ABSTRACT
Percutaneous balloon mitral valvotomy [BMV] is the gold standard treatment for rheumatic mitral stenosis [MS] in that it causes significant changes in mitral valve area [MVA] and improves leaflet mobility. Development of or increase in mitral regurgitation [MR] is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association [NYHA] functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient [MVPG and MVMG], left atrial [LA] pressure, pulmonary artery systolic pressure [PAPs], and MR severity before and after BMV, were evaluated. Totally, 105 patients [80% female] at a mean age of 45.81 +/- 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure [p value < 0.001] MVA significantly increased [mean area = 0.64 +/- 0.29 cm[2] before BMV vs. 1.90 +/- 0.22 cm2 after BMV; p value < 0.001] and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 [78.1 %] patients, but it increased in 18 [17.1%] and decreased in 5 [4.8%] patients. Patients with increased MR had a significantly higher calcification score [2.03 +/- 0.53 vs. 1.50 +/- 0.51; p value < 0.001] and lower MVA before BMV [0.81 +/- 0.23 vs. 0.94 +/- 0.18; p value = 0.010]. There were no major complications. In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV
ABSTRACT
There are limited data comparing long-term efficacy and safety of OPTIMA tacrolimus-eluting stent [TES] with Dual Antiplatelet Therapy [DAT] in daily practice. Therefore, we evaluated the safety and performance of OPTIMA TES with 2 or 6-month dual antiplatelet therapy in a 12-month follow up period. In a prospective, non-randomized single center registry in which 106 patients that underwent percutaneous coronary intervention with the OPTIMA TES between January 2010 and February 2011 were enrolled. After stenting, 62 patients received DAT for 2 months and the remainder for 6 months. Major Adverse Cardiac Events [MACE], stent thrombosis rate and target lesion revascularization [TLR] were evaluated in a 12-month follow-up period for 2-and 6-month DAT groups. No cases with death, MI or stent thrombosis were observed within the 12-month follow-up period in either of the groups. TLR and MACE rates were higher in 6-month DAT group compared to 2-month group [6.8% vs. 3.2% respectively, P=0.001] which may be due to this group having more diffuse disease [23.60 +/- 5.69 vs. 20.88 +/- 5.14, P=0.018]. OPTIMA tacrolimus-eluting stent is safe and efficient with short term DAT period. A randomized trial is needed for better evaluations of OPTIMA TES in daily clinical practice.
ABSTRACT
Drug-eluting stents [DES] have significantly decreased the need for repeat coronary revascularization but concerns remain regarding the safety of first and second generation DES. We compared the safety and efficacy of a biolimus-eluting stent [with biodegradable polymer] with an everolimus-eluting stent [with durable polymer] one We performed a randomized trial to compare the two types of stents. Two hundred patients undergoing PCI for de novo lesions were randomly assigned 1:1 to treatment with either biolimus-eluting [BioMatrix] or everolimus -eluting [Xience V] stent. The primary endpoint was a composite of cardiac death, myocardial infarction, and clinically driven target vessel revascularization within 12 months. Demographics, clinical, and lesion characteristic were comparable between two groups. The 30-day major adverse cardiac event [MACE] rate was 2% in BioMatrix group versus 0% in Xience group [p > 0.05]. After 12 months, the rates of cardiac death [0% in both groups], MI [2% versus 0%, p=0.49] and clinically -driven target vessel revascularization [0% in both groups] were similar for BioMatrix and Xience. No stent thrombosis was reported at 1, 6, 9 or 12 months after intervention in either group. BES [Biolimus-eluting stent] with biodegradable polymer and EES [Everolimus-eluting stent] with durable polymer appear similar with respect to MACE and stent thrombosis in this patient population. Many studies with longer follow up are needed to define better the role of BES with biodegradable polymer in treatment of coronary artery lesions
ABSTRACT
To assess the association between electrocardiogram [ECG] changes in non-ST-segment elevation acute coronary syndrome [NSTE-ACS] patients with severity of coronary artery disease [CAD] and short-term outcome. In this cross-sectional descriptive -analytical study, 111 patients admitted to the Cardiology Department of Shahid Madani Heart Hospital, Tabriz, Iran between March 2005 and March 2007 with first NSTE-ACS, and had undergone coronary angiography during index event were evaluated. One hundred and eleven patients [64 males, and 47 females] were enrolled, and their in-hospital and short-term outcome with a mean follow-up period 4.6 +/- 1.8 months was evaluated. Patients with ST-T changes on admission had higher rates of death [16.7 versus 2.7%, p=0.01], recurrent angina [36.1 versus 6.7%, p=0.001], and pulmonary edema [8.3 versus 1.3%, p=0.045]. The mean left ventricular ejection fraction [LVEF] of patients with ECG changes were significantly lower than those without ECG changes [p=0.001]. Mitral regurgitatio [MR] was also common among those with ECG changes [p=0.006]. In a multivariate regression analysis, the only independent predictor of short-term mortality and adverse clinical event was ST depression on ECG [p=0.001]. In patients with first NSTE-ACS, ST deviation is associated with adverse short-term outcome including more severe CAD, lower LVEF, and more common MR