ABSTRACT
To determine the feasibility and safety of early posthrombolysis coronary stenting and the incidence of further reocclusion, we followed 99 consecutive patients with acute myocardial infarction thrombolyzed with rt-PA 2.0 +/- 0.8 hr after onset. Culprit artery was stented 14.0 +/- 7.0 hr after thrombolysis. All patients underwent clinical and angiographic follow-up at 1 and 6 months. Angiographic success was achieved in 99% of cases. Neither major cardiac events nor bleeding or vascular complications occurred during hospital stay. At 30 days, no events occurred and normal flow persisted in all stented arteries. At 6 months, only one artery reoccluded (1%), resulting in a nonfatal reinfarction. Restenosis rate was 21%. Contribution of the infarcted area to left ventricular function significantly increased from baseline to 30-day and to 6-month evaluations. Thus, early posthrombolysis stenting is a safe strategy with a low reocclusion rate, which seems to allow functional recovery of the infarcted area. Further studies are necessary to define its impact on survival and cost-effectiveness.
Subject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Coronary Angiography , Myocardial Infarction/drug therapy , Myocardial Infarction/surgery , Plasminogen Activators/therapeutic use , Stents/adverse effects , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Aged , Cohort Studies , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Prospective Studies , Time FactorsABSTRACT
OBJECTIVE: The objective of this study was to compare the initial and long-term outcome of elderly and younger patients after coronary stent implantation. METHODS: The evolutions of 76 patients aged >75 years and of 860 patients aged < or =75 years who underwent consecutive stenting (from June 1991 to June 1997) were compared in a cohort study. RESULTS: The elderly patients had lower left ventricular ejection fractions (0.58 +/- 0.14 vs 0.61 +/- 0.13; P =.03) and more frequently had unstable angina (78.9% vs 55.3%; P <.0001), previous heart failure (10.5% vs 4.9%; P =.03), and multivessel disease (68.4% vs 58.3%; P =.08). After the procedure, the elderly patients showed a higher inhospital mortality rate (6.6% vs 2.4%; P =.03) and myocardial infarction rate (5.3% vs 1.7%; P =.04). The long-term follow-up period (mean, 3.2 +/- 1.4 years; median, 3.0 years) showed in the elderly a higher mortality rate (15.4% vs 5.8%; P =.006), a lower rate of repeat revascularization (9.2% vs 19.7%; P =.04), and a similar incidence rate of major adverse cardiac events (27.7% vs 28.2%; P =.93). Multivariate analysis of the elderly group identified female gender (hazard ratio, 2.19; 95% CI, 1.18 to 4.06; P =.012) and presence of multivessel disease (hazard ratio, 2.35; 95% CI, 1.05 to 5.26; P =.037) as independent predictors of further events. CONCLUSION: Patients aged >75 years have a less favorable baseline profile and higher inhospital and 3-year mortality rates. However, the incidence rate of major adverse cardiac events in the long term is acceptable and similar to that of younger patients.
Subject(s)
Coronary Disease/therapy , Stents , Adult , Age Factors , Aged , Aged, 80 and over , Cohort Studies , Coronary Disease/mortality , Coronary Restenosis/therapy , Female , Follow-Up Studies , Heart Diseases/mortality , Hospital Mortality , Humans , Male , Middle Aged , Multivariate Analysis , Prognosis , Stents/adverse effects , Stroke Volume , Treatment OutcomeABSTRACT
La ecocardiografía transesofágica mejora el rendimiento diagnóstico de la ecocardiografía con dobutamina, pero se trata de una prueba parcialmente invasiva y de seguridad mal conocida. Nuestro objetivo fue comparar las complicaciones de la ecocardiografía con dobutamina realizada por vía transtorácica con las de la vía transesofágica. Sesenta y tres pacientes con mala ventana transtorácica fueron sometidos a ecocardiografía transesofágica con dobutamina. El grupo control estaba constituido por 100 pacientes con ventana transtorácica adecuada. La presión arterial y frecuencia cardíaca basales fueron mayores en el primer grupo. No hubo diferencias en la frecuencia de administración de atropina, en el doble producto final ni en la incidencia de efectos secundarios. Tampoco hubo casos de taquicardia o fibrilación ventricular, infarto agudo, angina refractaria ni de intolerancia a la sonda transesofágica. La ecocardiografía transesofágica con dobutamina es una alternativa segura para el estudio de la cardiopatía isquémica en los pacientes con mala ventana transtorácica (AU)