Added On : 10th April 2011In a randomized trial, a radial approach by experienced operators was similar in efficacy to a femoral approach and resulted in a lower rate of vascular complications.
Findings from small trials and observational studies suggest that rates of vascular and bleeding complications of percutaneous coronary intervention (PCI) are lower with radial than with femoral arterial access. In a randomized, unblinded trial at 158 hospitals in 32 countries, investigators assigned 7021 patients (mean age, 62; 14% aged >75) with acute coronary syndromes (28% ST-segment-elevation myocardial infarction [STEMI]) to either radial or femoral access for coronary angiography and planned PCI between 2006 and 2010.
Added On : 8th May 2011Evidence-Based Therapies for ST-Segment-Elevation Myocardial Infarction Improve Survival
A national registry in Sweden captures comprehensive data on the evolution of STEMI treatment and outcomes.
Several reports have described trends in therapy and outcomes in patients with myocardial infarction (MI), but few have included unrestricted populations. This study focuses on trends in evidence-based therapies and mortality in 61,238 patients who had a first-time diagnosis of ST-segment-elevation MI (STEMI) at acute cardiac care hospitals throughout Sweden from 1996 through 2007.
Added On : 5th June 2011Myocardial Injury Associated with Transcatheter Aortic Valve Implantation
Most patients have elevated cardiac enzyme markers after uncomplicated TAVI, but higher levels may be associated with worse outcomes.
Little is known about adverse myocardial effects of transcatheter aortic valve implantation (TAVI), which may arise from hypotension (due to balloon valvuloplasty or rapid pacing), tissue compression during deployment, or ventricular puncture during transapical access. In this single-center Canadian study, investigators measured cardiac enzymes at multiple time points up to 72 hours after TAVI of a balloon-expandable prosthesis in 101 patients, 63 of whom had transapical access. Patients who died within 24 hours or had life-threatening procedural complications were excluded from the analysis.
Added On : 3rd July 2011Okay to Switch from Heparin to Bivalirudin Before Primary Percutaneous Coronary Intervention
In patients taking unfractionated heparin at baseline, those who switched did as well as — or better than — those who remained on UFH with an added glycoprotein IIb/IIIa inhibitor.
In the industry-sponsored HORIZONS-AMI trial, investigators compared bivalirudin with unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibition for antithrombosis during primary percutaneous coronary intervention (PCI; JW Cardiol May 21 2008). In this subanalysis, the effects of switching agents were assessed in the 2357 patients who had received UFH before randomization. Most (82%) received bolus-only UFH (about 5000 IU, on average) about 1 hour before study drug administration.