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1.
Int J Cardiol ; 230: 175-180, 2017 Mar 01.
Article in English | MEDLINE | ID: mdl-28062147

ABSTRACT

BACKGROUND: Percutaneous coronary intervention (PCI) is effective therapy for significant atherosclerotic coronary artery disease. Despite medical and technological advances in PCI, periprocedural myocardial infarction (PMI) remains a common complication. The frequency and factors associated with PMI have been well investigated in the developed world, yet there is a paucity of data from the developing world, especially Sub-Saharan Africa. METHODS: We prospectively enrolled 153 adult patients undergoing PCI at the Charlotte Maxeke Johannesburg Academic Hospital from the 1st of February 2014 to 31st October 2014. Periprocedural Creatinine Kinase-MB and hs-Troponin I were routinely measured before PCI and at 16-24h post-procedure. The third universal definition of myocardial infarction was used to define a PMI event. RESULTS: 152 participants met the inclusion criteria and were analysed for PMI. 70.4% participants were male. The mean age was 58.8 (SD 10.9) years old. Sixteen (10.5%) participants fulfilled the criteria for PMI. Side branch pinching with preserved TIMI III flow was noted in 62.5% of PMI cases. Duration of procedure (P=0.007), right coronary artery intervention (p=0.042) and total stent length (p=0.045) were independently associated with PMI. CONCLUSION: PMI occurred in 10.5% of cases undergoing PCI. This is consistent with the prevalence of PMI internationally. Larger multicentre studies are required in our demographic region to further define relevant predictors and outcomes associated with PMI.


Subject(s)
Academic Medical Centers/statistics & numerical data , Coronary Artery Disease/surgery , Intraoperative Complications/epidemiology , Myocardial Infarction/epidemiology , Percutaneous Coronary Intervention/adverse effects , Registries , Female , Follow-Up Studies , Humans , Incidence , Intraoperative Complications/diagnosis , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Prospective Studies , Risk Factors , South Africa/epidemiology , Time Factors
3.
Am Heart J ; 165(2): 109-15.e3, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23351812

ABSTRACT

BACKGROUND: In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disability in nearly half of those affected. Attenuation of the inflammatory response in TB pericarditis may improve outcome by reducing cardiac tamponade and pericardial constriction, but there is uncertainty as to whether adjunctive immunomodulation with corticosteroids and Mycobacterium w (M. w) can safely reduce mortality and morbidity. OBJECTIVES: The primary objective of the IMPI Trial is to assess the effectiveness and safety of prednisolone and M. w immunotherapy in reducing the composite outcome of death, constriction, or cardiac tamponade requiring pericardial drainage in 1,400 patients with TB pericardial effusion. DESIGN: The IMPI trial is a multicenter international randomized double-blind placebo-controlled 2 × 2 factorial study. Eligible patients are randomly assigned to receive oral prednisolone or placebo for 6 weeks and M. w injection or placebo for 3 months. Patients are followed up at weeks 2, 4, and 6 and months 3 and 6 during the intervention period and 6-monthly thereafter for up to 4 years. The primary outcome is the first occurrence of death, pericardial constriction, or cardiac tamponade requiring pericardiocentesis. The secondary outcome is safety of immunomodulatory treatment measured by effect on opportunistic infections (eg, herpes zoster) and malignancy (eg, Kaposi sarcoma) and impact on measures of immunosuppression and the incidence of immune reconstitution disease. CONCLUSIONS: IMPI is the largest trial yet conducted comparing adjunctive immunotherapy in pericarditis. Its results will define the role of adjunctive corticosteroids and M. w immunotherapy in patients with TB pericardial effusion.


Subject(s)
Bacterial Vaccines/therapeutic use , Immunotherapy/methods , Mycobacterium/immunology , Pericardial Effusion/surgery , Pericardiocentesis/methods , Pericarditis, Tuberculous/drug therapy , Prednisolone/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Aged , Antitubercular Agents/therapeutic use , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pericardial Effusion/etiology , Pericarditis, Tuberculous/complications , Pericarditis, Tuberculous/surgery , Pilot Projects , Prospective Studies , Treatment Outcome
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