132 research outputs found
Repeat interventions as a long-term treatment strategy in the management of progressive coronary artery disease.
Objectives. This study investigates whether repeat coronary interventions, applied over an extended time period, can successfully curtail the progression of ischemic symptoms and angiographic lumen narrowing.
Background. Coronary artery disease is a chronic and generally progressive disorder, and potential treatment strategies should be examined and compared with this chronicity in mind. Percutaneous interventional revascularization procedures could theoretically be useful in controlling progression of the disease through repeated use as new coronary lesions arise. However, the outcome of this long-term management concept has not previously been subjected to detailed investigation.
Methods. From a consecutive series of 4,357 interventional cardiac procedures, 544 patients were identified who received two or more interventions during the 13-year study period. These patients were categorized into one of three groups: restenosis (repeat interventions limited to the same target segment, N = 261), new stenosis (all repeat interventions directed to stenoses not previously treated, N
Women fare no worse than men 10 years after attempted coronary angioplasty.
A retrospective review of cardiac events occurring in all patients who underwent attempted coronary angioplasty in the first 5 years of our experience (1980-1985) was undertaken. Follow-up data were obtained from the civil registry, hospital records, patient, family, and referring physician. Patient survival curves were constructed and the outcome of women and men was compared. Eight hundred fifty-six patients, 172 women and 684 men with a mean age of 60.0 and 55.3 years, respectively, underwent attempted coronary angioplasty with an overall procedural success rate of 82%, 77.7% in women and 83.1% in men. Follow-up data were obtained in 837 patients (97.8%) with a mean period of 9.6 years (range 0-13.3 years).
The estimated 10 year survival in women was identical to men [79%, 95% confidence interval (CI) 72.6–85.4% vs. 78%, 95% C
Long-term clinical outcome after stent implantation in saphenous vein grafts
Objectives. We sought to determine the role of stent implantation in vein grafts by evaluating the long-term clinical outcome and estimated event-free survival at 5 years in 62 patients and by comparing our data with those of other treatment modalities previously reported. Background. Patients with recurrent angina after coronary artery bypass graft surgery pose a problem. Stent implantation has been advocated in an effort to avoid repeat operation and to address the limitations of balloon angioplasty. Methods. Patients undergoing stenting of a vein graft were entered into a dedicated data base. They were screened for death, infarction, bypass surgery and repeat angioplasty. Procedure-related events were included in the follow-up analysis. Survival and event-free survival curves were constructed by the Kaplan-Meier method. Results. A total of 93 stents (84 Wallstent and 9 Palmaz-Schatz) were implanted in 62 patients. During the in- hospital period, seven patients (11%) sustained a major cardiac eve
The influence of optimal medical treatment on the 'obesity paradox', body mass index and long-term mortality in patients treated with percutaneous coronary intervention: A prospective cohort study
Objective: To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon. Design: A retrospective cohort study. Setting: A tertiary care centre in Rotterdam. Participants: From January 2000 to December 2005, 6332 patients undergoing percutaneous coronary intervention for coronary artery disease were categorised into underweight (body mass index (BMI)30). Primary outcome measure: Mortality. Secondary outcome measures: Cardiac death and non-fatal myocardial infarction. Results: Optimal medical treatment was more common in obese patients as compared with normal weight patients (85% vs 76%; p<0.001). At a mean of 6.1 years, overweight and obese patients had a lower risk of all-cause mortality (HR: 0.75, 95% CI 0.66 to 0.86 and HR: 0.72, 95% CI 0.60 to 0.87, respectively). After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of longterm mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively). Conclusion: BMI is inversely related to long-term mortality in patients treated with percutaneous coronary intervention. Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI. A more optimal medical treatment in the obese group may explain the observed improved outcome in these patients
Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients
OBJECTIVE: To describe the long term clinical outcome (up to 11 years)
after coronary stenting. DESIGN: A single centre observational study
encompassing 1000 consecutive patients with a first stent implantation
(1560 stents) between 1986 and 1996, who were followed for at least one
year with a median follow up of 29 months (range 12-132 months). RESULTS:
Up to July 1997 the cumulative incidence of the major adverse cardiac
events (MACE) of death, non-fatal acute myocardial infarction, coronary
artery bypass grafting, and repeat percutaneous transluminal coronary
angioplasty was 8.2%, 12.8%, 13.1%, and 22.4%, respectively. Survival at
one, three, and five years was 95%, 91%, and 86%, respectively. Comparison
of MACE incidence during the "anticoagulant era" and the "ticlopidine era"
revealed significantly improved event free survival with ticlopidine (27%
v 13%; p < 0.005). Multivariable analyses showed that ejection fraction <
50% (relative risk (RR) 4. 1), multivessel disease (RR 3.0), diabetes (RR
2.9), implantation in saphenous vein graft (RR 2.1), indication for
unstable angina (RR 1. 9), and female sex (RR 1.7) were independent
predictors of increased mortality after stenting. Independent predictors
of any MACE were multivessel stenting (RR 2.0), implantation in saphenous
bypass graft (RR 1.6), diabetes (RR 1.5), anticoagulant treatment (versus
ticlopidine and aspirin) (RR 1.5), bailout stenting (RR 1.5), multivessel
disease (RR 1.4), and multiple stent implantation (RR 1. 5). CONCLUSIONS:
Long term survival and infarct free survival was good, particularly in
non-diabetic men with single vessel disease and good ventricular function,
who had a single stent implanted in a native coronary artery. A dramatic
improvement was observed in event free survival, both early and late, with
the replacement of anticoagulation by ticlopidine. This, of course, cannot
be separated from improved stent implantation techniques between 1986 and
1995. Ultimately, almost 40% of the patients experienced an adverse
cardiac event (mainly repeat intervention) in the long term. New advances
in restenosis treatments and in secondary prevention must be directed at
this aspect of patient management after stenting
Plasma natriuretic peptide levels reflect changes in heart failure symptoms, left ventricular size and function after surgical mitral valve repair
Background and aim: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has diagnostic and prognostic value in patients with heart failure. The present prospective study was designed to assess whether changes in NT-proBNP levels after surgical mitral valve repair reflect changes in heart failure symptoms an
Defective recovery of QT dispersion following transcatheter aortic valve implantation: Frequency, predictors and prognosis
Background: Corrected QT dispersion (cQTD) has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation (TAVI) are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods: A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on class I or III antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG (median: 6 months) analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results: In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ± 17 ms immediately after TAVI and 40 ± 16 ms at 6 months (15% reduction, P = 0.049). Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months (per 10 ms increase; OR: 1.89, 95% CI: 1.15-3.12). By univariable analysis, defective cQTD recovery was associated with late mortality (HR: 1.52, 95% CI: 1.05-2.17). Conclusions: Despite a gradual reduction of cQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may
Clinical, angiographic, and procedural predictors of angiographic restenosis after sirolimus-eluting stent implantation in complex patients
BACKGROUND: The factors associated with the occurrence of restenosis after sirolimus-eluting stent (SES) implantation in complex cases are currently unknown. METHODS AND RESULTS: A cohort of consecutive complex patients treated with SES implantation was selected according to the following criteria: (1) treatment of acute myocardial infarction, (2) treatment of in-stent restenosis, (3) 2.25-mm diameter SES, (4) left main coronary stenting, (5) chronic total occlusion, (6) stented segment >36 mm, and (7) bifurcation stenting. The present study population was composed of 238 patients (441 lesions) for whom 6-month angiographic follow-up data were obtained (70% of eligible patients). Significant clinical, angiographic, and procedural predictors of post-SES restenosis were evaluated. Binary in-segment restenosis was diagnosed in 7.9% of lesions (6.3% in-stent, 0.9% at the proximal edge, 0.7% at the distal edge). The following characteristics were identified as independent multivariate predictors: treatment of in-stent restenosis (OR 4.16, 95% CI 1.63 to 11.01; P<0.01), ostial location (OR 4.84, 95% CI 1.81 to 12.07; P<0.01), diabetes (OR 2.63, 95% CI 1.14 to 6.31; P=0.02), total stented length (per 10-mm increase; OR 1.42, 95% CI 1.21 to 1.68; P<0.01), reference diameter (per 1.0-mm increase; OR 0.46, 95% CI 0.24 to 0.87; P=0.03), and left anterior descending artery (OR 0.30, 95% CI 0.10 to 0.69; P<0.01). CONCLUSIONS: Angiographic restenosis after SES implantation in complex patients is an infrequent event, occurring mainly in association with lesion-based characteristics and diabetes mellitus
Effectiveness of the sirolimus-eluting stent in the treatment of patients with a prior history of coronary artery bypass graft surgery
Objective: Percutaneous coronary intervention in patients with a history of previous coronary artery bypass grafting (CABG) is associated with an increased rate of subsequent adverse events compared to those without prior CABG. We evaluated the impact of utilizing the sirolimus-eluting stent (SES) in this high-risk population. Methods: Since April 2002, SES implantation was utilized as the default strategy for all percutaneous procedures in our hospital. Consecutive patients with a history of previous CABG and de novo lesions (n=47) treated exclusively with SES, were compared to 66 patients who received bare stents in the 6-month period just before SES introduction. Results: There were no significant differences between the groups (SES and bare stent) with respect to baseline clinical or lesion characteristics. The only difference between the groups related to the nominal diameter of stent utilized, which was smaller in the SES group than the bare stent group. (The maximum diameter of SES available was 3.0 mm). At 1 year, the cumulative incidence of major adverse events (defined as death, myocardial infarction, or target vessel revascularization) was significantly lower in the SES group than the bare stent group [8.5 versus 30.3%, hazard ratio 0.37 (95% confidence interval 0.15-0.91); P=0.03]. Conclusions: The utilization of the sirolimus-eluting stent for percutaneous intervention in a high-risk population with a history of previous CABG surgery is associated with a significant reduction in the rate of major adverse cardiac events at 1 year
Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been
developed and improved as both diagnostic and guidance tools for interventional
procedures over the past three decades. IVUS has a resolution of 100µm with a
high tissue penetration and capability of assessing the entire structure of a coronary
artery including the external elastic membrane, whereas OCT has a higher resolution of
10–20µm to assess endoluminal structures with a limited tissue penetration compared
to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into
a single catheter system. With their inherent strength and limitations, the combined IVUS
and OCT probes are complementary and work synergistically to enable a comprehensive
depiction of coronary artery. In this review, we summarize the performance of the two
intracoronary imaging modalit
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