Impact of Bivalirudin Use on Outcomes in Nonagenarians Undergoing Percutaneous Coronary Intervention

Background: With an aging population, nonagenarians constitute an increasing percentage of patients with coronary artery disease. The aim of this study was to determine the predictors and outcome of nonagenarians undergoing percutaneous coronary intervention (PCI) for symptomatic coronary artery disease. Methods: From 2002 to 2007, a cohort of 171 consecutive nonagenarians underwent PCI and stent implantation in our center. Patients given bivalirudin (n = 79) during the procedure were compared to those given heparin (n = 92). In‐hospital and 6‐month rates of major adverse cardiovascular events (MACE) including death, myocardial infarction (MI), and target lesion revascularization were indexed. In‐hospital bleedings were also indexed. Results: The mean age was 92.5 ± 2.5 years. The population was 52% female. Nearly 30% of patients had diabetes mellitus and >25% had renal failure. The mean left ventricular ejection fraction was 45%± 14%. The clinical presentation was an acute MI in 59% of the cases. The in‐hospital rates of death and bleedings were 4.1% and 17.5%, respectively. Clinical presentations as MI or cardiogenic shock were associated with high rates of in‐hospital death: 19.3% and 30%, respectively. Bivalirudin use was associated with a 41.5% decrease in in‐hospital bleedings. The 6‐month incidence of MACE was 13.6% and was driven by death. Predictors of 6‐month outcomes were clinical presentations as MI or cardiogenic shock, renal failure, and total stent length. Conclusion: Nonagenarians represent a particular population with a high percentage of females and a high incidence of comorbidities. In this study, we highlighted that nonagenarians have logically a worse prognosis than is reported in younger patients, with especially high rates of in‐hospital bleedings. Bivalirudin use was associated with an important decrease in in‐hospital bleedings; thus, it should be systematically considered in such patients to improve early outcome.     

经皮股动脉穿刺冠状动脉介入诊疗术后人工压迫止血早期下地活动的临床观察

目的:观察经皮股动脉穿刺冠状动脉介入诊疗术后患者早期下地活动的可行性和安全性。方法:130例行冠状动脉介入诊断和治疗的患者在拔除6F动脉鞘管6h后下地活动,观察其穿刺点并发症的发生。结果:130例141个穿刺部位中发生小血肿8处,皮下淤血8处,小渗血3处,发生腹膜后血肿1处,随访1~3d,无严重出血并发症。结论:经皮股动脉穿刺冠状动脉介入诊疗术后6h下地活动是可行和安全的,可以减少患者的不适和降低患者住院费用。     

Atrial Fibrillatory Wall Motion and Degree of Atrial Remodeling in Patients with Atrial Fibrillation: A Tissue Velocity Imaging Study

Introduction: The atrial fibrillation cycle length (AFCL) and the intracardiac atrial electrogram morphology may be used to characterize atrial fibrillation (AF). However, assessment of these parameters requires an invasive electrophysiological study. We assessed clinical and electrophysiological correlates of noninvasive tissue velocity imaging (TVI) of the right and left atrial myocardial fibrillatory wall motion. Methods and Results: We performed an electrophysiological study in 12 patients with AF referred for His bundle ablation. Using atrial electrograms, we determined the AFCL (AFCL‐egm) and electrophysiological AF type. Simultaneously, transthoracic echocardiography was performed. We used the TVI traces to determine the cycle length of the atrial fibrillatory wall motion (AFCL‐tvi) and atrial fibrillatory wall velocities (AFV‐tvi). AFCL‐tvi matched very well with AFCL‐egm (r²= 0.98; P < 0.001), both in the left and right atrium. Patients with permanent AF had shorter AFCL‐tvi (155 ± 15 ms vs 216 ± 23 ms; P < 0.001), higher AFCL‐tvi variability, and lower AFV‐tvi compared to patients with paroxysmal AF. Three electrophysiological AF types were found based on the morphology of the electrograms and these related to specific TVI patterns. Conclusion: TVI of the atrial fibrillatory wall motion may enhance noninvasive characterization of atrial remodeling in patients with atrial fibrillation.     

A cadaveric study of the motor nerves to the levator scapulae muscle

Understanding the surgical anatomic relationships of the motor nerves to the levator scapulae muscle is imperative for reducing postoperative shoulder dysfunction in patients undergoing neck dissection. To elucidate this relevant anatomy, cervical (C3, C4) and brachial (C5 via dorsal scapular nerve) plexi contributions to the levator scapulae were assessed with respect to posterior triangle landmarks in 37 human cadaveric necks. An average of approximately 2 (actual 1.92) nerves from the cervical plexus (range 1 to 4 nerves) emerged from beneath the posterior border of the sternocleidomastoid muscle in a cephalad to caudad progression to enter the posterior triangle of the neck on their way to innervating the levator scapulae. These cervical plexus contributions exhibited a fairly regular relationship to the emergence of cranial nerve XI and the punctum nervosum along the posterior border of the sternocleidomastoid muscle. After emerging from the posterior border of the sternocleidomastoid to enter the posterior triangle of the neck, cervical plexus contributions to the levator scapulae traveled for a variable distance posteriorly and inferiorly, sometimes branching or coming together. Ultimately these nerves crossed the anterior border of the levator scapulae as 1 to 3 nerves (average 1.94) in a regular superior to inferior progression. The dorsal scapular nerve from the brachial plexus exhibited highly variable anatomic relations in the inferior aspect of the posterior triangle, and was found to penetrate or give branches to the levator scapulae in only 11 of 35 neck specimens. We have found that the levator scapulae receives predictable motor supply from the cervical plexus. Our data elucidate surgical anatomy useful to head and neck surgeons. (Otolaryngol Head and Neck Surg 1997;117:671-80.)     

The Recovery of the Testis over 8 Weeks after Short-Term Dosing with Ethylene Glycol Monomethyl Ether: Histology, Cell-Specific Enzymes, and Rete Testis Fluid Protein

The Recovery of the Testis over 8 Weeks after Short-Term Dosingwith Ethylene Glycol Monomethyl Ether Histology, Cell-SpecificEnzymes, and Rete Testis Fluid Protein. CHAPIN, R. E., DUTTON,S. L., ROSS, M. D., SWAISGOOD, R. R., AND LAMB, J. C, IV (1985)Fundam. Appl. Toxicol. 5, 515–525. Ethylene glycol monomethylether (EGME) has been found to affect meiotic spermatocytes,spermatids, other stages of spermatocytes, and spermatogonia,depending on the dose used. These studies, which examine testicularrecovery from EGME treatment, analyzed tissues from rats treatedfor 5 days with 0, 50, 100, or 200 mg EGME/kg/day and sacrificedat eight subsequent weekly intervals; some epididymal spermparameters of these animals have been described. Histologically,the testes of the low-dose group showed very mild changes, whilethe 100- and 200-mg/kg groups showed widespread damage and celldeath which recovered somewhat during the course of the study.There was no treatment-related effect on seminal vesicle orprostate weights. Rete testis fluid protein levels were changedonly in the high-dose group, when protein levels rose to a maximumof sixfold the control values at Week 4; by Week 6, there wasno difference between groups. Changes in cell-specific enzymeactivities were dose dependent and generally mirrored changesin the number of germ cells in the testis