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Archive for November, 2012

Mortality Morbidity Meeting 28 November 2012

This is a place-holder documenting this meeting occurred.

 

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Stent Fracture in Everolimus Eluting Stents and Clinical Outcome

November 23, 2012 2 comments

Stent fracture in EES  and clinical outcome are explored in this paper.

Journal Club 21 November 2012

Paper

Effects of Radial Versus Femoral Artery Access in Patients With Acute Coronary Syndromes With or Without ST-Segment Elevation

Presenter

AC

Summary

Objectives

The purpose of this study was to determine the consistency of the effects of radial artery access in patients with ST-segment elevation myocardial infarction (STEMI) and in those with non–ST-segment elevation acute coronary syndrome (NSTEACS).

Background

The safety associated with radial access may translate into mortality benefit in higher-risk patients, such as those with STEMI.

Methods

We compared efficacy and bleeding outcomes in patients randomized to radial versus femoral access in RIVAL (RadIal Vs femorAL access for coronary intervention trial) (N  7,021) separately in those with STEMI (n  1,958) and NSTEACS (n  5,063). Interaction tests between access site and acute coronary syndrome type were performed.

Results

Baseline characteristics were well matched between radial and femoral groups. There were significant interactions for the primary outcome of death/myocardial infarction/stroke/non–coronary artery bypass graft–related major bleeding (p  0.025), the secondary outcome of death/myocardial infarction/stroke (p  0.011) and mortality (p  0.001). In STEMI patients, radial access reduced the primary outcome compared with femoral access (3.1% vs. 5.2%; hazard ratio [HR]: 0.60; p  0.026). For NSTEACS, the rates were 3.8% and 3.5%, respectively (p  0.49). In STEMI patients, death/myocardial infarction/stroke were also reduced with radial access (2.7% vs. 4.6%; HR 0.59; p  0.031), as was all-cause mortality (1.3% vs. 3.2%; HR: 0.39; p  0.006), with no difference in NSTEACS patients. Operator radial experience was greater in STEMI versus NSTEACS patients (400 vs. 326 cases/year, p  0.0001). In primary PCI, mortality was reduced with radial access (1.4% vs. 3.1%; HR: 0.46; p  0.041).

Conclusions

In patients with STEMI, radial artery access reduced the primary outcome and mortality. No such benefit was observed in patients with NSTEACS. The radial approach may be preferred in STEMI patients when the operator has considerable radial experience. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy)

Mitral valve prolapse and sudden cardiac death

Journal Club 7 November 2012

Paper

Strategies for Multivessel Revascularization in Patients with Diabetes

Presenter

AC

Summary

Background

In some randomized trials comparing revascularization strategies for patients with
diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than
percutaneous coronary intervention (PCI). We sought to discover whether aggressive
medical therapy and the use of drug-eluting stents could alter the revascularization
approach for patients with diabetes and multivessel coronary artery disease.

Methods

In this randomized trial, we assigned patients with diabetes and multivessel coronary
artery disease to undergo either PCI with drug-eluting stents or CABG. The patients
were followed for a minimum of 2 years (median among survivors, 3.8 years). All
patients were prescribed currently recommended medical therapies for the control of
low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin.
The primary outcome measure was a composite of death from any cause, nonfatal
myocardial infarction, or nonfatal stroke.

Results

From 2005 through 2010, we enrolled 1900 patients at 140 international centers.
The patients’ mean age was 63.1±9.1 years, 29% were women, and 83% had threevessel
disease. The primary outcome occurred more frequently in the PCI group
(P = 0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG
group. The benefit of CABG was driven by differences in rates of both myocardial
infarction (P<0.001) and death from any cause (P = 0.049). Stroke was more frequent
in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the
CABG group (P = 0.03).

Conclusions

For patients with diabetes and advanced coronary artery disease, CABG was superior
to PCI in that it significantly reduced rates of death and myocardial infarction,
with a higher rate of stroke.

Journal Club 31 October 2012

Paper

None. TCT presentations on PFO Closure Trials

Presenter

CH