Prequtaneous transluminal angioplasty in patients with multivessel coronary disease: How important is complete revascularization for cardiac event-free survival?

AbstractThe relative influences of revascularizationstaus and baseline characteristics on long-term outcome were examined in 867 patients with multivessel coronarydisease who had undergone successful coronary angioplasty. These patients represented 83% of a total of 1,039 patients in whom angioplasty had been attempted with an in-hospltal mortality and infarction rate of 2.5% and 48%, respectively. Emergency coronary bypass surgery was needed in 4.9%. Of the 867 patients, 41% (group 1) were considered to have complete revascularization and 59% (group 2) to have incomplete revascularization. Univariate analysis revealed major differences between these two groups with patients in group 2 characterized by advanced age, more severe angina, a greater likelihood of previous coronary surgery and infarction, more extensive disease and poorer left ventricular function.Over a mean follow-up period of 26 months, the probability of event-free survival was significantly lower for group 2 only with respect to the need for coronary artery surgery (p = 0.004) and occurrence of severe angina (p = 0.04). The difference in modality was of borderline significance (p = 0.051) and there were no signiicant difference between 1 and 2 in either the incidence of myocardial infarction or the need for repeat angioplasty.Muitivariate analysis identified independent baseline predictors of late cardiac events that were then used to adjust the probabilities of event-free survival. This adjustment effectively removed any significant influence of completeness of revascuiarization on event-free survival for any of the above end points including the combination of death, myocardial infarction and need for coronary artery surgery. Therefore, late outcome in these patients is not significantly influenced by revascularization status but depends more on baseline patient characteristics

923-6 Intravenous Adenosine and Lidocaine to Limit Reperfusion Injury During Acute Myocardial Infarction: Preliminary Data

Adenosine (ADO) and lidocaine (LDO) given prior to restoration of blood flow reduces reperfusion injury in animals. We conducted a pilot study of intravenous ADO and LDO in pts undergoing direct angioplasty for acute myocardial infarction (AMI). Pts with ≤12 hours of chest pain and electrocardiographic evidence of AMI were given LDO 1mg/kg iv bolus and 2mg/min iv infusion beginning at the time of recruitment, and ADO 70mcg/kg iv infusion beginning when coronary occlusion (TIMI grade 0–1 blood flow) was confirmed angiographically. Pts with bronchospasm, blood pressure <100mmHg, or<1° heart block were excluded. ADO and LDO were given for 1 hour after vessel patency was restored. Myocardial area at risk and final infarction area were measured with serial Tc-99m-sestamibi perfusion studies (prior to angioplasty, before hospital discharge and 6 weeks after discharge). A salvage index (S1) was constructed by correcting the change in sestamibi perfusion defect for the mass of myocardium at risk. Analysis of 25 patients completing the protocol revealed a mean (±SD) salvage of 20±17% and S1=0.55. Salvage and S1 were 25±18% and 0.54 for anterior infarctions, 13±5% and 0.57 for inferior infarctions, respectively. These data were compared to an historical control group consisting of 50 patients undergoing direct angioplasty for AMI without adjunctive ADO/LDO. After adjustment for time to treatment and perfusion nadir, analysis of covariance revealed a similar degree of early salvage in the study and control groups (p=0.3). However, at 6 weeks, the median infarct size for study pts was 0. Using logistic regression analysis, significantly more study pts had no final measureable infarction at 6 weeks than control pts at hospital discharge (p=0.007). After adjusting for infarct size, location and time to treatment, this difference persisted (p=0.04).ConclusionsAdjunctive ADO and LDO during angioplasty for AMI may favorably affect late final infarction size. Randomized studies assessing 6 week final infarction size are needed

Intravascular ultrasound imaging: In vitro validation and pathologic correlation

AbstractIntravascuiar ultrasound imaging is a new method in which high resolution images of the arterial wall are obtained with use of a catheter placed within an artery. An in vitro Plexiglas well model was used to validate measurements of the luminal area, and an excellent correlation was obtained. One hundred thirty segments of fresh peripheral arteries underwent ultrasound imaging and the findings were compared with the corresponding histopathologic sections. luminal areas determined with ultrasound imaging correlated well with those calculated from microscopic slides (r = 0.98).Three patterns were identified on the ultrasound images: 1) distinct interface between media and adventitia, 2) indistinct interface between media and adventitia but different echo density layers, and 3) diffuse homogeneous appearance. The types of patterns depended on the relative composition of the and adventitia. Calcification of intimal plaque obscured underlying structures. Atherosclerotic plaque was readily visualized but could not always be differentiated from the underlying media

Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis

Aims: Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta-analysis approach. Methods: MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24–72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS. Results: 44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm2; 0.76–0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52–3.26, p = 0.007), LVEDV EDV (MD = 5.81 ml; 2.65–8.97, p = 0.0003) and decrease in MPG (MD = 7.96 mmHg; 8.73 to 7.20, p < 0.00001), LAP (MD = 10.09 mmHg; 11.06 to 9.12, p < 0.00001), and SPAP (MD = 15.55 mmHg; 17.92 to 13.18, p < 0.00001). On short term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post- PMBV stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7% respectively. On long term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7% respectively Conclusion: PMBV represents a successful approach for patients with mitral stenosis as evidenced by improvement in echocardiographic parameters and low rate of complications.The authors received no financial support for the research, authorship and publication of this article

Inductively coupled plasma mass spectrometric detection for multielement flow injection analysis and elemental speciation by reversed-phase liquid chromatography

The feasibility of using an inductively coupled plasma mass spectrometer as a muitieiement detector for flow injection analysis (FIA) and ion-pair reversed-phase liquid chromatography was investigated. Sample introduction was by uitrasonk nebulization with aerosol desolvation. Absolute detecton limits for FIA ranged from 0.01 to 0.1 ng for most elements using 10-pL injections. Over 30 elements were surveyed for their response to both anionic and cationic ion pairing reagents. The separation and selective detection of various As and Se species were demonstrated, yielding detection limits near 0.1 ng (as element) for ail six species present. Determination of 15 elements in a single injection with multiple ion monitoring produced shniiar detection limits. Isotope ratios were measured with sufficient precision (better than 2%) and accuracy (about 1 %) on eluting peaks of Cd and Pb to demonstrate that liquid chromatographyhductively coupled plasma mass spectrometry should make speciation studies with stable tracer isotopes feasible