Search

Aims: Reevaluation of clinical and angiographic predictors for percutaneous recanalization of coronary chronic total occlusion (CTO) using current techniques with conventional PTCA wires and balloons. Methods and Results: We studied 253 consecutive patients with 283 lesions who underwent attempted PTCA of CTO (mean time since occlusion 33 months, range 3–150 month). Immediate procedural success rate was 84.8% (95% CI = 80.3%–88.6%). Multiple clinical and angiographic characteristics were evaluated as possible predictors of success/failure. Multiple logistic regression analysis revealed that a tapered morphology (P < 0.001, OR = 6.1; 95% CI = 2.1–18.2), ≤45 degree of angulations of the target artery (P < 0.03, OR = 4.5; 95% CI = 1.2–17.2), length of occlusion

Angioplasty in patients with unstable coronary artery disease is associated with higher complication rates compared with patients with stable disease. In this report we describe our results from a group of patients with unstable disease (unstable angina pectoris and postmyocardial infarction) where a strategy of delaying angioplasty for5 days after admission was undertaken. Included are 2069 consecutive patients: 1197 treated for stable angina pectoris and 872 treated during admission for unstable angina or myocardial infarction. There was no difference between the two groups in angioplasty success (92.1% stable, 92.3% unstable), failure to dilate without complication (6.4% stable, 6.1% unstable), or in the rate of major complications: death (0.5% stable, 1.1% unstable), Q-wave myocardial infarction (0.9% stable, 1.1% unstable), and emergency coronary artery bypass (0.6% stable, 0.3% unstable). The duration of hospitalization following angioplasty was longer in the unstable group (5.6 +/- 8.1 days vs. 4.2 +/- 4.1 days; p0.001) because of longer duration of heparin infusion. There was no difference between groups in minor complications such as groin hematoma and pseudoaneurysm, renal failure, or infections. It was concluded that delaying angioplasty in unstable patients for5 days after admission is a safe and effective therapeutic strategy for this group of patients. The need for prolonged heparin infusion after angioplasty is increased in unstable patients and thus the duration of hospitalization after the procedure is longer.

1. In 24 patients who were undergoing coronary arteriography for the assessment of ischaemic heart disease, the relationship between the systemic and coronary vascular responses to acute intravenous digoxin administration (500 μg) and concurrent drug therapy with the calcium antagonist verapamil (group I) or a β-adrenoceptor antagonist (group II) or neither of these agents (group III) was examined. 2. Systemic vascular resistance (SVR) tended to rise rapidly after digoxin injection in patients in groups II and III, and tended to decline initially in patients in group I; however, these differences were not statistically significant (variance ratio [VR] = 0.77). 3. No significant differences were observed in coronary vascular responses to acute digoxin administration between the three groups of patients (VR = 0.34). 4. For the entire group of 24 patients, no statistically significant digoxin-induced effects on resistance could be demonstrated in either the systemic or coronary circulations, although in individual patients vasoconstrictor effects were observed. 5. We conclude that acute intravenous administration of digoxin does not consistently cause systemic or coronary vasoconstriction in patients with ischaemic heart disease. Variability in vasomotor responses to digoxin is not clearly related to concurrent drug therapy with verapamil or a β-adrenoceptor antagonist. The observation that systemic vascular resistance tends to increase in the first few minutes after digoxin injection should be addressed in future studies.

The mechanism of cardiopulmonary resuscitation is still debated. Two different theories have been proposed: direct cardiac compression versus intrathoracic pressure. A patient with dilated right cardiac chambers, who underwent a transesophageal echocardiography study during cardiopulmonary resuscitation, is reported. The direct compression mechanism was clearly demonstrated.

This report describes two patients with the combination of a coronary artery fistula from the left anterior descending artery (LAD) to the pulmonary artery together with hypertrophic cardiomyopathy.

We studied retrospectively 26 readily obtainable clinical and electrocardiographic variables in 22 consecutive patients who experienced primary ventricular fibrillation in association with an episode of acute myocardial infarction. Twenty-eight consecutive patients who had an uncomplicated course after acute myocardial infarction served as controls. The clinical profile of the two groups was similar except that patients who had primary ventricular fibrillation smoked more and had a higher peak creatinine phosphokinase level at the time of infarction. The data was evaluated using univariate and stepwise logistic regression analysis. This analysis demonstrated that patients who developed primary ventricular fibrillation had, on admission (1) more evidence of congestive heart failure (Killip classification), (2) a lower diastolic blood pressure, (3) greater ST-segment elevation, (4) a longer QTc interval, and (5) a less distinguishable J point on the electrocardiogram. This method of logistic analysis that utilizes easily obtainable hospital admission data serves as a preliminary model for prediction of the relative risk of primary ventricular fibrillation in a patient with acute myocardial infarction. The ability to identify patients at risk has important therapeutic implications.

We describe the installation and clinical application of a two-channel monitoring system in the intensive coronary care unit using a single patient cable and two exchangeable ECG modules. Routine use of this system during a period of three years has shown that it has many advantages in the precise documentation and diagnosis of transient cardiac arrhythmias and for the recognition and localization of ischemic episodes.

Two patients with classical effort-induced angina pectoris associated with abnormal ST-segment depression on graded exercise testing and normal coronary arteriograms are described. Both patients deteriorated during treatment with propranolol, and became asymptomatic during treatment with verapamil with normal graded exercise tests. Verapamil may thus improve an inadequate vasodilatatory response of the coronary vascular bed to effort.

The tip of a “high-torque” floppy guide wire became entrapped in a coronary artery during elective PTCA in four patients. In two it was removed through the guiding catheter, in the third an operative intervention was needed in order to free the wire, and in the fourth the remnant was left in situ. Interventional cardiologists should be aware of this potential complication.