The Journal of invasive cardiology
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Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) achieves brisk coronary flow in > 90% of patients, but myocardial reperfusion (reperfusion at the tissue level) is often suboptimal, as evidenced by persistent ST-segment elevation and abnormal myocardial blush. Patients with suboptimal myocardial reperfusion have limited myocardial salvage and increased mortality. Distal micro-embolization may contribute to poor myocardial reperfusion, and this has stimulated great interest in the use of adjunctive thrombectomy with primary PCI in an attempt to prevent distal micro-embolization and improve outcomes. ⋯ The results of these trials have been conflicting and the totality of evidence does not support the routine use of thrombectomy for removal of thrombus in patients with STEMI treated with primary PCI. In patients with large thrombus burden, distal macroembolization is common and is associated with poor outcomes. Adjunctive thrombectomy can effectively remove thrombus, and it seems appropriate to perform adjunctive thrombectomy prior to primary PCI in patients with large thrombus burden.
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Heavy alcohol consumption is a well-known cause of dilated cardiomyopathy and hypertension, but its effects on coronary atherosclerosis are less well understood. The objective of this study was to compare coronary anatomy and left ventricular dysfunction in patients with and without alcoholism associated with heavy consumption. ⋯ In a group of male VA patients presenting with chest pain, alcoholism was associated with a lower incidence and a lesser severity of angiographically-defined CAD, but had greater left ventricular dysfunction. There appears to be an inverse relationship between CAD and left ventricular function in patients with a history of heavy alcohol consumption.
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Patients with cardiac arrest have been excluded from most randomized trials on percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). ⋯ Combining immediate initiation of resuscitation maneuvers and primary PCI yields a very good clinical outcome in patients with AMI suffering from cardiac arrest.
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Randomized Controlled Trial
Nitroglycerin, nitroprusside, or both, in preventing radial artery spasm during transradial artery catheterization.
Radial artery spasm remains a major complication of transradial coronary interventions. The aim of this study was to compare the efficacy of three different intra-arterial vasodilating cocktails in reducing the incidence of radial artery spasm in patients undergoing transradial coronary angiography. The secondary goal was to assess the predictors of arterial spasm in this large group of patients. ⋯ In this prospective, randomized trial, the addition of a direct nitric oxide donor to nitroglycerin in an antispastic cocktail did not reduce the risk of spasm, and the use of nitroglycerin was found to be as effective as nitroprusside. Also, morphometric and mechanical factors play a significant role in predicting the occurrence of radial spasm. The sex of the patient, presence of diabetes, body surface area and smoking history appeared to play no role in predicting the occurrence of radial spasm.