RESUMO
The aim ot tnis study was to assess the results of interventional strategy in patients over 75 years of age admitted to hospital with acute coronary syndromes (ACS) without persistent ST elevation. Over three months, patients over the age of 75 undergoing coronary angiography for ACS were included in a multicentre register and followed up for 6 months. A total of 126 patients with an average age of 79 were included: 70% had at least one poor prognostic factor. The treatment on admission included: Aspirin (84%), Clopidogrel (60%), anti GpIIb-IIIa (12%) and Heparin (81%, of which 3/4 of cases were low molecular weight heparins). Coronary angiography (average delay 80 hours) showed single, double and triple vessel disease in 21, 29 and 35% of cases respectively. Coronary angioplasty was proposed in 83 patients and carried out in 82. Eleven patients underwent coronary artery bypass grafting and 31 were treated medically. During the hospital phase, there were 3 major cardiovascular complications: 1 death during coronary angiography, 1 intra-stent thrombosis and 1 death in the group undergoing bypass grafting, with no major bleeding complications. At 6 months, there were 8 (6.5%) major cardiovascular adverse events with 6 in the "angioplasty" group; 5 deaths (3 cardiac deaths), 3 myocardial infarcts. Two thirds of patients were asymptomatic. The authors conclude that interventional strategy in ACS of elderly patients is associated with a low rate of major adverse events. The benefits of this strategy should be confirmed by randomised trial.
Assuntos
Angioplastia/métodos , Angiografia Coronária , Doença da Artéria Coronariana/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias , Prognóstico , Stents , Síndrome , Resultado do TratamentoRESUMO
We recently showed that Isradipine, a calcium antagonist from the dihydropyridine group, reduces ischemia and improves ventricular function at rest and during exercise, 2 hours after a single oral dose, in patients with chronic stable angina. In the present study, we evaluated the effects of long acting slow release oral (SRO) Isradipine (5 mg) compared to a placebo in 30 coronary patients with stable chronic angina, randomized in a double blind-fashion. The following parameters were obtained at rest and during submaximal exercise: left and right ventricular (LV, RV) ejection fractions (EF; %) and peak filling rate (PFR; EDV/s), assessed by gated radionuclide angiography, clinical symptoms, electrocardiograms (ECG, ST segment depression; mm), systolic and diastolic blood pressure (SBP and DBP; mm Hg). Patients were then given two oral doses of either Isradipine or placebo (one a day). The same parameters were reassessed, at rest and during n equivalent exercise, 48 hours later (24 hours after the last administration of the drug). The results after Isradipine (n = 14) showed, at rest, a significant increase in LVEF and Pfr (51 +/- 9 to 54 +/- 8 and 1.97 +/- 0.44 to 2.36 +/- 0.71, respectively) and a decrease in DBP (93 +/- 11 to 87 +/- 13); and during exercise, a significant increase in LVEF (51 +/- 11 tot 55 +/- 13) and a decrease in ST segment depression (2.3 +/- 1.9 tot 1.9 +/- 1.6). No significant change was observed after placebo in the other 16 patients. We conclude that even 24 hours after an oral administration, Isradipine SRO maintains its beneficial effects both, at rest on LV systolic and diastolic function and pressure, and during exercise on ECG signs of ischemia with improvement in LV ejection fraction.
Assuntos
Angina Pectoris/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Coração/fisiopatologia , Isradipino/uso terapêutico , Função Ventricular , Adulto , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/fisiopatologia , Método Duplo-Cego , Teste de Esforço , Tolerância ao Exercício , Feminino , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Resultado do TratamentoRESUMO
Dual chamber pacing has been proposed as an alternative treatment to patients with cardiac failure refractory to optimal medical therapy. The influence of the site of ventricular pacing was studied in 15 patients with an average age of 68.7 +/- 8.7 years with dilated cardiomyopathies and an average left ventricular ejection fraction of 22.3 +/- 6.8%. Three temporary USCI electrodes were positioned in the right atrium, the right ventricular outflow tract (RVOT) and the right ventricular apex. The average duration of the QRS complexes and the haemodynamic parameters (PAP, PCP and cardiac index) were measured in sinus rhythm and during DDD apical, RVOT and simultaneous apical and RVOT pacing. The RVOT and simultaneous pacing significantly reduced the QRS duration (135 +/- 14 ms and 137 +/- 17 ms, p < 0.0001 respectively) compared with apical pacing (150 +/- 19 ms). The mean PAP and mean PCP remained unchanged in the different modes of pacing but the cardiac index increased significantly during RVOT pacing (2.99 +/- 0.67 l/min/m2) and simultaneous pacing (3 +/- 0.77 l/min/m2) compared with apical pacing (2.66 +/- 0.62 l/min/m2) (p < 0.001 and p < 0.01 respectively) and compared with sinus rhythm (2.62 +/- 0.7 l/min/m2) (p < 0.001 and p < 0.005 respectively). This study suggests that better results may be obtained with RVOT screw in lead than with the traditional right ventricular apical electrode.
Assuntos
Estimulação Cardíaca Artificial/métodos , Cardiomiopatia Dilatada/terapia , Insuficiência Cardíaca/terapia , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/terapiaRESUMO
Although single photon emission computed tomography (SPECT) has become widely utilized, the superiority of this technique compared to planar conventional imaging remains controversial. In order to compare these two techniques, we retrospectively analysed the results obtained in 70 patients who performed a thallium-201 exercise scintigraphy with a double acquisition during the same test, and who also underwent coronary and ventricular angiography. Overall, SPECT imaging yielded a higher sensitivity (93% vs 82% for SPECT and planar imaging respectively, p < 0.05), especially in the inferior and anterior regions. SPECT was also more sensitive for the detection of a single-vessel disease (90% vs 74% for SPECT and planar imaging respectively, p < 0.01). The specificity was assessed for both techniques with the help of circumferential computerized analysis, avoiding known causes of false positive scintigrams. We found a high specificity for both SPECT and planar imaging, without any significant difference between the two methods (87% vs 91% for the overall specificity of SPECT and planar imaging respectively, p = NS). Therefore, SPECT imaging analysed with discrimination shows an enhanced reliability over planar imaging for the detection and the localization of coronary artery disease, without increasing the risk of false positive tests.