Importance
The
Aspirin
and
Hemocompatibility
Events
With
a
Left
Ventricular
Assist
Device
in
Advanced
Heart
Failure
(ARIES-HM3)
study
demonstrated
that
aspirin
may
be
safely
eliminated
from
the
antithrombotic
regimen
after
HeartMate
3
(HM3
[Abbott
Cardiovascular])
left
ventricular
assist
device
(LVAD)
implantation.
This
prespecified
analysis
explored
whether
conditions
requiring
(prior
percutaneous
coronary
intervention
[PCI],
artery
bypass
grafting
[CABG],
stroke,
or
peripheral
vascular
disease
[PVD])
would
influence
outcomes
differentially
with
avoidance.
Objective
To
analyze
avoidance
on
hemocompatibility-related
adverse
events
(HRAEs)
at
1
year
implant
patients
history
of
CABG,
PCI,
PVD.
Design,
Setting,
Participants
was
an
international,
multicenter,
prospective,
double-blind,
placebo-controlled,
randomized
clinical
trial
including
implanted
de
novo
HM3
LVAD
across
51
centers.
Data
conducted
April
to
July
2024.
Interventions
Patients
were
1:1
ratio
receive
(100
mg
per
day)
placebo,
addition
vitamin
K
antagonist
(VKA)
targeted
international
normalized
2
both
groups.
Main
Outcomes
Measures
Primary
end
point
(assessed
for
noninferiority)
composite
survival
free
any
nonsurgical
(>14
days
implant)
HRAEs
pump
thrombosis,
bleeding,
arterial
thromboembolism
12
months.
Secondary
points
included
thrombosis
events.
Results
Among
589
628
(mean
[SD]
age,
57.1
[13.7]
years;
456
male
[77.4%])
who
contributed
primary
analysis,
PVD
present
41%
(240
patients).
There
no
interaction
between
presence
atherosclerotic
condition
effect
compared
placebo
(
P
interaction=
.23).
preset
10%
noninferiority
margin
not
crossed
studied
subgroup
patients.
Thrombotic
rare,
differences
without
=
.77).
treatment
associated
higher
rate
major
bleeding
group
prior
those
(rate
aspirin,
0.52;
95%
CI,
0.35-0.79).
Conclusions
Relevance
this
ARIES-HM3
demonstrate
advanced
heart
failure
have
classical
indications
antiplatelet
therapy
use
time
implantation,
safe
increased
risk.
Importantly,
elimination
but
reduction
Trial
registration
ClinicalTrials.gov
Identifier:
NCT04069156
Journal of the American College of Cardiology,
Год журнала:
2022,
Номер
80(4), С. 348 - 372
Опубликована: Июль 1, 2022
The
introduction
and
subsequent
iterations
of
drug-eluting
stent
technologies
have
substantially
improved
the
efficacy
safety
percutaneous
coronary
interventions.
However,
incidence
in-stent
restenosis
(ISR)
resultant
need
for
repeated
revascularization
still
occur
at
a
rate
1%-2%
per
year.
Given
that
millions
stents
are
implanted
each
year
around
globe,
ISR
can
be
considered
as
pathologic
entity
public
health
significance.
mechanisms
multifactorial.
Since
first
description
angiographic
patterns
ISR,
advent
intracoronary
imaging
has
further
elucidated
ISR.
armamentarium
treatment
strategies
also
evolved
over
time.
Currently,
an
individualized
approach
using
to
characterize
underlying
substrate
is
recommended.
In
this
paper,
we
comprehensively
reviewed
incidence,
mechanisms,
characterization
propose
contemporary
algorithm.
International Journal of Molecular Sciences,
Год журнала:
2022,
Номер
23(17), С. 9553 - 9553
Опубликована: Авг. 23, 2022
Atherosclerosis,
the
underlying
cause
of
coronary
artery
disease
(CAD),
has
a
significant
inflammatory
component.
White
blood
cell
count
is
an
affordable
and
accessible
way
to
assess
systemic
immune
response,
as
it
comprises
many
subgroups
with
distinct
complex
functions.
Considering
their
multidirectional
effect
on
atherosclerosis,
new
biomarkers
integrating
various
leukocyte
subgroups,
Systemic
Inflammatory
Index
(SII)
Response
(SIRI),
were
recently
devised
describe
balance
between
inflammation
reaction.
This
research
aimed
evaluate
relationship
intensity
measured
by
these
severity
CAD
assessed
angiography
diagnosis
acute
syndrome
(ACS)
or
stable
in
699
patients.
SIRI,
but
not
SII,
was
associated
diagnosis,
having
highest
values
for
patients
ACS
(STEMI),
significantly
higher
than
(p
<
0.01).
The
SII
SIRI
observed
three-vessel
CAD.
require
further
in-depth
well-designed
potential
clinical
setting.
Diagnostic
and
therapeutic
advances
during
the
past
decades
have
substantially
improved
health
outcomes
for
patients
with
acute
coronary
syndrome.
Both
age-related
physiological
changes
accumulated
cardiovascular
risk
factors
increase
susceptibility
to
syndrome
over
a
lifetime.
Compared
younger
patients,
in
large
growing
demographic
of
older
adults
are
relatively
worse.
Increased
atherosclerotic
plaque
burden
complexity
anatomic
disease,
compounded
by
noncardiovascular
comorbid
conditions,
contribute
worse
prognosis
observed
individuals.
Geriatric
syndromes,
including
frailty,
multimorbidity,
impaired
cognitive
physical
function,
polypharmacy,
other
complexities
care,
can
undermine
efficacy
guidelines-based
treatments
resiliency
survive
recover,
as
well.
In
this
American
Heart
Association
scientific
statement,
we
(1)
review
that
predispose
management
complexity;
(2)
describe
influence
commonly
encountered
geriatric
syndromes
on
disease
outcomes;
(3)
recommend
age-appropriate
guideline-concordant
revascularization
strategies,
transitions
use
cardiac
rehabilitation,
palliative
care
services,
holistic
approaches.
The
primacy
individualized
assessment
patient-centered
decision-making
is
highlighted
throughout.
