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1.
Cardiol J ; 28(6): 842-848, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33942280

RESUMO

BACKGROUND: Primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) can be challenging for high thrombus burden and catecholamine-induced vasoconstriction. The Xposition-S stent was designed to prevent stent undersizing and minimize strut malapposition. We evaluated 1-year clinical outcomes of a nitinol, self-apposing®, sirolimus-eluting stent, pre-mounted on a novel balloon delivery system, in de novo lesions of patients presenting with STEMI undergoing pPCI. METHODS: The iPOSITION is a prospective, multicenter, post-market, observational study. The primary endpoint, target lesion failure (TLF), was defined as the composite of cardiac death, recurrent target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). RESULTS: The study enrolled 247 STEMI patients from 7 Italian centers. Both device and procedural success occurred in 99.2% of patients, without any death, TV-MI, TLR, or stent thrombosis during the hospital stay and at 30-day follow-up. At 1 year, TLF occurred in 2.6%, cardiac death occurred in 1.7%, TV-MI occurred in 0.4%, and TLR in 0.4% of patients. The 1-year stent thrombosis rate was 0.4%. CONCLUSIONS: The use of an X-position S self-apposing® stent is feasible in STEMI pPCI, with excellent post-procedural results and 1-year outcomes.


Assuntos
Stents Farmacológicos , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose , Morte , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Stents , Resultado do Tratamento
2.
J Clin Med ; 8(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31752292

RESUMO

Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of evidence from clinical studies. In the current manuscript, we aim to provide a comprehensive, yet pragmatic, revision of the current available evidence regarding antithrombotic strategies in the domain of percutaneous cardiovascular interventions. We revise the evidence regarding antithrombotic therapy for secondary prevention in coronary artery disease and stent implantation, the complex interrelation between antiplatelet and anticoagulant therapy in patients undergoing percutaneous coronary intervention with concomitant atrial fibrillation, and finally focus on the novel developments in the secondary prevention after structural heart disease intervention. A special focus on treatment individualization is included to emphasize risk and benefits of each therapeutic strategy.

8.
Circ Cardiovasc Interv ; 7(4): 465-72, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25027519

RESUMO

BACKGROUND: Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established. METHODS AND RESULTS: Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function-adjusted CV (CV/eGFR 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ(2) of 5.973 (P=0.029). CONCLUSIONS: CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI.


Assuntos
Injúria Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Rim/efeitos dos fármacos , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/prevenção & controle , Injúria Renal Aguda/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/metabolismo , Rim/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Risco
10.
Clin Appl Thromb Hemost ; 20(6): 583-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24569627

RESUMO

BACKGROUND: The use of flow-mediated dilation (FMD) as a surrogate indicator for the extent of coronary artery disease (CAD) remains largely unknown. We assessed FMD at the brachial artery in 89 consecutive patients undergoing coronary angiography. METHODS AND RESULTS: Patients were classified in groups 0 to 3 according to the number of diseased vessels and the SYNTAX score was calculated. The FMD decreased significantly from groups 0 to 3 (P < .001). There was a significant linear relation between SYNTAX score and FMD (corrected r (2) = .64, P < .001). In multivariate analysis, a reduced FMD was the only significant independent predictor of the presence of CAD (odds ratio [OR] 1.78, P = .032) and of CAD severity (OR 1.85, P = .005). CONCLUSION: This study confirms that FMD is reduced in patients with CAD and that such reduction in FMD is related to the extent of the disease. Therefore, FMD at the brachial artery is likely to represent a reliable indicator of CAD burden.


Assuntos
Artéria Braquial , Angiografia Coronária , Doença da Artéria Coronariana , Endotélio Vascular , Vasodilatação , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/diagnóstico por imagem , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Catheter Cardiovasc Interv ; 82(6): 878-85, 2013 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-23703775

RESUMO

BACKGROUND: In patients undergoing primary percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), the occurrence of Contrast-Induced Nephropathy (CIN) has a pronounced impact both on morbidity and mortality. We investigated the variables associated with CIN development in 481 consecutive patients with STEMI undergoing primary PCI and evaluated the predictive value of a 3-variable clinical risk score (the AGEF score) based on age, left ventricular ejection fraction (EF), and estimated glomerular filtration rate (eGFR). METHODS: CIN was defined as an absolute increase in serum creatinine ≥0.5 mg/dL or an increase ≥25% from baseline within 72 hr. AGEF score was calculated by adding 1 point to the Age/EF(%) ratio if the eGFR was <60 mL/min per 1.73 m(2) . RESULTS: Overall, the incidence of CIN was 5.2%. In-hospital mortality was higher in patients with CIN than in those without (16% Vs 1.3%, P = 0.001). At multivariate analysis age (OR 1.06, P = 0.042), eGFR (OR 0.95, P = 0.001), EF (OR 0.94, P = 0.007) and post-procedural TIMI flow grade (OR 0.43, P = 0.045) were independent predictors of CIN. AGEF score was an accurate (OR 5.19, P < 0.001, AUC 0.88) and calibrated (Hosmer-Lemeshow χ(2) = 10.25, P = 0.25) predictor of CIN. CONCLUSIONS: Advanced age, depressed EF, and reduced eGFR are independent predictors of CIN development after primary PCI for STEMI. The preprocedural individual patient risk can be clinically assessed with the calculation of the AGEF score, which is based on such readily available parameters.


Assuntos
Meios de Contraste/efeitos adversos , Taxa de Filtração Glomerular/efeitos dos fármacos , Nefropatias/induzido quimicamente , Rim/efeitos dos fármacos , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/efeitos adversos , Volume Sistólico , Função Ventricular Esquerda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Creatinina/sangue , Técnicas de Apoio para a Decisão , Feminino , Mortalidade Hospitalar , Humanos , Rim/fisiopatologia , Nefropatias/sangue , Nefropatias/diagnóstico , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Razão de Chances , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Radiografia , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Regulação para Cima
13.
Int J Cardiol ; 149(2): e47-e49, 2011 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-19395072

RESUMO

Controlled hyperventilation leading to respiratory alkalosis may induce coronary artery spasm. This manoeuvre is currently used in the diagnosis of Prinzmetal's angina. We describe the case of a comatose patient with tracheostomy in whom hyperventilation, caused by excessive bronchial secretion resulting in partial obstruction of the tracheal cannula, was followed by ST segment elevation mimicking acute myocardial infarction.


Assuntos
Coma/fisiopatologia , Vasoespasmo Coronário/fisiopatologia , Hiperventilação/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Traqueostomia , Coma/complicações , Vasoespasmo Coronário/diagnóstico , Eletrocardiografia , Humanos , Hiperventilação/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico
16.
Int J Cardiol ; 134(1): e42-3, 2009 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-18367270

RESUMO

A 57-year-old woman with acute left leg ischemia due to popliteal artery occlusion and deep T-wave inversion at ECG revealed she had suffered, the day before, from typical chest pain after a confrontational argument; yet, she had not sought medical assistance. Echocardiography showed left ventricular wall motion abnormalities consistent with the diagnosis of emotional stress-induced takotsubo syndrome. Coronary angiography ruled out obstructive atherosclerotic disease and left ventriculography confirmed apical ballooning with evolving thrombosis. Left leg angiography demonstrated diffuse embolisation of the popliteal artery. Ventricular thrombosis is a complication of takotsubo syndrome and has been associated with adverse events supposed to be due to a cardioembolic mechanism, in particular cerebro-vascular accidents. To the best of our knowledge, this is the first direct visualization of systemic cardiogenic embolism in takotsubo syndrome. Physicians should be aware that ventricular thrombosis may be present in the earliest stages of the disease and that emboli dislocation can occur even before wall motion normalization.


Assuntos
Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Ventriculografia com Radionuclídeos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Síndrome Coronariana Aguda/complicações , Arteriopatias Oclusivas/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Poplítea
17.
Int J Cardiol ; 131(2): e63-4, 2009 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-17689733

RESUMO

In the setting of an acute inferior myocardial infarction undergoing primary stent implantation, we could document a macroscopic embolus moving along the right coronary artery. Coronary embolisation is a well known drawback of percutaneous coronary interventions and dedicated devices can be used in order to minimize myocardial damage. Nonetheless, unexpected macroscopic embolisation after the first manual contrast injection through a diagnostic catheter remains a possible complication and may lead to unsatisfactory results when the upstream pharmacological therapy is not appropriate.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Embolia/diagnóstico , Embolia/terapia , Idoso , Doença da Artéria Coronariana/complicações , Embolia/complicações , Humanos , Masculino , Stents
18.
J Cardiovasc Med (Hagerstown) ; 9(10): 1080-2, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18799978

RESUMO

The differential diagnosis between left ventricular aneurysm and diverticulum remains a matter of debate. Cardiac magnetic resonance is dramatically helpful in the anatomical and functional characterization of the walls of any angiographical left ventricular outpouching.


Assuntos
Divertículo/patologia , Aneurisma Cardíaco/patologia , Cardiopatias/patologia , Idoso , Angiografia Coronária , Diagnóstico Diferencial , Divertículo/classificação , Divertículo/fisiopatologia , Eletrocardiografia , Cardiopatias/classificação , Cardiopatias/fisiopatologia , Ventrículos do Coração/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Terminologia como Assunto
19.
Int J Cardiol ; 130(1): 89-91, 2008 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-17689702

RESUMO

The incidence of adverse events complicating coronary angiography is still considerably high. Founded concerns about risks of coronary angiography, and mainly its inherent invasiveness, have favored the increasing request for noninvasive techniques to evaluate the coronary anatomy, such as multislice computed tomography (MSCT). Nonetheless, it has to be kept in mind that several risks and complications are the same both for MSCT and conventional coronary angiography. Rotational angiography has been shown to be a powerful imaging tool for the evaluation of coronary anatomy resulting in the use of less contrast media and less radiation, without losing the possibility to obtain a precise, efficient and fast characterization of obstructive coronary artery disease. It is likely that in the next future the overall performance, taking into account both the diagnostic accuracy and the risk of exposure to radiation and contrast media, of MSCT techniques will have to be compared to that of rotational angiography, especially when the latter is coupled with minimally invasive approaches.


Assuntos
Meios de Contraste/administração & dosagem , Angiografia Coronária/instrumentação , Doença da Artéria Coronariana/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
G Ital Cardiol (Rome) ; 8(3): 161-7, 2007 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-17461358

RESUMO

It is commonly agreed that the electrocardiographic recognition of left ventricular hypertrophy (LVH) is difficult, or even impossible, in patients with bundle branch or fascicular block; the opposite, however, has been demonstrated by several studies. In the presence of intraventricular conduction disturbances, many criteria can reveal LVH, with sensitivity and specificity not inferior than that of electrocardiographic signs used in subjects with normal intraventricular conduction. The following criteria can be helpful in left bundle branch block: QRS voltage increase, left atrial enlargement, QRS duration > 155 ms. LVH is suggested by one or more of the following: Sokolow index > or = 35 mm, R wave in lead aVL > or = 11 mm, left axis deviation at -40 degrees or more, SV2 > 30 mm + SV3 >25 mm. In left anterior hemiblock, LVH is diagnosed whenever the sum of S wave in lead III plus the maximal R+S in a precordial lead is > or = 30 mm. Further criteria are SV1 + (R+S) in V5 or V6 > or = 25 mm, and the presence of secondary ST-T changes. In right bundle branch block, LVH is suggested by a left atrial enlargement pattern, secondary repolarization changes, and a sum of S wave in lead III plus the maximal R+S in a precordial lead > or = 35 mm.


Assuntos
Eletrocardiografia , Bloqueio Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Bloqueio Cardíaco/complicações , Humanos , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/fisiopatologia , Sensibilidade e Especificidade
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