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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

BACKGROUND.: Based on experience from other countries, the Medical Centre Alkmaar was granted permission to start the first Dutch PCI programme without on-site cardiac surgery. The cardiology group of the Medical Centre Alkmaar started an off-site PCI programme in 2002 with only primary PCI in the first year and a full PCI programme from November 2003 onwards. We report the first Dutch experience with acute cardiac surgery following a failed PCI procedure in an off-site clinic. PATIENTS.: From October 2002 until February 2007, 2500 patients were treated by PCI in the Medical Centre Alkmaar. These patients were treated for an acute myocardial infarction (33%), acute coronary syndromes (37%) or progressive angina (30%). In this first series of off-site PCI in the Netherlands, the incidence of emergency cardiac surgery following failed PCI was 0.2% All five patients who needed emergency surgery underwent elective PCI for progressive stable coronary artery disease. No emergency surgery was needed for primary PCIs in patients with an acute myocardial infarction. All patients survived emergency surgery following failed PCI. CONCLUSION.: Adherence to the Dutch guidelines of interventional cardiology with protocols describing a close collaboration with cardiac surgeons and an immediate availability of rapid ground transportation are mandatory when performing off-site PCI. This series extends the current expertise of emergency surgery after failed PCI to off-site clinics. With appropriate settings, off-site PCI may not be associated with an increase in the risk of adverse events. (Neth Heart J 2007;15:173-7.).
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PMID:Emergency cardiac surgery after a failed percutaneous coronary intervention in an interventional centre without on-site cardiac surgery. 1761 79

PCI is effective for reducing symptoms in patients with stable angina pectoris but does not improve prognosis. In earlier trials PCI has been associated with more procedure related complications in women than men, but this difference between genders has been less pronounced in more recent studies. In acute coronary syndromes there is no evidence of gender differences regarding the benefit of primary PCI for ST-segment elevation myocardial infarction. However, several trials of unstable angina and non-ST-segment elevation myocardial infarction indicate that women do not have the similar benefit of a routine, early, invasive treatment strategy compared with men.
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PMID:Gender differences following percutaneous coronary intervention. 1912 14

Chronic total occlusion (CTO) is defined as an occlusion of a coronary vessels (TIMI 0 flow) lasting longer than 3 months. Successful recanalisation of CTO improves left ventricular function and survival. Retrograde technique can be used in patients, who have well-developed collaterals, when the antegrade approach is ineffective or difficult to perform. A 68-year-old male was referred for coronary angiography because of exercise angina chest pain. Coronary angiogram showed a CTO of RCA with collaterals from LAD. Following the unsuccessful traditional antegrade approach in 2004, we attempted a retrograde approach. The PCI procedure was performed successfully and without complications.
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PMID:[Successful recanalisation of chronic total occlusion using retrograde approach]. 1949 53

Percutaneous transluminal coronary angioplasty (PTCA) or balloon angioplasty, was performed in the United States, but the technique remained challenged by the primary problem of ''re-stenosis'', which was approximately 30% closing of the coronary artery after balloon dilatation. When first PTCA introduced by Gruentzig in 1977, it was specific directed for patients who have angina, documented ischemia, single vessel disease, and proximal lesion (simple lesion). But then by the recent advanced in technology including guide wire, balloon, intravascular ultrasound, pharmacological therapy particularly of stents, it is than indicated in much more complex lesions. The extension of indication of PCI to more complex lesion were supported by many studies and clinical trials. Comprehensively indication of PCI were summarize in the two most well known guideline, following first to European Society of Cardiology (ESC, 2005) and second to the American Heart Association (AHA, 2007), American college of cardiology (ACC), and American Society of Cardiac Intervention (ASCAI). The latest guidelines for appropriateness criteria for coronary Revascularization was just published in Jan 2009 by The American College of Cardiology, Society for Cardiovascular Angiography and Intervention and Society of Thoracic surgery. In this guidelines indication of coronary revascularization is assessed following 3 categories which is appropriate, uncertain and inappropriate. Basically those guidelines are the same, there are differ in applying classification of recommendation and level of evidence, the systematic presentation, and the defining appropriateness indication of revascularization.
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PMID:Indication for percutaneous coronary angioplasty. 1975 90

Patients being considered for ICD therapy are a heterogeneous group.For the vast majority, who have significant left ventricular impairment, it has become common practice to assess their coronary artery anatomy as a surrogate for ischaemia and/or viability. Such patients are therefore frequently under the care of both electrophysiologists and interventionists. The coronary anatomy often raises the dilemma about whether such patients should undergo revascularisation. If the patients present with angina or in the context of an acute myocardial infarct then this decision is clear cut. By contrast, however, a significant proportion of them have no history to suggest ongoing ischaemia or of recent MI. In conventional practice, therefore, there would be no decisive mandate to offer them revascularisation, especially PCI, in the absence of further objective evidence of ischaemia or viability. A review of the literature in our paper does not resolve this dilemma.Further observational data are required to help guide cardiologists as to which of these patients will benefit from revascularisation, since in many cases the coronary anatomy is no surrogate for the presence of ischaemia or viability.
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PMID:What is the role for revascularisation in patients being considered for ICD therapy? 1975 15

The COURAGE study has stimulated intensive discussion about the optimal approach to treatment of patients with stable angina. To some, the study implied that PCI has no clinical benefit versus optimal medical therapy but this is open to alternative considered interpretation. To the interventionalist who deploys optimal medical therapy responsibly, the study highlights the importance of the concept of an ischaemia driven approach. The availability of the pressure wire has provided cardiologists with an important additional tool with which to tailor the delivery of revascularisation to not just the ischaemic patient but also to the ischaemic lesion. Such a strategy applied to COURAGE (and perhaps also to SYNTAX) might provide a very different comparative outcome.
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PMID:Is there evidence for prognostic benefit following PCI in stable patients? COURAGE and its implications: an interventionalist's view. 2051 29

The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries.
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PMID:Results of the Croatian Primary Percutaneous Coronary Intervention Network for patients with ST-segment elevation acute myocardial infarction. 2040 76

Strategies during elective PCI procedures in patients with stable angina and multivessel disease are in the majority of catheterisation laboratories, more often than not based, solely on the angiographic analysis on the spur of the moment. This despite the knowledge that angiographic images are often lacking the discriminating power to predict accurately the exact physiologic impact of individual lesions. Evidence is however accumulating telling us that routine stenting of non significant lesion is at best of no additional benefit for the patient. the introduction of dedicated angioplasty guidewires equipped at the tip with a miniature pressure-sensor has greatly expanded the possibilities to accurately evaluate the functional importance of any lesion during diagnostic coronary angiogram by measuring the FFR index. Ths index, based on the measurements of the trans-stenotic coronary gradient during maximal vasodilatation, is accurate, and easy to implement. Results from several important trials (e.g.,DEFER) have brought to our attention the fact that non significant coronary lesion sas documented by FFR measurements, in patients with single vessel disease can safely be left untreated. Recently, the remarkable results from the FAME trial have made a strong case for integrating functional evaluation as a routine work up especially in the presence of angiographic ambiguous lesions referred for PCI in patients with multivessel disease.
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PMID:Is functional assessment necessary in patients with stable angina? 2054 15

Acute coronary syndrome (ACS), encompassing unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI), is often the result of an acute thrombotic occlusion of the coronary vessels, associated with atheromatous plaque rupture or erosion. ACS is associated with a severely impaired prognosis and requires prompt and efficient specialist treatment. The clinical presentation may be identical across all three components of ACS. Establishing an accurate diagnosis without delay is of paramount importance to start treatment promptly. Patients with suspected ACS need to be referred immediately to A&E. Prehospital treatment, which includes aspirin, nitrates, morphine and oxygen (if hypoxic), should be initiated rapidly. Important features pointing towards a diagnosis of ACS include: typical characteristics of chest pain, presence of risk factors, and ECG changes suggestive of myocardial ischaemia. Chest discomfort in patients with ACS typically occurs at rest, is anginal in character and can range from mild tightness to central crushing chest pain. It may be associated with nausea, dyspnoea or diaphoresis. The chest pain may radiate to the arms, back or jaw and is often >20 minutes in duration. An accurate clinical history and a detailed examination are vital. Initial investigations are the same for all ACS events, with the need for urgent serial ECGs and the measurement of cardiac troponin levels, to assess myocardial damage. In NSTEMI, ECG changes suggestive of ischaemia are often present and associated with elevated cardiac troponin. In UA, there is a considerable reduction in myocardial perfusion leading to symptoms; but there is no rise in cardiac troponin. Risk stratification is imperative in assessment of ACS to allow efficient delivery of specialist care. Treatment includes: antiplatelets; antithrombotic agents; angina drugs; analgesia, and PCI.
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PMID:Managing unstable angina and non-ST elevation MI. 2066 21

Chronic stable angina is a clinical expression of myocardial ischemia associated with fixed atherosclerotic coronary stenosis, which prevents the adaptation of coronary circulation resulting in an increased oxygen requirement. We recommend that once the diagnosis of chronic stable angina is made, first every patient should be offered the optimal medical therapy, including ACE inhibitors, beta-blockers, statins, and nitrates. If the patients' symptoms are not controlled in spite of these drugs being used in maximum tolerated dosages, then these patients should be subjected to coronary angiography. If a patient shows a single-or double-vessel disease, then PCI should be offered. On the contrary, if the coronary angiogram shows a triple-vessel disease and left main disease, then one has to look for comorbidities that put the patient at a higher risk of CABG and the patient should be treated with PCI. Other patients with left main and triple-vessel disease having diabetes and left ventricular dysfunction should go directly for surgical revascularization. Overall, health related quality of life (HRQoL) is similar in both PCI and CABG.
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PMID:Percutaneous coronary intervention vs coronary artery bypass grafting in the management of chronic stable angina: A critical appraisal. 2087 86


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