Pub Date : 2024-09-01Epub Date: 2024-10-20DOI: 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。
{"title":"Antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention.","authors":"Mark Anthony Sammut, Robert F Storey","doi":"10.1080/14779072.2024.2388265","DOIUrl":"10.1080/14779072.2024.2388265","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Areas covered: </strong>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.</p><p><strong>Expert opinion: </strong>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 P2Y<sub>12</sub> 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.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461302","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}
Pub Date : 2024-09-01Epub Date: 2024-09-12DOI: 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。
{"title":"Clinical implications of combination proton pump inhibitor and triple therapies in patients with atrial fibrillation following percutaneous intervention: a guide for clinicians.","authors":"Jacob J Gries, Bing Chen, Hafeez Ul Hassan Virk, Umair Khalid, Hani Jneid, Yochai Birnbaum, Carl J Lavie, Chayakrit Krittanawong","doi":"10.1080/14779072.2024.2401865","DOIUrl":"10.1080/14779072.2024.2401865","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Areas covered: </strong>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.</p><p><strong>Expert opinion: </strong>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.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282544","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}
Pub Date : 2024-09-01Epub Date: 2024-09-19DOI: 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.
{"title":"Incidence and predictors of acute coronary syndrome after transcatheter mitral valve repair.","authors":"Mishita Goel, Irfan Shafi, Adel Elmoghrabi, Karthik Ramaseshan, Mohammed M Uddin, Nasser Lakkis, Chadi Alraies","doi":"10.1080/14779072.2024.2398443","DOIUrl":"10.1080/14779072.2024.2398443","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Research design and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282545","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}
Pub Date : 2024-09-01Epub Date: 2024-10-01DOI: 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。
{"title":"Linking head and heart health: the association between psychiatric outcomes for patients with major depressive disorder and myocardial ischemia - a systematic review.","authors":"Amanda Cardoso, Laiana Azevedo Quagliato, Natia Horato, Pablo Eduardo Pereira Dutra, Antonio Egidio Nardi","doi":"10.1080/14779072.2024.2409434","DOIUrl":"10.1080/14779072.2024.2409434","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) under the number CRD: 511650.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344253","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}
Pub Date : 2024-08-01DOI: 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.
{"title":"PTSD and mood disorders in implantable cardioverter defibrillator patients: is more psychological assessment needed?","authors":"Anne Sorrell, Rebecca Harrell, Elizabeth Jordan, Maeve Sargeant, Rajasekhar Nekkanti, John N Catanzaro, Samuel F Sears","doi":"10.1080/14779072.2024.2385974","DOIUrl":"10.1080/14779072.2024.2385974","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Areas covered: </strong>Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations.</p><p><strong>Expert opinion: </strong>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.</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":"141859379","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}
Pub Date : 2024-08-01Epub Date: 2024-07-16DOI: 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.
{"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}
Pub Date : 2024-08-01Epub Date: 2024-07-30DOI: 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.
{"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}
Pub Date : 2024-08-01Epub Date: 2024-07-30DOI: 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.
{"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}
Pub Date : 2024-08-01Epub Date: 2024-07-16DOI: 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.
{"title":"Current status and future directions in artificial intelligence for nuclear cardiology.","authors":"Robert J H Miller, Piotr J Slomka","doi":"10.1080/14779072.2024.2380764","DOIUrl":"10.1080/14779072.2024.2380764","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Areas covered: </strong>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.</p><p><strong>Expert opinion: </strong>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.</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":"141598956","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}
Pub Date : 2024-08-01Epub Date: 2024-09-11DOI: 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.
{"title":"Lipoprotein(a) in interventional cardiology: identifying patients at highest risk of recurrent cardiovascular events through early recognition - a case based review.","authors":"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","doi":"10.1080/14779072.2024.2387678","DOIUrl":"10.1080/14779072.2024.2387678","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Areas covered: </strong>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.</p><p><strong>Expert opinion: </strong>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.</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":"142282547","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}