Distal Versus Conventional Radial Access for Coronary Angiography and Intervention

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2022, Volume and Issue: 15(12), P. 1191 - 1201

Published: May 17, 2022

Currently, transradial access (TRA) is the recommended for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple during their lifetimes. Recently, distal (DRA) has emerged as a promising alternative to minimize RAO risk. A large-scale, international, randomized trial comparing TRA and DRA lacking. The aim this study was assess superiority compared conventional respect forearm RAO. DISCO RADIAL (Distal vs Conventional Radial Access) an multicenter, controlled in indications percutaneous procedure using 6-F Slender sheath were or systematic implementation best practices reduce primary endpoint incidence assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, site–related complications. Overall, 657 underwent TRA, 650 DRA. Forearm did not differ between groups (0.91% 0.31%; P = 0.29). Patent achieved 94.4% patients. Crossover rates higher (3.5% 7.4%; 0.002), median time shorter (180 153 minutes; < 0.001). spasm occurred more (2.7% 5.4%; 0.015). Overall bleeding events complications groups. With rigorous protocol, have equally low rates. associated crossover rate but time.

Language: Английский

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P2Y12 Inhibitor Monotherapy or Dual Antiplatelet Therapy After Complex Percutaneous Coronary Interventions

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 81(6), P. 537 - 552

Published: Feb. 1, 2023

Language: Английский

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Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS)

The Annals of Thoracic Surgery, Journal Year: 2024, Volume and Issue: 117(4), P. 669 - 689

Published: Jan. 28, 2024

Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet ERAS involves the provision protocolized evidence-based perioperative interventions. Given both growing enthusiasm for applying principles cardiac surgery broad scope relevant interventions, an international, multidisciplinary expert panel was assembled derive list potential program elements, review literature, provide statement regarding practice each topic area. This article summarizes those consensus statements their accompanying evidence. These results foundation best management adult patient undergoing surgery. is approach aimed at providing bundled interventions therapies throughout encounter.1Ljungqvist O. Scott M. Fearon K.C. recovery after surgery: review.JAMA Surg. 2017; 152: 292-298Crossref PubMed Scopus (2024) Google Scholar central adoption protocols that published serially updated specialties.2Stenberg E. Dos Reis Falcão L.F. O'Kane et al.Guidelines care in bariatric Society recommendations: 2021 update [published correction appears World J 2022;46:752].World 2022; 46: 729-751Crossref (0) Scholar, 3Nelson G. Bakkum-Gamez J. Kalogera gynecologic/oncology: recommendations–2019 update.Int Gynecol Cancer. 2019; 29: 651-668Crossref (408) 4Gustafsson U.O. M.J. Hubner elective colorectal (ERAS®) 2018.World 43: 659-695Crossref (1023) Registry-based observational studies reveal high compliance with these reduce prevent complications, thereby improving value delivered care.5Stone A.B. Grant M.C. Pio Roda C. al.Implementation costs United States: financial model sensitivity analysis based on experiences quaternary academic medical center.J Am Coll 2016; 222: 219-225Crossref 6Thiele R.H. Rea K.M. Turrentine F.E. al.Standardization care: impact enhanced protocol length stay, direct surgery.J 2015; 220: 430-443Crossref (302) 7ERAS Compliance GroupThe cancer resection: from international registry.Ann 261: 1153-1159Crossref (497) 8Grant C.M. Canner J.K. al.The anesthesia-influenced process measure stay: cohort.Anesth Analg. 128: 68-74Crossref (36) In 2019, Cardiac original guidance, which reviewed literature provided recommendations elements patients surgery.9Engelman D.T. Ben Ali W. Williams J.B. recommendations.JAMA 154: 755-766Crossref (541) interim, new data as well recognition additional strategies necessitated update. The Society, collaboration affiliated International has committee experts develop optimize patient. developed following 2019 "Recommendations Standards Development Guidelines" (ERAS Standards), standardizes formation guidance development group, search, evidence, formation, creation manuscript.10Brindle Nelson Lobo D.N. Ljungqvist Gustafsson Recommendations ERAS® standards guidelines.BJS Open. 2020; 4: 157-163Crossref (94) including surgeons, anesthesiologists, intensivists, allied nurses, identified individual expertise experience ERAS. 2021, group convened initial meeting agreed derived combination prior guidelines, surrogate examples other subspecialties, opinion, divided into respective phases care. effort then aligned Thoracic Surgeons (STS) underwent formal by STS Workforce Evidence Based endorsement submission publication. Literature searches areas were conducted librarian assistance where necessary included reviews, guideline documents, humans December English, retrievable PubMed, Embase, Cochrane databases. Medical Subject Heading terms element or intervention, procedure, outcome. Preference given meta-analyses, prospective randomized trials, well-designed, nonrandomized studies. event intervention not reported setting surgery, evidence pertaining noncardiac settings considered, appropriate. Most outlined this manuscript pertain population, any exceptions explicitly stated prose, along description case types (ie, coronary artery bypass grafting [CABG], valve, aortic, etc). series virtual in-person meetings present discuss resolve controversies interpretation available Summary text modeled guidelines. Quality assessed, designations rendered whether further research unlikely (high), likely (moderate), very (low) important effect intervention.10Brindle minimum 70% agreement required consensus. associated quality are Table 1, organized general, preoperative, intraoperative, postoperative, multiphase sections.Table 1Summary Statements Level EvidenceStatementLevel EvidencePatient engagement improved through incorporation shared decision-making principles.LowProgram implementation sustainment facilitated establishment team, dedicated coordinator, extension Heart Team.ModerateRoutine auditing evaluation adherence component high-quality care.ModerateMultifaceted screening risk assessment improves informed consent allows advanced planning.ModerateMulticomponent prehabilitation may be considered nonurgent surgery.LowLimiting nil per oz status clear liquids (>2 hours before surgery) reasonable factors aspiration.LowTransesophageal echocardiography encouraged moderate morbidity mortality.ModerateMechanical ventilation lung-protective mechanics fewer pulmonary complications.HighThe role mechanical during cardiopulmonary uncertain.ModeratePulmonary catheters use low-risk procedures incurs greater health resource utilization without mortality.ModerateCentral nervous system monitoring early indication neurologic risk, but study identify mitigate injury.ModerateStandardized factor prophylaxis nausea vomiting.ModerateGoal-directed perfusion play preventing organ injury bypass.LowStructured facilitate extubation within 6 safe potentially hasten procedures.ModerateHighly selective intraoperative immediate appropriate surgery.LowRoutine and, appropriate, comprehensive treatment bundle can incidence severity acute kidney injury.ModerateEarly ambulation upper extremity exercise tolerated hastened recovery.ModerateGoal-directed fluid hemodynamic therapy guide resuscitation injury.ModerateA multimodal reduces reliance opioid-based analgesia optimizes pain management.ModerateChest wall regional effective management.ModerateBlood product optimized blood program.ModeratePostoperative atrial fibrillation optimally addressed multifaceted prevention strategy.ModerateRoutine systematic delirium tool nonpharmacologic aid identification delirium.HighThe application practices site infection.High Open table tab Engagement social network care, foster education establish realistic expectations. Although endorsed multiple subspecialty guidelines,2Stenberg also reinforced principle decision making, representatives work directly clinicians determine therapeutic course action while incorporating patient's values preferences process.11Lawton J.S. Tamis-Holland J.E. Bangalore S. al.Writing Committee Members2021 ACC/AHA/SCAI Guideline Coronary Artery Revascularization: report American College Cardiology/American Association Joint Clinical Practice Guidelines.J Cardiol. 79: e21-e129Crossref (507) Patient augmented digital technologies, wearable remote monitors interactive applications, plan collection determinants familial involvement.12Cook D.J. Manning D.M. Holland D.E. al.Patient recovery: effectiveness e-health platform.J 2013; 217: 648-655Crossref (46) 13Ocagli H. Lorenzoni Lanera al.Monitoring valve replacement using devices: insights feasibility capability study: results.Int Environ Res Public Health. 2021; 18: 7171Crossref (5) 14Ben-Ali Lamarche Y. Carrier al.Use mobile-based patient-reported surgery.Innovations (Phila). 16: 536-544Crossref 15Charles E.J. Mehaffey J.H. Hawkins R.B. al.Effect one-year outcomes: cohort study.Ann Thorac 112: 1410-1416Abstract Full Text PDF (4) 16Charles al.Meaningful patient-centered 1 year surgery.Ann 273: e247-e254Crossref (9) Data emanating tools include physiological data, vitals, sleep statistics, movement, outcomes,17Mihalj Carrel T. Urman R.D. Stueber F. Luedi M.M. preoperative surgery.Curr Anesthesiol Rep. 10: 185-195Crossref (22) 18Havranek E.P. Mujahid M.S. Barr D.A. al.American Council Care Outcomes Research, Epidemiology Prevention, Cardiovascular Stroke Nursing, Lifestyle Cardiometabolic Health, Council. Social cardiovascular disease: scientific Association.Circulation. 132: 873-898Crossref (936) 19Perez Jolles Richmond Thomas Minority preferences, barriers, facilitators providers USA: review.Patient Educ Couns. 102: 1251-1262Crossref (53) 20Lamore K. Montalescot L. Untas A. Treatment chronic diseases: What family members' roles, needs attitudes? 100: 2172-2181Crossref (78) 21Abola R.E. Bennett-Guerrero Kent M.L. Perioperative Initiative Consensus Statement Patient-Reported Pathway.Anesth 2018; 126: 1874-1882Crossref modifications traditional metrics, increased emphasis physical, psychological, functional surgery.22Churruca Pomare Ellis L.A. al.Patient-reported outcome measures (PROMs): generic condition-specific discussion trends issues.Health Expect. 24: 1015-1024Crossref (136) Scholar,23Subramanian Kozower B.D. Brown L.M. Khullar O.V. Fernandez F.G. Patient-reported cardiothoracic 107: 294-301Abstract tools, such personal phone applications activity trackers, correlate disposition home vs facility) utilization.24Ayers B. Lee Wood al.Patient-Reported Measurement Information System (PROMIS) left ventricular assist devices.Ann 113: 859-865Abstract 25Killian M.O. Clifford S.A. Gupta D. Directly observed medication paediatric heart transplant recipients.Cardiol Young. 31: 2048-2050Crossref 26Hughes T.M. Merath Chen Q. al.Association healthcare utilization.Am 216: 7-12Abstract (134) Statement: principles. Evidence: Low team (MDT) represents Team proposed traditionally cardiology working concert ideal procedural intervention.11Lawton MDT includes disciplines, health, pharmacists, dietitians, more fundamental perfusionists, rehabilitation specialists. Multiple describe resistance change poor communication barrier implementation, whereas establishes among all disciplines recognized facilitator success.27Stone Yuan C.T. Rosen M.A. al.Barriers implementing pathways framework: 153: 270-279Crossref (68) 28Cohen R. Gooberman-Hill Staff qualitative studies.BMJ 9e022259Crossref (42) 29Martin Roulin Grass al.A multicentre assessing program.Clin Nutr. 37: 2172-2177Abstract 30Pearsall E.A. Meghji Z. Pitzul K.B. understand barriers enablers program.Ann 92-96Crossref (171) 31Ljungqvist de Boer H.D. Balfour al.Opportunities challenges next phase Surgery: 156: 775-784Crossref (124) designated coordinator pathway development, education, collection, reporting should part MDT.32Jawitz O.K. Bradford W.T. McConnell Engel Allender How start program.Crit Clin. 36: 571-579Abstract 33Francis N.K. Walker Carter al.Consensus training Delphi study.World 42: 1919-1928Crossref (39) 34Paton Chambers Wilson P. al.Effectiveness programmes: rapid synthesis.BMJ 2014; 4e005015Crossref (111) An gains "buy-in" stakeholders effectively communicating vision supporting provides ongoing members. crucial cultural shift successful implementation.35Knott Pathak McGrath views measurement England: study.BMJ 2012; 2e001878Crossref (52) 36Zorrilla-Vaca Stone Ripolles-Melchor al.Institutional secondary multicenter study.J Clin Anesth. 74110378Crossref (6) 37Salenger Morton-Bailey V. Gregory Engelman building implementation.Semin Cardiovasc 32: 187-196Abstract 38Morton-Bailey Salenger 10 commandments 493-497Crossref (2) Program Team. Moderate established registry, Adult Database (ACSD), major operations, promotes performance benchmarking informs improvement programs.39Shapira O.M. Blumenfeld Bolotin Grover F.L. Shahian participation Database: institutional national.Ann 103: 1683-1686Abstract 40Fernandez Kormos National annual report.Ann 108: 1625-1632Abstract 41Jacobs J.P. Grau-Sepulveda al.Current penetration, completeness, representativeness Database.Ann 1461-1468Abstract (23) 42Jacobs Prager R.L. al.Introduction Series: analysis, improvement, safety.Ann 1992-2000Abstract (73) There opportunity expansion current set variables specific elements.43Hirji Boyle E.M. al.Expert Surgery.World 45: 917-925Crossref (14) addition, multi-institutional registries subspecialities key allow researchers critically analyze assess Numerous service lines environments dose-response relationship between outcomes.44Gustafsson Hausel Thorell Soop Nygren Adherence surgery.Arch 2011; 146: 571-577Crossref (640) 45Currie Burch Jenkins J.T. 46Simpson J.C. Moonesinghe S.R. Grocott M.P.W. al.Enhanced UK: audit partnership programme 2009-2012.Br Anaesth. 115: 560-568Abstract (116) 47Ripollés-Melchor Ramírez-Rodríguez J.M. Casans-Francés complications Postoperative Within Protocol (POWER) Study.JAMA 725-736Crossref (183) 48Ripollés-Melchor Sánchez-Santos Abad-Motos al.Higher Society® shorter hospital stay increase readmissions association Protocols Complications Bariatric (POWER 3) study.Obes 1289-1299PubMed Regular adherence, addition registries, aides identifying associations highlights opportunities iteration improvement.49Hensley N.B. Cho B.C. Suffredini Abernathy J.A. do we dashboards enhance anesthesia?.J Cardiothorac Vasc 35: 2969-2976Abstract (7) 50Grant Galante Hobson D.B. al.Optimizing program: postimplementation strategy.Jt Comm Qual Saf. 524-533PubMed 51Fischer C.P. Knapp Cohen M.E. Ko C.Y. Wick E.C. outcomes.JAMA 982-984Crossref (3) 52Kołodziej Maciejewski Mendrala surgery.Kardiochir Torakochirurgia Pol. 32-36PubMed 53Magoon Choudhury Sarkar Joshi it just about putting bundles together?.Ann 276-278Crossref Routine Preoperative suitability optimization. 2 summary laboratory criteria assessment. predicted mortality European Risk Assessment 2011 revision (EuroSCORE II) calculators most widely used in-hospital morbidity, guidelines.11Lawton Scholar,54Pittams A.P. Iddawela Zaidi Tyson N. Harky Scoring systems stratification 1148-1156Abstract (8) Scholar,55Saxena Dhurandhar Bannon P.G. Newcomb A.E. benefits pitfalls surgery.Heart Lung Circ. 25: 314-318Abstract ScholarTable 2Recommended ComponentsComponentRationaleSTS EuroSCORE IIStratified short-term mortality.Frailty assessmentPrefrail frail marked adjusted mortality. several validated

Language: Английский

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Evolving Management Paradigm for Stable Ischemic Heart Disease Patients

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 81(5), P. 505 - 514

Published: Jan. 30, 2023

Language: Английский

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Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(23), P. 2167 - 2176

Published: Oct. 23, 2023

Language: Английский

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FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: 390(16), P. 1481 - 1492

Published: April 8, 2024

The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear.

Language: Английский

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The Multidisciplinary Heart Team in Cardiovascular Medicine

JACC Advances, Journal Year: 2023, Volume and Issue: 2(1), P. 100160 - 100160

Published: Jan. 1, 2023

Cardiovascular multidisciplinary heart teams (MDHTs) have evolved significantly over the past decade. These play a central role in treatment of wide array cardiovascular diseases affecting interventional cardiology, cardiac surgery, imaging, advanced failure, adult congenital disease, cardio-oncology, and cardio-obstetrics. To meet specific needs both patients programs, composition function MDHTs had to adapt evolve. Although lessons been learned from cancer care, best practices for operation yet be defined, evidence base supporting their effectiveness is limited. This expert panel review discusses history evolution MDHTs, treating across broad spectrum disciplines, basic tenets successful operation, future challenges facing them.

Language: Английский

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ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 81(25), P. 2445 - 2467

Published: May 25, 2023

Language: Английский

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Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

JAMA Cardiology, Journal Year: 2024, Volume and Issue: 9(5), P. 437 - 437

Published: March 20, 2024

Importance Among patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether the treatment efficacy of P2Y 12 inhibitor monotherapy after a short course dual antiplatelet therapy (DAPT) depends on type inhibitor. Objective To assess risks and benefits ticagrelor or clopidogrel compared with standard DAPT PCI. Data Sources MEDLINE, Embase, TCTMD, European Society Cardiology website were searched from inception to September 10, 2023, without language restriction. Study Selection Included studies randomized clinical trials comparing adjudicated end points in indication oral anticoagulation Extraction Synthesis Patient-level data provided by each trial synthesized into pooled dataset analyzed using 1-step mixed-effects model. The study is reported following Preferred Reporting Items for Systematic Review Meta-Analyses Individual Participant Data. Main Outcomes Measures primary objective was determine noninferiority vs composite death, myocardial infarction (MI), stroke per-protocol analysis 1.15 margin hazard ratio (HR). Key secondary major bleeding net adverse events (NACE), including point bleeding. Results Analyses included 6 25 960 PCI, whom 24 394 (12 403 receiving DAPT; 8292 monotherapy; 3654 45 prasugrel monotherapy) retained analysis. Trials conducted Asia, Europe, North America; all Asia. Ticagrelor noninferior (HR, 0.89; 95% CI, 0.74-1.06; P = .004), but not 1.37; 1.01-1.87; &amp;gt; .99), this finding driven noncardiovascular death. risk lower both 0.47; 0.36-0.62; &amp;lt; .001) 0.49; 0.30-0.81; .006; interaction 0.88). NACE 0.74; 0.64-0.86, 1.00; 0.78-1.28; .99; .04). Conclusions Relevance This systematic review meta-analysis found that all-cause MI, superior NACE. Clopidogrel similarly associated reduced stroke, largely because observed 1 exclusively East Asian an excess

Language: Английский

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Association between non-insulin-based insulin resistance indices and cardiovascular events in patients undergoing percutaneous coronary intervention: a retrospective study

Cardiovascular Diabetology, Journal Year: 2023, Volume and Issue: 22(1)

Published: June 29, 2023

Insulin resistance (IR) has been confirmed that getting involved in the pathophysiological process of cardiovascular diseases (CVD). Recently, increasing evidence suggests metabolic score for insulin (METS-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, and glucose (TyG) index, glucose-body mass (TyG-BMI) index are simple reliable surrogates IR. However, their abilities predicting outcomes patients undergoing percutaneous coronary intervention (PCI) not well explored. Therefore, this study aimed investigate association evaluate predictive performance each index.A total 2533 consecutive participants PCI were included study, data from 1461 used determine correlation these non-insulin-based IR indices with major adverse cardiac cerebrovascular events (MACCEs) via performing multivariate logistic models restricted cubic splines (RCS).During a median 29.8 months follow-up, 195 cases experienced incident MACCEs. In overall population, both univariate regression analyses indicated no statistically significant connection between Subgroup revealed interactions age subgroups TyG-BMI as METS-IR, sex TyG index. elderly patients, per 1.0-SD increment METS-IR had MACCEs, odds ratios (ORs) [95% confidence interval (CI)] 1.24 (1.02-1.50) 1.27 (1.04-1.56), respectively (both P < 0.05). Moreover, female all showed associations Multivariable-adjusted RCS curves demonstrated linear relationship MACCEs respectively. failed enhance basic risk model MACCEs.All four individuals, whereas only patients. Although inclusion did improve power either or appears be most promising secondary prevention stratification PCI.

Language: Английский

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