OBJECTIVES To identify the specific predictors of acute stent thrombosis in patients after primary percutaneous coronary intervention.METHODOLOGY This retrospective study was carried out at the Department of Cardiology Hayatabad Medical Complex Peshawar from 1st January to 30th June 2022. All consecutive patients with an angiographically confirmed stent thrombosis were enrolled. Patients gave informed consent for the inclusion of data in this registry. Stent thrombosis was categorized according to the timing of the event as acute (occurrence within the first 24 hours after the index procedure).RESULTSA total of 400 patients were included in the study. Age ranged between 35-70 years, with a mean age of 52.5. There were 260(65%) males and 140(35%) females, with male to female ratio of 1.8:1. All patients underwent primary PCI with stent implantation. According to the elapsed time since stent implantation, 42(10.5%) patients presented with acute stent thrombosis after primary percutaneous coronary intervention. The mean time to develop acute stent thrombosis after primary PCI was ±4.5 hours (range 3-6 hours). In most STEMI patients, 340(85%) received a loading dose of clopidogrel at the time of the index PCI. In 23(54.7%) patients, acute stent thrombosis occurred within 6 hours, 10(23.8%) within 12 hours, 6(14.2%) within 18 hours and 3(7.1%) after clopidogrel loading.CONCLUSIONInadequate stent expansion or mal-opposition, diabetes mellitus, chronic kidney disease, and female gender were the strong predictors of acute stent thrombosis.
Whether or whether or not tirofiban is beneficial within side the quick time period for sufferers with STEMI who go through PCI is debatable. A meta-analysis validated the short-term efficacy and safety of tirofiban in patients with ST-phase elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Comparing STEMI patients undergoing PCI with and without tirofiban. We found all relevant randomised controlled trials by searching scientific databases and websites. This fixed-results model computed RR and 95% CI. 10 RCTs included 5008 people. After 30 days, death from any cause (RR 0.79, CI 0.55-1.12, P=0.18), major bleeding (1.37, 0.93-2.03, P=0.11), or transfusion (1.23, 0.94-1.61, P=0.13) were no longer impacted. Minor bleeding (1.29, 1.02-1.63, P=0.04), thrombocytopenia (2.04, 1.40-2.97, P=0.0002), and 6-month all-purpose mortality (0.57, 0.36-0.90, P=0.02) showed statistically significant differences. Repeat revascularization (0.58, 0.43-0.78, P=0.0004) and myocardial infarction (0.55, 0.33-0.92, P=0.02) also differed. Mild bleeding and thrombocytopenia are more common with tirofiban, although reinfarction, revascularization, and death after 6 months are decreased.
Most interventional cardiologists choose the femoral route for non-compulsory and number one PCI (PCI). Transradial access is gaining popularity due to less issues at the entrance location. 100 patients with acute ST-phase elevation myocardial infarction were recruited in the study. The researcher divided the study population in 1/2, assigning 1/2 of Group A to patients whose first PCI was performed using the transfemoral route and 1/2 of Group B to transradial route patients. Comparing groups' problems. Major and small hematomas, bleeding difficulties, pseudoaneurysm of the femoral artery, and lack of radial artery have been visible in each group, even though the distinction become now no longer statistically significant. First, primary angioplasty may be performed transfemoral or transradial; second, there is no difference in complication rates between the femoral and radial techniques for patients with acute myocardial infarction undergoing first PCI; and third, the operator must utilise the method that is learned.
Distal radial coronary access is effective. This study examined if the access location affects vascular access and procedure success. A prospective database was created to compare rDRA and lDRA using propensity score matching. “Access time, coronary procedure success, radial spasm, ionising radiation exposure, and patient comfort were observed. The rDRA and lDRA compared 182 of 385 procedures. Approach success was comparable (97.6%vs.97.6%, p=1.0), access time (sec) was shorter (39 (25-60)vs.50 (29-90); p=0.0026), and procedural success was 100% vs. 100% (p=1.000). Radial spasm was not statistically significant (2.2%vs.6.62%, p=0.150). There were no significant differences between the groups in dose-area product (32 (20-57.1) Gy.m2 vs. 32.5 (19.4-46.3) Gy.m2; p=0.487) or fluoroscopy time (min; 4.4 (2.6-9)vs.4.3 (2.5-7.5); p=0.215.”No study population had vascular access concerns. Those undergoing coronary procedures spent about same time in the catheterization laboratory after switching to the rDRA as they did with the lDRA, but the rDRA required less time to get access to the heart.
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