Acute myocardial infarction in an 80 year-old woman caused by left main occlusion with concomitant chronic total occlusions of right and left coronary artery: Successful treatment with percutaneous revascularization

Although acute left main coronary artery occlusion is rare, it carries a very high mortality rate. Following the encouraging results of trials testing the effect of primary percutaneous coronary intervention, more cases of left main stenosis are treated as culprit lesion in acute myocardial infarction. Few cases of primary percutaneous intervention on left main occlusion have been published. We present the case of an elderly patient presenting with acute myocardial infarction complicated by cardiogenic shock due to left main occlusion, with concomitant chronic total occlusion of right and left anterior descending coronary arteries. Successful percutaneous intervention as a bridge to coronary artery bypass grafting was performed with stent implantation, which resulted in the relief of obstruction, the restoration of blood flow and the immediate clinical improvement of the patient. The patient left the hospital in good condition after 11 days, although she had refused the proposed coronary artery bypass graftin

Transcatheter aortic valve implantation: The new option for high-risk patients with aortic stenosis

Calcific aortic valve stenosis is the most common valvular heart disease in developed countries. Without surgery, the prognosis is extremely dismal. Therefore there is general agreement that surgical aortic valve replacement should be offered to patients with symptomatic severe aortic valve stenosis. However, surgery is denied to approx. 30–40% of elderly patients with severe, symptomatic aortic stenosis due to high perioperative risk. Transcatheter aortic valve implantation (TAVI) is a novel and effective procedure which provides a promising treatment option for some of these patients. This review focuses on TAVI systems, the patients who would benefit from TAVI, and the advantages and disadvantages of the procedure. (Cardiol J 2011; 18, 4: 461–468

Antithrombotic therapy in patients with atrial fibrillation after stent implantation in light of the new trials. Change of paradigm

Częstość występowania migotania przedsionków (AF) w populacji osób powyżej 20 roku życia wynosi około 3%, ale odsetki te w procesie starzenia, u chorych w nadciśnieniem tętniczym, chorobą niedokrwienną serca, niewydolnością krążenia , cukrzycą, wadami zastawkowymi, otyłością i przewlekłą niewydolnością nerek – znacznie wzrastająTriple antithrombotic therapy with warfin plus two antiplatelet agents (DAP) is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with risk of fatal and nonfatal bleeding. Furthermore, shortening the course of triple therapy does not substantially reduce the bleeding risk. Thus, although triple therapy may prevent ischemic events better, it also has the potential to cause considerable harm in many patients. Two new promising therapeutic strategies have emerged to reduce risk of bleeding among patients whom both oral anticoagulation and antiplateled therapy are indicated. The first is the use of non-vitamin K-antagonist oral anticoagulants — rivaroxaban and dabigatran. The second is omission of aspirin or clopidogrel from standard regimen and the use of a single P2Y12 inhibitors (SAP). In this article the results from four major trials of compared triple therapy (TT) versus dual therapy (DT) were presented. In two trials (WOEST and ISAR-REACT) patients with AF and stent implantation who were randomly assigned to receive warfin + DAPT (aspirin and clopidogrel) andpatients who were assigned to dual therapy were compared; warfin and single antiplatelet agent — clopidogrel or aspirin. Two new trials, PIONEER and RE-DUAL compared patients who were randomly assigned to receive non-vitamin K antagonist rivaroxaban and clopidogrel versus standard triple therapy (PIONEER) and dabigatran with clopidogrel versus standard triple therapy (RE-DUAL). In all four studies bleeding complications were significantly lower for patients treated with DT versus TT. Additionally, we presented an informal meta-analysis of the results of these four large trials, performed with the use of the DerSimonian and Laird method for random effects. The odds ratio of major and minor bleeding with dual therapy are half the odds with triple therapy 0.51 (0.37–0.69). The meta-analysis suggests that the risk of major adverse cardiovascular events is not higher with dual therapy than in triple therapy 0.89 (0.65–1.22). No single trial has been adequately powered to completely rule out an increase in ischemic events with dual therapy versus tripletherapy. The aggregate evidence suggests that the net clinical benefit of dual therapy should give cardiologists confidence to drop aspirin or clopidogrel when they are using a contemporary strategy in patients with AF after stent implantation

Przejściowe wydłużenie odstępu QT oraz odwrócenie załamków T: trudności diagnostyczne

ST-T deviations are usually related to myocardial ischaemia, hypertrophy or myocarditis. Less common reasons are drugs action(such as digoxin, phenytoin) dyselectrolytaemia, brain ischaemia, anemia and pericardial effusion. However, in some cases,the reason of electrocardiographic changes is unclear. In presented case, we analise the potential influence of ibandronic acidon QT-interval prolongation and T-wave inversion, in patient treated for osteoporosis

Long-term clinical results of biodegradable vascular scaffold ABSORB BVS™ using the PSP-technique in patients with acute coronary syndrome

Background: The PSP (predilatation, sizing, post-dilatation)-technique was developed to improve the prognosis of patients after bioresorbable vascular scaffold (BVS) implantation. In acute coronary syndrome (ACS) the use of BVS is particularly demanding and carries some potential risk regarding aggressive lesion preparation, proper vessel sizing due to spasm and thrombus inside the artery. The aim herein, was to determine the long-term results of BVS stenting in ACS patients depending on the scaffold implantation technique.Methods: The present study is a prospective, two-center study, which consisted of 182 patients who underwent percutaneous coronary intervention (PCI) with BVS (Absorb, Abbott Vascular, Santa Clara, California, USA) implantation for the ACS. All patients were divided into two groups. The first consisted of 52 patients treated with the PSP-technique (PSP group). The second group enrolled 130 patients treated with a non-PSP procedure (non-PSP group).Results: The procedure was successful in all patients. The mean observation time was 28.8 ± 16.5 months (median 28.3 months, interquartile range 24.0 [17.0–41.0] months). It was found that target vessel failure (TVF) was consistently reduced in patients using the PSP-technique as compared with the non-PSP group (5.8% vs. 17.7%, p = 0.03). Moreover, PSP-technique was superior to non-PSP-technique concerning major adverse cardiac events (MACE) (3.7% vs. 22.3%, p = 0.02). Logistic regression analysis revealed that the use of PSP technique significantly decreased the risk of target vessel revascularization (odds ratio [OR] 0.11, p = 0.01), TVF (OR 0.28, p = 0.03) and MACE (OR 0.29, p = 0.02).Conclusions: The PSP-technique for BVS implantation improves long-term results and should also be recommended for newer generations of the bioresorbable scaffold