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Antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention. 经皮冠状动脉介入术后心房颤动患者的抗血栓治疗。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-10-20 DOI: 10.1080/14779072.2024.2388265
Mark Anthony Sammut, Robert F Storey

Introduction: Patients who undergo percutaneous coronary intervention (PCI) with stenting usually require a period of dual antiplatelet therapy (DAPT) but, when an indication for long-term oral anticoagulation (OAC) such as atrial fibrillation (AF) coexists, triple antithrombotic therapy (TAT) with DAPT and OAC causes concern for excessive bleeding. Achieving the right balance between bleeding and adequate protection from ischemic events remains an issue of debate and subject to ongoing investigation of various antithrombotic regimens and durations.

Areas covered: This review describes the landmark clinical trials comparing TAT to a period of dual antithrombotic therapy (DAT) and subsequent meta-analyses. It also describes the international recommendations that have been derived from this evidence and identifies outstanding issues that could be addressed in upcoming or future trials.

Expert opinion: The current recommended default strategy of a short period of TAT with clopidogrel followed by the withdrawal of aspirin faces a challenge from the prospect of more consistent P2Y12 inhibition provided by ticagrelor and prasugrel. Ticagrelor monotherapy has already been trialed in patients after PCI without an indication for OAC. DAT with ticagrelor or prasugrel immediately post-procedure could emerge as a comparably safe and more efficacious regimen than one involving clopidogrel in the right setting.

导言:接受经皮冠状动脉介入治疗(PCI)和支架植入术的患者通常需要一段时间的双重抗血小板治疗(DAPT),但当心房颤动(AF)等长期口服抗凝药(OAC)的适应症同时存在时,DAPT 和 OAC 的三重抗血栓治疗(TAT)会导致出血过多的问题。如何在出血和充分预防缺血性事件之间取得适当的平衡仍是一个争论不休的问题,各种抗血栓治疗方案和持续时间的研究仍在进行中:本综述介绍了具有里程碑意义的临床试验,这些试验将 TAT 与一段时间的双重抗血栓治疗 (DAT) 进行了比较,并进行了后续的荟萃分析。本综述还介绍了从这些证据中得出的国际建议,并指出了在即将进行的或未来的试验中可以解决的未决问题:目前推荐的默认策略是使用氯吡格雷进行短期 TAT,然后停用阿司匹林,这一策略面临着挑战,因为替卡格雷和普拉格雷具有更稳定的 P2Y12 抑制作用。替卡格雷单药疗法已在无 OAC 适应症的 PCI 后患者中试用。在合适的情况下,术后立即使用替卡格雷或普拉格雷的 DAT 可能会成为比使用氯吡格雷更安全、更有效的治疗方案。
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引用次数: 0
Clinical implications of combination proton pump inhibitor and triple therapies in patients with atrial fibrillation following percutaneous intervention: a guide for clinicians. 经皮介入治疗后心房颤动患者联合使用质子泵抑制剂和三联疗法的临床意义:临床医师指南。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-09-12 DOI: 10.1080/14779072.2024.2401865
Jacob J Gries, Bing Chen, Hafeez Ul Hassan Virk, Umair Khalid, Hani Jneid, Yochai Birnbaum, Carl J Lavie, Chayakrit Krittanawong

Introduction: Patients on systemic oral anticoagulation with vitamin K antagonists (VKA) or non-vitamin K oral anticoagulants (NOAC) often require triple therapy following percutaneous coronary intervention, substantially increasing the risk of bleeding. Gastroprotective agents like proton pump inhibitors (PPI) are often employed to mitigate this risk, despite potential competitive inhibition between P2Y12-receptor inhibitors, NOACs, and VKAs. While the interactions and clinical outcomes of PPIs and DAPT have been frequently explored in literature, not many studies have evaluated the same outcomes for triple therapy.

Areas covered: This comprehensive narrative review of three studies on PPIs and triple from the PubMed/MEDLINE database supplemented by 23 other relevant studies aims to use the available literature to analyze the potential interactions between PPIs and triple therapy while shedding light on their mechanisms, clinical implications, and areas for optimization.

Expert opinion: If triple therapy is indicated following PCI, then patients at high-risk for bleeding may benefit from transition to apixaban and a PPI to lower the risk of gastrointestinal bleeding. More research is needed to determine the role of PPIs in triple therapies in prevention of gastrointestinal bleeding or potentiation of other adverse outcomes.

导言:使用维生素 K 拮抗剂 (VKA) 或非维生素 K 口服抗凝剂 (NOAC) 进行全身口服抗凝治疗的患者在经皮冠状动脉介入治疗后往往需要三联疗法,这大大增加了出血风险。尽管 P2Y12 受体抑制剂、NOAC 和 VKA 之间存在潜在的竞争性抑制作用,但为了降低这种风险,通常会使用质子泵抑制剂 (PPI) 等胃保护剂。虽然文献中经常探讨 PPI 和 DAPT 的相互作用和临床疗效,但对三联疗法的相同疗效进行评估的研究并不多:本综述对 PubMed/MEDLINE 数据库中有关 PPIs 和三联疗法的三项研究进行了全面的叙述性综述,并对其他 23 项相关研究进行了补充,旨在利用现有文献分析 PPIs 和三联疗法之间的潜在相互作用,同时阐明其机制、临床影响和需要优化的领域:专家观点:如果PCI术后需要三联疗法,那么出血高风险患者可能会受益于阿哌沙班和PPI的过渡治疗,以降低胃肠道出血风险。需要开展更多研究,以确定三联疗法中的 PPI 在预防胃肠道出血或加重其他不良后果方面的作用。
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引用次数: 0
Incidence and predictors of acute coronary syndrome after transcatheter mitral valve repair. 经导管二尖瓣修复术后急性冠状动脉综合征的发病率和预测因素。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-09-19 DOI: 10.1080/14779072.2024.2398443
Mishita Goel, Irfan Shafi, Adel Elmoghrabi, Karthik Ramaseshan, Mohammed M Uddin, Nasser Lakkis, Chadi Alraies

Background: Acute coronary syndrome (ACS) post-transcatheter mitral valve repair (TMVR) carries high mortality. We aim to study the incidence and predictors of ACS in patients who underwent TMVR.

Research design and methods: We queried the U.S. National Readmission Database to identify all cases of TMVR from 2016 to 2019. We further evaluated the incidence of ACS and used multivariable logistic regression to determine independent predictors of ACS in this population.

Results: Among 3,742 patients who underwent TMVR, 264 (7.05%) developed ACS. Among ACS patients, 204 (77%) had non-ST-segment elevation ACS and 66 (25%) had ST-segment elevation ACS. Independent predictors of ACS were acute limb ischemia, cardiogenic shock, history of coronary artery disease (CAD), smoking, cardiac arrest, respiratory failure requiring mechanical ventilation, and acute kidney injury. In-hospital mortality among ACS was three times higher in ACS patients than without ACS (16.76% vs. 5.45%, p-value < 0.01).

Conclusions: ACS is not an uncommon complication after TMVR. The occurrence of ACS after TMVR is associated with high in-hospital mortality, longer length of stay, and higher hospital charges. The strongest predictors of ACS in these patients are the development of acute limb ischemia, cardiogenic shock, and a history of CAD.

背景:经导管二尖瓣修复术(TMVR)后急性冠状动脉综合征(ACS)的死亡率很高。我们旨在研究接受经导管二尖瓣置换术(TMVR)患者的急性冠状动脉综合征(ACS)发生率和预测因素:我们查询了美国国家再入院数据库,以确定 2016 年至 2019 年的所有 TMVR 病例。我们进一步评估了ACS的发生率,并使用多变量逻辑回归确定了这一人群中ACS的独立预测因素:在3742名接受TMVR的患者中,264人(7.05%)发生了ACS。在 ACS 患者中,204 人(77%)为非 ST 段抬高型 ACS,66 人(25%)为 ST 段抬高型 ACS。急性心肌梗死的独立预测因素包括急性肢体缺血、心源性休克、冠状动脉疾病(CAD)病史、吸烟、心脏骤停、需要机械通气的呼吸衰竭和急性肾损伤。ACS患者的院内死亡率是无ACS患者的三倍(16.76%对5.45%,P值<0.01):结论:ACS并非TMVR术后的罕见并发症。结论:TMVR术后发生ACS并非罕见并发症,它与较高的院内死亡率、较长的住院时间和较高的住院费用相关。这些患者发生 ACS 的最强预测因素是急性肢体缺血、心源性休克和 CAD 病史。
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引用次数: 0
Linking head and heart health: the association between psychiatric outcomes for patients with major depressive disorder and myocardial ischemia - a systematic review. 将头部健康与心脏健康联系起来:重度抑郁症患者的精神状况与心肌缺血之间的关联--系统性综述。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 Epub Date: 2024-10-01 DOI: 10.1080/14779072.2024.2409434
Amanda Cardoso, Laiana Azevedo Quagliato, Natia Horato, Pablo Eduardo Pereira Dutra, Antonio Egidio Nardi

Introduction: The development of depression after myocardial infarction is associated with a 2- to 2.5-fold increased risk of all-cause mortality, cardiovascular mortality, and cardiovascular events. The objective of this study was to investigate, through a broad search of the literature, whether major depression is associated with worse psychiatric outcomes in middle-aged patients with myocardial ischemia.

Methods: An extensive search for studies on the association between major depression and myocardial ischemia was conducted in the PubMed, Embase, PsycINFO, and Web of Science databases. Randomized clinical trials of middle-aged patients with myocardial ischemia and concomitant depressive symptoms were included.

Results: The 14 articles included in this systematic review did not confirm an association between myocardial ischemia and depression with worse psychiatric outcomes in middle-aged patients. However, worse cardiovascular outcomes have been observed in patients with depression after myocardial infarction.

Conclusions: The findings of this study suggest that major depression increases cardiovascular risk in patients after acute myocardial infarction, possibly because of a more pronounced increase in inflammatory markers.

Registration: This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) under the number CRD: 511650.

导言:心肌梗死后出现抑郁与全因死亡率、心血管死亡率和心血管事件风险增加 2 到 2.5 倍有关。本研究的目的是通过广泛检索文献,研究重度抑郁症是否与中年心肌缺血患者精神状况恶化有关:方法:我们在 PubMed、Embase、PsycINFO 和 Web of Science 数据库中广泛检索了有关重度抑郁症与心肌缺血之间关系的研究。研究纳入了针对伴有抑郁症状的心肌缺血中年患者的随机临床试验:本系统综述收录的 14 篇文章并未证实心肌缺血和抑郁症与中年患者较差的精神状况之间存在关联。然而,在心肌梗塞后患有抑郁症的患者中观察到了更差的心血管预后:本研究结果表明,重度抑郁症会增加急性心肌梗死后患者的心血管风险,这可能是因为炎症标志物的增加更为明显:本系统综述已在国际系统综述前瞻性注册中心(PROSPERO)注册,注册号为 CRD: 511650。
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引用次数: 0
PTSD and mood disorders in implantable cardioverter defibrillator patients: is more psychological assessment needed? 植入式心律转复除颤器患者的创伤后应激障碍和情绪障碍:是否需要更多心理评估?
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1080/14779072.2024.2385974
Anne Sorrell, Rebecca Harrell, Elizabeth Jordan, Maeve Sargeant, Rajasekhar Nekkanti, John N Catanzaro, Samuel F Sears

Introduction: The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care.

Areas covered: Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations.

Expert opinion: Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning.

简介:本综述旨在确定 ICD 患者常见的情绪问题,并提出在患者护理中早期发现和监测所必需的简短心理筛查工具:专家意见:心理评估与心脏病学标准护理相结合,有助于克服与植入式心律转复除颤器(ICD)管理不善和相关心血管后果有关的许多障碍。事实证明,尽早发现和治疗 ICD 患者的情绪问题可提高生活质量(QOL)和患者预后。但目前,除了了解适当的治疗计划或转诊选择外,后勤挑战和时间限制仍是提供以患者为中心的综合护理的主要障碍。归根结底,所有心脏病诊所都将受益于包括心理健康顾问或内部心理学家在内的协作式医疗团队,他们可以提供咨询或转诊服务。此外,所有到诊所就诊的患者都应完成主动筛查措施,作为常规护理的一部分,以评估是否存在情绪问题,从而改善患者的治疗效果并帮助制定治疗计划。
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引用次数: 0
Challenges and solutions to implementing cardiac rehabilitation in a low- and middle-income country. 在中低收入国家实施心脏康复的挑战和解决方案。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI: 10.1080/14779072.2024.2379836
Abraham Samuel Babu, Vibha Bhat, Prinu Jose, Sebastian Padickaparambil, Ramachandran Padmakumar, Panniyammakal Jeemon

Background: Cardiac rehabilitation (CR) remains greatly underutilized, especially in low- and middle-income countries (LMIC). It is therefore important to explore factors that contribute to this, as perceived by health-care professionals (HCPs).

Research design and methods: This was a qualitative study using in-depth interviews that enrolled 18 HCPs (i.e. six each of physicians, physiotherapists, and nurses; mean experience in CR: 17.9 ± 11.8 yrs) working in cardiovascular care, and CR across private and government hospitals (both teaching and non-teaching) in India.

Results: The main challenges were related to lack of referrals, perceived lack of benefit from CR, poor infrastructure within hospitals and health systems, and differences in practice. The perceived inadequacies were lack of competencies in CR, limited task sharing strategies, and ineffective utilization of existing human resources. Devising strategies to improve awareness and competencies, facilitating task sharing, and remodeling holistic care with an active CR component may be beneficial to facilitate greater implementation of CR in India.

Conclusions: Challenges, inadequacies, and solutions to implementing CR have been explored by involving various HCPs commonly involved in delivering CR across different health systems in a LMIC.

Trial registration: www.ctri.nic.in with identifier CTRI/2020/07/026807.

背景:心脏康复(CR)的利用率仍然很低,尤其是在中低收入国家(LMIC)。因此,探讨医疗保健专业人员(HCPs)认为造成这种情况的因素非常重要:这是一项采用深入访谈的定性研究,共招募了 18 名在印度私立和公立医院(包括教学医院和非教学医院)从事心血管护理和 CR 工作的 HCP(即医生、物理治疗师和护士各 6 名;平均 CR 经验:17.9 ± 11.8 年):主要挑战涉及缺乏转诊、心血管疾病治疗缺乏效益、医院和卫生系统基础设施薄弱以及实践中的差异。所发现的不足之处包括缺乏 CR 方面的能力、任务分担策略有限以及现有人力资源利用效率低下。制定提高意识和能力的策略、促进任务分担以及重塑具有积极 CR 要素的整体护理,可能有利于促进 CR 在印度的更广泛实施:通过让低收入国家不同医疗系统中通常参与提供 CR 的各种 HCP 参与其中,探讨了实施 CR 的挑战、不足和解决方案。试验注册:www.ctri.nic.in,标识符为 CTRI/2020/07/026807。
{"title":"Challenges and solutions to implementing cardiac rehabilitation in a low- and middle-income country.","authors":"Abraham Samuel Babu, Vibha Bhat, Prinu Jose, Sebastian Padickaparambil, Ramachandran Padmakumar, Panniyammakal Jeemon","doi":"10.1080/14779072.2024.2379836","DOIUrl":"10.1080/14779072.2024.2379836","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) remains greatly underutilized, especially in low- and middle-income countries (LMIC). It is therefore important to explore factors that contribute to this, as perceived by health-care professionals (HCPs).</p><p><strong>Research design and methods: </strong>This was a qualitative study using in-depth interviews that enrolled 18 HCPs (i.e. six each of physicians, physiotherapists, and nurses; mean experience in CR: 17.9 ± 11.8 yrs) working in cardiovascular care, and CR across private and government hospitals (both teaching and non-teaching) in India.</p><p><strong>Results: </strong>The main challenges were related to lack of referrals, perceived lack of benefit from CR, poor infrastructure within hospitals and health systems, and differences in practice. The perceived inadequacies were lack of competencies in CR, limited task sharing strategies, and ineffective utilization of existing human resources. Devising strategies to improve awareness and competencies, facilitating task sharing, and remodeling holistic care with an active CR component may be beneficial to facilitate greater implementation of CR in India.</p><p><strong>Conclusions: </strong>Challenges, inadequacies, and solutions to implementing CR have been explored by involving various HCPs commonly involved in delivering CR across different health systems in a LMIC.</p><p><strong>Trial registration: </strong>www.ctri.nic.in with identifier CTRI/2020/07/026807.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care. STEMI 后院内心脏骤停:预防策略和骤停后护理。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-30 DOI: 10.1080/14779072.2024.2383648
Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D Henry, Kari Gorder

Introduction: In-Hospital Cardiac Arrest (IHCA) after ST-segment Elevation Myocardial Infarction (STEMI) is a subset of IHCA with high morbidity. While information on this selected group of patients is limited, closer inspection reveals that this is a challenging patient population with certain risk factors for IHCA following treatment of STEMI.

Areas covered: In this review article, strategies for prevention of IHCA post STEMI are reviewed, as well as best-practices for the care of STEMI patients post-IHCA.

Expert opinion: Early and successful reperfusion is key for the prevention of IHCA and has a significant impact on in-hospital mortality. A number of pharmacological treatments have also been studied that can impact the progression to IHCA. Development of cardiogenic shock post-STEMI increases mortality and raises the risk of cardiac arrest. The treatment of IHCA follows the ACLS algorithm with some notable exceptions.

导言:ST段抬高型心肌梗死(STEMI)后的院内心脏骤停(IHCA)是IHCA的一个分支,发病率很高。虽然有关这一特定患者群体的信息有限,但仔细观察可以发现,这是一个具有挑战性的患者群体,在 STEMI 治疗后存在发生 IHCA 的某些风险因素:在这篇综述文章中,回顾了 STEMI 后 IHCA 的预防策略以及 STEMI 患者 IHCA 后护理的最佳实践:早期成功的再灌注是预防 IHCA 的关键,对院内死亡率有重大影响。专家观点:早期成功的再灌注是预防 IHCA 的关键,对院内死亡率有重大影响。目前已研究出多种药物治疗方法,可影响 IHCA 的进展。SETEMI 后发生心源性休克会增加死亡率,并增加心脏骤停的风险。IHCA 的治疗遵循 ACLS 算法,但也有一些明显的例外。
{"title":"In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care.","authors":"Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D Henry, Kari Gorder","doi":"10.1080/14779072.2024.2383648","DOIUrl":"10.1080/14779072.2024.2383648","url":null,"abstract":"<p><strong>Introduction: </strong>In-Hospital Cardiac Arrest (IHCA) after ST-segment Elevation Myocardial Infarction (STEMI) is a subset of IHCA with high morbidity. While information on this selected group of patients is limited, closer inspection reveals that this is a challenging patient population with certain risk factors for IHCA following treatment of STEMI.</p><p><strong>Areas covered: </strong>In this review article, strategies for prevention of IHCA post STEMI are reviewed, as well as best-practices for the care of STEMI patients post-IHCA.</p><p><strong>Expert opinion: </strong>Early and successful reperfusion is key for the prevention of IHCA and has a significant impact on in-hospital mortality. A number of pharmacological treatments have also been studied that can impact the progression to IHCA. Development of cardiogenic shock post-STEMI increases mortality and raises the risk of cardiac arrest. The treatment of IHCA follows the ACLS algorithm with some notable exceptions.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-term outcomes following bioresorbable vascular scaffolds. 生物可吸收血管支架的长期疗效。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-30 DOI: 10.1080/14779072.2024.2375340
Kotaro Miyashita, Kai Ninomiya, Akihiro Tobe, Shinichiro Masuda, Nozomi Kotoku, Shigetaka Kageyama, Pruthvi C Revaiah, Tsung-Ying Tsai, Bo Wang, Scot Garg, Patrick W Serruys, Yoshinobu Onuma

Introduction: The higher scaffold thrombosis rates observed with the first-generation bioresorbable scaffolds (BRSs) compared to conventional drug-eluting stents were likely due in part to bioresorbable polymers having insufficient radial strength, necessitating larger strut profiles. Meta-analysis of the long-term outcomes from the first-generation Absorb bioresorbable vascular scaffold (BVS) showed that this period of excess risk ended at 3 years. Therefore, current attention has been focused on improving early outcomes by increasing the scaffold's tensile strength and reducing strut thickness.

Areas covered: This review summaries the lessons learned from the first-generation BRS. It updates the long-term clinical outcomes of trials evaluating the ABSORB BVS and metallic alloy-based BRS. In addition, it reviews the next-generation BRSs manufactured in Asia.

Expert opinion: Critical areas to improve the performance and safety of biodegradable scaffolds include further development in material science, surface modification, delivery systems, and long-term follow-up studies.

简介:与传统的药物洗脱支架相比,第一代生物可吸收支架(BRS)的支架血栓形成率较高,部分原因可能是生物可吸收聚合物的径向强度不足,因此需要更大的支架轮廓。对第一代 Absorb 生物可吸收血管支架(BVS)的长期疗效进行的 Meta 分析表明,超额风险期在 3 年后结束。因此,目前的关注重点是通过提高支架的抗拉强度和减少支架厚度来改善早期疗效:本综述总结了第一代 BRS 的经验教训。它更新了评估 ABSORB BVS 和基于金属合金的 BRS 的试验的长期临床结果。此外,它还回顾了亚洲生产的下一代 BRS:提高生物可降解支架性能和安全性的关键领域包括材料科学、表面改性、输送系统和长期随访研究的进一步发展。
{"title":"Long-term outcomes following bioresorbable vascular scaffolds.","authors":"Kotaro Miyashita, Kai Ninomiya, Akihiro Tobe, Shinichiro Masuda, Nozomi Kotoku, Shigetaka Kageyama, Pruthvi C Revaiah, Tsung-Ying Tsai, Bo Wang, Scot Garg, Patrick W Serruys, Yoshinobu Onuma","doi":"10.1080/14779072.2024.2375340","DOIUrl":"10.1080/14779072.2024.2375340","url":null,"abstract":"<p><strong>Introduction: </strong>The higher scaffold thrombosis rates observed with the first-generation bioresorbable scaffolds (BRSs) compared to conventional drug-eluting stents were likely due in part to bioresorbable polymers having insufficient radial strength, necessitating larger strut profiles. Meta-analysis of the long-term outcomes from the first-generation Absorb bioresorbable vascular scaffold (BVS) showed that this period of excess risk ended at 3 years. Therefore, current attention has been focused on improving early outcomes by increasing the scaffold's tensile strength and reducing strut thickness.</p><p><strong>Areas covered: </strong>This review summaries the lessons learned from the first-generation BRS. It updates the long-term clinical outcomes of trials evaluating the ABSORB BVS and metallic alloy-based BRS. In addition, it reviews the next-generation BRSs manufactured in Asia.</p><p><strong>Expert opinion: </strong>Critical areas to improve the performance and safety of biodegradable scaffolds include further development in material science, surface modification, delivery systems, and long-term follow-up studies.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current status and future directions in artificial intelligence for nuclear cardiology. 核心脏病学人工智能的现状和未来方向。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI: 10.1080/14779072.2024.2380764
Robert J H Miller, Piotr J Slomka

Introduction: Myocardial perfusion imaging (MPI) is one of the most commonly ordered cardiac imaging tests. Accurate motion correction, image registration, and reconstruction are critical for high-quality imaging, but this can be technically challenging and has traditionally relied on expert manual processing. With accurate processing, there is a rich variety of clinical, stress, functional, and anatomic data that can be integrated to guide patient management.

Areas covered: PubMed and Google Scholar were reviewed for articles related to artificial intelligence in nuclear cardiology published between 2020 and 2024. We will outline the prominent roles for artificial intelligence (AI) solutions to provide motion correction, image registration, and reconstruction. We will review the role for AI in extracting anatomic data for hybrid MPI which is otherwise neglected. Lastly, we will discuss AI methods to integrate the wealth of data to improve disease diagnosis or risk stratification.

Expert opinion: There is growing evidence that AI will transform the performance of MPI by automating and improving on aspects of image acquisition and reconstruction. Physicians and researchers will need to understand the potential strengths of AI in order to benefit from the full clinical utility of MPI.

简介心肌灌注成像(MPI)是最常见的心脏成像检查项目之一。精确的运动校正、图像配准和重建对高质量成像至关重要,但这在技术上具有挑战性,传统上一直依赖专家手工处理。通过精确的处理,可以整合丰富的临床、应激、功能和解剖数据,为患者管理提供指导:我们查阅了 Pubmed 和谷歌学术网站上 2020 年至 2024 年间发表的与核心脏病学中的人工智能相关的文章。我们将概述人工智能(AI)解决方案在提供运动校正、图像配准和重建方面的突出作用。我们还将回顾人工智能在提取混合 MPI 解剖数据方面的作用,否则这些作用就会被忽视。最后,我们将讨论整合大量数据以改善疾病诊断或风险分层的人工智能方法:越来越多的证据表明,人工智能将通过自动化和改进图像采集与重建的各个方面,改变多普勒成像的性能。医生和研究人员需要了解人工智能的潜在优势,才能从多普勒成像的全部临床用途中获益。
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引用次数: 0
Lipoprotein(a) in interventional cardiology: identifying patients at highest risk of recurrent cardiovascular events through early recognition - a case based review. 介入心脏病学中的脂蛋白(a):通过早期识别确定复发性心血管事件风险最高的患者--基于病例的回顾。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 Epub Date: 2024-09-11 DOI: 10.1080/14779072.2024.2387678
Mick P L Renkens, Casper F Coerkamp, Lars S Witte, Shabiga Sivanesan, Nick S Nurmohamed, Marit Westerterp, Patrick Serruys, Yoshinobu Onuma, Maik J Grundeken, Deborah N Kalkman, Marcel Beijk, Marije M Vis, José P S Henriques, Ronak Delewi, Erik Stroes, Joanna J Wykrzykowska, Robbert J de Winter, Bimmer E P M Claessen

Introduction: Lipoprotein(a) [Lp(a)] is linked to higher risks of atherosclerotic cardiovascular disease (ASCVD). Current guideline recommendations are quite liberal on measuring Lp(a) (Class IIa, Level C), and may lead to underuse among (interventional) cardiologists.

Areas covered: This case-based narrative review outlines four clinical cases of patients with elevated Lp(a) to illustrate its pathophysiological impact on coronary artery disease (CAD). The expert consensus statements from the American Heart Association (AHA) and European Atherosclerosis Society (EAS) served as the basis of this review. More recent publications, from 2023 to 2024, were accessed through the MEDLINE online library.

Expert opinion: We highlighted the importance of routine Lp(a) measurement in identifying patients at high risk for atherosclerosis, necessitating potent risk mitigation. Measuring Lp(a) helps clinicians identify which patients are at highest residual risk, who require potent pharmacological treatment and special attention during catheter interventions. As noninvasive and advanced intravascular imaging modalities evolve, future catheterization laboratories will integrate advanced imaging, diagnostics, and treatment, facilitating tailored patient care. Knowing Lp(a) levels is crucial in this context. While Lp(a)-lowering drugs are currently investigated in clinical trials, it is of paramount importance to know Lp(a) levels and strive toward aggressive management of other modifiable risk factors in patients with elevated Lp(a) and established symptomatic CAD being diagnosed or treated in catheterization laboratories.

导言:脂蛋白(a)[Lp(a)]与动脉粥样硬化性心血管疾病(ASCVD)的高风险有关。目前的指南建议对脂蛋白(a)的测量相当宽松(IIa 类,C 级),可能导致(介入)心脏病专家对脂蛋白(a)的使用不足:本病例综述概述了四例脂蛋白(a)升高患者的临床病例,以说明脂蛋白(a)对冠状动脉疾病(CAD)的病理生理影响。本综述以美国心脏协会(AHA)和欧洲动脉粥样硬化学会(EAS)的专家共识声明为基础。专家意见:我们强调了常规脂蛋白(a)测量在识别动脉粥样硬化高风险患者方面的重要性,因此有必要采取有力的风险缓解措施。测量脂蛋白(a)可帮助临床医生确定哪些患者残余风险最高,需要进行强效药物治疗,并在导管介入期间给予特别关注。随着无创和先进血管内成像模式的发展,未来的导管室将整合先进的成像、诊断和治疗,为患者提供量身定制的治疗。在这种情况下,了解脂蛋白(a)水平至关重要。虽然降低脂蛋白(a)的药物目前正在临床试验中进行研究,但对于脂蛋白(a)升高并在导管室诊断或治疗的已确诊无症状 CAD 患者来说,了解脂蛋白(a)水平并努力积极控制其他可改变的危险因素至关重要。
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引用次数: 0
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Expert Review of Cardiovascular Therapy
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