Coronary artery disease
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Coronary artery disease · Jan 2014
Attenuated plaque is associated with plaque prolapse accompanied by cardiac enzyme elevation after drug-eluting stent implantation.
This study aimed to evaluate the relationship between grayscale intravascular ultrasound-attenuated plaque (AP) and poststenting plaque prolapse (PP) as well as their influence on creatine kinase-myocardial band (CK-MB) elevation after drug-eluting stent (DES) implantation. ⋯ Baseline AP was associated with high-risk characteristics, higher frequency, and greater volume of poststenting PP accompanied by CK-MB elevation in patients with DES implantation.
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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 · Jan 2014
Observational StudyPrognostic impact of anaemia on patients with ST-elevation myocardial infarction treated by primary PCI.
The aim of this study was to investigate the effects of baseline anaemia on the outcome in patients treated by primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction. ⋯ Patients with anaemia undergoing PPCI are at a higher risk of an adverse outcome. Anaemia is a simple and powerful marker of poor prognosis. Although anaemia (based on the WHO definitions) does not appear to be an independent predictor of all-cause mortality or major adverse cardiac events after PPCI on multivariate analysis, there appears to be a threshold value of Hb among men, below which there is an associated increased risk for PPCI.