Clinical research in cardiology : official journal of the German Cardiac Society
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Review Meta Analysis
ST-segment resolution and prognosis after facilitated versus primary percutaneous coronary intervention in acute myocardial infarction: a meta-analysis.
Complete ST-segment resolution (STR) is associated with favorable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients with STEMI presenting early after symptom-onset is still a matter of debate. So far, there are only a few studies comparing the effect of facilitated and primary percutaneous coronary intervention (PCI) on early myocardial reperfusion assessed by STR. The objective of this meta-analysis was, therefore, to evaluate the extent of early STR and subsequent prognosis in facilitated versus primary PCI. ⋯ Prehospital initiated facilitated PCI results in a higher percentage of complete STR before and after PCI when compared with primary PCI. However, this enhanced early reperfusion did not significantly improve the outcome after facilitated PCI. Therefore, the current data suggest that facilitated PCI does not offer an advantage over primary PCI. The results from ongoing clinical trials in STEMI patients presenting early (<3 h) after symptom-onset with more effective antithrombotic co-therapy will provide guidance regarding the utility of a facilitated PCI strategy.
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The aim of this study was to assess the incidence, clinical predictors, and outcome of patients developing contrast medium induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). ⋯ This prospective study showed no differences in the incidence of developing CIN in patients undergoing PCI for STEMI or NSTEMI, but the predisposing factors, however, differed significantly. Although STEMI patients needed significantly more contrast medium for revascularisation, they did not develop CIN more often. CIN was associated with higher in-hospital complication rate and mortality. Thus, better preventive strategies according to the different predisposing factors leading to CIN are needed to reduce morbidity and mortality, especially in high risk patients.
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The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock. ⋯ In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice.
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A higher mortality risk for women with acute ST-elevation myocardial infarction (STEMI) has been a common finding in the past, even after acute percutaneous coronary intervention (PCI). We set out to analyze whether there are gender differences in real-world contemporary treatment and outcomes of STEMI. ⋯ Women underwent PCI therapy for STEMI with the same frequency and the same angiographic success as men. Despite their more advanced age and the higher prevalence of co-morbidities, they did not have a significantly higher 30-day mortality rate than men. Female gender was not an independent risk factor of 30-day mortality. Longer pre-hospital delays before hospital admission in women indicate that awareness of risk from coronary artery disease should be further raised in women.
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Randomized Controlled Trial Comparative Study
Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters.
To compare the effects of home-based and hospital-based exercise programs on exercise capacity, quality of life, psychological symptoms, and hemodynamic parameters in heart failure (HF) patients. ⋯ Both the hospital-based and home-based exercise groups improved significantly in functional capacity, quality of life, depression symptoms, and LVEF. Based on these results, we believe that physicians can recommend home-based exercise under strict supervision for stable HF patients. However, additional research should be conducted in this area.