WorldWideScience

Sample records for acute coronary angioplasty

  1. Primary coronary angioplasty in acute myocardial infarction.

    Grech, E. D.; Ramsdale, D. R.

    1996-01-01

    It is well established that recanalisation of the infarct-related artery is of great benefit in the early hours after acute myocardial infarction. This can be achieved by the use of thrombolytic agents and/or by percutaneous transluminal coronary angioplasty (PTCA). This article reviews data on the role of primary PTCA and summarises current opinion on its use.

  2. Coronary Angioplasty

    ... page from the NHLBI on Twitter. What Is Percutaneous Coronary Intervention? Español Percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), commonly known as coronary angioplasty (AN-jee- ...

  3. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes

    Riezebos, R.K.; Ronner, E.; Bals, ter, E.; Slagboom, T.; Smits, P.C.; Berg, ten, A.J.W.M.; Kiemeneij, F.; Amoroso, G.; Patterson, M S; Suttorp, M J; Tijssen, J.G.P.; Laarman, G.J.

    2009-01-01

    BACKGROUND: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics-a practice based on observational and retrospective data. OBJECTIVE: To compare immediate versus deferred angioplasty in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS: A randomised, prospective multicentre trial was performed in patients admitted with NSTE-ACS, eligible for percutaneous coronary in...

  4. Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

    The research was aimed at elucidation of the relationship of the clinical and angiographic factors, on the one hand, and development of acute occlusion following transluminal balloon coronary angioplasty TBCA, on the other. TBCA was carried out in 162 patients. Eight (4.9 %) patients developed acute occlusion of the coronary artery, which was complicated by acute myocardial infarction in 50 % cases. 35 refs.; 4 tabs

  5. [Reperfusion therapy in acute myocardial infarction: primary percutaneous transluminal coronary angioplasty or thrombolysis?].

    Bilkis, Valdas; Kibarskis, Aleksandras; Abraitis, Vytautas

    2004-01-01

    Randomized controlled trials that compared primary percutaneous transluminal coronary angioplasty with thrombolysis have shown that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction. Three large myocardial infarction registries - MITI, NRMI-2 and French registry - failed to show an advantage of primary angioplasty compared with thrombolysis. One of the latest trials mentioned in this paper restored the place of primary angioplasty as superior to thrombolysis in acute myocardial infarction. Data of patients treated with primary percutaneous transluminal coronary angioplasty in Clinic of Cardiology of Vilnius University are presented. PMID:15079110

  6. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes

    R.K. Riezebos; E. Ronner; E. ter Bals; T. Slagboom; P.C. Smits; J.M. ten Berg; F. Kiemeneij; G. Amoroso; M.S. Patterson; M.J. Suttorp; J.G.P. Tijssen; G.J. Laarman

    2009-01-01

    BACKGROUND: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics-a practice based on observational and retrospective data. OBJECTIVE: To compare immediate versus deferred angioplasty in patients with non-S

  7. Contribution of inhibitory receptor glycoprotein iib / iiia in coronary angioplasty and acute coronary syndrome, about 152 patients

    The aim of our study was to evaluate the immediate results and long-term intake of anti-GP IIb / IIIa inhibitors for patients with acute coronary syndrome treated with coronary angioplasty. The use of anti-GP IIb / IIIa is a valid therapeutic option in patients with acute coronary syndrome with signs of severity and for patients undergoing complex angioplasty. Adverse effects of anti-GP IIb / IIIa can be seen to encourage vigilance and careful monitoring during the administration of these molecules and perfect knowledge of their pharmacological properties for appropriate use.

  8. Factors influencing acute high-grade restenosis in emergency percutaneous transluminal coronary angioplasty for acute myocardial infarction.

    Kusachi, Shozo; Iwasaki,Kohichirou; Nishiyama, Osamu; Ueda, Minoru; Kita, Toshimasa; Hata,Takato; Taniguchi, Gyou; Watanabe, Hirofumi; Hina, Kazuyoshi; Saito, Daiji; Tsuji, Takao; Haraoka,Shoichi

    1989-01-01

    We studied the factors which may induce acute high grade restenosis in emergency percutaneous transluminal coronary angioplasty (PTCA). PTCA was attempted in 50 patients with acute myocardial infarction, and the balloon catheter passed successfully across the occlusion site in 47 (94%) of the patients. These 47 patients were analyzed. "Acute restenosis" was defined as a lesion which was revascularized to less than 50% luminal reduction narrowed again to more than 75% luminal reduction...

  9. Coronary Angioplasty Stent Placement

    Full Text Available Coronary Angioplasty Stent Placement Shawnee Mission Heart & Vascular Center, Shawnee Mission, Kansas February 19, 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center ...

  10. Holmium:YAG laser coronary angioplasty in acute myocardial infarction

    Topaz, On; Luxenberg, Michael; Schumacher, Audrey

    1994-07-01

    Patients who sustain complicated acute myocardial infarction in whom thrombolytic agents either fail or are contraindicated often need mechanical revascularization other than PTCA. In 24 patients with acute infarction complicated by continuous chest pain and ischemia who either received lytics or with contraindication to lytics, a holmium:YAG laser (Eclipse Surgical Technologies, Palo Alto, CA) was utilized for thrombolysis and plaque ablation. Clinical success was achieved in 23/24 patients, with 23 patients (94%) surviving the acute infarction. Holmium:YAG laser is very effective and safe in thrombolysis and revascularization in this complicated clinical setting.

  11. Balloon catheter coronary angioplasty

    The author has produced a reference and teaching book on balloon angioplasty. Because it borders in surgery and is performed on an awake patient without circulatory assistance, it is a complex and demanding procedure that requires thorough knowledge before it is attempted. The text is divided into seven sections. The first section describes coronary anatomy and pathophysiology, defines the objectives and mechanisms of the procedure and lists four possible physiologic results. The next section describes equipment in the catheterization laboratory, catheters, guidewires and required personnel. The following section is on the procedure itself and includes a discussion of examination, testing, technique and follow-up. The fourth section details possible complications that can occur during the procedure, such as coronary spasms, occlusion, thrombosis, perforations and ruptures, and also discusses cardiac surgery after failed angioplasty. The fifth section details complex or unusual cases that can occur. The sixth and seventh sections discuss radiation, alternative procedures and the future of angioplasty

  12. Primary percutaneous transluminal coronary angioplasty in the acute infarction of the right ventricle

    Gligić Branko

    2003-01-01

    Full Text Available Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab, according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

  13. Aggressive nonsurgical management of acute coronary artery occlusions developing immediately after percutaneous transluminal coronary angioplasty (PTCA)

    In 368 consecutive percutaneous transluminal coronary angiography (PTCA) procedures, acute occlusion of the dilated artery developed within the first hour after the procedure in 24 cases (6.5%). Four patients underwent emergency bypass surgery. In 17 of the remaining 20 patients, repeat balloon dilation was immediately attempted, and was successful in 11 instances (65%). Five of the six cases in which repeat balloon dilation was not successful responded well to surgical or medical therapy. The author conclude that acute occlusions of dilated coronary arteries shortly after PTCA do not automatically necessitate emergency bypass. Approximately two thirds of such cases can be managed by repeat dilation, converting a potential complication into a successful outcome

  14. [Clopidogrel versus prasugrel in acute coronary syndrome treated with coronary angioplasty].

    Lalor, Nicolas; Rodríguez, Leandro; Elissamburu, Pablo; Filipini, Eduardo; Conde, Diego; Nau, Gerardo; Cura, Fernando; Trivi, Marcelo

    2015-01-01

    Greater antithrombotic potency new antiplatelet agents have been added such as prasugrel (PR) and ticagrelor to the traditional use of clopidogrel (CL) in the treatment of acute coronary syndrome (ACS). This study was aimed at comparing the incidence of long term ischemic and hemorrhagic events in patients treated with CL or PR during hospitalization. Retrospective ACS data base analysis performed by our cardiology service was completed prospectively. There were consecutively included all patients with percutaneous coronary intervention (PCI) during hospitalization due to ACS from December 2011 thru December 2012. A total of 398 ACS patients who underwent PCI with stent implantation were recruited. No differences in cardiovascular related deaths were observed in both groups (PR 2.9% vs. CL 2.5%, p=0.48). PR group showed less re-infraction (1.9% vs. 6.8%, p=0.01) with more total bleedings (18.5% vs. 8.5%, p=0.001) and minor bleedings (12.4% vs. 3.4%, p<0.001) with no differences in major and life threatening bleedings (p=ns). Multivariate analysis showed that independent predictors of cardiovascular mortality were age (OR 1.08, CI 95% 1.02-1.16) and renal failure (OR 6.98, CI 95% 1.23-39.71). Independent predictors for total bleeding were age (OR 1.06, CI 95% 1.02-1.09),ST segment elevation myocardial infarction (OR 1.99, CI 95% 1.05-3.79), renal failure (OR 3.32, CI 95% 1.62-6.78) and prasugrel use (OR 3.97, CI 95% 1.87-8.41). Use of prasugrel, in the ACS that requires PCI with stent, is associated with a lower myocardial infarction a year after follow-up, and it also leads to an increase of milder hemorrhage. No significant differences were observed in the cardiovascular mortality of both groups. PMID:26339874

  15. Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty

    Miller, H.I.; Almagor, Y.; Keren, G.; Chernilas, J.; Roth, A.; Eschar, Y.; Shapira, I.; Shargorodsky, B.; Berenfeld, D.; Laniado, S.

    1987-03-01

    Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect.

  16. Coronary Angioplasty Stent Placement

    Full Text Available ... right coronary ostium, and we are in the process of taking our first images of the right ... coronary artery disease. Coronary artery disease is a process that we used to think took years and ...

  17. Coronary Angioplasty Stent Placement

    Full Text Available ... to open up blockages and improve coronary blood flow. You’ll have the opportunity to witness live ... or blockages that are formed that reduce blood flow. Coronary artery disease by-and-large is defined ...

  18. Coronary Angioplasty Stent Placement

    Full Text Available ... chest pain other than cardiac, but the most serious potentially is coronary artery disease. Coronary artery disease ... of the arteries. Diabetes Mellitus is a very serious cause of particularly premature atherosclerosis particularly in younger ...

  19. Coronary Angioplasty Stent Placement

    Full Text Available ... then he will exchange catheters and he will go to the right coronary art which, which goes ... may get. And you can see -- let me go to the next slide. Symptoms of coronary artery ...

  20. Coronary Angioplasty Stent Placement

    Full Text Available ... of the next hour you will learn about coronary artery disease, how blockage is performed, how we treat them, ... chest pain. Obviously, as cardiologists our concern is coronary artery disease or blockages that are formed that reduce blood ...

  1. Coronary Angioplasty Stent Placement

    Full Text Available ... chest pain other than cardiac, but the most serious potentially is coronary artery disease. Coronary artery disease is a process that we ... huge risk factor in the development of heart disease, as well as problems ... cause of particularly premature atherosclerosis particularly in younger ...

  2. Coronary Angioplasty Stent Placement

    Full Text Available ... of any flow-limiting blockages in the blood vessels that emanate from the left coronary system. And now we have threaded a catheter over to the blood vessel on the right side and engaged the right ...

  3. Coronary Angioplasty Stent Placement

    Full Text Available ... reduce blood flow. Coronary artery disease by-and-large is defined as a greater than 70 percent ... the back wall, and this is a very large vessel in this gentleman. It goes way along ...

  4. Coronary Angioplasty Stent Placement

    Full Text Available ... the most overlooked. 4 So there are certain risk factors that we have for coronary artery disease. ... heritage. Secondly is smoking. Smoking is a huge risk factor in the development of heart disease, as ...

  5. Coronary Angioplasty Stent Placement

    Full Text Available ... there is a role in this day and age area for coronary bypass surgery. 8 So what ... patient. We need to come back to how old the patient is, what the other comorbidities are, ...

  6. Coronary Angioplasty Stent Placement

    Full Text Available ... a false positive stress test. So in other words, the test was abnormal but there is no ... cardiac catheterization with coronary angiography. So in other words, we took a look. He implanted a catheter ...

  7. Coronary Angioplasty Stent Placement

    Full Text Available ... the course of the next hour you will learn about coronary artery disease, how blockage is performed, ... OR-Live” makes it easy for you to learn more, just click on the “Request information” button ...

  8. Coronary Angioplasty Stent Placement

    Full Text Available ... hopefully prevent them, and the different techniques we use to open up blockages and improve coronary blood ... huge body of data that shows that tobacco use is associated with accelerated hardening of the arteries. ...

  9. Coronary Angioplasty Stent Placement

    Full Text Available ... the vision of improving health. Hello and welcome. We’re coming to you live from the state- ... coronary artery disease, how blockage is performed, how we treat them, hopefully prevent them, and the different ...

  10. Coronary Angioplasty Stent Placement

    Full Text Available ... most overlooked. 4 So there are certain risk factors that we have for coronary artery disease. Probably ... Secondly is smoking. Smoking is a huge risk factor in the development of heart disease, as well ...

  11. Coronary Angioplasty Stent Placement

    Full Text Available ... coronary artery. Take in a breath, sir, and hold your breath. And the first picture seems to ... patient. Take in a deep breath, sir, and hold it. Jay, it’s certainly a very large vessel. ...

  12. Coronary Angioplasty Stent Placement

    Full Text Available ... two-part series featuring cardiovascular procedures and cardiovascular disease, in honor of American Heart Month. I’m ... next hour you will learn about coronary artery disease, how blockage is performed, how we treat them, ...

  13. Coronary Angioplasty Stent Placement

    Full Text Available ... improve coronary blood flow. You’ll have the opportunity to witness live a cardiac catheterization with possible ... procedure. During this webcast you’ll have the opportunity to ask questions. All you need to do ...

  14. Coronary Angioplasty Stent Placement

    Full Text Available ... initial injections. So this is the first view. Sir, turn your head over this way. Look to ... the right coronary artery. Take in a breath, sir, and hold your breath. And the first picture ...

  15. Coronary Angioplasty Stent Placement

    Full Text Available ... seen today is a cardiac catheterization or a diagnostic coronary angiogram. This is performed live from Shawnee, Mission Medical Center’s Heart and Vascular Center in Merriam, Kansas. ...

  16. Coronary Angioplasty Stent Placement

    Full Text Available ... to you live from the state-of-the-art Cardiac Catheterization Laboratory at Shawnee Mission Medical Center ... and he will go to the right coronary art which, which goes along the back wall of ...

  17. Coronary Angioplasty Stent Placement

    Full Text Available ... directly. Once he’s completed looking at the left system, then he will exchange catheters and he will ... blood vessels that emanate from the left coronary system. And now we have threaded a catheter over ...

  18. Coronary Angioplasty Stent Placement

    Full Text Available ... the most overlooked. 4 So there are certain risk factors that we have for coronary artery disease. Probably ... heritage. Secondly is smoking. Smoking is a huge risk factor in the development of heart disease, as well ...

  19. [Coronary angioplasty in elderly patients].

    Liistro, Francesco; Colombo, Antonio

    2002-01-01

    effect on the long-term outcome. These considerations could be "out of time" if the results obtained with the use of drug-eluting stents observed in selected patient populations will be confirmed in larger trials and in routine clinical practice. Whereas the advantages of the percutaneous versus the surgical approach in the elderly have not been fully clarified in patients with stable or unstable angina, primary angioplasty appears to be a very promising strategy in old patients with acute myocardial infarction. The improved clinical success with percutaneous revascularization in the elderly (acute mortality in patients > 85 years: 28.4% reperfused vs 38.5% not reperfused; p = 0.001) has to be related to the use of stents and to IIb/IIIa antagonists. In conclusion, when an old patient needs myocardial revascularization, the percutaneous approach should, in our opinion, be considered the treatment of choice in subjects either with stable or unstable angina and in those with acute myocardial infarction. At present, surgical revascularization provides better results in diabetic patients. The advent of drug-eluting stents may change many of the current limitations of percutaneous revascularization and further expand the use of this strategy. PMID:11899566

  20. Coronary Angioplasty Stent Placement

    Full Text Available ... symptoms one may get. And you can see -- let me go to the next slide. Symptoms of coronary artery ... take a suction catheter, very tiny catheter, and go out and suction out the clot, ... handed some more questions. Let’s see here. Dr. Mukhari, there’s a question that ...

  1. Coronary Angioplasty Stent Placement

    Full Text Available ... disease. First and foremost is medical therapy. Med management is extremely important, it maybe the simplest thing we can do, but often the most overlooked. 4 So there are certain risk factors that we have for coronary artery disease. ...

  2. Coronary Angioplasty Stent Placement

    Full Text Available ... we call a “dominant right coronary artery,” giving rise to multiple branches downstream, and there is an ... diet. Often statin therapy, particularly if their cholesterol levels or triglyceride levels are high, we’ll talk ...

  3. Coronary Angioplasty Stent Placement

    Full Text Available ... is associated with accelerated hardening of the arteries. Diabetes Mellitus is a very serious cause of particularly ... this next slide, we’ve talked about medical therapy, and then under “Percutaneous coronary intervention,” that is ...

  4. Coronary Angioplasty Stent Placement

    Full Text Available ... and recognize that women may have what we call “atypical symptoms.” They may have no symptoms at ... certainly a very large vessel. It’s what we call a “dominant right coronary artery,” giving rise to ...

  5. Coronary Angioplasty Stent Placement

    Full Text Available ... like to show you a slide here about treatment for what we call “significant coronary artery disease,” ... out that we also want to focus on treatment of non-flow limiting disease. First and foremost ...

  6. The effects of delayed percutaneous transluminal coronary angioplasty plus intracoronary stents on myocardial perfusion in patients with acute myocardial infarction

    Objective: To assess the myocardial perfusion in patients with acute myocardial infarction (AMI) after delayed percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stent implanting. Methods: Fifty-six patients with AMI were divided into delayed PTCA + stent group (treatment group, n=30) and control group (n=26). The treatment group were received delayed PTCA and coronary artery stents 15-30 d after AMI. The first 99Tcm-MIBI was performed 1-3 d before PTCA + stent (treatment group) and 15-30 d after AMI (control group), and followed by the second (1 month later), and the third (6 months later) 99Tcm-MIBI. Results: One month and six months after the treatment procedure (PTCA + stent), the blood flow deficit degree of myocardial infarction area in treatment group was much improved comparing with that before the procedure (treatment group, P0.05). Conclusions: There is residual myocardial viability in the AMI regions and PTCA + stent implantation keeps more jeopardize myocardium viable. Active therapy after AMI can significantly improve myocardial perfusion

  7. Coronary Angioplasty Stent Placement

    Full Text Available ... On occasion, if somebody comes in with an acute heart attack, they have clot in the vessel, we’ll ... question about that. People who have having an acute heart attack there is absolutely no question they need to ...

  8. Coronary Angioplasty Stent Placement

    Full Text Available ... such as non-cue wave heart attacks and myocardial infarctions, I think they need to be intervened upon. There is no question about that. People who have having an acute heart attack there is absolutely no question they ...

  9. Platelet PIA1/PIA2 polymorphism and the risk of periprocedural myocardial infarction in patients with acute coronary syndromes undergoing coronary angioplasty

    Verdoia, M.; Secco, G.G.; Cassetti, E.; Schaffer, A.; Barbieri, L.; Perrone-Filardi, P.; Marino, P.; Suryapranata, H.; Sinigaglia, F.; Luca, G. De

    2014-01-01

    Acute coronary syndromes (ACSs) represent a high-risk condition, as enhanced platelet reactivity importantly influences myocardial perfusion and procedural results after percutaneous coronary intervention (PCI). In fact, higher rate of periprocedural myocardial infarction (PMI) and reduced event-fre

  10. How Is Coronary Angioplasty Done?

    ... page from the NHLBI on Twitter. How Is Percutaneous Coronary Intervention Done? Before you have percutaneous coronary intervention (PCI), ... wall, relieving the blockage and improving blood flow. Percutaneous Coronary Intervention Figure A shows the location of the heart ...

  11. Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction. Analysis by quantitative ECG-gated SPECT

    We hypothesized that endothelial cell integrity in the risk area would influence left ventricular remodeling after acute myocardial infarction. Twenty patients (61±8 y.o.) with acute myocardial infarction underwent 99mTc-tetrofosmin imaging in the sub-acute phase and three months after successful primary angioplasty due to myocardial infarction. All patients were administered angiotensin-converting enzyme inhibitor after revascularization. Cardiac scintigraphies with quantitative gated SPECT were performed at the sub-acute stage and again 3 months after revascularization to evaluate left ventricular (LV) remodeling. The left ventricular ejection fraction (EF) and end-systolic and end-diastolic volume (ESV, EDV) were determined using a quantitative gated SPECT (QGS) program. Three months after myocardial infarction, all patients underwent cardiac catheterization examination with coronary endothelial function testing. Bradykinin (BK) (0.2, 0.6, 2.0 μg/min) was administered via the left coronary artery in a stepwise manner. Coronary blood flow was evaluated by Doppler flow velocity measurement. Patients were divided into two groups by BK-response: a preserved endothelial function group (n=10) and endothelial dysfunction group (n=10). At baseline, both global function and LV systolic and diastolic volumes were similar in both groups. However, LV ejection fraction was significantly improved in the preserved-endothelial function group, compared with that in the endothelial dysfunction group (42±10% to 48±9%, versus 41±4% to 42±13%, p<0.05). LV volumes progressively increased in the endothelial dysfunction group compared to the preserved-endothelial function group (123±45 ml to 128±43 ml, versus 111±47 ml to 109±49 ml, p<0.05). In re-perfused acute myocardial infarction, endothelial function within the risk area plays an important role with left ventricular remodeling after myocardial infarction. (author)

  12. Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study

    Karin Kogstad Else

    2000-11-01

    Full Text Available Abstract Objectives 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. Design Randomized, controlled, parallel-group design (intervention/conventional care. Setting Akershus County, southeast of Oslo City, Norway. Participants 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. Interventions 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.

  13. ANALYSIS OF OUTPATIENT PHYSICIANS, PRESCRIPTION OF DISAGGREGANT THERAPY FOR PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION AND/OR CORONARY ANGIOPLASTY WITH STENT IMPLANTATION WITHIN THE RECVAD REGISTRY

    A. V. Zagrebelnyi

    2015-01-01

    Full Text Available Objective: to estimate the quality of antiaggregants therapy in patients with coronary heart disease in outpatient settings. Materials and methods. The data of the retrospective outpatient RECVAD registry (3690 patients who lived in Ryazan and its Region and had evidence in their outpatient medical records for one of the diagnoses, such as coronary heart disease, hypertension, chronic heart failure, atrial fibrillation, or their concurrence, were used. Forty­nine patients after acute myocardial infarction (AMI and/or percutaneous coro­ nary interventions (PCI with stenting ≤ 1 year before their inclusion in the registry, who were to undergo dual antiaggregant therapy (DAT according to current clinical guidelines (CG, were identified among 427 patients after AMI and/or PCI with coronary angioplasty. Contra­ indications to DAT were simultaneously revealed and a relationship of the use of therapy to their presence was compared. Results. Among the 49 patients who had indications for DAT that was used in 15 (30.6 % cases and that was not in 3 (6.1 % patients in the presence of contraindications, 25 (51.0 % did not receive DAT in the absence of contraindications and 6 (12.3 % patients received the therapy in the presence of contraindications. Conclusion. DAT prescribed by outpatient physicians does not always meet the current CG. There are cases of not using DAT in the presence of obvious indications for DAT and, on the contrary, those of its use in the presence of contraindications. 

  14. Percutaneous Transluminal Coronary Angioplasty after Cardiac Transplantation

    Avedissian, Michael G.; Bush, Howard S; Leachman, D. Richard; Fighali, Sayid; Frazier, O. H.

    1989-01-01

    This report describes the 1st use of percutaneous transluminal coronary angioplasty in a posttransplant patient at the Texas Heart Institute. The patient, a 44-year-old man, experienced 3 episodes of moderate allograft rejection, hypercholesterolemia, transient severe hyperglycemia, and transient severe renal insufficiency in the posttransplant period. His cholesterol levels became elevated immediately and remained between 200 and 250 mg/dL, despite treatment with gemfibrozil. He had increasi...

  15. Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

    Mattos Luiz Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2% patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001. Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001. Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001. Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001 as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01. In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53. Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94, and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08. CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

  16. Fate of side branches after intracoronary implantation of the Gianturco-Roubin flex-stent for acute or threatened closure after percutaneous transluminal coronary angioplasty.

    Mazur, W; Grinstead, W C; Hakim, A H; Dabaghi, S F; Abukhalil, J M; Ali, N M; Joseph, J; French, B A; Raizner, A E

    1994-12-15

    Side branch occlusion may occur in the course of percutaneous transluminal coronary angioplasty (PTCA), particularly if complicated by site dissection. Concern that the additional placement of a stent may further jeopardize side branches is logical. Consequently, this study analyzed pre-PTCA, post-PTCA, poststent, and 6-month follow-up angiograms of 100 consecutive patients in whom 103 Gianturco-Roubin stents were implanted for acute or threatened closure after PTCA. Side branches were defined as major (> 50% of the stented vessel diameter) and minor ( 50% stenosis), and 129 minor branches were analyzed. Seven major branches (6%), all of which were diseased before PTCA, and 23 minor branches (18%) were lost after PTCA. Immediately after stent insertion, only 1 additional major and 1 minor branch were lost, whereas 2 of 7 major (29%) and 9 of 23 minor (39%) branches reappeared. At follow-up angiography, 7 major branches (6%) were more stenosed and 6 (6%) were improved compared with the angiogram before PTCA. Only 2 major (2%) and 5 minor (4%) branches remained occluded. Additionally, 2 major and 1 minor branch, which were patent after PTCA and stenting, were occluded at follow-up as a result of total occlusion of the stented segment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7977091

  17. Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up.

    Karsch, K R; Haase, K K; Voelker, W; Baumbach, A; Mauser, M; Seipel, L

    1990-06-01

    A clinical study was conducted to evaluate the efficacy and safety of percutaneous coronary excimer laser angioplasty in 60 patients with coronary artery disease. Forty-nine patients had stable exertional angina, and 11 patients had unstable angina despite medical therapy. A novel 1.4-mm diameter catheter with 20 quartz fibers of 100-microns diameter each arranged concentrically around a central lumen suitable for a 0.014-in. flexible guide wire was coupled to an excimer laser. A commercial excimer laser emitting energy at a wavelength of 308 nm with a pulse duration of 60 nsec was used. The laser was operated at 20 Hz. Mean energy transmission was 30 +/- 5 mJ/mm2. In five of the 60 patients, laser angioplasty was not attempted. In 23 patients with laser ablation alone, percent stenosis decreased from 76 +/- 14% before to 27 +/- 17% after ablation and was 34 +/- 15% at the early follow-up angiogram. In 32 patients, additional balloon angioplasty was performed because of vessel closure after laser ablation in 11 and an insufficient qualitative result in 21 patients. Of the 11 patients with unstable angina, one patient died due to vessel closure 3 hours after intervention, and two patients developed a myocardial infarction. In 22 of 47 patients with late follow-up angiography, restenosis within the 6-month follow-up period occurred. Rate of restenosis was higher in patients treated with laser ablation and balloon angioplasty (16 of 28) than in patients treated with laser ablation alone (six of 19). These results suggest that coronary excimer laser angioplasty for ablation of obstructive lesions is feasible and safe in patients with stable angina. However, development of new catheter systems is necessary for an improved success rate. PMID:2344680

  18. Safety and efficacy of angioplasty with intracoronary stenting in patients with unstable coronary syndromes. Comparison with stable coronary syndromes

    Luís C. L. Correia

    2000-06-01

    Full Text Available OBJECTIVE: To assess safety and efficacy of coronary angioplasty with stent implantation in unstable coronary syndromes. METHODS: Retrospective analysis of in-hospital and late evolution of 74 patients with unstable coronary syndromes (unstable angina or infarction without elevation of the ST segment undergoing coronary angioplasty with stent placement. These 74 patients were compared with 31 patients with stable coronary syndromes (stable angina or stable silent ischemia undergoing the same procedure. RESULTS: No death and no need for revascularization of the culprit artery occurred in the in-hospital phase. The incidences of acute non-Q-wave myocardial infarction were 1.4% and 3.2% (p=0.6 in the unstable and stable coronary syndrome groups, respectively. In the late follow-up (11.2±7.5 months, the incidences of these events combined were 5.7% in the unstable coronary syndrome group and 6.9% (p=0.8 in the stable coronary syndrome group. In the multivariate analysis, the only variable with a tendency to significance as an event predictor was diabetes mellitus (p=0.07; OR=5.2; 95% CI=0.9-29.9. CONCLUSION: The in-hospital and late evolutions of patients with unstable coronary syndrome undergoing angioplasty with intracoronary stent implantation are similar to those of the stable coronary syndrome group, suggesting that this procedure is safe and efficacious when performed in unstable coronary syndrome patients.

  19. Percutaneous coronary angioplasty in a cardiac transplant recipient.

    Gammage, M D; Shiu, M F; English, T A

    1988-01-01

    Two years after an orthotopic cardiac transplant a 28 year old man was found to have clinically significant stenosis of the right coronary artery at routine coronary angiography. This lesion was accompanied by a perfusion defect on exercise thallium scintigraphy. Percutaneous transluminal coronary angioplasty of the lesion improved the angiographic appearance of the stenosis and reduced the exercise thallium perfusion defect.

  20. Coronary embolism causing acute myocardial infarction in a patient with mitral valve prosthesis: successful management with angioplasty.

    Sial, Jawaid Akbar; Ferman, Mohammad Tariq; Saghir, Tahir; Rasool, Syed Ishtiaq

    2009-06-01

    A 24-year-old male patient with anterior myocardial infarction, caused by embolization from mitral valve prosthesis due to inadequate anticoagulation is presented. The patient underwent cardiac catheterization within 90 minutes of arrival. Angiography showed total occlusion of the left anterior descending coronary artery (LAD) after the second diagonal branch. Thrombus was extracted with export catheter from LAD, and coronary artery perfusion was restored. The pain disappeared completely immediately after this intervention. Transoesophageal echocardiography performed 2 days later revealed no thrombus at the prosthetic valve. In conclusion, this case demonstrated that coronary embolism may occur even without prosthetic valve thrombus or dysfunction with suboptimal International Normalized Ratio levels, and can be successfully treated with coronary angiography with clot extraction with aspiration catheter (Export XT 6F Medtronic) only, without stenting. PMID:19534381

  1. Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

    Lindefjeld, Dante S., E-mail: dslindef@puc.cl [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Guarda, Eduardo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Méndez, Manuel [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Martínez, Alejandro [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Pérez, Osvaldo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Fajuri, Alejandro; Marchant, Eugenio [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Aninat, Mauricio; Torres, Humberto [Hospital Dr. Gustavo Fricke, Viña del Mar-Chile (Chile); Dussaillant, Gastón [Hospital Clínico Universidad de Chile, Santiago-Chile (Chile)

    2013-01-15

    Background: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Objective: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Methods: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). Results: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up. Conclusions: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

  2. Effect of percutaneous transluminal coronary angioplasty on coronary reserve

    This study was done to assess the effect of percutaneous transluminal coronary angioplasty (PTCA) on regional myocardial perfusion (RMP) in the region distal to a stenosis in 48 patients. Quantitative RMP in ml/100g/min was measured from the washout of Xe-133 following selective injection into the involved coronary artery. After successful dilation, determined by a reduction in %stenosis to a ≤ 50% lesion and in pressure gradient across the lesion, the RMP measurement was repeated. In these patients, means %stenosis was 85% pre PTCA and 29% post PTCA with mean pressure gradient of 60 Hg pre PTCA and 21 mm Hg post PTCA. 21 of these 48 patients also had RMP measured after isoproterenol (ISO) both pre and post PTCA to increase myocardial oxygen demand to assess coronary reserve. Heart rate (HR) and systolic blood pressure (SBP) were constant pre and post PTCA which allowed a valid comparison. The results are presented. A group of 13 patients with normal coronary arteries and ventricular function showed a mean control RMP of 78 +- 15 and a mean ISO RMP of 140 +- 26. The data demonstrate that following successful PTCA quantitative RMP improves both at rest and with an ISO challenge and is similar to RMP in normal coronary arteries

  3. Spontaneous Coronary Dissection: “Live Flash” Optical Coherence Tomography Guided Angioplasty

    Bento, Angela Pimenta; Fernandes, Renato Gil dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

    2016-01-01

    Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

  4. Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: diameter versus densitometric area measurements

    P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); W. Wijns (William); M.J.B.M. van den Brand (Marcel); C.J. Kooijman; H.J. ten Katen (Harald); P.G. Hugenholtz (Paul)

    1984-01-01

    textabstractCineangiograms of 138 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) were analyzed with a computer-based coronary angiography analysis system. The results before and after dilatation are presented. In a first study group (120 patients), the severity of the o

  5. Protective effect of collateral vessels during coronary angioplasty.

    Norell, M. S.; Lyons, J. P.; Gardener, J E; Layton, C A; Balcon, R

    1989-01-01

    To assess the potential protective role of collateral vessels 27 patients undergoing angioplasty of the left anterior descending coronary artery were studied by intravenous digital subtraction left ventriculography. Fifteen patients had no collateral vessels (group 1) and 12 had some degree of collateral supply (group 2). During balloon inflation ST segment elevation in group 1 (4.9 mm) was significantly greater than that in group 2 (0.9 mm). Similarly the reduction in left ventricular ejecti...

  6. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik;

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and...... translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if...... patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction...

  7. Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction

    Akdemir, Ramazan; Karakurt, Özlem; Orcan, Salih; Karakoyunlu, Nihat; Mucahit Balci, Mustafa; SAĞNAK, Levent; Ersoy, Hamit; Bulent Vatan, Mehmet; Kilic, Harun; Yeter, Ekrem

    2012-01-01

    Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary an...

  8. Intracoronary radiation therapy using Re-188 after percutaneous coronary angioplasty

    Chae, In Ho; Lee, Myoung Mook; Lee, Dong Soo [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-07-01

    Percutaneous coronary angioplasty is well established therapeutic modality in the management of coronary artery disease. However, the high restenosis rate of 30 to 50% limits its usefulness. The principal mechanism of restenosis, intimal hyperplasia, is the proliferative response of vessel wall to injury, which consists largely of smooth muscle cells. A large body of animal investigations and a limited number of clinical studies have established the ability of ionizing radiation to reduce neointimal proliferation and restenosis rate significantly. Human studies have been reported that intravascular radiation after first restenosis inhibits a second restenosis. Encouraged by these reports, we are also conducting a double blind, placebo-controlled, randomized trial to evaluate this new therapeutic modality in patients with coronary artery stenosis. The objective of our trial is to determine the safety and efficacy of catheter-based solutional beta emitting radioisotope system in preventing restenosis after angioplasty. This review describes the vascular brachytherapy systems and isotopes that have been utilized in the initial clinical trials performed in this area of past PTCA coronary restenosis. The results of many worldwide ongoing clinical trials will determine whether this new technology will change the future practice of vascular intervention.

  9. Risk assessment after coronary angioplasty with SPECT myocardial perfusion studies

    The chest pain can be use for stratifying the risk of the patients after coronary angioplasty. Nevertheless this strategy has shown to have a low accuracy in the detection of restenosis and myocardial ischemia. Aims: To establish the usefulness of the SPECT studies in the risk stratification after the coronary angioplasty. Evaluate the incidence of silent ischemia or symptomatic, and its impact on the prognosis. Method: There were included 107 patients (p) submitted to a gated SPECT between the year of the coronary angioplasty. The analysis of the images was performed according to different scores (SSS, SRS, SDS). These data was correlated with the symptoms of the patients. We define group 1 (G1) as the asymptomatic without ischemia (n 59p), group 2 (G2) as silent ischemia (n = 28p) and group 3 (G3) as symptomatic with ischemia (n = 20p). A clinical follow-up was done in search of events (target vessel revascularization, unstable angina, AMI and death). Results: Significant differences were not observed in the clinical variables between the different groups. The SSS was lower in the G1 compare with G2 and G3 (p 0.0001) and was similar between the last two, p = NS (SSS: G1: 2.2 ± 4.9; G2: 7.6 ± 5.9; G3: 9.5 ± 6.8). The SDS was greater in G3 vs. G1 and G2, p = 0.0001, and greater in G2 vs. G1, p = 0.0001 (SDS: G1: 0; G2: 4.8 ± 3.5; G3: 7.2 ± 6.5). No differences where observed in the SRS between the three groups. In the follow-up the total percentage of events was lesser when compare the G1 with the G2 and G3 (G1: 3.3%; G2 and G3: 18.7%; p 0.02). The percentage of annual events of the G3 symptomatic with ischemia (11.03%) and G2 silent ischemia (4.04%) did not present differences (p 0.7). When the events of the G2 (4.04%) were compared with the G1 (1.24%) we observed a trend to major frequency of events in the G2 (p = 0.6). Conclusions: The presence of myocardial ischemia after coronary angioplasty is a determinant of the prognosis. Nevertheless, the extension

  10. Rescue coronary stenting in acute myocardial infarction

    Barbieri, Enrico; Meneghetti, Paolo; Molinari, Gionata; Zardini, Piero

    1996-01-01

    Failed rescue coronary angioplasty is a high risk situation because of high mortality. Coronary stent has given us the chance of improving and maintaining the patency of the artery. We report our preliminary experience of rescue stenting after unsuccessful coronary angioplasty.

  11. Radiation risk to patients from percutaneous transluminal coronary angioplasty

    This paper reports that percutaneous transluminal coronary angioplasty (PTCA) is commonly used to control coronary atherosclerosis, and in many patients repeated applications occur. We investigated the current level of radiation dose and the corresponding risk for PTCA patients. The frequency of PTCA and patient demographics were also examined. Data for 1,503 Ottawa Heart Institute patients undergoing PTCA between January 1, 1987, and December 31, 1989, were analyzed retrospectively. Entrance exposures were estimated from records of the fluoroscopy time per case, the number of cine frames used, and exposure rate measurements. These were converted to average organ doses by using the Monte Carlo results of the Rosenstein group. Risks of including fatal cancers were estimated according to ICRP Report 60 (draft)

  12. Angioplasty and stent placement - heart

    ... angioplasty; Coronary artery angioplasty; Percutaneous transluminal coronary angioplasty; Heart artery dilatation ... to carefully guide the catheter up into your heart and arteries. Dye will be injected into your ...

  13. [Percutaneous coronary Excimer laser angioplasty in patients with coronary heart disease].

    Karsch, K R; Haase, K K; Mauser, M; Ickrath, O; Voelker, W; Baumbach, A; Seipel, L

    1990-07-01

    To verify the efficacy and safety of percutaneous coronary excimer laser angioplasty in patients with coronary artery disease a prospective study was conducted in 60 patients. The application of laser light was possible in 55 of the 60 patients. A novel 1.4-mm diameter catheter with 20 quartz fibers of 100-microns diameter, each arranged concentrically around a central lumen suitable for an 0.014-inch flexible guide wire was used. The light source was a commercial excimer laser emitting energy at a wavelength of 308 nm, with a pulse duration of 60 ns. The laser was operated at 20 Hz; mean energy transmission was 30 +/- 5 mJ/mm2. In 23 of the 55 patients treated with excimer laser energy the qualitative angiographic results were sufficient. In 32 patients additional balloon angioplasty was necessary, either because of an insufficient result or due to vessel closure after laser ablation. In 47 of the 55 patients control angiography was performed within the 6-month follow-up period. Rate of restenosis was higher in patients treated with laser ablation and subsequent balloon angioplasty (16 of 28) than in patients treated with laser ablation alone (6 of 19). Results of the 6-month observation period suggest that 1) coronary excimer laser angioplasty in combination with subsequent balloon angioplasty results in a considerable increase of the restenosis rate; 2) the exclusive use of laser ablation also results in a restenosis rate comparable to balloon angioplasty alone; and 3) the impact of this new method using improved application systems and higher energy transmission has to be determined in further studies. PMID:2399764

  14. Acute Coronary Events

    Arbab-Zadeh, Armin; Nakano, Masataka; Virmani, Renu; Fuster, Valentin

    2012-01-01

    In the United States alone, more than 400,000 Americans die annually from coronary artery disease and more than 1,000,000 suffer acute coronary events, i.e., myocardial infarction and sudden cardiac death.1 Considering the aging of our population and increasing incidence of diabetes and obesity, the morbidity from coronary artery disease, and its associated costs, will place an increasing, substantial burden on our society.2 Between 2010 and 2030, total direct medical costs spent in the US for cardiovascular diseases are projected to triple from 273 to 818 billion dollars.2 Although effective treatments are available and considerable efforts are ongoing to identify new strategies for the prevention of coronary events, predicting such events in an individual has been challenging.3 In hopes of improving our ability to determine the risk of coronary events, it is prudent to review our knowledge of factors that lead to acute coronary events. PMID:22392862

  15. A COMPARISON OF HIRUDIN WITH HEPARIN IN THE PREVENTION OF RESTENOSIS AFTER CORONARY ANGIOPLASTY

    SERRUYS, PW; HERRMAN, JPR; SIMON, R; RUTSCH, W; BODE, C; LAARMAN, GJ; VANDIJK, R; VANDENBOS, AA; UMANS, VAWM; FOX, KAA; CLOSE, P; DECKERS, JW

    1995-01-01

    Background. The likelihood of restenosis is a major limitation of coronary angioplasty. We studied whether hirudin, a highly selective inhibitor of thrombin with irreversible effects, would prevent restenosis after angioplasty. We compared two regimens of recombinant hirudin with heparin. Methods. W

  16. Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study

    Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio [Montevergine Clinic, Mercogliano (Italy); Golino, Luca, E-mail: lucagolino.jazz@alice.it [Montevergine Clinic, Mercogliano (Italy); Moriggia-Pelascini Hospital, Gravedona, Como (Italy); Casafina, Alfredo; Schiano, Vittorio [Montevergine Clinic, Mercogliano (Italy); Gabrielli, Gabriele [University Hospital Ospedali Riuniti, Ancona (Italy); Ettori, Federica; Chizzola, Giuliano [Spedali Civili University Hospital, Brescia (Italy); Bernardi, Guglielmo; Spedicato, Leonardo [University Hospital S. Maria Misericordia, Udine (Italy); Armigliato, Pietro [Istituto Italiano Ricerche Mediche, Verona (Italy); Spampanato, Carmine [Telethon Institute of Genetics and Medicine (TIGEM), Naples (Italy); Furegato, Martina [Istituto Italiano Ricerche Mediche, Verona (Italy)

    2015-04-15

    Aim: An innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. Methods and Results: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%). Safety and effectiveness data were compared between patients treated with standard laser therapy and those treated with increased laser therapy. Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success in was obtained in 87 lesions (90.6%). There was no perforation, major side branch occlusion, spasm, no-reflow phenomenon, dissection nor acute vessel closure. Increased laser parameters were used successfully for 49 resistant lesions without complications. Conclusions: This study suggests that laser-facilitated coronary angioplasty is a simple, safe and effective device for the management of complex coronary lesions. Furthermore, higher laser energy levels delivered by this catheter improved the device performance without increasing complications. - Highlights: • We planned this multicenter study to examine the acute outcome of an innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) for treatment of complex coronary lesions. • We enrolled 80 patients with 100 lesions and performed excimer laser coronary angioplasty in 96 lesions (96%). • Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success was obtained in 87 lesions (90.6%). • Increased laser parameters were used successfully for 49 resistant

  17. ON THE SAFETY OF CONTRAST MEDIA USAGE DURING CORONARY ANGIOPLASTY IN KIDNEY TRANSPLANT RECIPIENTS

    I. G. Ryadovoy

    2010-06-01

    Full Text Available In the present study influence of contrast media on renal transplant function in patients with ischemic heart disease treated by coronary angioplasty and stenting waz estimated. Results are based on clinical and angiographic data, the analysis of amount of contrast media, average speed of it introduction, level of creatinine before and at the first 48 hours after coronary angioplasty in 42 patients with renal transplant. 

  18. Evaluation of effect of coronary angioplasty using dipyridamole 99mTc myocardial imaging

    To evaluate the effect of coronary angioplasty in patients with coronary artery disease, we performed dipyridamole 99mTc myocardial imaging pre-and post-angioplasty. Within one month, 97.8% myocardial segments showing redistribution before angioplasty became normal or improved after angioplasty, but none improved in segments showing 'fixed' defect only. Within one month, effective rate of treatment was 76.7% in 30 patients but 95.8% in 24 patients showing redistribution before angioplasty. Follow-up study within 6 months showed that the effective rate of treatment was 66.7% in 30 patients and 83.3% in 24 patients respectively. The myocardial imagings of three patients kept normal during one year follow-up. In 12.5% cases, the myocardial imaging showed reischemia which was confirmed by angiography

  19. High-fidelity translesional pressure gradients during percutaneous transluminal coroanry angioplasty: correlation with quantitative coronary angiography

    C. Lamm; M. Dohnal; P.W.J.C. Serruys (Patrick); H.U. Emanuelsson (Hakan)

    1993-01-01

    textabstractA fiberoptic pressure sensor mounted on an 0.018-inch guidewire (Pressure Guide) was used to measure the transstenotic pressure gradient in 30 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with lesions considered suitable for quantitative coronary angiographic

  20. [Exercise tolerance in patients after successful percutaneous transluminal coronary angioplasty].

    Tsumoto, S; Nakagawa, Y; Asakuma, S; Naruse, H; Komasa, N; Ohyanagi, M; Tateishi, J; Yasutomi, N; Fujitani, K; Iwasaki, T

    1991-01-01

    In 32 patients with successful percutaneous transluminal coronary angioplasty (PTCA), we performed treadmill exercise tests (TMET) before and about one month after PTCA to assess the correlation between the improvement in coronary artery lesions and exercise tolerance. Either the Bruce protocol (B: n = 12) or the modified Bruce protocol (MB: n = 20) was used; with the latter being applied to patients whose cardiac function seemed depressed. In 15 patients, oxygen consumption (VO2) was measured by analyzing the expired gases, 13 patients underwent exercise thallium-201 myocardial perfusion scintigraphy before and after PTCA, whose results were compared with those of TMET. In both B and MB protocols, the treadmill walking time was significantly prolonged after PTCA, compared to that before PTCA (B: 7.4 +/- 1.3 vs 9.5 +/- 1.9, MB: 11.4 +/- 3.5 vs 12.7 +/- 3.5 min). Heart rates (HR) and rate pressure products (RPP) were significantly increased after PTCA in both protocols (HR B: 139 +/- 18 vs 154 +/- 17, MB: 121 +/- 20 vs 137 +/- 19 bpm, RPP B: 26,500 +/- 5,600 vs 30,300 +/- 6,700, MB: 19,400 +/- 6,200 vs 22,700 +/- 6,600 mmHg.bpm), however, systolic blood pressure did not change significantly after PTCA in either protocol. While there was a significant improvement in VO2 after PTCA (21.6 +/- 6.3 vs 25.7 +/- 4.2 ml/kg/min), the O2-pulse remained unchanged. Thallium-201 myocardial scintigraphy revealed improvement of myocardial perfusion in 8 of the 13 cases examined.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1841916

  1. Intracoronary irradiation with rhenium 188 to reduce restenosis following a coronary angioplasty. Preliminary results

    This paper shows the preliminary results from our contribution to a coordinated project with the International Atomic Energy Agency, which corroborates that the intracoronary irradiation allows to reduce the restenosis following a percutaneous transluminal coronary angioplasty (PTCA) in patients with ischemic cardiopathy as a result of neointima hyperplasia reduction. In the treatment, both beta and gamma emitters can be used, but with the latter (specifically with rhenium 188), its is possible to use an angioplasty balloon catheter for therapy purposes

  2. [Ultrasound coronary angioplasty: state of the art and new clinical aspects].

    Rosenschein, U; Budde-Schwartzman, B

    1997-12-01

    Therapeutic ultrasound was shown to ablate thrombi and to disrupt atherosclerotic plaques in vitro and recently to recanalize occluded coronary arteries in acute myocardial infarction (AMI). The goal of this article is to update collective experience and to weigh the promising and unresolved aspects of this newly developed technology and its clinical results. As therapeutic ultrasound was for long known a synonym for lithotripsy of calculi diseases, it lastly received high attention as a catheter-based ultrasound method to ablate thrombi and disrupt atherosclerotic plaques in interventional cardiology (Figure 1). The effect of therapeutic ultrasound to ablate selectively pathological tissue depends on its bioselectivity for elastic fibers: After ultrasound sonication, healthy tissue-rich in elastin and collagen-including arterial wall remains intact whereas thrombus and plaque with their minimal elastic support are found to be highly susceptible to ablation. Our catheter for coronary ultrasound thrombolysis (Figure 2) consists of a solid metal probe and is connected to a piezo-electric transducer at its proximal end. The distal part ends in a three-wire flexible segment with a 1.6 mm tip ball to guarantee maximal wire flexibility and optimal transmission of ultrasound energy. The initial in vitro studies resulted in a fundamental understanding of the destructive effect of ultrasound on tissue based on 4 factors: mechanical vibration, thermal effects, microcurrents, and cavitation. The first studies on human peripheral vessels were published in 1991 being performed during femoral bypass surgery on occluded and partially obstructed arteries. The procedure was performed without perforation, no adverse side effects emerged, restenosis rate was 20%. The clinical application of coronary ultrasound angioplasty was initiated in 1991; Siegel published his data on 44 patients. In his study, 30 patients with chronic atherosclerotic occlusive lesions and 14 with unstable or

  3. Twenty-four-hour Tl-201 delayed scan underestimates myocardial viability in patients with acute myocardial infarction after percutaneous transluminal coronary angioplasty

    Myocardial viability in area at risk of acute myocardial infarction (AMI) after reperfusion therapy may be underestimated by the 24-hour images due to reverse redistribution (r-RD). Subjects were 37 AMI patients in whom Tc-99m pyrophosphate (PYP)/Tl-201 dual-isotope SPECT was positive. The 24-hour delayed scan was performed with only a Tl window. One month later, follow up rest Tl SPECT was performed to evaluate myocardial viability. In early (at PYP/Tl-201 dual-isotope SPECT), 24-hour, and one month follow up Tl studies, Tl uptake in the area of AMI was scored into four grades: 3 as normal to 0 as severely reduced. The scores were evaluated. Among the 37 AMI lesions, there were 16 r-RD, 3 RD, 16 fixed defect (FD) and 2 normal (positive PYP and normal Tl). Mean Tl scores were early; 1.4±1.1, 24-hr; 0.9±0.9 and one month; 1.3±1.1. The 24-hour Tl score was lower than the early and one month Tl scores (p<0.01). Reverse redistribution is frequently observed in an area at risk where PYP SPECT was positive. Nuclear medicine physicians should be aware of the existence of frequent r-RD in Tl scan to avoid the underestimation of myocardial viability in the acute phase after PTCA. (author)

  4. Excimer laser coronary angioplasty: experience with a prototype multifibre catheter in patients with stable angina pectoris.

    Kochs, M; Haerer, W; Eggeling, T; Hoeher, M; Schmidt, A; Hombach, V

    1992-03-01

    Percutaneous excimer laser coronary angioplasty (ELCA) was performed in a first group of 20 patients with stable angina pectoris caused by significant coronary stenosis, and long-term follow-up was evaluated. Prototype 4 to 5.5 French multifibre catheters with 18-20 quartz fibres of 100 microns diameter, concentrically arranged around a central lumen for taking up a guide wire, were coupled to a commercial XeCl excimer laser. Energy was delivered at a wavelength of 308 nm with a pulse duration of 60 or 120 ns. Operating at a repetition rate of 20 Hz, mean energy transmission was 13.4 +/- 6.8 mJ per pulse. In all but one patient the lesion could be passed by the catheter. Percent diameter stenosis decreased from 77.1 +/- 10.8% to 53.1 +/- 11.8% after ELCA. Complications were frequently observed, intracoronary thrombus formation in eight instances, dissection in six patients and spasm in five cases, causing total vessel occlusion in five procedures. All complications could be managed efficaciously by thrombolytic and vasodilating drugs and/or balloon angioplasty. Subsequent PTCA was performed in case of complication or insufficient stenosis reduction after ELCA in 18 patients with adequate results (residual stenosis, 28.5 +/- 10.2%). Long-term follow-up angiography, which could be performed in 16 of 19 laser treatments, demonstrated significant restenosis in only three patients. Our preliminary results suggest that, using ELCA, ablation of atherosclerotic lesions is feasible in most cases. However, compared with PTCA, stenosis reduction is significantly less, and the acute complication rate is much higher. Thus, further improvements of the catheter system are necessary in order to realize the advantages of excimer laser ablation, which can be demonstrated by experimental studies. PMID:1597220

  5. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Parag Chevli

    2014-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

  6. The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)

    The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) in Finland was studied using phantom measurements. Additional tests were made concerning the performance of TV fluoroscopy systems, cine fluorographic units and film processing. These tests include sensitometric quality control of film processing, automatic exposure control in fluoroscopy and cinefluorography, and contrast and resolution in a cine frame and TV image

  7. HEMOPERFUSION DURING CORONARY ANGIOPLASTY - 1ST EUROPEAN EXPERIENCE WITH A NEW HEMOPERFUSION PUMP

    DEMUINCK, ED; MEEDER, J; MAGIELSE, C; BOM, VJJ; VANDIJK, RB; VERKERKE, GJ; LIE, KI

    1994-01-01

    Hemolysis tests with fresh human blood were performed in vitro with a new 5 ml, piston-type hemoperfusion pump, designed to prevent myocardial ischemia during coronary angioplasty. Despite driving pressures greater than 3 atmospheres, shear stress greater than 200 Pa, turbulent pump flow, and the pr

  8. A cutting balloon for coronary angioplasty: new trend in the prevention of restenoses

    Results on application of angioplasty with a cutting balloon in 8 men with ischemia heart disease are presented all patients had injury of one coronary vessel. The first experience makes it possible to consider that application of a cutting balloon is not dangerous, the arteria wall traumatization is small and restonoses frequency should be consequently smaller. 7 refs.; 3 figs

  9. Percutaneous trans-ulnar artery approach for coronary angiography and angioplasty; A case series study

    Roghani-Dehkordi, Farshad; Hadizadeh, Mahmood; Hadizadeh, Fatemeh

    2015-01-01

    BACKGROUND Coronary angiography is the gold standard method for diagnosis of coronary heart disease and usually performed by femoral approach that has several complications. To reduce these complications, upper extremity approach is increasingly used and is becoming preferred access site by many interventionists. Although radial approach is relatively well studied, safety, feasibility and risk of applying ulnar approach in not clearly known yet. METHODS We followed 97 patients (man = 56%, mean ± standard deviation of age = 57 ± 18) who had undergone coronary angiography or angioplasty via ulnar approach for 6-10 months and recorded their outcomes. RESULTS In 97 patients out of 105 ones (92.38%), procedure through ulnar access were successfully done. Unsuccessful puncture (3 patients), wiring (2 patients), passing of sheet (2 patients), and anatomically unsuitable ulnar artery (1 patient) were the reasons of failure. In 94 patients (89.52%), the angiography and angioplasty was done without any complications. Five patients (5.1%) hematoma and 11 patients (11%) experienced low-grade pain that resolved with painkiller. No infection, amputation or need for surgery was reported. CONCLUSION This study demonstrated that ulnar access in our patients was a safe and practical approach for coronary angiography or angioplasty, without any major complication. Bearing in mind its high success rate, it can be utilized when a radial artery is not useful for the catheterization and in cases such as prior harvesting of the radial artery (in prior coronary artery bypass grafting). PMID:26715936

  10. ANTICOAGULANTS IN ACUTE CORONARY SYNDROME

    I. A. Latfullin; A. A. Podolskaya

    2016-01-01

    Clinical efficacy of unfractionated and low molecular heparins in acute coronary syndrome is discussed. New synthetic heparin derivative fondaparinux (Arixtra) is focused. Author’s brief experience of fondaparinux clinical implementation is presented.

  11. Prognostic value of myocardial perfusion tomographic imaging in patients after percutaneous transluminal coronary angioplasty plus stent

    Objective: To study the prognostic value of myocardial perfusion tomographic imaging in patients after percutaneous transluminal coronary angioplasty (PTCA) plus stent. Methods: Seventy-five patients underwent 99Tcm-methoxyisobutylisonitrile (MIBI) stress-rest myocardial perfusion tomographic imaging (6.91 ± 2.99) months after PTCA. They were then followed-up for (41.71 ± 20.00) months, and unstable angina pectoris, acute myocardial infarction, cardiac death and revascularization for cardiac events were recorded during follow-up. Results: Twenty-five patients had cardiac events during follow-up. And the cardiac event rate in patients with normal and fixed defects(5.9%, 16.7%) was significantly lower than that in those with reversible defects (52.5%, χ2=10.94, P2=6.57, P2=7.37, P=0.0066; χ2=6.28, P=0.012), and the mean time free of cardiac event after PTCA was (33.8 ± 5.0) months. Conclusion: The presence of reversible defects on post-PTCA cardiac imaging predicts a higher cardiac event rate, the myocardial perfusion tomography imaging after PTCA is valuable for predicting the prognosis of patients after PTCA plus stent. (authors)

  12. Serum Iron Concentration, but Not Hemoglobin, Correlates with TIMI Risk Score and 6-Month Left Ventricular Performance after Primary Angioplasty for Acute Myocardial Infarction

    Ching-Hui Huang; Chia-Chu Chang; Chen-Ling Kuo; Ching-Shan Huang; Tzai-Wen Chiu; Chih-Sheng Lin; Chin-San Liu

    2014-01-01

    Objective Anemia is associated with high mortality and poor prognosis after acute coronary syndrome (ACS). Increased red cell distribution width (RDW) is a strong independent predictor for adverse outcomes in ACS. The common underlying mechanism for anemia and increased RDW value is iron deficiency. It is not clear whether serum iron deficiency without anemia affects left ventricular (LV) performance after primary angioplasty for acute myocardial infarction (AMI). We investigated the prognost...

  13. Failure of epoprostenol (prostacyclin, PGI2) to inhibit platelet aggregation and to prevent restenosis after coronary angioplasty: results of a randomised placebo controlled trial.

    Gershlick, A H; Spriggins, D.; Davies, S W; Syndercombe Court, Y D; Timmins, J.; Timmis, A D; Rothman, M. T.; Layton, C; Balcon, R

    1994-01-01

    OBJECTIVE--To study the effect of epoprostenol (prostacyclin, PGI2) given before, during, and for 36 h after coronary angioplasty on restenosis at six months and to evaluate the transcardiac gradient of platelet aggregation before and after percutaneous transluminal coronary angioplasty (PTCA) in treated and placebo groups. DESIGN--Double blind placebo controlled randomised study. PATIENTS--135 patients with successful coronary angioplasty. METHODS--Intravenous infusion of PGI2 (4 ng/kg/ml) o...

  14. Assessment of "silent" restenosis and long-term follow-up after successful angioplasty in single vessel coronary artery disease: the value of quantitative exercise electrocardiography and quantitative coronary angiography

    G-J. Laarman (GertJan); H.E. Luijten; L.G.P.M. van Zeyl; K.J. Beatt (Kevin); J.G.P. Tijssen (Jan); P.W.J.C. Serruys (Patrick); P.J. de Feyter (Pim)

    1990-01-01

    textabstractExercise electrocardiographic (ECG) testing during follow-up after coronary angioplasty is widely applied to evaluate the efficacy of angioplasty, even in asymptomatic patients. One hundred forty-one asymptomatic patients without previous myocardial infarction underwent quantitative exer

  15. Significance of Cardiac Troponin T Release in Detecting Minor Myocardial Injury After Percutaneous Transluminal Coronary Angioplasty

    ALPER, Gülinnaz

    1999-01-01

    Cardiac Troponin T (TnT) is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. This study was designed to evaluate the diagnostic efficiency of TnT enzyme immunoassay in detecting myocardial damage in patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA) and to compare this newly developed test with t...

  16. Wiktor stent implantation in patients with restenosis following balloon angioplasty of a native coronary artery

    P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); V. Wiegand; G. Kober; J.F. Marquis; B. Valeix; R. Uebis; J. Piessen; P.P.T. de Jaegere (Peter)

    1992-01-01

    textabstractIntracoronary stenting has been introduced as an adjunct to balloon angioplasty aimed at overcoming its limitations, namely acute vessel closure and late restenosis. This study reports the first experience with the Wiktor stent implanted in the first 50 consecutive patients. All patients

  17. Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

    鹿小燕; 徐浩; 史大卓; 陈可冀

    2004-01-01

    Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS rate can reach 30% to 50%, even with direct stenting into the vessels, it still reaches 20% to 35%. So this affects long-term effect of interventional therapy, which directly relates to prognosis of patients with CHD and has been a hot spot of study in the field of preventing and treating CHD.

  18. Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

    鹿小燕; 徐浩; 史大卓; 陈可冀

    2004-01-01

    Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS rate can reach 30% to 50%, even with directstenting into the vessels, it still reaches 20% to 35%. So this affects long-term effect of interventional therapy, which directly relates to prognosis of patients with CHD and has been a hot spot of study in the field of preventing and treating CHD.

  19. Metabolic syndrome in acute coronary syndrome

    Objective: To determine the frequency of metabolic syndrome in male patients presenting with acute coronary syndrome Study design: A Descriptive study Place and duration of study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008 Patients and Methods: Male patients with acute coronary syndrome (ACS) were included. Patients having angioplasty (PCI), coronary artery bypass surgery in the past and other co-morbid diseases were excluded. All patients were assessed for the presence of five components of metabolic syndrome including hypertension, HDL-Cholesterol and triglycerides, glucose intolerance and abdominal obesity. Systolic, diastolic blood pressures, waist circumference (WC) and body mass index (BMI) were measured. ECG, cardiac enzymes, fasting glucose and lipid profile were also done. Results: A total of 135 male patients of ACS were studied with a mean age of 54.26 +- 11 years. Metabolic syndrome (MS) was present in 55 (40.7%) patients. MS with all five components was documented in 4 (7.27%) while MS with four and three components was seen in 23 (41.81%) and 28 (50.90%) patients respectively. Only 24 (43.63%) patients with MS had diabetes mellitus, remaining 31(56.36%) were non diabetic. Frequencies of diabetes, hypertension and family history of CAD were significantly higher (p<0.05) in patients with metabolic syndrome as compared to patients with normal metabolic status. Conclusion: Metabolic syndrome is fairly common and important risk factor in patients of IHD. Other risk factors like smoking, dyslipidemia, hypertension and diabetes were also frequently found. Public awareness to control the risk factors can reduce the prevalence of CAD in our country. (author)

  20. Radionuclide examination of ischemic heart disease patients after percutaneous transluminal coronary angioplasty

    Twenty five patients were examined prior to percutaneous transluminal coronary angioplasty (PTCA) and one week following it by exercise thallium scintigraphy, 6 of them were also examined summation radionuclide ventriculography. The results of the tests allowed to conclude that myocardial perfusion definitely improved in 18 patients, no change was found in 3 patients and a trend towards deterioration was recorded in 4 patients. The deteriorated or unchanged results of the radionuclide examinations could presumably be attributed to incomplete dilation of significant arterial stenosis, rapidly produced restenosis or extensive anatomical alteration in the coronary circulation. Best results were obtained when complete dilation could be achieved of the left anterior descending coronary artery in patients without any additional coronary artery lesions and myocardial infarction in their history. It was also found that growing experience of the PTCA team greatly improved the success rate of the procedure. (author). 4 figs., 2 tabs., 20 refs

  1. Acute Coronary Syndrome

    ... Privacy Policy What's Your Risk? Heart Attack Risk Assessment Determine your risk of having a heart attack or dying from coronary heart disease and get a report to discuss with your healthcare provider. Determine your risk of having a heart ...

  2. Holmium:YAG laser angioplasty: treatment of acute myocardial infarction

    Topaz, On

    1993-06-01

    We report our clinical experience with a group of 14 patients who presented with acute myocardial infarction. A holmium:YAG laser was applied to the infarct-related artery. This laser emits 250 - 600 mJ per pulse, with a pulse length of 250 microseconds and repetition rate of 5 Hz. Potential benefits of acute thrombolysis by lasers include the absence of systemic lytic state; a shortened thrombus clearing time relative to using thrombolytics; safe removal of the intracoronary thrombus and facilitation of adjunct balloon angioplasty. Potential clinical difficulties include targeting the obstructive clot and plaque, creation of debris and distal emboli and laser-tissue damage. It is conceivable that holmium:YAG laser can be a successful thrombolytic device as its wave length (2.1 microns) coincides with strong water absorption peaks. Since it is common to find an atherosclerotic plaque located under or distal to the thrombotic occlusion, this laser can also be applied for plaque ablation, and the patient presenting with acute myocardial infarction can clearly benefit from the combined function of this laser system.

  3. [Comparison of the results of coronary angioplasty and stenting during one year following surgery].

    Simonenko, V B; Seĭdov, V G; Zakharov, S V; Evsiukov, V V; Liubchuk, I V

    2007-01-01

    The purpose of the study was to compare long-term results of angioplasty and coronary arterial stenting (CAS) depending on the initial degree of coronary arterial (CA) lesion according to morphological stenosis classification, as well as to evaluate the influence of re-stenosis on myocardial contractility dynamics, anginal recurrence rate, and exercise tolerance. The subjects, 228 men after angioplasty and 184 men after CAS with wire stents without drug coating, were included in the study between 1989 and 2005. Coronarography was repeated in 358 patients one year after surgery. The patients were divided into two groups. The first group consisted of 161 patients, to who 180 stents were implanted. The second group consisted of 197patients, in who 226 angioplasty procedures were performed. Data were processed using standard variational statistical methods, i.e. the calculation of mean values and standard deviation. Statistical calculations were carried out using Analysis ToolPak- VBA software of Microsoft Excel 2000. The study found that one year after either intervention the number of patients without anginal symptoms fell significantly compared with this number during the in-hospital period. In group 2 the frequency of restenosis was higher and the number of patients with anginal symptoms was significantly bigger than in group 1; the number of asymptomatic patients was significantly bigger in group 1. Initial morphological characteristics of CA lesion had a significant effect on the long-term frequency of restenosis following endovascular treatment. Restenosis was 2 to 2.5 times more frequent in patients with C type CA lesion vs. patients with A type regardless the method of endovascular intervention. The results of the study demonstrate the importance of taking into account initial morphological characteristics of CA lesion; CAS is more preferable than angioplasty, especially in patients with C type CA lesion. PMID:17520881

  4. Transthoracic coronary flow reserve and dobutamine derived myocardial function: a 6-month evaluation after successful coronary angioplasty

    Pardo Moira

    2004-12-01

    Full Text Available Abstract After percutaneous transluminal coronary angioplasty (PTCA, stress-echocardiography and gated single photon emission computerized tomography (g-SPECT are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR and color Tissue Doppler (C-TD dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm and diastolic (Em and Am, Em/Am ratio peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 ± 0.4 versus 2.87 ± 0.6, p m at high-dose dobutamine (p m of middle septum (r = 0.55, p In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD.

  5. Two cases of radiation-induced skin injury following percutaneous transluminal coronary angioplasty (PTCA)

    Two cases of radiation-induced skin injury following percutaneous transluminal coronary angioplasty (PTCA) are reported. Case 1 is a 52-year-old man who underwent PTCA for 7 times. Case 2 is a 67-year-old man who underwent PTCA for 5 times. In both cases, a cutaneous lesion developed into an ulcer over the right infrascapular region. The ulcer was treated surgically. The histopathological features were compatible with chronic radiation dermatitis. To avoid such injury in interventional procedures with long fluoroscopic time, it is very important for medical staffs to recognize the radiation-induced skin injury and to reduce the patient's absorbed dose as much as possible. (author)

  6. Reducing Radiation Dose in Coronary Angiography and Angioplasty Using Image Noise Reduction Technology.

    Kastrati, Mirlind; Langenbrink, Lukas; Piatkowski, Michal; Michaelsen, Jochen; Reimann, Doris; Hoffmann, Rainer

    2016-08-01

    This study sought to quantitatively evaluate the reduction of radiation dose in coronary angiography and angioplasty with the use of image noise reduction technology in a routine clinical setting. Radiation dose data from consecutive 605 coronary procedures (397 consecutive coronary angiograms and 208 consecutive coronary interventions) performed from October 2014 to April 2015 on a coronary angiography system with noise reduction technology (Allura Clarity IQ) were collected. For comparison, radiation dose data from consecutive 695 coronary procedures (435 coronary angiograms and 260 coronary interventions) performed on a conventional coronary angiography system from October 2013 to April 2014 were evaluated. Patient radiation dosage was evaluated based on the cumulative dose area product. Operators and operator practice did not change between the 2 evaluated periods. Patient characteristics were collected to evaluate similarity of patient groups. Image quality was evaluated on a 5-grade scale in 30 patients of each group. There were no significant differences between the 2 evaluated groups in gender, age, weight, and fluoroscopy time (6.8 ± 6.1 vs 6.9 ± 6.3 minutes, not significant). The dose area product was reduced from 3195 ± 2359 to 983 ± 972 cGycm(2) (65%, p noise reduction technology. Image quality was graded as similar between the evaluated systems (4.0 ± 0.7 vs 4.2 ± 0.6, not significant). In conclusion, a new x-ray technology with image noise reduction algorithm provides a substantial reduction in radiation exposure without the need to prolong the procedure or fluoroscopy time. PMID:27344273

  7. Clinical effects of intracoronary brachytherapy on diffuse in-stent restenosis after coronary angioplasty

    Objective: To investigate the effect of intracoronary brachytherapy using 90Sr/90Yon in-stent restenosis in patients with coronary disease. Methods: Thirty-nine patients (male 29, female 10) with in-stent restenosis after percutaneous coronary intervention (PCI) were studied. The patients were divided randomly into two groups: single-balloon group (21 cases, control group) and brachytherapy group (18 cases, treatment group). All the lesions were treated with balloon angioplasty satisfactorily. After that the patients in treatment group took a brachytherapy using the Beta-Cath system (Novoste). After the operation, there was a 9-months follow-up. Results: Within the follow-up, one case (5.6%) in treatment group was found to be with in-stent restenosis and 8 cases(38.1%) in control group. There was significant difference between the two groups (P= 0.006). Conclusion: The brachytherapy using 90Sr/90Y after balloon angioplasty is safe, effective and feasible for containing diffuse in-stent restenosis in patients. (authors)

  8. Four-Year Follow-Up of TYPHOON (Trial to Assess the Use of the CYPHer Sirolimus-Eluting Coronary Stent in Acute Myocardial Infarction Treated With BallOON Angioplasty)

    Spaulding, Christian; Teiger, Emmanuel; Commeau, Philippe; Varenne, Olivier; Bramucci, Ezio; Slama, Michel; Beatt, Keavin; Tirouvanziam, Ashok; Polonski, Lech; Stella, Pieter R.; Clugston, Richard; Fajadet, Jean; de Boisgelin, Xavier; Bode, Christophe; Carrie, Didier; Erglis, Andrejs; Merkely, Bela; Hosten, Stefan; Cebrian, Ana; Wang, Patrick; Stoll, Hans-Peter; Henry, Patrick

    2011-01-01

    Objectives The aim of this study was to assess the long-term safety and efficacy of the CYPHER (Cordis, Johnson and Johnson, Bridgewater, New Jersey) sirolimus-eluting coronary stent (SES) in percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background

  9. Use of {sup 99m}Tc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

    Leoncini, Mario; Bellandi, Francesco; Maioli, Mauro; Toso, Anna; Dabizzi, Roberto Piero [Misericordia e Dolce Hospital, Division of Cardiology, Prato (Italy); Sciagra, Roberto; Pupi, Alberto [University of Florence, Department of Clinical Physiopathology, Nuclear Medicine Unit, Florence (Italy); Sestini, Stelvio; Coppola, Angela; Mennuti, Alberto [Misericordia e Dolce Hospital, Nuclear Medicine Unit, Prato (Italy)

    2004-10-01

    Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI. In 36 patients, treated with abciximab, primary PCI and stenting, {sup 99m}Tc-sestamibi was injected before PCI and gated SPECT acquired thereafter. Gated SPECT was repeated 7 and 30 days later. Perfusion defect, wall motion score index, left ventricular ejection fraction and volumes were examined. Before PCI, 14 patients (group A) showed TIMI flow 2-3 and 22 (group B) TIMI flow 0-1, but no differences in clinical variables, initial risk area, wall motion score, ejection fraction or volumes. Perfusion defect was smaller in group A at 7 (9%{+-}11% vs 19%{+-}14%, p<0.02) and 30 days (7%{+-}7% vs 16%{+-}12%, p<0.02) and the salvage index was higher at 30 days (77%{+-}22% vs 55%{+-}28%, p<0.02). Wall motion score was lower in group A at 30 days (p<0.05). Ejection fraction significantly improved in both groups at 7 and 30 days. End-diastolic volume showed a trend towards a reduction in group A, whilst it was significantly increased in group B. Conversely, end-systolic volume was significantly decreased in group A but remained unchanged in group B. In the setting of optimal myocardial reperfusion for myocardial infarction, preserved TIMI flow before PCI does not limit the initial risk area but it does improve myocardial salvage and functional recovery. (orig.)

  10. Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

    Ravkilde, J; Nissen, H; Mickley, H;

    1994-01-01

    The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

  11. Gene Therapy for the Prevention of in- Stent Restenosis Post Coronary Angioplasty

    P Ranjzad

    2005-10-01

    Full Text Available Around the world, Coronary Artery Disease (CAD is quickly becoming the most common cause of morbidity and mortality. Percutaneous coronary interventions- angioplasty and stent insertion- have proved effective and reliable treatments for CAD but their long-term efficacy is limited by the high rate of restenosis. This occurs in 30 – 50% of patients undergoing angioplasty and results in symptoms requiring repeat intervention in up to 75% of them. Stent insertion has been shown to reduce this rate but in-stent restenosis still occurs in 20-40% of cases. The high incidence of restenosis represents a large economic burden on health resources. As a consequence of the resistance of restenosis to traditional therapeutic approaches, gene therapy has emerged an attractive potential therapy for this problem. Excessive extracellular matrix (ECM deposition in the neointima is the main mechanism leading to luminal loss after coronary stenting. Transforming growth factor-β (TGF-β is a major regulator of ECM deposition and there is substantial evidence to suggest its role in restenosis. TGF-β1 is the predominant isoform in vascular tissues and its production is observed to be upregulated in human restenotic lesions and in the intima of injured animal vessels. The aim of this study is to develop, investigate and compare the effects of two potentially therapeutic recombinant, replication-deficient adenoviruses, which will give rise to the expression of transgenic proteins which antagonise the fibrogenic effects of TGF-β1 in coronary arteries post stent insertion. The cDNA for these proteins have each been inserted into replication deficient adenovirus vectors under the control of the Major Immediate/Early Murine Cytomegalovirus (MIEmCMV promoter. Virus identity and the presence of transgenes have been confirmed by restriction analysis and Southern blotting respectively. Efficient transgene expression has been confirmed in cultured porcine coronary vascular

  12. Acute stent recoil in the left main coronary artery treated with additional stenting.

    Battikh, Kais; Rihani, Riadh; Lemahieu, Jean Michel

    2003-01-01

    We report a case of acute stent recoil occurring after the stenting of an ostial left main coronary artery lesion. The marked recoil after high-pressure balloon inflation confirmed that the radial force of the first stent was unable to ensure vessel patency. The addition of a second stent provided the necessary support to achieve a good final result. This case illustrates a possible complication of aorto-ostial angioplasty that could be treated with double stenting. PMID:12499528

  13. Changes of the serum level of C-reactive protein after coronary angioplasty

    Objective: To study the changes of C-reactive protein level (CRP) after percutaneous transluminal coronary angioplasty (PTCA) and its relation with clinical outcome after the operation. Methods: Serum levels of CRP in 47 patients with unstable angina pectoris were measured via immunoradiometric assay (IRMA), before and 48 h, 1 week after operation. Incidence of restenosis was observed within a 9 months follow-up and the CRP levels of the patients with restenosis were compared with those of the patients without restenosis, CRP levels before and 48 h after coronary angiography in 25 cases were used as the controls. Results: The mean CRP level at 48 h after PTCA operation was significantly higher than that before operation (P < 0.01), while no differences between those at 1 week before and after PTCA operation and no significant difference between those of before and after coronary angiography operation were observed. Clinical restenosis was confirmed in 13 patients in the followup period and their CRP levels at 48 h after operation were significantly higher than that in the patients without restenosis (P < 0.01). Conclusion: Serum CRP levels at 48 h after PTCA operation were significantly higher than that before operation and it correlated closely with the clinical outcome

  14. Two cases of radiation-induced skin injury following percutaneous transluminal coronary angioplasty (PTCA)

    Matsumoto, Chiho; Ichino, Naoki; Araki, Yoshiko; Mouri, Yuki; Yamatodani, Yoshiko [Minoo City Hospital, Osaka (Japan); Morikawa, Kaoru

    1999-02-01

    Two cases of radiation-induced skin injury following percutaneous transluminal coronary angioplasty (PTCA) are reported. Case 1 is a 52-year-old man who underwent PTCA for 7 times. Case 2 is a 67-year-old man who underwent PTCA for 5 times. In both cases, a cutaneous lesion developed into an ulcer over the right infrascapular region. The ulcer was treated surgically. The histopathological features were compatible with chronic radiation dermatitis. To avoid such injury in interventional procedures with long fluoroscopic time, it is very important for medical staffs to recognize the radiation-induced skin injury and to reduce the patient`s absorbed dose as much as possible. (author)

  15. Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients.

    Tan, K H; Sulke, N.; Taub, N A; Watts, E.; Karani, S.; Sowton, E

    1993-01-01

    OBJECTIVE--To study the determinants of success of coronary angioplasty in patients with chronic total occlusions, and to formulate a multiple logistic regression model to improve selection of patients. DESIGN--A retrospective analysis of clinical and angiographic data on a consecutive series of patients. PATIENTS--312 patients (mean age 55, range 31 to 79 years, 86% men) who underwent coronary angioplasty procedure for a chronic total occlusion between 1981 and 1992. RESULTS--Procedural succ...

  16. Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

    Andreas; Kumar; Rodrigo; Bagur; Patrick; Béliveau; Jean-Michel; Potvin; Pierre; Levesque; Nancy; Fillion; Benoit; Tremblay; éric; Larose; Valérie; Gaudreault

    2014-01-01

    A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause.

  17. Left main coronary stenosis as a late complication of percutaneous angioplasty:an old problem,but still a problem

    Giuseppe Faggian; Gianluca Rigatelli; Francesco Santini; Giuseppe Petrilli; Paolo Cardaioli; Loris Roncon; Alessandro Mazzucco

    2009-01-01

    Objective Accelerated left main coronary stenosis (LMCS) is a known potential late complication of coronary artery catheter procedures. The aim of this study was to assess the current occurrence of LMCS as a delayed complication of percutaneous angioplasty (PTCA) of the left coronary branches in our institution. Methods The medical records of patients referred for coronary artery by-pass surgery from the same Cardiology Unit in the January 2003 to December 2006 period and presenting a significant (> 50%) LMCS as a new finding following a PTCA of the left coronary artery branches, were reviewed. Patients with retrospective evidence of any LMCS at previous coronary angiographies preceding the percutaneous procedure were excluded. Results Thirty-seven patients (5 females, mean age 71.1±8.6 years) out of 944 (4%) having undergone a PTCA, fulfilled the inclusion criteria, 19 (51%) after a procedure also involving the LAD coronary artery. Extraback-up guiding catheters were used in most cases. Use of multiple wires or balloons was observed in 3 cases (8%). Rotablator and proximal occlusion device were used in one case respectively (3%). Twenty patients (54%) have had more than one percutaneous coronary intervention on the left coronary branches. The mean time elapsed from the first angioplasty and surgical intervention was 18.1±7.8 months. Conclusions The potential occurrence of LMCS following a percutaneous intervention procedure, especially when complicated and repeated, should not be underestimated in the current era. This evidence may offer the rationale to schedule non-invasive imaging tests to monitor left main coronary patency after the procedure as well as to fuel further research to develop less traumatic materials.

  18. The use of abciximab associated with primary angioplasty for treating acute myocardial infarction

    Manuel Lisandro Hernández Brito; Newton F. Stadler de Souza Filho; Álvaro Vieira Moura; Luiz Augusto Lavalle; Rubens Zenobio Darwich; Marisa Leal; Eva Cantalejo Munhoz

    2002-01-01

    OBJECTIVE: To assess the benefit resulting from the use of abciximab associated with primary angioplasty. The following parameters were analyzed in-hospital, at 30 days, and 6 months: (a) flow in the culprit artery; (b) ventricular function; (c) combined outcome of death, acute myocardial infarction, and aditional revascularization. METHODS: From November 1997 to June 1999, a longitudinal nonrandomized study with historical data of 137 patients with acute myocardial infarction within the firs...

  19. Assessment of left ventricular performance during percutaneous transluminal coronary angioplasty: a study by intravenous digital subtraction ventriculography.

    Norell, M. S.; Lyons, J. P.; Gershlick, A H; Gardener, J E; Rothman, M. T.; Layton, C A; Balcon, R

    1988-01-01

    Left ventricular performance during percutaneous transluminal coronary angioplasty was assessed in 52 patients by intravenous digital subtraction ventriculography. After injection of contrast into the right atrium ventriculograms were obtained before and during balloon inflation. In 37 patients they were also obtained after the procedure. A 12 lead electrocardiogram was monitored throughout. During balloon inflation the left ventricular ejection fraction fell (from 73% to 57%) in all but one ...

  20. Myocardial perfusion assessed by dynamic computed tomography before and after percutaneous transluminal coronary angioplasty

    Mori, Takao; Takeuchi, Motoshi; Igarashi, Yuichiro and others

    1987-12-01

    A method for quantitatively and visually assessing myocardial perfusion using a new transmission computed tomography scanner and contrast media injection was devised. Myocardial perfusion was assessed before and after percutaneous transluminal coronary angioplasty (PTCA). Six patients with left anterior descending coronary artery stenosis undergoing PTCA were successfully studied. Cardiac outputs calculated from the ventricular curves of the ROIs in the left ventricular cavity correlated well with the thermodilution measurements using Swan-Ganz catheters (r = 0.90, p < 0.01). The ratios of myocardial blood flow (F) to the tissue element volume (V) were calculated (F/V) from the myocardial curves of the ROIs in the myocardium as parameters of myocardial perfusion, according to the Zierler's principle. The F/Vs in the myocardium perfused by the left anterior descending coronary artery before PTCA were significantly less than those of the control subjects (4.4 x 10/sup -2/ +- 1.2 x 10/sup -2/ vs 8.1 x 10/sup -2/ +- 2.9 x 10/sup -2/: p < 0.05). After PTCA, the F/Vs improved significantly (7.7 x 10/sup -2/ +- 2.0 x 10/sup -2/), but even after PTCA, the F/Vs in three patients with old myocardial infarction were lower than those of three without myocardial infarction (9.1 x 10/sup -2/ +- 1.3 x 10/sup -2/ vs 6.4 x 10/sup -2/ +- 1.6 x 10/sup -2/), suggesting that myocardial infarction may have a decreased vascular bed. For visual assessment, functional images were synthesized by deriving a functional parameter for blood flow (PH/M1E) from the gammavariate fitted time density curves for each pixel. In all patients, before PTCA, decreased myocardial perfusion was imaged as dark pixels. After PTCA, myocardial perfusion improved in all patients, but decreased perfusion was still observed in some. (J.P.N.).

  1. Detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise thallium scintigraphy

    The usefulness of serial exercise thallium scintigraphy (ETS) in the detection of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) was evaluated. The study was undertaken on 73 patients (45 without significant residual coronary stenosis; 28 with partial anatomic correction) who received coronary angiography (CAG) after over 6 month period following successful PTCA or after a recurrence of angina pectoris. ETS was performed serially before, soon after, at 3 months, and at 6 months after PTCA in order to determine the presence of chest pain (CP) and significant ST-segment depression (ST) during exercise, and of reversible defect (RD) in thallium images. Redistribution of 10 % or above on delayed images were considered as positive reversible defects. Restenosis was defined as an increase of the diameter stenosis of the dilated lesion above the 75 % level. Rate of restenosis was 29 % for patients followed for over 6 months with recurrences of angina early at 2.4 ± 1.9 months (mean ± SD). As to the positive ETS cases, 77 % were detected within the first 3 months, and 92 % whithin the 6 months. In the detection of restenosis, figures for RD sensitivity and specificity were 96 % and 88 % respectively, which were superior to those figures for CP (59 %, 85 %) and ST (74 %, 82 %). ETS was particularly useful in the identification of the restenotic vessel as well as in the detection of restenosis in patients with multi-vessel disease or partial anatomic correction, and thus has proven to be of extreme value in follow-up after PTCA. (author)

  2. Pathophysiology of coronary artery disease leading to acute coronary syndromes

    Ambrose, John A; Singh, Manmeet

    2015-01-01

    Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are among the most serious and catastrophic of acute cardiac disorders, accounting for hundreds of thousands of deaths each year worldwide. Although the incidence of AMI has been decreasing in the US according to the American Heart Association, heart disease is still the leading cause of mortality in adults. In most cases of AMI and in a majority of cases of SCD, the underlying pathology is acute intraluminal coronary thrombus f...

  3. [Clinical pathway "Acute Coronary Syndrome"].

    Grimm, W; Maisch, B

    2006-07-01

    The clinical pathway "acute coronary syndrome" of the university hospital Marburg describes the guideline-conform and consented management of patients with ST-segment elevation infarct (STEMI), non-ST-segment elevation infarct (NSTEMI) and Troponin negative unstable angina. A 12-lead ECG recording is made and read in all patients within 10 minutes. All patients with STEMI undergo immediate revascularisation using primary percutanuous catheter intervention (PCI) after administration of basic medical therapy. Primary PCI is also used in all patients with NSTEMI, persistent chest pain, rhythm or hemodynamic instability. Patients with unstable angina, who became free of symptoms after application of basic medication, but who have additional risk factors undergo cardiac catheterisation within 48 hours. Acute myocardial infarction can be ruled out in patients with twofold negative cardiac troponin levels during 6-12 hours. In the absence of further symptoms, these patiens undergo differential diagnostic evaluation of cardiac and extracardiac causes of chest pain. The introduction of this clinical pathway 2 years ago, which was consented before by the hospital board and the clinical directors, has lead to a remarkable improvement in the clinical decision-making at the emergency room of the hospital and reduced the door to intervention time considerably. PMID:16763796

  4. Revascularization Strategies in Patients with Diabetes Mellitus and Acute Coronary Syndrome.

    Buntaine, Adam J; Shah, Binita; Lorin, Jeffrey D; Sedlis, Steven P

    2016-08-01

    Patients with diabetes mellitus (DM) have more severe CAD and higher mortality in acute coronary syndrome (ACS) than patients without DM. The optimal mode of revascularization-coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)-remains controversial in this setting. For patients with DM and ST-segment elevation myocardial infarction, prompt revascularization of the culprit artery via PCI is generally preferable. In non-ST-elevation ACS, the decision on mode of revascularization is more challenging. Trials comparing CABG with percutaneous transluminal coronary angioplasty, bare metal stents, and first-generation drug-eluting stents in DM patients with multivessel have demonstrated decreased mortality in those receiving CABG. On the other hand, trials and retrospective analyses comparing CABG to PCI with second-generation drug-eluting stents have not shown a statistically significant mortality benefit favoring CABG. This potentially narrowed that gap between CABG and PCI requires further investigation. PMID:27339854

  5. High Prevalence of Risk Factors in Patients after PTCA (Percutaneous Transluminal Coronary Angioplasty) with Coronary Stents

    Indráková, V.; Sedlak, Petr; Adášková, Jana; Mazura, Ivan; Tomečková, Marie; Zvárová, Jana

    Prague: Czech Anthropological Society, 2009. ISBN 978-80-254-4746-8. [International Anthropological Congress of Aleš Hrdlička /5./. 02.09.2009-05.09.2009, Prague - Humpolec] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : cardiology * coronary stents * risk factors Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  6. Dual anterior descending coronary artery associated with coronary artery disease

    Siqueira Luciane da L. V.

    2003-01-01

    Full Text Available The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

  7. The early percutaneous coronary intervention in elderly patients with acute coronary syndrome

    Xiong HUANG; Xuebin CAO; Gang ZHANG

    2008-01-01

    It is challenging to undo early percutaneous intervention (PCI) in the elderly with acute coronary syndrome (ACS). Fifteen patients older than 65 years with ACS within 24 hours of the event were admitted from April 4, 2004 to December 12, 2005. All the patients had early percutaneous coronary intervention and were followed up for 6-12 months by telephone or in the out-patient department. Nine of the 15 patients exhibited acute myocardial infarction (AMI). Six exhib-ited unstable angina (UA). All the patients had early PCI. The average door-to-balloon time was 78 minutes (40-110 minutes). The average PCI time was 99 minutes (68-120 minutes). Nineteen of 36 lesions in the fifteen angioplasty patients were treated and 20 stents were implanted in total. All the procedures were considered successful. Neither deaths nor recurrent angina occurred in the 6-12 months of follow-up. It was shown that early PCI might be an effective and safe method to treat eld-erly patients with ACS.

  8. Nicorandil in patients with acute coronary syndrome and stable angina undergoing Percutaneous Coronary Intervention: literature review

    Neda Partovi; Homa Falsoleiman

    2014-01-01

    Percutaneous coronary intervention is an option for the treatment of coronary artery disease such as acute coronary syndrome and stable angina.Acute coronary syndrome has two groups including acute myocardial infarction and unstable angina.Periprocedural myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention and can be easily monitored by measuring myocardial enzymes. Coronary microvascular dysfunction in patients undergoing primary...

  9. Acute coronary syndrome with unusual form of right coronary artery aneurysm and treated with overlapping two covered stents across coronary aneurysm: case report

    Naresh Sen

    2016-04-01

    Full Text Available A 27-year old male presented with acute inferior wall myocardial infarction. Coronary angiogram revealed normal left coronary arteries and a giant coronary aneurysm in Right coronary artery (RCA. Primary angioplasty of RCA was performed. Large thrombus burden was retrieved with aspiration device and coronary flow restored. However, despite best efforts some thrombus remained and decision to stent was deferred to a later date. Dimensions of aneurysm on quantitative coronary angiogram were 16 mm in width and 43 mm in length. Two weeks later coronary angiogram revealed normal flow in RCA without any angiographically visible thrombus. PCI was performed with two 3.0 and times; 28 mm covered stents, graft master (JoStent deployed across the aneurysm, overlapping each other. This completely sealed the aneurysm and intravascular ultrasound confirmed no leakage through the covered stents. Patient remains asymptomatic 2 months post procedure on triple antiplatelet therapy. [Int J Res Med Sci 2016; 4(4.000: 1295-1297

  10. Optimization and audit of radiation dose during percutaneous transluminal coronary angioplasty

    Livingstone Roshan

    2007-01-01

    Full Text Available The percutaneous transluminal coronary angioplasty (PTCA is one of the interventional procedures which impart high radiation doses to patients compared to the other cardiologic procedures. This study intends to audit and optimize radiation dose imparted to patients undergoing PTCA. Forty-four patients who underwent PTCA involving single or multiple stent placement guided under cardiovascular X-ray machine were included in the study. Radiation doses were measured using dose area product (DAP meter for patients undergoing single and multiple stent placements during PTCA. A dose reduction of 27-47% was achieved using copper filters and optimal exposure parameters. The mean DAP values before optimization were 66.16 and 122.68 Gy cm 2 for single and multiple stent placement respectively. These values were 48.67 and 65.44 Gy cm 2 respectively after optimization. In the present scenario, due to the increase in the number of PTCAs performed and the associated risk from radiation, periodical audit of radiation doses for interventional procedures are recommended.

  11. Thrombotic occlusion of the ostial left main coronary artery in a patient with acute coronary syndrome

    Tatli, E.

    2009-01-01

    Ostial left main coronary artery (LMCA) occlusion is rarely seen in patients with acute coronary syndrome. Acute coronary syndrome resulting from an LMCA occlusion is associated with a significant morbidity and mortality rate, if it is managed with fibrinolysis. Electrocardiography can predict LMCA occlusion in patients with acute coronary syndrome. We report a 52-year-old male who presented with acute coronary syndrome and ostial LMCA occlusion. (Neth Heart J 2009;17:295-6.19789699)

  12. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    Nogueira, Raul G. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States); Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J. [Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States)

    2008-04-15

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score {<=}2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66{+-}17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17{+-}3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9{+-}3.9 h (anterior circulation) and 11.0{+-}7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and

  13. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients: Results with Use of a High Sensitivity Polymerase Chain Reaction Assay

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik; Holmstrup, Palle; Helqvist, Steffen; Tolker-Nielsen, Tim; Givskov, Michael; Hansen, Peter Riis

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction and purification steps, and demonstration of sensitivity levels of 25–125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence of bacteria in the arteries is a transient phenomenon. PMID:26695491

  14. High plasma coenzyme Q10 concentration is correlated with good left ventricular performance after primary angioplasty in patients with acute myocardial infarction

    Huang, Ching-Hui; Kuo, Chen-Ling; Huang, Ching-Shan; Tseng, Wan-Min; Lian, Ie Bin; Chang, Chia-Chu; Liu, Chin-San

    2016-01-01

    Abstract Exogenous administration of coenzyme Q10 (CoQ10) has been shown in experimental models to have a protective effect against ischemia–reperfusion injury. However, it is unclear whether follow-up plasma CoQ10 concentration is prognostic of left ventricular (LV) performance after primary balloon angioplasty in patients with acute ST segment elevation myocardial infarction (STEMI). We prospectively recruited 55 patients with STEMI who were treated with primary coronary balloon angioplasty. Plasma CoQ10 concentrations were measured before primary angioplasty (baseline) and 3 days, 7 days, and 1 month after STEMI using high-performance liquid chromatography. Echocardiography was performed at baseline and at 6-month follow-up. The control group comprised 54 healthy age- and sex-matched volunteers. Serial circulating CoQ10 concentrations significantly decreased with time in the STEMI group. The LV ejection fraction at 6-month follow-up positively correlated with the 1-month plasma CoQ10 tertile. Higher plasma CoQ10 concentrations at 1 month were associated with favorable LV remodeling and systolic function 6 months after STEMI. Multiple linear regression analysis showed that changes in CoQ10 concentrations at 1-month follow-up were predictive of LV systolic function 6 months after STEMI. Changes in CoQ10 concentrations correlated negatively with baseline oxidized low-density lipoprotein and fibrinogen concentrations and correlated positively with leukocyte mitochondrial copy number at baseline. Patients with STEMI who had higher plasma CoQ10 concentrations 1 month after primary angioplasty had better LV performance at 6-month follow-up. In addition, higher plasma CoQ10 concentration was associated with lower grade inflammatory and oxidative stress status. Therefore, plasma CoQ10 concentration may serve as a novel prognostic biomarker of LV systolic function after revascularization therapy for acute myocardial infarction. PMID:27495100

  15. Acute Coronary Syndrome and ST Segment Monitoring.

    Carey, Mary G

    2016-09-01

    Acute coronary syndrome (ACS) is caused by a critical obstruction of a coronary artery because of atherosclerotic coronary artery disease. Three specific conditions are included: ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. The ST segment on the electrocardiogram is a sensitive and specific marker of myocardial ischemia and infarction; however, ST segment deviation is regional not global, thus the ECG lead must be placed over the affected region of the myocardium. This article describes ACS and infarction and the use of ST segment monitoring to detect these conditions. PMID:27484662

  16. The use of abciximab associated with primary angioplasty for treating acute myocardial infarction

    Brito Manuel Lisandro Hernández

    2002-01-01

    Full Text Available OBJECTIVE: To assess the benefit resulting from the use of abciximab associated with primary angioplasty. The following parameters were analyzed in-hospital, at 30 days, and 6 months: (a flow in the culprit artery; (b ventricular function; (c combined outcome of death, acute myocardial infarction, and aditional revascularization. METHODS: From November 1997 to June 1999, a longitudinal nonrandomized study with historical data of 137 patients with acute myocardial infarction within the first 12 hours. Patients undergoing primary angioplasty and were divided into 2 groups: those receiving (A abciximab (26 or (B conventional therapy (111. TIMI flow and regional ventricular function estimated by the standard deviation (SD/chordis index were analyzed. RESULTS: At the end of angioplasty, TIMI 3 flow was observed in 76.9% and 83.8% of the patients in groups A and B, respectively (P=0.58. In the reevaluation, patients with TIMI flow <3 showed a 100% improvement in group A and a 33% in group B (P<0.0001. A significant improvement (P<0.0001 in regional ventricular function, by SD/chordis index, occurred in each group; no significant difference between groups however, was observed (29.9% x 20.2%; P=0.58. A nonsignificant reduction in the combined outcome in the in-hospital phase (3.85% A x 9.0% B; P=0.34 and on the 30th day (4.0% x 12.0%; P=0.22 was observed in group A. CONCLUSION: Abciximab improved blood flow. Primary angioplasty improved regional ventricular function independent of antithrombotic therapy. Abciximab showed a trend toward reducing the combined outcome in the in-hospital phase and on the 30th day.

  17. Monitoring the effect of heparin by measurement of activated clotting time during and after percutaneous transluminal coronary angioplasty.

    Rath, B.; Bennett, D. H.

    1990-01-01

    The anticoagulant effect of heparin during percutaneous transluminal coronary angioplasty was monitored by measurements of the activated clotting time in two studies that compared the effects of a single bolus of heparin with those of a bolus of heparin combined with a continuous infusion of the drug. In a preliminary study 40 patients received a single heparin bolus of 10,000 units (protocol I) and a further 40 patients received both a heparin bolus of 10,000 and a continuous infusion of hep...

  18. Inflammation: a trigger for acute coronary syndrome.

    Sager, Hendrik B; Nahrendorf, Matthias

    2016-09-01

    Atherosclerosis is a chronic inflammatory disease of the vessel wall and a major cause of death worldwide. One of atherosclerosis' most dreadful complications are acute coronary syndromes that comprise ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina. We now understand that inflammation substantially contributes to the initiation, progression, and destabilization of atherosclerosis. In this review, we will focus on the role of inflammatory leukocytes, which are the cellular protagonists of vascular inflammation, in triggering disease progression and, ultimately, the destabilization that causes acute coronary syndromes. PMID:27273431

  19. REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

    A. L. Alyavi

    2016-01-01

    Full Text Available Aim. To compare effect of percutaneous balloon angioplasty (PCA and a systemic thrombolysis (STL on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group. 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF and maximal output speed of left ventricle (LV. Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

  20. Captopril for prevention of Contrast Induced Nephropathy in patients undergoing Coronary Angioplasty: A double blind placebo controlled clinical trial

    M Hashemi

    2005-09-01

    Full Text Available Background: Contrast induced nephropathy is a potential cause of mortality and morbidity in patients undergoing angiography–angioplasty. Except for hydrating and probably low – isoosmolar contrast agents in high risk groups, other modalities have not provided benefit. We investigated preventive effects of captopril for contrast induced nephropathy during angiography–angioplasty. Methods: In a double blind placebo controlled clinical trial, 88 patients were randomized to two groups: 42 patients received captopril (12.5 mg every 8 hours from 2 hours before the procedure until 48 hours thereafter, and 46 patients received placebo in the same manner. Serum creatinine was measured before and 48 hours after angioplasty. The data were analyzed by SPSS software, using unpaired student t-test for comparing mean creatinine rise in both groups and paired student t-test for the changes in serum creatinine in each group. Results: The mean creatinine rise in captopril group (0.214 mg/dl and placebo group (0.226 mg/dl were not significantly different. The incidence of acute renal failure (creatinine rise more than 0.5 mg/dl in the captopril (11.9 % and placebo group (10.8 % were not significantly different. Conclusion: Captopril does not effectively prevent contrast nephropathy, but it is not harmful for renal function and can be administered safely during angiography – angioplasty in patients with normal renal function. However, the effect of captopril in patients with high- risk characteristics remains to be clarified. Of note, we found a trend for less creatinine rise in diabetics who received captopril during the procedure in comparison to diabetics who received placebo. Keywords: Angiography, Angioplasty, Contrast induced Nephropathy, Captopril, Angiotension Converting Enzyme Inhibitor, Creatinine

  1. Letter regarding article "Primary coronary angioplasty for ST-°©‐Elevation Myocardial Infarction in Qatar: First nationwide program"

    Mohamed Badreldin Elshazly

    2012-03-01

    Full Text Available Dear Editor: In their article “Primary Coronary Angioplasty for ST-Elevation Myocardial Infarction (STEMI in Qatar: First Nationwide Program”, Gehani et al. developed an impressive plan to implement primary percutaneous coronary intervention (PCI for the first time in Qatar [1]. As a graduate of Weill Cornell Medical College in Qatar, I have witnessed immense improvement in the Qatari healthcare system over the past few years. From building the new state of the art Heart Hospital to developing the first unified nationwide primary PCI program in the world, there is no doubt that Qatar has made an immense leap towards implementing world-class cardiovascular healthcare in the Middle East.

  2. Evidence of a cellular protective effect by antecedent angina independent of collateral flow recruitment during coronary angioplasty in humans

    The main aim of this study was to elucidate whether the beneficial effect of antecedent angina is a cellular protective effect or the result of an increase of collateral flow. Of 42 patients with angina who underwent percutaneous transluminal coronary angioplasty (PTCA) for proximal left anterior descending artery (LAD) stenosis, 22 had experienced antecedent anginal pain (AP) within 7 days prior to PTCA. 99mTc-sestamibi was injected during balloon inflation, and quantitative analysis of ischemic severity during coronary occlusion was calculated (SS). An electrocardiogram was recorded during ballooning to calculate the sum of ST elevation (ΣST). ΣST was significantly reduced in patients with AP compared with patients without AP (1.88±0.89 mV vs 1.18±0.74 mV, p=0.0088); however, no difference was observed in defect severity. A close correlation was observed between SS and ΣST in both groups. The multivariate regression model demonstrated that both a large SS (p<0.0001) and the absence of preceding AP (p=0.001) were significantly related to the elevation of ΣST. Recent angina can render the myocardium more resistant to subsequent ischemia during angioplasty and is true preconditioning rather than simply an increase of flow. (author)

  3. Acute Coronary Syndrome- Conservative vs Invasive Treatment

    LIM; Yean Teng

    2001-01-01

    @@atients with Acute Coronary Syndrome (ACS)are a clinical continuum-with patients presenting with unstable angina on one end, with patients with ST elevation myocardial infarction (STEMI) at the other end of the spectrum. In between are those with non- ST elevation myocardial infarction (NSTEMI) The pathophysiology is similar in these patients, namely isruption and fissuring of an atheromatous plaque,leading to enhanced platelet activation and local vasohyperactivity, with reduced flow and thrombus formation. While medical experts have reached consensus in the management of STEMI patients (thrombolysis nd / or percutaneous coronary intervention), optimalmanagement of patients with UA/NSTEMI remainsunclear.

  4. Rivaroxaban in patients with a recent acute coronary syndrome

    Mega, Jessica L; Braunwald, Eugene; Wiviott, Stephen D; Bassand, Jean-Pierre; Bhatt, Deepak L; Bode, Christoph; Burton, Paul; Cohen, Marc; Cook-Bruns, Nancy; Fox, Keith A A; Goto, Shinya; Murphy, Sabina A; Plotnikov, Alexei N; Schneider, David; Sun, Xiang; Verheugt, Freek W A; Gibson, C Michael; Grande, Peer

    2012-01-01

    Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome....

  5. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66±17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb

  6. Acute organophosphorus poisoning complicated by acute coronary syndrome.

    Pankaj, Madhu; Krishna, Kavita

    2014-07-01

    We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal. PMID:25672037

  7. Contemporary management of acute coronary syndrome

    Large, G

    2005-01-01

    This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the predicted level of risk. Patients at high risk should also receive a glycoprotein IIb/IIIa receptor inhibitor and should undergo early coronary arteriography with a view to percutaneous or surgical revascularisation. Lower risk patients should undergo non-invasive testing. When inducible myocardial ischaemia is exhibited coronary arteriography should follow. When non-invasive testing is negative, a conservative management strategy is safe. PMID:15811883

  8. Twenty-year evolution of Percutaneous coronary intervention and its impact on clinical outcomes a report from the NHLBI-sponsored, multicenter 1985–86 Percutaneous transluminal coronary angioplasty and 1997–2006 Dynamic Registries

    Venkitachalam, Lakshmi; Kip, Kevin E; Selzer, Faith; Wilensky, Robert L; Slater, James; Mulukutla, Suresh R; Marroquin, Oscar C; Block, Peter C; Williams, David O; Kelsey, Sheryl F

    2009-01-01

    Background Percutaneous coronary intervention has undergone rapid progress both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking. Methods and Results We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter NHLBI-sponsored 1985–86 Percutaneous coronary transluminal coronary angioplasty (PTCA) and 1997–2006 Dynamic Registries waves [wave 1: 1997–98, bare metal stents; wave 2: 1999, uniform use of stents; wave 3: 2001–02, brachytherapy; waves 4 and 5: 2004–2006, drug-eluting stents]. Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9, wave 1: 2.7, wave 2: 2.8, wave 3: 1.9, wave 4: 2.6, wave 5: 2, Ptrend:<0.001) and emergency CABG (PTCA Registry: 3.7, wave 1: 0.4, wave 2: 0.4, wave 3: 0.3, wave 4:0.4, wave 5: 0, Ptrend:<0.001). Compared to the PTCA Registry, risk for repeat revascularization (31–365 days following index PCI) was significantly lower in the Dynamic waves (adjusted hazard ratio, wave 1: 0.72, wave 2: 0.51, wave 3: 0.51, wave 4: 0.30, wave 5: 0.36; P< 0.05 for all). Conclusion Percutaneous interventions, in the last two decades, has evolved to include more urgent, comorbid cases, yet achieving high success rates with significantly reduced need for repeat revascularization. PMID:20031687

  9. Contemporary management of acute coronary syndrome

    Large, G

    2005-01-01

    This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the pre...

  10. The Acute Coronary Syndrome in elderly patients

    Kalliopi Vougiouka; Theodore Kapadohos

    2015-01-01

    The Acute Coronary Syndrome (ACS) is one of the most common and also life-threatening diseases. Elderly patients due to comorbidity and changes in anatomy and physiology of the body, present some differentiation in the clinical presentation of the disease and common symptoms. Aim: The purpose of this study was to review the literature about the specific characteristics that elderly people with ACS present. Method: A review of international and Greek bibliography of the last fifteen years was ...

  11. Acute coronary syndrome in pregnant women.

    El-Deeb, Mohammed; El-Menyar, Ayman; Gehani, Abdulrazzak; Sulaiman, Kadhim

    2011-04-01

    The purpose of this article is to review the available information on the pathophysiology, diagnosis, treatment and prognosis of acute coronary syndromes (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) during all stages of pregnancy. We searched the English-language literature indexed in MEDLINE, Scopus and EBSCO host research databases from 1980 through to August 2010 using the indexing terms 'pregnancy', 'ante-,peri-, and postpartum', 'acute coronary syndrome', 'myocardial infarction', 'STEMI' and 'NSTEMI'. Symptomatic coronary artery disease is still infrequent in women of childbearing age, but the recent increase in its prevalence in pregnancy has been attributed to the modern trend of childbearing in older years because many young working women are postponing having children. Although rare, acute pregnancy-related MI is a devastating event that may claim the life of a mother and her fetus. The incidence of MI is estimated at 0.6-1 per 10,000 pregnancies. The case fatality rate has been reported to be 5-37%. Owing to the rarity of the event, information related to MI in pregnancy is derived from case reports and, therefore, is subject to considerable reporting bias. Treatment needs to be prompt and urgent because of the very high mortality rate. Current guidelines for the diagnosis and treatment of MI should be expanded to include pregnancy-related MI. Screening and management of cardiovascular risk factors should be achieved before pregnancy. PMID:21517733

  12. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita; Tantry, Udaya; Jeong, Young-Hoon; Kozinski, Marek; Engstrøm, Thomas; Di Pasquale, Giuseppe; Kochman, Waclaw; Ardissino, Diego; Kedhi, Elvin; Stone, Gregg W; Kubica, Jacek

    2013-01-01

    The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

  13. Coronary angiographies of patients with recurrent acute coronary syndrome following coronary artery bypass grafting

    JIA Yu-he; YANG Yue-jin; WEI Yi-zhen; YAO Min; HU Sheng-shou

    2005-01-01

    @@ Coronary artery bypass grafting (CABG) is considered as a more complete means of revascularization than percutaneous coronary intervention (PCI). However, acute coronary syndrome (ACS) can still occur after CABG. The culprit vessel can be the graft vessel or the native vessel. Many questions remain unanswered in the Chinese literature regarding this topic: what are the short- and long-term pathological changes that induce ACS? Is there any difference between arterial and venous grafts with respect to the frequency of restenosis? Are there any patterns of ACS-related vessels in different periods after CABG? We aim to answer these fundamental questions by analyzing coronary angiographies of patients with recurrent ACS following CABG and provide evidence for reducing post-CABG restenosis.

  14. Dual pathway therapy in acute coronary syndrome.

    Stachon, Peter; Ahrens, Ingo; Bode, Christoph; Zirlik, Andreas

    2016-08-01

    In 10 % of patients, who suffer an acute coronary syndrome (ACS), a major cardiovascular event occurs despite optimal therapy. The occlusion of the vessel is driven by atherothrombosis, which arises from platelet activation and activation of the coagulation cascade. In the last decade the secondary prevention continuously improved by development of dual anti-platelet therapy with new P2Y12-inhibitors such as clopidogrel, prasugrel, and ticagrelor. Until recently, the coagulation cascade was not targeted in secondary prevention. The coagulation factor Xa plays a crucial role in thrombosis and is elevated in patients after acute coronary syndrome, therefore representing an attractive target for novel therapies in ACS. Former studies with vitamin K antagonists showed reduction of cardiovascular events but increased major bleedings. Two phase-3 trials investigated the role of novel oral anticoagulant agents on top of aspirin and clopidogrel in patients with ACS. The APPRAISE-2 study, which tested the oral factor Xa inhibitor apixaban was prematurely terminated because of an increase of major bleedings in the absence of an effect on cardiovascular events. In contrast, the ATLAS ACS2 TIMI-51 trial interrogating the oral factor Xa inhibitor rivaroxaban in a low dose regimen showed significant reduction of cardiovascular events as well as total mortality. Thus, add-on treatment with low dose rivaroxaban emerged as a new option for patients with ACS. This review illustrates recent advances in the development of antithrombotic therapy in acute coronary syndromes, provides guidance on which patients should receive which therapy for secondary prevention of events, and points out potentially fruitful new strategies for the future of antithrombotic treatment in ACS. PMID:26660521

  15. Ecstasy-induced acute coronary syndrome: something to rave about.

    Hoggett, Kerry; McCoubrie, David; Fatovich, Daniel M

    2012-06-01

    Ecstasy or 3,4-methylenedioxymethamphetamine is a commonly used illicit recreational drug, enjoying popularity for its stimulant effects. Although acute coronary syndrome is recognized after cocaine and methamphetamine use, association with Ecstasy use has rarely been reported. We report three cases of significantly delayed acute coronary syndrome and ST elevation myocardial infarction related to ingestion of Ecstasy. PMID:22672176

  16. The role of inflammatory stress in acute coronary syndrome

    沈成兴; 陈灏珠; 葛均波

    2004-01-01

    Objective To summarize current understanding of the roles of anti-inflammatory and proinflammatory mechanisms in the development of atherosclerosis and acute coronary syndrome and to postulate the novel concept of inflammation stress as the most important factor triggering acute coronary syndrome. Moreover, markers of inflammation stress and ways to block involved pathways are elucidated.Data sources A literature search (MEDLINE 1997 to 2002) was performed using the key words "inflammation and cardiovascular disease". Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and review articles on inflammation and acute coronary syndrome were selected.Data extraction Data and conclusions from the selected articles providing solid evidence to elucidate the mechanisms of inflammation and acute coronary syndrome were extracted and interpreted in the light of our own clinical and basic research.Data synthesis Inflammation is closely linked to atherosclerosis and acute coronary syndrome. Chronic and long-lasting inflammation stress, present both systemically or in the vascular walls, can trigger acute coronary syndrome.Conclusions Inflammation stress plays an important role in the process of acute coronary syndrome. Drugs which can modulate the balance of pro- and anti-inflammatory processes and attenuate inflammation stress, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin Ⅱ receptor blockers, statins, and cytokine antagonists may play active roles in the prevention and treatment of acute coronary syndrome when used in addition to conventional therapies (glycoprotein Ⅱb/Ⅲa receptor antagonists, mechanical intervention strategies, etc).

  17. Assessment of myocardial perfusion abnormality and hibernating myocardium by gated blood pool and exercise-stress thallium tomographies after successful coronary angioplasty

    Cardiac function and myocardial perfusion were assessed by exercise-stress thallium SPECT and resting gated blood pool SPECT techniques before and after 47 successful coronary angioplasties. Thallium perfusion was analyzed visually and quantitatively in stress and resting studies. Left ventricular ejection fraction (LVEF) and peak filling rate (PFR) were calculated and regional wall motion was scored by amplitude and phase images in radionuclide planar and tomographic imagings. The thallium redistribution in delayed or resting SPECTs was more sensitive (87%) for detecting myocardial ischemia compared to symptoms (36%) and ECG changes (60%). An exercise capacity, LVEF, PFR, and the scores of perfusion and regional wall motion were improved significantly after coronary angioplasty. Stress thallium and gated blood pool SPECTs showed the improvements of myocardial perfusion in 159 (79%) of 201 segments and regional wall motion in 47 (51%) of 92 segments, respectively. These results suggest that the combined use of stress thallium SPECT, gated blood pool planar and SPECT techniques can contribute not only to the assessment of the efficacy of coronary angioplasty but also to detecting the mismatching of myocardial perfusion and contraction ('myocardial hibernation') in infarct-related myocardial lesions. (author)

  18. Systemic blood coagulation activation in acute coronary syndromes

    Undas, Anetta; Szułdrzyński, Konstanty; Brummel-Ziedins, Kathleen E.; Tracz, Wiesława; Zmudka, Krzysztof; Mann, Kenneth G.

    2009-01-01

    We evaluated systemic alterations to the blood coagulation system that occur during a coronary thrombotic event. Peripheral blood coagulation in patients with acute coronary thrombosis was compared with that in people with stable coronary artery disease (CAD). Blood coagulation and platelet activation at the microvascular injury site were assessed using immunochemistry in 28 non-anticoagulated patients with acute myocardial infarction (AMI) versus 28 stable CAD patients matched for age, sex, ...

  19. Virtual histology assessment of coronary atheroma influences treatment strategy in the young acute coronary syndrome patient

    Ormerod, Julian; Johnston, Tom; Ramcharitar, Steve

    2014-01-01

    A 43-year-old woman having significant risk factors for ischaemic heart disease was admitted with an acute coronary syndrome (ACS). Coronary angiography revealed a non-flow limiting lesion in her right coronary artery with the rest of her arteries unremarkable. Risk stratification of the culprit lesion in the right coronary artery through intravascular ultrasound virtual histology demonstrated that the rupture plaque had less than 5% necrotic core with low vulnerability indices. This importan...

  20. Percutaneous coronary intervention therapy improved prognosis of high-risk patients with acute coronary syndromes

    JI Qiu-shang; ZHANG Yun; LI Gui-shuang; CHEN Yu-guo; MA Dong-dong; YANG Xiao-jing; ZHU Yuan-yuan

    2003-01-01

    @@ Objective In this study, we evaluated the effects of pereutaneous coronary intervention (PCI) therapy on prognosis of high-risk patients with acute coronary syndromes(ACS). Methods From September, 2001 to July, 2002 we continuously observed 110 eases of ACS patients, including 70 cases of acute myocardial infarction (AMI)and 40 cases of anstable angin apeetoris(UAP).

  1. Prognostic role of Helicobacter pylori infection in acute coronary syndrome: a prospective cohort study.

    Eskandarian, R; Ghorbani, R; Shiyasi, M; Momeni, B; Hajifathalian, K; Madani, M

    2012-04-01

    In a prospective cohort study, we evaluated the effect of Helicobacter pylori seropositivity on the risk of future adverse cardiovascular outcomes among patients with acute coronary syndrome (ACS). In 433 patients, IgA and IgG antibodies to H pylori, along with classic risk factors, including hypertension, diabetes, hyperlipidaemia, smoking and family history of coronary artery disease (CAD) were determined. Short and long-term follow-up information on adverse outcomes, defined as recurrence of unstable angina, myocardial infarction, coronary angioplasty, coronary artery bypass graft surgery, and sudden cardiac death was obtained. None of the classic CAD risk factors correlated with incidence of either short- or long-term outcomes. Seropositivity for H pylori was significantly associated with risk of short-term adverse outcomes, and independently predicted their incidence in multivariate regression (R = 3.05, p < 0.001). Results failed to show such an association between H pylori seropositivity and long-term adverse outcomes. H pylori infection may affect short-term prognosis in patients with ACS. Randomised trials are needed to evaluate the role of H pylori eradication in these patients. PMID:22555636

  2. Mean platelet volume and the risk of periprocedural myocardial infarction in patients undergoing coronary angioplasty

    Verdoia, M.; Camaro, C.; Barbieri, L.; Schaffer, A.; Marino, P.; Bellomo, G.; Suryapranata, H.; Luca, G. De

    2013-01-01

    BACKGROUND: Periprocedural myocardial infarction (PMI) represents a relatively common complication of percutaneous coronary intervention (PCI). Mean platelet volume (MPV) has been proposed as a marker for platelet activation, as larger sized platelets have been associated with higher pro-thrombotic

  3. Patient’s Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections

    Farajollahi Alireza; Rahimi Atena; Khayati Shal Ebrahim; Ghaffari Samad; Ghojazadeh Morteza; Tajlil Arezou; Aslanabadi Nasser

    2014-01-01

    Introduction: We aimed to determine angiography projections with lower Dose Area Product (DAP) rate by measuring the mean DAP and fluoroscopy times in coronary angiography (CAG) and percutaneous coronary intervention (PCI) and calculating DAP rate in different projections. Methods: DAP and fluoroscopy times were measured in all employed projections in real-time in 75 patients who underwent CAG or PCI by a single cardiologist in Madani Cardiovascular University Hospital (45 in CAG group and 30...

  4. Cardiac computed tomography in patients with acute coronary syndrome

    Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

  5. When is rotational angiography superior to conventional single‐plane angiography for planning coronary angioplasty?

    Taylor, Jane; Boutong, Sara; Brett, Sarah; Louis, Amal; Heppenstall, James; Morton, Allison C.; Gunn, Julian P.

    2015-01-01

    Objectives To investigate the value of rotational coronary angiography (RoCA) in the context of percutaneous coronary intervention (PCI) planning. Background As a diagnostic tool, RoCA is associated with decreased patient irradiation and contrast use compared with conventional coronary angiography (CA) and provides superior appreciation of three‐dimensional anatomy. However, its value in PCI remains unknown. Methods We studied stable coronary artery disease assessment and PCI planning by interventional cardiologists. Patients underwent either RoCA or conventional CA pre‐PCI for planning. These were compared with the referral CA (all conventional) in terms of quantitative lesion assessment and operator confidence. An independent panel reanalyzed all parameters. Results Six operators performed 127 procedures (60 RoCA, 60 conventional CA, and 7 crossed‐over) and assessed 212 lesions. RoCA was associated with a reduction in the number of lesions judged to involve a bifurcation (23 vs. 30 lesions, P RoCA improved confidence assessing lesion length (P = 0.01), percentage stenosis (P = 0.02), tortuosity (P RoCA augments quantitative lesion assessment, enhances confidence in the assessment of coronary artery disease and the precise details of the proposed procedure, but does not affect X‐ray dose, contrast agent volume, or procedure duration. © 2015 Wiley Periodicals, Inc. PMID:26012725

  6. Target vessel revascularization following percutaneous coronary intervention. A 10-year report from the Danish Percutaneous Transluminal Coronary Angioplasty Registry

    Jensen, Lisette Okkels; Thayssen, Per; Kassis, Eli;

    2005-01-01

    OBJECTIVE: To present the rate of target vessel revascularization (TVR) in a consecutive and unselected national population over 10 years. DESIGN: From 1989 to 1998 all percutaneous coronary interventions (PCIs) performed in Denmark were recorded in the Danish PTCA Registry. RESULTS: From 1989 to...... 1998 the annual rate of PCI rose from 46 to 753 per million inhabitants. From 1995 to 1998 TVR with PCI or coronary artery bypass grafting (CABG) within 9 months from the index PCI decreased significantly (p < 0.001) from 21.2% in 1995 (CABG 8.6% vs PCI 12.6%) to 11.7% in 1998 (CABG 4.3% vs PCI 7.......4%). Independent predictors for TVR were: coronary stenting (OR 0.60; 95% CI 0.52-0.69, p < 0.001), primary success rate (OR 0.69; 95% CI 0.53-0.89, p < 0.005), pre-PCI stenosis severity (OR 1.01; 95% CI 1.00-1.01, p = 0.03), left anterior descending coronary artery (OR 2.35; 95% CI 1.73-3.19, p < 0.001), right...

  7. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty

    Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported. Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated. Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0-2], and the other 11 had poor outcomes (mRS 3-6). Five of six patients who scored 9-14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3-8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site. Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization. (orig.)

  8. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty

    Kashiwagi, Junji; Okahara, Mika [Shinbeppu Hospital, Department of Radiology, Beppu, Oita (Japan); Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Mori, Hiromu [Oita University Faculty of Medicine, Department of Radiology, Yufu, Oita (Japan); Hori, Yuzo [Nagatomi Neurosurgical Hospital, Department of Radiology, Oita, Oita (Japan); Abe, Toshi [Kurume University School of Medicine, Department of Radiology, Kurume, Fukuoka (Japan)

    2010-05-15

    Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported. Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated. Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0-2], and the other 11 had poor outcomes (mRS 3-6). Five of six patients who scored 9-14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3-8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site. Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization. (orig.)

  9. Sheathless transradial coronary angioplasty in an achondroplasic patient with ST elevation myocardial infarction.

    Rahman, Nasir; Nabi, Amjad; Gul, Ibrahim

    2015-01-01

    We present a case of a 50-year-old man with achondroplasia, who presented with anterior ST segment myocardial infarction (STEMI). He was taken urgently to the catheterisation laboratory. Owing to his short stature, it was not possible to insert a radial artery sheath so he underwent a sheathless primary percutaneous coronary intervention (PCI) through the right radial artery, with no complication. He was shifted to the coronary care unit and had an uneventful hospital course. He was discharged in stable condition and follows up regularly as an outpatient. PMID:26508119

  10. Fondaparinux and acute coronary syndromes: update on the OASIS 5–6 studies

    François Schiele

    2010-03-01

    Full Text Available François SchieleDepartment of Cardiology, University Hospital Jean-Minjoz, Besançon, FranceAbstract: Anticoagulant therapy is a major component in the management of acute coronary syndromes (ACS. Four anticoagulant agents are currently commercially available for ACS, namely unfractionated heparin (UFH, enoxaparin, bivalirudin and fondaparinux. We describe the advantages of fondaparinux and the reasons that have hampered its uptake into routine management of ACS. Fondaparinux was shown to be efficacious in the prevention of deep vein thrombosis vs low-molecular-weight heparins, while in the setting of venous thrombo-embolic disease, it was shown to be noninferior to enoxaparin and UFH. Two pivotal studies have demonstrated the efficacy of fondaparinux as an anticoagulant in the setting of ACS, namely OASIS-5 in non-ST elevation ACS, and OASIS-6 in ST elevation myocardial infarction (MI. In OASIS-5, fondaparinux was shown to be noninferior to enoxaparin in terms of death, MI or refractory ischemia at 9 days. Furthermore, a 50% reduction in bleeding complications was obtained with fondaparinux vs enoxaparin, leading to a risk reduction for death. In OASIS-6, fondaparinux was shown to be superior to the comparator (UFH or placebo. European and North American guidelines give fondaparinux a Grade 1A and 1B recommendation respectively, but uptake of fondaparinux in routine practice has been slow. We explore reasons for this, such as prevailing doubts about the efficacy of fondaparinux in the setting of angioplasty, the problem of catheter thrombosis, and the lack of antidote in case of bleeding complications. With the exception of primary angioplasty, fondaparinux is as effective as enoxaparin or UFH, but is also associated with a considerable reduction in bleeding complications, and thus, an undeniable net clinical benefit.Keywords: fondaparinux, OASIS, acute coronary syndromes

  11. Cardiac MRI of acute coronary syndrome.

    Akerem Khan, Shamruz; Khan, Shamruz Akarem; Williamson, Eric E; Foley, Thomas A; Cullen, Ethany L; Young, Phillip M; Araoz, Philip A

    2013-05-01

    Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. New serological biomarkers, such as troponins, have improved the diagnosis of ACS; however, the diagnosis of ACS can still be difficult as there is marked heterogeneity in its presentation and significant overlap with other disorders presenting with chest pain. Evidence is accumulating that cardiac MRI provides information that can aid the detection and differential diagnosis of ACS, guide clinical decision-making and improve risk-stratification after an event. In this review, we present the relevant cardiac MRI techniques that can be used to detect ACS accurately, provide differential diagnosis, identify the sequelae of ACS, and determine prognostication after ACS. PMID:23668741

  12. Nuclear Cardiology in Acute Coronary Syndrome

    Paeng, Jin Chul; Lee, Dong Soo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2009-06-15

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS.

  13. Nuclear Cardiology in Acute Coronary Syndrome

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS

  14. The clinics of acute coronary syndrome.

    Cervellin, Gianfranco; Rastelli, Gianni

    2016-05-01

    Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt. PMID:27294087

  15. Nuclear cardiology in acute coronary syndromes

    Acute coronary syndromes are a frequent manifestation of a coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of trier pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trails. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarcts avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application

  16. Acute Coronary Syndrome Due to Spontaneous Coronary Artery Dissection in a Middle-Aged Man

    Davran Cicek

    2014-08-01

    Full Text Available True spontaneous coronary artery dissection (SCAD is an extremely rare but important cause of acute coronary syndrome, with only about 200 cases reported in the literature. Diagnosis is often made at autopsy. Risk factors include oral contraceptive use, atherosclerotic disease and the peripartum period. SCAD should be considered when a healthy young patient presents with the onset of acute myocardial ischemic syndrome. A timely diagnosis and intervention are mandatory as SCAD can cause sudden death. We present a case of SCAD with an uncommon clinical presentation of acute coronary syndrome and without identifiable risk factors, and successfully treated with non-invasive (medical therapy.

  17. Acute multivessel coronary artery occlusion: a case report

    Gan Feng

    2012-09-01

    Full Text Available Abstract Background In terms of clinical and angiographic findings, multiple simultaneous coronary occlusions in acute myocardial infarction are infrequent, and the mechanism of the occlusions is unclear. Case presentation We herein report a rare case of two simultaneously occluded coronary arteries, one of which subsequently underwent spontaneous lysis. An 88-year-old man had a 3-hour attack of acute crushing retrosternal chest pain. His first electrocardiogram showed ST-segment elevation in the inferior (II, III, and aVF and anterior (V3–V6 leads. His second electrocardiogram in the cardiac care unit showed ST-segment elevation in the inferior leads but ST-segment depression in the anterior leads. Emergency coronary angiography revealed that the right coronary artery was acutely and totally occluded at the midportion and that the proximal and midportion of the left anterior descending coronary artery had an acute thrombus. According to his electrocardiogram and coronary angiography findings, we inferred that the right coronary artery and left anterior descending coronary artery first totally occluded simultaneously, and then the thrombus in the left anterior descending coronary artery spontaneously underwent partial lysis. Therefore, intervention of the right coronary artery was performed followed by injection of glycoprotein IIB-IIIA inhibitor into the left anterior descending coronary artery. He had an uneventful hospital course and was discharged home 10 days later. Conclusion Because patients with multivessel coronary artery occlusion are often in serious condition, abnormal electrocardiographic results must be identified and affected vessel should be opened timely and efficiently to save the myocardium and reduce complications such as congestive heart failure.

  18. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  19. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    O. V. Reshetko

    2015-12-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  20. Impact of copeptin on diagnosis of acute coronary syndrome

    Zeinab H. El Sayed

    2014-07-01

    Conclusion: In suspected acute coronary syndrome, determination of copeptin and cardiac troponin I provides a remarkable negative predictive value, which aids in early and safe ruling out of myocardial infarction.

  1. Acute coronary ischemia during alcohol withdrawal: a case report

    Sriram Ganeshalingam; Epa Dhanesha; Rodrigo Chaturaka; Jayasinghe Saroj

    2011-01-01

    Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literatur...

  2. Thyroid Hormone Profile in Patients With Acute Coronary Syndrome

    Abdulaziz Qari, Faiza

    2015-01-01

    Background: Thyroid hormone has the a major role in the cardiovascular system function and cardiac a As well as to maintain the cardiovascular homeostasis A slightly change ind thyroid status actually affects cardiovascular mortality hemodynamic. The background of this study was to define the prevalence of thyroid dysfunction in acute coronary syndrome (ACS). Objectives: The primary objective was to define the prevalence of thyroid dysfunction in acute coronary syndrome, including Non-ST Segm...

  3. Frequency of risk factors in male patients with acute coronary syndrome

    To determine the frequency of risk factors in male patients presenting with acute coronary syndrome. Study Design: Observational study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008. Methodology: Male patients with acute coronary syndrome were included in this study. Patients having angioplasty (PCI), coronary artery bypass surgery, chronic liver and kidney diseases were excluded. Presence of diabetes, smoking, hypertension, dyslipidemia, physical activity, stress, a family history of coronary artery disease (CAD) and medication was documented. Blood pressure, ECG, cardiac enzymes, fasting blood glucose, lipid profile and echocardiography were done within 24 hours of admission. Body mass index and waist circumference were measured. Data was analysed using SPSS-15. Results: A total of 135 male patients of ACS were studied having mean age of 54.26+-11.60 years. Maximum number of patients aged between 51 to 60 years, (n = 41, 31.9%). STEMI (ST-elevation myocardial infarction) was diagnosed in 96 (71.1%) patients, non-STEMI in 12 (8.9%) while 27 (20%) patients were having unstable angina. Smoking was documented in 60 (44%) patients, hypertension in 50 (37%), diabetes in 34 (25.2%) and a family history of premature CAD was recorded in 24 (17.8%) patients. Fifty one (37.8%) patients were overweight (BMI = 25-29.9) while 22 (16.3%) were obese (BMI greater or equal to 30). Waist circumference > 90 cm was found in 86 (63.6%) subjects. Sixty four (47.4%) patients were active physically. Psychosocial stress was documented in 33 (23.75). Hypertension, diabetes and dyslipidemia were the most frequent combinations, observed in 24 (17.9%) subjects. Conclusion: Dyslipidemia, smoking, hypertension and diabetes were most frequent risk factors. Public awareness to control risk factors can reduce the prevalence of CAD. (author)

  4. Circulating endothelial cells in coronary artery disease and acute coronary syndrome

    Schmidt, David E; Manca, Marco; Höfer, Imo E

    2015-01-01

    Circulating endothelial cells (CECs) have been put forward as a promising biomarker for diagnosis and prognosis of coronary artery disease and acute coronary syndromes. This review entails current insights into the physiology and pathobiology of CECs, including their relationship with circulating en

  5. Acute attenuation of glycocalyx barrier properties increases coronary blood volume independently of coronary flow reserve

    J. Brands; J.A.E. Spaan; B.M. van den Berg; H. Vink; J.W.G.E. VanTeeffelen

    2010-01-01

    Brands J, Spaan JA, Van den Berg BM, Vink H, VanTeeffelen JW. Acute attenuation of glycocalyx barrier properties increases coronary blood volume independently of coronary flow reserve. Am J Physiol Heart Circ Physiol 298: H515-H523, 2010. First published November 25, 2009; doi:10.1152/ajpheart.01306

  6. Prognostic value of serum total bilirubin in patients with acute coronary syndrome after percutaneous coronary intervention

    孙同文

    2013-01-01

    Objective To investigate the predictive value of serum total bilirubin (STB) level in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) .Methods A total of 1273 consecutive patients treated with PCI in cardiology department,First Affiliated Hospital of Zhengzhou University from June

  7. Percutaneous Angioplasty and Stenting of left Subclavian Artery Lesions for the Treatment of Patients with Concomitant Vertebral and Coronary Subclavian Steal Syndrome

    Objective. To evaluate the efficacy of subclavian stenosis percutaneous transfemoral angioplasty (PTA)-treatment in patients with intermittent or complete subclavian steal syndrome (SSS), and coronary-subclavian steal syndrome (C-SSS) after left internal mammary artery-interventricular anterior artery (LIMA-IVA) by pass graft. Methods. We studied 42 patients with coronary subclavian steal syndrome subdivided in two groups; the first group consisted of 15 patients who presented an intermittent vertebral-subclavian steal, while the second group consisted of 27 patients with a complete vertebral-subclavian steal. All patients were treated with angioplasty and stent application and were followed up for a period of 5 years by echocolordoppler examination to evaluate any subclavian restenosis. Results. Subclavian restenosis was significantly increased in patients with a complete subclavian steal syndrome. The restenosis rate was 6.67% in the first group and 40.75% in the second group, These patients had 9.1 fold-increase risk (CI confidence interval 0.95-86.48) in restenosis. Conclusion. Patients with a complete subclavian and coronary steal syndrome present a higher risk of subclavian restenosis

  8. Isolated single coronary artery presenting as acute coronary syndrome: case report and review.

    Mahapatro, Anil K; Patro, A Sarat K; Sujatha, Vipperala; Sinha, Sudhir C

    2014-06-01

    Congenital single coronary artery is commonly associated with complex congenital heart diseases and manifests in infancy or childhood. But isolated single coronary artery is a rare congenital anomaly which can present as acute coronary syndrome in adults. The aim of the work is to discuss on isolated single coronary artery in two adults presenting as acute coronary syndrome. The first case underwent coronary angiography (CAG) through right radial route, but switched over to femoral for confirmation of diagnosis and due to radial spasm. An aortic root angiogram was done to rule out presence of any other coronary ostia. It revealed a single coronary artery originating from right sinus of valsalva. After giving rise to posterior descending artery branch at crux, it continued in the atrioventricular groove to the anterior basal surface of the heart and traversed as anterior descending artery. There was no atheromatous occlusive stenosis. This is R-I type single coronary artery as per Lipton classification. In the second case, angiography was completed through right radial route. It revealed a single coronary artery arising from right aortic sinus. Anterior descending and circumflex branch were originating from proximal common trunk of the single coronary artery and supplying the left side of the heart. The right coronary artery has diffuse atheromatous disease without significant stenosis in any major branch. This is R-III C type as per Lipton classification. A coronary anomaly of both origin and course is very rare. It may be encountered in adults evaluated for atherosclerotic coronary heart disease. Knowledge and understanding of anatomical types of this congenital anomaly will reduce time, anxiety, complications during CAG and cardiac surgery. PMID:25075168

  9. Acute coronary syndromes: an old age problem

    Alexander D Simms; Philip D Batin; John Kurian; Nigel Durham; Christopher P Gale

    2012-01-01

    The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes (ACS). This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological frailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

  10. Detection of restenosis after successful coronary angioplasty: Improved clinical decision making with use of a logistic model combining procedural and follow-up variables

    A prospective study of 111 patients who underwent repeat coronary angiography and exercise thallium-201 scintigraphy 6 +/- 2 months after complete revascularization by percutaneous transluminal coronary angioplasty was performed to assess whether clinical, procedure-related and postangioplasty exercise variables yield independent information for the prediction of angiographic restenosis after angioplasty. Complete revascularization was defined as successful angioplasty of one or more vessels that resulted in no residual coronary lesion with greater than 50% diameter stenosis. Restenosis was defined as a residual stenosis at the time of repeat angiography of greater than 50% of luminal diameter. Restenosis occurred in 40% of the patients. The 111 patients were randomly subdivided into a learning group (n = 84) and a testing group (n = 27). A logistic discriminant analysis was performed in the learning group and the logistic model was used to estimate a logistic probability of restenosis. This probability of restenosis was validated in the testing group. In the learning group of 84 patients univariate analysis of 39 factors revealed 8 factors related to restenosis: recurrence of angina (p less than 0.0001), postangioplasty abnormal finding on exercise thallium-201 scintigram (p less than 0.0001), exercise thallium-201 scintigram score (p less than 0.0001), difference between exercise and rest ST segment depression (p less than 0.001), postangioplasty exercise ST segment depression (p less than 0.001), absolute postangioplasty stenosis diameter (p less than 0.003), postangioplasty exercise work load (p less than 0.03) and postangioplasty exercise heart rate (p less than 0.05)

  11. Clinical significance of exercise induced ST segment depression after successful percutaneous transluminal coronary angioplasty

    To evaluate the clinical significance of ST segment depression during repeated Treadmill exercise after successful PTCA, Thallium-201 SPECT was performed. The Thallium-201 SPECT was performed before, one week after and 3-6 months after PTCA. All thirty-five patients had one vessel disease and positive Thallium-201 exercise test. During follow-up period for 3-6 months, 11 of 35 patients had persistent ST segment depression. Restenosis of dilated coronary lesion was demonstrated in 6 of 11 patients. In another 3 of 35 patients, exercise induced ST segment depression was disappered during follow-up Treadmill exercise. In 14 patients with persistent or transient ST segment depression after PTCA, Thallium-201 SPECT demonstrated transient ischemia in 5 of 6 patients with restenosis. In other 8 patients without restenosis, SPECT images did not demonstrate myocardial ischemia and coronary arteriographic findings could not verify side branch stenosis or intimal dissection which might cause myocardial ischemia. The etiology of ST segment depression after successful PTCA in one vessel disease is not produced by exercise induced myocardial ischemia but still unknown mechanisms may be present. (author)

  12. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention

    Verheugt Freek WA

    2001-05-01

    Full Text Available Abstract Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  13. Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes.

    Yerokun, Babatunde A; Williams, Judson B; Gaca, Jeffrey; Smith, Peter K; Roe, Matthew T

    2016-06-01

    For patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), guideline recommendations and treatment pathways focus on revascularization for definitive treatment if the patient is an appropriate candidate. Despite the widespread use of revascularization for NSTE-ACS, most patients undergo a percutaneous coronary intervention, whereas a minority of patients undergo coronary artery bypass grafting. Focusing specifically on the USA, the contemporary utilization, preoperative and perioperative considerations, and outcomes of NSTE-ACS patients undergoing coronary artery bypass grafting have not been comprehensively reviewed. PMID:26945187

  14. The Clinical Role of CT-Based Morphologic Description in Severely Calcified Coronary Arteries Ectasia Encountering Acute Coronary Syndrome

    Jen-Yuan Kuo; Jiun-Yi Li; Chung-Lieh Hung; Yen-Yu Liu; Jui-Peng Tsai

    2012-01-01

    Diffuse coronary arteries ectasia combined with calcification is seldom reported. Acute coronary syndrome, a potentially life-threatening disease, accompanied with coronary ectasia and diffuse calcification, made percutaneous coronary intervention difficult and risky owing to increasing complications rate. Dual-source computed tomography and three-dimensional volume rendering images help cardiovascular surgeon easier to localize the ideal site and facilitate the procedure.

  15. Relationship between coronary artery ectasia, cocaine abuse and acute coronary syndromes

    Dendramis, Gregory; Paleologo, Claudia; Piraino, Davide; Assennato, Pasquale

    2016-01-01

    Coronary artery ectasia (CAE) often represents a coronary angiography finding casually detected or following the occurrence of an acute coronary syndrome. The pathogenetic role of cocaine abuse in the genesis of CAE is still little known and very few data are available in literature. We describe a case of a 31-year-old male cocaine user admitted to our department for typical acute chest pain. Coronary angiography showed diffuse coronary ectasia with slow flows and without hemodynamically significant stenosis. An increasing of matrix metalloproteinases values and a reduction of their tissue inhibitors was showed both during hospitalization and at one month after discharge. This case report emphasizes the close relationship between cocaine abuse, CAE and acute coronary syndromes in patients without hemodynamically significant coronary stenosis. As reported by Satran et al, cocaine abuse should be considered an important risk factor for CAE and these patients appear to be at increased risk of angina and acute myocardial infarct. Further studies that can strengthen this hypothesis would be useful to deepen and better analyze this interesting association. PMID:27231522

  16. Acute Coronary Syndrome: Posthospital Outpatient Management.

    Veauthier, Brian; Sievers, Karlynn; Hornecker, Jaime

    2015-10-01

    When providing care for patients who are discharged from the hospital after experiencing acute coronary syndrome (ACS), several issues should be addressed. Drug regimens should be reviewed to ensure that patients are taking appropriate drugs, including antiplatelet agents, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, aldosterone antagonists, beta blockers/calcium channel blockers, cholesterol-lowering drugs, and nitroglycerin. The review also should confirm that patients understand when and how to take their drugs, and that there are no obstacles (eg, cost) that might result in nonadherence to drug regimens. Lifestyle modifications, including improvements in diet and exercise regimens, along with participation in a cardiac rehabilitation program, should be encouraged. Risk factor reduction measures include smoking cessation for smokers, weight management for patients who are overweight, and optimal control of blood pressure and blood glucose levels. Appropriate vaccinations should be administered; influenza and pneumococcal vaccines are indicated for all patients with ACS in the absence of contraindications. Patients requiring pain control should avoid use of nonsteroidal anti-inflammatory drugs because they increase the risk of cardiovascular events; acetaminophen or other drugs should be used. Finally, depression is common among patients with ACS. Screening for and management of depression are significant components of care. PMID:26439396

  17. Coronary Artery Bypass Grafting

    ... Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link to NHLBI to someone by ... include lifestyle changes, medicines, and a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty. PCI is ...

  18. Acute coronary ischemia during alcohol withdrawal: a case report

    Sriram Ganeshalingam

    2011-08-01

    Full Text Available Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Conclusions Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

  19. Pregnancy associated plasma protein-A in acute coronary pathology.

    Sapozhnikov A.N.

    2014-03-01

    Full Text Available The aim: to study pregnancy associated plasma protein A as a potential marker of myocardial necrosis with acute coronary syndrome. Material and methods. The rates of PPPP-A and insulin-like growth factor 1 were determined in 24 patients with acute myocardial infarction, in 18 patients with unstable angina and in the control group as well. Results. The rates of PPPP-A and ILGF-1 are accurately higher in the groups with acute coronary pathology in comparison to the patients with no ischemia. Conclusions. PPPP-A proves to be a marker of ischemia and/ or injury and could be used as a diagnostic predictor of an unstable atherosclerotic plaque in acute coronary development.

  20. Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

    Sarwar Umran

    2012-01-01

    Full Text Available We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery - the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase. To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

  1. Captopril for prevention of Contrast Induced Nephropathy in patients undergoing Coronary Angioplasty: A double blind placebo controlled clinical trial

    Hashemi, M.; Kharazi, A; Shahidi, S.

    2005-01-01

    Background: Contrast induced nephropathy is a potential cause of mortality and morbidity in patients undergoing angiography–angioplasty. Except for hydrating and probably low – isoosmolar contrast agents in high risk groups, other modalities have not provided benefit. We investigated preventive effects of captopril for contrast induced nephropathy during angiography–angioplasty. Methods: In a double blind placebo controlled clinical trial, 88 patients were randomized to two groups: 42 pa...

  2. Noninvasive Coronary Angiography with 64-Channel Multidetector Computed Tomography in Patients with Acute Coronary Syndrome

    Ulimoen, G. R.; Gjoennaess, E.; Atar, D.; Dahl, T.; Stranden, E.; Sandbaek, G. [Dept. of Radiology, Dept. of Vascular Diagnosis and Research, and Division of Cardiology, Aker Univ. Hospital, Oslo (Norway)

    2008-12-15

    Background: Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. Purpose: To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). Material and Methods: MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. Results: 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Conclusion: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome.

  3. Noninvasive Coronary Angiography with 64-Channel Multidetector Computed Tomography in Patients with Acute Coronary Syndrome

    Background: Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. Purpose: To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). Material and Methods: MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. Results: 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Conclusion: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome

  4. Matrix metalloproteinase-9 in patients with acute coronary syndrome

    Regent Lee

    2012-01-01

    To the Editor:I congratulate Wang et al1 in reporting further evidence for the role of matrix metalloproteinase-9 (MMP9)as a biomarker in acute coronary syndrome (ACS).In this study,the Authors examined the levels of MMP9 and C-reactive protein (CRP) in patients with a clinical diagnosis of unstable angina pectoris who subsequently underwent coronary angiography to evaluate the presence of coronary artery disease.Two subgroups of patients were defined according to the presence or absence of significant angiographic coronary artery stenosis.The level of MMP9 was significantly higher in patients with angiographic evidence of significant plaque disease (plaque group) compared with those without significant coronary stenosis (non-plaque group).No significant differences in the levels of CRP were observed between the two groups.

  5. Treatment-Resistant Depression and Mortality after Acute Coronary Syndrome

    Carney, Robert M.; Freedland, Kenneth E

    2009-01-01

    Depression is a risk factor for morbidity and mortality in patients with coronary heart disease (CHD), especially following acute coronary syndrome (ACS). Evidence from recent clinical trials suggests that treatment-resistant depression may be associated with a particularly high risk of mortality or cardiac morbidity in post-ACS patients. This manuscript reviews this evidence, and considers possible explanations for this relationship. Directions for future research are also considered, with p...

  6. Imaging Techniques in Acute Coronary Syndromes: A Review

    Vacek, James L.; Zimmerman, Stanley K.

    2011-01-01

    Coronary heart disease (CHD) remains the leading cause of death in the United States. National review of Emergency Department (ED) visits from 2007 to 2008 reveals that 9% are for chest pain. Of these patients, 13% had acute coronary syndromes (ACSs) (Antman et al., 2004). Plaque rupture with thrombus formation is the most frequent cause of ACS, and identifying patients prior to this event remains important for any clinician caring for these patients. There has been an increasing amount of re...

  7. Prognostic factors of male patients with acute coronary syndrome after percutaneous coronary intervention therapy

    Objective: To study the prognostic risk factors of male patients with coronary heart disease in stent placement era. Methods: One hundred and four patients were enrolled in this study (aged 64.9 ± 9.6 years) including 61 diagnosed as acute myocardial infarction, and 43 as unstable angina with followed up 11.9 ± 8.7 months. All factors including demographic factors, non-interventional work-up, associated clinical complications and results of coronary artery angiography reached a model of Logistic regression analysis. Results: Based on MACE (major adverse cardiac events), as quantitative factors, diseased proximal middle left anterior descending artery was a significant independent variable (P<0.05), and its coefficient was 22.00. Conclusions: Diseased proximal middle left anterior descending coronary artery is the prognostic factor of MACE in male patients with acute coronary syndrome. (authors)

  8. Effect of darapladib on major coronary events after an acute coronary syndrome

    O'Donoghue, Michelle L; Braunwald, Eugene; White, Harvey D; Steen, Dylan P; Lukas, Mary Ann; Tarka, Elizabeth; Steg, P Gabriel; Hochman, Judith S; Bode, Christoph; Maggioni, Aldo P; Im, KyungAh; Shannon, Jennifer B; Davies, Richard Y; Murphy, Sabina A; Crugnale, Sharon E; Wiviott, Stephen D; Bonaca, Marc P; Watson, David; Weaver, W Douglas; Serruys, Patrick W; Cannon, Christopher P; Steen, Dylan L; Jeppesen, Jørgen Lykke; Nielsen, Jens Erik Rokkedal

    2014-01-01

    after an acute coronary syndrome (ACS) event. DESIGN, SETTING, AND PARTICIPANTS: SOLID-TIMI 52 was a multinational, double-blind, placebo-controlled trial that randomized 13,026 participants within 30 days of hospitalization with an ACS (non-ST-elevation or ST-elevation myocardial infarction [MI]) at...... primary end point (major coronary events) was the composite of coronary heart disease (CHD) death, MI, or urgent coronary revascularization for myocardial ischemia. Kaplan-Meier event rates are reported at 3 years. RESULTS: During a median duration of 2.5 years, the primary end point occurred in 903...... with darapladib added to optimal medical therapy and initiated within 30 days of hospitalization did not reduce the risk of major coronary events. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01000727....

  9. Virtual histology assessment of coronary atheroma influences treatment strategy in the young acute coronary syndrome patient.

    Ormerod, Julian; Johnston, Tom; Ramcharitar, Steve

    2014-01-01

    A 43-year-old woman having significant risk factors for ischaemic heart disease was admitted with an acute coronary syndrome (ACS). Coronary angiography revealed a non-flow limiting lesion in her right coronary artery with the rest of her arteries unremarkable. Risk stratification of the culprit lesion in the right coronary artery through intravascular ultrasound virtual histology demonstrated that the rupture plaque had less than 5% necrotic core with low vulnerability indices. This important finding suggested that the re-rupture risk was low so aggressive pharmacological treatment that can influence the plaque characteristics was instigated in preference to mechanical plaque sealing with a coronary stent. At a year of follow-up the patient was well and had no further events. PMID:24477714

  10. Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

    Gehani, Abdurrazzak; Al Suwaidi, Jassim; Arafa, Salah; Tamimi, Omer; Alqahtani, Awad; Al-Nabti, Abdulrahman; Arabi, Abdulrahman; Aboughazala, Tarek; Bonow, Robert O; Yacoub, Magdi

    2012-01-01

    Abstract: In this article, we outline the plans, protocols and strategies to set up the first nationwide primary Percutaneous Coronary Intervention (PCI) program for ST-elevation myocardial Infarction (STEMI) in Qatar, as well as the difficulties and the multi-disciplinary solutions that we adopted in preparation. We will also report some of the landmark literature that guided our plans. The guidelines underscore the need for adequate number of procedures to justify establishing a primary-PCI service and maintain competency. The number of both diagnostic and interventional procedures in our centre has increased substantially over the years. The number of diagnostic procedures has increased from 1470 in 2007, to 2200 in 2009 and is projected to exceed 3000 by the end of 2012. The total number of PCIs has also increased from 443 in 2007, to 646 in 2009 and 1176 in 2011 and is expected to exceed 1400 by the end of 2012. These figures qualify our centre to be classified as ‘high volume’, both for the institution and for the individual interventional operators. The initial number of expected primary PCI procedures will be in excess of 600 procedures per year. Guidelines also emphasize the door to balloon time (DBT), which should not exceed 90 minutes. This interval mainly represents in-hospital delay and reflects the efficiency of the hospital system in the rapid recognition and transfer of the STEMI patient to the catheterization laboratory for primary-PCI. Although DBT is clearly important and is in the forefront of planning for the wide primary PCI program, it is not the only important time interval. Myocardial necrosis begins before the patient arrives to the hospital and even before first medical contact, so time is of the essence. Therefore, our primary PCI program includes a nationwide awareness program for both the population and health care professionals to reduce the pre-hospital delay. We have also taken steps to improve the pre-hospital diagnosis of

  11. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Chevli, Parag; Kelash, Fnu; Gadhvi, Pragnesh; Grandhi, Sreeram; Syed, Amer

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50) and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset o...

  12. Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction

    Liu, Heng-Liang; Liu, Yang; Hao, Zhen-Xuan; Geng, Guo-Ying; Zhang, Zhi-Fang; Jing, Song-Bin; Ba, Ning; Guo, Wei

    2015-01-01

    Objective: This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). Methods: A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compar...

  13. Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud;

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary...... intervention (PCI) for ST-segment elevation myocardial infarction significantly reduced major bleeding compared with heparin with or without glycoprotein IIb/IIIa inhibitors (GPI), but it was associated with an increase in AST. METHODS: We compared patients with (n = 12) or without AST (n = 2,184) regarding...

  14. Tachyarrhythmias, bradyarrhythmias and acute coronary syndromes

    Trappe Hans-Joachim

    2010-01-01

    Full Text Available The incidence of bradyarrhythmias in patients with acute coronary syndrome (ACS is 0.3% to 18%. It is caused by sinus node dysfunction (SND, high-degree atrioventricular (AV block, or bundle branch blocks. SND presents as sinus bradycardia or sinus arrest. First-degree AV block occurs in 4% to 13% of patients with ACS and is caused by rhythm disturbances in the atrium, AV node, bundle of His, or the Tawara system. First- or second-degree AV block is seen very frequently within 24 h of the beginning of ACS; these arrhythmias are frequently transient and usually disappear after 72 h. Third-degree AV blocks are also frequently transient in patients with infero-posterior myocardial infarction (MI and permanent in anterior MI patients. Left anterior fascicular block occurs in 5% of ACS; left posterior fascicular block is observed less frequently (incidence < 0.5%. Complete bundle branch block is present in 10% to 15% of ACS patients; right bundle branch block is more common (2/3 than left bundle branch block (1/3. In patients with bradyarrhythmia, intravenous (IV atropine (1-3 mg is helpful in 70% to 80% of ACS patients and will lead to an increased heart rate. The need for pacemaker stimulation (PS is different in patients with inferior MI (IMI and anterior MI (AMI. Whereas bradyarrhythmias are frequently transient in patients with IMI and therefore do not need permanent PS, there is usually a need for permanent PS in patients with AMI. In these patients bradyarrhythmias are mainly caused by septal necrosis. In patients with ACS and ventricular arrhythmias (VTA amiodarone is the drug of choice; this drug is highly effective even in patients with defibrillation-resistant out-of-hospital cardiac arrest. There is general agreement that defibrillation and advanced life support is essential and is the treatment of choice for patients with ventricular flutter/fibrillation. If defibrillation is not available in patients with cardiac arrest due to VTA

  15. EVOLUCIÓN CLÍNICA DE PACIENTES CON INFARTO AGUDO DE MIOCARDIO TRATADOS CON ANGIOPLASTIA PRIMARIA / Clinical evolution of patients with acute myocardial infarction treated with primary angioplasty

    Ernesto del Pino Sánchez

    2012-07-01

    Full Text Available ResumenIntroducción y objetivos: La angioplastia primaria restablece de manera rápida y mantenida la permeabilidad de la arteria coronaria responsable del infarto agudo de miocardio, disminuye significativamente la mortalidad, y mejora el pronóstico y la calidad de vida a largo plazo. El objetivo fue describir la evolución clínica de los pacientes con infarto agudo de miocardio tratados con angioplastia primaria. Método: Estudio descriptivo, longitudinal y prospectivo con 69 pacientes, recepcionados de 8:00 am a 4:00 pm, tratados con angioplastia primaria en el Instituto de Cardiología y Cirugía Cardiovascular, desde el 1 de julio de 2007 hasta el 31 de diciembre de 2008. Se realizó seguimiento clínico durante 180 días, donde se evaluó la frecuencia de sucesos clínicos mayores: muerte, reinfarto, angina postinfarto e inestable, necesidad de nueva revascularización y hemorragia mayor. Resultados: El tabaquismo y la hipertensión arterial tuvieron una prevalencia elevada. La localización inferior del infarto y la enfermedad de un vaso fueron las más frecuentes. Prevaleció el resultado inmediato exitoso. Los casos fallidos se relacionaron, con la coronaria derecha, el flujo TIMI 0 - 1 y el tiempo de evolución mayor de seis horas. Los sucesos clínicos mayores en el seguimiento fueron escasos y más frecuentes durante los primeros 30 días de seguimiento. Conclusiones: La angioplastia primaria realizada durante las primeras seis horas después del comienzo de los síntomas, es un procedimiento eficaz para tratar el infarto agudo de miocardio, debido al predominio del resultado exitoso y la escasa frecuencia de sucesos clínicos mayores durante seis meses de seguimiento clínico. / AbstractIntroduction and Objectives: Primary coronary angioplasty reestablishes fast and sustained way the permeability of acute myocardial infarction related artery. It decreases the mortality, improves the prognosis and quality of life to long-term. The

  16. Elective Percutaneous Coronary Intervention: The Relationship between Preprocedural Blood Glucose Levels and Periprocedural Myocardial Injury

    Madani, Mohsen; Alizadeh, Keivan; Ghazaee, Sepideh Parchami; Zavarehee, Abbas; Abdi, Seifollah; Shakerian, Farshad; salehi, Negar; Firouzi, Ata

    2013-01-01

    Regardless of the diabetic status of patients with coronary artery disease, hyperglycemia and hypoglycemia are adversely associated with cardiovascular events. The relationship between glucose levels and increased mortality risk in acute myocardial infarction has been shown through various glucose metrics; however, there is a dearth of multivariate analysis of the relationship between elective coronary angioplasty and preprocedural blood glucose levels.

  17. Nationwide trends in use and timeliness of diagnostic coronary angiography in acute coronary syndromes from 2005 to 2011

    Hansen, Kim Wadt; Sørensen, Rikke; Madsen, Mette; Madsen, Jan K; Jensen, Jan S; von Kappelgaard, Lene M; Mortensen, Poul E; Galatius, Søren

    2015-01-01

    AIMS: To examine trends in the use of diagnostic coronary angiography according to distance from home to the nearest invasive heart centre following implementation of fast-track protocols and extensive pre-hospital triaging of acute coronary syndrome patients. METHODS AND RESULTS: We performed a...... register-based cohort study of all patients admitted to Danish hospitals with incident acute coronary syndrome in 2005-2011. Diagnostic coronary angiography within 60 days of admission was investigated according to distance tertiles (DTs) calculated as range from each patient's home to the nearest invasive...... 0.94 (0.90-0.98) for 2010-2011. Length of hospital stay, time to coronary angiography, and 60-day mortality decreased in all DT. CONCLUSIONS: This nationwide study found significant increases in diagnostic coronary angiography use over time in incident acute coronary syndrome patients with a...

  18. Coronary Angioplasty Stent Placement

    Full Text Available ... paves the path so we can pass the metal stent. And then we take a stent and ... open up that balloon, and it expands that metal stent, which is generally stainless steel in compound, ...

  19. Coronary Angioplasty Stent Placement

    Full Text Available ... you can have a lesser plaque, 30 percent, 40 percent, which does not reduce blood flow, which ... That occurs in anywhere from 20 up to 40 percent of lesions. That’s why Medicated stents were ...

  20. Coronary Angioplasty Stent Placement

    Full Text Available ... often a difficult area to see on stress testing and such, and so we’ll be able ... much we can do right now about our genetic heritage. Secondly is smoking. Smoking is a huge ...

  1. Coronary Angioplasty Stent Placement

    Full Text Available ... Medical Center in Merriam, Kansas. During the program it’s easy for you to make referrals, make appointments, ... mail your questions then. Now let me turn it over to Dr. Mukhari to introduce the staff ...

  2. Coronary Angioplasty Stent Placement

    Full Text Available ... things need to make an impact on what decisions we make while we are pulling out a ... we talking about octogenarian maintainer? I think the decisions are going to be different. And I think ...

  3. Coronary Angioplasty Stent Placement

    Full Text Available ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ... time, very important. Oh, I think in the interest of the patient who has been laying on ...

  4. Coronary Angioplasty Stent Placement

    Full Text Available ... can’t change and modify, and that’s family history. There’s not much we can do right now ... so. I think the main vascular and the life threatening, immediate life threatening causes of chest pain ...

  5. Coronary Angioplasty Stent Placement

    Full Text Available ... is associated with accelerated hardening of the arteries. Diabetes Mellitus is a very serious cause of particularly ... one that came in from Art. He said, “Two weeks ago I had a drug-eluting stent ...

  6. Coronary Angioplasty Stent Placement

    Full Text Available ... there has been any damage to the heart muscle. There is also no indications that there is ... suggests that there’s no damage to the heart muscle. We don’t know yet if he has ...

  7. Coronary Angioplasty Stent Placement

    Full Text Available ... the opening of the blood vessel. It’s a collagen plug, and that will help seal the opening. ... stent should be on Plavix or a similar type of anti-platelet drug lifelong. One of the ...

  8. Coronary Angioplasty Stent Placement

    Full Text Available ... what they think is indigestion, they think it’s GI, and unfortunately it can turn out to be ... terms of probability is to look at the GI tract and then see if there is any ...

  9. Coronary Angioplasty Stent Placement

    Full Text Available ... featuring cardiovascular procedures and cardiovascular disease, in honor of American Heart Month. I’m Dr. Jay Jackson. I’ ... and sometimes these people come in the throes of a heart attack. The American heart association suggests that probably half of all ...

  10. Coronary Angioplasty Stent Placement

    Full Text Available ... Mukhari is also a board certified cardiologist, as well as a certified interventional specialist who will be ... What have you managed to do so far? Well, let me just show you what we have ...

  11. Coronary Angioplasty Stent Placement

    Full Text Available ... a big artery, a bare metal stent will work, a smaller artery or in some of the ... the equipment that we use from the early days has undergone a sea change. The catheters that ...

  12. Coronary Angioplasty Stent Placement

    Full Text Available ... have accessed the femoral artery, which is the big blood vessel in the leg, through which we ... getting to the point where if it’s a big artery, a bare metal stent will work, a ...

  13. Coronary Angioplasty Stent Placement

    Full Text Available ... they present to the hospital. So their first knowledge that they have heart disease is in the ... a stress test in a year, with the knowledge that this last stress test was a false ...

  14. Coronary Angioplasty Stent Placement

    Full Text Available ... heart. This could involve any one of the three major arteries. What you will be seeing here ... here, Jay, and now we’ll doing a -- 3 Take another angle to look at that. Take ...

  15. Coronary Angioplasty Stent Placement

    Full Text Available ... flow limiting and doesn’t seem to be something that would be causing this gentleman’s symptoms, which ... to make certain that we’re not missing something else, so the heart function is normal, good ...

  16. Coronary Angioplasty Stent Placement

    Full Text Available ... looking at the left system, then he will exchange catheters and he will go to the right ... anymore, because there has been a fairly highly rate of re-narrowing of these vessels. 7 Same ...

  17. Coronary Angioplasty Stent Placement

    Full Text Available ... not to just ignore any kind of symptoms. Diabetics, in particular, are a subclass of patients who ... vessel disease or multiple vessel blockages, or a diabetic, we think that the drug-eluting stents are ...

  18. Coronary Angioplasty Stent Placement

    Full Text Available ... at the initial shots, the left main is clean and I see no elements of any blockages ... contractility of the pump, arteries really look pretty clean with the exception of that downstream area in ...

  19. Coronary Angioplasty Stent Placement

    Full Text Available ... against the wall, but what happens is scar tissue forms, so it’s literally scarring in there. That ... secreted from the metal stent and prevents scar tissue from forming. So at one time it was ...

  20. Coronary Angioplasty Stent Placement

    Full Text Available ... the arteries. Diabetes Mellitus is a very serious cause of particularly premature atherosclerosis particularly in younger patients. Then things such as hypertension, obesity, and certainly what we call “hyperlipidemia” or “dislipidemia,” ...

  1. Coronary Angioplasty Stent Placement

    Full Text Available ... cardiovascular disease, in honor of American Heart Month. I’m Dr. Jay Jackson. I’m a board certified cardiologist and staff member at the Shawnee Mission Medical Center. I will be your host for today’s program. Joining ...

  2. Coronary Angioplasty Stent Placement

    Full Text Available ... I think one can safely say that the equipment that we use from the early days has ... ve gone through a fairly comprehensive list of equipment that we have used historically in dealing with ...

  3. Coronary Angioplasty Stent Placement

    Full Text Available ... disease. First and foremost is medical therapy. Med management is extremely important, it maybe the simplest thing ... to be go ahead and take patients into surgery and operate on them with blood thinning medicines ...

  4. Coronary Angioplasty Stent Placement

    Full Text Available ... door to informed medical care. “OR-Live,” the vision of improving health. Hello and welcome. We’re ... door to informed medical care. “OR-Live,” the vision of improving health. 10

  5. Coronary Angioplasty Stent Placement

    Full Text Available ... the tests that was done was a nuclear stress image study. And that study, as I mentioned earlier, suggested that there was a defect or decreased blood flow on the lateral wall of ... you have a false positive stress test. So in other words, the test was ...

  6. Coronary Angioplasty Stent Placement

    Full Text Available ... people in, because we have a saying in cardiology where time is muscle, and the quicker you ... us who have practiced the medicine or practiced cardiology from the standpoint of patient-centric view is ...

  7. Coronary Angioplasty Stent Placement

    Full Text Available ... disease. First and foremost is medical therapy. Med management is extremely important, it maybe the simplest thing ... a stress test in a year, with the knowledge that this last stress test was a false ...

  8. Coronary Angioplasty Stent Placement

    Full Text Available ... disease. First and foremost is medical therapy. Med management is extremely important, it maybe the simplest thing ... discomfort in this gentlemen, which might take some time but are not going to be quite as ...

  9. Coronary Angioplasty Stent Placement

    Full Text Available ... lower drug level, but it actually reduces the risk of cardiac events. So we’ll want to do everything with this gentleman to prevent that from happening. In absence of symptoms, we may want to repeat some kind of a stress test in a year, with the knowledge that this last stress test was a false ...

  10. Coronary Angioplasty Stent Placement

    Full Text Available ... long-term,” that has changed as a moving target. But at one point it was a year. ... deploy and very difficult to get to the target lesion. Now with the stents being as flexible ...