ABSTRACT
BACKGROUND: Current guidelines recommend the perioperative continuation of aspirin in patients with coronary drug-eluting stents (DES) undergoing noncardiac surgery. However, supporting evidence is limited. OBJECTIVES: This study aimed to compare continuing aspirin monotherapy vs temporarily holding all antiplatelet therapy before noncardiac surgery in patients with previous DES implantation. METHODS: We randomly assigned patients who had received a DES >1 year previously and were undergoing elective noncardiac surgery either to continue aspirin or to discontinue all antiplatelet agents 5 days before noncardiac surgery. Antiplatelet therapy was recommended to be resumed no later than 48 hours after surgery, unless contraindicated. The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, or stroke between 5 days before and 30 days after noncardiac surgery. RESULTS: A total of 1,010 patients underwent randomization. Among 926 patients in the modified intention-to-treat population (462 patients in aspirin monotherapy group and 464 patients in the no-antiplatelet therapy group), the primary composite outcome occurred in 3 patients (0.6%) in the aspirin monotherapy group and 4 patients (0.9%) in the no antiplatelet group (difference, -0.2 percentage points; 95% CI: -1.3 to 0.9; P > 0.99). There was no stent thrombosis in either group. The incidence of major bleeding did not differ significantly between groups (6.5% vs 5.2%; P = 0.39), whereas minor bleeding was significantly more frequent in the aspirin group (14.9% vs 10.1%; P = 0.027). CONCLUSIONS: Among patients undergoing low-to-intermediate risk noncardiac surgery >1 year after stent implantation primarily with a DES, in the setting of lower-than-expected event rates, we failed to identify a significant difference between perioperative aspirin monotherapy and no antiplatelet therapy with respect to ischemic outcomes or major bleeding. (Perioperative Antiplatelet Therapy in Patients With Drug-eluting Stent Undergoing Noncardiac Surgery [ASSURE-DES]; NCT02797548).
Subject(s)
Cardiomyopathies/diagnosis , Coronary Angiography/adverse effects , Coronary Vessel Anomalies/diagnosis , Coronary Vessels/injuries , Heart Injuries/diagnosis , Cardiomyopathies/complications , Cardiomyopathies/diagnostic imaging , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Diagnosis, Differential , Heart Injuries/etiology , Humans , Iatrogenic Disease , Video RecordingABSTRACT
OBJECTIVE: Nurses are usually first witnesses to in-hospital sudden cardiac arrests. Training of nurses has an impact on the efficiency and outcome of cardiopulmonary resuscitation (CPR), and thus, assessment of CPR knowledge among undergraduate nurses is very important to improve training program. METHODS: The questionnaire comprised of three parts about CPR knowledge: the first dealing with general questions to understand the importance of CPR in clinical practice; the second comprising the main goal and accuracy of CPR intervention; and the last consisting of questions targeting the indications, methods, and effectiveness of CPR. Descriptive statistics and multiple response analyses were done by IBM SPSS version 20. RESULTS: The students had good knowledge about the importance of CPR in clinical practice and stood average in knowing its indications and effectiveness. The mean score was 64.62±17.84 out of 100 points. While only 11% of them were completely aware about the universal compression ventilation ratio, 16.2% were aware of the current compression depth. In addition, 21.8% of participants have only indicated the order of CPR being compression, airway, and breathing. CONCLUSION: Knowledge of CPR is good among the nursing students. However, skills of CPR have to be improved by current training programs at regular intervals. Their knowledge and practical approach have to be updated with the current guidelines in CPR.
Subject(s)
Cardiopulmonary Resuscitation , Clinical Competence , Death, Sudden, Cardiac/prevention & control , Students, Nursing , Education, Nursing, Baccalaureate , Humans , Surveys and Questionnaires , TurkeySubject(s)
Shock, Cardiogenic/diagnosis , Ventricular Dysfunction, Left/diagnosis , Aged , Chest Pain/etiology , Diagnosis, Differential , Electrocardiography , Heart-Assist Devices , Humans , Intra-Aortic Balloon Pumping , Male , Percutaneous Coronary Intervention/methods , Shock, Cardiogenic/complications , Shock, Cardiogenic/therapy , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/therapy , Young AdultABSTRACT
OBJECTIVE: To determine the co-incidence of coronary artery disease (CAD) in patients investigated for peripheral arterial disease (PAD), and to establish the relationship between the risk factors in the two groups of patients. METHODS: The prospective study, done from January 2005 and April 2009, at the Cardiology Clinic of Rize Education and Research Hospital, Rize and John F. Kennedy Hospital, Istanbul, Turkey, had a cohort of 307 patients who had been diagnosed with peripheral artery disease either clinically or by ultrasonography for the arteries of the lower extremities and had undergone coronary angiography and peripheral angiography in the same or different sessions. The patients were evaluated in terms of age, gender and atherosclerotic risk factors. Relationship of the extent of peripheral arterial disease with coronary artery involvement was investigated. RESULTS: Of the 307 patients, 251 (81.8%) were male, and the mean age was 62.1 +/- 9.5 years. In the study population, 178 (58.0%) patients were diagnosed as hypertensive, 84 (27.4%) patients were diabetic, 18 (5.9%) patients had a family history of coronary artery disease, 111 (36.2%) were smokers, 149 (48.5%) were hypercholesterolemic, and 20 (6.5%) had cerebrovascular/carotid disease. In 92.3% of patients with peripheral arterial disease, various levels of coronary stenosis (P = 0.007) was noticed. Hypertension was a risk factor for both coronary and peripheral artery diseases (p = 0.012 and 0.027, respectively). Univariate logistic regression analysis demonstrated that the presence of peripheral artery disease was related to the coronary variety (Odds ratio [OR]: 6, 95% CI: 1.4-25.5, P = 0.016) and severe cases (diffused atherosclerotic stenosis and complete occlusion in all segments) significantly indicated the presence of some coronary pathology (OR: 8, 95% CI: 1.7-37.4, P = 0.008). This relationship maintained its significance after adjustment for age, gender, hypercholesterolaemia, smoking, hypertension, diabetes, family history, and the presence of cerebrovascular/carotid disease (p = 0.010). CONCLUSIONS: Peripheral coronary artery diseases had similar risk factors. The extent of peripheral arterial disease observed during peripheral lower extremity angiography was significantly associated with the presence and severity of coronary artery disease. Particular attention should be focused on the possibility of coronary artery disease in patients with established and extensive peripheral arterial disease. Non-invasive, as well as invasive tests, should be performed to decrease morbidity and mortality risk of such patients.
Subject(s)
Angiography/methods , Coronary Disease/complications , Coronary Disease/diagnostic imaging , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/diagnostic imaging , Chi-Square Distribution , Coronary Angiography , Coronary Disease/epidemiology , Coronary Disease/etiology , Female , Humans , Logistic Models , Male , Middle Aged , Peripheral Vascular Diseases/epidemiology , Peripheral Vascular Diseases/etiology , Prospective Studies , Risk Factors , Turkey/epidemiologyABSTRACT
There are several reports on the association between the factor V Leiden mutation and acute myocardial infarction (AMI) in young patients, in particular young males. A 28-year-old male patient was admitted with severe chest pain of new onset. He was an active smoker. His father had a history of coronary artery disease and AMI after the age of 45 years. There were no other major coronary risk factors. His electrocardiogram showed ST-segment elevation in the precordial leads V1 to V5. His blood pressure, pulse rate, and other clinical parameters were stable. Emergency coronary angiography showed a significant narrowing in the mid-portion of the left anterior descending (LAD) artery with a moderate intracoronary thrombus, and no or minimal atherosclerosis. The other coronary arteries were normal. Direct stenting was performed for the culprit lesion, which resulted in relief of obstruction and significant improvement in the LAD artery. DNA samples isolated from the peripheral blood were analyzed by polymerase chain reaction and the patient was found to be homozygous for the factor V Leiden mutation. Transthoracic echocardiography before discharge showed only mild hypokinesis of the anterior and apical segments.
Subject(s)
Factor V/genetics , Myocardial Infarction/etiology , Adult , Blood Flow Velocity , Coronary Vessels/pathology , Electrocardiography , Homozygote , Humans , Male , Mutation , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/pathology , Radiography , StentsABSTRACT
A circumflex (Cx) artery originating from the right coronary artery is one of the most common congenital coronary anomalies and is usually thought to be benign. Twin Cx arteries represent a very rare congenital anomaly with only three reported cases. Herein, we present a case of twin Cx arteries originating from the left main and right coronary arteries, respectively. A 50-year old male patient was admitted with chest pain. The electrocardiogram showed ST-segment elevation in leads D2, D3, and AVF, and ST-segment depression in the anterior leads. With the diagnosis of acute inferior myocardial infarction, the patient underwent coronary angiography which showed that the left Cx originating from the left main coronary artery was totally occluded by a thrombus in the mid-portion. There was another Cx arising from the proximal part of the right coronary artery with a significant stenosis in the proximal segment. Balloon angioplasty and stenting were successfully performed for the left Cx lesion, followed by direct stenting of the right Cx lesion one month later. The two Cx arteries were also evaluated by cardiac computed tomography angiography. The right Cx coursed between the pulmonary artery and the aorta and supplied the right part of the lateral wall of the left ventricle. The left Cx was located in the lateral wall and supplied the left part of the lateral wall of the left ventricle.
Subject(s)
Coronary Stenosis/complications , Coronary Thrombosis/complications , Coronary Vessel Anomalies/diagnostic imaging , Myocardial Infarction/complications , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/therapy , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/therapy , Electrocardiography , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/therapy , Stents , Tomography, X-Ray ComputedABSTRACT
Most coronary anomalies are clinically asymptomatic. However some of them may present with chest pain, syncope, heart failure and sudden death. Anomalous left anterior descending artery arising from right coronary artery is a very rare coronary anomaly.
Subject(s)
Coronary Vessel Anomalies , Chest Pain/etiology , Coronary Angiography , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Dyspnea/etiology , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
In search of associations between coronary artery disease and symptoms of depression and anxiety, we conducted a prospective cross-sectional study of 314 patients (age range, 19-79 yr) who had presented with chest pain. Coronary angiographic findings were classified into 5 categories (0-4), in which higher numbers indicated more severe disease. Symptoms of depression and anxiety were evaluated by the Beck depression and anxiety inventories, in which higher scores indicated more severe symptoms.Older age, male sex, diabetes mellitus, hypercholesterolemia, and high income were found in association with coronary artery disease. Woman patients exhibited significantly higher depression and anxiety scores (P < 0.001), even though they had coronary artery disease infrequently (P = 0.003). At first, no significant correlation was found between coronary artery disease levels 0, 1, 2, 3, or 4 and scores of depression or anxiety. After controlling for sex differences and other confounding variables, however, we found that every 1-point increase in the depression score was associated with an average 5% to 6% increase in abnormal coronary angiographic findings or definitive coronary artery disease, respectively (P = 0.01 and P = 0.002). Although there was no such association between anxiety score and coronary artery disease, the highest anxiety scores were encountered in patients with slow coronary flow.