RESUMEN
We estimated the benefit of a sirolimus-eluting stent (SES, Cypher) for diffuse (> 10 mm) in-stent restenosis (ISR) inside bare metal stents (BMS) because the feasibility of the SES was not confirmed after its recent approval in Japan. Clinical and angiographic outcomes after SES implantation to 93 diffuse ISR were compared with those of 3 groups treated by plain old balloon angioplasty (POBA, (n = 54)), cutting balloon angioplasty (CB, (n = 24)), and BMS (n = 41) in a series of 153 patients whose follow-up quantitative coronary angiography (QCA) evaluated 3-9 months after the treatments was obtained from January 2003 through December 2005. For 33 lesions in the SES group, 12-month follow-up QCA results were obtained and compared with those at 6 months. Ticlopidine (200 mg/day) was prescribed for at least 12 weeks after SES implantation and for 2 weeks after BMS in addition to aspirin (81-100 mg/day). Patient characteristics and the characteristics of previous implanted BMS in the SES group were not significantly different from those in the other groups. Death from cardiac causes and nonfatal myocardial infarction did not occur in any group. Stent thrombosis was not observed in the BMS and SES groups. The incidence of repeat target lesion revascularization (re-TLR) in the SES group (3.23%) was significantly lower compared with that of the POBA (37.0%), CB (25.0%), and BMS (29.3%) groups (P < 0.001, respectively). Late loss in the SES group (0.44 +/- 0.41 mm) was significantly smaller than that in the BMS group (1.34 +/- 0.74 mm) (P < 0.05). The rate of recurrent ISR (re-ISR) in SES (5.38%) was significantly lower than that in POBA (46.3%), CB (41.7%), and BMS (46.3%) (P < 0.001, respectively). The QCA variables at 6 months in the SES group were not significantly different from those at 12 months. Thus, SES implantation for diffuse ISR was far superior since it markedly reduced the incidence of re-TLR with re-ISR at up to 6-months follow-up. In addition, this angiographic patency after SES implantation continued until 12 months.
Asunto(s)
Reestenosis Coronaria/terapia , Sirolimus/administración & dosificación , Stents , Angioplastia Coronaria con Balón , Angiografía Coronaria , Fibrinolíticos/uso terapéutico , Estudios de Seguimiento , Humanos , Metales , Inhibidores de Agregación Plaquetaria/uso terapéutico , Diseño de Prótesis , Ticlopidina/uso terapéuticoRESUMEN
BACKGROUND: The incidence of subacute stent thrombosis (SAT) within 30 days after stenting with a sirolimus-eluting stent (Cypher) for acute myocardial infarction (AMI) was retrospectively compared to that with bare-metal stents (BMS). METHODS AND RESULTS: Among 559 lesions in 558 consecutive AMI from April 2003 to February 2006, the incidence of documented SAT after Cypher implantation (2/276 lesions, 0.72%) was almost the same as for BMS (2 cases, 0.71%). Aspirin (81-100 mg/day) plus ticlopidine (200 mg/day) were administered continuously after admission in all 4 cases. CONCLUSION: Documented SAT did not increase after stenting with Cypher for AMI under aspirin plus ticlopidine.
Asunto(s)
Trombosis Coronaria/epidemiología , Trombosis Coronaria/etiología , Infarto del Miocardio/cirugía , Stents/efectos adversos , Anciano , Aspirina/uso terapéutico , Reestenosis Coronaria/complicaciones , Trombosis Coronaria/prevención & control , Progresión de la Enfermedad , Femenino , Humanos , Inmunosupresores/administración & dosificación , Incidencia , Masculino , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estudios Retrospectivos , Sirolimus/administración & dosificación , Ticlopidina/uso terapéutico , Factores de TiempoRESUMEN
In the present study, the usefulness and feasibility of a new measuring microcatheter, the Navicath (Type-MUTO) microcatheter, for facilitating the stenting procedure subsequent to ablation using a rotablator (rota-stenting) is described. A method for measuring the length of the targeted lesion (lesion length) angiographically with the Navicath when exchanging the guide wires is presented using 2 representative cases of rota-stenting. In addition, the validity of the selected stent according to the measurement of lesion length with the Navicath was evaluated by comparing the length of the selected stent with lesion length before PCI measured by quantitative coronary angiography. Based on the results obtained, we believe the Navicath is useful for facilitating rota-stenting, and may even be applicable to PCI in general.
Asunto(s)
Aterectomía Coronaria/instrumentación , Estenosis Coronaria/cirugía , Stents , Anciano , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Estudios de Factibilidad , Femenino , HumanosRESUMEN
BACKGROUND: In Western countries, several multicenter collaborative studies on acute myocardial infarction (AMI) have provided much information about this disease. In Japan, on the other hand, there have been few cohort studies in which a sufficient number of Japanese patients with AMI were registered during a short period. This fact explains the absence of a database from which strategies for treating Japanese patients with AMI could be established. The purpose of this study was to build a comprehensive database on Japanese patients with AMI to elucidate their characteristics. METHODS: Between January 1999 and June 2001, we consecutively registered all patients with AMI who were admitted to 17 participating medical institutions, including The Heart Institute of Japan, Cardiology (HIJC), Tokyo Women's Medical University. A standardized case report form was used to register all the patients. RESULTS: A total of 3,021 consecutive patients was registered (2,136 men, 70.7%; 885 women, 29.3%) with a median age of 69 years [59, 77]. Among the patients, there were 851 elderly individuals (28.2%) > or = 76 years and 1102 patients with diabetes (36.5%). On index electrocardiogram, ST-elevation myocardial infarction was observed in 2,392 patients (79.2%). Within 24 hours after the onset of AMI, coronary angiography was conducted for 2,177 patients (72.1%). Primary percutaneous coronary intervention and coronary thrombolysis were conducted for 1,755 (58.1%) and 491 patients (16.3%), respectively, and percutaneous coronary intervention or coronary artery bypass grafting was additionally carried out in 303 patients. By the time of discharge, coronary angiography and coronary artery bypass grafting were performed in 2,659 (88.0%) and 137 patients (4.5%), respectively. During initial hospitalization, 285 patients died and the overall inhospital mortality rate was 9.4%. During hospitalization, cardiogenic shock and cardiac rupture were observed in 6.1% and 2.8% of the patients, respectively. The inhospital mortality rate is still high in patients with AMI with such mechanical complications and in elderly patients. CONCLUSION: In our prospective cohort, we showed that Japanese patients with AMI could be characterized as (1) having a disease severity comparable with values observed in Western populations and (2) receiving early reperfusion therapy by PCI, which was used widely and safely, but nevertheless (3) exhibiting a high inhospital mortality rate. Our data indicate that further improvements in therapy for AMI in elderly patients and for AMI with mechanical complications are essential in Japan.
Asunto(s)
Infarto del Miocardio/terapia , Sistema de Registros , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Estudios de Cohortes , Puente de Arteria Coronaria/efectos adversos , Femenino , Mortalidad Hospitalaria , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Although smoking cessation is widely encouraged because of the associated risk of cardiovascular events, the impact of smoking on target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) is controversial. Therefore, the present study retrospectively investigated the effect of smoking on TLR after plain-old balloon angioplasty (POBA; n=376) and stenting (STENT; n=434) in patients undergoing secondary coronary angiography at a single center. METHODS AND RESULTS: A smoker was defined as current smoking or quitting within 2 years of the first PCI. In the POBA group, the predictors for TLR, as calculated by multiple logistic regression analysis, were a complex type of lesion (p<0.0001) and the left anterior descending artery (LAD) as affected vessel (p<0.05). In the STENT group, the predictors were the final % diameter of stenosis after stenting, measured by quantitative coronary arteriography (p<0.0005), LAD (p<0.01), and smoking (p=0.049). When the STENT group was divided into 2 groups according to the diameter of the implanted stent, smoking was a predictive factors for TLR in the group that received relatively small stents (diameter < or =3.0 mm) (p<0.02), but not in the group that received larger stents (diameter > or =3.5 mm). CONCLUSION: Smoking has a deteriorative effect on TLR after implantation of relatively small coronary stents with a diameter of 3.0 mm or less.
Asunto(s)
Revascularización Miocárdica , Fumar/efectos adversos , Stents , Angioplastia Coronaria con Balón , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/terapia , Estudios RetrospectivosRESUMEN
A 42-year-old man was treated under a diagnosis of Churg-Strauss syndrome with predonisolone pulse therapy. Three days later, he developed cardiogenic shock following acute myocardial infarction. Coronary angiography showed total occlusions in three peripheral coronary vessels. Intraaortic balloon pumping was used to maintain hemodynamics and predonisolone pulse therapy was repeated. However, he developed cardiogenic shock again after the second pulse therapy and needed percutaneous cardiopulmonary support and intraaortic balloon pumping. Accordingly, combination therapy of predonisolone and cyclophosphamide was given. He then recovered. Follow-up angiography showed recanalization of the infarct-related arteries.
Asunto(s)
Síndrome de Churg-Strauss/complicaciones , Síndrome de Churg-Strauss/terapia , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Adulto , Puente Cardiopulmonar , Angiografía Coronaria , Ciclofosfamida/administración & dosificación , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Contrapulsador Intraaórtico , Masculino , Prednisolona/administración & dosificación , Quimioterapia por Pulso , Resultado del TratamientoRESUMEN
In order to bail out the slow-flow phenomenon (slow flow) created by a massive thrombus in an ectasic right coronary artery, a thrombus was mechanically extracted with a 6 Fr right Judkins (JR) catheter, which proved to be more useful than a usual thrombectomy using a Rescue PT system catheter (Rescue). In case 1, the Rescue was used in combination with thrombolysis but failed to alleviate the slow flow that was implicated in a large infarction. On the other hand, in case 2, aggressive thrombectomy with a 6 Fr JR catheter with an 8 Fr Amplatz guiding catheter successfully extracted the massive intracoronary thrombus, restoring good coronary flow. Therefore, mechanical extraction with a 6 Fr JR catheter is safe and useful in cases of massive thrombus when diffuse coronary artery ectasia complicates an acute myocardial infarction. In addition, this method should be applicable to cases of acute coronary syndrome with massive thrombus.
Asunto(s)
Trombosis Coronaria/terapia , Infarto del Miocardio/terapia , Reperfusión Miocárdica/instrumentación , Trombectomía/instrumentación , Adulto , Anciano , Cateterismo Cardíaco/instrumentación , Enfermedad Coronaria/complicaciones , Trombosis Coronaria/complicaciones , Dilatación Patológica/complicaciones , Femenino , Humanos , Masculino , Infarto del Miocardio/etiología , Resultado del TratamientoRESUMEN
Existing indices of coronary conductance (hyperemic flow-versus-pressure slope index, FPSI, and zero flow pressure, Pzf) have been developed as measures of microcoronary resistance. These indices, however, refer to cases of normal hearts, and there are no reports studying these indices following acute myocardial infarction. In this study, we investigated whether FPSI and Pzf truly measure the extent of myocardial salvage after successful reperfusion therapy. We also developed a new index of zero pressure flow, Fzp. Nineteen patients who underwent successful reperfusion therapy to the proximal portion of the left anterior descending artery (LAD) were studied. After successful reperfusion therapy, a Doppler wire was placed into the LAD. Aortic pressure was recorded in real time. Results from the aortic pressure and flow meter were combined to produce FPSI, Pzf, and Fzp. All cases underwent a resting thallium (Tl) and BMIPP scintigram within five days of successful reperfusion therapy. Infarcted myocardium was estimated using a severity score calculated from the Tl scintigraphy (TlSS), and the BMIPP (BMIPPSS) was estimated using a severity score. Patients with a TlSS/BMIPPSS ratio of less than 0.4 were assigned to the successful salvage group (group S), while the others were assigned to the failed salvage group (group F). FPSI of group F was 1.91 +/- 0.26 m/sec and of group S was 0.92 +/- 0.43 m/sec (P < 0.01). Pzf of group F was 51 +/- 3 mmHg and of group S was 51 +/- 5 mmHg (NS). Fzp of group F was -98 +/- 16 cm/sec and of group S was -46 +/- 4 cm/sec (P < 0.05). FPSI and the new index of Fzp were useful in estimating the extent of myocardial salvage. Our results suggest that the Pzf index could not differentiate between the two groups.
Asunto(s)
Circulación Coronaria/fisiología , Infarto del Miocardio/terapia , Reperfusión Miocárdica , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Vasos Coronarios/fisiopatología , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Miocardio/patología , Cintigrafía , Índice de Severidad de la EnfermedadRESUMEN
This study evaluated the impact of serum creatinine levels on in-hospital mortality in 1,359 consecutive patients with acute myocardial infarction (from a Japanese prospective multicenter registry) who underwent successful primary percutaneous coronary intervention (PCI). Even in the patients who underwent successful primary PCI, the in-hospital mortality of patients with mild (1.2 /=2.0 mg/dl) renal dysfunction was greater (17.1% and 34.5%, respectively) than that of patients without renal dysfunction (3.9%) (relative risk [RR] 1.72, 95% confidence interval [CI] 0.94 to 3.14, p = 0.080; and RR 4.26, 95% CI 1.48 to 12.27, p <0.0001, respectively).
Asunto(s)
Angioplastia Coronaria con Balón , Creatinina/sangre , Mortalidad Hospitalaria , Infarto del Miocardio/sangre , Infarto del Miocardio/mortalidad , Anciano , Estudios de Cohortes , Femenino , Humanos , Japón , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Masculino , Estudios Multicéntricos como Asunto , Infarto del Miocardio/terapia , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Sistema de RegistrosRESUMEN
Continuous ATP injection is used clinically for Tl imaging or coronary flow measurement and because the effect on human hemodynamics is unknown, the present study investigated it in 14 patients undergoing heart catheter examination. Continuous ATP injection induced chest symptoms in 13 of the patients and second-degree atrioventricular block in one, but these complications disappeared immediately after the end of ATP infusion. Continuous ATP injection decreased aortic pressure, but increased pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure. ATP increased heart rate, stroke volume and cardiac output, the latter the result of an increase in preload, a decrease in afterload, and the increase in heart rate.