19 research outputs found
Guida pratica alla diagnosi e alla terapia in cardiologia
AU:Michael H. Crawford, Komandoor SrivathsonTI:Essentials of diagnosis & treatment in cardiology.
ED:McGraw Hill Medical
Y:200
Emergency balloon aortic valvuloplasty in patients with critical aortic stenosis presenting with cardiogenic shock.
This report describes 2 cases of aortic valvuloplasty performed as emergency treatment in patients with critical aortic stenosis presenting with cardiogenic shock. This procedure can be life-saving, and allows the patients to undergo further evaluation for aortic valve replacement, or other definitive treatments such as the recently developed percutaneous heart valve implantation for patients with unacceptably high surgical risk
Prognostic value of isolated troponin I elevation after percutaneous coronary intervention.
BACKGROUND: Mild elevations of cardiac troponin are frequent after percutaneous
coronary intervention (PCI). Their prognostic value is uncertain in the absence
of changes in creatine kinase-MB (CK-MB).
METHODS AND RESULTS: We evaluated the relation between isolated elevations of
cardiac troponin I (cTnI) and all-cause mortality. We studied 3494 consecutive
patients who underwent PCI in 16 Italian tertiary cardiology centers. CK-MB and
cTnI were analyzed in a central laboratory. Duration of follow-up was 2 years.
The present analysis was restricted to 2362 patients with normal CK-MB and cTnI
values at baseline and no CK-MB elevation after PCI. A rise in cTnI after PCI
>0.15 ng/mL, the upper reference limit, was found in 932 patients (39.4%). A rise
>0.45 ng/mL (>3
7upper reference limit) was found in 467 patients (19.7%).
Compared with patients with normal cTnI, those with cTnI elevation >0.15 ng/mL
showed a slightly increased mortality (3.8% versus 2.6%; hazard ratio, 1.53; 95%
confidence interval, 0.97 to 2.42; P=0.069). A cTnI elevation >0.45 ng/mL was
associated with a higher risk of mortality (4.5% versus 2.7%; hazard ratio, 1.68;
95% confidence interval, 1.01 to 2.80; P=0.044), which, however, did not remain
significant after adjustment for concomitant risk factors (hazard ratio, 1.45;
95% confidence interval, 0.86 to 2.46; P=0.162). Postprocedural cTnI elevation
was associated with coronary and clinical features consistent with a worse risk
profile.
CONCLUSIONS: In the absence of a rise in CK-MB, elevated cTnI levels after PCI
are associated with a modest increased risk of death. However, this is not
independent of the concomitant adverse baseline clinical characteristics of these
patients