Интересные ссылки

[Maltsev]

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In RCTs, no significant differences were observed in the long-term rates of death or myocardial infarction after DES or BMS use for either off-label or on-label indications. In real-world nonrandomized observational studies with greater numbers of patients but the admitted potential for selection bias and residual confounding, DES use was associated with reduced death and myocardial infarction. Both RCTs and observational studies demonstrated marked and comparable reductions in target vessel revascularization with DES compared with BMS. These data in aggregate suggest that DES are safe and efficacious in both on-label and off-label use but highlight differences between RCT and observational data comparing DES and BMS.

Кстати, у кого нибудь есть фуллтекст?


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С Уважением,
Мальцев А.А.

[eqimi]

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[Maltsev]

Clopidogrel Resistance - Significance and Management

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С Уважением,
Мальцев А.А.

[Abugov]

Продолжаю офигевать. Такая статья была про PCI, теперь и про CABG:

Simple Upper-Arm Ischemic Preconditioning Protects Myocardium During CABG
B
y Kim Dalton
Wednesday, June 24, 2009

In patients undergoing elective coronary artery bypass grafting (CABG) with cardioplegia, a simple series of brief blood pressure cuff inflations and deflations on the upper arm prior to surgery reduces myocardial injury and thus may improve longer-term prognosis, according to a study published online June 8, 2009, ahead of print in Heart.

Other Organs May Benefit, Too

Based on extensive preclinical research, imposing brief ischemia followed by reperfusion appears to confer systemic protection. “Thus, in the setting of cardiac surgery, [remote ischemic preconditioning] has the potential to reduce not only myocardial injury but also renal, cerebral, and pulmonary side effects, which in turn can improve short- and long-term outcomes,” the investigators observe. In fact, according to Dr. Yellon, in future research the investigators plan to evaluate the effect of remote preconditioning on renal and cognitive function.

[Gilarov]

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ABSTRACT

Background Patients with a myocardial infarction with ST-segment elevation who present to hospitals that do not have the capability of performing percutaneous coronary intervention (PCI) often cannot undergo timely primary PCI and therefore receive fibrinolysis. The role and optimal timing of routine PCI after fibrinolysis have not been established.

Methods We randomly assigned 1059 high-risk patients who had a myocardial infarction with ST-segment elevation and who were receiving fibrinolytic therapy at centers that did not have the capability of performing PCI to either standard treatment (including rescue PCI, if required, or delayed angiography) or a strategy of immediate transfer to another hospital and PCI within 6 hours after fibrinolysis. All patients received aspirin, tenecteplase, and heparin or enoxaparin; concomitant clopidogrel was recommended. The primary end point was the composite of death, reinfarction, recurrent ischemia, new or worsening congestive heart failure, or cardiogenic shock within 30 days.

Results Cardiac catheterization was performed in 88.7% of the patients assigned to standard treatment a median of 32.5 hours after randomization and in 98.5% of the patients assigned to routine early PCI a median of 2.8 hours after randomization. At 30 days, the primary end point occurred in 11.0% of the patients who were assigned to routine early PCI and in 17.2% of the patients assigned to standard treatment (relative risk with early PCI, 0.64; 95% confidence interval, 0.47 to 0.87; P=0.004). There were no significant differences between the groups in the incidence of major bleeding.

Conclusions Among high-risk patients who had a myocardial infarction with ST-segment elevation and who were treated with fibrinolysis, transfer for PCI within 6 hours after fibrinolysis was associated with significantly fewer ischemic complications than was standard treatment. (ClinicalTrials.gov number, NCT00164190 [ClinicalTrials.gov] .)

[Gilarov]

Вот коллега khaertin порадуется...
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[Gilarov]

А нет ли у кого полного текста:
Contemporary Management of Atrial Fibrillation: Update on Anticoagulation
and Invasive Management Strategies
Mark A. Crandall, David J. Bradley, Douglas L. Packer, and Samuel J.
Asirvatham
Mayo Clin. Proc. 2009; 84(7): p. 643-662

[Abugov]

Сообщение от Gilarov

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Забавно... Интересно, а сколько наших ребят должно устроиться по-соседству?

[oldangio]

Огласите весь список пожалуйста

[khaertin]

Не знаю, как в других местах. В Казани же список можно начать с чиновников, заставляющих исполнителей по-тупому гнать "план по высоким технологиям"

[Abugov]

Сообщение от oldangio

Огласите весь список пожалуйста

ГЫ-гы! Серёга! Это ты?

[Maltsev]

Effect of Long-Term Clopidogrel Treatment on Platelet Function and Inflammation in Patients Undergoing Coronary Arterial Stenting

Publication: AJC 103(11):1546-1550 Authors: MJ Antonino, E Mahla, KP Bliden, et al.

Platelet reactivity to adenosine diphosphate and inflammation markers were measured in 110 consecutive patients (69 clopidogrel-naive patients and 41 patients receiving long-term clopidogrel therapy for >6 months) before nonemergent stenting by turbidimetric aggregometry and flow cytometry and multianalyte profiling, respectively. All patients were treated with aspirin. Prestenting adenosine diphosphate–induced platelet aggregation, P-selectin, and activated glycoprotein IIb/IIIa expression were lower in patients receiving long-term clopidogrel therapy compared with the clopidogrel-naive group (p <0.001), accompanied by lower levels of selected inflammation markers (p ≤0.05). Additionally, there were strong correlations between platelet aggregation and flow cytometric measurements (p ≤0.04) and between specific inflammation markers (p ≤0.02).

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С Уважением,
Мальцев А.А.

[Maltsev]

Clinical Manifestation and Prognosis of Early vs Late Stent Thrombosis of DES

Publication: J Interventional Cardiology 2009;22(3):228-233 Authors: G Lemesle, A De Labriolle, L Bonello, et al.

The records of 91 consecutive patients who presented with a definite ST (as defined by the Academic Research Consortium) from 2003 to 2007 were reviewed. Clinical presentation and outcome were compared based on the time of the event. Fifty-one patients presented with an early ST versus 40 with a late ST. The primary end-point was a composite of death-recurrent myocardial infarction (MI)-recurrent ST at 1 year. Baseline characteristics were similar. Patients with early ST had more initial stent implantation for an acute MI indication and presented more with cardiogenic shock when compared to patients with late ST: 43.1% versus 17.5% (P = 0.007) and 39.2% versus 20% (P = 0.042), respectively. There was no difference in the ST treatment except for more intraaortic balloon pump (IABP) use in the early ST group (28% vs. 10%, P = 0.034). Angiographic success rates were similar. The incidence of the composite primary end-point was 52.9% in the early ST group versus 30% in the late ST group (P = 0.034).

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С Уважением,
Мальцев А.А.

[Maltsev]

Long-Term Clinical Follow-up after SES vs BMS Implantation in Patients with ACS

Publication: J Interventional Cardiology 2009;22(3):216-221 Authors: M Ogita, T Nakamura, N Fujiwara, et al.

Consecutive 245 patients with ACS treated by primary stenting within 24 hours after onset were enrolled. There were 128 patients treated with SES and 117 patients were treated with BMS. We evaluated the incidence of major cardiac events (MACE; total death, nonfatal myocardial infarction, TVR) at 3 years, comparing with 8-month clinical outcome. Eight-month clinical follow-up shows a significantly lower incidence of TVR in the SES group, 3.1% in the SES group versus 9.4% in the BMS group (P = 0.04). At 3-year clinical follow-up, there was no significant difference in the rate of TVR between the two groups, 8.4% versus 12.4% (P = 0.37). Cumulative incidence of total MACE was 9.2% in the SES group compared with 15.9% in the BMS group (P = 0.18). Only one case of stent thrombosis was observed in the SES (late thrombosis), while two cases of stent thrombosis occurred in the BMS group (late and very late thrombosis; P = 0.55).

[Ссылки доступны только зарегистрированным пользователям ]


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С Уважением,
Мальцев А.А.

[Maltsev]

[Изображения доступны только зарегистрированным пользователям]

From Medscape Medical News
Contrast-Induced Nephropathy May Be Linked to Long-Term Adverse Events

Laurie Barclay, MD


June 26, 2009 (UPDATED June 30, 2009) — Contrast-induced nephropathy (CIN) is linked to long-term adverse events, according to the results of a study reported in the June 25 Online First issue of the Clinical Journal of the American Society of Nephrology. However, an accompanying editorial disagrees with these findings.

"The relationship of...CIN to long-term adverse events (AEs) is controversial," write Dr. Richard J. Solomon, from Fletcher Allen Health Care in Burlington, Vermont, and colleagues. "Although an association with AEs has been previously reported, it is unclear whether CIN is causally related to these AEs."

In a randomized, double-blind trial comparing iopamidol vs iodixanol as prevention strategies for CIN, long-term (≥ 1 year) follow-up was available for 294 participants. Using a χ2 test and Poisson regression analysis, the investigators determined the difference in the incidence of adverse events between patients who went on to have CIN and those who did not, as well as the difference in the incidence of adverse events between patients who received iopamidol or iodixanol. To strengthen and validate the findings and conclusions, the investigators performed the analysis using multiple definitions of CIN.

For all definitions of CIN, participants with CIN had a higher rate of long-term adverse events vs those without CIN. The incidence rate ratio for adverse events was twice as high in those with CIN, after adjustment for baseline comorbidities and risk factors. Participants who were randomly assigned to iopamidol had a lower incidence both of CIN and adverse events.

"The parallel decrease in the incidence of CIN and AEs in one arm of this randomized trial supports a causal role for CIN," the study authors write. "The specific pathophysiologic connection between CIN and long-term AEs is unclear."

Limitations of this study include inability to determine a dose-response effect and loss to follow-up of 120 patients of the original cohort.

"CIN after exposure to contrast media and defined by changes in SCr [serum creatinine] of ≥0.3 mg/dl and cystatin C increases of 15, 20, and 25% are associated with long-term AEs," the study authors conclude. "This validates the use of these definitions of CIN....These more sensitive definitions should be included as primary outcomes in future randomized clinical trials for CIN prevention."

In an accompanying editorial, Paul M. Palevsky, MD, from VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine in Pennsylvania, notes that the definitions of CIN used in this analysis differ from those specified a priori for the primary analysis. In particular, the present analysis used even smaller absolute increases in serum creatinine (>0.3 mg/dL vs. >0.5 mg/dL) and smaller relative increases (>15% to >25%) in serum cystatin C.

"Using these definitions, they have converted a 'negative' study to a 'positive' one, reporting higher rates of CIN associated with iodixanol administration as compared with iopamidol," Dr. Palevsky writes. "The authors conclude that the parallel decrease in the incidence of both CIN and adverse clinical outcomes associated with iopamidol as compared with iodixanol supports a causal role for CIN in the development of these outcomes, but have they truly demonstrated causality? Although in this analysis they report lower rates of both CIN and adverse outcomes in the iopamidol group as compared with iodixanol group, this association did not exist in their primary analysis."

Dr. Palevsky also points out that 1-year outcomes were determined in just more than 70% of the original study cohort and that the rates of CIN were similar with both contrast agents when a more conventional definition was used.

"Although results of this analysis do not negate a causal relationship, they are insufficient to support one," Dr. Palevsky concludes. "Rigorous validation of small changes in kidney function as meaningful surrogate end points for CIN will require larger trials—not smaller ones—designed with the statistical power to detect differences in clinically relevant end points. Only then will we be able to sort out the tangled relationship of cause and effect."

Bracco Diagnostics, Inc, supported this study and the underlying Cardiac Angiography in Renally Impaired Patients (CARE) trial and provided research funding to the study authors.

Dr. Palevsky has disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online June 25, 2009.
Authors and Disclosures
Journalist
Laurie Barclay, MD

Laurie Barclay, MD, is a freelance writer and reviewer for Medscape.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Medscape Medical News © 2009 Medscape, LLC
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С Уважением,
Мальцев А.А.