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#16
18.03.2011, 11:20
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Цитата:
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#18
18.03.2011, 11:57
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Цитата:
Among medically treated patients, mean (SD) duration of clopidogrel treatment was 302 (151) days and death orAMIoccurred in17.1%(n=268) of patients, with60.8%(n=163) of events occurring during 0 to 90 days, 21.3% (n=57) during 91 to 180 days, and 9.7% (n=26) during 181 to 270 days after stopping treatment with clopidogrel. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping treatment with clopidogrel was associated with a significantly higher risk of adverse events (incidence rate ratio [IRR], 1.98;95%confidence interval [CI], 1.46-2.69 vs the interval of 91-180 days). Similarly,amongPCI-treated patients with ACS,mean(SD) duration of clopidogrel treatment was 278 (169) days and death orAMIoccurred in 7.9% (n=124) of patients, with 58.9% (n=73) of events occurring during 0 to 90 days, 23.4% (n=29) during 91 to 180 days, and 6.5% (n=8) during 181 to 270 days after stopping clopidogrel treatment. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping clopidogrel treatment was associated with a significantly higher risk of adverse events (IRR, 1.82; 95% CI, 1.17-2.83).[Ссылки доступны только зарегистрированным пользователям ]
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#21
19.03.2011, 00:12
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Цитата:
[Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ]
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#22
19.03.2011, 05:43
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Цитата:
Следующая классификация, которую напомнил NPV. Взял из европейских рекомендаций по ведению ИМ с подъемом от 2008 года: [Ссылки доступны только зарегистрированным пользователям ]
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#23
19.03.2011, 07:32
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Классификация кровотечений, которую упомянула Khomitskaya:
TIMI major bleeding – intracerebral hemorrage, or any bleeding associated with a >5g/dL fall in hemoglobin or a 15% absolute decrease in hematocrit. TIMI minor bleeding – any bleeding event associated with a >3g/dL fall in hemoglobin or a 10% absolute decline in hematocrit, or a >4g/dL fall in hemoglobin or a 12% absolute decline in hematocrit in absence of overt bleeding. Major bleeding (REPLACE -2 definition) – intracerebral hemorrage, or any bleeding event associated with a >3g/dL fall in hemoglobin, or a >4g/dL fall in hemoglobin in the absence of overt bleeding, or any red cell transfusion of 2 or more units. GUSTO severe or life-threatening bleeding - intracerebral hemorrage or bleeding the causes hemodynamic compromise or requires intervention. GUSTO minor bleeding – bleeding that requires transfusion but does not case hemodynamic compromise. (All calculations of falls in hemoglobin are adjusted for any transfusion by the Landefeld index).
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#24
19.03.2011, 13:59
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Кое-что из NCDR® CathPCI Registry® v4.4.
The status of the PCI: Elective - The procedure can be performed on an outpatient basis or during a subsequent hospitalization without significant risk of infarction or death. For stable inpatients, the procedure is being performed during this hospitalization for convenience and ease of scheduling and NOT because the patient's clinical situation demands the procedure prior to discharge. If the diagnostic catheterization was elective and there were no complications, the PCI would also be elective. Urgent - The procedure should be performed on an inpatient basis and prior to discharge because of significant concerns that there is risk of ischemia, infarction and/or death. Patients who are outpatients or in the emergency department at the time that the cardiac catheterization is requested would warrant an admission based on their clinical presentation. Emergency - The procedure should be performed as soon as possible because of substantial concerns that ongoing ischemia and/or infarction could lead to death. "As soon as possible" refers to a patient who is of sufficient acuity that you would cancel a scheduled case to perform this procedure immediately in the next available room during business hours, or you would activate the on-call team were this to occur during off-hours. Salvage - The procedure is a last resort. The patient is in cardiogenic shock when the PCI begins (i.e. at the time of introduction into a coronary artery or bypass graft of the first guidewire or intracoronary device for the purpose of mechanical revascularization). Within the last ten minutes prior to the start of the case or during the diagnostic portion of the case, the patient has also received chest compressions for a total of at least sixty seconds or has been on unanticipated extracorporeal circulatory support (e.g. extracorporeal mechanical oxygenation, or cardiopulmonary support).
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#25
19.03.2011, 19:09
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Кое-что из NCDR® CathPCI Registry® v4.4.
Significant Dissection Typically, dissections described as type A or B are not considered significant dissections because there is no impairment of flow. Significant dissections are grade C dissections in the presence of ischemia, or grade D-F dissections, all of which are further described as: type C: persisting contrast medium extravasations; type D: spiral filling defect with delayed but complete distal flow; type E: persistent filling defect with delayed antegrade flow; type F: filling defect with impaired flow and total occlusion Hematoma Size Indicate the maximal dimension, in centimeters, of the hematoma (measured by palpation Coding Instructions: or imaging). The highest value between start of procedure and 72 hours after current procedure <3 cm 3-5 cm >5-10 cm >10 cm
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#26
19.03.2011, 23:29
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Цитата:
Цитата:
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#27
20.03.2011, 02:35
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Кое-что из NCDR® CathPCI Registry® v4.4. Интересно, что дефиниции в этом регистре 2011 года. Однако по-прежнему рекомендуется использовать давно известную классификацию типов поражений.
Lesion Complexity Non-High/Non-C Lesion - Non-high/non-C lesions are considered Type A or B lesions. They can be characterized as follows: Low Risk or Type A lesions: Descrete (<10 mm length) Concentric Readily accessible Non-angulated segment <45 degrees Smooth contour Little or no calcification Less than totally occlusive Not ostial in location No major branch involvement Absence of thrombus Medium Risk (Type B1) lesions: Tubular (10-20 mm length) Eccentric Moderate tortuosity of proximal segment Moderatly angulated segment, 45-90 degrees Irregular contour Moderate to heavy calcification Ostial in location Bifurcation lesions requiring double guidewires Some thrombus present Total occlusion <3 months old Medium Risk (Type B2 lesions): Two or more "B" characteristics High/C Lesion - Descriptions of a High Lesion Risk (C Lesion): Diffuse (length > 2cm) Excessive tortuosity of proximal segment Extremely angulated segments > 90 degrees Total occlusions > 3 months old and/or bridging collaterals Inability to protect major side branches Degenerated vein grafts with friable lesions
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#28
21.03.2011, 13:51
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Цитата:
 ЗЫ. Думаю, классификации очень нужный раздел!
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#29
21.03.2011, 17:04
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По горячим следам. Сегодня на выступлении услышал. Сам голенью занимаюсь, а не знал. Вдруг еще кому поможет. Интересная классификация:
[Ссылки доступны только зарегистрированным пользователям ] Согласен, если один тип больше 90% занимает, нужна ли классификация. Может лучше об аномалиях говорить. Да больно уж докладчики авторитетные. Классификация старая, но до сих пор рабочая.
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#30
23.03.2011, 07:34
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Carotid Artery Revascularization and Endarterectomy Registry v1.08
Aortic Arch Type Indicate the patient's aortic arch type configuration. The three types of aortic arch are based on the relationship of the innominate artery to the aortic arch. The more inferior the origin of the target artery (i.e., Type II or III aortic arch), the greater the difficulty in gaining access to the carotid artery. Type I The Type I aortic arch is characterized by origin of all three great vessels in the same horizontal plane as the outer curvature of the aortic arch. Type II In the Type II aortic arch, the innominate artery originates between the horizontal planes of the outer and inner curvatures of the aortic arch. Type III In the Type III aortic arch, the innominate artery originates below the horizontal plane of the inner curvature of the aortic arch.
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Линейный вид
