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1.
J Invasive Cardiol ; 29(2): 63-67, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27845873

RESUMEN

BACKGROUND: Rates and importance of periprocedural myocardial injury (PMI) after crossing coronary chronic total occlusions (CTOs) is not well understood. This study sought to investigate long-term clinical implications of PMI in patients undergoing percutaneous coronary intervention (PCI) for single CTO utilizing antegrade technique. METHODS: Out of 11,957 patients undergoing non-urgent PCI, a total of 1110 patients with symptomatic angina and single CTO were treated by antegrade PCI and observed for up to 10 years. The primary objective included cardiac death, while the secondary aim comprised all major adverse cardiovascular and cerebrovascular event (MACCE) rate. RESULTS: Troponin-defined PMI occurred in 4.7% patients (n = 52). At 1 year, the cardiac death and MACCE rates were significantly higher in patients with vs without PMI (hazard ratio [HR], 5.72; 95% confidence interval [CI], 1.59-20.49; P=.01; HR, 1.84; 95% CI, 1.07-3.18; P=.03, respectively). At long-term follow-up, patients with PMI had a trend toward a higher incidence of cardiac death than patients without PMI (HR, 2.51; 95% CI, 0.99-6.33; P=.05) and no differences were demonstrated in terms of overall MACCE between both groups (HR, 1.19; 95% CI, 0.73-1.93; P=.49). After propensity score adjustment, no significant differences were observed regarding the short-term and long-term outcomes. CONCLUSION: CTO-PCI is a safe procedure if routinely performed in symptomatic patients at a high-volume center. PMI does not influence long-term outcomes after antegrade CTO-PCI.


Asunto(s)
Oclusión Coronaria/cirugía , Infarto del Miocardio/epidemiología , Revascularización Miocárdica/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Puntaje de Propensión , Sistema de Registros , Anciano , Enfermedad Crónica , Angiografía Coronaria , Oclusión Coronaria/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Polonia/epidemiología , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Factores de Tiempo , Resultado del Tratamiento , Troponina/sangre
3.
Catheter Cardiovasc Interv ; 86(2): E49-57, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25599675

RESUMEN

AIMS: The effectiveness of revascularization of chronic total occlusion (CTO) remains intriguing. Thus, we sought to investigate whether a successful PCI for single CTO improves outcomes in a setting of stable angina and chronic occlusion of single coronary artery. METHODS AND RESULTS: Of 11 957 consecutive patients referred for nonurgent PCI between 2003 and 2010, 1110 displayed single CTO and were enrolled to the central CTO-registry database. The primary end-point included all-cause mortality, the secondary end-point a composite of safety outcome measure of all-cause death, nonfatal-MI, the need for urgent revascularization and stroke. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the long-term follow-up. Since the patient assignment was not random, we performed the propensity scoring to minimize selection bias; 734 patients (66%) had a successful PCI-CTO. Compared with successful procedures, unsuccessful procedures had similar rates of all-cause death both in crude (HR, 0.78; 95%CI, 0.49-1.25; P = 0.30) and adjusted analysis (HR, 0.80; 95%CI, 0.50-1.28; P = 0.34). A similar, significant reduction in overall MACE was noted with successful PCI-CTO compared with unsuccessful procedure in unadjusted (HR, 0.74; 95%CI, 0.56-0.96; P = 0.020) and adjusted calculation (HR, 0.73; 95%CI, 0.56-0.96; P = 0.019). Patients after successful PCI-CTO as compared with failed recanalization less frequently underwent surgical revascularization. The benefit was sustained at 3 years follow-up. CONCLUSIONS: Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization.


Asunto(s)
Angina Estable/terapia , Oclusión Coronaria/terapia , Intervención Coronaria Percutánea , Anciano , Angina Estable/diagnóstico , Angina Estable/fisiopatología , Distribución de Chi-Cuadrado , Enfermedad Crónica , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/mortalidad , Oclusión Coronaria/fisiopatología , Femenino , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/etiología , Oportunidad Relativa , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Puntaje de Propensión , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del Tratamiento
4.
J Invasive Cardiol ; 25(11): 567-72, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24184890

RESUMEN

BACKGROUND: There are limited data on the long-term safety and efficacy of drug-eluting stents (DES) implantation in patients with stable angina referred for elective percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). We therefore aim to investigate whether DES compared with bare-metal stent (BMS) implantation improves long-term outcomes after successful recanalization of single CTO. METHODS: A total of 345 consecutive patients who underwent successful recanalization of single CTO and received DES or BMS in the Cardioangiology Laboratories of the Medical University of Gdansk between January 1, 2006 and December 31, 2010 were included in the CTO Registry database. We compared the 1-year and long-term clinical outcomes of 137 consecutive patients who underwent PCI for CTO and DES implantation with outcomes of 208 patients after successful CTO treatment with BMS implantation. The median follow-up was 22.6 ± 3 months (21.0 ± 3.9 months for DES vs 23.6 ± 1.5 months for BMS; P<.001). The primary endpoints included a composite of all-cause death and non-fatal myocardial infarction (MI) and composite safety endpoint of major adverse cardiovascular events (MACEs), including death, MI and symptom-driven target lesion revascularization (TLR). A secondary endpoint was a symptom-driven TLR. RESULTS: After stent implantation we noted lower rates of the composite endpoint at 1-year (9.5% DES vs 18.3% BMS; P=.01) and long-term follow-up (11.7% DES vs 21.1% BMS; P=.02) due to fewer episodes of TLR in the DES group (5.1% DES vs 14.4% BMS; P=.006 at 1-year follow-up; 7.3% DES vs 14.4% BMS; P=.04 at long-term follow-up). No significant differences were documented in the rate of death, MI, or in-stent thrombosis between investigated subsets. After adjusting for patient and procedural characteristics as well as propensity, BMS implantation remained independently associated with an increased hazard of 1-year MACE (adjusted hazard ratio [AHR], 2.09; 95% confidence interval [CI], 1.2-3.64; P=.005) and long-term MACEs (AHR, 1.99; 95% CI, 1.18-3.38; P<.01). CONCLUSIONS: DES implantation during PCI for single CTO reduces MACE rate at 1-year and long-term follow-up due to the significant reduction of TLR in the DES group. Therefore, DES implantation should be preferred as an optimal treatment strategy of single CTO in stable angina patients.


Asunto(s)
Implantación de Prótesis Vascular/efectos adversos , Oclusión Coronaria/cirugía , Stents Liberadores de Fármacos , Complicaciones Posoperatorias/epidemiología , Sistema de Registros , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Enfermedad Crónica , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Pronóstico , Factores de Riesgo , Tasa de Supervivencia/tendencias , Factores de Tiempo
5.
J Hypertens ; 25(8): 1650-4, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17620962

RESUMEN

OBJECTIVE: The sympathetic nervous system is a key modulator of prognosis and outcome in cardiac ischaemia and infarction. The effects of acute cardiac ischaemia on sympathetic neural traffic in humans are unknown. We tested the hypothesis that angioplasty, and associated transient myocardial ischaemia, elicits changes in neural circulatory control, including direct intraneural measures of sympathetic traffic. METHODS: We measured muscle sympathetic nerve activity (MSNA), blood pressure and heart rate in 12 patients (11 men, one woman) undergoing clinically indicated elective coronary angioplasty of the left anterior descending (n = 7) or circumflex (n = 5) coronary artery. Baseline data were obtained for 2 min before occlusion. Each balloon inflation was designed to last up to 120 s. RESULTS: Coronary occlusion had no significant effect on blood pressure or heart rate. In contrast, occlusion resulted in a significant increase in MSNA, in 10 of the 12 patients, and in all seven of those patients undergoing angioplasty of the left anterior descending artery. The group mean increase in MSNA during occlusion was 36 +/- 11% (P = 0.008 versus preocclusion). MSNA increased within 60 s of occlusion (129 +/- 12% of baseline; n = 12; P = 0.04), and increased further during the next 60 s to 141 +/- 12% of baseline levels (n = 10; P < 0.001). Increases in MSNA were similar in patients with and without significant chest pain (39 +/- 9% versus 34 +/- 13%, respectively; P = 0.84). CONCLUSION: Acute coronary occlusion during angioplasty increases central sympathetic outflow, but there is no systematic change in heart rate. The increase in sympathetic nerve traffic cannot be explained by blood pressure changes or occlusion-related chest pain.


Asunto(s)
Angioplastia de Balón , Enfermedad Coronaria/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
Int J Cardiol ; 88(2-3): 229-37, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12714203

RESUMEN

BACKGROUND: The Pl(A2) allele of the gene encoding for GPIIIa subunit of the platelet membrane receptor glycoprotein (GP) IIb/IIIa has been suggested as a significant risk factor for thrombotic complications of coronary artery disease (CAD). The aim of the current investigation was to investigate the association between Pl(A) GPIIIa polymorphism and the extent of angiographically confirmed CAD in patients from the north region of Poland. METHODS: The study was performed in 397 male Caucasian patients. All subjects had significant coronary artery stenosis confirmed by elective coronary angiography. Screening for the Pl(A) GPIIIa genotypes was performed by polymerase chain reaction of genomic DNA, followed by NciI digestion and agarose gel electrophoresis. RESULTS: The genotype distribution of the Pl(A) GPIIIa polymorphism in our study group was Pl(A1/A1)-75%, Pl(A1/A2)-24% and Pl(A2/A2)-1% with Pl(A1) and Pl(A2) allele frequencies of 0.87 and 0.13, respectively. The prevalence of the homozygous Pl(A1/A1) genotype among subjects with multiple-vessel CAD (two or three vessels with at least 50% stenosis) was significantly higher than in patients with single-vessel disease; the odds ratio of Pl(A2/A2) or Pl(A1/A2) patients for having multiple-vessel CAD was 0.46 (95% CI 0.27-0.77, P<0.01). The mean CAD score for Pl(A1/A1) patients was significantly higher in comparison to Pl(A2/A2) and Pl(A1/A2) patients (7.58+/-2.20 and 6.98+/-2.37, respectively, P<0.05). CONCLUSIONS: Our results suggest, that the Pl(A1/A1) genotype of Pl(A) GPIIIa polymorphism is associated with more severe CAD in male Caucasian patients from the north region of Poland.


Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Glicoproteínas de Membrana/genética , Activadores Plasminogénicos/genética , Polimorfismo Genético/genética , Población Blanca/genética , Adulto , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Polonia , Reacción en Cadena de la Polimerasa , Índice de Severidad de la Enfermedad
7.
Wiad Lek ; 55 Suppl 1: 115-9, 2002.
Artículo en Polaco | MEDLINE | ID: mdl-15002229

RESUMEN

The coronary disease is nowadays one of the main causes of death in Poland. To fight epidemy of the coronary disease, not only the prevention and proper treatment are necessary, but the sufficient availability of the diagnostic methods, as well. The aim of our work was to evaluate the availability of coronarography among the patients from Northern Poland. We analysed the data of the patients who underwent the coronarography in years 1997-1998. During that time there were 3916 examined patients. In the analysis the sex, age and place of residence were taken into consideration. Women were 28.93% of all the diagnosed patients. The sex structure basically didn't differ according to the place of residence (city--women 28.7%, village--30.64%). The average age of the diagnosed patients was 58 years. There was a statistically significant difference between the average age of women and men (women 59 years, while men 57 years). The age distribution varied also in the statistically significant degree according to the place of living--the average age of village people was 56 years, little cities 58 years, big cities 59 years. The village people were only 10% of all diagnosed patients. In the analysis of the collected data significant differences in availability of coronarography were found-especially between rural and urban areas. Also the age and sex of the diagnosed patients varied significantly-most probably due to the distribution of the risk factors.


Asunto(s)
Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Adulto , Distribución por Edad , Factores de Edad , Angiografía Coronaria/métodos , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/prevención & control , Femenino , Humanos , Masculino , Polonia , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Salud Rural/estadística & datos numéricos , Distribución por Sexo , Factores Sexuales , Salud Urbana/estadística & datos numéricos , Salud Urbana/tendencias
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