Introdução: A comunicação interatrial tipo ostium secundum(CIA) é uma cardiopatia congênita frequente, sendo a mais comumente encontrada na população adulta. Seu tratamento está indicado quando há repercussão hemodinâmica caracterizada pelo aumento das dimensões das câmaras direitas à ecocardiografia, independente da presença de sintomas. Nas últimas 2 décadas o fechamento percutâneo da CIA emergiu como a modalidade terapêutica preferencial devido sua alta eficácia e menor morbidade que a correção cirúrgica.Tanto o tratamento cirúrgico como o percutâneo da CIA resultam em remodelamento cardíaco com redução progressiva do tamanho das câmaras direitas e aumento das esquerdas. Recentemente, novas técnicas ecocardiográficas vem sendo empregadas para avaliação das dimensões, geometria e função das câmaras cardíacas incluindo o ecocardiograma tridimensional e o rastreamento de marcadores acústicos. Hipótese e objetivos: Partiu-se da hipótese que o fechamento percutâneo da CIA, por ser um método não invasivo, levaria a rápido remodelamento cardíaco mesmo em adultos com sobrecarga volumétrica crônica das câmaras direitas. Tivemos como objetivo avaliar o comportamento temporal do remodelamento cardíaco e analisar possíveis diferenças existentes entre pacientes de diferentes faixas etárias e com tamanhos diversos de CIA. Material e métodos: Estudo observacional, prospectivo, não randomizado de um braço único de uma coorte de adultos submetidos ao fechamento percutâneo da CIA com a prótese Cera (Lifetech, Shenzheng, China) e acompanhados por um ano. Foram selecionados 29 adultos com CIA com repercussão hemodinâmica com anatomia favorável para a oclusão percutânea e sem contra-indicações para tal. O remodelamento cardíaco foi estudado por meio de várias técnicas ecocardiográficas incluindo as clássicas e outras de introdução recente. A ecocardiografia bidimensional foi usada para a medição das dimensões do átrio direito (AD), ventrículo direito (VD) e ventrículo esquerdo (VE), para determinação da área fracionada do VD (FAC) e da excursão anterior da valva tricúspide (TAPSE) e para análise volumétrica das câmaras cardíacas. A ecocardiografia tridimensional foi empregada para análise volumétrica e funcional do VD. O rastreamento de marcadores acústico foi utilizado para avaliação da função do AD, VD e VE. O teste ANOVA foi usado para avaliação das mudanças observadas nas variáveis repetidas ao longo do tempo com comparações múltiplas de Bonferroni quando aplicável. Uma análise intra e interobservador das medidas foi realizada utilizando coeficientes de concordância. Resultados: A média de idade e peso dos pacientes foi de 45,2 ± 17,0 anos e 68,8 ± 14,0 kgs, respectivamente. Nenhum paciente apresentada hipertensão pulmonar significativa. A média do tamanho da CIA foi de 20,2 ± 5,0 mm e a média do tamanho da prótese implantada foi de 22,9 ± 6,2 mm. Em todos os pacientes houve sucesso no implante. Não houve complicações relacionadas ao procedimento e em todos os pacientes foi observada oclusão do defeito. Após o procedimento, houve redução precoce (< 3 meses) das dimensões do AD (p<0,001) e do VD (p<0,001) e aumento das dimensões do VE (p<0,014). Não houve mudanças significativas na função de deformação longitudinal do AD para onda P (p=0,227) e para onda T (p=0,124). Houve redução abrupta da função do VD pelo TAPSE (p=0,032), pela deformação longitudinal (p=0,002) e pela ecocardiografia tridimensional (p=0,084). Não houve mudanças significativas da onda S\' (p=0,55) e da FAC (p=0789) do VD. Houve redução precoce do volume de ejeção do VD (p< 0,001) e aumento do volume de ejeção do VE (p=0,027). Houve redução da deformação longitudinal do VE (p=0,049) e não houve mudanças na função do VE pelo método de Simpson (p=0,462). Pacientes maiores que 60 anos (n=8) apresentaram valores iniciais maiores nas dimensões do AD e redução mais prolongada (p=0,0497). Pacientes com CIAs maiores que 20 mm (n=12) apresentavam valores iniciais maiores de TAPSE com redução mais retardada (p=0,013). Todas as mudanças observadas inicialmente nos primeiros 3 meses se sustentaram ao final do seguimento. Houve excelente concordância na análise intraobservador para todas as medidas repetidas (CCI> 0,9) com exceção da deformação do VE (CCI< 0,7). A concordância entre as medidas realizadas por diferentes observadores não foi tão boa, com apenas as variáveis TAPSE, deformação do VE e dimensões do AD possuindo CCI > 0,7. Conclusões: O fechamento percutâneo da CIA em adultos de meia idade leva a rápido remodelamento cardíaco tanto do ponto de vista anatômico como funcional com resultados sustentados dentro do primeiro ano de seguimento. Tais mudanças temporais são observadas independente do tamanho da CIA e da idade dos pacientes, denotando o efeito benéfico do procedimento sobre a geometria e o funcionamento cardíaco global em todos adultos portadores desta frequente cardiopatia congênita. / Introduction: The atrial septal defect of the secundum type (ASD) is a frequent congenital heart disease, being the most commonly encountered in the adult population. Treatment is indicated when there is hemodynamic burden characterized by increased dimensions of the right chambers on echocardiography, regardless of the presence of symptoms. In the last two decades, percutaneous closure of the ASD has emerged as the preferred therapeutic modality due to its high efficacy and lower morbidity when compared to surgical correction. Both surgical and percutaneous treatment of the ASD result in cardiac remodeling with progressive reduction in the size of the right chambers and increase in the left chambers. Recently, new echocardiographic techniques have been employed to assess the dimensions, geometry and function of the cardiac chambers including three-dimensional echocardiography (3D echo) and acoustic speckle tracking. Hypothesis and objectives: Hypothesizing that percutaneous closure, being a non-ivasive method, results in a fast cardiac remodeling even in adults with chronic volume overload of the right chambers, our aim was to assess the temporal pattern of cardiac remodeling and analyse possible differences between patients of different age groups and different ASD sizes. Material and methods: This was an observational, prospective, non randomized, single arm study of a cohort of adults submitted to percutaneous closure of the ASD with the Cera device (Lifetech, Shenzheng, China) followed along a year. Twenty nine adults with hemodynamicaly significant ASDs with suitable anatomy for percutaneous closure and no contra-indications for the procerdure were selected. Cardiac remodeling was assessed by various echocardiographic techniques including standard and new ones. Bidimensional echocardiography was used to measure the dimensions of the right atrium (RA), right ventricle (RV) and left ventricle (LV), to determine the fractional area of the RV (FAC) and the systolic anterior excursion of the tricuspid valve (TAPSE), and to analyse the volumes of the cardiac chambers. Three-D echo was employed for volumetric and functional analysis of the RV. Acoustic speckle tracking was utilized to assess the function of the RA, RV and LV. ANOVA tests were used to assess the observed changes in the repeated variables over time with multiple Boferoni comparison as applicable. An intra and interobserver analysis of the measurements was performed using concordance coefficients. Results: Mean age and weight was 45,2 ± 17,0 years and 68,8 ± 14,0 kgs, respectively. No patient had significant pulmonar arterial hypertension. The ASD dimension and the size of the device was a mean of 20,2 ± 5,0 mm and 22,9 ± 6,2 mm, respectively. In all patients the device was implanted successfully. There were no complications related to the procedure and in all patients the ASDs were successfully closed. After the procedure, there was an early (< 3 months) reduction of the RA (< 0.001) and RV (< 0.001) sizes and an increase of the LV dimensions (p< 0.014). There were no significant changes in the function of the RA as assessed by longitudinal strain (p=0.227 for the P wave and p=0.124 for the T wave). There was an abrupt reduction of the RV function assessed by TAPSE (p=0.032), longitudinal strain (p=0.002) and 3D echo (p=0.084). There were no changes in the S\' wave (p=0.55) and FAC (p=0.789) of the RV. There was an immediate decrease in the RV stroke volume (p< 0.001) and an increase in the LV srtroke volume (p=0.027). There was a reduction in LV longitudinal strain (p=0.049) and no change in LV function as assessed by the Simpson method (p=0.462). Patients older than 60 years of age (n=8) presented with larger RA dimensions, which decreased in a slower fashion (p=0.0497). Patients with ASDs larger than 20 mm (n=12) had initial higher TAPSE values, which decreased in a slower fashion (p=0.013). All changes observed earlier on endured after a year. There was excellent concordance in the intra observer analysis for all the repeated measures (CCI > 0.9) with the exception of LV strain (CCI < 0.7). The concordance between different observers was not as good with only TAPSE, LV strain, and RA dimensions variables having a CCI > 0.7. Conclusions: Percutaneous closure of the ASD in middle aged adults results in fast cardiac remodeling from both the anatomic and functional point of view with sustained results over the first year of follow up. These temporal changes are observed regardless of the ASD size and the age of the patients, which demonstrates the beneficial effect of the procedure over the cardiac geometry and global function in all adults who have this frequent congenital heart disease.

No description available.

La thèse « Arrêt cardiaque réfractaire aux traitements pharmacologiques: quelle solution proposer pour améliorer la circulation systémique et cérébrale? » a montré que l'amélioration de la fonction circulatoire peut être obtenue à plusieurs étapes de la prise en charge de l'arrêt cardiaque. La première étude du travail, sous la forme d'une étude expérimentale à double randomisation, a montré que l'assistance circulatoire type extracorporeal life support ECLS apporte un bénéfice sur la mortalité dans la prise en charge de l'arrêt cardiaque réfractaire chez le cochon, et que l'adrénaline administrée en intraveineux lors de la résuscitation prolongée n'améliore pas la survie des animaux. La deuxième étude a montré que la canulation pour l'ECLS peut être réalisée rapidement par voie percutanée à l'aide d'un repérage échographique et en utilisant des guides rigides en salle de cathétérisme cardiaque chez les patients en arrêt cardiaque réfractaire, permettant l'initiation de l'ECLS dans des centres dotés de salle de cathétérisme sans chirurgie cardiovasculaire. La troisième étude a retrouvé que l'état de choc et le pH artériel<7,11 sont des critères pronostiques identifiant les patients qui, après un arrêt cardiaque, présentent une reprise d'une circulation spontanée mais sont à risque de décéder d'insuffisance circulatoire réfractaire au traitement par catécholamines. La quatrième étude à montré que la stabilisation de la fonction circulatoire par l'ECLS peut être suivie par une meilleure récupération de la fonction ventriculaire gauche en modulant la postcharge, par un dispositif pulsatile diminuant le débit de l'ECLS lors de la systole cardiaque. Enfin, l'optimisation de la circulation cérébrale nécessite en plus de l'optimisation de la circulation systémique, le contrôle de l'interaction entre la pression en gaz carbonique et le débit sanguin cérébral qui est amélioré par une normalisation de la pression en gaz carbonique en stratégie pH-stat. Cette stratégie mesure la pression en gaz carbonique à la température réelle du patient au lieu de la température de référence 37° comme dans la stratégie alpha-stat. L’ensemble de ces résultats, pouvant être appliqués à différentes étapes de la prise en charge d'un patient présentant un arrêt cardiaque, pourraient permettre l'amélioration du pronostic des patients. / The doctoral dissertation « Cardiac arrest refractory to pharmacological treatments : what solution to propose to improve systemic and cerebral circulation ? » showed that circulatory function improvement can be achieved at several stages of the management of cardiac arrest patients. The first study of the dissertation, a double randomization experimental study, showed that extracorporeal life support - ECLS type circulatory assistance improves mortality in refractory cardiac arrest in pigs, and intravenous administration of epinephrine during prolonged resuscitation does not improve survival.The second study showed that cannulation for ECLS can be performed rapidly by the percutaneous technique using echography guidance and stiff wires in the catheterization laboratory in refractory cardiac arrest patients allowing for ECLS initiation in centres with catheterization laboratories but without cardiovascular surgery.The third study found that circulatory shock and arterial pH<7.11 are prognostic criteria identifying patients who, after a cardiac arrest, have return of spontaneous circulation but are at risk of death from circulatory failure refractory to catecholamine treatment.The fourth study showed that hemodynamic stabilization by ECLS can be followed by a better recovery of the left ventricular function by modulating afterload using a pulsatile device lowering ECLS output during systole.Finally, optimization of the cerebral circulation requires besides optimization of the systemic circulation, the control of the interaction between carbon dioxyde partial pressure and cerebral circulatory output, which is improved by normalizing carbon dioxyde partial pressure in pH-stat strategy. This strategy measures partial pressure of carbon dioxyde at the real temperature of the patients instead of the theoretical 37° reference temperature as in alpha-stat strategy.All these results can be applied at different stages of the management of cardiac arrest patients and may improve their prognosis.

<p>Uvod: Pravovremena i pouzdana stratifikacija rizika pacijenata sa akutnim ST eleviranim infarktom miokarda (STEMI) je važna zbog adekvatnog zbrinjavanja ovih bolesnika. Primarna perkutana koronarna intervencija (pPCI) je dovela do značajnog pobolj&scaron;anja ishoda pacijenata sa STEMI, a time moguće i do promene prediktivne važnosti različitih faktora rizika. Jung variabla je jednostavan klinički indeks rizika koji se koristi tokom inicijalne prezentacije pacijenata. Pokazana je prediktivna vrednost Jung varijable za hospitalni mortalitet pacijenata sa STEMI lečenih fibrinolitičkom terapijom, dok uloga Jung varijable u dugoročnoj prognozi pacijenata lečenih putem pPCI nije razja&scaron;njena. Cilj: Dokazati prediktivni značaj i odrediti najbolju vrednost Jung varijable u predviđanju jednogodi&scaron;njeg neželjenog kliničkog ishoda kod pacijenata sa STEMI lečenih pPCI, kao i dokazati njenu validnost na nezavisnoj populaciji. Metode: Sprovedena je prospektivna studija praćenja pacijenata sa STEMI lečenih pPCI tokom godinu dana; primarna studija je sprovedena u Institutu za kardiovaskularne bolesti Vojvodine (IKVBV), a validaciona u Vojnomedicinskoj akademiji (VMA). Ishodi studije: smrtni ishod, akutna srčana insuficijencija (AHF) i zbirni neželjeni ishod. Jung varijabla je računata prema formuli: sistolni krvni pritisak / (srčana frekvencija &times; godine života) &times; 100. Prediktivna vrednost Jung variable i prethodno etabliranih skorova rizika TIMI, PAMI i Zwolle je evaluiarana adekvatnim statističkim metodama. Rezultati: Od 647 pacijenata uključenih u primarnu studiju, umrlo je 70 (10.8%), dok je AHF imalo 42 (6.5%); od 418 pacijenata uključenih u validacionu studiju umrlo je 33 (7.9%), a 52 (12.4%) pacijenta je imalo AHF. U primarnoj studiji Jung variabla je bila prediktor smrtnog ishoda i zbirnog neželjenog ishoda, dok je u validacionoj studiji Jung varijabla bila nezavisni prediktor nastanka AHF (p&lt;0.01). Za mortalitet, Jung variabla &lt;= 2.35 je imala sensitivnost 74.3% i specifičnost 77.3%. U primarnoj studiji, C-statistike i 95% interval poverenja Jung varijable za jednogodi&scaron;nji mortalitet i zbirni neželjeni ishod su bile dobre (0.784 (0.750-0.815) i 0.764 (0.729-0.796)) i poredive sa TIMI, PAMI i Zwolle skorovima (p&gt;0.05). C-statistika za predikciju AHF i zbirnog neželjenog ishoda u validacionoj studiji je bila dobra (0.732 (0.655-0.809) i 0.721 (0.655-0.788)), ali manja u odnosu na ostale ispitivane skorove (p&lt;0.01). Zaključak: Jung varijabla je nezavisni prediktor jednogodi&scaron;njeg smrtnog ishoda i zbirnog neželjenog ishoda pacijenata sa STEMI lečenih pPCI u IKVBV i nezavisni prediktor AHF u validacionoj studiji. Jung varijabla, TIMI, PAMI i ZWOLLE skorovi imaju dobar i porediv diskriminatorni kapacitet za sve praćene ishode u primarnoj studiji, dok je u validacionoj studiji Jung varijabla imala dobar diskriminatorni kapacitet za AHF i zbirni neželjeni ishod, ali manji u odnosu na ostale ispitivane skorove.</p> / <p>Background: Accurate eary risk stratification of patients with ST-elevation myocardial infarction (STEMI) is important in the management of this patients. Primary percutaneous coronary intervention (pPCI) in patients with STEMI has improved the outcome significantly and might have changed the relative contribution of different risk factors. Jung variable is a simple clinical risk index, designed to be used at initial presentation. It is predictive of in hospital mortality in STEMI patients treated with fibrinolysis, but it&#39;s long term predictive power in patients treated with pPCI is not elucidated. Aim: To determine the prognostic accuracy and cut off value of Jung variable for one year clinical outcomes in STEMI patients treated with pPCI, and to validate it in independent STEMI patients. Methods: Two prospective studies of consecutive patients treated with pPCI were conducted; primary study in Institute of Cardiovascular diseases of Vojvodina and validation study in Military medical academy. One-year clinical outcomes (all-cause mortality, acute heart failure (AHF) and combined end point) were assessed. The Jung variable was calculated using the equation: systolic blood/ (heart rate&times;age)&times;100. The predictive value of Jung variable and previously established scores TIMI, PAMI, and Zwolle were evaluated with adequate statistical analyses. Results: Out of 647 patients 70 (10.8%) died and 42 (6.5%) had AHF in primary, while out of 418 patients 33 (7.9%) died and 52 (12.4%) had AHF in validation study. In primary study Jung variable was independent predictor of mortality and combined end point, while it was independent predictor of AHF in validation study (p&lt;0.01). Jung variable &lt;= 2.35 had sensitivity 74.3% and specificity 77.3% for mortality. In a primary study, C-statistic and 95% confidence intervals of Jung variable for one-year mortality and for combined end point were well (0.784 (0.750-0.815) and 0.764 (0.729-0.796), respectively) and comparable to TIMI, PAMI and Zwolle risk score (p&gt;0.05). C-statistic for predicting one-year AHF and combined clinical endpoint in a validation study was well (0.732 (0.655-0.809) and 0.721 (0.655-0.788), respectively), but lower than other risk scores (p&lt;0.01). Conclusion: The Jung variable was independent predictor of one year mortality and combined end point in primary study STEMI patients treated with pPCI and independent predictor of AHF in validation study. The Jung variable, TIMI, PAMI, and Zwolle risk scores performed well and comparable for all clinical outcomes in primary, while in a validation study Jung variable performed well for AHF and combined end point, but significantly lower than other risk scores.</p>

L’exposition cutanée aux produits chimiques par des rejets criminels ou accidentels impose une méthode de décontamination rapide et efficace pour sauver des vies et limiter le transfert de la contamination. L’exploration bibliographique recense des produits toxiques (armes chimiques, toxiques industriels) ainsi que les décontaminants naturels ou synthétiques et leurs méthodes d’application dans un contexte d’intervention sur le terrain. Le sujet vise à la qualification d’un outil de décontamination, la terre de foulon dans des formulations simples, faciles à mettre en œuvre en urgence par les services de Sécurité civile (sapeurs-pompiers). Le travail réalisé comporte :La caractérisation chimique et structurale de la poudre de terre de foulon NBC-Sys qui a permis d’identifier le composant principal : la palygorskite, La formulation et la caractérisation galénique et physico-chimique (granulométrie, zêta potentiel) en milieu concentré et milieu dilué des systèmes dispersés,La capacité d’adsorption de la terre de foulon et ses formulations vis-à-vis d’un modèle contaminant, le 4-cyanophenol, d’intérêt pour l’évaluation de la décontamination, in vitro en milieu aqueux, ex vivo sur explant cutané. L’adsorption du 4-CP en solution aqueuse (10, 100 et 500 mg/L-1) est rapide (5-15min) au contact de la terre de foulon, varie avec le ratio terre de foulon/4-CP, atteint un plateau (saturation) entre 45 et 60 min, l’équilibre entre 60 min et 120 min. Les suspensions de terre de foulon sont plus efficaces (90%) pour la décontamination que les poudres (70%) et l’eau (60%) dans des conditions expérimentales identiques. L’évaluation de la terre de foulon et ses formulations sur les paramètres physiologiques de la peau (perte insensible en eau et conductance) in vivo chez l’homme ne montre pas d’altération de la fonction barrière cutanée.L’ensemble est un premier pas vers une référence (qui n’existe pas actuellement), incluant une méthodologie de décontamination chimique / Cutaneous exposure to contaminants chemicals after criminal or accidental release enforces a rapid and efficient decontamination to save lives and avoid cross contamination. A bibilographic exploration of this work identifies toxic chemical (chemical warfare agents, toxic industrial chemicals), raw and synthetic decontaminants and their application methods applied in emergency. The aim of this study focuses on a decontamination tool qualification, the fuller’s earth (FE), simple formulated, easy to apply in emergency by civil Security services (fire fighter brigades). The work performed includes :The chemical and structural characterization of the powder of fuller’earth NBC-Sys , that lead to identify the palygorskite as main component, The formulation of dispersed systems and their physico chemical characterization (granulometry, zêta potentiel) in concentrated or diluted medium. The adsorption capacity of the FE and formulations for a contaminant model, the 4-cyanophenol, to assess decontamination in vitro, in aqueous medium, ex vivo on cutaneous explant.4-CP adsorption in aqueous solutions (10, 100 et 500 mg/L-1) is rapid (5-15min), when contact with FE, vary with the ratio FE/ 4-CP, to reach a plateau phase (saturation) between 45 and 60 minutes, and an steady state between 60 and 120 min. FE suspensions are more efficient (90%) than powder (70%) and water (60%) in the same experimental conditions. L’évaluation de la terre de foulon et ses formulations sur les paramètres physiologiques de la peau (perte insensible en eau et conductance) in vivo chez l’homme ne montre pas d’altération de la fonction barrière cutanée. FE and its suspensions were assessed on physiological skin parameters (Transepidermal water loss and conductance) in vivo in a human study and exhibit no alteration on the skin barrier function. Results obtained is a first step towards a reference (that actually don’t exist) including a chemical decontamination method

The initial treatment options for patients with stable coronary artery disease include optimal medical therapy alone, or coronary revascularization with optimal medical therapy. The most common revascularization modality is percutaneous coronary intervention (PCI) with either bare metal stents (BMS) or drug-eluting stents (DES). PCI is believed to reduce recurrent angina and thereby decrease the need for additional procedures compared to optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset the increased costs and small increase in adverse events associated with PCI. The objectives of this thesis were to determine the degree of angina relief afforded by PCI and develop a tool to provide contemporary estimates of the impact of angina on quality of life. In addition, we sought to develop a comprehensive state-transition model, calibrated to real world costs and outcomes to compare the cost-effectiveness of initial medical therapy versus PCI with either BMS or DES in patients with stable coronary artery disease. ii We performed a systematic search and meta-analysis of the published literature. Although PCI was associated with an overall benefit on angina relief (odds ratio [OR] 1.69; 95% Confidence Interval [CI] 1.24-2.30), this benefit was largely attenuated in contemporary studies (OR 1.13; 95% CI 0.76-1.68). Our meta-regression analysis suggests that this observation was related to greater use of evidence-based medications in more recent trials. Using simple linear regression, we were able to create a mapping tool that could accurately estimate utility weights from data on the Seattle Angina Question, the most common descriptive quality of life instrument used in the cardiovascular literature. In our economic evaluation, we found that an initial strategy of PCI with a BMS was cost- effective compared to medical therapy, with an incremental cost-effectiveness ratio (ICER) of $13,271 per quality adjusted life year gained. In contrast, DES had a greater cost and lower survival than BMS and was therefore a dominated strategy.

The initial treatment options for patients with stable coronary artery disease include optimal medical therapy alone, or coronary revascularization with optimal medical therapy. The most common revascularization modality is percutaneous coronary intervention (PCI) with either bare metal stents (BMS) or drug-eluting stents (DES). PCI is believed to reduce recurrent angina and thereby decrease the need for additional procedures compared to optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset the increased costs and small increase in adverse events associated with PCI. The objectives of this thesis were to determine the degree of angina relief afforded by PCI and develop a tool to provide contemporary estimates of the impact of angina on quality of life. In addition, we sought to develop a comprehensive state-transition model, calibrated to real world costs and outcomes to compare the cost-effectiveness of initial medical therapy versus PCI with either BMS or DES in patients with stable coronary artery disease. ii We performed a systematic search and meta-analysis of the published literature. Although PCI was associated with an overall benefit on angina relief (odds ratio [OR] 1.69; 95% Confidence Interval [CI] 1.24-2.30), this benefit was largely attenuated in contemporary studies (OR 1.13; 95% CI 0.76-1.68). Our meta-regression analysis suggests that this observation was related to greater use of evidence-based medications in more recent trials. Using simple linear regression, we were able to create a mapping tool that could accurately estimate utility weights from data on the Seattle Angina Question, the most common descriptive quality of life instrument used in the cardiovascular literature. In our economic evaluation, we found that an initial strategy of PCI with a BMS was cost- effective compared to medical therapy, with an incremental cost-effectiveness ratio (ICER) of $13,271 per quality adjusted life year gained. In contrast, DES had a greater cost and lower survival than BMS and was therefore a dominated strategy.

No description available.

No description available.

Clopidogrel is an antiplatelet drug prescribed to prevent stent thrombosis after a percutaneous coronary intervention (PCI). Previous evidence suggests that some widely prescribed statins may inhibit the antiplatelet effects of clopidogrel via competitive metabolism of its activating enzyme cytochrome P450 3A4 (CYP3A4). / The objective was to investigate the possibility of an interaction post-PCI between statins and clopidogrel. / We carried out a population-based cohort study identifying 10,491 patients using clopidogrel post-PCI (2001-2004). The outcome was a composite of death of any cause, myocardial infarction, unstable angina, repeat revascularization, and cerebrovascular events. We found that co-prescription of CYP3A4-metabolized statins (hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.79-1.15), or non-CYP3A4-metabolized statins (HR 0.82, 95% CI 0.63-1.07) with clopidogrel was not associated with increase in adverse outcomes. / We observed no evidence of interaction between clopidogrel and statins in a large population cohort of PCI patients, suggesting unlikelihood of an important interaction.