The Experts below are selected from a list of 663 Experts worldwide ranked by ideXlab platform
Giuseppe De Luca - One of the best experts on this subject based on the ideXlab platform.
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percutaneous coronary intervention related time delay patient s risk profile and survival benefits of primary Angioplasty vs lytic therapy in st segment elevation myocardial infarction
American Journal of Emergency Medicine, 2009Co-Authors: Giuseppe De Luca, Ettore Cassetti, Paolo MarinoAbstract:Abstract Background Previous reports have suggested an impact of patient's risk profile and percutaneous coronary intervention (PCI)–related time delay on the benefits of primary Angioplasty as compared with fibrinolysis. However, several factors, such as inappropriate interpretation and definition of delays, missing currently available trials, and arguable risk-benefit analysis, limit the value of these reports. Thus, the aim of the current review is to assess whether the prognostic impact of PCI-related time delay may vary according to patient's risk profile, presentation delay, and type of lytic therapy. Methods We obtained results from all randomized trials comparing fibrinolysis and primary Angioplasty in ST-segment elevation myocardial infarction. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) for papers published from January 1990 to April 2007. The following key words were used: randomized trial , myocardial infarction , reperfusion , primary Angioplasty , Rescue Angioplasty , fibrinolysis , thrombolysis , duteplase , reteplase , tenecteplase , and alteplase . Major clinical end point assessed was mortality at 30-day follow-up. The relationship between mortality benefits from primary Angioplasty, patient's risk profile, and PCI-related time delay was evaluated by using a weighted least-square regression in which results from each trial were weighted by the square root of the number of patients of each trial. Results A total of 27 trials were finally included, with 4399 patients randomized to primary Angioplasty and 4474 patients randomized to fibrinolysis. The relationship between the benefits from primary Angioplasty and PCI-related time changed according to risk profile. The higher the risk profile, the larger the reduction in mortality benefits from primary Angioplasty as compared with fibrinolysis per each 10 minutes of PCI-related time delay (0.75%, 0.45%, and 0%, in high-, medium-, and low-risk patients, respectively). Furthermore, the impact was observed only in trials enrolling patients within the first 6 hours from symptom onset. Conclusions When primary Angioplasty is selected as reperfusion strategy, all efforts should be attempted to shorten time-to-treatment, particularly in medium- or high-risk patients and in early presenters, because in these patients, a larger loss of mortality benefits as compared with fibrinolysis is observed per each 10 minutes of PCI-related time delay.
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adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for st elevation myocardial infarction a meta analysis of randomized trials
European Heart Journal, 2008Co-Authors: Giuseppe De Luca, Dariusz Dudek, Gennaro Sardella, Bernard Chevalier, Paolo Marino, Felix ZijlstraAbstract:Aims The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. Growing interests are on manual thrombectomy devices as compared with other mechanical devices. In fact, they are inexpensive and user-friendly devices, and thus represent an attractive strategy. The aim of the current study was to perform an updated meta-analysis of randomized trials conducted with adjunctive manual thrombectomy devices to prevent distal embolization in AMI. Methods and results The literature was scanned by formal searches of electronic databases [MEDLINE, CENTRAL, EMBASE, and The Cochrane Central Register of Controlled trials (http://www.mrw.interscience.wiley.com/cochrane/Cochrane\_clcentral\_articles_ fs.html)] from January 1990 to May 2008, the scientific session abstracts (from January 1990 to May 2008) and oral presentation and/or expert slide presentations (from January 2002 to May 2008) [on transcatheter coronary therapeutics (TCT), AHA (American Heart Association), ESC (European Society of Cardiology), ACC (American College of Cardiology) and EuroPCR websites]. We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following keywords were used: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, thrombectomy, thrombus aspiration, manual thrombectomy, Diver catheter, Pronto catheter, Export catheter, thrombus vacuum aspiration catheter. Information on study design, type of device, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by two investigators. Disagreements were resolved by consensus. A total of nine trials with 2417 patients were included [1209 patients (50.0%) in the manual thrombectomy device group and 1208 (50%) in the control group]. Adjunctive manual thrombectomy was associated with significantly improved postprocedural TIMI (thrombolysis in myocardial infarction) 3 flow (87.1 vs. 81.2%, P < 0.0001), and postprocedural MBG 3 (myocardial blush grade 3) (52.1 vs. 31.7%, P < 0.0001), less distal embolization (7.9 vs. 19.5%, P < 0.0001), and significant benefits in terms of 30-day mortality (1.7 vs. 3.1%, P = 0.04). Conclusion This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive manual thrombectomy devices is associated with better epicardial and myocardial perfusion, less distal embolization and significant reduction in 30-day mortality. Thus, adjunctive manual thrombectomy devices, if not anatomically contraindicated, should be routinely used among STEMI (ST-segment elevation myocardial infarction) patients undergoing primary Angioplasty.
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coronary stenting versus balloon Angioplasty for acute myocardial infarction a meta regression analysis of randomized trials
International Journal of Cardiology, 2008Co-Authors: Giuseppe De Luca, Giuseppe Biondizoccai, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Paolo MarinoAbstract:INTRODUCTION: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. RESULTS: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p=0.81) and 1-year mortality (5.1% versus 5.2%, p=0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta -0.63 [-25.4; -2.45], p=0.022) and 1-year follow-up (beta -0.61 [-15.9; -0.76], p=0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p<0.0001) and 6 to 12 months (11.3% versus 18.4%, p<0.0001) follow-up, without any difference in terms of reinfarction. CONCLUSIONS: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores.
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Coronary stenting versus balloon Angioplasty for acute myocardial infarction: A meta-regression analysis of randomized trials
'Elsevier BV', 2008Co-Authors: Giuseppe De Luca, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Giuseppe Biondi Zoccai, Paolo MarinoAbstract:Introduction: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. Methods: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. Results: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p = 0.81) and 1-year mortality (5.1% versus 5.2%, p = 0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta - 0.63 [- 25.4; - 2.45], p = 0.022) and 1-year follow-up (beta - 0.61 [- 15.9; - 0.76], p = 0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p < 0.0001) and 6 to 12 months (11.3% versus 18.4%, p < 0.0001) follow-up, without any difference in terms of reinfarction. Conclusions: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores. © 2007 Elsevier Ireland Ltd. All rights reserved
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adjunctive mechanical devices to prevent distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction a meta analysis of randomized trials
American Heart Journal, 2007Co-Authors: Giuseppe De Luca, Gregg W Stone, Harry Suryapranata, David Antoniucci, F J Neumann, Massimo ChiarielloAbstract:Background The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. The aim of this meta-analysis was to combine data from all randomized trials conducted with adjunctive mechanical devices to prevent distal embolization in AMI. Methods The literature was scanned by formal searches of electronic databases (MEDLINE and Central) from January 1990 to October 2006, scientific session abstracts (from January 1990 to October 2006), and oral presentation and/or expert slide presentations (from January 2002 to October 2006) (on the Transcatheter Cardiovascular Therapeutics, American Heart Association, European Society of Cardiology, American College of Cardiology, and European Percutaneous Revascularization Web sites). We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following key words were used: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, thrombectomy, thrombus aspiration, proximal or distal protection device, X-sizer, Diver, Export Catheter, Angiojet, Rescue catheter, Pronto catheter, PercuSurge, GuardWire, FilterWire, and SpideRX. Disagreements were resolved by consensus. Results A total of 21 trials with 3721 patients were included (1877 patients [50.4%] in the adjunctive mechanical device group and 1844 [49.6%] in the control group); 1502 patients (40.3%) were randomized in trials with distal protection devices, and 2219 patients (59.7%) were randomized in trials with thrombectomy devices. Adjunctive mechanical devices were associated with a higher rate of postprocedural TIMI 3 flow (89.4% vs 87.1%, P = .03), a significantly higher rate of postprocedural myocardial blush grade 3 (48.8% vs 36.5%, P Conclusions This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive mechanical devices to prevent distal embolization is associated with better myocardial perfusion and less distal embolization, but without an apparent improvement in survival.
Paolo Marino - One of the best experts on this subject based on the ideXlab platform.
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percutaneous coronary intervention related time delay patient s risk profile and survival benefits of primary Angioplasty vs lytic therapy in st segment elevation myocardial infarction
American Journal of Emergency Medicine, 2009Co-Authors: Giuseppe De Luca, Ettore Cassetti, Paolo MarinoAbstract:Abstract Background Previous reports have suggested an impact of patient's risk profile and percutaneous coronary intervention (PCI)–related time delay on the benefits of primary Angioplasty as compared with fibrinolysis. However, several factors, such as inappropriate interpretation and definition of delays, missing currently available trials, and arguable risk-benefit analysis, limit the value of these reports. Thus, the aim of the current review is to assess whether the prognostic impact of PCI-related time delay may vary according to patient's risk profile, presentation delay, and type of lytic therapy. Methods We obtained results from all randomized trials comparing fibrinolysis and primary Angioplasty in ST-segment elevation myocardial infarction. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) for papers published from January 1990 to April 2007. The following key words were used: randomized trial , myocardial infarction , reperfusion , primary Angioplasty , Rescue Angioplasty , fibrinolysis , thrombolysis , duteplase , reteplase , tenecteplase , and alteplase . Major clinical end point assessed was mortality at 30-day follow-up. The relationship between mortality benefits from primary Angioplasty, patient's risk profile, and PCI-related time delay was evaluated by using a weighted least-square regression in which results from each trial were weighted by the square root of the number of patients of each trial. Results A total of 27 trials were finally included, with 4399 patients randomized to primary Angioplasty and 4474 patients randomized to fibrinolysis. The relationship between the benefits from primary Angioplasty and PCI-related time changed according to risk profile. The higher the risk profile, the larger the reduction in mortality benefits from primary Angioplasty as compared with fibrinolysis per each 10 minutes of PCI-related time delay (0.75%, 0.45%, and 0%, in high-, medium-, and low-risk patients, respectively). Furthermore, the impact was observed only in trials enrolling patients within the first 6 hours from symptom onset. Conclusions When primary Angioplasty is selected as reperfusion strategy, all efforts should be attempted to shorten time-to-treatment, particularly in medium- or high-risk patients and in early presenters, because in these patients, a larger loss of mortality benefits as compared with fibrinolysis is observed per each 10 minutes of PCI-related time delay.
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adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for st elevation myocardial infarction a meta analysis of randomized trials
European Heart Journal, 2008Co-Authors: Giuseppe De Luca, Dariusz Dudek, Gennaro Sardella, Bernard Chevalier, Paolo Marino, Felix ZijlstraAbstract:Aims The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. Growing interests are on manual thrombectomy devices as compared with other mechanical devices. In fact, they are inexpensive and user-friendly devices, and thus represent an attractive strategy. The aim of the current study was to perform an updated meta-analysis of randomized trials conducted with adjunctive manual thrombectomy devices to prevent distal embolization in AMI. Methods and results The literature was scanned by formal searches of electronic databases [MEDLINE, CENTRAL, EMBASE, and The Cochrane Central Register of Controlled trials (http://www.mrw.interscience.wiley.com/cochrane/Cochrane\_clcentral\_articles_ fs.html)] from January 1990 to May 2008, the scientific session abstracts (from January 1990 to May 2008) and oral presentation and/or expert slide presentations (from January 2002 to May 2008) [on transcatheter coronary therapeutics (TCT), AHA (American Heart Association), ESC (European Society of Cardiology), ACC (American College of Cardiology) and EuroPCR websites]. We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following keywords were used: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, thrombectomy, thrombus aspiration, manual thrombectomy, Diver catheter, Pronto catheter, Export catheter, thrombus vacuum aspiration catheter. Information on study design, type of device, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by two investigators. Disagreements were resolved by consensus. A total of nine trials with 2417 patients were included [1209 patients (50.0%) in the manual thrombectomy device group and 1208 (50%) in the control group]. Adjunctive manual thrombectomy was associated with significantly improved postprocedural TIMI (thrombolysis in myocardial infarction) 3 flow (87.1 vs. 81.2%, P < 0.0001), and postprocedural MBG 3 (myocardial blush grade 3) (52.1 vs. 31.7%, P < 0.0001), less distal embolization (7.9 vs. 19.5%, P < 0.0001), and significant benefits in terms of 30-day mortality (1.7 vs. 3.1%, P = 0.04). Conclusion This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive manual thrombectomy devices is associated with better epicardial and myocardial perfusion, less distal embolization and significant reduction in 30-day mortality. Thus, adjunctive manual thrombectomy devices, if not anatomically contraindicated, should be routinely used among STEMI (ST-segment elevation myocardial infarction) patients undergoing primary Angioplasty.
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coronary stenting versus balloon Angioplasty for acute myocardial infarction a meta regression analysis of randomized trials
International Journal of Cardiology, 2008Co-Authors: Giuseppe De Luca, Giuseppe Biondizoccai, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Paolo MarinoAbstract:INTRODUCTION: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. RESULTS: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p=0.81) and 1-year mortality (5.1% versus 5.2%, p=0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta -0.63 [-25.4; -2.45], p=0.022) and 1-year follow-up (beta -0.61 [-15.9; -0.76], p=0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p<0.0001) and 6 to 12 months (11.3% versus 18.4%, p<0.0001) follow-up, without any difference in terms of reinfarction. CONCLUSIONS: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores.
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Coronary stenting versus balloon Angioplasty for acute myocardial infarction: A meta-regression analysis of randomized trials
'Elsevier BV', 2008Co-Authors: Giuseppe De Luca, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Giuseppe Biondi Zoccai, Paolo MarinoAbstract:Introduction: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. Methods: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. Results: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p = 0.81) and 1-year mortality (5.1% versus 5.2%, p = 0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta - 0.63 [- 25.4; - 2.45], p = 0.022) and 1-year follow-up (beta - 0.61 [- 15.9; - 0.76], p = 0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p < 0.0001) and 6 to 12 months (11.3% versus 18.4%, p < 0.0001) follow-up, without any difference in terms of reinfarction. Conclusions: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores. © 2007 Elsevier Ireland Ltd. All rights reserved
Massimo Chiariello - One of the best experts on this subject based on the ideXlab platform.
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coronary stenting versus balloon Angioplasty for acute myocardial infarction a meta regression analysis of randomized trials
International Journal of Cardiology, 2008Co-Authors: Giuseppe De Luca, Giuseppe Biondizoccai, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Paolo MarinoAbstract:INTRODUCTION: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. RESULTS: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p=0.81) and 1-year mortality (5.1% versus 5.2%, p=0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta -0.63 [-25.4; -2.45], p=0.022) and 1-year follow-up (beta -0.61 [-15.9; -0.76], p=0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p<0.0001) and 6 to 12 months (11.3% versus 18.4%, p<0.0001) follow-up, without any difference in terms of reinfarction. CONCLUSIONS: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores.
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Coronary stenting versus balloon Angioplasty for acute myocardial infarction: A meta-regression analysis of randomized trials
'Elsevier BV', 2008Co-Authors: Giuseppe De Luca, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Giuseppe Biondi Zoccai, Paolo MarinoAbstract:Introduction: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. Methods: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. Results: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p = 0.81) and 1-year mortality (5.1% versus 5.2%, p = 0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta - 0.63 [- 25.4; - 2.45], p = 0.022) and 1-year follow-up (beta - 0.61 [- 15.9; - 0.76], p = 0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p < 0.0001) and 6 to 12 months (11.3% versus 18.4%, p < 0.0001) follow-up, without any difference in terms of reinfarction. Conclusions: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores. © 2007 Elsevier Ireland Ltd. All rights reserved
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adjunctive mechanical devices to prevent distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction a meta analysis of randomized trials
American Heart Journal, 2007Co-Authors: Giuseppe De Luca, Gregg W Stone, Harry Suryapranata, David Antoniucci, F J Neumann, Massimo ChiarielloAbstract:Background The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. The aim of this meta-analysis was to combine data from all randomized trials conducted with adjunctive mechanical devices to prevent distal embolization in AMI. Methods The literature was scanned by formal searches of electronic databases (MEDLINE and Central) from January 1990 to October 2006, scientific session abstracts (from January 1990 to October 2006), and oral presentation and/or expert slide presentations (from January 2002 to October 2006) (on the Transcatheter Cardiovascular Therapeutics, American Heart Association, European Society of Cardiology, American College of Cardiology, and European Percutaneous Revascularization Web sites). We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following key words were used: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, thrombectomy, thrombus aspiration, proximal or distal protection device, X-sizer, Diver, Export Catheter, Angiojet, Rescue catheter, Pronto catheter, PercuSurge, GuardWire, FilterWire, and SpideRX. Disagreements were resolved by consensus. Results A total of 21 trials with 3721 patients were included (1877 patients [50.4%] in the adjunctive mechanical device group and 1844 [49.6%] in the control group); 1502 patients (40.3%) were randomized in trials with distal protection devices, and 2219 patients (59.7%) were randomized in trials with thrombectomy devices. Adjunctive mechanical devices were associated with a higher rate of postprocedural TIMI 3 flow (89.4% vs 87.1%, P = .03), a significantly higher rate of postprocedural myocardial blush grade 3 (48.8% vs 36.5%, P Conclusions This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive mechanical devices to prevent distal embolization is associated with better myocardial perfusion and less distal embolization, but without an apparent improvement in survival.
Baptista J - One of the best experts on this subject based on the ideXlab platform.
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Angioplastia Primária em Portugal Entre 2002-2013. Atividade Segundo o Registo Nacional de Cardiologia de Intervenção
Sociedade Portuguesa de Cardiologia, 2016Co-Authors: Pereira H, Campante Teles R, Costa M, Canas Da Silva, P, Gama Ribeiro, Martins D, Matias F, Pereira-machado F, Baptista JAbstract:INTRODUCTION AND OBJECTIVES: The aim of the present paper was to report trends in coronary Angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. METHODS: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. RESULTS: In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue Angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. CONCLUSION: During the reporting period there was a three-fold increase in primary Angioplasty rates per million population. Rescue Angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach
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Trends in coronary Angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional Cardiology
'Elsevier BV', 2016Co-Authors: Pereira H, Campante Teles R, Costa M, Canas Da Silva, P, Martins D, Matias F, Pereira-machado F, Da Gama Ribeiro, Baptista JAbstract:INTRODUCTION AND OBJECTIVES: The aim of the present paper was to report trends in coronary Angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. METHODS: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. RESULTS: In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue Angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. CONCLUSION: During the reporting period there was a three-fold increase in primary Angioplasty rates per million population. Rescue Angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach
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Angioplastia primária em Portugal entre 2002-2013. Atividade segundo o Registo Nacional de Cardiologia de Intervenção
'Elsevier BV', 2016Co-Authors: Pereira H, Costa M, Martins D, Matias F, Pereira-machado F, Teles R, Silva P, Baptista JAbstract:Introduction and Objectives: The aim of the present paper was to report trends in coronary Angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. Methods: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. Results: In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per mil- lion population per year. Rescue Angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. Conclusion: During the reporting period there was a three-fold increase in primary Angioplasty rates per million population. Rescue Angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach.Introdução e objetivos: Foi nosso objetivo reportar a evoluc¸ão da angioplastia coronária no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (ICP-P), entre 2002-2013. Métodos: Os dados prospetivos multicêntricos do Registo Nacional de Cardiologia de Intervenc¸ão (RNCI) e os dados oficiais da Direc¸ão Geral de Saúde (DGS) foram conjugados para estudar as ICP-P realizadas entre 2002-2013. Resultados: Em 2013 realizaram-se 3524 angioplastias primárias (ICP-P), representando um crescimento de 315% relativamente ao ano de 2002. Em 2002 a ICP-P representava 16% do total de angioplastias coronárias, passando a representar 25% nos anos de 2012-2013. Entre 2002-2013 o número de procedimentos por milhão de habitantes aumentou de 106 para 338 e a angioplastia de recurso decresceu de 70,7 para 2%. Durante o período em análise, a utilizac¸ão de stents eluidores de fármaco cresceu de 9,9 para 69,5%. Após 2008, observou-se uma utilizac¸ão crescente da trombectomia de aspirac¸ão, atingindo 46,7% em 2013. Os inibidores das glicopro- teínas II b/ III a registaram um decréscimo no seu uso, sendo de 73,2% em 2002 e de 23,6% em 2013. O acesso radial cresceu de 8,3% em 2008 até 54,6% em 2013. Conclusões: Durante o período em análise, a taxa de angioplastia coronária por milhão de habitantes triplicou. A angioplastia de recurso foi ultrapassada pela angioplastia primária a partir de 2006. Observaram-se novas tendências no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST, salientando-se a utilizac¸ão de stents eluidores de fármacos e o acesso radial
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coronary stenting versus balloon Angioplasty for acute myocardial infarction a meta regression analysis of randomized trials
International Journal of Cardiology, 2008Co-Authors: Giuseppe De Luca, Giuseppe Biondizoccai, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Paolo MarinoAbstract:INTRODUCTION: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. RESULTS: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p=0.81) and 1-year mortality (5.1% versus 5.2%, p=0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta -0.63 [-25.4; -2.45], p=0.022) and 1-year follow-up (beta -0.61 [-15.9; -0.76], p=0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p<0.0001) and 6 to 12 months (11.3% versus 18.4%, p<0.0001) follow-up, without any difference in terms of reinfarction. CONCLUSIONS: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores.
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Coronary stenting versus balloon Angioplasty for acute myocardial infarction: A meta-regression analysis of randomized trials
'Elsevier BV', 2008Co-Authors: Giuseppe De Luca, Adnan Kastrati, Gregg W Stone, Harry Suryapranata, David Antoniucci, Massimo Chiariello, Giuseppe Biondi Zoccai, Paolo MarinoAbstract:Introduction: Although stenting has been shown to reduce the need for target vessel revascularization (TVR) in acute myocardial infarction (AMI), the benefits in terms of mortality and reinfarction are still unclear. Previous meta-analyses have failed to include all currently available randomized trials. The aim of the current study was to perform an updated meta-analysis to evaluate the benefits of coronary stenting for AMI in terms of mortality, reinfarction, and TVR, and whether these benefits correlated with the patient's risk profile. Methods: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to September 2006. We examined all completed, published, randomized trials of coronary stenting for AMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, stenting, and balloon Angioplasty. Information on study design, type of stent, inclusion and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators. Disagreements were resolved by consensus. Results: A total of 13 randomized trials were identified and analyzed involving 6922 patients (3460 or 50% randomized to stent and 3462 or 50% to balloon). Stenting was not associated with a significant reduction in 30-day (2.9% versus 3.0%, p = 0.81) and 1-year mortality (5.1% versus 5.2%, p = 0.81), as compared to balloon Angioplasty. However, a significant relationship was observed between patient's risk profile and mortality benefits from coronary stenting at 30-day (beta - 0.63 [- 25.4; - 2.45], p = 0.022) and 1-year follow-up (beta - 0.61 [- 15.9; - 0.76], p = 0.034). Stenting was associated with benefits in terms of TVR at both 30-day (3.1% versus 5.1%, p < 0.0001) and 6 to 12 months (11.3% versus 18.4%, p < 0.0001) follow-up, without any difference in terms of reinfarction. Conclusions: Among AMI patients undergoing primary Angioplasty, coronary stent implantation, when anatomically and technically feasible, may be considered, in addition to benefits in terms of TVR, to reduce mortality in high-risk patients, who may be identified by the use of validated risk scores. © 2007 Elsevier Ireland Ltd. All rights reserved
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adjunctive mechanical devices to prevent distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction a meta analysis of randomized trials
American Heart Journal, 2007Co-Authors: Giuseppe De Luca, Gregg W Stone, Harry Suryapranata, David Antoniucci, F J Neumann, Massimo ChiarielloAbstract:Background The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. The aim of this meta-analysis was to combine data from all randomized trials conducted with adjunctive mechanical devices to prevent distal embolization in AMI. Methods The literature was scanned by formal searches of electronic databases (MEDLINE and Central) from January 1990 to October 2006, scientific session abstracts (from January 1990 to October 2006), and oral presentation and/or expert slide presentations (from January 2002 to October 2006) (on the Transcatheter Cardiovascular Therapeutics, American Heart Association, European Society of Cardiology, American College of Cardiology, and European Percutaneous Revascularization Web sites). We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following key words were used: randomized trial, myocardial infarction, reperfusion, primary Angioplasty, Rescue Angioplasty, thrombectomy, thrombus aspiration, proximal or distal protection device, X-sizer, Diver, Export Catheter, Angiojet, Rescue catheter, Pronto catheter, PercuSurge, GuardWire, FilterWire, and SpideRX. Disagreements were resolved by consensus. Results A total of 21 trials with 3721 patients were included (1877 patients [50.4%] in the adjunctive mechanical device group and 1844 [49.6%] in the control group); 1502 patients (40.3%) were randomized in trials with distal protection devices, and 2219 patients (59.7%) were randomized in trials with thrombectomy devices. Adjunctive mechanical devices were associated with a higher rate of postprocedural TIMI 3 flow (89.4% vs 87.1%, P = .03), a significantly higher rate of postprocedural myocardial blush grade 3 (48.8% vs 36.5%, P Conclusions This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive mechanical devices to prevent distal embolization is associated with better myocardial perfusion and less distal embolization, but without an apparent improvement in survival.