ABSTRACT
As the prevalence of asymptomatic COVID-19 continues to increase, there is an increasing possibility that patients with COVID-19 may presen with ST-segment elevation myocardial infarction (STEMI). With social distancing and restricted access to preventive healthcare and emergency services, the management of acute cardiac emergencies such as myocardial infarction has suffered collateral damage. Thus far, global trends suggest a decrease in STEMI activations with possible worse outcomes due to delayed presentation and management. In this review, we discuss the challenges to STEMI management in the COVID-19 era and provide potential solutions for adherence to evidence-based therapies as the pandemic progresses into the year 2021.
Subject(s)
COVID-19/complications , Infection Control/organization & administration , ST Elevation Myocardial Infarction/therapy , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiologyABSTRACT
There does not appear to be a difference in patient outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis whether using first- or second-generation drug elutting stent. This is despite increase in patients having more adjunctive procedures such as intravascular imaging and newer generation antiplatelet agents. This single-center study provokes questions as to why there has not been improvement in outcomes.
Subject(s)
Coronary Stenosis , Drug-Eluting Stents , Percutaneous Coronary Intervention , Family Characteristics , Humans , Patients , Stents , Treatment OutcomeSubject(s)
Aortic Valve/surgery , Evidence-Based Medicine/standards , Heart Valve Diseases/surgery , Heart Valve Prosthesis/standards , Practice Patterns, Physicians'/standards , Transcatheter Aortic Valve Replacement/standards , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Cardiac Imaging Techniques/standards , Clinical Competence/standards , Clinical Decision-Making , Consensus , Credentialing/standards , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/physiopathology , Hemodynamics , Humans , Learning Curve , Patient Selection , Predictive Value of Tests , Prosthesis Design/standards , Risk Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Treatment Outcome , Workload/standardsABSTRACT
The use of mechanical thrombectomy in STEMI with large amount of jeopardized myocardium may preserve regional wall motion When appropriate and done with proper removal technique, there does not appear to be any increased incidence of neurologic complications The guideline recommendation that mechanical thrombectomy should not be done routinely is supported by these authors.
Subject(s)
Myocardial Infarction , ST Elevation Myocardial Infarction , Humans , Myocardium , Registries , ThrombectomyABSTRACT
The learning curve for TAVR is determined based on technical (procedural) data from PARTNER-1 Trial The number of cases needed to reach a learning curve for TAVR in PARTNER-1 was 50 for original sites and fell to 25 for late entering sites Analyses such as this is important in developing guidelines for other emerging technologies.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Education, Medical, Graduate/standards , Heart Valve Prosthesis , Learning Curve , Teaching/standards , Transcatheter Aortic Valve Replacement/education , Femoral Artery , Humans , Time Factors , Transcatheter Aortic Valve Replacement/methodsABSTRACT
Current guidelines indicate that routine aspiration thrombectomy (AT) has a level III indication and AT is only indicated for "bail-out" indications. "Bail-out" situations are not well defined. The AT catheter may still be necessary and have other uses such as distal contrast or drug delivery.
Subject(s)
Suction , Thrombectomy , Catheters , Humans , Treatment OutcomeSubject(s)
Myocardial Infarction/therapy , Percutaneous Coronary Intervention , Electrocardiography , Evidence-Based Medicine , Humans , Myocardial Infarction/physiopathology , Myocardial Infarction/surgery , Percutaneous Coronary Intervention/methods , Randomized Controlled Trials as Topic , Thrombectomy/methods , Treatment OutcomeSubject(s)
Accreditation/standards , Cardiac Catheterization/standards , Cardiology/standards , Certification/standards , Heart Valve Diseases/therapy , Heart Valve Prosthesis Implantation/standards , Pulmonary Valve , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Clinical Competence/standards , Heart Valve Diseases/diagnosis , Heart Valve Diseases/physiopathology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Humans , Pulmonary Valve/physiopathology , Risk Factors , Treatment OutcomeABSTRACT
With the evolution of transcatheter valve replacement, an important opportunity has arisen for cardiologists and surgeons to collaborate in identifying the criteria for performing these procedures. Therefore, The Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), and The Society of Thoracic Surgeons (STS) have partnered to provide recommendations for institutions to assess their potential for instituting and/or maintaining a transcatheter valve program. This article concerns transcatheter pulmonic valve replacement (tPVR). tPVR procedures are in their infancy with few reports available on which to base an expert consensus statement. Therefore, many of these recommendations are based on expert consensus and the few reports available. As the procedures evolve, technology advances, experience grows, and more data accumulate, there will certainly be a need to update this consensus statement. The writing committee and participating societies believe that the recommendations in this report serve as appropriate requisites. In some ways, these recommendations apply to institutions more than to individuals. There is a strong consensus that these new valve therapies are best performed using a Heart Team approach; thus, these credentialing criteria should be applied at the institutional level. Partnering societies used the ACC's policy on relationships with industry (RWI) and other entities to author this document (http://www.acc.org/guidelines/about-guidelines-and-clinical-documents). To avoid actual, potential, or perceived conflicts of interest due to industry relationships or personal interests, all members of the writing committee, as well as peer reviewers of the document, were asked to disclose all current healthcare-related relationships including those existing 12 months before the initiation of the writing effort. A committee of interventional cardiologists and surgeons was formed to include a majority of members with no relevant RWI and to be led by an interventional cardiology cochair and a surgical cochair with no relevant RWI. Authors with relevant RWI were not permitted to draft or vote on text or recommendations pertaining to their RWI. RWI were reviewed on all conference calls and updated as changes occurred. Author and peer reviewer RWI pertinent to this document are disclosed in the Appendices. In addition, to ensure complete transparency, authors' comprehensive disclosure information (including RWI not pertinent to this document) is available in Appendix AII. The work of the writing committee was supported exclusively by the partnering societies without commercial support. SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chances that these therapies will become a successful part of the armamentarium for treating valvular heart disease in the United States. In addition, these recommendations will hopefully facilitate optimum quality during the delivery of this therapy, which will be important to the development and successful implementation of future, less invasive approaches to structural heart disease.