The impact of TAVR, which has become standard therapy for patients with severe AS who are deemed high-risk for surgical intervention, upon long-term cognitive function are unknown. A study of 51 patients undergoing cognitive assessment at 30-days and 1 year post TAVR has indicated that TAVR is associated with global improvement in cognitive status that is more pronounced amongst those who had cognitive impairment prior to the procedure.
The FRISC-II study was a landmark study confirming the safety and efficacy of an early invasive strategy in patients presenting with non-ST elevation acute coronary syndrome. 15-year follow-up data from the study has indicated that the invasive strategy postponed death or next MI by a mean of 549 days, an effect that was larger in non-smokers, patients with elevated troponin and GDF-15.
A significant proportion of patients with suspected ST-elevation and undergoing angiography as part of a PPCI pathway are found to have unobstructed coronary arteries. A multimodality imaging study of such patients has indicated a 13% prevalence and aetiological diagnoses ranging from cardiomyopathies, myopericarditis, MI, severe valve disease, pulmonary embolism and type A aortic dissection.
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The optimal duration of dual antiplatelet therapy in patients undergoing complex PCI remains uncertain. Analysis of data from 6 randomized studies comparing long-term (≥12 months) versus short-term (3 or 6 months) in such patients has indicated that long-term DAPT leads to significant reduction in MACE. Long-term DAPT was associated with increased bleeding risk, which was similar between groups.
Differences in 30-day mortality rates following an acute MI and long-term survival in response to hospital performance are unknown. An analysis of 119,735 patients involving 1824 hospital has suggested that life expectancy declines as hospital risk-standardized mortality rate quintile increases. Patients treated in high-performance hospital may live 0.74 to 1.14 years longer than patients treated in low-performing hospitals.
The efficacy of hypothermia in survivors of in-hospital cardiac arrest is uncertain. A cohort study of 26,183patients successfully resuscitated from in-hospital cardiac arrest either treated or not treated with hypothermia has indicated that hypothermia therapy may be associated with lower in-hospital survival and favorable neurological survival.
TAVR has emerged as an effective treatment modality for severe aortic stenosis but long-term data for its efficacy are lacking. Data from the FRENCE-2 registry of 4,201 patients with a median follow-up of 3.8 years has indicated 3-year all cause mortality of 42% and cardiovascular mortality of 17.5%. Predictors of mortality were male sex, low BMI, AF, dialysis, NYHA class III or IV, higher EuroSCORE, transapical or subclavian approach, need for PPM, and post implant AR grade ≥2.
Chronic total occlusion (CTO) in a non-infarct related artery is present in up to 15% of the STEMI population but whether early intervention alters left ventricular function is unknown. The EXPLORE trial randomized 304 such patients to either additional PCI of the CTO within 1 week of successful primary PCI or optimal medical therapy and indicated that additional PCI of the CTO has no effect upon LVEF or LVEDV at 4-month follow-up.
Predictors of target vessel failure (TVF) defined as a composite of cardiac death, MI, ST or TVR following bifurcation stenting using a 2-stent strategy have not been clearly defined. Data from 951 patients has identified left main bifurcation, SYNTAX score >32 and diabetes as independent predictors of TVF. The use of second generation DES, non-compliant balloon and final kissing ballooning could be associated with better clinical outcomes.
Nicole Lou Reporter, MedPage Today/CRTonline.org
M Hivert, et al.; Circ 2016; 134:e308-e327
T Mittal, et al.; Heart 2016; 102:1728-1734
G Gennaro, et al.; AJC 2016; 118:1097-1104
L Wallentin, et al.; The Lancet 2016; 388:1903-1911
V Auffret, et al.; JACC 2016 ONLINE FIRST
Who among the presidential candidates have a better health care plan?
Not a major difference between their plans
Antreas Hindoyan, MD
Tarek Helmy, MD
J. Aaron Grantham, MD
Elena Ladich, MD, et al.
Alok Saurav, MD, et al.
Edward Koifman, MD, et al.
Shao-Liang Chen, MD, et al.
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