44 research outputs found
Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation: A systematic review and meta-analysis
No full textBACKGROUND:
Conflicting data have been reported related to the impact of atrial fibrillation (AF) on the outcomes after transcatheter aortic valve implantation (TAVI). We aimed to assess the prognosis of TAVI-treated patients according to the presence of pre-existing or new-onset AF.
METHODS:
Studies published between April 2002 and November 2016 and reporting outcomes of pre-existing AF, new-onset AF, or sinus rhythm in patients undergoing TAVI were identified with an electronic search. Pairwise and network meta-analysis were performed. Outcomes of interest were short- and long-term mortality, stroke, and major bleeding.
RESULTS:
Eleven studies (11,033 individuals) were eligible. Compared to sinus rhythm, short-term and long-term mortality were significantly higher in new-onset AF (short-term OR 2.9, P=.002; long-term OR 2.3, P<.0001) and pre-existing AF groups (short-term OR 2.7, P=.004; long-term OR 2.8, P<.0001). Compared to sinus rhythm, new-onset AF increased the risk of stroke at early (OR 2.1, P<.0001) and late follow-up (OR 1.92, P<.0001), and the risk of early bleedings (OR 1.65, P=.002), while pre-existing AF increased the risk of late stroke (OR 1.3, P=0.03), but not the risk of bleeding. Compared to pre-existing AF, new-onset AF correlated with higher risk of early stroke (OR 1.7, P=.002) and major bleedings (OR 1.7, P=.002).
CONCLUSIONS:
AF is associated with impaired outcomes after TAVI, including mortality, stroke and (limited to new-onset AF) major bleedings. Compared to pre-existing AF, new-onset AF correlates with higher risk of early stroke and major bleedings. Improved management of AF in the TAVI setting, including tailored antithrombotic treatment strategies, remains a relevant need
[The EBC MAIN study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies for the treatment of left main bifurcation lesions]
No full textSCOPO DELLO STUDIO
Trial clinico prospettico randomizzato, internazionale, multicentrico volto a valutare gli outcome clinici in pazienti con lesione della biforcazione del tronco comune meritevoli di rivascolarizzazione coronarica percutanea (PCI) e randomizzati a strategia provisional progressiva o doppio stenting sistematico.
POPOLAZIONE E CENTRI COINVOLTI
467 pazienti con indicazione a PCI del tronco comune in biforcazione (classe Medina 1,1,1 o 0,1,1 – stenosi >50% sia a livello del tronco comune che dei rami collaterali) arruolati in 31 centri di
11 paesi europei.
INTERVENTO
A seguito della randomizzazione, 230 pazienti sono stati assegnati al braccio tecnica provisional progressiva (proximal optimization technique [POT] e kissing balloon [KB] finale mandatori) e 237 al braccio doppio stenting (tecnica T/TAP, culotte e double kissing [DK]-minicrush a discrezione dell’operatore con KB finale mandatorio).
OUTCOME PRINCIPALI
• Endpoint primario: endpoint composito di morte, rivascolarizzazione della lesione target (TLR) e infarto miocardico a 12 mesi.
• Endpoint secondari: componenti dell’endpoint primario, trombosi di stent, status anginoso e terapia farmacologica.
RISULTATI
La popolazione arruolata, con un’età media di 71 anni, presentava un SYNTAX score medio di 23 nei due bracci. Nel 20% dei pazienti randomizzati a strategia provisional è stato impiantato un secondo stent nel ramo collaterale, e nel braccio doppio stenting le tecniche culotte (53%) e T/TAP (33%) sono state le più utilizzate. Il successo tecnico e procedurale è risultato sovrapponibile nei due gruppi, così come l’endpoint primario a 1 anno (14.7% provisional vs 17.7% doppio stenting; hazard ratio 0.8, intervallo di confidenza 95% 0.5-1.3; p=0.34). Anche l’incidenza di morte (3.0% vs 4.2%, p=0.48), infarto miocardico (10.0% vs 10.1%, p=0.91), TLR (6.1% vs 9.3%, p=0.16) e trombosi di stent (1.7% vs 1.3%, p=0.90) non hanno mostrato differenze statisticamente significative. Tempo procedurale, dose di radiazioni e consumo di materiali sono risultati inferiori nel caso
di approccio provisional. Vi è stato infine un miglioramento statisticamente significativo della classe CCS e dell’angina index indipendentemente dalla strategia adottata
Six-year clinical outcomes of first-generation drug-eluting stents: a propensity-matched analysis.
No full textOBJECTIVE:
Drug-eluting stents are more effective in reducing restenosis than bare-metal stents. Paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) are the most widely used first-generation drug-eluting stents, but long-term comparative data on these are scant. The aim of the present report is to investigate the 6-year clinical outcomes of PES versus SES in a matched cohort of single-center registry patients.
MATERIALS AND METHODS:
Data were obtained from the observational, monocentric registry of 632 consecutive patients who underwent percutaneous coronary intervention between September 2002 and September 2005 with PES or SES. We assessed the composite and separate occurrence of the major adverse cardiac events (MACE), including death, nonfatal myocardial infarction, and target lesion revascularization (TLR).
RESULTS:
After a propensity 1 : 1 matching analysis, baseline clinical, procedural, and angiographic characteristics were well balanced between the two groups. Throughout the 6 years of follow-up, there were no significant differences between PES and SES in terms of MACE (P=0.52), all-cause death (P=0.24), myocardial infarction (P=0.25), stent thrombosis (P=0.38), and TLR (P=0.68). The sensitivity analysis on the total unmatched population confirmed this result, the stent type not being predictive of MACE (PES vs. SES group, hazard ratio 0.97, 95% confidence interval 0.66-1.41, P=0.87) or TLR (PES vs. the SES group, hazard ratio 1.35, 95% confidence interval 0.69-2.64, P=0.38).
CONCLUSION:
In this 'real-life' registry, PES and SES showed a comparable safety and efficacy profile throughout the 6 years of follow-up. The increase in the rate of TLR was slow and comparable between the two groups, even though the 'late catch-up' phenomenon showed a different temporal pattern between PES and SES
Unmasking Myocardial Bridge-Related Ischemia by Intracoronary Functional Evaluation
No full text
Background—
Invasive physiological assessment of myocardial bridges (MBs) is largely unsettled. Unlike fractional flow reserve (FFR), instantaneous wave–free ratio (iFR) is a diastole-specific index. As such, its value might not be hampered by systolic pressure overshooting and negative systolic pressure gradient caused by the compression of the tunneled coronary artery.
Methods and Results—
We prospectively enrolled 20 patients with angina and/or positive noninvasive stress test, absence of significant coronary artery stenosis, and angiographic suspicion/evidence of MB in the left anterior descending artery. According to a prespecified protocol, all patients underwent functional intracoronary evaluation with FFR at rest and after dobutamine (up to 20 μg kg
−1
min
−1
) and atropine (1 mg) intravenous infusion. iFR at baseline and dobutamine-induced hyperemic wave–free period pressure ratio were also recorded. FFR values ≤0.80 and iFR values ≤0.89 were considered indicative of hemodynamic significance of MB. At baseline, no MB was hemodynamically significant according to FFR, whereas iFR was below the cutoff value in all but 7 patients. During inotropic challenge, median FFR did not change significantly (0.87–0.86,
P
=0.59).
Conclusions—
Physiological evaluation of MBs with iFR seems to be more consistent with patients’ symptoms and noninvasive test results compared with FFR.
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Parameters Related to Tree-Width, Zero Forcing, and Maximum Nullity of a Graph
No full textTree-width, and variants that restrict the allowable tree decompositions, play an important role in the study of graph algorithms and have application to computer science. The zero forcing number is used to study the maximum nullity/minimum rank of the family of symmetric matrices described by a graph. We establish relationships between these parameters, including several Colin de Verdière type parameters, and introduce numerous variations, including the minor monotone floors and ceilings of some of these parameters. This leads to new graph parameters and to new characterizations of existing graph parameters. In particular, tree-width, largeur d'arborescence, path-width, and proper path-width are each characterized in terms of a minor monotone floor of a certain zero forcing parameter defined by a color change rule.This is the peer-reviewed version of the following article: Barioli, Francesco, Wayne Barrett, Shaun M. Fallat, H. Tracy Hall, Leslie Hogben, Bryan Shader, Pauline van den Driessche, and Hein Van Der Holst. "Parameters Related to Tree‐Width, Zero Forcing, and Maximum Nullity of a Graph." Journal of Graph Theory 72, no. 2 (2013): 146-177, which has been published in final form at DOI: 10.1002/jgt.21637. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Posted with permission.</p
PRELIMINARY RESULTS OF CLINICAL EVALUATION OF THE FREE/TOTAL PROSTATE-SPECIFIC ANTIGEN RATIO IN A MULTICENTRIC STUDY
No full textPRELIMINARY RESULTS OF CLINICAL EVALUATION OF THE FREE/TOTAL PROSTATE-SPECIFIC ANTIGEN RATIO IN A MULTICENTRIC STUDY
No full textPercent free prostate-specific antigen in assessing the probability of prostate cancer under optimal analytical conditions
No full textAlthough general consensus exists that percent free prostate-specific antigen (PSA) is superior to total immunoreactive PSA for prostate cancer (CaP) detection, its diagnostic performance is not yet well established. Analytical problems may account for difficulties in evaluating percent free PSA because the free PSA concentration is substantially lower than that of total PSA. The aim of the present study was to establish the diagnostic performances of the IMMULITE percent free PSA assay from Diagnostics Products Corp. under experimental conditions optimized to minimize analytical variability. Eighty-five patients with untreated primary CaP and 261 with untreated benign prostate hypertrophy (BPH) were prospectively enrolled. The Diagnostics Products IMMULITE total (Third Generation) and free PSA were measured by the same technician, using the same instrument and the same reagent batch. We calculated the post-test probability to express how the likelihood of the diagnosis of CaP changed after the percent free PSA was determined. Areas under the ROC curves of percent free PSA were better than those of total PSA in every evaluated range of total PSA. The percent free PSA could have reduced the rate of unnecessary biopsies by 47% in patients with total PSA >/=4 microg/L with only 3.8% false-negative results. The post-test probability of percent free PSA was, however, 4 microg/L. However, the post-test probability provided by percent free PSA is relatively low in asymptomatic patients 50-70 years of age
Prostate cancer probability after total PSA and percent free PSA determination.
No full textThe percent free PSA value is a promising diagnostic tool for prostate cancer. However, its actual role has not yet been established because of the widely diverging sensitivity and specificity values. This could depend at least in part on analytical difficulties, since the free PSA concentration is much lower than that of total PSA. The present investigation was designed to evaluate the diagnostic performance of the percent free PSA in the most favorable analytical conditions.
MATERIALS AND METHODS:
81 patients affected by newly diagnosed, untreated primary prostate cancer (CaP) and 239 patients with untreated benign prostatic hyperplasia (BPH) were prospectively enrolled. Hybritech total and free PSA were measured by the same technician using the same reagent batch.
RESULTS:
The percent free PSA was not significantly associated with age, tumor stage, gland volume, Gleason score, and total PSA, nor was it significantly affected by concomitant prostatic complications either in CaP or BPH. Percent free PSA was more effective than total PSA in the differential diagnosis between CaP and BPH in every evaluated dose range of total PSA. Percent free PSA determination could have reduced the rate of unnecessary biopsies in cases with total PSA > or = 4 ng/mL and > or = 10 ng/mL (avoided biopsies 61% and 63%, respectively). The post-test probability of the disease, which represents the proportion of patients with a positive percent free PSA value who have the disease, was, however, relatively low in younger patients with total PSA within the normal range.
CONCLUSIONS:
The diagnostic performance of the percent free PSA value is enhanced when the methodological variability is reduced, particularly in men with low total PSA. Percent free PSA is superior to total PSA in distinguishing primary CaP from BPH in patients with total PSA between 2 and 30 ng/mL. The percent free PSA value is effective in reducing the rate of unnecessary biopsies in men with total PSA higher than 4 or 10 ng/mL. However, due to its relatively low post-test probability, the percent free PSA value should be interpreted with caution in the decision-making related to individual patients and should be used in association with clinical and instrumental evaluation of the patient
Image_1_One-year results from the Assessing MICRO-vascular resistances via IMR to predict outcome in ST-elevation myocardial infarction patients with multivessel disease undergoing primary PCI (AMICRO) trial.JPEG
No full textBackgroundIn ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce.AimsWe designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling.MethodsThe study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up.ResultsA significant improvement of IRA-IMR values (from 47.9 to 34.2, p ConclusionAfter successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI.Clinical trial registrationhttps://clinicaltrials.gov/, identifier [NCT 02325973].</p
