scholarly journals Importance of the Exercise Test Follow-up Programme for Patients with Coronary Artery Disease who Underwent Percutaneous Coronary Intervention

2009 ◽  
Vol 63 (4-5) ◽  
pp. 151-155
Author(s):  
Iveta Mintāle ◽  
Inga Narbute ◽  
Sanda Jēgere ◽  
Milāna Zabunova ◽  
Dace Lūriņa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Coronary Artery ◽  
Exercise Test ◽  
Coronary Intervention ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Importance of the Exercise Test Follow-up Programme for Patients with Coronary Artery Disease who Underwent Percutaneous Coronary Intervention The clinical course and prognosis of coronary heart disease (CHD) can be modified favourably with percutaneous coronary intervention (PCI) in combination with medication. A follow-up programme was developed in the Latvian Centre of Cardiology, which included a stress electrocardiogram for patients after PCI. This is the first study in Latvia, and provides wide opportunities to evaluate functional status of patients, treatment effectiveness, possible risks and prognosis after PCI. Exercise tests are widely used for the evaluation and diagnostics of CHD. This method has been successfully implemented in diagnostics of restenosis in coronary arteries, a process which pathophysiologically differs from primary atherosclerosis. A total of 7,300 patients with CHD were followed-up in one year after PCI. An exercise test was conducted one, three, six and twelve months after PCI. Clinical and functional status of patients and risk of restenosis were evaluated and corrections in medications were made. Seventeen percent of patients had chest pain and 13% had significant ST-segment changes in electrocardiogram. Restenosis of coronary arteries in angiography were established in 6.4%. In half of those patients above restenosis was diagnosed early — three to six months after PCI. We established a patient subgroup (22%) with "silent" ischemia (positive exercise test without chest pain), out of whom 41% had restenosis. For left main (LM) disease patients 50% of all restenosis diagnoses also were diagnosed early (three to six month after PCI). Restenosis was associated with ST-segment deviation in the exercise electrocardiogram. A lower Robinson index (RI) was registered in the same group of patients. A focussed follow-up programme performing exercise test allows to determine timely possible risk of restenosis, to adapt medication doses, to reduce risk factors and to influence positively patients' compliance.

scholarly journals Clopidogrel and Ticagrelor Do Not Influence Platelet Indices After Percutaneous Coronary Intervention

2020 ◽  
Vol 25 (4) ◽  
pp. 35-37
Author(s):  
Ioana Șuş ◽  
Laszlo Hadadi ◽  
Cristina Somkereki ◽  
Dan Dobreanu
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Platelet Indices ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Platelet indices have been linked to the severity and prognosis of coronary artery disease, but a very small number of studies assessed them under dual antiplatelet therapy after percutaneous coronary intervention (PCI). The aim of this study was to evaluate changes in mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) in these patients. A number of 437 patients with stable coronary artery disease, 131 patients with non ST segment elevation acute coronary syndrome and 151 patients with ST segment elevation myocardial infarction were included in the study. There was no difference between the three groups regarding platelet indices prior to PCI. Follow-up data was available for 181 patients, at a mean follow-up time of 69 (46-98) days. MPV, PDW and PLC-R were similar to those prior to PCI in all three groups. Regarding the P2Y12 inhibitor, clopidogrel or ticagrelor, there was no difference at follow-up between platelet indices irrespective of the indication for PCI.

Should Percutaneous Coronary intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?.

2020 ◽  
Vol 16 ◽  
Author(s):  
George Kassimis ◽  
Grigoris V. Karamasis ◽  
Athanasios Katsikis ◽  
Joanna Abramik ◽  
Nestoras Kontogiannis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Symptom Relief ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of the optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.

scholarly journals Identify Unsuitable Patients with Left Main Coronary Artery Disease in Intermediate SYNTAX Scores Treated by Percutaneous Coronary Intervention

2017 ◽  
Vol 20 (6) ◽  
pp. 258 ◽  
Author(s):  
Chunxiao Zhang ◽  
Yaguang Zheng ◽  
Xinbin Liu ◽  
Yutong Cheng ◽  
Yang Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Repeated Revascularization

Background: With the follow-up extending to 5 years, the outcomes of SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) trial were comparable between coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in left-main (LM) patients with intermediate SYNTAX scores of 23–32. A subdivision depending on SYNTAX score will help to identify unsuitable LM patients with intermediate SYNTAX scores to receive PCI treatment.Methods: Between January 2011 and June 2013, 104 patients with LM Coronary Artery Disease (CAD) undergoing PCI were selected retrospectively. We compared clinical outcomes in patients with SYNTAX score <27 and ≥27. The follow-up time was 25.23 ± 7.92 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to compare various outcomes between two groups.Results: Higher rates of repeated revascularization (18.2% versus 4.2%, P = .027) and major adverse cerebro-cardiovascular events (MACCE) (24.2% versus 7.0%, P = .014) were shown in patients with SYNTAX score ≥ 27. After multivariate adjustment, a significant higher risk of repeated revascularization (hazard ratio: 6.25, 95% confidence interval: 1.48 to 26.37, P = .013) and MACCE (hazard ratio: 4.49, 95% confidence interval: 1.41 to 14.35, P = .011) were also found in patients with SYNTAX score ≥ 27.Conclusions: Based on the higher rate of repeated revascularization and MACCE, patients with LM CAD and intermediate SYNTAX scores will need a subdivision to identity the one not benefit from PCI. CABG is still the standard treatment method for patients of LM CAD with a SYNTAX score of ≥ 27.

scholarly journals Prinzmetal angina in a patient with previous coronary artery disease.Topic review and case report

2021 ◽  
Vol 29 ◽  
pp. 1-6
Author(s):  
Débora Rocha ◽  
Leonardo Amaral ◽  
Pedro Borges ◽  
Flavio Barbosa ◽  
Ana Nogueira ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Case Report ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Electrocardiographic Changes ◽  
Coronary Procedures ◽  
Artery Disease

Prinzmetal angina is described as episodes of chest pain that occur at rest, associated with electrocardiographic changes in the ST-segment, which may or may not evolve to ischemia, and are not caused by coronary artery disease, having more recently been related to a coronary vasospasm. This diagnosis becomes especially challenging in patients who have already undergone previous percutaneous coronary procedures. We report a case of a patient diagnosed with Prinzmetal angina with a recent percutaneous coronary intervention due to coronary artery disease.

scholarly journals Outcomes of DES in Diabetic and Nondiabetic Patients with Complex Coronary Artery Disease after Risk Stratification by the SYNTAX Score

2016 ◽  
Vol 10 ◽  
pp. CMC.S37239 ◽  
Author(s):  
Mohamed Loutfi ◽  
Mohamed A. Sadaka ◽  
Mohamed Sobhy
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Repeat Revascularization ◽  
Percutaneous Coronary ◽  
Artery Disease

Diabetes mellitus (DM) increases the risk of adverse outcomes after coronary revascularization. Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD). Aim The aim of this study was to assess the outcomes of drug-eluting stent (DES) insertion in DM and non-DM patients with complex coronary artery disease (CAD) after risk stratification by the percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Methods and Results We performed multivessel percutaneous coronary intervention (PCI) for 601 lesions in 243 DM patients and 1,029 lesions in 401 non-DM patients. All included patients had MVD and one or more lesions of type B2/C. The two-year outcomes and event rates were estimated in the DM and non-DM patients using Kaplan–Meier analyses. The baseline SYNTAX score was ≤22 in 84.8% vs. 84%, P = 0.804, and 23-32 in 15.2% vs. 16%, P = 0.804, of the DM and non-DM patients, respectively. The number of diseased segments treated (2.57 ± 0.75 vs. 2.47 ± 0.72; P = 0.066) and stents implanted per patient (2.41 ± 0.63 vs. 2.32 ± 0.54; P = 0.134) were similar in both groups. After a mean follow-up of 642 ± 175 days, there were no differences in the major adverse cardiac and cerebrovascular events (MACCE; 26.7% vs. 20.9%; P = 0.091), composite end point of all-cause death/myocardial infarction (MI)/stroke (12.3% vs. 9%; P = 0.172), individual MACCE components of death (3.7% vs. 3.2%; P = 0.754), MI (6.6% vs. 4%; P = 0.142), and absence of stroke in the DM and non-DM patients. An increased need for repeat revascularization was observed in DM patients (18.5% vs. 10.2%; P = 0.003). In the multivariate analysis, DM was an independent predictor of repeat revascularization (hazard ratio: 1.818; 95% confidence interval: 1.162-2.843; P = 0.009). Conclusions DES implantation provides favorable early and mid-term results in both DM and non-DM patients undergoing PCI for complex lesions. After a mean follow-up of two years, DM and non-DM patients with complex CAD treated by PCI using new-generation DES showed no differences with regard to MACCE and other secondary end points. However, higher rates of ischemia-driven repeat revascularization were observed in DM patients.

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