Urgent Revascularization Strategies in Patients With Diabetes Mellitus and Acute Coronary Syndrome

Publication date: August 2019Source: Canadian Journal of Cardiology, Volume 35, Issue 8Author(s): Lucas C. Godoy, Patrick R. Lawler, Michael E. Farkouh, Bronwyn Hersen, José C. Nicolau, Vivek RaoAbstractThe prevalence of diabetes mellitus (DM) is rising globally and in Canada. Besides being a risk factor for the development of coronary artery disease, DM is also a marker of poor prognosis in patients with acute coronary syndrome (ACS), increasing the risks for ischemic and bleeding complications. Patients with DM have a high prevalence of multivessel coronary artery disease (MVD) and robust evidence has supported coronary artery bypass surgery (CABG) as the optimal revascularization strategy in the setting of stable ischemic heart disease. In the acute scenario, particularly in patients with non–ST-segment elevation (NSTE) ACS (NSTE-ACS), there are many uncertainties regarding the best revascularization strategy. Most guidelines suggest an invasive and timely approach (that is, performing coronary catheterization within 72 hours after the onset of the NSTE-ACS) and make recommendations about choosing between percutaneous coronary intervention (PCI) or CABG on the basis of data for patients with stable ischemic heart disease. Recent observational and subgroup analyses suggest that CABG might be the preferential method of revascularization for patients with DM and MVD also in the NSTE-ACS setting; however, dedicated randomized clinical trials are lacking. Finally, ...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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ConclusionsExtra-pelvic endometriosis, traditionally thought to be rare, have been reported in a considerable number of cases. Heightened awareness and clinical suspicion of the disease, and multi-disciplinary approach is recommended to achieve prompt diagnosis and optimize patient outcomes. At this time, there are no comparative studies to provide recommendations regarding optimal diagnostic methods, treatment options and outcomes for endometriosis involving extra-pelvic sites.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
The objective of this study was to evaluate the influence of gross tumor morphology on clinicopathological profile of CRCs in Kashmiri population.MethodsThis 5-year study is a prospective (2 yrs) and retrospective (3 yrs) study conducted from 2011 to 2016 in the Colorectal Surgery Division at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India. Parameters studied were age, sex, site of lesion, clinical presentations, gross tumor morphology, and histopathology of the lesion.ResultsA total of 930 patients with CRC were included. Infiltrative variety was the most common morphology in patients aged 1...
Source: Current Medicine Research and Practice - Category: General Medicine Source Type: research
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Source: Journal of Clinical and Translational Endocrinology - Category: Endocrinology Source Type: research
ConclusionOur study showed a significant association between alterations in intestinal microbial composition and T1D; however, in some articles, it is not clear which one happens first. Investigation of altered gut microbiota can help in the early detection of T1D before seropositivity. Targeted microbiome modulation can be a novel potential therapeutic strategy.
Source: Gut Pathogens - Category: Microbiology Source Type: research
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Publication date: Available online 20 March 2019Source: Canadian Journal of CardiologyAuthor(s): Lucas C. Godoy, Patrick R. Lawler, Michael E. Farkouh, Bronwyn Hersen, José C. Nicolau, Vivek RaoAbstractThe prevalence of diabetes mellitus (DM) is rising globally and in Canada. Besides being a risk factor for the development of coronary artery disease, DM is also a marker of poor prognosis in patients with acute coronary syndrome (ACS), increasing the risks for both ischemic and bleeding complications. Patients with DM have a high prevalence of multivessel coronary artery disease (MVD) and robust evidence has supporte...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
DAPT score (Dual Antiplatelet Therapy Score) was developed to dichotomize patients after percutaneous coronary intervention [PCI] into those who will benefit from prolonged DAPT (score 2 or more) and those who are more likely to be harmed by DAPT (score less than 2). A recent study evaluated DAPT with aspirin and clopidogrel given for 2 years vs 6 months in 1970 patients undergoing PCI [1]. Primary efficacy outcomes were death, myocardial infarction or cerebrovascular accident. Primary safety outcome was significant bleeding. In this retrospective study they concluded that prolonged DAPT resulted in harm in patients with l...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
ConclusionVorapaxar provides clinicians with a novel mechanism of action to further reduce the burden of ischemic heart disease. Identification of patients with a high ischemic risk and low bleeding risk would enable clinicians to maximize the utility of this unique agent.
Source: Drugs in R&D - Category: Drugs & Pharmacology Source Type: research
This article reviews the efficacy of extended (>12 months) compared to standard (12 months) DAPT for reducing myocardial infarction and stent thrombosis rates, especially in diabetic elderly patients. Literature screening was conducted at PubMed and Cochrane database using "dual antiplatelet", "duration", "adult-onset diabetes mellitus", "elderly" and, "drug-eluting stent" as keywords. Article types were limited to meta-analysis, systematic review, randomized clinical trial, or clinical trial that compared the efficacy of extended to standard duration of DAPT. Clinical o...
Source: Acta medica Indonesiana - Category: Internal Medicine Tags: Acta Med Indones Source Type: research
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