RESUMO
Timely recognition of the characteristic electrocardiographic pattern of de Winter syndrome is important for providing immediate reperfusion therapy for acute anterior myocardial infarction. In this case, an electrocardiogram showed 1- to 3-mm upsloping ST-segment depression at the J point in leads V1 to V6, with loss of R wave progression in leads V1 to V4. Urgent angiography showed occlusion of the proximal left anterior descending coronary artery and 70% stenosis in the ostial first diagonal branch (Medina type 1.1.1.). For this bifurcation lesion, we successfully performed a modified jailed-balloon technique to protect the side branch during percutaneous coronary intervention stenting. Thereafter, thrombolysis in myocardial infarction 3 flow was restored in both branches. This modified jailed-balloon technique is safe and effective in stent placement for de Winter syndrome without any loss of side branches.
Assuntos
Angioplastia Coronária com Balão/métodos , Arteriopatias Oclusivas/complicações , Vasos Coronários/patologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Angioplastia Coronária com Balão/instrumentação , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Stents , Resultado do TratamentoAssuntos
Povo Asiático/genética , Reestenose Coronária/genética , Etnicidade/genética , Estudos de Associação Genética , Metaloproteinase 3 da Matriz/genética , Intervenção Coronária Percutânea/efeitos adversos , Polimorfismo Genético , Stents/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/enzimologia , Reestenose Coronária/etiologia , Feminino , Humanos , Masculino , Metaloproteinase 3 da Matriz/sangue , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To investigate the association between inflammatory mediators, matrix degrading enzymes and acute coronary syndrome (ACS) and the impact of early reperfusion therapy on circulating biomarkers. DESIGN: Peripheral serum levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9) were determined in 134 patients with ACS. These biomarkers were serially monitored in ten patients with intravenous thrombolytic therapy (IVT). RESULTS: Serum levels of IL-6, hs-CRP and MMP-9 were higher in unstable angina (UA) and myocardial infarction (MI) groups than in control or SA group (p<0.05). Peripheral IL-6 level in patients with MI was greater after percutaneous coronary intervention (PCI) (p<0.01) or IVT (p<0.05). Serial concentration determination revealed marked elevation of serum IL-6 and MMP-9 levels, both reaching peak values (like creatine kinase-MB). CONCLUSIONS: Elevated levels of IL-6, hs-CRP and MMP-9 provide a link between inflammation, matrix degradation and the development and progression of ACS. IL-6 and MMP-9 appear to be released mainly from vulnerable plaque or necrotic myocardium during the acute phase of MI.
