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3.
Arq. bras. cardiol ; 117(3): 503-510, Sept. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1339182

ABSTRACT

Resumo Fundamento: Os efeitos benéficos do elabela no sistema cardiovascular foram demonstrados em estudos. Objetivo: Comparar os níveis séricos de elabela de pacientes com oclusão total crônica (OTC) com pacientes controle com artérias coronárias normais e investigar se há correlação com o desenvolvimento colateral. Métodos: Estudo transversal e prospectivo. O estudo incluiu cinquenta pacientes (28,0% mulheres, idade média 61,6±7,3 anos) com OTC em pelo menos um vaso coronário e 50 pacientes (38% mulheres, idade média 60,7±6,38 anos) com artérias coronárias normais. Os pacientes do grupo OTC foram divididos em dois grupos: Rentrop 0-1, composto por pacientes com fraco desenvolvimento colateral e Rentrop 2-3, composto por pacientes com bom desenvolvimento colateral. Além da idade, sexo, características demográficas e exames laboratoriais de rotina dos pacientes, foram medidos os níveis de elabela. Resultados: As características demográficas e os valores laboratoriais mostraram-se semelhantes em ambos os grupos. Ao passo que o nível médio de NT-proBNP e troponina estava maior no grupo OTC, o nível médio de elabela estava menor (p<0,05 para todos). Na análise de regressão multivariada, os níveis de NT-proBNP e elabela foram considerados preditores independentes para OTC. Além disso, o nível de elabela apresentou-se estatisticamente maior em pacientes do grupo Rentrop 2-3 em comparação com os pacientes do grupo Rentrop 0-1 (p<0,05). Conclusões: Em nosso estudo, mostramos que o nível médio de elabela estava baixo em pacientes com OTC em comparação com pacientes normais. Além disso, constatamos que o nível de elabela é inferior em pacientes com desenvolvimento colateral fraco em comparação com pacientes com bom desenvolvimento colateral. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Abstract Background: The beneficial effects of Elabela on the cardiovascular system have been shown in studies. Objective: To compare serum Elabela levels of chronic total occlusion (CTO) patients with control patients with normal coronary arteries, and to investigate whether there is a correlation with collateral development. Methods: The study was planned cross-sectionally and prospectively. Fifty patients (28.0% female, mean age 61.6±7.3years) with CTO in at least one coronary vessel and 50 patients (38% female, mean age 60,7±6.38 years) with normal coronary arteries were included in the study. Patients in the CTO group were divided into two groups as Rentrop 0-1, those with weak collateral development, and Rentrop 2-3 with good collateral development. In addition to the age, sex, demographic characteristics and routine laboratory tests of the patients, Elabela levels were measured. Results: Demographic characteristics and laboratory values were similar in both groups. While the mean NT-proBNP and troponin were higher in the CTO group, the Elabela mean was lower (p <0.05 for all). In the multivariate regression analysis, NT-proBNP and Elabela levels were found to be independent predictors for CTO. Also, Elabela level was found to be statistically higher in Rentrop class 2-3 patients compared to Rentrop class 0-1 patients (p<0.05). Conclusion: In our study, we showed that the average Elabela level was low in CTO patients compared to normal patients. In addition, we found the level of Elabela to be lower in patients with weak collateral development compared to patients with good collateral development. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Subject(s)
Humans , Male , Female , Aged , Coronary Occlusion , Angina, Stable , Chronic Disease , Multivariate Analysis , Coronary Angiography , Collateral Circulation , Coronary Vessels , Middle Aged
4.
Int. j. med. surg. sci. (Print) ; 8(3): 1-11, sept. 2021. tab
Article in Spanish | LILACS | ID: biblio-1292472

ABSTRACT

El intervencionismo coronario se asocia a la aparición de nefropatía inducida por contraste. El propósito del estudio fue evaluar el riesgo de desarrollar nefropatía inducida por contraste (NIC) en pacientes con obstrucción coronaria significativa y su relación con factores de riesgo conocidos para esta nefropatía. Se diseñó un estudio de cohorte prospectiva con 160 pacientes atendidos en el cardiocentro del hospital "Hermanos Ameijeiras", Cuba, a los cuales se les realizó una coronariografía invasiva, entre enero 2016 y julio 2017. La edad promedio fue de 61,6 ± 9,2 años; el 70,6% eran hombres. Predominaron los antecedentes patológicos personales de cardiopatía isquémica (85,6%), y de hipertensión arterial (75,6%). El 75% de los casos presentó una oclusión coronaria significativa. La frecuencia de nefropatía por contraste fue de 42,5%. Los factores que guardaron importante relación estadística con la presencia de oclusión arterial significativa fueron la cardiopatía isquémica conocida (p<0,001), el intervencionismo coronario percutáneo previo (p=0,007), la creatinina después (p=0,043) y la NIC (p=0,016) así como el volumen de contraste administrado (p=0,006). En el subgrupo de pacientes con oclusión significativa el hematocrito bajo (p=0,025) y el intervencionismo coronario percutáneo de urgencia (p=0,007) fueron los factores más influyentes. Se concluye que los pacientes con oclusión coronaria significativa tienen un riesgo aumentado para el desarrollo de la nefropatía por contraste. La corrección de aquellos factores de riesgo que sean modificables (como el hematocrito bajo) y la correcta aplicación del protocolo de hidratación son esenciales para prevenir esta complicación.


Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the "Hermanos Ameijeiras" hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication


Subject(s)
Humans , Male , Female , Contrast Media/adverse effects , Coronary Occlusion , Acute Kidney Injury , Prospective Studies , Risk Factors
6.
Chinese Medical Journal ; (24): 302-308, 2020.
Article in English | WPRIM | ID: wpr-878044

ABSTRACT

BACKGROUND@#The development of the technique has improved the success rate of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). However, long-term outcomes remain unclear. The present study sought to investigate long-term outcomes of PCI for IS-CTO.@*METHODS@#A total of 474 IS-CTO patients were enrolled at two cardiac centers from 2015 to 2018 retrospectively. These patients were allocated into either successful or failed IS-CTO PCI groups. The primary endpoint (major adverse cardiac events [MACE]) consisted of recurrent angina pectoris (RAP), target-vessel myocardial infarction (MI), heart failure, cardiac death, or ischemia-driven target-vessel revascularization (TVR) at follow-up. Multivariable Cox regression analysis was used to investigate the association between treatment appropriateness and clinical outcomes.@*RESULTS@#A total of 367 patients were successfully treated with IS-CTO PCI while 107 patients had failed recanalization. After a median follow-up of 30 months (interquartile range: 17-42 months), no significant difference was observed between the two groups for the following parameters: cardiac death (successful PCI vs. failed PCI: 0.9% vs. 2.7%; adjusted hazard ratio [HR]: 1.442; 95% confidence interval [CI]: 0.21-9.887; P = 0.709), RAP (successful PCI vs. failed PCI: 40.8% vs. 40.0%; adjusted HR: 1.025; 95% CI: 0.683-1.538; P = 0.905), heart failure (successful PCI vs. failed PCI: 6.1% vs. 2.7%; adjusted HR: 0.281; 95% CI: 0.065-1.206; P = 0.088), target-vessel related MI (successful PCI vs. failed PCI: 1.5% vs. 2.7%; adjusted HR: 1.150; 95% CI: 0.221-5.995; P = 0.868), MACE (successful PCI vs. failed PCI: 44.2% vs. 45.3%; adjusted HR: 1.052; 95% CI: 0.717-1.543; P = 0.797). More patients were free of angina in the successful IS-CTO PCI group compared with failed PCI in the first (80.4% vs. 60%, P 18 months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of TVR (HR: 2.682; 95% CI: 1.295-5.578; P = 0.008) or MACE (without TVR) (HR: 1.898; 95% CI: 1.036-3.479; P = 0.038) in successful IS-CTO PCI.@*CONCLUSIONS@#After a median follow-up of 30 months, the successful IS-CTO PCI group had MACE similar to that of the failed PCI group. However, the successful IS-CTO PCI group had improved angina symptoms and were free from requiring coronary artery bypass grafting in the first or second years. To decrease MACE, DAPT was found to be essential and recommended for at least 18 months for IS-CTO PCI.


Subject(s)
Chronic Disease , Coronary Occlusion/surgery , Follow-Up Studies , Humans , Myocardial Infarction , Percutaneous Coronary Intervention , Retrospective Studies , Risk Factors , Stents , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-828515

ABSTRACT

de Winter syndrome is a special equivalent of anterior ST-segment elevation myocardial infarction (STEMI) characterized by the absence of overt ST-elevation with upsloping ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often associated with total occlusion of the proximal left anterior descending coronary artery. Herein we present a case of de Winter syndrome in a 63-year-old man, whose initial ECG showed no ST-segment elevation, but subsequent coronary angiography confirmed total occlusion of the proximal LAD coronary artery. The patient was successfully treated via mechanical reperfusion therapy and stenting through percutaneous coronary intervention (PCI). de Winter syndrome is associated with a high mortality often due to insufficient awareness of this condition by clinicians. Immediate reperfusion therapy by PCI is the life-saving treatment for the patients diagnosed with this syndrome, and prompt recognition of the ECG pattern is critical to ensure the timely administration of the therapy.


Subject(s)
Coronary Angiography , Coronary Occlusion , Diagnostic Imaging , Therapeutics , Electrocardiography , Humans , Male , Middle Aged , Myocardial Reperfusion , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Stents , Treatment Outcome
8.
Rev. bras. cir. cardiovasc ; 34(6): 645-652, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057499

ABSTRACT

Abstract Objective: To perform a systematic review and meta-analysis of studies comparing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical treatment (MT) in patients with chronic total occlusions (CTOs). Methods: We identified eligible observational studies published in the China National Knowledge Infrastructure database, PubMed, Excerpta Medica database, Google Scholar, Cochrane Library, Web of Science, and "Clinical trials" registration from 1999 to October 2018. Main outcome measures were all-cause mortality, cardiac death, major adverse cardiac events (MACEs), and myocardial infarction (MI). Results: There were eight observational studies including 6985 patients. Patients' mean age was 64.4 years. Mean follow-up time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients) presented decreased all-cause mortality (odd ratio [OR]: 0.46, 95% confidence interval [CI]: 0.36-0.60; P<0.001), cardiac death (OR: 0.40, 95% CI: 0.31-0.52; P<0.001), MACE (OR: 0.55, 95% CI: 0.43-0.71; P<0.001), and MI (OR: 0.40, 95% CI: 0.26-0.62; P<0.001). Comparing with MT, CABG (613 patients) presented lower all-cause mortality (OR: 0.50, 95% CI: 0.36-0.69; P<0.001) and MACE (OR: 0.50, 95% CI: 0.26-0.96; P=0.04), but not lower MI (OR: 0.23, 95% CI: 0.03-1.54; P=0.13) and cardiac death (OR: 0.83, 95% CI: 0.51-1.35). Comparing with CABG, PCI did not present decreased risk for those outcomes. Conclusions: PCI or CABG was associated with better clinical outcome in patients with CTO than MT. PCI is not better than CABG in decreasing mortality, MI, cardiac death, and MACE in coronary CTO patients.


Subject(s)
Humans , Male , Female , Coronary Occlusion/therapy , Odds Ratio , Coronary Artery Bypass , Risk Factors , Clinical Trials as Topic , Treatment Outcome , Observational Studies as Topic , Coronary Occlusion/surgery , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/mortality
9.
Rev. bras. cir. cardiovasc ; 34(4): 420-427, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020496

ABSTRACT

Abstract Objective: To evaluate the patency of individual and sequential coronary artery bypass in patients with ischemic heart disease. Methods: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data. Results: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%). Conclusion: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vascular Patency/physiology , Coronary Artery Bypass/methods , Myocardial Ischemia/surgery , Coronary Occlusion/therapy , Anastomosis, Surgical/methods , Radiographic Image Interpretation, Computer-Assisted , Risk Factors , Treatment Outcome , Coronary Angiography , Myocardial Ischemia/diagnostic imaging , Coronary Vessels/diagnostic imaging , Coronary Occlusion/diagnostic imaging , Computed Tomography Angiography
10.
Rev. bras. cir. cardiovasc ; 34(4): 491-494, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020492

ABSTRACT

Abstract We present a patient diagnosed Stanford Type A aortic dissection, who was misdiagnosed as acute myocardial infarction for 5 days. In the surgery, the right coronary ostium was totally occluded, and the right coronary artery (RCA) was bluish from the trunk to branches. The true lumen couldn't be found when we opened the RCA. We had to give up coronary artery bypass grafting (CABG). After a regular surgery of type A aortic dissection, the patient was failed to wean from cardiopulmonary bypass due to the right heart dysfunction. The Extracorporeal membrane oxygenation (ECMO) was instituted. The right ventricular wall motion was gradually improved during the post-operation period. This is the first report of using ECMO to successfully treat a complete occlusion of the right coronary artery due to a Type A aortic dissection. This case demonstrates the value of ECMO in assisting right heart function to ensure stable hemodynamics and myocardial recovery in the type A aortic dissection with coronary involvement.


Subject(s)
Humans , Female , Adult , Extracorporeal Membrane Oxygenation , Coronary Occlusion/surgery , Aneurysm, Dissecting/surgery , Coronary Occlusion/diagnostic imaging , Aneurysm, Dissecting/diagnostic imaging
12.
Rev. bras. cir. cardiovasc ; 34(1): 114-117, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985245

ABSTRACT

Abstract Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.


Subject(s)
Humans , Male , Middle Aged , Thromboangiitis Obliterans/complications , Coronary Artery Disease/etiology , Coronary Occlusion/etiology , Saphenous Vein/transplantation , Thromboangiitis Obliterans/surgery , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/methods , Coronary Angiography/methods , Coronary Occlusion/surgery , Coronary Occlusion/diagnostic imaging , Computed Tomography Angiography/methods , Mammary Arteries/surgery
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(1 (Supl)): 94-96, jan.-mar. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1015189

ABSTRACT

O eletrocardiograma (ECG) é fundamental na avaliação dos pacientes com síndrome coronariana aguda (SCA), pois possibilita a identificação precoce dos pacientes com sinais de oclusão coronariana (infarto agudo do miocárdio com supradesnivelamento do segmento ST - IAMCSSST), que se beneficiam com estratégias de reperfusão miocárdica de emergência. Os casos de SCA sem supradesnivelamento de segmento ST pressupõem ausência de oclusão coronariana, e o ECG pode mostrar sinais de isquemia como inversão simétrica de ondas T, infradesnivelamento de segmento ST, ou mesmo ser normal em até 15% dos casos. No entanto, recentemente foi descrito um padrão eletrocardiográfico raro, conhecido como padrão "De Winter", relacionado à oclusão coronariana aguda da artéria descendente anterior (ADA) em seu terço proximal, na ausência de supradesnivelamento de segmento ST. Este é o relato de um paciente jovem, do sexo masculino, com quadro clínico anginoso típico, menos de uma hora depois de angioplastia eletiva da ADA, que apresentou padrão "De Winter" no ECG e teve confirmada trombose aguda de stent. O reconhecimento desse padrão eletrocardiográfico incomum é fundamental para garantir terapia de reperfusão coronariana emergencial em casos de síndrome coronariana aguda


he electrocardiogram (ECG) is a crucial tool in the evaluation of patients with acute coronary syndrome (ACS), since it allows the early identification of patients with signs of coronary occlusion (ST-elevation myocardial infarction ­ STEMI), who benefit from emergency myocardial reperfusion strategies. On the other hand, cases of non-ST-elevation ACS presumably have no coronary occlusion, and the ECG may show signs of ischemia such as symmetrical T-wave inversion, ST-segment depression, or even be normal in up to 15% of cases. However, a rare ECG pattern, known as the "De Winter" pattern, related to an acute occlusion of the Left Anterior Descending (LAD) coronary artery in its proximal third segment, has been recently described without ST-segment elevation. This is a case report of a young male patient with typical chest pain symptoms less than one hour after an elective LAD angioplasty, who presented with "De Winter" pattern on the ECG and had confirmed acute stent thrombosis. The recognition of this unusual electrocardiographic pattern is essential to guarantee emergency coronary reperfusion therapy in cases of acute coronary syndrome


Subject(s)
Humans , Male , Adult , Electrocardiography/methods , Acute Coronary Syndrome , Coronary Occlusion , Thrombosis , Myocardial Reperfusion/methods , Stents , Angioplasty/methods , Myocardial Infarction
14.
Article in English | WPRIM | ID: wpr-728023

ABSTRACT

Body surface potential map, an electric potential distribution on the body torso surface, enables us to infer the electrical activities of the heart. Therefore, observing electric potential projected to the torso surface can be highly useful for diagnosing heart diseases such as coronary occlusion. The BSPM for the heart of a patient show a higher level of sensitivity than 12-lead ECG. Relevant research has been mostly based on clinical statistics obtained from patients, and, therefore, a simulation for a variety of pathological phenomena of the heart is required. In this study, by using computer simulation, a body surface potential map was implemented according to various occlusion locations (distal, mid, proximal occlusion) in the left anterior descending coronary artery. Electrophysiological characteristics of the body surface during the ST segment period were observed and analyzed based on an ST isointegral map. We developed an integrated system that takes into account the cellular to organ levels, and performed simulation regarding the electrophysiological phenomena of the heart that occur during the first 5 minutes (stage 1) and 10 minutes (stage 2) after commencement of coronary occlusion. Subsequently, we calculated the bipolar angle and amplitude of the ST isointegral map, and observed the correlation between the relevant characteristics and the location of coronary occlusion. In the result, in the ventricle model during the stage 1, a wider area of ischemia led to counterclockwise rotation of the bipolar angle; and, during the stage 2, the amplitude increased when the ischemia area exceeded a certain size.


Subject(s)
Cardiac Electrophysiology , Computer Simulation , Coronary Occlusion , Coronary Vessels , Electrocardiography , Electrophysiological Phenomena , Electrophysiology , Heart , Heart Diseases , Humans , Ischemia , Torso
15.
Arch. cardiol. Méx ; 88(2): 93-99, abr.-jun. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1054999

ABSTRACT

Resumen Objetivos: El objetivo de este estudio es evaluar variables angiográficas predictivas negativas y la presencia de la rama lateral en la proximidad de la capa distal de la oclusión en el resultado de la intervención coronaria percutánea de las oclusiones totales crónicas. Método: Las variables angiográficas potencialmente negativas fueron evaluadas retrospectivamente en 156 oclusiones totales crónicas sometidas a intervención coronaria percutánea. Se utilizó regresión logística binaria con una finalidad predictiva para identificar un modelo de variables que en su conjunto puedan predecir satisfactoriamente el resultado negativo de la intervención. Resultados: Las variables asociadas de forma independiente al fracaso de procedimiento fueron la enfermedad multivaso (odds ratio = 5,12; intervalo de confianza del 95%, 1,94-13,5; P = 0.001), la presencia de muñón ambiguo (odds ratio = 5,08; IC intervalo de confianza del 95%, 2,22- 11,63; P < 0.001), longitud de la oclusión ≥20 mm (odds ratio = 3,7; IC intervalo de confianza del 95%, 1,37-9,97; P = 0.01) y la localización ostial de la oclusión (odds ratio = 6,53; intervalo de confianza del 95%, 1,67-25,63; P = 0.007). La rama lateral en la proximidad de la capa distal no permaneció en el modelo predictivo. Conclusión: La enfermedad multivaso, muñón ambiguo, una longitud ≥20 mm y la localización ostial son factores independientes y predictivos de un resultado desfavorable de la angioplastia. La rama lateral en la capa distal de la oclusión no se asoció al fracaso de la intervención. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).


Abstract Objective: The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. Methods: Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. Results: Variables independently associated with the procedural failure were multivessel disease (odds ratio = 5.12; 95% confidence interval (CI); 1.94-13.5; P = .001), ambiguous stump presence (odds ratio = 5.08; 95% CI; 2.22-11.63 P < .001), occlusion length ≥20 mm (odds ratio = 3.7; 95% CI; 1.37-9.97 P = .01), and ostial location (odds ratio = 6.53; 95% CI; 1.67-25.63; P = .007). Side branch at distal cap proximity did not remain in the predictive model. Conclusions: Multivessel disease, ambiguous stump, a length ≥20 mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).


Subject(s)
Humans , Male , Female , Middle Aged , Coronary Angiography , Coronary Occlusion/surgery , Coronary Occlusion/diagnostic imaging , Percutaneous Coronary Intervention , Chronic Disease , Predictive Value of Tests , Retrospective Studies , Treatment Failure
16.
Arq. bras. cardiol ; 110(5): 476-483, May 2018. graf
Article in English | LILACS | ID: biblio-950156

ABSTRACT

Abstract Percutaneous coronary intervention in chronic total occlusion is a rapidly evolving area, being considered the last frontier of interventional cardiology. In recent years, the development of new techniques and equipment, as well as the training of specialized personnel, increased their success rates, making it the most predictable procedure available. Although the number of randomized and controlled studies is still limited, results from large multicentered registries allow us to safely offer this intervention to patients, as another treatment option along with the optimized drug treatment and myocardial revascularization surgery. This review summarizes the last and most relevant publications in the subject in order to provide an overall view of the field's current status.


Resumo A intervenção coronária percutânea em oclusão total crônica é uma área em rápida evolução, sendo considerada a última fronteira da cardiologia intervencionista. Nos últimos anos, o desenvolvimento de novas técnicas e equipamentos, assim como o treinamento de operadores especializados, elevaram sua taxa de sucesso, tornando o procedimento mais previsível. Apesar do número de estudos randomizados e controlados ainda ser limitado, resultados de grandes registros multicêntricos nos permitem oferecer essa intervenção aos pacientes com segurança, como mais uma opção de tratamento junto ao tratamento medicamentoso otimizado e ao lado cirurgia de revascularização miocárdica. Na presente revisão, resumimos as últimas e mais relevantes publicações sobre o assunto a fim de fornecer uma visão geral do atual estado da área.


Subject(s)
Humans , Angioplasty, Balloon, Coronary/methods , Coronary Occlusion/therapy , Chronic Disease , Risk Factors , Coronary Angiography
17.
Chinese Medical Journal ; (24): 1412-1419, 2018.
Article in English | WPRIM | ID: wpr-688103

ABSTRACT

<p><b>Background</b>Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion.</p><p><b>Methods</b>From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year.</p><p><b>Results</b>Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ = 36.253, P < 0.001) and cardiac arrest (8.3% vs. 3.5%, χ = 5.529, P = 0.019). For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction (TIMI) flow grade<3 were significantly higher than those in the patients with a TIMI flow grade of 3 (STEMI group: 51.7% [15/29] vs. 4.1% [14/343], P < 0.001; NSTEMI group: 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEMI group were associated with higher risks of MACE (16.7% vs. 9.1%, P = 0.009) and cardiac death (5.4% vs. 1.3%, P = 0.011) compared with NSTEMI patients at 1 month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI (all P = 0.72) in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction (all P > 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients.</p><p><b>Conclusions</b>Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.</p>


Subject(s)
Aged , Coronary Occlusion , Pathology , General Surgery , Coronary Vessels , Pathology , General Surgery , Female , Humans , Male , Middle Aged , Myocardial Infarction , Pathology , General Surgery , Percutaneous Coronary Intervention , Methods , Retrospective Studies , Risk Factors , ST Elevation Myocardial Infarction , Pathology , General Surgery , Treatment Outcome
18.
Article in Korean | WPRIM | ID: wpr-758433

ABSTRACT

PURPOSE: Patients with a suspected acute myocardial infarction (AMI) in the setting of a new or presumably new left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to clinicians. This study was conducted to identify the frequency of ST-segment elevation myocardial infarction (STEMI)-equivalent in this population, determine the diagnostic value of electrocardiographic and echocardiographic features and propose a new diagnostic algorithm. METHODS: From 793 patients who underwent emergent coronary angiography between January 1, 2012 and July 31, 2015, we examined data pertaining to 21 patients with new or presumably new LBBB. These patients were classified into three groups: 1) STEMI-equivalent, defined as an acute coronary occlusion on coronary angiogram (six patients), 2) non-STEMI (NSTEMI) (six patients), and 3) diagnosis other than myocardial infarction (non-MI) (nine patients). RESULTS: Six patients who met the ST-segment concordance criteria (score≥3) were STEMI-equivalent. On the other hand, seven patients with a discordant ST-elevation of ≥5 mm (score=2) were NSTEMI or non-MI. Therefore ST-segment concordance was highly sensitive and specific for the diagnosis of STEMI-equivalent. Compared with NSTEMI patients, nine non-MI patients with a normal angiogram had a low ejection fraction (35.6±19.0 vs. 56.0±12.9, p=0.04) and increased left ventricle end-diastolic dimension (63.9±8.8 vs. 51.7±6.4, p=0.012). CONCLUSION: Only a minority of patients with LBBB and suspected AMI have a STEMI-equivalent. Low ejection fraction and increased end-diastolic dimension of left ventricle indicate normal coronary angiogram in patients without ST-segment concordance of Sgarbossa criteria. We propose a new modified diagnostic algorithm in this population.


Subject(s)
Bundle-Branch Block , Coronary Angiography , Coronary Occlusion , Diagnosis , Echocardiography , Electrocardiography , Hand , Heart Ventricles , Humans , Myocardial Infarction
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