1,721,018 research outputs found
[The HEAT-PPCI study]
No full textBackground. La bivalirudina, in associazione con l’uso selettivo degli inibitori della glicoproteina (GP) IIb/IIIa, rappresenta uno standard di cura riconosciuto nell’angioplastica coronarica primaria (PPCI). Scopo dello studio è stato quello di confrontare la terapia antitrombotica con bivalirudina o eparina non frazionata nel corso di tale procedura.
Metodi e risultati. Tra il 7 febbraio 2012 e il 20 novembre 2013, sono stati randomizzati 1829 pazienti su un totale di 1917 pazienti sottoposti ad angiografia d’emergenza presso il nostro centro (pari al 97% dei pazienti afferiti consecutivamente), di cui 1812 inclusi nell’analisi finale. 751 pazienti (83%) dei 905 inclusi nel gruppo bivalirudina e 740 pazienti (82%) dei 907 inclusi nel gruppo eparina sono stati sottoposti ad angioplastica coronarica. Il tasso di utilizzo degli inibitori della GP IIb/IIIa era sostanzialmente simile nei due gruppi (122 pazienti [13%] nel gruppo bivalirudina e 140 pazienti [15%] nel gruppo eparina). L’endpoint primario di efficacia si è verificato in 79/905 pazienti (8.7%) del gruppo bivalirudina e in 52/907 pazienti (5.7%) del gruppo eparina (differenza di rischio assoluto 3.0%; rischio relativo [RR] 1.52, IC 95% 1.09-2.13, p=0.01). L’endpoint primario di sicurezza si è verificato in 32/905 pazienti (3.5%) del gruppo bivalirudina e in 28/907 pazienti (3.1%) del gruppo eparina (differenza di rischio assoluto 0.4%; RR 1.15, IC 95% 0.70-1.89, p=0.59).
Conclusioni. Rispetto alla bivalirudina, l’eparina riduce l’incidenza degli eventi ischemici avversi maggiori nel contesto della PPCI, a fronte di nessun incremento delle complicanze emorragiche. L’uso sistematico di eparina, invece che di bivalirudina, si tradurrebbe in una sostanziale riduzione dei costi correlati al farmaco. [Lancet 2014;384:1849-58
Ruolo attuale dell'utilizzo di tirofiban come inibitore del recettore piastrinico glicoproteico IIb/IIIa
No full textRuolo attuale dell'utilizzo di tirofiban come inibitore del recettore piastrinico glicoproteico IIb/III
Early coverage of Bioabsorbable Scaffold after STEMI analysed by 2D and 3D optical coherence tomography
No full textCase report: role of multimodality imaging in diagnostics and follow-up of a giant intramyocardial dissecting haematoma
Full text linkBackground Intramyocardial dissecting haematoma (IDH) is a rare life-threatening event usually complicating an acute myocardial infarction.
Poor data exist about diagnosis, management, and outcome.
Case summary We reported a case of giant IDH managed conservatively, thanks to stable clinical status and haemodynamics, which evolved to
wards resorption. Echocardiography and second-level imaging tools, like computed tomography scan and cardiac magnetic resonance, helped in differential diagnosis and studying the haematoma evolution over time, especially providing data about dimension, connection with the left ventricular cavity, consolidation, and resorption. The course is influenced by many factors including localization, edge integrity, and antithrombotic therapy on board. In this case, IDH resorption was observed despite the huge size and anticoagulant therapy on board, used for secondary cardioembolic protection, under close imaging follow-up.
Discussion Intramyocardial dissecting haematoma management depends on clinical stability, and imaging provides key data about diagnosis and evolutio
Left Ventricular Thrombosis in Immune Checkpoint Inhibitor Myocarditis Mimicking ST-Segment Elevation Myocardial Infarction
No full textWe present a case of ventricular thrombosis occurring in myocarditis due to immune checkpoint inhibitors (ICIs), presenting as myocardial infarction and complicated by refractory cardiogenic shock. Although myocarditis is a well-known adverse event of ICIs, intraventricular thrombus formation in this context is extremely rare. Differential diagnosis between ventricular thrombosis and tumoral mass can be challenging, especially in oncologic patients. Careful clinical evaluation and multimodality imaging are essential for correct diagnosis. The incidence of ICI cardiovascular complications is relatively low, but associated mortality is alarmingly high. Therefore, we intend to discuss the difficulties in managing these life-threatening cardiovascular complications
Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome
Full text linkTakotsubo syndrome (TTS) is a rare disease mimicking acute coronary syndrome, often triggered by physical or emotional stress, and characterized by transient left ventricular dysfunction. Recurrences are described in about 5% of cases and may have different clinical and imaging patterns. In the present report, SARS-COV-2 infection, even in the absence of symptoms and overt emotional stress, seems correlated with recurrence of TTS, due to the absence of other recognized triggers. The hypothesis is that in predisposed patients, events like catecholamine-induced myocyte injury, direct viral damage, cytokine storm, immune-mediated damage, and procoagulant state, all possibly induced by the infection, may elicit endothelial dysfunction as substrate for TTS onset
Chronic total occlusion successfully treated with a bioresorbable everolimus-eluting vascular scaffold
No full textFully bioresorbable vascular scaffolds (BVS) are a new approach to the percutaneous treatment of coronary artery disease. The BVS have not yet been fully tested in complex lesions, including chronic total occlusion (CTO). We report a CTO case successfully treated with a second-generation bioabsorbable drug-eluting scaffold
In the era of the valve-in-valve: is transcatheter aortic valve implantation (TAVI) in sutureless valves feasible?
No full textSutureless aortic valve implantation has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to improve surgical outcomes by facilitating less traumatic minimally invasive approaches and reducing cross-clamp and cardiopulmonary bypass duration. However, the absence of sutures may have detrimental effects after sutureless interventions, including paravalvular leakages, valve dislocation, and stent-infolding. Transcatheter aortic valve-in-valve implantation (A-ViV) is emerging as a valuable procedure in patients with dysfunctioning biological aortic valves who are deemed inoperable with conventional surgery. Here we present the first-in-man case of trans-femoral implant of a balloon expandable aortic valve in a leaking sutureless self-expandable valve
Biolimus-a9 eluting stent implantion for unprotected left main coronary artery stenosis: 9-month strut coverage as assessed by optical coherence tomography
No full textOBJECTIVE: To evaluate strut coverage after biolimus-A9 eluting stent (BES) implantation for unprotected left main artery (ULMA) stenosis during follow-up and identify features associated with the length of uncovered stent segment, as assessed by frequency domain-optical coherence tomography (FD-OCT). BACKGROUND: Incomplete stent strut coverage is a risk factor for late stent thrombosis. Long-term interaction between vessel wall and BES in the context of ULMA stenting has not been investigated in depth. METHODS: We prospectively enrolled 32 patients with ULMA stenosis treated with BES. FD-OCT was performed at 9-month follow-up. Both malapposed and uncovered segment length were indexed for the segment between the distal and proximal cross-sections in which stent struts were circumferentially visible. Patients were divided into two groups according to the median value of maximal indexed uncovered segment length. Study endpoints were the rate of strut coverage and predictors of high uncovered segment length. RESULTS: We analyzed 3622 struts. The rate of covered struts was 87%. A high correlation was found between malapposed and uncovered segment length (r ≤ 0.82; P<.001). The median value of indexed-uncovered segment length was 0.308. On multivariable analysis, patients undergoing final kissing balloon were at lower risk of high uncovered segment length (odds ratio, 0.81; 95% confidence interval, 0.008-0.837; P≤.04). CONCLUSION: In patients undergoing BES implantation for treatment of ULMA stenosis, the rate of 9-month strut coverage is high. The use of final kissing balloon reduces the risk of high uncovered stent segment length
- …
