Spontaneous coronary dissection and its long-term prognostic implications in a cohort of 19 cases.

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It mainly affects women with no significant cardiovascular risk factors and its presentation varies from unstable angina to sudden death. Knowledge of the condition is based only on individual case reports and the lack of large case series means that its treatment and prognostic implications have not been fully established. We present data on 19 instances of spontaneous coronary artery dissection in 18 patients who were treated at our center between May 1998 and January 2009. The median follow-up period was 3.8 years (interquartile range: 1.3-4.6 years). Once the acute phase had passed, the prognosis was favorable and there were no implications for functioning. One patient presented with a relapse in another coronary artery and another patient gave birth without complications 3 years after the dissection.

Disección coronaria espontánea y sus implicaciones pronósticas a largo plazo en una cohorte de 19 casos / Spontaneous coronary dissection and its long-term prognostic implications in a cohort of 19 cases

La disección coronaria espontánea es una causa infrecuente de síndrome coronario agudo que afecta predominantemente a mujeres sin apenas factores de riesgo cardiovascular y cuya presentación varía desde la angina inestable hasta la muerte súbita. Los conocimientos de esta entidad se reducen a casos clínicos aislados, y la ausencia de grandes series hace que su tratamiento y sus implicaciones pronósticas no estén plenamente establecidos. Presentamos los datos de 19 casos en 18 pacientes atendidos en nuestro centro desde mayo de 1998 hasta enero de 2009, con una mediana [intervalo intercuartílico] de 3,8 [1,3-4,6] años de seguimiento. Una vez superada la fase aguda, el pronóstico fue favorable sin implicaciones funcionales. Una paciente presentó una recidiva en una coronaria diferente y otra paciente dio a luz sin complicaciones a los 3 años de la disección (AU)

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It mainly affects women with no significant cardiovascular risk factors and its presentation varies from unstable angina to sudden death. Knowledge of the condition is based only on individual case reports and the lack of large case series means that its treatment and prognostic implications have not been fully established. We present data on 19 instances of spontaneous coronary artery dissection in 18 patients who were treated at our center between May 1998 and January 2009. The median follow-up period was 3.8 years (interquartile range: 1.3-4.6 years). Once the acute phase had passed, the prognosis was favorable and there were no implications for functioning. One patient presented with a relapse in another coronary artery and another patient gave birth without complications 3 years after the dissection (AU)

Elevación del segmento ST en precordiales como presentación electrocardiográfica inusual del infarto de ventrículo derecho aislado / Precordial ST-elevation in isolated right ventricular infarction: an un usual electrocardiographic presentation

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Vía transradial en el tratamiento percutáneo del infarto agudo de miocardio con stents coronarios / Transradial approach for percutaneous coronary stenting in the treatment of acute myocardial infarction

Introducción y objetivo. El tratamiento del infarto agudo de miocardio (IAM) mediante intervención coronaria percutánea (ICP) con stent determina un excelente resultado clínico inmediato y un buen pronóstico. El objetivo de este estudio es comparar la seguridad y eficacia de la vía arterial radial (VAR) con la vía arterial femoral (VAF). Pacientes y método. Entre mayo de 2001 y junio de 2003, se incluyó en el estudio observacional a 162 pacientes consecutivos con IAM < 12 h tratados mediante implante percutáneo de stents. Por VAR se abordó a 103 pacientes y por VAF, a los 59 restantes. Se compararon el éxito del procedimiento, los acontecimientos cardíacos adversos mayores y la incidencia de complicaciones locales entre ambas vías. Resultados. En ambos grupos la duración de la fluoroscopia (22,4 ñ 15,4 min frente a 24,5 ñ 19,5 min), la frecuencia de éxitos inmediatos (el 96,1 frente al 94,9 por ciento) y el número de acontecimientos cardíacos adversos mayores (el 6,8 frente al 8,5 por ciento) fueron similares. En ningún caso se produjeron complicaciones locales por la VAR (0 frente a 5 pacientes por VAF; p = 0,007). Conclusiones. El éxito y la seguridad de la VAR en el tratamiento percutáneo con stents de pacientes con IAM son similares a los que se obtienen por VAF, pero la incidencia de complicaciones locales, especialmente hemorragia, es significativamente menor. Por tanto, la VAR podría ser la de elección en pacientes con riesgo elevado de hemorragia. Infarto agudo de miocardio (AU)

[Transradial approach for percutaneous coronary stenting in the treatment of acute myocardial infarction]. / Vía transradial en el tratamiento percutáneo del infarto agudo de miocardio con stents coronarios.

INTRODUCTION AND OBJECTIVE: Treatment of acute myocardial infarction by percutaneous coronary intervention with stenting leads to excellent immediate clinical results and a good prognosis. The aim of this study was to compare in this selected population the safety and effectiveness of radial artery access versus femoral artery access. PATIENTS AND METHOD: Between May 2001 and June 2003, 162 consecutive patients with acute myocardial infarction < 12 hours treated by percutaneous stenting were included in an observational study. The radial artery approach was used in 103 patients, and the femoral artery approach in the remaining 59 patients. The success of the procedure, incidence of major adverse cardiac events and local puncture complications were compared in patients treated with the radial artery versus the femoral artery approach. RESULTS: Fluoroscopy time (22.4 [15.4] min vs 24.5 [19.5] min), immediate success of the procedure (96.1% vs 94.9%), and the incidence of major adverse cardiac events (6.8% vs 8.5%) did not differ between the two groups. Bleeding complications due to local puncture were present only in the femoral artery access group (0 vs 5 patients; P= .007). CONCLUSIONS: In selected patients with acute myocardial infarction treated with primary stent implantation, the success rate and clinical safety of the radial artery approach are similar to those of the femoral artery approach, but the incidence of local complications, especially bleeding, is significantly lower in the former. Thus the radial artery approach should become the approach of choice in patients at high risk for bleeding complications.