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1.
Singapore medical journal ; : 334-338, 2015.
Artículo en Inglés | WPRIM | ID: wpr-337138

RESUMEN

<p><b>INTRODUCTION</b>Conventional knowledge holds that the majority of ruptured atherosclerotic plaques causing ST-segment elevation myocardial infarction (STEMI) are found in moderate stenoses that produce < 50% loss of arterial diameter. This study aimed to analyse the culprit lesions in patients who presented with STEMI and underwent primary percutaneous coronary intervention (PPCI) at our institution.</p><p><b>METHODS</b>Patients who underwent PPCI between June 2008 and August 2010 at our institution were included in the analysis. Quantitative coronary angiography was performed for the culprit lesions immediately after antegrade flow was restored by thrombectomy, low-profile balloon predilatation or guidewire crossing.</p><p><b>RESULTS</b>A total of 1,021 patients were included in the study. The mean age was 57 ± 12 years and 85.2% were male. Lesion measurement was done after coronary flow was restored by thrombectomy (73.1%), balloon dilatation (24.1%) and following guidewire passage across the lesion (2.8%). Mean minimal luminal diameter was 1.1 ± 0.5 mm, mean reference vessel diameter was 2.8 ± 0.6 mm, mean diameter stenosis was 61 ± 16% and mean lesion length was 16 ± 6 mm. Most (80.2%) of the culprit lesions had diameter stenoses > 50% (p < 0.01). Although balloon angioplasty was performed in 24.1% of the patients, the majority (64.2%) still had diameter stenoses > 50%. High-grade stenoses (> 50%) were more frequently observed in male patients (p = 0.04).</p><p><b>CONCLUSION</b>Contrary to the existing paradigm, we found that most of the patients with STEMI in our institution had culprit lesions with diameter stenosis > 50%.</p>


Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angioplastia , Angioplastia Coronaria con Balón , Constricción Patológica , Angiografía Coronaria , Vasos Coronarios , Cirugía General , Intervención Coronaria Percutánea , Placa Aterosclerótica , Valores de Referencia , Estudios Retrospectivos , Rotura , Infarto del Miocardio con Elevación del ST , Cirugía General , Factores Sexuales , Trombectomía , Métodos
2.
Annals of the Academy of Medicine, Singapore ; : 157-163, 2015.
Artículo en Inglés | WPRIM | ID: wpr-309526

RESUMEN

<p><b>INTRODUCTION</b>This study aimed to examine the long-term clinical outcomes of coronary fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in a real-world population in an Asian tertiary centre.</p><p><b>MATERIALS AND METHODS</b>All patients who underwent FFR measurement for intermediate coronary lesions in our centre from June 2002 to December 2009 were enrolled. A threshold of FFR ≤0.75 was used for revascularisation. All the patients were prospectively followed-up for major adverse cardiac events (MACE) of death, myocardial infarction (MI), target vessel revascularisation (TVR) and stent thrombosis.</p><p><b>RESULTS</b>Based on FFR measurement, 368 (57%) patients were treated medically while 278 (43%) underwent revascularisation. At a mean follow-up duration of 29.7 ± 16 months, 53 (14.4%) patients in the medical therapy group and 32 (11.5%) patients in the revascularised group experienced MACE (P = 0.282). There were no statistical differences in all the clinical endpoints between the 2 groups.</p><p><b>CONCLUSION</b>Medical therapy based on FFR measurement is associated with low incidences of MACE at long-term follow-up.</p>


Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aspirina , Usos Terapéuticos , Estenosis Coronaria , Diagnóstico , Terapéutica , Quimioterapia Combinada , Estudios de Seguimiento , Intervención Coronaria Percutánea , Métodos , Inhibidores de Agregación Plaquetaria , Usos Terapéuticos , Estudios Retrospectivos , Ticlopidina , Usos Terapéuticos , Resultado del Tratamiento
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