Document Detail


Effectiveness of primary percutaneous coronary interventions for stent thrombosis.
MedLine Citation:
PMID:  19327415     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There are very few (and conflicting) data about the effectiveness of primary percutaneous coronary interventions (PCIs) for stent thrombosis (ST) treatment. We sought to evaluate the prevalence, efficacy, and outcomes of primary PCI in patients with ST-elevation acute myocardial infarction (STEMI) due to ST in 2,464 consecutive patients treated by primary PCI. ST was the cause of STEMI in 67 patients (3%). Patients with ST showed a lower rate of significant collateral circulation (0% vs 6%, p = 0.034) and a higher peak creatine kinase value (2,678 +/- 3,221 vs 2,375 +/- 2,189 U/L, p = 0.003) compared with the other 2,397 patients with STEMI. PCI was successful in 64 patients (96%) in the ST group and consisted of additional stenting (78%) or only balloon angioplasty (22%). Abciximab and rheolytic thrombectomy were used in 75% and 31% of patients, respectively. Procedure (39 +/- 26 vs 32 +/- 19 minutes, p = 0.0001) and fluoroscopy (13 +/- 10 vs 10 +/- 8 minutes, p = 0.0001) times were longer, and contrast medium amount (221 +/- 89 vs 194 +/- 103 ml, p = 0.034) larger in patients with ST compared with patients with de novo STEMI. Six-month death (12% vs 8%, p = 0.216) and nonfatal reinfarction (10% vs 1%, p = 0.0001) rates were higher in patients with ST compared with those without. At 6-month angiographic follow-up (n = 1,843 of 2,269), the restenosis/reocclusion rate was 54% versus 17% (p = 0.0001) in patients with and without ST. In conclusion, the prevalence of primary PCI for ST is low. Additional stenting with or without thrombectomy is effective in restoring vessel patency in patients with ST, but restenosis and reocclusion are frequent. ST treated with successful PCI is associated with a large infarct and poor outcome.
Authors:
Guido Parodi; Gentian Memisha; Benedetta Bellandi; Renato Valenti; Angela Migliorini; Nazario Carrabba; Ruben Vergara; David Antoniucci
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-02-07
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-30     Completed Date:  2009-04-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  913-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Careggi Hospital, Florence, Italy. parodiguido@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / instrumentation*
Coronary Angiography
Drug-Eluting Stents*
Electrocardiography
Female
Follow-Up Studies
Graft Occlusion, Vascular / complications,  epidemiology,  therapy*
Humans
Incidence
Italy / epidemiology
Male
Myocardial Infarction / diagnosis,  etiology,  therapy
Prospective Studies
Survival Rate / trends
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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