Интересные ссылки

[dmblok]

Сергей, может мы чего не понимаем...
Надо дождаться специалистов - статистических магов.

[LupusDoc]

Сообщение от dmblok

По моему субъективному мнению - эта статья какое-то статистическое извращение.

А мне понравилось. Краткостью результатов :

RESULTS
Table 1 shows the baseline characteristics of the patients. Mean
age was 49.8 years; 49.7 (men) and 49.9 (women). The mean 10-
year CHD risk for the total population was 9.0% (11.1% and
7.2% for men and women, respectively).
For both men and women, the estimated baseline CHD risk
increased with age (fig 1). Using the quadratic equations (line of
best fit for our data): y=29.225+0.211(age)+0.004(age2) for
men; and y=24.688+0.085(age)+0.003(age2) for women; the
transition from low to moderate/high baseline risk of developing
CHD occurred at about age 47.8 for men and 57.3 for
women. If a higher threshold was used (.15% 10-year CHD
risk), the age transition from low/moderate to high baseline risk
of developing CHD took place at ages 55.8 for men and 68.1 for
women (table 2).

[Abugov]

Вроде ничего особо нового, но кажется полезным:

Emergency Pretreatment Feasible

“The most important finding of this study is that contrast-allergic patients with STEMI who receive emergency pretreatment and then undergo direct PCI for STEMI may not have adverse effects,” the study authors write. “Although this finding may be surprising to cardiologists, a large body of radiology literature suggests that repeat administration of contrast to contrast-allergic patients is rarely dangerous.”

Based on their experience, the investigators offer 6 recommendations:

* Clinicians should weigh the potential benefits of PCI against the risks of repeat contrast reaction, “recognizing that reactions range from minimal to severe or even life-threatening. For patients in whom contrast has caused cardiovascular or respiratory collapse, contrast-requiring emergency procedures should be undertaken only if the potential benefits are considerable.”
* During emergency PCI, it is “reasonable to give intravenous steroids, knowing that they will not prevent immediate reactions but might prevent or mitigate sustained or delayed reactions.”
* Nonionic contrast agents should be used.
* Intravenous H1 and H2 blockers are also reasonable, even though their value is unproved. However, H2 blockers cannot be given alone, because “unopposed H1 histamine receptor stimulation may result in . . . vasoconstriction of the coronary arteries.”
* While the value of montelukast has not been studied in relation to contrast allergy, “[a]naphylaxis is thought to be at least partly regulated by leukotrienes and might be inhibited by a leukotriene inhibitor.”
* Operators should know, or have on-hand, the protocol for immediate treatment for acute reactions including cardiovascular or respiratory collapse. Resuscitation equipment should also be available.

[Abugov]

Хижина дяди Тома:

Black Medicare patients are less likely to be admitted to specialty cardiac hospitals for revascularization than white patients, although the disparity largely disappears when black patients live near such centers, according to a study published online November 5, 2008, ahead of print in Circulation: Cardiovascular Quality and Outcomes.

[Gilarov]

Meeting Report ESC Forum on Drug Eluting Stents
European Heart House, Nice,
27–28 September 2007
[Ссылки доступны только зарегистрированным пользователям ]
Если не откроется
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[vitti]

Уважаемый дмблок!
Если Вас не затруднит, выложите пожалуйста следующую статью:
«J Am Coll Cardiol Intv, 2008; 1:351-357, doi:10.1016/j.jcin.2008.06.003
The "Crush" Technique for Coronary Artery Bifurcation Stenting: Insights From Micro-Computed Tomographic Imaging of Bench Deployments»

[Gilarov]

Картинки забавные, но контрастный препарат еще лучше
Uncommon variation in the papillary muscles presenting with ST elevation and T-wave inversion
Chi Young Shim, Jong-Won Ha, Sung Jin Hong, Jinsun Kim, Eui-Young Choi, Namsik Chung, and Seung-Yun Cho*
European Heart Journal 2008 29(21):2633
A 61-year-old woman was admitted for intermittent chest discomfort that had been present for 2 months. She was normotensive and denied any past history of medical illness. On physical examination, grade 2 systolic click murmur at the left ventricular (LV) apex was auscultated. A routine electrocardiogram (Panel A) revealed ST-segment elevation and T-wave inversion in V2 to V5 precordial leads with high voltage of QRS complex which made us suspect possible hypertrophic cardiomyopathy. Two-dimensional echocardiography showed no evidence of LV hypertrophy in all segments. However, unexpectedly, unusual structures of papillary muscles were detected. The papillary muscles were interlinked each others with numerous fine tendons and formed parallel arrangement without hypertrophies (Panel B). The anterior mitral leaflet was mildly prolapsed without significant mitral regurgitation. To clarify the structures of papillary muscles, perflurocarbon-exposed sonicated dextrose albumin (PESDA), a pulmonary circulation passing contrast agent, was injected via an antecubital vein. Contrast echocardiogram with PESDA showed contrast filling and opacification of the LV cavity showed more clearly the unusual variation of papillary muscles with four parallel bellies (Panel C). Coronary angiography showed no significant luminal narrowing (Panels D and E). A contrast-enhanced image obtained by magnetic resonance imaging showed consistent findings in structures (Panel F) and no delayed hyperenhancement of four papillary muscles, so there was no evidence of fibrosis in the papillary muscles (Panel G). This case illustrates that the variations of the papillary muscles should be considered for differential diagnosis of abnormal electrocardiographic findings such as ST elevation and T-wave inversion.

[rsp]

Сообщение от vitti

Уважаемый дмблок!
Если Вас не затруднит, выложите пожалуйста следующую статью:
«J Am Coll Cardiol Intv, 2008; 1:351-357, doi:10.1016/j.jcin.2008.06.003
The "Crush" Technique for Coronary Artery Bifurcation Stenting: Insights From Micro-Computed Tomographic Imaging of Bench Deployments»

ловите...
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[Igor73]

Clinical Equivalence of Generic and Brand-Name Drugs Used in Cardiovascular DiseaseA Systematic Review and Meta-analysis
Aaron S. Kesselheim, MD, JD, MPH; Alexander S. Misono, BA; Joy L. Lee, BA; Margaret R. Stedman, MPH; M. Alan Brookhart, PhD; Niteesh K. Choudhry, MD, PhD; William H. Shrank, MD, MSHS

JAMA. 2008;300(21):2514-2526.
Context Use of generic drugs, which are bioequivalent to brand-name drugs, can help contain prescription drug spending. However, there is concern among patients and physicians that brand-name drugs may be clinically superior to generic drugs.
Objectives To summarize clinical evidence comparing generic and brand-name drugs used in cardiovascular disease and to assess the perspectives of editorialists on this issue.
Data Sources Systematic searches of peer-reviewed publications in MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1984 to August 2008.
Study Selection Studies compared generic and brand-name cardiovascular drugs using clinical efficacy and safety end points. We separately identified editorials addressing generic substitution.
Data Extraction We extracted variables related to the study design, setting, participants, clinical end points, and funding. Methodological quality of the trials was assessed by Jadad and Newcastle-Ottawa scores, and a meta-analysis was performed to determine an aggregate effect size. For editorials, we categorized authors' positions on generic substitution as negative, positive, or neutral.
Results We identified 47 articles covering 9 subclasses of cardiovascular medications, of which 38 (81%) were randomized controlled trials (RCTs). Clinical equivalence was noted in 7 of 7 RCTs (100%) of β-blockers, 10 of 11 RCTs (91%) of diuretics, 5 of 7 RCTs (71%) of calcium channel blockers, 3 of 3 RCTs (100%) of antiplatelet agents, 2 of 2 RCTs (100%) of statins, 1 of 1 RCT (100%) of angiotensin-converting enzyme inhibitors, and 1 of 1 RCT (100%) of [Изображения доступны только зарегистрированным пользователям]-blockers. Among narrow therapeutic index drugs, clinical equivalence was reported in 1 of 1 RCT (100%) of class 1 antiarrhythmic agents and 5 of 5 RCTs (100%) of warfarin. Aggregate effect size (n = 837) was –0.03 (95% confidence interval, –0.15 to 0.08), indicating no evidence of superiority of brand-name to generic drugs. Among 43 editorials, 23 (53%) expressed a negative view of generic drug substitution.
Conclusions Whereas evidence does not support the notion that brand-name drugs used in cardiovascular disease are superior to generic drugs, a substantial number of editorials counsel against the interchangeability of generic drugs.
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[Yariko]

Lower-than-expected bleeding in CABG patients taking clopidogrel within five days preop
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[Yariko]

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction [Ссылки доступны только зарегистрированным пользователям ]
Hani Jneid, MD; Gregg C. Fonarow, MD; Christopher P. Cannon, MD et al.
Background—Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era.
Methods and Results—Using the Get With the Guidelines–Coronary Artery Disease database, we examined sex differences in care processes and in-hospital death among 78 254 patients with AMI in 420 US hospitals from 2001 to 2006. Women were older, had more comorbidities, less often presented with ST-elevation myocardial infarction (STEMI), and had higher unadjusted in-hospital death (8.2% versus 5.7%; P<0.0001) than men. After multivariable adjustment, sex differences in in-hospital mortality rates were no longer observed in the overall AMI cohort (adjusted odds ratio [OR]=1.04; 95% CI, 0.99 to 1.10) but persisted among STEMI patients (10.2% versus 5.5%; P<0.0001; adjusted OR=1.12; 95% CI, 1.02 to 1.23). Compared with men, women were less likely to receive early aspirin treatment (adjusted OR=0.86; 95% CI, 0.81 to 0.90), early beta-blocker treatment (adjusted OR=0.9; 95% CI, 0.86 to 0.93), reperfusion therapy (adjusted OR=0.75; 95% CI, 0.70 to 0.80), or timely reperfusion (door-to-needle time <30 minutes: adjusted OR=0.78; 95% CI, 0.65 to 0.92; door-to-balloon time <90 minutes: adjusted OR=0.87; 95% CI, 0.79 to 0.95). Women also experienced lower use of cardiac catheterization and revascularization procedures after AMI.
Conclusions—Overall, no sex differences in in-hospital mortality rates after AMI were observed after multivariable adjustment. However, women with STEMI had higher adjusted mortality rates than men. The underuse of evidence-based treatments and delayed reperfusion among women represent potential opportunities for reducing sex disparities in care and outcome after AMI. (Circulation. 2008;118:000-000.)

[dmblok]

Сообщение от Khomitskaya

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

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[Abugov]

update

[dmblok]

ST-Segment Recovery and Outcome After Primary Percutaneous Coronary Intervention
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[rsp]

то ли у них хирурги плохие, то ли очень хорошие рентгенхирурги, либо это действительно правда: 4-х летние результаты стентирования ствола ЛКА "дезами"...
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и через 4 года....
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источник - tctmd