[Primary angioplasty in acute myocardial infarct. A report on 304 consecutive patients]. / Angioplastía primaria en infarto agudo del miocardio. Reporte de 304 pacientes consecutivos.

The purpose of this study is to describe a single-center experience in primary coronary angioplasty in 304 consecutive patients with acute myocardial infarction. Sixty-seven percent were men and 33% women, the mean age was 69 years. The time from onset to treatment was 3.5 hours, 14% had previous bypass surgery and 23% prior myocardial infarction, 11% arrived in cardiogenic shock. Coronary angiography showed multivessel disease in 56% of patients, 73% had TIMI 0-1 flow. Successful PTCA occurred in 95% and in hospital mortality was 6.5%. Primary coronary angioplasty is a successful reperfusion method in acute myocardial infarction and it is associated with low mortality even in high risk groups. The rates of success and major complications in this series are similar to other publications.

[Use of nitric oxide in the evaluation of pulmonary arterial hypertension]. / Uso del óxido nítrico en la valoración de la hipertensión arterial pulmonar.

The purpose of this article is to describe a patient with severe pulmonary artery hypertension, who was evaluated in the catheterization laboratory with the use of nitric oxide to check the degree of reversibility of the pulmonary hypertension. The patient is a 18 months old baby with atrio-ventricular canal and severe pulmonary hypertension, whose vascular resistance dropped from 8.75 Wood U/m2 to 1.32 Wood U/m2. With these findings the pulmonary artery hypertension was considered reversible and made him a good candidate for successful corrective surgery. The use of nitric oxide is very useful for the evaluation of the degree of reversibility of the pulmonary vascular resistance in cases with severe pulmonary artery hypertension with a left to right shunt.

[Cardiogenic shock in acute myocardial infarct. Its coronary angioplasty treatment]. / Choque cardiogénico en el infarto agudo del miocardio. Tratamiento con angioplastía coronaria.

Ventricular dysfunction is the most common cause of in-hospital death in patients with acute myocardial infarction. When cardiogenic shock is manifested the mortality is very high. Seven patients with cardiogenic shock complicating acute myocardial infarction were treated with emergency coronary angioplasty. Four patients required cardiopulmonary resuscitation (CPR), 2 intraaortic balloon pump support and one femoro-femoral bypass pump support during the coronary angioplasty. The angiography success rate was 86%. Two patients died, one in the catheterization laboratory and the other one 24 hours later. The hospital mortality was 29%. Of the patients who survived 4 are in functional class I and one in functional class II (NYHA). Coronary angioplasty therapy in patients with cardiogenic shock complicating acute myocardial infarction plays a decisive role in the reduction of mortality.

[Coronary and renal percutaneous angioplasty performed in the same procedure. A report on 5 consecutive cases]. / Angioplastía percutánea coronaria y renal realizadas en el mismo procedimiento. Reporte de 5 casos consecutivos.

Percutaneous transluminal coronary and renal angioplasty (PTA and Renal PTA) were performed during the same procedure in five of 100 patients who underwent PTCA between August 1989 and June 1990. All patients were male, with systemic hypertension (HT) with angina grade I to IV. The median age was 62 years (range 53 to 74). Three patients had controlled HT with 2 to 4 drugs and 2 were uncontrolled even after multiple antihypertensive treatment. Two patients were diabetic and the serum creatinine levels were normal except in one patient (1.9 mg/dL). Lesions more than 70% obstruction of luminal diameter were approached. Multivessel PTCA was done in one patient, multi-lesion in 2 and single lesion in other two. A total of 11 lesions were dilated, 4 in LAD, 5 in Cx and 2 in RCA (type A = 2, type B = 9). Complete revascularization was achieved in all cases. Five renal lesions were approached, 4 in the proximal third and one on the middle third. In 2 patients the blood pressure (BP) fell within normal limits without medication. In other 2 there was an improvement and were easily controlled with just one drug. One patient had no improvement and required multiple therapy to control it. The only complication observed was in a diabetic with previous abnormal serum creatinine who developed non-oliguric renal failure and returned to basal creatinine level at the third day post PTCA. In selected cases PTCA and renal PTA can be safely performed during the same procedure, with the advantage of cost reduction.

[Coronary angioplasty of multiple vessels and lesions in unstable functional class-IV angina]. / Angioplastía coronaria de vasos y lesiones múltiples en angina inestable clase functional IV.

A select group of 26, class IV unstable angina patients that had multiple lesions or multivessel disease were treated with percutaneous transluminal coronary angioplasty (PTCA). Complete revascularization was the endpoint in all patients. Seventy lesions were dilated (mean = 2.6 lesions per patient). In the tandem multi-lesion group (13 patients) 2.23 lesions per patient were approached (Range 2-3) and in the multivessel disease group (13 patients) a mean of 3.15 lesions per patient were attempted (Range 2-6). An overall success rate of 96% per patient (25/26 patients) and 95.7% primary success per lesion were achieved with no mortality. We report the results of a select group of unstable angina patients with multi-lesion or multivessel disease who underwent PTCA. A careful performance was associated with high primary success in the high risk group achieving clinical and angiographic improvement.

[Silent myocardial ischemia in unstable angina and acute myocardial infarction. Prospective clinical study]. / Isquemia miocardica asintomatica en la angina inestable y en el infarto miocardico agudo. Investigacion clinica prospectiva.

To establish the prevalence and characteristics of silent myocardial ischemia in patients with unstable angina and acute myocardial infarction and its possible correlation with coronary artery lesions; two groups patients were studied, fifteen with unstable angina and fifteen with acute myocardial infarction. In all patients a continuous 24 hours ECG recording was made with a solid state microprocessor for ST variation analysis, and all underwent coronary arteriography and ventriculography, the severity of coronary heart disease was determined by Gensini scoring system and the coronary angiography morphology was studied. In 86% patients with unstable angina ischemic ST changes were found, 90% of these episodes were silent. There were 66% of the patients with acute myocardial infarction and ST ischemic changes of these 75% were silent. There was no correlation with the ischemic myocardium score index, nor with the angiographic morphology or the heart rate. Therefore it can be said that myocardial ischemia is a result not only of anatomic factors but of many others such as vasoconstriction, endothelial, myocardial, systemic and hemorheological alterations.