RESUMEN
AIMS: Recent studies have shown that coronary cyclic flow variations (CCFV) is a platelet-related phenomenon that occurred following reperfusion. Although CCFV predicts acute complications following thrombolytic therapy, its impact following percutaneous coronary interventions (PCI) has not been evaluated yet. METHODS AND RESULTS: One hundred and thirty-one patients with ST-segment Elevation Myocardial Infarction (STEMI) who underwent PCI were included in the analysis. All patients have 24-hour ST-segment monitoring. The development of CCFV was defined as > or = 3 ST-segment transitions (> or =150 microV). We divided the population in two groups according to the presence (n=14, 10.6%) or absence (n=117) of CCFV. The relation between CCFV and 30-day major adverse cardiac events (MACE) was analyzed using a multivariate logistic regression model adjusting for age, sex, diabetes, smoking, anterior infarct, Killip class, and final TIMI flow grade. Clinical and angiographic characteristics were similar between the two groups. Higher 30-day mortality (21.4 vs. 3.8%, p=0.022) and MACE rates (42.9 vs. 10.7%, p=0.005) were seen in the CCFV group. Multivariate regression analysis revealed that patients with CCFV were at increased risk of 30-day MACE (adjusted RR 5.09; 95% CI 1.3-19.1; p=0.0016). CONCLUSION: The presence of CCFV altered primary PCI may provide an early indication of insufficient myocardial perfusion and impending catastrophic outcome.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/mortalidad , Circulación Coronaria/fisiología , Anciano , Angioplastia Coronaria con Balón/métodos , Velocidad del Flujo Sanguíneo/fisiología , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Reperfusión Miocárdica/efectos adversos , Reperfusión Miocárdica/métodos , Reperfusión Miocárdica/mortalidad , Pronóstico , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Early antithrombotic therapy after biological aortic valve replacement (AVR) is controversial. The aim of this study was to determine the rate of thromboembolic events (TE) without anticoagulation treatment during the first 3 months after surgery. Out of 143 consecutive patients who underwent biological AVR from January 1998 to December 2004, 127 patients who did not receive anticoagulation were included (89%). Events during the first 3 months after surgery included: 2 strokes (1.5%), 2 major bleedings (1.5%) and 9 deaths (7%) (none of them due to TE). In conclusion, the management of patients without antithrombotic treatment after biological AVR seems to be safe due to a low rate of TE.