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Introduction@#In 1987 Jerome Ritchie, David Auth and colleagues first introduced rotational atherectomy (rotablation) as a technique for the endovascular treatment of obstructive atherosclerotic disease. Rotational atherectomy covers 3-5% of all procedures in big PCI centers, while <1% in smaller centers. By study of Warth DC et al. in 1994, at early period when it was first introduced, procedure complication of rotablation was about 40%, those with coronary dissection 29%, coronary artery occlusion 11.2%, side branch occlusion 1.8%, distal occlusion 0.9%, no relow phenomenon 6.1%, severe vasospasm 13.8% and vascular perforation 1-2%. </br> By advanced techniques and technologies that kind of complications reduced significantly, it occurs as same as other PCI procedures. </br> In our country PCI procedure was first introduced in Third State Central Hospital in 2000, since then 20 years has passed. During this period coronary intravascular diagnosis and treatment developed progressively performing 14751 PTCA procedures, of those 8355(56,6%) PCI cases. By statistics of 2017, myocardial infarction occurred 1145.6 in 10000 population, showing sharp increase, and cardiovascular mortality became number one cause and has tendency to increase further.</br> To inform first outcome of rotational atherectomy of atherosclerosis that is severely calcified and unavailable to introduce balloon catheter or stent. To conduct atherectomy treatment methods, accustoming professionals, order and get ready the treatment materials for necessity.</br> We successfully performed rotablation in severely calcified mLAD of 56 years of male patient by staged PCI, whose infarct related artery Lcx was revascularized 3 months previously. As a result the patient was fully revascularized, the balloon catheter passed through the narrowing and stent was implanted successfully.
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@#BACKGROUND: Acute myocardial infarction is leading cause of global morbidity and mortality and major health care burden in worldwide. Previous studies demonstrated that restoration of myocardial tissue perfusion after primary PCI is significant factor of improved outcome. In Mongolia, studying long term effects of primary PCI in patients with AMI and its’ association with coronary blood flow, tissue Doppler imaging, left ventricular global strain pattern in speckle-tracking echocardiography and risk factors are essential in theoretical and clinical practice. AIMS: To determine long term effects of primary PCI in patients with AMI and its’ association with left ventricular strain pattern in speckle-tracking echocardiography, risk factors and patient prognosis. METHODS: We used prospective cohort study design. We were selected 414 patients with AMI who treated by primary PCI between 2015 and 2016 at the State Third Central Hospital. Echocardiographic examination was conducted on Philips iE33 xMATRIX ultrasound machine. The PCI was performed according to the MNS:6379-2013 standard. RESULTS: Mean age was 60±13 and majority of them were male 84% (n=347). Complete coronary perfusion (TIMI-3) was achieved in patients 88% (n=367) after primary PCI. There was weak, negative correlation between coronary TIMI flow grade and left ventricular global longitudinal strain (r=-0.183, CI 95% -0.289 to-0.066, p<0.001). In patients with incomplete coronary perfusion (TIMI<3), mortality rate was significantly higher during 24 months follow-up. After primary PCI, 24 months mortality was 9.9% (n=39). Cut-off value of left ventricular global longitudinal strain which predict long term (within 24 month follow-up) mortality was -12.93% (sensitivity 74.4%, specificity 74.3%). Mortality during 24 months follow-up was significantly different between left ventricular global longitudinal strain groups (log-rank test p<0.001) and mortality was higher in left ventricular global longitudinal strain ≥ -12.93% group. CONCLUSION: Coronary no-reflow phenomenon is associated with long term mortality in patients with AMI. In patients with AMI who treated by PCI, long term mortality is predictable with left ventricular global longitudinal (≥-12.93%, p<0.001) strain.
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@#BACKGROUND. The aim of this study was to investigate the prognostic impacts of drug-eluting stents (DES) and bare-metal stents (BMS) in patients undergoing percutaneous coronary intervention (PCI) and risk factors of stent restenosis. MATERIAL AND METHODS. We conducted a retrospective cohort study based on the Angiographic diagnostic and treatment Department of 3rd State Central Hospital of Mongolia. Patients who had undergone coronary stenting between 2000 and 2017 were recruited and monitored until the end of 2010. RESULTS. Among a total of 4520 selected patients with a mean age of 58±7 years, 2125 subjects had BMS and 2395 subjects had DES. The incidence of stent restenosis and stent thrombosis were significantly lower in the DES (37; 1,5%) group as compared with the BMS (201; 9,4%) group. Patients who have stent restenosis presented comorbidities, such as diabetes 214(47,8%), hypertension 54(22,6%), prior PCI 21(8,2%), re-infarction 12(5,04%), chronic kidney disease 16(6,7%), hyperlipidemia 21(8,2%). СONCLUSION. Implantation of DES was related to better outcomes than for BMS, in terms of reducing restenosis and stent thrombosis after PCI. STEMI patients who have co morbidities have greater risk of stent stenosis and thrombosis
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BackgroundThe cardiovascular disease is leading cause of mortality and constantly increasing every year forpast decades. In 2014, cardiovascular diseases were the leading cause of NCD deaths (17.5 milliondeaths) [7] In Mongolia cardiovascular disease is also leading the cause of mortality and morbidity.It is increasing every year, 479.4 per 10000 population in 2012 was increased to 848.1 per 10000population in 2013 [1, 2].Dr.Jerardin, prof. Z.Lkhagvasuren implanted first stent in Mongolia in 2000. There is rapiddevelopment in interventional cardiology treatment since then.Material and MethodsSince 2011 until 2015, total of 4545 coronary angiography, 2322 stent implantation was performed.This study has included the patients of last 5 years. Total of 1257 patients who were treated with AMIduring 2011 to 2015 at the Third central State Hospital were analyzed.Results73.7% of the patients had left coronary artery disease and 26.3% had right coronary artery disease.Tis findings were similar with other local researcher’s study [3, 4].59.4% of the occlusions were 75-99% stenosis, 23.5% had total occlusion. 62.9% of LAD occlusionwere stenosis over 75%. It demonstrated majority of cases performed were high severe lesions. Thisalso may be demonstrating that patients are receiving treatment in their late stage of the disease.Every stage complication such as mortality, was 3.5%, complication such as restenosis followingone month of after stent implantation was 9-13.1%. Overall mortality rate has decreased each year,11.9% in 2011, 7.8% in 2012, and 4.6% in 2013 relatively. General achievement is now 88.1-95.4%,which is comparable to other countries.Conclusion1257 patients presented with acute myocardial infarction were studied: 880 (70, 0%) were male, 377(30, 0%) were female. Mean age of patients was 55, 08±1, 23; it was 75 patients had no risk factors,751 patients with 1-2 risk factors, 431 patients with 3 or more risk factors. Angiographic distributionof lesion shows 74, 4% had LAD disease, 64, 5% had RCA disease, 25, 8% had LCX lesion, 12, 9%had dialonal LCA lesion.
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Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.
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The Cardiovascular disease is leading the cause of mortality and morbidity and constantly increasingevery year for past decades. World wide 32 million people gets acute heart attack and 2.5 million deaths occur every year due to AMI. In Mongolia Cardiovascular disease is also leading the cause of mortality and morbidity. It is dramatically increasing every year, 479.4 per 10,000 population in 2012 was increased to 848.1 per 10,000 population in 2013. Dr.B.Jerardin, Prof.Z.Lkhagvasuren and his junior L.Jargalsaikhan jointly implanted first stent inMongolia in 2010. There is rapid development in interventional treatment skills since then. Since 2000 until 2014, total of 3791 coronary angioraphy, 1841 stent implantations was performed.This study has included the patients of last 5 years. Total of 898 patients who are treated with AMI during October 2010 to October 2014 at Third State Central Hospital were analyzed. 73.7% of the patients had left coronary artery disease and 26.3% had right coronary disease. Thisfinding was same with other local researchers study (Galtsog et al. 1987, D.Narantuya et al. 2001).59.4% of the occlusions were 75-99% stenosis, 23.5% had total occlusion. 62.9% of the LAD occlusionwere stenosis of over 75%. It demonstrated majority of the cases performed were high severe lesions.This also may be demonstrating that patients are receiving treatment in their late stage of the disease. Early stage complication such as mortality, restenosis was 3.5%, complication within following one month of after stent implantation was 9-13.1%. Overall mortality rate has decreased each year, 11.9% in 2010, 7.8% in 2012, 4.6% in 2013 relatively. General achievement is now 88.1%-95.4%, which is comparable to other countries.Implementation of coronary procedures in daily practice was one of the major achievements in thecardiovascular field in Mongolia. Patients from capital city are relatively been able to receive coronaryinterventional treatment within 12 hours of onset. However, patients arriving golden standard timingis not sufficient enough as well there are still major concerns for patients living in distant rural areas.
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Background: Continuous positive airway pressure (CPAP) can improve left and right ventricular (LV and RV) func¬tion in patients with congestive heart failure (CHF). Material and Methods: We have chosen 30 patients with CHF who were treated in Department of Cardiology, Shastin’s Central hospital. CHF etiology was ischemic and dilatation cardiomyopathy. Baseline respiratory rate, SpO2, heart rate, systolic and diastolic blood pressure, cardiac output, ejection fraction and Tricuspid Annular Plane Systolic Excursion (TAPSE) values were noted. All the measurements were repeated at the end of CPAP. Statistical analysis: Statistical analysis performed by SPSS 17.0 program and we compared pre and post CPAP findings. P<0.05 was considered to be significant. Results: After CPAP patients respiratory rate decreased from 23.63±4.72 to 20±3.74 per minute (р=0.01), SpO2 increased from 91.25±4.1% to 98.25±1.16%, heart rate decreased from 86.75±8.28 to 77.38±7.35 per minute (p=0.05), systolic blood pressure decreased from 107.88±17.94 mmHg to 97.75±14.78 mmHg (p=0.01), diastolic blood pressure decreased from 81.13±17.16 mmHg to 73.38±15.89 mmHg (p=0.01), cardiac output increased from 5.57±1.55 l/min to 5.76±1.86 l/min (p=0.01), ejection fraction increased from 27.81±7.66% to 31.7±7.97% (p=0.05), TAPSE increased from 1.49±0.25 mm to 1.69±0.23 mm (p=0.01) respectively. Pearson’s coefficient between dia¬stolic blood pressure and cardiac output is -0.282, between diastolic blood pressure and ejection fraction is -0,493, between diastolic blood pressure and TAPSE is -0.581 respectively. Conclusion: CPAP improves LV, RV function and some respiratory parameters in patients with CHF