RESUMO
The high take-off of the coronary artery is rarely encountered in the catheterization laboratory. But the origin of a single coronary artery with high take-off makes it even more rare. The high take-off of a single coronary artery may have an association with coronary artery disease, as in this case. In the present case, a 55-year-old male underwent a coronary angiogram, but coronaries could not be cannulated despite multiple catheter usage. Then, computed tomography was performed which revealed high take-off of single coronary artery and had triple vessel disease, for which coronary artery bypass surgery was performed successfully.
RESUMO
OBJECTIVE: The objective of this registry is to establish safety and efficacy of BioMatrix, BioMatrix™-Biolimus A9™ eluting stent in diabetic population in India. BACKGROUND: Diabetes mellitus is a major predisposing factor for coronary artery disease. Prognosis for diabetic population patients presenting with coronary artery disease who undergo coronary revascularization is inferior to non diabetics and remains an independent risk factor of restenosis, need for revascularization, and overall mortality. Stent thrombosis is a potential complication of first generation, permanent polymer drug-eluting stents. Biodegradable polymer is a good relief in this era and its utility in diabetic patients will be a major advantage for them. METHODS: 334 patients with diabetes mellitus and requiring angioplasty, implanted with BioMatrix stent were followed at 1, 6, 12 and 24 months who entered in a multicenter registry in India. We analyzed the incidence of major adverse cardiac events (MACE) and stent thrombosis (ST) at 1, 6, 12 and 24 months. RESULTS: The mean age was 58.71 ± 9.2 years, 81% were males, comorbidity index was 1.6 ± 1.02, and 59.1% presented with acute coronary syndrome. The incidence of adverse event rates was: MACE 1.27%. There were no incidences of myocardial infarction (MI) and target vessel revascularization (TVR). Definite stent thrombosis occurred only in 2 patients. CONCLUSION: In this registry of diabetic population treated with BioMatrixTM-Biolimus A9TM eluting stent (BioMatrix), the reported incidence of MACE and ST were much lower than previously published results. The 1- and 2-year follow-up result supports favorable clinical outcomes of using BioMatrix stents as a suitable alternative to contemporary DES available during PCI in diabetic patients.
Assuntos
Implantes Absorvíveis , Angioplastia Coronária com Balão/instrumentação , Estenose Coronária/terapia , Angiopatias Diabéticas/terapia , Stents Farmacológicos , Sirolimo/análogos & derivados , Idoso , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/mortalidade , Feminino , Seguimentos , Humanos , Índia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Medição de Risco , Índice de Gravidade de Doença , Sirolimo/farmacologia , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoAssuntos
Doença da Artéria Coronariana/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Reperfusão Miocárdica/métodos , Terapia Trombolítica/métodos , Terapia Combinada , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Medicina Baseada em Evidências , Feminino , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Índia , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Prognóstico , Radiografia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Papel (figurativo) , Análise de Sobrevida , Terapia Trombolítica/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: The RADI pressure wire may be used in stenotic coronary arteries to calculate myocardial fractional flow reserve (FFR(myo)), the ratio between distal hyperaemic coronary pressure and aortic pressure. A ratio less than 0.75 categorizes lesions of haemodynamic significance for which percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be warranted. We undertook this study to evaluate the cost implications of performing these measurements. METHODS: We recorded FFR(myo) using RADI wires in 32 coronary artery lesions of between 30 and 60% diameter stenosis in 31 patients and assessed how this information changed our management. RESULTS: We followed our original "management plan" in only eight patients. PCI or CABG was performed in eight whose lesions were characterised by a FFR(myo) value of 0.76 or less. Myocardial perfusion imaging (MPI) was done in only one of nine for whom this had seemed to be appropriate. Two-thirds of those for whom PCI had appeared to be warranted were treated conservatively and only one quarter of the original "surgical" group underwent CABG. CONCLUSION: Although RADI pressure wires are an additional expense, it is appropriate to use them to assess coronary stenotic lesions of indeterminate severity. When we took into account the savings that arose from changes in management, the additional cost of measuring FFR(myo) was around dollar 580 per study.
Assuntos
Aorta/fisiopatologia , Determinação da Pressão Arterial/economia , Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea/fisiologia , Estenose Coronária/diagnóstico , Pressão Ventricular/fisiologia , Adulto , Idoso , Angioplastia Coronária com Balão , Ponte de Artéria Coronária , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Little information exists regarding mid-term and long-term patency of radial artery grafts. METHODS AND RESULTS: We performed restudy coronary angiography at 5.2+/-0.4 years after surgery on 50 asymptomatic patients who had undergone coronary artery bypass graft surgery, using at least 1 radial artery graft, to determine both graft patency and presence of narrowing. We examined preoperative clinical or angiographic variables that might predict graft occlusion. Radial artery graft patency was 89%, with 91% of grafts free of narrowing. Preoperative New York Heart Association anginal class < or =2, target vessel proximal stenosis < or =70%, and small target vessel supply territory were predictive of graft occlusion. CONCLUSIONS: At 5 years after surgery, radial artery grafts have disease-free patency rates that are similar to other graft types.