ABSTRACT
Background: Around 20% of percutaneous coronary interventions (PCIs) are used to treat coronary bifurcation syndromes. Technical success was defined as successfully bridging the occluded portion with a wire and balloon and reopening the artery with a 40% residual stenosis in all views. Technical success is defined by the absence of a serious adverse cardiac event throughout the hospital stay (MACE). The purpose of this study was to evaluate the procedural and clinical results associated with LM bifurcational intervention. Methods: A controlled study was carried out on 100 patients eligible to Left Main bifurcational intervention were included. the patients were divided into two groups according to the stenting technique used, the provisional group (n=70) who managed with one stent strategy, and the non-provisional group (n=30) who managed with a double kissing crush, culotte, T stenting, or TAP technique. This study recorded the incidence of MACE: death, non-fatal myocardial infarction, or target lesion revascularizations were recorded at 6 and 12 months of follow-up. Results: It is insignificantly different mortality incidence between the 2 groups but non-fatal myocardial infarction, stent thrombosis, re-PTCA, and target lesion revascularizations were significantly increased in the non-provisional group. As regards clinical success in 2 groups, this study found 68 patients in the provisional group and 24 patients in the non-provisional group fulfilled the characteristics of clinical success. Conclusions: In LM-bifurcational intervention, there is a significant increase in the incidence of MACE in the non-provisional group and so the clinical outcome is better in the provisional stenting than the non-provisional stenting.
ABSTRACT
Background: ST-Elevation myocardial infarction is a major public health problem and a leading cause of death both in developed and developing countries. The values of hematological biomarkers were evaluated as predictors of in hospital mortality and complications, in patients with acute coronary syndromes (ACS). This study aimed to draw a relationship between different hematological parameters and short-term clinical result in STEMI cases treated by primary percutaneous coronary intervention. Methods: This prospective research involved 100 participants that had a STEMI and were receiving primary PCI and they were subjected to detailed history, general and local examination, resting surface ECG, baseline laboratory tests, reperfusion, transthoracic echocardiogram and follow up of clinical outcome. Results: After STEMI, there was not significantly different between cases with low and high NLR (P <0.4). There was significantly different between cases with low and high NLR after STEMI, low and high MPV [in heart failure, death and rehospitalization] and after STEMI, in diabetic patients and in NLR between low and high MPV groups after STEMI (P < 0.05), there was no significant statistical difference between patients with low and high PDW and after STEMI. LVEF were significant less in participants had MACE (P <0.036). In stepwise multivariate regression analysis of hematological parameters, NLR and MPV were significant predictive factors of MACE (P < 0.05). Conclusions: Hematological and coagulation parameters may be utilized as diagnostic and prognostic indicators. Early risk classification enables doctors to closely monitor and treat high-risk patients, as well as schedule them for regular follow-ups, helping to the reduction of mortality.
ABSTRACT
Despite the high technical expertise in percutaneous mitral commissurotomy [PMC], mitral regurgitation [MR] remains a major procedure-related complication. The aim of this work is to find out the most sensitive and applicable predictors of development of significant mitral regurgitation [SMR] following percutaneous mitral commissurotomy using Inoue balloon technique. We studied the pre-procedural [Clinical, echocardiography, and hemodynamic] and procedural predictors of significant mitral regurgitation [identified as increase of >/= 2/4 grades of pre-PMC MR by color Doppler flow mapping] following valvuloplasty using Inoue balloon in 54 randomized patients with severe mitral stenosis. Multiple stepwise logistic regression analysis was performed for variables found positive on univariate analysis to determine the most important predictor [s] of developing SMR. The incidence of SMR following PMC using Inoue technique was 18.5% [10 patients]. MV scoring systems were the only variables that showed significant differences between both groups [Group A without SMR and Group B with SMR]. However, no clinical, other echocardiographic measurements, hemodynamic or procedural variables could predict the development of SMR. Using multiple regression analysis, the best predictive factor for the risk of SMR post Inoue BMV was the total MR-echo score with a cut-off point of 7 and a predictive percentage of 97.7%. The total MR-echo score is the only independent predictor of SMR following PMC using Inoue technique with a cut-off point of 7