Интересные ссылки

[dmblok]

Validation of a New Simple Scale to Measure Symptoms in Atrial Fibrillation: The Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) Scale

Paul Dorian1,9; Peter G. Guerra2;
Circulation: Arrhythmia and Electrophysiology. 2009

[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

[Ссылки доступны только зарегистрированным пользователям ]
AHA/ASA Issues Guidelines on Intracranial Neurointerventional Procedures
A new scientific statement looks at evidence supporting various intracranial interventions for acute ischemic stroke.

[dmblok]

Percutaneous Coronary Intervention for Stable Coronary Artery Disease
JACC Vol. 52, No. 11, 2008
[Ссылки доступны только зарегистрированным пользователям ]

A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease
[Ссылки доступны только зарегистрированным пользователям ]

[audovichenko]

Похоже, что "неопределенно долгий прием клопидогреля" после имплантации DES будет-таки заменен конечным сроком в 12 месяцев.Подробности [Ссылки доступны только зарегистрированным пользователям ][Ссылки доступны только зарегистрированным пользователям ] 2009 Mar 15;103(6):801-5. Epub 2009 Jan 24.)

[Gilarov]

Сильно нужна статья
Antithrombotic therapy in patients treated with oral anticoagulation undergoing coronary artery stenting. An expert consensus document with focus on atrial fibrillation.
Rubboli A, Halperin JL, Airaksinen KE, Buerke M, Eeckhout E, Freedman SB, Gershlick AH, Schlitt A, Tse HF, Verheugt FW, Lip GY
Ann Med. 2008;40(6):428-36.
Вообще, гады. Такой любопытный документ напечатать в совершенно недоступном журнале.

[eqimi]

Сообщение от Gilarov

Сильно нужна статья

[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

Percutaneous Device Closure of Patent Foramen Ovale for Secondary Stroke Prevention.
A Call for Completion of Randomized Clinical Trials A Science Advisory From the American Heart Association/American Stroke Association and the American College of Cardiology Foundation.
[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

American Stroke Association have released 2 new guidelines: one advocating urgent treatment of transient ischemic attacks and changing the clinical definition, and the other approving telemedicine consultations in acute stroke assessment.
New AHA/ASA Guidelines on TIA Management and Telemedicine in Acute Stroke Released The American Heart Association and the American Stroke Association have released 2 new guidelines: one advocating urgent treatment of transient ischemic attacks and changing the clinical definition, and the other approving telemedicine consultations in acute stroke assessment.

[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging
[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

No Significant Reduction of CV Events With Aspirin in Peripheral Artery Disease
A meta-analysis of trials assessing the effects of aspirin with or without dipyridamole in patients with PAD finds no significant benefit in reducing overall cardiovascular events, although there was a significant reduction in stroke as a secondary end point.
[Ссылки доступны только зарегистрированным пользователям ]

[Yariko]

Definition and Evaluation of Transient Ischemic Attack
Abstract—This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD2 score
3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis. (Stroke. 2009;40:2276-2293.)

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[Yariko]

Obesity and Cardiovascular Disease
Risk Factor, Paradox, and Impact of Weight Loss
Carl J. Lavie, MD, Richard V. Milani, MD, Hector O. Ventura, MD
New Orleans, Louisiana
Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases. Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease, including HTN, HF, CHD, and peripheral arterial disease, have a better prognosis compared with nonoverweight/ nonobese patients. This review summarizes the adverse effects of obesity on CV disease risk factors and its role in the pathogenesis of various CV diseases, reviews the obesity paradox and potential explanations for these puzzling data, and concludes with a discussion regarding the current state of weight reduction in the prevention and treatment of CV diseases. (J Am Coll Cardiol 2009;53:1925–32)

[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

TIMACS Published, Supports Early Intervention in High-Risk Non-STEMI ACS

News Author: Steve Stiles
CME Author: Charles P. Vega, MD, FAAFP

May 28, 2009 — Whether invasive management was carried out early or delayed didn't make a significant difference to the primary end point of death, MI [myocardial infarction], or stroke at six months in a randomized trial called Timing of Intervention in Acute Coronary Syndromes (TIMACS), which entered patients with non-ST-segment-elevation MI (non-STEMI) acute coronary syndrome (ACS) [1].

The study, previously reported and now published in the May 21, 2009 issue of the New England Journal of Medicine, also suggested that early intervention may have reduced patients' risk of death, MI, or refractory ischemia, a prespecified secondary end point. The difference was driven by a sharp decrease in the rate of refractory ischemia.

TIMACS further suggested that patients with GRACE scores categorizing them as high risk benefited significantly from early intervention with respect to both composite end points. Safety outcomes, such as bleeding rates, were similar with the two strategies.

The findings suggest that "routine early intervention may be a preferred option for patients with acute coronary syndromes when access to cardiac catheterization and PCI [percutaneous coronary intervention] capability is readily available," write the authors, led by Dr Shamir R Mehta (McMaster University, Hamilton, ON). "When access to these facilities is not readily available (eg, on weekends or after hours), the results of our study provide reassurance that patients who are not at high risk can undergo interventions less urgently."

The group's published numbers and conclusions are virtually the same as those Mehta preliminarily presented at the American Heart Association 2008 Scientific Sessions, as covered by heartwire at the time.

In TIMACS, 3031 patients with non-STEMI ACS were randomized to early intervention (n=1593) or delayed intervention (n=1438). "Early" meant that patients went to the catheterization laboratory within 24 hours of presenting. "Delayed" was defined as at least 36 hours later.

Prespecified TIMACS End Points at Six Months, Hazard Ratios (HR) for Early vs Delayed Intervention, Overall and Stratified by GRACE Risk Scores End point HR (95% CI)
Death, MI, or stroke* 0.85 (0.68–1.06)
Death, MI, or refractory ischemia 0.72 (0.58–0.89)
Death, MI, or stroke, high-risk GRACE scores 0.65 (0.48–0.89)
Death, MI, or stroke, low- to intermediate-risk GRACE scores 1.12 (0.81–1.56)


*Primary end point

"The treatment of patients with acute coronary syndromes is optimal when the intensity of therapy, both medical and nonmedical (coronary angiography and revascularization), is tailored to the patient's risk of an ischemic cardiac event or a treatment-related complication," observe Drs L David Hillis and Richard A Lange (University of Texas Health Science Center, San Antonio) in an editorial accompanying TIMACS [2]. "The magnitude of benefit correlates with the patient's level of risk."

(The editorial from Hillis and Lange also covers the EARLY-ACS trial, published in the same issue, which compared "early" and "delayed" provisional treatment with the glycoprotein IIb/IIIa receptor blocker eptifibatide in invasively managed high-risk ACS patients. That study had been presented at the American College of Cardiology 2009 Scientific Sessions and, along with its early-release online publication [3], was covered then by heartwire.)

TIMACS was partially supported by GlaxoSmithKline, Sanofi-Aventis, and Organon International; disclosures for individual coauthors are in the report. Hillis and Lange report no conflicts.

References
Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 2009; 360:2165-2175.
Hillis DL, Lange RA. Optimal management of acute coronary syndromes. N Engl J Med 2009; 360:2237-2240.
Clinical Context


There are many treatment options for patients with ACS, and an editorial by Hillis and Lange, which accompanies the current article, reviews recommendations for medical treatment for these critical patients. All patients with ACS and no contraindications to treatment should receive immediate treatment with aspirin and clopidogrel as well as statins and antianginal medications. Although patients at low risk may receive unfractionated heparin, patients at high risk may benefit from the addition of glycoprotein IIb/IIIa inhibitors to the anticoagulation regimen.

High-risk patients with ACS also benefit from coronary angiography and revascularization, but the ideal timing for these procedures remains unclear. The current study addresses this issue.

Study Highlights

Patients eligible for study participation had unstable angina or myocardial infarction without ST-segment elevation. All participants also met at least 2 of the following criteria:
Age 60 years or older
Cardiac biomarkers above the upper limit of the normal range
Results on electrocardiography compatible with ischemia
Participants were assigned to undergo early (< 24 hours after randomization) or delayed (≥ 36 hours after randomization) coronary angiography. Revascularization was performed at the discretion of the cardiologist.
The primary outcome of the study was the composite of death, new myocardial infarction, or stroke at 6 months. Researchers also evaluated a planned secondary outcome, which included the composite of death, myocardial infarction, or refractory ischemia at 6 months.
3031 patients underwent randomization. The mean age was 65 years, and slightly more than one third of participants were women. Approximately 20% had a history of a previous coronary procedure. The rate of evidence-based medical treatment of ACS was high in both groups.
The median times to angiography in the early and delayed treatment groups were 14 and 50 hours, respectively.
The primary outcome occurred among 9.6% of the early treatment group and 11.3% of the delayed treatment group at 6 months, a nonsignificant difference. There was also no difference between groups in the individual risks for death, new myocardial infarction, and stroke.
However, participants in the early group experienced significantly lower rates of the secondary composite outcome of death, myocardial infarction, or refractory ischemia at 6 months (9.5% vs 12.9%; hazard ratio, 0.72). This difference was mainly the result of a lower rate of refractory ischemia in subjects receiving early vs delayed treatment (1.0% vs 3.3%), and the presence of refractory ischemia increased the risk for subsequent myocardial infarction by a factor of 4.
The rate of heart failure was similar between groups.
The rate of repeated coronary intervention was slightly higher in the early treatment group vs the delayed treatment group at 30 days (5.9% vs 4.2%).
The rate of major bleeding events was similar between groups.
Subgroup analysis based on age and sex failed to alter the main study outcome.
In patients at high cardiovascular risk, early treatment was associated with improved outcomes vs delayed treatment for both the primary composite outcome (hazard ratio, 0.65) outcome and secondary composite outcome (hazard ratio, 0.62).
Among participants at a low risk for cardiovascular events, there was no difference between early and delayed treatment in any study outcome.
There were no significant differences in outcomes among participants who received early angiography at less than 6 hours, 6 to 12 hours, or more than 12 hours.
Clinical Implications

All patients with ACS and no contraindications to treatment should receive immediate treatment with aspirin and clopidogrel as well as statins and antianginal medications. Although patients at low risk may receive unfractionated heparin alone for anticoagulation, patients at high risk may benefit from the addition of glycoprotein IIb/IIIa inhibitors to the anticoagulation regimen.
In the current study, early angiography for patients with ACS did not improve the primary composite outcome of death, myocardial infarction, or stroke vs delayed angiography. However, early angiography was superior in a secondary outcome, which included refractory ischemia, and it was also superior overall in high-risk patients.

[Gilarov]

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[Maltsev]

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--
С Уважением,
Мальцев А.А.