scholarly journals Multivessel Percutaneous Coronary Intervention in Patients with Acute ST-segment Elevation Myocardial Infarction in Same Sitting

2015 ◽  
Vol 8 (1) ◽  
pp. 53-58
Author(s):  
AHM Waliul Islam ◽  
Shams Munwar ◽  
Azfar H Bhuiyan ◽  
Sahabuddin Talukder ◽  
AQM Reza ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Positive Family History ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Background: Aim of the study was to evaluate the primary procedural success of Multivessel Percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction at the same sitting.Methods: Total 23 (13.4%) patients were enrolled in this very preliminary study, among the total 171 patients who had primary PCI at our center from Jan 2010 to February 2015. Among them, Male: 20 and Female: 3. Total 52 stents were deployed in 46 territories. Mean age were for both male and female were 54 yrs. Associated coronary artery disease risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, positive family history for coronary artery disease and Smoking.Results: Among the study group; 17(74%) were Dyslipidemic, 11(47.8%) were hypertensive; 8(34.8%) patients were Diabetic, positive family history 4(17.4%) and 9(39%) were all male smoker. Female patients were more obese (BMI: M 26: F 27). Common diagnosis at admission based on ECG evidence was; Inferior wall myocardial infarction: 12 (52.2%), Anterior wall myocardial infarction 9(39.1%) and lateral 2(8.7%). Common stented territory was left anterior descending artery 9(39.1%), right coronary artery 7(30.4%), and left circumflex artery 7(30.4%). Stent used: Bare metal stent 3 (5.7%), DES: 49 (94.2%). Among the different drug eluting stents, Everolimus 26 (52%), Sirolimus 8(15.4%) and Zotarolimus 9(17.3%), Paclitaxel 2 (3.8%), Biolimus 2 (3.8%), Genous 2 (3.8%).Conclusion: In the current prospective non randomized study, we found that the multivessel primary PCI for ST elevation myocardial infarction with non-culprit vessel are suitable for PCI at the same sitting with better in-hospital and 1 yr survival outcome.Cardiovasc. j. 2015; 8(1): 53-58

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.

Abstract 15071: Effect of Percutaneous Coronary Intervention on Death and Myocardial Infarction in Patients Withstable Coronary Artery Disease and Inducible Ischemia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Qais Radaideh ◽  
Mohammed Osman ◽  
Babikir Kheiri ◽  
Ahmad Al-Abdouh ◽  
mahmoud Barbarawi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stress Testing ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Severe Ischemia

Introduction: There has been a continuous debate about the survival benefit of percutaneous coronary intervention (PCI) for the management of patients with stable coronary artery disease (CAD) and moderate to severe ischemia. To address this, we performed a meta-analysis of RCTs comparing PCI plus MT vs. MT alone in stable CAD patients to evaluate endpoints of all-cause mortality, cardiovascular (CV) mortality, and MI in a larger cohort of patients with objective evidence of myocardial ischemia. Methods: An electronic database search was conducted for RCTs that compared PCI on top of MT versus MT alone. A random effects model was used to calculate relative risk (RR) and 95% confidence intervals (CIs). Results: A total of 7 RCTs with 10,043 patients with a mean age of 62.54 ± 1.56 years and a median follow up of 3.9 years were identified. Among patients with (CAD) and moderate to severe ischemia by stress testing, PCI didn’t show any benefit for the primary outcome of all-cause mortality compared to MT(RR = 0.85; 95% CI 0.646-1.12; p= 0.639). There was also no benefit in cardiovascular (CV) death (RR = 0.88 ; 95% CI 0.71-1.09; p =0.18) or myocardial infarction (MI) (RR = 0.271 ; 95% CI 0.782-1.087; P =0.327) in the PCI group as compared to MT. Conclusions: Among patients with (CAD) and evidence of moderate to severe ischemia by stress testing, PCI on top of MT appears to add no mortality benefit as compared to with MT alone.

scholarly journals Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

2020 ◽  
Vol 27 (4) ◽  
pp. E202041
Author(s):  
Nestor Seredyuk ◽  
Andrii Matlakh ◽  
Yaroslava Vandzhura ◽  
Mykyta Bielinskyi ◽  
Oleksii Skakun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
The Right

Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12  inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.

Percutaneous coronary intervention in stable coronary artery disease

2014 ◽  
Vol 155 (49) ◽  
pp. 1952-1959
Author(s):  
Zsolt Piróth
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Artery Disease

Percutaneous coronary intervention is a well-established symptomatic therapy of stable coronary artery disease. Using a literature search with special emphasis on the newly-published FAME 2 trial data, the author wanted to explore why percutaneous coronary intervention fails to reduce mortality and myocardial infarction in stable coronary artery disease, as opposed to surgical revascularisation. In the FAME 2 trial, fractional flow reserve-guided percutaneous coronary intervention with second generation drug eluting stents showed a significant reduction in the primary composite endpoint of 2-year mortality, myocardial infarction and unplanned hospitalization with urgent revascularisation as compared to medical therapy alone. In addition, landmark analysis showed that after 8 days, mortality and myocardial infarction were significantly reduced. The author concludes that percutaneous coronary intervention involving fractional flow reserve guidance and modern stents offers symptomatic, as well as prognostic benefit. Orv. Hetil., 2014, 155(49), 1952–1959.

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.

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