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Biomedical subjects

L Bolognese

Publications and source records attributed to L Bolognese.

At least 37 records · Page 2Linked to original sources
PubMed1999

Doppler-derived mitral deceleration time: an early strong predictor of left ventricular remodeling after reperfused anterior acute myocardial infarction.

BACKGROUND: The relation between remodeling and left ventricular (LV) diastolic function has not yet been fully investigated. The aim of this study was to determine whether early assessment of Doppler-derived mitral deceleration time (DT), a measure of LV compliance and filling, may predict progressive LV dilation after acute myocardial infarction (AMI). METHODS AND RESULTS: Fifty-one patients (aged 61+/-11 years; 6 women) with anterior AMI successfully treated with direct coronary angioplasty underwent 2-dimensional and Doppler echocardiographic examinations within 24 hours of admission, at days 3, 7, and 30 and 6 months after the index infarction. Mitral flow velocities were obtained from the apical 4-chamber view with pulsed Doppler. End-diastolic volume index (EDVI) and end-systolic volume index (ESVI) were calculated with the Simpson's rule algorithm. Patients were divided according to the DT duration assessed at day 3 in 2 groups: group 1 (n=33) with DT >130 ms and group 2 (n=18) with DT </=130 ms. Patency and restenosis rate at 6 months were similar between the 2 groups (94% group 1 vs 89% group 2; P=0.52; 27% group 1 vs 33% group 2; P=0.64, respectively). LV volume indexes were similar in both groups at baseline (EDVI: 71+/-3 group 1 vs 70+/-3 mL/m2 group 2, P=0.42; ESVI: 43+/-3 group 1 vs 48+/-3 mL/m2 group 2, P=0.13, respectively). From day 3 on, LV volume indexes progressively increased in group 2 and were significantly larger than those of group 1 at 6 months (LVEDVI 61+/-3 group 1 vs 104+/-6 mL/m2 group 2, P=0.00001; LVESVI 31+/-3 group 1 vs 73+/-6 mL/m2 group 2, P=0.00001, respectively). A significant inverse correlation was found between DT and changes in EDVI at 6 months (r=-0.68; P<0.0000001). By stepwise multiple regression analysis among several clinical, demographic, angiographic, and echocardiographic variables, DT was the most powerful predictor of EDVI changes at 6 months (P=0.02). CONCLUSIONS: These data suggest that early estimation (day 3) of Doppler-derived mitral DT provides a simple and accurate mean to predict late LV dilation after reperfused AMI.

Adult↗
PubMed1999

Systematic primary angioplasty in octogenarian and older patients.

BACKGROUND: There are conflicting data about the efficacy of aggressive treatment and early intervention among high-risk patients with acute myocardial infarction (AMI), such as elderly patients. This study sought to determine the short- and long-term outcome of octogenarian and older patients after primary percutaneous transluminal coronary angioplasty (PTCA). METHODS: In our tertiary referral center a program of primary PTCA was begun in 1995, and the systematic care for AMI included primary PTCA in all patients with AMI, with no age restriction. Over a period of 3 years, 55 octogenarian or older patients underwent primary PTCA. RESULTS: Between January 1995 and July 1998, 719 patients with AMI underwent primary PTCA. Of these, 55 patients were octogenarians or older (mean age, 84 +/- 3 years). Primary PTCA failure occurred in 3 (5%) patients. An optimal acute angiographic result was achieved in 51 (93%) patients. Stenting of the infarct vessel was accomplished in 33 (60%) patients. The 30-day mortality rate was 16%. The mortality rate was 4% in patients without cardiogenic shock on presentation and 70% in patients with cardiogenic shock. The recurrent ischemia rate was 13% and resulted in nonfatal reinfarction in 2 patients and repeat PTCA in 5 patients. As determined by multivariate analysis, an optimal acute angiographic result and cardiogenic shock were significantly related to mortality. The 1-year survival rate was 77%. CONCLUSIONS: The results of this study suggest that the benefits of primary PTCA apply to the very elderly and support an early aggressive strategy for this high-risk patient subset.

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PubMed1999

Early predictors of left ventricular remodeling after acute myocardial infarction.

Ventricular remodeling after acute myocardial infarction is characterized by alteration in left ventricular (LV) size, shape, and wall thickness and involves both the infarcted and the noninfarcted regions of the ventricle. These structural changes are the result of several distinct pathologic processes that contribute to progressive LV dilation: rearrangement of wall structure, myocyte hypertrophy, and increasing muscle mass without an increase in wall thickness (eccentric hypertrophy). The pathogenesis of LV remodeling is multifactorial. Multiple factors may in fact contribute at different stages from the time of coronary occlusion until the development of ventricular dilation: These include the magnitude of the loss of contractile elements, the abrupt alteration in systolic and diastolic loading conditions, the activation of circulating neurohormones and local autocrine trophic factors, and the patency of the infarct-related artery. Although remodeling occurring early after infarction may be an appropriate compensatory response to preserve ventricular function, recent observations have suggested that this long process has a deleterious effect on LV function and prognosis. Thus attempts to inhibit these structural changes have been the focus of recent experimental and clinical studies. This review focuses on interactive factors that influence postinfarction LV remodeling, emphasizing the role of some new emerging determinants such as the extent of surviving myocardium within the infarcted and noninfarcted zones.

Autocrine Communication↗
PubMed1999

Detecting myocardial salvage after primary PTCA: early myocardial contrast echocardiography versus delayed sestamibi perfusion imaging.

UNLABELLED: The extent of myocardial salvage after primary percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (AMI) is variable and cannot be predicted on the basis of either vessel patency or early regional wall motion assessment. The aim of this study was to evaluate the reliability of microvascular integrity, as shown by myocardial contrast echocardiography (MCE), as an indicator of tissue salvage and a predictor of late functional recovery, and to compare MCE with the quantification of tracer activity in sestamibi perfusion imaging. METHODS: Twenty-six patients with AMI who received successful treatment with primary PTCA were examined with MCE during cardiac catheterization immediately before and after vessel recanalization. Myocardial contrast effect was scored as 0 (absent), 0.5 (partial) or 1 (normal). Wall motion was assessed by two-dimensional echocardiography on admission and 1 mo later with a 16-segment model and 4-point score. Resting sestamibi SPECT was collected within 1 wk after AMI. The risk area was defined by MCE as the sum of the segments with no perfusion (score 0) before PTCA. Myocardial viability was defined by MCE as an increase in contrast score in the same segments after PTCA and by sestamibi SPECT as a preserved tracer activity (>60% of peak activity). The functional recovery after 1 mo detected by two-dimensional echocardiography was the reference standard for viability. RESULTS: A total of 50 segments showed perfusion defects before PTCA (risk area). Immediately after PTCA, the MCE score increased in 44 of 50 segments, whereas sestamibi SPECT showed preserved activity in 22 of 50 segments. After 1 mo, the wall motion score decreased in 22 of 50 segments (viable segments) and was unchanged in the remaining 28 segments. Thus, MCE showed a sensitivity of 91% and a specificity of 14% in detecting viable myocardium, whereas sestamibi SPECT showed a lower sensitivity (68%) but a significantly higher specificity (75%; P < 0.00001). The positive predictive values were 45% and 68% for MCE and SPECT (P < 0.005), respectively, and the negative predictive values were 67% and 71%, respectively. On a patient basis, SPECT was more specific (79% versus 21%; P < 0.01) and showed a higher overall predictive accuracy (88% versus 50%; P < 0.01) than MCE. CONCLUSION: The demonstration of microvascular integrity by MCE performed immediately after primary PTCA has a limited diagnostic value in predicting salvaged myocardium. Conversely, tracer activity quantification in resting sestamibi SPECT performed in a later stage is confirmed to be a reliable approach for recognizing myocardial stunning and predicting functional recovery.

Angioplasty, Balloon, Coronary↗
PubMed1999

Effectiveness of in-ward management of femoral access after invasive procedures using large sheaths.

BACKGROUND: The cost-effectiveness of expensive suture mediation devices for the management of femoral access is currently under investigation, while the effectiveness of in-ward femoral access management by standard care has not yet been assessed. METHODS: To determine whether a logistic model that includes management of femoral access by the cardiology ward staff is effective, 945 consecutive invasive procedures using > or = 8 Fr sheaths were prospectively screened over a 6-month study period. Vascular complications included: any need for surgical or endovascular repair, ultrasound-guided compression, any femoral or iliac bleeding requiring blood transfusion. RESULTS: During the study period there were 581 diagnostic procedures, and 364 interventional procedures. Interventional procedures included 98 primary PTCA, 42 coronary atherectomies, and 39 intraaortic balloon pump supported PTCA. Vascular complication rate was 1.6% (surgical repair 0.2%, ultrasound-guided compression 1.1%, blood transfusion 0.3%). CONCLUSIONS: The vascular access management by the cardiology ward staff was associated with a very low rate of vascular complications. This policy may play a role in reducing costs and improving logistics.

Aged↗
PubMed1999

Efficacy of a "stent-like" PTCA strategy in current clinical practice.

Retrospective analysis within the BENESTENT-l trial has shown that patients having a "stent-like" result after standard PTCA had angiographic and clinical outcomes similar to those of patients receiving a stent. The objective of this study is to assess the efficacy of a "stent-like" PTCA strategy in native coronary arteries in non-selected patients. From our data base, 503 consecutive patients who underwent successful PTCA or stent supported PTCA were stratified according to a target lesion length < 15 mm, a reference vessel diameter > or = 2.5 mm, and a postprocedural residual stenosis < 30%. After stratification, 132 patients with "stent-like" PTCA, and 88 with single stent implantation were compared on two-year clinical outcomes. Two-year event-free survival rate was 70% in the "stent-like" PTCA group, and 83% in the stent group (p = 0.022). Stent-like PTCA is associated with a higher restenosis rate and higher adverse events rate as compared to single stent supported PTCA, whatever the indication for stenting.

Aged↗
PubMed1999

[Systematic treatment of acute myocardial infarction with primary angioplasty. Early clinical and angiographic results and after 6 months].

UNLABELLED: Starting in 1995, at our institution all patients with acute myocardial infarction (AMI) who gave informed consent were treated by primary percutaneous transluminal coronary angioplasty (PTCA) without limitations in entry criteria. This report presents early and six-month clinical and angiographic results of the 720 patients (77% male, median age 64 years) treated by direct PTCA between January 1, 1995 and July 31, 1998. On admission, 33% of patients were in Killip class > 1, and 101 patients (14%) were in early cardiogenic shock. Optimal acute angiographic success (TIMI grade 3 flow with residual stenosis < 30%) was achieved in 683 patients (95%). Primary or unplanned stenting of infarct related artery (IRA) for a suboptimal or poor angiographic result after primary PTCA was performed in 454 patients (63%). The mean time from hospital arrival to recanalization was 62 +/- 28 min. At 30 days, the mortality rate was 4.9% (1.8% in Killip class < 4 patients and 24% in patients with cardiogenic shock). The reinfarction rate was 1.2%. At 30 days, coronary angiography showed restenosis or reocclusion of the IRA in 55 patients (8.9%). During the six-month follow-up (30-180 days), there were 11 deaths (1.5%) and 2 non-fatal reinfarctions (0.3%). At six months, the IRA patency rate was 95%, while the mean ejection fraction improvement in 422 patients with paired ventriculograms was 7%. Recurrent ischemia occurred in 144 patients (20%) and resulted in 7 deaths, 11 non-fatal reinfarctions and 126 repeat targeted vessel revascularization. CONCLUSIONS: The major finding of our experience is that direct coronary angioplasty may result in excellent early and late outcome in a population without limitations in entry criteria. The low mortality and the few recurrent myocardial ischemic events are connected with the high patency rate at 6 months. The extensive use of stents improves the angiographic results and the clinical outcome.

Adult↗
PubMed1998

Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty.

The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful direct angioplasty. Thirty-seven patients, successfully treated with direct angioplasty, underwent myocardial contrast echocardiography before and after angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of > or = 50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of > or = 30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.

Aged↗
PubMed1998

Preliminary experience with stent-supported coronary angioplasty in long narrowings using the long Freedom Force stent: acute and six-month clinical and angiographic results in a series of 27 consecutive patients.

This report describes our preliminary experience with coronary stent-supported angioplasty in long narrowings using a long stent with an innovative design. Twenty-seven consecutive patients with target lesions >20 mm in length had a stenting procedure using the Freedom Force long coronary stent (Global Therapeutics, Inc., Broomfield, CO). Target lesion length ranged from 20.7-57.5 mm (mean, 27.66+/-9.41 mm). A total of 35 stents was implanted with a mean stented length of 36.26+/-12.36 mm. The stenting procedure was successful in all patients. Single long stent implantation was performed in 19 patients, while 8 patients had double stent implantation. No major cardiac adverse events occurred during hospital stay. The restenosis rate at the 6-mo angiographic follow-up was 38% (follow-up rate, 96%). During follow-up, no major cardiac events such as death, myocardial infarction, or coronary artery surgery occurred, while 3 patients (11%), all with recurrent angina and angiographic restenosis, underwent repeat coronary angioplasty. Potential advantages of this innovative stent in long narrowings relate to its high flexibility in passing through long tortuous diseased segments, and in treating long lesions using only 1 or 2 stents.

Angioplasty, Balloon, Coronary↗
PubMed1998

Restenosis after coronary stenting in current clinical practice.

BACKGROUND: Randomized trials have demonstrated that planned coronary stenting may lower restenosis rate in patients with de novo short lesions. In a prospective study we sought to determine the frequency of restenosis, reocclusion, and adverse cardiovascular events after coronary stenting in a series of 258 consecutive nonselected patients, including those with complex lesions not fulfilling past and ongoing randomized trial criteria for stent implantation. METHODS: Criteria for stenting were as follows: (1) dissection associated with occlusion or threatened closure, (2) a residual percentage stenosis > 30% or nonocclusive dissection, (3) restenotic lesion or chronic total occlusion. RESULTS: In most cases (89%) the target lesion had two or more unfavorable morphologic characteristics, whereas only 11% of target lesions could be classified as type A or B1 lesions. Overall, the 6-month restenosis rate was 23%. By use of subgroup analysis restenosis rate was found to range widely, from 11% to 46%. With multivariate analysis, only four variables were found to be independently related to restenosis: age > 63 years (odds ratio [OR] = 2.651, p = 0.011), female sex (OR = 3.807, p = 0.002), lesion length > 12 mm (OR 3.185, p = 0.002), and type C lesion (OR 2.527, p = 0.014). CONCLUSIONS: Results from randomized trials on coronary stenting cannot be extrapolated to current clinical practice because most of the treated lesions do not fulfill the criteria adopted in these studies for stent implantation. The restenosis rate is nearly four times greater for long and complex lesions treated by multiple stent implantation as compared with simple lesions, and additional studies need to be performed to evaluate the efficacy of stenting on these lesions.

Adult↗
PubMed1998

Systematic direct angioplasty and stent-supported direct angioplasty therapy for cardiogenic shock complicating acute myocardial infarction: in-hospital and long-term survival.

OBJECTIVES: This prospective observational study was conducted to examine the apparent impact of a systematic direct percutaneous transluminal coronary angioplasty (PTCA) strategy on mortality in a series of 66 consecutive patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, and to analyze the predictors of outcome after successful direct PTCA. BACKGROUND: Previous studies have reported encouraging results with PTCA in patients with AMI complicated by cardiogenic shock, but a biased case selection for PTCA may have heavily influenced the observed outcomes. METHODS: All patients admitted with AMI were considered eligible for direct PTCA, including those with the most profound shock, and no upper age limit was used. The treatment protocol also included stenting of the infarct-related artery for a poor or suboptimal angiographic result after conventional PTCA. RESULTS: Between January 1995 and March 1997, 364 consecutive patients underwent direct PTCA, and in 66 patients AMI was complicated by cardiogenic shock. In patients with cardiogenic shock, direct PTCA had a success rate of 94%; an optimal angiographic result was achieved in 85%; primary stenting of the infarct-related artery was accomplished in 47%; and the in-hospital mortality rate was 26%. Univariate analysis showed that patient age, chronic coronary occlusion and completeness of revascularization were significantly related to in-hospital mortality. The mean follow-up period was 16 +/- 8 months. Survival rate at 6 months was 71%. Comparison of event-free survival in patients with a stented or nonstented infarct-related artery suggests an initial and long-term benefit of primary stenting. CONCLUSIONS: Systematic direct PTCA, including stent-supported PTCA, can establish a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in the great majority of patients presenting with AMI and early cardiogenic shock. High performance criteria, including new devices such as coronary stents, should be considered in randomized trials where mechanical revascularization therapy is being tested.

Adult↗
PubMed1998

A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.

OBJECTIVES: This study sought to compare stenting of the primary infarct-related artery (IRA) with optimal primary percutaneous transluminal coronary angioplasty (PTCA) with respect to clinical and angiographic outcomes of patients with an acute myocardial infarction. BACKGROUND: Early and late restenosis or reocclusion of the IRA after successful primary PTCA significantly contributes to increased patient morbidity and mortality. Coronary stenting results in a lower rate of angiographic and clinical restenosis than standard PTCA in patients with angina and with previously untreated, noncomplex lesions. METHODS: After successful primary PTCA, 150 patients were randomly assigned to elective stenting or no further intervention. The primary end point of the trial was a composite end point, defined as death, reinfarction or repeat target vessel revascularization as a consequence of recurrent ischemia within 6 months of randomization. The secondary end point was angiographic evidence of restenosis or reocclusion at 6 months after randomization. RESULTS: Stenting of the IRA was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 9% in the stent group and 28% in the PTCA group (p=0.003); the incidence of restenosis or reocclusion was 17% in the stent group and 43% in the PTCA group (p=0.001). CONCLUSIONS: Primary stenting of the IRA, compared with optimal primary angioplasty, results in a lower rate of major adverse events related to recurrent ischemia and a lower rate of angiographically detected restenosis or reocclusion of the IRA.

Adult↗
PubMed1998

[Rapid resolution of ST-segment elevation predicts functional recovery in acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty].

OBJECTIVES: This study was designed to prospectively assess the ability of the 12-lead electrocardiogram (ECG) and optimal ECG criteria to predict late functional recovery in patients with acute myocardial infarction (AMI) treated with primary coronary angioplasty (PTCA) BACKGROUND: A simple clinical method to predict clinical outcome in patients with reperfused AMI is highly desirable from a clinical point of view. METHODS: Seventy-five patients with AMI treated with successful PTCA (TIMI flow grade 3 and residual stenosis < 30%) underwent serial 12-lead ECG before PTCA and every hour for the first 6 hours and then at 9, 12, and 18 hours after PTCA. All patients underwent two-dimensional echocardiography before PTCA and 1 and 6 months later for the evaluation of regional wall motion. The ST segment level in the lead exhibiting the maximal ST elevation (ST increase max) and the sum of the ST segment elevation (sigma ST increases) were calculated on initial ECG and a cut-off values of > or = 50% reduction of ST increases max sigma ST increases elevation and sampling intervals were correlated with late functional recovery. A wall motion score index (WMSI: 1 = normal to 4 = dyskinesia) and 16-segment model were used. Reversible dysfunction was defined as a decrease of > or = 0.22 in WMSI. RESULTS: At univariate analysis a > or = 50% reduction of both ST increases max and sigma ST increases was related to late functional recovery. Multiple logistic regression analysis revealed that reduction of sigma ST increases was the most powerful predictor of late functional recovery (p = 0.008). A > or = 50% reduction of sigma ST increase within 4 hours of PTCA provided the optimal criterion for predicting late functional recovery. CONCLUSIONS: Rapid reduction of sigma ST increases elevation is an accurate predictor of left ventricular functional recovery in patients with AMI treated with primary PTCA. Optimal criteria include a reduction in sigma ST increases elevation > or = 50% within 4 hours of PTCA.

Adult↗
PubMed1997

Influence of infarct-zone viability on left ventricular remodeling after acute myocardial infarction.

BACKGROUND: The relation between residual myocardial viability after acute myocardial infarction (AMI) and ventricular remodeling has yet to be fully elucidated. We hypothesized that the presence of residual viability would favorably influence left ventricular remodeling after AMI and that serial changes in left ventricular dimensions might be related to the extent of myocardial viability in the infarct zone. METHODS AND RESULTS: Ninety-three patients with a first AMI successfully treated with primary coronary angioplasty underwent two-dimensional echocardiography within 24 hours of admission and low-dose dobutamine echocardiography at a mean of 3 days after AMI. Two-dimensional echocardiography and coronary angiography were obtained in all patients 1 and 6 months after coronary angioplasty. On the basis of dobutamine echocardiography responses, patients were divided in two subsets: those with (n=48; group I) and those without (n=45; group II) infarct-zone viability. There was no difference in minimal lesion diameter and infarct-related artery patency at 1 and 6 months between the two groups. Group II patients had significantly greater end-diastolic (76+/-18 versus 53+/-14 mL/m2; P<.0003) and end-systolic (42+/-17 versus 22+/-11 mL/m2; P<.0003) volumes at 6 months than did patients in group 1. The extent of infarct-zone viability was significantly inversely correlated with percent changes in end-diastolic volumes at 6 months (r=-.66; P<.000001) and was the most powerful independent predictor of late left ventricular dilation. CONCLUSIONS: After reperfused AMI, the degree of left ventricular dilation, when it occurs, is inversely related to the extent of residual myocardial viability in the infarct zone. Thus, the absence of residual infarct-zone viability discriminates patients who develop progressive left ventricular dilation after reperfused AMI from those who maintain normal left ventricular geometry.

Aged↗
PubMed1997

Rapid reduction of ST-segment elevation after successful direct angioplasty in acute myocardial infarction.

The aim of this study was to evaluate whether assessment of ST-segment changes in the 12-lead electrocardiogram from admission to 30 minutes after successful direct coronary angioplasty can predict myocardial damage and functional outcome in patients with acute myocardial infarction (AMI). Of 158 consecutive patients, 117 (92 men, aged 61 +/- 11 years) were prospectively classified into 2 groups: group 1, <50% reduction in ST-segment elevation in a single selected lead (42 patients); group 2, > or =50% reduction in ST-segment elevation (75 patients). Baseline characteristics were similar except for anterior wall AMI and Killip class >2, which were more prevalent in group 1. Peak creatine kinase was significantly higher in group 1 (3,690 +/- 2,809 vs 2,592 +/- 1,960 U/L; p = 0.018). One-month echocardiograms were obtained in 102 patients (87%). Infarct zone wall motion score index decreased in both groups, but this reduction was higher in group 2 (p <0.001). Functional recovery (>0.22 decrease in infarct zone wall motion score index) was observed in 34% of group 1 and in 78% of group 2 patients (p <0.001). One-month left ventricular ejection fraction was higher in group 2 (p <0.001). At multivariate analysis, reduction of ST-segment elevation was the only independent predictor of functional recovery (p <0.001). In conclusion, ST-segment analysis provides rapid and inexpensive information allowing identification of patients who are likely to benefit the most from myocardial reperfusion as early as 30 minutes after the last balloon inflation.

Adult↗
PubMed1997

Bailout coronary stenting without anticoagulation or intravascular ultrasound guidance: acute and six-month angiographic results in a series of 120 consecutive patients.

The purpose of this study was to evaluate the feasibility, safety, and efficacy of bailout coronary stenting without anticoagulation or intravascular ultrasound guidance in patients with acute or unequivocal threatened closure after conventional angioplasty. One hundred twenty consecutive patients were prospectively enrolled according to the following criteria: 1) acute or threatened closure after balloon angioplasty; 2) reference vessel diameter > or = 2.5 mm. All patients after stent implantation were on antiplatelet treatment with aspirin and ticlopidine. Four types of stents were used: Palmaz-Schatz (J&J), Gianturco-Roubin (Cook), Freedom (Global Therapeutics), and Microstent (AVE). Procedural results: a total of 206 stents were implanted in 134 target lesions with a stent deployment success rate of 100%; 44 target lesions were treated with multiple stent implantation; the mean luminal diameter after stenting was 3.14 +/- 0.34 mm, and the mean final percent diameter stenosis was -2 +/- 10%; the mean balloon to vessel ratio was 1.11 +/- 0.15; the mean final pressure inflation was 13.9 +/- 2.4 atm; an optimal angiographic result was achieved in 128 lesions (96%). In-hospital results: in-hospital recurrent ischemia occurred in 4 patients (3%); recurrent ischemia resulted directly in death in 1 patient, in nonfatal Q-waves infarction in 2 patients, and in emergency coronary artery surgery in 1 patient. Six-month clinical follow-up results: event free survival rate was 77%; 1 patient had non fatal infarction; the incidence of repeat revascularization procedures was 19%; there were no cardiac deaths. Angiographic follow-up results (follow-up rate 93%): the restenosis or reocclusion rate was 28%. Bailout coronary stenting without chronic anticoagulation treatment or intravascular ultrasound guidance may be considered a highly feasible and safe treatment for acute or threatened closure after failed angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1996

Direct angioplasty and stenting of the infarct-related artery in acute myocardial infarction.

This study provides the incidence of in-hospital and 1-month recurrent ischemia in 118 patients with acute myocardial infarction when an aggressive direct angioplasty strategy was performed, including stenting of the infarct artery. Coronary stenting in acute myocardial infarction is feasible, and acute and 1-month angiographic results after stenting seem superior to those after standard angioplasty alone.

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