Asunto(s)
Bioprótesis/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Falla de Prótesis , Reemplazo de la Válvula Aórtica Transcatéter , Aleaciones , Válvula Aórtica , Estenosis de la Válvula Aórtica , Humanos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
BACKGROUND: Studying the outcomes in patients presenting with cardiogenic shock with ST-segment elevation myocardial infarction (CS-STEMI) and undergoing primary or rescue percutaneous coronary intervention (PCI) may give an insight to the unmet needs in STEMI-care in our region and may help in future recommendations in improving survival. MATERIALS AND METHODOLGY: During the period from January 2001- June 2017, there were 114 patients included in the study. The demographic, clinical and angiographic characteristics were compared between the survivors and non-survivors. All these variables were also compared between two-time frames (Phase 1- January 2001 to June 2007; Phase 2- July 2007 to June 2017). RESULTS: Among patients undergoing PCI for STEMI, 7.5% were in cardiogenic shock. In-hospital mortality for the patients included in the study was 53.5%. Total ischemic time (OR=0.99, 0.99-1; p=0.02), left ventricular ejection fraction (LVEF) (OR=0.90, 0.82-0.98; p=0.02), need for cardio-pulmonary resuscitation (OR=0.12, 0.24-0.66; p=0.01), and post PCI TIMI flows (OR=0.08, 0.02-0.29; p<0.001) were the significant determinants of in-hospital mortality in the regression analysis. There was no significant change in mortality between the two phases of the study, though there was a reduction in total ischemic and door-to-balloon times, transfer admissions, use of thrombolytics, glycoprotein IIb/IIIa inhibitors, intra-aortic balloon pump, and mechanical ventilation in phase 2. CONCLUSION: Patients presenting in CS-STEMI and undergoing PCI continue to experience high mortality rates, despite improvements in total ischemic times. Further improvement in the systems-of-care are required to bring about reduction in mortality in this high-risk subset.
Asunto(s)
Intervención Coronaria Percutánea/métodos , Infarto del Miocardio con Elevación del ST/cirugía , Choque Cardiogénico/etiología , Volumen Sistólico/fisiología , Electrocardiografía , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/mortalidad , Choque Cardiogénico/mortalidad , Choque Cardiogénico/fisiopatología , Factores de TiempoRESUMEN
Patent hemostasis technique is used with the trans radial (TR) band to prevent radial artery occlusion following diagnostic coronary angiogram or percutaneous coronary intervention using radial artery access. We report epidermal bulla as a complication of TR band usage and a modified patent hemostasis technique using barbeau test to prevent this complication.
Asunto(s)
Vesícula/etiología , Epidermis/patología , Técnicas Hemostáticas/efectos adversos , Intervención Coronaria Percutánea/métodos , Complicaciones Posoperatorias , Vesícula/diagnóstico , Humanos , Arteria RadialRESUMEN
Percutaneous coronary intervention (PCI) is often denied for individuals with coronary artery disease who are prone to develop contrast-induced acute kidney injury. We report a 73-year-old, stage 3 chronic kidney disease patient (CKD), who underwent coronary artery bypass surgery and saphenous vein graft (SVG) stenting in the past, presented with in-stent restenosis (ISR) of SVG stent. Zero contrast optical coherence tomography (OCT) guided-PCI was successfully performed using low molecular weight dextran-40 (LMWD-40) as the flush medium. Our report suggests the safety and feasibility of LMWD-40-based OCT-guided zero contrast PCI in ISR of SVG in a CKD patient, although further prospective studies are needed to evaluate this technique.