RESUMO
Of 634 consecutive patients who had percutaneous coronary intervention (PCI) for acute coronary syndromes, 34 (5%) had major bleeding after PCI, 253 (40%) had minor bleeding after PCI, and 347 (55%) had no bleeding after PCI. Significant independent risk factors for major bleeding after PCI were increased troponin I level (P = 0.004; odds ratio [OR] = 4.7), prior coronary artery disease (P = 0.029; OR = 3.7), platelet glycoprotein IIb/IIIa inhibitors (P = 0.002; OR = 9.8), glomerular filtration rate (GFR) <30 versus >or=60 mL/min/1.73 m(2) (P < 0.0001; OR = 39.7), GFR 30-59 versus >or=60 mL/min/1.73 m(2) (P = 0.0001; OR = 9.4), and clopidogrel loading dose >300 mg (P = 0.0001; OR = 8.9). Significant independent risk factors for minor bleeding after PCI were increased troponin I level (P = 0.0004; OR = 2.1), platelet glycoprotein IIb/IIIa inhibitors (P = 0.039; OR = 2.4), GFR 30-59 versus >or=60 mL/min/1.73 m(2) (P < 0.0001; OR = 2.5), thrombolytics (P = 0.01; OR = 2.7), clopidogrel loading dose >300 mg (P < 0.0001; OR = 4.2), and systolic blood pressure during PCI (P < 0.0001; OR = 1.03 per mm Hg). In-hospital deaths included 5 of 34 patients (15%) with major bleeding, none of 253 patients (0%) with minor bleeding, and none of 347 patients (0%) with no bleeding (P < 0.0001). Hospital duration was 11.0 days in patients with major bleeding, 3.4 days in patients with minor bleeding, and 1.8 days in patients with no bleeding (P < 0.0001).
Assuntos
Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão/efeitos adversos , Hemorragia/etiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/métodos , Pressão Sanguínea , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Fatores de Risco , Índice de Gravidade de Doença , Troponina I/metabolismoRESUMO
We investigated the prevalence of in-hospital complications in 500 patients undergoing percutaneous coronary intervention (PCI) treated with heparin 5000 IU administered systemically (group 1) at the time of PCI versus in 500 age-matched and sex-matched patients undergoing PCI treated with heparin 70 IU/kg administered systemically (group 2) at the time of PCI. There was no significant difference in baseline characteristics, indications for PCI, cardiovascular drug therapy at the time of PCI, prevalence of 1-vessel, 2-vessel, and 3-vessel obstructive coronary artery disease, and in-hospital complications between the 2 groups. In-hospital death occurred in 0.2% of group 1 patients versus 0.8% of group 2 patients. Non-ST-segment elevation myocardial infarction occurred in 0.2% of group 1 patients versus 0.4% of group 2 patients. Stroke occurred in 0.2% of group 1 patients versus 0.2% of group 2 patients. Stent thrombosis occurred in 0.2% of group 1 patients versus 0.8% of group 2 patients. Occlusion of a side branch occurred in 0.2% of group 1 patients versus 0.4% of group 2 patients. A hematoma needing intervention occurred in 0.2% of group 1 patients versus 0.2% of group 2 patients. Regression analysis showed that none of the differences between the 2 groups were significant. The sample size was adequate to conclude that a fixed low dose of heparin 5000 IU administered systemically at the time of PCI is noninferior to standard therapy with heparin.
Assuntos
Angioplastia Coronária com Balão , Anticoagulantes/farmacologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Heparina/farmacologia , Idoso , Anticoagulantes/uso terapêutico , Doença da Artéria Coronariana/mortalidade , Relação Dose-Resposta a Droga , Feminino , Heparina/uso terapêutico , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Prevalência , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/tratamento farmacológicoRESUMO
We investigated in 277 consecutive patients, mean age 63 years, with ST-segment elevation acute myocardial infarction transferred from 25 community hospitals to a tertiary percutaneous coronary intervention (PCI) center from a median distance of 21 miles the incidences of in-hospital mortality, stroke, and recurrent myocardial infarction associated with transfer times. Of the 277 patients, 158 (57%) had thrombolytic therapy at the referring hospital. Of the 277 patients, 63 (23%) had adjunctive PCI, 119 (43%) had primary PCI, and 95 (34%) had rescue PCI. Of the 277 patients, 42 (15%) were hemodynamically unstable. Median transfer times were 102 minutes with primary PCI, 119 minutes with rescue PCI, and 144 minutes for adjunctive PCI (P < 0.0001 for adjunctive PCI versus primary PCI; P = 0.011 for adjunctive PCI versus rescue PCI). Median transfer time was 98 minutes for hemodynamically unstable patients and 121 minutes for hemodynamically stable patients (P = 0.005). In-hospital death occurred in eight of 277 patients (3%). In-hospital stroke occurred in three of 277 patients (1%). In-hospital recurrent myocardial infarction occurred in none of 277 patients (0%). There was no association of transfer times with in-hospital mortality or stroke. In-hospital mortality occurred in three of 112 patients (3%) who had bare metal stents and in five of 165 patients (3%) who had drug-eluting stents.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Transferência de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Recidiva , Acidente Vascular Cerebral/epidemiologia , Terapia TrombolíticaRESUMO
BACKGROUND: To investigate the 5-year survival of patients with coronary angiographic evidence of no coronary artery disease (CAD), nonobstructive CAD, and revascularized 1-vessel, 2-vessel, and 3-vessel obstructive CAD. MATERIAL/METHODS: Coronary angiography was performed in 2,057 unselected patients, mean age 69 years (57% men and 43% women), with an acute coronary syndrome (50%) or anginal chest pain.(50%). RESULTS: Of 2,057 patients, 760 (37%) had obstructive CAD with >50% obstruction of at least 1 major coronary artery (left anterior descending, left circumflex, and right coronary) and were revascularized, 695 (34%) had nonobstructive CAD (<50% obstruction), and 602 (29%) had normal coronary arteries. At 60+/-16-month follow-up, all-cause mortality occurred in 41 of 602 patients (7%) with no CAD (group 1), in 80 of 695 patients (12%) with nonobstructive CAD (group 2), in 50 of 302 patients (17%) with revascularized 1-vessel obstructive CAD (group 3), in 47 of 201 patients (23%) with 2-vessel revascularized obstructive CAD (group 4), and in 72 of 257 patients (28%) with 3-vessel revascularized obstructive CAD (group 4). Log-rank tests to compare survival curves among the 5 groups showed p=0.004 for groups 1 versus 2; p<0.0001 for groups 1 versus 3, 1 versus 4, 1 versus 5, 2 versus 4, and 2 versus 5; and p=0.007 for groups 3 versus 5. CONCLUSIONS: Patients with nonobstructive CAD had a worse survival than those with no CAD, a nonsignificant difference in survival than those with revascularized 1-vessel obstructive CAD, and a better survival than those with revascularized 2-vessel or 3-vessel obstructive CAD.
Assuntos
Doença da Artéria Coronariana/mortalidade , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , MasculinoRESUMO
BACKGROUND: Although insertion of multiple stents into a single coronary vessel during single-vessel percutaneous coronary intervention (PCI) is common, there are no data on long-term occurrence of major adverse cardiac events (MACE) in patients treated with multiple stents versus a single stent. METHODS: The incidence of MACE (death, myocardial infarction, or target vessel revascularization) during long-term follow-up was investigated in 634 patients who underwent single-vessel PCI. Of the 634 patients, 319 (50%) had a single stent, and 315 (50%) had multiple stents inserted. Stepwise Cox regression analyses were performed to identify significant independent prognostic factors for MACE. RESULTS: At 47-month follow-up, MACE occurred in 61 of 319 patients (19%) who had a single stent versus in 57 of 315 patients (18%) who had multiple stents (P not significant). Significant independent predictors of MACE were use of vein grafts (hazard ratio = 1.94; 95% CI, 1.24-3.03; P = 0.0038) and use of drug-eluting stents (hazard ratio = 0.49; 95% CI, 0.34-0.72; P = 0.0002). CONCLUSIONS: At long-term follow-up of single-vessel PCI, the incidence of MACE was similar in patients with multiple or single stents inserted even after controlling for the length of stents.
Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Doença das Coronárias/cirurgia , Revascularização Miocárdica/instrumentação , Stents/efeitos adversos , Idoso , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Doença das Coronárias/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidade , Reoperação , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: The aim of the study was to investigate the severity of coronary artery disease (CAD) in patients who had a planar QRS-T angle >90 degrees versus Assuntos
Angiografia Coronária
, Doença da Artéria Coronariana/diagnóstico por imagem
, Doença da Artéria Coronariana/diagnóstico
, Eletrocardiografia
, Idoso
, Doença da Artéria Coronariana/complicações
, Vasos Coronários/patologia
, Feminino
, Humanos
, Hipertrofia Ventricular Esquerda/complicações
, Modelos Logísticos
, Masculino
, Pessoa de Meia-Idade
, Fatores de Risco
RESUMO
Coronary angiography was performed because of chest pain in 198 patients (146 women, 52 men; mean age 66 years) who had dual-energy x-ray absorptiometry scans of the spine and left hip because of suspected osteoporosis or osteopenia. Of the 198 patients, 53 (27%) had osteoporosis, 79 (40%) had osteopenia, and 66 (33%) had normal bone mineral density (BMD). Obstructive coronary artery disease with >50% narrowing of > or =1 major coronary artery was present in 40 of 53 patients (76%) with osteoporosis, in 54 of 79 patients (68%) with osteopenia, and in 31 of 66 patients (47%) with normal BMD (p <0.005 comparing osteoporosis with normal BMD, p <0.01 comparing osteopenia with normal BMD). In conclusion, in patients who undergo coronary angiography because of chest pain, patients with osteoporosis or osteopenia have a higher prevalence of obstructive coronary artery disease than those with normal BMD.
Assuntos
Doenças Ósseas Metabólicas/complicações , Doença das Coronárias/complicações , Estenose Coronária/complicações , Osteoporose/complicações , Absorciometria de Fóton , Idoso , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico por imagem , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Osteoporose/diagnóstico por imagem , Estudos RetrospectivosRESUMO
The prevalence of >70% narrowing of 1, 2, or 3 major coronary arteries and of 3 major coronary arteries was investigated in 2,465 patients (1,437 men, 1,028 women; mean age 69 +/- 13 years) with severe, moderate, mild, or no mitral annular calcium (MAC) diagnosed by 2-dimensional echocardiography who underwent coronary angiography for suspected coronary artery disease. Greater than 70% narrowing of 1, 2, or 3 major coronary arteries was present in 259 of 315 patients (82%) with severe MAC (group 1), in 835 of 1,052 patients (79%) with moderate or mild MAC (group 2), and in 756 of 1,098 patients (69%) with no MAC (group 3) (p <0.001 comparing group 1 with group 3 and group 2 with group 3). Greater than 70% narrowing of 3 major coronary arteries was present in 149 of 315 patients (47%) in group 1, in 366 of 1,052 patients (35%) in group 2, and in 325 of 1,098 patients (30%) in group 3 (p <0.001 comparing group 1 with group 3 and group 1 with group 2; p <0.01 comparing group 2 with group 3). In conclusion, MAC is associated with obstructive >or=1-vessel coronary artery disease and with obstructive 3-vessel coronary artery disease.
Assuntos
Calcinose/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Prevalência , Índice de Gravidade de Doença , UltrassonografiaRESUMO
Sixty-four-multislice coronary computed tomographic angiography (CTA) and coronary angiography were performed in 145 patients (mean age 67 +/- 10 years), and stress testing was performed in 47 of these patients to determine the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA and of stress testing in diagnosing obstructive coronary artery disease (CAD) in patients with suspected CAD. In 145 patients, coronary CTA had 98% sensitivity, 74% specificity, 90% positive predictive value, and 94% negative predictive value in diagnosing obstructive CAD. In 47 patients, stress testing had 69% sensitivity, 36% specificity, 78% positive predictive value, and 27% negative predictive value for diagnosing obstructive CAD, whereas coronary CTA had 100% sensitivity, 73% specificity, 92% positive predictive value, and 100% negative predictive value for diagnosing obstructive CAD. In conclusion, coronary CTA has better sensitivity, specificity, positive predictive value, and negative predictive value than stress testing in diagnosing obstructive CAD.
Assuntos
Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Teste de Esforço/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Estenose Coronária/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
The data submitted to the New York State Department of Health Coronary Angioplasty Reporting System Database on coronary angioplasties performed at Westchester Medical Center/New York Medical College from 1996 to 2005 were analyzed. Compared with 1996, during 2005, more coronary angioplasties were performed (1,624 vs 1,122), and the patients were older (mean age 64.5 vs 61.0 years, p <0.001), weighed more (84.2 vs 82.0 kg, p <0.001), had a higher mean body mass index (28.8 vs 28.3 kg/m(2), p <0.001), and had a higher prevalence of diabetes mellitus (27% vs 17%, p <0.001). The prevalence of systemic hypertension was significantly higher in 2005 (76%) than in 1996 (54%) (p <0.001). In conclusion, in 2005 compared with 1996, patients who underwent coronary angioplasty at Westchester Medical Center/New York Medical College were older, had higher body mass indexes, and had higher prevalences of diabetes mellitus and systemic hypertension.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Diabetes Mellitus , Hipertensão/complicações , Fatores Etários , Angioplastia Coronária com Balão/estatística & dados numéricos , Índice de Massa Corporal , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , New York/epidemiologia , Prevalência , Estudos RetrospectivosRESUMO
The time from the onset of symptoms of acute myocardial infarction to primary coronary angioplasty was 18 +/- 23 h in 386 men and 19 +/- 24 h in 154 women (p not significant) and 14 +/- 19 h in 27 blacks, 19 +/- 23 h in 493 whites, and 13 +/- 11 h in 20 patients of different races (p not significant). In-hospital mortality was 6% in 144 patients aged > or =70 years and 1% in 396 patients <70 years (p < 0.005). In-hospital mortality was 2% in 386 men and 4% in 154 women (p not significant). In-hospital mortality was 2% in 493 whites, 4% in 27 blacks, and 0% in 20 patients of other races (p not significant). In-hospital mortality was 6% in 143 patients with a left ventricular ejection fraction (LVEF) <40% and 1% in 397 patients with a LVEF > or =40% (p < 0.005). In-hospital mortality was 5% in 223 patients with a glomerular filtration rate (GFR) <90 ml/min and 1% in 317 patients with a GFR > or =90 ml/min (p < 0.005).
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Idoso , População Negra , Feminino , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Função Ventricular Esquerda , População BrancaRESUMO
AIMS: Bivalirudin use as a procedural anticoagulant in patients undergoing percutaneous coronary intervention (PCI) is associated with a lower incidence of thrombocytopaenia compared to other antithrombotic agents. We aimed to evaluate the prognostic impact of baseline thrombocytopaenia and early changes in platelet counts among patients undergoing PCI with exclusive use of bivalirudin. METHODS AND RESULTS: We evaluated 7,505 patients who underwent PCI over a period of eight years. Patients who received unfractionated heparin and glycoprotein IIb/IIIa receptor inhibitors were specifically excluded. Eight hundred and fifty-eight (11.4%) patients had baseline thrombocytopaenia and 451 (6.0%) developed acquired thrombocytopaenia. After adjustment for potential covariates, moderate to severe acquired thrombocytopaenia was the strongest independent predictor (HR 4.34, 95% CI: 2.13-8.84; p<0.001) of in-hospital net adverse clinical events, which included major adverse cardiac events and major bleeding complications. Age, male gender, baseline platelet count and intra-aortic balloon pump (IABP) insertion were independent predictors of in-hospital acquired thrombocytopaenia. After a mean follow-up of 2.6±1.7 years, moderate to severe baseline thrombocytopaenia (HR 2.42, 95% CI: 1.79-3.29; p<0.001), moderate to severe acquired thrombocytopaenia (HR 2.37, 95% CI: 1.13-4.97; p=0.02) and severe changes in platelet count (>67 k) were significant predictors of mortality. CONCLUSIONS: In patients undergoing PCI with bivalirudin, moderate to severe baseline and acquired thrombocytopaenia along with severe changes in platelet count are associated with higher long-term mortality.
Assuntos
Antitrombinas/uso terapêutico , Fragmentos de Peptídeos/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Trombocitopenia/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/métodos , Anticoagulantes/uso terapêutico , Feminino , Heparina/uso terapêutico , Hirudinas , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Proteínas Recombinantes/uso terapêutico , Trombocitopenia/mortalidade , Resultado do TratamentoRESUMO
Percutaneous transluminal coronary angioplasty (PTCA) was performed in all 1,050 patients hospitalized within 24 hours of symptoms of documented acute myocardial infarction (AMI) from 1998 to 2002. Hospital mortality was similar in women and men who underwent PTCA for AMI but was higher in patients aged 75 to 95 years (10%) than in patients aged 21 to 50 (2.1%, p <0.001), 51 to 64 (2.3%, p <0.001), and 65 to 74 years (4%, p <0.02). Hospital mortality was higher in patients who had PTCA for AMI during off-normal (5.8%) than normal hours (3.2%, p <0.05).
Assuntos
Angioplastia Coronária com Balão/mortalidade , Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Resultado do Tratamento , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , New York/epidemiologia , Radiografia , Fatores Sexuais , Carga de TrabalhoRESUMO
A treadmill exercise sestamibi stress test (TESST) was performed in 609 consecutive diabetic persons with a mean age of 70 years and no history of coronary artery disease (CAD) who were referred for a TESST because of chest pain or dyspnea. Of 609 patients, 301 (49%) had a predicted exercise capacity Assuntos
Complicações do Diabetes/epidemiologia
, Teste de Esforço
, Tolerância ao Exercício
, Infarto do Miocárdio/epidemiologia
, Acidente Vascular Cerebral/epidemiologia
, Idoso
, Dor no Peito
, Doença da Artéria Coronariana
, Complicações do Diabetes/mortalidade
, Dispneia
, Feminino
, Humanos
, Incidência
, Masculino
, Infarto do Miocárdio/mortalidade
, Isquemia Miocárdica
, Prognóstico
, Modelos de Riscos Proporcionais
, Estudos Prospectivos
, Acidente Vascular Cerebral/mortalidade
, Estados Unidos/epidemiologia
RESUMO
Of 529 patients with heart failure and a mean left ventricular ejection fraction of 29%, 209 (40%) were treated with cardiac resynchronization therapy (CRT) plus an implantable cardioverter-defibrillator (ICD) and 320 (60%) with an ICD. Mean follow-up was 34 months for both groups. Stepwise logistic regression analysis showed that significant independent variables for appropriate ICD shocks were statins (risk ratio = 0.35, P < .0001), smoking (risk ratio = 2.52, P < .0001), and digoxin (risk ratio = 1.92, P = .0001). Significant independent variables for time to deaths were use of CRT (risk ratio = 0.32, P = .0006), statins (risk ratio = 0.18, P < .0001), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (risk ratio = 0.10, P < .0001), hypertension (risk ratio = 24.15, P < .0001), diabetes (risk ratio = 2.54, P = .0005), and age (risk ratio = 1.06, P < .0001). In conclusion, statins reduced and smoking and digoxin increased appropriate ICD shocks. Use of CRT, statins, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers reduced mortality and hypertension, diabetes, and older age increased mortality.
Assuntos
Reanimação Cardiopulmonar/métodos , Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Ecocardiografia , Feminino , Seguimentos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Fumar/efeitos adversos , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
UNLABELLED: We investigated the prevalence of vascular complications after PCI following hemostasis in 190 patients (67% men and 33% women, mean age 64 years) treated with the AngioSeal vascular closure device (St. Jude Medical, Austin, Texas) versus 238 patients (67% men and 33% women, mean age 64 years) treated with the Mynx vascular closure device (AccessClosure, Mountain View, California). RESULTS: Death, myocardial infarction or stroke occurred in none of the 190 patients (0%) treated with the AngioSeal versus none of 238 patients (0%) treated with the Mynx. Major vascular complications occurred in 4 of 190 patients (2.1%) treated with the AngioSeal versus 5 of 238 patients (2.1%) treated with the Mynx (p not significant). Major vascular complications in patients treated with the AngioSeal included removal of a malfunctioning device (1.1%), hemorrhage requiring intervention (0.5%) and hemorrhage with a loss of > 3g Hgb (0.5%). The major vascular complications in patients treated with the Mynx included retroperitoneal bleeding requiring surgical intervention (0.8%), pseudoaneurysm with surgical repair (0.8%) and hemorrhage with a loss of > 3g Hgb (0.4%). These complications were not significantly different between the two vascular closure devices (p = 0.77). Minor complications included hematoma > 5 cm (0.5%, n = 1) within the AngioSeal group, as well as procedure failure requiring > 30 minutes of manual compression after device deployment, which occurred in 7 out of 190 patients (3.7%) treated with the AngioSeal versus 22 of 238 patients with the Mynx (9.2%) (p = 0.033). CONCLUSIONS: Major vascular complications after PCI following hemostasis with vascular closure devices occurred in 2.1% of 190 patients treated with the AngioSeal vascular closure device versus 2.1% of 238 patients treated with the Mynx vascular closure device (p not significant). The Mynx vascular closure device appears to have a higher rate of device failure.
Assuntos
Falso Aneurisma/epidemiologia , Falso Aneurisma/etiologia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Cateterismo Cardíaco/instrumentação , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/instrumentação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Idoso , Falso Aneurisma/cirurgia , Estudos Transversais , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/cirurgia , Reoperação , Espaço Retroperitoneal/cirurgiaRESUMO
BACKGROUND: There are no data comparing the long-term outcome of bare-metal stents (BMS) vs drug-eluting stents (DES) in patients with hepatitis C virus (HCV) infection. HYPOTHESIS: In patients with HCV infection, the rate of major adverse cardiac events (MACE) would be less, and the mortality rates similar, in patients treated with DES than in patients treated with BMS. METHODS: The incidence of major adverse cardiac events (MACE) during long-term follow-up, including death, myocardial infarction, and target-vessel revascularization, was investigated in HCV-infected patients who also underwent percutaneous coronary intervention with bare-metal or drug-eluting stents. RESULTS: Of 78 patients studied, BMS were placed in 41 patients and DES stents in 37 patients. Stepwise Cox regression analyses were performed to identify significant independent risk factors for MACE. At 42 +/- 11-month follow-up, MACE occurred in 9 of 41 patients (22%) in the BMS group (mean age 63 +/- 11 years, 66% men) vs in 7 of 37 patients (19%) in the DES group (mean age 61 +/- 9 years, 65% men). There was no significant difference in MACE in the BMS group vs the DES group. This persisted even after controlling for length of the stent, complexity of lesion, and other comorbidities. All-cause mortality was not significantly different in the BMS group vs the DES group (7% vs 5%). CONCLUSIONS: At long-term follow-up of HCV-infected patients with stable liver function, the rates of MACE and of all-cause mortality were similar in the BMS and DES groups.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Hepatite C/complicações , Metais , Infarto do Miocárdio/etiologia , Stents , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Feminino , Hepatite C/mortalidade , Hepatite C/fisiopatologia , Humanos , Fígado/fisiopatologia , Fígado/virologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , New York , Modelos de Riscos Proporcionais , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
No data are available comparing the long-term outcome of sirolimus-eluting stents (SESs) versus paclitaxel-eluting stents (PESs) in patients with moderate to severe renal insufficiency. The incidence of major adverse cardiac events (MACE), including death, myocardial infarction, and target vessel revascularization, during long-term follow-up were studied in patients with a glomerular filtration rate of <60 ml/min/1.73 m(2), as measured by the Modification of Diet in Renal Disease (MDRD) study equation, who also underwent percutaneous coronary intervention with drug-eluting stents. Of 428 patients studied, PESs were placed in 287 patients and SESs in 141 patients. Stepwise Cox regression analyses were performed to identify significant independent risk factors for MACE. At 47 + or - 19 months of follow-up, MACE had occurred in 49 (17%) of 287 patients in the PES group (mean age 71 + or - 11 years, 55% men) and in 31 (22%) of 141 patients in the SES group (mean age 71 + or - 12 years, 53% men). No significant difference was found in the MACE rate between the PES and SES groups. This persisted even after controlling for stent length, lesion complexity, and other co-morbidities. Also, all-cause mortality was not significantly different between the PES and SES groups (7.1% vs 8.5%, respectively). In conclusion, during long-term follow-up of patients with moderate to severe renal insufficiency, the rates of MACE and all-cause mortality were similar in the PES and SES groups.
Assuntos
Doenças Cardiovasculares/terapia , Stents Farmacológicos , Paclitaxel/administração & dosagem , Insuficiência Renal/complicações , Sirolimo/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/terapia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Estudos RetrospectivosRESUMO
OBJECTIVE: To investigate the severity of coronary artery disease by coronary angiography in age-matched and sex-matched patients with diabetes mellitus with atrial fibrillation versus sinus rhythm. METHODS: The patients included 245 men and women, mean age of 70 years, with diabetes and atrial fibrillation and 245 age-matched and sex-matched patients with diabetes and sinus rhythm who underwent coronary angiography. Baseline characteristics and indications for coronary angiography were similar in both groups. RESULTS: Greater than 50% narrowing of one, two, or three major coronary arteries were present in 229 of 245 patients (94%) with diabetes and atrial fibrillation and in 211 of 245 patients (86%) with diabetes and with sinus rhythm (P<0.01). Greater than 50% narrowing of three major coronary arteries were present in 150 of 245 patients (61%) with diabetes and atrial fibrillation and in 75 of 245 patients (31%) with diabetes and sinus rhythm (P<0.001). CONCLUSION: Patients with diabetes and atrial fibrillation have a significantly higher prevalence of greater than 50% narrowing of one or more major coronary arteries and of three major coronary arteries than patients with diabetes and sinus rhythm.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Complicações do Diabetes/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Estudos de Casos e Controles , Estenose Coronária/epidemiologia , Estenose Coronária/etiologia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de DoençaRESUMO
After thrombolytic therapy with tenecteplase for ST-segment elevation acute myocardial infarction, 376 patients were transferred from their hospital to Westchester Medical Center for percutaneous coronary intervention with stenting. Of 376 patients, 102 (27%) received bare-metal stents and 274 (73%) received drug-eluting stents with sirolimus-eluting or paclitaxel-eluting stents. At 43 months of follow-up, major adverse cardiac events occurred in 25 (25%) of 102 patients treated with bare-metal stents versus 40 (15%) of 274 patients treated with drug-eluting stents (p = 0.024). Cox regression analysis showed that significant independent prognostic factors for major adverse cardiac events were previous coronary artery bypass surgery (hazard ratio 2.2, p = 0.019), width of stent (hazard ratio 0.44, p = 0.006), and bare-metal stent (hazard ratio 1.8, p = 0.019). In conclusion, patients with bare-metal stents had a 1.8 times greater risk of developing major adverse cardiac events than did those using drug-eluting stents after controlling the confounding effects of previous coronary artery bypass surgery and stent width.