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4.
Rev. bras. cir. cardiovasc ; 34(2): 165-172, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990563

ABSTRACT

Abstract Introduction: Quantitative flow ratio (QFR) is a novel method enabling efficient computation of FFR from three-dimensional quantitative coronary angiography (3D QCA) and thrombolysis in myocardial infarction (TIMI) frame counting. We decided to perform a systematic review and quantitative meta-analysis of the literature to determine the correlation between the diagnosis of functionally significant stenosis obtained by QFR versus FFR and to determine the diagnostic accuracy of QFR for intermediate coronary artery stenosis. Methods: We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy. Results: Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94. Conclusion: QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis.


Subject(s)
Humans , Coronary Angiography/methods , Coronary Stenosis/physiopathology , Coronary Stenosis/diagnostic imaging , Fractional Flow Reserve, Myocardial/physiology , Regression Analysis , Reproducibility of Results , Sensitivity and Specificity , Imaging, Three-Dimensional/methods
5.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.156-164.
Monography in Portuguese | LILACS | ID: biblio-1009286
6.
Rev. bras. cir. cardiovasc ; 33(6): 567-572, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977470

ABSTRACT

Abstract Introduction: In this study we try to observe the fate of the left internal thoracic artery grafts that were bypassed to left anterior descending artery with moderate stenosis identified with fractional flow reserve (FFR) technique. Doppler ultrasonography was chosen as a noninvasive screening method. Methods: A total of 30 patients who underwent coronary artery bypass grafting depending on results of the fractional flow reserve between January 2007 and January 2012, were subjected to transthoracic color Doppler ultrasonographic evaluation irrespective of the presence of symptoms, and the presence of a systolic-diastolic flow pattern was investigated using the supraclavicular approach. Results: The left internal thoracic artery graft was found to be functional in 63.3% of patients within a mean period of 35.1±19.7 months between coronary bypass and color Doppler ultrasonography. This period was found to be 29.4±19.6 months in the functional graft group, and 44.7±16.6 months in the dysfunctional graft group (P=0.046). Preoperative complaints of angina were reported to fall from 88.9% to 16.7% in the functional graft group, when compared to the postoperative period (P<0.001), but fell from 90.9% to 36.4% in the dysfunctional graft group (P=0.034). Conclusion: Functional left internal thoracic artery graft rates of the study population were found to be lower than the studies reported in the literature.


Subject(s)
Humans , Male , Female , Middle Aged , Thoracic Arteries/transplantation , Coronary Stenosis/surgery , Coronary Stenosis/diagnostic imaging , Internal Mammary-Coronary Artery Anastomosis/methods , Myocardial Revascularization/methods , Time Factors , Severity of Illness Index , Cross-Sectional Studies , Treatment Outcome , Ultrasonography, Doppler, Color , Graft Survival
7.
Arch. endocrinol. metab. (Online) ; 62(4): 410-415, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950086

ABSTRACT

ABSTRACT Objective: The association between coronary artery disease (CAD) and thyroid function remains controversial. We evaluated the thyroid function and graduated well-defined CAD as confirmed by quantitative coronary angiography (CA). Subjects and methods: We evaluated the serum TSH, free thyroxine, free triiodothyronine and thyroid antibody levels in 300 consecutive patients (age 61.6 ± 9.9 years and 54% were male) undergoing CAD diagnosis as confirmed by CA. Plaques with ≥ 50% stenosis being indicative of obstructive CAD, and patients were divided into groups according to main epicardial coronary arteries with plaques (0, 1, 2, 3). Lipid profiles and a homeostasis model assessment (HOMA-IR) were determined. Results: Serum median (25% and 75% percentile) TSH levels in patients with group 2 and 3 (2.25; 1.66-3.12 mU/L and 4.99; 4.38-23.60 mU/L, respectively) had significantly higher TSH concentrations (p < 0.0001) than the group 0 (1.82; 1.35-2.51 mU/L). Furthermore, patients of group 3 had higher TSH concentration (p < 0.0001) than those of group 1 (1.60; 0.89-2.68 mU/L). Group 3 were older (64 ± 8.5 vs. 59 ± 9.5, p = 0.001), had more patients with dyslipidemia (84% versus 58%, p < 0.001), male (54% versus 44%, p = 0.01), hypertension (100% versus 86%, p < 0.001), and smoking (61% versus 33%, p < 0.001) than group 0. Multivariate stepwise logistic analysis showed TSH, age, HbA1c, and HOMA-IR were the CAD associated variables. Conclusions: In this cohort, elevated TSH levels in the high normal range or above are associated with the presence and severity of CAD besides may represent a weak CAD risk factor.


Subject(s)
Humans , Male , Middle Aged , Aged , Coronary Artery Disease/blood , Thyrotropin/blood , Thyroid Function Tests , Thyroxine/blood , Triiodothyronine/blood , Coronary Artery Disease/diagnostic imaging , Glycated Hemoglobin A/analysis , Insulin Resistance , Cholesterol/blood , Cross-Sectional Studies , Risk Factors , Age Factors , Coronary Angiography , Coronary Stenosis/diagnostic imaging
8.
Rev. bras. cir. cardiovasc ; 33(3): 309-311, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-958415

ABSTRACT

Abstract Moyamoya disease is a rare, idiopathic, progressive, occlusive disease of the internal carotid artery characterized by the development of collateral vasculature in the brain base. In patients with accompanying coronary artery disease, cardiopulmonary bypass posses a potential risk for perioperative cerebral ischemic complication. Herein, we report a 53-year-old male case of Moyamoya disease and coronary artery disease who was treated with off-pump coronary artery bypass grafting.


Subject(s)
Humans , Male , Middle Aged , Coronary Stenosis/complications , Coronary Artery Bypass, Off-Pump/methods , Moyamoya Disease/surgery , Angiography, Digital Subtraction/methods , Risk Factors , Treatment Outcome , Coronary Angiography/methods , Ultrasonography, Doppler/methods , Coronary Stenosis/diagnostic imaging , Moyamoya Disease/diagnostic imaging
9.
Arq. bras. cardiol ; 108(5): 396-404, May 2017. tab, graf
Article in English | LILACS | ID: biblio-838737

ABSTRACT

Abstract Background: Coronary computed tomography angiography (CCTA) allows for noninvasive coronary artery disease (CAD) phenotyping. Factors related to CAD progression are epidemiologically valuable. Objective: To identify factors associated with CAD progression in patients undergoing sequential CCTA testing. Methods: We retrospectively analyzed 384 consecutive patients who had at least two CCTA studies between December 2005 and March 2013. Due to limitations in the quantification of CAD progression, we excluded patients who had undergone surgical revascularization previously or percutaneous coronary intervention (PCI) between studies. CAD progression was defined as any increase in the adapted segment stenosis score (calculated using the number of diseased segments and stenosis severity) in all coronary segments without stent (in-stent restenosis was excluded from the analysis). Stepwise logistic regression was used to assess variables associated with CAD progression. Results: From a final population of 234 patients, a total of 117 (50%) had CAD progression. In a model accounting for major CAD risk factors and other baseline characteristics, only age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01-1.07), interstudy interval (OR 1.03, 95%CI 1.01-1.04), and past PCI (OR 3.66, 95%CI 1.77-7.55) showed an independent relationship with CAD progression. Conclusions: A history of PCI with stent placement was independently associated with a 3.7-fold increase in the odds of CAD progression, excluding in-stent restenosis. Age and interstudy interval were also independent predictors of progression.


Resumo Fundamento: Angiografia coronariana por tomografia computadorizada (ACTC) permite fenotipagem não invasiva da doença arterial coronariana (DAC). Fatores relacionados à progressão da DAC têm valor epidemiológico. Objetivo: Identificar os fatores associados com a progressão da DAC em pacientes submetidos à avaliação sequencial por ACTC. Métodos: Nós analisamos retrospectivamente 384 pacientes consecutivos que apresentavam pelo menos duas avaliações por ACTC entre dezembro de 2005 e março de 2013. Devido às limitações na quantificação da progressão da DAC, os pacientes que haviam sido submetidos previamente à revascularização cirúrgica ou intervenção coronariana percutânea (ICP) entre as avaliações foram excluídos. A progressão da DAC foi definida como qualquer aumento no escore adaptado de estenose segmentar (calculado com utilização do número de segmentos afetados e gravidade da estenose) em todos os segmentos coronarianos sem stent (restenose intra-stent foi excluída da análise). Regressão logística stepwise foi utilizada para avaliar as variáveis associadas com a progressão da DAC. Resultados: De uma população final de 234 pacientes, um total de 117 (50%) pacientes apresentaram progressão da DAC. Em um modelo considerando os principais fatores de risco para DAC e outras características basais, apenas a idade (odds ratio [OR] 1,04, intervalo de confiança de 95% [IC95%] 1,01-1,07), intervalo entre avaliações (OR 1,03, IC95% 1,01-1,04) e ICP prévia (OR 3,66, IC95% 1,77-7,55) mostraram uma relação independente com a progressão da DAC. Conclusões: Uma história de ICP com implante de stent esteve independentemente associada a um aumento de 3,7 vezes na chance de progressão da DAC, excluindo a restenose intra-stent. Idade e intervalo entre avaliações também foram preditores independentes de progressão.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/diagnostic imaging , Coronary Angiography/methods , Disease Progression , Computed Tomography Angiography/methods , Prognosis , Severity of Illness Index , Coronary Artery Disease/surgery , Retrospective Studies , Age Factors , Coronary Stenosis/surgery , Coronary Stenosis/diagnostic imaging , Percutaneous Coronary Intervention
10.
Arq. bras. cardiol ; 108(1): 38-46, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-838681

ABSTRACT

Abstract Background: Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used. Objective: To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. Methods: Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies. Results: All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. Conclusion: Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.


Resumo Fundamento: A avaliação funcional da obstrução arterial coronariana é empregada na prática cardiológica para correlacionar a obstrução anatômica e a queda de fluxo. Dentre as formas de avaliação, o estudo da reserva fracionada de fluxo (RFF) coronariano se tornou a mais utilizada. Objetivo: Avaliar a correlação entre a RFF com achados de isquemia, obtidos por métodos não invasivos como a ecocardiografia de estresse ou medicina nuclear, e a presença de obstrução crítica da artéria coronária. Métodos: Estudo retrospectivo de casos tratados com procedimentos sistematizados e padronizados para doença coronariana entre março de 2011 e agosto de 2014. Foram incluídos 96 pacientes com 107 obstruções coronarianas críticas (> 50% no tronco da coronária e/ou ≥ 70% nos demais segmentos) estimadas por angiografia coronariana quantitativa (ACQ) e ultrassonografia intracoronariana (USIC). Todos os casos apresentaram isquemia em um dos estudos não invasivos. Resultados: Ao estudo da RFF com adenosina na dose de 140 µg/kg/min, valores ≤ 0,80 foram encontrados em 52% dos casos. Na análise de correlação para RFF ≤ 0,80, avaliando-se sensibilidade/especificidade, valor preditivo positivo/negativo, acurácia e curva ROC em relação ao grau de estenose, extensão da estenose e presença de isquemia, não foram observados valores de significância ou de forte correlação. Conclusão: A RFF coronariana a um valor de corte de 0,80 não apresentou correlação com testes não invasivos de isquemia em pacientes com obstruções coronarianas graves à ACQ e USIC.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/physiopathology , Coronary Artery Disease/diagnostic imaging , Fractional Flow Reserve, Myocardial/physiology , Reference Values , Severity of Illness Index , Cineangiography/methods , Retrospective Studies , Risk Factors , Analysis of Variance , Sensitivity and Specificity , Coronary Angiography/methods , Statistics, Nonparametric , Coronary Vessels/physiopathology , Coronary Stenosis/physiopathology , Coronary Stenosis/diagnostic imaging , Echocardiography, Stress/methods , Myocardial Perfusion Imaging/methods
11.
Rev. chil. cardiol ; 35(2): 177-182, 2016.
Article in Spanish | LILACS | ID: lil-796806

ABSTRACT

La angiografía coronaria ha sido y continúa siendo el pilar sobre el cual se deciden las intervenciones terapéuticas en la enfermedad coronaria constituyendo el grado de estenosis de las placas ateromatosas uno de los principales marcadores de isquemia miocárdica y por lo tanto del pronóstico de la enfermedad. Sin embargo, es un hecho repetidamente documentado que los fenómenos coronarios agudos se producen con mayor frecuencia en placas con estenosis angiográficamente no significativas; por lo tanto, la vulnerabilidad de las placas no parece tener relación con su grado de estenosis y en consecuencia tampoco con la producción de isquemia miocárdica. Esta conclusión no concuerda con los hallazgos histopatológicos ni con los grados de severidad de las estenosis que comprometen el flujo coronario. El objetivo de la presente comunicación es tratar de aclarar esta controversia analizando la información entregada por la histopatología de las lesiones agudas culpables de los infartos. Precisar si las lesiones coronarias crónicas que producen isquemia (probables causantes de futuros infartos) se correlacionan con el grado de estenosis anatómica; proponer el posible mecanismo que vincula el grado de estenosis a la vulnerabilidad de las placas y esbozar una explicación para conciliar los hallazgos angiográficos con los his-topatológicos y funcionales.


Coronary angiography has long been and is still the basic method for deciding coronary interventions, and the severity of stenosis remains the main prognostic marker of the disease. However, plaque vulnerability does not appear to be associated with a greater degree of angiographic stenosis, which is not consistent with histopathological findings or with physiological assessment of ischemia-producing lesions. The purpose of this article is to briefly review this controversy while suggesting that plaques vulnerability correlate with the degree of anatomical and functional stenosis, and to describe the potential mechanism that could determine this vulnerability as well as to give likely explanations that reconcile angiographic findings with histopathological and functional observations.


Subject(s)
Humans , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Myocardial Infarction/etiology , Severity of Illness Index , Coronary Vessels/injuries , Coronary Stenosis/complications , Coronary Stenosis/physiopathology , Coronary Stenosis/pathology , Plaque, Atherosclerotic
12.
Yonsei Medical Journal ; : 1079-1086, 2016.
Article in English | WPRIM | ID: wpr-34058

ABSTRACT

PURPOSE: To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization. MATERIALS AND METHODS: Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory. RESULTS: Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively. CONCLUSION: CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.


Subject(s)
Aged , Angina, Stable/diagnostic imaging , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Myocardial Revascularization , Predictive Value of Tests , Tomography, X-Ray Computed , United States
13.
Article in English | WPRIM | ID: wpr-155943

ABSTRACT

Extrinsic compression of the left main coronary artery (LMCA) secondary to pulmonary artery dilatation is a rare syndrome. Most cases of pulmonary artery hypertension but no atherosclerotic risk factors rarely undergo coronary angiography, and hence, diagnoses are seldom made and proper management is often delayed in these patients. We describe a patient that presented with pulmonary hypertension, clinical angina, and extrinsic compression of the LMCA by the pulmonary artery, who was treated successfully by percutaneous coronary intervention. Follow-up coronary angiography showed patent stent in the LMCA in the proximity of the dilated main pulmonary artery. This case reminds us that coronary angiography and percutaneous coronary intervention should be considered in pulmonary hypertension patients presenting with angina or left ventricular dysfunction.


Subject(s)
Angina Pectoris/etiology , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Dilatation, Pathologic , Female , Humans , Hypertension, Pulmonary/etiology , Middle Aged , Pulmonary Artery/diagnostic imaging , Stents , Tomography, X-Ray Computed , Ventricular Dysfunction, Left
14.
Article in English | WPRIM | ID: wpr-80578

ABSTRACT

Despite the noninvasiveness and accuracy of multidetector computed tomography (MDCT), its use as a routine screening tool for occult coronary atherosclerosis is unclear. We investigated whether the ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1), an indicator of the balance between atherogenic and atheroprotective cholesterol transport could predict occult coronary atherosclerosis detected by MDCT. We collected the data of 1,401 subjects (877 men and 524 women) who participated in a routine health screening examination of Asan Medical Center. Significant coronary artery stenosis defined as > 50% stenosis was detected in 114 subjects (8.1%). An increase in apoB/A1 quartiles was associated with increased percentages of subjects with significant coronary stenosis and noncalcified plaques (NCAP). After adjustment for confounding variables, each 0.1 increase in serum apoB/A1 was significantly associated with increased odds ratios (ORs) for coronary stenosis and NCAP of 1.23 and 1.18, respectively. The optimal apoB/A1 ratio cut off value for MDCT detection of significant coronary stenosis was 0.58, which had a sensitivity of 70.2% and a specificity of 48.2% (area under the curve, 0.61; 95% CI, 0.58-0.63, P < 0.001). Our results indicate that apoB/A1 ratio is a good indicator of occult coronary atherosclerosis detected by coronary MDCT.


Subject(s)
Adult , Aged , Apolipoprotein A-I/blood , Apolipoproteins B/blood , Area Under Curve , Carotid Stenosis/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Odds Ratio , ROC Curve , Tomography, X-Ray Computed
16.
Article in English | WPRIM | ID: wpr-225542

ABSTRACT

OBJECTIVE: We wanted to evaluate the image quality, diagnostic accuracy and radiation exposure of 64-slice dual-source CT (DSCT) coronary angiography according to the heart rate in symptomatic patients during daily clinical practice. MATERIALS AND METHODS: We performed a retrospective search for the DSCT coronary angiography reports of 729 consecutive symptomatic patients. For the 131 patients who underwent invasive coronary angiography, the image quality, the diagnostic performance (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] for detecting significant stenosis > or = 50% diameter) and the radiation exposure were evaluated. These values were compared between the groups with differing heart rates (HR): mean HR or = 65 and HR variability (HRV) or = 15. RESULTS: Among the 729 patients, the CT reports showed no stenosis or insignificant coronary artery stenosis in 72%, significant stenosis in 26% and non-diagnostic in 2%. For the 131 patients who underwent invasive coronary angiography, 95% of the patients and 97% of the segments were evaluable, and the overall per-patient/per-segment sensitivity, the perpatient/per-segment specificity, the per-patient/per-segment PPV and the per-patient/per-segment NPV were 100%/90%, 71%/98%, 95%/88% and 100%/97%, respectively. The image quality was better in the HR or = 65 group (p = 0.001), but there was no difference in diagnostic performance between the two groups. The mean effective radiation doses were lower in the HR < 65 or HRV < 15 group (p < 0.0001): 5.5 versus 6.7 mSv for the mean HR groups and 5.3 versus 9.3 mSv for the HRV groups. CONCLUSION: Dual-source CT coronary angiography is a highly accurate modality in the clinical setting. Better image quality and a significant radiation reduction are being rendered in the lower HR group.


Subject(s)
Adult , Aged , Aged, 80 and over , Artifacts , Contrast Media , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Female , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Predictive Value of Tests , Quality Assurance, Health Care , Radiation Dosage , Radiographic Image Interpretation, Computer-Assisted/methods , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/methods
17.
Article in English | WPRIM | ID: wpr-137393

ABSTRACT

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.


Subject(s)
Age Factors , Aged , Cardiovascular Agents/administration & dosage , Cohort Studies , Coronary Angiography , Coronary Restenosis/diagnosis , Coronary Stenosis/diagnostic imaging , Drug-Eluting Stents , Female , Humans , Male , Middle Aged , Paclitaxel/administration & dosage , Prosthesis Failure , Registries , Risk Factors , Sex Factors , Sirolimus/administration & dosage
18.
Article in English | WPRIM | ID: wpr-137392

ABSTRACT

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.


Subject(s)
Age Factors , Aged , Cardiovascular Agents/administration & dosage , Cohort Studies , Coronary Angiography , Coronary Restenosis/diagnosis , Coronary Stenosis/diagnostic imaging , Drug-Eluting Stents , Female , Humans , Male , Middle Aged , Paclitaxel/administration & dosage , Prosthesis Failure , Registries , Risk Factors , Sex Factors , Sirolimus/administration & dosage
19.
Article in English | WPRIM | ID: wpr-161029

ABSTRACT

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.


Subject(s)
Adult , Aged , Chest Pain/diagnosis , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Decision Making , Emergency Service, Hospital , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Sensitivity and Specificity , Tomography, X-Ray Computed/methods
20.
Endovascular Journal. 2009; 2 (1): 13-17
in English | IMEMR | ID: emr-91059

ABSTRACT

64-slice CT coronary angiography is now available as a valuable technology in evaluating patients, both with and without symptoms for the detection of coronary lesions and in making decision whether or not further invasive testing is needed. The aim of our study was to evaluate the diagnostic performance of 64-slice CT angiography for detection of significant coronary artery stenoses in comparison with conventional coronary angiography. During a period of 20 months [April 2007-November 2008] we studied 565 patients with 64-slice CT angiography of coronary arteries who fulfilled following criteria; having a positive stress test such as thallium-scan or stress echocardiography if symptomatic, sinus heart rhythm and able to hold breath for 15 seconds. We scheduled coronary angiography for 58 of these patients with mean age of 52 +/- 10.5 years [37 men and 21 women] who have one or more significant stenoses of coronary arteries. A significant lesion was assumed if the diameter reduction of vessel was = 50%. The overall sensitivity and specificity of 64-slice CT for detection of significant coronary artery stenoses in this study were 95% and 94% respectively. The positive predictive value was 85% and negative predictive value was 94%. We found that 64-slice CT correctly identified all patients with three vessel disease. This technique was reliable to classify 90% of patients [52/58] as having one, two or three vessel disease correctly. In conclusion 64-slice CT coronary angiography has a high degree of both sensitivity and specificity in detection of significant coronary artery stenoses


Subject(s)
Humans , Male , Female , Tomography, Spiral Computed , Coronary Disease/diagnosis , Coronary Disease/diagnostic imaging , Coronary Stenosis/diagnosis , Coronary Stenosis/diagnostic imaging , Exercise Test , Thallium , Echocardiography, Stress , Sensitivity and Specificity , Predictive Value of Tests
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