ABSTRACT
BACKGROUND AND OBJECTIVES: We evaluated the efficacy and safety of the left transradial approach as compared to the right radial approach when performing transradial coronary intervention. SUBJECTS AND METHODS: We performed the transradial coronary intervention in 711 cases via the left approach (Lt. group) and in 614 cases via the right approach (Rt. group) for patients with a normal Allen's test of both arms. We evaluated the procedural success rate, the crossover rate, the puncture time, the total procedural duration, the fluoroscopy time, the amount of contrast agent used and the local vascular complications of both groups. RESULTS: The baseline clinical and angiographic profiles were comparable between both groups. The puncture time, the amount of contrast agent used, choice of the guide catheter and local vascular complications were similar for the two groups. There was no difference in the procedural success rate (Rt. group; 96.4% vs. Lt. group; 96.2%, p=NS). However, there was tendency for a higher success rate via radial access for the Lt. group than for the Rt. group (Rt. group; 91.9% vs. Lt. group; 93.5%, p=0.056). The crossover rate was lower for the Lt. group than for the Rt. group (2.7 % vs. 4.6%, respectively; p=0.04). The total procedural time (32.3+/-15.4. vs. 30.7+/-17.6 min, respectively; p=0.03) and fluoroscopy time (16.9+/-12.6 vs. 13.9+/-7.9 min, respectively; p<0.01) were shorter in the Lt. group. The number of guide catheters used was higher in the Rt. group compared to the Lt. group (1.21+/-0.48 vs. 1.08+/-0.33, respectively; p=0.04). CONCLUSION: The left radial approach may provide increased procedural efficacy for transradial PCI compared to the right radial approach along with similar complications.
Subject(s)
Humans , Angioplasty , Arm , Catheters , Coronary Vessels , Fluoroscopy , Punctures , Radial ArteryABSTRACT
BACKGROUND AND OBJECTIVES: A correlation between the BNP reduction ratio and prognosis could be expected to be found by evaluating the BNP reduction depending on the volume status during the early period. SUBJECTS AND METHODS: Between October 2002 and June 2004, 120 patients with acute heart failure (AHF)(<1 month) were included. The patients were divided into three groups according to their volume status, as follows. Group I: patients with clinical & radiological wet status, Group II: clinical dry & radiological wet status and Group III: clinical & radiological dry status. The blood BNP (Triage(r)) level and clinical parameters were analyzed. The bad prognostic parameters were defined as readmission due to heart failure, a major adverse cardiac event or cardiovascular death. RESULTS: The mean patient age was 68.0+/-12.7 years, and 50.0% of the subjects were male. The most frequent etiology of AHF was ischemic heart disease (35.8%). There were 61.7, 24.1 and 14.2% in Groups I, III and III, respectively. The baseline BNP level was higher in group I and II than in group III patients (I: 1540.4+/-1202.8, II: 1482.8+/-1281.6, III: 666.4+/-827.9 pg/mL, p=0.036) as was the early BNP reduction ratio (I: 69.8+/-27.1, II: 67.4+/-32.8, III: 1.3+/-144.9%, p=0.007). Sixteen (13.3%) patients had a poor prognosis. From a logistical analysis, the early BNP reduction ratio (p=0.004) and creatinine level (p=0.029) were significant predictors of the clinical outcomes. CONCLUSION: The early change in the BNP level varied depending on the degree of congestive status, and was also correlated with the level of clinical outcomes. Therefore, in our opinion, the early monitoring of the BNP level will provide significant clinical information in AHF patients.
Subject(s)
Humans , Male , Creatinine , Estrogens, Conjugated (USP) , Follow-Up Studies , Heart Failure , Heart , Myocardial Ischemia , Natriuretic Peptide, Brain , PrognosisABSTRACT
BACKGROUND AND OBJECTIVES: The stent material and thickness may influence the rate of restenosis following coronary artery stenting. A thin strut cobalt-alloy stent has been developed in an attempt to reduce the restenosis rate, while maintaining the radiopacity and radial strength. The purpose of this study was to compare a stainless steel Core(r) stent (thickness: 90 micrometer/HUMED Co. Ltd, Korea) with that of a cobalt alloy Core(r) stent (thickness: 60 micrometer/HUMED Co. Ltd, Korea) in a porcine coronary stent restenosis model. MATERIALS AND METHODS: The cobalt alloy (Co-alloy) and stainless steel (SS) stents were implanted in 24 porcine coronary arteries. Four weeks after stenting, the pigs were sacrificed after quantitative coronary angiography (QCA). The coronary arteries were perfusion-fixed and stained, and a pathological examination performed by computer-aided histomorphometry. RESULTS: The minimal luminal diameter at 4 weeks was larger in the Co-alloy than the SS group according to the QCA (1.8+/-0.8 mm vs. 2.7+/-0.8 mm, p=0.019). The neointimal area was significantly smaller in the Co-alloy than the SS group (1.96+/-0.68 mm2 vs. 0.89+/-0.27 mm2, p<0.001). The intima/media area ratio was significant lower in the Co-alloy than the SS group (1.33+/-0.46 vs. 0.69+/-0.21, p=0.003). CONCLUSION: The thin strut cobalt alloy Core(r) stent significantly reduces the neointimal formation compared to the stainless steel Core(r) stent in a porcine coronary stent injury model.
Subject(s)
Alloys , Cobalt , Coronary Angiography , Coronary Restenosis , Coronary Vessels , Models, Animal , Phenobarbital , Stainless Steel , Stents , SwineABSTRACT
BACKGROUND AND OBJECTIVES: Plasma B-type natriuretic peptide (BNP) can be increased in patients with renal insufficiency (RI). The aim of this study was to evaluate the diagnostic value of BNP for systolic heart failure (HF) in patients with moderate to severe RI. SUBJECTS AND METHODS: Between Aug 2002 and May 2004, 433 patients found to have systolic HF or moderate to severe RI were included. The patients were divided into 3 groups (group I; only HF, group II; only RI, group III; HF and RI). The severity of RI was graded according to the calculated creatinine clearance (Ccr); moderate 30< or =Ccr<60, severe 15< or =Ccr<30 or end stage renal disease (ESRD) Ccr<15 mL/min. RESULTS: The mean age of the patients was 67.6+/-12, and 49% were male. There were significant differences in the mean BNP levels between group III and the other two groups (p<0.001); group I (n=65, 837.3+/-884), group II (n=137, 1049.4+/-1332) and group III (n=231, 1738.3+/-1501 pg/mL). A weak negative correlation was note between BNP and Ccr (r=-0.335, p<0.001) in patients with RI. As the renal function deteriorated, the mean BNP of groups II and III was found to be elevated (moderate 625.5+/-574, 1183.0+/-1056; severe 760.5+/-1211, 2205.4+/-1470; ESRD 2157.6+/-1831, 3209.9+/-1900 pg/mL, p<0.05), with the mean BNP of group III being higher than that of group II for each grade (p<0.05). From the ROC curve, the optimal cut-off point of BNP for the diagnosis of systolic HF in patients with RI was 829 pg/mL (accuracy 68%, sensitivity 66% and specificity 70%, p<0.001). CONCLUSION: In the case of patients with moderate to severe RI, a higher BNP cut-off point for the diagnosis of systolic HF and a relatively lower diagnostic accuracy of BNP should be considered.
Subject(s)
Humans , Male , Creatinine , Diagnosis , Heart Failure , Heart Failure, Systolic , Kidney Failure, Chronic , Natriuretic Peptide, Brain , Plasma , Renal Insufficiency , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND AND OBJECTIVES: In the early phase of acute chest pain, the diagnosis of acute coronary syndrome (ACS) is often difficult to achieve in an emergency department (ED) due to the non-diagnostic ECG and cardiac markers. Ischemia modified albumin (IMA) has recently been shown to be a sensitive early biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA for the patients with suspected ACS and who have normal ECG/cardiac markers. SUBJECTS AND METHODS: We enrolled 142 consecutive patients who presented to the ED due to suspected ACS, and they had a normal EKG and troponin-I/CK-MB within 5 hours after the onset of their chest pain. The diagnosis of ACS was based upon the clinical findings, the results of serial ECG/troponin and the coronary angiography. The ideal cutoff value of IMA for ACS was calculated by the receiver operator characteristic (ROC) curve analysis. RESULTS: The ACS was diagnosed in 80/142 (56%). The ROC curve area for the IMA test was 0.77 (CI; 0.70-0.85, p<0.01). At a cutoff value of 98.5 U/mL, the sensitivity, specificity and negative predictive values for ACS were 73%, 75% and 75%, respectively. At a cutoff value of 85 U/mL, the sensitivity and specificity and negative predictive values for ACS were 92%, 35% and 95%, respectively. CONCLUSION: IMA might be a useful diagnostic marker of ACS for those patients with normal ECG/cardiac markers and who present within 5 hours after the onset of chest pain.
Subject(s)
Humans , Acute Coronary Syndrome , Biomarkers , Chest Pain , Coronary Angiography , Coronary Disease , Diagnosis , Electrocardiography , Emergency Service, Hospital , Ischemia , Myocardium , ROC Curve , Sensitivity and SpecificityABSTRACT
An acute thromboembolism of the peripheral artery is a common complication in patient with inappropriately treated atrial fibrillation. A case of successful recanalization of a thromboembolic occlusion of the left common femoral artery, using the PercuSurge GuardWire(TM) System, with a 7 Fr. guiding catheter, was experienced in a patient with atrial fibrillation.