Suchergebnisse

BACKGROUND: Acute heart failure as
a complication of acute anteroapical ST elevation
myocardial infarction is the most frequent complication and
Is the first cause of death in the acute and chronic phase.
At present, medical pharmacological treatment has been
improved and guidelines have been proposed for the
management of these patients who have a good evolution, but
a non negligible percentage of patients have refractory
heart failure, hemodynamic instability, pulmonary
congestion, which implies a longer hospital stay and
nosocomial infections. OBJECTIVE: To reduce mortality of
acute anteroapical ST elevation myocardial infarction not
reperfused Killip and Kimbal class III. MATERIALS AND
METHODS: We included patients attended at the Hospital
Central Militar interventional cardiology department, with
the diagnosis of acute anteroapical ST elevation myocardial
infarction not reperfused. The infarct was classified as
Killip and Kimbal class III with decreased ejection
fraction and after 72 hours of optimal medical treatment
for heart failure, persisted in the Killip and Kimbal class
III. Coronary angiography and ventriculography were
performed, finding total obstruction of the anterior
descending artery and akinesia, dyskinesia or anteroapical
left ventricular aneurysm. The technique of splinting of
anterior descending artery with stents was performed in the
hemodynamic laboratory. Their management was continued in
the coronary care unit. Transthoracic echocardiography was
performed 8 days after the intervention. RESULTS: A total
of 21 patients who met the selection criteria were
included. The ejection fraction of the left ventricle prior
to the procedure was on average 29%. Five subjects
developed cardiogenic shock in the first twelve hours of
hospitalization, but only one died. Of the remaining
subjects, two additional deaths were observed, none at an
early age (first 30 days). The 30-day survival was 95.2%,
with a median survival of 29.76 days (95% CI 29.3, 30.2).
CONCLUSION: In patients with acute anteroapical ST
elevation myocardial infarction not reperfused Killip and
Kimbal class III with reduced left ventricular ejection
fraction (less than 35%) and akinesia dyskinesia-apical
aneurysm, the technique of splinting of anterior descending
artery with stents was associated with a better prognosis
with a 30-day survival rate was 95.2%, with a median
survival of 29.76 days (95% CI 29.3, 30.2), with a
significant improvement in left ventricular ejection
fraction (previous 30.5 + 6.4% , posterior 33.3 + 6.5%, p =
0.016).

BACKGROUND: Coronary stent
restenosis is a neointimal hyperplasia, which leads to the
obstruction of the previously treated lesion. Its incidence
is around 10%. The treatment is a new intervention with
balloon angioplasty and implantation of a new stent to
reestablish blood flow. OBJECTIVE: To determine if there is
a difference between the different treatment strategies
against intrastent restenosis such as the bioabsorbable
endoprosthesis, drug-eluting stent and drug-eluting
balloon, evaluated by angiography after 12 months of being
treated an intrastent stenosis. MATERIALS AND METHODS:
Observational, ambispective, crosssectional and comparative
study consisting of the evaluation of patients with
angina-compatible disease in the following 12 months to the
treatment for intrastent stenosis. We reviewed the
angiographies of the patients who entered the Cath Lab of
the Hospital Central Militar for evaluation of intrastent
restenosis due to previous balloon angioplasty or previous
coronary intervention with implantation of a drug-eluting
or bioabsorbable stent after angina. RESULTS: Three groups
were treated with intrastent stenosis, the first using
bioabsorbable stent, the second with drug-eluting stent and
another group treated with a medicated balloon; in the
control angiographies performed on patients with angina, a
statistically significant difference was found in the
therapy used for intrastent stenosis (15.7%, 65.1%, 70%, p
< 0.001), with a higher success rate in bioabsorbable
stent group in relation to the other two therapies.
However, there was no difference in the treatment of
intrastent stenosis with the use of drug-eluting stents vs.
medicated balloon (65.1%, 70%, p < 0.75).

BACKGROUND: Coronary artery
disease is the most common single cause of death in all
countries of the world, corresponding to 12.8% of all
deaths. Complications in the acute phase may lead the
patient to a state of cardiogenic shock being the leading
cause of death in patients hospitalized for acute
myocardial infarction with 50% mortality despite
reperfusion therapy, optimal medical treatment and
intraaortic balloon support. OBJECTIVE: To reduce mortality
secondary to cardiogenic shock due to anteroapical
ST-segment elevation acute myocardial infarction (STEMI).
MATERIALS AND METHODS: We included patients with
anteorapical STEMI who coronary blood flow was restored by
primary angioplasty and continue with cardiogenic shock
despite various supportive therapies. By angioplasty
technique the "containment balloon", an angioplasty balloon
was placed on the left anterior descending artery, which
was the diameter according to the vessel and 80 mm in
length covering the entire course of the artery and it was
inflated with contrast undiluted, leaving it for 12 hours,
new measurements were made (pulmonary capillary wedge
pressure, cardiac index) with the pulmonary artery catheter
during this time. At the end of 12 hours the balloon was
deflated and removed from the coronary, then bare metal
stents were placed distal to proximal. RESULTS: In this
study we observed higher mortality with standard treatment
than the reported in the literature. However, making an
intervention with the containment balloon this mortality is
reduced by 66.6 % (p< 0.01) in the control group. It
could be demonstrated an increase in ejection fraction at
48 hours average of 34% (p< 0.01) in patients treated by
containment balloon. CONCLUSION: It is a novel, useful,
reproducible and no learning curve technique with superior
survival benefit in patients with cardiogenic shock due to
anteroapical STEMI. The cost of this technique is less than
the cost of different ventricular assist
devices.