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Find video protocols related to scientific articles indexed in Pubmed.
Spontaneous Coronary Artery Dissection: Revascularization Versus Conservative Therapy.
Circ Cardiovasc Interv
PUBLISHED: 11-20-2014
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Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic acute coronary syndrome for which optimal management remains undefined.
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Evaluating the Generalizability of a Large Streamlined Cardiovascular Trial: Comparing Hospitals and Patients in the Dual Antiplatelet Therapy Study Versus the National Cardiovascular Data Registry.
Circ Cardiovasc Qual Outcomes
PUBLISHED: 11-18-2014
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The Dual Antiplatelet Therapy Study is large streamlined clinical trial designed to evaluate antiplatelet treatment strategies in a broadly inclusive population of subjects treated with coronary stents. Whether large streamlined trials can successfully include a representative group of study sites and patients has not been formally assessed.
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Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents.
N. Engl. J. Med.
PUBLISHED: 11-18-2014
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Background Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain. Methods Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a thienopyridine drug (clopidogrel or prasugrel) and aspirin, patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving aspirin. The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial infarction, or stroke) during the period from 12 to 30 months. The primary safety end point was moderate or severe bleeding. Results A total of 9961 patients were randomly assigned to continue thienopyridine treatment or to receive placebo. Continued treatment with thienopyridine, as compared with placebo, reduced the rates of stent thrombosis (0.4% vs. 1.4%; hazard ratio, 0.29 [95% confidence interval {CI}, 0.17 to 0.48]; P<0.001) and major adverse cardiovascular and cerebrovascular events (4.3% vs. 5.9%; hazard ratio, 0.71 [95% CI, 0.59 to 0.85]; P<0.001). The rate of myocardial infarction was lower with thienopyridine treatment than with placebo (2.1% vs. 4.1%; hazard ratio, 0.47; P<0.001). The rate of death from any cause was 2.0% in the group that continued thienopyridine therapy and 1.5% in the placebo group (hazard ratio, 1.36 [95% CI, 1.00 to 1.85]; P=0.05). The rate of moderate or severe bleeding was increased with continued thienopyridine treatment (2.5% vs. 1.6%, P=0.001). An elevated risk of stent thrombosis and myocardial infarction was observed in both groups during the 3 months after discontinuation of thienopyridine treatment. Conclusions Dual antiplatelet therapy beyond 1 year after placement of a drug-eluting stent, as compared with aspirin therapy alone, significantly reduced the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events but was associated with an increased risk of bleeding. (Funded by a consortium of eight device and drug manufacturers and others; DAPT ClinicalTrials.gov number, NCT00977938 .).
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Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randall's Plaque.
Clin J Am Soc Nephrol
PUBLISHED: 08-04-2014
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Overgrowth of calcium oxalate on Randall's plaque is a mechanism of stone formation among idiopathic calcium oxalate stone-formers (ICSFs). It is less clear how stones form when there is little or no plaque.
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Fundamental Concepts of Effective Troponin Use- Important Principles For Internists.
Am. J. Med.
PUBLISHED: 07-30-2014
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Troponin testing is an essential component of our diagnostic approach to patients in acute medical care settings. With the advent of highly sensitive troponin assays, its importance will extend to patients in chronic disease settings as well. While elevated troponin levels provide diagnostic information, inform treatment decisions and influence patient prognosis, proper interpretation of the values is essential. It requires an understanding of the operating characteristics of troponin testing; the likelihood ratios associated with a positive/negative test result and the pre and post-test probabilities related to individual clinical settings. These principles will only become more important as highly sensitive assays become introduced over the coming years in the United States. This article reviews the important principles of Troponin testing focusing in particular on acute settings and is aimed at internal medical and hospital specialists.
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Defining the optimal cardiac troponin T threshold for predicting death caused by periprocedural myocardial infarction after percutaneous coronary intervention.
Circ Cardiovasc Interv
PUBLISHED: 07-22-2014
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There is controversy about the diagnostic and prognostic significance of percutaneous coronary intervention-related myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold.
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A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: implications for MR enterography.
Eur J Radiol
PUBLISHED: 07-14-2014
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To assess if erythromycin increases gastric emptying and hence improves small intestinal distention during MR enterography.
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Comparison of manual and semiautomated techniques for analyzing gastric volumes with MRI in humans.
Am. J. Physiol. Gastrointest. Liver Physiol.
PUBLISHED: 07-10-2014
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Gastric emptying, accommodation, and motility can be quantified with magnetic resonance imaging (MRI). The first step in image analysis entails segmenting the stomach from surrounding structures, usually by a time-consuming manual process. We have developed a semiautomated process to segment and measure gastric volumes with MRI. Gastric images were acquired with a three-dimensional gradient echo MRI sequence at 5, 10, 20, and 30 min after ingestion of a liquid nutrient (Ensure, 296 ml) labeled with gadolinium in 20 healthy volunteers and 29 patients with dyspeptic symptoms. The agreement between gastric volumes measured by manual segmentation and our new semiautomated algorithm was assessed with Lin's concordance correlation coefficient (CCC) and the Bland Altman test. At 5 min after a meal, food volumes measured by manual (352 ± 4 ml) and semiautomated (346 ± 4 ml) techniques were correlated {CCC[95% confidence interval (CI)] 0.70 (0.52, 0.81)}; air volumes measured by manual (88 ± 6 ml) and semiautomated (84 ± 6 ml) techniques were also correlated [CCC (95% CI) 0.89 (0.82, 0.94)]. Findings were similar at subsequent time points. The Bland Altman test was not significant. The time required for semiautomated segmentation ranged from an average of 204 s for the 5-min images to 233 s for the 20-min images. These times were appreciably smaller than the typical times of many tens of minutes, even hours, required for manual segmentation. To conclude, a semiautomated process can measure gastric food and air volume using MRI with comparable accuracy and far better efficiency than a manual process.
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Prognostic Impact of Pulmonary Artery Systolic Pressure in Patients Undergoing Transcatheter Aortic Valve Replacement for Aortic Stenosis.
Am. J. Cardiol.
PUBLISHED: 07-01-2014
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Baseline pulmonary hypertension (PH) is a predictor of poor outcomes in patients with severe aortic stenosis (AS). Surgical aortic valve replacement is thought to alleviate PH. The aim of this study was to determine the prognostic impact of PH in patients who underwent transcatheter aortic valve replacement (TAVR). An observational cohort study was conducted using prospectively collected data on 277 consecutive patients with severe AS who underwent TAVR at the Mayo Clinic (Rochester, Minnesota) from November 1, 2008, to June 31, 2013. Clinical and echocardiographic data, pulmonary function characteristics, and outcomes stratified by tertiles of pulmonary artery systolic pressure (PASP) were analyzed. From 277 patients who underwent TAVR, 251 patients had PASP assessment at baseline. Those in the highest PASP tertile (PASP ?49 mm Hg) had more severe chronic lung disease and worse diastolic dysfunction. Being in the highest PASP tertile was an independent predictor of long-term mortality (hazard ratio 2.88, 95% confidence interval 1.15 to 7.23). Patients in the highest PASP tertile had longer lengths of hospital stay, while other short-term outcomes (30-day mortality and readmission, stroke, prolonged ventilation, and reoperation for bleeding) were similar across PASP tertiles. TAVR was associated with a decrease in PASP in the highest PASP tertile at 1 week after the procedure (-8 ± 14 mm Hg) and at 3 months (-7 ± 15 mm Hg) compared with baseline. In conclusion, among patients with severe AS who underwent TAVR, higher baseline PASP was strongly associated with diastolic dysfunction and chronic lung disease. Patients with higher baseline PASP tolerated TAVR relatively well in the early postprocedural phase, with diminished long-term survival. PH should not disqualify patients with severe AS from consideration for TAVR.
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Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial.
Eur. Heart J.
PUBLISHED: 05-21-2014
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Coronary artery bypass grafting (CABG) has been considered the standard of care for patients with three-vessel disease (3VD), but long-term comparative results from randomized trials of CABG vs. percutaneous coronary intervention (PCI) using drug-eluting stents (DES) remain limited.
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Differences in baseline characteristics, practice patterns and clinical outcomes in contemporary coronary artery bypass grafting in the United States and Europe: insights from the SYNTAX randomized trial and registry.
Eur J Cardiothorac Surg
PUBLISHED: 05-14-2014
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To investigate the until now undefined extent of differences in baseline characteristics, practice patterns and clinical outcomes of patients undergoing coronary artery bypass grafting (CABG) for complex coronary artery disease in the USA versus Europe.
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Neuroimaging patterns of ischemic stroke after percutaneous coronary intervention.
Catheter Cardiovasc Interv
PUBLISHED: 05-13-2014
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We sought to determine neuroimaging patterns, ischemic mechanisms, and functional outcomes of ischemic stroke related to percutaneous coronary intervention (PCI) over a 16-year period. Background: Stroke is a feared complication of PCI, associated with poor patient outcomes. The majority of strokes that occur after PCI are ischemic rather than hemorrhagic. However, mechanisms of cerebral ischemia in this setting are incompletely understood.
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Novel balloon catheter device with pacing, ablating, electroporation, and drug-eluting capabilities for atrial fibrillation treatment-preliminary efficacy and safety studies in a canine model.
Transl Res
PUBLISHED: 05-13-2014
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Pulmonary vein isolation is an established therapeutic procedure for symptomatic atrial fibrillation (AF). This approach involves ablation of atrial tissue just outside the pulmonary veins. However, patient outcomes are limited because of a high rate of arrhythmia recurrence. Ablation of electrically active tissue inside the pulmonary vein may improve procedural success, but is currently avoided because of the complication of postablation stenosis. An innovative device that can ablate inside pulmonary veins and prevent stenosis is a viable strategy to increase long-term efficacy. We have developed a prototypical balloon catheter device capable of nonthermal pulmonary vein ablation along with elution of an antifibrotic agent intended to eliminate arrhythmogenic substrate without the risk of stenosis and have demonstrated its functionality in 4 acute canine experiments. Further optimization of this device may provide an innovative means to simultaneously ablate and prevent pulmonary vein stenosis for improved AF treatment in humans.
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Mechanical closure devices for atrial fibrillation.
Trends Cardiovasc. Med.
PUBLISHED: 05-08-2014
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Atrial fibrillation (AF) is the most commonly sustained arrhythmia and is a major cause of stroke and systemic embolism. Chronic oral anticoagulation reduces this risk, but at the cost of increased bleeding. In addition, a substantial proportion of AF patients who are at moderate-to-high risk for stroke are undertreated due to real or perceived contraindications. The major source of thromboembolism in AF appears to be the left atrial appendage (LAA). Therefore, device closure of the LAA represents a mechanical approach to stroke prevention in AF patients. In this review, we describe the rationale for device closure of the LAA, summarize the current dataset for LAA closure devices, and set forth a framework to help guide patient selection for device therapy.
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Shape analysis of the prostate: establishing imaging specifications for the design of a transurethral imaging device for prostate brachytherapy guidance.
Brachytherapy
PUBLISHED: 05-03-2014
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To examine specific prostate and urethra dimensions and prostate shape to facilitate the design of a transurethral ultrasonographic imaging device.
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Aortic Valve Replacement for Severe Aortic Valve Stenosis in the Nonagenarian Patient.
Ann. Thorac. Surg.
PUBLISHED: 04-04-2014
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Outcome data are limited on aortic valve replacement (AVR) in nonagenarian patients. This study reports our experience in the treatment of this elderly population.
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Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial.
Circulation
PUBLISHED: 04-03-2014
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Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date.
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Axillary artery conduit formation for arterial access during transapical transcatheter aortic valve replacement.
J Card Surg
PUBLISHED: 03-19-2014
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Transapical transcatheter valve replacement is a relatively new technique for select patients with aortic valve stenosis, most of whom have severe peripheral vascular disease. We report our experience with the use of a right axillary artery conduit for arterial access during transapical valve replacement.
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Beyond the learning curve: transapical versus transfemoral transcatheter aortic valve replacement in the treatment of severe aortic valve stenosis.
J Card Surg
PUBLISHED: 03-07-2014
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Most studies comparing transapical and transfemoral transcatheter aortic valve replacement include the center's early operative experience, which may negatively impact the outcomes. This study reports our experience beyond the learning curve with transapical and transfemoral transcatheter aortic valve replacement.
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Quality, economics, and national guidelines for transcatheter aortic valve replacement.
Prog Cardiovasc Dis
PUBLISHED: 03-05-2014
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Transcatheter aortic valve replacement (TAVR) is a transformative technology for the treatment of aortic stenosis, requiring a multidisciplinary collaboration in the form of a "heart team" that includes interventional cardiologists and cardiac surgeons. As this new technology continues to disperse rapidly, its proper therapeutic role evolves and leads to important questions regarding who should perform the procedure, where it should be performed, and who should pay for it. Herein, we review the most recent guidelines governing the use of TAVR in the United States and Europe. We then summarize the available registry data, which, despite its limitations, presents the clearest picture of TAVR in clinical use. Finally, we discuss the costs and relative cost-effectiveness of TAVR. Taken together, these are the elements from which the larger questions surrounding TAVR must be answered.
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Risk scores for 30-day mortality after percutaneous coronary intervention: new insights into causes and risk of death.
Mayo Clin. Proc.
PUBLISHED: 02-28-2014
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To determine the causes and risk of death after percutaneous coronary interventions (PCIs) and to compare the discriminatory ability of the New York State Risk Score (NYSRS) with the Mayo Clinic Risk Score (MCRS).
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Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial.
J. Am. Coll. Cardiol.
PUBLISHED: 02-25-2014
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In the PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) trial that evaluated patients with nonvalvular atrial fibrillation (NVAF), left atrial appendage (LAA) occlusion was noninferior to warfarin for stroke prevention, but a periprocedural safety hazard was identified.
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Time-trend analysis on the Framingham risk score and prevalence of cardiovascular risk factors in patients undergoing percutaneous coronary intervention without prior history of coronary vascular disease over the last 17 years: a study from the Mayo Clinic PCI registry.
Clin Cardiol
PUBLISHED: 02-18-2014
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There is a paucity of data on the temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated the secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD).
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Statistical SPECT processing in MRI-negative epilepsy surgery.
Neurology
PUBLISHED: 02-14-2014
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To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal-interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE).
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Advances in radiofrequency ablation of the cerebral cortex in primates using the venous system: Improvements for treating epilepsy with catheter ablation technology.
Epilepsy Res.
PUBLISHED: 02-13-2014
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Pharmacology frequently fails for the treatment of epilepsy. Although surgical techniques are effective, these procedures are highly invasive. We describe feasibility and efficacy of minimally invasive mapping and ablation for the treatment of epilepsy.
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Utilization of radial artery access for percutaneous coronary intervention for ST-segment elevation myocardial infarction in New York.
JACC Cardiovasc Interv
PUBLISHED: 02-13-2014
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This study sought to determine the utilization and outcomes for radial access for percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in common practice.
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Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures.
Med Phys
PUBLISHED: 02-11-2014
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In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated.
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Trends in cause of death after percutaneous coronary intervention.
Circulation
PUBLISHED: 02-10-2014
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The impact of changing demographics on causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined.
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Prognostic implications of severe coronary calcification in patients undergoing coronary artery bypass surgery: An analysis of the SYNTAX Study.
Catheter Cardiovasc Interv
PUBLISHED: 02-05-2014
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To investigate the prognostic implications of the presence of severe lesion calcification in patients undergoing coronary artery bypass graft (CABG) operation.
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Transcatheter versus surgical aortic valve replacement in patients with prior coronary artery bypass graft operation: a PARTNER trial subgroup analysis.
Ann. Thorac. Surg.
PUBLISHED: 02-01-2014
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The Placement of Aortic Transcatheter Valves (PARTNER) trial reported a reduced rate of mortality in patients with previous coronary bypass grafting (CABG) operation who received surgical aortic valve replacement (SAVR) in comparison with transcatheter aortic valve replacement (TAVR). We sought to further evaluate these groups.
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Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State.
Circ Cardiovasc Interv
PUBLISHED: 01-28-2014
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Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC.
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Assessing the risk of aortic valve replacement for severe aortic stenosis in the transcatheter valve era.
Mayo Clin. Proc.
PUBLISHED: 01-20-2014
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Surgical aortic valve replacement had been the only definitive treatment of severe aortic stenosis before the availability of transcatheter valve technology. Historically, many patients with severe aortic stenosis had not been offered surgery, largely related to professional and patient perception regarding the risks of operation relative to anticipated benefits. Such patients have been labeled as "high risk" or "inoperable" with respect to their suitability for surgery. The availability of transcatheter aortic valve replacement affords a new treatment option for patients previously not felt to be optimal candidates for surgical valve replacement and allows for the opportunity to reexamine the methods for assessing operative risk in the context of more than 1 available treatment. Standardized risk assessment can be challenging because of both the imprecision of current risk scoring methods and the variability in ascertaining risk related to operator experience as well as local factors and practice patterns at treating facilities. Operative risk in actuality is not an absolute but represents a spectrum from very low to extreme, and the conventional labels of high risk and inoperable are incomplete with respect to their utility in clinical decision making. Moving forward, the emphasis should be on developing an individual assessment that takes into account procedure risk as well as long-term outcomes evaluated in a multidisciplinary fashion, and incorporating patient preferences and goals in a model of shared decision making.
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Risk stratification for long-term mortality after percutaneous coronary intervention.
Circ Cardiovasc Interv
PUBLISHED: 01-14-2014
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A simple risk score to predict long-term mortality after percutaneous coronary intervention (PCI) using preprocedural risk factors is currently not available. In this study, we created one by simplifying the results of a Cox proportional hazards model.
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Take as directed-strategies to improve adherence to cardiac medication.
Nat Rev Cardiol
PUBLISHED: 12-17-2013
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In patients with cardiovascular diseases, adherence to medication is a fundamental prerequisite for pharmacological therapy to be effective. Nonadherence to medication is a major public health problem that compromises the effectiveness of therapies and results in suboptimal clinical outcomes. The behaviour of nonadherence is complex and is strongly influenced by an interaction between various factors, such as patient education, communication between patients and physicians, drug dosing schedules, and access to health care. Interventions have been implemented to target these barriers to adherence; however, individual interventions have generally been associated with fairly modest improvements in adherence. Financial incentive schemes and modern technology, such as mobile telephone applications, are being harnessed as novel strategies to improve adherence. Ultimately, multifaceted strategies tailored to individual patients are likely to be required to improve long-term adherence to medication and consequently enhance patient health.
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Sex-related differences in fractional flow reserve-guided treatment.
Circ Cardiovasc Interv
PUBLISHED: 10-22-2013
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Sex-specific differences affect the evaluation, treatment, and prognosis of coronary artery disease. We tested the hypothesis that long-term outcomes of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) are different between women and men.
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Magnetic navigation facilitates percutaneous coronary intervention for complex lesions.
Catheter Cardiovasc Interv
PUBLISHED: 08-27-2013
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We sought to determine the utility of a magnetic navigation system (MNS) in treating a variety of coronary artery lesions including those that could not be revascularized with standard percutaneous coronary intervention (PCI). MNS may add value in the treatment of tortuous arteries and bifurcation lesions; however its widespread adoption has lagged because of cost and a lack of clear advantage over conventional PCI. We performed a retrospective analysis to determine whether MNS improved procedural success for highly complex lesions.
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Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients.
J Interv Cardiol
PUBLISHED: 08-20-2013
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To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines.
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Left Atrial Appendage Occlusion: Opportunities and Challenges.
J. Am. Coll. Cardiol.
PUBLISHED: 07-10-2013
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Stroke prevention in patients with atrial fibrillation is a growing clinical dilemma as the incidence of the arrhythmia increases and risk profiles worsen. Strategies in patients with nonvalvular atrial fibrillation have included anticoagulation with a variety of drugs. Knowledge that stroke in this setting typically results from thrombus in the LAA has led to the development of mechanical approaches, both catheter based and surgical, to occlude that structure. Such a device, if it were safe and effective, may avoid the need for anticoagulation and prevent stroke in the large number of patients who are currently not treated with anticoagulants. Regulatory approval has been difficult due to trial design challenges, balance of the risk benefit ratio, specific patient populations studied, selection of treatment in the control group and specific endpoints and statistical analyses selected. Accumulating data from randomized trials and registries with longer term follow up continues to support a role for left atrial appendage exclusion from the central circulation as an alternative to anticoagulation in carefully selected patient populations.
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An update on transcatheter aortic valve replacement.
Curr Probl Cardiol
PUBLISHED: 06-11-2013
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Before the development of transcatheter aortic valve replacement (TAVR), patients with severe symptomatic aortic stenosis and significant comorbidities who were deemed inoperable were left with no therapeutic option but palliative care. Today, 11 years after Dr Alain Cribiers first transcatheter aortic valve implantation in 2002, more than 50,000 TAVRs have been performed worldwide, majority in Europe. Short-term results from the recently conducted Placement of Aortic Transcatheter Valve (PARTNER) I trial and long-term results from the European/Canadian registry experiences show significant reduction in mortality compared with medical therapy alone (inoperable cohort B) and noninferiority of TAVR versus open aortic valve replacement in high-risk patients (operable high-risk cohort A). Technical advances and increasing operator experience will further decrease procedure-related complications and may make TAVR an alternative to open aortic valve replacement in even younger and low- to medium-risk patients with severe symptomatic calcific aortic valve stenosis.
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Impact of 3-Dimensional Bifurcation Angle on 5-Year Outcome of Patients After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: A Substudy of the SYNTAX Trial (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardi
JACC Cardiovasc Interv
PUBLISHED: 06-02-2013
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This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial.
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Assessment of the new appropriate use criteria for diagnostic catheterization in the detection of coronary artery disease following noninvasive stress testing.
Int. J. Cardiol.
PUBLISHED: 05-29-2013
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Appropriate use criteria (AUC) for diagnostic catheterization (DC) developed by the American College of Cardiology Foundation (ACCF) and other professional societies were recently published. These criteria have yet to be examined thoroughly using existing DC databases.
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Management of pulmonary vein rupture after percutaneous intervention: utility of a hybrid approach.
Ann. Thorac. Surg.
PUBLISHED: 05-28-2013
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Percutaneous intervention of subtotally occluded pulmonary veins can be difficult owing to the cicatrized nature of the stenotic vein tissue. A 55-year-old man with complete left superior and left inferior pulmonary vein occlusions 4 years after repeated atrial fibrillation radiofrequency ablations for symptomatic paroxysmal atrial fibrillation underwent sequential angioplasty, during which an uncovered stent was placed and expanded 2 mm from the pulmonary vein ostium. Hemodynamics rapidly deteriorated, and intracardiac echocardiogram confirmed pericardial tamponade. Median sternotomy was rapidly performed, and a tear encompassing approximately one-third of the circumference of the fibrotic and scarred left upper pulmonary vein was identified. The patient was supported on cardiopulmonary bypass, the heart was arrested, the left atrium was opened, and a covered 10-mm × 10-cm Viabahn covered stent was inserted. Additional external repair of pulmonary vein/epicardial tissue was performed to completely seal the perforation.
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Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring.
Int Forum Allergy Rhinol
PUBLISHED: 05-14-2013
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We aimed to test the hypothesis that three-dimensional (3D) volume-based scoring of computed tomography (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone.
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Incidence, correlates, and significance of abnormal cardiac enzyme rises in patients treated with surgical or percutaneous based revascularisation: a substudy from the Synergy between Percutaneous Coronary Interventions with Taxus and Cardiac Surgery (SYN
Int. J. Cardiol.
PUBLISHED: 05-10-2013
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The aim of the present investigation was to determine the long-term prognostic association of post-procedural cardiac enzyme elevation within the randomised Synergy between Percutaneous Coronary Intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) Trial.
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Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.
Heart Surg Forum
PUBLISHED: 04-30-2013
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Oral P2Y?? platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y?? platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y?? platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y?? inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown.
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The STS-ACC transcatheter valve therapy national registry: a new partnership and infrastructure for the introduction and surveillance of medical devices and therapies.
J. Am. Coll. Cardiol.
PUBLISHED: 03-17-2013
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The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry is a novel, national registry for all new TVT devices created through a partnership of the STS and the ACC in close collaboration with the Food and Drug Administration, the Center for Medicare and Medicaid Services, and the Duke Clinical Research Institute. The registry will serve as an objective, comprehensive, and scientifically based resource to improve the quality of patient care, to monitor the safety and effectiveness of TVT devices, to serve as an analytic resource for TVT research, and to enhance communication among key stakeholders.
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Short-Term and Long-Term Clinical Impact of Stent Thrombosis and Graft Occlusion in the SYNTAX Trial at 5 Years: Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery Trial.
J. Am. Coll. Cardiol.
PUBLISHED: 03-01-2013
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The aim of this study was to report the short-term and long-term clinical impact of stent thrombosis (ST) and graft occlusion (GO) in the final 5-year outcomes of the SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery) trial.
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Incomplete revascularization is associated with greater risk of long-term mortality after stenting in the era of first generation drug-eluting stents.
Am. J. Cardiol.
PUBLISHED: 02-26-2013
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The association between incomplete revascularization (IR) and long-term mortality after stenting in the era of drug-eluting stents is not well understood. In the present study, we test the hypothesis that IR is associated with a greater risk of long-term (5-year) mortality after stenting for multivessel coronary disease. Using data from the Percutaneous Coronary Intervention Reporting System of New York State, 21,767 patients with multivessel disease who underwent stenting during October 2003 to December 2005 were identified. Complete revascularization (CR) was achieved in 6,844 patients (31.4%), and 14,923 patients (68.6%) were incompletely revascularized. The CR and IR patients were propensity matched on a 1:1 ratio on the number of diseased vessels, the presence of total occlusion, type of stents, and the probability of achieving CR estimated using a logistic model with established risk factors as independent variables. Patients were followed for vital status until December 31, 2008 using the National Death Index. Differences in survival between the matched CR and IR patients were compared. Among the 6,511 pairs of propensity-matched patients, the 5-year survival rate for IR was lower compared with CR (79.3% vs 81.4%, p = 0.004), and the risk of death during follow-up was 16% greater for IR compared with CR (hazard ratio 1.16, 95% confidence interval 1.06 to 1.27, p = 0.001). In addition, subgroup analyses demonstrated that the association between IR and long-term mortality was not dependent on major patient risk factors. In conclusion, IR is associated with an increased risk of long-term mortality after stenting for multivessel disease in the era of drug-eluting stents.
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On mixed reality environments for minimally invasive therapy guidance: systems architecture, successes and challenges in their implementation from laboratory to clinic.
Comput Med Imaging Graph
PUBLISHED: 02-08-2013
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Mixed reality environments for medical applications have been explored and developed over the past three decades in an effort to enhance the clinicians view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking, and display technology into a common framework centered around and registered to the patient. However, in spite of their reported benefits, few mixed reality environments have been successfully translated into clinical use. Several challenges that contribute to the difficulty in integrating such environments into clinical practice are presented here and discussed in terms of both technical and clinical limitations. This article should raise awareness among both developers and end-users toward facilitating a greater application of such environments in the surgical practice of the future.
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The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.
JACC Cardiovasc Interv
PUBLISHED: 01-18-2013
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This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality.
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Pharmacogenomic testing and antithrombotic therapy: ready for prime time?
Rambam Maimonides Med J
PUBLISHED: 01-01-2013
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Pharmacogenomics is the study of an individuals interaction with a specific drug based upon the genetic make-up of the individual. Pharmacogenomic testing can be a powerful tool in testing a drugs potential efficacy and toxicity on an individual patient. For this tool to be used correctly, certain criteria have to be met. First and foremost is the strength of association between the genetic variation and the drugs interaction. The predictiveness of pharmacogenomics for the individual patient must be factored in as well. If these criteria are not met, requiring pharmacogenomic testing is at best a waste of money and in some cases can endanger the patients life. Stent thrombosis is a serious and many times fatal outcome in a small minority of patients who have received drug-eluting stents. Here, we discuss a case in which the FDA issued a "boxed warning" about the use of the anti-clotting medication, clopidogrel, used to prevent stent thrombosis, the pharmacogenomic data available at the time the warning was issued, and the medical communitys response to the FDAs warning. This article also discusses developments in the field of anti-clotting therapy since the FDAs warning.
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Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data.
Eur J Cardiothorac Surg
PUBLISHED: 12-21-2011
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To assess whether incomplete revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has an effect on long-term outcomes.
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Percutaneous coronary intervention at centers with and without on-site surgery: a meta-analysis.
JAMA
PUBLISHED: 12-15-2011
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Percutaneous coronary interventions are performed at centers without onsite surgery, despite current guidelines discouraging this.
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Factors associated with 30-day readmission rates after percutaneous coronary intervention.
Arch. Intern. Med.
PUBLISHED: 11-28-2011
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Thirty-day readmission rates have become a publicly reported quality performance measure for congestive heart failure, acute myocardial infarction, and percutaneous coronary intervention (PCI). However, little is known regarding the factors associated with 30-day readmission after PCI.
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Left atrial appendage closure: a percutaneous transcatheter approach for stroke prevention in atrial fibrillation.
Eur. Heart J.
PUBLISHED: 10-31-2011
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Atrial fibrillation is a frequent cause of stroke; in the elderly, more than 20% of strokes are attributed to this common arrhythmia. Anticoagulation with warfarin reduces the risk of stroke by ?60%; however, a large proportion of patients with atrial fibrillation do not receive this treatment because of relative/absolute contraindications. Moreover, patients often discontinue warfarin for a variety of reasons and chronic warfarin administration rates remain suboptimal. Although the compliance with anticoagulation may improve with novel anticoagulants and bleeding risk can be somewhat reduced when compared with warfarin, there is still a progressive increase in bleeding complications over time. Accordingly, new approaches for stroke prevention in these patients are being explored and tested. In transoesophageal echocardiographic (TEE) studies, more than 90% of thrombi were found in the left atrial appendage (LAA) in non-valvular atrial fibrillation, and transcatheter LAA closure is developed and examined as a novel approach to reduce the risk of stroke in these patients. The PROTECT-AF study provides first evidence from a randomized clinical trial that a strategy of LAA occlusion using the Watchman device can be non-inferior to anticoagulation with warfarin for a combined endpoint in patients with non-valvular atrial fibrillation (mean CHADS(2) score 1.8). In successfully occluded patients fulfilling TEE criteria (86%), warfarin was stopped after 45 days, followed by aspirin and clopidogrel for 6 months after randomization and subsequently aspirin. The PREVAIL trial is further evaluating this concept. Limited data are available for another LAA occlusion system, the Amplatzer Cardiac Plug (ACP) device, for which the ACP trial has been initiated. Left atrial appendage occlusion needs to be performed with meticulous care by experienced operators because periprocedural complications such as pericardial effusion or stroke have been documented. With increased operator experience and technical improvements of the device, these complications can be minimized.
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Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting: a North American perspective: executive summary.
Circ Cardiovasc Interv
PUBLISHED: 10-20-2011
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The optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation who have had a coronary stent is unclear. It is well recognized that "triple therapy" with aspirin, clopidogrel, and warfarin is associated with an increased risk of bleeding. National guidelines have not made specific recommendations, given the lack of adequate data. In choosing the best antithrombotic options for a patient, consideration needs to be given to the risks of stroke, stent thrombosis, and major bleeding. This executive summary describes these risks, provides specific recommendations concerning vascular access, stent choice, concomitant use of proton pump inhibitors, and the use and duration of triple therapy after stent placement, based on the risk assessment.
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Impact of incomplete revascularization on long-term mortality after coronary stenting.
Circ Cardiovasc Interv
PUBLISHED: 10-04-2011
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The impact of incomplete revascularization (IR) on adverse outcomes after percutaneous coronary intervention remains inconclusive, and few studies have examined mortality during follow-ups longer than 5 years. The objective of this study is to test the hypothesis that IR is associated with higher risk of long-term (8-year) mortality after stenting for multivessel coronary disease.
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Non-surgical left atrial appendage closure for stroke prevention in atrial fibrillation.
J. Cardiovasc. Electrophysiol.
PUBLISHED: 09-13-2011
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Non-Surgical Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. The most feared complication associated with atrial fibrillation (AF) is stroke, the risk of which increases with advanced age. Because of its complex anatomy and diminished blood flow during AF, the left atrial appendage (LAA) has been a common site of left atrial thrombi and presumed source of thromboembolism. Systemic anticoagulation to treat what may be largely a localized phenomenon is associated with significant complications. Newer anticoagulation agents hold great promise in facilitating dosing and eliminating drug and food interactions, but do not eliminate bleeding risk. These challenges have led to interest in mechanical exclusion of the LAA as a means of preventing thromboembolism in AF. Although surgery permits greater visualization and management of complications, the potential morbidity has limited adoption in often-frail elderly patients. In this paper, we review the current state of percutaneous left atrial exclusion for stroke prevention in AF, and the strengths and limitations of each of these strategies. The nonsurgical approaches to excluding the LAA from the central circulation can be divided into 3 broad categories: transseptally placed devices, percutaneous epicardial approach, and hybrid approaches. The availability of several approaches will allow physician selection of the optimal approach for a given patient based on clinical, physiological, and anatomical considerations. LAA exclusion stands to become an increasingly attractive option for patients with nonvalvular AF because it can be offered to elderly AF patients, and eliminates the long-term cumulative bleeding risks and adherence challenge of anticoagulants.
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Myocardial revascularization by percutaneous coronary intervention: past, present, and the future.
Curr Probl Cardiol
PUBLISHED: 09-06-2011
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Percutaneous coronary revascularization was introduced over 30 years ago by Dr Andreas Grüntzig. This event catapulted adult invasive cardiology from a diagnostic entity to a therapeutic modality, which has since become the most frequently performed coronary revascularization procedure worldwide. This success has been built on several key concepts-problem identification, targeted solutions, applied technology, populations-based testing, postmarket surveillance, and education. These concepts will continue to be of paramount importance as novel percutaneous innovations and strategies are brought to bear on an increasingly broader group of patients with cardiovascular disease. In this review, we trace the history, review current practices, and also provide insight into future potential innovations, as it pertains to percutaneous coronary revascularization.
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Transcatheter aortic valve implantation: assessing the learning curve.
JACC Cardiovasc Interv
PUBLISHED: 07-15-2011
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The aim of this study was to assess the learning curve for the implantation of the percutaneous aortic valve via the transfemoral route.
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Association of door-in to door-out time with reperfusion delays and outcomes among patients transferred for primary percutaneous coronary intervention.
JAMA
PUBLISHED: 06-23-2011
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Patients with ST-elevation myocardial infarction (STEMI) requiring interhospital transfer for primary percutaneous coronary intervention (PCI) often have prolonged overall door-to-balloon (DTB) times from first hospital presentation to second hospital PCI. Door-in to door-out (DIDO) time, defined as the duration of time from arrival to discharge at the first or STEMI referral hospital, is a new clinical performance measure, and a DIDO time of 30 minutes or less is recommended to expedite reperfusion care.
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Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial.
Eur. Heart J.
PUBLISHED: 06-22-2011
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Long-term randomized comparisons of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in left main coronary (LM) disease and/or three-vessel disease (3VD) patients have been limited. This analysis compares 3-year outcomes in LM and/or 3VD patients treated with CABG or PCI with TAXUS Express stents.
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30-day readmission for patients undergoing percutaneous coronary interventions in New York state.
JACC Cardiovasc Interv
PUBLISHED: 04-29-2011
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This study sought to report percutaneous coronary intervention (PCI) 30-day readmission rates, identify the impact of staged (planned) readmissions on overall readmission rates, determine the significant predictors of unstaged readmissions after PCI, and specify the reasons for readmissions.
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Long-term mortality of coronary artery bypass grafting and bare-metal stenting.
Ann. Thorac. Surg.
PUBLISHED: 04-26-2011
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There is little information on relative survival with follow-up longer than 5 years in patients undergoing coronary artery bypass grafting (CABG) and patients undergoing percutaneous coronary intervention (PCI) with stenting. This study tested the hypothesis that CABG is associated with a lower risk of long-term (8-year) mortality than is stenting with bare-metal stents for multivessel coronary disease.
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Trends, predictors, and outcomes of cerebrovascular events related to percutaneous coronary intervention: a 16-year single-center experience.
JACC Cardiovasc Interv
PUBLISHED: 04-23-2011
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We sought to determine trends, predictors, in-hospital and long-term outcomes of cerebrovascular events (CVE) related to percutaneous coronary intervention (PCI) over a 16-year period.
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Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective.
Thromb. Haemost.
PUBLISHED: 04-21-2011
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The optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation who have had a coronary stent is unclear. It is well recognised that "triple therapy" with aspirin, clopidogrel, and warfarin is associated with an increased risk of bleeding. National guidelines have not made specific recommendations given the lack of adequate data. In choosing the best antithrombotic options for a patient, consideration needs to be given to the risks of stroke, stent thrombosis and major bleeding. This document describes these risks, provides specific recommendations concerning vascular access, stent choice, concomitant use of proton-pump inhibitors and the use and duration of triple therapy following stent placement based upon the risk assessment.
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Comparison of outcomes for patients receiving drug-eluting versus bare metal stents for non-ST-segment elevation myocardial infarction.
Am. J. Cardiol.
PUBLISHED: 04-19-2011
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The outcomes for patients undergoing percutaneous coronary interventions (PCI) with drug-eluting stents (DESs) and bare metal stents (BMSs) have been compared in many studies for patients with ST-segment elevation myocardial infarction. However, little is known about the relative outcomes for patients with non-ST-segment elevation myocardial infarction (NSTEMI). The aim of the present study was to compare the NSTEMI outcomes for PCI with DESs and BMSs. New Yorks PCI registry was used to propensity-match 4,776 pairs of patients with NSTEMI who had received DESs and BMSs from January 1, 2003 to December 31, 2007. These patients were followed up through December 31, 2008 to test for differences in mortality, target vessel revascularization, and total repeat revascularization. The outcomes were also compared for various patient subsets. At a median follow-up period of 3.68 years, the patients receiving DESs had significantly lower mortality (16.58% vs 14.52%, difference 2.06%, p<0.001), target vessel revascularization (13.08% vs 11.04%, p=0.009), and total repeat revascularization (22.16% vs 18.77%, p<0.001). The patients receiving paclitaxel-eluting and sirolimus-eluting stents both experienced superior outcomes compared to patients receiving BMSs. The patients receiving DESs had significantly lower mortality rates than their propensity-matched counterparts receiving BMSs when they were ?65 years (difference 2.29%, p=0.01) and male (difference 2.77%, p=0.003). In conclusion, patients with NSTEMI undergoing PCI experienced lower 4-year mortality, target vessel revascularization, and repeat revascularization rates when they had received DESs than when they had received BMSs, and patients who were >65 years old, and men received notable benefits.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.