共查询到20条相似文献，搜索用时 21 毫秒
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Rupert P. Williams Guus A. de Waard Kalpa De Silva Matthew Lumley Kaleab Asrress Satpal Arri Howard Ellis Awais Mir Brian Clapp Amedeo Chiribiri Sven Plein Paul F. Teunissen Maurits R. Hollander Michael Marber Simon Redwood Niels van Royen Divaka Perera 《The American journal of cardiology》2018,121(1):1-8
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Background
Elderly (≥ 75 years) patients form a large sub-group of non–ST-segment elevation myocardial infarction (NSTEMI) population but are vastly under-represented in trials. Thus, the benefits of an early angiography in the elderly remain unclear. In this systematic review, we compared outcomes of “invasive” and “conservative” strategies of NSTEMI management in elderly patients.Methods
A comprehensive search of major databases was performed. We included comparative studies of any design that enrolled patients ≥ 75 years, and where outcomes of both strategies of NSTEMI management were available.Results
Among the included studies (3 randomized and 6 observational), there were 6340 patients in the “invasive” group and 13,358 patients in the “conservative” group. The 12-month mortality rate (odds ration [OR], 0.45; p < 0.00001), the 30-day mortality (OR, 0.50; p = 0.0009), and events of stroke (OR, 0.42; p < 0.00001) were significantly lower in the invasive group. Major bleeding was higher in the invasive cohort (OR, 1.63; p = 0.03). Analysis of randomised studies showed lower reinfarction with invasive approach at 12 months (p = 0.0001). Significant heterogeneity was noted among studies according to study design.Conclusion
The overall benefit with invasive strategy comes from the data of observational studies that are prone to selection bias. We believe that there is a need for a large randomized study in the elderly patients regarding management of NSTEMI. 相似文献20.
Mizuki Miura Mara Gavazzoni Maurizio Taramasso Francesco Maisano 《The Canadian journal of cardiology》2019,35(4):544.e15-544.e17
A 74-year-old man presented with dyspnea due to severe mitral regurgitation (MR) caused by rupture of the chordae tendineae. Percutaneous edge-to-edge mitral valve repair was performed using the MitraClip system (Abbott Vascular, Santa Clara, CA). After leaflet grasping via an XTR clip, transesophageal echocardiography (TEE) revealed marked reduction of MR, but elevation of the transmitral gradient was detected no matter how the position of grasping was changed. Finally, we replaced the XTR to the NTR system. After leaflet grasping via an NTR clip, TEE revealed marked reduction of MR from severe to mild and an adequate transmitral gradient. 相似文献