Incidence Of Coronary Occlusion Research Articles

Aortic Valve-in-Valve in Externally Mounted Bioprosthesis: A Safe Treatment Option for Bioprosthetic Structural Valve Dysfunction.

ObjectiveAortic valve-in-valve implantation for prosthetic valve dysfunction is a good alternative to reoperative valve replacement. There are some limitations to this approach including the risk of coronary occlusion, patient prosthesis mismatch, and valve malposition. The incidence of coronary occlusion is higher in aortic valve-in-valve than de novo aortic stenosis cases. Multiple factors can contribute to this complication, and the type of bioprosthesis has been implicated.MethodsWe examined our experience of 80 aortic valve-in-valve cases with internally and externally mounted leaflet valves.ResultsProcedural success was achieved in 95% of cases with an overall 30-day mortality of 1.3%. Clinical and procedural outcomes were similar in the both cohorts.ConclusionsOur data suggest that aortic valve-in-valve implantation can be safely performed in carefully selected patient with internally and externally mounted leaflet bioprosthesis.

Incidence and Impact of Totally Occluded Culprit Coronary Arteries in Patients Presenting With Non–ST-Segment Elevation Myocardial Infarction

The accuracy of the 12-lead electrocardiogram in detecting coronary artery occlusion is limited. We sought to determine the incidence, distribution, and outcomes of patients who have total occlusion of the culprit artery but present with non-ST-segment elevation myocardial infarction (NSTEMI). The randomized Acute Catheterization and Urgent Intervention Triage Strategy trial enrolled 13,819 patients presenting with non-ST-segment elevation acute coronary syndromes who underwent an early invasive strategy. The present study includes 1,319 patients with baseline biomarker elevation (NSTEMI) and no history of coronary artery bypass graft who underwent percutaneous coronary intervention of a single culprit vessel. We compared the baseline characteristics and outcomes according to whether the culprit vessel was occluded (baseline Thrombolysis In Myocardial Infarction [TIMI] 0 to 1) or patent (TIMI 2 to 3 flow) by angiographic core laboratory assessment. TIMI 0 to 1 flow in the culprit artery was present in 262 of 1,319 (19.9%) patients. The incidence of coronary occlusion was 28.4%, 19.3%, and 12.6% in patients with NSTEMI because of right coronary, left circumflex, and left anterior descending artery disease, respectively. Patients with an occluded culprit artery were more commonly men and had ST-segment deviation ≥1mm. One-year outcomes, including death (3.5% vs 3.0%, p= 0.68) and myocardial infarction (8.4% vs 9.6%, p= 0.47), did not differ significantly between patients with versus without occluded culprit arteries, respectively. In conclusion, the present study demonstrates that the culprit artery is totally occluded in approximately 1 in 5 patients presenting with NSTEMI and single-vessel disease; however, the presence of total occlusion in NSTEMI was not associated with an incremental hazard of death or reinfarction at 1year.

The doctor and his heart.

Medical discoveries within the past two decades, and particularly within the past ten years, have decidedly changed once accepted concepts of many forms of heart disease. This is particularly true of our knowledge about myocardial infarction. An attitude for which I see no real basis prevails in the minds of too many medical men, that, except for anticoagulant therapy, the problems of coronary occlusion remain unchanged since Herrick's classic description. My purpose is to review certain pertinent aspects of the subject in the light of current concepts relative to pathogenesis, pathophysiology, and treatment of this disorder. This review may interest you as a physician, as a friend of someone who has had a myocardial infarct, or as a patient who has had or may have a coronary occlusion. Incidence Anyone interested in the incidence of coronary occlusion has but to read the last lines of the death notices in any issue of the Journal of the American Medical Association. Multiply that impression by the number...