Objective The optimal strategy during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction and multivessel disease is still controversial. Therefore, the aim of our study is ...Objective The optimal strategy during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction and multivessel disease is still controversial. Therefore, the aim of our study is to evaluate the short- and long-term effect of complete revas- cularization （CR） versus infarct-related artery revascularization （IR） following primary PCI. Methods We identified randomized controlled studies （RCTs） by systematic search of PubMed, EMBASE, Web of Science, ClinicalTrials.gov Website, Cochrane Library and Google scholar Database. Primary outcome was major adverse cardiac events （MACE）. Result Nine RCTs （2198 patients） with mean follow-up of 21.1 months were retrieved. Overall, CR was associated with significantly lower risk of MACE compared with IR therapy when followed by long-term duration （≥ 12 months） （RR： 0.56; 95% Ch 0.47-0.68; I^2 = 58.5%）. Additionally, CR was associated with equivalent rates of all-cause mortality （RR： 0.76; 95% CI： 0.53-1.08; I^2= 0.0%） and myocardial infarction （RR： 0.81; 95% CI： 0.57-1.16; I^2= 26.4%） compared with control. Meanwhile, risk of stroke was similar between groups （RR： 0.73; 95% CI： 0.24-2.19; I^2= 0.0%）. However, rates of cardiac death and target vessel revascularization were significantly decreased in the CR group （RR： 0.41; 95% CI： 0.23-0.72; I^2 = 0.0% and RR： 0.46; 95% CI： 0.37-0.57; I^2= 47.4%）. Conclusion Complete revascularization appears to have long-term clinical benefit with regard to adverse cardiac events following primary PCI. However, more studies are needed to confirm these findings.展开更多
For many years,cardiovascular clinicians have been making the argument that complete revascularization is the way to proceed in patients with any form of ischemic heart disease.I believe that cardiovascular surgeons a...For many years,cardiovascular clinicians have been making the argument that complete revascularization is the way to proceed in patients with any form of ischemic heart disease.I believe that cardiovascular surgeons agree with this approach and try their best to completely revascularize patients at the time of coronary artery bypass graft surgery.At the University of Florida,we,like many others in the world,treat an acute myocardial infarction as an emergency,and,if there is ST segment elevation,the patient is transported immediately to the cardiac catheterization laboratory from the emergency department,for recanalization of the culprit artery.展开更多
Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years lea...Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success.The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still underutilized.It has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular events.The application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with CTO.The increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.展开更多
AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHOD...AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHODS We searched PubMed using the keywords “complete revascularization”, “incomplete revascularization”, “cor-onary artery bypass”, and “percutaneous coronary intervention”. We selected randomized controlled studies （RCT） and observational studies only for review. The main outcomes of interest were mortality, myocardial infarction （MI） and repeat revascularization. We identified further studies by hand searching relevant publications and included those that met with the inclusion criteria in our fnal analysis and performed a systematic review.RESULTSTen studies were identified, including 13327 patients of whom, 8053 received complete revascularization and 5274 received ICR. Relative to ICR, CR was associated with lower mortality （RR： 0.755, 95%CI： 0.66 to 0.864, P = 0.765, I2 = 0.0%）, lower rates of MI （RR： 0.759, 95%CI： 0.615 to 0.937, P = 0.091, I2 = 45.1%）, lower rates of MACCE （RR： 0.731, 95%CI： 0.668 to 0.8, P = 0.453, I2 = 0.0%） and reduced rates of repeat coronary revascularization （RR： 0.691, 95%CI： 0.541 to 0.883, P = 0.0, I2 = 88.3%）.CONCLUSIONCR is associated with lower rates of adverse outcomes. CR can be used as a standard in the choice of any particular revascularization strategy.展开更多
The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report</span><span style="font-family:"">,&...The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report</span><span style="font-family:"">,</span><span style="font-family:""> a patient presented with TVD has been managed with anaortic off-pump complete arterial revascularization (OPCABG) by using composite LIMA RIMA Y Sequential 5 grafts to achieve complete arterial revascularization successfully. This type of operative procedure is technically difficult in a resource poor country like Bangladesh. However, this has been done by a group of young cardiac surgeon. During follow up</span><span style="font-family:"">,</span><span style="font-family:""> the patient is in a good condition.展开更多
Twenty five casses of complete revascularization for coronary artery discase by sequential aortocoronary saphaneous bypass operation were performed from April 1990 to July 1993.
基金Acknowledgement This work is supported by grants from National Natural Science foundation of China （81570323） and Beijing Lab for Cardiovascular Precision Medicine, Beijing, China （PXM2017_014226_000037）.
文摘Objective The optimal strategy during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction and multivessel disease is still controversial. Therefore, the aim of our study is to evaluate the short- and long-term effect of complete revas- cularization （CR） versus infarct-related artery revascularization （IR） following primary PCI. Methods We identified randomized controlled studies （RCTs） by systematic search of PubMed, EMBASE, Web of Science, ClinicalTrials.gov Website, Cochrane Library and Google scholar Database. Primary outcome was major adverse cardiac events （MACE）. Result Nine RCTs （2198 patients） with mean follow-up of 21.1 months were retrieved. Overall, CR was associated with significantly lower risk of MACE compared with IR therapy when followed by long-term duration （≥ 12 months） （RR： 0.56; 95% Ch 0.47-0.68; I^2 = 58.5%）. Additionally, CR was associated with equivalent rates of all-cause mortality （RR： 0.76; 95% CI： 0.53-1.08; I^2= 0.0%） and myocardial infarction （RR： 0.81; 95% CI： 0.57-1.16; I^2= 26.4%） compared with control. Meanwhile, risk of stroke was similar between groups （RR： 0.73; 95% CI： 0.24-2.19; I^2= 0.0%）. However, rates of cardiac death and target vessel revascularization were significantly decreased in the CR group （RR： 0.41; 95% CI： 0.23-0.72; I^2 = 0.0% and RR： 0.46; 95% CI： 0.37-0.57; I^2= 47.4%）. Conclusion Complete revascularization appears to have long-term clinical benefit with regard to adverse cardiac events following primary PCI. However, more studies are needed to confirm these findings.
文摘For many years,cardiovascular clinicians have been making the argument that complete revascularization is the way to proceed in patients with any form of ischemic heart disease.I believe that cardiovascular surgeons agree with this approach and try their best to completely revascularize patients at the time of coronary artery bypass graft surgery.At the University of Florida,we,like many others in the world,treat an acute myocardial infarction as an emergency,and,if there is ST segment elevation,the patient is transported immediately to the cardiac catheterization laboratory from the emergency department,for recanalization of the culprit artery.
文摘Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success.The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still underutilized.It has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular events.The application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with CTO.The increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.
文摘AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHODS We searched PubMed using the keywords “complete revascularization”, “incomplete revascularization”, “cor-onary artery bypass”, and “percutaneous coronary intervention”. We selected randomized controlled studies （RCT） and observational studies only for review. The main outcomes of interest were mortality, myocardial infarction （MI） and repeat revascularization. We identified further studies by hand searching relevant publications and included those that met with the inclusion criteria in our fnal analysis and performed a systematic review.RESULTSTen studies were identified, including 13327 patients of whom, 8053 received complete revascularization and 5274 received ICR. Relative to ICR, CR was associated with lower mortality （RR： 0.755, 95%CI： 0.66 to 0.864, P = 0.765, I2 = 0.0%）, lower rates of MI （RR： 0.759, 95%CI： 0.615 to 0.937, P = 0.091, I2 = 45.1%）, lower rates of MACCE （RR： 0.731, 95%CI： 0.668 to 0.8, P = 0.453, I2 = 0.0%） and reduced rates of repeat coronary revascularization （RR： 0.691, 95%CI： 0.541 to 0.883, P = 0.0, I2 = 88.3%）.CONCLUSIONCR is associated with lower rates of adverse outcomes. CR can be used as a standard in the choice of any particular revascularization strategy.
文摘The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report</span><span style="font-family:"">,</span><span style="font-family:""> a patient presented with TVD has been managed with anaortic off-pump complete arterial revascularization (OPCABG) by using composite LIMA RIMA Y Sequential 5 grafts to achieve complete arterial revascularization successfully. This type of operative procedure is technically difficult in a resource poor country like Bangladesh. However, this has been done by a group of young cardiac surgeon. During follow up</span><span style="font-family:"">,</span><span style="font-family:""> the patient is in a good condition.
文摘Twenty five casses of complete revascularization for coronary artery discase by sequential aortocoronary saphaneous bypass operation were performed from April 1990 to July 1993.
