Abstract

Although rare, iatrogenic left main coronary artery (LM) dissection is a feared complication of coronary catheterization. Its incidence, optimal therapeutic management, and prognosis remain largely unknown. The aim of the present study was to estimate the incidence, characterize the population at risk, depict the initial management, and evaluate the long-term prognosis of iatrogenic LM dissection. Thirty-eight patients who fulfilled the National Heart, Lung, and Blood Institute diagnostic criteria for iatrogenic LM dissection were retrieved from our database and followed up by telephone or physician visit. The primary end point was freedom from major adverse cardiac events (MACE) at 5 years. The overall incidence of iatrogenic LM dissection during the study period was 0.07% (38/51,452 patients) and almost twice as common with percutaneous coronary intervention than coronary angiography. From 38 patients, 1 (3%) patient died before any therapeutic attempt was performed, 6 (16%) patients were treated conservatively, and 31 (82%) patients underwent stent implantation and/or coronary artery bypass grafting (CABG). In-hospital outcome was favorable irrespective of the therapeutic strategy. During the 5-year follow-up, among 31 patients who underwent revascularization treatment by stenting or CABG, one patient died in each group from a cardiac cause, and MACE were observed in 12 patients (39%). Kaplan-Meier cumulative survival estimates showed no significant difference between different revascularization treatment strategies. Iatrogenic LM dissection is a rare complication of cardiac catheterization procedures with favorable early and long-term outcome when recognized timely and managed properly.

Highlights

  • A special group of iatrogenic complications are associated with various diagnostic manipulations — from a physical examination of the patient to angiographic studies, diagnostic laparoscopy or thoracoscopy

  • Yatrogenia, which occur with the use of preparations containing contrast, which are widely used in clinical practice (CT with contrasting, angiography, etc.) with a diagnostic purpose, are considered in detail

  • The article describes the risk factors, knowledge of which and awareness of their presence in the patient are mandatory before the introduction of drugs containing contrast

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Summary

КАРОТИДНАЯ АНГИОГРАФИЯ

Среди 333 больных, у которых выполнено 347 диагностических процедур каротидной ангиографии, осложнения наблюдались у 12 человек (3,5%). В таблице 2 представлены основные осложнения и их частота у больных после коронароангиографии. При бактериологическом исследовании крови у больных непосредственно и через 12 часов после процедуры коронароангиографии положительная культура Сахарный диабет (диабетическая нефропатия)/ Diabetes mellitus (diabetic nephropathy). Летальность при коронароангиографии возрастает при чрескожных коронарных вмешательствах [24], особенно при наличии факторов риска (пожилой возраст, кардиогенный шок, снижение фракции выброса левого желудочка, срочные чрескожные коронарные вмешательства, острый инфаркт миокарда, сахарный диабет, почечная недостаточность, многососудистое поражение). Показатели летальности в этих ситуациях колеблются от 0,65% при селективных чрескожных коронарных вмешательствах до 4,81% у больных инфарктом миокарда с подъемом интервала ST [24]

Осложнения при эндоскопических исследованиях
Приводим клиническое наблюдение
Nephropathy in Patients Undergoing Percutaneous Coronary
Full Text
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