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PREDICTORS OF IMPROVEMENT IN LEFT
VENTRICULAR FUNCTION AFTER STENT IMPLANTATION OF CHRONIC
CORONARY OCCLUSION
Akgül F, Batyraliev T, Karben Z,
Serçelik A, Vural A, Fettser D.
The effect of coronary stent implantation on
left ventricular (LV) performance in patients with chronic coronary
occlusion is not well known.
The aim of this study was to
assess the effect of bare metal and drug eluting stents implantation on LV
ejection fraction (LVEF) and to examine what clinical and angiographic
factors may have an effect on recovery of LVEF.
Three hundred and four
patients who underwent successful stent implantation for chronic occlusion
of a major epicardial coronary artery existing for at least one month were
included into the study. Echocardiographic examination was performed before
and six months after stent implantation.
A significant increase in
LVEF (53.2±11.9% to 57.0±11.1%; p <0.0001) with a decrease in both LV end-diastolic
volume index (85.6±18.9 ml/m2 to 80.1±17.1 ml/m2; p <0.001) and LV end-systolic
volume index (40.0±15.8 ml/m2 to 34.1±14.3 ml/m2; p <0.0001) after stent
implantation of chronic coronary occlusion was observed in the entire group.
There was no significant difference in the increase of LVEF between bare
metal stent and drug eluting stent groups. Multivariate analysis revealed
that baseline LVEF 50%, occlusion duration <2 months and diabetes mellitus
to be independent predictors of improvement in LVEF.
Stent implantation for a
chronic coronary occlusion has a beneficial effect on LVEF during the first
6 months after the stent implantation, especially in patients with depressed
LV function and occlusion duration <2 months.
Key Words: Chronic
coronary occlusion, Stent implatation, Left ventricular function
THE EFFECT
OF CLOPIDOGREL ON IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE
CORONARY SYNDROME WITHOUT INTERVENTIONAL THERAPY
Bıyık İ, Özdemir A, Salman
A, Tayyar N.
To evaluate the effect
of clopidogrel on in-hospital mortality in patients with
acute coronary syndrome (ACS) treated with medically.
In the
registry of 3024 cases, patients were divided as unstable
angina pectoris (UAP), non-ST segment elevation myocardial
infarction (NSTEMI) and ST-segment elevation myocardial
infarction (STEMI). Two subgroups of first two groups were
constituted whether patients treated with standard therapy (heparin,
acetyl salicylic acid, beta-blocker, nitrates) and
clopidogrel or patients treated with only standard therapy.
In STEMI patients four subgroups were constituted whether
patients were treated with thrombolytic, standard therapy
and clopidogrel. In-hospital mortality rates of all groups
were compared.
In UAP, of
711 patients, mortality were found 1.4 % in clopidogrel
group and 2.3 % not taking (p>0.05). In NSTEMI, of 1326
patients, mortality were 2.5 % in clopidogrel group and 4.2
% not taking (p<0.05). In STEMI, of 987 patients, in
thrombolytic groups, mortality were 3.7 % in clopidogrel
group and 5.8 % not taking (p>0.05). In no thrombolytic
groups, mortality were 11.5 % in clopidogrel group and 37.5
% not taking (p<.001). In-hospital mortality rates were
significantly lower in patients taking clopidogrel in three
groups, although, benefit of clopidogrel is not
statistically significant in UAP and STEMI patients taking
thrombolytic.
The analysis
reveals that clopidogrel provides significant in-hospital
mortality benefit in patients with NSTEMI and STEMI not
taking thrombolytic. However, the benefit of clopidogrel in
patients with UAP and STEMI taking thrombolytic was seemed
less evident in this analysis.
P-WAVE DURATION AND P-WAVE DISPERSION IS
INCREASED IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Yıldırım N, Arat N, Çiftçi
B, Fırat Güven S, Sabah İ.
Prolonged P-wave
duration and increased P-wave dispersion (PD) have been
reported to be associated with atrial fibrillation. In the
present study we aimed to investigate minimum (Pmin) and
maximum P-wave duration (Pmax) and PD in patients with
obstructive sleep apnea (OSA).
Patients
with OSA (n=30, mean age 38±6 years) and their 30 age and
gender matched control subjects were prospectively analyzed
after an overnight sleep study. The severity of OSA was
determined by apnea-hypopnea index (AHI). Left atrial
diameter, left ventricular end diastolic diameter and left
ventricle ejection fraction were measured by transthoracic
echocardiography. Pmax and Pmin were measured from 12-lead
surface electrocardiogram. PD was calculated as the
difference between Pmax and Pmin. The relation between Pmax,
PD and AHI was also investigated.
Left atrial
diameter was higher in patients with OSA compared to control
subjects (4.3±0.3 cm vs 3.9±0.3 cm, p<0.01). Pmax (109±15
msec vs 92±16 msec, p<0.01) and PD (58±14 msec vs 40±6 msec,
p<0.01) of patients with OSA were found to be significantly
higher than those of controls although Pmin was not
statistically different between the groups (p>0.05).
Additionally Pmax and PD were found to be positively
correlated with left atrial diameter (r=0.41, p<0.01 and
r=0.65, p<0.01 respectively). However no correlation was
detected between Pmax (r=0.036, p>0.05), PD (r=0.043,
p>0.05) and AHI
Pmax and PD
were found to be significantly higher in patients with OSA
than in control subjects regardless of AHI.
THE EFFECT OF TRIMETAZIDINE ON IN-HOSPITAL
MORTALITY IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL
INFARCTION WITHOUT INTERVENTIONAL THERAPY:A NON-INVASIVE CENTER
EXPERIENCE
Bıyık İ, Özdemir A, Salman
A, Tayyar N.
To investigate the effect of
trimetazidine on in-hospital mortality of patients with acute ST segment
elevation myocardial infarction (STEMI) given medical therapy only.
937 patients with STEMI
treated with medically were included and divided into four groups: Group-1
patients (n=561) treated with thrombolytic, heparin, acetyl salicylic acid,
beta blocker, clopidogrel and nitrates: Group-2 patients (n=276) treated
with thrombolytic, heparin, acetyl salicylic acid, beta blocker, clopidogrel,
nitrates and trimetazidine: Group-3 patients (n=108) treated with heparin,
acetyl salicylic acid, beta blocker, clopidogrel and nitrates: Group-4
patients (n=42) treated with heparin, acetyl salicylic acid, beta blocker,
clopidogrel, nitrates and trimetazidine. In-hospital mortality rates of four
groups were compared.
The mean duration of
hospitalization was 4.71±1.8 day. 33 of 561 patients in group-1 and 9 of 276
patients in group-2 were died of cardiac causes. The mortality rates of
patients taking thrombolytic therapy were 5.9 % and 3.3 %, respectively,
(p<0.05). In-hospital mortality rates were significantly lower in patients
taking trimetazidine together with thrombolytic. Thirty of 108 patients in
group-3 and 6 of 42 patients in group-4 were died of cardiac causes. The
mortality rates of the patients not taking thrombolytics were 28 % and 14 %,
respectively, (p<0.05). In-hospital morta-lity rates were significantly
lower in the patients taking trimetazidine in the groups not taking
thrombolytics.
This analysis reveals that
trimetazidine added to standard therapy in patients with STEMI treated with
medically may provide in-hospital mortality advantage. To confirm these
results, large scale, randomized trials are needed.
PERCUTANEOUS CORONARY INTERVENTIONS
IN PATIENTS WITH CHRONIC TOTAL OCCLUSIONS OF CORONARY ARTERIES:
FEASIBILITY, COMPLICATIONS AND LONG-TERM RESULTS OF PROCEDURES
Fettser D, Arystanova A, Batyraliev T, Serçelik A, Vural A, Koçak A,
Abdramanov K.
Implementation of percutaneous coronary interventions (PCI)
in patients with chronic total occlusions (CTO) of coronary
arteries has always posed a challenge for interventional
cardiologists. This is due to the fact that in CTO frequency
of success of interventions is much lower than in procedures
on non-occluded arteries. Also it is established, that at
the given coronary interventions the risk of major adverse
cardiac events is as higher as the frequency of restenosis.
Probably for these reasons presence of occlusion of coronary
artery is the most powerful predictor of the direction of
the patient to coronary artery bypass grafting.
However, new
devices for passage of total chronic occlusions have become
available in clinical practice, which allowed for
interventionists significantly increase the frequency of
successful interventions and improve outcomes of PCI, and
the saved up experience has allowed minimize the frequency
of coronary events in these percutaneous procedures. All
this provided a further boost to the development of this
trend in interventional cardiology. At the same time, some
cardiologists continue to express doubts about the benefits
of PCI in patients with CTO. In this regard, the analysis of
several clinical studies was performed, which answers to
question of the feasibility of PCI for CTO, and the results
demonstrate the clinical efficacy of these procedures as in
short as in long-term periods of observation.
ACUTE THROMBOSIS OF THE LEFT SUBCLAVIAN
ARTERY AND ACUTE CORONARY SYNDROME SECONDARY TO CARBON MONOXIDE
INTOXICATION
Biçer A, Kılıç H, Balcı M, Doğan M,
Karakurt Ö, Akdemir R.
Carbon monoxide (CO)
toxicity is often overlooked because CO is tasteless and
odorless and its clinical symptoms and signs are nonspecific.
The brain and the heart may be severely affected after CO
exposure with carboxyhemoglobin levels exceeding 20%.
Neurologic consequenses of poisoning have been well
described, however the cardiovascular consequences of CO
poisoning are limited to isolated case reports of
electrocardiographic (ECG) changes, myocardial dysfunction
and myocardial infarction.
We describe
a case of acute occlusion of the left subclavian artery
accompanying myocardial infarction due to CO poisoning, in a
patient with prior coronary artery by-pass grafting surgery,
including a graft of the left internal mammarian artery to
the left anterior descending arter (LIMA-LAD). The
subclavian artery was succesfully salvaged by percutaneous
intervention and LIMA-LAD by-pass graft flow has been
obtained. To the best of our knowledge, acute occlusion of
the subclavian artery accompanying myocardial infarction due
to CO poisoning is uncommon and previously unreported.
THE SACCULAR CORONARY ARTERY ANEURYSM
TREATED BY POLYTETRAFLUOROETHYLENE COATED STENT IMPLANTATION
Keleş T, Durmaz T, Akar
Bayram N, Bozkurt E.
Coronary artery aneurysms are
dilatations of arterial segments, which are typically
incidentally identified at angiography. There is no
therapeutic consensus regarding this finding. Treatment may
consist of surgical, percutaneous, or medical interventions.
We present a case of saccular coronary artery aneurysm and
review the literature on the use of polytetrafluoroethylene
covered stents as a therapeutic option for this condition.
AN ACCIDENTAL CALCIFICATION UNDER
FLOUROSCOPY DURING CORONARY ANGIOGRAPHY: HYDATID CYST
Yeter E, Keleş T, Durmaz
T, Akçay M, Akar Bayram N, Bozkurt E.
The patient who is
fifty four years old man was appeal emergency room due to
angina pectoris. He was accept to the coronary care unit
with definition of acute inferior posterior and right
ventricule myocardial infarction. He was undergone coronary
angiography sixth day after admission. We observed the
accidental prominent calcific area on the right upper
abdominal zone of the patient. Hydatid cyst with thining
wall in the liver that might have been rupture in the near
future was determined. The calcifications should not be
overlooked even if they are seen on the body except from
cardiac area under flouroscopy during the angiography. At
least, like this cases should be refered to operate to the
surgical clinic.
