A Narrative Review of Revascularization in Chronic Coronary Syndrome/Disease: Concepts and Misconceptions.

Ischemic heart disease represents a significant global burden of morbidity and mortality. While revascularization strategies are well defined in acute settings, there are uncertainties regarding chronic coronary artery disease treatment. Recent trials have raised doubts about the necessity of revascularization for "stable", chronic coronary syndromes or disease, leading to a shift towards a more conservative approach. However, the issue remains far from settled. In this narrative review, we offer a summary of the most pertinent evidence regarding revascularization for chronic coronary disease, while reflecting on less-often-discussed details of major clinical trials. The cumulative evidence available indicates that there can be a prognostic benefit from revascularization in chronic coronary syndrome patients, provided there is significant ischemia, as demonstrated by either imaging or coronary physiology. Trials that have effectively met this criterion consistently demonstrate a reduction in rates of spontaneous myocardial infarction, which holds both prognostic and clinical significance. The prognostic benefit of revascularization in patients with heart failure with reduced ejection fraction remains especially problematic, with a single contemporary trial favouring surgical revascularization. The very recent publication of a trial focused on revascularizing non-flow-limiting "vulnerable" plaques adds further complexity to the field. The ongoing debates surrounding revascularization in chronic coronary syndromes emphasize the importance of personalized strategies. Revascularization, added to the foundational pillar of medical therapy, should be considered, taking into account symptoms, patient preferences, coronary anatomy and physiology, ischemia tests and intra-coronary imaging.

Coronary Intravascular Lithotripsy Effectiveness and Safety in a Real-World Cohort.

Background: Coronary artery calcification is a predictor of adverse outcomes after percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) is a promising tool for the treatment of calcified lesions. The aim of this study was to assess the effectiveness and safety of IVL. Methods: A single-center observational study of PCI procedure, with assessment of the outcomes of patients undergoing PCI using IVL, was performed. Angiographic procedural success was used as the primary effectiveness endpoint. The primary safety endpoint was defined as a composite of cardiac death, myocardial infarction and target vessel revascularization within 30 days. Results: A total of 111 patients were included. Indications for PCI spanned the spectrum of chronic (53.2%) and acute coronary syndromes (43%). Lesion preparation before IVL was performed with non-compliant (42%), cutting or OPN (14.4%) balloons and with atherectomy techniques in 11% of procedures. Intravascular imaging was used in 21.6% of procedures. The primary effectiveness endpoint was achieved in 100% and the primary safety endpoint in 3.6% of procedures. Peri-procedural complications were minimal and successfully resolved. Conclusions: IVL was an effective and safe technique for the treatment of calcified coronary lesions. These findings contribute to the growing body of evidence supporting the use of IVL in the management of these challenging scenarios.

O stress no relacionamento conjugal

Este estudo teve como objetivo verificar o efeito do treino de controle do Stress (TCS) em casais. Participaram 15 casais no total de 30 sujeitos divididos em 3 grupos de 5 casais cada um. O diagnóstico inicial avaliou o stress, as estratégias de enfrentamento, os estressores pessoais, como por exemplo características do tipo A de comportamento, crenças irracionais e fontes estressoras do casal. O TCS foi realizado durante 8 sessões com o grupo experimental. Um grupo controle passou por um programa de palestras variadas, às quais não abordaram conteúdos psicológicos e ao stress. O outro grupo controle (o de passagem do tempo) não sofreu nenhuma intervenção, apenas passou pelas avaliações inicial e final. A avaliação pós-sessão de controle contou com os 15 casais que passaram pelos mesmos instrumentos da avaliação inicial. Os resultados mostraram que 98 por cento das pessoas encontravam-se na fase de resistência ao stress 1 por cento em alerta e 1 por cento em exaustão. Os sintomas físicos foram os mais detectados entre os casais. O treino de controle do stress teve como resultado uma redução significativa nos sintomas de stress. Também o nível de satisfação conjugal e de crenças irracionais melhorou após o treino de controle do stress. Conclui-se que o treino de controle do stress foi eficaz para o grupo experimental. Será recomendável que programas de controle de stress tanto no que se refere a prevenção, como tratamento seja realizado com grupos de casais, a fim de promover um relacionamento mais harmonioso (AU)