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The Integrative Coronary Heart Disease (CHD) Prevention Program
Published in Mark C Houston, The Truth About Heart Disease, 2023
A summary of the results of this study are shown below:Randomized trial of 420 patients with moderate to severe CHF defined as NYHA class 3 and 4 over ten years.2 mg/kg CoQ10 per day (100 mg tid) vs placebo plus standard therapy. Increased serum COQ 10 levels three times.Primary short-term endpoints: NYHA function class, six-minute walk test, NT-pro BNP. No difference between groups. No significant change in EF.Reduced MACE (major adverse cardiac events) by 43% (p = 0.003 CI: 32–80) and all-cause mortality 42% (major adverse cardiovascular events: hospitalization or death due to CHF, CV/MI death, SCD, cardiac transplant, mechanical circulatory support.)Reduced all-cause mortality by 50% (p = 0.01) and CHF.
Vascular Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Yiu-Che Chan, John Wang, Julian Wong, Edward Choke, Tjun Tang
CT-A shows severe aortoiliac occlusive disease, near occlusion of the aortic bifurcation and bilateral common iliac arteries, and patent external iliac arteries. How will you counsel this patient for therapy?Lifestyle modification with smoking cessation is imperative for limiting progression of disease, reducing perioperative major adverse cardiovascular events, and durability of revascularisation, be it open surgery or endovascular surgery.Open surgical revascularisation is achieved with aorto-bi-iliac bypass and is appropriate for young patients due to its superior long-term patency. It has notable morbidity (20% that include bleeding, infection, pneumonia, renal failure, peri-operative myocardial infarction, bowel ischaemia) and mortality (1%–3%).13Endovascular revascularisation can be achieved with bilateral iliac stenting (with kissing stents) or covered endovascular reconstructions of aortic bifurcation (CERAB).13,14 Both have good short and intermediate term patency (5 years) but long-term data are scant. The morbidity and mortality for endovascular revascularisation is recognisably lower than open surgery.
Statins Are Independently Associated with Reduced Mortality in Patients Undergoing Infrainguinal Bypass Graft Surgery for Critical Limb Ischemia
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Results None of the studied drug classes had a measurable effect on major adverse cardiovascular events (7.8%) or early perioperative mortality (2.7%). Statins were found to confer a survival benefit at one year (86% vs. 81%, HR 0.71%, 95% CI: 0.52–0.98; p = 0.03) by analysis of unweighted and propensity score-weighted data (Figure 28.1). Beta-blockers and antiplatelet agents had no measured impact on survival. None of the studied medications had an appreciable effect on 1-year patency. Beta-blockade improved 1-year primary patency in the unweighted data but was not significant in the propensity score-weighted analysis. Cox regression significant predictors of 1-year mortality were statin use (HR 0.67; CI 0.51–0.90, P = 0.001), age >75 (HR 2.1; 95% CI 1.60–2.82, p = 0.001), CAD (HR 1.5; CI: 1.15–2.01; p = 0.01), CKD stage IV (HR 2.0; CI: 1.17–3.55, p = 0.001) and stage V (HR 3.4; 95% CI 2.39–4.73, p < 0.001), and tissue loss (HR 1.9; CI 1.23–2.80, p = 0.003) (Table 28.1).
A comparison of front-line oral anticoagulants for the treatment of non-valvular atrial fibrillation: effectiveness and safety of direct oral anticoagulants in the FANTASIIA registry
Published in Expert Opinion on Pharmacotherapy, 2022
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Martín Ruiz-Ortiz, Javier Muñiz, Inmaculada Roldán-Rabadán, Déborah Otero, Raquel López-Gálvez, Ángel Cequier, Vicente Bertomeu-Martínez, Lina Badimón, Manuel Anguita, Gregory Y.H. Lip, Francisco Marín
After 3 years of follow-up, we analyzed adverse clinical outcomes. Thromboembolic events were defined as stroke or TIA or peripheral embolism. Strokes were defined as ischemic stroke, transitory ischemic attack, and hemorrhagic stroke. Bleeding events were assessed according to the 2005 International Society of Thrombosis and Hemostasis criteria [18]. We also collected all-cause mortality, and cardiovascular mortality was defined as being secondary to a cardiovascular event (acute coronary syndrome, heart failure, lethal arrhythmia or sudden death, artery aneurysm rupture or stroke). Major adverse cardiovascular events (MACE) was defined as the composite of ischemic stroke, myocardial infarction, coronary revascularization, and cardiovascular mortality. Net clinical outcomes were defined as the composite of stroke/systemic thromboembolism, major bleeding, or all-cause mortality.
Remote ischaemic conditioning in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention: an updated meta-analysis of clinical outcomes
Published in Acta Cardiologica, 2021
Raul A. Borracci, Eugenia Amrein, José M. Alvarez Gallesio, Senta Trucksäss, Claudio C. Higa
In addition, a meta-analysis including only studies designed to report major cardio-vascular events as a primary endpoint with at least 12-month follow-up was performed with the LIPSIA CONDITIONING [16–17], CONDI [23], DANAMI-3-iPOST [21], RIC STEMI11, and CONDI 2/ERIC PPCI12 trials (Figure 4). Globally, 7493 STEMI patients were included in this meta-analysis, 3746 receiving RIC plus primary percutaneous coronary intervention (intervention group), and 3747 receiving primary percutaneous coronary intervention alone (control group). A total of 749 major adverse cardiovascular events were reported for both groups with mean follow-up between 12 and 45 months. The sample size of the studies ranged from 251 to 5115 patients. Remote ischaemic conditioning protocols included only postconditioning in one RCT [21], while the rest included both interventions. In this pooled analysis, the random effects model showed an OR equal to 0.75 (95% CI 0.54 − 1.06), with a significant heterogeneity (Cochran Q = 13.0, p = 0.012, I2 = 69.1%, 95% CI 0.0 − 88.0) but no publication bias (Begg test Z = 1.71, p = 0.086). The sensitivity analysis for the random effects model demonstrated that only the exclusion of the CONDI 2/ERIC PPCI12 trial modified the significance of the global effect (OR 0.66, 95% CI 0.47 − 0.93), favouring RIC intervention.
Outcomes of percutaneous intervention in in-stent versus de-novo chronic total occlusion: a meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2020
Tanveer Mir, Waqas Ullah, Yasar Sattar, Yasser Al-Khadra, Fahed Darmoch, Homam Moussa Pacha, M Chadi Alraies
Articles were screened at the level of title and abstract. Full text of potentially relevant articles was read by two independent authors. Disagreements were resolved by consensus. All extracted data from the included studies were collected into a spreadsheet and verified by a third author. Demographics, baseline comorbidities, clinical presentation, stent properties, follow-up data, and clinical outcomes of all patients were recorded. The primary outcomes included major adverse cardiovascular events (MACE). Secondary outcomes included components of MACE [cardiac death and myocardial infarction (MI)] and procedural success. Successful revascularization was defined as residual stenosis <30% and TIMI flow grade ≥3. All studies have included PCI procedures which were driven by ischemia; however, viability was not checked.