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Shavadia Jay S. Alemayehu Wendimagegn deFilippi Christopher Westerhout Cynthia M. Tromp Jasper Granger Christopher B. Armstrong Paul W. van Diepen Sean 《Journal of thrombosis and thrombolysis》2022,53(4):841-850
Journal of Thrombosis and Thrombolysis - Early prediction of significant morbidity or mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) represents an unmet... 相似文献
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Jay S. Shavadia Minh N. Vo Kevin R. Bainey 《The Canadian journal of cardiology》2018,34(12):1564-1572
Coronary calcification often complicates atherosclerosis. With an aging population, coinciding with lower thresholds for coronary angiography and percutaneous coronary intervention (PCI), severe calcific coronary stenoses remain a challenge for interventional cardiologists. Although advances in coronary guidewires, percutaneous balloons, and adjunctive procedural devices have improved success of PCI, recalcitrant calcified lesions not amenable to the conventional technique frequently occur. Coronary atherectomy with plaque modification provides a therapeutic alternative. As such, various modalities such as rotational, orbital or laser atherectomy, and more recently shockwave lithoplasty have become therapeutic options for PCI. We provide a summary of the principles, technique, and contemporary evidence for these currently approved devices designed to treat severe coronary calcific lesions. 相似文献
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Jay S. Shavadia Matthew T. Roe Anita Y. Chen Joseph Lucas Alexander C. Fanaroff Ajar Kochar Christopher B. Fordyce James G. Jollis Jacqueline Tamis-Holland Timothy D. Henry Akshay Bagai Michael C. Kontos Christopher B. Granger Tracy Y. Wang 《JACC: Cardiovascular Interventions》2018,11(18):1837-1847
Objectives
The aim of this study was to describe the prevalence of pre-hospital cardiac catheterization laboratory activation and its association with reperfusion timeliness and in-hospital mortality.Background
For patients with ST-segment elevation myocardial infarction diagnosed in the field, catheterization laboratory pre-activation may lead to more timely reperfusion and improved outcomes.Methods
A total of 27,840 patients with ST-segment elevation myocardial infarction transported via emergency medical services to 744 percutaneous coronary intervention–capable hospitals in the ACTION Registry from January 2015 to March 2017 were evaluated, excluding patients with cardiac arrest or requiring pre–percutaneous coronary intervention intubation. Catheterization laboratory pre-activation was defined as activation >10 min prior to hospital arrival.Results
Catheterization laboratory pre-activation occurred in 41% of patients (n = 11,379), with minor presenting differences between those with and without catheterization laboratory pre-activation. Compared with no catheterization laboratory pre-activation, pre-activation patients were more likely to be directly transported to the catheterization laboratory on hospital arrival (23.3% vs. 5.3%), to have shorter hospital arrival–to–catheterization laboratory arrival time (median 17 min [interquartile range (IQR): 7 to 25 min] vs. 28 min [IQR: 18 to 39 min]), to have shorter door-to-device time (40 min [IQR: 30 to 51 min] vs. 52 min [IQR: 41 to 65 min]), and to have a greater likelihood of achieving first medical contact–to–device time ≤90 min (76.6% vs. 68.6%) (p < 0.001 for all). Pre-activation was associated with lower in-hospital mortality (2.8% vs. 3.4%; p = 0.01). Patients treated at hospitals in the lowest tertile of pre-activation rates had higher mortality than those treated at hospitals in the highest tertile before and after adjustment (3.6% vs. 2.7%; adjusted odds ratio: 1.33; 95% confidence interval: 1.08 to 1.63).Conclusions
In the United States, catheterization laboratory pre-activation occurred in fewer than one-half of emergency medical services–transported patients with ST-segment elevation myocardial infarction. Its association with faster reperfusion and lower mortality supports greater use of this strategy. 相似文献5.
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Jay Shavadia Gerald Yonga Sitna Mwanzi Ashna Jinah Abednego Moriasi Harun Otieno 《Cardiovascular journal of Africa》2013,24(2):6-9
Introduction
Scant data exist on the epidemiology and clinical characteristics of atrial fibrillation in Kenya. Traditionally, atrial fibrillation (AF) in sub-Saharan Africa is as a result of rheumatic valve disease. However, with the economic transition in sub-Saharan Africa, risk factors and associated complications of this arrhythmia are likely to change.Methods
A retrospective observational survey was carried out between January 2008 and December 2010. Patients with a discharge diagnosis of either atrial fibrillation or flutter were included for analysis. The data-collection tool included clinical presentation, risk factors and management strategy. Follow-up data were obtained from the patients’ medical records six months after the index presentation.Results
One hundred and sixty-two patients were recruited (mean age 67 ± 17 years, males 56%). The distribution was paroxysmal (40%), persistent (20%) and permanent AF (40%). Associated co-morbidities included hypertension (68%), heart failure (38%) diabetes mellitus (33%) and valvular abnormalities (12%). One-third presented with palpitations, dizziness or syncope and 15% with a thromboembolic complication as the index AF presentation. Rate-control strategies were administered to 78% of the patients, with beta-blockers and digoxin more commonly prescribed. Seventy-seven per cent had a CHA2DS2VASC score ≥ 2, but one-quarter did not receive any form of oral anticoagulation. At the six-month follow up, 6% had died and 12% had been re-admitted at least once. Of the high-stroke risk patients on anticoagulation, just over one-half were adequately anticoagulated.Conclusion
Hypertension and diabetes mellitus, not rheumatic valve disease were the more common co-morbidities. Stroke risk stratification and prevention needs to be emphasised and appropriately managed. 相似文献8.
Pituitary apoplexy is a common clinical syndrome characterised by acute headache, ophthalmoplegia, diminished visual acuity and altered mental status caused by the sudden haemorrhage or infarction of the pituitary gland. The two cases reported highlight the variability in presentation which underscores the need for a high index of suspicion and the need for MRI in patients presenting with a thunderclap headache and 'normal' initial investigations. 相似文献
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Jay Shavadia Quazi Ibrahim Sunil Sookram Neil Brass Darren Knapp Robert C. Welsh 《The Canadian journal of cardiology》2013