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ÖKG-Jahrestagung – Abstracts (Zur Publikation nachgereichte Abstracts)

J KARDIOL 2008; 15 (5–6)

187 (1)

Zur Publikation nachgereichte Abstracts

Long-Term Clinical Follow-Up of Drug-Eluting Coro-

nary Stents After Successful Treatment of Bare Metal

Stent Instent Restenosis

122

A. Kypta, C. Steinwender, R. Hofmann, K. Kerschner, J. Kammler, S. Hönig,

F. Leisch

Krankenhaus der Stadt Linz, Abteilung Innere Medizin I, Austria

Background Different trials have demonstrated a dramatic reduc-

tion in incidence of in-stent restenosis (ISR) following implantation

of drug eluting stents (DES) compared with bare metal stents

(BMS). The clinical outcome following successful (no re-restenosis

after 6 months) implantation of a DES for BMS ISR is less well de-

fined. The aim of this study was to assess the safety and efficacy of

DES (sirolimus and paclitaxel) in the treatment of patients with

BMS ISR which had angiographicaly less than 50 % restenosis at 6

months after implantation of DES.

Methods and results All 204 patients (mean age 66 ± 10, 52 fe-

male, 152 male) who received a DES (120 sirolimus, 84 paclitaxel)

for treatment of BMS ISR from May 2002 to December 2004 at a

single institution were entered into a prospectively collected data-

base. Six month angiographic follow-up and long term clinical out-

comes (36–60 months) were collected. At baseline, the most com-

mon target vessel was the left anterior descending coronary artery

(41 %), and 3 % of lesions were in the left main (LM). Multivessel

disease was present in 82 (40 %) of patients. Saphenous vein grafts

were excluded. The mean reference diameter was 2.79 ± 0.6 mm

and the mean lesion length was 18.1 ± 11 mm. There was one acute

letal stent thrombosis three days after implantation of a sirolimus

stent. No additional procedural or in-hospital major adverse cardiac

events (MACE – cardiac death, myocardial infarction or target le-

sion revascularisation) occurred. In patients who were symptomatic

at the time of controll angiography, 25 (12.2 %) had significant

(> 60 %) restenosis. In all of these patients a new DES was im-

planted. At this point of time, a paclitaxel eluting stent was im-

planted in pts. previously treated with a sirolimus eluting stent and

vice versa. The six months MACE rate was 12.2 %. Of the remain-

ing 179 (100 %) patients long term clinical follow-up (36–60

months) was available in 177 (98.8 %) patients. The 36–60 months

MACE rate was 17.4 %. Late stent thrombosis occurred in 4 (2.3 %)

of patients. There were 7 (4 %) cardiac death and 3 (1.7 %) non-

cardiac deaths.

Conclusion Stenting of restenosis after BMS using a DES evolves

as an option with acceptable short-term and mid-term results.

Whether a change of stent type (paclitaxel to sirolimus and vice

versa) during treatment of re-restenosis is of further benefit has to

be defined.

Fourteen-Month Follow-Up of Acute Myocardial

Infarcts With Contrast-enhanced Cardiac Magnetic

Resonance: Size and Function 123

K. Pedaring, G. Klug, A. Mayr, M. Nowosielski, M. Nocker, M. Schocke, T. Trieb,

A. Köhler, O. Pachinger, B. Metzler

Department of Cardiology, Innsbruck Medical University, Austria

Background Cardiac magnetic resonance (CMR) imaging is a

unique tool to study infarct size and cardiac function with high ac-

curacy and reproducibility. Nevertheless data on long-term investi-

gations in acute myocardial infarction is limited.

Methods We performed CMR in 28 patients (age: 55 ± 12 years,

23 male) within 2.14 ± 1.8 days after first acute myocardial infarc-

tion and primary angioplasty as well as 4 ± 1 and 14 ± 1 months

thereafter. Infarct size was determined as percent of LV tissue on de-

layed Gadolinium enhanced phase-sensitive IR-SSFP sequences.

Ejection fraction (EF) as well as left ventricular myocardial mass

(MM) were obtained from short-axis cine-MR sequences.

Results Mean infarct size at baseline was 10.8 ± 2.1 %. Two patients

were excluded from further evaluation because the increase in inf-

arct size exceeded that of the rest by ≥ 2SD and therefore recurrent

ischemia could not be ruled out. Infarct size measures between baseline

and the follow-ups showed an excellent agreement (r = 0.740 and

r = 0.886, p < 0.001) while infarct size decreased to 11 ± 2 % after

4 months (p < 0.05) and 10.2 ± 6.5 % after 14 months (p < 0.002, p =

ns versus 4 months). Large infarcts showed a greater reduction in

size as expressed by the linear correlation of initial infarct size with

the percentage in size reduction (r = –0.856, p < 0.001).

EF increased from 45.7 ± 9.0 % to 51.9 ± 8.9 % (p < 0.001) and 50.8

± 8.3, respectively (p < 0.001, p = ns versus 4 months) whereby the

separate measures showed good correlations (baseline to 4 months r

= 0.704, baseline to 14 months r = 0.763, p < 0.001). Patients with

initially lower EF recovered myocardial function moderately better

as indicated by the inverse correlation of baseline EF to the increase

in EF during follow-up (r = –0.455, p < 0.02).

Conclusion Our pilot study shows that CMR is a useful research tool

for the long-term follow-up of acute myocardial infarctions although its

clinical impact in this setting has to be further determined.

Percutaneous Aortic Valve Replacement for Severe

Symptomatic Aortic Stenosis: Patient Selection and

Management 124

G. Stoschitzky, R. Hödl, N. Watzinger, P. Oberwalder, B. Pieske, O. Luha, R. Maier

Division of Cardiology, Department of Medicine, Medical University Graz, Austria

Background Degenerative aortic stenosis (AS) is currently the

most frequent heart valve disease in industrialised countries with

surgical aortic valve replacement as the treatment of choice. Since

comorbidities increase the operative risk of surgical valve replace-

ment, particularly in elderly patients, percutaneous aortic valve re-

placement (PAVR) might be a suitable alternative therapy for high

risk patients. However, patients need to be selected very carefully.

Methods Between April 2007 and January 2008, 63 patients

(25 males, 38 females, age 79 ± 7 years) with severe symptomatic

AS (aortic valve area 0.55 ± 0.15 cm², peak transvalvular aortic

pressure gradient 95 ± 32 mmHg, mean transvalvular aortic pres-

sure gradient 58 ± 20 mmHg) and various comorbidities (St. p. coro-

nary artery bypass graft, St. p. mitral valve replacement, severe

chronic obstructive pulmonary disease, end-stage renal failure,

haematologic diseases) were admitted to our institution in order to

assess the eligibility for PAVR with the self-expanding CoreValve

bioprosthesis. Risk calculation revealed a logistic EuroSCORE of

28 ± 15 %. Further to clinical assessment echocardiography, cardiac

catheterisation, and computed tomography were performed.

Results 52 patients were found to be eligible for PAVR. Neverthe-

less, in five of these patients surgical aortic valve replacement was

recommended due to an acceptable individual risk score. In 20 pa-

tients PAVR was performed successfully within two months follow-

ing initial admission. Four patients refused PAVR, another five de-

ceased prior to PAVR being on the waiting list, and 18 are still wait-

ing for PAVR. Eleven patients were not suitable for PAVR since the

diameter of the aortic valve annulus was < 19 mm (four patients),

the ascending aorta was dilated > 45 mm at the sino-tubular junction

(one patient), and vascular access was impossible due to severe pe-

ripheral arterial disease (six patients), respectively.

Discussion PAVR emerges as a suitable alternative treatment for

severe symptomatic AS, particularly in elderly patients with high

risk of surgical valve replacement. However, thorough patient se-

lection is mandatory including clinical assessment, echocardio-

graphy, cardiac catheterisation, and computed tomography.

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