scholarly journals Cerebral embolism and complex aortic plaques: Secondary prevention

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 378-378
Author(s):  
Robert Wetterholm ◽  
Christian Blomstrand ◽  
Elisabeth Aspenlid ◽  
Odd Bech-Hansen ◽  
Kenneth Caidahl
Keyword(s):  
Heart Disease ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Oral Anticoagulation ◽  
Cerebral Embolism ◽  
Ischemic Heart ◽  
Embolic Event ◽  
Significant Difference ◽  
Group A

P212 Background: After a cerebral embolic event, complex plaques in the proximal aorta constitute an important finding by transesophageal echocardiography (TEE). Yet, there is no consensus regarding its optimal treatment, and we studied the short-term outcome in this group of patients. Method: Between August 1995 and August 1998, 424 patients were examined with TEE after a suspected cerebral embolic event. We re-evaluated the 94 examinations with any plaques noticed in the proximal aorta and reviewed the medical charts for previous embolic events, diabetes, hypertension, ischemic heart disease, ECG, laboratory findings, antithrombotic treatment and outcome (mean follow-up time 19 months). Results: Of 94 patients with any plaques in the proximal aorta, 75 were complex (protruded more than 4 mm or had a mobile component), and 55 of these were finally diagnosed as having suffered cerebral embolism. After exclusion of 8 patients with atrial fibrillation, 47 patients constituted the study group. As secondary prevention, 32 and 15 patients were on antiplatelets and oral anticoagulation, respectively, at event or end of follow-up. In the antiplatelet group (A), 8 of 32 patients (25%) suffered a new cerebral embolic episode vs. none in the anticoagulant group (B) (p=0.03). Mean time to recurrent embolism was 10 months. No hemorrhagic stroke or other important bleeding occurred during follow-up. Leukocyte count was slightly higher in group A (8.7±2.4 vs. 7.2 ± 1.9× 10 9 /L, p=0.04), no other significant difference was found between groups A and B regarding mean age (64 vs. 67 years), systolic blood pressure (171±32 vs. 166±23mmHg, p=0.60), left atrial size (17.9±4.0 vs. 19.0±5.0 cm 2 , p=0.42), hemoglobin conc. (143±15 vs. 140±14 g/L, p=0.53), S-cholesterol (5.9±1.5 vs. 6.5±1.2 mmol/L, p=0.23), S-triglycerides (1.9±1.0 vs. 2.0±1.1 mmol/L, p=0.70), history of diabetes, ischemic heart disease, hypertension or smoking. Conclusion: Complex plaques in the proximal aorta are frequently found in patients with cerebral embolism. Our study indicates that these patients benefit from oral anticoagulation, while treatment with antiplatelets is associated with a high incidence of recurrent embolism.

scholarly journals Results of the alcohol septal ablation in combination with simultaneous endoprosthesis of coronary arteries in treatment of patients, suffering obstructive hypertrophic cardiomyopathy and concurrent ischemic heart disease

2019 ◽  
Vol 86 (11-12) ◽  
pp. 3-8
Author(s):  
K. V. Rudenko ◽  
L. O. Nevmerzhytska ◽  
O. Yu. Dudnyk ◽  
S. M. Fanta ◽  
V. V. Lazoryshynets
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Ischemic Heart Disease ◽  
Coronary Arteries ◽  
Systolic Pressure ◽  
Ischemic Heart ◽  
Alcohol Septal Ablation ◽  
Significant Difference ◽  
Obstructive Hypertrophic Cardiomyopathy

Objective. To study the immediate and remote follow-up results of treatment in patients, suffering obstructive hypertrophic cardiomyopathy and concurrent ischemic heart disease, using the alcohol septal ablation in combination with simultaneous endoprosthesis of coronary arteries. Materials and methods. In the investigation were included 129 patients, suffering obstructive hypertrophic cardiomyopathy, to whom the alcohol septal ablation was performed in 2009 - 2018 yrs in M. M. Amosov National Institute of Cardiovascular Surgery. All the patients were distributed into two groups: the first -14 (10.9%) patients with concurrent ischemic heart disease and the second -115 (89.1%) patients without concurrent ischemic heart disease. Results. Reduction of the systolic pressure gradient in the exit tract of the left ventriculus, mitral regurgitation, and the functional class characteristic in accordance to criteria of a New-York Association of Cardiologists in both groups in immediate and late periods of observation have appeared statistically proved. In a remote period of follow-up in 13 (92.9%) patients, suffering the ischemic heart disease, a satisfactory hemodynamical result was registered, and in 1 (7.1%) - poor. Conditionally poor results in this group of patients were absent. The patients without an ischemic heart disease (n=107) in accordance to the above mentioned indices were distributed in a follow manner: 74 (69.2%), 28 (26.2%) and 5 (4.7%), accordingly. Statistically significant difference in accordance to hemodynamical results between two groups of patients was absent in immediate and remote periods of follow-up. Conclusion. Simultaneous conduction of the alcohol septal ablation in combination with endoprosthesis of coronary arteries in patients, suffering obstructive hypertrophic cardiomyopathy and concurrent ischemic heart disease, constitutes a safe proved combined intervention procedure, which owes good immediate results, persisting in the remote period.

scholarly journals Mortality, appropriate and inappropriate shocks - observations from an institutional implantable cardioverter defibrillator registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Prepolec ◽  
V Pasara ◽  
E Ciglenecki ◽  
JE Bogdanic ◽  
J Putric Posavec ◽  
...  
Keyword(s):  
Heart Disease ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Ischaemic Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ischemic Heart ◽  
Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
Device Infection

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Implantable cardioverter defibrillator (ICD) is an effective therapy for primary (PP) and secondary prevention (SP) of sudden cardiac death (SCD). ICD adverse events include inappropriate shocks (IS), device infection and failure.  Methods We analysed the data concerning all newly implanted ICDs in our institution from 2011 to 2017. Follow-up data was collected until the end of 2019. Results In total, 507 ICDs were implanted (85.4% male, 57.6 ± 14.0 years-old), 375 (74.0%) for PP and 132 (26.0%) for SP. The mean follow-up was 34.3 ± 23.8 months. ICD delivered therapy in 42.4% of SP and in 28.8% of PP patients (p = 0.15). In PP, shocks were delivered in 25.7% of non-ischaemic heart disease (NIHD) and in 17.6% ischaemic heart disease (IHD) patients (p = 0.81). IS were significantly more common in NIHD patients (13.8% vs 2.4% in IHD group, p < 0.0001). PP patients with NIHD also had a higher shock burden (average of 8.0 ± 17.4 shocks compared to 2.7 ± 3.0 in the IHD group). However, it failed to reach the level of statistical significance (p = 0.052). In SP, the rate of ICD activation and that of IS were similar in both groups (IHD and NIHD). In total, 32.6% of SP patients received appropriate shock (AS) and 5.3% of them received at least one IS (average number of AS and IS being 8.7 ± 11.5 and 1.1 ± 0.4 respectively). Mortality was significantly higher in SP than in PP (34.8% vs 13.9%, p < 0.001). In PP, significantly more deaths occurred among IHD than NIHD patients (18.8% vs 10.0%, p < 0.001).  Conclusion The prevalence of AS and IS was relatively higher than reported elsewhere. Same was true for mortality. Interestingly, the rate of IS was somewhat higher in NIHD than in IHD, which was unexpected. ICD outcomes Primary prevention Secondary prevention Total IHD NIHD Total IHD NIHD Patients, n 375 165 210 132 88 44 Patients with ICD activation, n (%) 108 (28.8) 46 (27.9) 62 (29.5) 56 (42.4) 33 (37.5) 22 (50.0) Patientns with AS, n (%) 60 (16.0) 27 (16.4) 33 (15.7) 43 (32.6) 29 (33.0) 14 (31.8) Patientns with IS, n (%) 33 (8.8) 4 (2.4) 29 (13.8) 7 (5.3) 5 (5.7) 2 (4.5) AS delivered (mean ± SD) 5.6 ± 13.3 2.7 ± 3.0 8.0 ± 17.4 8.7 ± 11.5 9.9 ± 12.2 9.7 ± 17.6 IS delivered (mean ± SD) 3.2 ± 5.1 1.2 ± 0.5 3.5 ± 5.4 1.1 ± 0.4 1.0 ± 0 3.2 ± 5.2 Deaths, n (%) 52 (13.9) 31 (18.8) 21 (10.0) 46 (34.8) 32 (36.4) 14 (31.8) Time to death (months, mean ± SD) 20.3 ± 13.9 19.9 ± 12.6 21.1 ± 16.5 27.1 ± 25.7 28.9 ± 24.9 22.6 ± 28.1 ICD, implantable cardioverter defibrillator; IHD, ischemic heart disease; NIHD, non-ischemic heart disease; AS, appropriate shock; IS, inappropriate shock

scholarly journals Unique referral system contributes to long-term net clinical benefits in patients undergoing secondary prevention therapy after percutaneous coronary intervention

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242707
Author(s):  
Shigetaka Kageyama ◽  
Koichiro Murata ◽  
Ryuzo Nawada ◽  
Tomoya Onodera ◽  
Yuichiro Maekawa
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Referral System ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Clinical Benefits

Cardiovascular disease, including ischemic heart disease, is a leading cause of death worldwide. Improvement of the secondary prevention of ischemic heart disease is necessary. We established a unique referral system to connect hospitals and outpatient clinics to coordinate care between general practitioners and cardiologists. Here, we evaluated the impact and long-term benefits of our system for ischemic heart disease patients undergoing secondary prevention therapy after percutaneous coronary intervention. This single-center retrospective observational study included 3658 consecutive patients who underwent percutaneous coronary intervention at Shizuoka City Hospital between 2010 and 2019. After percutaneous coronary intervention, patients were considered conventional outpatients (conventional follow-up group) or subjected to our unique referral system (referral system group) at the attending cardiologist’s discretion. To audit compliance of the treatment with the latest Japanese guidelines, we adopted a circulation-type referral system, whereby general practitioners needed to refer registered patients at least once a year, even if no cardiac events occurred. Clinical events in each patient were evaluated. Net adverse clinical events were defined as a combination of major adverse cardiac, cerebrovascular, and major bleeding events. There were 2241 and 1417 patients in the conventional follow-up and referral system groups, with mean follow-ups of 1255 and 1548 days and cumulative net adverse clinical event incidences of 27.6% and 21.5%, respectively. Kaplan–Meier analysis showed that the occurrence of net adverse clinical events was significantly lower in the referral system group than in the conventional follow-up group (log-rank: P<0.001). Univariate and multivariate analyses revealed that the unique referral system was a significant predictor of the net clinical benefits (hazard ratio: 0.56, 95% confidence interval: 0.37–0.83, P = 0.004). This result was consistent after propensity-score matching. In summary, our unique referral system contributed to long-term net clinical benefits for the secondary prevention of ischemic heart disease after percutaneous coronary intervention.

A critical reappraisal of aspirin for secondary prevention in patients with ischemic heart disease

2016 ◽  
Vol 181 ◽  
pp. 92-100 ◽  
Author(s):  
Robert C. Welsh ◽  
Matthew T. Roe ◽  
Philippe Gabriel Steg ◽  
Stefan James ◽  
Thomas J. Povsic ◽  
...  
Keyword(s):  
Heart Disease ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Ischemic Heart
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