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Krzysztof Zmudka

Publications and source records attributed to Krzysztof Zmudka.

At least 19 recordsLinked to original sources
PubMed2006

Diagnostic value of carotid intima-media thickness in indicating multi-level atherosclerosis.

UNLABELLED: Carotid intima-media thickness (CIMT) is an indicator of atherosclerosis, but its association with multi-level involvement is sparsely investigated. Study aimed to examine interrelation between CIMT and number of arterial territories with significant (>50%) stenoses, including coronary, supraaortic, renal and iliac/femoral arteries. METHODS AND RESULTS: Study formed 415 patients (294 men), aged 62.9+/-9.3 years referred to coronary angiography. CIMT assessment was performed in common, bulb and internal carotid segments, and expressed as the mean aggregate value. In all patients, both coronary, renal angiography and supraaortic, iliac/femoral arteries ultrasound was performed. Group I formed 102 patients without significant lesions in any of investigated territories; group II formed 131 patients with single territory; group III formed 102 patients with two territory and group IV formed 80 patients with three to four territory involvements. CIMT correlated with increasing number of involved territories (r=0.751, p<0.001). Aggregate CIMT, previous myocardial infarction, creatinine level, hypertension, hs-CRP, smoking were independent predictors of multi-level involvement (p<0.001, R=0.768). ROC curves showed that CIMT cut-off value of 1.308 mm could distinguish 0-1 from two to three level involvement with sensitivity of 81.6%, specificity 88.8%, PPV 85.1%, NPV 86.3% (odds ratio 35.9, range 20-65). CONCLUSIONS: CIMT increases with number of involved territories. CIMT is an independent predictor of significant multi-level atherosclerosis, showing high sensitivity and specificity for indicating more advanced territorial atherosclerotic involvement.

Adult↗
PubMed2006

Dose escalation trial of the efficacy, safety, and pharmacokinetics of a novel fibrinolytic agent, BB-10153, in patients with ST elevation MI: results of the TIMI 31 trial.

BACKGROUND: Currently available fibrinolytic agents are limited by their ability to restore normal blood flow in only half of patients, the risk of reocclusion, and the risk of intracranial hemorrhage. The genetically engineered agent BB-10153 is activated by thrombin, not plasminogen activator enzymes, which limits its activity to the site of thrombus which may in turn reduce the risk of systemic bleeding. BB-10153 also has a relatively long half-life of 3-4 hours, which may also limit the potential for early reocclusion [1, 2]. METHODS: The study was a phase II, open-label, multi-center, dose escalation, single-dose administration study to determine the efficacy, safety, tolerability, pharmacokinetics and pharmacodynamics of BB-10153 in ST segment elevation MI (STEMI). STEMI patients (n = 50) received a single dose of BB-10153 at one of six dose levels (1.0, 2.0, 3.0, 5.0, 7.5 and 10 mg/kg). The primary endpoint was TIMI flow grade (TFG) 3 at 60 minutes following the intravenous bolus of BB-10153. RESULTS: Mean area under the curve for drug concentration ranged from 48.0 microg.h/mL in the 1 mg/kg dose group to 788.6 microg.h/mL in the 10 mg/kg dose group. Likewise, mean Cmax generally increased with dose over the entire dose range, from 4.9 microg/mL in the 1 mg/kg dose group to 139.6 microg/mL in the 10 mg/kg dose group. The mean apparent terminal half-life (t1/2) was 4.4 hours (range 2.2 to 7.6 hours). Few patients in the 1-3 mg/kg dosage groups achieved TFG 3 on the one-hour post-dose angiogram (4/20, 20%), and no patients achieved complete ST segment resolution. The 5, 7.5 and 10 mg/kg doses were associated with similar rates of TIMI grade 3 flow of approximately three per seven patients. Pooling TFG 3 data from the 5, 7.5 and 10 mg/kg groups yielded a TIMI grade 3 flow rate of 34% (n = 10/29; range 29-43%). No patients experienced 30-day death, recurrent acute MI, cardiogenic shock, stroke or anaphylaxis during the study. One patient experienced recurrent angina and developed recurrent myocardial ischemia requiring urgent revascularization. Three patients sustained TIMI major bleeding events (one in 1 mg/kg group, two in 7.5 mg/kg group), six patients sustained TIMI minor bleeds (one in the 2, 3, 7.5 and 10 mg/kg groups, two in the 5 mg/kg group), twp patients sustained TIMI minimal bleeds (one in each of the 2 and 10 mg/kg groups) and no patients sustained intracranial hemorrhage (ICH). CONCLUSION: In a dose escalation study of a single intravenous bolus, the novel fibrinolytic agent, BB-10153 was associated with a rise in the mean area under the curve and Cmax for drug concentration over the dose range 1 to 10 mg/kg. Higher doses were associated with a range of TIMI grade 3 flow of 29-43%, and no patients experienced 30-day death, recurrent acute MI, cardiogenic shock, stroke or anaphylaxis during the study. In a dose escalation study of a single intravenous bolus, the novel fibrinolytic agent, BB-10153 was associated with a rise in the mean area under the curve and Cmax for drug concentration over the dose range 1 to 10 mg/kg. Higher doses were associated with a range of TIMI grade 3 flow of 29-43%, and no patients experienced 30-day death, recurrent acute MI, cardiogenic shock, stroke or anaphylaxis during the study.

Area Under Curve↗
PubMed2006

Angiographic and clinical outcome after percutaneous coronary interventions following combined fibrinolytic therapy in acute myocardial infarction.

INTRODUCTION: Combined therapy with fibrinolytic agent and platelet GPIIb/IIIa inhibitor not followed by an interventional procedure does not improve prognosis in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) when compared to fibrinolysis alone. On the other hand, in the past percutaneous coronary interventions (PCI) performed after fibrinolysis were associated with low angiographic efficacy, a high risk of bleeding and a high rate of early cardiovascular events. AIM: Evaluation of angiographic and clinical outcomes in patients with STEMI treated with PCI following combined fibrinolytic therapy. METHODS AND RESULTS: Complete angiographic and clinical data of 187 patients who underwent PCI immediately after combined fibrinolytic therapy were obtained from a survey of 669 consecutive patients with STEMI <12 hours, at age <75 years, without cardiogenic shock, who were transferred from regional hospitals to the catheterisation laboratory within 90 minutes and after the initiation of combined fibrinolytic therapy (alteplase 15 mg iv as a bolus followed by an infusion of 35 mg over 60 minutes; abciximab iv bolus of 0.25 mg/kg followed by a 12 h infusion of 0.125 microg/kg per minute; unfractionated heparin). At baseline angiographic examination revealed no flow (TIMI 0+1) in the infarct-related artery in 17.1% of patients, impaired flow (TIMI 2) in 17.1% and normal (TIMI 3) in 65.8% of cases. After immediate PCI, a significant improvement in epicardial perfusion (TIMI 2+3, 99.5%) and in microcirculation was achieved. This favourable effect was seen only in the group of patients with baseline TIMI 0+1 flow, whereas PCI in the group with baseline TIMI 3 flow did not cause any further improvement in microcirculatory perfusion. The rate of cardiovascular events within the first 30 days and 12 months after the procedures were similar in the studied subgroup of patients. CONCLUSIONS: PCI performed after combined fibrinolytic therapy in STEMI patients is associated with high efficacy and improvement in indices of epicardial perfusion and microcirculation. These benefits are confined mainly to patients with primarily impaired flow in the infarction-related artery (TIMI 0+1). However, the clinical results of this strategy, particularly in patients undergoing PCI following successful combined fibrinolytic therapy, must still be proved in further randomised trials.

Aged↗
PubMed2006

Transcoronary stem cell delivery using physiological endothelium-targeting perfusion technique: the rationale and a pilot study involving a comparison with conventional over-the-wire balloon coronary occlusions in patients after recent myocardial infarction.

INTRODUCTION: Recent evidence shows poor efficacy of over-the-wire balloon catheter (OTW) coronary occlusive technique adopted widely for intracoronary bone marrow stem cell (BMSC) delivery. The waterfall effect of OTW-balloon inflation/deflation with reactive > or = 2-fold flow velocity increase might be partly responsible for poor BMSC retention. AIM: To evaluate the safety, feasibility and tolerability of perfusion-infusion BMSC delivery with the facilitation of cell rolling in contact with the coronary endothelium (a pre-requisite for downstream transmigration). METHODS: We randomly assigned 11 patients (age 41-72 years) with first anterior myocardial infarction treated with PTCA+stent and LVEF < or =45% at 6-9 days to OTW in-stent occlusive (3 x 3 min.) BMSC delivery or cell infusion via a perfusion catheter with multiple side holes (SH-PC). RESULTS: OTW and SH-PC patients had a similar infarct size (mean peak CK 4361 vs 4717 U/L), LVEF (41.2% vs 40.3%), infused mononuclear cell number (2.99 x 108 range 0.61-7.48 x 108 vs 3.28 x 108 range 1.64-4.39 x 108), CD 34(+) number (1.79 x 106 vs 1.62 x 106), cell viability (91.5% vs 91.8%) and clonogenicity (CFU assay). None of the SH-PC, but 67% of OTW patients, had ST-segment elevation with chest pain (and nsVT in one) that limited OTW occlusion tolerance to 50-110 sec. At 6 months DLVEF in the OTW vs SH-PC patients was +4.2% (2-6) vs +8.8% (5-16) by MRI and +4.8 (2-7) vs +13.8% (2-24) by SPECT. CONCLUSIONS: Our work indicates that the SH-PC technique can be used safely for intracoronary BMSC transplantation. Further research is needed to determine whether the putative advantages of physiological SH-PC delivery translate into enhanced BMSC homing.

Adult↗
PubMed2005

Peristent remodeling and neointimal suppression 2 years after polymer-based, paclitaxel-eluting stent implantation: insights from serial intravascular ultrasound analysis in the TAXUS II study.

BACKGROUND: The purpose of this study was to evaluate long-term vascular responses as long as 2 years after implantation of polymer-based, paclitaxel-eluting stents in contrast to uncoated stents. METHODS AND RESULTS: TAXUS II is a randomized, double-blind trial comparing slow-release (SR) and moderate-release (MR) TAXUS stents with bare-metal control stents (BMSs). One hundred sixty-one event-free patients (SR, 43; MR, 41; and BMS, 77) underwent serial intravascular ultrasound (IVUS) analysis after the procedure and at 6 months and 2 years. At 2 years, neointimal responses continued to be significantly suppressed in the SR and MR groups when compared with the BMS group (BMS, 1.49+/-1.12 mm2; SR, 0.94+/-0.76 mm2 [P=0.004]; and MR, 1.06+/-0.90 mm2 [P=0.02]). Between 6 months and 2 years, the BMS group showed compaction of the neointima (Delta, -0.22+/-1.05 mm2 [P=0.08]). In contrast, both the SR and MR groups exhibited an increase (Delta SR, 0.30+/-0.76 mm2 (P=0.01); MR, 0.41+/-0.94 mm2 [P=0.009]). Between 6 months and 2 years, the initial increase in plaque outside the stent regressed in the BMS and SR groups to levels comparable to those after the procedure, whereas expansive remodeling partially regressed in the MR group (Delta between after the procedure and 2 years BMS, -0.34+/-1.28 mm2 [P=0.05]; SR, -0.02+/-1.40 mm2 [P=0.93]; MR, 0.32+/-1.56 mm2 [P=0.27]). CONCLUSIONS: The 2-year follow-up demonstrates that neointimal suppression was dose independent and that this effect was still sustained at 2 years. However, the increase in area outside the stent seen at 6 months regressed to different extents in a dose-dependent manner at 2 years.

Aged↗
PubMed2005

Clinical efficacy of polymer-based paclitaxel-eluting stents in the treatment of complex, long coronary artery lesions from a multicenter, randomized trial: support for the use of drug-eluting stents in contemporary clinical practice.

BACKGROUND: Intracoronary polymer-based stent delivery of paclitaxel has been shown to be effective in reducing restenosis in simple coronary lesions, but the evidence base for contemporary use in longer, more complex coronary stenoses is lacking. METHODS AND RESULTS: TAXUS VI is a prospective, multicenter, double-blind, randomized trial assessing clinical and angiographic outcomes of the TAXUS Moderate Release paclitaxel-eluting stent in the treatment of long, complex coronary artery lesions. Four hundred forty-eight patients at 44 sites were randomized (1:1) between a drug-eluting TAXUS Express2 and an uncoated Express2 control stent. Per protocol, the 9-month follow-up included an angiographic reevaluation in all patients. The primary end point was the rate of target-vessel revascularization 9 months after the study procedure; secondary end points included the rate of target-lesion revascularization and binary restenosis at follow-up. Mean lesion length in the study was 20.6 mm, with a mean stent-covered length of 33.4 mm. Of all lesions, 55.6% were classified as complex lesions (type C of the AHA/ACC classification). At 9 months, target-vessel revascularization was 9.1% in the TAXUS group and 19.4% in the control group (P=0.0027; relative reduction, 53%). Target-lesion revascularization was reduced from 18.9% to 6.8%, respectively (P=0.0001). The incidence of major adverse cardiac events was similar in the 2 groups, 16.4% and 22.5% in TAXUS and control, respectively (P=0.12), including comparable rates for acute myocardial infarction. Binary restenosis in the stented area was reduced from 32.9% in the control group to 9.1% in the TAXUS patients (P<0.0001). CONCLUSIONS: The finding that the TAXUS Moderate Release stent system is safe and effective in the treatment of long, complex coronary artery lesions provides the evidence base for the more widespread use of drug-eluting stents in contemporary clinical practice.

Adult↗
PubMed2005

MO.MA -- a new cerebral stroke protection system during carotid artery stenting.

BACKGROUND: Carotid angioplasty and stenting (CAS) has been introduced as an alternative to carotid endarterectomy for the treatment of carotid atherosclerosis. Due to the risk of embolisation during CAS, the usage of cerebral protection devices is obligatory. AIM: To assess the safety and efficacy of the novel cerebral protection device -- the MO.MA system. METHODS: Twenty one patients selected for carotid stenting were included into the study. We estimated the deliverability of the device to the target site, procedural success rate and the incidence of adverse events. RESULTS: All performed procedures were successful without major cerebro-vascular complications during both 30-day and 6-month follow-up periods. CONCLUSIONS: The MO.MA system is safe and effective in preventing stroke during CAS.

Adult↗
PubMed2004

Direct stenting with TAXUS stents seems to be as safe and effective as with predilatation. A post hoc analysis of TAXUS II.

BACKGROUND AND METHOD: Although direct coronary stenting does not improve angiographic outcome, it makes sense by reducing procedure times, radiation exposure and costs. Other potential advantages of direct stenting may be a reduction of myocardial ischemia time, which could be clinically relevant in high-risk patients. With the introduction of drug-eluting stents, however, concern arose that direct stenting would possibly damage the polymer coating and change or diminish the efficacy of the programmed drug release. Also, concerns about safety by preventing optimal apposition of single stent struts developed. It is the purpose of this paper to retrospectively analyze the data from the TAXUS-II Trial (536 patients) regarding patients with and without direct stenting. While predilatation was recommended per protocol, direct stenting was not forbidden: thus, direct stenting was performed in 49 patients (TAXUS n = 23, control n = 26). RESULTS: In the TAXUS groups, there was no significant difference regarding major adverse cardiac events (MACE; 7.5% vs. 4.3%), angiographic restenosis in the analysis segment (4.8% vs. 4.3%), late loss (0.28 +/- 0.36 vs. 0.33 +/- 0.30 mm) or intravascular ultrasound-(IVUS-)measured volume obstruction (7.95 +/- 9.84% vs. 5.61 +/- 7.91%) at six months between the predilated and directly stented patients. The same was true for the patients receiving the control stent. Compared with the directly stented control group, the statistically significant positive effects of TAXUS direct stenting were maintained, regarding angiographic restenosis in the analysis segment (4.3% vs. 30.8%), late loss (0.33 +/- 0.30 vs. 0.80 +/- 0.62 mm) or IVUS-measured volume obstruction (5.61 +/- 7.91% vs. 22.50 +/- 21.62%) at six months. MACE was reduced from 19.2% to 4.3%; due to the small number of patients this trend did not reach statistical significance. After predilatation, all parameters were significantly improved by the TAXUS stent. CONCLUSION: Comparison of patients receiving TAXUS stents with or without predilatation revealed no differences in clinical, angiographic or IVUS parameters at six months. This suggests that direct stenting with the polymer-based paclitaxel-eluting TAXUS stent is feasible, safe and equally effective. Randomized trials comparing stenting after predilatation versus direct stenting with drug-eluting stents are warranted.

Angioplasty, Balloon, Coronary↗
PubMed2004

Combined Abciximab REteplase Stent Study in acute myocardial infarction (CARESS in AMI).

BACKGROUND: Most patients with acute myocardial infarction (AMI) are admitted to hospitals without percutaneous transluminal coronary angioplasty (PTCA) facilities or are initially managed in a prehospital mobile unit. Thrombolysis remains the most readily available reperfusion treatment in those settings, but the optimal subsequent strategy in those patients is unclear. If a mechanical recanalization is likely to be performed in an emergency, it is probably desirable that the patient receives abciximab, the glycoprotein IIb/IIIa antagonist with the strongest evidence of benefit for angioplasty in AMI. OBJECTIVE: The aim of this trial is to compare the effects on clinical outcome and cost-effectiveness of 2 strategies after immediate treatment with abciximab and half-dose reteplase for ST-elevation AMI: to manage the patients conservatively (referring them for rescue PTCA only if needed) or to immediately send all patients for emergency coronary angioplasty. METHODS: The Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction (CARESS in AMI) is an open, prospective, randomized, multicenter clinical trial conducted in patients with high-risk ST-segment elevation AMI treated within 12 hours from symptom onset in hospitals without PTCA facilities or in a prehospital mobile intensive care unit. Apart from contraindications to thrombolysis, the main exclusion criteria are age > or =75 years and a past history of CABG surgery or a percutaneous coronary intervention procedure involving the infarct-related artery. Enrollment will be performed in hospitals without PTCA facilities or directly in the ambulance if a dedicated system is in place for prehospital diagnosis and treatment of AMI. Patients will receive half-dose reteplase and full-dose abciximab and will subsequently be randomized to conventional medical therapy (with referral for emergency rescue PTCA allowed in selected cases) or emergency angioplasty. The primary end point is the 30-day combined incidence of mortality, reinfarction, and refractory ischemia. In order to obtain a 95% power (2-sided) to detect a 42% reduction in the primary end point, 900 patients are required in each arm of the study. Secondary end points include the 1-year composite end point of mortality, reinfarction, refractory ischemia, and hospital readmission because of heart failure; resource use at 30 days and 1 year; and the incidence of inhospital stroke and bleeding complications in the 2 groups. RESULTS: Seventy-four patients have been randomized (as of March 10, 2004); results are expected in June 2005. CONCLUSION: This study will establish whether angioplasty must be started as soon as possible in all patients who receive combined pharmacologic reperfusion with the glycoprotein IIb/IIIa inhibitor abciximab and half-dose thrombolysis or whether it can be postponed or skipped in patients with signs of successful reperfusion, with obvious organizational advantages.

Abciximab↗
PubMed2004

Detection of microvascular injury by evaluating epicardial blood flow in early reperfusion following primary angioplasty.

BACKGROUND: In a significant proportion of patients with acute myocardial infarction (AMI), successful opening of the infarct related artery (IRA) does not translate into adequate perfusion at the tissue level. We hypothesised that deterioration of epicardial blood flow in early reperfusion may identify early signs of coronary microvascular injury. METHODS: In 272 consecutive patients (age 56.9+/-10.4 years) with AMI treated by primary angioplasty (PCI), coronary blood flow (Trombolysis in Myocardial Infarction (TIMI) scale and corrected TIMI frame count (cTFC)) was evaluated before [B], immediately after [O] and 15 min after [O15] opening of the IRA. The sum of ST-segment elevation in standard ECG leads (sigmaST) was measured at [B], at [O15] and 24 h after [C24]. Microvascular injury was assessed by indexes STi(O15)=sigmaST(O15)/sigmaST(B), STi(C24)=sigmaST(C24)/sigmaST(B), and by peak CK-MB release. Coronary flow deterioration (cTFC(DET)) was defined as the difference between cTFC(O15) and cTFC(O). RESULTS: TIMI-3 flow was achieved in 236 (90.8%) patients at [O]. In the early phase of reperfusion (between [O] and [O15]), TIMI flow deteriorated by >/=1 point in 19 (7.3%) patients despite angiographic optimisation of the PCI result. At [O15] 224 (86.2%) patients had TIMI-3 flow (reflow), 36 (13.8%) patients had TIMI</=2 flow (no-reflow). cTFC(DET) was 30.2+/-16.5 in the no-reflow group but only 7.5+/-4.0 in the reflow group (p<0.001). cTFC(DET) showed a significant correlation with STi(O15) (r=0.63; p<0.001), STi(C24) (r=0.62; p<0.001) and peak CK-MB (r=0.36; p=0.001). In conclusion, we found that an increase in corrected TIMI frame count following successful IRA opening in AMI is an early angiographic indicator of coronary microvascular injury.

Adult↗
PubMed2004

Use of the Parodi Anti-Emboli System and transient subclavian steal for cerebral protection during emergent vertebral artery recanalization.

PURPOSE: To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent vertebral artery recanalization. CASE REPORT: A 56-year-old chimney sweep was referred with recurrent episodes of vertigo and gait ataxia. Left vertebral artery (LVA) flow was barely detectable on duplex Doppler, and brain computed tomography revealed a small infarct in the posterior inferior cerebellar artery territory. Angiography showed subtotal ostial stenosis of the LVA with poor distal flow and possible thrombus. Due to a high risk of distal embolization with percutaneous treatment, anticoagulation was initiated, and the lesion was to be re-evaluated in 2 to 3 weeks. However, 2 days later, the patient developed severe, aggravating headache, gait and left-limb ataxia, horizontal nystagmus, and vomiting. Emergent angiography showed a total ostial LVA occlusion. The PAES was employed to elicit a temporary subclavian steal during percutaneous LVA recanalization, thus protecting the brain from embolization. The ostial LVA was successfully recanalized and stented, with immediate symptom cessation. CONCLUSIONS: The PAES can be successfully applied in the subclavian artery to prevent distal embolization during emergent vertebral artery recanalization. Since a significant proportion of vertebral strokes are embolic, PAES may play a novel role in the treatment of acute cerebellar stroke.

Angioplasty, Balloon↗
PubMed2004

The value of myocardial contrast echocardiography compared with SPECT in detecting myocardial perfusion abnormalities in patients with anterior acute myocardial infarction.

BACKGROUND: Microvasculature damage after myocardial infarction (MI), known as "no-reflow" phenomenon, may occur in some patients with acute MI in spite of invasive treatment and opened infarct-related coronary artery. There are several non-invasive and invasive methods used for the coronary flow assessment at the tissue level. AIM: To compare the value of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute MI with (99m)Tc MIBI SPECT study. METHODS: Sixteen patients (11 males, 5 females, mean age 55.4+/-10.2 years) underwent primary coronary angioplasty or facilitated angioplasty (with reduced dose of a fibrinolytic drug and glycoprotein IIb/IIIa inhibitor) (PCI) for acute anterior MI. TIMI grade flow, TIMI Myocardial Perfusion Grade (TMPG), corrected TIMI frame count (cTFC), wall motion score index (WMSI) and segmental perfusion by myocardial contrast echocardiography (MCE) were estimated in real time before and immediately after PCI. MCE was repeated on the third day after PCI. All patients underwent (99m)Tc MIBI SPECT study (SPECT) while at rest on the third day after PCI. The area at risk was defined as the number of segments with no perfusion before angioplasty. Reflow was defined as an increase in contrast score in the same segments after angioplasty. RESULTS: Baseline MCE showed 95 segments with perfusion defects. Immediately after PCI, 77 segments were found with perfusion defect; in 10 patients improvement of myocardial perfusion was observed whereas in 6 patients perfusion defect remained unchanged. On the third day further improvement was observed in 8 patients. The number of segments with perfusion defect decreased to 53. SPECT detected perfusion defect in 54 segments. The agreement between MCE and SPECT for detecting perfusion abnormality was 98% (kappa 0.94). CONCLUSIONS: MCE is a safe technique for detecting myocardial perfusion in patients with acute MI. MCE proves that both primary and facilitated angioplasty improve myocardial perfusion in two thirds of patients with acute MI. Serial MCE allows identification of patients with both early and late improvement of myocardial perfusion. There is a very strong correlation between MCE and SPECT in the assessment of perfusion defects.

Aged↗
PubMed2004

[Primary percutaneous coronary interventions in acute myocardial infraction with ST-segment elevation. Experience in a heart catheterization unit without surgical backup].

BACKGROUND: Primary percutaneous coronary intervention (PCI) in patients (pts) with ST-segment elevation myocardial infarction is regarded as treatment superior to thrombolysis. Coronary stents and GP IIb/IIIa receptor inhibitors improved safety and clinical outcome of interventional procedures. Safety of primary PCI procedure in catheterisation laboratories which do not have on-site surgical backup is still under evaluation. METHODS: In a cohort of 249 consecutive patients we analysed short and long-term clinical outcome of primary PCI performed in catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time < 30 minutes. RESULTS: Coronary stents were implanted in 43% pts. GP IIb/IIIa receptor inhibitors were used in 54.2% pts. Cardiogenic shock on admission was diagnosed in 7.2% pts. Intra-aortic balloon counterpulsation usage was necessary in 6.4% pts. In-hospital mortality was 6% (3.5% in non-shock pts). In two pts (0.8%) during hospitalization repeat PCI was performed--in one case due to reinfarction. No urgent cardiosurgery intervention was necessary. Mortality and myocardial infarction rate after hospital discharge during 6 month follow up was 2.4% and 2.8% respectively. In 4% pts repeated PCI was performed due to restensosis. Cumulative event free survival was 84%. CONCLUSION: Primary PCI procedure for acute myocardial infarction seems to be feasible and safe in catheterisation laboratories without on-site surgical backup provided usage of stents, GPIIb/IIIa receptor inhibitors and intraaortic balloon counterpulsation and cooperation with a nearby cardiosurgery department with short transfer time.

Aged↗
PubMed2004

Primary coronary angioplasty in patients with ST segment elevation acute myocardial infarction and diabetes.

BACKGROUND: Subjects with diabetes constitute 13-25% of patients with ST segment elevation acute myocardial infarction (STEMI). In spite of the introduction of thrombolytic therapy, patients with STEMI and diabetes continue to have worse prognosis than those without diabetes. Primary percutaneous coronary intervention (PCI) has been shown in recent years to be the most effective therapy in patients with STEMI. AIM: To compare the outcome of STEMI patients with or without diabetes who underwent primary PCI. METHODS: The study group consisted of 500 consecutive patients with STEMI. The occurrence of major adverse cardiac events (MACE) which included death, reinfarction or repeated PCI of the target vessel, was analysed peri-operatively and during a six-month follow-up period.Results. Diabetes was diagnosed in 68 (13.6%) patients. The mean time duration from the onset of STEMI symptoms to treatment was similar in patients with or without diabetes (230+/-97 min vs 231+/-139 min, NS). Patients with diabetes were older (61.9+/-8.9 vs 57.9+/-10.8 years, p=0.004), had higher body mass index (29+/-4 vs 27+/-5, p=0.002), more frequent history of coronary artery disease (57.4% vs 37.9%, p=0.002), higher prevalence of arterial hypertension (71.6% vs 56.8%, p=0.02) and more frequently the left anterior descending artery as the infarct-related artery (58.8% vs 42.1%, p=0.01). Immediately after PCI, epicardial and myocardial reperfusion rates were lower in patients with rather than without diabetes (TIMI 3: 84.9% vs 91.3%, p=NS, cTFC: 32+/-26 vs 22+/-16, p<0.0001, and MPG3: 25% vs 41.9% p=0.008). Diabetes increased the risk of MACE during in-hospital period by 2.7 times. The rate of MACE during a six-month follow-up period was almost two times higher in patients with rather than without diabetes (death: 8.8% vs 5.1%, reinfarction: 1.5% vs 1.2%, repeated PCI: 11.8% vs 6.9%). CONCLUSIONS: Primary PCI-achieved epicardial and myocardial reperfusion rate is lower in STEMI patients with rather than without diabetes. The presence of diabetes almost doubles the risk of MACE during a six-month follow-up.

Aged↗
PubMed2004

[Use of coronary artery multislice spiral computed tomography (MSCT) to identify patients for surgical revascularisation].

Conventional coronary angiography is the undisputed gold standard for the detection of coronary artery disease. A small but not negligible risk related to the procedure, cost, and radiation exposure have given rise to the development of noninvasive alternatives such as multi-slice computed tomography, and magnetic resonance coronary angiography. In some patients classic X-ray coronary angiography involves high risk and technical difficulties. Fast, non-complicated and easy to use non-invasive imaging procedures should be developed to avoid unnecessary or technically difficult, uncomfortable situations for patients with documented myocardial ischemia. We present three cases of patients who underwent coronary artery bypass graft surgery or were disqualified from it on the basis of MSCT imaging.

Aged↗