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1.
Khirurgiia (Mosk) ; (8): 36-40, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464272

RESUMO

Objective - analysis of coronary angiography data in long-term period after coronary artery bypass surgery. MATERIAL AND METHODS: There were 78 patients (75 (96.2%) men and 3 (3.8%) women) with recurrent angina pectoris after CABG. Postoperative follow-up period ranged from 1 month to 8 years. RESULTS: There were 104 and 39 local stenoses and occlusions de novo, respectively. New local stenoses appeared in 31 arteries with patent bypass grafts and in 18 arteries with closed graft. There were 143 (60.3%) patent and 94 (39.7%) occluded grafts. All grafts (n=4, 100%) were patent after bypass grafting of one coronary artery, 3 (13.7%) grafts were occluded after bypass grafting of 2 coronary arteries. Occlusion of 57 (45.2%) out of 126 grafts was noted after bypass grafting of 3 coronary arteries, in case of grafting of 4coronary arteries - 34 (40%) out of 85 grafts. CONCLUSION: Thus, the main causes of thrombosis of the grafts were poor distal vessels, technical errors in harvesting and implantation of the grafts, mediastinitis, overestimated indications for surgery (coronary stenoses <50%), progression of atherosclerotic process, usage of venous grafts. Also, there is a direct relationship between transplant thrombosis and the number of bypassed coronary arteries.


Assuntos
Angina Pectoris/etiologia , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Oclusão de Enxerto Vascular/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Estenose Coronária/etiologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Vasos Coronários/cirurgia , Feminino , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Recidiva , Grau de Desobstrução Vascular
2.
Cardiovasc Pathol ; 42: 54-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31306942

RESUMO

Kawasaki disease (KD) is among one of the most common causes of vasculitis in children. Since KD was first described in 1967, there have been several reports of patients who did not meet the full diagnostic criteria for KD but who ultimately developed significant coronary artery lesions. Children with incomplete KD are at similar risk of developing coronary artery abnormalities to those with complete Kawasaki. A previously healthy 13-year-old Asian male was seen at a clinic for fever, pharyngitis, and conjunctivitis. He was given antibiotics for a presumed streptococcal pharyngitis. Two weeks later, the decedent complained of chest pain, collapsed, and was transported by Emergency Medical Services to a nearby hospital where he was pronounced deceased on arrival. A complete autopsy was done by the local medical examiner. Histologically, all three coronary arteries showed varying degrees of severe transmural lymphoplasmacytic inflammation, marked vascular smooth muscle intimal proliferation, focal destruction of muscular and elastic layers, and luminal stenosis. Some vessels had recent thrombi. We present an example of incomplete KD in an older child and reiterate the importance of obtaining relevant medical history in sudden death cases that come to the Medical Examiner Office, especially in the pediatric age group.


Assuntos
Trombose Coronária/etiologia , Vasos Coronários/patologia , Morte Súbita Cardíaca/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Adolescente , Causas de Morte , Trombose Coronária/patologia , Morte Súbita Cardíaca/patologia , Evolução Fatal , Humanos , Masculino , Síndrome de Linfonodos Mucocutâneos/patologia
3.
Heart Surg Forum ; 22(2): E131-E133, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-31013223

RESUMO

BACKGROUND: Pacemaker lead-related thrombosis is a rare but severe complication in patients with pacing lead implantation in the right ventricle. We present a case with recurrent syncope after single-chamber implantable cardioverter defibrillator (ICD) implantation. Pacing lead-related thrombosis was observed during open-heart surgery. This induced intermittent pacemaker dysfunction and recurrent syncope. CASE PRESENTATION: A 67-year-old male patient presented with frequent episodes of syncope and a history of dilated cardiomyopathy and paroxysmal ventricular tachycardia. Normal coronary angiography was found, and therefore a single-chamber ICD was implanted into the right ventricle to prevent cardiac events in 2013. However, he was referred to our hospital because of recurrent syncope 3 to 4 years after ICD implantation. A comprehensive investigation was performed to find out the etiology for the recurrent syncope. Pacing lead thrombosis was finally observed during open-heart surgery, which can introduce intermittent pacemaker dysfunction. After the thrombus was removed and the lead was separated from the posterior leaflet of the tricuspid valve, the ICD functioned normally after reprogramming. Oral anticoagulant was prescribed after discharging. During the 1-year follow-up period, this patient was free of syncope. CONCLUSIONS: This case illustrated that pacemaker lead-associated thrombosis should be considered when the cardiac implantable electronic device fails to prevent patients from having cardiac events. Oral anticoagulant might be important for preventing thrombosis among patients with ICD implantation into the right ventricle.


Assuntos
Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Eletrodos Implantados/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Síncope/etiologia , Idoso , Eletrocardiografia , Ventrículos do Coração , Humanos , Masculino , Falha de Prótese , Recidiva
4.
BMC Cardiovasc Disord ; 19(1): 93, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014237

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) for bifurcation lesions has often been challenging for Interventionists. Application of the correct intra-procedural technique is vital to generate beneficial outcomes after PCI. We aimed to systematically compare the post interventional cardiovascular outcomes which were reported using crush versus provisional stenting techniques for bifurcation lesions. METHODS: A computerized search was carried out through Medical Literature Analysis and Retrieval System Online, EMBASE, the Cochrane Central and through www.ClinicalTrials.gov for English publications comparing crush versus the provisional stenting techniques for coronary bifurcation lesions during PCI. Major adverse cardiac events, all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, target vessel and target lesion revascularizations were the endpoints in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) were generated during statistical analysis to represent the data. RESULTS: Six studies consisting of a total number of 2220 participants (1085 participants were assigned to the crush stenting technique and 1135 participants were assigned to the provisional stenting technique) enrolled between years 2004 and 2016 were included in this analysis. During a follow-up time period from six to sixty months, major adverse cardiac events (OR: 0.73, 95% CI: 0.59-0.91; P = 0.005), target vessel revascularization (OR: 0.62, 95% CI: 0.43-0.89; P = 0.01) and target lesion revascularization (OR: 0.62, 95% CI: 0.45-0.85; P = 0.003) were significantly lower in patients who were assigned to the crush stenting technique. However, all-cause mortality (OR: 0.90, 95% CI: 0.48-1.68; P = 0.74), cardiac death (OR: 0.56, 95% CI: 0.29-1.08; P = 0.08), myocardial infarction (OR: 0.89, 95% CI: 0.62-1.27; P = 0.53) and stent thrombosis (OR: 0.72, 95% CI: 0.36-1.42; P = 0.34) were not significantly different. CONCLUSION: In patients with coronary bifurcation lesions undergoing PCI, crush stenting technique was associated with significantly lower major adverse cardiac events and repeated revascularization without any change in mortality, myocardial infarction and stent thrombosis when compared to the provisional technique showing a benefit of crush over the provisional stenting technique during PCI.


Assuntos
Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/métodos , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Trombose Coronária/etiologia , Trombose Coronária/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/mortalidade , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
6.
Int J Cardiovasc Imaging ; 35(7): 1189-1198, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30911857

RESUMO

Due to expansion limits of the Absorb bioresorbable scaffold a meticulous implantation with correct sizing is required. We sought to investigate the clinical outcomes based on the sizing of the device related to the maximal lumen diameter measured by quantitative coronary angiography in Absorb BVS and Xience EES treated lesions in the AIDA trial. Sizing of Absorb bioresorbable vascular scaffold (BVS) and Xience everolimus eluting stent (EES) was graded according to the definitions of device non-oversize and device oversize on pre-procedural angiography. Lesion-oriented outcomes (LOCE) (device thrombosis, TLR and TVMI) that occurred during 2 years follow-up were related to device non-oversized or oversized status. In the Absorb BVS group, LOCE occurred in 48 (7.4%) lesions in the oversized group and in 32 (8.2%) lesions in the non-oversized group (HR 0.91; 95% CI 0.58-1.42; p = 0.681), whereas TLR occurred in 34 (5.3%) lesions and in 23 lesions (5.9%), respectively (HR 0.89; 95% CI 0.52-1.51; p = 0.666). Definite scaffold thrombosis occurred in 11 (1.7%) device oversized treated lesions against 16 (4.1%) device non-oversized treated lesions (HR 0.41; 95% CI 0.19-0.89; p = 0.020). There were no differences in event rates between oversized and non-oversized groups in lesions treated with Xience EES. There was no significant difference in LOCE between oversized and non-oversized treated Absorb BVS and Xience EES treated lesions. Non-oversized Absorb BVS implantation was associated with a higher risk of scaffold thrombosis at complete 2 years follow-up. The majority of very late scaffold thrombosis occurred in properly sized devices.


Assuntos
Implantes Absorvíveis , Fármacos Cardiovasculares/administração & dosagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Stents Farmacológicos , Everolimo/administração & dosagem , Intervenção Coronária Percutânea/instrumentação , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Humanos , Países Baixos , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Heart Vessels ; 34(8): 1297-1308, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30859377

RESUMO

The appropriate stent platform for treating coronary bifurcation lesions (CBLs) remains controversial. Previous bench tests have demonstrated the superiority of a 2-link cell design to 3-link cell design for creating inter-strut dilation at the side branch ostium. This randomized multicenter prospective BEGIN trial compared the biodegradable polymer-based biolimus A9-eluting stent (2-link BES) with the durable polymer-based cobalt chromium everolimus-eluting stent (3-link EES) in 226 patients with de novo CBLs. Patients with true bifurcations, defined as > 50% stenosis in the main vessel and side branch (SB) and an SB diameter > 2.25 mm, were enrolled. Guide wire re-crossing to the distal cell (near the carina) in the jailed SB and final kissing inflation were recommended. The SB angiographic endpoint was < 50% stenosis diameter. Left-main CBLs (13.5% vs. 13.0%) and 2-stent technique (30.6% vs. 22.6%) rates were similar. The primary endpoints (minimum lumen diameter at the SB ostium measured at an independent core laboratory at the 8-month follow-up) were comparable (1.64 ± 0.50 mm vs. 1.63 ± 0.51 mm, p = 0.976). There was no significant difference in composite outcomes of cardiac death, myocardial infarction, or target vascular revascularization at 12 months (7.4% vs. 8.0%, p = 0.894). Two-link BES and 3-link EES showed similar 8-month angiographic and 1-year clinical outcomes for true CBLs.


Assuntos
Implantes Absorvíveis , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Everolimo/administração & dosagem , Intervenção Coronária Percutânea , Sirolimo/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Trombose Coronária/etiologia , Trombose Coronária/mortalidade , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Polímeros/química , Estudos Prospectivos , Desenho de Prótese , Sirolimo/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
9.
ESC Heart Fail ; 6(3): 575-578, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30854779

RESUMO

Heart transplantation (HTx) is the gold standard therapy to improve quality and quantity of life in end-stage heart failure patients. However, recipients are at risk of experiencing allograft rejection and post-transplant complications, in the acute as well as chronic phase. A 43-year-old man with a history of left ventricular non-compaction underwent orthotopic HTx. On Day 7, transthoracic echocardiography showed a sudden decrease in cardiac function with hypokinesis in a left ventricular anterior wall distribution. Coronary angiography revealed a large thrombus in the left main trunk. With intra-aortic balloon pump support, emergency percutaneous coronary intervention was performed. Endomyocardial biopsy showed no rejection. A left main trunk thrombus is rare in the early phase after HTx, but it can be a life-threatening complication. Transthoracic echocardiography is well known to be important in the management of heart transplant recipients, and coronary angiography as well as myocardial biopsy should be considered when left ventricular wall motion is impaired.


Assuntos
Trombose Coronária , Transplante de Coração/efeitos adversos , Intervenção Coronária Percutânea , Adulto , Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Humanos , Masculino
10.
Int J Cardiovasc Imaging ; 35(2): 239-247, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30747368

RESUMO

Intravascular ultrasound (IVUS) guidance is not routinely performed in real-word clinical practice partly because the benefit of IVUS guidance is not well established. This updated meta-analysis aims to compare IVUS-guided and angiography-guided drug-eluting stent (DES) implantation, simultaneously stressing the value of an optimal IVUS-defined procedure. Medline, Scopus, Google Scholar, and Cochrane Controlled Trials Registry were searched for the randomized trials comparing IVUS-guided and angiography-guided DES implantation. Nine eligible randomized trials including 4,724 patients were identified. At a mean follow-up of 16.7 months, IVUS guidance was associated with a significant lower risk of major adverse cardiovascular events (MACE) [5.4% vs. 9.0%; relative risks (RR): 0.61, 95% confident interval (CI) 0.49-0.74, p < 0.001], cardiac death (0.6% vs. 1.2%; RR: 0.49, 95% CI 0.26-0.92, p = 0.03), target vessel revascularization (3.5% vs .6.1%; RR: 0.58, 95% CI 0.42-0.80, p = 0.001), target lesion revascularization (3.1% vs. 5.2%; RR: 0.59, 95% CI 0.44-0.80, p = 0.001), and definite/probable stent thrombosis (0.5% vs .1.1%; RR: 0.45, 95% CI 0.23-0.87, p = 0.02) compared with angiography guidance. No significant differences in all cause death and myocardial infarction were noted between the two groups. Subgroup analysis showed that patients who met the optimal criteria had a lower rate of MACE than those with IVUS-defined suboptimal procedure (RR: 0.33, 95% CI 0.06-0.60, p = 0.02). The present meta-analysis with the largest sample size to date demonstrates that IVUS-guided DES implantation significantly reduces cardiac death, coronary revascularization and stent thrombosis, particularly for patients with IVUS-defined optimal procedures compared with angiography guidance.


Assuntos
Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Ultrassonografia de Intervenção , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Trombose Coronária/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Radiografia Intervencionista , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/mortalidade
12.
Arch Cardiovasc Dis ; 112(2): 113-123, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30630761

RESUMO

BACKGROUND: Several randomized studies have shown that bioresorbable vascular scaffold (BVS) technology is associated with an increased risk of stent thrombosis. AIM: This study aimed to assess the rates of adverse outcomes at 1 year in patients treated with the Absorb BVS (Abbott Vascular, Santa Clara, CA, USA), using data from a large nationwide prospective multicentre registry (FRANCE ABSORB). METHODS: All patients receiving the Absorb BVS in France were included prospectively in the study. Predilatation, optimal sizing and postdilatation were recommended systematically. The primary endpoint was a composite of cardiovascular death, myocardial infarction and target lesion revascularization at 1 year. Secondary endpoints were scaffold thrombosis and target vessel revascularization at 1 year. RESULTS: A total of 2072 patients at 86 centres were included: mean age 55±11 years; 80% men. The indication was acute coronary syndrome (ACS) in 49% of cases. Predilatation and postdilatation were done in 93% and 83% of lesions, respectively. At 1 year, the primary endpoint occurred in 3.9% of patients, the rate of scaffold thrombosis was 1.5% and the rate of target vessel revascularization was 3.3%. In a multivariable analysis, diabetes and total Absorb BVS length>30mm were independently associated with the occurrence of the primary endpoint, whereas oral anticoagulation and total Absorb BVS length>30mm were independently associated with occurrence of scaffold thrombosis. CONCLUSIONS: The Absorb BVS was implanted in a relatively young population, half of whom had ACS. Predilatation and postdilatation rates were high, and 1-year outcomes were acceptable.


Assuntos
Implantes Absorvíveis , Síndrome Coronariana Aguda/cirurgia , Angina Instável/cirurgia , Angioplastia Coronária com Balão/instrumentação , Infarto do Miocárdio/cirurgia , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Adulto , Idoso , Angina Instável/diagnóstico por imagem , Angina Instável/mortalidade , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Trombose Coronária/etiologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Estudos Prospectivos , Desenho de Prótese , Recidiva , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Nat Rev Cardiol ; 16(4): 243-256, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30518952

RESUMO

Stent thrombosis (ST) is a rare but severe complication of coronary procedures with high mortality, high relapse rate and a very complex pathophysiology. An individual's susceptibility to ST is multifactorial and results from interactions between clinical factors, endothelial biology, hypersensitivity and/or inflammatory reactions, blood rheology, platelet reactivity, clotting factors, physical and mechanical properties of the stent and from the effects of these different factors on the fluid dynamics of blood flow. Since the introduction of stents 32 years ago, continuous improvements in our understanding of the pathophysiology of ST have triggered important advances, including new therapies, new technologies and an increased awareness of the implications of implantation techniques. Furthermore, advances in medical imaging and in the mathematical processing of this information have allowed a more detailed assessment of the mechanisms of ST at the time of its onset. Evidence shows that addressing the risk factors for ST leads to a substantial reduction in its incidence, both early and late after stent implantation. A better knowledge of the mechanisms of this complication is, however, necessary to direct the choice of the most appropriate strategy for its prevention and treatment.


Assuntos
Doença da Artéria Coronariana/terapia , Trombose Coronária/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Stents , Implantes Absorvíveis , Doença da Artéria Coronariana/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Stents Farmacológicos , Humanos , Desenho de Prótese , Medição de Risco , Fatores de Risco , Stents Metálicos Autoexpansíveis , Resultado do Tratamento
14.
J Pathol ; 247(4): 505-512, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30506885

RESUMO

Extracellular traps generated by neutrophils contribute to thrombus progression in coronary atherosclerotic plaques. It is not known whether other inflammatory cell types in coronary atherosclerotic plaque or thrombus also release extracellular traps. We investigated their formation by macrophages, mast cells, and eosinophils in human coronary atherosclerosis, and in relation to the age of thrombus of myocardial infarction patients. Coronary arteries with thrombosed or intact plaques were retrieved from patients who died from myocardial infarction. In addition, thrombectomy specimens from patients with myocardial infarction were classified histologically as fresh, lytic or organised. Neutrophil and macrophage extracellular traps were identified using sequential triple immunostaining of CD68, myeloperoxidase, and citrullinated histone H3. Eosinophil and mast cell extracellular traps were visualised using double immunostaining for eosinophil major basic protein or tryptase, respectively, and citrullinated histone H3. Single- and double-stained immunopositive cells in the plaque, adjacent adventitia, and thrombus were counted. All types of leucocyte-derived extracellular traps were present in all thrombosed plaques, and in all types of the in vivo-derived thrombi, but only to a much lower extent in intact plaques. Neutrophil traps, followed by macrophage traps, were the most prominent types in the autopsy series of atherothrombotic plaques, including the adventitia adjacent to thrombosed plaques. In contrast, macrophage traps were more numerous than neutrophil traps in intact plaques (lipid cores) and organised thrombi. Mast cell and eosinophil extracellular traps were also present, but sparse in all instances. In conclusion, not only neutrophils but also macrophages, eosinophils, and mast cells are sources of etosis involved in evolving coronary thrombosis. Neutrophil traps dominate numerically in early thrombosis and macrophage traps in late (organising) thrombosis, implying that together they span all the stages of thrombus progression and maturation. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.


Assuntos
Doença da Artéria Coronariana/etiologia , Eosinófilos/fisiologia , Armadilhas Extracelulares/metabolismo , Macrófagos/fisiologia , Infarto do Miocárdio/etiologia , Neutrófilos/fisiologia , Doença da Artéria Coronariana/patologia , Trombose Coronária/etiologia , Trombose Coronária/patologia , Vasos Coronários , Humanos , Mastócitos/fisiologia , Infarto do Miocárdio/patologia , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/patologia , Fatores de Tempo
15.
J Cardiovasc Med (Hagerstown) ; 20(1): 46-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30531616
16.
Angiology ; 70(5): 431-439, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30370779

RESUMO

We retrospectively analyzed short- and long-term outcomes of patients who received bailout tirofiban during primary percutaneous intervention (pPCI). A total of 2681patients who underwent pPCI between 2009 and 2014 were analyzed; 1331 (49.6%) out of 2681 patients received bailout tirofiban. Using propensity score matching, 2100 patients (1050 patient received bail-out tirofiban) with similar preprocedural characteristics were identified. Patients who received bailout tirofiban had a significantly higher incidence of acute stent thrombosis, myocardial infarction, and major cardiac or cerebrovascular events during the in-hospital period. There were numerically fewer deaths in the bailout tirofiban group in the unmatched cohort (1.7% vs 2.5%, P = .118). In the matched cohort, in-hospital mortality was significantly lower (1.1% vs 2.4%, P = .03), and survival at 12 and 60 months were higher (96.9% vs 95.2%, P = .056 for 12 months and 95.1% vs 92.0%, P = .01 for 60 months) in the bailout tirofiban group. After multivariate adjustment, bailout tirofiban was associated with a lower mortality at 12 months (odds ratio [OR]: 0.554, 95% confidence interval [CI], 0.349-0.880, P = .012) and 60 months (OR: 0.595, 95% CI, 0.413-0.859, P = .006). In conclusion, bailout tirofiban strategy during pPCI is associated with a lower short- and long-term mortality, although in-hospital complications were more frequent.


Assuntos
Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tirofibana/uso terapêutico , Adulto , Idoso , Transtornos Cerebrovasculares/etiologia , Trombose Coronária/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Inibidores da Agregação de Plaquetas/efeitos adversos , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Tirofibana/efeitos adversos , Resultado do Tratamento
17.
J Thromb Thrombolysis ; 47(1): 157-161, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30269287

RESUMO

The incidence of acute myocardial infarction in the setting of acute pancreatitis is very rare. The recognition of such complex diagnosis may be clinically challenging, as the symptoms of both conditions are often indistinguishable. We report a case in which we encountered both conditions concurrently, and hypothesize that the ambient inflammatory and pro-thrombotic milieu of acute pancreatitis resulted in acute coronary thrombosis despite the absence of significant coronary atherosclerosis. Among multiple coronary imaging modalities currently in use, optimal cohesion tomography provided a unique capability for direct visualization of the coronary thrombus. (1) Inflammatory processes such as acute pancreatitis promote a thrombogenic state. (2) Presentation of acute myocardial infarction is variable and can mimic a variety of medical conditions. (3) Intravascular imaging is emerging as a useful tool in delineating details of intra-coronary pathology not clear on standard fluoroscopy. (4) The above case highlights the likely concurrence of pathologies that follow common pathways such as system-wide inflammation and coagulation. Clinicians must be aware of this uncommon yet very likely possibility and keep a low threshold to perform ECG and cardiac biomarker testing if symptoms are suggestive of a myocardial infarction, even in the presence of a clear alternative diagnosis.


Assuntos
Trombose Coronária/etiologia , Pancreatite/complicações , Coagulação Sanguínea , Trombose Coronária/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Inflamação , Infarto do Miocárdio/diagnóstico , Tomografia de Coerência Óptica
18.
Ann Cardiol Angeiol (Paris) ; 68(1): 53-55, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30149894

RESUMO

A 58 year-old man was admitted in our ICU for cardiogenic shock and electrical storm. His medical history was marked by a triple redo valvular surgery complicated by a recurrent aortic pseudoaneurysm of the ascending aorta. Coronary angiogram and heart CT scan diagnosed an extensive anterior myocardial infarction related to an extrinsic compression of the left main stem by this massive and calcified pseudoaneurysm. Angioplasty or new cardiac surgery options were rejected by the heart team. Despite an unusual indication, the patient was registered on the heart transplant list, and underwent it successfully.


Assuntos
Falso Aneurisma/cirurgia , Aorta , Oclusão Coronária/cirurgia , Transplante de Coração , Choque Cardiogênico/cirurgia , Falso Aneurisma/complicações , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Infarto do Miocárdio/etiologia , Recidiva , Choque Cardiogênico/etiologia , Calcificação Vascular/complicações , Calcificação Vascular/cirurgia
19.
Eur J Cardiothorac Surg ; 55(2): 371-373, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29868867

RESUMO

Antiphospholipid syndrome is an autoimmune disorder with frequent clinical manifestation of arterial, venous or small vessel thromboembolic events and/or foetal morbidity. Hereby, we present a case report of a patient with a large arterial thrombus originating from the ostium of the right coronary artery accompanied by multiple systemic embolization and right ventricular failure. As a bridge-to-recovery strategy, an extracorporeal right ventricular assist device was successfully applied, representing an effective first choice option in selected patients with isolated acute right heart failure.


Assuntos
Síndrome Antifosfolipídica/complicações , Aorta/cirurgia , Doenças da Aorta , Trombose Coronária , Insuficiência Cardíaca , Coração Auxiliar , Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Pessoa de Meia-Idade
20.
Ann Thorac Surg ; 107(2): e105-e106, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30028978

RESUMO

Electric shock-induced myocardial infarction is rare. Shock-induced coronary artery thrombosis and dissection in multiple distributions have not been reported. After shock, coronary thrombosis may cause anginal symptoms, and any coronary artery may be damaged. A 32-year-old man presented with angina and ischemia-related symptoms after 6,000-V electric shock. He reported occasional exertional angina; the stress echocardiography result was positive for ischemia. Cardiac catheterization showed severe multivessel disease, an occluded left anterior descending coronary artery, and an occluded circumflex artery with collateralization to the distal left anterior descending coronary artery. Surgical intervention detected global coronary dissection and thrombosis. Bypass grafting achieved complete revascularization. The patient was successfully discharged home.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Coronário/etiologia , Trombose Coronária/etiologia , Traumatismos por Eletricidade/complicações , Adulto , Cateterismo Cardíaco , Doença da Artéria Coronariana/etiologia , Humanos , Masculino
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