Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal ste...Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95(1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10(11%), subacute in 61(64%), and late in 24(25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86(91%), complicated by death in 2(2%), and coronary artery bypass grafting in 2(2%) patients. Myocardial infarction occurred in 77(81%) patients with a peak creatine kinase level of 1466±1570 U/L. Left ventricular ejection fraction declined from 0.54±0.19 prior to 0.48±0.16(P< 0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death(11%), reinfarction(16%), and recurrent stent thrombosis(12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow(OR=0.1, CI 95%0.01-0.54, P< 0.001) and diameter stenosis< 50%(OR=0.06, CI 95%0.01-0.32, P< 0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab(OR=4.3, CI 95%1.1-17.5). Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.展开更多
Background: Idiopathic ventricular tachycardia(VT) often originates from the r ight ventricular outflow tract (RVOT), but foci deep to the endocardium, in the epicardium, or in the left ventricle are not uncommon. Alt...Background: Idiopathic ventricular tachycardia(VT) often originates from the r ight ventricular outflow tract (RVOT), but foci deep to the endocardium, in the epicardium, or in the left ventricle are not uncommon. Although these extra-RVO T foci can be targeted with ablation, risks involved are higher and success rate s lower. Simple electrocardiographic(ECG) criteria allowing(1) discrimination of RVOT foci from extra-RVOT foci and(2) assessment of the chance of success of a right heart ablation procedure are desirable. Methods: Twenty-five consecutive patients referred for radiofrequency(RF) ablation of idiopathic VT or severely symptomatic idiopathic ventricular premature contractions were included. Localiz ation of VT origin and success rates of VT ablation in the RVOT were analyzed ac cording to the ECG pattern. Results: The analysis of the R wave in V2 was the st rongest single predictor of whether the VT had an RVOT or an extra-RVOT origin. An R wave amplitude ≥30%of the QRS amplitude designated the VT focus in the R VOT with positive and negative predictive values of 95 and 100%, respectively. Analysis of R wave duration in V2 had similar predictive values, whereas the R/S transitionzone in precordial leads had slightly lower predictive values. Sevent een of 20 arrhythmias(85%) with an R wave amplitude ≥30%of the QRS amplitude in V2 could be successfully abolished by an exclusively right heart procedure. C onclusions: The analysis of ECG pattern makes it possible to guide the manageme nt of patients with idiopathic VT in predicting the arrhythmias that can be safely targeted with RF ablation from the RVOT with high success rates. Copyright.展开更多
A 28-year-old woman suddenly has rapid palpitations accompanied by chest pain and dizziness while playing her cello. She is brought to an emergency department. She has a faint regular pulse of 190 beats per minute. He...A 28-year-old woman suddenly has rapid palpitations accompanied by chest pain and dizziness while playing her cello. She is brought to an emergency department. She has a faint regular pulse of 190 beats per minute. Her blood pressure is 82/54 mm Hg. Cardiovascular examination reveals no signs of heart failure. An electrocardiogram shows a regular tachycardia with a narrow QRS complex and no apparent P waves. How should her case be managed?展开更多
文摘Aims: To investigate the efficacy and outcome of emergency percutaneous coronary interventions(PCI) in patients with stent thrombosis. Methods and results: Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95(1.6%) patients suffered from stent thrombosis. The timing of stent thrombosis was acute in 10(11%), subacute in 61(64%), and late in 24(25%) patients. Procedural and clinical outcomes of emergency PCI for treatment of stent thrombosis were investigated. Emergency PCI was successful in 86(91%), complicated by death in 2(2%), and coronary artery bypass grafting in 2(2%) patients. Myocardial infarction occurred in 77(81%) patients with a peak creatine kinase level of 1466±1570 U/L. Left ventricular ejection fraction declined from 0.54±0.19 prior to 0.48±0.16(P< 0.05) at the time of stent thrombosis after emergency PCI. A 6 month major adverse clinical events comprised death(11%), reinfarction(16%), and recurrent stent thrombosis(12%) after emergency PCI. Multivariable logistic regression analysis identified the achievement of TIMI 3 flow(OR=0.1, CI 95%0.01-0.54, P< 0.001) and diameter stenosis< 50%(OR=0.06, CI 95%0.01-0.32, P< 0.001) during emergency PCI to be independently associated with a reduced risk of cardiac death. Recurrent stent thrombosis was independently predicted by the omission of abciximab(OR=4.3, CI 95%1.1-17.5). Conclusion: Emergency PCI for treatment of stent thrombosis effectively restores vessel patency and flow. Patients presenting with stent thrombosis are at risk for recurrent myocardial infarction and recurrent stent thrombosis.
文摘Background: Idiopathic ventricular tachycardia(VT) often originates from the r ight ventricular outflow tract (RVOT), but foci deep to the endocardium, in the epicardium, or in the left ventricle are not uncommon. Although these extra-RVO T foci can be targeted with ablation, risks involved are higher and success rate s lower. Simple electrocardiographic(ECG) criteria allowing(1) discrimination of RVOT foci from extra-RVOT foci and(2) assessment of the chance of success of a right heart ablation procedure are desirable. Methods: Twenty-five consecutive patients referred for radiofrequency(RF) ablation of idiopathic VT or severely symptomatic idiopathic ventricular premature contractions were included. Localiz ation of VT origin and success rates of VT ablation in the RVOT were analyzed ac cording to the ECG pattern. Results: The analysis of the R wave in V2 was the st rongest single predictor of whether the VT had an RVOT or an extra-RVOT origin. An R wave amplitude ≥30%of the QRS amplitude designated the VT focus in the R VOT with positive and negative predictive values of 95 and 100%, respectively. Analysis of R wave duration in V2 had similar predictive values, whereas the R/S transitionzone in precordial leads had slightly lower predictive values. Sevent een of 20 arrhythmias(85%) with an R wave amplitude ≥30%of the QRS amplitude in V2 could be successfully abolished by an exclusively right heart procedure. C onclusions: The analysis of ECG pattern makes it possible to guide the manageme nt of patients with idiopathic VT in predicting the arrhythmias that can be safely targeted with RF ablation from the RVOT with high success rates. Copyright.
文摘A 28-year-old woman suddenly has rapid palpitations accompanied by chest pain and dizziness while playing her cello. She is brought to an emergency department. She has a faint regular pulse of 190 beats per minute. Her blood pressure is 82/54 mm Hg. Cardiovascular examination reveals no signs of heart failure. An electrocardiogram shows a regular tachycardia with a narrow QRS complex and no apparent P waves. How should her case be managed?
