Optimal Timing of Invasive Coronary Angiography following NSTEMI.
- 作者列表："Mahendiran T","Nanchen D","Meier D","Gencer B","Klingenberg R","Räber L","Carballo D","Matter CM","Lüscher TF","Windecker S","Mach F","Rodondi N","Muller O","Fournier S
Objective:To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI). Background:Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission. Methods:NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke). Results:Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12-24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12-24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637-1.733, p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (. Conclusions:In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved one-year cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.
目的: 获得非ST段抬高型心肌梗死 (NSTEMI) 患者入院24小时内血管造影最佳时机的真实世界视角。 背景: 目前的指南建议在NSTEMI住院后24小时内进行血管造影。最近的判决试验发现，NSTEMI患者入院后12小时内的血管造影与高危患者的心血管结局改善相关。我们比较了入院12小时内接受血管造影的真实世界NSTEMI患者与入院后12至24小时接受血管造影的患者的结局。 方法: 在入院24小时内接受血管造影的无危及生命特征的NSTEMI患者从SPUM-ACS登记系统获得，SPUM-ACS登记系统是瑞士四所大学医院连续收治的急性冠状动脉综合征患者的队列。Cox模型评估了门至导管时间与一年主要不良心血管事件 (MACE: 心血管死亡率、心肌梗死和卒中) 之间的相关性。 结果: 2672例NSTEMI患者中，1832例符合纳入标准。其中，1464例患者在12小时内接受了血管造影检查 (12小时组)，368例患者在12小时至24小时内接受了血管造影检查 (12小时至24小时组)。多元logistic回归分析发现，入院时外是与血管造影延迟相关的唯一因素.2 : 1 1倾向评分匹配后，来自12 h组的736名患者和来自12-24 h组的368名患者在一年MACE发生率方面没有显著差异 (7.7% 对7.3%，HR: 1.050，95% CI 0.637-1.733，p = 0.847)。按GRACE评分分层 (>140 vs. ≤ 140) 发现12 h组高危患者MACE无显著降低 (p = 0.847)。按GRACE评分分层 (>140 vs. ≤ 140) 发现12 h组高危患者MACE无显著降低 (. 结论: 在一个未经选择的NSTEMI患者的真实世界队列中，与入院后12和24小时的血管造影相比，入院12小时内的血管造影与改善的一年心血管结局无关，即使在高风险患者中也是如此。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.