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1.
Ann Emerg Med ; 61(3): 339-47, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23021348

RESUMO

STUDY OBJECTIVE: Reducing door-to-balloon times for acute ST-segment elevation myocardial infarction (STEMI) patients has been shown to improve long-term survival. We aim to reduce door-to-balloon time for STEMI patients requiring primary percutaneous coronary intervention by adoption of out-of-hospital 12-lead ECG transmission by Singapore's national ambulance service. METHODS: This was a nationwide, before-after study of STEMI patients who presented to the emergency departments (ED) and required percutaneous coronary intervention. In the before phase, chest pain patients received 12-lead ECGs in the ED. In the after phase, 12-lead ECGs were performed by ambulance crews and transmitted from the field to the ED. Patients whose ECG showed greater than or equal to 2 mm ST-segment elevation in anterior or greater than or equal to 1 mm ST-segment elevation in inferior leads for 2 or more contiguous leads and symptom onset of less than 12 hours' duration were eligible for percutaneous coronary intervention activation before arrival. RESULTS: ECGs (2,653) were transmitted by the ambulance service; 180 (7%) were suspected STEMI. One hundred twenty-seven patients from the before and 156 from the after phase met inclusion criteria for analysis. Median door-to-balloon time was 75 minutes in the before and 51 minutes in the after phase (median difference=23 minutes; 95% confidence interval 18 to 27 minutes). Median door-to-balloon times were significantly reduced regardless of presentation hours. Overall, there was significant reduction in door-to-activation, door-to-ECG, and door-to-cardiovascular laboratory times. No significant difference was found pertaining to adverse events. CONCLUSION: This study describes a nationwide implementation of out-of-hospital ECG transmission resulting in reduced door-to-balloon times, regardless of presentation hours. Out-of-hospital ECG transmission should be adopted as best practice for management of chest pain.


Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio/terapia , Ambulâncias/estatística & dados numéricos , Angioplastia Coronária com Balão/normas , Eletrocardiografia/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Singapura , Fatores de Tempo , Resultado do Tratamento
2.
Eur J Cardiothorac Surg ; 42(2): 268-76; discussion 276, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22334629

RESUMO

OBJECTIVES: The feasibility of transcatheter aortic valve implantation (TAVI) in patients with a failing surgical aortic bioprosthesis has been reported from single centres. We present results from a multi-centre feasibility study in such patients followed for 1 year after TAVI. METHODS: This study evaluated 18 patients undergoing implantation with the 18-Fr CoreValve TAVI prosthesis in a failing surgical aortic bioprosthesis at three centres in Germany. Subject inclusion requirements included ≥ 75 years old and either surgical risk with logistic European System for Cardiac Operative Risk Evaluation ≥ 15% or ≥ 1 high-risk co-morbidity. RESULTS: Implanted subjects were 79 ± 4 years old, 67% males, 78% NYHA Class III/IV, with logistic EuroSCORE 34 ± 14, and had failed surgical bioprostheses from six manufacturers. The procedure was considered technically successful in 94% (17/18) of cases. One subject was converted to surgery during the procedure. Mortality at 30 days and 1 year was 11% (2/18) and 28% (5/18), respectively. Two cardiac deaths occurred, including 1 within 30 days. Two subjects had strokes, both within 30 days. After 30 days and 1 year, respectively, 86 and 73% of subjects improved at least 1 NYHA class and the remainder had no change. No aortic regurgitation was reported beyond mild (Grade 1) at 6- and 12-month follow-up. CONCLUSIONS: Most patients with a failing aortic surgical bioprosthesis were successfully implanted with a TAVI prosthesis in this multi-centre feasibility study. Outcomes at 30 days were within expectations for this very high-risk subgroup and improvements were sustained through 12 months.


Assuntos
Valva Aórtica/cirurgia , Bioprótese , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Falha de Prótese , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
3.
J Interv Cardiol ; 25(3): 235-44, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22308978

RESUMO

BACKGROUND: Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients. METHODS: This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis. RESULTS: TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 - 119.5) versus 98 (IQR 80.8 - 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 - 45.0) versus 37 (IQR 28.0 - 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups. CONCLUSION: In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI.


Assuntos
Angiografia Coronária/instrumentação , Vasos Coronários/patologia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/instrumentação , Catéteres , Angiografia Coronária/métodos , Estudos de Viabilidade , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Intervenção Coronária Percutânea/métodos , Artéria Radial , Estudos Retrospectivos , Resultado do Tratamento
5.
Am J Cardiol ; 108(6): 893-5, 2011 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-21726839

RESUMO

Percutaneous interventions for valvular heart disease are rapidly gaining momentum. Transcatheter aortic valve implantation for aortic stenosis in patients with high surgical risk and percutaneous mitral valve repair with the MitraClip have been shown to be noninferior to surgery. Little is known about the combination of these interventions in patients with mixed valvular disease. The investigators present 2 patients, both with acute device successes but contrasting outcomes, and attempt to glean some insights from these patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Insuficiência da Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Bioprótese , Ecocardiografia , Feminino , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem
7.
Catheter Cardiovasc Interv ; 77(6): 910-4, 2011 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-21425427

RESUMO

Transcatheter aortic valve implantation (TAVI) is rapidly becoming an accepted treatment option for a selected group of high risk or inoperable patients with severe aortic stenosis. However, this procedure is not without complications. We report a case of acute type A aortic dissection due to balloon aortic valvuloplasty during TAVI that was successfully sealed by the CoreValve prosthesis, thus avoiding surgical intervention.


Assuntos
Aneurisma Aórtico/etiologia , Dissecção Aórtica/etiologia , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/instrumentação , Cateterismo/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Doença Iatrogênica , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/diagnóstico , Aortografia/métodos , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Desenho de Prótese , Radiografia Intervencionista , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
8.
Catheter Cardiovasc Interv ; 77(7): 1071-5, 2011 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-21413126

RESUMO

Transcatheter aortic-valve implantation is rapidly emerging as an effective, safe, and sustainable alternative for a specific subset of high-surgical risk and/or inoperable patients with severe aortic stenosis. However, technical challenges remain for this relatively new procedure, not the least mal-positioning of the transcatheter prosthesis resulting in acute aortic regurgitation. We report a case of deep implantation of a CoreValve prosthesis that was inadvertently pulled out of the aortic annulus during repositioning. The patient received a second sequential CoreValve successfully.


Assuntos
Insuficiência da Valva Aórtica/terapia , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/efeitos adversos , Cateterismo , Angiografia Coronária , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Desenho de Prótese , Radiografia Intervencionista , Resultado do Tratamento
9.
Ann Acad Med Singap ; 38(12): 1085-9, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20052445

RESUMO

INTRODUCTION: Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in hospitals without on-site cardiac surgery capability, despite receiving only a class IIb recommendation in the ACC/AHA practice guidelines, can be performed effectively and safely. We reviewed the fi rst 3 years of our experience. MATERIALS AND METHODS: This is a retrospective single centre review of all patients receiving primary PCI for STEMI between 2003 and 2005. Demographic, procedural and outcome data were analysed. RESULTS: There were 259 patients who underwent primary PCI. The mean age was 55.3 +/- 12.3 years. Median door-to-balloon time was 97.5 minutes and 45.2% and 52.9% had anterior and inferior STEMI, respectively. The majority of patients presented with Killip class I (87.6%); however, 5.8% were in Killip class IV. Single vessel disease was found in 47.1%. Angiographic PCI success (defined as residual stenosis <50% with TIMI 3 fl ow) was achieved in 89.1%. Usage of stents, distal protection and aspiration devices were 97.2%, 27.8% and 34.1 %, respectively; 9.3% required intra-aortic balloon pump insertion. No patients required transfer for emergency coronary bypass surgery as a result of PCI complications. Post-PCI ST resolution >50% was achieved in 80.6%. The mean post-infarct left ventricular ejection fraction was 44.1%. In-hospital, 30-day, 6-month and 1-year mortality rates were 2%, 2.8%, 4.0% and 4.8%, respectively. Clinically driven target lesion revascularisation rate was 2.8% at 1 year. CONCLUSIONS: Our results are comparable to those from on-site surgical centres. This supports the feasibility and safety of primary PCI in cardiac centres without on-site cardiac surgery.


Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
10.
Ann Acad Med Singap ; 36(4): 244-6, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17483852

RESUMO

INTRODUCTION: Intravenous thrombolysis has been shown to improve outcome after acute cerebral infarction if given within 3 hours of symptom onset. There are no data in Singapore on the timing of hospital presentation after acute cerebral infarction as well as factors and reasons for delayed presentation. MATERIALS AND METHODS: As intravenous thrombolysis has recently been licensed for use in acute cerebral infarction in Singapore, we studied 100 consecutive acute cerebral infarction admitted to the Singapore General Hospital for timing of hospital presentation, reasons associated with delay in presentation and hypothetical acceptance of intravenous thrombolysis. RESULTS: Only 9% of patients presented to hospital within 2 hours of symptom onset. Factors associated with hospital presentation within 2 hours were a large stroke and lack of pre-hospital consultation. Failure to recognise the severity of symptoms and inability to seek medical attention unaided were the 2 most common reasons for delayed presentation. One-third of patients or their relatives hypothetically would accept intravenous thrombolysis, suggesting that a thrombolysis service is feasible at the Singapore General Hospital. However, it would be hindered by the low proportion of patients who present early to hospital after symptom onset. CONCLUSION: Our results support the need for a public education programme to highlight the identification of stroke symptoms and the need to present to hospital as soon as possible after the onset of stroke symptoms.


Assuntos
Infarto Cerebral/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Resultado do Tratamento , Doença Aguda , Idoso , Infarto Cerebral/fisiopatologia , Serviço Hospitalar de Emergência , Feminino , Hospitais Gerais , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Singapura , Fatores de Tempo
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