Cardiovascular revascularization medicine : including molecular interventions
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Cardiovasc Revasc Med · Dec 2016
Review Meta AnalysisComparison of heparin, bivalirudin, and different glycoprotein IIb/IIIa inhibitor regimens for anticoagulation during percutaneous coronary intervention: A network meta-analysis.
Numerous GPIs are available for PCI. Although they were tested in randomized controlled trials, a comparison between the different GPI strategies is lacking. Thus, we performed a Bayesian network meta-analysis to compare different glycoprotein IIb/IIIa inhibitor (GPI) strategies with heparin and bivalirudin for percutaneous coronary intervention (PCI). ⋯ Our network meta-analysis of 38,645 patients demonstrated that GPI regimens were associated with a reduction in recurrent myocardial infarction or major adverse cardiovascular events for PCI, while bivalirudin was associated with the lowest risk of bleeding.
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Cardiovasc Revasc Med · Dec 2016
Multicenter Study Comparative Study Observational StudyAssociation of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
Patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at an increased risk of developing contrast-induced acute kidney injury (CI-AKI). Data on the association between transradial (TRA) vs. transfemoral (TFA) access and the risk of CI-AKI in this setting are limited. ⋯ In patients with STEMI undergoing primary PCI, the overall incidence of contrast-induced acute kidney injury (CI-AKI) was low (6.7%). Transradial access was not associated with a lower risk of CI-AKI as compared with transfemoral access.
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Cardiovasc Revasc Med · Dec 2016
Comparative Study Observational StudyPre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility.
Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion. ⋯ In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI.
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Cardiovasc Revasc Med · Sep 2016
Comparative Study Observational StudyComparison of clinical outcomes with the utilization of monitored anesthesia care vs. general anesthesia in patients undergoing transcatheter aortic valve replacement.
There is no clear consensus in regard to the optimal anesthesia utilization during transcatheter aortic valve replacement (TAVR). The aim was to compare outcomes of transfemoral (TF) TAVR under monitored anesthesia care (MAC) vs. general anesthesia (GA) and evaluate the rates and causes of intra-procedural MAC failure. ⋯ TF TAVR under MAC is feasible and safe, results in shorter hospital stays, can be performed in the majority of cases, and should be utilized as the default strategy. Trans-esophageal echocardiography utilization during TAVR with MAC is safe and feasible. The most common cause for conversion of MAC to GA is cardiac instability and hypotension. The complete heart team should be available at all times in case the need arises for a rapid conversion to GA.
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Cardiovasc Revasc Med · Sep 2016
Review Case ReportsWhen to close iatrogenic atrial septal defect after percutaneous edge to edge repair of mitral valve regurgitation.
Transseptal puncture is increasingly utilized in electrophysiology and interventional cardiology. With a wide range of therapeutic indications, incidence of iatrogenic atrial septal defect (iASD) is likely to increase. ⋯ She developed persistent hypoxemia following MitraClip(®) procedure, requiring closure of iASD resulting in immediate recovery of hemodynamics. In here, we discuss the hemodynamic changes following percutaneous mitral valve repair and review the evidence supporting the closure of iatrogenic atrial septal defects.