Use Of Angiography In Patients Research Articles

Is early PCI associated with a clinical benefit in post-cardiac arrest patients without STEMI pattern? Insights from the Parisian registry (PROCAT II)

Rationale: Early PCI is associated with improved survival in out-of-hospital cardiac arrest (OHCA) patients resuscitated from a cardiac arrest of ischemic cause. However it is still unclear if this benefit is restricted to STEMI patients or if it can be extended to patients without STEMI on post-resuscitation ECG. We aimed to assess the influence of early PCI in this specific population. Methods: Providing that there is no obvious extra-cardiac cause, an immediate coronary angiogram is usually performed in all OHCA patients admitted in our hospital and all characteristics are prospectively collected in a computerized database. We isolated data from the subgroup of patients without STEMI on initial ECG. Using logistical regression, we investigated the association between early PCI and favourable outcome (defined with CPC 1 or CPC2) and we searched predictive factors for PCI requirement. Results: During the 10-years study period (2004-2013), 946 post-CA patients were explored by immediate coronary angiogram after OHCA. Among them, 704/946 (74%), mostly male (75%) and average age of 60 y.o. have no STEMI on the post-resuscitation ECG. PCI was deemed necessary in 203/704 (29%). A favourable outcome was observed in 86/203 (42%) in patients with PCI compared with 167/501 (33%) in patients without PCI (p=0.02). After adjustment on other covariates, PCI was associated with a better outcome (ORadj=1.79[1.08-2.95], p=0.02). Initial shockable rhythm (ORadj=3.03 [1.97-4.66], p Conclusion: We found a culprit coronary lesion requiring PCI in nearly one third of OHCA patients without STEMI. In these patients, PCI was associated with a nearly two-fold increase in the rate of favourable outcome. Identification of candidates of such strategy relies mostly on age and first observed rhythm. Our findings encourage the use of immediate coronary angiography in patients resuscitated from OHCA, even if there is no STEMI pattern on initial ECG.

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury.

The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.

Clinical presentation of myocardial infarction contributes to lower use of coronary angiography in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have high mortality following myocardial infarction (MI), but are less likely to undergo coronary angiography than those without CKD. Whether this phenomenon is explained by differences in the presentation of MI or by bias against performing coronary angiography in patients with CKD is unclear. We examined the clinical presentation of 1876 elderly patients who presented with MI and categorized them by estimated glomerular filtration rate: >60 ml/min (no/mild CKD), 30-60 ml/min (CKD Stage 3) or <30 ml/min (CKD Stage 4/5). Compared with patients with no/mild CKD, patients with CKD Stage 3 or Stage 4/5 had more comorbidity, greater prior nursing home use, and higher frequency of conduction abnormalities or anterior infarction. By contrast, peak creatinine kinase-MB fraction (CK-MB) concentrations were lower and ST-elevation MI was less common in patients with CKD Stage 3 or Stage 4/5. In univariate analyses, patients with CKD Stage 4/5 (odds ratio (OR)=0.34, 95% confidence interval (CI): 0.23-0.50) or Stage 3 (OR=0.57, 95% CI: 0.45-0.73) were markedly less likely to undergo angiography than subjects with no/mild CKD. After multivariable adjustment, the association of CKD Stage 3 with the use of coronary angiography was attenuated (OR=0.78, 95% CI: 0.60-1.03), but CKD Stage 4/5 remained strongly associated with lower use (OR=0.52, 95% CI: 0.34-0.80). Clinical features of MI are different in patients with and without CKD and may partly explain the low use of angiography in patients with CKD Stage 3. However, the clinical features of MI do not account for its underuse in MI patients with CKD Stages 4/5. Whether reduced use of angiography in patients with advanced CKD is justified must be evaluated in formal risk-benefit analyses.

Comparison of Bare Metal Stents Versus Drug-Eluting Stents on Clinical Decision Making in Patients With Previous Percutaneous Coronary Intervention Admitted for Suspected Acute Coronary Syndrome

To determine whether the decreased rate of restenosis observed with drug-eluting stents (DES) has changed the treatment of patients with recurrent symptoms after stent placement, we compared patients hospitalized with presumed cardiac symptoms within 1 year after placement of either a DES or a bare metal stent (BMS). In this retrospective, single-center study, cases were identified from consecutive patients who received a DES from March 2003 to July 2004 or a BMS from August 2001 to June 2002. No differences were noted in the rate of hospitalization, hospitalization for presumed cardiac symptoms, use of coronary angiography in patients hospitalized for presumed cardiac symptoms, or average interval to hospitalization. In contrast, restenosis and the need for additional revascularization procedures were higher in the BMS group. The primary indication for additional revascularization was restenosis in the BMS group and progression of coronary artery disease in the DES group. In the DES group, the need for revascularization was significantly higher in patients with multi- versus single-vessel coronary artery disease (26% vs 7%, p < 0.05). In conclusion, the rate of hospitalization and use of coronary angiography in patients with recurrent symptoms were similar in patients who received a BMS or DES, despite the decreased rates of restenosis and additional revascularization procedures observed with DESs.

Splenic vein thrombosis in patients with a normal size spleen.

The frequency of splenic vein obstruction secondary to pancreatic or retroperitoneal diseases has been only recently appreciated. The diagnosis is important because it frequently results in development of gastric and duodenal varices. It is often assumed that the diagnosis should only be suspected in patients with splenomegaly. This report describes 19 patients in whom splenic vein thrombosis was diagnosed by angiography although clinically unsuspected. In 11, the spleen was normal in size although extensive gastric varices were present. In 3 patients the presenting problem was massive hematemesis. Review of the upper gastrointestinal examinations in these patients showed thickened gastric or duodenal folds although in the absence of esophageal varices, the diagnosis was not made prior to angiography. More liberal use of angiography in patients with an appropriate clinical background, such as a history of pancreatitis, may lead to earlier and more frequent diagnosis of splenic vein obstruction. Varices that result from splenic vein obstruction can be cured by splenectomy.

Selective angiography in splenic trauma

The increasing use of angiography in patients suspected of having traumatic splenic injury has made possible the identification of minor splenic injuries in patients with equivocal findings. Arteriograms, the clinical course, and the appearance of the spleen at laparotomy were compared in forty-one patients. Six patients thought to have minor injuries on arteriography were successfully treated nonoperatively.