RESUMO
To assess the incidence of in-hospital major adverse cardiac events (MACE), we analyzed 694 procedures in 613 consecutive patients during one year period. Patient population included 550 (79.2%) patients with unstable angina, 43 (6.2%) with stable angina and 101 (14.5%) with acute myocardial infarction. Elective percutaneous transluminal coronary angioplasty (PTCA) was performed in 593 (85.4%) patients, rescue PTCA in 7 (1%), and primary PTCA in 94 (13.5%). Angiographic lesion morphology was as follows: type A 30%; type B 58%; type C 12%. We compared patient population who received stent with PTCA-balloon only. Technical success was 95% and clinical success was achieved in 80% of the cases. Overall mortality was 1% in the stent group and 3% in the conventional PTCA. The incidence of MACE was 4% and 15.1% in the stent and angioplasty balloon groups respectively. We found a dramatic impact on reduction of the incidence of acute complications in the groups with stenting for unstable angina (p = 0.0001) and acute myocardial infarction (p = 0.0001). The major clinical advantage of stenting over balloon angioplasty was a lower need for repeated procedures.
Assuntos
Doença das Coronárias/cirurgia , Cardiopatias/prevenção & controle , Stents , Doença Aguda , Angina Instável/complicações , Angina Instável/cirurgia , Angioplastia Coronária com Balão , Angiografia Coronária , Doença das Coronárias/complicações , Doença das Coronárias/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Since its introduction by Dos Santos in 1929, arterial angiography by translumbar percutaneous approach has suffered some transformations. Nowadays it has been replaced by other percutaneous approaches and it is indicated only when these routes of access have failed due to aortoiliac or subclavian arteries obstruction. This report presents a patient with Takayasu's Arteritis with severe peripheral arterial obstruction and unstable angina, who underwent coronary arteriography and aortography by translumbar approach. A review of this technique is made.
Assuntos
Angiografia Coronária/métodos , Arterite de Takayasu/diagnóstico por imagem , Angina Instável/diagnóstico por imagem , Angina Instável/etiologia , Aorta Torácica/diagnóstico por imagem , Aortografia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Arterite de Takayasu/complicações , Arterite de Takayasu/cirurgiaRESUMO
The objective of our study was to validate the diagnostic utility of cardiac troponine T in acute ischemic syndromes, and also in cases of difficult diagnosis. We analyzed its concordance and compare them with conventional enzymatic quantitative methods. We determined sensitivity, specificity, positive and negative predictive values and likelihood ratio. Kappa index was used to know the concordance grade between T troponin and the positive or negative results of the quantitative enzymatic curve. Stochastic significance was valued by Chi square of Mcnemar test. In seventy patients who arrived to the hospital with chest pain who were assigned to five different groups. The sensitivity in quantitative markers was higher than qualitative methods, however the specificity, likelihood ratio was lower. In the total group the concordance analysis between qualitative and quantitative markers was adequate, (kappa index 0.65 p < 0.05). This study suggest that the rapid bedside qualitative test by cardiac Troponin T is a good diagnostic marker compared with conventional quantitative markers to evaluate chest pain in acute ischemic syndromes.