In-hospital course of early invasive strategy in acute coronary syndromes

Unstable angina is emerging as a major public health problem worldwide. Two approaches - an early invasive strategy or a conservative strategy - are used of the management of non-ST elevation acute coronary syndrome [MSTE-ACS]. An early invasive strategy involves the use of early coronary angiography and revascularization with percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]. A conservative strategy involves initial treatment with aggressive pharmacologic treatment, and coronary angiography with revascularization is used if there is evidence of spontaneous or provoked ischemia within the hospital stay. Two hundred sixty-one patients coronary syndrome were enrolled in this study for early invasive strategy. Patients received aspirin, heparin, clopidogrel, and lipid-lowering therapy. The primary endpoint was a composite of death, non-fatal myocardial infarction, cerebrivascular accident, and recurrent chest pain. Angiograms were assessed qualitatively by two expert invasive cardiologists. Sixty-seven percent of the patients underwent percutaneous [33%] or surgical [34%] revascularization. The overall death rate was 1.1%. In-hospital major adverse cardiac event [MACE] rate was 3.2% in the revascularization groups. According to the favorable in-hospital course in patients referred for PCI or CABG, it seems that accurate selection of patients who may be candidates for early invasive strategies is of paramount importance. We found that diabetes, cardiac enzyme elevations [Troponin T], ST/T changes, and the presence of two or more risk factors besides diabetes are powerful predictors of the patients who will undergo revascularization. Proper selection of patients admitted with ACS for invasive strategy is warranted. Positive cardiac enzymes [Troponin T], diabetes mellitus, and presence of two or more major CAD risk factors are helpful for patient selection

Frequent oversizing during Amplatzer device deployment for percutaneous PDA closures

Transcatheter closure of small to moderate patent ductus arteriosus [PDA] has been well established during this last decade. The Amplatzer device occluder [ADO] is self-expandable device with ease of delivery and a rapid learning curve. The aim of the study was to access the optimum sizing of ADO in regard to maximum efficacy with respect to shunt occlusion without oversizing and reducing bulk and potential protrusions. From April 2007 to July 2008, a total of twenty-four adult PDA closures were reviewed. Occlusion was achieved via antegrade venous approach. Our primary objective was an evaluating of optimum ADO sizing for PDA closures. We retrospectively compared the patients with a theoretical optimum size as regards complications and residual shunts. PDA size determination was based on the smallest diameter at pulmonary artery [PA] side. Based on specific criteria, undersizing was not observed in our cases, while oversizing was noted in 42% of cases. Oversizing did not lead to a decrease in residual shunts [37.5% vs. 36%, p=NS]. Although no short-term complications were observed in the oversized group, oversizing resulted in a characteristic mushroom deformity due to unnecessary tension applied to our device. The Chinese device also performed well in terms of deployment and short-term complications with no significant difference in comparison to its American counterpart [p=NS]. An acceptable rate of acute complications was obtained; nonetheless, we were frequently oversizing, leading to mild device deformation and protrusion. Although not previously described in the literature, the terminal ballooning of the ADO should alert us of such a complication

Detection of atherosclerotic plaque composition using intravascular images

Acute coronary syndromes [ACS] and sudden cardiac death are the main causes of morbidity and mortality in the world. ACS are often the first manifestation of coronary artery disease, and the rupture of a coronary plaque is the main cause of ACS. Histopathological studies have revealed that the majority of thrombi result from plaque rupture. Grayscale intravascular ultrasonography [IVUS], a tomographic imaging tool, can visualize coronary atherosclerosis in vivo, elucidating plaque area, plaque distribution, lesion length, and coronary remodeling. IVUS has demonstrated the discrepancies between the extent of atherosclerosis seen by coronary angiography and the actual extent of atherosclerotic disease. Quantitative assessment of plaque composition has, however, not been possible with grayscale IVUS analysis, until now