American heart journal
-
American heart journal · Dec 1996
Clinical TrialNo subacute thrombosis and femoral bleeding complications under full anticoagulation in 150 consecutive patients receiving non-heparin-coated intracoronary Palmaz-Schatz stents.
Intracoronary stenting has been shown to have better immediate and long-term clinical outcomes and less restenosis than standard balloon angioplasty. However, the benefit was achieved at the cost of higher rates of coronary thrombosis, bleeding complications, the need for anticoagulation, and longer hospital stay. For the latter reasons there is a tendency to replace the anticoagulants by antiplatelet agents alone after stenting. ⋯ In contrast to other reported series, these results support the idea that with careful puncture technique and meticulous postoperative wound care, intracoronary stenting can be successfully performed with the patient under full anticoagulation without major risks of bleeding and femoral vascular complications. Furthermore with a full but comparatively lower dose of anticoagulation, subacute thrombotic complications can be reduced to 0% even with non-heparin-coated stents without the use of intravascular ultrasound guidance and without the use of adjunctive high-pressure poststenting inflation in most patients. The restenosis rate and long-term clinical outcomes remained very favorable.
-
American heart journal · Dec 1996
Active compression-decompression versus standard cardiopulmonary resuscitation in a porcine model: no improvement in outcome.
Active compression-decompression cardiopulmonary resuscitation (CPR) is a new innovative basic life-support technique during which the anterior chest wall is actively decompressed by a suction device. CPR techniques were studied in 36 swine to test the hypothesis that active compression-decompression CPR improves coronary perfusion pressure, myocardial blood flow during CPR, and 24-hour survival. After 30 seconds of untreated ventricular fibrillation, CPR was begun and continued for 12.5 minutes by one of the three following methods: (1) active compression-decompression CPR with a suction device modified to include a precision force transducer; (2) standard CPR performed with a force transducer device; and (3) standard manual CPR performed without a force transducer device. ⋯ Initial return of spontaneous circulation, 24-hour survival, and trauma scores were also evaluated. Active compression-decompression CPR produced consistently better results than did standard CPR performed with a force transducer, but not better than standard CPR performed manually without a force transducer. The use of a force-measuring device with standard CPR may compromise hemodynamic response and outcome.
-
American heart journal · Dec 1996
Comparative StudyCorrespondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization.
The correspondence of aortic valve area measurements from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization was determined in 100 patients with severe aortic stenosis (aortic valve area < or = 0.75 cm2), moderate aortic stenosis (aortic valve area > 0.75 to < or = 1.2 cm2), mild aortic stenosis (aortic valve area > 1.2 to < or = 2.0 cm2), and nonstenotic aortic valves (aortic valve area > 2.0 cm2). Because high correlation does not require high agreement, data were assessed by analysis of agreement. ⋯ Similar levels of agreement when comparing these independent methods for determining the aortic valve area indicate that direct planimetry by transesophageal echocardiography, the continuity equation with transthoracic echocardiography, and the Gorlin formula are equally accurate and may be used interchangeably. Clinically important discrepancies between methods are uncommon and are readily settled by adding a third method.