Интересные ссылки

[livsy]

Тогда буду признателен за доступ в закрома Родины (можно не нашей...) и к основанию айсберга.

[Abugov]

Забавно:

Friday, January 30, 2009 | Source: European Heart Journal
Study Questions Intra-Aortic Balloon Pump Use in STEMI
By Caitlin E. Cox
Intra aortic balloon pump (IABP) use in the context of high risk ST segment elevation myocardial infarction (STEMI) appears to do more harm than good.…

Да и это тоже:

Thursday, January 29, 2009 | Source: American Journal of Cardiology
No Increased Risk from Clopidogrel Cessation at 1 Year
By Kim Dalton

А вот это - вообще офигеть:

Friday, January 23, 2009 | Source: American Journal of Cardiology
Research Highlights Reasons for Racial Disparities in DES Outcomes
By Caitlin E. Cox
After drug eluting stent (DES) implantation, African Americans face a higher risk of adverse outcomes—including stent thrombosis—than their non African…

[YAGOR]

Сообщение от livsy

Тогда буду признателен за доступ в закрома Родины (можно не нашей...) и к основанию айсберга.

Буржуйские закрома. [Ссылки доступны только зарегистрированным пользователям ]
Для доступа в закрома нашей Родины на РМС нужно одеть красный пиджак.

[dav1972]

Сообщение от YAGOR

Для доступа в закрома нашей Родины на РМС нужно одеть красный пиджак.

Все стесняюсь спросить, а Вы почему в синем?

[Vlad34]

Согласен на наказание за оффтоп, но не могу... Спасибо YAGOR. Ощущения мыши, попавшей в зернохранилище!

[YAGOR]

Сообщение от dav1972

Все стесняюсь спросить, а Вы почему в синем?

Болею.

[Anton Verbine]

[Ссылки доступны только зарегистрированным пользователям ]

[dmblok]

Сообщение от Anton Verbine

[Ссылки доступны только зарегистрированным пользователям ]

1)Такие занятные картиночки видимо надо иметь особый навык смотреть. Я не вижу таких значимых изменений, как описаны. Опыта в таких вещах вообще нет. Интересно как бы это все выглядило на ЭХО.
2)А почему сразу бы не сделать ангиографию?

[Igor73]

Значение МРТ в диагностике ИБС в принципе трудно переоценить.

[Fro]

Сообщение от Igor73

Значение МРТ в диагностике ИБС в принципе трудно переоценить.

Может быть... А есть все-таки какие-нибудь преимущества над ЭХО-КГ со всеми его вариантами?

[dav1972]

Сообщение от Abugov

Забавно:

Алаверды:
A systematic review and meta-analysis of intra aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?
[Ссылки доступны только зарегистрированным пользователям ]

Aims: Intra-aortic balloon counterpulsation (IABP) in ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock is strongly recommended (class IB) in the current guidelines. We performed meta-analyses to evaluate the evidence for IABP in STEMI with and without cardiogenic shock.

Methods and results: Medical literature databases were scrutinized to identify randomized trials comparing IABP with no IABP in STEMI. In absence of randomized trials, cohort studies of IABP in STEMI with cardiogenic shock were identified. Two separate meta-analyses were performed respectively. The first meta-analysis included seven randomized trials (n = 1009) of STEMI. IABP showed neither a 30-day survival benefit nor improved left ventricular ejection fraction, while being associated with significantly higher stroke and bleeding rates. The second meta-analysis included nine cohorts of STEMI patients with cardiogenic shock (n = 10529). In patients treated with thrombolysis, IABP was associated with an 18% [95% confidence interval (CI), 16–20%; P < 0.0001] decrease in 30 day mortality, albeit with significantly higher revascularization rates compared to patients without support. Contrariwise, in patients treated with primary percutaneous coronary intervention, IABP was associated with a 6% (95% CI, 3–10%; P < 0.0008) increase in 30 day mortality.

Conclusion: The pooled randomized data do not support IABP in patients with high-risk STEMI. The meta-analysis of cohort studies in the setting of STEMI complicated by cardiogenic shock supported IABP therapy adjunctive to thrombolysis. In contrast, the observational data did not support IABP therapy adjunctive to primary PCI. All available observational data concerning IABP therapy in the setting of cardiogenic shock is importantly hampered by bias and confounding. There is insufficient evidence endorsing the current guideline recommendation for the use of IABP therapy in the setting of STEMI complicated by cardiogenic shock. Our meta-analyses challenge the current guideline recommendations.

[dmblok]

To Abugov and dav1972
Алаверды обоим: [Ссылки доступны только зарегистрированным пользователям ]



Elective versus provisional intraaortic balloon pumping in unprotected left main stenting......Antonio Colombo, MDa Milan and Naples, Italy

Effects of intra-aortic balloon counterpulsation on coronary pressure in patients with stenotic coronary arteries. Conclusions Elective IABP may prevent intraprocedural events in elective ULM stenting, especially in patients at higher risk. (Am Heart J 2006;152:565272.)

Role of Prophylactic Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Percutaneous Coronary Intervention. 2006 Elsevier Inc. All rights
reserved. (Am J Cardiol 2006;98:608–612)

[Abugov]

Ндаааа..... Календарикам и ручкам кирдык:

Wednesday, February 04, 2009 | Source: Food and Drug Administration
Physicians Debate Whether Limiting Industry Gifts Will Make a Difference
By Caitlin E. Cox

Главно дело! Самые бескорыстные пекутся:

Also in a telephone interview, Martin B. Leon, MD, of Columbia University Medical Center (New York, NY), said that he agreed the changes concerning gifts were justified. “Pharmaceutical and device company marketing directly to physicians, which has been the standard over a period of decades, really has crossed the bounds of what are now considered to be appropriate conflict-of-interest considerations,” he told TCTMD, explaining that these rules should extend to everything from small items like pens to meals and entertainment to educational items like textbooks. Basically, any gift “provided to physicians that could in any way be interpreted as providing a bias for physician use of FDA-approved products is indeed problematic.”

Dr. Leon said that he believes it is impossible to know to what extent gifts really affect behavior. “But the conflict of interest question is one that extends beyond the actual value of the gift . . . It’s the perception, and it’s a perception that’s widely held by the public, by the press, that the industry is trying to influence physicians making objective decisions about how to properly use FDA-approved devices and drugs,” he said. “And I cannot argue that the perception isn’t important. It is widespread and the only way to eradicate that perception is to eliminate that activity.”

Хотя и одумываются, слегка:

However, Drs. Popp and Leon question some of the more stringent efforts to limit industry-physician interaction, because physicians provide important feedback to companies that can improve the quality of their products and lead to innovation. Dr. Leon stressed that these efforts should not lump marketing and research activities together. “If we regulate too strictly a physician’s ability to participate in those research-related activities then I think it could have a negative impact on the way basic and clinical research is done,” he said.

Ладно, будем писать своими ручками, а дату в телефоне проверим. А вот Юноне Владиславовне большой привет из-за Большой Воды:

Wednesday, February 04, 2009 | Source: Food and Drug Administration
FDA Panel Unanimously Recommends Approval of Prasugrel
By Brian Vastag

[Yariko]

A population-based study of the drug interaction between proton pump inhibitors and clopidogrel

David N. Juurlink MD PhD, Tara Gomes MHSc, Dennis T. Ko MD MSc, Paul E. Szmitko MD, Peter C. Austin PhD, Jack V. Tu MD PhD, David A. Henry MD, Alex Kopp BA, Muhammad M. Mamdani PharmD MPH

Background: Most proton pump inhibitors inhibit the bioactivation of clopidogrel to its active metabolite. The clinical significance of this drug interaction is unknown.
Methods: We conducted a population-based nested case–control study among patients aged 66 years or older who commenced clopidogrel between Apr. 1, 2002, and Dec. 31, 2007, following hospital discharge after treatment of acute myocardial infarction. The cases in our study were those readmitted with acute myocardial infarction within 90 days after discharge. We performed a secondary analysis considering events within 1 year. Event-free controls (at a ratio of 3:1) were matched to cases on age, percutaneous coronary intervention and a validated risk score. We categorized exposure to proton pump inhibitors before the index date as current (within 30 days), previous (31–90 days) or remote (91–180 days).
Results: Among 13 636 patients prescribed clopidogrel following acute myocardial infarction, we identified 734 cases readmitted with myocardial infarction and 2057 controls. After extensive multivariable adjustment, current use of proton pump inhibitors was associated with an increased risk of reinfarction (adjusted odds ratio [OR] 1.27, 95% confidence
interval [CI] 1.03–1.57). We found no association with more distant exposure to proton pump inhibitors or in multiple sensitivity analyses. In a stratified analysis, pantoprazole, which does not inhibit cytochrome P450 2C19, had no association with readmission for myocardial infarction (adjusted OR 1.02, 95% CI 0.70–1.47).
Interpretation: Among patients receiving clopidogrel following acute myocardial infarction, concomitant therapy with proton pump inhibitors other than pantoprazole was associated with a loss of the beneficial effects of clopidogrel and an increased risk of reinfarction.
Cite this article as CMAJ 2009;180(7). DOI:10.1503/cmaj.082001

[Ссылки доступны только зарегистрированным пользователям ]

[Igor73]

Сообщение от Fro

Может быть... А есть все-таки какие-нибудь преимущества над ЭХО-КГ со всеми его вариантами?

Вот тут вот все написано. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging. JACC Vol. 48, No. 7, 2006.
Я, правда, как кардиолог до МРТ еще пока не дорос. Слишком все сложно. Пользуюсь этим великим изобретением крайне редко.