The effect of mobile application-based technology use on medication compliance and modification of risk factors in post PTCA cohort of patients

Mobile application-based technology was used to study medication compliance and influence on cardiovascular lifestyle in ischemic heart disease (IHD) patients who undergo percutaneous transluminal coronary angioplasty (PTCA). The Mobile-app was made available at Google play store; the app was downloaded and instructions to use were thought to patients by the research team during hospitalization in the study group. A total of two hundred patients with ischemic heart disease who underwent PTCA were enrolled into the study. The control group had telephonic follow up at periodic interval. Both groups had clinical follow ups at appropriate time intervals. Higher medication compliance, smaller number of adverse events and regular follow ups were significantly more in mobile-app group than in control group.

Door to Balloon Time in St-Segment Elevation Myocardial Infarction (STEMI): A Prospective Study

Background: The most acute manifestation of coronary artery disease is ST-segment elevation myocardial infarction (STEMI) and is associated with mortality and morbidity. In the majority of cases, complete thrombotic occlusion develops from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI. Early diagnosis and immediate reperfusion reduce the risk of post-STEMI complications and heart failure and thereby are the most effective ways to limit myocardial ischemia and infarct size. If primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus and PCI has become the preferred reperfusion strategy in patients with STEMI. Methods: From the emergency section of the hospital in the month of October 2021, 7 adult patients were identified with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary. We used the framework of regression discontinuity to test for discontinuity at 90 minutes among the included cases. The Door - Balloon as 90 minutes minus the time between hospital arrival and catheterization laboratory arrival -defined as a novel variable. To assess the relationship between remaining Door - Balloon time and access site we have estimated multivariable logistic regression models. Results: The results of primary PTCA in the month of October 2021 were performed in less than 90 minutes without any mortality in 7 patients. Conclusions: Our Data on mortality and morbidity benefits of primary angioplasty shows a 100% decrease in mortality of patients undergoing primary PTCA within 90 minutes as compared to international data which shows a 40% decrease.

Clinical profile of patients with acute coronary syndrome with special reference to diabetes mellitus.

Background: Ischemic heart disease is defined as inadequate blood flow resulting in decreased oxygenation to the myocardium due to severe narrowing and/or complete blockage of coronary arteries. Although a number of risk factors have been identified over the past several decades, the precise aetiology and mechanisms leading to the development of CAD are not fully understood. These includes abnormal levels of circulating cholesterols with elevated level of LDL-cholesterol and reduced level of HDL-cholesterol, hypertension, cigarette smoking, diabetes mellitus, male gender, post-menopausal state, advanced age, sedentary life style, obesity and a positive family history of premature cardiovascular disease female population. Methods: Our study was aimed to interrogate and to assess the patients presenting with acute coronary syndrome, for the presence of conventional risk factors with special eye on diabetes and to stratify patients with acute coronary syndrome according to their diabetic status (Diabetic vs. non diabetic) and also to study pattern of involvement of coronary arteries in diabetic and non-diabetic patients and to stratify patient according to treatment they received PTCA vs. CABG. Results: It was observed that out of 100 patients with diabetes mellitus, 71% patients were having diabetes mellitus. Among the diabetics in this study, STEMI (73.13%) was the commonest presentation of ACS. On the other hand amongst diabetics, 58.33% had STEMI. Conclusion: Patients with diabetes mellitus had more dyslipidemia, hypertension and smokers. This group of patients required maximum intervention in the form PTCA and CABG.

Seguridad de la angioplastía coronaria ambulatoria por vía transradial: experiencia de un centro / Safety of trans-radial ambulatory coronary angioplasty: a single center experience

Introducción: El número creciente de intervenciones coronarias ha generado una demanda mayor de camas hospitalarias. Se ha reportado que luego de un periodo postintervención de 4 a 6 horas no se observan complicaciones asociadas a la angioplastía coronaria (AC). Objetivo: Evaluar la seguridad del alta precoz luego de la angioplastía coronaria. Material y métodos: Se analizaron los pacientes (pts) sometidos a AC y dados de alta luego de una observación de 4 horas, en el período comprendido entre Enero 2004 y Agosto 2010. Se analizaron las variables clínicas y angiografías. Se consideraron criterios de seguridad: infarto y/o trombosis del stent, complicaciones hemorrágicas y mortalidad hasta los 30 días. Resultados: Se realizó AC ambulatoria a 414 pacientes con una edad de 63.17 +/- 10.4 años. 80 por ciento fueron hombres. El 53 por ciento fueron portadores de enfermedad de 2 y 3 vasos. La AC fue exitosa en el 95.9 por ciento de casos. El 49 por ciento de las lesiones tratadas fueron de complejidad mayor (tipo B2 y C). Se analizaron los índices de seguridad en tres periodos: 4 a 24 horas, 24 horas a 7 dias y de 7 días a 30 días, observándose solo 3 hemorragias menores en el período más precoz y ningún sangramiento mayor, nueva revascularización, infarto agudo del miocardio, accidente cerebrovascular, ni mortalidad en ninguno de los tiempos analizados. Conclusión: El alta precoz luego de la AC por vía radial es un procedimiento seguro independiente de la complejidad de la anatomía coronaria.

The increasing number of percutaneous coronary angioplasty (PTCA) procedures poses a strain on the availability of hospital. There is evidence that no complications of PTCA are observed 4 o 6 hr after the procedure. Aim: To evaluate the safety of early discharge after PTCA Methods: Patients submitted to PTCA from January to August 2010 who were discharged after a 4 hr observation period had their clinical and angiographic characteristics assessed. Infarction, stent thrombosis and 30 day mortality were determined. Results: 414 patients were included. Mean age was 63.2 years (SD 10.4), 80 percent of them males. 53 per cent had 2 or 3 vessel disease. PTCA was successful in 95.9 percent of cases. 49 per cent of coronary artery lesions were type B2 or C. 3 minor bleeding episodes occurred before 24 hr after the procedure. No major bleedings, new revascularization, acute myocardial infarction, stroke were seen up to 30 days post procedure. There was no mortality. Conclusion: Early discharge after trans-radial artery PTCA is safe even for treatment of complex coronary artery lesions.

Acceso radial durante la angioplastía primaria en el infarto agudo al miocardio / Radial artery access to perform primary angyoplasty in acute myocardial infarction

Introdución: El acceso radial (AR) ha demostrado reducir las complicaciones vasculares asociadas a la coronariografía y angioplastía coronaria; sin embargo, su rol en la angioplastía primaria (AP) durante el infarto agudo al miocardio con supradesnivel del segmento ST (IAM c/SDST) es muy escasa. En diciembre de 2007, nuestro equipo adoptó esta técnica como primera opción durate la AP Objetivo. Estudiar si el AR durante la AP es tan rápido y seguro como el acceso femoral (AF). Métodos: Utilizando el registro de nuestro laboratorio, analizamos todos los pacientes con IAM c/SDST que fueron tratados con AP en nuestro hospital en el período Septiembre 2005 - Agosto 2009, y luego de identificar los pacientes de acuerdo al AF y AR, comparamos el tiempo "puerta-balón", los resultados an-giográficos, el éxito clínico y las complicaciones relacionadas al acceso. El seguimiento se efectuó a través de las visitas médicas y vía telefónica. Los valores se muestran como promedio +/- DS. Resultados: En el periodo estudiado, en 354 (75 por ciento) pacientes se utilizó AF y en 118 (25 por ciento) el AR. La edad promedio de ambos grupos fue similar, 61+/-12 años en el grupo con AF vs 62+/-12 años en AR (p=ns) y no hubo diferencias en las características clínicas de los grupos. El tiempo "puerta-balón" fue 62+/-37 minutos vs 61+/-29 minutos en AF y AR respectivamente (p=ns) con una tasa de éxito superior al 94 por ciento en ambo grupos. En el grupo de AF hubo 3 por ciento de complicaciones vasculares vs 0 por ciento en AR. La mortalidad global a 30 días fue 5,1 por ciento en el grupo de AF y de 4,0 por ciento en AR (p=ns). Conclusión: El acceso radial para la AP permite abrir la arteria culpable en tiempos similares al AF y con una menor incidencia de complicaciones vasculares.

Background: Radial access (RA) has been shown to help reduce vascular complications of coronary ar-teriography and angioplasty (PTCA). However, little experience has been reported with RA to perform primary PTCA in ST elevation acute myocardial infarction (STEMI). Since December 2007, we selected RA as a first option for primary PTCA in STEMI. Aim: to determine whether RA is as effective, safe and expeditious as femoral access (FA) in primary PTCA for STEMI Method: we performed a retrospective review of our database of all patients undergoing primary PTCA in our laboratory from Sept 2005 through August 2009. We compared all patients who had a PTCA using a FA to those in whom the RA was used. The door to balloon time, angiographic results, clinical success rate and complications related to the vascular access were compared between groups. Follow-up was based con clinical visits and phone calls. Values are expressed as mean and SD. Results: 375 patients had an FA (75 percent) and 118 an RA (25 percent). Mean age was similar in both groups (61+/-12 vs 62+/-12, respectively, NS). Selected clinical characteristics did no differ between groups. Door to balloon time was 62+/-37 min for FA and 61+/-29 min for RA (NS). Clinical success rate exceeded 94 percent in both groups. Vascular complications occurred in 3 percent in the AF group. No vascular complications were observed in the RA group. Thirty day overall mortality rates were 5.2 percent in FA and 4.0 percent in RA (NS). Conclusion: Radial access can be used for primary PTCA in STEMI with similar success rates and lower incidence of vascular complications, when compared to the traditional femoral access.

Intervenciones coronarias percutáneas guiadas con medición de flujo de reserva coronario / Percutaneous coronary intervention guided by measurement of coronary flow reserve

Introducción: La revascularización de una estenosis coronaria que induce isquemia mejora el estatus funcional del paciente y su pronóstico. Por el contrario, la angioplastía de una lesión que no provoca isquemia puede implicar complicaciones sin beneficios. La medición de flujo de reserva coronario (FFR) es un índice del significado fisiopatológico de las estenosis coronarias. Objetivos: Comparar los eventos cardiovasculares adversos mayores (MACE) en pacientes en quienes la FFR permitió excluir una o más lesiones de angioplastia (Grupo FFR >0,75) con aquellos en que ésta obligó a la revascularización (grupo FFR < 0,75). Métodos: Estudio observacional en 74 pacientes derivados para angioplastía entre agosto de 2006 y julio de 2010. Se realizó medición de FFR con ade-nosina a lesiones de severidad intermedia (60-70 por ciento). Una FFR translesional <0,75 se consideró significativa para isquemia y subsidiaria de angioplastía. Se hizo un seguimiento de los MACE definidos como: muerte, infarto, necesidad de revascularización y/o presencia de angor. Resultados: 35 pacientes (47,3 por ciento) constituyeron el Grupo FFR >0,75, y en ellos disminuyó el porcentaje de lesiones múltiples angiográficamente significativas (dos o más vasos), desde un 51,4 por ciento (previo a la realización de FFR), a un 25,7 por ciento. En este grupo se utilizó un promedio de 0.7 stents por paciente, mientras que en el grupo FFR <0,75 (39 pacientes), este fue de 1.5 stents. Se efectuó un seguimiento promedio de 21,5 meses. Diecinueve pacientes (25,6 por ciento) desarrollaron MACE (28 eventos). No hubo fallecidos ni diferencias significativas en el análisis multifactorial en cuanto a infartos o angor, pero sí en la necesidad de nueva revascularización, siendo ésta significativamente mayor en el grupo FFR <0,75 (12,8 por ciento versus 2,9 por ciento, p=0,047). Conclusiones: La medición del FFR permite, en caso de descartar isquemia, disminuir la necesidad de angioplastías...

The treatment of coronary stenosis causing myocardial ischemia improves functional capacity and prognosis. Treatment of non-ischemia inducing coronary stenosis may lead to complications with no benefit to the patient Measurement of coronary flow reserve (CFR) may be used to assess the significance of coronary artery stenosis. Aim: To compare major adverse cardiovascular events (MACE) in patients with significant stenosis (CFR < 0.75), with those in which one or more stenosis was not significant (CFR > 0.75) and thus were not subjected to PTCA in the corresponding artery. Methods: 74 patients were included from August 2006 to July 2010. CFR was measured in lesions exhibiting 6070 percent stenosis, using adenosine. A value <0.75 was considered significant and led to PTCA. Patients were followed for death, myocardial infarction, revascularization and/or angina. Results: 35 patients (47 percent) constituted the >0.75 CFR group. After evaluation of CFR the number of significant coronary stenosis decreased from 51.4 percent to 25.7 percent. They received a mean of 0.7 stents per patient. On the other hand, in the group with CFR <0.75 (39 patients) the mean number of stents was 1.5. Patients were followed for a mean of 21.5 months. 28 MACE events were observed in 19 patients (25.6 percent). No deaths were observed. Multivariable analysis revealed no significant difference between groups regarding myocardial infarction or angina. The need for myocardial revascularization was greater in the CFR <0.75 group compared to the CFR >0.75 group (12.8 percent vs 2.9 percent, respectively, p=0.047). Conclusion: The exclusion of myocardial ischemia as inferred by a CFR >0.75 allowed a significantly lower number of PTCAs without increase in MACE at a medium term follow up. A greater number of revascularization procedures was required in patients with CFR <0.75, which is expected from the greater number of lesions subjected to PTCA.

Experiencia preliminar: STENT MGUARD en angioplastía coronaria con alta carga trombótica, ¿una nueva alternativa en protección embólica? / Percutaneous coronary angioplasty in patients with high thrombotic load: a preliminary evaluation using the MGuard stent

Introducción: La microembolización se asocia a más eventos cardiovasculares adversos (MACE) especialmente en angioplastía (PTCA) de puentes venosos aortocoronarios (PAC) o en síndrome coronario agudo (SCA). El stent MGuard evitaría la embolización distal. Nuestro objetivo: evaluar el stent con micromalla de dacron como alternativa de protección embólica. Métodos: Registro prospectivo de PTCA con stent MGuard en de SCA de PAC y vasos nativos. Resultados: 15 angioplastias, de ellas 53 por ciento con infarto agudo miocárdico con supradesnivel de ST (IAM con SDST). PTCA en vasos nativos: 60 por ciento y PAC: 40 por ciento (antigüedad: 13 +/- 3 años). El 53 por ciento tuvo flujo inicial TIMI 0-1, alto contenido trombótico (66 por ciento: 4-5 en escala de trombos TIMI). Se predilató la lesión en 73 por ciento de los casos, se empleó Reopro en 2 casos, no se usó filtros de protección ni aspirador de trombos. Las dimensiones del stent MGuard: 22.2 +/- 4.4 mm de largo por 3.7 +/- 0.44 mm de diámetro. El 100 por ciento con flujo TIMI 3 final, 93 por ciento con impregnación miocárdica grado 3. Subgrupo de IAM con SDST: 71 por ciento obtuvo < 23 cuadros TIMI/segundo, 100 por ciento con regresión del SDST mayor de 50 por ciento a 90 minutos de PTCA. Subgrupo de PTCA de PAC: (excepto caso de PTCA de PAC en IAM c/SDST) no se registró elevación de la CK total o MB post PTCA. Seguimiento: un caso de trombosis al mes. Conclusión: El MGuard stent parece ser efectivo en la protección de la microcirculación. Se requieren estudios para evaluar la seguridad clínica y eficacia en protección embólica.

Background: Coronary angioplasty (PTCA) is associated to a greater incidence of major adverse cardiac events (MACE) in patients with stenosis of saphenous vein grafts (SVG) and in those with acute coronary syndromes (ACS). The MGuard stent, a device with a dacron micro mesh, is currently being evaluated for the prevention of distal thrombotic embolization in these patients. Aim to evaluate the MGuard stent, for the prevention of distal embolization. Methods: analysis of a prospective registry of patients submitted to PTCA for ACS in native coronary arteries or occluded SVG using the MGuard stent. Results: 15 PTCA procedures were performed, 53 percent in patients with ST segment elevation acute myocardial infarction (STE-MI). PTCA was performed in native vessels in 60 percent patients and in SVG in 40 percent. Interval from surgery in these patients was 13+/-3 years. 53 percent of patients had initial TIMI fow rate 0-1 and 66 percent had a thrombotic load of 4-5 (TIMI scale). Lesions were predilated in 73 percent of cases; abxicimab was used in 2 patients and no protection filters or thrombus aspiration were performed. MGuard stent dimensions were 22.2+/-4.4 mm in length, and 3.7+/-0.44 mm in diameter. Final TIMI 3 fow was observed in all patients; 93 percent of then had grade 3 myocardial impregnation. In the subgroup of patients with STE-MI, a 23 frames/sec TIMI frame count was observed with >50 percent reduction of ST elevation 90 min after PTCA. In patients with SVG, except one patient with ACS, no elevation of total or MB- CK was observed. Follow up revealed reocclusion in 1 patient, 1 month after the procedure. Conclusion: The MGuard stent appears to be an effective device to protect the microcirculation form distal embolization during PTCA. Studies with larger number of patients and extended periods of follow up are encouraged by these results.

The present study of drug for promoting blood circulation to removing blood stasis on preventing and cureing restenosis after PTCA / 国际中医中药杂志

The restenosis after PTCA is the present puzzle. Researches show the advantage of drug for promoting blood circulation to removing blood stasis on preventing and cureing restenosis after PTCA. This article discuss Traditional Chinese Medicine's pathological mechanism after PTCA, and clinical and experimental reserch about Single Traditional Medicinal Herb, Traditional Chinese approved prescription, novel Preparation of drug for promoting blood circulation to removing blood stasis on preventing and cureing restenosis after PTCA. The purpose is improving the recognization of drug for the Promoting blood circulation to removing blood stasis.

Intervencionismo en oclusiones crónicas: evaluación de la efectividad cruce de distintas guías y balones según complejidad / Percutaneous coronary interventions in chronic coronary occlusions: effectiveness of different guides and balloons according to complexity of total coronary artery occlusion

Antecedentes: El intervencionismo en las oclusiones totales crónicas (OTC) requiere técnicas complejas y el éxito es poco predecible. Es útil identificar la efectividad de las guías de cruce y del balón para el intervencionismo en distintos niveles de complejidad de OTC. Objetivos: Evaluar la efectividad de cruce de distintas guías y balones en el tratamiento de OTC. Métodos: Se revisa en forma retrospectiva la efectividad de distintos tipos de guías y balones de cruce utilizados en intervencionismo de OTC efectuados entre agosto de 2007 y agosto de 2009. Se define "efectividad" como la capacidad de avanzar y cruzar la oclusión crónica con la guía y el balón, ambas necesarias para efectuar la angioplastia de la OTC. Se agrupan los resultados según el nivel de complejidad de la OTC de acuerdo a score propio, distinguiendo entre OTC simples, complejas y de alta complejidad. Resultado: En el período estudiado se revisan 90 OTC. Se utilizan 148 guías (1,6 guía/proc.) y se utilizan 92 balones en 76 procedimiento que logran paso efectivo de guía. (1,2 bal/proc). Se realiza una tabla con la tasa de efectividad de distintas guías y balones de cruce. Destaca la utilidad de guía PT2 en lesiones simples y complejas, como la utilidad de la guía Miracle 6 en OTC de alta complejidad. Conclusiones: En OTC se obtiene un éxito de 67 por ciento en nuestro medio, con mayor efectividad de la guía PT2 en lesiones simples y complejas y de Miracle 6 en lesiones de alta complejidad. En cuanto a balones se obtiene mayor efectividad en los tipo Maverick, Mercury y Voyaguer de 1,5 mm en lesiones simples y complejas, como del Balón Maverick de 1,5 mm en lesiones de alta complejidad. Es de gran utilidad un registro de la efectividad de balones y guías en el tratamiento de OTC, lo que permite al intervencionista una adecuada elección del material con el consecuente ahorro de tiempo y mayor efectividad del procedimiento.

Background.: PCI in chronic coronary occlusions requires complex techniques and is associated to less predictable results. It is important to evaluate the effectiveness of different guides and balloons in PCI for total coronary occlusion (TCO). Aim: To evaluate the effectiveness of different guides and balloons in the treatment of TCO. Methods: A retrospective review of the effectiveness of different guides and balloons in the treatment of TCO performed from 2007 to 2009 was carried out Effectiveness was defined as the ability to traverse the occlusion with the guide and the balloon. The analysis was performed according to groups defined by the complexity of the TCO as assessed by a locally developed score. Occlusions were classified as simple, complex or highly complex. Results: 90 procedures were analyzed 148 guides were utilized (mean of 1.6 per procedure) and 92 balloons were used in 76 cases were the guide successfully crossed the occlusion. The PT2 guide was effective for simple and complex lesions, whereas de Miracle 6 guide was effective in the treatment of highly complex lesions. Regarding balloons, the Maverick, Mercury and Voyageur 1.5 mm were satisfactory in simple and complex lesions, while the Maverick 1.5mm was more effective in highly complex lesions Conclusion: TCO was successfully treated by PCI in 67 percent of cases. PT2 guides and all types of balloons were effective for treatment of simple and complex lesions. In contrast, the Miracle 6 guide and the Maverick 1.5 balloon were more effective in highly complex lesions. These findings may be useful to help de proper selection of angioplasty materials when treating.

Effect of YQHXFF on Expression of Matrix Metalloproteinase-2 after Percutaneous Transluminal Coronary Angioplasty in Rabbits with Hyperlipidemia / 中国康复理论与实践

@#: Objective To observe the effects of YQHXFF on the expression of matrix metalloproteinase-2 （MMP-2） in the rabbits with hyperlipidemia after percutaneous transluminal coronary angioplasty (PTCA). Methods 28 male New Zealand white rabbits were randomly divided into the control group, the model group and the YQHXFF intervention group. The models of restenosis were established with injuring carotid arteries in cholesterolfied rabbits. After 8 weeks, MMP-2 were measured with reverse transcription polymerize chain reaction (RT-PCR) and pathologic alter were observed with HE staining. Results The expression of MMP-2 mRNA in injured artery were much higher in the model group. Compared with those in the model group, the expression of MMP-2 in the YQHXFF intervention group markedly decreased and intimal hyperplasia markedly lighten. Conclusion YQHXFF can inhibit the expression of MMP-2 and lighten the intimal hyperplasia after PTCA.

Application of evidence-based nursing in patients with acute myocardial infarction undergoing PTCA and intracoronary stenting / 中国实用护理杂志

Objective To validate the clinical effect of evidence-based nursing on early rehablilitation of patients with acute myocardial infarction undergoing PTCA and intracoronary stenting. Methods 47 patients with acute myocardial infarction undergoing PTCA and intracoronary stenting were divided into the nursing group(24 cases)and the control group(23 cases).The nursing group received nursing with evidence-based nursing pattern while the control adopted routine nursing method. The nursing effect in the two groups was compared in the following aspects such as the incidence rate of adverse effect,average hospitalization days, athletic ability and psychological status. Results The incidenece rate of adverse effect Was lower(P＜0.05)and the average hospitalization days were shorter(P＜0.01)than those of the control group with addition of cardiovascular complications(P＞0.05).The athletic ability and psychological status were also superior to those of the control group(P＜0.05).Conclusion Application of evidence-based nursing could hasten the rehabilitative process of patients undergoing PTCA and intracoronary stenting.

The clinical significance on the change of ST segments after direct percutaneous transcoronary angioplasty com- bined with Lipo-PGE1 in treating acute myocardial infarction / 中国实用内科杂志

Objective The aim of the study is to approach the clinical significance of the change of ST segments after di- rect percutaneous transcoronary angioplasty(PTCA) combined with Lipo-PGE_1 in treating Acute Myocardial Infarction (AMI).Methods The change of the ST segments on EKG of 76 patients with AMI are observed in 30 minutes after un- derwent direct PICA combined with Lipo-PGE_1,and the relations are analyzed that are prospectively to their therapy effect,the degree of injured cardiac muscle,the cardial functions,and the prognosis.Results The patients who treated with the PCTA combined with Lipo-PGE_1 ST segments on EKG 30 minutes after operations reduced significantly,cardiac muscle is injured lowly,their cardial functions are better.Conclusion The change of ST segments after direct percutane- ous transcoronary angioplasty (PTCA) combined with Lipo-PGE_1 in treating acute myocardial infarction is one of the guide line to estimate the perfnsion of cardiac muscle,and to estimate prognosis farther.

The protected effect of emergency percutaneous transluminal coronary angioplasty to cardiac function in acute myocardial infarction patients with diabetic / 中国基层医药

0.05),and the Killip classification and LVEF in the period of hospitalization after 24 hours and AMI after 3 months in PTCA group were significantly improved compared with that in no-PCTA group(P

Percutaneous Transluminal Coronary Angioplasty for Coronary Artery Stenosis in a Young Patient with Long Term Kawasaki Disease

Kawasaki Disease (KD) is an acute, febrile, multisystem disease of children. More severe complications in 15~25% of cases include, the development of coronary aneurysms, ischemic heart disease, and sudden cardiac death. The standard treatment for significant coronary artery stenosis has generally been aortocoronary bypass surgery, although percutaneous transluminal coronary angioplasty (PTCA) has been described in a small number of patients. This report describes a 14 year old boy with a history of KD who developed multiple coronary aneurysms and stenosis. We performed PTCA, which was successful in relieving the stenosis of the left circumflex artery.

Comparison of Secondary Surgical Methods in Congenital Nasolacrimal Duct Obstruction after Failed Primary Probing

PURPOSE: Evaluate the surgical results and clinical value of monocanalicular stenting (Monaka(R))(FCI Ophthalmics, Marshfield Hills, MA, U.S.A) and balloon catheter dacryoplasty (DCP) using PTCA balloon (Stormer(R)) for congenital nasolacrimal duct (NLD) obstruction in children. METHODS: The authors performed monocanalicular stenting (Monaka(R)) and balloon catheter (Stormer(R)) DCP as a secondary treatment of 25 children (27 lacrimal systems) over 12 months of age who had undergone ineffective probing treatment. The patients were followed up over 3 months and the postoperative outcome was assessed by fluorescein dye test. RESULTS: Nine of eleven children (nine of eleven lacrimal systems, 81.8%) and seven of nine children (seven of nine lacrimal systems, 77.7%) showed objective and subjective improvement, respectively. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary treatments for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery have been failed. Balloon dacryoplasty is a new procedure in improve the life-quality and reduce the complications rather than monocanalicular stenting.

Price Disparity of Medical Devices in Japan and Overseas / General Medicine

Despite large revenues in terms of reimbursement from health insurance, many cardiovascular centers in Japan are losing money. On the other hand, manufacturers of cardiac interventional devices are making money in Japan. A big price disparity exists in the field of cardiac interventions between Japan and the West according to many surveys, the first among them being published by JETRO (Japan External Trade Commission) in 1996. Since then, the Central Social Insurance Medical Council has been discussing this issue, but the gap has not been dissolved. The IHEP (Institute for Health Economics and Policy) report on the actual condition of distribution channels for medical devices in 1997, describes several reasons for the high prices of medical equipment and devices in Japan. Among them, the high prices are best explained for by well-acknowledged fact that the sole importing distributors, which are often subsidiaries of the US manufacturers, set high prices (70% of the purchase price of hospitals) when the devices reach Japan. While we proposed several practical approaches to address this problem, we consider the high government-set prices of the devices must be dealt with first. Why is it bad to leave the government-set reimbursement price of medical devices so high, given the fact that hospitals are able to earn the margin profit because the actual price that they pay to distributors is significantly lower than the reimbursement price ? Because, if the total health expenditure of Japan can not be increased in amount due to the government budgetary problems, then the remaining budget left over to cover physician fees will likely be decreased and will eventually hurt the hospitals financial state. The government should take quick action to eliminate the existing price disparity.

Relationship between Cognitive Appraisal and Cardiac Risk Reduction Behavior Following Coronary Angioplasty / 성인간호학회지

PURPOSE: According to Lazarus & Folkman (1984), appraising a stressor as a threat is associated with negative psychological and physical adjustment, whereas appraising a stressor as a challenge is positive psychological and physical adjustment. This study examined how cognitive appraisal of PTCA(heart disease threat and treatment appraisal) related to the cardiac risk reduction behaviors(smoking cessation, low salt and low cholesterol diet, regular exercise and stress management) 6 weeks following discharge. METHOD: Data were collected from 50 subjects with successful primary PTCA. RESULT: Heart disease threat was negative related to treatment appraisal (r=-0.240, p=0.046). Psychological well-being was negative related to heart disease threat (r=-0.317, p=0.012) and positive related to treatment appraisal(r=0.402, p=0.002). The cardiac risk reduction behaviors score was negative related to heart disease threat(r= -0.296, p=0.018) and positive related to treatment appraisal(r=-0.291, p=0.020). CONCLUSION: More negative appraisal was related to lower the cardiac risk reduction behaviors score. But more positive appraisal was related to higher the cardiac risk reduction behaviors score. So, there is a need to develop the cognitive-behavioral intevention that increase the coping strategy to replace with positive appraisal.

Emergency coronary surgery for failed PTCA as paradigm for changing patters inpercutaneous coronary angioplasty:twenty-year results / 中华胸心血管外科杂志

Objective: To assess the 20-year results of emergency coronary artery bypass grafting (eCABG) for failed percutaneous coronary angioplasty (fPTCA). Methods: Between 1977 and 1997, 101 patients, (56±5)years (32 to 78 years), underwent eCABG (8.5±25) hours (1 to 168 hours) after fPTCA. The mean preoperative left-ventricular ejection fraction was (57±9)% (30 to 75%). Single-vessel disease (SVD) was found in 55%, two-vessel disease (TwVD) in 39% and triple-vessel disease (TrVD) in 15% of patients, with the left anterior descending coronary artery (LAD) being affected in 74%. 15% of patients had full cardiopulmonary resuscitation prior to eCABG. Results: The incidence of eCABG for fPTCA dropped from 29% (1977-82) to 6% (1983-87), 0.02% (1988-92) and to 0.004% (1993-97) (P=0.000). Patients mean age increased from (50±10) (1977-82) to (62±10) years (1993-97) (P=0.0001). The incidence of TrVD increased from 4% (1977-82) to 68% (1993-97) (P=0.0001), the LAD being dilated in 76% of patients between 1977-82 and in 36% between 1993-97 (P=0.009). Hospital mortality for eCABG was 5% and was stable over time. The use of the left internal mammary artery increased from 8% (1977-82) to 54% (1993-97) (P=0.006). After (14±4) years (1 to 20 years), the actuarial survival was (84±8)%, freedom from myocardial infarction (70±11)% and freedom from reoperation (58±17)%. Conclusion: PTCA has become a safe procedure despite the higher incidence of older patients with TrVD. eCABG for fPTCA carries an acceptable mortality with off-pump coronary artery surgical techniques already applie two decades ago. Patients surviving surgery have an excellent long-term survival.

Experiences of PTCA and stents by radial artery from grass roots(attached 55 cases) / 介入放射学杂志

Objective Evaluate the feasibility of PTCA and stents by radial artery. Methods we had operated PTCA for 25 cases by radial artery from July 2004 to April 2005. The average age is 63 years old including 40 men and 15 women. Results 67 stents were implanted in 55 patients including 30A cases, 26 B cases and 11C cases. These stents is about 8mm to 33mm in length and 2.5mm to 4.0mm in width. The successful rate is 96%(53/55), and two case was failed, because the guiding wire can not pass by chronic obstruction in LAD all. There is no case by femoral. All the procedures have no heart complications, obstruction of radial artery and vascular complications. Conclusions The way is good for PTCA by radial artery. Its advantages are mild injury, high successful rate and few complications, and the salted hospitals can use the technology successfully.

Clinical Efficacy of Percutaneous Transluminal Coronary Angioplasty (PTCA) in Chronic Renal Failure / 대한신장학회잡지

BACKGROUND: Ischemic heart disease has become more important in regard to mortality in hemodialysis patients. Although PTCA has been used for the treatment of ischemic heart disease, its result has little been reported in chronic renal failure(CRF) patients not in maintenance dialysis. We examined the therapeutic outcome of PTCA in CRF group in comparison with that in control group with normal renal function. METHODS: In a retrospective case-control study, 15 patients with CRF(Scr >or=1.4 mg/dL) were compared with 29 sex, age and diabetes mellitus matched controls without renal disease who had been randomly selected from the PTCA registry of our institution. Restenosis was evaluated by follow-up angiography or recurrent angina. Twenty-two PTCAs were performed over 26 stenotic lesions in CRF group, and thirty-nine PTCAs undergone over 56 lesions in control group. RESULTS: CRF group consisted of 11 men and 4 women with a mean age of 59.2+/-9.2(mean+/-SD) years and a mean serum creatinine of 3.8+/-2.4 mg/ dL. Cause of renal failure was diabetes mellitus in 11 cases(73%). Angiographic lesion success was confirmed in 17(65%) out of the 26 stenotic sites and stents were inserted successfully in the other nine lesions. Restenosis was confirmed by angiography in 10 lesions(38.5%) over a mean of seven months and suspected by recurrent angina in 6 lesions(23.1%), so overall restenosis rate was 61.6% in CRF group. Risk of restenosis was little different compared with control group in single- and double vessel disease, but increased up to 89% in triple vessel disease in CRF in contrast with control group. Among CRF group patients with serum creatinine >or=2.5 mg/dL showed much increased restenosis rate(77%) compared with those with serum creatinine <2.5 mg/dL (46%). CONCLUSION: Restenosis rate significantly increased in CRF patients who have multivessel disease or advanced renal failure, so other reperfusion therapy should be considered for them.