RESUMO
Drug-eluting stents (DES) are widely used for the treatment of coronary artery disease, and a sirolimus-eluting stent (SES; Cypher) was the first DES introduced into clinical practice. Although pathological reactions of coronary arteries to SES have been described in autopsy cases, there are few reports regarding calcification of the coronary arteries after SES implantation. The present report describes the findings of an autopsy conducted 16 months after SES implantation that showed remarkable persistent calcification. In addition, previously reported pertinent pathological findings are also described.
Assuntos
Calcinose/patologia , Doença da Artéria Coronariana/patologia , Stents Farmacológicos/efeitos adversos , Parada Cardíaca/patologia , Intervenção Coronária Percutânea/métodos , Sirolimo/administração & dosagem , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Autopsia , Calcinose/complicações , Doença da Artéria Coronariana/terapia , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Humanos , Fatores de TempoAssuntos
Inibidores da Colinesterase/efeitos adversos , Doença por Corpos de Lewy/tratamento farmacológico , Fenilcarbamatos/efeitos adversos , Parada Sinusal Cardíaca/induzido quimicamente , Parada Sinusal Cardíaca/epidemiologia , Idoso de 80 Anos ou mais , Inibidores da Colinesterase/administração & dosagem , Inibidores da Colinesterase/uso terapêutico , Comorbidade , Eletrocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Doença por Corpos de Lewy/epidemiologia , Fenilcarbamatos/administração & dosagem , Fenilcarbamatos/uso terapêutico , RivastigminaRESUMO
AIM: We evaluated the effect of pimobendan, a positive inotropic agent, in elderly patients with frequent readmission as a result of heart failure despite conventional therapy. METHODS: Pimobendan was given to five male patients with severe chronic heart failure (New York Heart Association class III-IV) (age range 69-89 years; mean 78 ± 8 years; ischemic cardiomyopathy in three cases, dilated cardiomyopathy in two cases) who required repeated admission for heart failure despite conventional therapy with angiotensin inhibitors, beta-blockers, diuretics and anti-arrhythmic agents. After the addition of pimobendan at a dose of 1.25-3.75 mg/day, we evaluated serum levels of brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), septal e' and left ventricular end-diastolic diameter (LVDD) by echocardiography, as well as readmission rates for more than 2 years. RESULTS: The serum level of BNP significantly decreased after treatment with pimobendan, although its level returned to pretreatment levels after 2 years. LVEF significantly improved after the treatment, with the improvement continuing beyond the 2 years, although LVDD did not change after treatment. Septal e' significantly improved after the treatment, although its level returned to pretreatment levels at 2 years after the treatment. Readmission rates significantly decreased for 2 years after the treatment, although one patient required cardiac resynchronization therapy for severe heart failure, and another patient required cardiac pacemaker implantation for sick sinus syndrome 2 years after adding pimobendan. CONCLUSIONS: Pimobendan in conjunction with conventional therapy for heart failure decreases the readmission rate in elderly patients with severe heart failure for at least 2 years.