Background Few reports described outcomes of complete compared with infarct-related artery (IRA)-only revascularisation in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Moreover, no studies have compared the simultaneous treatment of non-IRA with the IRA treatment followed by an elective procedure for the other lesions (staged revascularisation). Methods The outcomes of 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were studied. Before the first angioplasty patients were randomly assigned to three different strategies: culprit vessel angioplasty-only (COR group); staged revascularisation (SR group) and simultaneous treatment of non-IRA (CR group). Results During a mean follow-up of 2.5 years, 42 (50.0%) patients in the COR group experienced at least one major adverse cardiac event (MACE), 13 (20.0%) in the SR group and 15 (23.1%) in the CR group, p<0.001. Inhospital death, repeat revascularisation and rehospitalisation occurred more frequently in the COR group (all p<0.05), whereas there was no significant difference in re-infarction among the three groups. Survival free of MACE was significantly reduced in the COR group but was similar in the CR and SR groups. Conclusions Culprit vessel-only angioplasty was associated with the highest rate of long-term MACE compared with multivessel treatment. Patients scheduled for staged revascularisation experienced a similar rate of MACE to patients undergoing complete simultaneous treatment of non-IRA.Primary percutaneous coronary intervention (PCI) is currently the treatment of choice in patients with acute ST-segment elevation myocardial infarction (STEMI). Coronary artery disease (CAD) is a diffuse process and patients presenting with a coronary syndrome in 20e40% of cases have multiple significant coronary lesions, which confer a substantially increased risk of cardiovascular morbidity and mortality. Contemporary guidelines recommend dilating only the infarct-related artery (IRA) during the urgent procedure, leaving the other stenosed vessels untreated (culprit-only revascularisation) or to dilate during a second elective procedure (staged revascularisation). Simultaneous treatment of IRA and non-IRA is recommended only in patients with cardiogenic shock.4 5 However, these guidelines are based on the results of earlier studies. With advancing technology and newer antiplatelet drugs, outcomes have improved even in patients undergoing multivessel and higher-risk elective procedures. 6 Yet, few reports have described outcomes of multivessel compared with IRA-only revascularisation in patients undergoing urgent mechanical reperfusion for STEMI, 7 8 and none have distinguished simultaneous treatment of non-IRA from the staged approach. Therefore, the optimal management of patients with multivessel disease in this setting remains still unclear.The aim of this study was to compare long-term outcomes of three different strategies during primary PCI in patients with STEMI ...
SummaryHypothesis: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parmeters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up.M(>thod.s: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (24.5 mm; <45 mm), with cardiac death as the end point. In the second phase, all patients were further divided into two groups according to their clinical course. A multivariate analysis was performed to determine independent correlated parameters of cardiac mortality and overall clinical outcome.Results: Cardiac mortality rate was 47.9%: 29% in the group without left atrial dilation and 54.3% in the group with dilated left atrium. Multivariate analysis revealed that left atrium 245 mm, New York Heart Association functional classes IIIAV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predicton of cardiac mortality, while left atrium 245 mm, left ventricular end-diastolic pressure >17 mmHg, and exercise tolerance I IS min were independent predictors of poor clinical outcome.Conclusions: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.
Background-Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting. Methods and Results-Both patients with CHD undergoing coronary stenting (120 patients) and control subjects (58 patients) were submitted to an oral glucose tolerance test (OGTT). Fasting leptin levels and fasting and postglucose load insulin sensitivity were assessed. Endothelial function was measured by nitrite and nitrate release (NOx) during OGTT. More than 50% of patients treated with stent implantation presented impaired glucose tolerance or type 2 diabetes, which was previously undiagnosed. These patients also had higher glucose, insulin, and leptin levels than control subjects. Among the stented patients, insulin and leptin levels were higher in patients with restenosis than in patients without restenosis. A significant increase in NOx levels was found during OGTT both in patients without restenosis and in control subjects. On the contrary, NOx profiles were blunted in patients with restenosis. At multiple regression analysis, only ⌬AUC-NOx areas and insulin sensitivity index showed an independent correlation with the minimal lumen diameter at follow-up. Conclusions-We demonstrated that insulin resistance and endothelial dysfunction are independent predictors of early restenosis after coronary stenting.
Early sheet removal and short-time compression with QuikClot® Interventional™ can reduce the rate of RAO after diagnostic or interventional procedures especially in patients not on double antiplatelet therapy.
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