53 research outputs found
CMR ventriculometry for evaluation of ecg hypertrophy criteria in a preventive medicine population
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
Biolimus-A9 polymer-free coated stent in high bleeding risk patients with acute coronary syndrome: a Leaders Free ACS sub-study.
Aims: Although a true clinical challenge, high bleeding risk patients with an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have never been specifically studied. Leaders Free ACS, a pre-specified Leaders Free sub-study, determined efficacy, and safety of a combination of 1-month dual anti-platelet therapy (DAPT) with implantation of either a polymer-free Biolimus-A9-coated stent (BA9-DCS) or a bare-metal stent (BMS) in these patients. Methods and results: Leaders Free included 2466 patients undergoing PCI who had at least 1 of 13 pre-defined factors for an increased bleeding risk. Of these, 659 ACS patients were included in this analysis (BA9-DCS 330, BMS 329). At 12-month follow-up, treatment with the BA9-DCS was more effective (clinically driven target-lesion revascularization 3.9 vs. 9.0%, P = 0.009) and safer (cumulative incidence of cardiac death, myocardial infarction, or definite or probable stent thrombosis 9.3 vs. 18.5%, P = 0.001), driven by significantly lower rates of cardiac mortality (3.4 vs. 6.9%, P = 0.049) and myocardial infarction (6.9 vs. 13.8%, P = 0.005). Conclusion: We believe that the results of this sub-analysis from the Leaders Free trial are likely to significantly impact clinical practice for high bleeding risk patients presenting with an ACS: the use of a BMS can, in our view, no longer be recommended, and, given the paucity of available data for second-generation DES with shortened DAPT in these patients, the BA9-DCS should currently be considered as the device with the strongest evidence to support its use for this indication
Clinical Consensus Conference: Survey on Gram-Positive Bloodstream Infections with a Focus on Staphylococcus aureus
The increased incidence over the past decade of bloodstream infections (BSIs) caused by gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus , highlights the critical need for a consistent approach to therapy. However, there is currently no international consensus on the diagnosis and management of gram-positive BSIs. The Clinical Consensus Conference on Gram-Positive Bloodstream Infections was convened as a session at the 9th International Symposium on Modern Concepts in Endocarditis and Cardiovascular Infections held in 2007. Participants discussed various aspects of the practical treatment of patients who present with gram-positive BSI, including therapeutic options for patients with BSIs of undefined origin, the selection of appropriate empirical therapy, and treatment of complicated and uncomplicated BSIs. The opinions of participants about these key issues are reflected in this articl
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
Reperfusion delay in patients with high-risk ST-segment elevation myocardial infarction: every minute counts, much more than suspected
Rapid MR assessment of left ventricular systolic function early after acute myocardial infarction using single breath-hold cine imaging with temporal parallel acquisition technique (TPAT) and 4D guide-point modeling
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