RESUMO
BACKGROUND: India has the highest burden of acute coronary syndromes in the world, yet little is known about the treatments and outcomes of these diseases. We aimed to document the characteristics, treatments, and outcomes of patients with acute coronary syndromes who were admitted to hospitals in India. METHODS: We did a prospective registry study in 89 centres from 10 regions and 50 cities in India. Eligible patients had suspected acute myocardial infarction with definite electrocardiograph changes (whether elevated ST [STEMI] or non-STEMI or unstable angina), or had suspected myocardial infarction without ECG changes but with prior evidence of ischaemic heart disease. We recorded a range of clinical outcomes, and all-cause mortality at 30 days. FINDINGS: We enrolled 20,937 patients. Of the 20,468 patients who were given a definite diagnosis, 12,405 (60.6%) had STEMI. The mean age of these patients was 57.5 (SD 12.1) years; patients with STEMI were younger (56.3 [12.1] years) than were those with non-STEMI or unstable angina (59.3 [11.8] years). Most patients were from lower middle 10,737 (52.5%) and poor 3999 (19.6%) social classes. The median time from symptoms to hospital was 360 (IQR 123-1317) min, with 50 (25-68) min from hospital to thrombolysis. 6226 (30.4%) patients had diabetes; 7720 (37.7%) had hypertension; and 8242 (40.2%) were smokers. Treatments for STEMI differed from those for non-STEMI or unstable angina. More patients with STEMI than with non-STEMI were given anti-platelet drugs (98.2%vs 97.4%); angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) (60.5%vs 51.2%); and percutaneous coronary interventions (8.0%vs 6.7%, p<0.0001 for all comparisons). Thrombolytics (96.3% streptokinase) were used for 58.5% of patients with STEMI. Conversely, fewer patients with STEMI than those with non-STEMI or unstable angina were given beta blockers (57.5%vs 61.9%); lipid-lowering drugs (50.8%vs 53.9%); and coronary bypass graft surgery (1.9%vs 4.4%, p<0.0001 for all comparisons). The 30-day outcomes for patients with STEMI were death (8.6%), reinfarction (2.3%), and stroke (0.7%). Outcomes for those with non-STEMI or unstable angina were better: death (3.7%), reinfarction (1.2%), and stroke (0.3%, p<0.0001 for all comparisons). Use of key treatments also differed by socioeconomic status: more rich patients than poor patients were given thrombolytics (60.6%vs 52.3%), beta blockers (58.8%vs 49.6%), lipid-lowering drugs (61.2%vs 36.0%), ACE inhibitors or ARB (63.2%vs 54.1%), percutaneous coronary intervention (15.3%vs 2.0%), and coronary artery bypass graft surgery (7.5%vs 0.7%, p<0.0001 for all comparisons). Mortality was higher for poor patients than for rich patients (8.2%vs 5.5%, p<0.0001). Adjustment for treatments (but not risk factors and baseline characteristics) eliminated this difference in mortality. INTERPRETATION: Patients in India who have acute coronary syndromes have a higher rate of STEMI than do patients in developed countries. Since most of these patients were poor, less likely to get evidence-based treatments, and had greater 30-day mortality, reduction of delays in access to hospital and provision of affordable treatments could reduce morbidity and mortality.
Assuntos
Cardiotônicos/uso terapêutico , Doença das Coronárias/tratamento farmacológico , Idoso , Doença das Coronárias/mortalidade , Doença das Coronárias/fisiopatologia , Eletrocardiografia , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Classe Social , Resultado do TratamentoRESUMO
14 patients who underwent balloon valvoplasty had trans-pulmonic gradient evaluated by continuous wave Doppler echocardiography. Maximum systolic gradients measured from Doppler flow velocities were correlated with peak to peak gradient obtained at cardiac catheterisation. Prior to valvoplasty, there was good correlation between the Doppler maximum gradient (92.85 +/- 34.7mm Hg) and the peak to peak catheter gradient (105.57 +/- 56.60 mm Hg), (r = 0.91, p = less than 0.001). Immediately after balloon valvoplasty, the maximum Doppler gradient did not correlate with the peak to peak catheter gradient (r = 0.33, p = NS). Exclusion of patients with infundibular gradients improved the correlation coefficient between the Doppler maximum and peak to peak catheter gradient to 0.69. At late restudy following valvoplasty, when regression of infundibular stenosis was noted in 6 out of 8 patients, the Doppler maximum and catheter peak to peak gradient had excellent correlation (r = 0.97, p = less than 0.001). In patients with lone valvular gradient immediately following valvoplasty and at late restudy, maximum Doppler gradients correlated well with catheter gradients in 14 estimations (r = 0.66, p = less than 0.01). This study shows that the non-invasive quantification of pulmonary valve stenosis can be reliably undertaken, using continuous wave Doppler echocardiography before balloon valvoplasty and during follow-up, after the procedure when the infundibular stenosis has regressed. The presence of an infundibular gradient immediately after balloon dilatation makes the Doppler prediction less reliable.
Assuntos
Cateterismo , Ecocardiografia Doppler , Estenose da Valva Pulmonar/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Valor Preditivo dos TestesRESUMO
Strokes following cardiac surgery occur in about 5% of patients. Intra-arterial thrombolysis is a good option in such a setting where intravenous thrombolysis is contraindicated, and when in-hospital strokes are detected well within the window for treatment and the chances of complete reperfusion are maximum. On postoperative day 4 after atrial septal defect correction, a 34-year-old woman with paroxysmal atrial fibrillation developed left middle cerebral artery stroke causing severe neurological deficits. Intra-arterial thrombolysis with urokinase led to remarkable recovery.
Assuntos
Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Angiografia Cerebral , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
Coronary artery disease involving both coronary ostia (left main and right coronary) is extremely rare in a premenopausal female, without pre-existing coronary risk factors. We report a case of tight bilateral coronary ostial disease which presented in unusual clinical circumstances in a young female, which was successfully revascularized by single-stage aorto-ostial cutting balloon angioplasty and stenting.
Assuntos
Angioplastia Coronária com Balão , Doenças da Aorta/terapia , Estenose Coronária/terapia , Stents , Adulto , Doenças da Aorta/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , RadiografiaRESUMO
Aneurysm of the peripheral pulmonary arteries is rare. Rupture of pulmonary artery aneurysms manifesting as recurrent hemoptysis with exsanguination is well recognized. We report the case of a young woman who presented with massive hemothorax and shock at the sixth month of pregnancy due to a ruptured lingular artery aneurysm. She was treated with selective coil embolization of the lingular artery to achieve hemostasis. Subsequently, clot evacuation from the pleural space was done. This case is reported for its unsuspected presentation, rarity and to highlight the use of catheter coil embolization to achieve control of bleeding and exclusion of the aneurysm from the pulmonary circulation.
Assuntos
Aneurisma Roto/complicações , Aneurisma Roto/terapia , Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Adulto , Aneurisma Roto/patologia , Feminino , Humanos , Artéria Pulmonar/patologiaAssuntos
Calcinose/diagnóstico por imagem , Cardiopatias/fisiopatologia , Pericárdio/patologia , Cateterismo Cardíaco , Eletrocardiografia , Cardiopatias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Radiografia , Função Ventricular Esquerda , Função Ventricular DireitaAssuntos
Angioplastia com Balão/estatística & dados numéricos , Doenças das Valvas Cardíacas/terapia , Sistema de Registros , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Adolescente , Adulto , Coartação Aórtica/cirurgia , Estenose da Valva Aórtica/terapia , Criança , Feminino , Comunicação Interatrial/cirurgia , Humanos , Índia , Masculino , Estenose da Valva Mitral/terapia , Estenose da Valva Pulmonar/terapia , Estenose da Valva Tricúspide/terapiaRESUMO
Cerebral thromboembolism is a serious complication. Early recognition and rapid reperfusion can prevent long-term neurological morbidity. We report a case of successful intra-arterial thrombolysis for middle cerebral artery embolic stroke during percutaneous mitral commissurotomy, which resulted in complete neurological recovery.
Assuntos
Implante de Prótese de Valva Cardíaca , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/etiologia , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/etiologia , Estenose da Valva Mitral/cirurgia , Ativadores de Plasminogênio/uso terapêutico , Terapia Trombolítica , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Adulto , Anticoagulantes/uso terapêutico , Angiografia Cerebral , Ecocardiografia Transesofagiana , Feminino , Heparina/uso terapêutico , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infusões Intra-Arteriais , Complicações Intraoperatórias/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
We report a rare complication due to fracture of the blade of a cutting balloon in the setting of a tough nondilatable restenotic lesion. This resulted in a mural hematoma as a result of dissection of coronary artery.