The Journal of invasive cardiology
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The objective of this retrospective analysis of high-risk patients treated with bivalirudin during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was to evaluate the safety and feasibility of direct thrombin inhibitor (DTI) without concomitant glycoprotein (GP) IIb/IIIa inhibition. ⋯ This evaluation demonstrates excellent TIMI flow without the addition of GPIIb/IIIa inhibitors. The low mortality and complication rates suggest anticoagulation with bivalirudin in patients with STEMI undergoing PCI is feasible and warrants further study in larger controlled trials to evaluate the effectiveness of bivalirudin in this patient population.
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Intercoronary communication is a rare condition in which there is an open-ended circulation with bidirectional blood flow between two coronary arteries. This report highlights a case of an intercoronary connection between the right coronary and circumflex arteries with unidirectional flow. Selective injection of the right coronary artery showed retrograde filling only of the circumflex artery, but left coronary injection did not fill the right coronary artery.
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Case Reports
Acute myocardial infarction due to left main compression aortic dissection treated by direct stenting.
We describe a case of acute myocardial infarction (AMI) due to compression of the left main coronary artery (LMCA) by a false channel created by an acute aortic dissection (AAD). The dynamic pattern of artery obstruction is detailed as a key element to the diagnosis of extrinsic coronary compression throughout the angiography. Treatment by direct stenting restored complete anterograde coronary flow and improved myocardial perfusion.
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Comparative Study
Improved efficiency in acute myocardial infarction care through commitment to emergency department-initiated primary PCI.
Demonstrate improved efficiency of initial and subsequent in-hospital care following emergency department (ED) physician-initiated primary angioplasty (1 PCI). ⋯ Conversion to ED physician-initiated 1 PCI for ST-elevation myocardial infarction significantly improved efficiency of care as measured by MDBT, NSI and LOS. Effectiveness measures, including survival to discharge, discharge medications and 30-day MACE, demonstrated improvement or favorable trends.