The document summarizes the results of clinical trials evaluating bioresorbable vascular scaffolds (BVS). It describes improvements made to the BVS device and platform (Cohort B) based on the findings of an initial clinical study (Cohort A), including making the strut distribution more uniform and the scaffold stronger initially to reduce late lumen loss. Results showed Cohort B had less reduction in scaffold area at 6 months compared to Cohort A and late lumen enlargement between 6 months and 2 years. The studies provide evidence that BVS devices can fully degrade and resorb over time while maintaining vessel patency.
Myocardial Viability - the STICH Trial NEJM May 2011callroom
This study examined whether testing for myocardial viability can identify patients with coronary artery disease and left ventricular dysfunction who benefit most from coronary artery bypass grafting (CABG) compared to medical therapy alone. Of over 1200 patients enrolled in the main trial, 601 who underwent viability testing by single-photon emission computed tomography (SPECT) or dobutamine echocardiography were included in this substudy. Patients who had viability testing were more likely to have certain risk factors and worse heart function. The study aimed to determine if viability testing could identify which patients would have improved survival rates with CABG versus medical therapy.
This study compared outcomes for 217 patients who received the MGuard stent versus 216 patients who received a bare metal stent for ST-elevation myocardial infarction. The MGuard stent aims to prevent distal embolization during angioplasty for STEMI. Results showed no differences in mortality, major adverse cardiac events, or cardiovascular mortality/non-fatal myocardial infarction between the groups. However, the rate of target lesion revascularization was significantly higher in the MGuard stent group compared to the bare metal stent group. The study concludes that the MGuard stent is a safe option for STEMI but is associated with a higher long-term rate of target lesion revascularization than bare metal stents.
This study evaluated radial artery injury after percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) at baseline and 9-month follow up in 100 patients. At baseline, 11% had intimal tears and 3% had medial dissections. At follow up, 10% had intimal tears and 7% had medial dissections, with no significant differences between time points. Compared to prior studies using longer sheaths, this study found a lower number of radial artery injuries, possibly due to the use of shorter 7cm sheaths. Serial OCT analysis found no persistent changes in arteries with initial injuries. This suggests short sheath use may reduce radial artery injury risk after transradial PCI.
This document discusses rehabilitation in heart transplant patients. It provides statistics on heart transplants performed from 1988-2006, including the most common causes of heart disease. It also discusses treatment at the time of transplant, trends in recipient characteristics, and survival rates post-transplant. Complications after transplant like hypertension, renal dysfunction, hyperlipidemia, diabetes and coronary altery disease are common. Exercise intolerance is also discussed. Rehabilitation including exercise training can help increase VO2 max and reduce complications like osteoporosis and obesity. Safety precautions during rehabilitation are also recommended.
Diabetes Mellitus & Multi vessel disease-part 1cardiositeindia
This document discusses diabetes and multivessel coronary artery disease. It summarizes data from the BARI and ARTS trials comparing outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease. The BARI and ARTS trials found that CABG resulted in better long-term outcomes compared to PCI with bare-metal stents in diabetic patients with multivessel disease. However, subsequent analyses found no difference in outcomes between CABG and PCI with drug-eluting stents in this patient population.
This document summarizes a study on mortality after head injuries conducted at JPN Apex Trauma Centre, AIIMS, New Delhi from November 2007 to October 2008. The study included 1286 head injury patients and found that mortality increased with the severity of injury based on GCS score, ranging from 3% for minor injuries to 35% for severe injuries. Risk of death was also higher for compound injuries, penetrating injuries, and among patients who did not survive beyond 48 hours of arrival. Overall mortality was found to be 23%, which compares favorably to international data.
Diabetes Mellitus and multivessel disease- Part iicardiositeindia
This document summarizes a study comparing percutaneous coronary intervention (PCI) using drug-eluting stents to coronary artery bypass grafting (CABG) for treating multivessel coronary artery disease in patients with diabetes (the CARDIA trial). Some key points:
- The CARDIA trial randomized 510 diabetic patients with multivessel or complex single vessel disease to either optimal PCI using drug-eluting stents plus abciximab or to CABG.
- At 1 year, the rates of death, myocardial infarction, stroke, and the composite of these events were not significantly different between the PCI and CABG groups, indicating PCI was non-inferior to CABG.
-
1) The document discusses the continuum of pain care for military service members and veterans, from the battlefield through transitions to different healthcare systems.
2) It describes reforms to the DoD and VA healthcare systems that implement a "medical home" model and "stepped care" approach to pain management, with primary care coordinating with pain medicine and rehabilitation specialists.
3) Key challenges include managing acute pain from battlefield injuries, preventing the transition to chronic pain, and ensuring continuity of care as service members move between active military health systems and the VA system.
Myocardial Viability - the STICH Trial NEJM May 2011callroom
This study examined whether testing for myocardial viability can identify patients with coronary artery disease and left ventricular dysfunction who benefit most from coronary artery bypass grafting (CABG) compared to medical therapy alone. Of over 1200 patients enrolled in the main trial, 601 who underwent viability testing by single-photon emission computed tomography (SPECT) or dobutamine echocardiography were included in this substudy. Patients who had viability testing were more likely to have certain risk factors and worse heart function. The study aimed to determine if viability testing could identify which patients would have improved survival rates with CABG versus medical therapy.
This study compared outcomes for 217 patients who received the MGuard stent versus 216 patients who received a bare metal stent for ST-elevation myocardial infarction. The MGuard stent aims to prevent distal embolization during angioplasty for STEMI. Results showed no differences in mortality, major adverse cardiac events, or cardiovascular mortality/non-fatal myocardial infarction between the groups. However, the rate of target lesion revascularization was significantly higher in the MGuard stent group compared to the bare metal stent group. The study concludes that the MGuard stent is a safe option for STEMI but is associated with a higher long-term rate of target lesion revascularization than bare metal stents.
This study evaluated radial artery injury after percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) at baseline and 9-month follow up in 100 patients. At baseline, 11% had intimal tears and 3% had medial dissections. At follow up, 10% had intimal tears and 7% had medial dissections, with no significant differences between time points. Compared to prior studies using longer sheaths, this study found a lower number of radial artery injuries, possibly due to the use of shorter 7cm sheaths. Serial OCT analysis found no persistent changes in arteries with initial injuries. This suggests short sheath use may reduce radial artery injury risk after transradial PCI.
This document discusses rehabilitation in heart transplant patients. It provides statistics on heart transplants performed from 1988-2006, including the most common causes of heart disease. It also discusses treatment at the time of transplant, trends in recipient characteristics, and survival rates post-transplant. Complications after transplant like hypertension, renal dysfunction, hyperlipidemia, diabetes and coronary altery disease are common. Exercise intolerance is also discussed. Rehabilitation including exercise training can help increase VO2 max and reduce complications like osteoporosis and obesity. Safety precautions during rehabilitation are also recommended.
Diabetes Mellitus & Multi vessel disease-part 1cardiositeindia
This document discusses diabetes and multivessel coronary artery disease. It summarizes data from the BARI and ARTS trials comparing outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease. The BARI and ARTS trials found that CABG resulted in better long-term outcomes compared to PCI with bare-metal stents in diabetic patients with multivessel disease. However, subsequent analyses found no difference in outcomes between CABG and PCI with drug-eluting stents in this patient population.
This document summarizes a study on mortality after head injuries conducted at JPN Apex Trauma Centre, AIIMS, New Delhi from November 2007 to October 2008. The study included 1286 head injury patients and found that mortality increased with the severity of injury based on GCS score, ranging from 3% for minor injuries to 35% for severe injuries. Risk of death was also higher for compound injuries, penetrating injuries, and among patients who did not survive beyond 48 hours of arrival. Overall mortality was found to be 23%, which compares favorably to international data.
Diabetes Mellitus and multivessel disease- Part iicardiositeindia
This document summarizes a study comparing percutaneous coronary intervention (PCI) using drug-eluting stents to coronary artery bypass grafting (CABG) for treating multivessel coronary artery disease in patients with diabetes (the CARDIA trial). Some key points:
- The CARDIA trial randomized 510 diabetic patients with multivessel or complex single vessel disease to either optimal PCI using drug-eluting stents plus abciximab or to CABG.
- At 1 year, the rates of death, myocardial infarction, stroke, and the composite of these events were not significantly different between the PCI and CABG groups, indicating PCI was non-inferior to CABG.
-
1) The document discusses the continuum of pain care for military service members and veterans, from the battlefield through transitions to different healthcare systems.
2) It describes reforms to the DoD and VA healthcare systems that implement a "medical home" model and "stepped care" approach to pain management, with primary care coordinating with pain medicine and rehabilitation specialists.
3) Key challenges include managing acute pain from battlefield injuries, preventing the transition to chronic pain, and ensuring continuity of care as service members move between active military health systems and the VA system.
This document summarizes the results of a randomized trial comparing outcomes of PCI performed at hospitals with and without on-site cardiac surgery. It found that at 6 weeks and 9 months, rates of death, heart attack, bleeding, stroke and other complications were similar between the two hospital types. However, PCI failure and use of bare-metal stents were higher, and staged procedures and catheterization lab visits were more frequent, at hospitals without on-site surgery.
This document summarizes the results of the ARISE trial, which compared the Angio-Seal vascular closure device to manual compression using a radial artery approach in 240 patients undergoing coronary procedures for acute coronary syndrome. The trial found no significant differences in vascular complications, major bleeding, transfusion needs, or other safety outcomes between the two approaches at 30 days. Specifically, the risk difference for the primary endpoint of vascular complications was -0.83% (95% CI, -9.31-7.65) in favor of Angio-Seal, meeting the prespecified non-inferiority criterion. The results demonstrate that Angio-Seal is not inferior to manual compression in terms of safety and effectiveness when
Multi Institutional Cohort to Facilitate Cardiovascular Disease Biomarker Val...HMO Research Network
This pilot study aims to incorporate emerging biomarkers into cardiovascular disease risk prediction models using existing biobank samples. The study retrospectively analyzed over 18,000 patients from two healthcare systems, identifying over 800 cases of acute myocardial infarction. Risk factors like age, sex, smoking history, blood pressure, diabetes and lipids were significant predictors of AMI. A simulated biomarker improved the predictive performance of risk models, correctly reclassifying hundreds of cases. An initial screen of genetic variants identified APOE and 9p21 as potentially useful biomarkers after validation in larger samples.
This document summarizes the 5-year clinical outcomes from the LEADERS trial, which compared the Biolimus A9-eluting stent with a biodegradable polymer to the Sirolimus-eluting stent with a durable polymer. The main findings over 5 years of follow-up were:
1) The Biolimus stent was non-inferior to the Sirolimus stent for the primary endpoint of major adverse cardiac events (MACE), comprising cardiac death, heart attack (MI), or clinically-indicated target vessel revascularization (TVR).
2) There were no significant differences between the stents in rates of cardiac death, heart attack (MI), or stent thrombosis.
This document analyzes the attributable costs of surgical site infections (SSI) and endometritis (EMM) after low transverse cesarean delivery. The authors used two different statistical methods, generalized least squares and propensity score matched-pairs analysis, to determine the costs. For SSI, the attributable total hospital cost was $3,529 using generalized least squares and $2,852 using propensity score matching. For EMM, the attributable total hospital cost was $3,956 using generalized least squares and $3,842 using propensity score matching. The majority of excess costs were due to room and board and pharmacy costs.
Top Five Clinical Trials of PCI in 2019 Han Naung Tun
"My five top trials in #interventionalcardiology in 2019". View this extensive slideset by Andreas Baumbach @EAPCIPresident where he covers the potential impact of these trials on clinical practice & their relevance for practice guidelines ow.ly/G64930q7R1K
#ESC
#EuroPCR
This document summarizes the evolution of percutaneous treatment for multivessel coronary artery disease over time, as new devices were introduced. It shows that the percutaneous approach was initially modified based on bare-metal stents, then drug-eluting stents, and techniques like provisional stenting. Studies compared outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) over many years. More recent data utilize the SYNTAX score to help determine the optimal revascularization strategy based on disease complexity. In conclusion, the percutaneous approach for multivessel disease has been refined with technological advances.
Study I examined associations between promoter methylation of 10 tumor suppressor genes (e.g. RASSF1A, GSTP1) in breast tumor tissue and prognosis in a population-based cohort of breast cancer patients followed for 8 years. Methylation of certain genes like GSTP1 and TWIST1 were associated with increased breast cancer mortality. Patients with more methylated genes had higher mortality, with a 41% increased risk of breast cancer death for each additional methylated gene. Overall, DNA methylation shows potential as a prognostic biomarker for breast cancer outcomes.
In this downloadable slideset, Joseph J. Eron, Jr., MD, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at potential future agents and strategies currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Date posted: 6/1/2016
The Two Faces of Geriatric Kidney DiseaseJoel Topf
1) A study modeled the outcomes of 10,000 older patients with CKD who received yearly evaluations over 18 years comparing reporting of creatinine levels versus eGFR using the MDRD formula. eGFR prevented 29 cases of ESRD and 13 premature deaths but also overdiagnosed CKD 11,348 times.
2) A 10-year study in Tromso, Norway of 58,086 people found that among those with eGFR of 30-59, two-thirds had no events while 31% died and 2% developed renal failure within 10 years on average. Older patients had faster loss of GFR but lower risk of renal failure.
3) A study of 112 older
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...Cristiano Amarelli
The document discusses a study examining risk factors for early graft failure (EGF) within 24 hours of heart transplantation. The study analyzed 317 transplant recipients and identified factors significantly associated with EGF, including male sex, redo surgery, high donor inotrope use, weight mismatch over 20%, and longer ischemic time. EGF occurred in 32 patients (10.1%) and was associated with high mortality of 52.9%.
Drug Characteristics Associated with Medication Adherence Across Eight Diseas...HMO Research Network
This study analyzed medication adherence across 8 disease states based on drug characteristics. Researchers found that adherence varied significantly based on whether drugs were generic or brand name, with generic drugs generally having higher adherence rates. Adherence also decreased as out-of-pocket costs for patients increased. When examining specific conditions, adherence was highest for hypertension drugs and lowest for asthma/COPD medications. Certain drug classes within conditions demonstrated different adherence levels as well. Overall, the study identified drug characteristics and costs as important factors influencing medication adherence across multiple diseases.
This document summarizes the experience with percutaneous coronary intervention (PCI) of the left main coronary artery at the Hungarian Institute of Cardiology between 2007-2008 and 2011. It finds that while the radial approach became more common and techniques like fractional flow reserve were used more in 2011, long-term outcomes like death, myocardial infarction, and revascularization remained similar between the periods. The best predictor of 5-year survival after left main PCI was found to be the SYNTAX II score.
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
1) Atrial fibrillation prevalence increases with age and is a global epidemic. It is more common in patients with cardiovascular disease or multiple risk factors. (2) Patients with atrial fibrillation have higher rates of cardiovascular events compared to those without. (3) NOACs (non-vitamin K antagonist oral anticoagulants) such as dabigatran, rivaroxaban, apixaban, and edoxaban were shown to be as effective or more effective than warfarin for stroke prevention, with lower rates of hemorrhagic stroke and intracranial bleeding in major clinical trials.
This document discusses the evolution of drug-eluting stent (DES) technology, including DES systems that use bioabsorbable polymers. Several bioabsorbable polymer DES systems are described, including the BioMatrix DES which uses a biodegradable polylactic acid polymer coating to deliver biolimus, and data is presented showing low late lumen loss and low rates of restenosis. Other bioabsorbable polymer DES discussed include the Synergy DES, DESyne, Inspiron, Orbus DES, and Biomine DES. The document highlights advantages of bioabsorbable polymer DES systems over durable polymer DES, as bioabsorbable polymers avoid long-term inflammation and delays in re-end
Which Chest Pain Can Be Safely Discharged From EdRashidi Ahmad
This document discusses strategies for evaluating and safely discharging chest pain patients from the emergency department (ED). It notes that over 30% of medical admissions are for chest pain, but only 50% actually have acute coronary syndrome (ACS). The diagnostic challenges include non-specific symptoms, limitations of electrocardiograms and cardiac markers in the early stages of ACS. Risk prediction tools like the TIMI score can help determine which low-risk patients may be safely discharged. Younger patients with no cardiac risk factors and normal initial tests have a very low 0.14% risk of ACS. Stress tests and echocardiography have limitations in the ED setting but may help rule out problems in some patients. The goal is to
This document discusses a phase I study of 225Ac-J591 for men with metastatic castration-resistant prostate cancer (mCRPC). The study tested single doses of 225Ac-J591, an alpha-emitting radiopharmaceutical targeting prostate-specific membrane antigen (PSMA), in escalating cohorts. No maximum tolerated dose was achieved, though one patient in the highest cohort experienced dose-limiting toxicities. Most patients had received multiple prior treatments, including androgen receptor-targeted therapies and PSMA-targeted radionucleotides. The results suggest 225Ac-J591 may be a promising targeted radiotherapy for mCRPC.
BioNIR/EluNIR eDES: 1 Year Outcomes of BIONICS and NIREUS studiesMedinol Ltd
Dr. David Kandzari's overview of the 1 year outcomes of the BIONICS and NIREUS pivotal & randomized studies of the EluNIR elastomer DES by Medinol (formerly BioNIR). Presented during TCT 2016
The document discusses renal denervation (RD), a procedure to treat resistant hypertension. It provides background on how sympathetic nerve fibers affect renal function and blood pressure. Studies show that RD reduces renal and total body norepinephrine spillover. One study found that RD reduced mean 24-hour systolic and diastolic blood pressure by 33/11 mmHg more than the control group. The document also discusses potential applications of RD for conditions like glucose intolerance, polycystic ovary syndrome, atrial fibrillation, heart failure, obstructive sleep apnea, and chronic kidney disease. It summarizes several studies reporting reductions in blood pressure, fasting glucose, insulin levels, and improved insulin sensitivity after RD. Open
El documento describe la historia y resultados de la denervación renal percutánea, un procedimiento para tratar la hipertensión arterial resistente. Se realizó en 126 pacientes en varias ciudades de Venezuela en 2012, logrando en la mayoría una disminución de la presión arterial sistólica. También resume la evolución histórica de las tecnologías utilizadas en este procedimiento.
More Related Content
Similar to Nuevas Fronteras en Cardiologia Intervencionista 2013
This document summarizes the results of a randomized trial comparing outcomes of PCI performed at hospitals with and without on-site cardiac surgery. It found that at 6 weeks and 9 months, rates of death, heart attack, bleeding, stroke and other complications were similar between the two hospital types. However, PCI failure and use of bare-metal stents were higher, and staged procedures and catheterization lab visits were more frequent, at hospitals without on-site surgery.
This document summarizes the results of the ARISE trial, which compared the Angio-Seal vascular closure device to manual compression using a radial artery approach in 240 patients undergoing coronary procedures for acute coronary syndrome. The trial found no significant differences in vascular complications, major bleeding, transfusion needs, or other safety outcomes between the two approaches at 30 days. Specifically, the risk difference for the primary endpoint of vascular complications was -0.83% (95% CI, -9.31-7.65) in favor of Angio-Seal, meeting the prespecified non-inferiority criterion. The results demonstrate that Angio-Seal is not inferior to manual compression in terms of safety and effectiveness when
Multi Institutional Cohort to Facilitate Cardiovascular Disease Biomarker Val...HMO Research Network
This pilot study aims to incorporate emerging biomarkers into cardiovascular disease risk prediction models using existing biobank samples. The study retrospectively analyzed over 18,000 patients from two healthcare systems, identifying over 800 cases of acute myocardial infarction. Risk factors like age, sex, smoking history, blood pressure, diabetes and lipids were significant predictors of AMI. A simulated biomarker improved the predictive performance of risk models, correctly reclassifying hundreds of cases. An initial screen of genetic variants identified APOE and 9p21 as potentially useful biomarkers after validation in larger samples.
This document summarizes the 5-year clinical outcomes from the LEADERS trial, which compared the Biolimus A9-eluting stent with a biodegradable polymer to the Sirolimus-eluting stent with a durable polymer. The main findings over 5 years of follow-up were:
1) The Biolimus stent was non-inferior to the Sirolimus stent for the primary endpoint of major adverse cardiac events (MACE), comprising cardiac death, heart attack (MI), or clinically-indicated target vessel revascularization (TVR).
2) There were no significant differences between the stents in rates of cardiac death, heart attack (MI), or stent thrombosis.
This document analyzes the attributable costs of surgical site infections (SSI) and endometritis (EMM) after low transverse cesarean delivery. The authors used two different statistical methods, generalized least squares and propensity score matched-pairs analysis, to determine the costs. For SSI, the attributable total hospital cost was $3,529 using generalized least squares and $2,852 using propensity score matching. For EMM, the attributable total hospital cost was $3,956 using generalized least squares and $3,842 using propensity score matching. The majority of excess costs were due to room and board and pharmacy costs.
Top Five Clinical Trials of PCI in 2019 Han Naung Tun
"My five top trials in #interventionalcardiology in 2019". View this extensive slideset by Andreas Baumbach @EAPCIPresident where he covers the potential impact of these trials on clinical practice & their relevance for practice guidelines ow.ly/G64930q7R1K
#ESC
#EuroPCR
This document summarizes the evolution of percutaneous treatment for multivessel coronary artery disease over time, as new devices were introduced. It shows that the percutaneous approach was initially modified based on bare-metal stents, then drug-eluting stents, and techniques like provisional stenting. Studies compared outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) over many years. More recent data utilize the SYNTAX score to help determine the optimal revascularization strategy based on disease complexity. In conclusion, the percutaneous approach for multivessel disease has been refined with technological advances.
Study I examined associations between promoter methylation of 10 tumor suppressor genes (e.g. RASSF1A, GSTP1) in breast tumor tissue and prognosis in a population-based cohort of breast cancer patients followed for 8 years. Methylation of certain genes like GSTP1 and TWIST1 were associated with increased breast cancer mortality. Patients with more methylated genes had higher mortality, with a 41% increased risk of breast cancer death for each additional methylated gene. Overall, DNA methylation shows potential as a prognostic biomarker for breast cancer outcomes.
In this downloadable slideset, Joseph J. Eron, Jr., MD, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at potential future agents and strategies currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Date posted: 6/1/2016
The Two Faces of Geriatric Kidney DiseaseJoel Topf
1) A study modeled the outcomes of 10,000 older patients with CKD who received yearly evaluations over 18 years comparing reporting of creatinine levels versus eGFR using the MDRD formula. eGFR prevented 29 cases of ESRD and 13 premature deaths but also overdiagnosed CKD 11,348 times.
2) A 10-year study in Tromso, Norway of 58,086 people found that among those with eGFR of 30-59, two-thirds had no events while 31% died and 2% developed renal failure within 10 years on average. Older patients had faster loss of GFR but lower risk of renal failure.
3) A study of 112 older
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...Cristiano Amarelli
The document discusses a study examining risk factors for early graft failure (EGF) within 24 hours of heart transplantation. The study analyzed 317 transplant recipients and identified factors significantly associated with EGF, including male sex, redo surgery, high donor inotrope use, weight mismatch over 20%, and longer ischemic time. EGF occurred in 32 patients (10.1%) and was associated with high mortality of 52.9%.
Drug Characteristics Associated with Medication Adherence Across Eight Diseas...HMO Research Network
This study analyzed medication adherence across 8 disease states based on drug characteristics. Researchers found that adherence varied significantly based on whether drugs were generic or brand name, with generic drugs generally having higher adherence rates. Adherence also decreased as out-of-pocket costs for patients increased. When examining specific conditions, adherence was highest for hypertension drugs and lowest for asthma/COPD medications. Certain drug classes within conditions demonstrated different adherence levels as well. Overall, the study identified drug characteristics and costs as important factors influencing medication adherence across multiple diseases.
This document summarizes the experience with percutaneous coronary intervention (PCI) of the left main coronary artery at the Hungarian Institute of Cardiology between 2007-2008 and 2011. It finds that while the radial approach became more common and techniques like fractional flow reserve were used more in 2011, long-term outcomes like death, myocardial infarction, and revascularization remained similar between the periods. The best predictor of 5-year survival after left main PCI was found to be the SYNTAX II score.
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
1) Atrial fibrillation prevalence increases with age and is a global epidemic. It is more common in patients with cardiovascular disease or multiple risk factors. (2) Patients with atrial fibrillation have higher rates of cardiovascular events compared to those without. (3) NOACs (non-vitamin K antagonist oral anticoagulants) such as dabigatran, rivaroxaban, apixaban, and edoxaban were shown to be as effective or more effective than warfarin for stroke prevention, with lower rates of hemorrhagic stroke and intracranial bleeding in major clinical trials.
This document discusses the evolution of drug-eluting stent (DES) technology, including DES systems that use bioabsorbable polymers. Several bioabsorbable polymer DES systems are described, including the BioMatrix DES which uses a biodegradable polylactic acid polymer coating to deliver biolimus, and data is presented showing low late lumen loss and low rates of restenosis. Other bioabsorbable polymer DES discussed include the Synergy DES, DESyne, Inspiron, Orbus DES, and Biomine DES. The document highlights advantages of bioabsorbable polymer DES systems over durable polymer DES, as bioabsorbable polymers avoid long-term inflammation and delays in re-end
Which Chest Pain Can Be Safely Discharged From EdRashidi Ahmad
This document discusses strategies for evaluating and safely discharging chest pain patients from the emergency department (ED). It notes that over 30% of medical admissions are for chest pain, but only 50% actually have acute coronary syndrome (ACS). The diagnostic challenges include non-specific symptoms, limitations of electrocardiograms and cardiac markers in the early stages of ACS. Risk prediction tools like the TIMI score can help determine which low-risk patients may be safely discharged. Younger patients with no cardiac risk factors and normal initial tests have a very low 0.14% risk of ACS. Stress tests and echocardiography have limitations in the ED setting but may help rule out problems in some patients. The goal is to
This document discusses a phase I study of 225Ac-J591 for men with metastatic castration-resistant prostate cancer (mCRPC). The study tested single doses of 225Ac-J591, an alpha-emitting radiopharmaceutical targeting prostate-specific membrane antigen (PSMA), in escalating cohorts. No maximum tolerated dose was achieved, though one patient in the highest cohort experienced dose-limiting toxicities. Most patients had received multiple prior treatments, including androgen receptor-targeted therapies and PSMA-targeted radionucleotides. The results suggest 225Ac-J591 may be a promising targeted radiotherapy for mCRPC.
BioNIR/EluNIR eDES: 1 Year Outcomes of BIONICS and NIREUS studiesMedinol Ltd
Dr. David Kandzari's overview of the 1 year outcomes of the BIONICS and NIREUS pivotal & randomized studies of the EluNIR elastomer DES by Medinol (formerly BioNIR). Presented during TCT 2016
Similar to Nuevas Fronteras en Cardiologia Intervencionista 2013 (20)
The document discusses renal denervation (RD), a procedure to treat resistant hypertension. It provides background on how sympathetic nerve fibers affect renal function and blood pressure. Studies show that RD reduces renal and total body norepinephrine spillover. One study found that RD reduced mean 24-hour systolic and diastolic blood pressure by 33/11 mmHg more than the control group. The document also discusses potential applications of RD for conditions like glucose intolerance, polycystic ovary syndrome, atrial fibrillation, heart failure, obstructive sleep apnea, and chronic kidney disease. It summarizes several studies reporting reductions in blood pressure, fasting glucose, insulin levels, and improved insulin sensitivity after RD. Open
El documento describe la historia y resultados de la denervación renal percutánea, un procedimiento para tratar la hipertensión arterial resistente. Se realizó en 126 pacientes en varias ciudades de Venezuela en 2012, logrando en la mayoría una disminución de la presión arterial sistólica. También resume la evolución histórica de las tecnologías utilizadas en este procedimiento.
Este documento discute los problemas y soluciones relacionados con las endoprótesis para aorta torácica. Algunos desafíos incluyen el perfil alto, la navegabilidad compleja y la adaptación al cayado aórtico irregular. Se han desarrollado varias soluciones como sistemas mallados, vainas hidrofílicas e introductores largos. Los sistemas de liberación secuencial y las barras laterales curvas ayudan a mejorar la aposición a la pared aórtica. Los diseños cónicos y
Este documento describe las características y resultados de un nuevo dispositivo de endoprótesis abdominal llamado Treovance. Ofrece un bajo perfil, fácil navegabilidad y liberación precisa. Proporciona múltiples sistemas de fijación para evitar migración y desconexión. Los estudios iniciales mostraron éxito técnico del 100% y bajas tasas de complicaciones a mediano plazo, comparables a otros dispositivos. Treovance puede tratar anatomías complejas y ofrece una alternativa prometedora para el trat
Este documento describe las ventajas potenciales del balón medicado como alternativa a los stents medicados en ciertas situaciones especiales. El balón medicado podría proporcionar una liberación más homogénea y rápida de fármacos sin dejar una malla metálica permanente. Estudios como PEPCAD han demostrado que el balón medicado es efectivo para el tratamiento de lesiones de alto riesgo de reestenosis como la reestenosis intrastent, vasos pequeños y bifurcaciones, con resultados angiográficos y clínicos sim
Este documento describe el papel del cardiólogo en la revascularización de pacientes diabéticos con pie diabético isquémico. Explica que la aterosclerosis es una enfermedad sistémica y que cada 30 segundos se pierde un miembro inferior por diabetes en algún lugar del mundo. Presenta los dos grandes síndromes del pie diabético: neuropático e isquémico. Luego, detalla el protocolo de tratamiento para el pie diabético isquémico, el cual incluye exámenes clínicos, tratamiento de in
La tercera definición universal de infarto del miocardio de 2012 introduce cambios en los criterios para la detección y clasificación del infarto, haciéndolo más dependiente de los biomarcadores cardíacos como la troponina de alta sensibilidad. Se define el infarto del miocardio como la muerte de células cardíacas debido a isquemia prolongada, y se clasifica en 5 tipos principales dependiendo de la causa subyacente.
Este documento resume los resultados de estudios sobre nuevos anticoagulantes orales (NACO) como alternativa a la warfarina en la prevención secundaria después de un síndrome coronario agudo (SCA). Resume los estudios RE-DEEM sobre dabigatrán y APPRAISE-1 sobre apixabán, mostrando que a dosis más altas aumentan el riesgo de sangrado pero no mejoran los resultados clínicos, lo que llevó a suspender el brazo de dosis alta en APPRAISE-1. También resume las caracter
Este documento presenta el stent liberador de fármacos híbrido Orsiro. Orsiro combina un recubrimiento pasivo de silicona llamado PROBIO que encapsula el stent, con un recubrimiento activo biodegradable llamado BIOlute que libera sirolimus de manera controlada. Estudios muestran que Orsiro ofrece excelente navegabilidad, perfil de cruce y liberación controlada de fármacos, con mínima inflamación vascular a largo plazo. La evidencia clínica sugiere que Orsiro es e
Este documento describe el enfoque del cirujano vascular para el tratamiento de la enfermedad arterial periférica (EAP). Define la EAP como las enfermedades vasculares causadas por aterosclerosis y procesos tromboembólicos que afectan la aorta, las arterias viscerales y las arterias de las extremidades inferiores. Explica los métodos de diagnóstico, incluidos los índices tobillo-brazo, y los tratamientos disponibles como el tratamiento médico, la angioplastia, los stents y la cirugía de
Este documento resume una presentación sobre la reserva de flujo coronario fraccionada (FFR) en un congreso de cardiología intervencionista. Explica que la FFR mide la fracción del flujo coronario máximo que puede alcanzarse a través de una estenosis, y que estudios como DEFER y FAME han demostrado que la FFR puede guiar decisiones de revascularización versus tratamiento médico óptimo para mejorar resultados para los pacientes.
Un paciente masculino de 37 años sufrió un accidente de tránsito que resultó en una fractura de pelvis y una transección aórtica. Se le implantó con éxito una endoprótesis aórtica para tratar la lesión aórtica, y posteriormente se resolvió quirúrgicamente la fractura de pelvis. Los exámenes posteriores mostraron una buena evolución sin complicaciones, por lo que el paciente fue dado de alta.
Este documento presenta el caso de una paciente de 78 años que recibió una revascularización percutánea del tronco principal e implante de endoprótesis valvular aórtica CoreValve debido a una estenosis valvular aórtica severa y enfermedad arterial coronaria obstructiva de 3 vasos. La intervención transcatéter fue exitosa sin complicaciones. A los 6 meses de seguimiento, la paciente presentaba un gradiente transvalvular aórtico bajo y ninguna insuficiencia valvular residual o eventos cardiovasculares adversos.
Este documento describe un caso de revascularización percutánea guiada por ultrasonido de la arteria circunfleja con origen anómalo en una paciente de 57 años. La paciente tuvo un infarto y angiografía mostró estenosis significativa en la arteria circunfleja. Se usó ultrasonido intracoronario para evaluar la lesión y guiar la implantación exitosa de un stent medicado. El origen anómalo de la arteria era poco común pero el ultrasonido demostró ser útil para navegar la arteria tortuosa y evaluar tromb
El estudio DECLARE-LONG II encontró que el tratamiento con stent medicado seguido de cilostazol redujo la reestenosis tardía en pacientes con lesiones coronarias largas en comparación con el tratamiento con stent medicado seguido de placebo. Los pacientes tratados con stent medicado y cilostazol tuvieron tasas significativamente menores de pérdida de diámetro intrastent y segmentaria a los 8 meses, así como tasas más bajas de reestenosis intrastent, reestenosis intrasegmentaria y revascularización de la lesión diana a
Este documento resume los resultados de una reunión de la organización SOLACI sobre el estado actual de la cardiología intervencionista en Latinoamérica. Se discutió que las enfermedades cardiovasculares están aumentando en la región a pesar de reducciones recientes en la mortalidad. Los sistemas de salud son ineficientes y las inversiones en cardiología son inadecuadas. Se propuso promover la educación pública, aumentar la participación gubernamental, crear asociaciones civiles, fomentar programas de angioplastia primaria y mejorar
Este documento presenta el caso de una paciente de 66 años con diabetes que desarrolló un pseudoaneurisma en la arteria femoral común izquierda después de someterse a una angiografía de las extremidades inferiores. La paciente fue trasladada a una sala de hemodinamia donde se utilizó trombina guiada por ultrasonido para cerrar con éxito el pseudoaneurisma, lo que permitió su alta hospitalaria después de 72 horas. El documento concluye que la inyección de trombina guiada por ecografía es una técnica mínim
Se trata de paciente masculino de 83 años de edad con diagnostico de DM tipo 2 insulino dependiente en insucificiencia cardíaca en clase funcional II/IV por cardiopatía hipertensiva y valvulopatía
Este documento presenta el caso de un hombre de 63 años que sufrió una pérdida súbita de la conciencia mientras estaba de pie, precedida de dolor torácico. Las pruebas mostraron una dilatación importante de la raíz de la aorta y una insuficiencia aórtica. El mecanismo de la pérdida de conciencia se consideró neuromediado debido al dolor causado por una disección de la aorta. El paciente fue sometido a una cirugía de reparación del aneurisma con implante de un tubo val
Este documento presenta el caso clínico de un paciente de 24 años con síndrome de Brugada detectado en un examen de rutina. El paciente no presentaba síntomas pero tenía antecedentes familiares de muerte súbita. Se realizaron pruebas adicionales que confirmaron el diagnóstico y mostraron alto riesgo de arritmias. Se implantó un desfibrilador cardíaco que efectivamente trató un episodio posterior de fibrilación ventricular. El síndrome de Brugada es una causa frecuente de muerte súbita
More from Sociedad Venezolana de Cardiología Intervencionista (SOVECI) (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Nuevas Fronteras en Cardiologia Intervencionista 2013
1. XI Congreso de Cardiología
Intervencionista – SOVECI 2013
Caracas, Venezuela, 21-23 Febrero, 2013
“Nuevas Fronteras en
Cardiología Intervencionista”
J. Eduardo Sousa
Instituto Dante Pazzanese de Cardiologia
Hospital do Coração
Dante
Pazzanese São Paulo, Brasil
2. XI Congreso de Cardiología
Intervencionista – SOVECI 2013
Caracas, Venezuela, 21-23 Febrero, 2013
J. Eduardo Sousa
Instituto Dante Pazzanese de Cardiologia
Hospital do Coração
São Paulo, Brasil
3. Novas Fronteiras em
Cardiologia Intervencionista
Dos Balões aos Stents Bioabsorvíveis
Doenças Estruturais: TAVI
Procedimentos Híbridos
4. Os Três Componentes da Primeira Geração da Nova
Biotecnologia para Prevenção da Reestenose (*)
Polímero
(veículo carreador)
Stents Agente
Plataforma Farmacológicos Farmacológico
de 1ª Geração
Prevenção:
da proliferação CML (sem apoptose)
da excessiva produção de matriz
(*) Ideal: PT < 0,50mm; Reestenose angiográfica < 10%; RLA < 5%
5. FIM: Sirolimus-Eluting Stents
Dante
Pazzanese
FIRST IN MAN Study
J. Eduardo Sousa, MD, PhD, FACC
Instituto Dante Pazzanese de Cardiologia
São Paulo - Brazil
6. Circulation 2001;103:192-5
Sustained Suppression of Neointimal Proliferation by
Sirolimus-Eluting Stents
One-Year Angiographic and Intravascular Ultrasound Follow-Up
J. Eduardo Sousa, MD, PhD; Marco A. Costa, MD, PhD; Alexandre C. Abizaid, MD, PhD;
Benno J. Rensing, MD, PhD; Andrea S. Abizaid, MD; Luiz F. Tanajura, MD; Ken Kozuma, MD;
Glenn Van Langenhove, MD, PhD; Amanda G.M.R. Sousa, MD, ‘PhD; Robert Falotico, PhD;
Judith Jaeger, BA; Jeffrey J. Popma, MD; Patrick W. Serruys, MD, PhD
Circulation 2001;104:2007-11
8. Two-Year Angiographic and Intravascular Ultrasound
Follow-Up After Implantation of Sirolimus-Eluting Stents in
Human Coronary Arteries
J. Eduardo Sousa, MD, PhD; Marco A. Costa, MD, PhD; Amanda G.M.R. Sousa, MD, PhD;
Alexandre C. Abizaid, MD, PhD; Ana C. Seixas, MD; Andrea S. Abizaid, MD; Fausto Feres,
MD, PhD; Luiz A. Mattos, MD, PhD; Robert Falotico, PhD; Judith Jaeger, BA; Jeffrey J.
Popma, MD; Patrick W. Serruys, MD, PhD
Circulation 2003;107:381-383
Four-Year Angiographic and Intravascular Ultrasound
Follow-Up of Patients Treated with Sirolimus-Eluting Stents
J. Eduardo Sousa, MD, PhD; Marco A. Costa, MD, PhD; Alexandre Abizaid, MD, PhD; Fausto
Feres, MD, PhD, Ana C. Seixas, MD; Luiz F. Tanajura, MD, PhD; LuizA. Mattos, MD, PhD,
Robert Falotico, PhD; Judith Jaeger, BA; Jeffrey J. Popma, MD; Patrick W. Serruys, MD,
PhD, Amanda G.M.R. Sousa, MD, PhD
Circulation 2005;111:2326-9
9. Meta-análise: Stents Farmacológicos X Não Farmacológicos
183.772 pacientes - II
- 30 registros envolvendo 174.302 ptes. (BMS X DES – Off
label) com evolução > 1 ano. Os DES apresentaram:
• 20% de redução significativa no nº de óbitos
HR 0,80 (0.72, 0.88)
• 11% de redução significativa na ocorrência
do IM - HR 0,89 (0.80, 0.98)
• 47% de redução significativa da revascularização
do vaso alvo - HR 0,53 (0.47, 0.61)
Kirtane AJ, Stone GW. ACC-2008.
10. Stents Farmacológicos
Uso Clínico no Brasil
1ª Geração: 2002 - 2011
CYPHER® - Sirolimus
TAXUS® - Paclitaxel
2ª Geração: 2005 -2011
ENDEAVOR® /RESOLUTE® - Zotarolimus
XIENCE V® /PROMUS® - Everolimus
BIOMATRIX® - Biolimus A9*
* Polimero bioabsorvível
11. LEADERS: 5-Year Follow-Up from a
Prospective, Randomized, Trial of
Biolimus A9-Eluting Stents with a
Biodegradable Polymer vs. Sirolimus-
Eluting Stents with a Durable Polymer
P. W. Serruys, P. Buszman, A. Linke, T. Ischinger,
D. Antoni, V. Klauss, H. Y. Sohn, F. Eberli, R. Corti,
W. Wijns, M. C. Morice, C. Di Mario, P. Jüni,
S. Windecker
Serruys P. TCT 2012
14. DESIRE Registry - Hospital do Coração
(Drug-Eluting Stents In the REal World)
PI: J. Eduardo Sousa
May 2002 – June 2012
São Paulo, Brazil
15. Maio 2002 – Junho 2012
População
(n= 4.229 P)
Implante do Stent
Farmacológico
(n= 7.000 SF)
16. Incidence and Predictors of Very Late
(> 4 Years) Major Cardiac Adverse
Events in the DESIRE (Drug-Eluting
Stents in the Real World)-Late Registry
J. Ribamar Costa, JR, MD, Amanda Sousa, MD, PHD, Adriana
C. Moreira, MD, Ricardo A. Costa, MD, Manuel Cano, MD, Galo
Maldonado, MD, Cantídio Campos, BS, Mariana Carballo, BS,
Ricardo Pavanello, MD, J. Eduardo Sousa, MD
JACC Cardiovascular Interventions 2010;3(1):12-8
17. 1.010 P / 1.408 SF
(1,4 stents/ P)
Cypher®
81%
Taxus®
19%
18. DESIRE-Late Registry: Cardiac Death
Cumulative Incidence
Costa JR et al. JACC Cardiovascular Interventions 2010;3(1):12-8
26. Everolimus-Eluting
Bioresorbable Vascular Scaffold
ML VISION Bioresorbable Bioresorbable
Everolimus
Delivery System Device Platform Coating
• Seven • Polylactide • Polylactide • Similar dose and
generations of (PLLA) (PDLLA) coating release rate to
MULTI-LINK • Naturally • Fully
XIENCE V
success resorbed, fully
metabolized biodegradable
• World-class
deliverability
All illustrations are artists’ renditions
26
27. ABSORB Cohort A (PI P. Serruys)
Clinical Study Overall Population
30 patients
n = 4 excluded in Per Treatment Population
(3 received non-BVS stent, 1 device failure)
Intent to treat Per treatment
6-month 30 patients 26 patients
follow-up clinical QCA
n = 1 missed F/U visits*
n = 1 missed
F/U visits* n = 1 non-cardiac death**
n = 5 refused angiography
29 patients 19 patients
2 & 3-year 2-year
follow-up clinical QCA/IVUS follow-up
*One patient missed the 9, 12, 18 month and 2 year visits
**Two patients died of non-cardiac causes at 706 and 888 days
Serruys, PW., AHA 2009.
28. ABSORB Cohort A
Temporal Lumen Dimensional Changes, Per Treatment
Post-PCI 6 Mos. 24 Mos.
n = 25 n = 25 n = 19
Scaffold
Area
ABSORB MLA = 5.09mm2 11.8% 3.92mm2 4.34mm2 17.2%
Cohort A
Late Loss = 0.43 mm
Late lumen loss at 6 months mainly due to reduction in scaffold area
Very late lumen enlargement noted from 6 months to 2 years
Serruys, PW, et al. Lancet 2009; 373: 897-910.
29. BVS Device Optimization
• More uniform strut distribution
• More even support of arterial wall
• Lower late scaffold area loss
―Maintain radial strength for at
Cohort A least 3-4 months
• Storage at room temperature
• Improved device retention
• Unchanged:
Cohort B – Material, coating and backbone
– Strut thickness
– Drug release profile
– Total degradation Time
30. ABSORB Cohort B
• N = 101; 12 sites (Europe, Australia, New
Zealand) PIs: P. Serruys, J. Ormiston
• Clinical follow-up schedule:
– 30 days, 6 months, 12 months, annually to 5 years
• Imaging schedule:
Group 1 (n = 45)
6 12 24
QCA, IVUS, OCT, IVUS VH Baseline Months Months Months
Group 2 (n = 56)
31. ABSORB Cohort A and B
Temporal Lumen Dimensional Changes
Post-PCI 6 Mos. 24 Mos.
n = 25 n = 25 n = 18
Scaffold
ABSORB Area
Lumen
Cohort A Lumen Area Area
11.8% 5.19 mm2 5.46 mm2
Unpaired
6.04 mm2 10.85%
Analysis*
Late Loss = 0.43 mm
n = 33
n = 33 n = 33
Scaffold
ABSORB Area
Lumen
Mean Lumen Area Area
Cohort B 6.36 mm2 6.85 mm2
6.53 mm2 1.7%
Serial Analysis** 7.7%
Late Loss = 0.19 mm
*Serruys, PW., TCT 2008
**Serruys, PW., TCT 2011
32. ABSORB EXTEND: PI: A. Abizaid
Non-Randomized, Single-Arm, Continued Access Trial
1000 subjects
Up to 100 OUS sites
Clinical follow-up
30d 6mo 12 mo 24 mo 36 mo
MSCT follow-up
OCT follow-up
Study Objective: Continued Access trial. FPI: Jan 11, 2010
Endpoints: No hypothesis-testing, typical PCI clinical endpoints
Treatment: Up to 2 de novo lesions in different epicardial vessels
Planned overlapping allowed in lesions >22 and ≤ 28 mm
Device Sizes: Scaffold diameters: 2.5, 3.0 mm
Scaffold lengths: 18, 28 mm
33. MACE Through 6 Months
10
Cohort B
EXTEND 194-day HR
1.99 [0.58,6.87]
p=0.27*
MACE (%)
5.0%
5
Δ = 2.5%
2.5%
0
0 30 60 90 120 150 180 210 240
Time Post Index Procedure (Days)
Number at risk
Time after index procedure (days) 0 37 194
Cohort B 101 99 96
EXTEND 200 195 194
* P-value is not from formal hypothesis testing and is displayed for descriptive purpose only.
34. DESolve™ Bioresorbable Coronary Scaffold
Taking advanced technologies from … and incorporating them into a scaffold
Elixir’s DES platforms … that bioresorbs over 1 – 2 years
Excellent radial strength
Low recoil PLLA-based polymer with excellent
Drug release to provide sustained durability and flexibility
neointimal inhibition Proven biocompatibility
Low drug dose Proprietary fabrication and processing
technology
• Broad range of sizes
• 3.0, 3.25, and 3.5 mm diameters
• 2.5, 2.75, and 3.75 available soon
• 14 and 18 mm lengths
35. DESolve FIM Study Design
Single, de novo coronary artery lesions
reference vessel diameter: 3.0mm
lesion length: ≤10mm, DAPT 12 months
Myolimus 3mcg/mm
3 sites
16 patients enrolled
Belgium and New Zealand
Clínico
30d 6mo 1yr 2yr 3yr 4yr 5yr
QCA, USIC e OCT
Principal Imaging Endpoint:
6-month in-stent late lumen loss
Desfechos principais
Clínico: ECAM (óbito cardíaco, IAM relacionado ao vaso tratado e RLA guiada por isquemia) e
trombose do SVA
ACQ: perda luminal tardia, reestenose binária e % de estenose intra stent
USIC: % de obstrução do stent
OCT: Descrição quaitativa e quantitiva do segmento e das hastes
MSCT: Descrição quaitativa e quantitiva da morfologia vascular aos 12 e 24 meses
36. QCA
In-scaffold Analysis n=14 (paired)
RVD (mm)
post-procedure 2.84 ± 0.23
at 6 months 2.78 ± 0.27
MLD (mm)
post-procedure 2.60 ± 0.19
at 6 months 2.41 ± 0.28
% Diameter Stenosis
post procedure 8.05 ± 7.90
at 6 months 12.63 ± 11.37
Acute Recoil (%) 6.4 ± 4.6
Late Lumen Loss (mm) at 6 months 0.19 ± 0.19
Binary Restenosis (%) at 6 months 0.0
37. IVUS
Post-PCI 6 months
MLA =
MLA =
5.10
5.35 mm2
mm2
n=11 (paired)
In-scaffold Serial Analysis Post-procedure 6 months
Mean Scaffold Area (mm2) 5.35 ± 0.78 5.61 ± 0.81*
Mean Lumen Area (mm2) 5.35 ± 0.78 5.10 ± 0.78*
% Volume Obstruction at 6 months -- 7.18 ± 3.37
Malapposition (%) 0 0
*p=ns between baseline and follow-up
38. OCT
6-month
In-scaffold Cross Section Level Serial Analysis Baseline Follow-up
n=10 (paired)
Mean Scaffold area (mm2) 6.57 ± 0.68 6.80 ± 0.85*
Mean NIH Area (obstructive) (mm2) -- 0.71 ± 0.36
Mean NIH Obstruction (%) 13.16 ± 5.59
--
In-scaffold Strut Level Serial Analysis
Total number of Analyzed Struts 2,984 2,575
Frequency of covered Struts/patient (%) -- 98.68 ± 2.44
Mean NIH Thickness over Covered Struts (mm) -- 0.12 ± 0.04
*p=ns between baseline and follow-up
39. Pre Post Follow-up
NOT CALIBRATED NOT CALIBRATED
01-WEP
48. Centro de Intervenções em Doenças
Estruturais do Coração - CIDEC
Dante - Programa Prótese Aórtica -
Pazzanese
Intervencionista Cirurgião Cardiologista
Eduardo Sousa L. C. Bento Souza Amanda Sousa
Alexandre Abizaid Magaly Arrais Auristela Ramos
Dimytri Siqueira
Manuel Cano
Ribamar Costa
Antonio Kambara
Tomografia Ecocardiografista
Ibraim Pinto Jorge Assef
Tiago Senra Anestesista Rodrigo Barreto
Caetano Nigro David Le Bihan
Mercedes Maldonado
49. Experiência Dante Pazzanese
Novembro de 2009 a Fevereiro de 2013
Características clínicas n = 112 pacientes
Idade, anos 81,6 ± 7,0
Sexo feminino 64,0%
Classe III / IV NYHA 87,0%
Diabetes 26,1%
HAS 65,2%
DPOC 8,7%
FA / Flutter 11,9%
Insuficiência renal* 77,7%
EuroSCORE logístico, % 24,3 ± 14,1%
* Clearance de Creatinina < 60 ml/min
50. Experiência Dante Pazzanese
Novembro de 2009 a Fevereiro de 2013
Aspectos técnicos n = 112 pacientes
Anestesia
Geral 96,7%
Sedação 3,3%
Eco transesofágico 96,7%
Acesso
Femoral 91,3%
Subclávia 1,1%
Transapical 3,2%
Transaórtico 5,4%
Prótese utilizada
Corevalve® 75%
Sapien XT® 15,2%
Acurate Symetis® 10,0%
51. Experiência Dante Pazzanese
Novembro de 2009 a Fevereiro de 2013
Eventos Cardíacos Adversos em 30 Dias
Mortalidade 13,0%
Acidente vascular cerebral 2,2%
Complicações vasculares maiores 6,5%
Complicações hemorrágicas maiores 7,6%
Necessidade de marcapasso 15,6%
67. AVV, 80 anos, sexo masculino 31/01/2013
TAVI (Transaórtica)
Valvoplastia com balão
Eletrodo de marcapasso
provisório
68. AVV, 80 anos, sexo masculino 31/01/2013
TAVI (Transaórtica)
Liberação da prótese Core valve® Nº31
69. WMS, 86 anos, sexo masculino 21/01/2013
86 Anos: ACD + TAVI (Staged)
Pré Pós
Xience
2,75 x 12mm
Xience
3,5 x 15mm
Xience
4,0 x 15mm
70. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Aortografia inicial
Valva aórtica bicúspide
71. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Valvoplastia com balão
72. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Liberação da prótese Core valve® Nº29
73. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Houve deslocamento da prótese
Plano valvar
74. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Tração da prótese para a aorta ascendente
Prótese
tracionada
Laço
75. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Laço
Laço
1ª prótese
1ª prótese
2ª prótese
2ª prótese
76. WMS, 86 anos, sexo masculino 29/01/2013
86 Anos: ACD + TAVI (Staged)
Após o procedimento, ausência de
gradiente VE-Ao
VE = 192 x 46mmHg
Ao = 140 x 70mmHg VE = 96 x 20mmHg
Ao = 96 x 50mmHg
77. Novas Fronteiras em
Cardiologia Intervencionista
Dos Balões aos Stents Bioabsorvíveis
Doenças Estruturais: TAVI
Abordagem Híbrida
78.
79.
80.
81.
82. Sala Híbrida
Dante
Pazzanese
Procedimentos: Maio 2011 / Janeiro 2012
Total: 75
12
11 TAVI
C. Congênitas
10
9 Vascular
Apêndice AE 8
8
7 7 “Leak”
6
Número
6
4 4
4
3 3
22 2 2
2
1 1 1 1 1
0
83. Dante
Acesso Transapical
Pazzanese
Direto + anterogrado - controle (curta distancia)
Sem limite do introdutor- diametero (versatil - novos
devices)
Aplicavel para arteriopatas (doenca vascular periferica)
Não passa pelo arco aórtico (menos AVC)
88. Conclusões - I
1- A Cardiologia Intervencionista tem hoje
posição invejável na liderança das técnicas de
revascularização miocárdica. Os resultados
clínicos são próximos à excelência.
2- Entretanto, necessitamos avançar algo mais
em relação à segurança, haja visto os novos
dados de ocorrência tardia de trombose dos
stents, ainda que em níveis baixos (1-2%/ano).
89. Conclusões - II
3- No momento, as melhores propostas de controle
deste fenômeno são: polímeros bioabsorvíveis,
stents sem polímeros e a possibilidade concreta
de aplicação clínica dos stents bioabsorvíveis.
4- A Cardiologia Intervencionista fortalece-se ainda
mais com a consolidação da técnica de implante
de prótese aórtica por via percutânea e o
crescimento da abordagem híbrida no tratamento
das afecções cardiovasculares complexas.