HEARTLINE HSM Genoa Cardiology Meeting - Aristea

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11 Primary Safety Endpoint included: • Device embolization requiring retrieval; • Pericardial effusion requiring intervention; • Cranial bleeds and gastrointestinal bleeds; • Any bleed that requires ≥ 2uPRBC; Eighty-seven percent of implanted subjects were able to cease warfarin at days and the rate further increased at later time points; reasons for remaining on warfarin therapy after -days were observation of ow in the LAA (n = 0), physician order (n = 1 ), other reasons (n = 9). As far as safety endpoints are concerned events in device group were classied as ischemic stroke: they were all periprocedural and extended hospitalization by 7 days; three events were related to air embolism; one hemorrhagic stroke in device group vs 6 in control group were adjudicated. By note, device events occurred 1 days post implant while patient was on warfarin and /6 stroke events in control group patients resulted in death. In conclusion, in AF patients who were candidates for warfarin therapy, device closure of the LAA using the Watchman device (Atritech, Plymouth, MN) was associated with a reduction in hemorrhagic stroke risk vs warfarin, and all-cause stroke and all-cause mortality outcomes were noninferior to warfarin. 10 Safety events, particularly pericardial effusion, were more common in the device group, but these have decreased over time with procedural modications and enhanced training, the researchers noted. Indications Currently, when to close LAA? Patients with: • Permanent atrial brillation • High risk of stroke And with: • Contraindication to warfarin • High risk of bleeding with OAC • Difcult to maintain INR within the therapeutic range • Poor compliance • Difculty to manage the patient because of logistic problems AMPLATZER ® Cardiac Plug (AGA Medical Corporation) The AMPLATZER Cardiac Plug (ACP; Figure 2) is a transcatheter self-expanding device constructed from a nitinol mesh and polyester patch, ACP consists of a lobe and a disc connected by a central waist. The ACP is available in 8 sizes: 16, 18, 20, 22, 2 , 26, 28, and 0 mm.
References 1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial brillation in adults: National implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial brillation (atria) study. Jama. 2001;28 :2 70-2 7 2. Echocardiographic predictors of stroke in patients with atrial brillation: A prospective study of 1066 patients from clinical trials. Archives of internal medicine. 1998;1 8:1 16-1 20 . Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial brillation. The stroke prevention in atrial brillation investigators committee on echocardiography. Annals of internal medicine. 1998;128:6 9-6 7 . Frost L, Engholm G, Johnsen S, Moller H, Husted S. Incident stroke after discharge from the hospital with a diagnosis of atrial brillation. The American journal of medicine. 2000;108: 6- 0 . Risk factors for stroke and efcacy of antithrombotic therapy in atrial brillation. Analysis of pooled data from ve randomized controlled trials. Archives of internal medicine. 199 ;1 :1 9-1 7 6. Adjusted-dose warfarin versus low-intensity, xed-dose warfarin plus aspirin for high-risk patients with atrial brillation: Stroke prevention in atrial brillation iii randomised clinical trial. Lancet. 1996; 8:6 -6 8 7. Patients with nonvalvular atrial brillation at low risk of stroke during treatment with aspirin: Stroke prevention in atrial brillation iii study. The spaf iii writing committee for the stroke prevention in atrial brillation investigators. Jama. 1998;279:127 -1277 8. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classication schemes for predicting stroke: Results from the national registry of atrial brillation. Jama. 2001;28 :286 -2870 9. Go AS, Hylek EM, Chang Y, Phillips KA, Henault LE, Capra AM, Jensvold NG, Selby JV, Singer DE.Anticoagulation therapy for stroke prevention in atrial brillation: How well do randomized trials translate into clinical practice? Jama. 200 ;290:268 -2692 10.Holmes DR, Reddy VY, Turi ZG et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial brillation: a randomised non-inferiority trial. Lancet 2009; 7 : – 2. Figure 2 11
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HEARTLINE BOOK HEARTLINE HSM Genoa
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Infarto Miocardico Acuto Esteso: c
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La siopatologia cellulare dell’in
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Sia in modelli di piccola che di gr
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Citochine nell’infarto miocardico
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mande ci viene probabilmente sugger
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L’ecocontrastograa nello studio d
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imaging molecolare con ECM, permett
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mostrato che il miocardio ischemico
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Trial Clinici sulla Terapia Cellula
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nistra dopo riperfusione efcace. I
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“Apical Ballooning Syndrome”: c
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Fig. 3 ABS: ECG di presentazione in
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Lesioni Coronariche critiche in sin
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Infarto Miocardico Acuto: nuovi ori
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(1.9%), indipendentemente dal tratt
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I dati clinici a tre anni del Trial
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Cardiopatia Ischemica: nuovi orizzo
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Prasugrel Anche il Prasugrel è un
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Montalescot G, Wiviott SD, Braunwal
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che riunisce tutti gli ospedali con
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Costituzione di reti per lo shock c
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• Hub vs OspRER: due ricoveri, am
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Discussione Lo studio ha analizzato
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Nella TERZA FASE • Il progetto e
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Infarto miocardico acuto con ST sop
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6 Nel registro STEMI del San Martin
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8 Un terzo dei pz. proveniva dal 11
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60 Outcome in base al rischio ed al
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62 più rapidi rispetto a quelli ch
Page 64 and 65: 6 Bibliograa 1. Keeley EC, Boura JA
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Page 68 and 69: 68 Tabella 1 Tabella 2 Caratteristi
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Page 88 and 89: 88 brinolisi e poi trasferiti per e
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Page 106 and 107: 106 Tabella 8 Tabella 9 Le complica
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Page 116 and 117: 116 Fibrillazione Atriale: nuovi sc
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HEARTLINE HSM Genoa Cardiology Meeting - Aristea

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