1,721,004 research outputs found
Coronary artery disease: to cath or not to cath? When and how best to cath: those are the remaining questions.
No full textCoronary artery disease is the leading cause of death worldwide and it often clinically manifests as stable angina. The optimal diagnostic and therapeutic strategy of patients with stable angina may be controversial. Coronary revascularization with percutaneous coronary intervention (PCI) is associated with a reduction in cardiovascular events in patients with acute coronary syndrome, whereas recent trials have failed to demonstrate the superiority of myocardial revascularization over optimal medical therapy in stable angina. The treatment of a patient with stable angina is still challenging, as the definition of "stable" and "unstable" is not so clear. Moreover, the benefit of PCI in terms of quality of life is evident, and independent from its neutral effect on survival. To date, the best timing of coronary angiography and the role of further investigations on myocardial ischemia still need to be defined. On the other hand, in spite of the clear benefit on clinical outcome of an early invasive treatment of patients with acute coronary syndrome, elderly are often undertreated, whereas the overtreatment with PCI of stable patients undergoing non cardiac surgery might even increase ischemic events due to the premature discontinuation of the antiplatelet therapy, without reducing the perioperative risk
Clinical impact of simultaneous complete revascularization vs. culprit only primary angioplasty in patients with st-elevation myocardial infarction and multivessel disease: a meta-analysis.
No full textImpact of greater than 12-month dual antiplatelet therapy duration on mortality: Drug-specific or a class-effect? A meta-analysis
No full textClinical efficacy and safety of intracoronary vs. intravenous abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials.
No full textClinical impact of simultaneous complete revascularization vs. culprit only primary angioplasty in patients with st-elevation myocardial infarction and multivessel disease: a meta-analysis
No full textEarly vs. delayed invasive strategy in patients with acute coronary syndromes without ST-segment elevation: a meta-analysis of randomized studies.
No full textMeta-analysis of randomized trials of glycoprotein IIb/IIIa inhibitors in high-risk acute coronary syndromes patients undergoing invasive strategy
No full textItem does not contain fulltextIt is still unknown whether upstream administration of glycoprotein (Gp) IIb/IIIa inhibitors, aiming at cooling the culprit lesion before angioplasty, is superior to its selective downstream administration in high-risk patients with acute coronary syndromes (ACSs) undergoing coronary angioplasty. Therefore, the aim of the present study was to perform a meta-analysis of randomized trials comparing upstream to downstream administration of Gp IIb/IIIa inhibitors in high-risk patients with ACS undergoing early invasive strategy. We obtained results from all randomized trials on this issue. The literature was scanned by formal searches of electronic databases from January 1990 to March 2010. The following key words were used: "randomized trial," "myocardial infarction," "ACS," "coronary angioplasty," "upstream," "downstream," "Gp IIb/IIIa inhibitors," "abciximab," "tirofiban," and "eptifibatide." Primary and secondary clinical end points were mortality and myocardial infarction at 30 days, respectively. Major bleeding complications were assessed as a safety end point. Seven randomized trials were included in the meta-analysis, involving 19,929 patients (9,981 or 50.0% in the upstream Gp IIb/IIIa inhibitors group and 9,948 or 50% in the downstream Gp IIb/IIIa inhibitors group). Upstream Gp IIb/IIIa inhibitors did not decrease 30-day mortality (2.0% vs 2.0%, p = 0.84) or recurrence of myocardial infarction (7.0% vs 7.6%, p = 0.11) but were associated with higher risk of major bleeding complications (1.8% vs 1.3%, p = 0.0002). In conclusion, this meta-analysis shows that in high-risk patients with ACS undergoing an early invasive strategy, upstream administration of Gp IIb/IIIa inhibitors does not improve clinical outcome compared to a downstream selective administration, and it is associated with an increased risk of major bleeding complications. Therefore, a strategy of upstream Gp IIb/IIIa inhibitors cannot be recommended
Manual vs mechanical thrombectomy during PCI for STEMI: a comprehensive direct and adjusted indirect meta-analysis of randomized trials.
No full textThrombus removal by manual thrombectomy improves coronary flow and myocardial perfusion after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI); growing interest is on mechanical devices for thrombectomy which may allow a larger thrombus removal as compared to manual devices. We aimed to perform the first direct and adjusted indirect meta-analysis of studies on manual and mechanical thrombectomy in PCI for STEMI.
METHODS:
The literature was scanned for direct and indirect randomized comparisons between manual and/or mechanical thrombectomy and/or placebo by formal searches of electronic databases from November 1994 to June 2013. Clinical and procedural endpoints were selected.
RESULTS:
Three studies directly comparing (2 RCTs and 1 non-randomized; N = 513) and 21 RCTs (N = 4514) indirectly comparing the two strategies were included in the meta-analysis. The direct meta-analysis showed comparable rates of survival (p = 0.88), re-infarction (MI) (p = 0.84) and procedural outcomes between the two strategies; direct evidence was however limited in number of enrolled patients. The indirect meta-analysis showed a superior reduction in mortality with manual thrombectomy compared to mechanical thrombectomy in the overall analysis (p = 0.01); by excluding trials with low percentage of patients with intracoronary thrombus (< 50%) at baseline, the two strategies were comparable in survival, but mechanical thrombectomy was associated with a significant reduction in re-MI (p < 0.001) and stroke (p = 0.04).
CONCLUSIONS:
This meta-analysis lends support to mechanical thrombectomy in the population with high thrombus burden only where, compared to manual thrombectomy, it is likely to provide higher benefits
Drug-eluting stents vs. bare metal stents in saphenous vein graft disease. Insights from a meta-analysis of 7,090 patients.
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