El más extenso meta-análisis realizado entre CABG y stents en enfermedad arterial coronaria compleja demuestra que los pacientes tratados con CABG tienen significativamente mayor incidencia de stroke que los tratados con PCI y stents. Esto se debe a una mayor incidencia de accidentes cerebrovasculares durante los primeros 30 días del procedimiento.
http://www.onlinejacc.org/content/72/4/386
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En este Editorial de Cardiovascular Revascularization Medicine se analiza el estudio ORBITA (PCI con DES vs placebo en pacientes con angina crónica estable).
El autor analiza las angiografías de los pacientes incluídos en el ORBITA y determina que en un 41% de ellos los criterios de inclusión del estudio podrían no haberse cumplido.
doi:10.1016/j.carrev.2018.07.018
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Un estudio multicéntrico en la revista Circulation demostró que en población de alto riesgo con regurgitación mitral sintomática la supervivencia es mayor luego de la intervención con MitraClip comparada al tratamiento conservador solo.
Abstract
Background: Survival outcome after MitraClip treatment, compared with surgical or conservative treatment, is not well defined. We examined survival after MitraClip treatment in a large multicenter real-life setting.
Methods and Results: We retrospectively formed matched high-risk surgically and conservatively treated control cohorts to compare to a high-risk MitraClip cohort. One thousand thirty-six patients were included in 4 Dutch centers, of which 568 were treated with the MitraClip. The observed survival at 5-year follow-up in our MitraClip cohort was low (39.8%) but was comparable to our conservative cohort (40.5%). Observed 5-year survival for our surgical cohort was 76.3%. However, there were significant differences between the baseline characteristics of the 3 studied cohorts, with the MitraClip cohort having the highest comorbidity burden. After adjusting for baseline differences by using Cox regression, the MitraClip and surgical cohorts showed similar survival ratios (hazard ratio, 0.92; 95% confidence interval, 0.67–1.26; P=0.609), whereas both showed a lower mortality hazard when compared with conservative treatment (hazard ratio, 0.61; 95% confidence interval, 0.49–0.77; P<0.001 and hazard ratio, 0.56; 95% confidence interval, 0.42–0.76; P<0.001, respectively).
Conclusions: This matched analysis suggests a lower mortality hazard for MitraClip intervention in a high-risk population with symptomatic mitral regurgitation when compared with conservative management alone.
http://circinterventions.ahajournals.org/content/11/6/e005985
Read MoreUn paper publicado en Circulation analizó la incidencia de mortalidad y accidente cerebrovascular en pacientes con enfermedad carotídea moderada, severa y oclusiva comparado a los que no presentaban dicha condición a 30 días y 1 año, sometidos a reemplazo de válvula aórtica percutánea (TAVI). La enfermedad carotídea no se asoció con un mayor riesgo de accidente cerebrovascular o mortalidad post TAVI a 30 días o 1 año.
Abstract
Background: Stroke is a serious complication of both transcatheter aortic valve replacement (TAVR) and carotid artery disease (CD). The implications of CD in patients undergoing TAVR are unclear.
Methods and Results: The Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapies Registry, consisting of data from consecutive US TAVR cases during the years 2013 to 2015, was linked to Medicare claims data to ascertain 30-day and 1-year cumulative incidence rates of stroke and all-cause mortality. We compared 30-day and 1-year stroke and mortality outcomes between patients with no-CD and patients with moderate, severe, and occlusive CD and adjusted for baseline covariates using proportional hazards models. Among 29 143 patients undergoing TAVR across 390 US sites, 22% had CD. Patients with CD had higher rates of prior hypertension, diabetes mellitus, stroke, and myocardial infarction. Observed in-hospital stroke rates were 2.0% among no-CD, 2.5% among moderate CD, 3.0% among severe CD, and 2.6% among occlusive CD. There was no association between the presence of CD and 30-day stroke (adjusted hazard ratio, 1.16; 95% confidence interval, 0.94–1.43) or mortality (adjusted hazard ratio, 1.10; 95% confidence interval, 0.95–1.28). There was no association between CD and 1-year stroke (adjusted hazard ratio, 1.03; 95% confidence interval, 0.86–1.24) or mortality (adjusted hazard ratio, 1.02; 95% confidence interval, 0.93–1.12). Furthermore, there was no significant risk-adjusted association between severity of CD and 30-day or 1-year stroke or mortality.
Conclusions: CD is common among TAVR patients, present in 1 of 5. CD was not associated with an increased risk of stroke or mortality at 30 day or 1 year. Post-TAVR stroke seems to be because of mechanisms other than CD.
http://circinterventions.ahajournals.org/content/11/6/e006322
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