Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention Results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial
Germano Di Sciascio, MD,* Giuseppe Patti, MD,* Vincenzo Pasceri, MD,† Achille Gaspardone, MD,‡ Giuseppe Colonna, MD,§ Antonio Montinaro, MD§
Rome and Lecce, Italy

Objectives This study was designed to investigate whether an acute atorvastatin reload before percutaneous coronary intervention (PCI) protects patients receiving chronic statin therapy from periprocedural myocardial damage.
Background Previous ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) studies demonstrated that short-term pre-treatment with atorvastatin reduces myocardial infarction during PCI in statin-naïve patients with both stable angina and acute coronary syndromes.
Methods A total of 383 patients (age 66 + 10 years, 305 men) with stable angina (53%) or non–ST-segment elevation acute coronary syndromes (47%) and chronic statin therapy (55% atorvastatin) undergoing PCI were randomized to atorvastatin reload (80 mg 12 h before intervention, with a further 40-mg pre-procedural dose [n = 192]) or placebo (n = 191). All patients received long-term atorvastatin treatment thereafter (40 mg/day). The primary end point was 30-day incidence of major adverse cardiac events (cardiac death, myocardial infarction, or unplanned revascularization).
Results The primary end point occurred in 3.7% of patients treated with atorvastatin reload and in 9.4% in the placebo arm (p = 0.037); this difference was mostly driven by reduction in periprocedural myocardial infarction. There was lower incidence of post-procedural creatine kinase-myocardial band and troponin-I elevation greater than the upper limit of normal in the atorvastatin arm (13% vs. 24%, p = 0.017 and 37% vs. 49%, p = 0.021, respectively). Multivariable analysis identified atorvastatin reload as a predictor of decreased risk of 30-day incidence of major adverse cardiac events (odds ratio: 0.50, 95% confidence interval: 0.20 to 0.80; p = 0.039),
mainly in patients with acute coronary syndromes (82% relative risk reduction; p = 0.027).
Conclusions The ARMYDA-RECAPTURE study suggests that reloading with high-dose atorvastatin improves the clinical outcome of patients on chronic statin therapy undergoing PCI. These findings may support a strategy of routine reload with high-dose atorvastatin early before intervention even in the background of chronic therapy. (J Am Coll Cardiol 2009;54:000–000) © 2009 by the American College of Cardiology Foundation

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P.S. запостился на высоте 10 000 метров:eek:, wifi на борту самолета реально пашет

The FAIR-HF (Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure) trial, reported on by Anker and colleagues in this issue of the Journal,9 is a multicenter trial that evaluated the efficacy of intravenous-iron infusion on symptoms and submaximal exercise capacity in a cohort of patients with mild or moderate heart failure due to left ventricular systolic dysfunction (NCT00520780). The trial enrolled 459 patients with NYHA functional class II or III symptoms, a depressed left ventricular ejection fraction, and documented iron deficiency. According to a randomized, placebo-controlled design, patients were assigned to receive 200 mg of intravenous iron or infused saline weekly until their iron stores were replete. Then, intravenous iron or placebo infusions were continued every 4 weeks up to week 24. The primary end points were the self-reported Patient Global Assessment and the NYHA functional class at week 24. Secondary end points included the distance on the 6-minute walk test and health-related quality-of-life validated surveys at weeks 4, 12, and 24.

The two groups of patients were well matched regarding the baseline characteristics: overall, 82% had NYHA class III symptoms; the mean left ventricular ejection fraction was 32%; the mean serum ferritin level was 52 µg per liter in the ferric carboxymaltose group and 60 µg per liter in the placebo group; and 50% of patients had anemia. Ferric carboxymaltose therapy rapidly increased ferritin levels to be within the normal range; a modest increase in the serum hemoglobin level was seen in patients who had anemia (mean [±SE] increase, 9.1±2.2 g per liter; P<0.001) but not in patients who did not have anemia. The administration of intravenous iron, as compared with placebo, convincingly improved the self-reported Patient Global Assessment (odds ratio, 2.5) and the NYHA functional class (odds ratio, 2.4). For the self-reported Patient Global Assessment, 50% of the treated patients reported that they were much or moderately improved, as compared with only 28% of the control patients. The degree of improvement in both end points was similar in patients with anemia and those without anemia. Furthermore, significant improvement in the secondary end points, including an increase of more than 30 m in the 6-minute walk distance, was also observed. There was also a nonsignificant trend toward fewer hospitalizations for cardiovascular reasons (hazard ratio, 0.53; 95% confidence interval, 0.25 to 1.09; P=0.08).
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Anemia and Iron Deficiency — New Therapeutic Targets in Heart Failure?
G. William Dec, M.D., New England Journal of Medicine
__________________________________________________ _

N Engl J Med. 2009 Nov 17.

Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency.
Anker SD, et.al.

BACKGROUND: Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection fraction, and iron deficiency, either with or without anemia. METHODS: We enrolled 459 patients with chronic heart failure of New York Heart Association (NYHA) functional class II or III, a left ventricular ejection fraction of 40% or less (for patients with NYHA class II) or 45% or less (for NYHA class III), iron deficiency (ferritin level <100 mug per liter or between 100 and 299 mug per liter, if the transferrin saturation was <20%), and a hemoglobin level of 95 to 135 g per liter. Patients were randomly assigned, in a 2:1 ratio, to receive 200 mg of intravenous iron (ferric carboxymaltose) or saline (placebo). The primary end points were the self-reported Patient Global Assessment and NYHA functional class, both at week 24. Secondary end points included the distance walked in 6 minutes and the health-related quality of life. RESULTS: Among the patients receiving ferric carboxymaltose, 50% reported being much or moderately improved, as compared with 28% of patients receiving placebo, according to the Patient Global Assessment (odds ratio for improvement, 2.51; 95% confidence interval [CI], 1.75 to 3.61). Among the patients assigned to ferric carboxymaltose, 47% had an NYHA functional class I or II at week 24, as compared with 30% of patients assigned to placebo (odds ratio for improvement by one class, 2.40; 95% CI, 1.55 to 3.71). Results were similar in patients with anemia and those without anemia. Significant improvements were seen with ferric carboxymaltose in the distance on the 6-minute walk test and quality-of-life assessments. The rates of death, adverse events, and serious adverse events were similar in the two study groups. CONCLUSIONS: Treatment with intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life; the side-effect profile is acceptable.

Cardiac Imaging With Computed Tomography and Magnetic Resonance: Update
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Continuation of Low-Dose Aspirin in Peptic Ulcer Bleeding
 

Широко распространено мнение о том, что перед КАГ и ТБКА со стентированием нужно делать гастоскопию, т.к. минимум 12 месячный прием плавикс+аспирин при пропущенной кровоточащей язве - это смерть. Мало того, в каждой приличной клинике обычно заведующие могут привести 1-2 примера фатальных пропущенных кровотечений у таких пациентов. Обычно, если такая язва находится при ЭГДС пациента отправляют домой лечиться на 2-4 недели, потом повторная ЭГДС и ТБКА.
На мой взгляд при оценке риска/пользы учитывается в основном риск кровотечения, т.к. он происходит в стационаре или сразу после вмешательства (ТБКА), что позволяет пациентам потом обвинять врачей во всех смертных грехах. Если же мы пациента отпускаем домой лечить язву, отменив ему аспирин, и он дома тихо умирает от инфаркта, то здесь к больнице никаких претензий обычно не возникает.
Доказательной базы (РКИ) под ту или иную тактику не было и каждый решает этот вопрос на свое усмотрение.
В Annals Internal Medicine сегодня опубликована удивительная статья, которая, на мой взгляд, существенно меняет ситуацию. По мнению авторов этого слепого рандомизированного исследования аспирин отменять не только не нужно, но и смертельно опасно у пациентов с ИБС.
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Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism
 

Игорь, при цене дабигатрана 10000 руб/мес, у варфарина остается масса показаний.

Вот-вот, и не стоит сбрасывать со счетов отсутствие внятной тактики при осложнениях-кровотечениях:


The management of bleeding complications associated
with traditional anticoagulants, including warfarin, UFH
and LMWHs, is aided by the availability of antidotes
(vitamin K, protamine), laboratory tests to assess the level
of anticoagulation (INR, aPTT, antiXa activity), and clinical
guidelines. Comparatively, there is little information
available at present to guide management of
bleeding complications associated with the new oral anticoagulants.
No specific antidotes are available and there is
little information regarding the potential role of blood
products, antifibrinolytic agents (aminocaproic acid, tranexamic
acid) or prohemostatic agents like recombinant
factor VIIa to manage bleeding associated with dabigatran,
rivaroxaban or apixaban. Methods to accelerate removal of
these drugs from plasma using dialysis, hemoperfusion or
plasmapheresis have yet to be investigated...

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Украинский журнал для кардиологов. может кому пригодится)

Очень интересный форум
 

По свежим книгам - просто клондайк!
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The American Diabetes Association (ADA) revised clinical practice recommendations for diabetes diagnosis promote hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. The new recommendations are published December 29 in the January supplement of Diabetes Care. Семь бед - один диабет. Насчет аспирина тоже интересно.
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Полный текст гайда
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А есть ли возможность выложить полный текст для скачивания?

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Вот еще свеженький гайд
Heart Disease and Stroke Statistics—2010 Update
A Report From the American Heart Association
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