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Drug-eluting stents and drug-eluting balloons are the best strategies to treat coronary in-stent restenosis
Commentary on: Giacoppo D, Gargiulo G, Aruta P, et al.. Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients. BMJ 2015;351:h5392. Context Drug-eluting stents (DES) drastically improved the efficacy of percutaneous coronary intervention by reducing the risk of in-stent restenosis (ISR) and subsequent need of target lesion revascularisation (TLR). However, despite the advances in DES technology, the incidence of ISR is still significant and considering that more than five million DES are implanted each year worldwide...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Giustino, G., Mehran, R. Tags: Clinical trials (epidemiology), Immunology (including allergy), Stroke, Interventional cardiology, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research

Complete revascularisation in patients with ST-segment elevation myocardial infarction and multivessel disease: contemporary data in context
Commentary on: Engstrøm T, Kelbæk H, Helqvist S, et al.. DANAMI-3—PRIMULTI Investigators. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial. Lancet 2015;386:665–71. Context Primary percutaneous coronary intervention is recommended in patients presenting with ST-segment Elevation Myocardial infarction (STEMI).1 In 40–60% of STEMI patients there is disease in non-infarct-related arteries (IRAs).2 Such patients have higher ...
Source: Evidence-Based Medicine - March 21, 2016 Category: Internal Medicine Authors: Banning, A. S., Gershlick, A. H. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research

Longer dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has higher anti-ischaemic efficacy than shorter DAPT but is associated with more frequent bleeding
Commentary on: Spencer FA, Prasad M, Vandvik PO, et al.. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015;163:118–26. Context Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 receptor antagonist is recommended after drug eluting stent implantation (DES) for at least 12 months by the American College of Cardiology/American Heart Association1 and for 6–12 months by European guidelines. Recent randomised controlled trials (RCT) suggested comparable efficacy of short-term DAPT versus therapy o...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Navarese, E. P. Tags: Journalology, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Ethics Therapeutics/Prevention Source Type: research

Supplemental oxygen in patients without hypoxia in ST segment elevation myocardial infarction increases myocardial injury and infarct size
Commentary on: Stub D, Smith K, Bernard S, et al.. AVOID Investigators. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143–50. Context In patients with ST segment elevation myocardial infarction (STEMI), timely reperfusion, best obtained with primary percutaneous coronary intervention (pPCI), is a mainstay to reduce infarct size (IS) and improve clinical outcome. Routine oxygen administration in normoxic patients with STEMI before pPCI, while mentioned by international guidelines,1 is not supported by randomised evidence. Stub and colleagues performed the AVOID study to compare...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Crimi, G. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Pain (neurology), Stroke, Interventional cardiology, Ischaemic heart disease, Drugs: respiratory system Therapeutics/Prevention Source Type: research

Coronary artery bypass surgery continues to remain the treatment of choice for multivessel coronary artery disease even in the era of new-generation drug-eluting stents
Commentary on: Park SJ, Ahn JM, Kim YH, et al; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015;372:1204–12. Context Multivessel coronary artery disease (MVCAD) may be found in patients subjected to coronary angiography. It is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). The expanded use of PCI, following development of drug-eluting stents (DES), necessitated comparison of its outcomes with CABG (gold standard therapy). The SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) trial favoured...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Mohr, F. W., Davierwala, P. M. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research

Meta-analysis compares anticoagulant strategies in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
Commentary on: Bangalore S, Toklu B, Kotwal A, et al. Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomised trials in the era of stents and P2Y12 inhibitors. BMJ 2014;349:g6419 Context Optimal anticoagulant therapy in patients receiving primary intervention for acute myocardial infarction (MI) is widely debated. Prior studies have been heterogeneous in doses and concomitant treatments such that it has been unclear whether effects have been those of newer medication or a result of changes in these co-interventions. A meta-analytic approach can ...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Patti, G. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests Therapeutics/Prevention Source Type: research

Bypass surgery is more cost-effective than percutaneous coronary interventions for most patients with multivessel or left main coronary artery disease
Commentary on: Cohen DJ, Osnabrugge RL, Magnuson EA, et al; SYNTAX Trial Investigators. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2014;130:1146–57. Context The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) trial compared outcomes of percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary a...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Agarwal, S., Kapadia, S. R. Tags: Health policy, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Health economics, Health service research Economic analysis Source Type: research

Similar 5-year clinical outcomes in patients with stable coronary artery disease and myocardial ischaemia managed with an initial approach of medical therapy compared with medical therapy plus percutaneous coronary intervention
Commentary on: Stergiopoulos K, Boden WE, Hartigan P, et al.. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischaemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med 2014;174:232–40. Context In patients with stable coronary artery disease (CAD), the presence of myocardial ischaemia is associated with increased cardiac event rates. Percutaneous coronary intervention (PCI) achieves greater short-term reductions in myocardial ischaemia and angina than medical therapy. In contrast to patients with acute cor...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Archbold, R. A. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics Source Type: research

Percutaneous coronary intervention of culprit and non-culprit coronary arteries in acute ST-elevation MI may improve outcomes
Commentary on: Wald DS, Morris JK, Wald NJ, et al.. Randomised trial of preventive angioplasty in myocardial infarction. N Engl J Med 2013;369:1115–23. Context The paramount goal of the treatment for acute ST-elevation myocardial infarction (STEMI) is the emergent restoration of blood flow through percutaneous coronary intervention (PCI) of the infarct-related or ‘culprit artery’, generally identified as an occluded vessel from a thrombotic lesion. However, multivessel coronary artery disease (CAD) is frequently present in patients with STEMI and portends a worse prognosis. The optimal revascularisation s...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Chen, S. H., Chakrabarti, A. K. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests Therapeutics Source Type: research