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52.
《The Egyptian Heart Journal》2014,66(3):251-257
BackgroundGlycoprotein IIb/IIIa inhibitor therapy during primary percutaneous coronary intervention (PCI) decreases the incidence of major adverse cardiac events.AimTo study the impact of high bolus dose tirofiban on left ventricular ejection fraction in patients with acute anterior ST segment elevation MI treated with primary PCI.Patients and methodsForty patients presenting to Ain Shams University, and specialized hospitals with the diagnosis of acute anterior STEMI were treated with primary PCI. Twenty patients were given conventional intravenous bolus dose tirofiban (10 μg/kg) upstream prior to primary angioplasty and twenty patients were given intravenous high bolus dose tirofiban (25 μg/kg) upstream prior to PCI. In-hospital follow up was done including echocardiography, and serial cardiac enzymes in addition to clinical follow up for MACE and bleeding complications.ResultsSuccessful primary angioplasty was attained in all patients. The LV systolic function was significantly better in the high bolus dose group in comparison to the conventional bolus dose groups (48% vs 41%, P < 0.01). The incidence of recurrent ischemia was statistically non-significant between the two groups (5% vs 25%, P > 0.05). Both regimens were safe and the bleeding complications were minimal and did not differ between the study groups.ConclusionIn patients presenting with acute anterior STEMI and treated with primary PCI, the high bolus dose tirofiban given intravenously upstream prior to PCI seems to be a safe and effective regimen to achieve a better left ventricular ejection fraction in comparison to the conventional bolus dose regimen, without increasing the risk of bleeding. 相似文献
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54.
Jyunya Matsumi MD Shigeru Saito MD FACC FSCAI 《Catheterization and cardiovascular interventions》2008,71(6):810-814
After the introduction of the retrograde approach in percutaneous coronary intervention for chronic total occlusion (CTO), different kinds of strategies and techniques have been developed in order to achieve final success. However, it has not been fully demonstrated whether these strategies and techniques can really improve the final result. We observed one case, for which the initial attempt of the retrograde approach for a CTO lesion was unsuccessful despite the successful approach of a retrograde guidewire to the lesion, and with the second retrograde approach 3 years later being eventually successful by using various kinds of strategies and techniques. This case clearly demonstrates how the final success through the retrograde approach can be achieved by using a combination of the improved strategies and techniques for CTO lesions. © 2008 Wiley‐Liss, Inc. 相似文献
55.
Santiago Jimenez-Valero Belen Santos Fernando Pajin Tomas Canton Esther Lazaro Jose Moreu Gonzalo Hernandez Luis Rodriguez Padial 《Catheterization and cardiovascular interventions》2007,70(4):492-497
OBJECTIVES: The aim of our study was to evaluate the safety and midterm clinical results of dexamethasone-eluting stent (DexES) implantation in ST-segment elevation acute myocardial infarction (STEMI). BACKGROUND: Inflammation plays a pivotal role in both inestabilization of coronary atherosclerotic plaques and development of restenosis after stent placement. Antiinflammatory agents may attenuate those mechanisms and improve clinical outcomes. There is little information about clinical results of DexES and no data are available about their utilization during percutaneous coronary intervention (PCI) in STEMI. METHODS: Consecutive patients with STEMI that underwent primary or rescue PCI in our institution were treated with DexES. Clinical follow-up with routine realization of noninvasive test for detection of myocardial ischemia and coronariography if necessary, were performed. The objective of the study was to evaluate the rate of MACE (death, reinfarction, or target lesion revascularization) during midterm follow-up. RESULTS: The procedure was successful in 96.7% of cases. There were no in-hospital deaths or reinfarctions. One acute stent thrombosis occurred and no subacute thrombosis were observed. During a mean follow-up period of 384 days, cardiac-related death was 1.1%, there were no reinfarctions or late stent thrombosis and target lesion revascularization rate was 4.2%. CONCLUSION: We conclude that utilization of DexES for PCI in STEMI is safe and provides good midterm clinical outcomes. 相似文献
56.
Background: ST‐segment elevation myocardial infarction (STEMI) mandates rapid percutaneous coronary intervention (PCI) for optimal outcomes. The aim of this study was to assess our hospital practice for managing acute STEMI, identify processes associated with time delays, instrument changes to our acute STEMI management protocol and assess their effectiveness for improving our door‐to‐balloon time. Methods: We aimed to achieve this through the establishment of a quality improvement programme involving the cardiology and emergency departments. We analysed consecutive patients presenting with STEMI (April to September 2005 (group A) and the corresponding period in 2006 (group B), and compared patients presenting ‘in hours’ (0700 hours to 1800 hours (Monday to Friday)) versus ‘out of hours’ (all other times including public holidays). Results: In group A, 38 patients presented with a STEMI. Assessing time‐to‐treatment analysis, the median door to balloon time for primary PCI was significantly greater for ‘out of hours’ than ‘in hours’ (120 vs 67 min). The greatest time delay to PCI was from the PCI decision time to catheter laboratory arrival. Local changes were implemented to improve ‘out of hours’ times, including initiation of ‘Code AMI’. There were 59 patients in group B. We found that our changes led to a 29% improvement in ‘out of hours’ door‐to‐balloon time (median time 82 min, P = 0.005) with 69% being managed ≤90 min (P = 0.049) (group B). Conclusion: We have shown that ongoing review through a quality improvement programme improves door‐to‐balloon times, which is integral in the optimal management of patients with acute STEMI treated with primary PCI. 相似文献
57.
Cardiac catheterization through ipsilateral radial and ulnar artery access during the same procedure
Dilip Kumar Madhumanti Panja Ashesh Halder Soumya Patra Arindam Pande Sanjeev Salil Kumar Mukherjee Rana Rathor Roy Ejaz Ahmad Bari Anil Kumar Singhi 《Indian heart journal》2021,73(3):387-388
We evaluated the safety and feasibility of ipsilateral radial and ulnar artery cannulation during the same catheterization procedure. Crossover from radial to femoral was done in 122 patients. Both ipsilateral radial and ulnar catheterization were performed in 16 patients without any complications, which was further supported by Doppler ultrasonography. 相似文献
58.
Tae-Min Rhee Kyung Woo Park Chi-Hoon Kim Jeehoon Kang Jung-Kyu Han Han-Mo Yang Hyun-Jae Kang Bon-Kwon Koo Hyo-Soo Kim 《JACC: Cardiovascular Interventions》2018,11(24):2453-2463
Objectives
The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.Background
There are limited data regarding the optimal PCI strategy for LM bifurcation lesions with new-generation drug-eluting stents.Methods
A patient-level pooled analysis of 5 nationwide multicenter registries was performed. Rates of target lesion failure, thrombotic adverse cardiovascular events, and their individual components at 3-year were analyzed. Subgroup analysis according to DAPT duration was performed.Results
From 13,172 patients undergoing PCI with new-generation drug-eluting stents, a total of 700 patients were treated for LM bifurcation lesions, 567 with a 1-stent strategy and 133 with a 2-stent strategy. Rates of target lesion failure and target lesion revascularization were higher in the 2-stent group, driven mainly by complex lesion profiles. Risks for thrombotic adverse cardiovascular events and its components were comparable between the 2 strategies. Subgroup analysis showed that risks for target lesion failure and thrombotic adverse cardiovascular events in the 2-stent group were significantly higher than in the 1-stent group in those with DAPT interruption <1 year, while they were similar in those receiving DAPT maintenance ≥1 year.Conclusions
Up to 20% of patients who underwent LM bifurcation PCI eventually required a 2-stent strategy, which was as safe as a 1-stent strategy with the use of new-generation drug-eluting stents. Careful pre-emptive case selection as well as prolonged DAPT may be necessary when considering a 2-stent strategy in LM PCI given its higher rate of repeat revascularization and lesion failure than the 1-stent approach. 相似文献59.
《Journal of the American College of Cardiology》2020,75(6):590-604
BackgroundThe majority of stent-related major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) are believed to occur within the first year. Very-late (>1-year) stent-related MACE have not been well described.ObjectivesThe purpose of this study was to assess the frequency and predictors of very-late stent-related events or MACE by stent type.MethodsIndividual patient data from 19 prospective, randomized metallic stent trials maintained at a leading academic research organization were pooled. Very-late MACE (a composite of cardiac death, myocardial infarction [MI], or ischemia-driven target lesion revascularization [ID-TLR]), and target lesion failure (cardiac death, target-vessel MI, or ID-TLR) were assessed within year 1 and between 1 and 5 years after PCI with bare-metal stents (BMS), first-generation drug-eluting stents (DES1) and second-generation drug-eluting stents (DES2). A network meta-analysis was performed to evaluate direct and indirect comparisons.ResultsAmong 25,032 total patients, 3,718, 7,934, and 13,380 were treated with BMS, DES1, and DES2, respectively. MACE rates within 1 year after PCI were progressively lower after treatment with BMS versus DES1 versus DES2 (17.9% vs. 8.2% vs. 5.1%, respectively, p < 0.0001). Between years 1 and 5, very-late MACE occurred in 9.4% of patients (including 2.9% cardiac death, 3.1% MI, and 5.1% ID-TLR). Very-late MACE occurred in 9.7%, 11.0%, and 8.3% of patients treated with BMS, DES1, and DES2, respectively (p < 0.0001), linearly increasing between 1 and 5 years. Similar findings were observed for target lesion failure in 19,578 patients from 12 trials. Findings were confirmed in the network meta-analysis.ConclusionsIn this large-scale, individual patient data pooled study, very-late stent-related events occurred between 1 and 5 years after PCI at a rate of ∼2%/year with all stent types, with no plateau evident. New approaches are required to improve long-term outcomes after PCI. 相似文献
60.
目的:探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者行急诊PCI救治时行优质护理的临床价值。方法选取急性冠状动脉综合征患者100例,随机均分为2组(n=50)。对照组行常规护理,观察组在常规护理基础上给予优质护理,比较治疗效果。结果2组患者的治疗效果差异较大,差异有统计学意义(P<0.05)。结论急性冠状动脉综合征患者行急诊PCI救治时行优质护理具有较高的临床应用价值,可以在临床中进行大力推广并普及使用。 相似文献