RESUMO
AIMS: The aim was to describe outcomes among patients with stable coronary artery disease (CAD) with or without a history of myocardial revascularization in a large contemporary cohort. METHODS AND RESULTS: Patients with stable CAD were selected from the Reduction of Atherothrombosis for Continued Health (REACH) registry. The cohort was divided into patients with ( n = 25 583) and without ( n = 13 133) a history of myocardial revascularization. Crude outcomes were described according to the use and type of revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The primary outcome was cardiovascular (CV) death. At baseline, the non-revascularized group was older and had more CV risk factors. At 36-month median follow-up, previous revascularization was associated with a lower risk of CV death [crude incidence rate (CIR): 6.82 vs. 9.08%, hazard ratio (HR) 0.73 [95% confidence interval (CI) 0.66-0.80]; P < 0.01]. This association was seen for patients with a history of PCI (CIR 5.78 vs. 8.88%, HR 0.64 [0.58-0.71]; P ≤ 0.01), but not with CABG (HR 1.26 [1.14-1.49]; P < 0.01), and was consistent regardless of prior MI and the timing of prior revascularization. CONCLUSION: Among patients with stable CAD, a history of myocardial revascularization was associated with lower CV mortality, particularly when PCI was the mode of revascularization. Coronary artery disease patients managed non-invasively represent a high-risk group.
RESUMO
Transcatheter heart valve endocarditis is a rare, but life threatening complication. We describe the case of a patient who was successfully treated by transcatheter aortic valve-in-valve-in-valve replacement with a favorable 1-year outcome, despite severe early complications.
Assuntos
Estenose da Valva Aórtica/terapia , Bioprótese , Cateterismo Cardíaco/métodos , Endocardite/etiologia , Endocardite/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/efeitos adversos , Ecocardiografia Transesofagiana/métodos , Endocardite/diagnóstico por imagem , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Radiografia , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Resultado do TratamentoAssuntos
Calcinose/cirurgia , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Calcinose/complicações , Calcinose/diagnóstico , Ecocardiografia Transesofagiana , Feminino , Septos Cardíacos , Humanos , Imageamento Tridimensional , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/etiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XAssuntos
Valva Aórtica/cirurgia , Transtornos Cerebrovasculares/cirurgia , Implante de Prótese de Valva Cardíaca , Artéria Cerebral Média/cirurgia , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/cirurgia , Acidente Vascular Cerebral/cirurgia , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Cálcio , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/prevenção & controle , Feminino , Humanos , Angiografia por Ressonância Magnética , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/patologia , Radiografia , Stents/estatística & dados numéricos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
Health related quality of life (HRQoL) is used increasingly as a measure of the outcome of CHD. As an improvement in survival of CHD continues, assessment of HRQoL has become an important and useful outcome measure complementing the traditional "hard outcomes" such as mortality for evaluating benefits of medical interventions. Increasing number of clinical trials is applying HRQoL as an outcome measure of CHD therapy. Assessment of HRQoL in CHD should comprise a disease-specific measure in addition to a generic measure. This review aims to provide an overview of generic, disease-specific, and utility measures used in the assessment of HRQoL in CHD.