RESUMEN
BACKGROUND: Asymptomatic acute ischemic stroke (aAIS) following primary percutaneous coronary intervention (p-PCI) in patients with acute coronary syndrome (ACS) has not been studied in detail. METHODS AND RESULTS: Of 75 patients who underwent p-PCI, 26 (34.7%) developed aAIS as determined by diffusion-weighted magnetic resonance imaging (MRI). Including the approach to the coronary artery (via lower limb or right upper limb), 23 factors were compared between patients with (n=26) and without (n=49) aAIS. Age, hypertension, smoking, plasma glucose levels, Killip grade, right coronary artery (RCA) as culprit vessel, percutaneous coronary intervention (PCI) time, and the frequency of device insertion into the coronary artery differed in a statistically significant manner. However, multivariate analysis showed that the RCA (odds ratio 3.477) and the frequency of device insertion (1.375) were independent factors linked to the incidence of aAIS. Moreover, anterior or posterior location and left or right cerebral circulation of aAIS were equivalent in both approaches. CONCLUSIONS: Cranial MRI images following emergency PCI revealed that 34.7% of the patients with ACS had aAIS that might be caused by manipulating the catheter or devices in the ascending aorta, micro-air bubble embolism during injection, or micro-thrombus embolism derived from the ACS lesions during the PCI procedure.
Asunto(s)
Síndrome Coronario Agudo/complicaciones , Angioplastia Coronaria con Balón/efectos adversos , Accidente Cerebrovascular/etiología , Síndrome Coronario Agudo/terapia , Anciano , Estudios de Casos y Controles , Cateterismo/efectos adversos , Vasos Coronarios , Embolia Aérea/complicaciones , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Tromboembolia/complicacionesRESUMEN
BACKGROUND: Previous reports indicate that D-dimer testing (DT) for acute aortic dissection (AAD) has a sensitivity of 100%, but each study comprised less than 30 patients. The aim of this study was to evaluate the positive rate and factors related to the results of DT for AAD in a larger population. METHODS AND RESULTS: DT (cutoff; upper normal limit) was performed for 113 consecutive AAD patients within 24 h of symptom onset. In total, 104 (92%) patients exhibited positive DT. The positive rate of DT showed a low tendency in patients aged less than 70 years and for a time interval from symptom onset to admission within 120 min, and there were significant differences between those with and without a thrombosed false lumen (TFL) (86.4% (n=59) vs 98.1% (n=54), p=0.033), complete TFL (excluding patients with ulcer-like projection (ULP) from those with a TFL) (81.1% (n=37) vs 97.4% (n=76), p=0.005) and length score (1 (n=28); 78.6%, 2 (n=40); 95.0%, 3 (n=45); 97.8%, p=0.005). Multivariate analysis demonstrated age (odds ratio =1.164, p=0.013), complete TFL (0.048, 0.030) and length score (6.271, 0.033) as independent factors. CONCLUSIONS: Physicians should be aware that younger patients with short dissection length and a TFL without ULP are liable to have false-negative DT results.
Asunto(s)
Antifibrinolíticos , Aorta/patología , Enfermedades de la Aorta/diagnóstico , Productos de Degradación de Fibrina-Fibrinógeno , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades de la Aorta/patología , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/complicaciones , Infarto de la Arteria Cerebral Media/microbiología , Staphylococcaceae , Insuficiencia de la Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/cirugía , Proteína C-Reactiva/análisis , Caries Dental/epidemiología , Caries Dental/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico , Infarto de la Arteria Cerebral Media/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Public access defibrillation has been introduced to improve the outcome of patients experiencing out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the best location for automated external defibrillators (AED). METHODS AND RESULTS: All patients who were resuscitated after OHCA by emergency medical technicians in Takatsuki City over 6 years were enrolled. The annual incidence of OHCA and the number of 1-year survivors with good neurological outcome in each of 21 sub-location categories were investigated, as well as the ratio of ventricular fibrillation (VF) as the initial rhythm to the total OHCA in each of 5 location categories. In total, there were 1,112 patients with OHCA, 62 (5.6%) with VF and 14 (1.3%) with good neurological outcome. The annual incidence of cardiac arrest (CA) per site was the highest in railway stations (0.3000), followed by hospitals (0.1802), homes for the aged (0.1115), playgrounds (0.0769) and golf courses (0.0667). However, none of the patients experiencing CA at railway stations, homes for the aged and golf courses had a good neurological outcome. The ratio of VF to total CA was the highest in the workplace (35.3%). CONCLUSIONS: The 6 locations, including workplace, are recommended as appropriate locations for AED.
Asunto(s)
Áreas de Influencia de Salud , Desfibriladores , Servicios Médicos de Urgencia , Paro Cardíaco/terapia , Femenino , Hospitales , Humanos , Japón , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Patients with aortic dissection (AD) often demonstrate positive heart-type fatty acid-binding protein (H-FABP), but its significance is unclear. METHODS AND RESULTS: In 63 of 64 consecutive AD patients, the serum H-FABP concentration was measured and the H-FABP positive rate calculated (cutoff value: 6.2 ng/ml) for each of following factors: (1) with or without dissection of the ascending aorta; and (2) a thrombosed false lumen; (3) length score; (4) presence of shock; (5) malperfusion of limbs; (6) ST elevation and/or depression on electrocardiogram; and (7) renal dysfunction. In total 36 AD patients had a positive H-FABP test. Statistically significant differences in the H-FABP positive rate were observed between those with and without ascending AD (76.7% vs 39.4%, p = 0.003), and in the length score (p < 0.001). Multivariate logistic regression test demonstrated that the most significant factor was the length score (odds ratio: 2.239 (95% confidence interval: 1.119-4.481), p = 0.023). Moreover, a significant correlation was observed between length score and absolute H-FABP value (r = 0.420, p = 0.001). CONCLUSIONS: In patients with AD, an increased serum H-FABP concentration is caused by the protein being released not only from the cardiac muscle but also from skeletal muscle, or possibly the aortic wall. Physicians using H-FABP for detection of myocardial injury need to be aware that patients with a long or ascending AD will show an elevation of H-FABP.
Asunto(s)
Rotura de la Aorta/sangre , Proteínas Portadoras/sangre , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiopatología , Rotura de la Aorta/patología , Biomarcadores/sangre , Proteínas de Unión a Ácidos Grasos , Corazón/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: It is important to rapidly distinguish patients with acute aortic dissection of the ascending aorta (AADa) from those with acute myocardial infarction (AMI), because minimizing the time to initiation of reperfusion therapy leads to maximum benefits for AMI and erroneous reperfusion therapy for AADa can produce harmful outcomes. The aim of this study was to find a simple test to distinguish such patients. METHODS AND RESULTS: Data were collected from 29 consecutive patients with AADa and 49 consecutive patients with AMI who were admitted within 4 h of the onset of symptoms. The D-dimer concentration and the ratio of the maximum upper mediastinal diameter to the maximum thoracic diameter on plain chest radiograph (M-ratio) in the emergency room were studied retrospectively. Setting the cutoff values of the D-dimer concentration and the M-ratio to 0.8 or 0.9 microg/ml and 0.309, respectively, gave a sensitivity of 93.1% and 93.1% for AADa, respectively, and a sensitivity of 91.8% and 85.7% for AMI, respectively. CONCLUSIONS: The D-dimer value and the M-ratio, with appropriate cutoff values, have potential as tests that can be routinely used to exclude AADa patients from patients diagnosed with AMI prior to reperfusion therapy.
Asunto(s)
Aneurisma de la Aorta Torácica/sangre , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Disección Aórtica/sangre , Disección Aórtica/diagnóstico por imagen , Isquemia Miocárdica/sangre , Isquemia Miocárdica/diagnóstico por imagen , Anciano , Biomarcadores/análisis , Servicios Médicos de Urgencia , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , RadiografíaRESUMEN
A 69-year-old man with a recurrent ventricular tachycardia (VT) was admitted. The patient was diagnosed as myotonic dystrophy type 1 (DM1) and DNA analysis revealed 1,800 CTG-repeat expansion in the myotonic dystrophy protein kinase (DMPK) gene. Ultrasonic cardiogram (UCG), left ventriculogram (LVG) and magnetic resonance imaging (MRI) did not show any abnormal sign including fatty infiltration. But, endomyocardial biopsy obtained from ventricular outflow tract revealed severe fatty infiltration and interstitial fibrosis. Radiofrequency catheter ablation at the biopsy site could eliminate VT, so it was strongly suggested that the re-entry circuit was formed by focal fatty-fibrosis. Careful observation should be continued for a long period.