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See detailRevascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis.
Windecker, Stephan; Stortecky, Stefan; Stefanini, Giulio G. et al

in BMJ (Clinical research ed.) (2014), 348

OBJECTIVE: To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN: Bayesian network meta-analyses to combine ... [more ▼]

OBJECTIVE: To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN: Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES: Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: 100 trials in 93,553 patients with 262,090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment. CONCLUSION: Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation to a variable degree. Our results provide evidence for improved survival with new generation drug eluting stents but no other percutaneous revascularisation technology compared with medical treatment. [less ▲]

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See detailTreatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study
Linke, Axel; Wenaweser, Peter; Gerckens, Ulrich et al

in European Heart Journal (2014)

Aim Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following ... [more ▼]

Aim Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following implantation of a self-expanding transcatheter aortic valve system in a fully monitored, multi-centre ‘real-world’ patient population in highly experienced centres. Methods and results Patients with severe aortic stenosis at a higher surgical risk inwhomimplantation of theCoreValve Systemwas decided by the Heart Teamwere included. Endpointswere a composite of major adverse cardiovascular and cerebrovascular events (MACCE; all-cause mortality, myocardial infarction, stroke, or reintervention) and mortality at 30 days and 1 year. Endpoint- related eventswere independently adjudicated based on Valve AcademicResearch Consortiumdefinitions.Atotal of 1015 patients [mean logistic EuroSCORE 19.4+12.3% [median (Q1,Q3), 16.0% (10.3, 25.3%)], age 81+6 years] were enrolled. Implantation of the CoreValve System led to a significant improvement in haemodynamics and an increase in the effective aortic valve orifice area. At 30 days, theMACCErate was 8.0% (95% CI: 6.3–9.7%), all-cause mortalitywas 4.5% (3.2–5.8%), cardiovascular mortality was 3.4% (2.3–4.6%), and the rate of stroke was 3.0% (2.0–4.1%). The lifethreatening or disabling bleeding rate was 4.0% (2.8–6.3%). The 12-month rates of MACCE, all-cause mortality, cardiovascular mortality, and stroke were 21.2% (18.4–24.1%), 17.9% (15.2–20.5%), 11.7% (9.4–14.1%), and 4.5% (2.9–6.1%), respectively. The 12-month rates of all-cause mortality were 11.1, 16.5, and 23.6% among patients with a logistic Euro- SCORE ≤10%, EuroSCORE 10–20%, and EuroSCORE .20% (P , 0.05), respectively. Conclusion The ADVANCE study demonstrates the safety and effectiveness of the CoreValve System with low mortality and stroke rates in higher risk real-world patients with severe aortic stenosis. [less ▲]

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See detailSurgical or percutaneous revascularization for isolated left anterior descending stenoses: are we in the same boat?
Stefanini, Giulio; Windecker, Stephan; Kolh, Philippe ULg

in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2014)

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See detailLinee guida per il trattamento delle valvulopatie (versione 2012). Task Force congiunta per il Trattamento delle Valvulopatie della Societa Europea di Cardiologia (ESC) e dell'Associazione Europea di Chirurgia Cardiotoracica (EACTS).
Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita et al

in Giornale Italiano di Cardiologia (2006) (2013), 14(3), 167-214

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See detailGrupo de Trabajo para el manejo del infarto agudo de miocardio con elevacion del segmento ST de la Sociedad Europea de Cardiologia (ESC).
Steg, Gabriel; James, Stefan K.; Atar, Dan et al

in Revista Espanola de Cardiologia (2013), 66(1), 531-5346

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See detail2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
Montalescot, Gilles; Sechtem, Udo; Achenbach, Stephan et al

in European heart journal (2013), 34(38), 2949-3003

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See detailActualizacion de las guias de la Sociedad Europea de Cardiologia (ESC) para el manejo de la fibrilacion auricular de 2010 Elaborada en colaboracion con la Asociacion Europea del Ritmo Cardiaco.
Camm, A. John; Lip, Gregory Y. H.; Caterina, Raffaele De et al

in Revista espanola de cardiologia (2013), 66(1), 541-5424

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See detailGuidelines on the management of valvular heart disease (version 2012).
Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita et al

in European Heart Journal (2012), 33(19), 2451-96

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See detailThird universal definition of myocardial infarction.
Thygesen, Kristian; Alpert, Joseph S.; Jaffe, Allan S. et al

in Journal of the American College of Cardiology (2012), 60(16), 1581-98

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See detailGuidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita et al

in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2012), 42(4), 1-44

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See detailESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC).
Regitz-Zagrosek, Vera; Blomstrom Lundqvist, Carina; Borghi, Claudio et al

in European Heart Journal (2011), 32(24), 3147-97

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