marzo, 2018

  • Mas Datos a Favor de Revascularización Funcional que validan la estrategia «conservadora» en Angioplastia

    On: 15 marzo, 2018
    In: Sin categoría
    Views: 805
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  • Cambiar la estrategia de la Angioplastia es tan importante como el uso de DES

    On: 12 marzo, 2018
    In: Sin categoría
    Views: 769
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    Un trabajo mostró que cambiar la estrategia de PCI es igual de relevante que el uso de DES en angioplastia de múltiples vasos.
    Un estudio recientemente publicado validó los hallazgos del Score de ERACI y la estrategia «conservadora» en el uso de stents durante la angioplastia de vasos múltiples.
    Resultados de dos estudios multicéntricos observacionales en la Argentina así lo demuestran.

    https://www.ncbi.nlm.nih.gov/pubmed/29519729

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  • Reciente meta-análisis muestra prevalencia de la cirugía convencional(SAVR) sobre el implante percutáneo de válvula aórtica(TAVI)

    On: 8 marzo, 2018
    In: Cardiología Clínica, Cardiología Intervencionista, Investigación
    Views: 1008
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    Este estudio, que incluyó dos estudios randomizados y 4 estudios observacionales en pacientes con estenosis aórtica y bajo riesgo clínico, mostró similar mortalidad en el período hospitalario entre TAVI y SAVR, pero una mayor sobrevida a los 3 años con SAVR.
    Se incluyeron 3487 pacientes de 6 estudios, 4 de ellos observacionales y 2 randomizados. El TAVI se acompañó de menor insuficiencia renal y riesgo de sangrado pero mayores complicaciones vasculares e indicación de marcapaso definitivo.

    Abstract/Summary

    Background
    Although transcatheter aortic valve replacement (TAVR) is officially indicated for high risk aortic stenosis (AS) patients, the procedure is increasingly being performed in patients who are not at high surgical risk, including a substantial number of low risk patients. However, data on the benefit of TAVR in this patient population is limited.

    Methods
    We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) of TAVR versus surgical aortic valve replacement (SAVR) in patients who are at low surgical risk. The primary outcome was all-cause mortality. The secondary outcomes included stroke, myocardial infarction, bleeding, and various procedural complications.

    Results
    Six studies (2 RCTs and 4 PSM studies) totaling 3,484 patients were included. Follow-up ranged from 3 months to 3 years (median 2 years). The short-term mortality was similar with either TAVR or SAVR (2.2% for TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56–1.41, P = 0.62), however, TAVR was associated with increased risk for intermediate-term mortality (17.2% for TAVR and 12.7% for SAVR, RR 1.45, 95% CI 1.11–1.89, P = 0.006). In terms of periprocedural complications, TAVR was associated with reduced risk for bleeding and renal failure and an increase in vascular complications and Pacemaker implantation.

    Conclusions
    In patients who are at low surgical risk, TAVR seems to be associated with increased mortality risk. Until more data in this population is available, SAVR should remain the treatment of choice for these patients.

     http://onlinelibrary.wiley.com/doi/10.1002/ccd.27518/abstract

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