RESUMEN

BACKGROUND: Patients suffering from congestive heart failure (CHF) frequently feel physical suffering and anxiety. OBJECTIVES: The researchers investigated whether back massage could reduce anxiety, discomfort, and physical suffering in patients with CHF. The effects of gender and severity-dependent response of back massage on anxiety and discomfort in patients were also analyzed. DESIGN: The study used a quasi-experimental design with one group pretest and posttest. PARTICIPANTS: Sixty-four participants were recruited in southern Taiwan. OUTCOME MEASURES: The modified State Anxiety Inventory, the discomfort Visual Analogue Scale, electronic blood pressure (BP) gauges, stethoscopes and the pulse oximetry were used in this study. RESULTS: The participants' systolic BP (F (3, 189)=18.91, p<0.01), diastolic BP (F (3, 189)=13.40, p<0.01), heart rate (F (3, 189)=26.28, p<0.01), and respiratory rates (F (3, 189)=5.77, p<0.01) were significantly decreased after back massage. Oxygen saturation levels showed significant increases (F (3, 189)=42.82, p<0.01). Male participants revealed a more significant reduction in anxiety than the female participants (F (1, 50)=7.27, p=0.01). Those with more severe heart failure and greater levels of anxiety (F (2, 61)=4.31, p=0.02) and systolic BP (F (2, 61)=3.86, p=0.03) demonstrated significantly greater responses to back massage. CONCLUSIONS: Back massage significantly reduced anxiety in the study population. Systolic BP decreased to a greater degree in the male participants, particularly in those with severe heart failure and greater levels of anxiety and higher systolic BP. This study was conducted without a control group. Randomized clinical trials are needed to validate the effectiveness of back massage on patients with CHF.

Asunto(s)

Ansiedad/psicología , Ansiedad/terapia , Nivel de Alerta , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/terapia , Masaje/psicología , Calidad de Vida/psicología , Anciano , Presión Sanguínea , Recolección de Datos , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Oximetría , Dolor/psicología , Dimensión del Dolor , Satisfacción del Paciente , Inventario de Personalidad , Frecuencia Respiratoria , Factores Sexuales , Resultado del Tratamiento

RESUMEN

Few studies have reported results for transradial (TR) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. The purpose of this study was to evaluate the feasibility and safety of bilateral radial PCI for CTO lesions.Eighty-five consecutive patients with CTO lesions received PCI via a bilateral TR approach. A high radial artery puncture (10-15 cm above styloid process) accommodating a 7 Fr catheter (85 cm long) was used for a retrograde approach, and a 6 Fr catheter was used in the other radial artery for an antegrade approach. Retrograde wiring was conducted primarily or after failure of antegrade wiring. Mean duration of CTO was 42.8 ± 54.9 months. Vessels with occlusions attempted were the left anterior descending artery (40.0%; 34/85), right coronary artery (58.8%; 50/85), and left circumflex artery (1/85). PCI re-attempts were made in 41.2% of the cases. The overall success rate was 87.1%. Retrograde wiring was successful in 61/85 cases (71.8%), via septal collaterals followed by epicardial collaterals and saphenous vein graft. There were no major complications (30 day in-hospital death, Q wave myocardial infarction, or emergency bypass surgery), or serious access site complications.For experienced TR-PCI operators who are already doing complex TR coronary interventions, the bilateral radial approach for CTO lesions appears feasible and safe.

Asunto(s)

Angioplastia Coronaria con Balón/métodos , Cateterismo Periférico , Oclusión Coronaria/terapia , Arteria Radial , Enfermedad Crónica , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Resultado del Tratamiento

RESUMEN

BACKGROUND: This study evaluated the 30-day clinical outcome of patients with acute inferior wall ST-elevation myocardial infarction (AIW-STEMI) from occlusion of the left circumflex artery (LCX) vs the right coronary artery (RCA) undergoing primary percutaneous coronary intervention (PCI). HYPOTHESIS: The clinical outcomes of AIW-STEMI caused by RCA and LCX occlusion may be different for patients undergoing primary PCI. METHODS: Between May 2002 and September 2009, 646 consecutive patients with AIW-STEMI undergoing primary PCI were enrolled. Of these patients, 520 (80.5%) with AIW-STEMI caused by RCA occlusion were categorized into group 1, whereas the remaining 126 (19.5%) whose AIW-STEMI was caused by LCX occlusion served as group 2. RESULTS: The results demonstrated that the frequency of advanced congestive heart failure, respiratory failure requiring mechanical ventilatory support, and 30-day mortality were remarkably higher in group 2 than in group 1 (all P < 0.01). Conversely, the incidence of right ventricular infarction and complete heart block were notably higher in group 1 than in group 2 (all P < 0.001). Additionally, the peak level of creatine kinase-isoenzyme MB was significantly higher, whereas the left ventricular ejection fraction was notably lower in group 2 than in group 1. Multivariate analysis demonstrated that advanced CHF, high serum creatinine level, low systolic blood pressure, low left ventricular ejection fraction, and LCX as the infarct-related artery were significantly and independently predictive of 30-day mortality (all P < 0.05). CONCLUSIONS: The 30-day prognostic outcome was less favorable in LCX-related AIW-STEMI compared with RCA-related AIW-STEMI undergoing primary PCI.

Asunto(s)

Angioplastia Coronaria con Balón , Oclusión Coronaria/terapia , Infarto de la Pared Inferior del Miocardio/terapia , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/mortalidad , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Oclusión Coronaria/sangre , Oclusión Coronaria/complicaciones , Oclusión Coronaria/mortalidad , Oclusión Coronaria/fisiopatología , Forma MB de la Creatina-Quinasa/sangre , Femenino , Bloqueo Cardíaco/etiología , Insuficiencia Cardíaca/etiología , Humanos , Infarto de la Pared Inferior del Miocardio/sangre , Infarto de la Pared Inferior del Miocardio/etiología , Infarto de la Pared Inferior del Miocardio/mortalidad , Infarto de la Pared Inferior del Miocardio/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Respiración Artificial , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Taiwán , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular Izquierda

RESUMEN

OBJECTIVE: To evaluate procedure outcomes, complications, and the predictors of device success while using the Tornus in CTO revascularization. BACKGROUND: The success of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) may be limited by the presence of severe calcified CTO lesions, especially in the smallest balloon uncrossable arteries. A penetrating device (Tornus) could improve the success rate. METHODS: Device and angiographic success rates as well as procedural complications were assessed in 56 patients, who were consecutively and retrospectively enrolled into this study. Device success was defined as successful passage of the Tornus catheter through a CTO lesion. Procedure success was defined by a final TIMI 3 flow and <30% residual stenosis. RESULTS: The device success rate was 71.4% in 40 patients and failure rate was 28.6% in 16 patients. The final procedure success was significantly higher in the Tornus success group compared with the Tornus failure group (87.5% vs. 37.5%, P < 0.001). One patient in the Tornus success group (1.8%) had wire perforation resulting in cardiac tamponade and cardiac death. Another patient (1.8%) in the Tornus success group had acute in-stent thrombosis and non-Q MI in 24 hr and was resuscitated by emergent PCI. The only independent predictor of device success was a calcium score < 2 (odds ratio (OR): 3.86 (95% CI: 1.14-13.1, P = 0.03). CONCLUSION: The Tornus catheter can be used in severe calcified CTO PCI when the calcium score <2 and not be used in patients with a calcium score ≥2.

Asunto(s)

Angioplastia Coronaria con Balón/instrumentación , Catéteres , Oclusión Coronaria/terapia , Calcificación Vascular/terapia , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/mortalidad , Distribución de Chi-Cuadrado , China , Enfermedad Crónica , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/mortalidad , Diseño de Equipo , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Selección de Paciente , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Stents , Factores de Tiempo , Resultado del Tratamiento , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/mortalidad

RESUMEN

BACKGROUND: Long-term follow-up studies revealed a significant decline in the benefits of intracoronary radiation for in-stent restenosis. METHODS AND RESULTS: A total of 25 study and 25 contemporaneous control patients with diffuse in-stent restenosis who underwent cutting balloon angioplasty (CBA) transradially, followed by subsequent intracoronary irradiation with a liquid ß-emitter Rhenium-188 (¹88Re)-filled balloon were enrolled in the study. The mean clinical follow-up durations were 64.9 ± 13.0 and 66.3 ± 13.8 months for the irradiated and control patients, respectively. Six-month angiographic restenosis was observed in 16% (4 of 25) of the patients in the irradiated group and 48% (12 of 25) of the patients in the control groups (P = 0.03). The 6-month major adverse cardiac events (MACE) rate was 12% and 44%, respectively (P = 0.025). The 3-year follow-up angiography was performed in 16 of 21 (76%) irradiated patients and in 4 of 13 (31%) control patients who had no significant restenosis at the 6-month angiographic follow-up. Restenosis occurred in 1 of 16 (7%) irradiated patients and 2 of 4 (50%) control patients. Late target lesion revascularization was performed in 1 irradiated and 2 control patients. The MACE rate within 6 years was significantly reduced in the irradiated group (20% vs. 56%, P = 0.019). CONCLUSIONS: Brachytherapy using ¹88Re-filled balloon following CBA for diffuse in-stent restenotic native coronary arteries is effective in reducing target lesion restenosis and improving long-term outcomes.

Asunto(s)

Angioplastia Coronaria con Balón/instrumentación , Braquiterapia/métodos , Cateterismo Cardíaco , Reestenosis Coronaria/terapia , Arteria Radial , Radioisótopos/uso terapéutico , Renio/uso terapéutico , Stents , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/mortalidad , Braquiterapia/efectos adversos , Braquiterapia/mortalidad , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Distribución de Chi-Cuadrado , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/etiología , Reestenosis Coronaria/mortalidad , Reestenosis Coronaria/radioterapia , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Medición de Riesgo , Factores de Riesgo , Taiwán , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Percutaneous coronary intervention (PCI) with stent implantation is now considered a safe and feasible treatment for stenosis of the unprotected left main coronary artery (ULMCA). Because few studies have focused on de novo distal ULMCA lesions, a propensity score-matched cohort study was conducted to compare bare metal stents (BMS) with drug-eluting stents (DES) for long-term outcomes following PCI. METHODS AND RESULTS: This study reviewed the outcomes of patients undergoing PCI with DES (n=127) or BMS (n=51) for distal de novo ULMCA stenosis. The baseline demographic, angiographic and procedural characteristics differed between the 2 groups, indicating potential selection bias. The propensity score-matched cohort showed that the DES group had significantly less target lesion revascularization (TLR) and major adverse cardiovascular events (MACE) following PCI than the BMS group. Furthermore, heart failure (HF) of New York heart Association functional class III/IV was associated with an increased risk of TLR and MACE, whereas implantation of DES in patients with significant HF led to more favorable outcomes. CONCLUSIONS: Lower rates of TLR and MACE occurred in patients following PCI with DES implantation than with BMS implantation for distal ULMCA stenosis. Implantation of DES in patients with significant HF may improve the unfavorable outcome. When PCI is chosen to manage distal ULMCA stenosis, DES is the preferred stent type.

Asunto(s)

Angioplastia Coronaria con Balón/instrumentación , Estenosis Coronaria/terapia , Stents , Anciano , Estudios de Cohortes , Reestenosis Coronaria/epidemiología , Reestenosis Coronaria/prevención & control , Estenosis Coronaria/epidemiología , Stents Liberadores de Fármacos , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/epidemiología , Oclusión de Injerto Vascular/prevención & control , Insuficiencia Cardíaca/epidemiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Modelos de Riesgos Proporcionales , Proyectos de Investigación , Estudios Retrospectivos , Factores de Riesgo , Sesgo de Selección , Índice de Severidad de la Enfermedad , Resultado del Tratamiento

RESUMEN

Same-day discharge transradial percutaneous coronary intervention (TRI) has been reported to be safe and feasible in Western countries. However, Asia has not produced any reports related to this matter. The present study explored the safety and feasibility of patients with indications for TR coronary angiography and ad hoc PCI with a same-day discharge protocol. Between October 1995 and December 2002, 660 adult patients were admitted to our hospital for ad hoc PCIs. Of these, 214 patients were discharged on the day of their PCI (group A), while the remaining 446 patients were referred for out-patient department (OPD) PCI with subsequent admission (group B). Periprocedural complications were not significantly different between the groups. There were no differences in 1-month major adverse cardiac events including death, myocardial infarction, and target vessel revascularization (1.4% versus 0.2% for groups A and B, respectively; P = 0.068). Three group A cases (1.4%) experienced peri- and post-PCI myocardial infarction and one group B case (0.2%) experienced a post-PCI myocardial infarction. No patient died or required emergency bypass surgery. In group A, 8 cases (3.7%) required cutting balloon angioplasty and 2 cases (0.9%) needed rotational atherectomy. TRI is safe and feasible on an outpatient basis. For select patients, even though PCI can carry the potential risk of subsequent cutting balloon angioplasty or rotational atherectomy, the procedure should still be considered.

Asunto(s)

Atención Ambulatoria , Angioplastia Coronaria con Balón , Infarto del Miocardio/terapia , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial , Resultado del Tratamiento

RESUMEN

Levels of circulating endothelial progenitor cells (EPCs) in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI) were investigated in this study. Flow cytometric analysis of the circulating EPC level (CD31/CD34 [E(1)], CD62E/CD34 [E(2)], and KDR/CD34 [E(3)]) was determined from blood samples of 161 consecutive patients with STEMI undergoing primary PCI. Angiogenesis was evaluated using mononuclear cell-derived EPCs on Matrigel. The EPC number (E(1-3)) was lower in STEMI patients than in normal subjects (n = 25) (P < 0.005). Patients with high EPCs (E(1-3)) (≥1.2%) had a lower left ventricular ejection fraction, elevated white blood cell count and creatinine level, advanced Killip score (≥class 3), more advanced congestive heart failure (CHF) (≥class 3), and increased 30-day mortality than those with a low EPC (E(1-3)) level (<1.2%) (P < 0.0001). Angiogenesis was lower in patients with a high EPC level than those with a low EPC level and normal controls (P < 0.001). Both the advanced Killip score and the CHF were independent predictors of increased EPC levels (P < 0.05). Multivariate analysis identified a high EPC (E(3)) level to be the most important predictor of increased 30-day major adverse clinical outcome (MACO) (P < 0.0001). In conclusion, the circulating EPC level is a major independent predictor of 30-day MACO in patients with STEMI undergoing primary PCI.

Asunto(s)

Células Endoteliales/fisiología , Infarto del Miocardio/sangre , Células Madre/fisiología , Enfermedad Aguda , Adulto , Anciano , Angioplastia Coronaria con Balón , Biomarcadores/sangre , Movimiento Celular , Proliferación Celular , Células Endoteliales/citología , Femenino , Citometría de Flujo , Insuficiencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Células Madre/citología , Volumen Sistólico

RESUMEN

Cobalt chromium stents (CCS) are seldom compared to drug-eluting stents (DES) for coronary intervention in published clinical trials. We evaluated the daily usage patterns of CCS in comparison to DES unconstrained by eligibility criteria. We compared consecutive patients (n = 303) with de novo lesions treated exclusively with a CCS to 432 patients treated exclusively with a DES. Patients in the CCS group were older, frequently had heart failure, renal failure, prior coronary balloon angioplasty, prior stroke, more comorbidities, and more multivessel disease than the DES group. The DES group had longer and more type C and left anterior descending (LAD) coronary artery lesions. The in-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target lesion revascularization (TLR)) were similar. At 6 months, the cumulative rate of MACE was 12.9% in the CCS group and 5.6% in the DES group (P < 0.001), and this was driven by TLR. The rates of stent thrombosis were similar in CCS (0.9%) and DES (1.0%) patients. In conclusion, the CCS were used in clinically higher risk patients, while DES were used in more severely diseased coronary arteries. Drug-eluting stent use resulted in lower rates of clinically driven repeat revascularization with similar rates of death, MI, stroke, and stent thrombosis.

Asunto(s)

Angioplastia Coronaria con Balón , Aleaciones de Cromo , Estenosis Coronaria/terapia , Stents Liberadores de Fármacos , Anciano , Estudios de Cohortes , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/etiología , Diseño de Equipo , Femenino , Oclusión de Injerto Vascular/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Selección de Paciente , Pautas de la Práctica en Medicina , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

The efficacy of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has improved dramatically due to the development of new devices. Severe calcification of coronary lesions may be encountered even when the guidewire crosses the CTO, preventing the balloon from penetrating the lesion. A new "Tornus" penetration catheter has been developed for CTO recanalization. The purpose of this study was to evaluate the feasibility and safety of the Tornus catheter compared with traditional rotational atherectomy for CTO lesions. From August 2002 to July 2009, 77 patients with CTO of the coronary artery were selected to undergo PCI. Forty-one patients were treated with rotational atherectomy before the availability of the Tornus catheter when the smallest balloon failed to pass the CTO lesion. Later, 36 patients were treated with a Tornus catheter. Device and angiographic success rates as well as procedural complications were assessed. Device success was defined when the Tornus or Rota burr passed through the lesion. Major complications included death, Q-myocardial infarction, or emergency bypass surgery. Minor complications included perforation, cardiac tamponade, no reflow phenomenon, or long spiral dissection.The mean procedural time was significantly longer in the Tornus group (144 minutes versus 115 minutes, P = 0.01), while the device success rate was significantly lower (77% versus 95%, P = 0.024). Rotational atherectomy was subsequently performed in 3 of 8 Tornus failure cases. There were no between group differences in major complication rate (6% Tornus versus 5% rotational atherectomy). There was an insignificant trend for lower minor complication rates in the Tornus group (17% versus 20%).Use of the Tornus catheter was associated with significantly longer procedural duration and lower device success rates compared to rotational atherectomy. Major and minor complications were not different between the groups. Our findings suggest that Tornus catheter penetration is not superior to conventional rotational atherectomy for CTO recanalization.

Asunto(s)

Angioplastia Coronaria con Balón , Aterectomía Coronaria/instrumentación , Oclusión Coronaria/terapia , Anciano , Calcinosis/complicaciones , Calcinosis/diagnóstico , Calcinosis/terapia , Estudios de Cohortes , Angiografía Coronaria , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/etiología , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVES: This study tested the hypothesis that early extracorporeal membrane oxygenator offered additional benefits in improving 30-day outcomes in patients with acute ST-segment elevation myocardial infarction complicated with profound cardiogenic shock undergoing primary percutaneous coronary intervention. METHODS: Between May 1993 and July 2002, 920 patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention. Of these patients, 12.5% (115) with cardiogenic shock were enrolled in this study (group 1). Between August 2002 and December 2009, 1650 patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention. Of these patients, 13.3% (219) complicated with cardiogenic shock were enrolled (group 2). RESULTS: The incidence of profound shock (defined as systolic blood pressure remaining < or =75 mm Hg after intra-aortic balloon pump and inotropic agent supports) was similar in both groups (21.7% vs. 21.0%, p > .5). Extracorporeal membrane oxygenator support, which was available only for patients in group 2, was performed in the catheterization room. The results demonstrated that final thrombolysis in myocardial infarction grade 3 flow in infarct-related artery was similar between the two groups (p = .678). However, total 30-day mortality and the mortality of patients with profound shock were lower in group 2 than in group 1 (all p < .04). Additionally, the hospital survival time was remarkably longer in patients in group 2 than in patients in group 1 (p = .0005). Furthermore, multivariate analysis demonstrated that unsuccessful reperfusion, presence of advanced congestive heart failure, profound shock, and age were independent predictors of 30-day mortality (all p < .02). CONCLUSION: Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day outcomes in patients with ST-segment elevation myocardial infarction with complicated with profound cardiogenic shock.

Asunto(s)

Angioplastia Coronaria con Balón , Oxigenación por Membrana Extracorpórea , Infarto del Miocardio/cirugía , Choque Cardiogénico/complicaciones , Anciano , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Resultado del Tratamiento

RESUMEN

The occurrence of central vein total occlusion results in upper arm edema, pain, and hemodialysis access failure in uremic patient. Previous studies have proven the effectiveness of percutaneous balloon angioplasty for central vein total occlusion. Here, we report a rare case of successful revascularization of central vein total occlusion via antegrade and retrograde approach.

Asunto(s)

Angioplastia de Balón , Brazo/irrigación sanguínea , Derivación Arteriovenosa Quirúrgica/efectos adversos , Fallo Renal Crónico/terapia , Diálisis Renal , Enfermedades Vasculares/terapia , Anciano , Angioplastia de Balón/instrumentación , Catéteres , Constricción Patológica , Diseño de Equipo , Humanos , Masculino , Flebografía , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/etiología

RESUMEN

BACKGROUND: Atrial fibrillation arises in 20-30% of patients with sick sinus syndrome, increasing the risk of systemic embolization and mortality. The aim of this study was to examine the clinical determinants of development of paroxysmal atrial fibrillation in sick sinus syndrome patients before implantation of a pacemaker. METHODS: This case-control survey involved 144 patients (mean age ± SD age: 72 ± 9 years) in whom implantation of a transvenous permanent pacemaker was planned for sick sinus syndrome. Patients were classified into two groups, patients with (n = 71) and without (n = 73) a history of paroxysmal atrial fibrillation before implantation. Clinical characteristics and echocardiographic parameters were analyzed. RESULTS: The peri-implant right atrial area and left atrial area were significantly larger in patients with, than those without, paroxysmal atrial fibrillation. Multiple logistic regression analysis identified that the size of the left atrial area independently correlated with the development of atrial fibrillation: each 1 cm2 increase in left atrial area corresponded to a 44% increase in risk (odds ratio = 1.44 [1.22, 1.71]; p < 0.001). CONCLUSIONS: The left atrial size independently correlates with the development of paroxysmal atrial fibrillation in sick sinus syndrome patients before pacemaker implantation.

Asunto(s)

Fibrilación Atrial/etiología , Fibrilación Atrial/patología , Síndrome del Seno Enfermo/complicaciones , Anciano , Estudios de Casos y Controles , Ecocardiografía , Electrocardiografía , Femenino , Atrios Cardíacos/patología , Humanos , Masculino

RESUMEN

BACKGROUND: The aim of this study is to investigate the impact of uric acid on clinical outcomes in patients with angiographically proven coronary artery disease. METHOD: Six hundred and forty seven consecutive patients with angiographically proven significant coronary artery disease were enrolled in this retrospective study. Patients were assigned to serum uric acid level >or= 6.4 mg/dL and < 6.4 mg/dL groups based on baseline fasting uric acid levels and determined by a receiver operating characteristic curve. The mean follow-up duration was 4.6 +/- 1.1 years after coronary angiography. The primary endpoints were all cause mortality and death from cardiovascular disease. RESULTS: The five-year survival rates for patients free from all-cause mortality with levels of uric acid >or= 6.4 mg/dL and < 6.4 mg/dL were 82% and 92% respectively (p < 0.0001). Five-year survival rates for patients free from cardiovascular mortality with levels of uric acid uric acid >or= 6.4 mg/dL and < 6.4 mg/dL were 91% and 97% respectively (p = 0.003). Multivariate Cox regression analysis showed that serum uric acid was an independent predictor of all-cause death (p = 0.01) but was not an independent predictor of cardiovascular mortality (p = 0.063) after adjusting for multi-vessel coronary artery disease, chronic renal insufficiency and a left ventricular ejection fraction < 40%. CONCLUSIONS: After multivariate adjustment, the fasting serum uric acid level was an independent predictor of all-cause mortality, but probably not an independent predictor of cardiovascular mortality in patients with angiographically proven coronary artery disease.

Asunto(s)

Enfermedades Cardiovasculares/mortalidad , Enfermedad de la Arteria Coronaria/sangre , Ácido Úrico/sangre , Anciano , Angiografía Coronaria , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

BACKGROUND: The aim of the present study was to test the hypothesis that the transradial arterial approach (TRA) is not inferior to the transfemoral arterial approach (TFA) for

Asunto(s)

Angioplastia Coronaria con Balón/métodos , Infarto del Miocardio/terapia , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Anticoagulantes/uso terapéutico , Circulación Coronaria , Femenino , Arteria Femoral , Humanos , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Arteria Radial , Seguridad , Stents , Factores de Tiempo , Tirofibán , Resultado del Tratamiento , Tirosina/análogos & derivados , Tirosina/uso terapéutico

RESUMEN

The transradial artery approach to angioplasty has rarely been reported as a method for treating dysfunctional Brescia-Cimino fistulas. This study evaluated the feasibility, safety, and 1-year efficacy of this method for treating dysfunctional Brescia-Cimino fistulas. We retrospectively evaluated 154 consecutive procedures in 131 patients (age, 58.3 +/- 11.6 years; male, 48.1%) who underwent the transradial approach in dysfunctional Brescia-Cimino fistulas in the 1-year period after the procedure. The operator determined the use of a regular or a cutting balloon (two cases) in combination with urokinase injection (one case) or catheter thromboaspiration. Radial artery puncture was successful in all cases. Fifty-two cases (33.8%) had totally occluded fibrotic lesions. The overall anatomic success rate and clinical success rate were 61% (94/154) and 81.1% (125/154), respectively. In cases with a totally occluded fibrotic lesion, the clinical success rate was 46%. Successful intervention was associated with a significant reduction in the radial arterial systolic and diastolic pressures. There were no complications of symptomatic arterial embolization or pulmonary embolism, and one complication of venous rupture was successfully treated by compression. The primary patency rates based on intention-to-treat were 75.3% at 30 days and 39.0% at 1 year after the procedure. Excluding the cases with a totally occluded lesion, the clinical success rate was 99% (101/102) and the primary patency rates were 84.3% (86/102) and 52.0% (53/102) at 3 months and 1 year after the procedure, respectively. In conclusion, the transradial approach is a feasible, safe, and effective alternative for catheter intervention for dysfunctional Brescia-Cimino fistulas. Its success rate in cases with a totally occluded fibrotic lesion is unsatisfactory.

Asunto(s)

Angioplastia de Balón/métodos , Derivación Arteriovenosa Quirúrgica , Arteria Radial , Diálisis Renal/métodos , Angiografía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Medios de Contraste/administración & dosificación , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Estudios Retrospectivos , Resultado del Tratamiento , Grado de Desobstrucción Vascular

RESUMEN

OBJECTIVE: The aim of this study was to examine the serum oxidative stress in patients with severe mitral regurgitation. DESIGN AND METHODS: This study analyzed serum oxidative stress index in patients with severe mitral regurgitation [persistent atrial fibrillation (AF) or sinus rhythm], paroxysmal lone AF patients and healthy subjects. RESULTS: The serum oxidative stress index was significantly higher in the mitral regurgitation AF group and sinus group than in the lone AF group and healthy subjects (p<0.0001). Left atrial size was significantly larger in the mitral regurgitation AF group and sinus group than in the lone AF group and healthy subjects (p<0.0001). The oxidative stress index significantly and positively correlated with left atrial size in the overall study population (r=0.439, p=0.0008). CONCLUSIONS: This study provides new evidence of increased oxidative stress in human severe mitral regurgitation, probably contributing to atrial enlargement.

Asunto(s)

Atrios Cardíacos/metabolismo , Atrios Cardíacos/patología , Insuficiencia de la Válvula Mitral/sangre , Insuficiencia de la Válvula Mitral/metabolismo , Estrés Oxidativo , Antioxidantes/metabolismo , Femenino , Humanos , Hipertrofia , Masculino , Persona de Mediana Edad , Modelos Cardiovasculares , Oxidantes/metabolismo

RESUMEN

BACKGROUND: Although recent studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) achieves clinical outcomes comparable to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease, long-term studies are rarely performed. METHODS AND RESULTS: This study reviewed outcomes in 363 patients undergoing CABG (n=216), PCI with DES (n=94) or PCI with bare-metal stent (BMS) (n=53) for ULMCA stenosis between January 2000 and March 2007. The CABG group had more patients with diabetes (50.5%) and 3- or 4-vessel disease (77.3%) than the PCI group. Kaplan-Meier survival estimates showed higher TLR-free survival and revascularization-free survival in CABG group. Although cardiac-death-free survival did not significantly differ between the 3 groups, the DES group had the highest overall survival. Age (hazard ratio (HR): 1.060; 95% confidence interval (CI): 1.017-1.104) and diffuseness score (HR: 1.157; 95%CI: 1.019-1.313) were significant independent risk factors for cardiac death. CONCLUSIONS: There was higher TLR in the PCI group with either DES or BMS, but cardiac death did not significantly differ between the 3 groups. Advanced age and diffuse coronary atherosclerosis may increase the risk of cardiac death following revascularization.

Asunto(s)

Puente de Arteria Coronaria , Estenosis Coronaria/mortalidad , Estenosis Coronaria/cirugía , Stents , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo

RESUMEN

We investigated the prognostic risk and the clinical outcome of young-adult patients with ST-segment elevation (ST-se) acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Between May 1999 and September 2007, primary PCI was performed in 1680 consecutive patients with AMI of onset < 12 hours (cardiogenic shock within 18 hours) at Kaohsiung Chang Gung Memorial Hospital. Of these patients, 163 (9.7%) young-age patients (defined as male of < 45 years old and female of < 55 years old) were enrolled into this study. A comparable number (n = 175) of patients > or = 55 years old, who presented with AMI of < 12 hours duration having undergone primary PCI between November 2004 and May 2006, were retrospectively reviewed and enrolled as control subjects. The procedural success (defined as normal blood flow achieved in the infract-related artery) was similar between the young-age and old-age patients (P = 1.0). Additionally, the incidence of an advanced Killip score (defined as > or = score 3 upon presentation), 30-day and 6-month cumulative mortality did not differ between these two groups of patients (P > 0.1). However, the 30-day major adverse clinical outcome (MACO) (defined as New York Heart Association Functional Classification > or = 3 or 30-day mortality) was significantly lower in the young-age than in the old-age patients (P < 0.001). Further, multiple stepwise logistic regression analysis showed that an advanced Killip score along with the peak level of CK-MB was independently predictive of 30-day MACO (P < 0.05) in young-age patients. In conclusion, the prognostic outcome is favorable in young-adult ST-se AMI undergoing primary PCI. Traditional risk factors remain effective for stratification of young-adult AMI patients into high- or low-risk subgroups.

Asunto(s)

Angioplastia Coronaria con Balón/métodos , Pueblo Asiatico , Infarto del Miocardio/epidemiología , Adulto , Anciano , Angiografía Coronaria , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/terapia , Oportunidad Relativa , Pronóstico , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Taiwán/epidemiología

RESUMEN

BACKGROUND: Ischemic mitral regurgitation indicates a poor prognosis after acute myocardial infarction (AMI). This study addresses the clinical characteristics and contribution of ischemic mitral regurgitation to the midterm survival rate of patients following first AMI in our institution. METHODS: Between January 2000 and December 2002, patients who underwent 2-dimensional color Doppler echocardiographic quantitation of ischemic mitral regurgitation within 30 days after first myocardial infarction (MI) were analyzed. RESULTS: During the study period, 519 patients were enrolled (mean age 62.7 +/- 12 years, 76% men). The population was divided into 2 groups based on the degree of mitral regurgitation (MR). Group A included 440 subjects with no MR (n = 41), trivial MR (n = 188), and mild MR (n = 211). Group B included 79 subjects with moderate MR (n = 64), and severe MR (n = 15). Group B patients were more likely to be older (p < 0.05), women (p < 0.01), and nonsmokers (p < 0.01). Group B had a higher prevalence of inferior wall MI (p < 0.01) and lateral wall MI (p < 0.01). After 6 months of follow-up, 57 deaths had occurred (42 in Group A and 15 in Group B). Group B had a lower survival rate than Group A 180 days post-AMI (19% vs. 9.79%, p < 0.01). CONCLUSIONS: Post-AMI patients with significant ischemic mitral regurgitation were more likely to be older, female, and nonsmokers. There was a positive association between the severity of ischemic mitral regurgitation and inferior MI and lateral wall MI. The severity of ischemic mitral regurgitation showed a significant inverse relationship with the mid-term post-MI survival rate.

Asunto(s)

Insuficiencia de la Válvula Mitral/complicaciones , Infarto del Miocardio/complicaciones , Anciano , Ecocardiografía Doppler , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones