Asunto(s)
Quistes/diagnóstico , Ecocardiografía/métodos , Neoplasias Cardíacas/diagnóstico , Imagen por Resonancia Cinemagnética/métodos , Imagen Multimodal , Tomografía Computarizada por Rayos X/métodos , Nodo Atrioventricular , Procedimientos Quirúrgicos Cardíacos , Quistes/cirugía , Diagnóstico Diferencial , Femenino , Neoplasias Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Enfermedades RarasRESUMEN
Stenting the culprit lesion in patients presenting with acute coronary syndrome (ACS) is the standard of care. Although plaque rupture on an atheromatous lesion is the most common underlying pathology, other mechanisms can also result in ACS presentation; some of which can be managed without stenting. Here we describe a case that was managed conservatively, after evaluating plaque erosion as the underlying mechanism and lack of obstructive lesion. This case highlights the importance of intracoronary imaging to assess the underlying mechanism in patients presenting with acute coronary syndrome.
Asunto(s)
Síndrome Coronario Agudo/patología , Enfermedad de la Arteria Coronaria/patología , Infarto del Miocardio/patología , Placa Aterosclerótica/patología , Infarto del Miocardio con Elevación del ST/patología , Síndrome Coronario Agudo/diagnóstico , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/patología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Placa Aterosclerótica/diagnóstico , Infarto del Miocardio con Elevación del ST/diagnóstico , Tomografía de Coherencia Óptica/métodosRESUMEN
Investigation and utilization of molecularly targeted agents has induced a number of drug adverse effects that are not typically associated with conventional chemotherapy. QT interval prolongation, a cardiac toxicity that increases the risk of fatal arrhythmia, is associated with several novel oncology therapies. Classes of molecularly targeted agents with described QT effects include histone deacetylase inhibitors, multitargeted tyrosine kinase inhibitors, vascular disruption agents, farnesyl protein transferase inhibitors, Src/Abl kinase inhibitors, and protein kinase C inhibitors. Concurrently, guidelines for monitoring the QT-prolonging effects of drugs under development have become increasingly rigorous. Although these guidelines apply to anticancer agents, they were not specifically designed for the oncology patient population. This article will review the pathophysiology of QT prolongation, methods of preclinical QT assessment, and current guidelines for QT evaluation in early phase trials. Additionally, molecularly targeted agents with QT effects will be summarized, and mechanisms of addressing this toxicity in the context of oncology drug development will be explored.
Asunto(s)
Antineoplásicos/efectos adversos , Síndrome de QT Prolongado/inducido químicamente , Animales , Ensayos Clínicos Fase I como Asunto/normas , Ensayos Clínicos Fase II como Asunto/normas , Aprobación de Drogas , Evaluación Preclínica de Medicamentos , Electrocardiografía , Humanos , Síndrome de QT Prolongado/fisiopatología , Guías de Práctica Clínica como Asunto , Vigilancia de Productos Comercializados , Factores de Riesgo , Estados Unidos , United States Food and Drug AdministrationRESUMEN
OBJECTIVES: We hypothesized that the bifurcation angle (BA) may affect the outcome of crush stenting (CS) of bifurcation lesions and thus set out to determine the effect of the BA on outcome of patients undergoing coronary bifurcation CS. METHODS: Of 538 bifurcation PCI cases performed between November 2003 and March 2005, 133 were performed using CS (n = 56), balloon CS (n = 71), or reverse CS (n = 6). Patients were divided into low-angle and high-angle groups using the median BA as the cut point. RESULTS: The median BA was 50 degrees. High-angle patients were more likely to be women (33% vs 15%, P = .02), with a prior percutaneous coronary intervention (26% vs 12%. P = .05) and coronary artery bypass grafting (15% vs 5%, P = .05). Procedural success was 98.5% in the low-angle and 95.4% in the high-angle group (P = nonsignificant). Two high-angle patients had acute stent thrombosis, and 1 died in hospital. Four additional high-angle patients (6.1%) and 1 low-angle patient (1.5%) died (P = nonsignificant) during follow-up. Major adverse cardiac events (MACE) occurred more frequently in the high-angle group (22.7% vs 6.2%, P = .007). Bifurcation angle > or = 50 degrees (P = .004), no final kissing balloon inflation (P = .012), and creatinine clearance < 40 mL/min (P = .031) independently predicted MACE. CONCLUSIONS: Bifurcation angle > or = 50 degrees is an independent predictor of MACE after bifurcation CS, in addition to no final kissing balloon inflation and severe renal dysfunction. A high BA confers a setting of increased turbulent flow that is further exacerbated by suboptimal treatment of the crushed side-branch stent. Further study to improve outcome in this subset of patients is warranted.
Asunto(s)
Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Stents , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Enfermedad Coronaria/complicaciones , Femenino , Estudios de Seguimiento , Cardiopatías/epidemiología , Cardiopatías/etiología , Humanos , Incidencia , Enfermedades Renales/complicaciones , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la Enfermedad , Stents/efectos adversos , Resultado del TratamientoRESUMEN
Radiation-induced arteritis is a described rare complication of radiotherapy, particularly in patients with cancer. We report bilateral radiation-induced arteritis leading to stenoses in the external iliac arteries, which was treated with primary percutaneous arterial stenting, and review the current literature on the topic.