In-hospital outcome in patients presenting with acute coronary syndrome with left main coronary artery disease: A report from Japanese prospective multicenter percutaneous coronary intervention registry.

In-hospital outcome in patients presenting with acute coronary syndrome with left main coronary artery disease: A report from Japanese prospective multicenter percutaneous coronary intervention registry. J Cardiol. 2019 Dec 30;: Authors: Tani H, Sawano M, Numasawa Y, Kobayashi Y, Suzuki M, Noma S, Shiraishi Y, Ueda I, Fukuda K, Kohsaka S Abstract BACKGROUND: Patients presenting with acute coronary syndrome (ACS) from left main (LM) disease are at a high risk for mortality despite recent advancement in devices and techniques during percutaneous coronary interventions (PCI). We aimed to evaluate patient characteristics, clinical presentations, and key clinical characteristics associated with adverse in-hospital outcomes among ACS patients undergoing LM-PCI. METHODS: We retrospectively identified 280 LM-ACS patients (3.7 %) from 7608 ACS patients in the prospective multicenter Japan Cardiovascular Database-Keio Inter-Hospital Cardiovascular Studies registry from March 2009 to May 2016 and divided them into those with/without PCI/coronary artery bypass grafting. We compared baseline demographics, coronary lesion characteristics, PCI details, and short-term outcomes, including in-hospital mortality and periprocedural complications, between the two groups. RESULTS: Among LM-ACS patients, 38.6 % presented with ST elevation myocardial infarction, 29.6 % with cardiogenic shock (CS), and 15.4 % with cardiac arrest. The observed in-hospital mortality rate...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research

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Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract BACKGROUND: Despite the increasing number of patients after percutaneous coronary intervention (PCI) requiring coronary artery bypass grafting (CABG), studies on the impact of these procedures on surgical revascularisation outcomes are sparse. Furthermore, advances in cardiology require reassessment of their potential prognostic significance. AIM: We sought to assess the influence of previous PCI on CABG outcomes. METHODS: A total of 211 consecutive patients scheduled for CABG were enrolled into this prospective study. Patients after PCI (group 1, n = 99) were compared with subjects with no hist...
Source: Kardiologia Polska - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
This case comes from Sam Ghali  (@EM_RESUS). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs:HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98%This is his 12-Lead ECG:He is in atrial fibrillation with a rapid ventricular response at a rate of around 140 bpm. There are several abberantly conducted beats. There is ST-Elevation in aVR of several millimeters and diffuse ST-Depression with the maximal depression vector towards Lead II in the limb leads and towards V5 in the precordial leads.ECG reading is all ab...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
In this issue of the Journal, Rohn et al. report their experience with urgent coronary bypass graft surgery (CABG) for patients with ST-segment elevation acute myocardial infarction (STEMI), operated within 24hours of the onset of symptoms [1]. This usually occurred in the situation where percutaneous coronary intervention (PCI) with balloon or stent had either failed or was not possible. They report their results on 135 patients, documenting an early mortality of 8.1%, and demonstrating that the major risk factor for early death is poor haemodynamic status at presentation, measured as either Killip class or with cardiogenic shock.
Source: Heart, Lung and Circulation - Category: Cardiology Authors: Tags: Editorial Source Type: research
CONCLUSIONS: The revascularized HF patients had a similar mortality and higher risk of death or hospitalizationsat 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality. PMID: 28980296 [PubMed - as supplied by publisher]
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
Background— Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations. Methods and Results— A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment–elevation myocardial infarction, and 80% had anterior myocardial infarctio...
Source: Circulation: Cardiovascular Interventions - Category: Cardiology Authors: Tags: Myocardial Infarction, Angiography, Percutaneous Coronary Intervention, Complications Coronary Artery Disease Source Type: research
Conclusion Primary PCI for acute STEMI is feasible in our setup and associated with high success rate, low mortality in non-shock patients and low complication rates.
Source: Indian Heart Journal - Category: Cardiology Source Type: research
CONCLUSION: Even though the clinical and peri-procedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG. PMID: 27554363 [PubMed - as supplied by publisher]
Source: Archivos de Cardiologia de Mexico - Category: Cardiology Authors: Tags: Arch Cardiol Mex Source Type: research
This article collected 20 nonagenarians who were proved to have significant coronary lesions. Of them, 2 were treated with CABG, 6 with medical treatment and 12 with PCI. For the 12 patients treated with PCI, a control group of 48 patients with ages younger than 90 years was collected from the same institution for comparison. On reading this article, it may be safe to conclude that age itself is not a limitation for adapting PCI to treat the elderly patient, whether he or she is 65 years old or 95 years old. But the associated conditions, including general condition, anatomic changes, co-morbid conditions, etc., should be ...
Source: Journal of Indian College of Cardiology - Category: Cardiology Source Type: research
Conclusions In patients presenting with syncope and obstructive CAD, PCI was not associated with significant improvements in the risk of readmission, but was associated with lower long-term mortality compared with medical therapy, suggesting the need to more definitively assess the benefit of PCI among elderly syncope patients.
Source: American Heart Journal - Category: Cardiology Source Type: research
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