The Journal of invasive cardiology
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Trials of rescue angioplasty (rPCI) following failed fibrinolysis have excluded patients with cardiogenic shock and the benefit of rPCI in this setting is unknown. We compared the clinical, angiographic characteristics, 30-day and 1-year outcomes of cardiogenic shock patients undergoing rPCI with those undergoing primary percutaneous coronary intervention (PPCI). ⋯ In the setting of cardiogenic shock, rPCI patients were treated later than those undergoing PPCI. They had a lower final TIMI 3 flow and higher 1-year mortality. Even patients with a successful rPCI procedure had a higher 1-year mortality than those with a successful PPCI. Rescue angioplasty in the setting of cardiogenic shock was found be an independent predictor of mortality. Rescue angioplasty in elderly patients in cardiogenic shock (>75 years) may be a futile treatment. Efforts should be made to improve reperfusion and survival in these patients, possibly by either adopting PPCI for all patients presenting with ST-elevation acute myocardial infarction or, if this is not logistically possible, adopting PPCI for selected high-risk patients or early referral for rPCI in high-risk groups receiving fibrinolysis.
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Comparative Study
The safety of a bivalirudin-based approach in patients undergoing rotational atherectomy.
Rotational atherectomy is associated with a high incidence of periprocedural myonecrosis. Glycoprotein (GP) IIb/IIIa inhibitors have been demonstrated to be particularly effective in this population in reducing periprocedural myocardial infarction. While bivalirudin-based therapy has emerged as an attractive alternative to heparin in patients undergoing contemporary percutaneous coronary intervention, it is unclear if such a strategy is safe in patients undergoing rotational atherectomy. ⋯ Bivalirudin-based therapy can be safely used in selected patients undergoing rotational atherectomy. Further studies are warranted to confirm our findings.
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Comment Comparative Study
Cardiogenic shock--the role of revascularization after failed thrombolysis.
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We evaluate the yield and safety of coronary angiography (CA) in adult patients who underwent cardiac catheterization for percutaneous transcatheter closure of secundum atrial septal defect (ASD) or patent foramen ovale (PFO). Out of 268 patients, 180 were adults; 82 were adults with ASD and 98 were adults with PFO. ⋯ No complications associated with coronary angiography were observed. CA should be considered a part of cardiac catheterization in selected patients referred for transcatheter closure of secundum ASD or PFO.
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We present a case of delayed rupture of a femoro-popliteal saphenous vein bypass graft after stent-supported angioplasty, resulting in a large, severely symptomatic pseudoaneurysm of the thigh. This was successfully treated with deployment of a covered stent graft. The possible mechanisms of pseudoaneurysm formation in this case are discussed, and a brief review of the literature regarding the endovascular management of this clinical entity is offered.