RESUMO
PURPOSE: To compare the clinical, angiographic, therapeutic and prognostic characteristics of nonagenarians presenting with non-ST elevation acute coronary syndrome with those of patients under 90 years of age. METHODS: We used the CRAC register database including 6 catheterization laboratories in the Center Val-de-Loire region. Only patients with positive-troponin non-ST elevation ACS included in the registry from 2014 to 2017 were selected for epidemiological and procedural data. Regarding antiplatelet therapy, hospital and one-year follow-up data, only patients in the 2014-2015 period were analyzed. RESULTS: From January 1st, 2014 to December 31st, 2017, 5.964 patients with a positive-troponin non-ST ACS, including 133 nonagenarians (2.2%) were included in the CRAC registry. Arterial hypertension and the history of coronary angioplasty were more common among nonagenarians. They present more multivessel and left main disease. The use of the bare metal stent was predominant in 2014-2015 and then became marginal in 2016-2017. Clopidogrel was the most widely used anti platelet and more than one in two nonagenarians remain on dual therapy after 12 months. One-year stroke and hospital and one-year mortality were higher in this age group. CONCLUSIONS: Nonagenarians with a positive-troponin non-ST elevation ACS have more severe coronary artery disease and a poorer prognosis than those younger than 90 years of age.
Assuntos
Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/terapia , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Estenose Coronária/diagnóstico , Feminino , França/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Prognóstico , Sistema de Registros , StentsAssuntos
Falso Aneurisma/diagnóstico por imagem , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Aneurisma Cardíaco/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Falso Aneurisma/patologia , Falso Aneurisma/cirurgia , Infarto Miocárdico de Parede Anterior/patologia , Procedimentos Cirúrgicos Cardíacos/métodos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Ecocardiografia/métodos , Aneurisma Cardíaco/patologia , Aneurisma Cardíaco/cirurgia , Neoplasias Cardíacas/patologia , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Medição de Risco , Neoplasias Cutâneas/patologiaRESUMO
Type 2 cyclo-oxygenase inhibitors are new anti-inflammatory drugs with better gastrointestinal tolerance than traditional non-steroidal anti-inflammatory drugs. They have no platelet anti-aggregant effects and there is still some discussion as to whether this new therapeutic class has any pro-thrombotic effects. The authors report two cases of myocardial infarction in patients considered to be at low risk treated by type 2 cyclo-oxygenase inhibitors.
Assuntos
Inibidores de Ciclo-Oxigenase/uso terapêutico , Isoenzimas/antagonistas & inibidores , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase/efeitos adversos , Fator V/genética , Feminino , Humanos , Masculino , Proteínas de Membrana , Pessoa de Meia-Idade , Mutação , Infarto do Miocárdio/genética , Prostaglandina-Endoperóxido Sintases , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Traumatic lesions of the tricuspid valve complicating pacemaker lead extractions appear to be rare. We report two cases of partial rupture of the tricuspid valve, following apparently uneventful extraction of permanent ventricular leads, resulting in severe regurgitation and, in one case, chronic heart failure. TEE was useful to identify the traumatic mechanism of tricuspid regurgitation (TR) and the extent of valvular lesions in these patients. Such etiology should be suspected, and TEE performed, in patients developing TR or heart failure late after lead extraction.
Assuntos
Ecocardiografia Transesofagiana , Corpos Estranhos/terapia , Marca-Passo Artificial , Valva Tricúspide/lesões , Idoso , Eletrodos , Corpos Estranhos/diagnóstico por imagem , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/terapia , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Recidiva , Ruptura , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagemRESUMO
The authors report the anatomo-clinical features of aortic insufficiency complicating atrophic polychondritis, a rare inflammatory disease affecting mainly cartilaginous tissues. This case illustrates the inflammatory changes of the aortic wall, particularly progressive during this disease, responsible for aortic insufficiency and aneurysmal dilatation of the ascending aorta which required aortic valve replacement and prosthetic replacement of the ascending aorta. Histological analysis showed inflammatory lesions of the aortic wall comparable to the cartilaginous lesions described in this condition and suggesting a common physiopathogenic mechanism.