Background: Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier.
Background: The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.
Approximately half of patients with ST-segment–elevation myocardial infarction (STEMI) have angiographically significant multivessel disease and, in these patients, the European (2012) and US (2013) guideline recommendations have been that only the culprit artery should be treated acutely. In the setting of cardiogenic shock, the guidelines recommend treating any nonculprit arteries to achieve as complete a revascularization as possible. Both of these recommended strategies are based on level C evidence (observational studies and consensus opinion). In the past 4 years, there have been 3 new randomized trials that have contributed to the knowledge base in this area (Table).
The continuing evolution of new technologies has resulted in a noted improvement in procedural outcomes in patients undergoing percutaneous coronary interventions (PCI) for chronic total occlusions (CTO). We now have an expansive selection of interventional tools and techniques to successfully perform these complex interventional procedures. Coronary guide wires specifically engineered to facilitate crossing almost any CTO lesion are now available. We have developed plaque modification tools, devices facilitating directed subintimal tracking and reentry, and retrograde CTO techniques resulting in previously unimagined procedural success rates approaching >80% in the hands of experienced operators. These tools have allowed us to expand the group of patients that we now consider approachable, although CTO PCI currently represent only 3% to 4% of all PCI procedures performed in the United States. Similarly, procedural complication rates continue to decline, although other factors such as radiation exposure, contrast volume, and the increased use of costly resources remain problematic. Overall, these observations underscore the need for the cardiac interventional community to more objectively understand the risks and benefits of CTO PCI.
Background: Catheter ablation for ventricular tachycardia and premature ventricular complexes (PVCs) is common. Catheter ablation of atrial fibrillation is associated with a risk of cerebral emboli attributed to cardioversions and numerous ablation lesions in the low-flow left atrium, but cerebral embolic risk in ventricular ablation has not been evaluated.
Background: Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain the strength of association and to quantify the diagnostic accuracy of different ultrasound signs in predicting CoA prenatally.
Background: Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation. However, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative mitral regurgitation with a flail leaflet.
Background: Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive.
Background: Despite growing recognition of type 2 myocardial infarction (T2MI; related to supply/demand mismatch), little is known about its risk factors or its association with outcome.
Background: Thrombus aspiration during percutaneous coronary intervention (PCI) for the treatment of ST-segment–elevation myocardial infarction (STEMI) has been widely used; however, recent trials have questioned its value and safety. In this meta-analysis, we, the trial investigators, aimed to pool the individual patient data from these trials to determine the benefits and risks of thrombus aspiration during PCI in patients with ST-segment–elevation myocardial infarction.
Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE).
Background: Total anomalous pulmonary venous connection (TAPVC) is a rare form of congenital heart disease. This study describes current surgical treatment strategies and experiences in a cohort of patients from 2 congenital cardiac centers in Shanghai and Guangdong in China.
Background: There are limited data on aspirin (ASA) desensitization for patients with coronary artery disease. The aim of the present study was to assess the safety and efficacy of a standard rapid desensitization protocol in patients with ASA sensitivity undergoing coronary angiography.
Background: Sex differences in the outcomes after percutaneous coronary intervention with drug-eluting stents and in the response to clopidogrel therapy have been reported; however, the differential risk of high platelet reactivity (HPR) on clopidogrel in women versus men is unknown.
Background: The incidence of contrast-induced acute kidney injury is strongly related to the amount of the given contrast. Our objectives were to evaluate the efficacy and safety of coronary sinus aspiration (CSA) procedure to reduce the volume of the given contrast and attenuate the risk of contrast-induced acute kidney injury.
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