cardíaco en el Infarto Agudo de Miocardio
1: CMAJ 2002
Jan 8;166(1):51-9 [Texto
advances in the management of acute coronary syndromes: 3. The role of
General Hospital, British Columbia. email@example.com
Types: Review Review, Tutorial
2: J Am Coll
Cardiol 2001 Jun 15;37(8):2170-214 [Texto
College of Cardiology/Society for Cardiac Angiography and Interventions
Clinical Expert Consensus Document on cardiac catheterization laboratory
standards. A report of the American College of Cardiology Task Force on
Clinical Expert Consensus Documents.
Bates ER, Berger PB, Clark DA, Cusma JT, Dehmer GJ, Kern MJ, Laskey WK,
O'Laughlin MP, Oesterle S, Popma JJ, O'Rourke RA, Abrams J, Bates ER,
Brodie BR, Douglas PS, Gregoratos G, Hlatky MA, Hochman JS, Kaul S, Tracy
CM, Waters DD, Winters WL Jr; American College of Cardiology. Task Force
on Clinical Expert Consensus Documents.
Types: Consensus Development Conference Review
3: West J Med
2001 Apr;174(4):257-61 [Texto
artery disease: Part 1. Epidemiology and diagnosis.
Medicine, New York University School of Medicine, New York, NY 10016, USA.
artery disease (CAD) is the leading cause of death in Americans,
accounting for about 500,000 deaths every year. The annual incidence of
myocardial infarction (MI) is about 1.5 million. As many as 2 million
middle-aged men may have silent myocardial ischemia. (1)
4: West J Med
2001 May;174(5):330-5 [Texto
artery disease: part 2. Treatment.
Medicine, New York University School of Medicine, New York, NY 10016, USA.
5: Chest 2001
complication of retrograde dissection to the coronary sinus of valsalva
during percutaneous revascularization: a single-center experience and
Yip HK, Wu CJ,
Yeh KH, Hang CL, Fang CY, Hsieh KY, Fu M.
Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital,
Kaohsiung Medical Center, Kaohsiung, Taiwan, Republic of China.
While coronary dissection, which is one of the most frequently occurring
complications during interventional procedures, has various forms,
extensive coronary dissection retrograde to the coronary sinus of Valsalva
(CSV) is very rarely observed. METHODS AND RESULTS: Within the last 5
years, we retrospectively reviewed our experience with 4,700 consecutive
patients who underwent angioplasty procedures, 7 of whom (0.15%) developed
extensive coronary dissection retrograde to the CSV. Six of the seven
patients developed retrograde dissection of the right CSV during
angioplasty to the right coronary artery. One of the seven patents
developed retrograde dissection of the left CSV during angioplasty to the
left anterior descending artery. Retrograde dissection, which extended to
the ascending aorta in two patients, was observed by transthoracic
echocardiography and surgical findings, respectively. Five patients were
successfully treated by coronary stenting. However, this complication
caused four patients to have acute myocardial infarctions, resulting in
emergency surgery for one patient and in-hospital death for another.
CONCLUSIONS: Our experience increased our understanding of this very rare
complication. However, this complication may be life threatening, and
patients in this clinical setting may have a potential risk for acute
myocardial infarction, emergency surgery, or even sudden cardiac death.
Therefore, it is important to learn how to promptly diagnose and manage
Circulation 2000 Mar 21;101(11):1344-51 [Texto
physiology revisited : practical insights from the cardiac catheterization
Internal Medicine, Division of Cardiology, Saint Louis University Health
Sciences Center, St. Louis, MO 63110, USA. firstname.lastname@example.org
coronary physiological measurements can be made in the cardiac
catheterization laboratory using sensor-tipped guidewires; they include
the measurement of poststenotic absolute coronary flow reserve, the
relative coronary flow reserve, and the pressure-derived fractional flow
reserve of the myocardium. Ambiguity regarding abnormal microcirculation
has been reduced or eliminated with measurements of relative coronary flow
reserve and fractional flow reserve. The role of microvascular flow
impairment can be separately determined with coronary flow velocity
reserve measurements. In addition to lesion assessment before and after
intervention, emerging applications of coronary physiology include the
determination of physiological responses to new pharmacological agents,
such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial
infarction. Measurements of coronary physiology in the catheterization
laboratory provide objective data that complement angiography for clinical
7: J Am Coll
Cardiol 2000 Feb;35(2):380-1
Comment on: J
Am Coll Cardiol. 2000 Feb;35(2):371-9.
of myocardial infarction: looking beyond efficacy.
Mehta S, Yusuf S.
Types: Comment Editorial Review
8: Am Heart J
1999 Aug;138(2 Pt 2):S158-63
devices add to the results of PTCA in acute myocardial infarction?
Cardiology, Lenox Hill Hospital, 130 E 77th Street, New York, NY 10021,
randomized trials have established that timely mechanical reperfusion with
the use of balloon angioplasty is superior to thrombolytic therapy in
patients with acute myocardial infarction. Furthermore, recent data from
prospective randomized trials suggest that primary stent implantation may
further improve the results of balloon angioplasty by reducing the need
for repeat interventions at follow-up. The role of IIb-IIIa platelet
receptor antagonists as adjunctive therapy to catheter-based coronary
interventions in acute myocardial infarction is promising, but the
incremental benefit that these agents add to stent implantation awaits the
results of dedicated randomized trials. Mechanical thrombolysis or
thrombectomy devices may have a role in a minority of patients with large
9: Am Heart J
1999 Aug;138(2 Pt 2):S142-52
of reperfusion strategies.
California, 505 Parnassus Avenue, San Francisco, CA 94143-0124, USA.
of acute myocardial infarction has become the standard of management
during the first few hours. Cost per year of life saved is one measure of
the effectiveness of reperfusion strategies. Estimates of the cost per
year of life saved have been approximately $17,000 for streptokinase and
percutaneous transluminal coronary angioplasty and approximately $33,000
for tissue plasminogen activator. Assuming that percutaneous transluminal
coronary angioplasty is more effective than thrombolysis, we calculated
the cost-effectiveness of this strategy in different hospital settings.
The estimated costs in hospitals with existing cardiac catheterization
laboratories were $11,000 per year of life saved for primary angioplasty
and $14,000 for thrombolysis compared with no intervention. In hospitals
without catheterization facilities, it would be cost-ineffective to build
such laboratories only to treat acute infarction with angioplasty.
Preliminary results suggest that stenting may also be cost-effective in
association with angioplasty.
10: Can J
Cardiol 1998 Oct;14(10):1259-66
and application of ultraminiature catheter pressure transducers.
of Physiology, University of Leipzig, Germany. email@example.com
After a brief
historical account of the methods for pressure measurements in the
cardiovascular system, the basic structural elements of a new generation
of miniaturized catheter pressure transducers are described. These
catheters have an outside diameter at the tip of 0.9 mm (3 French) and
have been routinely applied in left and right heart catheterization in
intact, anesthetized rats. Together with cardiac output measured by the
thermodilution technique, a complete set of basal functional parameters
can be obtained in vivo. The method of cardiac catheterization in rats is
accurate, reliable and easy to perform. As to left heart function, changes
occurring in several models of cardiac hypertrophy and heart failure have
been recorded and correlated with morphological and metabolic alterations.
In addition, the functional effects of catecholamines and thyroid hormones
have been evaluated. In addition to the routine catheterization procedure,
a double catheter method has been introduced recently, which allows
measurement of left ventricular isovolumetric pressure in intact rats.
Catheterization of the right ventricle requires a more refined catheter
with a characteristic bend at the tip so that it can be comfortably slid
from the right atrium into the right ventricle. With this method it was
found that right ventricular systolic pressure was elevated markedly in
rats with chronic myocardial infarction induced by ligation of the left
anterior descending coronary artery, by pulmonary artery banding, by
intermittent chronic hypoxia and by noradrenaline administration. The
ultraminiature catheter pressure transducer has also been successfully
applied in an isolated working rat heart preparation. Recent modifications
of this kind of catheters also enabled the catheterization of the left
ventricle in mice. Future applications of ultraminiature catheter pressure
transducers may be directed to catheterization of the pulmonary artery in
rats and to the in vivo and in vitro assessment of heart function of
Cardiol 1998 Mar;21(3):207-10
angina: specialty-related disparities in implementation of practice
Holubkov R, Zell KA, Edmundowicz D, Shapiro AH, Feldman AM.
Medicine, University of Pittsburgh, Pennsylvania, USA.
The agency for Health Care Policy and Research (AHCPR) has published
practice guidelines to improve the quality of care patients with unstable
angina. Prior to publication, studies demonstrated that when compared with
cardiologists, internists were less likely to use effective pharmacologic
therapies or revascularization in patients with unstable angina.
HYPOTHESIS: The study was undertaken to determine whether the AHCPR
guideline publication abolished specialty-related disparities in care.
METHODS: We performed a chart review of consecutive patients hospitalized
at a university-affiliated institution with an admission diagnosis of
chest pain in the absence of myocardial infarction and a noncardiac
etiology. Treatment and diagnostic cardiac testing were compared between
risk-stratified patients cared for by a generalist (n = 125) and those
whose care was guided by a cardiologist (n = 211). RESULTS: In those with
low-risk unstable angina, generalists were less likely to prescribe
recommended aspirin (71 vs. 88%, p < 0.01) and beta blockers (9 vs.
37%, p < 0.001), and heparin (20 vs. 49%, p < 0.001), and to perform
a recommended diagnostic stress test or cardiac catheterization (28 vs.
60%, p < 0.001). In those with at least intermediate risk, generalists
were less likely to prescribe beta blockers (19 vs. 52%, p < 0.001),
heparin (19 vs. 66%, p < 0.001), and nitrates (77 vs. 96%, p <
0.001), and to refer for diagnostic testing (19 vs. 65%, p < 0.001).
Generalists' care was associated with significantly lower hospital charges.
CONCLUSIONS: AHCPR guidelines for the evaluation and treatment of unstable
angina are implemented more effectively, but not uniformly, by
cardiologists at our institution. Further studies are necessary to
evaluate the barriers to implementation of the AHCPR guidelines.