Short and long term outcomes of primary angioplasty in patients aged 75 years and over

The treatment of elderly patients with ST segment elevated myocardial infarction (STEMI) remains controversial. This study aimed to investigate the effects of primary angioplasty in elderly patients on in-hospital and long term major adverse cardiac events (MACE).Materials and methods: From October 2003 to March 2008, we retrospectively enrolled 220 patients aged 75 years and over with STEMI who underwent primary angioplasty. Patients’ characteristics, in-hospital and long term events were recorded.Results: Male/Female ratio of patients was 129/91 and mean age was 78.7 ± 3.6 (range, 75-97) years, and 58.6% of male). Of these patients 29.2% were diabetics, 69.8% were hypertensive, 34.4% were smoker and 43.5% were anemic at admission. Anterior myocardial infarction was diagnosed in 52.3% of patients. Mean pain-balloon time was 222 ± 116 minutes. Eighty two (38.2%) of these 220 patients had three-vessel disease and 12 (5.7%) were diagnosed as cardiogenic shock. Procedural success was observed in 79.6% of patients. Heart failure was observed 27.7% in hospital and intra aortic pump was used in 14.5% of patients. There was no significant difference between age groups in long term major cardiac events and in hospital mortality. Diabetes, leukocyte count at admission and in hospital heart failure were independent predictors of short term MACE and low hemoglobin level at admission and peak CKMB levels were independent predictors of long term MACE.Conclusions: Primary angioplasty in patients aged 75 years and over seems to be associated with low procedural complication, high procedural success, improved short and long term survival

Increased mean platelet volume associated with extent of slow coronary flow

Background: Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices. Methods: In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF. Results: Among the 147 patients (mean age 52.7 ± 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 ± 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15–10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99–12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43–8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22–2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43–4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05–4.33, p = 0.03) was identified as an independent correlate of extent of SCF. Conclusions: Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF

Primer Perkütan Koroner Girişimin Nadir Bir Komplikasyonu: Sorumlu Lezyona Komşu Koroner Arterde Gelişen Total Oklüzyon

ST yükselmeli miyokard infarktüsü (STYMİ) olan hastalarda, primer perkutan koroner girişim (PKG) sırasında gelişen trombotik ve aterosklerotik materyal embolizasyonu bu işlem içim önemli bir dezavantajdır. Çünkü distal embolizasyon bu hastalarda başarılı reperfüzyonu engelleyerek, daha fazla miyokardiyal hasara ve daha kötü prognoza yol açar. Bununla birlikte, primer PKG uygulanan hastalarda nadir olarak proksimal embolizasyon da gelişebilmektedir. Biz bu yazıda, başarılı primer PKG uygulanan iki hastada, proksimal embolizasyona bağlı gelişen total oklüzyon olgularını sunduk. Primer PKG esnasında trombotik materyalin embolizasyonununa karşı kullanılabilecek intrakoroner trombektomi ve distal koruma cihazları gibi çeşitli yöntemler vardır. Fakat bu işlemler yalnızca distal embolizasyona karşı etkili olduklarından, bizim vakalarımızda kullanılmaları durumunda, muhtemelen faydalı olmayacaktı. Bununla birlikte, iki basit teknik vakalarımızda sunduğumuz komplikasyonlara karşı koruyucu olabilir. Bu teknikler; total lezyonun proksimal kısmının dilatasyon sırasında anjiyoplasti balonu ile tamamen kaplanması ve balon dilatasyonu sırasında aşırı basınçtan kaçınmaktır

Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder

WOS: 000372767000020PubMed: 26897292Aims: Paravalvular regurgitation is an important complication of mitral valve replacement. Although surgical repair is mostly recommended, it is associated with significant morbidity. On the other hand, percutaneous closure is a less invasive alternative approach. Percutaneous approaches to treatment of paravalvular prosthetic regurgitation have emerged recently. One of them is the Occlutech Paravalvular Leak Device. The aim of this study was to evaluate early and midterm outcomes of percutaneous paravalvular leak closure utilising a novel occluder. Methods and results: Twenty-one consecutive symptomatic patients who had moderate or severe paravalvular prosthetic regurgitation on transoesophageal echocardiography were included in the study. All the patients were clinically evaluated and found inoperable for surgery. They underwent transapical repair with the Occlutech Paravalvular Leak Device. The patients were followed for 17 +/- 5 months. Attempts were made to rectify 41 defects in 21 patients with 100% success. Mean procedure time was 76140 min and fluoroscopy time was 44 +/- 37 min. Early post-procedural outcome was uneventful in all cases, with >= 1 grade reduction in regurgitation in all of the patients. There was no mortality during hospital stay. There was one case of haemothorax in one patient and one case of pneumothorax in another. Post-implantation 90-day follow-up data were obtained for 19 patients, and 12-month data were obtained for 12 patients. No deaths due to any cause, stroke or surgery for prosthetic impingement, worsening or relapse of paravalvular leak during follow-up were recorded. One patient underwent reintervention and was treated successfully with the same occluder 11 months after the index procedure. Conclusions: The novel Occlutech Paravalvular Leak Device, which was designed specifically for mitral and aortic paravalvular regurgitation, is an additional, useful tool in the device armamentarium for the treatment of PVL