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Titolo:
Clinical and angiographic outcome of patients with acute inferior myocardial infarction and right ventricular involvement treated with direct PTCA
Autore:
Giannitsis, E; Hartmann, F; Wiegand, U; Katus, HA; Richardt, G;
Indirizzi:
Univ Lubeck, Med Klin 2, D-23538 Luebeck, Germany Univ Lubeck Luebeck Germany D-23538 Med Klin 2, D-23538 Luebeck, Germany
Titolo Testata:
ZEITSCHRIFT FUR KARDIOLOGIE
fascicolo: 1, volume: 89, anno: 2000,
pagine: 28 - 35
SICI:
0300-5860(200001)89:1<28:CAAOOP>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
TISSUE-PLASMINOGEN-ACTIVATOR; ST-SEGMENT DEPRESSION; THROMBOLYTIC THERAPY; CORONARY ANGIOPLASTY; PROGNOSTIC-SIGNIFICANCE; REPERFUSION THERAPY; INTRAVENOUS STREPTOKINASE; IMMEDIATE ANGIOPLASTY; CARDIOGENIC-SHOCK; IMPACT;
Keywords:
primary angioplasty; right ventricular infarction; procedural success; follow-up;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Katus, HA Univ Lubeck, Med Klin 2, Ratzeburger Allee 160, D-23538 Luebeck,Germany Univ Lubeck Ratzeburger Allee 160 Luebeck Germany D-23538 rmany
Citazione:
E. Giannitsis et al., "Clinical and angiographic outcome of patients with acute inferior myocardial infarction and right ventricular involvement treated with direct PTCA", Z KARDIOL, 89(1), 2000, pp. 28-35

Abstract

Objectives: This study sought to determine the procedural success and the in-hospital outcome after primary coronary angioplasty in patients with acute inferior myocardial infarction and right ventricular involvement (RVI). Background: RVI represents an easily detectable, highly prevalent subset of acute inferior infarction associated with poor outcome even in the era ofthrombolysis. Primary PTCA may offer advantages in patients with inferior infarction involving the right ventricle. Methods: Primary coronary angioplasty with optional stenting was performedin 87 of 88 consecutive patients presenting within 24 hours after onset ofacute inferior myocardial infarction. On the basis of right precordial ST segment elevations at admission, patients were classified into those without (n = 61) and those with RVI (n = 27). The patients were followed prospectively for angiographic success at 10 days and for in-hospital clinical outcome. Results: Baseline characteristics including age, severity of coronary artery disease, proportion of stent implantation, and occurrence of cardiogenicshock were comparable. Patients with RVI had larger infarct sizes (lactatedehydrogenase level: 962 vs 580 U/l, p = 0.03), developed more often complete atrioventricular block (18.5 vs 2 %, p = 0.0038), needed more often parasymphatholytics (48.1 vs 14.8 %, p < 0.001), and had a substantially higher incidence of the Bezold-Jarisch reflex (29.6 vs 6.6 %, p < 0.01) following reperfusion. Success of recanalization therapy acutely and at 10 days, as well as in-hospital mortality were similar in patients with and without RVI (88.5 vs 85.2 %, 79.3 vs 84.7 %, 7.4 vs 9.8 %). However, patients with RVI revealed a greater lumen gain acutely after PTCA (2.49 vs 2.13 mm, p = 0.025) and experienced less frequently major cardiac events (14.8 vs 36.1 %, p = 0.03) which included reinfarction, re-ischemia, coronary bypass grafting, stent thrombosis, and cardiac death. In addition, procedural success was established more rapidly (fluoroscopy time: 10 vs 15 min, p = 0.032) and with less contrast material (242 vs 295 mi, p 0.015) in patients with RVI. This is probably due to the more proximal location (84.6 vs 6.6 %, p < 0.0001) and the larger reference diameter (3.17 vs 2.79 mm, p = 0.03) of the occluded right coronary artery. Conclusions: Primary PTCA is an appropriate reperfusion strategy in patients with RVI. Further comparative studies are required to compare the effectiveness of primary PTCA with early thrombolytic therapy in this high risk setting.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/01/20 alle ore 14:31:09