- MeSH
- disekce aorty * diagnostické zobrazování etiologie MeSH
- dopravní nehody MeSH
- koronární cévy * diagnostické zobrazování MeSH
- lidé MeSH
- motorová vozidla MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: There are no data about the prevalence of silent coronary artery disease in asymptomatic severe aortic stenosis patients with normal exercise testing. Importantly, unmasking significant coronary artery disease in patients with aortic stenosis could influence the choice/timing of treatment in these patients. METHOD: Exercise testing was performed on semi-supine ergobicycle. Cardiopulmonary analysis during exercise testing, echocardiography, and laboratory analysis at rest was done. Standard clinical/electrocardiography criteria were assessed for symptoms/signs of ischemia during/after exercise testing. In patients with normal exercise testing coronary angiography was performed using standard femoral/radial percutaneous approach. Coronary stenosis was considered significant if >70% of vessel diameter or 50%-70% with fractional flow reserve ≤0.8. RESULTS: Total of 96 patients with normal exercise testing were included (67.6 years, 50.6% males). No patient had any complication or adverse event. The Pmean was 52.7 mmHg, mean indexed aortic valve area was 0.36 cm/m and left ventricular ejection fraction, 69.5%. 19/96 patients (19.8%) had significant coronary artery disease on coronary angiography. Multivariate logistic regression analysis revealed brain natriuretic peptide and blood glucose as independent predictors of silent coronary artery disease. Brain natriuretic peptide value of 118 pg/ml had sensitivity/specificity of 63%/73% for predicting coronary artery disease (area under the curve 0.727, P = 0.006). CONCLUSION: Our results are the first to show that in patients with severe aortic stenosis, normal left ventricular ejection fraction,, and normal exercise testing, significant coronary artery disease is present in as many as 1/5 patients. In such patients, further prospective studies are warranted to address the diagnostic value of brain natriuretic peptide in detecting silent coronary artery disease.
- MeSH
- aortální stenóza komplikace patofyziologie MeSH
- asymptomatické nemoci * MeSH
- koronární angiografie MeSH
- koronární stenóza komplikace diagnóza epidemiologie metabolismus MeSH
- krevní glukóza metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- natriuretický peptid typu B metabolismus MeSH
- nemoci koronárních tepen komplikace diagnóza epidemiologie metabolismus MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- stupeň závažnosti nemoci MeSH
- zátěžový test MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: A relationship between carotid stenosis and coronary arterial disease (CAD) is widely accepted; however, data on the exact prevalence of coronary disease in patients with severe carotid stenosis are lacking. Information on the prevalence and predictors of CAD among these patients could impact diagnostic and treatment approaches. AIM: The primary aim of this study was to determine the prevalence of significant CAD among patients referred for carotid artery revascularization. The secondary objectives included characterizing the association between the level of advancement of carotid stenosis and the presence of CAD, and between atherosclerotic risk factors and the presence of CAD in patients with carotid stenosis, and also to determine whether there was a difference in the prevalence of CAD between patients with symptomatic versus asymptomatic carotid stenosis. PATIENTS AND METHODS: We included 200 patients with severe carotid stenosis, of whom 77 (38.5%) had symptomatic stenosis. All patients underwent coronary angiography no more than 6 months before the scheduled carotid revascularization. Of the 200 total of patients, 192 underwent carotid stenting, six underwent carotid endarterectomy, and two were treated conservatively. CAD was defined as stenosis of at least 50% on recent coronary angiography or a history of previous percutaneous coronary intervention and/or coronary aortic bypass graft; the prevalence was 77.5% among our patients. There was no statistically significant difference in the prevalence of CAD between patients with unilateral versus bilateral carotid stenosis or contralateral carotid occlusion. The difference in the severity of coronary disease, which was given by the SYNTAX score, was not significant between these groups. Factors associated with the presence of CAD were male sex, a history of smoking, and global or regional wall motion disorder on echocardiography. We did not find any significant difference in the prevalence of CAD between patients with symptomatic versus asymptomatic carotid stenosis. CONCLUSION: We observed a very high prevalence of concomitant CAD in patients with severe carotid stenosis. The results of our study suggest that routine preprocedural screening for CAD in patients with carotid artery stenosis could identify a large proportion of patients with silent CAD; whether treatment for CAD before carotid revascularization can prevent periprocedural myocardial infarction should be addressed in a randomized-controlled trial.
- MeSH
- endovaskulární výkony přístrojové vybavení MeSH
- hodnocení rizik MeSH
- koronární angiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci koronárních tepen diagnostické zobrazování epidemiologie MeSH
- prevalence MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stenóza arteria carotis diagnostické zobrazování epidemiologie terapie MeSH
- stenty * MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Polsko MeSH
BACKGROUND: The aim of this study was to evaluate access-site complications in patients with ST-segment elevation myocardial infarction treated with a transradial primary percutaneous coronary intervention relative to three different P2Y12 platelet inhibitors. PATIENTS AND METHODS: We enrolled 334 consecutive patients (76.9% men, age: 59.4±9.1 years) treated by one of the following: clopidogrel (n=118), prasugrel (n=102), and ticagrelor (n=114). The use of the IIb/IIIa inhibitor, abciximab, was left to the operators' discretion. The time needed to achieve patent hemostasis, compression time, and local complications were analyzed. RESULTS: The baseline characteristics were similar in all three P2Y12 platelet inhibitor groups. Abciximab was used in 72 (21.6%) patients. Administration of abciximab was associated with a higher incidence of grade II and III hematomas (23.6 vs. 5.0%, P<0.0001, and 5.6 vs. 1.1%, P=0.041, respectively). Among different platelet P2Y12 receptor inhibitor groups, the incidences of hematomas grade II and III were similar in patients who did (P≥0.14) and did not (P≥0.31) receive abciximab. There were no grade IV or V hematomas in any of the groups. Patent hemostasis was achieved faster (24.5±13.4 vs. 43.5±30.0 min, P<0.0001) and compression time was shorter (113.2±53.6 vs. 217.8±115.5 min, P<0.0001) when abciximab was not used. Radial artery occlusion occurred in one (0.3%) patient. CONCLUSION: After transradial primary percutaneous coronary intervention, early patent hemostasis and short artery compression times were associated with a higher incidence of local hematomas. The incidence of hematomas was dependent on the use of abciximab, but unrelated to the type of P2Y12 inhibitor used. All hematomas were without clinical consequences.
- MeSH
- adenosin škodlivé účinky analogy a deriváty MeSH
- arteria radialis * diagnostické zobrazování MeSH
- časové faktory MeSH
- hematom chemicky indukované MeSH
- hemostatické techniky MeSH
- imunoglobuliny - Fab fragmenty škodlivé účinky MeSH
- infarkt myokardu s elevacemi ST úseků diagnostické zobrazování terapie MeSH
- inhibitory agregace trombocytů škodlivé účinky MeSH
- koronární angioplastika škodlivé účinky metody MeSH
- krvácení chemicky indukované prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- monoklonální protilátky škodlivé účinky MeSH
- periferní katetrizace škodlivé účinky metody MeSH
- prasugrel hydrochlorid škodlivé účinky MeSH
- punkce MeSH
- purinergní receptory P2Y - antagonisté škodlivé účinky MeSH
- rizikové faktory MeSH
- senioři MeSH
- tiklopidin škodlivé účinky analogy a deriváty MeSH
- trombocytový glykoproteinový komplex IIb-IIIa účinky léků MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- MeSH
- arteria radialis * MeSH
- arteriální okluzní nemoci prevence a kontrola MeSH
- koronární angioplastika metody MeSH
- krvácení prevence a kontrola MeSH
- lidé MeSH
- periferní katetrizace metody MeSH
- srdeční katetrizace metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- komentáře MeSH
- úvodníky MeSH
AIM: To assess the occurrence of late clinical events after the discontinuation of dual antiplatelet treatment in patients with drug-eluting stent implantation, complex coronary artery disease and high clinical risk profile. METHODS: Between January 2004 and December 2005, 2080 patients underwent percutaneous coronary intervention, including 276 patients (13%) who were treated with drug-eluting stents. At the 6-month follow-up, 273 patients remained event-free and of these, 171 completed the 12-month and 18-month follow-ups and have been enrolled in the analysis. Dual antiplatelet treatment was administered for 6 months in all patients. RESULTS: At the 18-month follow-up, stent thrombosis had occurred in 10 patients (5.8%), resulting in five sudden deaths and five target-vessel nonfatal myocardial infarctions. The majority (80%) of the events had developed within 7-12 months. The larger stent area and left main interventions were significantly associated with stent thrombosis (P=0.031 and P=0.001, respectively). CONCLUSIONS: Our study confirmed worrisome results concerning drug-eluting stent thrombosis after the discontinuation of dual antiplatelet treatment. The rate of stent thrombosis-related events in our high-risk cohort of patients reached almost 6% with a 50% mortality. The majority (80%) of the events occurred within the months 7-12.
- MeSH
- balónková koronární angioplastika metody přístrojové vybavení MeSH
- inhibitory agregace trombocytů farmakologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci koronárních tepen mortalita terapie MeSH
- přežití po terapii bez příznaků nemoci MeSH
- registrace MeSH
- riziko MeSH
- senioři MeSH
- stenóza MeSH
- stenty uvolňující léky MeSH
- trombóza MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- angina pectoris komplikace metabolismus MeSH
- C-reaktivní protein metabolismus MeSH
- infarkt myokardu komplikace metabolismus MeSH
- koronární angiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci koronárních tepen komplikace metabolismus MeSH
- senioři MeSH
- zátěžový test MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- balónková koronární angioplastika metody MeSH
- časové faktory MeSH
- koronární angiografie MeSH
- koronární nemoc terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- stenty MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
BACKGROUND: The present study was designed to evaluate the role of tachycardia-induced dynamic coronary artery diameter changes in the development of myocardial ischemia. METHODS: Coronary angiography at rest and during atrial pacing-induced myocardial ischemia was performed in 22 patients. The diameter of the proximal and the corresponding distal coronary artery segments at rest and during pacing was measured using quantitative coronary angiography. Plasma levels of noradrenaline, adrenaline, dopamine and endothelin were determined in a subset of 14 patients in blood drawn from aorta and coronary sinus at rest and during pacing. RESULTS: Luminal diameter in normal proximal and distal segments increased, respectively, from 2.93 +/- 0.34 and 1.40 +/- 0.04 mm at rest to 3.03 +/- 0.25 and 1.58 +/- 0.07 mm during atrial pacing. The diameter of the proximal coronary artery segments with significant concentric stenosis decreased from 1.28 +/- 0.4 mm at rest to 0.95 +/- 0.34 mm during pacing, whereas segments with either significant eccentric or non-significant stenosis did not change significantly. A correlation was found between the noradrenaline level in the coronary sinus and the distal coronary artery diameter. CONCLUSIONS: A decrease in diameter of coronary artery segments with concentric stenosis during tachycardia might contribute to the development of myocardial ischemia. Some of the dynamic coronary artery changes may be influenced by the plasma level of noradrenaline. No evidence was found to suggest that dynamic changes in the diameter of proximal segments are related to the changes in diameter of the corresponding distal segments.
- MeSH
- dospělí MeSH
- ischemická choroba srdeční krev patofyziologie patologie radiografie MeSH
- kardiostimulace umělá MeSH
- koronární angiografie MeSH
- koronární cévy * patofyziologie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- vazokonstrikce * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
