1
|
Greffier J, Moliner G, Pereira F, Cornillet L, Ledermann B, Schmutz L, Lomma M, Cayla G, Beregi JP. Assessment of Patient's Peak Skin Dose Using Gafchromic Films During Interventional Cardiology Procedures: Routine Experience Feedback. RADIATION PROTECTION DOSIMETRY 2017; 174:395-405. [PMID: 27522056 DOI: 10.1093/rpd/ncw191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 04/22/2016] [Indexed: 06/06/2023]
Abstract
To assess the interest of Gafchromic films in detection of patient's peak skin dose (PSD) in interventional cardiology. A prospective study of 112 patients was conducted (July-December 2015). Three diagnostic and therapeutic procedures were evaluated: coronary angiography (CA), coronary angiography and coronary angioplasty for one or two vessels disease (CA-PTCA) and coronary angioplasty of complex chronic total occlusion (CTO). Dosimetric indicators (DIs) were collected and PSD were measured with Gafchromic films. Dose distribution was evaluated within 10 'Thorax Body-zone' defined by the system. Correlations between PSD and DI or dose distribution were computed. Delivered dose increased in complex procedures. The PSD were 0.121 ± 0.063 Gy for CA, 0.256 ± 0.142 Gy for CA-PTCA and 1.116 ± 0.721 Gy for CTO. High correlations were observed for PSD and DI as well for dose distribution within the 'Thorax Body-zone'. Film dosimetry is suggested for CTO procedures since the threshold of 2 Gy for skin injuries is likely to be exceeded.
Collapse
Affiliation(s)
- J Greffier
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - G Moliner
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - F Pereira
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - L Cornillet
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - B Ledermann
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - L Schmutz
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - M Lomma
- Department of Biostatistics, Epidemiology, Public Health and Bio-informatics, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - G Cayla
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - J P Beregi
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| |
Collapse
|
2
|
Angiografía del día siguiente tras fibrinólisis exitosa frente al tratamiento convencional, en el síndrome coronario agudo con elevación del segmento ST, fibrinolisado. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
3
|
Ruiz-Bailén M, Romero-Bermejo FJ, Ramos-Cuadra JÁ, Rucabado-Aguilar L, Chibouti-Bouichrat K, Castillo-Rivera AM, Pintor-Mármol A, Expósito-Ruiz M, García MIR, Dolores-Pola-Gallego-de-Guzmán M, Gómez-Jiménez J, Torres-Ruiz JM, Ulecia-Martínez M. Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units. ACTA ACUST UNITED AC 2011; 13:21-9. [PMID: 21244229 DOI: 10.3109/17482941.2010.538697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the frequency and the factors associated with performance of echocardiography in acute coronary syndrome (ACS) patients during their stay in intensive care units or coronary care units (ICU/CCU). METHODS Retrospective cohort study including all patients diagnosed with acute coronary syndrome-unstable angina (UA), acute myocardial infarction (AMI)-included in the 'ARIAM' Spanish multi-centre register. The study period was from June 1996 to December 2005. The follow-up period is limited to the time of stay in the Intensive Care Units or Coronary Care Units (ICUs/CCUs). A univariate analysis was carried out on the patients with UA and AMI according to whether or not echocardiograms were performed during their stay in ICU/CCU. In addition the data was evaluated for any temporal variation in the performance of echocardiography, and two multivariate analyses were carried out to evaluate the factors associated with performance of echocardiography in UA and AMI patients. RESULTS The study period included 45,688 AMI patients and 17,277 UA patients. Echocardiograms were performed in 26.87% AMI patients and 16.75% UA patients. In total, 15,172 echocardiograms were performed in ACS patients (23.6%). The multivariate analysis demonstrated that the variables associated with the performance of echocardiography in UA were: Killip and Kimball class, cigarette smoking, family history of cardiovascular events, cardiogenic shock, uncontrolled angina, mechanical ventilation and treatment with ACE inhibitors, while the presence of previous AMI was associated with fewer echocardiograms being performed. In AMI, the multivariate analysis showed the following variables to be associated with the performance of echocardiography: Killip and Kimball class, Q-AMI, right heart failure, the need for insertion of Swan-Ganz catheter, cardiogenic shock, high-degree AV block and the administration of ACE inhibitors, while age was associated with fewer being performed. Over the 10 years of the study period, there was a discrete but significant increase in the use of echocardiography in patients in ICU/CCU. CONCLUSIONS Echocardiography is not commonly used in ACS patients while in ICU/CCU. UA and AMI patients who did have echocardiograms during their stay in ICU/CCU were chiefly those presenting heart failure and major complications, and represent a subpopulation with poor prognosis. The performance of echocardiography in ACS patients increased slightly over the length of their stay in ICU/CCU.
Collapse
Affiliation(s)
- Manuel Ruiz-Bailén
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico del Complejo Hospitalario de Jaén, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Angiolillo DJ, Ferreiro JL. Platelet adenosine diphosphate P2Y12 receptor antagonism: benefits and limitations of current treatment strategies and future directions. Rev Esp Cardiol 2010; 63:60-76. [PMID: 20089227 DOI: 10.1016/s1885-5857(10)70010-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Platelet P2Y12 receptor antagonism with clopidogrel has represented a major advancement in the pharmacological management of patients with atherothrombotic disease, in particular those with acute coronary syndromes and undergoing percutaneous coronary interventions. Despite the benefit associated with clopidogrel therapy in these high risk settings, laboratory and clinical experience have led to identify some of its caveats, among which its wide range of platelet inhibitory response is the most relevant. Genetic, cellular and clinical factors are implied in variability in response to clopidogrel. Importantly, pharmacodynamic findings have shown to have important prognostic implications, underscoring the need for more optimal antiplatelet treatment strategies. The aim of this manuscript is to provide an overview on the current status and future directions in P2Y12 receptor antagonism, with particular emphasis on interindividual variability in response to clopidogrel and strategies, including novel antiplatelet agents, to improve platelet P2Y12 inhibition.
Collapse
Affiliation(s)
- Dominick J Angiolillo
- University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida 32209, USA.
| | | |
Collapse
|
5
|
Inhibición del receptor plaquetario P2Y12 de adenosina difosfato plaquetario: efectos beneficiosos y limitaciones de las estrategias terapéuticas actuales y perspectivas futuras. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70010-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
6
|
Rapid desensitization to acetylsalicylic acid in acute coronary syndrome patients with NSAID intolerance. Rev Esp Cardiol 2009; 62:224-5. [PMID: 19232198 DOI: 10.1016/s1885-5857(09)71543-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
7
|
Dalmau G, Gaig P, Gázquez V, Mercé J. Desensibilización rápida al ácido acetilsalicílico en pacientes con intolerancia a AINE afectos de síndrome coronario agudo. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70167-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
8
|
Pérez-Vizcayno MJ, Hernández-Antolín RA, Alfonso F, Bañuelos de Lucas C, Escaned J, Jiménez P, Fernández-Ortiz A, Fernández C, Macaya C. Evolución en los últimos 20 años en el perfil demográfico, epidemiológico y clínico, técnica y resultados de los procedimientos coronarios percutáneos. Rev Esp Cardiol 2007; 60:932-42. [PMID: 17915149 DOI: 10.1157/13109646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to describe the changes observed in clinical practice in our interventional cardiology unit over the last 20 years. METHODS Between January 1, 1986 and December 31, 2005, >or=17,204 percutaneous transluminal coronary angioplasties (PTCAs) were performed at our center. They were analyzed in four periods of 5 years each. After each procedure, prospective data on patient, procedural, and outcome variables were recorded. The data were analyzed with regard to when the procedure was performed, and the patients' sex and age (i.e., < or >or=75 years). Data from 2006 were used as a reference, but were not included in the analysis. RESULTS The number of PTCAs increased significantly. Over the time period, mean patient age increased (from 57[10] years to 62[12] years for males and from 66[10] years to 70[11] years for females), and there were significant increases in the proportions of women (from 16% to 22%) and patients aged >75 years (from 7% to 22%). Among men, the incidence of smoking decreased while that of hypertension, diabetes and hyperlipemia increased. Among women, however, there was no change in risk factors. The numbers of urgent and emergent procedures (17% of PTCAs were for acute myocardial infarction in 2006) increased in both sexes and age groups, more ad hoc procedures were carried out, and more lesions were treated, usually with a stent. Over time, the success rate increased and the complication rate decreased in both sexes and age groups. In-hospital mortality for all procedures, except those for acute myocardial infarction, was 0.7% in males and 1.4% in females (P=.012). CONCLUSIONS Significant changes were observed over the last 20 years in the baseline characteristics of, the techniques used in, and the outcomes obtained in patients undergoing percutaneous coronary intervention.
Collapse
Affiliation(s)
- María J Pérez-Vizcayno
- Unidad de Hemodinámica, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Carrillo P, López-Palop R, Pinar E, Saura D, Párraga M, Picó F, Valdés M, Bertomeu V. Tratamiento del infarto agudo de miocardio con angioplastia primaria in situ frente a transferencia interhospitalaria para su realización: resultados clínicos a corto y largo plazo. Rev Esp Cardiol 2007. [DOI: 10.1157/13108993] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
López Menchaca R, Herrero Martínez JM, Suárez Fernández C. [Association of antiagregants: when and how]. Med Clin (Barc) 2007; 128:383-9. [PMID: 17386246 DOI: 10.1157/13099977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aterothrombotic disease (coronary, cerebrovascular and peripheral artery disease) is the most common cause of mortality and disability in the world, antiaggregants representing one of its therapeutic and preventive pillars. We have drugs at present that act at different levels of platelet aggregation (COX inhibitors as well as inhibitors of phosphodiesterase, ADP P2Y12 receptor and IIb/IIIa receptor). We review here the efficacy and safety of the association of antiaggregants in most relevant clinical scenarios, including current clinical recommendations and an analysis of supportive evidence.
Collapse
|
11
|
Hernández Antolín RA, Fernández-Vázquez F, Moreu Burgo J, López Palop R. [Interventional cardiology 2006]. Rev Esp Cardiol 2007; 60 Suppl 1:19-32. [PMID: 17352853 DOI: 10.1157/13099710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The range of applications of percutaneous coronary intervention (PCI) continues to expand and a growing number of patients are being treated, including those with extensive cardiovascular disease, more serious comorbid conditions, and more complex lesions. Even so, the success rate is high, serious complications are rare in stable patients, and the restenosis rate has been dramatically reduced by drug-eluting stents. Nevertheless, percutaneous techniques still have major limitations restricting their use in some type of lesions, such as bifurcations and total occlusions, and their role in relation to surgical revascularization has not yet been well defined in the treatment of the left main coronary artery or multivessel disease. The development of novel types of coated stent with better mechanical characteristics and a lower risk of occlusion will further expand the ambit of PCI. The role of PCI in the management of acute coronary syndromes is already well defined, and has increased the preference for an invasive rather than a conservative approach in high-risk patients without ST elevation and the preference for primary angioplasty rather than thrombolysis in those with ST elevation. The development and implementation of integrated coronary syndrome treatment networks will enable human and material resources to be used efficiently, and will guarantee rapid access to high-quality PCI for those who need it. The potential usefulness of combining cellular therapy with interventional procedures in the treatment of acute myocardial infarction has still to be determined. At present, there is extensive research into noncoronary interventions, which, in the not too distant future, could provide percutaneous treatment for the many elderly patients with severe aortic stenosis who are not currently eligible for surgery.
Collapse
|
12
|
Bautista Cabello J, Ignacio Emparanza J, Ansuategi E. Mejorando las búsquedas clínicas. Filtros geográficos, filtros metodológicos. Dos lógicas distintas, dos usos diferentes. Rev Esp Cardiol 2006. [DOI: 10.1157/13096588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
13
|
Antoñanzas Villar F, Pinillos García M. Equidad y variabilidad del uso de las tecnologías médicas. Rev Esp Cardiol 2006. [DOI: 10.1157/13096586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
López-Palop R, Moreu J, Fernández-Vázquez F, Hernández Antolín R. Registro Español de Hemodinámica y Cardiología Intervencionista. XV Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2005). Rev Esp Cardiol 2006. [DOI: 10.1157/13095784] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Oliva G. Coste-efectividad de los stents liberadores de fármacos: implicaciones para la práctica clínica y el coste sanitario. Rev Esp Cardiol (Engl Ed) 2006; 59:865-8. [PMID: 17020698 DOI: 10.1157/13093251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
16
|
Aguado-Romeo MJ, Márquez-Calderón S, Buzón-Barrera ML. Diferencias entre mujeres y varones en el acceso a procedimientos cardiovasculares intervencionistas en los hospitales públicos de Andalucía. Rev Esp Cardiol 2006. [DOI: 10.1157/13091882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
Galache Osuna JG, Sánchez-Rubio J, Calvo I, Diarte JA, Lukic A, Placer LJ. ¿Mejora el uso de abciximab intracoronario el resultado del intervencionismo percutáneo? Estudio prospectivo y aleatorizado. Rev Esp Cardiol 2006. [DOI: 10.1157/13090138] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
18
|
Hernández Antolín RA, Rodríguez Hernández JE. Estrategias de revascularización: importancia del sexo. Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1157/13087901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
19
|
Grapow MTR, von Wattenwyl R, Zerkowski HR. [Current evidence-based situation in coronary revascularization--CABG vs. PCI and diabetes?]. Clin Res Cardiol 2006; 95 Suppl 1:i31-4. [PMID: 16598545 DOI: 10.1007/s00392-006-1101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A variety of randomized, controlled trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) found similar results in mortality but significant differences in number of reinterventions in favor of CABG. This work gives an overview about the relevance and limitations of these studies in line with newly published large scale observational studies, which reveal significantly lower mortality-rates in CABG patients. Emphasis is placed on the special situation in the diabetic patient.
Collapse
Affiliation(s)
- M T R Grapow
- Division of Cardio-Thoracic Surgery, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
| | | | | |
Collapse
|
20
|
Hernández Antolín RA, Fernández Vázquez F, Moreu Burgos J, López Palop R. [Interventional cardiology in 2005]. Rev Esp Cardiol 2006; 59 Suppl 1:38-49. [PMID: 16540019 DOI: 10.1157/13084447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Drug-eluting stents have been shown to reduce the rate of restenosis significantly in all types of lesion, patient and clinical context without increasing thrombotic complications. Although their high cost limits the extent to which they can replace bare-metal stents, their use will increase inexorably in coming years. In addition to stents containing sirolimus and paclitaxel, which have already been approved, two additional drug-eluting stents have appeared on the market this year: one elutes tacrolimus and the other, ABT578 (a rapamycin analogue). Now that the restenosis rate has been dramatically reduced, the main limitations on percutaneous coronary intervention (PCI) stem from problematic lesions such as those at bifurcations and chronic total occlusions. Although these lesions can be tackled more often and more successfully than in the past, the results obtained are very different from those achieved with other types of lesion. With improvements in safety and long-term efficacy, the number of indications for PCI has expanded to include patients with multivessel disease, left main coronary artery disease, left ventricular dysfunction, and diabetes, conditions in which surgical revascularization was thought necessary only a few years ago. Acute coronary syndromes now make up an increasing proportion of indications for PCI, both in absolute and relative terms. One future challenge is the early identification and treatment of vulnerable plaques before they manifest clinically in the form of irreversible complications such as sudden death or acute myocardial infarction. The use of multislice computed tomography, such as 64-slice detector systems, has considerably increased the sensitivity, specificity, and positive and negative predictive values of diagnosis to around 90%, though diagnostic accuracy may be considerably less in patients with severe coronary calcification, stents, or cardiac arrhythmias. Although the technique is straightforward for patients, the image reconstruction process is time-consuming, few centers currently offer the technique, and radiation exposure is several times that with conventional invasive coronary angiography. It appears that the main application of the technique is in ruling out coronary disease in low-risk patients rather than being part of the diagnostic work-up in those with a high probability of coronary artery disease.
Collapse
Affiliation(s)
- Rosa A Hernández Antolín
- Unidad de Hemodinámica, Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain.
| | | | | | | |
Collapse
|
21
|
Bardají A, Alonso J, García-Moll X, Bueno H. Actualización en cardiopatía isquémica 2005. Rev Esp Cardiol 2006; 59 Suppl 1:3-19. [PMID: 16537073 DOI: 10.1157/13084444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This article is a review of the main developments in acute coronary syndromes reported in publications and conference presentations in 2005. It covers the pathophysiology, secondary prevention, prognosis, and treatment of ST-segment elevation and non-ST-segment elevation acute coronary syndromes, and the latest clinical practice guidelines.
Collapse
Affiliation(s)
- Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain.
| | | | | | | |
Collapse
|