Routine thrombectomy in patients presenting with STEMI has remained controversial in light of recent randomized data. An individual patient based meta-analysis of the three randomized studies (TAPA, TASTE, and TOTAL) has concluded that routine thrombus aspiration during PPCI does not improve clinical outcomes. In patients with high thrombus burden, a trend towards reduced cardiovascular death but increased stroke rate was observed.
The LEADERS FREE study confirmed the safety and efficacy of the BioFreedom Biolimus A9 drug coated stent using a 1-month dual antiplatelet therapy regime in patients with high risk of bleeding. 2-Year data from the study has indicated that the safety and efficacy of the drug coated stent was maintained with similar rates of major bleeding and coronary thrombotic events. Multivariate correlates of major bleeding were age >75 years, anemia, raised creatinine, and planned long-term anticoagulation.
Although tranexamic acid may reduce bleeding complications in patients undergoing cardiac surgery, it is uncertain if this translates into improved clinical outcomes. A randomized study of patients undergoing CABG who were at risk of perioperative complications to either aspirin or placebo and tranexamic acid or placebo has concluded that tranexamic acid reduced the risk of bleeding but was associated with an increased risk of postoperative seizures.
The safety and efficacy of Cangrelor in combination with glycoprotein IIb/IIIa inhibitors (GPIs) has not been addressed. Pooled, patient level analysis of the three CHAMPION studies suggests that the efficacy of Cangrelor in reducing ischemic complications in patients undergoing PCI was maintained regardless of GPI administration although bleeding complications were greater.
CSI PodCase of the Month (Dec2016)
Dr. Lowell Satler - Director of the MedStar Washington Hospital Center Cath Lab talk with Dr. Chadi Alraies about the lastest PFO Closure Device for patients wtih cryptogenic stroke.
The causes and economical impact of early readmission following TAVR are unknown. Data from the 12221 TAVR patients has shown 30-day readmission rates of 17.9%, 61.8% of which were non-cardiac related. Independent predictors of 30-day readmission were length of stay > 5 days, acute kidney injury, >4 Elixhauser comorbidities, transapical TAVR, chronic kidney disease, chronic lung disease, and discharge to skilled nursing facility. Mean length of stay was 4 days and cost of readmission was approximately $8302.
As compared to permanent scaffolds, bioabsorbable vascular scaffolds (BVS) provide a number of theoretical advantages but the rates of stent thrombosis with BVS have remained problematic. A meta-analysis of 24 studies and including 22373 patients reporting the rates of very late stent thrombosis (VLST) in patients undergoing BVS or everolimus-eluting stents (EES) has confirmed higher rates of VLST with BVS between 1 and 2 years and ST through 2 years.
A number of randomized studies have advocated multivessel PCI in patients presenting with STEMI who are found to have multivessel disease. Data from the British Columbia Cardiac Registry of 6,503 STEMI patients has indicated that a strategy of culprit vessel intervention with staged revascularization is associated with lower mortality and rates of repeat revascularization compared to either multivessel PCI at the time of presentation or a strategy revascularization limited to the culprit vessel.
The prevention of contrast nephropathy (CN) has remained a challenge particularly in high-risk patients. In a study of 53 type II diabetic patients with renal impairment requiring coronary angiography, a strategy of coronary sinus aspiration simultaneously during each coronary injection was associated with a significant reduction in the development of CN. Investigators calculated that more than 1/3 of the given contrast could be removed through this technique.
Nicole Lou Reporter, MedPage Today/CRTonline.org
J McEvoy, et al.; Circ 2017; 135:153-65
J Kim, et al.; Circ 2017; 135:128-39
P Garot, wt al.; JACC 2017; 69:162-71
M Zettler, et al.; AJC 2017; 183:62-68
M Vaduganathan, et al.; JACC 2017; 69:176-85
Is there a role for embolic protection device in patients undergoing TAVR?
No role, without efficacy data
Role in selected group of patients
Role for every patient
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