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1.
EuroIntervention ; 15(9): e804-e811, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31217142

RESUMO

AIMS: The aim of this study was to describe the epidemiology, mechanisms, management, and outcomes of coronary artery perforation during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS AND RESULTS: We included 1,811 consecutive patients undergoing CTO PCI at five centres between 2011 and 2018. Coronary perforation was observed in n=99 (5.5%). Patients with perforation were older, had a higher J-CTO score, more often required antegrade dissection/re-entry and the retrograde approach, and had lower success rates. The frequency of Ellis type I, II, III and III "cavity spilling" perforations was 11%, 46%, 28%, and 14%, respectively. In 48% of cases, perforation involved the CTO vessel, while the retrograde approach was responsible for 46% of cases. In 53% of cases perforations required intervention. The most frequently applied management strategies included clinical observation (47%), covered stent implantation (25%), balloon occlusion (9%), and coil/fat embolisation (9%). Tamponade was observed in 20/99 (20%) perforation cases. Ellis type III perforations were most frequently observed at the CTO site. These were accountable for 16/20 tamponades and 3/5 deaths. In-hospital mortality was 5.1% vs 0.3% in patients with versus those without perforation (p<0.001). Older age, occlusion length >20 mm, rotational atherectomy, antegrade dissection/re-entry, and the retrograde approach were independently associated with coronary perforation. Patients with perforation suffered an increased incidence of target vessel failure on short-term follow-up. CONCLUSIONS: Coronary perforation is observed in a non-negligible proportion of CTO PCIs, often requires intervention, and is associated with tamponade and mortality in a minority of patients. CTO vessel-related perforations are associated with the highest burden of morbidity and mortality.


Assuntos
Oclusão Coronária/cirurgia , Vasos Coronários/lesões , Intervenção Coronária Percutânea/efeitos adversos , Lesões do Sistema Vascular/epidemiologia , Idoso , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/epidemiologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Intervenção Coronária Percutânea/métodos , Derrame Pericárdico , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico
2.
Medicine (Baltimore) ; 98(18): e15436, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045809

RESUMO

RATIONALE: de Winter electrocardiograph (ECG) pattern signifies proximal left anterior descending coronary artery (LAD) occlusion and extensive anterior myocardial infarction, and it is found in about 2% of patients with proximal LAD occlusion. However, it is often unrecognized by physicians. In this case report, we present a patient with chest pain but showing an atypical and delayed de Winter ECG pattern. PATIENT CONCERNS: A previously healthy 61-year-old man attended our emergency department with chest pain radiating to the left arm and back for 4 hours, who was without serious cardiovascular risk factors. ECG at emergency department showed no significant changes. High-sensitivity cardiac troponin I (hs-cTnI) was within normal limit. DIAGNOSIS: At 5 hours after onset, ECG showed significant upsloping ST depression at J point in precordial leads V3 to V6, slight ST elevation in aVR and depression in inferior leads, and hs-cTnI peaked at 2.610 µg/L. The diagnosis of de Winter ECG pattern was confirmed by coronary angiography with an occlusion of the proximal LAD. INTERVENTIONS: A stent was implanted through percutaneous coronary intervention. OUTCOMES: The patient's chest pain was relieved without further increase of hs-cTnI. ECG after procedure showed ST segment back to baseline in leads V4 to V6, but persistent ST elevation in V1 to V3 with QS or Q wave. LESSONS: Timely diagnosis of de Winter ECG pattern is very important, especially the atypical and delayed ECG changes. It should be treated as ST elevation myocardial infarction equivalent and deserves emergent revascularization therapy.


Assuntos
Dor no Peito/etiologia , Oclusão Coronária/diagnóstico , Eletrocardiografia , Oclusão Coronária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Fatores de Tempo , Troponina I
3.
Turk Kardiyol Dern Ars ; 47(3): 239-242, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30982823

RESUMO

A patient with advanced rheumatic heart valve disease underwent aortic and mitral valve replacement with tricuspid ring annuloplasty. There was an anomalous left circumflex coronary artery (LCCA) arising from the right coronary artery (RCA) running along the anterior surface of an enlarged right ventricle (RV). During the immediate postoperative course, signs of inferior and lateral myocardial ischemia developed. An emergent coronary angiography revealed LCCA entrapment. An additional suture placed in the RV outflow tract used to optimize exposition of the aortic root during the aortotomy was determined to be the origin of the coronary entrapment. No similar case of LCCA occlusion has previously been reported. This is a description of successful management of this complication.


Assuntos
Oclusão Coronária/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Cardiopatia Reumática/cirurgia , Valva Tricúspide , Idoso , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Stents
4.
Indian Heart J ; 71(1): 65-73, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31000185

RESUMO

BACKGROUND: Chronic total occlusion (CTO) continues to be challenging lesion subset for percutaneous intervention. Last decade has seen tremendous increase in percutaneous coronary intervention (PCI) in this subset owing to improved understanding of the anatomy and enhanced skillset with availability of dedicated hardware. We sought to study the outcomes of CTO PCI in an Indian public hospital. METHODS: This was a single-center non-randomized descriptive follow-up study on CTO PCI. The end-points were procedural success, immediate, and late adverse cardiovascular events [major adverse cardiac event (MACE)] and change in angina and left ventricular function at follow-up. RESULTS: A total 389 CTO lesions were treated with a success rate of 87% (339/389). The mean Japanese chronic total occlusion (J-CTO) score was 1.78 ± 0.12 (mean ± standard deviation). Multivariate analysis of different angiographic components of J-CTO score identified tortuosity (p = 0.001), calcifications (p ≤ 0.001), and blunt stump (p = 0.007) as independent predictors of procedural failure. The periprocedural mortality was less than 1%, and the non-life threatening complications were about 4%. The MACE rate was significantly higher in the procedural failure group (60%) than in the procedural success group (5.3%, p < 0.001). An increase in left ventricular ejection fraction (LVEF) was noted following successful CTO PCI after complete revascularization. CONCLUSIONS: The success rates for CTO PCI in this registry were about 87%. Immediate and long-term clinical outcomes were better with lower MACE (5%) after a successful procedure. A key outcome variable included an increase in LVEF among patients after a successful CTO PCI. The overall periprocedural complications were about 5.5%, but majority were non-life threatening.


Assuntos
Oclusão Coronária/cirurgia , Vasos Coronários/cirurgia , Intervenção Coronária Percutânea/métodos , Volume Sistólico/fisiologia , Doença Crônica , Angiografia Coronária , Circulação Coronária/fisiologia , Oclusão Coronária/diagnóstico , Oclusão Coronária/epidemiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
5.
Int Heart J ; 60(2): 457-461, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799381

RESUMO

Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal "jailed" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.


Assuntos
Angioplastia Coronária com Balão/métodos , Bloqueio Atrioventricular , Estimulação Cardíaca Artificial/métodos , Oclusão Coronária , Vasos Coronários , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Oclusão Coronária/diagnóstico , Oclusão Coronária/etiologia , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Remoção de Dispositivo/métodos , Septos Cardíacos , Humanos , Masculino , Marca-Passo Artificial , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recuperação de Função Fisiológica , Resultado do Tratamento
6.
J Invasive Cardiol ; 31(2): E40, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700630

RESUMO

A 31-year-old man with Noonan syndrome who suffered an out-of-hospital cardiac arrest presented at our institution with severe postanoxic coma (Glasgow coma scale 3), but normalized electrocardiogram and stable hemodynamics. Coronary angiography documented a giant right coronary artery supplying collateral flow to the left coronary artery, which presented a left main functional occlusion.


Assuntos
Oclusão Coronária/complicações , Vasos Coronários/diagnóstico por imagem , Parada Cardíaca/etiologia , Hipertensão Pulmonar/complicações , Síndrome de Noonan/complicações , Adulto , Angiografia Coronária , Oclusão Coronária/diagnóstico , Eletrocardiografia , Evolução Fatal , Parada Cardíaca/diagnóstico , Humanos , Hipertensão Pulmonar/diagnóstico , Masculino , Tomografia Computadorizada por Raios X
7.
J Invasive Cardiol ; 31(2): E45, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700634

RESUMO

To our knowledge, this is the first report of primary percutaneous coronary intervention in a patient with a superdominant left circumflex artery, in which the entire right coronary artery myocardium territory is provided by the left circumflex. Coronary angiographic images of our 80-year-old male patient illustrate this anomaly. Single coronary arteries are among the most rare anatomic coronary anomalies, and the absence of right coronary artery ostium has been described as the rarest of these anomalies. Coronary events in such cases can be catastrophic due to the large amount of myocardium at risk.


Assuntos
Oclusão Coronária/diagnóstico , Trombose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem , Idoso de 80 Anos ou mais , Angiografia Coronária , Oclusão Coronária/complicações , Oclusão Coronária/cirurgia , Trombose Coronária/complicações , Trombose Coronária/cirurgia , Humanos , Masculino , Intervenção Coronária Percutânea/métodos
8.
Crit Pathw Cardiol ; 18(1): 32-39, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30747763

RESUMO

BACKGROUND: The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients. METHODS: We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level. All patients had coronary computed tomographic angiography (CCTA) with CCS, and our final cohort consisted of 1988 patients. Obstructive CAD was defined as luminal narrowing of ≥50% in 1 or more vessels by CCTA. Patients were classified according to PTP as low (<10%), intermediate (10%-90%), or high (>90%). RESULTS: The DFM classified 293 (14.7%), 1445 (72.7%), and 250 (12.6%) of patients as low, intermediate, and high risk, respectively, with corresponding 30-day MACE rates of 0.0%, 2.35%, and 14.8%. For patients with intermediate PTP and CCS ≤10, the negative predictive value was 99.2% (95% confidence interval: 98.7-99.8) for 30-day MACE while it was 92.62% (95% confidence interval: 87.9-97.3) for patients with high PTP. Among patients with a high PTP and CCS of zero, the prevalence of 30-day MACE and obstructive CAD remained high (7.07% and 10.1%, respectively). CONCLUSIONS: In acute chest pain patients without evidence of ischemia on initial electrocardiogram and cardiac troponin, low PTP by DFM or the combination of intermediate PTP and CCS ≤10 had excellent negative predictive values to rule out 30-day MACE. CCS is not sufficient to exclude obstructive CAD and 30-day MACE in patients with high PTP.


Assuntos
Cálcio/metabolismo , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Calcificação Vascular/diagnóstico , Doença Aguda , Causas de Morte/tendências , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Oclusão Coronária/complicações , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Estados Unidos/epidemiologia , Calcificação Vascular/complicações , Calcificação Vascular/metabolismo
10.
BMJ Case Rep ; 12(2)2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733249

RESUMO

Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.


Assuntos
Oclusão Coronária/diagnóstico , Traumatismos Faciais/terapia , Infarto Miocárdico de Parede Inferior/diagnóstico , Enfisema Mediastínico/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Traqueostomia , Angioplastia Coronária com Balão , Cateterismo Cardíaco , Dor no Peito , Oclusão Coronária/cirurgia , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Enfisema Mediastínico/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia
11.
Korean J Radiol ; 20(1): 83-93, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30627024

RESUMO

Objective: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). Materials and Methods: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. Results: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77-0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (ß = -0.61, p < 0.001) and changes in EF (ß = -0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17-0.85; p = 0.019). Conclusion: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.


Assuntos
Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Idoso , Circulação Colateral , Meios de Contraste , Oclusão Coronária/patologia , Oclusão Coronária/terapia , Vasos Coronários/fisiologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Miocárdio/patologia , Razão de Chances , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Recuperação de Função Fisiológica , Sensibilidade e Especificidade
12.
Medicina (Kaunas) ; 55(1)2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30646563

RESUMO

Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). Methods: 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. Results: CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). The Hosmer⁻Lemeshow chi squares (df, p value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Conclusions: Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient⁻physician shared decision-making.


Assuntos
Oclusão Coronária/diagnóstico , Oclusão Coronária/epidemiologia , Angina Microvascular/diagnóstico , Angina Microvascular/epidemiologia , Algoritmos , Estudos de Coortes , Angiografia Coronária , Estudos Transversais , Diagnóstico Diferencial , Teste de Esforço , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Curva ROC , Medição de Risco , Fatores de Risco
14.
Clin Cardiol ; 42(2): 222-226, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30536892

RESUMO

BACKGROUND: A large percentage of patients with non-ST-segment acute coronary syndrome (NSTE-ACS) present with acute total occlusion (TO) of some major epicardial vessel that does not generate electrocardiographic changes. Ongoing research into the methods of accurately predicting acute TO have not yielded great success. HYPOTHESIS: High-sensitivity cardiac troponin T (hs-cTnT) has a good predictive value for the presence of acute TO of the culprit artery in patients with NSTE-ACS. METHODS: A single-center retrospective study of 1011 patients diagnosed with NSTE-ACS who underwent coronary angiography and hs-cTnT measured on admission. The predictive value of hs-cTnT in the presence of acute TO was assessed by the area under the ROC curve. RESULTS: The mean age of the population was 67.12 ± 13.18 and 74.1% were male. 7.3% of the patients presented with acute TO. The AUC for hs-cTnT to predict acute TO was 0.95. A hs-cTnT value of 1006 ng/L (71.8 fold of the URL) best predicted the presence of acute TO, with a sensitivity of 86% and specificity of 95% positive predictive value (PPV): 86% and negative predictive value (NPV): 94%. CONCLUSIONS: Hs-cTnT was a good predictor of acute TO in patients with NSTE-ACS. Hs-cTnT values greater than 1006 ng/L were highly predictive of acute TO of a major coronary vessel.


Assuntos
Síndrome Coronariana Aguda/sangue , Oclusão Coronária/sangue , Eletrocardiografia , Troponina T/sangue , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Idoso , Biomarcadores/sangue , Angiografia Coronária , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
16.
Circ Cardiovasc Interv ; 11(11): e006941, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30571203

RESUMO

Background The aim of this study was to evaluate the functional result of chronic total occlusion percutaneous coronary intervention (PCI) measured by fractional flow reserve (FFR) immediately post the index procedure and at short-term follow-up. Methods and Results This was a prospective single-center observational study. Consecutive patients with right coronary artery chronic total occlusion scheduled for elective PCI were included. FFR measurements were performed immediately after successful PCI and at 4 months follow-up. Twenty-six patients completed baseline and follow-up measurements. Mean age was 61.2±9.7 years, 88.5% of the patients were male, and 19.2% were diabetic. The mean FFR immediately after successful chronic total occlusion PCI was 0.82±0.10 and significantly increased to 0.89±0.07 at 4 months ( P<0.001). The FFR increased in 77% of the patients with a mean absolute increase of 0.07±0.08. The incidence of FFR ≤0.80 immediately after PCI was significantly higher amongst patients with subintimal versus intraplaque recanalization (23% versus 12%; P=0.03). At 4 months, FFR ≤0.80 was found only in 2 patients with subintimal recanalization. At follow-up, 42.7% of the patients continued to have an FFR <0.90. Conclusions Post chronic total occlusion PCI, FFR increased significantly at short-term follow-up compared with measurements post index procedure. Because FFR remained <0.90 in many cases, further efforts should be made to optimize procedural results.


Assuntos
Cateterismo Cardíaco , Oclusão Coronária/terapia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Idoso , Doença Crônica , Circulação Colateral , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
17.
Indian Heart J ; 70(4): 548-555, 2018 Jul - Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170652

RESUMO

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is the last frontier in coronary intervention. PCI of CTO carries multiple advantages, such as significant improvement in symptoms, improvement in abnormal wall motion and left ventricular function and, possibly, increased long-term survival. As of today the procedural success is markedly improved because of technical innovations and is limited to highly experienced operators. To enhance the overall success rate from a worldwide perspective, a thorough understanding of its pathophysiology is critical to further development of newer techniques and technologies. In this review, the author outlines in-depth the evidence that underpins our understanding of CTO pathophysiology and its insight into CTO intervention that incorporates various steps and techniques to cross the lesion.


Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea/métodos , Sistema de Registros , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/fisiopatologia , Oclusão Coronária/cirurgia , Saúde Global , Humanos , Incidência , Fatores de Risco
19.
J Invasive Cardiol ; 30(8): E69-E70, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30068789

RESUMO

In patients with small or unfavorable coronary sinus (CS) anatomies, implantation of a CS reducer in atypical sites might be considered, if the target vein is of appropriate size and provides appropriate venous drainage.


Assuntos
Oclusão Coronária/cirurgia , Seio Coronário/cirurgia , Idoso , Angiografia Coronária , Oclusão Coronária/diagnóstico , Seio Coronário/diagnóstico por imagem , Vasos Coronários , Desenho de Equipamento , Humanos , Masculino , Flebografia
20.
Yonsei Med J ; 59(5): 602-610, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29869458

RESUMO

PURPOSE: Many recent studies have reported that successful percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for chronic total occlusion (CTO) has more beneficial effects than failed CTO-PCI; however, there are only limited data available from comparisons of successful CTO-PCI with medical therapy (MT) in the Korean population. MATERIALS AND METHODS: A total of 840 consecutive CTO patients who underwent diagnostic coronary angiography, receiving either PCI with DESs or MT, were enrolled. Patients were divided into two groups according to the treatment assigned. To adjust for potential confounders, propensity score matching (PSM) analysis was performed using logistic regression. Individual major clinical outcomes and major adverse cardiac events, a composite of total death, myocardial infarction (MI), stroke, and revascularization, were compared between the two groups up to 5 years. RESULTS: After PSM, two propensity-matched groups (265 pairs, n=530) were generated, and the baseline characteristics were balanced. Although the PCI group showed a higher incidence of target lesion and vessel revascularization on CTO, the incidence of MI tended to be lower [hazard ratio (HR): 0.339, 95% confidence interval (CI): 0.110 to 1.043, p=0.059] and the composite of total death or MI was lower (HR: 0.454, 95% CI: 0.224 to 0.919, p=0.028), compared with the MT group up to 5 years. CONCLUSION: In this study, successful CTO PCI with DESs was associated with a higher risk of repeat PCI for the target vessel, but showed a reduced incidence of death or MI.


Assuntos
Angiografia Coronária/métodos , Oclusão Coronária/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea , Idoso , Oclusão Coronária/diagnóstico , Oclusão Coronária/mortalidade , Stents Farmacológicos/efeitos adversos , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Pontuação de Propensão , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
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