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"Pharmacologic" distal protection using prophylactic, intragraft nicardipine to prevent no-reflow and non-Q-wave myocardial infarction during elective saphenous vein graft intervention.
- Source :
-
The Journal of invasive cardiology [J Invasive Cardiol] 2007 Feb; Vol. 19 (2), pp. 58-62. - Publication Year :
- 2007
-
Abstract
- Background: Coronary saphenous vein bypass graft (SVG) stenting has been associated with up to a 30% rate of no-reflow or myocardial infarction (MI) when performed without distal protection.<br />Methods: We evaluated the technique using prophylactic pharmacologic arteriolar vasodilatation with intracoronary nicardipine followed by immediate direct stenting for the treatment of degenerated coronary SVGs without mechanical distal protection. Data were collected from 83 consecutive elective SVG interventions in 68 patients. Quantitative coronary angiographic measurements were performed by the Borgess angiographic core lab. Electrocardiograms (ECGs), CPKs, and CPK-MBs were obtained preprocedure and at 12 to 18 hours after the intervention. Follow-up data at 30 days were obtained in 67/68 (98%) patients.<br />Results: The average graft age was 11.9 +/- 6.6 years with thrombus in 26/83 vessels (31%). The primary adverse endpoint of total CPK >3 times the upper limit of normal (ULN), or CPK-MB >3 times the ULN were seen in 1/68 (1.5%) and 3/68 (4.4%) patients, respectively. No-/slow-reflow was observed transiently in 2/83 SVG interventions (2.4%). Of the patients, 1/68 had persistent, minor ECG changes after stenting (1.4%). No patient had a Q-wave MI. Inhospital major adverse cardiac events (MACE) (death, MI, repeat TLR) were observed in only 3/68 patients (CPK-MB elevation). There were no additional MACE events (0/68) from hospital discharge to 30 days.<br />Conclusions: (1) Prophylactic vasodilatation with intragraft nicardipine followed by direct stenting appears to be a safe and effective means of performing elective SVG revascularization; (2) this approach may provide a simple and time- and cost-effective alternative or adjunct to mechanical distal protection for elective SVG interventions.
- Subjects :
- Aged
Cardiac Catheterization methods
Coronary Angiography
Coronary Artery Bypass methods
Coronary Vessels drug effects
Coronary Vessels physiopathology
Cost-Benefit Analysis
Electrocardiography
Female
Graft Occlusion, Vascular drug therapy
Humans
Male
Myocardial Infarction physiopathology
Nicardipine administration & dosage
Nicardipine economics
Regional Blood Flow drug effects
Saphenous Vein pathology
Stents adverse effects
Treatment Outcome
Vasodilation drug effects
Vasodilator Agents administration & dosage
Vasodilator Agents economics
Graft Occlusion, Vascular surgery
Myocardial Infarction etiology
Myocardial Infarction prevention & control
Nicardipine therapeutic use
Saphenous Vein transplantation
Vasodilator Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1557-2501
- Volume :
- 19
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of invasive cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 17268038