The Journal of invasive cardiology
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Case Reports
Large mycotic pseudoaneurysm of the left circumflex treated with antibiotics and covered stent.
Coronary artery mycotic aneurysms are rare complications of infective endocarditis. They are usually managed surgically with excision of the aneurysm. ⋯ We report a case of a giant mycotic coronary aneurysm following infective endocarditis which was treated with intravenous antibiotics and covered stent. This case highlights a new treatment modality in critically ill patients.
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Multicenter Study
The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program.
Published mortality models for percutaneous coronary intervention (PCI), including the Clinical Outcomes Assessment Program (COAP) model, have not considered the effect of out-ofhospital cardiac arrest. The primary objective of this study was to determine if the inclusion of out-of-hospital cardiac arrest altered the COAP mortality model for PCI. The COAP PCI database contains extensive demographic, clinical, procedural and outcome information, including out-of-hospital cardiac arrest, which was added to the data collection form in 2006. ⋯ In the new multivariate model, out-of-hospital cardiac arrest was highly associated with mortality (odds ratio = 5.50; 95% confidence interval [CI] = 3.28-9.25). When evaluated in the test set, the new model had excellent discrimination (c-statistic = 0.89; 95% CI = 0.85-0.93). Out-of-hospital cardiac arrest is an important determinant of risk-adjusted in-hospital mortality for PCI, particularly for hospitals with low volumes and relatively high volumes of cardiac arrest cases.
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Cerebral hyperperfusion syndrome (HPS) results from autoregulatory failure of cerebral blood flow following carotid endarterectomy (CEA) or carotid artery stenting (CAS) and encompasses a range of neurological findings including headache, seizure, intracranial hemorrhage (ICH), altered mental status and focal neurological changes. This report is the largest single-operator series evaluating the incidence and predictors of HPS following CAS. ⋯ The incidence of HPS is low (1.45%) following CAS, but it is an important complication to distinguish from stroke and TIA. Patients with a recent TIA may be predisposed to HPS. This report may underestimate the incidence of HPS, since patients with an isolated headache did not meet our diagnostic criteria and routine post-procedure brain CT imaging was not performed. The clinical predictors of HPS and its optimum management remain to be determined.
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Case Reports
Coronary artery air embolism causing pulmonary edema secondary to acute coronary syndrome in a diver.
Air embolism in the coronary arteries is a known complication of coronary angiography. Diving is a non-iatrogenic cause of arterial air embolism, commonly presenting with neurological and musculoskeletal symptoms. This is the first known case of coronary air embolism confirmed on coronary angiography in a diver presenting with pulmonary edema secondary to acute coronary syndrome. The possible mechanisms of coronary air embolism during a dive are reviewed in this article.
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Randomized Controlled Trial Clinical Trial
Magnesium sulphate during transradial cardiac catheterization: a new use for an old drug?
To assess the effect of intra-arterial magnesium on the radial artery during transradial cardiac catheterization. ⋯ This study demonstrates that magnesium is a more effective vasodilator when compared to verapamil, with a reduced hemodynamic effect, and is equally effective at preventing radial artery spasm. As such, the use of this agent offers distinct advantages over verapamil during radial catheterization.