|
#181
08.07.2009, 14:19
|
||||
|
||||
|
Coronary Artery Bypass Surgery Helpful During Long-Term for Children With Kawasaki Disease CME
News Author: Laurie Barclay, MD CME Author: Charles P. Vega, MD, FAAFP CME Released: 07/07/2009; Valid for credit through 07/07/2010 July 7, 2009 — Coronary artery bypass graft (CABG) surgery offers long-term benefits for children with cardiovascular complications of Kawasaki disease (KD), according to the results of a study reported in the June 22 Online First issue of Circulation. "The long-term outcome of pediatric coronary artery bypass for patients with severe inflammatory coronary sequelae secondary to Kawasaki disease is unknown," write Soichiro Kitamura, MD, from the National Cardiovascular Center in Osaka, Japan, and colleagues. "We describe the long-term outcome of...114 patients after their surgery for KD coronary complications, presently the world's most common cause of pediatric coronary artery disease." This case series consisted of 114 children and adolescents aged 1 to 19 years (median age, 10 years) when undergoing CABG. Median follow-up was 19 years (maximum, 25 years). The mean number of distal anastomoses per patient was 1.7 ± 0.8. The internal thoracic artery was used in all but 3 patients, most frequently for left anterior descending artery stenosis, whereas 24 patients had saphenous vein grafting, primarily for lesions affecting other arteries. Coronary and graft statuses were evaluated with multiple angiograms. There were no operative or in-hospital deaths. All 5 deaths occurring during follow-up were cardiac in origin. Survival rates at 20 and 25 years were 95% (95% confidence interval [CI], 88% - 98%). Cardiac event-free rates were 67% at 20 years and 60% at 25 years (95% CI, 46% - 72%). The most prevalent events were percutaneous coronary intervention and reoperation. Although 88 patients (77%) continued to receive medications, all 109 survivors are currently asymptomatic when performing their daily activities. At 20 years, the overall graft patency rate was 87% (95% CI, 78% - 93%) for internal thoracic artery grafts (n = 154) and 44% (95% CI, 26% - 61%) for saphenous vein grafts (n = 30; P < .001). For non–left anterior descending artery lesions, patency was also significantly better for arterial grafts (87%; 95% CI, 73% - 94%; n = 59) vs saphenous vein grafts (42%; 95% CI, 23% - 60%; n = 27; P = .002). "Although the 25-year survival was excellent after pediatric coronary bypass for Kawasaki disease, the event-free rate declined progressively," the study authors write. "This reality mandated continued follow-up. Reinterventions successfully managed most cardiac events." Limitations of this study include observational design and possible selection bias. "An internal thoracic artery [ITA] graft was the most favorable for children," the study authors conclude. "Pediatric coronary bypass surgery with the use of the ITA should be an established treatment for severe coronary disease due to KD." In an accompanying editorial, Brian W. McCrindle, MD, MPH, from The Hospital for Sick Children, Toronto, Ontario, Canada, notes that most patients with KD will be expected to survive into adulthood. "Successful transition to adult care is an important issue," Dr. McCrindle writes. "Outcomes must be tracked seamlessly into adulthood if ongoing concerns about prognosis are to be resolved. In the meantime, advocacy for healthy lifestyle and screening and management of cardiovascular risk factors for all patients is prudent and recommended." The study authors and Dr. McCrindle have disclosed no relevant financial relationships. Circulation. Published online June 22, 2009. Clinical Context KD can have severe clinical consequences that extend into adulthood, and an editorial by McCrindle, which accompanies the current article, provides a review of KD. Although the incidence of KD is 20 to 25 per 100,000 children younger than 5 years in North America, it is 7 to 8 times more common in Japan. Coronary artery aneurysms are a major complication of KD, occurring in approximately one quarter of patients. However, when KD is treated appropriately with intravenous immunoglobulin, the rate of aneurysm formation is closer to 4%. KD can also promote cardiac valvulitis and myocarditis. Some children with severe abnormalities of the coronary arteries require CABG, but the long-term outcomes of this surgery are largely unknown. The current study reports on outcomes decades after surgery in patients with a history of KD. Study Highlights 114 children and adolescents younger than 20 years underwent CABG for inflammatory coronary obstructive lesions associated with KD. The median age of subjects at the time of the operation was 10 years, and 25% of subjects were girls. A total of 45% of subjects experienced KD during the first year of life. Approximately one third of the study cohort had experienced a previous myocardial infarction, and 14% had a left ventricular ejection fraction less than 50% before CABG. The median duration of the time from acute illness with KD to CABG was 6 years. The number of distal anastomoses per patient was 1.7, and all but 3 subjects received grafts using the internal thoracic artery. The most frequent site of anastomosis was the left anterior descending artery. The current study describes outcomes at a median follow-up duration of 19 years after CABG. There were no operative or hospital deaths. The 20- and 25-year survival rates were 95%. All 5 recorded deaths were among patients with a history of reduced left ventricular ejection fraction. Among survivors, no patient required a heart transplant. Cardiac events occurred in 29% of subjects during follow-up. The most common event by far was the need for postoperative coronary interventions. A total of 15% of all participants underwent percutaneous coronary intervention, and 8% had reoperation involving the coronary vessels. Percutaneous coronary interventions were performed at a mean of 9 years after the original CABG. The mean postoperative left ventricular ejection fraction was 55%. Only 23% of patients did not receive regular medications at the time of their last follow-up visit. 41% of surviving patients were permitted to perform in all physical activities by their cardiologist. All 109 survivors were symptom-free in their daily activities. The 20-year graft patency rates for internal thoracic artery and saphenous vein grafts were 87% and 44%, respectively. Clinical Implications KD is more common in Japan vs North America. The rate of coronary aneurysm formation in KD can be 25%, but appropriate treatment with intravenous immunoglobulin dramatically reduces the formation of coronary aneurysms. KD can also promote cardiac valvulitis and myocarditis. In the current study, the 25-year survival rate after CABG for KD was 95%, and most patients had good physical function. However, most patients also required treatment with long-term medications, and the overall rate of cardiac events during follow-up was 29%. 
|
|
#182
16.07.2009, 11:25
|
||||
|
||||
|
Вот такой вот грейпфрут...
[Изображения доступны только зарегистрированным пользователям] From Southern Medical Journal Grapefruit Juice and Verapamil: A Toxic Cocktail Unnikrishnan Pillai, MD; Jameel Muzaffar, MD; Sandeep Sen, MD; Abigail Yancey, PharmD, BCPS Published: 07/09/2009 Abstract and Introduction Abstract The US public consumes grapefruit juice in large quantities, with 14% of the population drinking the juice at least weekly. Grapefruit juice is a well-documented inhibitor of the CYP3A4 isoenzyme, which is involved in the metabolism of over 50% of commonly prescribed drugs. Here we report an unusual case of verapamil toxicity in a 42-year-old female, which resulted from accidental ingestion of only three tablets of the sustained release preparation (120 mg each) over 24 hours which resulted in severe toxicity. Introduction The US public consumes grapefruit juice in large quantities, with 14% of the population drinking the juice at least weekly. Grapefruit juice is a well-documented inhibitor of the CYP3A4 isoenzyme, which is involved in the metabolism of over 50% of commonly prescribed drugs.[1] Here we report an unusual case of verapamil toxicity, which resulted from accidental ingestion of only three tablets of the sustained release preparation (360 mg) over 24 hours and resulted in severe toxicity. Case Report A 42-year-old white female with a long-standing history of migraine headaches and no other medical history was admitted to our hospital with a 6-hour history of worsening headache and palpitations progressing to altered sensorium. She had a 2-week history of poorly controlled migraine for which she had been taking Fioricet (butalbital, acetaminophen and caffeine) in addition to her usual home medications, which consisted of topiramate, sumatriptan, amitriptyline and verapamil SR 120 mg daily. On the morning prior to admission, in addition to her usual dose, she accidentally took two additional tablets of verapamil SR 120 mg over a span of six hours after the first dose. In the emergency department, she was poorly responsive and was found to have complete heart block with a ventricular escape rhythm of 34 beats per minute, systolic blood pressure of 56 mm/Hg, hypoxic respiratory failure, severe anion gap metabolic acidosis, and hyperglycemia. She was emergently intubated with full ventilatory support and temporary pacing with the support of vasopressors and calcium chloride. An extensive workup for sepsis, myocardial ischemia, acute coronary syndrome, and street drug overdose was unremarkable. Salicylate and amitriptyline were undetectable in the serum. Her serum verapamil level, drawn 24 hours after consumption of the first tablet, was found to be elevated five times above the upper therapeutic limit (2772 ng/mL, therapeutic range: 100-600 ng/mL). Her norverapamil level was also elevated at 1895 ng/mL (therapeutic range: 100-400 ng/mL). The patient showed dramatic improvement with supportive measures and was successfully weaned off the ventilator and vasopressor support within two days. Upon recovery, she categorically denied taking more than 360 mg of verapamil SR. This was corroborated by a pill count from her medicine bottle and by crosschecking with her pharmacy on the dose and strength of her verapamil tablets. She denied using any over-the-counter medicines or herbal products which could potentially elevate her verapamil level. A careful review of her medicines failed to reveal any significant drug interaction with verapamil. Upon persistent questioning, it was finally discovered that, due to her nausea, she had been drinking large quantities of grapefruit juice during the days preceding her admission with a total estimated amount of three to four liters consumed over the course of seven days prior to admission. Discussion Pharmacokinetics More than 90% of verapamil is absorbed from the upper gastrointestinal tract. It undergoes extensive first-pass metabolism, and only 20-35% of the drug reaches the systemic circulation.[2] Bioavailability of verapamil is characteristically nonlinear, which increases with chronic use and increasing dose. The drug undergoes extensive and variable hepatic metabolism, the two major metabolites being D-617 and norverapamil, which are catalyzed mainly by CYP3A4 enzymes. Elimination half-life with a single oral dose is 3-7 hours, which increases to 4.5 to 12 hours after repeated oral dosing caused by the saturation of enzyme systems. Grapefruit juice can alter the pharmacokinetics of oral medications by different mechanisms. It is known to inhibit CYP3A4 irreversibly, an enzyme found in intestinal apical enterocytes and hepatocytes, whose normal function is to oxidize drugs before they enter the systemic circulation. This inhibitory effect can last up to 72 hours after final consumption of the grapefruit juice.[3] Concomitant consumption of grapefruit juice increases bioavailability for felodipine by 200%, nifedipine 57% and verapamil by 36%.[4] Another significant interaction is the inhibition of the P-glycoprotein by grapefruit juice and also by verapamil.[3] These are proteins present in intestinal enterocytes, which reduce the amount of drug available for absorption. Inhibition of P-glycoprotein increases the amount of drugs entering the systemic circulation. Other fruits which inhibit the CYP3A4 enzyme system include Seville orange juice, pimelo, and common orange juice (30% of the inhibitory effect compared to grapefruit). Conclusion An extensive literature search revealed that taking verapamil 120 mg q6 hourly (480 mg in a 24 hour period) resulted in a plasma level ranging from 125 to 400 ng/ml.[5] Our patient took only 360 mg of verapamil over 24 hours, and her serum verapamil level was 2772 ng/mL. This was probably the result of a change in verapamil pharmacokinetics due to the patient's long-term use and grapefruit juice consumption, which inhibited CYP3A4 and P-glycoprotein, and thus increased the bioavailability of verapamil. Physicians need to be cognizant of the potential dangerous interactions of grapefruit juice with commonly used medicines and the need to advise patients to avoid grapefruit juice when they are on these medicines (Table 1). [Изображения доступны только зарегистрированным пользователям] Key Points
References
Authors and Disclosures Unnikrishnan Pillai, MD, Jameel Muzaffar, MD, Sandeep Sen, MD, Abigail Yancey, PharmD, BCPS, Internal Medicine and the Medical Clinic, St. Mary's Health Center; St. Louis College of Pharmacy, St. Louis, MO Disclosure: The authors have no financial disclosures to make. Reprint Address Unnikrishnan Pillai, MD, Department of Internal Medicine, St. Mary's Health Center, 6420 Clayton Road, St. Louis, MO 63117; E-Mail: [Ссылки доступны только зарегистрированным пользователям ]. South Med J. 2009;102(3):308-309. © 2009 Lippincott Williams & Wilkins
|
|
#184
17.07.2009, 10:14
|
||||
|
||||
|
Comparison of Primary Percutaneous Coronary Intervention and Fibrinolytic Therapy...
Huynh et al. Circulation.2009; 119: 3101-3109 [Ссылки доступны только зарегистрированным пользователям ]
|
|
#185
17.07.2009, 10:16
|
||||
|
||||
|
Should Patient Characteristics Influence Target Anticoagulation Intensity for Stroke Prevention in Nonvalvular Atrial Fibrillation?
Circulation: Cardiovascular Quality and Outcomes. 2009;2:297-304 [Ссылки доступны только зарегистрированным пользователям ]
|
|
#186
21.07.2009, 09:25
|
||||
|
||||
|
[Ссылки доступны только зарегистрированным пользователям ] Periprocedural MI Not a Reliable Measure of Hospital PCI Quality Key Points:
By Jason Kahn The benchmark for the overall quality of percutaneous coronary interventions (PCI) performed at individual hospitals, periprocedural myocardial infarction (MI) is established by measuring cardiac markers such as CK-MB following the procedure. But because there is such inconsistency in performing tests for these markers, periprocedural MI rates are inappropriate and unreliable measures of PCI quality, according to findings reported in the May 27, 2008, issue of the Journal of the American College of Cardiology. Researchers led by Tracy Y. Wang, MD, of the Duke Clinical Research Institute (Durham, NC), analyzed data from the National Cardiovascular Data Registry on 213,395 patients who underwent elective PCI at 463 hospitals between January 1, 2004, and March 30, 2007. They found that 52,746 patients (24.7% of the total PCI population) had CK-MB assessment after PCI. Meanwhile, only 59 of 463 hospitals (12.7%) performed post-procedure cardiac marker testing on a routine basis (≥70% of the time) in this population. Those hospitals that did routinely measure cardiac markers were associated with higher diagnostic catheterization rates and PCI volumes per year. Implications for Periprocedural MI After adjustment for independent predictors of mortality, patients undergoing elective PCI at hospitals that routinely measured post-procedure markers showed a trend toward lower in-hospital mortality (OR 0.74, 95% CI, 0.53-1.02). In addition, patients treated at hospitals that perform routine cardiac marker testing were more likely to be discharged on guideline-recommended secondary prevention therapies. However, periprocedural MI detection (peak CK-MB levels >3 times the upper limit of normal) was positively correlated with the frequency of CK-MB measurement (P < 0.0001), and hospitals that more routinely measured cardiac markers had significantly higher rates of periprocedural MI detection (4.8% vs. 1.6%, P < 0.0001). The authors note that the trend toward reduced mortality and greater adherence to recommended medications for PCI patients at hospitals that routinely test for cardiac markers suggest better overall care, and that the higher incidence of periprocedural MI at such centers may be a case of “the more you look, the more you find.” In an e-mail communication with TCTMD, Dr. Wang said, “The message here is that while periprocedural MIs are considered a benchmark of PCI quality across hospitals, in real-world practice, very few hospitals actually measure the markers that establish or rule out this complication. Therefore, true rates of this adverse outcome cannot be accurately assessed. Thus, at present, PCI quality of each hospital cannot be compared using this marker.” Source: Wang TY, Peterson ED, Dai D, et al. Patterns of cardiac marker surveillance after elective percutaneous coronary intervention and implications for the use of periprocedural myocardial infarction as a quality metric: A report from the National Cardiovascular Data Registry (NCDR). J Am Coll Cardiol 2008;21:2068-2074. [Ссылки доступны только зарегистрированным пользователям ] -- С Уважением, Мальцев А.А.
|
|
#187
21.07.2009, 09:34
|
||||
|
||||
|
В догонку...
[Ссылки доступны только зарегистрированным пользователям ] Periprocedural MI Does Not Predict Long-Term Mortality Key Points:
By Kim Dalton Monday, July 20, 2009 In patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), the occurrence of a periprocedural myocardial infarction (MI) in and of itself has no bearing on prognosis. In contrast, a spontaneous MI unrelated to PCI appears to be a powerful predictor of mortality. These findings, published in the July 28, 2009, issue of the Journal of the American College of Cardiology, have implications not only for post-PCI patient management but also for the design of randomized trials, suggesting that periprocedural and spontaneous MIs should not be considered equivalent endpoints, the authors say. In a retrospective analysis, investigators led by Gregg W. Stone, MD, of Columbia University Medical Center (New York, NY), looked at 1-year outcomes of 7,773 patients with non-STEMI ACS from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial who underwent PCI. A periprocedural MI developed in 6.0% of patients, and a subsequent spontaneous MI (a median 107.5 days after randomization) occurred in 2.6%. Prior to adjustment for baseline risk factors, those who suffered either type of infarction had a significantly higher risk of dying at 30 days or within 1 year. Patients with either type of MI also had significantly higher rates of unplanned revascularization for ischemia and major bleeding (P < 0.0001). Importantly, however, the incidence of mortality at 1 year was significantly higher in patients who developed a spontaneous MI compared with those who had only a periprocedural MI (16.0% vs. 6.0%; P < 0.0001). Post Adjustment, Only Spontaneous MI Predicts Mortality After adjustment for baseline clinical and angiographic differences between the 2 groups, spontaneous MI was by far the strongest independent predictor of mortality within the following year (HR 7.49; 95% CI, 4.95-11.33; P < 0.0001). In contrast, after adjustment for baseline variables, a periprocedural MI was not linked to subsequent risk of dying within that time frame (HR 1.30; 95% CI, 0.85-1.98; P = 0.22). The rates of definite stent thrombosis at 1 year were similar for both types of MI patients, and mortality was considerably higher in patients who experienced stent thrombosis than in those who did not. However, spontaneous MI was linked to high mortality (12.0%) even in the absence of stent thrombosis, while the death rate in patients with periprocedural MI who did not experience stent thrombosis (4.1%) was comparable to that of patients who did not suffer an MI (2.6%). The authors observe that “periprocedural MI is a marker of clinical syndrome acuity, atherosclerotic plaque burden, and procedural complexity, and although increases in periprocedural cardiac enzymes do represent myonecrosis, in most cases the level of myocardial damage is below the threshold to significantly increase short-term or late mortality.” The investigators say that their “findings support the recommendation of the European Society of Cardiology/American College of Cardiology/American Heart Association global task force that spontaneous and periprocedural MI should be classified separately and considered discretely for clinical decision making,” adding that neither should they be considered equivalent as clinical endpoints in randomized trials. Higher Enzyme Level May Be Prognostic The question of the importance of a periprocedural MI “is a longstanding issue, and [despite these findings] I think it will continue,” said David P. Faxon, MD, of Brigham and Women’s Hospital (Boston, MA), in a telephone interview with TCTMD. This paper supports the conclusion of an earlier Mayo Clinic study (Prasad A, et al. Circ Cardiovasc Intervent. 2008;1:10-18.), he observed. In that study, although a periprocedural MI was shown to portend a bad outcome, it was not an independent predictor of prognosis. “It was clearer in the prior study that it was principally the preprocedural elevation of troponin that in the multivariable analysis eliminated the postprocedural elevation [as a potential independent risk factor],” Dr. Faxon said. Although that is not directly stated in this study, “I suspect it’s the same finding,” he added. Dr. Faxon pointed out that the authors of the current study used the accepted definition for periprocedural MI, but in fact that is an arbitrary cutpoint. “I would have loved to see them take these data and say, ‘Okay, let’s use various cutpoints or combinations of factors to redefine what a meaningful periprocedural MI is’—one that has a predictive value so that when I measure it, as a clinician, I might manage someone differently. I don’t know that from this study,” he said. Long-term follow-up from a registry with significantly larger numbers of patients than this study would be required to define what a significant MI is, especially since the percentage of patients who develop very high enzymes post PCI is quite small, Dr. Faxon said. Meanwhile, this study continues to support the relevance of measuring CK-MB or troponin, Dr. Faxon added, because even though an elevation may not be an independent predictor of mortality, it is a simple summary marker of patients’ underlying risk, which several studies have linked to more diffuse and more extensive disease, he said. One novel contribution of this paper, Dr. Faxon said, is it shows that patients with post-procedure enzyme increases are more likely to have several complications, including unplanned revascularization and increased bleeding. “So [elevated enzymes] may identify a population that may be more difficult to treat, and that’s a concern,” he added. Study Details A periprocedural MI was defined as an event occurring on the day of or the day after PCI, whereas a spontaneous MI was defined as one occurring after this time period. The study employed 2 definitions of periprocedural MI:
To minimize the impact of crossover, patients were excluded if they had both types of MI during the study period. An invasive approach was routinely used (93% of patients were stented), and adjunctive anticoagulant therapy included either bivalirudin alone or a glycoprotein IIb/IIIa inhibitor in combination with either unfractionated or low-molecular-weight heparin. Note: Dr. Stone and several study coauthors are faculty members of the Cardiovascular Research Foundation, which owns and operates TCTMD. Source: Prasad A, Gersh BJ, Bertrand ME, et al. Prognostic significance of periprocedural versus spontaneously occurring myocardial infarction after percutaneous coronary intervention in patients with acute coronary syndromes. J Am Coll Cardiol. 2009;54:477-486. [Ссылки доступны только зарегистрированным пользователям ] -- С Уважением, Мальцев А.А.
|
|
#188
22.07.2009, 09:35
|
||||
|
||||
|
Antiplatelet Therapy in Patients With Anticoagulants Undergoing PCI
[Ссылки доступны только зарегистрированным пользователям ] Volume 104, Issue 3, Pages 338-342 (1 August 2009) Antiplatelet Therapy in Patients With Anticoagulants Undergoing Percutaneous Coronary Stenting (from STENTIng and oral antiCOagulants [STENTICO]) Martine Gilard, MD(a), Didier Blanchard, MD(b), Gérard Helft, MD(c), Didier Carrier, MD(d), Helene Eltchaninoff, MD(e), Loic Belle, MD(f), Gérard Finet, MD(h), Hervé Le Breton, MD(g), Jacques Boschat, MD(a), STENTICO Investigators Received 2 January 2009; received in revised form 14 March 2009; accepted 14 March 2009. published online 05 June 2009. We evaluated the safety and efficacy of dual antiplatelet therapy, in association with oral anticoagulant (OAC) therapy, in patients undergoing percutaneous coronary intervention (PCI). The use of this triple therapy increases the rate of adverse outcomes, as shown by retrospective studies. In this first prospective multicenter registry STENTIng and oral antiCOagulation (STENTICO), all patients with OAC therapy undergoing PCI were included and followed up at 2 and 12 months. A total of 359 patients were included from 40 French centers. In 234 (65.2%; group 1) of these 359 patients, OAC therapy was discontinued (22 ± 31 days). In 125 patients (34.8%; group 2), triple therapy was continued. The baseline characteristics were similar in the 2 groups. In group 2, a radial approach was more often used (65.6% vs 43.8%, p = 0.003), fewer drug-eluting stents were implanted (33.3% vs 24.8%, p = 0.06), and fewer anti-glycoprotein IIb/IIIa antagonists were prescribed (5.6% vs 8.5%, p = 0.02). The stroke rate did not differ significantly, at 3.0% (95% confidence interval 0.8% to 5.2%) for group 1 versus 0.8% (95% confidence interval −0.8% to 2.4%) in group 2. Severe and moderate bleeding, according to the Global Use of Strategies to Open Coronary Arteries (GUSTO) criteria, occurred in 2.1% and 6.4% of groups 1 and 2, respectively (p = 0.04). A significant difference in bleeding risk was found between the femoral and radial approaches (10.3% vs 3.8%, respectively; p = 0.01). In conclusion, adding dual antiplatelet therapy to pre-existing OAC therapy increases the post-PCI bleeding risk. Temporary discontinuation decreased this bleeding risk but tended to increase the risk of stroke. A radial approach for PCI could be a good alternative to the conventional femoral route to avoid bleeding. (a) Department of Cardiology, University Hospital of Brest, Brest, France (b) Department of Cardiology, Clinique St. Gatien, Tours, France (c) Department of Cardiology, University Hospital of Paris, Paris, France (d) Department of Cardiology, University Hospital of Toulouse, Toulouse, France (e) Department of Cardiology, University Hospital of Rouen, Rouen, France (f) Department of Cardiology, Hospital of Annecy, Annecy, France (g) Department of Cardiology, University Hospital of Rennes, Rennes, France (h) University Hospital of Lyon, Lyon, France Corresponding author: Tel: (+33) 2-9834-7505; fax: (+33) 2-9805-3277 PII: S0002-9149(09)00815-7 doi:10.1016/j.amjcard.2009.03.053 © 2009 Elsevier Inc. All rights reserved. [Ссылки доступны только зарегистрированным пользователям ] -- С Уважением, Мальцев А.А.
|
|
#189
22.07.2009, 11:18
|
||||
|
||||
|
Мажем стенты мышьяком...
[Изображения доступны только зарегистрированным пользователям] Heparin-immobilized Polymers as Non-inflammatory and Non-thrombogenic Coating Materials for Arsenic Trioxide Eluting Stents Gong F, Cheng X, Wang S, Zhao Y, Gao Y, Cai H. Key Laboratory for Ultrafine Materials of Ministry of Education, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai 200237, China We have synthesized heparin-immobilized copolymers of L-lactide (LA) and 5-methyl-5-benzyloxycarbonate-1,3-dioxan-2-one (MBC) as non-inflammatory and non-thrombogenic biodegradable coating materials. These copolymers were used in fabricating arsenic trioxide (As(2)O(3)) eluting stents to reduce late-stage adverse events such as thrombosis, localized hypersensitivity, and inflammation that occur when applying stents to treat coronary artery diseases. Heparinized copolymers effectively reduced platelet adhesion and protein adsorption, while increased the plasma recalcification time and thromboplastin time in vitro. Histological analysis of the polymer-coated stents in a porcine coronary artery injury model indicated that one heparinized copolymer (Hep-Co90, LA:MBC=90:10) with the highest LA content of 90% and the lowest degradation rate induced the least foreign body reactions and inflammation, which were as small as those induced by bare metal stents. Consequently, Hep-Co90 was used as the stent coating material for local As(2)O(3) delivery. Histomorphometric evaluations suggested no significant difference between bare metal stents and As(2)O(3) eluting stents at 1 and 3 months post implantation. At 6 months, the lumen area in the porcine coronary arteries treated with As(2)O(3) eluting stents is 32.4% higher than those treated with bare metal stents while the neointimal area, neointimal thickness, and stenosis rate decreased by 25.8%, 32.5%, and 31.2%, respectively. As(2)O(3) eluting stent using Hep-Co90 as the drug carrier and stent coating material presented in this study represents a novel promising device in preventing in-stent restenosis. PMID: 19607942 [PubMed - as supplied by publisher] Acta Biomater. 2009 Jul 13. [Epub ahead of print] [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] doi:10.1016/j.actbio.2009.07.013 -- С Уважением, Мальцев А.А.
|
|
#190
23.07.2009, 14:27
|
||||
|
||||
|
Primary Percutaneous Coronary Angioplasty With and Without Eptifibatide in ST-Segment Elevation Myocardial Infarction A Safety and Efficacy Study of Integrilin-Facilitated Versus Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction (ASSIST)
[Ссылки доступны только зарегистрированным пользователям ]
|
|
#192
10.08.2009, 14:54
|
||||
|
||||
|
Любителям агрегации
Randomized Comparison of Adjunctive Cilostazol Versus High Maintenance Dose Clopidogrel in Patients With High Post-Treatment Platelet Reactivity: Results of the ACCEL-RESISTANCE (Adjunctive Cilostazol Versus High Maintenance Dose Clopidogrel in Patients With Clopidogrel Resistance) Randomized Study. [Ссылки доступны только зарегистрированным пользователям ]
|
|
#194
16.08.2009, 23:05
|
||||
|
||||
|
[Ссылки доступны только зарегистрированным пользователям ]
Интересное наблюдение, но меня заинтересовало даже не это, а цифры смертности:1,3% и 0,7%. Блин, чтоб я так жил!
|
|
#195
17.08.2009, 09:58
|
||||
|
||||
|
Alison L. Bailey, Dawn C. Scantlebury and Susan S. Smyth
Thrombosis and Antithrombotic Therapy in Women [Ссылки доступны только зарегистрированным пользователям ]
|
Линейный вид
