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Soomro NA, Khan MN, Naseeb K, Batra MK, Majeed H, Bhatti U, Ashraf T, Karim M. Outcomes of Primary Percutaneous Coronary Intervention through a Transradial Approach in a Tertiary Care Cardiac Center. Cureus 2019; 11:e6484. [PMID: 32025407 PMCID: PMC6984168 DOI: 10.7759/cureus.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 11/05/2022] Open
Abstract
Background Transradial approach for percutaneous coronary intervention (PCI) is gaining popularity due to lesser bleeding and other access site related complications. This study aims to determine the in-hospital outcomes of primary PCI through a transradial approach in a tertiary care cardiac center. Methods Consecutive patients with ST-segment elevation myocardial infarction presenting within 12 hours with symptoms without a previous history of thrombolytic therapy, coronary angioplasty, or cardiac surgery were included in the study. All patients underwent a diagnostic angiogram followed by primary PCI of the infarct-related artery through a radial route and were kept under observation during the hospital stay for forearm hematoma or mortality. Results A total of 180 patients were included in this study, with a mean age of 52.04±7.31 years. Majority (87.2%) of the patients were male, and diabetes (72.8%) was the most commonly observed co-morbid condition followed by hypertension (67.2%). Hospital mortality rate was 3.9% (7 patients), and post-procedure forearm hematoma was noted in 5.6% (10 patients). An increased mortality rate was found to be associated with age above 50 years (7.1% vs. 0.0%; p=0.012) and non-hypertension (8.5% vs. 1.7%; p=0.026). An increased incidence of forearm hematoma was found to be associated with age above 50 years (10.2% vs. 0.0%; p=0.002), diabetic mellitus (7.6% vs. 0.0%; p=0.047), hyperlipidemia (11% vs. 0.0%; p=0.001), and non-smoking (10.2% vs. 0.0%; p=0.003). Conclusion Our study showed that primary PCI through a transradial approach is a safe option with excellent success rates in terms of both mortality rates and morbidity such as forearm hematoma.
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Affiliation(s)
| | - Muhammad N Khan
- Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Khalid Naseeb
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Mahesh K Batra
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), karachi, PAK
| | - Haris Majeed
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Usman Bhatti
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Tariq Ashraf
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Musa Karim
- Statistician, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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Piątek J, Kędziora A, Konstanty-Kalandyk J, Kiełbasa G, Olszewska M, Wróbel K, Song BH, Darocha T, Wróżek M, Kapelak B. Minimally invasive coronary artery bypass as a safe method of surgical revascularization. The step towards hybrid procedures. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:320-325. [PMID: 29362575 PMCID: PMC5770863 DOI: 10.5114/aic.2017.71614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Coronary artery disease is nowadays responsible for approximately 15% of hospitalizations in Poland. Minimally invasive coronary artery bypass (MIDCAB) represents an attractive alternative to a sternotomy, and at the same time provides better life quality and facilitates quick rehabilitation. AIM To evaluate whether MIDCAB can be performed with similar early and mid-term results as off-pump coronary artery bypass (OPCAB) and therefore can be considered as a safe stage in hybrid revascularization. MATERIAL AND METHODS In a retrospective cohort study, we analyzed 73 consecutive patients who underwent coronary artery bypass grafting (left internal mammary artery to left anterior descending artery) between 2013 and 2016 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. Thirty-eight (52.1%) MIDCAB and 35 (47.9%) OPCAB patients were enrolled. RESULTS Short-term results did not significantly differ between groups and similar 30-day mortality was observed (MIDCAB 2.6% vs. OPCAB 2.9%, p = 1). The median follow-up period was 21 months. There were no statistical differences in terms of overall survival or cardiac mortality between groups (94.7% vs. 88.6%, p = 0.42; 2.6% vs. 2.9%, p = 1, respectively). The rate of hospitalization due to cardiac causes was similar in both groups (7.9% vs. 5.1%, p = 1) and there were no differences in current exacerbation of angina or heart failure, with median NYHA class I and CCS class I in both groups. CONCLUSIONS Despite higher technical difficulty, MIDCAB procedures can be performed with similar safety results as OPCAB procedures. No differences in terms of mortality, repeat revascularization or recurrent angina are observed.
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Affiliation(s)
- Jacek Piątek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, University Hospital, Krakow, Poland
| | - Marta Olszewska
- Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Wróbel
- Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland
| | - Bryan HyoChan Song
- Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Darocha
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland
| | - Marcin Wróżek
- Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland
| | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
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Staged versus "one-time" multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:760-767. [PMID: 27899940 PMCID: PMC5122501 DOI: 10.11909/j.issn.1671-5411.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the clinical outcomes of “one-time” versus staged multivessel stenting in elderly (≥ 60 years) patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). Methods We analyzed data of consecutive NSTE-ACS patients with multivessel percutaneous coronary intervention (PCI) who were enrolled in General Hospital of Shenyang Military Region between 2008 and 2012. A total of 1090 eligible patients aged ≥ 60 were further categorized into “one-time” group (n = 623) and staged PCI group (n = 467) according to intervention strategy. The primary endpoint was composite outcome of myocardial infarction (MI) or cardiac death during 3-year follow-up. Results The estimated 3-year composite rate of cardiac death or MI was 7.0% in the staged PCI group and 9.5% in the “one-time” group (P = 0.110). Multivariate analysis confirmed the benefit of staged PCI on the primary events in the elderly (HR: 0.638, 95% CI: 0.408–0.998, P = 0.049). In a propensity score matched cohort, staged PCI was associated with lower rates of primary events (6.1% vs. 10.4%, P = 0.046) and MI (3.4% vs. 7.4%, P = 0.037) at three years. In addition, there were reduced trends in the stent thrombosis at 30 days (0.3% vs. 1.4%, P = 0.177) and at three years (1.1% vs. 2.4%, P = 0.199) in the staged PCI group. There was no significant difference in the 3-year target vessel revascularization (15.5% vs. 14.4%, P = 0.746). Conclusions In elderly NSTE-ACS patients with MVD, staged PCI might be an optimal strategy associated with reduced long-term cardiac death or MI compared with “one-time” PCI strategy, which needs further confirmation.
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Yu X, Li Y, Wang Q, Liang M, Xu K, Han Y. "One-Time" versus Staged Multivessel Intervention in Intermediate to Very High-Risk Patients with Non-ST-Segment Elevation Acute Coronary Syndromes. Korean Circ J 2016; 46:774-783. [PMID: 27826335 PMCID: PMC5099332 DOI: 10.4070/kcj.2016.46.6.774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 01/20/2023] Open
Abstract
Background and Objectives To compare clinical outcomes of staged versus "one-time" percutaneous coronary intervention (PCI) in intermediate to very high-risk patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) and multivessel coronary disease (MVD). Subjects and Methods 1531 NSTE-ACS patients with multivessel PCI and meeting the criteria of intermediate to very high risk were screened from a prospectively registered database obtained from General Hospital of Shenyang Military Region between 2008 and 2012. They were categorized into "one-time" PCI (n=859) and staged PCI (n=672) according to intervention strategy. The primary outcomes included a 3-year major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularization. Results At 3 years, no significant differences in MACE (20.8% vs. 19.7%, p=0.608) and cardiac death/MI (7.1% vs. 9.1%, p=0.129) were observed between the two groups. After propensity score matching, there was no statistical significance in MACE (18.9% vs. 21.8%, p=0.249); whereas cardiac death/MI was significantly lower in the staged PCI group (7.0% vs.11.1%, p=0.033). Ninety-day landmark analysis showed that the staged PCI group had a lower 90-day incidence of MACE (1.2% vs. 3.3%, p= 0.037) and cardiac death/MI (0.7% vs. 2.6%, p=0.031). For the 90-day to 3-year follow-up period, the incidences of MACE (17.9% vs. 19.1%, p=0.641) and cardiac death/MI (6.3% vs. 8.7%, p=0.191) were similar in both groups. Conclusion In intermediate- to very high-risk NSTE-ACS patients with MVD, staged PCI is superior to "one-time" PCI in terms of cardiac death/MI.
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Affiliation(s)
- Xiaofan Yu
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liao Ning, China.; Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China.; Department of Cardiology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Yi Li
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China
| | - Qiancheng Wang
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liao Ning, China
| | - Ming Liang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liao Ning, China
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Liu Z, Zhao L, Li Y, Wang Z, Liu L, Zhang F. Evaluation of early interventional treatment opportunity of the elderly & high-risk patients with non-ST segment elevation acute myocardial infarction. Pak J Med Sci 2015; 31:1053-6. [PMID: 26648985 PMCID: PMC4641254 DOI: 10.12669/pjms.315.7881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To investigate the effect of treatment on prognosis of patients with different timing of early interventional treatment for non-ST segment elevation acute myocardial infarction (NSTEMI). Methods: Forty two cases above 75 years old, diagnosed with high-risk on NSTEMI, were selected in cardiology department of Xinxiang central hospital. They were randomly divided into two groups: 22 in group A and 20 in group B. Group A was performed PCI surgery within 12 hours after the onset while group B from 12 to 24 hour after the onset. Major adverse cardiovascular events (including death, heart failure readmission rates after ischemia, malignant arrhythmias, again target vessel revascularization) and bleeding data were recorded at the three terms of hospitalization, one month after the onset and six months after the onset. Results: Angina, malignant arrhythmia and heart failure during hospitalization can be reduced after interventional treatment carried out within 12 hours after the onset. Readmission rates after ischemia, heart failure and the incidence of death can be significantly reduced after interventional treatment carried out during 1-6 month after the onset with no significant increase in bleeding rate. Conclusion: In the treatment of elderly patients with NSTEMI, early interventional treatment is safe and effective.
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Affiliation(s)
- Zhiqiang Liu
- Zhiqiang Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Lipei Zhao
- Lipei Zhao, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Yibo Li
- Yibo Li, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Zhifang Wang
- Zhifang Wang, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Lingling Liu
- Lingling Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Fucheng Zhang
- Fucheng Zhang, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
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