Anatolian Journal of Cardiology最新文献

Background: Primary percutaneous coronary intervention (PPCI) is preferred as the reperfusion option for patients with ST-segment elevation myocardial infarction (STEMI).

Methods: This study conducted the pharmacoinvasive strategy with half-dose recombinant human prourokinase (PHDP) trial to evaluate whether the PHPD encompassing early fibrinolysis coupled with timely catheterization, provides efficacy and safety similar to that of PPCI in STEMI patients. We randomly assigned patients with STEMI aged 18-80 years who presented within 24 h of their symptoms to receive either PHDP or PPCI.

Results: There was no significant difference in the 2 arms for the primary endpoints, which were defined as thrombolysis in myocardial infarction (TIMI) flow grade 3, TIMI myocardial perfusion grade 3, and ST-segment resolution ≥70% 1 hour after percutaneous coronary intervention. The secondary endpoints, including slow flow/no-reflow (P < .001), malignant arrhythmia (P < .001), and hypotension (P < .001), occurred more frequently in the PPCI arm than in the PHDP arm. The combined 30-day follow-up outcomes occurred more often in the PPCI group than in the PHDP group (P = .032). There were no reported cases of in-hospital intracranial hemorrhage or major bleeding events; the rates of minor bleeding events were similar (P = .157).

Conclusion: Among patients with STEMI presenting ≤24 hours after symptom onset who received the PHDP, the efficacy of complete epicardial and myocardial reperfusion was similar to that among patients who received the PPCI. In addition, PHDP was associated with a decreased risk of procedure-related complications. Conducting clinical efficacy and safety trials with the pharmacoinvasive strategy and the half-dose of fibrinolytic drug is warranted.

Endocarditis is the most common cause of death from brucellosis. The information used to guide the management of cases with Brucella endocarditis has relied on case reports/series. Risk factors related to death and other adverse outcomes in patients with Brucella endocarditis were identified by an individual-patient data analysis of all reported Brucella endocarditis cases in the literature. The keywords "Bruce" and "endocard" were used to search articles published until July 2022 on PubMed and ULAKBIM databases. Case reports/series containing patients with endocarditis caused by Brucella spp., aged ≥17 years, and with data on antimicrobial or surgical treatment were included in the study. Epidemiological, clinical, laboratory, and treatment characteristics and outcomes of 273 cases from 86 eligible articles were recorded. It was found that male gender, a Wright serum tube agglutination (STA) titer of ≥1/1280 on admission, development of heart failure due to endocarditis were independent risk factors that increase mortality, while the usage of aminoglycoside and cardiac surgical intervention for endocarditis were factors reducing mortality. Including streptomycin or gentamicin in the treatment regimen may benefit patients with Brucella endocarditis. Valve surgery could be life-saving in patients with Brucella endocarditis. An STA titer of ≥1/1280, which probably reflects long-term and advanced disease, may be used as a marker for increased mortality. However, additional and more reliable studies are needed to define the most appropriate management approach in diagnosing and treating cases with Brucella endocarditis due to the low quality of the current evidence.

Background: Preventive measures for radial artery complications in distal transradial approach are not fully studied. Our aim was to investigate the role of nitroglycerine injection in patients undergoing coronary angiography via distal transradial access.

Methods: In this study, 168 patients who underwent angiographic procedures performed via distal transradial route with or without nitroglycerine injection were evaluated. Demographic, angiographic, and laboratory characteristics were recorded. Radial artery outcomes, including radial artery spasm, radial artery occlusion, and hematoma were compared between these groups and P values < .05 indicated significant differences.

Results: Radial artery outcome occurred in 22% of the study population (n = 37), with radial artery spasm being the most encountered complication (n = 28, 16.7%). The groups were not different in terms of radial artery complications. Procedural features were also comparable except for the total contrast volume used.

Conclusion: Coronary angiographic procedures could be performed safely using distal transradial access without nitroglycerine injection.