Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Próteses Valvulares Cardíacas , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Próteses e Implantes , Desenho de Prótese , Resultado do TratamentoRESUMO
INTRODUCTION AND OBJECTIVES: Catheter-directed therapy (CDT) for acute pulmonary embolism (PE) is an emerging therapy that combines heterogeneous techniques. The aim of the study was to provide a nationwide contemporary snapshot of clinical practice and CDT-related outcomes. METHODS: This Investigator-initiated multicenter registry aimed to include consecutive patients with intermediate-high risk (IHR) or high-risk (HR), acute PE eligible for CDT. The primary outcome of the study was in-hospital all-cause death. RESULTS: A total of 253 patients were included, of whom 93 (36.8%) had HR-PE, and 160 (63.2%) had IHR-PE with a mean age of 62.3±15.1 years. Local thrombolysis was performed in 70.8% and aspiration thrombectomy in 51.8%, with 23.3% of patients receiving both. However, aspiration thrombectomy was favored in the HR-PE cohort (80.6% vs 35%; P<.001). Only 51 patients (20.2%) underwent CDT with specific PE devices. The success rate for CDT was 90.9% (98.1% of IHR-PE patients vs 78.5% of HR-PE patients, P<.001). In-hospital mortality was 15.5%, and was highly concentrated in the HR-PE patients (37.6%) and significantly lower in IHR-PE patients (2.5%), P<.001. Long-term (24-month) mortality was 40.2% in HR-PE patients vs 8.2% in IHR-PE patients (P<.001). CONCLUSIONS: Despite the high success rate for CDT, in-hospital mortality in HR-PE is still high (37.6%) compared with very low IHR-PE mortality (2.5%).
Assuntos
Fibrinolíticos , Embolia Pulmonar , Humanos , Pessoa de Meia-Idade , Idoso , Fibrinolíticos/uso terapêutico , Terapia Trombolítica/métodos , Resultado do Tratamento , Embolia Pulmonar/terapia , Trombectomia/métodos , Catéteres , Sistema de Registros , Estudos RetrospectivosAssuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Próteses e Implantes , Próteses Valvulares Cardíacas/efeitos adversos , Desenho de Prótese , Resultado do Tratamento , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgiaRESUMO
BACKGROUND: TiNO-coated BAS have demonstrated competitive outcomes compared to drug-eluting stents (DES). These devices allow short antiplatelet regimens and may be a good option for the growing elderly population undergoing percutaneous coronary intervention (PCI). METHODS: Multicenter observational trial in routine clinical practice. A propensity-score matched analysis compared a prospective cohort of patients ≥ 75 years undergoing PCI with BAS, with a contemporary and retrospective cohort treated with last-generation DES. The co-primary endpoints of the study were the Target-Lesion-Failure (Cardiac death, non-fatal myocardial infarction, or target lesion revascularization) and Major Adverse Cardiovascular Events (total death, non-fatal myocardial infarction, stroke, or new revascularization) at 1 year. RESULTS: Whole population included 1000 patients, and 326 patients in each group were matched for analysis. No differences in primary endpoints were found: TLF 10.4% vs. 11% (HR 0.96 (Confidence Interval 95%, 0.36-1.7; p = 0.87)) and MACE 16.3% vs. 17.2% (HR 0.98 (Confidence Interval 95%; 0.3-1.5, p = 0.93)). Patients treated with BAS received shorter antiplatelets regimens (dual antiplatelet therapy at 1 year, 25.7% vs. 70.6%, p = 0.0001), and they presented lower incidence of bleeding (3.7% vs. 11.7%, HR 0.3 (IC 95% 0.16-0.6, p = 0.001)). CONCLUSION: In this real-life registry of patients ≥ 75 years, BAS were similar to the latest-generation DES in terms of efficacy and reduced the duration of the antithrombotic therapy, lowering bleeding events.
Assuntos
Stents Farmacológicos , Infarto do Miocárdio , Intervenção Coronária Percutânea , Idoso , Stents Farmacológicos/efeitos adversos , Humanos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Stents/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Pulmonary veins stenosis (PVS) after atrial fibrillation radiofrequency ablation is an uncommon complication. When it occurs, percutaneous treatment is the preferred approach. There is a lack of standardized procedures, and when stenting restenosis is relatively common. CASE SUMMARY: We present a young patient with recurrence of PVS after first percutaneous treatment. The recurrence of haemoptysis and dyspnoea after treatment in PVS allowed the diagnosis of significant stenosis again in our patient. In the Heart Team, we opted for a new percutaneous treatment, using intravascular ultrasound (IVUS) to optimize the final result. DISCUSSION: Nowadays, percutaneous approach is preferred and among percutaneous treatments for PVS, stenting has shown better results than balloon angioplasty (BA). Despite this, experience in in-stent restenosis is limited, and there is a lack of adequate and specific material for its approach. In this case, we present the possible role of the IVUS and the drug-coated BA in this entity.
Assuntos
Fibrilação Atrial , Intervenção Coronária Percutânea , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Acidente Vascular Cerebral , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Monitorização Hemodinâmica/métodos , Estudos Prospectivos , Hemorragia/epidemiologiaRESUMO
This corrects the article DOI: 10.23736/S0026-4725.19.05064-3.
Assuntos
Estenose de Veia Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Fibrilação Atrial/cirurgia , Feminino , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Ablação por Radiofrequência/efeitos adversos , Estenose de Veia Pulmonar/diagnóstico por imagem , Estenose de Veia Pulmonar/etiologia , Resultado do TratamentoAssuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Serviço Hospitalar de Cardiologia , Cateterismo Periférico , Artéria Femoral , Departamentos Hospitalares , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/mortalidade , Feminino , Humanos , Masculino , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Punções , Sistema de Registros , Medição de Risco , Fatores de Risco , Espanha , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
BACKGROUND: The safety and feasibility of ambulatory PCI has been demonstrated in selected patients with "simple" lesions, but it is not well known whether it could be applied in more "complex" scenarios. METHODS: Main objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with "complex angioplasty" (CA group: 313 (30%)) were analysed and compared with those of "simple angioplasty" (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24â¯h and at 1â¯month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications. RESULTS: Feasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52-2.35, pâ¯<â¯0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24â¯h (vs. 0.17% SA) or 30â¯days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1â¯month in the CA group, 5.5% vs. 2.7%, p: 0.07). CONCLUSIONS: The feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.
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Assistência Ambulatorial , Doença da Artéria Coronariana/terapia , Tempo de Internação , Alta do Paciente , Intervenção Coronária Percutânea , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Sistema de Registros , Medição de Risco , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do TratamentoAssuntos
Implantes Absorvíveis , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Ponte de Artéria Coronária/efeitos adversos , Reestenose Coronária/etiologia , Oclusão de Enxerto Vascular/cirurgia , Veia Safena/transplante , Idoso , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do TratamentoRESUMO
Introducción y objetivos: El aumento exponencial de la intervención coronaria y la generalización del acceso radial son el escenario ideal para iniciar programas de angioplastia ambulatoria con el objetivo de disminuir ocupación y reducir el coste manteniendo la seguridad. Se presentan por primera vez datos de un registro multicéntrico español sobre angioplastia transradial ambulatoria en pacientes seleccionados. Métodos: Registro prospectivo de angioplastia ambulatoria electiva con acceso radial-cubital en pacientes con cardiopatía isquémica estable. Los pacientes eran dados de alta el mismo día y se realizó seguimiento a las 24 h y a los 30 días. Se analizan la seguridad y la factibilidad. Resultados: De un total de 723 pacientes incluidos (el 76% varones; edad, 66,6 ± 10,5 años), a 533 (73,7%) se les dio finalmente el alta tras 4-12 h de vigilancia. El motivo más frecuente de ingreso entre los 190 (26,7%) restantes fue inestabilidad clínica tras el procedimiento (60,5%). El antecedente de arteriopatía periférica, un valor de creatinina basal más elevado, la realización del procedimiento ad hoc y sobre enfermedad multivaso fueron predictores independientes de ingreso. A las 24 h se registró un evento adverso mayor (0,19%) en 1 paciente que necesitó ingreso por hemorragia mayor no relacionada con el acceso vascular. A los 30 días se registraron 3 eventos mayores (0,56%), 1 trombosis subaguda de stent, 1 revascularización sobre un vaso diferente del tratado y 1 ictus minor. A los 30 días habían necesitado ingreso 8 pacientes (1,5%). Conclusiones: La aplicación de un programa de angioplastia ambulatoria transradial-cubital con alta tras 4-12 h de vigilancia es factible y segura en pacientes apropiadamente seleccionados (AU)
Introduction and objectives: The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. Methods: Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24 hours and 30 days. Safety and feasibility were analyzed. Results: Of the 723 patients included (76% male; age, 66.6 ± 10.5 years), 533 (73.7%) were finally discharged after 4 to 12 hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24 hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. Conclusions: The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours surveillance is safe and feasible in well-selected patients (AU)
Assuntos
Humanos , Doença das Coronárias/cirurgia , Intervenção Coronária Percutânea/métodos , Angioplastia Coronária com Balão/métodos , Estudos Prospectivos , Assistência Ambulatorial , Registros de Doenças/estatística & dados numéricos , Segurança do PacienteRESUMO
INTRODUCTION AND OBJECTIVES: The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. METHODS: Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24hours and 30 days. Safety and feasibility were analyzed. RESULTS: Of the 723 patients included (76% male; age, 66.6±10.5 years), 533 (73.7%) were finally discharged after 4 to 12hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. CONCLUSIONS: The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours' surveillance is safe and feasible in well-selected patients.
Assuntos
Doença da Artéria Coronariana/cirurgia , Pacientes Ambulatoriais , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/mortalidade , Estudos de Viabilidade , Feminino , Seguimentos , Hospitalização/tendências , Humanos , Incidência , Masculino , Seleção de Pacientes , Estudos Prospectivos , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Cardiac catheterization in anticoagulated patients is usually performed after the anticoagulation has been withdrawn, at least in the previous 48h, and sometimes bridging therapy with heparin is used. METHODS: A prospective observational study including 489 patients undergoing transradial catheterization was conducted. A total of 140 patients were under acenocoumarol (group A) and they were compared with the remainder (group B) for complications after the procedure (bleeding and vascular access complications). RESULTS: Patients in group A were older (74±12 years vs. 68±17 years, p<0.01) and the main indication for anticoagulation was atrial fibrillation (58.6%). No complications occurred during the procedures. There were no acute bleedings just after the bandage removal. During the first 24h, only 3 (2.1%) radial occlusions in group A and 2 (0.6%) in group B (p=0.14) were recorded. Hematomas between 5 and 10cm appeared in 5% of the group A vs. 4.6% in group B. During the 1-month follow-up period, one more radial occlusion in each group was recorded and there were 4 (1.1%) additional mild hematomas in group B and none in group A (p=0.48). CONCLUSIONS: Performing a transradial diagnostic cardiac catheterization without removal of the oral chronic anticoagulation appears safe in patients under acenocumarol therapy.
Assuntos
Anticoagulantes/uso terapêutico , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Heparina/uso terapêutico , Idoso , Anticoagulantes/efeitos adversos , Feminino , Hematoma/induzido quimicamente , Heparina/efeitos adversos , Humanos , Masculino , Estudos Prospectivos , Artéria RadialRESUMO
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