ABSTRACT
Regadenoson is a pharmacologic stress agent that has been widely adopted as an alternative over other pharmacologic vasodilator agents due to its ease of use, patient tolerance, and safety profile. We report the case of dynamic ST-segment elevation electrocardiogram changes after regadenoson injection during an inpatient single-photon emission computed tomography myocardial perfusion stress test, with subsequent coronary angiography revealing the presence of hemodynamically significant coronary artery disease. Our findings confirm that transient regadenoson-induced ST-segment elevations are a marker for hemodynamically significant disease even in the setting of low-risk SPECT perfusion images.
Subject(s)
Adenosine A2 Receptor Agonists/adverse effects , Coronary Artery Disease/diagnostic imaging , Purines/adverse effects , Pyrazoles/adverse effects , Coronary Angiography , Electrocardiography , Exercise Test , Heart Rate/drug effects , Humans , Male , Middle Aged , Myocardial Perfusion Imaging , Tomography, Emission-Computed, Single-PhotonSubject(s)
Defibrillators, Implantable/microbiology , Electrocardiography , Endocarditis, Bacterial/microbiology , Staphylococcal Infections/microbiology , Bacteremia/microbiology , Catheterization/adverse effects , Device Removal , Electrodes, Implanted/microbiology , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Equipment Contamination , Fatal Outcome , Female , Heart Valves/microbiology , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Middle Aged , Recurrence , Renal Dialysis/instrumentation , Staphylococcal Infections/diagnostic imaging , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Ultrasonography , Vancomycin Resistance , Ventricular Fibrillation/complications , Ventricular Fibrillation/therapyABSTRACT
Myocardial bridging is associated with myocardial infarction (MI) on rare occasions. The mechanism by which this occurs is unclear; vessel occlusion in this setting may be due to superimposed thrombosis or vasospasm. An unusual case is presented of postoperative MI from thrombosis associated with myocardial bridging and intravascular volume depletion, with subsequent distal embolization. Endothelial injury as a result of myocardial bridging may predispose to thrombus formation. To avoid MI, adequate fluid hydration is recommended during the perioperative period in patients with myocardial bridging.
Subject(s)
Coronary Thrombosis/complications , Coronary Vessel Anomalies/complications , Embolism/etiology , Myocardial Infarction/etiology , Aged, 80 and over , Cardiac Catheterization , Coronary Thrombosis/diagnosis , Coronary Vessel Anomalies/diagnosis , Humans , Male , Postoperative PeriodABSTRACT
OBJECTIVES: We sought to determine how practice patterns for unprotected left main stenosis have changed with the advent of drug-eluting stents (DES). BACKGROUND: Percutaneous coronary intervention (PCI) of unprotected left main coronary stenosis has been controversial. METHODS: We analyzed data submitted to the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) between January 1, 2002 and December 31, 2004 from 1,276,582 cardiac catheterizations at 417 institutions. Of these, 53,548 (4.2%) had left main stenosis >50% and no prior CABG. After excluding the unrevascularized, the patient sample (N = 32,562) was analyzed for PCI vs. CABG. Data was stratified by year/quarter, bare metal stent vs. DES, elective vs. urgent/emergent situations, LVEF < or > or =40%, and %left main and RCA stenosis. RESULTS: Of unprotected left main revascularizations from 2002 to 2004, PCI increased from 17.0% to 21.9%, while CABG decreased from 83.0% to 78.1% (P < 0.0001). In 2002, bare metal stents were used for all PCIs; in 2004, bare metal stent use was only 25.5%, while DES use was 74.5% (P < 0.0001). Of elective procedures, PCI rose from 19.1% to 27.5% while CABG fell from 80.9% to 72.5% (P < 0.0001). Similar trends, all significant, were seen in every clinical situation. CONCLUSIONS: In the era of DES, the rate of PCI for unprotected left main stenosis has risen, while CABG has declined. These findings are seen across varying clinical situations, including elective procedures. DES have rapidly and largely replaced bare metal stents for PCI of unprotected left mains. However, PCI is still chosen less frequently than CABG for unprotected left main revascularization.
