No abstract

Background Recently, the COMPASS trial demonstrated that dual therapy reduced cardiovascular outcomes compared with aspirin alone in patients with stable atherosclerotic disease. Methods and Results We sought to assess the proportion of patients eligible for the COMPASS trial and to compare the epidemiology and outcome of these patients with those without COMPASS inclusion or with any exclusion criteria in a contemporary, nationwide cohort of patients with stable coronary artery disease (CAD). Among the 4068 patients with detailed information allowing evaluation of eligibility, 1416 (34.8%) did not fulfill the inclusion criteria (COMPASS-Not-Included), 841 (20.7%) had exclusion criteria (COMPASS-Excluded) and the remaining 1811 (44.5%) were classified as COMPASS-Like. At 1 year, the incidence of major adverse cardiovascular event (MACE), a composite of cardiovascular death, myocardial infarction and stroke, was 0.9% in the COMPASS-Not-Included and 2.0% in the COMPASS-Like (p = 0.01), and 5.0% in the COMPASS-Excluded group (p < 0.0001 for all comparisons). Among the COMPASS-Like population, patients with multiple COMPASS enrichment criteria presented a significant increase in the risk of MACE (from 1.0% to 3.3% in those with 1 and ≥3 criteria, respectively; p = 0.012), and a modest absolute increase in major bleeding risk (from 0.2% to 0.4%, respectively; p = 0.46). Conclusions In a contemporary real-world cohort registry of stable CAD, most patients resulted as eligible for the COMPASS. These patients presented a considerable annual risk of MACE that consistently increases in the presence of multiple risk factors.

Na oddělení urgentního příjmu byla pro paroxysmální noční dyspnoe přivezena 78letá žena s ischemickou chorobou srdeční v anamnéze a s trvalou fi brilací síní, léčená warfarinem. Přístrojové vyšetření ukazovalo na časnou fázi akutního srdečního selhání. Poslední hodnota INR byla 3,64, přičemž všechny předchozí dostupné hodnoty INR byly v terapeutickém rozmezí (2-3). Transthorakální 2D echokardiografi cké vyšetření prokázalo dilataci levé komory a závažné snížení systolické funkce. V levé síni byla zjištěna přítomnost echogenního stopkatého útvaru nasedajícího na mezisíňové septum. O 12 hodin později si pacientka náhle začala stěžovat na bolest v levé paži. Byl zjištěn tromboembolický uzávěr levé pažní tepny akutně řešený embolektomií s použitím Fogartyho katétru. Během první hodiny po tomto výkonu si několik tromboembolických příhod opakujících se po sobě nakonec vyžádalo amputaci paže. Podávání warfarinu bylo přerušeno a současně byla zahájena léčba dabigatranem v dávce 150 mg dvakrát denně; následně došlo k vymizení trombotického útvaru a úpravě klinického stavu pacientky.

No abstract

No abstract

Intravascular administration of iodinated contrast media is an essential tool for the imaging of blood vessels and cardiac chambers, as well as for percutaneous coronary and structural interventions. Along with the spreading of diagnostic and interventional procedures, the increasing incidence of contrast-induced nephropathy (CIN) has become an important and prognostically relevant problem. CIN is thought to be largely dependent on oxidative damage, and is a considerable cause of renal failure, being associated with prolonged hospitalization and significant morbidity/mortality. The most effective treatment strategy of this serious complication remains prevention, and several preventive measures have been extensively investigated in the last few years. Preprocedural hydration is the best-known and mostly accepted strategy. The administration of sodium bicarbonate has controversial effects, and is likely to be ineffective when the infused dose is unable to achieve adequate urine alkalinization. Since alkaline pH suppresses the production of free radicals, increasing urine pH would be an attractive goal for CIN prevention. In a prospective randomized controlled, open-label clinical trial we will test the hypothesis that urine alkalinization with either oral or intravenous bicarbonate on top of hydration alone is the main determinant of CIN prevention (primary endpoint) in a population of patients with moderate or severe chronic kidney disease scheduled for coronary angiography and/or angioplasty. If we then demonstrate nonsignificant differences in urine alkalinization and incidence of CIN between the two bicarbonate groups (secondary endpoint), a practical implication will be that oral administration is preferable for practical reasons over the administration of intravenous bicarbonate.

No abstract

No abstract