RESUMEN
In a series of 129 patients having coronary angioplasties in St. James's Hospital in 1989, the average age was 54.8 (30-77 years). There were 102 (79%) men and 27 (21%) females. Clinical indications were unstable angina 62, stable angina 26, post myocardial infarction 39 and asymptomatic ischaemia 2. The distribution of coronary disease was single vessel 62%, double vessel 28%, triple vessel 7% and previous coronary bypass surgery 3%. Only 10 patients had more than one vessel dilated. Primary success was achieved in 119 (92%), there were no deaths, 3 patients had abrupt closure of the vessel during angioplasty and sustained a nonfatal myocardial infarction, 1 patient required urgent bypass surgery and 2 patients had peripheral vascular complications requiring surgery. There were 6 failed angioplasties, 4 of which had chronic total occlusion. At a mean follow-up of 5.3 months, 85 patients had no symptoms, 34 had angina, 2 developed myocardial infarction and 1 died suddenly at 5 months. Repeat angiography was performed in 96 (79%) patients. At follow-up, no symptoms were present in 69% of those with single vessel disease and 70% of multivessel disease. Of those who had more than one vessel dilated in multivessel disease, 80% were asymptomatic (P = NS). There were 11 patients with initial total occlusion at presentation, 4 had failed angioplasties, 5 recurrent angina of which 4 reoccluded and 1 restenosed and only 2 were asymptomatic and without restenosis. Angioplasty was performed with primary success (92%) and follow up results (70% asymptomatic). Those with single or multivessel disease had similar clinical outcome, favouring the use of target vessel angioplasty. Long term results following angioplasty of chronic total occlusions were poor and suggests the need for additional treatment.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Angioplastia Coronaria con Balón/estadística & datos numéricos , Enfermedad Coronaria/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Angina de Pecho/terapia , Angina Inestable/terapia , Angioplastia Coronaria con Balón , Isquemia Miocárdica/terapia , Angina de Pecho/diagnóstico , Angina Inestable/diagnóstico , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnósticoRESUMEN
Percutaneous transluminal coronary angioplasty (PTCA) is a widely successful revascularisation procedure. The restenosis rate has not significantly improved, despite the addition of many therapeutic agents. We describe the role of intra-coronary stents in the management of recurrent occlusion, restenosis and intracoronary dissection. We describe and discuss the problems associated with placement of the stent. The intracoronary stent has a successful adjuvant role to play with angioplasty in reducing both the elective and emergency requirements for coronary artery bypass grafting.
Asunto(s)
Angina de Pecho/cirugía , Angioplastia Coronaria con Balón , Puente de Arteria Coronaria/instrumentación , Enfermedad Coronaria/cirugía , Isquemia Miocárdica/cirugía , Revascularización Miocárdica/instrumentación , Stents , Adulto , Angiocardiografía , Angioplastia Coronaria con Balón/instrumentación , Materiales Biocompatibles , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Percutaneous transluminal coronary angioplasty was performed in 25 patients with unstable angina and in a similar group of 25 patients with stable angina. The frequency of single, double, and triple vessel disease was identical in each group. Technical success was achieved in 22 (81%) out of 27 attempts in those with unstable angina and in 14 (52%) out of 27 attempts in those with stable angina. Vessel occlusion occurred in nine patients, necessitating emergency bypass surgery in four. There was evidence of myocardial infarction in three patients in each group and one patient in the unstable group subsequently died. Twenty eight of 32 successfully treated patients were followed up by means of repeat coronary arteriography, exercise electrocardiography, and clinical assessment after a mean (SD) interval of 14 (7) months. There was angiographic evidence of restenosis in 32% (seven of 22) of lesions in the unstable group and 44% (four of nine) of lesions in the stable group. There were no late infarctions or deaths during the follow up period. These results support the growing evidence that angioplasty can be carried out safely and effectively in patients with unstable angina.
Asunto(s)
Angina de Pecho/terapia , Angina Inestable/terapia , Angioplastia de Balón , Angina de Pecho/fisiopatología , Angina Inestable/fisiopatología , Presión Sanguínea , Vasos Coronarios/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The purpose of this study was to examine the usefulness of digital subtraction angiography in the evaluation of left ventricular function (LVF). LVF was examined in 24 patients by three methods, (a) conventional ventriculography using an intraventricular injection (CLV) of 40 ml of contrast medium, (b) small volume (10-15 ml) left ventriculogram (SVLV) and (c) intravenous injection of 30 ml contrast medium (IVLV). Images were recorded via a conventional image intensifier--TV chain on to video tape and later analysed using a nuclear medicine computer with a digital interface. There was excellent correlation of ejection fraction and wall motion abnormalities between CLV and SVLV methods (r = 0.92 and r = 0.71, respectively) and good correlation between CLV and IVLV methods (r = 0.88 and r = 0.67, respectively). However, only minimal contrast induced premature ventricular contractions were observed in either the SVLV or IVLV methods compared with approximately 60% in the CLV method. Exclusion of studies containing ectopic cardiac cycles considerably improved the correlation between CLV and SVLV (r = 0.97) and between CLV and IVLV methods (r = 0.95). In conclusion, our results indicate that conventional left ventriculography may be replaced by either intravenous or small volume intraventricular methods with little loss of wall motion definition or error in ejection fraction estimation. The less invasive nature of the SVLV and IVLV methods should increase the usefulness of left ventriculography and extend its application to the assessment of left ventricular reserve under stress and during drug intervention.
Asunto(s)
Angiografía/métodos , Enfermedad Coronaria/diagnóstico por imagen , Corazón/diagnóstico por imagen , Técnica de Sustracción , Adulto , Complejos Cardíacos Prematuros/inducido químicamente , Computadores , Medios de Contraste/efectos adversos , Humanos , Persona de Mediana Edad , Contracción Miocárdica , Volumen Sistólico , Grabación de Cinta de VideoAsunto(s)
Marcapaso Artificial , Síndrome del Seno Enfermo/terapia , Adolescente , Adulto , Anciano , Niño , Electrocardiografía , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Síndrome del Seno Enfermo/complicaciones , Síndrome del Seno Enfermo/fisiopatologíaAsunto(s)
Servicios de Salud Comunitaria , Enfermedad Coronaria/prevención & control , Tamizaje Masivo , Adulto , Anciano , Presión Sanguínea , Colesterol/sangre , Enfermedad Coronaria/diagnóstico , Electrocardiografía , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Esfuerzo Físico , Probabilidad , Fumar/complicacionesRESUMEN
The Dublin cardiac ambulance service operates two specially-equipped ambulances from a private ambulance station; five metropolitan hospitals provide coronary care beds on a rota system. The service covers an area of 450 square miles (1,165 sq km) and a population of 800,000. The ambulances are staffed solely by trained ambulance personnel. During the first three years 1,973 patients were transported to hospital. Primary ventricular fibrillation was encountered in 20 patients and successfully treated in 17. No deaths occurred in the ambulance.Over 98% of the patients were transferred uneventfully to hospital, so a medical team from the hospital on duty was called on 30 occasions only. A feature of the Dublin service is the low cost of a standard ambulance call, at about pound7.50.