RESUMEN
BACKGROUND: Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. METHODS: We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. RESULTS: Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). CONCLUSIONS: Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Arteria Femoral , Hematoma/etiología , Hemorragia/etiología , Anciano , Angioplastia Coronaria con Balón/métodos , California , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Punciones , Radiografía , Espacio Retroperitoneal , Estudios Retrospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: Prediction of the location of culprit lesions responsible for ST-segment elevation myocardial infarctions may allow for prevention of these events by safe and easily deliverable local therapies. METHODS: A retrospective analysis of coronary movement was performed on coronary angiograms of patients who subsequently represented with ST-segment elevation myocardial infarction treated by primary or rescue angioplasty at a single institution. RESULTS: Twenty patients were identified. The stretch-compression type of coronary artery movement (CAM) was a statistically significant independent predictor of the segment containing the culprit lesion (odds ratio 6.10, p-value 0.005). CONCLUSIONS: The stretch-compression type of coronary artery movement is an independent predictor of the location of culprit lesions responsible for ST-segment elevation myocardial infarctions.
Asunto(s)
Estenosis Coronaria/complicaciones , Infarto del Miocardio/etiología , Anciano , Angioplastia Coronaria con Balón , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Valor Predictivo de las Pruebas , Proyectos de Investigación , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Atrial septostomy is a palliative treatment for severe pulmonary hypertension. We report the insertion of a novel custom-made fenestrated Amplatzer atrial septostomy device following repeat atrial septostomy for severe pulmonary hypertension in a terminally ill patient with scleroderma resulting in 6 months of palliation.