Treatment of a true CXA-OM bifurcation lesion using a one stent drug coated balloons provisional technique

Background: Provisional stenting is a favorable option for most bifurcation lesions, while two stent techniques show benefits in true bifurcation performed by experts. Using one stent and DCB in true bifurcation lesions still remains questionable.1,2 Case report: 76-year-old male presented with persisting chest pain. ECG showed no specific ischemic changes, while hsTnI was highly elevated. He had gone PCI LAD 14 years ago. Diagnosis: right coronary angiography revealed occlusion of RCA, while left coronary angiography revealed LLS of 20% in proximal LAD stent, 70% stenosis of mid LAD, and acute occlusion of secondary OM branch on bifurcation level, while CxA was stenosed 70-80%. Management: PCI CxA-OM2 was performed with DES Xience expedition 2,75/33mm in CxA-OM2 with POT 3,25/12mm proximally, then after rewiring and adequate lesion preparation a DEB Sequent please 2,5/25mm in CxA distally was performed. After two months we performed an elective PCI LAD and checked out the result of CxA bifurcation which was optimal. Conclusion: Using one stent and DCB in true bifurcation lesions still remains questionable. There are no data from a prospective study, while there are data from the observational study which enrolled 130 patients. DCB-only strategy was performed in 54% patients, 34.6% had at least one stent in the main branch, 8.5% had at least one stent in the side branch and 3.1% at least one stent in the main branch and side branch. Study follow up lasted for 9.8 months. The TLR rate was 4.5%, MACE was 6.1%, and no stent thrombosis was detected. This study suggested that the DCB+one stent, and DCB-only strategy was safe and effective in selected bifurcations, possibly allowing for an abbreviated antiplatelet regimen

NIJEMI AKUTNI INFARKT MIOKARDA KOD BOLESNIKA SA ŠEĆERNOM BOLESTI U IZVANBOLNIČKOJ HITNOJ MEDICINI

Aim of the Study: Silent acute myocardial infarction occurs commonly in diabetic patients. Currently, it is not fully understood whether altered perception of ischemia also predisposes atypical presentations, and therefore leads to under-diagnosing the acute myocardial infarction (AMI) in diabetic patients. In this study, we tried to determine whether chest pain in AMI occurred less frequently in diabetic patients. Methods: In this retrospective study, we included patients admitted from April 2014 to November 2019. Data were collected using eHitna and BIS as the nation-wide programs for patient tracking and registry in Croatia. All patients included in the study had initially called Department of Emergency Medicine of Brod-Posavina County, which then resulted in an intervention. Patients were then transferred to Dr Josip Benčević General Hospital, where they were hospitalized. All patients had discharge letters with the diagnosis specifi ed by ICD-10 classifi cation as I21 spectrum (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), i.e. AMI. Results: In this study, we included 180 patients having suffered AMI who were hospitalized and treated. There were 35 (19%) diabetic patients (DP) and 145 (81%) non-diabetic patients (non-DP). Chest pain was absent in nine (26%) DP and 13 (9%) non-DP (p=0.007). There was no difference in sex distribution within the two groups, with 60% and 68% male patients in DP and non-DP, respectively (p=0.395). The mean patient age was signifi cantly different between the two groups, i.e. 69 years in DP and 64 years in non-DP (p=0.034). Discussion: AMI in diabetic patients could have altered clinical presentation, which has often been researched therefore. Some researchers have reported that atypical or silent presentations are more frequent in DP with AMI, whereas others found no differences when compared to non-DP. In our study, absence of chest pain as a characteristic of silent AMI was experienced by 17% more DP as compared to non-DP, suggesting that DM infl uences clinical presentation of AMI. It is important to emphasize the importance of such fi ndings in emergency medicine where patients often describe their various symptoms. The mean age of DP having suffered AMI was signifi cantly higher (even up to 5 years) in comparison to non-DP. Despite the fact that DM is a risk factor for developing AMI, this fi nding could be explained by the fact that DM is more common in elderly population. Conclusion: Chest pain occurs signifi cantly less frequently in DP that develop AMI than in non-DP. Therefore, DP have a higher probability of developing silent AMI.Cilj: Nijemi akutni infarkt miokarda (AIM) se pojavljuje češće u bolesnika s dijabetesom. Predisponira li izmijenjena percepcija ishemije atipičnu prezentaciju te se zbog toga nedovoljno dijagnosticira AIM u bolesnika s dijabetesom, nije još dovoljno istraženo. U ovoj studiji pokušali smo utvrditi pojavljuje li se bol u prsištu kod AIM rjeđe kod bolesnika s dijabetesom. Metode: U ovu retrospektivnu studiju uključili smo bolesnike primljene od travnja 2014. do studenoga 2019. godine. Koristili smo bazu podataka programa “e-hitna” i “BIS” te sakupljali i analizirali podatke o bolesnicima koji su zatražili intervenciju izvanbolničke hitne medicinske službe u našoj županiji, bili prevezeni u Opću bolnicu “Dr. Josip Benčević”, hospitalizirani te im je kao otpusna dijagnoza postavljena prema klasifi kaciji MKB-10 bila u spektru dijagnoze I21 (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), tj. AIM. Dijabetes je zabilježen kod bolesnika koji su bili na inzulinu ili oralnim hipoglikemicima, uključujući dijabetes tip 1 i tip 2. Rezultati: U studiju smo uključili 180 bolesnika koji su doživjeli AIM. Od tog broja ih je 35 (19,4 %) imalo dijabetes (DP), a 145 (80,6 %) nije imalo dijabetes (ne-DP). Bol u prsištu nije bila prisutna u devet (26 %) DP i 13 (9 %) ne-DP (p=0,007). Nije bilo značajne razlike u distribuciji prema spolu ni u jednoj skupini bolesnika (p=0,35). Muškaraca je bilo 60 % u DP i 68 % u ne-DP. Prosječna dob značajno se razlikovala u dvjema skupinama. U DP je prosječna dob bila 69 godina, a u ne-DP 64 godine (p=0,034). Rasprava: Akutni infarkt miokarda u bolesnika s dijabetesom može se prezentirati izmijenjenom kliničkom slikom i zbog toga se često istraživao. Neki istraživači su pokazali da je atipična ili nijema prezentacija infarkta češća u bolesnika s dijabetesom, dok drugi nisu pronašli razlike u usporedbi s nedijabetičarima. U ovoj studiji smo primijetili da je izostanak boli u prsištu kao karakteristika nijemog AMI učestaliji u dijabetičara s AIM. To dovodi do zaključka da dijabetes utječe na kliničku sliku AIM. Treba istaknuti važnost takvog rezultata u izvanbolničkoj hitnoj medicini gdje se bolesnici često prezentiraju raznim simptomima. Srednja vrijednost dobi dijabetičara koji su doživjeli AIM bila je značajno veća nego u nedijabetičara. Unatoč činjenici da je dijabetes rizični čimbenik za razvoj AIM, ovaj rezultat možemo tumačiti činjenicom da je dijabetes zastupljeniji u starijoj populaciji. Zaključak: Bol u prsištu se javlja rjeđe u bolesnika s dijabetesom koji imaju AIM nego u onih koji nemaju dijabetes. Zbog toga dijabetičari imaju veće izglede da razviju nijemi AIM.