ABSTRACT
This study was conducted to compare the clinical outcomes of drug-eluting stents (DESs) with those of standard bypass surgery for the treatment of patients with left main lesions in a single-center experience. From January 2000 to October 2005, a total of 96 patients with significant unprotected left main disease were treated with DES implantation, and 245 with bypass surgery. Baseline features, such as Euroscore, were similar between groups, except for diabetes and hypertension, which were more frequent in the surgical group. The combination of death, Q-wave myocardial infarction, stroke, and repeated revascularization (major adverse cardiac and cerebrovascular events [MACCEs]) at 30 days occurred in 2.1% after DES implant and 9.0% after surgery (p=0.03). At 1 year, DES-treated patients more frequently needed repeat revascularization (5.2% vs 0.8%; p=0.02), although combined MACCE rates were similar (10.4% for DES, 11.4% for surgery; p=0.50). Moreover, after a mean follow-up of 1.3+/-0.8 and 3.2+/-1.6 years for the DES and surgical groups, there were no significant differences in MACCEs, respectively. In conclusion, in our experience, percutaneous treatment of patients with unprotected left main disease with DESs provided similar clinical results compared with surgical revascularization at a midterm follow-up.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/surgery , Coronary Disease/therapy , Stents , Aged , Angioplasty, Balloon, Coronary/methods , Coronary Disease/mortality , Coronary Stenosis/mortality , Coronary Stenosis/surgery , Coronary Stenosis/therapy , Diabetic Angiopathies/mortality , Diabetic Angiopathies/surgery , Diabetic Angiopathies/therapy , Female , Humans , Immunosuppressive Agents/administration & dosage , Length of Stay , Male , Middle Aged , Multivariate Analysis , Survival Analysis , Treatment OutcomeABSTRACT
UNLABELLED: Introduction and objectives. Intracoronary Doppler guidewire measurement provides information about the state of the myocardial microcirculation. Our aim was to assess the relationship between the pattern of coronary flow and myocardial viability. Patients and method. The study included 19 patients who had had a recent myocardial infarction (< 1 month), who underwent percutaneous revascularization of the responsible vessel, and who agreed to angiographic follow-up. Patients were divided into two groups according to the extent of the akinetic area observed at follow-up responsible (149 [40] days) in the myocardial region supplied by the responsible artery: one group (n=11) had preserved regional contractility (i.e., an akinetic area less than 30%); the other group (n=8) had impaired regional contractility (i.e., an akinetic area equal to or greater than 30%). Coronary flow in the artery was responsible assessed after revascularization and at follow-up using the Doppler guidewire method. RESULTS: After revascularization, patients with preserved regional contractility had a higher diastolic deceleration half-time than those with impaired regional contractility (628 [188] ms vs 376 [131] ms, P=.02). At follow-up, the difference in coronary flow between the groups had disappeared. Patients in whom regional contractility was preserved demonstrated a significant increase in coronary flow reserve at follow-up (1,8 [0,5] vs 2,3 [0,5], P=.01). CONCLUSIONS: After timely revascularization (within one month) of the vessel responsible for a myocardial infarction, the pattern of coronary flow observed in patients with viable myocardium differed from that in those with non-viable myocardium. The differences disappeared during follow-up.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Circulation/physiology , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/physiopathology , Stents , Coronary Angiography , Echocardiography, Doppler/methods , Female , Heart/diagnostic imaging , Heart/physiology , Humans , Male , Middle Aged , Myocardial Infarction/therapyABSTRACT
Introducción y objetivos. La guía intracoronaria Doppler suministra información sobre el estado de la microcirculación miocárdica. Nuestro objetivo fue evaluar la relación entre las características del flujo coronario en la arteria causante del infarto y el mantenimiento de viabilidad miocárdica. Pacientes y método. Se incluyó a 19 pacientes con infarto reciente (1 mes), revascularización percutánea de la arteria causante y disposición para una revaluación angiográfica en el seguimiento. Los pacientes se dividieron en 2 grupos, según la extensión de acinesia en el territorio de la arteria causante del infarto en el seguimiento (149 +/- 40 días): grupo con contractilidad regional preservada (n = 11, con un porcentaje de acinesia = 30%). Tras la revascularización, y en el control de seguimiento, se analizó el flujo coronario en la arteria causante del infarto con guía Doppler. Resultados. Los pacientes con contractilidad regional preservada presentaron, después de la revascularización, un mayor tiempo de hemidesaceleración diastólico (628 ± 188 frente a 376 +/- 131 ms; p = 0,02). En el control de seguimiento, las diferencias en el patrón de flujo coronario entre los dos grupos desaparecen. Además, en el seguimento se produce un aumento significativo de la reserva coronaria únicamente en el grupo con contractilidad preservada (1,8 +/- 0,5 frente a 2,3 +/- 0,5; p = 0,01). Conclusiones. Tras revascularización de la arteria causante de un infarto reciente hay un patrón diferencial de flujo coronario entre los pacientes con y sin viabilidad. Estas diferencias desaparecen en el seguimiento
Introduction and objectives. Intracoronary Doppler guidewire measurement provides information about the state of the myocardial microcirculation. Our aim was to assess the relationship between the pattern of coronary flow and myocardial viability. Patients and method. The study included 19 patients who had had a recent myocardial infarction (< 1 month), who underwent percutaneous revascularization of the responsible vessel, and who agreed to angiographic follow-up. Patients were divided into two groups according to the extent of the akinetic area observed at follow-up responsible (149 [40] days) in the myocardial region supplied by the responsible artery: one group (n=11) had preserved regional contractility (i.e., an akinetic area less than 30%); the other group (n=8) had impaired regional contractility (i.e., an akinetic area equal to or greater than 30%). Coronary flow in the artery was responsible assessed after revascularization and at follow-up using the Doppler guidewire method. Results. After revascularization, patients with preserved regional contractility had a higher diastolic deceleration half-time than those with impaired regional contractility (628 [188] ms vs 376 [131] ms, P=.02). At follow-up, the difference in coronary flow between the groups had disappeared. Patients in whom regional contractility was preserved demonstrated a significant increase in coronary flow reserve at follow-up (1,8 [0,5] vs 2,3 [0,5], P=.01). Conclusions. After timely revascularization (within one month) of the vessel responsible for a myocardial infarction, the pattern of coronary flow observed in patients with viable myocardium differed from that in those with non-viable myocardium. The differences disappeared during follow-up
Subject(s)
Male , Female , Adult , Aged , Middle Aged , Humans , Myocardial Infarction/therapy , Myocardial Revascularization , Myocardial Contraction/physiology , Angioplasty, Balloon, Coronary/methods , Stents , Follow-Up Studies , Treatment OutcomeABSTRACT
INTRODUCTION AND OBJECTIVES: Experience with 4 F catheters in cardiac catheterization is limited. These devices appear to be more suitable for the radial artery approach than conventional 6 F catheters. METHODS: We analyze our preliminary experience with diagnostic catheterization of the radial artery with 4 F catheters. Angiographic images were evaluated using a predefined scale (1. poor; 2. acceptable; 3. optimal). In a subgroup of patients who underwent coronary angioplasty, the quantitative angiographic data obtained with the 4 F catheter were compared to those obtained with the 6 F guide catheter. In all cases the patients were clinically followed-up at 24 h and 7 days. RESULTS: Two hundred and six studies performed over a 12-month period were reviewed. In 6 cases (2.9%) the femoral vein had to be used instead and in 4 cases (1.9%) the 4 F catheters were replaced by 6 F catheters. The left coronary angiography was graded as optimal in 83% and as acceptable in 15%. Right coronary artery images were considered optimal in 93% and acceptable in 7%. There was an excellent correlation between the reference diameter obtained by quantitative angiography with the 4 F catheter and values obtained with a 6 F guide catheter (r = 0.92; p < 0.01). No major vascular complications occurred. CONCLUSION: 4 F catheters are appropriate for systematic use in diagnostic procedures using the radial access.
Subject(s)
Coronary Angiography/methods , Radial Artery , Cardiac Catheterization/methods , Catheters, Indwelling , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical ProceduresABSTRACT
Introducción y objetivos. La experiencia con los catéteres de 4 F para el cateterismo cardíaco es limitada. Estos dispositivos parecen más apropiados para el abordaje radial que los catéteres convencionales de 6 F. Métodos. Análisis de la experiencia preliminar con cateterismos por vía radial con catéteres de 4 F. La evaluación de la calidad de la angiografía se basó en una escala preestablecida (1, pobre; 2, regular; 3, óptima). En un subgrupo de pacientes sometidos a angioplastia, se compararon los datos de angiografía cuantitativa con 4 F y con el catéter-guía de 6 F. Se hizo una revisión clínica sistemática en todos los casos a las 24 h y a los 7 días. Resultados. Se revisaron 206 cateterismos en un período de 12 meses. En 6 casos (2,9 por ciento) se cambió la vía de abordaje a la arteria femoral y en 4 casos (1,9 por ciento) se cambió a catéteres de 6 F. En el 83 por ciento de los casos se valoró la coronariografía izquierda como óptima y en un 15 por ciento de los casos ésta era regular. Las imágenes de la coronaria derecha eran óptimas en el 93 por ciento de los casos y regular en el 7 por ciento. Se demostró una excelente correlación entre el diámetro de referencia, obtenido por angiografía cuantitativa con catéteres de 4 F, y el conseguido con catéter-guía de 6 F (r = 0,92; p < 0,01). No hubo complicaciones vasculares mayores. Conclusión. Los catéteres de 4 F son apropiados para uso sistemático en los procedimientos diagnósticos por la vía radial. (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Radial Artery , Coronary Angiography , Minimally Invasive Surgical Procedures , Catheters, Indwelling , Cardiac CatheterizationABSTRACT
La cardiopatía hipertensiva se caracteriza por la suma de interacciones sobre el miocardio y sobre la circulación coronaria, en dependencia del grado de hipertrofia y de las modalidades de afectación coronaria, o sea de grandes o pequeños vasos. Existen diferentes patrones de función ventricular y hemodinámica coronaria. Aunque el ECG mantiene su valor en el diagnóstico de la hipertrofia ventricular izquierda, sin dudas, es el ecocardioggrama el proceder más sensible y seguro. En general la disfunción diastólica del VI precede a la disfunción diastólica durante el prolongado período de evolución del proceso hipertrófico hacia la insuficiencia cardíaca. El estudio eco-Doppler brinda una información importantísima desde el punto de vista funcional aún en estadios precoces del proceso. En el momento actual existe el criterio de que la terapéutica antihipertensiva, además de condicionar el descenso de los niveles tensionales ha de favorecer la regresión de la HVI y modificar los diturbios de la microcirculación coronaria que se asocian a la enfermedad y, aunque existen algunas evidencias sobre la reversibilidad del proceso hipertrófico, no existen pruebas hoy día, sólidamente documentados, sobre los efectos en la microcirculación coronaria del tratamiento antihipertensor (AU)
Subject(s)
Humans , Cardiomegaly/diagnosis , Coronary Circulation , Coronary Vessels , Electrocardiography , Echocardiography , Hypertension/physiopathology , Hypertension/drug therapy , Antihypertensive Agents/therapeutic useABSTRACT
La cardiopatía hipertensiva se caracteriza por la suma de interacciones sobre el miocardio y sobre la circulación coronaria, en dependencia del grado de hipertrofia y de las modalidades de afectación coronaria, o sea de grandes o pequeños vasos. Existen diferentes patrones de función ventricular y hemodinámica coronaria. Aunque el ECG mantiene su valor en el diagnóstico de la hipertrofia ventricular izquierda, sin dudas, es el ecocardioggrama el proceder más sensible y seguro. En general la disfunción diastólica del VI precede a la disfunción diastólica durante el prolongado período de evolución del proceso hipertrófico hacia la insuficiencia cardíaca. El estudio eco-Doppler brinda una información importantísima desde el punto de vista funcional aún en estadios precoces del proceso. En el momento actual existe el criterio de que la terapéutica antihipertensiva, además de condicionar el descenso de los niveles tensionales ha de favorecer la regresión de la HVI y modificar los diturbios de la microcirculación coronaria que se asocian a la enfermedad y, aunque existen algunas evidencias sobre la reversibilidad del proceso hipertrófico, no existen pruebas hoy día, sólidamente documentados, sobre los efectos en la microcirculación coronaria del tratamiento antihipertensor