scholarly journals Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome and multiple coronary atherosclerosis

2017 ◽  
Vol 89 (4) ◽  
pp. 29-34 ◽  
Author(s):  
V I Ganyukov ◽  
R S Tarasov ◽  
Yu N Neverova ◽  
N A Kochergin ◽  
O L Barbarash ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Coronary Atherosclerosis ◽  
Long Term Results ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aim. To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). Subjects and methods. A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months. Results. The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcomes Conclusion. The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.

scholarly journals Extensively Thrombosed Ectatic Circumflex Coronary Artery Fistula Presenting as Acute Coronary Syndrome

2019 ◽  
Vol 15 (4) ◽  
pp. 316-319
Author(s):  
Nooraldaem Yousif ◽  
Mohammady Shahin ◽  
Robert Manka ◽  
Slayman Obeid
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Fistula ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Clear Cut ◽  
Coronary Syndrome ◽  
St Segment ◽  
Previous Medical History

Background: Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and reopening symptomatic occluded CAF is ongoing. Case Summary: We are reporting a 30-year-old male patient with no previous medical history presented as non-ST segment elevation myocardial Infarction. Coronary angiography showed an entirely thrombosed ectatic circumflex artery with a suspicion of thrombosed coronary arterial fistula. In view of the ongoing ischemia in the setting of acute coronary syndrome; we tried to open percutaneously but all efforts were to no avail. Discussion: In this case report, we are sharing our experience in the management of this challenging case in view of the rarity of such peculiar clinical condition and the unfavourable presentation along with the lack of clear-cut Guideline and Consensus whether to/not to open such huge and immensely thrombosed symptomatic coronary artery fistula as well as the dilemma of choosing the best long-term medical treatment between antiplatelets vs anticoagulants in such young patient.

scholarly journals Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil

2015 ◽  
Vol 13 (3) ◽  
pp. 370-375 ◽  
Author(s):  
Alexandre de Matos Soeiro ◽  
Felipe Lourenço Fernandes ◽  
Maria Carolina Feres de Almeida Soeiro ◽  
Carlos Vicente Serrano Jr ◽  
Múcio Tavares de Oliveira Jr
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Characteristics ◽  
Young Patients ◽  
Coronary Bypass ◽  
Percutaneous Coronary Angioplasty ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Objective In Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population.Methods This is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried out between May 2010 and May 2013. Data were obtained on demographics, laboratory test and angiography results, and the coronary treatment adopted. Statistical analysis was presented as percentages and absolute values.Results Approximately 57% were men and the median age was 50 years (30 to 55). The main risk factors were arterial hypertension (68%), smoking (67%), and dyslipidemia (43%). Typical pain was present in 90% of patients. In young individuals, 25.7% showed ST segment elevation. Approximately 56.5% of patients presented with a single-vessel angiographic pattern. About 7.1% were submitted to coronary bypass surgery, and 42.1% to percutaneous coronary angioplasty. Intrahospital mortality was 1.5%, and the combined event rate (cerebrovascular accident/stroke, cardiogenic shock, reinfarction, and arrhythmias) was 13.8%. After a mean follow-up of 10 months, mortality was 9.8%, while 25.4% of the patients had new ischemic events, and 37.3% required readmission to hospital.Conclusion In the short-term, young patients presented with mortality rates below what was expected when compared to the rates noted in other studies. However, there was a significant increase in the number of events in the 10-month follow-up.

scholarly journals Comparison of strategies for myocardial revascularization in patients with coronary heart disease and multivessel coronary artery disease

2020 ◽  
Vol 10 (4) ◽  
pp. 30-35
Author(s):  
Aleksandr V. Bocharov ◽  
Leonid V. Popov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Vascular Lesions ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Artery Disease

Justification. To this day, the problem of choosing the method of complete revascularization in the category of patients with acute coronary syndrome without the ST segment elevation and multi-vascular lesions of the coronary bed does not lose its relevance. The goal of this study was to compare the results of surgical manipulations in patients who underwent percutaneous coronary intervention using 3rd-generation drug-coated stents and coronary artery bypass grafting, according to the two-year follow-up data. Methods. The results of surgical and endovascular revascularization strategies were compared in 140 patients with ischemic heart disease and multivessel coronary disease after previously successfully performed stenting of a clinically dependent artery using 3rd-generation drug-coated stents for acute coronary syndrome without the ST segment elevation based on the results of a two-year follow-up. Results. There were no statistically significant differences in clinical, demographic and operational characteristics between the groups, except for the number of smoking patients, wich was significantly higher in the PCI group. In the PCI group, there was a statistically significant difference in the frequency of repeated revascularizations and the combined MACCE point. Discussion. The obtained results showed the advantage of CABG in a group of patients with previously successfully performed PCI of the clinically dependent artery for non -STEMI and multi-vascular lesions. Conclusion. In patients with coronary artery disease and multivascular lesions of the coronary bed, who had successfully underwent stenting of the clinical-dependent artery using stents of the 3rd generation with drug coating for acute coronary syndrome without the ST segment elevation, and intermediate severity of lesions on the SYNTAX scale when performing full functional revascularization by coronary artery bypass grafting or stenting, there are no differences in the indicators of cardiovascular mortality, myocardial infarction, acute cerebrovascular disease, frequency of return of the clinic angina pectoris, with the exception of the frequency of repeated revascularization and composite MACCE points, which was statistically significantly higher in the group of stenting.

scholarly journals The effect of coronary stent type on the long-term results of coronary artery bypass surgery after stenting clinically related artery in acute coronary syndrome in patients with multivessel coronary artery disease

2019 ◽  
Vol 34 (3) ◽  
pp. 144-152
Author(s):  
A. V. Bocharov ◽  
L. V. Popov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Stents ◽  
Long Term Results ◽  
Bare Metal ◽  
Coronary Syndrome

Justification. The results of endovascular revascularization are largely determined by the type of stents used. The use of baremetal coronary stents significantly worsens the long-term results of endovascular treatment of coronary artery disease. Given the widespread use of bare-metal coronary stents in the Russian Federation for the treatment of coronary artery disease and acute coronary syndrome, in particular, the issue of the impact of the above-mentioned endovascular interventions on the long-term results of coronary artery bypass grafting (CABG) performed after endovascular revascularization of the clinically related artery in patients with acute coronary syndrome and multivessel lesions does not lose relevance.Aim. To compare the long-term results of the staged strategies of revascularization of the coronary bed: CABG performed after stenting the clinically related artery with third-generation biodegradable polymer-based sirolimus-eluting stents for acute coronary syndrome and CABG performed after stenting the clinically related artery with bare-metal coronary stents for acute coronary syndrome.Material and Methods. The analysis used the data of two-year follow-up of patients who underwent two-stage revascularization: at the first stage, patients received stenting of the clinically related artery for acute coronary syndrome and, at the second stage, they received coronary artery bypass grafting no later than 90 days from the date of stenting. The study included 218 patients with multivessel lesions of the coronary bed, admitted with clinical manifestation of acute coronary syndrome. The long-term follow-up period was 24 months. The following end points were analyzed: cardiovascular mortality, myocardial infarction, re-revascularization, and combined MACCE end point (cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, and re-revascularization). The observation was carried out at the hospital stage and, then, on an outpatient basis once every three months.Results. There were no significant differences between the groups. The frequency of repeated revascularization, including repeated revascularization of the stented artery, and recurrence of angina were significantly higher in the group with baremetal coronary stents. There were no significant differences between the groups in regard to cardiovascular mortality, nonfatal myocardial infarction and acute cerebrovascular accidents. The frequency of MACCE events was significantly higher in the group of bare-metal coronary stents, mainly due to the frequency of repeated revascularizations.Conclusion. Coronary artery bypass grafting performed in the early period after stenting of the clinically related artery using bare-metal coronary stents in patients with acute coronary syndrome and multivessel lesions was associated with a significantly larger number of repeated coronary revascularizations and higher rate of recurrent angina compared to a similar strategy, but with the use of modern third-generation biodegradable polymer-based sirolimus-eluting stents.

scholarly journals MI with Non-obstructive Coronary Artery Presenting with STEMI: A Review of Incidence, Aetiology, Assessment and Treatment

2020 ◽  
Vol 15 ◽  
Author(s):  
Ying X Gue ◽  
Rahim Kanji ◽  
Sabiha Gati ◽  
Diana A Gorog
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Correct Diagnosis ◽  
Correct Treatment ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Plaque Disruption ◽  
Methodical Approach ◽  
St Segment ◽  
Assessment And Treatment

MI with non-obstructive coronary artery (MINOCA) is a condition previously thought to be benign that has recently been shown to have comparable mortality to that of acute coronary syndrome with obstructive coronary disease. The heterogeneity of the underlying aetiology makes the assessment, investigation and treatment of patients with MINOCA challenging. The majority of patients with MINOCA presenting with ST-segment elevation MI generally have an underlying coronary or myocardial cause, predominantly plaque disruption or myocarditis. In order to make the correct diagnosis, in addition to the cause of the presentation, a meticulous and methodical approach is required, with targeted investigations. Stratification of patients to guide investigations that are more likely to provide the diagnosis will allow the correct treatment to be initiated promptly. In this article, the authors review the contemporary incidence, aetiology, recommended assessment and treatment of patients with MINOCA presenting with ST-segment elevation MI.

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