Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Oct 2015
Observational StudyExtracorporeal membrane oxygenation support in acute coronary syndromes complicated by cardiogenic shock.
Acute coronary syndrome (ACS) complicated by shock is associated with high mortality despite the use of percutaneous support devices. Extracorporeal membrane oxygenation (ECMO) offers cardiopulmonary support but its safety and efficacy in the ACS setting is still under investigation. ⋯ In patients with severe shock or refractory ventricular arrhythmias due to ACS, VA-ECMO likely offers an alternative form of biventricular support albeit with significant resource utilization and morbidity. A better understanding of how to manage patients with ACS requiring VA-ECMO support including the associated morbidities such as bleeding is necessary.
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MitraClip implantation yields low in-patient MACCE even in higher-risk patients. Bleeding and vascular complications remain the most important procedural related complications. Development of smaller caliber devices, investigation of alternative access techniques to improve safety and better patient selection are needed to optimize the outcomes of this procedure.
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Catheter Cardiovasc Interv · Sep 2015
Editorial Review Meta AnalysisShort- and long-term outcomes in diabetes patients undergoing percutaneous coronary intervention with bivalirudin compared with heparin and glycoprotein IIb/IIIA inhibitors: A meta-analysis of randomized trials.
Diabetes patients undergoing percutaneous coronary intervention (PCI) have more complications than nondiabetes patients, including increased long-term mortality. Use of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitors (GPI) in diabetes patients undergoing PCI and its effect on long-term mortality were evaluated in few randomized trials, but with conflicting results. ⋯ Among patients with diabetes undergoing PCI, bivalirudin caused less major and minor bleeding compared with heparin and GPI, with similar rates of MACE, death, MI, and urgent revascularization at 30 days, but significantly lower mortality rates at 1 year.
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Catheter Cardiovasc Interv · Sep 2015
Meta AnalysisBivalirudin versus heparin in patients with acute myocardial infarction: A meta-analysis of randomized trials.
The aim of this study was to assess the impact of bivalirudin, as compared to unfractionated heparin, on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). ⋯ In patients with STEMI, bivalirudin, as compared to heparin, increases the risk of stent thrombosis and ischemia driven repeat revascularization at 30 days. There is no strong evidence that bivalirudin significantly reduces major bleeding at 30 days. Bivalirudin does not have an effect on all-cause mortality at 30 days.
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Bleeding rates with unfractionated heparin (UH) without concomitant use of glycoprotein IIb/IIIa inhibitors as compared to bivalirudin are similar. Ischemic event rates during the index hospitalization are similar in the heparin and bivalirudin subgroups. Low does heparin (60-70 units/kg) with a target ACT of 200-250 sec may obviate the historical improved safety of bivalirudin demonstrated in certain clinical trials.