Assuntos
Fármacos Cardiovasculares/uso terapêutico , Aconselhamento , Tomada de Decisões , Registros Eletrônicos de Saúde , Fidelidade a Diretrizes , Insuficiência Cardíaca , Encaminhamento e Consulta , Idoso , Desfibriladores Implantáveis , Prescrições de Medicamentos/normas , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Valva Mitral/cirurgia , Guias de Prática Clínica como Assunto , Abandono do Hábito de Fumar , Sociedades Médicas , Volume Sistólico , Estados UnidosRESUMO
BACKGROUND: The optimal management of coronary lesions involving side branches is not known. New devices are being developed for dedicated bifurcation stenting or improved side branch access or protection. Several of these devices are bare-metal stent (BMS) platforms. The risk of side branch compromise and outcome after standard BMS is not known. METHODS: We evaluated the frequency of side branch involvement and the rate of side branch compromise in a retrospective analysis of 1,440 patients from three pooled historical BMS clinical trials. The impact of side branch compromise on in-hospital and nine-month clinical outcomes was assessed. RESULTS: Side branches >2 mm in diameter were present within the stented segment in 39% of treated lesions. Compromise of a side branch occurred in 27% of 1,440 lesions, including 22% of side branches that were not diseased prior to stenting. Compromise was associated with increased in-hospital MI (13.5% vs. 7.6%, P = 0.001), a trend for increased nine-month clinically driven target vessel revascularization (TVR, 17.4% vs. 13.2%, P = 0.058), and increased nine-month target vessel failure (composite of cardiac death, target vessel MI or TVR, 29.7% vs. 20.2%, P < 0.001). CONCLUSION: At least moderate-sized side branches are involved frequently in lesions enrolled in routine clinical trials. Unexpected compromise of these side branches is common and is associated with increased in-hospital and nine-month adverse outcomes.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/terapia , Pacientes Internados , Metais , Stents , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Modelos de Riscos Proporcionais , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Primates exhibit complex social and cognitive behavior in the wild. In the laboratory, however, the expression of their behavior is usually limited. A large body of literature shows that living in an enriched environment alters dendrites and synapses in the brains of adult rodents. To date, no studies have investigated the influence of living in a complex environment on brain structure in adult primates. We assessed dendritic architecture, dendritic spines, and synaptic proteins in adult marmosets housed in either a standard laboratory cage or in one of two differentially complex habitats. A month-long stay in either complex environment enhanced the length and complexity of the dendritic tree and increased dendritic spine density and synaptic protein levels in the hippocampus and prefrontal cortex. No differences were detected between the brains of marmosets living in the two differentially complex environments. Our results show that the structure of the adult primate brain remains highly sensitive even to modest levels of experiential complexity. For adult primates, living in standard laboratory housing may induce reversible dendritic spine and synapse decreases in brain regions important for cognition.
