Cardiovascular Medicine

5 pages, 178 KB

Open AccessReview

Antithrombin Treatment of Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

by Nils Kucher, Stephan Windecker, Francois Mach, Pierre-Frederic Keller, Christan Roguelov and Bernhard Meier

Cardiovasc. Med. 2008, 11(1), 7; https://doi.org/10.4414/cvm.2008.01297 - 25 Jan 2008

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Abstract

Antithrombotic therapy in patients with acute coronary syndromes (ACS) targets activated platelets, thrombin, and certain clotting factors, and has been shown to improve clinical outcomes, including recurrent myocardial infarction and cardiovascular death. The majority of patients presenting with ACS in Switzerland are referred [...] Read more.

Antithrombotic therapy in patients with acute coronary syndromes (ACS) targets activated platelets, thrombin, and certain clotting factors, and has been shown to improve clinical outcomes, including recurrent myocardial infarction and cardiovascular death. The majority of patients presenting with ACS in Switzerland are referred for coronary angiography and percutaneous coronary intervention (PCI) using an early invasive strategy. Optimal antithrombotic treatment is particularly important during mechanical intervention at the coronary culprit lesion due to the activation of the clotting cascade following stent mediated arterial injury. The combination of aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors is recommended for high-risk ACS patients undergoing PCI. Unfractionated heparin has been used for many years as antithrombin of choice in these patients; it is usually started at the time of presentation and is continued during PCI. Several shortcomings of unfractionated heparin have resulted in the development of a variety of novel anticoagulants, including low molecular weight heparins, fondaparinux, and bilvalirudin. Several antithrombotic drug regimens are now available to treat ACS patients and have been included in international consensus guidelines. This article is intended to serve as a practical guide to interventional cardiologists and other interested physicians treating patients with ACS who are managed with an early invasive strategy. Current options of anticoagulant drug regimens are summarised from a practical point of view, with special attention to the upstream antithrombotic treatment prior to referral to the cardiac catheterisation laboratory. Unfractionated heparin (UFH) still is the antithrombotic agent of choice for patients with urgent PCI or haemodynamic instability. Enoxaparin can be used as an alternative to UFH as upstream treatment and as antithrombotic agent during PCI. Fondaparinux is especially useful as upstream treatment if PCI is delayed for several hours; however, UFH is needed during PCI in patients on fondaparinux. Bivalirudin is useful during PCI in elderly patients or those with an increased bleeding risk. Full article

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2 pages, 218 KB

Open AccessEditorial

Le Chaînon Manquant dans le Traitement du Syndrome Coronarien Aigu: L'éducation Thérapeutique

by Pierre-Frédéric Keller, Alain Golay, René Lerch and François Mach

Cardiovasc. Med. 2008, 11(1), 5; https://doi.org/10.4414/cvm.2008.01302 - 25 Jan 2008

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Abstract

La prise en charge des syndromes coronariens aigus (SCA) s’est considérablement développée au cours des 20 dernières années. Le taux de mortalité reste néanmoins élevé (>10% à 6 mois) [...] Full article

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2 pages, 180 KB

Open AccessCommunication

Jahresbericht 2006 der Schweizerischen Arbeitsgruppe für Kardiale Rehabilitation (SAKR)

by Raphael Koller, Andreas Hoffmann, Michael Lefkovits, Marco Bettoni, Mauro Capoferri, Hansueli Tschanz, Roger Weber and Andrea Gyöngy

Cardiovasc. Med. 2008, 11(1), 31; https://doi.org/10.4414/cvm.2008.01296 - 25 Jan 2008

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Abstract

Im Bereiche der Fortbildung führte die SAKR 2006 erstmals zusammen mit den Herztherapeuten (VSHT) eine gemeinsame Herbsttagung durch, die schwergewichtig dem Thema der Motivation gewidmet war und von den Teilnehmern eine interaktive Mitarbeit verlangte [...] Full article

2 pages, 175 KB

Open AccessCommunication

Jahresbericht 2006 der Arbeitsgruppe Herzinsuffizienz

by H. P. Brunner, F. Widmer, R. Lerch, M. Leventhal, T. Suter, G. Moschovitis, K. Nüesch and O. M. Hess

Cardiovasc. Med. 2008, 11(1), 29; https://doi.org/10.4414/cvm.2008.01295 - 25 Jan 2008

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Abstract

Die Arbeitsgruppe zählte am Ende des Berichtsjahres 131 Mitglieder, davon 78 ordentliche und 53 ausserordentliche Mitglieder. Die Zahl der Mitglieder ist im letzten Jahr um 2 ordentliche und 8 ausserordentliche gewachsen [...] Full article

3 pages, 168 KB

Open AccessCommunication

Comments to the 2007 Recommendations for the Treatment of Essential Hypertension by the Swiss Society of Hypertension

by Paul Erne and Yves Allemann

Cardiovasc. Med. 2008, 11(1), 26; https://doi.org/10.4414/cvm.2008.01299 - 25 Jan 2008

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Abstract

The new 2007 guidelines of the Swiss Society of Hypertension have just been released and are available at the website www.swisshypertension.ch/guidelines.htm [...] Full article

4 pages, 847 KB

Open AccessEditorial

What Is an Optimal Stent? Biological Requirements of Drug-Eluting Stents

by Giovanni G. Camici

Cardiovasc. Med. 2008, 11(1), 22; https://doi.org/10.4414/cvm.2008.01301 - 25 Jan 2008

Cited by 2 | Viewed by 48

Abstract

Although drug eluting stents (DES) have been successful in preventing neointima formation thereby decreasing the rates of restenosis, several concerns remain about the incidence of stent thrombosis – a rare complication associated to high mortality. For this reason, much effort is being made [...] Read more.

Although drug eluting stents (DES) have been successful in preventing neointima formation thereby decreasing the rates of restenosis, several concerns remain about the incidence of stent thrombosis – a rare complication associated to high mortality. For this reason, much effort is being made in searching for new molecules and approaches to develop innovative DES able to inhibit restenosis as well as decreasing the incidence of late stent thrombosis. Second generation DES have recently entered daily clinical practice but definitive data concerning their efficacy are not available yet. Still, the close relationship between agents used on first generation DES and those employed in second generation DES gives us reason to speculate that more efforts are needed in order to make concrete advances. This review article focuses on the existing problems of currently available DES as well as the innovations needed in order to improve further the outcome of stent implantation. Present time efforts should be directed towards identifying multi-coatings to be applied on inert polymers so as to have targeted approaches for each of the therapeutical requirements of a stented coronary artery. An ideal stent should locally inhibit vascular smooth muscle cells proliferation, enhance endothelial healing through improved endothelial progenitor cells function and ultimately prevent platelets activation. Current technology seems to offer individual alternatives for all these requirements; so the “perfect stent” should be soon available. Full article

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1 pages, 205 KB

Open AccessInteresting Images

Spontaneous Closure of an AV-Fistula of the Internal Mammary Artery

by Frank Enseleit, Thomas Largiadèr and Rolf Jenni

Cardiovasc. Med. 2008, 11(1), 21; https://doi.org/10.4414/cvm.2008.01293 - 25 Jan 2008

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Abstract

A 31-year-old female with known Marfan-syndrome was admitted for diagnostic evaluation of suspected pulmonary embolism after spontaneous delivery [...] Full article

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2 pages, 452 KB

Open AccessInteresting Images

Flutter Auriculaire 2:1 Simulant un Bloc Atrio-Ventriculaire de Premier Degré

by Henri Sunthorn and Juan Sztajzel

Cardiovasc. Med. 2008, 11(1), 19; https://doi.org/10.4414/cvm.2008.01300 - 25 Jan 2008

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Abstract

Patient de 72 ans présente, environ une année après l’ablation par radiofréquence de l’isthme cavotricuspide pour un flutter auriculaire, des symptômes de fatigue et des palpitations sans facteur déclenchant particulier [...] Full article

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3 pages, 402 KB

Open AccessCase Report

Transcatheter Closure of Perimembranous Ventricular Septal Defect in Adult Using the Amplatzer Septal Occluder: Report of Two Challenging Cases

by Giovanni B. Pedrazzini, Mario Carminati, Franco Faletra and Tiziano Moccetti

Cardiovasc. Med. 2008, 11(1), 16; https://doi.org/10.4414/cvm.2008.01298 - 25 Jan 2008

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Abstract

Ventricular septal defect (VSD) accounts for 20% of congenital cardiovascular malformations and 10% of those diagnosed in adults. Its prevalence is estimated at 1.17 per 1000 births and at 0.5 per 1000 adults and has increased recently because of improved detection [...] Full article

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4 pages, 184 KB

Open AccessArticle

Influence of Drug Eluting Stents on Surgical Revascularisation

by Franz F. Immer, Sonja Bachmann, Mario Togni, Stephan Windecker, Bernhard Meier and Thierry P. Carrel

Cardiovasc. Med. 2008, 11(1), 12; https://doi.org/10.4414/cvm.2008.01294 - 25 Jan 2008

Viewed by 35

Abstract

Introduction: Drug eluting stents (DES) were introduced in clinical routine to reduce neointimal hyperplasia and thus restenosis. Aim of the present study was to analyse the impact of previous PTCAtherapy on the clinical outcome of CABG-surgery in a single center experience. Patients [...] Read more.

Introduction: Drug eluting stents (DES) were introduced in clinical routine to reduce neointimal hyperplasia and thus restenosis. Aim of the present study was to analyse the impact of previous PTCAtherapy on the clinical outcome of CABG-surgery in a single center experience. Patients and methods: Data of 411 consecutive patients undergoing isolated CABG-surgery within a 10-months period were analysed. 328 patients (79.8%) were previously treated by the in-house interventional cardiology team. Characteristics of patients with and without previous balloon angioplasty (PTCA) and/or stent were compared. Results: 72/328 patients (22%) were treated by percutaneous coronary intervention prior to CABG (14 had PTCA only (19.4%), 36 stents without PTCA (50%) and 22 PTCA and stents (30.6%)). Despite use of DES in 53 patients (91.4%), stent failure was found in 29.2% in the interventional treated collective. Patients treated interventionally were younger (63.0 ± 10.0 years vs 66.1 ± 9.7 y; p <0.01) and had a lower incidence of diabetes (12.5% vs 25.8%; p <0.01) in comparison to patients not previously treated by PTCA. They presented with a lower EUROScore (4.0 ± 2.9 vs 5.2 ± 3.7; p <0.01). Perioperative myocardial ischaemia (CK-MB >60 IU/l) was more frequent in the PCI-group than in patients who underwent CABG without previous PCI (12.4% vs 6.3%; p <0.01). One year follow-up revealed no differences between the two groups as far as survival and freedom from reintervention were analysed. Conclusions: 80% of the patients who received interventional treatment before CABG-surgery presented with a stent. In one third, patients were addressed to surgery, due to stent failure. We observed a higher incidence of perioperative myocardial ischaemia in patients who underwent previous interventional treatment. Full article

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Cardiovasc. Med., Volume 11, Issue 1 (01 2008) – 10 articles

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