ABSTRACT
BACKGROUND: Since the introduction of stents in 1994, improved clinical results have boosted the development of coronary angioplasty in Chile. Drug eluting stents, that have a reduced rate of restenosis, are being increasingly used. AIM: To assess the acute and long-term results of bare metal stent implantation. PATIENTS AND METHODS: Acute and long-term clinical, procedural and angiographic results were assessed in non acute myocardial infarction patients undergoing coronary stent implantation between August 1996 and December 2003. RESULTS: During the study period, 932 patients aged 30 to 87 years (194 women) had at least one stent implanted. Twenty two percent were diabetic, 33% had recent myocardial infarction, 53% unstable angina and 22% stable angina. Angiographic and clinical success were 99.6% and 98.2%, respectively. In hospital death was 0.5%. During a mean follow-up of 19.1 months, all cause mortality was 3.9%, cardiac death 1.9% and survival free of major cardiac ischemic events was 85.3%. Only 6.4% of lesions underwent target vessel revascularization (TVR). Independent predictors of TVR were previous surgery, left anterior descending artery, small post stent minimum luminal diameter. Ostial location, in-stent restenosis, and younger age were non significant predictors. CONCLUSIONS: Acute and long-term results of bare metal stents in this population were excellent. An intriguingly low rate of TVR was seen. Selective bare metal stenting should continue in lesions and patients with a low risk of clinical restenosis.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Stenosis/therapy , Stents , Adult , Aged , Aged, 80 and over , Chile , Coronary Restenosis/etiology , Coronary Stenosis/pathology , Epidemiologic Methods , Female , Humans , Male , Middle Aged , Myocardial Infarction/therapy , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVES: To evaluate the health effects of methyl isothiocyanate (MITC) and other byproducts resulting from the soil-incorporated (shank) application of 25,000 pounds of metam-sodium on July 8, 2002, near the community of Arvin, California. METHODS: Residents in a four-block area were interviewed regarding eye and upper respiratory irritation, non-specific systemic symptoms, and lower respiratory complaints. The distribution of cases was compared to results of Industrial Source Complex (ISC3) air dispersion modeling for the metam-sodium byproduct, methyl isothiocyanate (MITC). The 1-hour 200 ppb no-observed-effect- level (NOEL) and 800 ppb lowest-observed-effect level (LOEL) from a previous human eye irritation study were used to interpret the results of the air modeling estimates. Peak concentrations were compared to the 4-minute NOEL of 600 ppb and the LOEL of 1.9 ppm. RESULTS: Two-hundred-fifty-two cases of irritant, non-specific systemic, and respiratory symptoms were associated with the metam-sodium application. These included 178 community residents or visitors and 74 employees of a carrot packing operation located in the affected neighborhood of Arvin. The most severe reported illness occurred in a community visitor with a history of pre-existing pulmonary disease, who was hospitalized for a week with respiratory distress. ISC3 Modeling indicated 1-hour MITC concentrations in the affected community ranged from 0.8-1.0 ppm, in the range of the LOEL, with peak concentrations between 2.4 and 3.2 ppm. CONCLUSION: Estimated MITC concentrations during the episode exceeded both the 4-minute NOEL and 1-hourNOELby approximately four fold. The high concentrations of MITC present in the affected neighborhood may have been partially attributable to failure to immediately complete a required post-application water-treatment on 15 of the 100 treated acres. However, because of the limited area involved, the violation was unlikely to have accounted for the entire incident. Similar episodes may occur when metam-sodium fumigants are used adjacent to other rural communities.
Subject(s)
Air Pollutants/adverse effects , Environmental Exposure/adverse effects , Herbicides/toxicity , Isothiocyanates/toxicity , Respiratory Tract Diseases/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Agricultural Workers' Diseases/chemically induced , Agricultural Workers' Diseases/epidemiology , California/epidemiology , Child , Child, Preschool , Environmental Monitoring/methods , Epidemiological Monitoring , Female , Humans , Infant , Male , Middle Aged , No-Observed-Adverse-Effect Level , Occupational Exposure , Respiratory Tract Diseases/chemically inducedABSTRACT
La insuficiencia renal aguda (IRA) puede ser una complicación de la angioplastia coronaria (AC). En su patogenia participan variables inherentes al paciente como relacionadas al procedimiento. El objetivo de este estudio fue evaluar la incidencia y predictores de IRA en pacientes sometidos a AC. Analizamos a 913 pacientes sometidos a AC entre 08/1998 y 07/2003. Sólo 42 (4,6 por ciento) pacientes desarrollaron IRA (aumento de la creatinemia ≥ 0,5 mg/dl respecto del basal). Los predictores independientes de IRA fueron: edad (p=0,002; OR = 1,04), creatininemia basal (p < 0,001; OR = 4,00), caída del hematocrito (p = 0,001; OR = 1,15), insuficiencia cardiaca (p < 0,01; OR = 7,74), shock (p = 0,006; OR = 8,49) y la cantidad de medio de contraste (p = 0,006; OR = 1,005). Conclusiones: La IRA es una complicación poco frecuente de la angioplastia coronaria. La mayor edad, el daño renal previo, la pérdida sanguínea, el estado hemodinámico y el mayor volumen de medio de contraste usado son los predictores independientes de su ocurrencia.
