome (from SPACE registry).
The aim of this study was to assess the prevalence, clinical features, and in-hospital outcomes of heart failure in patients with acute coronary syndrome (ACS). ⋯ ACS patients with CHF in the Saudi Project for Assessment of Coronary Events were older, more likely to have more cardiac risk factors, and less likely to be treated with optimum medical treatment on admission. These findings were associated with higher incidence of their in-hospital adverse outcomes. More aggressive treatment is warranted to improve prognosis.
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Coronary artery disease · Nov 2013
Comparative Study Observational StudyLong-term effectiveness and safety of triple versus dual antiplatelet therapy after percutaneous coronary intervention for unprotected left main coronary artery disease.
We sought to compare the long-term effectiveness and safety of triple antiplatelet therapy (TAPT) versus dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (uLMCAD). ⋯ TAPT after drug-eluting stent implantation in patients with uLMCAD did not improve the long-term clinical outcome when compared with conventional DAPT, although it was a safe strategy.