1,721,096 research outputs found
The Conundrum of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation
No full text
Evolving Indications for Transcatheter Aortic Valve Interventions
No full textPURPOSE OF REVIEW
The purpose of this review was to summarize recent progress in the field of transcatheter aortic valve replacement (TAVR), discuss expansion of indications, and identify areas of future clinical applications.
RECENT FINDINGS
Favorable clinical outcomes as well as continued refinement of transcatheter heart valve technology have prompted the continuous expansion of indications for TAVR. The results of randomized clinical trials comparing the safety and efficacy of TAVR relative to conventional surgical aortic valve replacement (SAVR) in lower- than high-risk patients have recently been published, and trials among lower-risk categories are ongoing. Furthermore, evidence of the feasibility and safety of TAVR in patients with other pathological conditions is accumulating. Large pivotal randomized studies support the extension of TAVR to intermediate-risk patients. Moreover, TAVR is emerging as a valuable treatment option for other categories including patients with bicuspid aortic valve, those with pure native aortic regurgitation deemed inoperable, and those with degenerated surgical bioprosthetic valves
Mortality after bleeding versus myocardial infarction in coronary artery disease: a systematic review and meta-analysis.
No full textBACKGROUND
Bleeding is the principal safety concern of antithrombotic therapy and occurs frequently among patients with coronary artery disease (CAD).
AIMS
We aimed to evaluate the prognostic impact of bleeding on mortality compared with that of myocardial infarction (MI) in patients with CAD.
METHODS
We searched Medline and Embase for studies that included patients with CAD and that reported both the association between the occurrence of bleeding and mortality, and between the occurrence of MI and mortality within the same population. Adjusted hazard ratios (HRs) for mortality associated with bleeding and MI were extracted and ratios of hazard ratios (rHRs) were pooled by using inverse variance weighted random effects meta-analyses. Early events included periprocedural or within 30-day events after revascularisation or acute coronary syndrome (ACS). Late events included spontaneous or beyond 30-day events after revascularisation or ACS.
RESULTS
A total of 141,059 patients were included across 16 studies; 128,660 (91%) underwent percutaneous coronary intervention. Major bleeding increased the risk of mortality to the same extent as MI (rHRsbleedingvsMI 1.10, 95% CI: 0.71-1.71, p=0.668). Early bleeding was associated with a higher risk of mortality than early MI (rHRsbleedingvsMI 1.46, 95% CI: 1.13-1.89, p=0.004), although this finding was not present when only randomised trials were included. Late bleeding was prognostically comparable to late MI (rHRsbleedingvsMI 1.14, 95% CI: 0.87-1.49, p=0.358).
CONCLUSIONS
Compared with MI, major and late bleeding is associated with a similar increase in mortality, whereas early bleeding might have a stronger association with mortality
Safety and efficacy of resolute zotarolimus-eluting stents compared with everolimus-eluting stents: a meta-analysis.
No full textBACKGROUND
Although new-generation drug-eluting stents represent the standard of care among patients undergoing percutaneous coronary intervention, there remains debate about differences in efficacy and the risk of stent thrombosis between the Resolute zotarolimus-eluting stent (R-ZES) and the everolimus-eluting stent (EES). The aim of this study was to evaluate the safety and efficacy of the R-ZES compared with EES in patients undergoing percutaneous coronary intervention.
METHODS AND RESULTS
A systematic literature search of electronic resources was performed using specific search terms until September 2014. Random-effects meta-analysis was performed comparing clinical outcomes between patients treated with R-ZES and EES up to maximum available follow-up. The primary efficacy end point was target-vessel revascularization. The primary safety end point was definite or probable stent thrombosis. Secondary safety end points were cardiac death and target-vessel myocardial infarction. Five trials were identified, including a total of 9899 patients. Compared with EES, R-ZES had similar risks of target-vessel revascularization (risk ratio [RR], 1.06; 95% confidence interval [CI], 0.90-1.24; P=0.50), definite or probable stent thrombosis (RR, 1.26; 95% CI, 0.86-1.85; P=0.24), cardiac death (RR, 1.01; 95% CI, 0.79-1.30; P=0.91), and target-vessel myocardial infarction (RR, 1.10; 95% CI, 0.89-1.36; P=0.39). Moreover, R-ZES and EES had similar risks of late definite or probable very late stent thrombosis (RR, 1.06; 95% CI, 0.53-2.11; P=0.87). No evidence of significant heterogeneity was observed across trials.
CONCLUSIONS
R-ZES and EES provide similar safety and efficacy among patients undergoing percutaneous coronary intervention
Coronary artery disease and myocardial revascularization in patients undergoing transcatheter aortic valve replacement
No full textPatent foramen ovale closure vs. medical therapy for recurrent stroke prevention: Evolution of treatment effect during follow-up
No full textBACKGROUND
Little is known regarding changes in treatment effect over time associated with patent foramen ovale (PFO) closure among patients with embolic stroke of unknown origin.
METHODS
We reconstructed Kaplan-Meier curves for stroke from individual randomized trials comparing PFO closure vs. medical therapy among patients with embolic stroke. Random effects Cox-regression analyses were performed in order to estimate hazard ratios (HRs) with 95% confidence intervals (95%CIs).
RESULTS
A total of 2531 patients enrolled across 4 randomized trials were included. PFO closure was associated with a significant reduction in the risk of stroke at longest available follow-up (HR 0.18, 95%CI 0.06 to 0.59, P=0.005). However, recurrent stroke was already significantly reduced among patients randomized to PFO closure at 1-year (HR 0.40, 95%CI 0.20 to 0.80, P=0.010), with the treatment effect remaining consistent (P-for-interaction=0.356) between 1- and 5-year (HR 0.14, 95%CI 0.05 to 0.55, P=0.005) and beyond 5-year (HR 0.20, 95%CI 0.03 to 1.19, P=0.077).
CONCLUSIONS
Among patients with embolic stroke of unknown origin, PFO closure reduces the risk of stroke compared with medical therapy, with a significant reduction in recurrences starting already within 1-year after percutaneous PFO closure
Radial versus femoral approach in STEMI: what do we know so far?
No full textRadial approach has been used since 1989 to perform coronary angiography as an alternative to femoral access. During past decades, the development of dedicated equipment has led to high efficacy also in complex procedures. ST elevation myocardial infarction (STEMI) is known to be a high bleeding risk setting and in turn bleeding events can negatively impact on outcomes. Observational studies have demonstrated feasibility, efficacy and safety of radial approach when compared to femoral access in STEMI patients, with benefit in bleeding rates. These advantages have also been described in specific populations such as in the elderly and in patients with cardiogenic shock. Some large randomized trials have been conducted to assess outcomes of transradial access versus transfemoral access, with RIVAL and MATRIX representing the largest two studies. The RIVAL documented a significant reduction in access site-related complications in the global population of acute coronary syndrome (ACS) patients, with also lower mortality and net clinical adverse events (NACE), mainly driven by significant reduction of bleeding and all-cause mortality, in the STEMI sub-group. Overall, the MATRIX trial confirmed that radial access decreased bleeding and all-cause death thus reducing the rate of NACE and supporting the transradial access as the one to be preferred in ACS patients. Clinical advantages of radial access have been also tested in smaller randomized trials corroborating the evidence of radial access as a highly recommendable alternative to femoral access in the setting of primary percutaneous coronary intervention (p-PCI). The current evidence suggests that radial access should become the default access for patients with ACS undergoing invasive management
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