Critical Pathways in Cardiology最新文献

{"title":"Hyperuricemia and Cardiovascular Risk: Insights and Implications.","authors":"Abdalhakim Shubietah, Ameer Awashra, Fathi Milhem, Mohammad Ghannam, Moath Hattab, Islam Rajab, Haroun Neiroukh, Massa Zahdeh, Ahmad Nouri, Abdalrahman Assaassa, Kiran Nair, Ankit Sahni, Anan Abu Rmilah","doi":"10.1097/HPC.0000000000000388","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000388","url":null,"abstract":"<p><p>Hyperuricemia, characterized by elevated serum uric acid levels, has been linked to cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, metabolic syndrome, and coronary artery disease. This relationship, however, is complex; while some studies indicate a strong association, others suggest it may be influenced by confounding factors. The rising global prevalence of hyperuricemia underscores the necessity for a deeper understanding of its cardiovascular implications. Hyperuricemia results from an imbalance in uric acid production and excretion, driven by dietary factors, obesity, insulin resistance, and other conditions. Elevated uric acid levels contribute to cardiovascular risk through mechanisms such as inflammation, oxidative stress, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system. This review highlights the importance of ongoing research to clarify hyperuricemia's role in cardiovascular disease and suggests that urate-lowering therapies, such as xanthine oxidase inhibitors, may confer cardiovascular benefits; however, evidence remains conflicting. The CARES trial indicated an increased risk of cardiovascular and all-cause mortality with febuxostat compared to allopurinol, raising safety concerns. In contrast, the FAST trial demonstrated that febuxostat was non-inferior to allopurinol, with even lower all-cause mortality. These opposing findings emphasize the complexity of treatment decisions and the need for individualized management strategies for hyperuricemia. Clinical decisions should consider individual patient risks and characteristics. Ultimately, this comprehensive analysis aims to enhance prevention and management strategies for cardiovascular diseases related to hyperuricemia. The overview includes discussions on major studies such as the Framingham Heart Study, CARES, FAST, PRIZE, and FREED trials, examining their results. It explores whether hyperuricemia is a causal factor versus an associated risk factor and whether it serves as a marker or mediator of disease. Additionally, the review addresses novel biomarkers and predictive models, the management of hyperuricemia in the context of cardiovascular risk, the role of urate-lowering therapies in cardiovascular disease, variability in guidelines and recommendations, and the impact of hyperuricemia in special populations such as those with diabetes and chronic kidney disease. The cardiovascular risk associated with hyperuricemia across various demographics is also discussed. Furthermore, the review suggests that existing risk scores might be modified to include uric acid levels in patients with hyperuricemia. • Hyperuricemia is linked to cardiovascular diseases through inflammation, oxidative stress, and endothelial dysfunction. • Urate-lowering therapies may offer cardiovascular benefits but require individualized risk assessment. • Cardiovascular risks of hyperuricemia vary by demographi","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Perforation Occurring During Percutaneous Coronary Intervention Is Associated With Persistently High Mortality and Complications.","authors":"Mohammad Reza Movahed, Nishant Satapathy, Mehrtash Hashemzadeh","doi":"10.1097/HPC.0000000000000373","DOIUrl":"10.1097/HPC.0000000000000373","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30.</p><p><strong>Methods: </strong>The National Inpatient Sample database, years 2016-2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients suffering from perforation were compared with patients without perforation during PCI.</p><p><strong>Results: </strong>PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12%) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs. 2.5%, odds ratio, 5.6; CI, 5-6.3; P < 0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period.</p><p><strong>Conclusions: </strong>Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%), with persistently high mortality rates over the years, suggesting that treatment of perforations needs further improvement.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0373"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Single Long Stents Versus Overlapping Stents on Clinical Outcomes in Primary PCI.","authors":"Guilherme Pinheiro Machado, Martin Negreira-Caamaño, Daniel Tébar Márquez, Marcia Moura Schmidt, Alan Pagnoncelli, Gustavo Neves de Araujo, Sandro Cadaval Goncalves, Marco Wainstein, Alexandre Schaan de Quadros, Alfonso Jurado-Román, Rodrigo Wainstein","doi":"10.1097/HPC.0000000000000371","DOIUrl":"10.1097/HPC.0000000000000371","url":null,"abstract":"<p><strong>Background: </strong>Patients with long coronary lesions undergoing primary percutaneous coronary intervention (pPCI) have higher rates of adverse clinical events. Both stent length and stent overlap are associated with worse outcomes; however, data comparing very long stent (VLS) to overlapping stents (OSs) are limited, particularly during pPCI. This study aimed to compare the impact of a single VLS versus ≥2 OSs on clinical outcomes in a multicenter registry of patients undergoing pPCI.</p><p><strong>Methods: </strong>This study included patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI using a single VLS (≥38 mm) or ≥2 OS (total stent length, ≥38 mm) in the culprit lesion. After propensity score matching based on tortuosity, calcification, Killip class, culprit lesion length ≥40 mm, and culprit vessel, the final cohort for analysis was selected. The primary endpoint was a combination of mortality and target lesion failure (reinfarction, stent thrombosis, or new revascularization) at 2 years.</p><p><strong>Results: </strong>Among 647 consecutive STEMI patients who underwent pPCI between March 2016 and September 2022, 353 received VLS and 294 received OSs. After propensity score matching, 264 patients remained (132 in each group). The occurrence of the primary outcome (VLS: 12.9 vs. OS: 15.9%; P = 0.86), all-cause mortality (VLS: 7.6 vs. OS: 9.8%; P = 0.51), and target lesion failure (VLS: 8.3 vs. OS: 6.8, P = 0.64) were similar between the 2 groups.</p><p><strong>Conclusions: </strong>In this cohort of real-world patients with STEMI undergoing pPCI, we found no significant difference in outcomes between VLS and OSs. Both strategies are reasonable treatment options for STEMI patients.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Embolic Protection in Percutaneous Coronary Intervention Without Saphenous Venous Graft Lesions in ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis.","authors":"Maisha Maliha, Vikyath Satish, Kuan Yu Chi, Diego Barzallo Zeas, Amrin Kharawala, Nishat Shama, Nathaniel Abittan, Sneha Nandy, Anita Osabutey, Nidhi Madan, Prabhjot Singh, Eleonora Gashi","doi":"10.1097/HPC.0000000000000376","DOIUrl":"10.1097/HPC.0000000000000376","url":null,"abstract":"<p><strong>Introduction: </strong>Embolic protection devices (EPDs) are catheter-based devices that can be used to capture atherosclerotic remnants released during percutaneous coronary intervention (PCI). We aim to study the efficacy and safety of EPDs in PCIs without saphenous vein grafts (SVGs) in ST-segment-elevation myocardial infarction (MI).</p><p><strong>Methods: </strong>Three electronic databases of MEDLINE, Web of Science, and Embase were searched from inception to April 10, 2024, to identify relevant randomized controlled trials that compared outcomes of patients subjected to EPD during PCI with a control group where EPDs were not utilized. The primary outcome was 30-day all-cause mortality. Secondary outcomes were major adverse cardiovascular and cerebrovascular events at 30 days, post-PCI thrombolysis in MI grade 3 flow attainment, ST-segment resolution at 90 minutes post-procedure, and postprocedure angiographically detectable signs of distal embolization. The effect estimates of outcomes were assessed using risk ratio (RR) with a 95% confidence interval (CI). Random-effects meta-analysis was conducted using the restricted maximum likelihood method, given that the interstudy variance was inevitable.</p><p><strong>Results: </strong>We included 3 randomized controlled trials enrolling 741 patients (age, 61.6 ± 12.15 years; 22% females) undergoing PCI without SVG lesions. As opposed to the control group, the use of EPD did not yield a significant effect on all-cause mortality [RR, 0.76 (95% CI, 0.31-1.86); I 2 = 0%], major adverse cardiovascular and cerebrovascular events [RR, 0.66 (95% CI, 0.34-1.27); I 2 = 0%], post-PCI thrombolysis in MI 3 flow [RR, 1.18 (95% CI, 0.86-1.62); I 2 = 77%], and ST-segment resolution at 90 minutes post-procedure [RR, 1.05 (95% CI, 0.90-1.22); I 2 = 0%]. However, EPD significantly decreased angiographically detectable signs of distal embolization [RR, 0.60 (95% CI, 0.36-0.99); I 2 = 0%].</p><p><strong>Conclusions: </strong>EPD significantly reduced angiographically detectable signs of distal embolization in PCI without SVG lesions in ST-segment-elevation MI though there were no clinical signs of improved flow or mortality. Further trials are necessary to thoroughly evaluate the potential benefits and requirements of EPD usage in such procedures.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0376"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking the Potential of the HEART Pathway: Predicting MACE and Facilitating Nurse-Physician Collaboration in Chest Pain Unit.","authors":"Zahra Behpour, Zahra Amirsardari, Haniye Aghakhani, Mohammadesmaeil Zanganehfar, Shiva Khaleghparast, Fidan Shabani, Hooman Bakhshandeh, Parham Sadeghipour","doi":"10.1097/HPC.0000000000000374","DOIUrl":"10.1097/HPC.0000000000000374","url":null,"abstract":"<p><strong>Background and objective: </strong>The HEART pathway serves as a tool for predicting major adverse cardiac events (MACE) among patients presenting with acute chest pain, aiding in the early discharge of low-risk patients and reducing unnecessary cardiac investigations. This study aimed to evaluate physician-nurse reliability of the HEART pathway and investigate the efficacy of HEART pathway to predict 3-month MACE in patients with acute chest pain.</p><p><strong>Methods: </strong>We conducted a prospective study on 97 patients experiencing acute chest pain. A team of 3 professionals, a nurse, a cardiology resident, and a cardiology attending physician, performed risk stratification. We assessed interrater reliability among the raters as well as explored 3-month MACE outcomes.</p><p><strong>Results: </strong>Excellent pairwise agreements were found between the raters. Overall agreement among raters was excellent, with an intraclass correlation coefficient of 0.84 (95% confidence interval: 0.73-0.97). The HEART pathway score exhibited strong predictive power (area under curve: 0.85) for 3-month MACE. At a cutoff score of 4, sensitivity, specificity, and negative predictive values were 87.5%, 58.9%, and 95.8%, respectively.</p><p><strong>Conclusions: </strong>The HEART pathway score effectively predicts 3-month MACE in patients with acute nontraumatic chest pain. Moreover, the high agreement among the attending physician, the resident physician, and the nurse suggests that nurses could use this tool, potentially reducing the workload on physicians.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0374"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a High Sensitivity Troponin HEART Pathway-Based Clinical Decision Protocol on Observation Visits.","authors":"George B Hughes, Iyesatta Emeli, Matthew A Wheatley, Abhinav Goyal, Janetta Bryksin, Timothy P Moran, Matthew T Keadey, Michael A Ross","doi":"10.1097/HPC.0000000000000370","DOIUrl":"10.1097/HPC.0000000000000370","url":null,"abstract":"<p><strong>Background: </strong>Use of high-sensitivity troponin (hs-cTn) might lead to an increase in hospital observation visits due to a higher number of abnormal troponin levels.</p><p><strong>Study objectives: </strong>To determine the impact of incorporating hs-cTn into a chest pain clinical decision protocol (CDP) on observation visits in a large academic health system.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study of all chest pain observation patients in 4 hospitals in an academic health system over 24 months. All hospitals used the Beckman Coulter Unicel Dxi instrument, and all shared the same emergency department (ED) chest pain protocol, which used the HEART pathway and serial troponins and directed ED dispositions to either an observation stay, ED discharge, or inpatient admission. Outcomes studied before and after the introduction of an hs-cTn protocol included daily chest pain observation census, cost, observation hours, and inpatient admit rate. Census was reported as the daily chest pain observation census and as a proportion of all observation visits. Data were retrieved from a health system data warehouse and a cost accounting program.</p><p><strong>Results: </strong>There were 6712 chest pain observation visits over 24 months, with 4087 visits before and 2634 visits after the hs-cTn protocol implementation. Comparison groups were similar in terms of age, gender, and type of insurance. There were 10.59 (95% CI, 10.24-10.95) daily chest pain observation visits before and 7.66 (95% CI, 7.34-7.97) visits after implementation, with a 28% (95% CI, 35%-20%) decrease in the total daily census. As a portion of all observation visits, there was a 22% drop in the proportion that were observed for chest pain. The daily number of chest pain patients requiring inpatient admission was unchanged. The daily total direct cost for chest pain observation decreased with an effective daily cost savings of $4313 USD (95% CI, $1534-$6998). The total daily number of chest pain observation bed hours also decreased by 41.5 hours (95% CI, 13.4-96.4 hours).</p><p><strong>Conclusions: </strong>Implementation of a hs-cTn chest pain protocol was associated with a significant decrease in the number and proportion of observation visits, a decrease in total daily cost and bed hours used, and no increase in inpatient admissions.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0370"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bivalirudin Versus Heparin in Patients Undergoing Percutaneous Coronary Intervention in Acute Coronary Syndromes.","authors":"Chayakrit Krittanawong, Tania Ahuja, Zhen Wang, Yusuf Kamran Qadeer, Errol Moras, Hafeez Ul Hassan Virk, Mahboob Alam, Hani Jneid, Samin Sharma","doi":"10.1097/HPC.0000000000000372","DOIUrl":"10.1097/HPC.0000000000000372","url":null,"abstract":"<p><strong>Introduction: </strong>Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes remain inconclusive. We aimed to systematically analyze PCI outcomes by comparing unfractionated heparin and bivalirudin.</p><p><strong>Methods: </strong>We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed the data. Conflicts were resolved through consensus. Random-effects meta-analyses were used.</p><p><strong>Results: </strong>A total of 10 prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding [relative risk (RR): 1.68, 95% confidence interval (CI): 1.29-2.20], nonaccess site complications (RR: 4.6, 95% CI: 1.75-12.09), thrombolysis in myocardial infarction major bleeding (RR: 1.70, 95% CI: 1.20-2.41), major bleeding risks (RR: 1.87, 95% CI: 1.49-2.36), cardiovascular disease death (RR: 1.26, 95% CI: 1.02-1.57), and thrombocytopenia (RR: 1.67, 95% CI: 1.07-2.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, major adverse cardiovascular event, stroke, reinfarction, target vessel revascularization, and acute or stent thrombosis.</p><p><strong>Conclusions: </strong>The present meta-analysis demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or major adverse cardiovascular event.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0372"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory Analysis of Urine PO 2 Peri-Procedural Kinetics and CI-AKI Prognostic Abilities in Patients Undergoing PCI.","authors":"Georgios Chalikias, Dimitrios Stakos, Theodoros Kostakis, Choulia Nalmbant, Belkis Malkots, Vasilios Koutroulos, Kalliopi Theodoridou, Adina Thomaidis, Dimitrios Tziakas","doi":"10.1097/HPC.0000000000000367","DOIUrl":"10.1097/HPC.0000000000000367","url":null,"abstract":"<p><p>Novel contrast-induced acute kidney injury (CI-AKI) biomarkers are needed to detect earlier and with greater precision the pathophysiological changes in the renal medulla associated with kidney damage. We prospectively assessed the kinetics of urine oxygen tension (PO 2 ) in control healthy individuals and its prognostic ability for CI-AKI in patients undergoing percutaneous coronary intervention (PCI). We enrolled 202 consecutive patients (78% men, mean age 66 ± 10 years) treated with elective or urgent PCI. PO 2 was measured using a point-of-care (POC) standard blood gas analyzer at 3 time points (baseline, post-within 3 hours-PCI, and at 24 hours post-PCI) in urine samples. CI-AKI was defined as an increase of ≥25% or ≥0.5 mg/dl in pre-PCI serum creatinine at 48 hours post-PCI. Between baseline and post-PCI measurements, patients without CI-AKI showed a decrease of -37 (36) mm Hg in PO 2 urine levels, whereas patients with CI-AKI showed a decrease of only -23 (38) mm Hg. ( P = 0.014). Using receiver operating characteristic curve analysis, percentage change in urine PO 2 immediately after PCI relative to baseline levels significantly predicted CI-AKI (area under the curve 0.804; 95% confidence interval, 0.717-0.892). A significant drop in urine PO 2 appears as a normal response of the kidney medulla to an acute insult (contrast media) immediately post-PCI with recovery to baseline levels 24 hours later. The absence or attenuation of this drop in urine PO 2 could predict CI-AKI earlier and more precisely.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0367"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department and Critical Care Use of Clevidipine for Treatment of Hypertension in Patients With Acute Stroke.","authors":"Scott S Brehaut, Angelina M Roche","doi":"10.1097/HPC.0000000000000375","DOIUrl":"10.1097/HPC.0000000000000375","url":null,"abstract":"<p><strong>Background and purpose: </strong>Clevidipine is a parenteral dihydropyridine calcium channel blocker that received Food and Drug Administration approval in 2008 for the reduction of blood pressure (BP) when oral therapy is not feasible or not desirable. Soon after approval, our institution incorporated clevidipine into protocols for the management of hypertension among acute stroke patients, based on the drug's rapid onset of action and straightforward titration to goal. A subsequent retrospective review of its use in otherwise alteplase-eligible ischemic stroke patients with BP greater than 185/110 mm Hg (n = 32, in 2014) revealed that clevidipine in that setting demonstrated the shortest median time to BP control, the shortest median door-to-alteplase administration time, and the lowest administered volume of any parenteral antihypertensive used. As a result, clinical protocols in our institution were modified to make clevidipine first-line antihypertensive in both ischemic and hemorrhagic acute stroke. In this study, we report our institution's experience with clevidipine in acute stroke, comprising the largest such report to date.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all acute stroke patients who received clevidipine in the emergency department (ED) or intensive care unit (ICU) (n = 295) for the management of clinically significant hypertension between January 1, 2015, and December 31, 2017. Metrics analyzed included target (goal) BP for thrombolysis eligibility among patients intended for lytic therapy according to stroke management guidelines in effect at the time of care.</p><p><strong>Results: </strong>The median time for initial parenteral antihypertensive dose to goal (DTG) BP for all ischemic stroke patients (both those intended for and those not intended for lytic therapy) with complete data (n = 71 of 204) was 15 minutes; median time for door-to-IV-alteplase administration for ischemic stroke patients with complete data (n = 14 of 34 treated patients) was 59 minutes. The median time for initial parenteral antihypertensive DTG BP for all hemorrhagic stroke patients with complete data (n = 33 of 91 treated patients) was 39 minutes.</p><p><strong>Conclusions: </strong>We conclude that the salutary findings of the initial small study are valid across a larger patient sample of all acute stroke types. Based on these data, clevidipine is shown to be safe, consistent, and effective in the treatment of acute hypertension in ischemic and hemorrhagic stroke events, and is a reasonable first-line treatment option for acute hypertension in this setting.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0375"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Aortic Valve Implantation in Brazilian Public Health System: A single center experience.","authors":"Guilherme Pinheiro Machado, Pedro Castilhos Crivelaro, Gustavo Neves de Araujo, Alan Pagnoncelli, Julia Silva, Camila Porto, Wagner Azevedo, Rodrigo Petersen Saadi, Eduardo Keller Saadi, Orlando Wender, Marco Wainstein, Felipe Costa Fuchs","doi":"10.1097/HPC.0000000000000387","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000387","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) has been established as the treatment of choice for severe aortic stenosis in high risk as well as patients above 75 years-old in all risk spectrums. Despite its worldwide adoption, implementation in lower-middle-income countries such as Brazilian public health system (SUS, acronym in Portuguese) is incipient.</p><p><strong>Objectives: </strong>This study aimed to evaluate TAVI exclusively within SUS patients.</p><p><strong>Methods: </strong>This was prospective cohort study in a public tertiary hospital in southern Brazil. All patients who underwent TAVI between 2018 and 2024 were included. The cohort was divided into two temporal periods: from July 2018 to December 2022 (n=60) and January 2023 to October 2024 (n=65). The clinical and procedural characteristics and in-hospital as well as 1 year of outcomes were evaluated according to Valve Academic Research Consortium-2 (VARC-2) criteria.</p><p><strong>Results: </strong>During the study period, 125 patients underwent TAVI. The average age was 80 years (± 10), 49.6% were male. The mean aortic valve area was 0.76 cm2 and the mean gradient was 45 (±13) mmHg. The mean STS predicted risk of mortality (STS-PROM) score was 4.6% (±3.6). Device success was achieved in 119 patients (95.2%). In-hospital mortality was 2 (1.6%). New permanent pacemaker was required in 16 (12.8%). Demographic and clinical characteristics between the first and the second periods were similar.</p><p><strong>Conclusions: </strong>The mortality and complications rate of TAVI performed within the scope of the Brazilian public health system were consistent with the clinical experience of other international registries.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}