1,721,066 research outputs found
Mechanical circulatory support in cardiogenic shock: a critical appraisal
No full textAcute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a life-threatening condition frequently encounter in patients with multivessel coronary artery disease (MVD)
Sex-based Differences in Complications Following Percutaneous Coronary Interventions
No full textPurpose of Review: The role that sex plays in the incidence and outcomes of PCI related complications is not well understood. The purpose of this review is to highlight the commonly encountered peri-procedural complications and search for any sex differences in the published literature. Recent Findings: Procedure related complications and long-term cardiovascular outcomes remain worse in women. The delayed presentation of women with coronary events and delayed referral for an invasive diagnostic angiogram and subsequent revascularization likely contribute to the worse outcomes. Whether the smaller vessel size, residual Syntax Score, and other biological factors impact periprocedural outcomes is controversial and warrants device and procedure specific research to identify sex differences. Summary: Modern day percutaneous revascularization has achieved very high acute procedural success rates and low complication rates with the advent of structured training programs, development of appropriate use criteria and refined devices and technologies in the catheterization laboratory. However, both procedure related complications and long-term cardiovascular outcomes remain worse in women
Bioresorbable Coronary Scaffold Technologies: What's New?
No full textDespite some expected benefits of BRS, none of the available data have confirmed the advantage of the first-generation BRS over the metallic DES. Thus, the current generations of BRS, especially the Absorb BVS, should not be preferred to conventional DES in everyday clinical practice. To not leave behind the desirable vascular restoration therapy concept, the next generations of BRS should aim not only to improve the acute performance of the device but, above all, to improve long-term safety. Such developments might be achieved both by device improvement, but also with a proper technique of implantation, intravascular imaging guidance, as well as careful patient and lesion selection. Accordingly, new-generation devices have been developed with thinner struts, greater radial force and vessel wall coverage, less recoil and shorter resorption time with a lesser degree of inflammation secondary to polymer resorption. Reasonable long-term safety/efficacy evaluations are now recommended to establish comparable mid-term clinical outcomes and clear clinical advantages after complete resorption compared with currently available metallic DES
The BVS concept. From the chemical structure to the vascular biology: the bases for a change in interventional cardiology
No full textBioresorbable vascular scaffolds (BVS), the fourth generation of percutaneous coronary intervention (PCI), aim to improve the long-term outcomes of PCI facilitating the restoration of the physiology of the treated vessels when the scaffold dismantling process is completed. In this paper we will review all the technical aspects as well as the potential clinical indications of this technology
[High-risk ST-elevation acute coronary syndrome in a patient with multivessel coronary artery disease complicated by refractory cardiogenic shock undergoing complex percutaneous coronary revascularization: role and timing of mechanical circulatory support devices]
No full textCardiogenic shock (CS) following acute myocardial infarction complicated by severe ventricular dysfunction remains the leading cause of death despite customized pharmacological therapy and optimal revascularization. The use of temporary mechanical circulatory support (MCS) devices during refractory CS might represent the only chance of survival to address the underlying systemic inflammatory response preventing the development of multiorgan failure. We report the case of a patient with a very-high-risk non-ST-elevation acute coronary syndrome and multivessel calcific coronary artery disease complicated by refractory CS undergoing complex percutaneous coronary revascularization. We show a gradual and complementary use of MCS devices tailored on hemodynamic monitoring, clinical and laboratory variables and multidisciplinary collaboration to early recognize the downward spiral that may ensue with multiorgan dysfunction or potential complications leading to death
Breaking Down Cardiogenic Shock: An Analytical Reflection on the DanGer-SHOCK and ECLS-SHOCK Trials
Full text linkMechanical circulatory support devices, particularly the microaxial flow pump (mAFP), have gained traction in managing cardiogenic shock in patients with acute myocardial infarction. However, trials like DanGer-SHOCK (Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock) and ECLS-SHOCK (Extracorporeal Life Support in Infarct Related Cardiogenic Shock) have reported differing outcomes, making it challenging to draw definitive conclusions. To explore this further, we conducted a comparative analysis of the 30-day and 6-month mortality rates from the DanGer-SHOCK and ECLS-SHOCK trials, examining differences in patient populations and risk profiles. The goal was to determine whether these differences could explain the conflicting outcomes or if the benefits observed in the DanGer-SHOCK trial were directly attributable to the mAFP strategy. One key finding is that, despite similar control group mortality rates, the intervention group in DanGer-SHOCK demonstrated a notably lower mortality rate at both 30 days and 6 months compared with the ECLS trial, with an absolute difference of approximately 8%. This benefit is not due to inherent risk differences but is instead attributed to the Impella-based strategy. Compared with standard care, mAFP data revealed a 7% mortality reduction at 30 days, which grew to 12.7% at 180 days, highlighting the long-term effectiveness of the mAFP strategy in maintaining hemodynamic stability and improving survival. These results suggest that, in cardiogenic shock management, the DanGer unloading strategy, when combined with percutaneous coronary intervention, plays a significant role in improving long-term survival through early intervention and ventricular unloading, independent of control group factors. Further research is needed to confirm the broader applicability of this approach in different patient populations
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