Primary Angioplasty: Mechanical Interventions for Acute Myocardial Infarction PDF
Preview Primary Angioplasty: Mechanical Interventions for Acute Myocardial Infarction
Primary Angioplasty Primary Angioplasty Edited by David Antoniucci MRCP(UK) MD Head Division of Cardiology Careggi Hospital Viale Morgagni Florence 1-50134 Italy © 2004 Taylor & Francis, an imprint of the Taylor & Francis Group First published in the United Kingdom in 2004 by Taylor & Francis, an imprint of the Taylor & Francis Group, 11 New Fetter Lane, London EC4P 4EE This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Tel.: +44 (0) 20 7583 9855 Fax.: +44 (0) 20 7842 2298 E-mail: [email protected] Website: http://www.dunitz.co.uk All rights reserved. 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Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein. For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing informa- tion or instructional material issued by the manufacturer. A CIP record for this book is available from the British Library. ISBN 0-203-50747-9 Master e-book ISBN ISBN 0-203-59598-X (Adobe eReader Format) ISBN 1-84184-342-3 (Print Edition) Distributed in North and South America by Taylor & Francis 2000 NW Corporate Blvd Boca Raton, FL 33431, USA Within Continental USA Te;.: 800 272 7737; Fax.: 800 374 3401 Outside Continental USA Tel.: 561 994 0555; Fax.: 561 361 6018 E-mail: [email protected] Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover, Hampshire SP10 5BE, UK Tel.: +44 (0)1264 332424 E-mail: [email protected] Contents Contributors vii Preface ix Section 1: The Clinical Perspective 1 Pathophysiological basics of acute myocardial infarction 3 Guido Parodi The epicardial vessel (cid:1) The microcirculation (cid:1) The myocardium 2 Major subgroups at presentation 15 Angela Migliorini, Giampaolo Cerisano, Piergiovanni Buonamici, Guia Moschi Electrocardiography (cid:1) Echocardiography (cid:1) Angiography (cid:1) Elderly patients (cid:1) Women (cid:1) Diabetics (cid:1) Cardiogenic shock Section 2: The Technical Perspective 3 Techniques 45 Angela Migliorini, Renato Valenti Entry site (cid:1) Guiding catheters (cid:1) Coronary wires and angioplasty balloons (cid:1) Techniques for assessment of the anatomy of a target vessel persistently occluded after crossing the wire (cid:1) Thrombectomy (cid:1) Emboli protection devices (cid:1) Stents (cid:1) Other techniques 4 Platelet glycoproteins IIb/IIIa inhibitors 59 Renato Valenti, Guido Parodi, Angela Migliorini Abciximab (cid:1) Eptifibatide and tirofiban 5 Mechanical support 65 Renato Valenti, Guido Parodi Intraaortic balloon pumping (cid:1) Other percutaneous mechanical circulatory support devices Section 3: The Vessel Perspective 6 Right coronary artery (RCA) 71 Renato Valenti, Angela Migliorini 7 Left anterior descending artery (LAD) 117 Renato Valenti, Angela Migliorini vi Contents 8 Left circumflex artery (LCX) 149 Renato Valenti, Angela Migliorini 9 Left main trunk (LMT) 163 Renato Valenti, Angela Migliorini 10 Multivessel coronary intervention 169 Renato Valenti, Angela Migliorini Section 4: The Efficacy Perspective 11 Primary percutaneous coronary intervention for acute myocardial infarction in the ‘real world’ 179 Renato Valenti, Emilio Vincenzo Dovellini, Giovanni Maria Santoro Effectiveness of percutaneous mechanical intervention for AMI (cid:1) Impact of time to treatment on outcome of patients treated by PCI for AMI (cid:1) Institutional volume of primary PCI (cid:1) Practice guidelines (cid:1) Logistic models and organizational scenarios (cid:1) Role of cardiac surgery backup 12 Assessment of myocardial reperfusion in acute myocardial infarction 187 Giovanni Maria Santoro The no-reflow phenomenon (cid:1) Assessment of myocardial reperfusion 13 The concepts of rescue and facilitated percutaneous intervention in perspective 201 Guido Parodi Rescue angioplasty (cid:1) Facilitated primary angioplasty (cid:1) Transfer for primary angioplasty Index 207 Contributors David Antoniucci MD Angela Migliorini MD Head Associate Chief Division of Cardiology Division of Cardiology Careggi Hospital Careggi Hospital Viale Morgagni Viale Morgagni Florence I-50134 Florence I-50134 Italy Italy Piergiovanni Buonamici MD Guia Moschi MD Associate Chief Associate Chief Division of Cardiology Division of Cardiology Careggi Hospital Careggi Hospital Viale Morgagni Viale Morgagni Florence I-50134 Florence I-50134 Italy Italy Giampaolo Cerisano MD Guido Parodi MD Associate Chief Associate Chief Division of Cardiology Division of Cardiology Careggi Hospital Careggi Hospital Viale Morgagni Viale Morgagni Florence I-50134 Florence I-50134 Italy Italy Emilio Vincenzo Dovellini MD Giovanni Maria Santoro MD Associate Chief Head Division of Cardiology Division of Cardiology Careggi Hospital San Giovanni d’Dio Hospital Viale Morgagni Via di Torregalli 3 Florence I-50134 50143 Florence Italy Italy Renato Valenti MD Associate Chief Division of Cardiology Careggi Hospital Viale Morgagni Florence I-50134 Italy Preface Primary percutaneous coronary intervention (PCI) is the A comprehensive review of interventional techniques is best therapeutic option for patients with acute myocardial supported by a full description of cases representing differ- infarction (AMI). ent angiographic and clinical patient subsets. The aim of this book is a complete and concise update There are a number of previously controversial issues on the rationale, techniques, and effectiveness of percuta- that we believe are no longer relevant and have not been neous mechanical revascularization for AMI. discussed here. This is the case with the comparison This aim has been achieved by the synergism of a between primary angioplasty and fibrinolysis, or the feasi- complete and critical review of the key studies that are the bility of primary angioplasty in current clinical practice. foundation of evidence-based medicine with the so-called Again, general interventional cardiology issues that are not ‘technology of experience’. The latter is based on the experi- specific to AMI have not been addressed. ence of a high-volume center with more than 2000 patients These choices have resulted in an innovative format with AMI treated by primary PCI, with no restriction based that includes four sections based on clinical, technical, on clinical status on admission, and representative of the ‘real procedural, and logistic aspects of mechanical intervention world’ of AMI. This growth in knowledge proceeded at the for AMI. The book may be read in a conventional way, same pace as pioneering developments in new interven- from beginning to end, or alternatively, starting from one tion techniques and adjunctive therapies, such as infarct of the four sections, and then following all possible artery stenting, direct stenting, thrombectomy, antiembolic sequences for the remaining three sections. protection devices, and the use of antiplatelet drugs. In addition to the Contributors, I would like to thank In this book, pathophysiologic and clinical aspects of AMI Vanda Boschi, one of the most extraordinary individuals and reperfusion have been put in an interventional involved in the primary PCI program of the Division of perspective, in order to provide the rationale for the best Cardiology of the Careggi Hospital, for her encouragement interventional approach to the patient with AMI. and unlimited support. David Antoniucci
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