In animal studies reperfusion of coronary arteries is commonly accompanied by ventricular arrhythmias. It is not certain, however, whether ventricular arrhythmias can be used as a reliable non-invasive marker of reperfusion in humans. Two-channel In humans, however, some of the arrhythmias seen in the first hours after the onset of infarction can be attributed to the inherent electrical instability of the ischaemic myocardium and not to reperfusion. To investigate the difference between "infarction arrhythmias" and "reperfusion arrhythmias", we need to measure the patency rate of the infarct-related coronary artery and disorders of the heart rhythm within a well-defined interval.We therefore determined the predictive value of ventricular arrhythmias for patency of the infarct-related vessel in patients with acute transmural infarction by monitoring the heart rhythm with Holter recording from the start of streptokinase administration until angiographic visualisation of the infarctrelated vessel up to four hours later (that is, the study period). Patients and methods PATIENTSFifty seven patients with acute myocardial infarction were treated with intravenous streptokinase. We studied male and female patients below the age of 71 years with symptoms of acute myocardial infarction for less than four hours and ST segment elevation of > 1 mm in at least two leads of the standard 12 lead electrocardiogram. We excluded patients with a history of abnormal bleeding, use of anticoagulant drugs, recent surgery (<2 weeks), previous cerebral haemorrhage or injury, impaired renal function (serum creatinine concentration > 300 ymol/l), systolic blood pressure > 200 mm Hg, diastolic > 120 mm Hg, severe heart failure with pulmonary congestion on admission, any malignancy (except those of the skin), or previous treatment with streptokinase.
A 46-year-old male, with a history of old myocardial infarction (MI) in the first diagonal branch (D1) treated with balloon angioplasty three years before, was admitted to our institution because of chest pain on effort. Coronary angiography revealed coronary artery aneurysms measuring approximately 10 mm and 7 mm in the left anterior descending artery (LAD) and D1, respectively (Figure 1A), which were not clearly detected three years before. Moreover, significant stenoses were also demonstrated proximal to both aneurysms, distal to the D1 aneurysm, and in the obtuse marginal (OM) branch (Figure 1A, Figure 1B). The fractional flow reserve (FFR) in the LAD was 0.50, as measured with PressureWire™‚ Certus™ (St. Jude Medical, St. Paul, MN, USA) (Figure 1C). Electrocardiography showed a Q-wave in I, aVL, which indicated transmural MI in the D1 region (Figure 2A). Echocardiography showed thinness of the wall with akinetic motion in the anterolateral left ventricular wall. The left ventricular ejection fraction was 53% and there was no valvular pathology. 201Tl-123I-BMIPP scintigraphy demonstrated no viability in the D1 region (Figure 2B). Coronary angiography (Figure 2C) was performed in approximately the same view as the coronary computed tomography (Figure 2D) to be easily compared. Reststress myocardial perfusion scintigraphy showed ischaemia in the LAD and OM regions, and transmural MI in the D1 region. The fusion image of coronary computed tomography and scintigraphy
Drug-eluting stents (DES) were first used on-label - in simple patients with low clinical risk and easily accessible lesions. Currently, DES are increasingly used off-label - in complex patients undergoing percutaneous coronary interventions (PCI) with historically higher event risk. Therefore, our aim was to investigate whether patients with off-label indications for DES use had similar outcomes compared to patients who were treated for on-label indications only. We analysed two-year follow-up data of 1,387 TWENTE trial patients, treated with second-generation everolimus-eluting XIENCE V or zotarolimus-eluting Resolute stents, and compared off-label vs. on-label DES use with regard to the following clinical endpoints: cardiac death, myocardial infarction (MI), periprocedural MI (≤48 hrs), and target vessel revascularisation (TVR). Patients with off-label DES use (n=1,033; 74.5%) had more diabetes (22.9% vs. 17.5%; p=0.032), previous MI (35.9% vs. 22.3%; p<0.001), type B2/C lesions (84.7% vs. 62.7%; p<0.001), and acute coronary syndromes (57.8% vs. 33.3%; p<0.001). Nevertheless, cardiac death and TVR rates were similar to those of patients with on-label DES use (p>0.8). Following off-label DES use, there was a higher incidence of PMI (5.0% vs. 1.4%; p=0.003), of which only 1.1% reached creatine kinase levels >5x the upper limit of normal (ULN). Despite differences in risk profile, patients with off-label DES use did not differ from patients with on-label DES use in clinical endpoints other than periprocedural MI. These largely positive findings underline the favourable safety profile of second-generation DES.
pathology. To refresh the imaging data, patient can be moved from ISS to MC suites, data acquisition takes place, and the patient is then returned to the ISS where the new MR imaging data can be used to complete the procedure. Results: The current set up also permits utilisation of PET in conjunction with ISS procedures, e.g., as the final imaging modality to control whether PET-enhancing pathology was completely removed or angioplasty perfoemd. For instance, after completion of ablation under MR imaging, the patient can be moved into the PET/CT suite. A PET image produced after tracer injection and uptake can then be used to assess the completeness of the ablation procedure. Conclusions: A room layout combining 3T MRI and PET/CT with other interventional modalities (e.g., fluoroscopy, ultrasound, CT) has been realized for integrated multimodality image-guided diagnosis and therapy of cardiovascular diseases. Such a design enables corollary studies into novel workflows for taking full advantage of the integrated design.
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