Subject(s)
Cardiac Catheterization/adverse effects , Recurrent Laryngeal Nerve Injuries , Vocal Cord Paralysis/etiology , Aged , Coronary Stenosis/diagnosis , Diagnosis, Differential , Female , Glucocorticoids/administration & dosage , Humans , Injections, Intravenous , Laryngoscopy , Syndrome , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/drug therapyABSTRACT
Diffuse coronary artery disease (CAD) is considered unfavorable for interventional procedures; however, the results of stenting of diffuse CAD have not been completely characterized. We performed stenting in 100 consecutive patients with diffuse CAD, defined as significant stenosis >20 mm (n = 59 patients), multiple significant stenoses in the same artery (n = 23 patients), or significant narrowing involving the whole length of the coronary artery (n = 18 patients). Angiographic success was achieved in 103 arteries (100%) and clinical success was obtained in all 100 patients. There were no deaths; no patient had stent closure, acute myocardial infarction, or required emergency coronary artery bypass surgery. All 100 patients had >6 months follow-up (mean 18 +/- 7 months, range 7 to 31); 77 (77%) remained asymptomatic, and 5 (5%) had acute myocardial infarction, of whom 2 died (2%). In-stent restenosis was observed in 12 patients (12%) and repeat angioplasty was performed in 10. Including those patients who underwent repeat angioplasty, 89 (89%) maintained clinical improvement and 95 (95%) were alive and free of bypass surgery during follow-up. Life-table analysis showed 86% freedom from death, myocardial infarction, and target lesion revascularization at 28 months. Thus, selected patients with diffuse CAD may be treated with satisfactory acute and long-term results by stent implantation.
Subject(s)
Angioplasty, Balloon, Coronary/methods , Coronary Disease/therapy , Stents , Coronary Angiography , Coronary Disease/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Recurrence , Severity of Illness IndexSubject(s)
Myocardial Infarction/diagnosis , Pregnancy Complications, Cardiovascular/diagnosis , Puerperal Disorders/diagnosis , Cardiac Catheterization , Coronary Angiography , Echocardiography , Electrocardiography , Female , Humans , Maternal Age , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Myocardial Infarction/etiology , Pregnancy , Pregnancy Complications, Cardiovascular/drug therapy , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Complications, Cardiovascular/etiology , Pregnancy, High-Risk , Puerperal Disorders/drug therapy , Puerperal Disorders/epidemiology , Puerperal Disorders/etiologyABSTRACT
BACKGROUND: The aim of this study was to evaluate the plasma concentration of a platelet-derived protein, platelet factor 4 (PF4), before and after exercise in coronary artery disease. METHODS: We enrolled 60 patients with documented ischemic heart disease. The subjects were divided into two groups: Group 1 patients with previous myocardial infarction (n = 20, 13 males, 7 females, mean age 51.6 +/- 7.5 years, range 38-62 years); Group 2 patients with exercise-induced angina (n = 40, 22 males, 18 females, mean age 52.6 +/- 8.0 years, range 38-65 years). Patients with hypertension, hyperlipidemia and diabetes were excluded. Patients with angina or ST segment depression during the stress test were included in a subgroup (n = 33, 21 males, 12 females, mean age 50.3 +/- 6.3 years, range 40-65 years). Twenty healthy subjects without coronary risk factors (13 males, 7 females, mean age 53.2 +/- 7.1 years, range 38-65 years) served as controls. PF4 was measured in all patients at baseline and 5 min after a bicycle exercise test. Plasma PF4 levels were measured performed by radioimmunoassay (ng/ml, normal range 0-10). RESULTS: Patients with ischemic heart disease showed a high basal concentration of PF4 compared with controls. PF4 levels at baseline vs after stress test were 4.1 +/- 2.5 vs 5.3 +/- 2.6 ng/ml in healthy subjects; 33.4 +/- 15.8 vs 56.2 +/- 28.2 ng/ml (p < 0.001) in Group 1; 22.4 +/- 15.8 vs 44.6 +/- 28.4 ng/ml (p < 0.001) in Group 2; 29.9 +/- 15.5 vs 67.7 +/- 26.1 ng/ml in the subgroup with angina or ST segment depression (p < 0.001), and 23.1 +/- 16.5 vs 26.0 +/- 18.1 ng/ml in those without angina or ST segment depression (NS). CONCLUSIONS: These findings support the hypothesis that a significant increase in PF4 levels after exercise is associated with clinically significant coronary artery disease.
