RESUMO
OBJECTIVE: This study evaluates the safety and efficacy of the XIENCE V 4.0 mm stent for the treatment of de novo native coronary artery lesions. BACKGROUND: In the SPIRIT III trial, the XIENCE V everolimus-eluting stent (EES), compared with the TAXUS EXPRESS(2) paclitaxel-eluting stent (PES) in 2.5-3.75 mm diameter coronary arteries, resulted in reduced angiographic late loss (LL), noninferior rates of target vessel failure (TVF), and fewer major adverse cardiac events (MACE). METHODS: The SPIRIT III 4.0 mm registry was a concurrent arm of the SPIRIT III trial consisting of 69 nonrandomized patients with lesions Assuntos
Angioplastia Coronária com Balão/instrumentação
, Fármacos Cardiovasculares/administração & dosagem
, Angiografia Coronária
, Estenose Coronária/diagnóstico por imagem
, Estenose Coronária/terapia
, Stents Farmacológicos
, Sirolimo/análogos & derivados
, Idoso
, Angioplastia Coronária com Balão/efeitos adversos
, Angioplastia Coronária com Balão/mortalidade
, Estenose Coronária/mortalidade
, Everolimo
, Feminino
, Humanos
, Estimativa de Kaplan-Meier
, Masculino
, Pessoa de Meia-Idade
, Infarto do Miocárdio/etiologia
, Paclitaxel/administração & dosagem
, Valor Preditivo dos Testes
, Estudos Prospectivos
, Sistema de Registros
, Medição de Risco
, Método Simples-Cego
, Sirolimo/administração & dosagem
, Trombose/etiologia
, Fatores de Tempo
, Resultado do Tratamento
, Estados Unidos/epidemiologia
RESUMO
The aim was to establish a registry of patients with a diagnosis of Takotsubo cardiomyopathy (TC) to help learn more about the characteristics, treatment strategies, and natural history of this disease. Data for patients with TC diagnosed from July 2004 to April 2008 at 2 major hospitals in Rhode Island were obtained. A data set was created that included baseline demographics and characteristics, hospital, course, and clinical outcomes. TC was diagnosed in 70 patients during the study period. Postmenopausal women comprised 95% of the cohort. Six patients presented with cardiogenic shock, 9 required intubation, 3 experienced sustained ventricular arrhythmias, and 1 patient died of cardiac causes. Average ejection fraction was 37% at cardiac catheterization. Troponin-I was increased in all except 1 patient. Follow-up echocardiography showed full recovery of wall motion abnormalities, with an average ejection fraction of 59%. Most patients were treated using standard cardiovascular medications for acute coronary syndrome, and 43% were discharged on warfarin therapy because of severe apical wall motion abnormalities. Univariate analysis suggested that long-term use of angiotensin-converting enzyme inhibitors before the onset of TC was protective against cardiogenic shock, sustained ventricular arrhythmia, and death. Consecutive cases grouped into different seasons showed a statistically significant spike in the occurrence of TC during the summer months. In conclusion, the acute phase of this condition may lead to critical illness and death, and use of an angiotensin-converting enzyme inhibitor may have a protective effect. Overall long-term prognosis and recovery of left ventricular function were excellent.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Cateterismo Cardíaco/métodos , Sistema de Registros , Cardiomiopatia de Takotsubo/epidemiologia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Prognóstico , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Rhode Island/epidemiologia , Índice de Gravidade de Doença , Volume Sistólico/fisiologia , Taxa de Sobrevida/tendências , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/prevenção & controle , Fatores de Tempo , Função Ventricular Esquerda/efeitos dos fármacos , Função Ventricular Esquerda/fisiologiaRESUMO
Takotsubo cardiomyopathy is a disease in which patients present with signs and symptoms mimicking an acute coronary syndrome and, thus, undergo cardiac catheterization. At the time of catheterization, however, no critical coronary lesions are found. Most of these patients have a characteristic left ventriculogram and recent history of a preceding stressor. While the acute phase of the illness can lead to ventricular tachyarrhythmias and possibly even death, a key feature of this syndrome in the majority of patients is its generally benign course and reversibility in myocardial dysfunction over a period of days to weeks. The pathophysiology of Takotsubo cardiomyopathy remains unclear. Optimal long-term medical therapy has not been well established at this time, since the etiology of the disease process remains a source of debate.