5 research outputs found
Intracoronary Brachytherapy, a Promising Treatment Option for Diabetic Patients: Results from a European Multicenter Registry (RENO)
Despite advances in the interventional treatment of coronary disease, diabetics still have double the case fatality rate as nondiabetics. The purpose of this an
Influence of Bleeding Risk on Outcomes of Radial and Femoral Access for Percutaneous Coronary Intervention: An Analysis From the GLOBAL LEADERS Trial
Background: Radial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding. Methods: Patients from the Global Leaders trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days. Results: In the overall population, there were no statistical differences between radial and femoral access in the rate of the primary end point, a composite of all-cause mortality, or new Q-wave myocardial infarction (MI) (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety end point, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding (HR 0.55, 95% CI 0.36-0.84). Compared by bleeding risk strata, in the high bleeding score population, the primary (HR 0.47, 95% CI 0.26-0.85; P = 0.012; Pinteraction = 0.019) and secondary safety (HR 0.57, 95% CI 0.35-0.95; P = 0.030; Pinteraction = 0.631) end points favoured radial access. In the low bleeding score population, however, the differences in the primary and secondary safety end points between radial and femoral artery access were no longer statistically significant. Conclusions: Our findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding. Because thisContexte : Il a et e d emontr e que l âaccès par lâartère radiale reduit la
mortalite et les h emorragies, en particulier chez les patients
presentant un syndrome coronarien aigu. Malgr e cela, les cardiologues
interventionnels qui ont acquis de lâexperience en matière d âaccès par
lâartère femorale pr efèrent encore utiliser cette voie lorsqu âils doivent
pratiquer une intervention coronarienne percutanee. On connaĂŽt mal lâinterĂŞt de chacune de ces techniques d âaccès vasculaire au regard du
risque dâhemorragie.
Methodologie : Les patients de lâessai GLOBAL LEADERS ont et e
repartis en deux groupes, selon qu âils presentaient un risque
dâhemorragie faible ou elev e d âaprès le score PRECISE-DAPT median,
puis les resultats cliniques ont et e compar es Ă 30 jours.
Resultats : Dans lâensemble de la population, aucune difference sta-
tistiquement significative nâa et e observ ee entre l âaccès radial et
lâaccès femoral quant au critère d âevaluation principal, compos e de la
mortalite toutes causes confondues et d âun nouvel infarctus du myocarde (IM) avec onde Q (rapport des risques instantanes [RRI] de 0,70;
intervalle de confiance [IC] Ă 95 % : 0,42-1,15). Lâaccès radial a et e
associe à un taux signi ficativement plus faible de survenue du critère
secondaire dâevaluation de l âinnocuite, c âest-Ă -dire une hemorragie de
type 3 ou 5 selon la classification du BARC (Bleeding Academic
Research Consortium) (RRI de 0,55; IC Ă 95 % : 0,36-0,84). Lorsquâon
compare les sujets en fonction du risque dâhemorragie, les critères
dâevaluation de l âinnocuite principal (RRI de 0,47; IC Ă 95 % : 0,26-
0,85; p Âź 0,012; pinteraction Âź 0,019) et secondaire (RRI de 0,57; IC Ă
95 % : 0,35-0,95; p Âź 0,030; pinteraction Âź 0,631) sont favorables Ă
lâaccès radial au sein de la population presentant un risque d âhemor-
ragie elev e. Dans la population pr esentant un risque d âhemorragie
faible, les differences entre l âaccès radial et lâaccès femoral quant aux
critères dâevaluation de l âinnocuite principal et secondaire ne sont
toutefois plus statistiquement significatives.
Conclusions : Selon ces observations, les resultats concernant la
mortalite ou la survenue d âun nouvel IM avec onde Q et le risque
dâhemorragie de type 3 ou 5 selon la classi fication du BARC indiquent
que lâaccès radial serait Ă privilegier lorsque le risque d âhemorragie est
elev e, mais pas lorsqu âil est faible. Comme il ne sâagissait pas dâune
analyse principale, il convient de considerer ces observations comme
etant g en eratrices d âhypothèses
Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry
Objective: To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS). Background: Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date. Methods: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry i
Coronary artery bypass graft versus percutaneous coronary intervention with drug-eluting stent implantation for diabetic patients with unprotected left main coronary artery disease: The D-DELTA registry
Aims: Data regarding the impact on clinical outcomes of PCI with DES implantation vs. CABG to treat unprotected left main coronary artery (ULMCA) disease in diabetic patients are still insufficient. The present study evaluated the short-term and long-term results of percutaneous and surgical revascularisation in diabetic patients with ULMCA disease in a large population. Methods and results: A total of 826 diabetic patients with ULMCA stenosis who received DES (n=520) or underwent CABG (n=306) were selected and analysed from the DELTA registry. In-hospital MACCE was significantly higher in the CABG group, mainly driven by a higher incidence of MI. At four-year follow-up, freedom from death and the composite endpoint of death, MI and cerebrovascular accident (CVA) was similar in the two treatment groups (CABG 87.4%, PCI 82.5%, p=0.124, and CABG