Lethal outcome associated with percutaneous coronary interventions in patients with coronary artery disease – a complication or natural progression of the disease?

Despite advancements in technology and medication therapy, coronary artery disease continues to remain the number one cause of death. Treatment for coronary artery disease requires life style modifications, medication therapy, percutaneous coronary interventions, and sometimes coronary artery bypass surgery. Though percutaneous coronary interventions are considered safe and are commonly occurring procedures, there are still risks for complications. One of the most frequently occurring complications is hematoma of the femoral artery site. The purpose of this study was to determine if there was an increased incidence of hematomas in individuals undergoing percutaneous coronary intervention with associated sheath times of less than five hours (Group A) as compared to sheath time of greater than five hours (Group B). The study used a retrospective, two group design and was conducted at a tertiary care center that performs over 1500 PCI’s annually. Inclusion criteria included adults over the age of 18 who were hemodynamically stable, had no known bleeding disorders, and were punctured once at the femoral artery to perform the percutaneous intervention. Two hundred fifty medical records were reviewed utilizing a data collection tool designed by the researcher. Total sample size was 55, 21 in Group A and 34 in Group B. Six hematomas were documented as occurring, but were not reportable based on the ACC definition. Hematomas were documented in the medical record using the terms “small”, “medium,” and “large” versus an objective measurement. No hematomas were identified using the ACC definition, which was the measurement standard for this research hospital. Sheath times in Group A averaged 4.02 hours, and group B 7.42 hours. There was a higher incidence of descriptive hematoma that did not meet the criteria of this study in Group B. Results call for recommendations of on-going documentation of post procedure hematomas using a standardized, reliable, and valid measuring tool. APRN’s can be instrumental in implementing change in patient care , hospital policy and on the national level by assuring that hematomas are accurately and consistently documented. Further research is indicated related to sheath times and potential associated negative outcomes.

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The lower the better? Optimal achieved blood pressure for patients with coronary artery disease undergoing percutaneous coronary interventions and kidney failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.2728 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Yang ◽

H.B Leu

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Kidney Failure ◽

Cardiovascular Events ◽

Chinese Patients ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Artery Disease

Abstract Background This study investigates the ideal achieved blood pressure (BP) in ethnic Chinese patients with coronary disease (CAD) and kidney failure (eGFR<15 ml/min/1.73m2). Methods A total of 575 kidney failure patients who had undergone percutaneous coronary interventions (PCI) were enrolled and divided into 6 to 4 groups according to blood pressure range were analyzed. The clinic outcomes included major cardiovascular events (MACE) and MACE plus hospitalization for congestive heart failure (Total CV event). Results The mean systolic BP was 135.02±24.73 mmHg and diastolic BP was 70.74±13.05 mmHg. Systolic BP 140–149mmHg and diastolic BP 80–89mmHg had lowest MACE/CV event incidence rate (11%/23%; 13.2%/21.1%) compare to other groups. Patients with systolic BP<120mmHg had a higher risk MACE (HR: 2.014; 95% CI: 1.172–3.462, p=0.008) when compared to those with systolic BP 140–149 mmHg. Patients with systolic BP≥160mmHg (HR: 1.838; 95% CI, 3.266–1.035, p=0.038). And diastolic blood BP ≥90mmHg (HR: 2.191; 95% CI: 1.147–4.188, p=0.018) had a higher risk of total cardiovascular events when compared to those with systolic BP 140–149 mmHg and diastolic BP 80–89 mmHg. Conclusions A J-shaped BP association of systolic (140–149 mmHg) and diastolic (80–89 mmHg) was found with decreased cardiovascular events for coronary artery disease with kidney failure after undergoing PCI in non-western population. Funding Acknowledgement Type of funding source: None

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Study on 100 cases of coronary artery disease underwent percutaneous coronary interventions

University Heart Journal ◽

10.3329/uhj.v5i1.3434 ◽

2009 ◽

Vol 5 (1) ◽

pp. 13-16

Author(s):

Administrator BanglaJOL ◽

Md Faruque ◽

Fazlur Rahman ◽

AQM Reza ◽

Mizanur Rahman ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angioplasty ◽

Percutaneous Coronary Interventions ◽

Vessel Disease ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Artery Disease ◽

Transluminal Coronary Angioplasty

This prospective study was done in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh during the period of January 2004 to January2005 to see the effectiveness and safety profile of percutaneous coronary interventions in patients with coronary artery disease. 100 patients with male 90 percent and female 10 percent undergo percutaneous coronary intervention in our unit during this period. Indication of percutaneous coronary interventions were chronic stable angina with stress test positive in 20 percent cases, unstable angina with prior myocardial infarction in 30 percent cases, unstable angina without prior myocardial infarction in 20percent cases, acute inferior myocardial infarction with post myocardial infarction angina in 20 percent cases and acute anterior myocardial infarction with post myocardial infarction angina in 10 percent cases. Angiographic diagnosis of the patients were single vessel disease in 70 percent cases , double vessel disease in 24 percent cases and triple vessel disease in 11 percent cases. Total number of disease coronary arteries was 146 and 125 lesions were treated. Out of 125, 120 lesions were treated with percuteneous transluminal coronary angioplasty with stenting and 5 lesions with plain percuteneous transluminal coronary angioplasty .Total occlusion was treated in 7 cases. Mean diameter of stent used was 3.02 ± 0.42 mm. Patients were discharged by three to four days of the procedure with improved clinical conditions. Residual stenosis after deploying of stent was less than l 0 percent. Our angiographic success rate was 98 percent, procedural success 96 percent and clinical success 95 percent. Failed percuteneous transluminal coronary angioplasty in 2 cases all of them were chronic total occlusion. One patient died on third day of the procedure due to ventricular asystole, he was a patient of triple vessel disease. Following procedure, course of the patients were uneventful. In the field of maagement of coronary artery disease percutaneous coronary intervention is the internationally recognized standard treatment worldwide for more than last 2 decades. From our result it is found that in most of the indicated cases of PCI can be done efficiently with very minimum rate of failure & complication. Key word: Percutaneous coronary interventions, coronary artery disease. doi: 10.3329/uhj.v5i1.3434 University Heart Journal Vol. 5, No. 1, January 2009 13-16

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