[Causes and outcomes of coronary arteries perforations].

Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. Aim of this study--to assess inhospital and long term outcomes in patients in whom perforation occurred during coronary intervention and elucidation of predictors of coronary artery perforation. Between May 1997 and October 2002 perforations were formed in the course of percutaneous interventions in 127 patients what amounted 1.08% of 11,793 patients, subjected to coronary interventions, and 0.77% of 16,494 treated coronary segments. Causes of perforations were complex stenoses, chronic occlusions, calcified lesions, small predicted and minimal vessel lumen, high percent stenosis, use of excimer laser or thromboextrator. Rates of arterial perforations and subsequent adverse events including cardiac tamponade and urgent coronary artery bypass surgery as well as mortality had been declining throughout observation period.

[Clinical, angiographical, and procedural causes of acute vessel closure during transluminal coronary intervention]. / Klinicheskie, angiograficheskie i protsedurnye prichiny vnezapnogo zakrytiia sosuda vo vremia transliuminal'nogo koronarnogo vmeshatel'stva.

AIM: To elucidate factors related to acute vessel closure (AVC) after transluminal coronary intervention. METHODS: From population of 10439 patients subjected to transluminal coronary intervention 2 groups were formed: with (n=885) and without (n=885) acute vessel closure (AVC). Twenty five clinical, angiographical and procedural characteristics of patients of these 2 groups were included into mono and multifactorial logistic regression analysis. RESULTS AND CONCLUSION: The following factors were univariate predictors of acute vessel closure: smoking [odds ratio (OR) 1.42], unstable angina (OR=2.130, acute myocardial infarction within previous 24 hours (OR 2.76), cardiogenic shock (OR 4.31), urgent procedure (OR 1.94), eccentric stenosis (OR 1.67), calcified lesion (OR 2.21), preexisting thrombosis (OR 3.79), lacerated complicated stenosis (OR 2.02), tortuous lesion (OR 1.35), low operator experience (OR 3.37), balloon angioplasty as sole procedure (OR 1.66), concomitant rheolytic thrombectomy (OR 1.95), urgent stenting (OR 1.45). Elective stenting significantly lowered risk of acute vessel thrombosis. Multifactorial step-up analysis selected the following independent predictors of AVC: smoking, acute myocardial infarction within previous 24 hours, cardiogenic shock, preexisting thrombosis, lacerated complicated stenosis, and concomitant rheolytic thrombus extraction. Thus only elective stenting significantly reduced risk of AVC.

[Prospective analysis of conservative treatment of acute coronary syndrome]. / Prospektivnyi analiz konservativnogo lecheniia ostrogo koronarnogo sindroma.

The in-hospital and intermediate outcomes in 341 patients with acute coronary syndrome treated with conservative (non-invasive) interventions were analysed. The coronary reperfusion was achieved in 59% patients with acute myocardial infarction (MI) treated with thrombolysis, but in 27% patients with MI treated only heparin and aspirin. In-hospital survival was 91% in 93 patients with MI treated with thrombolysis and 82% in 71 patients with MI without thrombolysis. On 6 month survival was 86% in patients with MI treated with thrombolysis, 70% in patients with MI without thrombolysis, 79% in patients with non-Q-wave MI and 88% in patients with unstable angina.