RESUMO
OBJECTIVES: The aim of this study was to investigate the impact of intensively lowered low-density lipoprotein cholesterol (LDL-C) level on the deferred lesion prognosis after revascularization deferral based on fractional flow reserve (FFR). BACKGROUND: Lowering LDL-C is associated with lower cardiovascular event rate, but its benefit on the deferred lesion prognosis has not been well evaluated. METHODS: This retrospective, single-center, observational study analyzed 192 deferred lesions with FFR value >0.80 in 192 patients with stable coronary artery disease. According to the first follow-up LDL-C level, they were assigned to the LOW group (<70 mg/dL) or the HIGH group (≥70 mg/dL). Deferred lesion failure (DLF) was defined as the composite of deferred lesion revascularization and deferred vessel myocardial infarction. RESULTS: Of all participants, 61 and 131 patients were assigned to the LOW and the HIGH group, respectively. During the median follow-up of 2.8 years, DLF occurred in 1 and 14 patients in the LOW group and the HIGH group (1.6% and 10.7%, log-rank p = .043), respectively. The incidence of any unplanned revascularization was also significantly lower in the LOW group than in the HIGH group (3.3% vs. 14.5%, log-rank p = .032). CONCLUSIONS: The incidence of DLF was significantly lower in the patients with LDL-C < 70 mg/dL than in those with LDL-C ≥ 70 mg/dL at the first follow-up after FFR-based deferral of revascularization.
Assuntos
Anticolesterolemiantes/uso terapêutico , LDL-Colesterol/sangue , Doença da Artéria Coronariana/terapia , Estenose Coronária/terapia , Dislipidemias/tratamento farmacológico , Revascularização Miocárdica , Idoso , Anticolesterolemiantes/efeitos adversos , Biomarcadores/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologia , Estenose Coronária/fisiopatologia , Progressão da Doença , Regulação para Baixo , Dislipidemias/sangue , Dislipidemias/complicações , Dislipidemias/diagnóstico , Ezetimiba/uso terapêutico , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Tempo para o Tratamento , Resultado do TratamentoRESUMO
Deep vein thrombosis occasionally causes paradoxical embolism in patients with a patent foramen ovale (PFO). We report the case of a 42-year-old female who was hospitalized for stroke. Detailed investigations revealed the existence of a PFO, pulmonary embolism, and ovarian vein thrombosis extending to inferior vena cava. She had a uterine myoma to be operated on but no other thrombophilic disorders. Anticoagulation therapy with direct oral anticoagulant successfully reduced the thrombus and prevented the recurrence of paradoxical embolism.
RESUMO
A 65-year-old obese woman with an oversized neck and dysphagia underwent transesophageal echocardiography (TEE). The procedure was complicated by difficulty in insertion from the pharynx to esophagus, and her head and neck gradually swelled. Computed tomography (CT) revealed extensive emphysema from the neck to superior mediastinum, which suggested pharyngeal perforation. A nasogastric tube was inserted, and the patient received antibiotics to prevent secondary mediastinitis. CT performed 1 week later showed improvement of emphysema and no evidence of mediastinitis. Perforation along the orogastric pathway during TEE is a rare but life-threatening complication to which physicians performing TEE should pay attention.
