ABSTRACT
INTRODUCTION: Primary transradial percutaneous coronary intervention (TRI) is shown to be efficacious in stable patients with acute coronary syndrome. We aimed to evaluate the application of primary TRI for acute ST elevation myocardial infarction (STEMI), including among high-risk patients from our registry. METHODS: This was a single-centre case series comprising 138 patients who underwent primary TRI for STEMI between May 2007 and June 2008. TRI was attempted with a 6-Fr guiding catheter in all patients regardless of Killip class status. Outcome measures were success rates of primary TRI, door-to-balloon time, procedure duration and volume of contrast used. All patients were followed up for major adverse cardiac events in-hospital, at 30 days and six months. RESULTS: A total of 138 patients had primary TRI attempted for STEMI. Four patients failed primary TRI and required a femoral approach. The remaining 134 patients underwent primary TRI. The mean patient age was 56.4 years. Most patients with acute STEMI presented in Killip class I and II (91.8 percent). Only 8.2 percent were in Killip class III or IV on admission. 50 percent of patients presented with anterior STEMI. The median door-to-balloon time for this group was 92 (interquartile range [IQR] 77-121) minutes, with a median procedure time of 39 (IQR 29-51) minutes. The success rate of primary TRI was 97.1 percent. CONCLUSION: Success rate, procedural and radiation time for TRI are comparable to those achieved via the femoral approach. Primary TRI is therefore a feasible and effective approach for acute STEMI, even in high-risk patients.
Subject(s)
Angioplasty, Balloon, Coronary/methods , Myocardial Infarction/therapy , Aged , Catheterization , Contrast Media/pharmacology , Coronary Circulation , Female , Humans , Male , Middle Aged , Perfusion , Registries , Risk , Risk Factors , Stents , Treatment OutcomeSubject(s)
Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitors , Radial Artery , Female , Humans , Male , WristABSTRACT
A 29-year-old woman with frequent syncope attacks was referred for electrophysiological study and consideration for radio-frequency ablation of her ventricular arrhythmias. Her ECG showed features of right ventricular outflow tract premature contraction. Differential diagnoses for the causes of syncope in this patient include: right ventricular outflow tract tachycardia, arrythmogenic right ventricular dysplasia, and neurocardiogenic syncope. She underwent a tilt table test, which showed a malignant cardioinhibitory response. She developed abrupt syncope with 32 seconds of asystole during the test. She was given intravenous atropine and was resuscitated. A dual chamber rate-responsive pacemaker was implanted for her the next day. She was discharged well subsequently. Although the prognosis in patients with prolonged aystole in malignant vasovagal syncope is unknown, most doctors will still choose to implant a permanent pacemaker for patients with malignant neurocardiogenic syncope when the sinus arrest is prolonged.
Subject(s)
Bundle-Branch Block/diagnosis , Electrocardiography , Syncope, Vasovagal/diagnosis , Ventricular Premature Complexes/diagnosis , Adult , Bundle-Branch Block/therapy , Diagnosis, Differential , Echocardiography , Exercise Test , Female , Humans , Pacemaker, Artificial , Recurrence , Syncope, Vasovagal/therapy , Ventricular Premature Complexes/therapyABSTRACT
Fifty years ago, dentists had always used modelling compound to take functional bite pattern as a method for making the occlusal surface of a crown in order to simplify the final occlusal adjustment. Therefore, the writer adopted the same method to fabricate crown bridge with inlay wax and to construct denture with paraffin wax. The results achieved the same simplification during occlusal adjustment procedure.
