Association between the risks of contrast-induced nephropathy after diagnostic or interventional coronary management and the transradial and transfemoral access approaches.

Introduction: The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA). Methods: Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI. Results: Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P= 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P= 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study. Conclusion: The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.

Mitral annular calcification-related calcified amorphous tumor in a patient with normal renal function: a case report.

A calcified amorphous tumor (CAT) of the heart is a non-neoplastic mass, characterized by nodules of calcium on a background of amorphous fibrinous material. Mitral annular calcification (MAC) is one of the conditions most frequently associated with CAT. Most MAC-related CAT cases are reported in end-stage renal disease (ESRD) patients. This report is a description of a patient with normal renal function who was incidentally diagnosed with a CAT arising from MAC. An asymptomatic 43-year-old man with normal renal function underwent echocardiography. The echocardiography results revealed a highly mobile hyperechoic mass attached to the atrial side of the mitral annulus superimposed on a heavily calcified mitral annulus. Cardiac surgery and histopathological evaluation confirmed a diagnosis of MAC-related CAT. While MAC-related CAT is usually associated with ESRD patients, the precise etiology and management strategy of this benign tumor remain unclear. The rare incidence of this tumor in patients with normal renal function highlights the importance of further research of the pathology of this uncommon condition.

Rapid improvement in right ventricular free wall longitudinal strain measures after successful percutaneous mitral commissurotomy.

BACKGROUND: Percutaneous mitral commissurotomy (PMC) is currently the treatment of choice for patients with symptomatic mitral stenosis (MS) that have favorable valvular characteristics. We aimed to evaluate the effect of PMC on the longitudinal strain of the right ventricular (RV) free wall in patients with severe MS. METHODS: This prospective study recruited patients who underwent PMC. Transesophageal and transthoracic echocardiographic examinations were performed. The mitral valve area (MVA) was measured by three-dimensional evaluation. The RV longitudinal strain was measured via the speckle-tracking method. RESULTS: A total of 42 patients with a maximum MVA of 1.5 cm2 underwent PMC in our study. The MVA increased significantly after the procedure (pre-PMC MVA = 0.94 ± 0.20 cm2 vs post-PMC MVA = 1.45 ± 0.18 cm2 ; P < .01). Systolic pulmonary artery pressure decreased from 46.05 ± 14.08 mm Hg preprocedurally to 35.86 ± 7.53 mm Hg postprocedurally (P < .01). The mean RV free wall longitudinal strain was -19.00 ± 5.14%, which rose significantly after PMC to -20.97 ± 3.81 (P < .05). There were postprocedural increases, albeit nonsignificant, in the tricuspid annular peak systolic excursion, the peak systolic Doppler velocity of the RV free wall, and fractional area change. The improvement in the RV longitudinal strain was more prominent in the patients with an MVA of less than 1.0 cm2 . CONCLUSIONS: There was a significant post-PMC rise in the RV free wall longitudinal strain measures in our study population, demonstrating an immediate improvement in the RV systolic function of the patients.

Left ventricular end-diastolic pressure-guided hydration for the prevention of contrast-induced acute kidney injury in patients with stable ischemic heart disease: the LAKESIDE trial.

OBJECTIVES: Contrast-induced acute kidney injury (CI-AKI) is a serious complication in patients undergoing diagnostic cardiac angiography or percutaneous coronary intervention. We aimed to evaluate the preventive effects of left ventricular end-diastolic pressure (LVEDP)-guided hydration for the prevention of CI-AKI in patients with chronic kidney disease undergoing cardiac catheterization. METHODS: This prospective randomized single-blind clinical trial enrolled 114 eligible patients with an estimated glomerular filtration rate (eGFR) of 15 < eGFR ≤ 60 mL/min/1.73 m2 [according to the level-modified Modification of Diet in Renal Disease formula (MDRD)] and stable ischemic heart disease undergoing coronary procedures. The patients were randomly allocated 1:1 into the LVEDP-guided hydration group (n = 57) or the standard hydration group (n = 57). CI-AKI was defined as a greater than 25% or greater than 0.5 mg/dL (44.2 mmol/L) increase in the serum creatinine concentration compared with the baseline value. Hydration with 0.9% sodium chloride at a rate of 1 mL/kg/h (0.5 mL/kg/h if left ventricular ejection fraction < 40%) within 12 h was given to all the patients in both groups before the procedure. In the LVEDP-guided group, the hydration infusion rate was adjusted according to the LVEDP level during and after the procedure. RESULTS: The incidence of CI-AKI was 7.01% (4/57) in the LVEDP-guided group vs 3.84% (2/52) in the standard hydration group (summary odds ratio 0.53, 95% CI 0.093-3.022; P = 0.463). Major adverse cardiac events, hemodialysis, or related deaths occurred in neither of the groups during hospitalization or the 30-day follow-up. CONCLUSIONS: In the present study, LVEDP-guided fluid administration, by comparison with standard hydration, failed to offer protection against the risk of CI-AKI in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention.

Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis.

Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time. Conclusion: In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications.

Effect of flaxseed consumption on flow-mediated dilation and inflammatory biomarkers in patients with coronary artery disease: a randomized controlled trial.

BACKGROUND/OBJECTIVE: Available data indicate a possible beneficial effect of flaxseed on cardiovascular disease, but limited studies have evaluated the effects of flaxseed on endothelial dysfunction and biomarkers of inflammation in patients with coronary artery disease (CAD). The purpose of the present study was to examine the effect of flaxseed consumption on flow-mediated dilation (FMD) and inflammatory markers in CAD patients. SUBJECTS/METHOD: In this randomized controlled parallel trial, 50 patients with CAD of both genders were randomly allocated to 12 weeks consumption of flaxseed (30 g/day) or usual care control. Before and after the intervention, changes in brachial FMD and plasma high-sensitivity C-reactive protein (hs-CRP), interleukine-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured. RESULTS: Forty-four participants (aged 56.43 ± 8.21 years; BMI 26.65 ± 2.44 kg/m2) completed the study. No significant weight change was observed in either group. Compared to control (n = 23), flaxseed consumption (n = 21) was associated with improved FMD (mean of change from baseline was 5.1 vs -0.55%; p = 0.001 for the flaxseed and control, respectively). When compared to control, flaxseed consumption was associated with reduced inflammatory markers (mean of change from baseline for hs-CRP was -1.18 and -0.3 mg/L, p = 0.003; for IL-6 was -7.65 and -0.77 pg/mL, p = 0.017; for TNF-α was -34.73 and -2.18 pg/mL p = 0.001 in flaxseed and control, respectively). CONCLUSIONS: The results of this study indicate that by adding flaxseed to diet of CAD patients, it is possible to improve FMD and plasma levels of inflammatory markers.

Comparison between rosuvastatin and atorvastatin for the prevention of contrast-induced nephropathy in patients with STEMI undergoing primary percutaneous coronary intervention.

Introduction: There is some controversy over the efficacy of statins for the prevention of contrastinduced nephropathy (CIN). There have also been reports on varying efficacies of different statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of CIN was assessed. Methods: This single-blind randomized clinical trial was performed on 495 random patients with myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI. Results: The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There was no significant difference between rosuvastatin group compared with atorvastatin group, regarding the CIN grading (P = 0.14). Conclusion: Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the prevention of CIN.

Value of pathologic Q wave in surface electrocardiography in the prediction of myocardial nonviability: A cardiac magnetic resonance imaging-based study.

In surface electrocardiography (ECG), Q wave is often considered as a sign of irreversibly scarred myocardium. Cardiac magnetic resonance (CMR) imaging is an accurate mean for the detection of myocardial viability. Herein, we study the predictive value of Q wave in nonviable (scarred) myocardium by CMR study. Retrospective analysis of the ECG and CMR data of 35 coronary artery disease patients was performed. The delayed enhancement CMR protocol was used for the detection of viability. The presence of a pathologic Q wave in surface ECG was negatively related to myocardial viability with a kappa measurement of agreement of -0.544 and P < 0.0001. Pathologic Q wave in surface ECG can be used as a simple tool for myocardial viability prediction.

Self-Expandable Stent for Repairing Coarctation of the Left-Circumferential Aortic Arch with Right-sided Descending Aorta and Aberrant Right Subclavian Artery with Kommerell's Aneurysm.

Endovascular treatment offers a great advantage in the management of main arteries stenoses. However, simultaneous presence of a group of anomalies may complicate the situation. Here we present a case of 21-year-old man with aortic coarctation. Radiographic imaging and angiography demonstrated aortic coarctation of the left-circumferential aortic arch, right-sided descending aorta, and Kommerell's diverticulum at the origin of right subclavian artery. These anomalies have rarely been reported to concurrently exist in the same case and the treatment is challenging. Percutaneous treatment for repair of aortic coarctation was successfully performed with deployment of self-expanding nitinol stents. Follow-up demonstrated the correction of blood pressure and improvement of the symptoms. It appears that deployment of self-expandable nitinol stents present a viable option for the management of coarcted aorta in patients having all or some of these anomalies together.

Intracoronary versus Intravenous eptifibatide during percutaneous coronary intervention for acute ST-segment elevation myocardial infarction; a randomized controlled trial.

Although aspirin and clopidogrel seem to be quite enough during low risk percutaneous coronary intervention (PCI), the combination may need some reinforcement in complex situations such as primary PCI. By modifying the route and also the duration of administration, glycoprotein IIb/IIIa inhibitors might be a viable option. The aim of this study is to compare the benefits and disadvantages of three different methods of administration of eptifibatide in primary PCI population. Primary PCI candidates were randomized in three groups on which three different methods of administration of eptifibitide were tested: intravenous bolus injection followed by 12-h infusion (IV-IV), intracoronary bolus injection followed by intravenous infusion (IC-IV) and, only intracoronary bolus injection (IC). 99 patients were included in the present study. There was no significant difference among the three groups regarding all cause in hospital and one month mortality (p value = 0.99), re-myocardial infarction (p value = 0.89), post-PCI TIMI flow grade 3 (p value = 0.97), ST segment resolution (p value = 0.77) and peak troponin levels (p value = 0.82). The comparison of vascular access and major bleeding complications were not possible due to low events rate. By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure.

Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection.

Blunt chest traumatic coronary artery dissection is an uncommon cause of atherosclerotic and non-atherosclerotic Acute Myocardial Infarction (AMI). Injuries of the coronary artery after blunt chest trauma are caused by different mechanisms such as vascular spasm, dissection and intimal tear or rupture of an existing thrombus formation. Chest pain might be masked by other injuries in patients with multiple traumas in car accident. Present case report is on a 37-year-old male without any specific past medical history who reported to the emergency department of a hospital with chest discomfort and was discharged with the impression of chest wall pain. After three days he experienced severe chest pain and he was admitted with the impression of acute coronary syndrome and underwent coronary angiography which showed Left Anterior Descending (LAD) artery dissection. The possibility of injury of the coronary artery should be kept in mind after blunt trauma to the chest. This condition is sometimes underdiagnosed. Its diagnosis may be difficult because chest pain can be interpreted as being secondary to chest wall contusion or it may be overshadowed by other injuries. Coronary dissection diagnosis after chest trauma requires clinical suspicion and systematic evaluation. Electrocardiography (ECG) should be done for every patient with thoracic trauma as the clinical findings may be misleading.

In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

BACKGROUND: Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in-hospital and 6-month outcomes of primary PCI in elderly patients (≥ 75 years) with STEMI. METHODS: A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed. RESULTS: The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0% were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged ≥ 75 years, [hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001]. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION: Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability.

Intravenous magnesium sulfate: new method in prevention of contrast-induced nephropathy in primary percutaneous coronary intervention.

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is an adverse consequence of percutaneous coronary interventions which results in significant morbidity and mortality and adds to the costs of diagnostic and interventional cardiology procedures. Various pathophysiological mechanisms have been proposed for CI-AKI and various agents tested for its prevention. There is currently a general agreement that adequate pre-procedural hydration constitutes the cornerstone of prevention, yet there are reports of the use of some other agents with various efficacies. We prospectively tested IV magnesium sulfate (Mg) for CI-AKI prevention. METHOD AND DESIGN: This study is a prospective, randomized, open-labeled, single-center clinical trial. We randomly assigned 122 consecutive patients to two groups. The first group was the control group with routine treatment (n = 64), and second group was the study group with routine treatment plus IV magnesium sulfate 1 g just before the procedure (n = 62). Serum creatinine was measured before the procedure and 2 days after the procedure. The primary end point was the occurrence of CI-AKI within 48 h. CI-AKI was defined as 0.5 mg/dl or more increase in serum creatinine or 25% or more increase above baseline serum creatinine. There was no difference in definition if both of these parameters were present. RESULTS: The control and study groups were comparable in the overall predicted risk of CI-AKI. Also, the type and volume of the contrast were not significantly different between the two groups. Following angioplasty, CI-AKI occurred in 17 (26.6%) patients in the control group and nine (14.5%) patients in the study group; there was a significant reduction in CI-AKI in the study group (P = 0.01). Additionally, there was no mortality or a need for hemodialysis in either group. CONCLUSION: In primary PCI patients, the prophylactic use of intravenous Mg can be recommended to be added to traditional hydration for CI-AKI prevention.

Difficult management of coronary artery disease in a patient with thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome affecting multiple organs. There is no sufficient evidence regarding the clinical cardiac manifestations of TTP. Nonetheless, pathologic cardiac involvement is quite frequent in acute TTP, which is predominantly manifested as myocardial necrosis due to coronary arteriolar microthrombosis. The present case report describes a 43-year-old man with long-standing remitted TTP, who suffered from a sequence of refractory thrombotic epicardial coronary events. Aggressive medical and interventional therapies, including long-term dual antiplatelets and coronary angioplasty, were finally successful in remitting the thrombotic events. During his two-year follow up, he has been asymptomatic.

Intracoronary adenosine to prevent myonecrosis in patients with stable angina undergoing percutaneous interventions: a double-blinded randomized controlled trial.

BACKGROUND: Significant elevation of cardiac biomarkers after percutaneous coronary intervention (PCI) is associated with increased mortality. However, clinical importance of lesser degrees of cardiac enzyme elevation has not been well understood. Multiple factors might have an etiologic role, and the incidence of myonecrosis has not changed dramatically despite pharmacological and technological advances in PCI. The aim of this study was to evaluate the role of intracoronary (IC) Adenosine in preventing the elevation of cardiac enzymes as a marker of myonecrosis after PCI in patients with chronic stable angina. METHODS: Two hundred sixty patients with chronic stable angina who were candidates for PCI were randomly assigned to double-blinded pretreatment with IC Adenosine or placebo before crossing of the guide wire. The patients were observed during the hospital course, and blood samples were obtained in standard intervals after the intervention for cardiac biomarkers. The primary end point of this study was post-PCI myonecrosis, and secondary end point was safety of IC Adenosine administration in the setting of PCI in patients with chronic stable angina. RESULTS: Of the 260 patients, who were initially randomized, finally 83 patients were analyzed in the placebo and 96 in the Adenosine arms. The study patients were comparable in clinical and angiographic characteristics. The mean of the patients' age was 57.3 years (range = 35 to 79 years), and 71.5% were male. There were no differences in the mean serum cardiac biomarkers between the study groups (mean creatine kinase-MB [CK.MB] level of 29.5 ± 14.5 IU/L in the placebo group and 31.5 ± 18.5 IU/L in the control group; p value = 0.41; mean cardiac troponin I (cTnI) level of 0.097 ± 0.178 µg/L in the placebo group and 0.167 ± 0.5 µg/L in the control group; p value = 0.24). CONCLUSION: Despite promising results in primary PCI, our study showed that a strategy of IC Adenosine pretreatment is not beneficial in reducing post-PCI myonecrosis in patients with chronic stable angina and should not be routinely used.

Application of the health belief model in promotion of self-care in heart failure patients.

Heart failure (HF) is a condition due to a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. In developing countries, around 2% of adults suffer from heart failure, but in people over the age of 65, this rate increases to 6-10%. In Iran, around 3.3% of adults suffer from heart failure. The Health Belief Model (HBM) is one of the most widely used models in public health theoretical framework. This was a cohort experimental study, in which education as intervention factor was presented to case group. 180 Heart failure patients were randomly selected from patients who were referred to the Shahid Rajaee center of Heart Research in Tehran and allocated to two groups (90 patients in the case group and 90 in the control group). HBM was used to compare health behaviors. The questionnaire included 69 questions. All data were collected before and 2 months after intervention. About 38% of participants don't know what, the heart failure is and 43% don't know that using the salt is not suitable for them. More than 40% of participants didn't weigh any time their selves. There was significant differences between the mean grades score of variables (perceived susceptibility, perceived threat, knowledge, Perceived benefits, Perceived severity, self-efficacy Perceived barriers, cues to action, self- behavior) in the case and control groups after intervention that was not significant before it. Based on our study and also many other studies, HBM has the potential to be used as a tool to establish educational programs for individuals and communities. Therefore, this model can be used effectively to prevent different diseases and their complications including heart failure.

Effect of garlic powder tablet on carotid intima-media thickness in patients with coronary artery disease: a preliminary randomized controlled trial.

BACKGROUND/OBJECTIVES: This study was designed to investigate whether garlic powder tablets in adjunct to conventional medical treatment could have an effect on carotid intima-media thickness (CIMT) and plasma lipoproteins and lipids in patients with coronary artery disease (CAD). SUBJECTS/METHODS: A randomized, placebo-controlled, clinical trial was conducted on 56 patients with CAD between the ages of 25 and 75 years. The patients were randomly divided into two groups: garlic group (n = 27), receiving garlic powder tablet (1200 µg allicin/tab) twice daily and the placebo group (n = 29), receiving placebo for 3 months. The rate of atherosclerosis progression was measured by B-mode ultrasonography as the increase in CIMT. RESULTS: After 3 months of taking garlic tablets, CIMT values had minor variations (0.009 ± 0.007 mm reduction from baseline), while in the placebo group, an increase in CIMT values was observed (0.04 ± 0.01 mm increase from baseline). After 3 months of treatment, mean CIMT difference from baseline was significantly differ between the two groups (p < 0.001). Plasma lipids and lipoproteins (total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, Apolipoprotein A1 and Apolipoprotein B) did not differ between the two groups. CONCLUSIONS: The results suggest that dry garlic powder tablet is superior to placebo in prevention of CIMT progression in patients with CAD and may be considered as an adjunct treatment for atherosclerosis.

Impella 2.5 in a patient with left main coronary artery occlusion.

Short-term assist devices have been indicated in many clinical settings mostly as a bridge to the next step. In this article, we report a case of cardiogenic shock due to acute occlusion of left main coronary artery who was scheduled to be transferred from Iran to Germany for the next treatment (permanent assist device implantation). Impella 2.5 (Abiomed Inc., Danvers, MA, USA), a short-term assist device, made the long distance journey possible. .

Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction (STEMI).

BACKGROUND: Although percutaneous coronary intervention (PCI) improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction (STEMI) patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI. METHODS: Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years) with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. RESULTS: Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05). According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044) and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050) had reverse and male gender had direct significant associations with failed reperfusion (OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068). More degrees of ST resolution occurred when the right coronary artery was the culprit vessel (p value = 0.001). The presence of more than three cardiac risk factors was associated with failed reperfusion (p value = 0.050). CONCLUSION: Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy.

Percutaneous mitral valvuloplasty using echocardiographic intercommissural diameter as reference for balloon sizing: a randomized controlled trial.

BACKGROUND: Percutaneous balloon mitral valvuloplasty is the preferred therapeutic strategy in patients with mitral stenosis, but it has shortcomings in a subset of patients. HYPOTHESIS: A new method of balloon sizing through echocardiographic measurement of the intercommissural diameter would be safe and effective and lead to better outcomes. METHODS: Eighty-six mitral-stenosis patients were randomly assigned to undergo balloon mitral valvuloplasty either with height-based balloon reference sizing (HBRS group, n = 43) or with balloons sized by the echocardiographic measurement of intercommissural diameter (EBRS group, n = 43). Postprocedural mitral valve area (MVA) and severity of mitral regurgitation (MR) were assessed via echocardiography and ventriculography. Intention-to-treat approach was applied for the statistical analysis. RESULTS: Baseline characteristics were not different between the groups. The mean of the estimated balloon reference sizes was significantly higher in the HBRS patients than in the EBRS group (26.4 ± 0.92 mm, 95% confidence interval [CI]: 26.2-26.6 vs 24.5 ± 1.03 mm, 95% CI: 24.2-24.7, respectively; P = 0.006). Final MVAs were significantly larger in the EBRS group (1.5 ± 0.2 cm(2), 95% CI: 1.46-1.59 vs 1.4 ± 0.2 cm(2), 95% CI: 1.35-1.47, respectively; P = 0.01). The occurrence of new or aggravated MR was significantly lower in the EBRS group as assessed both by echocardiography (P = 0.04) and ventriculography (P = 0.05). Mitral regurgitation was aggravated in 13 (29.3%) patients in the HBRS group and in 5 (11.5%) patients in the EBRS group. CONCLUSIONS: Percutaneous balloon mitral valvuloplasty via the Inoue technique using balloons sized by the echocardiographic measurement of the maximal commissural diameter is an effective and safe method that might lead to an acceptable increase in the MVA and significant decrease in the rate and severity of iatrogenic MR.