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Undergoing Percutaneous Coronary Intervention (undergoing + percutaneou_coronary_intervention)
Selected AbstractsCase Report: Atheroembolic renal disease in a 72-year-old patient through coronary intervention after myocardial infarctionHEMODIALYSIS INTERNATIONAL, Issue 4 2008Anna Laura HERZOG Abstract Cholesterol embolization or atheroembolic renal disease (AERD) is an often underdiagnosed issue in patients featuring a prevalent risk profile. It is a multisystemic disease with progressive renal insufficiency due to foreign body reaction of cholesterol crystals flushed into a small vessel system of the kidneys from the arteriosclerotic plaques. The most common setting in which it occurs is iatrogenic after vascular catheterization and less frequent spontaneously. Typical clinical symptoms are delayed impairment of renal function, cutaneous manifestations such as livedo reticularis or purple toes with persistingly palpable arterial pulse, myalgia, systemic symptoms such as weight loss and fever, and abdominal and neurological symptoms. Diagnosis is generally made by clinical appearance, risk profile, and interval of time from intervention; a definitive diagnosis can only be made by renal biopsy. Even though the exact incidence is not known because most patients do not undergo biopsy due to older age, comorbidity, and other explanations for loss of renal function, it is estimated to be 4% after vascular intervention. Patient and renal outcome is dependent on comorbidity, risk profile, and preexisting chronic kidney disease (CKD). About 30% of patients are estimated to require maintenance dialysis and these patients have a high risk of death within 24 months after the first renal replacement therapy. Prognosis is also influenced by severity. The case reported is a 72-year-old male patient with preexisting CKD stage 3 undergoing percutaneous coronary intervention after myocardial infarction and consecutive AERD with typical clinical appearance 6 weeks after the event. [source] Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approachJOURNAL OF CLINICAL NURSING, Issue 17 2009John X Rolley Aim., To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. Background., Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management. Design., Systematic review. Method., The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage). Results., Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase. Conclusions., Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design. Relevance to clinical practice., To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family. [source] Clinical Experience with a Novel Intracoronary Perfusion Catheter to Treat No-Reflow Phenomenon in Acute Coronary SyndromesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2010GABRIEL MALUENDA M.D. Background:,The no-reflow phenomenon is an often seen complication in patients presenting with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This event is associated with poor prognosis and poses a therapeutic challenge. Methods:,This retrospective study cohort was composed of 30 patients who presented with ACS between September 2007 and April 2009, and developed no-reflow during subsequent PCI. The primary end-point was defined as normal Thrombolysis In Myocardial Infarction (TIMI) 3 flow with myocardial blush grade (MBG) ,2 or an increase in TIMI flow by ,2 grades with a MBG ,2 after intracoronary drug infusion via the ClearWay (CW) RX perfusion catheter. Results:,The population presented with a relatively high prevalence of cardiovascular risk factors. ST-elevation myocardial infarction was the most common presentation (60.0%), while 20% of the patients presented with cardiogenic shock. After intracoronary infusion of nicardipine or nitroprusside using the CW catheter, TIMI flow improved from the baseline in 19 cases (63.3%, P < 0.001), and 16 patients (53.3%, P < 0.001) achieved normal coronary flow at the end of the procedure. The rate of in-hospital death was 6.7% (2 cases). No clinical differences were noted between those patients who successfully achieved normal coronary flow and those with persistent no-reflow. Conclusion:,The infusion of intracoronary drugs using the novel perfusion CW RX catheter seems to be safe and could help to improve myocardial perfusion in a selected group of patients presenting with ACS who developed no-reflow during PCI. (J Interven Cardiol 2010;23:109-113) [source] Favorable Long-Term Survival in Patients Undergoing Stent PCI of Unprotected Left Main Coronary Artery Compared to Predicted Short-Term Prognosis of CABG Estimated by EuroSCORE: Clinical Determinants of Long-Term OutcomeJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2009RALF LEHMANN M.D. Aims/Methods: The long-term outcome of patients (pts) undergoing percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) is unclear so far. We prospectively investigated the outcome of 102 consecutive patients who underwent stent PCI of unprotected LMCA. Patients were divided according to clinical indication for PCI: stable coronary artery disease (CAD) (N = 60), NSTEMI (N = 18), STEMI (N = 24). Expected in-hospital mortality of coronary artery bypass grafting (CABG) was calculated using the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and compared to the observed survival rate during long-term follow-up (mean 1.8 ± 1.2 years). Results: The observed 30-day mortality was 1.7% (1/60 pts) in patients with stable CAD, 11% (2/18 pts) in NSTEMI patients, and 13% (3/24 pts) in STEMI patients. The observed mortality was lower than the predicted mortality of CABG as calculated by the logistic EuroSCORE. Using receiver-operator characteristics curves (ROC), EuroSCORE demonstrated a high predictive value for both 30-day mortality as well as 1-year mortality (AUC > 0.8; P < 0.01). Prognostically relevant patient related factors (P < 0.01) included severely reduced left ventricular ejection fraction (HR 3.24), ACS (HR 3.18), STEMI (HR: 3.01), Killip class IV (HR 7.69), occurrence of neoplastic disease (HR 3.97), and elevated CRP (HR 3.86). Conclusions: LMCA-PCI was associated with lower long-term mortality rates compared to the estimated mortality of CABG. This prospective observational study suggests that DES-PCI of unprotected LMCA in "all-comers" can be carried out with reasonable risk. [source] Treatment Strategies in Non-ST-Elevation Acute Coronary Syndromes in Patients Undergoing Percutaneous Coronary Intervention: An Evidence-Based Review of Clinical Trial Results and Treatment Guidelines: Report on a Roundtable DiscussionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2008F.A.C.C., MARC COHEN M.D. With the availability of new data and the recent release of new European and US guidelines, contemporary care paradigms for the treatment of patients with non-ST-elevation acute coronary syndromes (NSTE ACS), including those undergoing percutaneous coronary intervention, are likely to undergo substantial changes. In recognition of this shifting landscape as well as the impact of new guidelines on care models for the treatment of patients with NSTE ACS, a roundtable was convened on October 25, 2007, to discuss the implications of these changes. The purpose of this review is to summarize the presentations and subsequent discussions from the roundtable, which examined the guidelines and evidence from a variety of perspectives, and to explore the best ways to incorporate new treatment paradigms into everyday clinical care. The multiple viewpoints expressed by the roundtable attendees illustrate the recognition that at this point, consensus has not been reached on the optimum algorithm for treatment of these patients. This article focuses on issues discussed during the roundtable from the perspective of the practicing cardiologist. [source] Sequence of Electrocardiographic and Acoustic Cardiographic Changes and Angina during Coronary Occlusion and Reperfusion in Patients Undergoing Percutaneous Coronary InterventionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009A.N.P., Eunyoung Lee R.N., Ph.D. Background: Previous studies have suggested that ventricular function may be impaired without or prior to electrocardiographic changes or angina during ischemia. Understanding of temporal sequence of electrical and functional ischemic events may improve the detection of myocardial ischemia. Methods: A prospective study was performed in 21 subjects undergoing percutaneous coronary intervention (PCI) who had both ST amplitude changes >2 standard deviations above baseline on 12-lead electrocardiography (ECG), and new or increased third or fourth heart sound (S3 or S4) intensity measured by computerized acoustic cardiography. The sequence of the onset and resolution of these signs of ischemia were examined following coronary balloon inflation and deflation. Results: Electrocardiographic ST amplitude and diastolic heart sound changes occurred contemporaneously, shortly after coronary occlusion (mean onset from balloon inflation; ST changes, 21 ± 17 seconds; S4, 25 ± 26 seconds; S3, 45 ± 43 seconds). In 40% of patients, a new or increased S3 or S4 developed earlier than ST changes. Anginal symptoms occurred in only 2 of the 21 subjects during ischemia with a mean onset time of 68 seconds. ST-segment changes resolved earliest (33 seconds after balloon deflation) while diastolic heart sounds (89 ± 146 seconds) and angina (586 ± 653 seconds) resolved later. Conclusion: A new or intensified S3 and/or S4 occurred contemporaneously with electrocardiographic changes during ischemia. These diastolic heart sounds persisted longer than ST changes following coronary reperfusion. Acoustic cardiographic assessment of diastolic heart sounds may aid in the early detection of myocardial ischemia, particularly in those patients with an uninterpretable ECG. [source] Stenting and glycoprotein IIb/IIIa inhibition in patients with acute myocardial infarction undergoing percutaneous coronary intervention: Findings from the global registry of acute coronary events (GRACE)CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2003Gilles Montalescot MD Abstract Stenting and GP IIb/IIIa inhibition are promising adjunctive therapies in PCI. The Global Registry of Acute Coronary Events (GRACE) is a registry of unselected patients with acute coronary syndromes, allowing for the study of treatments in a real-world environment. Data from GRACE patients with AMI who underwent PCI were analyzed. After adjusting for demographics, baseline characteristics, and previous medications, treatment with GP IIb/IIIa inhibitors and a stent and treatment with a stent alone were significant predictors of survival at 6 months. Stents were used in 90.9% of patients. GP IIb/IIIa inhibitors were used in 59.7%; in most cases they were started after the beginning of the procedure. The in-hospital death rate (7.6%) was highest in patients undergoing urgent PCI. Mortality at 6 months following PCI was 14.4% among patients who received neither GP IIb/IIIa inhibitors nor a stent, compared to patients who received both GP IIb/IIIa inhibitors and a stent (7.3%), GP IIb/IIIa inhibitors alone (12.8%), or a stent alone (6.7%) Catheter Cardiovasc Interv 2003;60:360,367. © 2003 Wiley-Liss, Inc. [source] Does gender affect the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock who undergo percutaneous coronary intervention?CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2003David Antoniucci MD Abstract This study sought to determine the impact of female gender on clinical outcome in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) due to predominant ventricular failure undergoing percutaneous coronary intervention (PCI). We analyzed gender-related differences in procedural, angiographic, and clinical outcomes in 208 consecutive patients with AMI complicated by CS. Out of 208 patients with CS, 65 were women and 143 men. Women were older than men (74 ± 10 years vs. 66 ± 12 years; P < 0.001) and had a greater incidence of a history of hypertension (43% vs. 29%; P = 0.041). The 6-month mortality rate was 42% in women and 31% in men (P = 0.157). There were no differences between groups in reinfarction rate and target vessel revascularization rate. Multivariate analysis showed age as the only variable independently related to the 6-month mortality, while female gender was not related to the risk of death. The benefit of early PCI is similar in women and men, and any potential referral bias in the use of PCI based on gender differences should be avoided. Cathet Cardiovasc Intervent 2003;59:423,428. © 2003 Wiley-Liss, Inc. [source] Bleeding Complications in Acute Coronary Syndromes and Percutaneous Coronary Intervention: Predictors, Prognostic Significance, and Paradigms for Reducing RiskCLINICAL CARDIOLOGY, Issue S2 2007Steven V. Manoukian M.D. Abstract In clinical trials up to 30% of patients with acute coronary syndromes (ACS) or undergoing percutaneous coronary intervention (PCI) experience bleeding complications, and even higher rates have been reported in contemporary practice. A growing body of data suggests a strong correlation between bleeding and both short- and long-term adverse outcomes, including mortality, which is independent of baseline characteristics and remains evident in most trials, despite variations in the definition of major bleeding. Although the value of antithrombin and antiplatelet therapy in reducing the risk of ischemic events is well established, the mechanisms of action that confer the benefits of these therapies have an inherent tendency to increase the risk of bleeding complications. As a result, characterization of baseline hemorrhagic risk is critical and must be accomplished before selecting an antithrombotic therapy. Risk factors for bleeding may be divided into two categories: nonmodifiable (including age, gender, race, weight, renal insufficiency, anemia, and acuity of presentation) and modifiable (including choice of antithrombotic therapy and PCI procedural characteristics). Of these predictive factors, the choice, dosage, and duration of the antithrombin and/or antiplatelet regimen are perhaps the most readily modifiable, especially in patients with an increased risk of bleeding. This review explores the nature of the association between bleeding and adverse outcomes, including mortality; evaluates risk factors for bleeding; and examines mechanisms for reducing bleeding complications through the selection of appropriate antithrombotic therapy. Copyright © 2007 Wiley Periodicals, Inc. [source] Management of patients with non,ST-segment elevation acute coronary syndromes: Insights from the pursuit trialCLINICAL CARDIOLOGY, Issue S5 2000Dan J. Fintel M.D The glycoprotein (GP) IIb-IIIa inhibitor eptifibatide (INTEGRILIN®, COR Therapeutics, Inc., South San Francisco, California, and Key Pharmaceuticals, Inc., Kenilworth, New Jersey) is a novel and highly potent antithrombotic agent indicated for the management of patients with non-ST-segment elevation acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention. The approval of eptifibatide for non-ST-segment elevation ACS was based on the positive results of the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. With enrollment of almost 11,000 patients, not only is the PURSUIT trial the largest trial of a GP IIb-IIIa inhibitor to date, but it is also the largest clinical study ever conducted in patients with non-ST-segment elevation ACS. The key feature of the PURSUIT trial is that patient management closely resembled standard clinical practice, because decisions about the use and timing of invasive cardiac procedures were made by the individual physicians rather than being prespecified in the study protocol. Eptifibatide therapy was associated with a significant reduction in the incidence of the primary endpoint,a composite of death or myocardial infarction at 30 days (14.2 vs. 15.7% in the placebo group; p = 0.042). Of importance is the fact that the beneficial effect of eptifibatide was independent of the management strategy pursued during study drug infusion (invasive or conservative), and it was achieved with few major safety concerns. These findings demonstrate that the use of eptifibatide should be considered for all patients presenting with signs and symptoms of intermediate- to high-risk non-ST-segment elevation ACS. [source] | ||||||||||