Vein graft disease:avoiding problems.
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Graft Occlusion, Vascular↗
Biomedical subjects
R Myler
Publications and source records attributed to R Myler.
Percutaneous coronary intervention in the current era compared with 1985-1986: the National Heart, Lung, and Blood Institute Registries.
BACKGROUND: Although refinements have occurred in coronary angioplasty over the past decade, little is known about whether these changes have affected outcomes. METHODS AND RESULTS: Baseline features and in-hospital and 1-year outcomes of 1559 consecutive patients in the 1997-1998 Dynamic Registry who were having first coronary intervention were compared with 2431 patients in the 1985-1986 National Heart, Lung, and Blood Institute Registry. Compared with patients in the 1985-1986 Registry, Dynamic Registry patients were older (mean age, 62 versus 58 years; P:<0.001) and more often female (32.1% versus 25.5%; P:<0.001). In the Dynamic Registry, procedures were more often performed for acute myocardial infarction (22.9% versus 9.9%; P:<0.001) and treated lesions were more severe (84.5% versus 82.5% diameter reduction; P:<0.001), thrombotic (22.1% versus 11.3%; P:<0.001) or calcified (29.5% versus 10.8%; P:<0.001). Stents were used in 70.5% of Dynamic Registry patients, whereas 1985-1986 patients received balloon angioplasty alone. Procedural success was higher in the Dynamic Registry (92.0% versus 81.8%; P:<0.001) and the rate of in-hospital death, myocardial infarction, and emergency coronary bypass surgery combined was lower (4.9% versus 7.9%; P:=0.001) than in the 1985-1986 Registry. The 1-year rate for CABG was lower in the Dynamic Registry (6.9% versus 12.6%; P:<0.001). CONCLUSIONS: Although Dynamic Registry patients had more unstable and complex coronary disease than those in the 1985-1986 Registry, their rate of procedural success was higher whereas rates of complications and subsequent CABG were lower. Results of percutaneous coronary intervention have improved substantially over the past decade.
Angioplasty, Balloon, Coronary↗
Coronary heart disease in Filipino and Filipino-American patients: prevalence of risk factors and outcomes of treatment.
BACKGROUND: Very little has been published on Filipino (F) or Filipino-American (FA) health. Nothing has been written about coronary risk factors and their relationship to outcomes of percutaneous coronary intervention or cardiac surgical treatment in this group. The purpose of this study was to analyze prospectively collected data at a center treating coronary artery disease in a large series of Filipino patients. METHODS: From January 1, 1992 to December 1, 1996, 527 consecutive FA patients and 3,176 Caucasians (C) were identified from an ongoing cardiac database. In-hospital and late outcomes post discharge were evaluated and results between the FA and C groups were compared. RESULTS: The FA population had a higher incidence of hypertension (79% vs. 61%, p < 0.0001) and diabetes (34.7% vs. 24.1%, p < 0.001) compared to C patients. Hypercholesterolemia was similar in both groups. Obesity (FA 12.2% vs. C 18.3%, p < 0.0001) and current smoking (FA 15.8% vs. C 21.5%, p < 0.001) were more common in the C patients. Age at presentation did not differ between groups. Morbidity and mortality were higher in the FA patients following intervention in the catheterization lab (4.2% vs. 1.3%, p < 0.01). Logistic regression showed that FA ethnicity was an independent predictor of death after catheterization laboratory intervention (p < 0.01), along with emergency procedure, depressed ejection fraction, history of myocardial infarction (MI) and age greater than 65. For coronary bypass surgery, mortality and rate of MI was similar in both groups. Late follow-up post discharge (mean 17 months, range 12Eth 68) was obtained on 90% and 89% of eligible FA and C patients, respectively. Occurrence of late death and MI did not differ between the groups. However, need for any reintervention (catheterization laboratory or surgical) was significantly higher in the FA patients (21.2% vs. 14. 9%, p < 0.001). Cox proportional hazard regression modeling showed that FA ethnicity was an independent predictor of need for late reintervention (p < 0.01), along with type of initial treatment, history of diabetes, presence of triple vessel disease, initial presentation with acute MI and age greater than 65. CONCLUSION: Filipino-Americans have a higher prevalence of hypertension and diabetes, and a lower prevalence of smoking and obesity compared to Caucasians. FA ethnicity is an independent predictor of higher mortality after catheterization laboratory intervention and increased need for late reintervention. However, the rate of late MI and death in FA was similar to C patients. These results suggest that FA patients, especially those presenting with diabetes for CAD treatment, need to be followed closely after percutaneous intervention or cardiac surgery procedures.
Aged↗
Documentation of decline in morbidity in women undergoing coronary angioplasty (a report from the 1993-94 NHLBI Percutaneous Transluminal Coronary Angioplasty Registry). National Heart, Lung, and Blood Institute.
To determine whether there has been an improvement in the relatively unfavorable outcome of percutaneous transluminal coronary angioplasty (PTCA) in women, the 1993 to 1994 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry collected data from 12 clinical centers that participated in the earlier registries. We compared 274 consecutive women in 1993 to 1994 with 545 consecutive women in 1985 to 1986 undergoing PTCA. Women in the 1993 to 1994 registry were older (64.3 vs 61.0 years, p <0.001) with more diabetes mellitus (34.3% vs 19.9%, p <0.001), congestive heart failure (13.7% vs 8.6%, p <0.05), and comorbid disease (19.5% vs 9.3%, p <0.001). Left ventricular function and multivessel coronary artery disease were similar between groups. Angiographic success (90.9% vs 85.1%, p <0.05) and clinical success (89.4% vs 79.4%, p <0.001) were higher in women undergoing PTCA in 1993 to 1994 than in 1985 to 1986. Whereas there was no difference in in-hospital mortality (1.5% vs 2.6%), the incidence of nonfatal myocardial infarction (1.8% vs 4.6%, p <0.05), emergency coronary artery bypass graft surgery (1.8% vs 4.6%, p <0.05), and the combined end points of death, myocardial infarction, and emergency coronary artery bypass grafting (4.4% vs 9.7%, p <0.01) were lower in women in 1993 to 1994 than in women in 1985 to 1986, respectively. Multivariate analysis revealed an odds ratio of 0.36 (95% confidence interval 0.18 to 0.72) for major complications and of 2.34 (95% confidence interval, 1.49 to 3.69) for clinical success in the 1993 to 1994 versus 1985 to 1986 registry. Therefore, despite a higher risk profile, women undergoing PTCA in 1993 to 1994 have a higher clinical success and lower major complication rate than women treated with PTCA in 1985 to 1986.
Aged↗
National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry as a standard for comparison of new devices. When should we use it, and what should we compare?
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Angioplasty, Balloon, Coronary↗
One-year follow-up results of the 1985-1986 National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry.
In 1,801 patients in the 1985-1986 Percutaneous Transluminal Coronary Angioplasty Registry, overall 1-year mortality was 3.2%, the 1-year myocardial infarction rate was 7.2%, and the 1-year coronary artery bypass surgery rate was 13.2%. In the 78% of the cohort with all lesions successfully dilated and without major procedural complications (successful patients), the corresponding rates were 1.9%, 2.6%, and 6.4%. Nearly 20% of all deaths, 40% of all infarctions, and 25% of all bypass operations occurred in the small subset of patients (6.8%) who sustained periprocedural occlusion. Event rates were higher in patients with multivessel disease than in those with one-vessel disease. At 1 year, angina-free status was reported by approximately three fourths of all surviving patients, regardless of initial success. However, compared with successful patients, unsuccessful patients underwent intervening bypass surgery (42% vs. 6%) to achieve asymptomatic status more frequently. Comparison of the 1-year event rates in the 1985-1986 registry with those in the 1977-1981 registry indicated reductions in all major untoward events. These reductions became apparent after controlling for the more extensive disease of the 1985-1986 registry patients. In contrast, use of repeat angioplasty has increased by 50%. We conclude that the improved initial results reported in the 1985-1986 registry cohort were maintained at 1-year follow-up.
Angina Pectoris↗
Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981. The National Heart, Lung, and Blood Institute Registry.
In August 1985, the Percutaneous Transluminal Coronary Angioplasty Registry of the National Heart, Lung, and Blood Institute reopened at its previous sites to document changes in angioplasty strategy and outcome. The new registry entered 1802 consecutive patients who had not had a myocardial infarction in the 10 days before angioplasty. Patient selection, technical outcome, and short-term major complications were compared with those of the 1977 to 1981 registry cohort. The new-registry patients were older and had a significantly higher proportion of multivessel disease (53 vs. 25 percent, P less than 0.001), poor left ventricular function (19 vs. 8 percent, P less than 0.001), previous myocardial infarction (37 vs. 21 percent, P less than 0.001), and previous coronary bypass surgery (13 vs. 9 percent, P less than 0.01). The new-registry cohort also had more complex coronary lesions, and angioplasty attempts in these patients involved more multivessel procedures. Despite these differences, the in-hospital outcome in the new cohort was better. Angiographic success rates according to lesion increased from 67 to 88 percent (P less than 0.001), and overall success rates (measured as a reduction of at least 20 percent in all lesions attempted, without death, myocardial infarction, or coronary bypass surgery) increased from 61 to 78 percent (P less than 0.001). In-hospital mortality for the new cohort was 1 percent, and the nonfatal myocardial infarction rate was 4.3 percent. Both rates are similar to those for the old registry. The long-term efficacy of current angioplasty remains to be determined.
Age Factors↗
[Disobliteration of coronary arteries by the laser. Peroperative experience].
The authors report their experience of coronary artery disobliteration by laser in 10 patients. This was a preliminary study to assess the effects of an Argon laser on atheromatous coronary stenosis in vivo. This technique was used during coronary bypass surgery. Two series of patients were treated: an initial group of 5 patients who underwent laser therapy associated with coronary bypass surgery; a second group undergoing laser therapy alone without distal bypass grafting. The results were assessed by immediate angiography in the first series and by the passage of calibrated probes in both series. Secondary control angiography after 3 weeks was carried out in all patients. The immediate results showed a constant improvement (less than 25%) in the degree of stenosis. However, secondary angiography showed secondary occlusion in 88% of cases. These preliminary results show: the immediate efficacy of Argon laser in reducing the size of atheromatous plaques, the innocuity of the method as there were no postoperative deaths, a high incidence of secondary failure which could be related to the type of indication (competitive flow in the first group and poor distal run off in the second group of patients) or to the type of laser used. The authors consider this to be a promising technique but a lot of clinical and experimental work remains to be done before it can be adopted for routine use.
Aged↗
[Coronary artery disease. Conservative therapy, aortocoronary bypass operation, or transluminal angioplasty].
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Catheterization↗
[Percutaneous transluminal dilatation of chronic coronary stenoses. First experiences].
The technique of percutaneous transluminal dilatation of coronary artery stenosis consists of a catheter system introduced via the femoral artery under local anesthesia. A preshaped guiding catheter is positioned in the orifice of the coronary artery and through this a dilatation catheter is inserted into the branches if the artery. This dilatation catheter (outer diameter 0.5--1.25 mm) is equipped with a sausage-shaped distensible segment (balloon) at the tip. The balloon is inflated to a pressure of 5 atm. This pressure compresses the atherosclerotic material in a direction perpendicular to the wall of the vessel, therby dilating the lumen. Up to now 29 patients have been treated with primary success in 23 (79%) and long-lasting success in 21 (72%). Three patients underwent emergency coronary surgery to avoid infarction. Dilatation is indicated in patients with disabling angina which jeopardizes their quality of life and with coronary lesions which are proximal, subtotal, concentric and non-calcified.
Angiography↗