scholarly journals Cardiac Care of Non-COVID-19 Patients During the SARS-CoV-2 Pandemic: The Pivotal Role of CCTA

2021 ◽  
Vol 8 ◽  
Author(s):  
Edoardo Conte ◽  
Saima Mushtaq ◽  
Maria Elisabetta Mancini ◽  
Andrea Annoni ◽  
Alberto Formenti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Therapy ◽  
Coronary Revascularization ◽  
Invasive Coronary Angiography ◽  
Diagnostic Technique ◽  
Suspected Coronary Artery Disease ◽  
St Elevation Myocardial Infarction ◽  
Clinical Indication ◽  
Non Invasive ◽  
St Elevation

Aim: The aim of this study is to evaluate the potential use of coronary CT angiography (CCTA) as the sole available non-invasive diagnostic technique for suspected coronary artery disease (CAD) during the coronavirus disease 2019 (COVID-19) pandemic causing limited access to the hospital facilities.Methods and Results: A consecutive cohort of patients with suspected stable CAD and clinical indication to non-invasive test was enrolled in a hub hospital in Milan, Italy, from March 9 to April 30, 2020. Outcome measures were obtained as follows: cardiac death, ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina. All the changes in medical therapy following the result of CCTA were annotated. A total of 58 patients with a mean age of 64 ± 11 years (36 men and 22 women) were enrolled. CCTA showed no CAD in 14 patients (24.1%), non-obstructive CAD in 30 (51.7%) patients, and obstructive CAD in 14 (24.1%) patients. Invasive coronary angiography (ICA) was considered deferrable in 48 (82.8%) patients. No clinical events were recorded after a mean follow-up of 376.4 ± 32.1 days. Changes in the medical therapy were significantly more prevalent in patients with vs. those without CAD at CCTA.Conclusion: The results of the study confirm the capability of CCTA to safely defer ICA in the majority of symptomatic patients and to correctly identify those with critical coronary stenoses necessitating coronary revascularization. This characteristic could be really helpful especially when the hospital resources are limited

Abstract 11800: Optimal Coronary Revascularization in Patients With Unstable Angina or Non-ST-Elevation Myocardial Infarction: 5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Akira Marui ◽  
Takeshi Kimura ◽  
Noboru Nishiwaki ◽  
Kazuaki Mitsudo ◽  
Tatsuhiko Komiya ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
Coronary Revascularization ◽  
St Elevation Myocardial Infarction ◽  
Left Main ◽  
Left Main Disease ◽  
Risk Of Death ◽  
St Elevation ◽  
Term Benefit

Background: SYNTAX trial revealed the long-term benefit of coronary artery bypass grafting (CABG) relative to percutaneous coronary intervention (PCI) using drug-eluting stent (DES) in patients with stable angina with complex coronary disease. However, long-term benefit of CABG relative to PCI in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) has not been well elucidated. Methods and Results: We identified 673 patients with 3-vessel and/or left main disease with UA or NSTEMI among 15,939 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2 (PCI: n=425, CABG: n=238). Age was not different between the 2 groups (p=0.58). Rate of Killip class III or IV (pulmonary edema or cardiogenic shock) was not different between the 2 groups (14% vs. 11%, p=0.19). Number of treated lesion was higher in the CABG group (2.0±1.0 vs. 3.0±1.0, p<0.001). Pre-procedural SYNTAX score was significantly higher in the CABG group (26.8±10.8 vs. 32.2±10.5, p<0.001). Unadjusted 30-day mortality was 6.0% for PCI and 2.9% for CABG. [Table] Five-year outcomes revealed that all-cause mortality after PCI was significantly higher than after CABG (hazard ratio [95% confidence interval]; 1.59 [1.15-2.21], p=0.005). The risk of composite of death, stroke, or myocardial infarction (MACCE) after PCI were also higher than after CABG (1.63 [1.23-2.16], p<0.001). In patients with 3-vessel disease without left main disease (n=465), the risks of death and MACCE after PCI were significantly higher than after CABG (1.59 [1.04-2.43], p=0.03 and 1.60 [1.10-2.34], p=0.01). Similarly the risks of death and MACCE after PCI were also higher than after CABG in patients with left main disease (n=208) Conclusions: In patients with UA or NSTEMI, 5-year outcomes revealed that CABG relative to PCI reduced the risk of death, MACCE, and any revascularization in the DES era both in patients with 3-vessel and left main disease.

scholarly journals Non-invasive mechanical ventilation for reperfusion myocardial injury prevention after endovascular surgeries in patients with ST-elevation myocardial infarction (STEMI)

2013 ◽  
Vol 94 (1) ◽  
pp. 50-54
Author(s):  
M I Neimark ◽  
S V Zayashnikov ◽  
O A Kalugina ◽  
L N Berestennikova
Keyword(s):  
Myocardial Infarction ◽  
Mechanical Ventilation ◽  
Ejection Fraction ◽  
Conventional Treatment ◽  
Myocardial Injury ◽  
Comparison Group ◽  
Invasive Mechanical Ventilation ◽  
St Elevation Myocardial Infarction ◽  
Non Invasive ◽  
St Elevation

Aim. To determine the need for pressure controlled non-invasive mechanical ventilation for reperfusion myocardial injury prevention in patients with ST-elevation myocardial infarction (STEMI). Methods. The study enrolled 61 patients admitted to the intensive care unit within 6 hours from the debut of chest pain, ST-segment elevation on electrocardiogram and oxygen saturation less than 90%. A percutaneous coronary intervention on an affected coronary artery was performed in all patients 30-90 minutes from admission. Non-invasive mechanical ventilation using the «MAQUET Servo-s» machine was started in patients of the first group (31 patients, mean age 66.3±10.7 years, males - 19, females - 12) with positive end expiratory pressure of 2-6 cm H2O, pressure support of 6-10 cm H2O, 40-60% O2 gas mix. Patients of the second group (comparison group, 30 patients, mean age 63.5±9.8 years, males - 16, females - 14) were offered a conventional treatment of ST-elevation myocardial infarction, including inhalations of humidified oxygen (6-8 liters per minute) using a nasal cannula. Results. Systolic, diastolic blood pressure and heart rate were 123.0±9.4 mm Hg, 81.2±11.3 mm Hg, 70.1±6.1 beats per minute in patients of the first group in 6 hours after admission. In patients of the comparison group the following parameters were measured as 157±12.4 mm Hg, 90.2±10.1 mm Hg, 92.6±10.2 beats per minute. The absolute risk increase of arrhythmias related to reperfusion myocardial injury was 17.8% (р 0.05) for the patients from the second group. Ejection fraction on a transthoracic echocardiogram (Teichholz method) was measured as 47.0±4.0 and 60.5±7.4% in patients from the first and the second groups respectively (р 0.05). Conclusion. Non-invasive mechanical ventilation decreases the risk for arrhythmias related to reperfusion myocardial injury, and increases the ejection fraction compared to conventional treatment and can be applied in patients with STEMI.

scholarly journals Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Asano ◽  
Y Mitsuhashi ◽  
J Yamashita ◽  
R Ito ◽  
M Saji ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Treatment ◽  
Coronary Revascularization ◽  
The Elderly ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
Short Term ◽  
Short Term Mortality ◽  
St Elevation ◽  
The Impact

Abstract Background It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients. Methods Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated. Results In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]). Conclusion The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased. Funding Acknowledgement Type of funding source: None

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