1,721,005 research outputs found
Management and outcome of major bleeding in patients on triple therapy after coronary stenting. Clues from the warfarin and coronary STENTing (WAR-STENT) registry
No full textIn-hospital antithrombotic therapy and outcomes of elderly patients on warfarin undergoing percutaneous coronary intervention: Insights from the WAR-STENT registry
No full textIn the patients on warfarin undergoing percutaneous coronary intervention included in the prospective, multicentre, observational WAR-STENT registry, age ≥75 years was associated with a significant increase in in-hospital major bleeding, length of hospitalization, and use of bare-metal stents, with no differences in the peri-procedural management and antithrombotic therapy
Sport in ischemic heart disease: Focus on primary and secondary prevention
Full text linkIschemic heart disease (IHD) is one of the leading causes of death and morbidity in the world. The role of primary prevention is particularly relevant since IHD can be for a long time asymptomatic until the occurrence of a condition that could lead to plaque instabilization or increased oxygen demand. Secondary prevention is also essential to improve patients' prognosis and quality of life. The aim of this review is to provide a detailed and updated description of the role of sport and physical activity both in primary prevention and secondary prevention. In primary prevention, sport and physical activity are effective through the control of the main cardiovascular risk factors, such as hypertension and dyslipidemia. In secondary prevention, sport and physical activity can lead to a reduction in subsequent coronary events. Every effort must be made to encourage the performance of physical and sports activity both in asymptomatic subjects at risk and those with a history of IHD
Transfemoral approach with systematic use of FemoSealTM closure device compared to transradial approach in primary angioplasty
No full textOBJECTIVES: To compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) and thrombolysis in myocardial infarction (TIMI) bleedings in primary percutaneous coronary intervention (pPCI) performed through transradial approach (TRA) or transfemoral approach (TFA) with systematic closure by FemoSealTM.
BACKGROUND:
Although the risk of bleeding can be reduced using vascular closure devices (VCD), there are few data comparing TRA and TFA with VCD, particularly in the setting of pPCI.
METHODS:
we included in this retrospective registry 777 patients who underwent pPCI at two centers from years 2010 to 2013. Exclusion criteria were implantation of intra-aortic balloon pump and achievement of femoral hemostasis by other means than FemoSealTM. We performed propensity-score matching and multivariate analysis to adjust for clinical and procedural confounders.
RESULTS:
We enrolled 511 patients in TRA group and 266 in TFA group. Both in the general population and in the propensity-matched population, the incidence of MACCE was comparable in TRA vs. TFA patients (3.5 vs. 3.4% and 4.4 vs. 2.6%, respectively; P = ns). On the contrary, we observed a higher incidence of TIMI bleedings in TFA vs. TRA patients (5.6 vs. 2.2% in the general population and 6.6 vs. 1.3% in the propensity-matched population; P < 0.05); this difference was mainly driven by TIMI major bleedings. TFA was an independent predictor of bleeding at multivariate analysis.
CONCLUSIONS:
In pPCI the rate of TIMI major bleedings was higher in TFA with closure by FemoSealTM as compared to TRA, whereas the rates of minor bleedings and of MACCE were similar
Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures
Full text linkBACKGROUND: Different tools and devices are effective to reduce operator radiation exposure at thorax level during percutaneous coronary procedures, but the operator radiation dose received at pelvic region still remains high. Our aim was to evaluate the efficacy of under-the-table adjunctive shields to reduce operator radiation exposure during percutaneous coronary procedures Methods and Results: The EXTRA-RAD study (Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures) is a prospective, single-center, randomized study. Patients who underwent transradial coronary procedures were randomized into 2 groups: group 1 (standard arrangement) and group 2 (adjunctive anti-rx shield under the angiographic table). In group 2, a further randomization was performed to compare 2 different under-the-table shields (a small curtain and a drape). A total of 205 procedures (122 diagnostic coronary angiographies and 83 percutaneous coronary interventions) performed in 157 patients by 4 different operators were included without significant differences in clinical and procedural characteristics between groups. The use of adjunctive shields was associated with lower radiation dose compared with no shield at pelvic region (42 μSv [14-98] in group 1, 13 μSv [5-27] in group 2; P<0.0001) and also at thorax level (4 μSv [1-13] in group 1, 2 μSv [1-4] in group 2; P=0.001). The reduction in dose was observed in all the operators. No significant differences were observed in pelvic dose using the 2 different shields ( P=0.183). CONCLUSIONS: The use of adjunctive anti-rx shields under the angiographic table during transradial coronary procedures is associated with a significant lower radiation dose to operators at pelvic and thorax level. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03259126
Radial artery occlusion and hand strength after percutaneous coronary procedures: Results of the HANGAR study
No full textObjectives: The aim of this prospective study was to evaluate muscle force of the hand, thumb, and forefinger in patients with prolonged radial occlusion after transradial percutaneous coronary procedures. Background: There are no data on hand strength and function in patients with prolonged radial occlusion after percutaneous coronary procedures. Methods: Elective patients with chronic stable angina undergoing percutaneous coronary procedures were evaluated the day before the procedure for radial artery patency, Allen test, hand grip, and thumb and forefinger pinch tests. The same measures were performed the day after the procedure and at follow-up. At follow-up, patients were divided in two groups according to the radial patency (group 1) or occlusion (group 2). Results: Of the 99 patients included in the study, 90 patients had a patent radial artery (group 1), and nine (9.1%) patients had an occluded artery (group 2). At baseline, there were no significant differences in hand grip test between the two groups (42 ± 11 kg in group 1 and 41 ± 17 kg in group 2, P = 0.74). In both groups, after the procedure, the hand grip test values was significantly reduced compared with baseline values (40 ± 11 kg in group 1, P < 0.0001 and 37 ± 17 kg in group 2, P = 0.007). Finally, at follow-up, in both groups, the hand grip test values returned to baseline values. Thumb and forefinger pinch tests did not show significant differences after the procedure and at follow-up, compared with baseline. Conclusions: Radial artery occlusion after percutaneous coronary procedures was not associated with a reduction in hand and finger strength
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Operator Pelvic Radiation Exposure during Percutaneous Coronary Procedures
No full textOBJECTIVES: To evaluate operator pelvic radiation exposure during percutaneous coronary procedures. BACKGROUND: During percutaneous coronary procedures, the operator's pelvic region is close to the x-ray source and is probably exposed to more radiation than the operator's thorax. However, no data are available on the pelvic radiation exposure of interventional cardiologists. METHODS: The RADIANT study (NCT01974453) is a prospective, single-center, observational study evaluating operator radiation exposure during percutaneous coronary procedures using electronic dosimeters placed at thorax level. In the last period of the study enrollment, a single operator was also equipped with an adjunctive electronic dedicated dosimeter to evaluate pelvic radiation exposure. RESULTS: From a total of 2028 procedures included in the RADIANT study, operator pelvic doses were available for 138 procedures (68 right radial, 55 left radial, and 15 transfemoral). Median fluoroscopy time was 226 sec (interquartile range [IQR], 117-407 sec) and the dose-area product (DAP) was 15.3 Gyâ¢cm2(IQR, 9.3-27.8 Gyâ¢cm2). Radiation dose at pelvic region was significantly higher (40.1 Î1⁄4Sv; IQR, 22.7-76.3 Î1⁄4Sv) compared to thorax dose (5.6 Î1⁄4Sv; IQR, 1.5-12 Î1⁄4Sv; P<.001) even after normalization by DAP (2.98 Î1⁄4Sv/Gyâ¢cm2[IQR, 1.6-4.6 Î1⁄4Sv/Gyâ¢cm2] at pelvic vs 0.33 Î1⁄4Sv/Gyâ¢cm2[IQR, 0.11-0.81 Î1⁄4Sv/Gyâ¢cm2] at thorax level; P<.001). No significant differences were observed comparing pelvic dose in right radial (42 Î1⁄4Sv), left radial (39 Î1⁄4Sv), or femoral access (40 Î1⁄4Sv; Pâ¤.43). CONCLUSIONS: Operator radiation exposure to the pelvic region during percutaneous coronary procedures is significantly higher compared to thorax radiation dose independently of the vascular access site employed
Operator radiation exposure during right or left transradial coronary angiography: A phantom study
No full textBackground: Previous studies showed a possible lower radiation dose absorbed by operators comparing LRA and
RRA for percutaneous coronary procedures. The reasons of this lower radiation dose are notwell known. The aim
of this study was to evaluate the radiation dose absorbed by operators comparing left with right radial access
(LRA and RRA respectively) during a simulated diagnostic coronary angiography using a phantom.
Methods: A coronary angiography examination was simulated on a phantom by 5 operators using eight projections
with 5 seconds fluoroscopy each. Each operator was equipped with 4 electronic dosimeters placed at thorax, at left
wrist, at left head and at hip level. Radiation doseswere expressed inpicosievertandnormalizedbydoseareaproduct.
Results: LRA compared to RRA was associated with a significant lower operator dose at wrist (36 pSv/cGYcm2
[IQR 18–59 pSv/cGYcm2] and 48 pSv/cGYcm2 [IQR 22–148 pSv/cGYcm2] respectively, p = 0.01) and thorax
(3 pSv/cGYcm2 [IQR 2–5 pSv/cGYcm2] and 10 pSv/cGYcm2 [6–23 pSv/cGYcm2] respectively, p b 0.001) but
with a significant higher radiation dose at hip level (102 pSv/cGYcm2 [IQR 44–199 pSv/cGYcm2] and 67 pSv/
cGYcm2 [IQR 39–132 pSv/cGYcm2] respectively, p = 0.02). Conversely the radiation dose at left side of the
head did not show significant differences between the two approaches.
Conclusions: In this phantomstudy simulating a diagnostic coronarography the use of LRA compared to RRAwas
associated with a significant lower radiation dose at wrist and thorax but with an increased dose at hip level.
Summary: To evaluate the radiation dose absorbed by operators comparing left with right radial access (LRA and
RRA respectively) we simulated a diagnostic coronary angiography using a dedicated phantom. Operators were
equipped with dedicated electronic dosimeters at wrist, hip, head and thorax level. LRA compared to RRA was
associated with a significant lower operator dose at wrist and thorax but with a significant higher radiation
dose at hip level whereas the radiation dose at left side of the head did not show significant differences between
the two approaches
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