Factor XI deficiency is a very rare congenital coagulation disorder. Bleeding complications should be considered when treating a patient with unstable angina and congenital coagulation disorder during and after percutaneous coronary intervention (PCI). Thrombotic complications can develop after fresh frozen plasma (FFP) transfusion and drug-eluting stent (DES) implantation. We report here on the successful management of a patient having unstable angina with factor XI deficiency, and this patient was treated with PCI under intravascular guidance and with the aid of FFP and hemostatic devices.
Background and Objectives:Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term follow-up, compared with thrombolytic therapy for acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients. Subjects and Methods:Two hundred and twenty three patients (Group I: n=66, age≥75 years, Group II: n=157, age<75 years), who underwent primary PCI for AMI at Chonnam National University Hospital, between 2000 and 2002, were analyzed according to their clinical, angiographic characteristics, inhospital and one-year survival. Results:Group I had a higher percentage of women (45.5% vs. 19.1%, p= 0.00), multi-vessel disease (42% vs. 28%, p=0.031), right coronary artery disease (52% vs. 33%, p=0.021), and more frequent histories of diabetes mellitus (35% vs. 22%, p=0.039) and less smoking (38% vs. 60%, p= 0.003) than Group II. Successful reperfusion by PCI was achieved in 97 and 96 %, respectively (p=NS). The rates of in-hospital mortality were similar in both groups (12.1% vs. 8.2%, p=NS). There were no significant differences in the major adverse cardiac events between the two groups during the one-year clinical p=NS). Conclusion:Primary PCI in AMI patients older than 75 years can be performed with comparable procedural success rates and long-term clinical outcomes to those of younger patients. (Korean Circulation J 2005;35:613-619) KEY WORDS:Elderly;Myocardial infarction;Angioplasty. 서 론 최근에 급성 심근경색증 환자에서 혈전용해제보다 일차적 경피적 관상동맥 중재술(PCI: percutaneous coronary intervention)이 단기적 및 장기적 임상 효과가 좋음이 보고 되고 있으며, 1-4) 2004년 American College of Cardiology/ 논문접수일:2005년 3월 02일 심사완료일:2005년 5월 23일 교신저자:정명호, 501-757 광주광역시 동구 학1동 8번지 전남대학교 의과대학 전남대학교병원 심장센터, 의과학연구소 전화:(062) 220-6243·전송:(062) 228-7174·E-mail:myungho@chol.com
Background and Objectives:The therapeutic efficacy of combined platelet glycoprotein IIb/IIIa receptor blocker with low molecular weight heparin (LMWH) is unknown for patients with acute myocardial infarction (AMI) and who underwent percutaneous coronary intervention (PCI). Subjects and Methods:A total of 140 patients with AMI and who underwent high-risk PCI was divided into two groups: UFH (group I: 70 patients, 58.7±10.5 years of age), and dalteparin (group II: 70 patients, 59.6±9.8 years of age). The major adverse cardiac events (MACE) during hospitalization and during the 4 years after PCI were evaluated. Results:The baseline clinical characteristics and angiographic characteristics were not different between the two groups. There were 62.9% totally occluded lesions with thrombus in both groups. Procedural success was achieved for 91.4% of the group I patients and for 90.0% of the group II patients. Any bleeding and hemorrhagic events were not different between the two groups. No significant intracranial bleeding was observed in both groups. The number of in-hospital MACEs was 7 (10.0%) in group I and 4 (5.7%) in group II. Four-year clinical follow-up was performed for 97% of the patients. As a result of the MACEs during the 4 years after PCI, death occurred in 6 (8.6%) patients in group I and in 7 (10.0%) patients in group II. Myocardial infarction occurred in 4 (5.7%) and 4 (5.7%) patients, respectively, target vessel revascularizations were done in 23 (32.9%) and 16 (22.9%) patients, respectively, and coronary artery bypass surgery was done in 3 (4.3%) and 1 (1.4%) patients, respectively. Overall, MACEs occurred in 33 (47.1%) patients of group I and in 26 (35.1%) patients of group II during the 4-year clinical follow-up (p=0.23). Conclusion:The long-term clinical outcome of dalteparin combined with abciximab is comparable with that of UFH plus abciximab for the high risk patients with AMI who receive PCI.
We describe the case of a 30-year-old man with systemic lupus erythematosus (SLE) and he was struck with non-ST segment elevation myocardial infarction: this was due to the presence of multiple coronary artery aneurysms those were full of thrombi. A diagnostic coronary angiogram revealed huge dilatations in the proximal three coronary arteries with multiple filling defects and a decreased flow rate, and these were suggestive of thrombi within the coronary artery aneurysms. An intravascular ultrasound (IVUS) examination revealed huge aneurysmal dilatations with movable thrombi in three coronary arteries. He had an uneventful recovery without us having to perform any percutaneous coronary intervention.
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