Az akut miokardiális infarktus előfordulását és prognózisát befolyásoló tényezők vizsgálata

Coronary heart disease (CHD) is the leading cause of death and disability and has a major impact on both developing and developed nations. The acute manifestation of CHD is defined as an acute coronary syndrome (ACS). The two main cornerstones of the treatment of this condition are the immediate administration of antiplatelet agents after diagnosis and the reperfusion therapy, most commonly percutaneous coronary intervention (PCI), during which the vascular segment responsible for the development of acute myocardial infarction (AMI) is identified and treated by mechanical reperfusion and implantation of stents in the coronary artery stenoses. Although the therapeutic options and strategy for ACS have developed fast in the last decades, there are still unresolved questions in need of further clarification. Regarding the administration of antiplatelet drugs immediately after diagnosis (being most commonly clopidogrel and aspirin in Hungary), previous studies demonstrated large interindividual differences in response to clopidogrel. The term “clopidogrel resistance” was created and widely applied to refer to patients with an inappropriate response, which raised important questions regarding the treatment of AMI. Another major issue regarding the treatment of ACS is the type of stents implanted during PCI in different patient populations since nowadays not only bare-metal stents (BMS) but also stents delivering antiproliferative drugs (drug-eluting stent, DES) are available. In recent years several new anticoagulants (direct oral anticoagulant, DOAC) have been introduced for various indications. Since the use of these drugs concerns large patient populations it brings up important questions regarding their cardiovascular safety

Apixaban and risk of myocardial infarction: meta-analysis of randomized controlled trials

The coagulation system contributes greatly to the evolution of myocardial infarction (MI). Anticoagulation may reduce the occurrence of MI as monotherapy or with con- comitant use of aspirin. Activated factor X antagonists (anti- Xa) and direct thrombin inhibitors have promising results in various indications in non-inferiority trials. However, results regarding their cardiovascular safety are heterogeneous. We systematically evaluated the risk of MI and mortality in patients receiving the new-generation oral anti-Xa agent apixaban. Electronic databases were searched to find pro- spective, randomized, controlled clinical trials (RCT) that evaluated the clinical impact of apixaban. Efficacy measures included frequency of MI, cardiovascular and overall mor- tality. Outcome parameters of RCTs were pooled with a ran- dom-effects model. Between January 2000 and December 2013, 12 RCTs comprising 54,054 patients were identified. Based on the pooled results, there was no increase in the risk of MI in patients treated with apixaban [odds ratio (OR) 0.90;95 % confidence interval (CI) 0.77–1.05; p = 0.17] com- pared to different controls. Cardiovascular and overall mor- tality with apixaban was comparable to the control groups (OR 0.88; 95 % CI 0.72–1.06; p = 0.18, OR 0.89; 95 % CI 0.77–1.03; p = 0.11, respectively). The pooled risk of major bleeding was lower in the apixaban treated groups (OR 0.84; 95 % CI 0.62–1.12; p = 0.23) however this reached signifi- cant level only in subgroup analysis of trials with anticoagu- lant regimes in the control (OR 0.66; 95 % CI 0.51–0.87; p = 0.003). In a broad spectrum of patients and compared to different controls apixaban treatment was not associated with an increase in MI or mortality

Zero and Minimal Fluoroscopic Approaches During Ablation of Supraventricular Tachycardias : A Systematic Review and Meta-Analysis

Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. To guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches have become available, using three-dimensional electroanatomical mapping systems. Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardia (SVT).Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing electrophysiology (EP) procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RRs) with 95% confidence interval (CI).Twenty-four studies involving 9,074 patients met our inclusion criteria. There was no difference between the groups in terms of acute success rate (RR = 1.00, 95% CI, 0.99-1.01; p = 0.97) and long-term success rate (RR: 1.01, 95% CI, 1.00-1.03; p = 0.13). Compared to the conventional method, zero-and-minimal fluoroscopy (Z/MF) ablation significantly reduced fluoroscopic time [MD: -1.58 min (95% CI, -2.21 to -0.96 min; p < 0.01)] and ablation time [MD: -25.23 s (95% CI: -42.04 to -8.43 s; p < 0.01)]. No difference could be detected between the two groups in terms of the procedure time [MD: 3.06 min (95% CI: -0.97 to 7.08; p = 0.14)] and the number of ablation applications [MD: 0.13 (95% CI: -0.86 to 1.11; p = 0.80)]. The complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95% CI: 0.45-1.05; p = 0.08).The Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time without compromising the acute and long-term success or complication rates

Vaszkuláris ultrahangvezérelt vena femoralis punkciók szív-elektrofiziológiai beavatkozások során = Vascular ultrasound guided femoral vein puncture in cardiac electrophysiology procedures

Az invazív szív-elektrofiziológia vizsgálatok és katéterablációk leggyakoribb szövődményei a vaszkuláris behatolással kapcsolatosak. Szemben a hagyományos anatómiai alapokon nyugvó, palpáció-irányított technikával, az ultrahangvezérléssel végzett punkciók potenciális előnyöket biztosíthatnak, amelyekkel a vaszkuláris szövődmények aránya csökkenthető. Összefoglaló közleményünk célja az elektrofiziológiai beavatkozások során ultrahangvezérléssel végzett vena femoralis punkciókkal kapcsolatos tudományos adatok áttekintése, saját eredményeink ismertetése, továbbá a saját laboratóriumukban alkalmazott metódus bemutatása