RESUMO
OBJECTIVE: To analyze the angiographic results of endovascular treatment for chronic coronary occlusions in patients with coronary heart disease. MATERIAL AND METHODS: In 2009 to 2013 attempted endovascu-ar recanalization of chronic coronary occlusions in 854 patients with coronary heart disease. The patients' age ranged from3 6 to 68 years (mean 52 years). The estimated du-ation of occlusion was m1 onth to more than 3 years. There were 193 (22.6%) females and 661 (77.4%) males. 462 (54.1%) patients had a history of myocardial infarction. 738 (86.4%) and 116 (13.6%) patients had true (TIMI grade 0) and functional (TIMI grade i1 occlusions, respectively. Multi- and univascular lesions were found in 683 (79.9%) and 171 (20.1%) patients, respectively. Silent occlusions with preserved myocardial contractility were identified in 165 (19.3%) patients. RRESULTS:Blood flow could be successfully restored in 616 (72.1%) patients. Recanalization of chronic coronary occlusion failed in 238 (27.9%) patients. CCONCLUSION:Recanalization of chronic coronary occlusions is a highly effective and relatively safe technique. The efficiency of the procedure largely depends on the duration of occlusion, its X-ray morphological characteristics, and the experience of a physician.
Assuntos
Oclusão Coronária , Vasos Coronários , Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/prevenção & controle , Radiografia Intervencionista/métodos , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/fisiopatologia , Oclusão Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moscou , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Multiple coronary artery atherosclerotic lesions are a major cause of ischemic cardiomyopathy. Myocardial revascularization in patients with ischemic cardiomyopathy in the presence of the viable myocardium and/or ischemic areas leads to improved central hemodynamic parameters and as a consequence to better quality of life and prognosis as a whole. The paper describes a clinical case of successful coronary artery angioplasty and stenting in a patient with ischemic cardiomyopathy. Following 8 months, there was a considerable improvement in the patient's general condition, an increase in left ventricular ejection fraction, and a reduction in cardiac cavity sizes.
Assuntos
Angioplastia Coronária com Balão/métodos , Cardiomiopatias , Isquemia Miocárdica , Stents , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Angiografia Coronária/métodos , Ecocardiografia sob Estresse/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/terapia , Volume Sistólico , Resultado do TratamentoAssuntos
Diagnóstico por Imagem/métodos , Procedimentos Endovasculares/métodos , Oclusão de Enxerto Vascular , Isquemia Miocárdica/cirurgia , Saúde Global , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/etiologia , Humanos , Incidência , Fatores de RiscoAssuntos
Injúria Renal Aguda , Diagnóstico por Imagem , Iopamidol , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/prevenção & controle , Meios de Contraste/química , Meios de Contraste/farmacologia , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/normas , Humanos , Iopamidol/química , Iopamidol/farmacologia , Órgãos em Risco , Concentração Osmolar , Segurança do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , ViscosidadeRESUMO
With the aim to investigate influence of glycemic control on clinical state and course of disease, renal function, and neurohormonal profile of patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM) we studied 81 patients with NYHA functional class (FC) II - III CHF, left ventricular ejection fraction (LVEF) 45% and type 2 DM. As a result of randomization 2 groups were formed - active with achievement of target levels of glycemia (n=41) and usual treatment (n=40). Retrospective analysis in dependence of efficacy of sugar lowering therapy was also conducted. Group 1 (n=18) comprised patients with achieved 1% lowering of glycated hemoglobin (HbA1 ), group 2 (n=26) - patients with bA1c lowering < 1%, group 3 (n=31) - patients with increase of HbA1 . Total duration of the investigation for the first analysis was 12, for the second - 6 months. Control examination was carried out at baseline, after 6 and 12 months of investigation and included assessment of clinico-functional status, glomerular filtration rate, neurohormonal profile (brain natriuretic peptide, noradrenalin, and angiotensin II). The state of carbohydrate metabolism was assessed with the help of determination of the level of HbA1c and oral glucose tolerance test. Absence of dynamics of glycemia in active and nonactive groups, in the active group improvement of clinico-functional status, quality of life, and parameters of remodeling was noted. Complementary retrospective analysis revealed improvement of functional status, renal function, and lowering of RAAS activity at 1% lowering of HbA1 and achievement of its target values. With this it was shown that betterment of functional possibilities ensued at lowering of HbA1c level not less than by 0.8%. Thus necessity and efficacy of strict glycemic control of DM in patients with CHF was proved.
