#1
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Ññûëêè, íîâîñòè, èíòåðåñíûå ôàêòû è ò.ï.
Êîëëåãè, äðóçüÿ, ïðåäëàãàþ, ïî óñìîòðåíèþ Ìîäåðàòîðîâ è îáùåñòâåííîñòè, ñäåëàòü â èíòåðâåíöèîííîì ðàçäåëå òîïèê ïî îáðàçó è ïîäîáèþ òîïèêà "Èíòåðåñíûå ññûëêè" â òåðàïåâòè÷åñêîé êàðäèîëîãèè. Åñëè òîïèê áóäåò ðàçâèâàòüñÿ, âïîñëåäñòâèè ìîæíî áóäåò è ïðèêðåïèòü.
Äëÿ çàòðàâêè - èíòåðåñíàÿ ñòàòüñÿ: çàâèñèìîñòü èñõîäîâ ïëàíîâûõ ïëàñòèê îò âðåìåíè ñóòîê. Time of Day and Outcomes of Nonurgent Percutaneous Coronary Intervention Performed during Working Hours Warren J. Cantor, MD; Bradley H. Strauss, MD, PhD; Michelle M. Graham, MD; Danielle A. Southern, MSc; Ken Woo, MD; Ben Tyrrell, MD; Merril Knudtson, MD; William A. Ghali, MD, MPH [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Abstract Background During daytime working hours, outcomes may be worse when percutaneous coronary intervention (PCI) is performed later in the day because of operator fatigue and differences in process of care. Methods Using the APPROACH database, we analyzed 2,492 consecutive nonurgent PCI procedures performed during working hours. Patients undergoing PCI for acute coronary syndromes were excluded. Patients were separated into 2 groups based on whether PCI was started in the morning (7:00 AM-12:00 PM, n = 1,446) or after noon (12:01 PM-6:00 PM, n = 1,037). Outcomes included procedural complications; target vessel revascularization (TVR); and death at 7 days, 30 days, and 1 year. Results Patients undergoing PCI in the afternoon were more likely to have heart failure, reduced ejection fraction, and Canadian Cardiovascular Society class IV or atypical angina symptoms; more likely to be inpatients; less likely to have stable angina; and less likely to receive glycoprotein IIb/IIIa inhibitors. Patients undergoing PCI in the afternoon had significantly higher unadjusted rates of the composite of death and TVR at 7 days (0.9% vs 0.3%, P = .04) and 30 days (2.0% vs 1.0%, P = .04) and death at 1 year (2.2% vs 1.1%, P = .03) compared with PCI performed in the morning. After multivariate adjustment, the differences in the composite of death and TVR at 30 days and at 1 year were not statistically significant. Conclusion Patients undergoing nonurgent PCI during working hours after noon had higher rates of TVR in the first 30 days and death at 1 year. Further study is required to determine whether patient characteristics, operator fatigue, differences in process of care, or a combination of these factors accounts for the difference in outcomes. [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] ÇÛ: Èíòåðåñíî: ñîîòíîøåíèå ïëàñòèê ïðè ÎÊÑ è ïðè ñòàáèëüíûõ ôîðìàõ ÈÁÑ â èññëåäóåìûõ ëàáîðàòîðèÿõ: [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] |
#2
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Exercise Stress Test Results in Patients With Bare Metal Stents or Drug-Eluting Stent
Conclusions: DES implantation is associated with a higher rate of positive EST, compared to BMS, 1 month after PCI, likely due to a higher prevalence of endothelial dysfunction. EST seems to be helpful in predicting clinical outcome in patients with coronary stent implantation.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#3
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Stable CAD Patients Often Overestimate PCI Benefits
Key Points:
By Kim Dalton Wednesday, September 08, 2010 Most patients with stable coronary artery disease (CAD) who undergo catheterization believe that percutaneous coronary intervention (PCI), if necessary, will help prevent a future, possibly fatal myocardial infarction (MI). Most cardiologists, on the other hand, are aware that the benefit of PCI in this situation is limited to angina relief, according to results of a survey published in the September 7, 2010, issue of Annals of Internal Medicine. Investigators led by Michael B. Rothberg, MD, MPH, of Baystate Medical Center (Springfield, MA), surveyed 153 patients admitted to a single center for catheterization and possible PCI between December 2007 and August 2008. The survey contained questions about symptoms, the consent procedure, and perceptions regarding the benefits of PCI. In addition, for each of the 53 patients who underwent PCI, the researchers sent an abbreviated form of the survey along with a copy of the patient’s record to the cardiologist who performed the procedure as well as a general survey to all referring and interventional cardiologists at the center asking about the consent procedure, the anticipated benefits of elective PCI, and shared decision making without reference to a specific patient. Ninety-six percent (95% CI 92%-99%) of patients reported that they felt they understood why they might undergo PCI, while more than half said they were actively involved in the decision-making process. Nonetheless, 88% (95% CI 81%-93%) believed that PCI would prevent an MI and 82% (95% CI 75%-89%) believed it would prevent a fatal MI. The expectations of those who actually underwent PCI were similar to those who did not. In contrast, patients’ cardiologists believed PCI would prevent an MI in only 9 cases (17%) and a fatal MI in only 8 cases (15%). In 2 of these cases, the patient had a recent change in angina that would have excluded them from the COURAGE trial (showing no additional benefit of PCI over optimal medical therapy). However, in most cases the cardiologist believed substantial myocardium was at risk. Divide Between Patients’ and Physicians’ Understanding There was a disconnect between patients’ understanding and that of their cardiologists. Not only were patients more likely than their physicians to believe that PCI would prevent MI (prevalence ratio 4.25; 95% CI 2.31-7.79) and fatal MI (prevalence ratio 4.83; 95% CI 2.23-10.46), but patients also were less likely than their physicians to report pre-PCI angina (77% vs. 98%; P = 0.004) or to believe that they participated in the decision-making process (78% vs. 94%; P = 0.039). In response to 3 patient scenarios, most of the cardiologists, including interventionalists and referring physicians, said any benefits of PCI were largely limited to symptom relief. Moreover, in evaluating 2 of the 3 scenarios, 70% of cardiologists did not identify any benefit to PCI, yet 43% said they would perform the procedure anyway. In both univariate and multivariate analysis, 2 patient characteristics were associated with beliefs about PCI’s benefits:
Overestimating Benefits: Two Sides of the Coin The authors point out that most patients tend to believe a treatment offered will be beneficial even when presented with evidence to the contrary. Moreover, they may not understand the distinction between unstable angina (for which PCI may be life-saving) and stable angina because both conditions cause chest pain. Patients know that angina increases MI risk but, without being specifically informed, they are much less likely to know that alleviating angina will not decrease the risk, the investigators say. On the other side, physicians have little incentive to discourage patients from undergoing PCI and subconsciously may persuade themselves that a patient’s symptoms are more limiting than they really are, Dr. Rothberg and colleagues write. Another potential source of PCI overuse is ad hoc intervention, or performing PCI immediately following catheterization, they add, noting that this practice leaves little opportunity for informed decision making or consultation with the patient’s other physicians. “Our finding that many patients with little or no angina nonetheless were undergoing catheterization and PCI highlights that even after the publication of COURAGE, the indications for PCI are still not clear,” the authors write. Beefing Up the Benefit Side of Informed Consent In an accompanying editorial, Alicia Fernandez, MD, of the University of California, San Francisco (San Francisco, CA), writes that what is needed to improve physician-patient communications is “careful observational research, with direct recording of informed consent discussions and open-ended interviews with patients and physicians. “That the processes we typically use fail to accurately convey information on expected benefits is particularly distressing” for stable coronary artery disease, for which “patients’ informed preferences and values should guide the choice among several reasonable and effective treatment options,” Dr. Fernandez asserts. A key element of informed consent is assessment of patient understanding, she adds, suggesting that supplementary educational information and decision aids be incorporated into the informed consent process. In a telephone interview with TCTMD, Ajay J. Kirtane, MD, SM, of Columbia University Medical Center (New York, NY), said that observations from his own practice confirm 1 study finding: To most patients, it makes intuitive sense that opening up an artery can prevent an MI. Oversimplifying ‘Stable CAD’ In that sense the study is valuable, he commented, but the authors’ one-size-fits-all approach in portraying the benefits of PCI for stable CAD is somewhat disconcerting. “What gets lost in this article is that many patients with stable CAD were not in the COURAGE trial or any randomized trial. Saying that PCI does not improve mortality in stable CAD is a gross oversimplification of the complexity of patients that we treat in clinical practice,” Dr. Kirtane said. The fact that both referring physicians and interventionalists were aware of the results of the COURAGE trial is good news, he noted. The likely reason there were some apparent discrepancies between their knowledge of the data and the decision to perform PCI is that stable CAD is a complex disease. Moreover, the scenarios presented to physicians for evaluation of the benefit of PCI did not do justice to that complexity, he observed. “You have to make sure that you appropriately risk-stratify these patients. And when you administer informed consent, the onus is on the physician to convey [the treatment implications of any added complexity],” he concluded. Study Details Of 153 patients:
The 53% of patients who underwent PCI were more likely than those who did not to have a positive stress test result, but angina was similar in both groups. Most patients reported that a physician spent at least 5 minutes explaining PCI, and more than half received written information about it. Sources:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#4
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Äàííûå ïî êàðîòèäíîìó ñòåíòèðîâàíèþ â Çàïàäíîé Åâðîïå 2009-2010
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#5
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Ïðàñóãðåë ôîåâà?
Öèòàòà:
Öèòàòà:
__________________
Àáóãîâ Ñåðãåé Àëåêñàíäðîâè÷. Ðîññèéñêèé Íàó÷íûé Öåíòð Õèðóðãèè èì. àêàäåìèêà Á.Â. Ïåòðîâñêîãî. |
#6
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äàííûå ðåãèñòðà ýíäîâàñêóëÿðíûõ è õèðóðãè÷åñêèõ âìåøàòåëüñòâ â Åâðîïå çà 2009- 1 êâ 2010 ïî àíåâðèçìàì, ñîííûì è ïåðèôåðè÷åñêèì àðòåðèÿì
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Î÷åíü èíòåðåñíûå öèôðû, ìîæåò êîìó-òî èíòåðåñíî. |
#7
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Ðåêàíàëèçàöèÿ õðîíè÷åñêèõ òîòàëüíûõ îêêëþçèé. Ïèùà äëÿ ðàçìûøëåíèé...
Èíîãäà èõ, íàâåðíîå, íóæíî îòêðûâàòü...
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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#8
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×Ê íå êîìïðîìåòèðóåò ðåçóëüòàòû âûïîëíåííîãî ïîçäíåå ÊØ
Èñõîäû ÊØ íå çàâèñÿò îò òîãî, âûïîëíÿëîñü ëè ïàöèåíòó ðàíåå ×Ê èëè íåò.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#9
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Öèòàòà:
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#10
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Î÷åðåäíîé êëîíäàéê ïî êíèæêàì.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#12
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#13
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Drug delivery at the aortic valve tissues of healthy domestic pigs with a PEVB
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Öèòàòà:
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#14
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Simultaneous hybrid revascularization by carotid stenting and coronary artery bypass
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Öèòàòà:
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#15
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Periprocedural management and in-hospital outcome of patients with indication for OA
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Öèòàòà:
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