Showing 45 results for Coronary Artery
Af Zand Parsa,
Volume 59, Issue 6 (11-2001)
Abstract
In the past, coronary artery bypass grafting was the treatment of choice for patients with symptomatic multi vessel coronary artery disease, but in recent years per cutaneous transluminal coronary angioplasty (PTCA) accepted as an alternative approach to revascularization. To assess the initial success and in hospital results of coronary angioplasty of more than one lesion per procedure in patients with multi vessel coronary artery disease, a retrospective analysis of patients who underwent selective coronary angioplasty at Imam Khomeini medical center from 1994-1997 were peformed. From 1994 to 1997 per cutaneous transluminal coronary angioplasty (PTCA) were done in 257 patients, that 201 (78.2 percent) were male and their age range 23-73 years. The numbers of patients with multi vessel coronary artery disease were 98 (38.13 percent), that complete revascularization (PTCA of more than one lesion per procedure) underwent in 34 (13.58 percent) of them (27 men, 7 women, age: mean±SD 48±9.8 range 30-70). A total of 71 lesions were tried, that 22 (31 percent) were type A, 45 (63.4 percent) were type B, and 4 (5.6 percent) were type C. Among patients 21 (61.8 percent) had unstable angina and 13 (38.2 percent) had stable angina. Procedures were successful in 68 (95.8 percent) of lesions and 31 (91.2 percent) patients were discharged fro procedural complications included 3 (8.8 percent) non-Q wave myocardial infarction and no mortality. Without any complication, (success defined as residual stenosis <50 percent). As a conclusion, in selected patients with multi vessel coronary artery disease PTCA of more than one lesion per-procedure is effective and safe.
Rafiei M, Sadr S M, Mirjalili M R, Nayeb Zadeh M, Namayandeh S M,
Volume 62, Issue 1 (4-2004)
Abstract
Background: All the patients with Angina pectoris have not stenotic coronary artery. Syndrome x consists of patients with Angina pectoris and positive Exercise test along with normal coronary angiography. Syndrome x includes 25-30 percent of those who undergo diagnostic coronary arteriography at the different centers. In our study it was attempted to know the prevalence and characteristics of this special group in Afshar cath-lab.
Materials and Methods: In a prospective cross sectional descriptive study 200 patients who were admitted for coronary angiography evaluated in terms of Risk factors: HTN, Family history Hyperlipidemia, DM, Cigarette smoking , clinical symptoms , response to TNG, different symptoms, ECG and Exercise test. data in two subgroups with normal and abnormal Coronary angioghraphy were compared. Six patients were excluded because of ambiguous Coronary angiography.
Results: Among 194 patients 51 patients (26.3% )had normal coronary artery. 38.9% of female and 21.4% of males showed normal coronary angioghraphy (P = 0.013). The prevalence of risk factors among those with syndrome x and abnormal coronary Artery were as follow. HTN 37% vs 42% , Hyperlipidemia 50% vs 51% , smoking 25% vs 37% , DM 12% vs 28% , obesity 45% vs 47% Positive family history for CAD = 21.5% vs 47% respectively. Angina relieved suitably with TNG in 24% of those with syndrome x compared to 76% suitable response in those with abnormal coronary arteries.(P Value = 0.49 ). Regarding to functional class , 87% of patients with normal coronary artery belonged to class I and II. also 26% had atypical pain 50% had normal rest ECG and 51% achieved stage III or IV of Bruce protocol during Exercise test.
Conclusion: Syndrome x was more prevalent among women ,also angina was less typical and less responsive to TNG. Most patients had not positive familial history for CAD. normal ECG was more prevalent among those with syndrome x .
E. Neamatipoor, A. Sabri, F. Dahi, F. Soltanipoor,
Volume 64, Issue 3 (5-2006)
Abstract
Background: coronary artery disease (CAD) is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%. CAD risk factors change with time and there are very few studies in this field in Iran. These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period.
Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI) in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets. Comparison of means was done by t-test and prevalence of risk factors by chi-square test.
Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022). No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01).
Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.
Salarifar M, Kazemeini S.m, Haji Zeinali A.m,
Volume 65, Issue 1 (3-2008)
Abstract
Background: Premature coronary artery disease (CAD) has a familial predisposition and
occurrence. We determined the prevalence of CAD and related risk factors in individuals
with a history of premature CAD in their first-degree relatives.
Methods: This study included 700 healthy individuals with a history of premature CAD
in their parents or siblings in Tehran Heart Center in 2003-2004. History of smoking,
diabetes mellitus (DM) or hypertension was taken. Fasting levels of blood sugar (FBS),
triglycerides (TG), cholesterol, LDL and HDL were measured. Noninvasive studies for
CAD were performed with resting echocardiography (ECG) and ECG with exercise
tolerance test (ETT). Patients with positive findings for ischemia in these tests underwent
a myocardial perfusion scan and if positive proceeded to coronary angiography.
Results: The mean age of our subjects was 35.2 (15-65) years. DM was found in 5.3%,
smoking in 14.7%, hypertension in 20.6%, cholesterol above 200 mg/dl in 39.9%, TG
above 150 mg/dl in 58.6%, LDL above 130 mg/dl in 38% and HDL below 40 mg/dl in
32.6%. In addition, 6.4% had ECG changes and 3% echocardiographic abnormalities in
favor of ischemia. ETT was positive in 7.3% and myocardial perfusion scan in 2.1%.
Coronary angiography showed 50-70% stenosis in eight patients (1.1%) and >70% in
four patients (0.6%).
Conclusion: High cholesterol, TG and LDL and low HDL were found among our
subjects. Risk factor determination in these individuals may prove to be beneficial.
Noninvasive tests for CAD yield low true-positive results and are not recommended in
the population as a whole. In certain subgroups, including those with persons older than
40 years and diabetic patients, these tests may be useful.
Nozari Y, Nabati M,
Volume 65, Issue 7 (10-2007)
Abstract
Background: Epidemiological studies have suggested an association between higher body iron stores and coronary artery disease. It is believed that inflammation and oxidation are important mechanisms involved in the complex pathological process of atherogenesis. Free radical production is catalyzed and accelerated in the presence of iron. The determination of plasma ferritin levels is a convenient iron balance assessment method. The purpose of this study was to define the correlation of ferritin levels with severity and extent of coronary artery atherosclerosis.
Methods: In this cross-sectional study, 240 consecutive patients underwent previously indicated coronary artery angiography and were divided into two groups according to their angiographic findings: group 1 with 50% stenosis or less in each of the coronary arteries, and group 2 with more than 50% stenosis of the coronary arteries. Blood samples were taken for routine biochemical tests, including evaluation of serum ferritin levels. The severity and extension of coronary artery stenosis was determined by Gensini score.
Results: Group 1 consisted of 120 patients with a mean age of 52 6.8 years, and group 2 had 120 patients with a mean age of 58.1 10.4 years. We found a correlation between serum ferritin level and severity of coronary artery stenosis among men (p=0.02) however, there was no significant difference in serum levels of ferritin between the two groups (63.88 ng/ml vs. 44.26 ng/ml). Furthermore, there was no significant difference in serum ferritin levels of subgroups of patients with major risk factors such as hypertension, hyperlipidemia, hyperglycemia and smoking.
Conclusion: Overall this study cannot confirm a strong correlation of serum ferritin levels with severity of coronary atherosclerosis in our study population. However, in men it could have a role in the promotion and augmentation of coronary atherosclerosis, suggesting that ferritin could be a comparable index in patients with ischemic heart disease. Therefore, further study is necessary to assess etiological relationship between serum ferritin levels and extension of coronary artery stenosis.
Khorsandi M T, Mohammadi M, Motasaddi Zarandy M, Mandegar M H, Yoosefnia M A, Sabetazad B,
Volume 65, Issue 7 (10-2007)
Abstract
Background: Hearing is one of the most significant senses There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery.
Methods: age, audiometric changes before and after surgery (hearing levels at multiple frequencies, speech reception threshold and speech discrimination score), minimum blood pressure during the operation, and the time on bypass, measured on One hundred consecutive patients who candidate for coronary artery bypass surgery and the results analysed.
Results: One hundred patients completed the tests. Based on hearing changes found on pre- and post-operative tests, the patients were divided into 3 groups: Those with no change (47 patients) according to their audiometric results those with slight changes ≤10 db (43 patients) and those having average deficits of more than 10 db (10 patients). All the patients were male. None of the patients had complete or severe sensorineural hearing loss. The third group had more prolonged pumping duration when compared with the others groups (p=0.002). Furthermore, 90 percent of patients with a sensorineural hearing loss more than 10 db had diabetes mellitus and hyperlipidemia as risk factors.
Conclusion: Sudden sensorineural hearing loss is a sequela in patients who undergoing coronary artery bypass surgery however, it was usually mild and asymptomatic. Pumping time during the operation is a significant factor in occurring of this complication. With proper treatment of underlying diseases and eliminating the risk factors with improvement of our cardiopulmonary pumps we probably can get better hearing results.
Kazemi Khaledi A, Taghizadeh M,
Volume 66, Issue 8 (11-2008)
Abstract
Background: Multislice computed tomography (MSCT) is a noninvasive method of detecting coronary artery disease (CAD). The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64-MSCT) in daily practice, without patient selection.
Methods: Sixty-four consecutive suspected CAD patients underwent both 64-MSCT and quantitative coronary angiography (QCA). The CT system The mean time span between MSCT and QCA was 7.2±3.9 days. For the 64-MSCT, detection or exclusion of CAD, defined as one or more areas of >50% stenosis within major epicardial coronary arteries, the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) were evaluated both per patient and per segment.
Results: Sixty-one of the 64 coronary CT angiograms (95%) were of diagnostic image quality. QCA showed significant CAD in 64% (39/61) of the patients, with the other 36% (22/61) showing nonsignificant disease or no disease. Sensitivity, specificity, accuracy, PPV, and NPV of 64-MSCT per patient were 92%, 86%, 90%, 92% and 96%, respectively. By the per-segment analysis, 695 of 791 coronary artery segments were assessable (88%). Of these, 64-MSCT showed a sensitivity of 80%, specificity of 92%, accuracy of 90%, PPV of 65%, and NPV of 96%, respectively, in detecting CAD.
Conclusions: Both per patient and per segment analyses for coronary 64-MSCT showed a higher diagnostic accuracy than QCA. This suggests 64-MSCT should primarily be used for risk stratification on a per patient basis as a noninvasive gate-keeper diagnostic method.
Eslami M, Mehrpooya M, Broumand B, Seifi S,
Volume 67, Issue 1 (4-2009)
Abstract
Background: Uric acid as a final product of purine metabolism has a role of risk factor for cardiovascular disease with less clear mechanism in general population. The aim of this study was Assessing and finding association between uric acid levels and CAD as a risk factor in renal transplant candidates and if we can predict need to revascularization according to uric acid level as an important measure.
Methods: This is a cross-sectional study that has been studied since April 2007 up to December 2008, in imam Khomeini and pars hospitals in Tehran. Inclusion criteria were patients with ESRD, more than 40 years who were candidates for renal transplantations. They underwent coronary angiography without regarding clinical cardiac symptom or results of noninvasive tests (for avoiding referral bias) and simultaneous analysis of serum uric acid level and results of this two producers were analyzed. Excluding criteria were patients who didn't tend to coronary angiography, those who hadn't adequate artery access, or potential co morbidity so that angiography was impossible and life expectancy less than 6 month.
Results: 56 (24 females and 32 males) were constituted. 89.3% (50) of patients had coronary artery disease. The average of uric acid level was significantly different in patients with and without CAD [7.62±1.07mg/dl and 5.95±1.29mg/dl respectively] (p=0.0024). Moreover, there was statistically significant difference in serum uric level between patients who were candidate for revascularization and the others [7.89±0.79mg/dl and 6.2±1.27mg/dl respectively] (p<0.001).
Conclusion: It seems that serum uric acid can be considered as a cardiovascular risk factor in renal transplant candidates and also as a predictor for related treatment.
Abiri M, Sadeghian S, Hakki E, Boroumand Ma, Mehdipour P, Izadi M, Keramatipour M,
Volume 67, Issue 2 (5-2009)
Abstract
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Background: Coronary
Artery Disease (CAD) is a major cause of death worldwide including Iran. The risk of developing disease in patients
without symptoms is assessed in part by factors that are associated with disease.
Among these factors family history points to the significance of genetic
component in the risk of CAD. The identification of the genetic variants that
confer risk for CAD is essential for detecting high-risk individuals, so
preventative life style and therapeutic action can be taken before overt
disease develops. So far more than 100 genes have been reported with possible
role in developing risk for CAD. Matrix- Gla Protein (MGP) is one of these
genes that association of its single nucleotide polymorphism (SNP) with CAD has
been reported. Among the polymorphisms,
there are two promoter SNPs at position -7 & -138 that their association
with CAD has been reported before. Here we investigated the association of
these SNPs with CAD in Iranian population.
Methods: 150 cases and 150 controls were selected on the basis of their
clinical assessments and angiographic reports. DNA was extracted from blood
samples. The genotypes for both SNPs were determined using Polymerase Chain
Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method with size
fractionation on Polyacrylamide gel.
Results: The
comparison of allele & genotype frequencies between patients and controls
showed that there is an excess of A allele at position -7 and T allele at
position -138 among patients, although these differences were not significant (p<0.2, and p<0.5 respectively).
Conclusions: This study
suggests no association of these SNPs with CAD in Iranian population.
Confirmation of this finding needs independent repeat of similar studies.
Keywords: Coronary
Artery Disease (CAD), Matrix Gla Protein (MGP), Single Nucleotide Polymorphism (SNP).
Ebrahim Hassani , Rasoul Farasatkish , Evaz Heydarpour , Mohammadzia Totoonchi , Alireza Mahoori ,
Volume 67, Issue 9 (12-2009)
Abstract
Background: Measuring end tidal carbon dioxide (ETCo2) is one of the methods used for estimating arterial carbon dioxide (PaCo2) during general anesthesia. ETCo2 measurements maybe obviate the need for repeating arterial puncture for determination of arterial PaCo2. This study performed to determine the accuracy of ETCo2 levels as a measure of PaCo2 levels in patients undergoing coronary artery bypass graft and also to evaluate variation of the gradient between PaCo2 and ETCo2, peri- cardiopulmonary bypass operation. Methods: In a prospective, cross-sectional study, a total of 40 patients with age 57±11 (35-73) years old undergoing coronary artery bypass graft were enrolled. ETCo2 levels (mmHg) were recorded using side stream capnography at the time of arterial blood gas sampling, before (T0) and after (T1) cardiopulmonary bypass. Results: Mean P(a-ET)Co2 at T0 was 4.3±4.4mmHg, with the mean PaCo2, 33±6mmHg and mean ETCo2, 29±5mmHg and these values at T1 were 4.5±4.1mmHg, 33±5mmHg and 29±2mmHg respectively. There was no variation of the mean gradient (PaCo2-PETCo2) during, before and after cardiopulmonary bypass (p>0.870). Significant correlation was found between ETCo2 and PaCo2 at T0 and T1 (r=0.754 and 0.685respectively and p=0.001). Conclusion: Capnography is a non- invasive and a safe technique for determining arterial PCo2 and for measurements of ETCo2 that correlate well with PaCo2 values in healthy patients undergoing coronary artery bypass graft. ETCo2 measurements maybe sufficient measures of PaCo2 in selected patients and obviate the need for repeatingarterial blood gas determination. Further study is warranted.
Zand Parsa Af, Ziai H, Fallahi B,
Volume 68, Issue 3 (6-2010)
Abstract
Background: Coronary Artery Disease (CAD) is one of the leading causes of mortality
and morbidity all over the world. One of the most important predictors of outcome of patients with coronary aterey disease is the site of stenosis i.e. Proximal versus nonproximal stenosis. This study designed to evaluate the relationship between CAD risk factors and site of stenosis.
Methods: In this case- control study in the patients undergone coronary angiography (CAG) in Imam Khomeini Hospital, Tehran, Iran a total of 125 CAD patients with proximal lesion in CAG enrolled the study as case group and equal sex and age matched number of patients with non proximal lesion selected as control group. Two groups were compared based on presence or absence of DM, hypertension, hyper cholestrolemia, hypertriglyceridemia and cigarette smoking.
Results: Relative frequency of DM was 33.6% and 10.4% in case and control group respectively (p< 0.0001). Relative frequency in two groups were 33.6 vs 28.8% For HTN (p= 0.41), 30.4% vs 29.6% for hyper cholestrolemia (p= 0.89), 19.2% vs 16.8% for hypertriglyceridemia (p= 0.062) and 28.8 vs 39.2 for C/S (p= 0.08). Multivessle disease was significantly more prevalent in diabetics compared with non diabetic patients
89.1% vs 61% (p< 0.0001), no relationship was seen with HTN (p= 0.41), Hyper cholest- rolemia (p= 0.052) hypertriglyceridemia (p= 0.38) and cigarette smoking (p= 0.375). Conclusion: Proximal involvement of coronary arteries and multivessle disease in CAD patients is related to the history of DM but not to the history of hypertension, hypercholestrolemia, hypertriglyceridemia and cigarette smoking.
Edalati Fard M, Khatami Smr, Sadeghian S, Salari Far M,
Volume 68, Issue 6 (9-2010)
Abstract
Background: The relationship between Coronary Artery Disease (CAD) and the prevalence of Renal Artery Stenosis (RAS) has been demonstrated. Despite high incidence of heart diseases and high frequency of CAD risk factors among Iranian population, this relation has not been clearly determined. This study estimated the prevalence of RAS and its determinants in Iranian angiographic candidates. We also tried to find which risk factors of atherosclerosis are associated more frequently with renal artery stenosis.
Methods: In a cross-sectional study that was performed at the Tehran Heart Center, in Tehran, Iran, 146 patients who were candidate for angiography with suspected CAD were consecutively included. Selective renal angiography was performed following coronary angiography in all patients with established coronary artery stenosis and the presence and severity of RAS was evaluated.
Results: Prevalence of RAS in study patients was 25.3% (men, 13.7% and women 47.1%, (p<0.001). We found that only 6.2% of the patients had bilateral R.A.S. Also, RAS≥50% was found in 17.1% of patients. Regarding number of defected coronary vessels, two- and three-vessel diseases were found in 30.0% and 39.0% of participants, respectively. No significant relationship was found between the number of involved coronaries and the severity as well as side of RAS (p=0.716) Significant multivariate predictors of RAS were female gender (p=0.001), advanced age, (p=0.046) duration of hypertension (p=0.032) and baseline serum creatinine concentration (p=0.018).
Conclusions: Routine angiographic assessment of renal arteries following coronary angiography is recommended especially in women as well as those with long-term duration of hypertension or renal dysfunction.
Tanaray B, Eslami M, Salehi M, Jahanzad I, Emami M,
Volume 68, Issue 7 (10-2010)
Abstract
Background: Studies of the association between post operative AF and Plasma level of NT- Pro BNP have reported conflicting findings. The aim of the present study was evaluation of the association between post coronary bypass graft- Atrial Fibrillation (AF) and Plasma level of NT- ProBNP as an independent risk factor of AF development in patients undergoing coronary artery bypass graft.
Methods: In a cohort study, 79 patients with sinus rhythm who admitted in Imam Khomeini Hospital in Tehran, Iran, during February 2009 and February 2010 for CABG are included the study and followed for developing post operative AF rhythm.
Results: Post operative AF was found in 17.7% of patients. The peak time from the operation to the first AF episode was in second post op day in ten patients (71.4%). The serum level of ProBNP in patients with AF was significantly higher (1624± 647 versus 221± 238 pg/ml, p< 0/0001). Increased age, Increased LA size and high plasma level of ProBNP were associated with increased risk for post op AF. After adjustment of risk factors, plasma level of ProBNP was the most important risk factor with odds ratio of 15.34 with CI 95% 1.77-132.95 and then LA diameter with odds ratio of 6.11 with CI 95% 0.99-37.42 was independently correlated with post op AF. Correlation between plasma level of ProBNP with age and LA size was seen too (LA size r = 0.0281, p= 0.012). Between age and ProBNP (r= 0.337, p= 0.002). The best cut off point for plasma ProBNP as a predictor of post op AF was 854 pg/ml.
Conclusion: Increased level of preoperative ProBNP levels could be an independent predictor of post operative Atrial Fibrillation.
Eshraghi N, Tarzamni Mk, Afrasiabi A, Safaie N, Halimi M, Eshraghi A,
Volume 68, Issue 7 (10-2010)
Abstract
Background: A correlation between coronary artery disease (CAD) and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima-media thickness (IMT) of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG).
Methods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined.
Results: There was a significant weak positive correlation between the IMT of common carotid artery (ρ = 0.193, p = 0.039) and common femoral artery (ρ = 0.206, p = 0.028) with the number of involved carotid vessels the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease.
Conclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD however, these parameters are not a surrogate for predicting the CAD severity.
Forouzan Nia Skh, Hadadzadeh M, Mirhosseini Sj, Hosseini H, Abdollahi Mh, Forat Yazdi M, Rasti M, Dehghanizadeh H, Ghoreishian Sm,
Volume 68, Issue 9 (12-2010)
Abstract
Background: One of the most important components of coronary
artery bypass graft surgery is need for blood transfusion that increases
morbidity and mortality. The aim of this study was to evaluate the factors
affecting the need for blood transfusion during off pump coronary artery bypass
(OPCAB)
surgery.
Methods: In
this descriptive case control study 923
patients who had undergone OPCAB at Afshar Hospital in Yazd,
Iran, from July 2008 to January 2010
were evaluated. The data was gathered from their records and was analyzed.
Results: 54% of
male and 79% of female patient need
blood transfusion. Mean age in patients needed transfusion was 61.58±11.11
years and in other group was 60.27±10.98
years of the patients that needed transfusion (p= 0.08). 563
(61%) of the patients needed transfusion with the
average of two units. The need for blood transfusion was higher in female
gender (p< 0.0001),
low hematocrit (p< 0.0001),
diabetes (p< 0.001),
hypertension (p< 0.025)
and multiple grafts (p< 0.027).
There were no significant differences in preoperative hemostasis tests,
affection to hyperlipidemia, CVA or
renal failure, antiplatelet drug administration and the application of left internal
mammary artery between the transfusion and non transfusion groups.
Conclusion: In this study preoperative
hematocrit was most important risk factor in transfusion in patients that
underwent OPCAB. Female gender, preoperative
low hematocrit, multiple grafts, diabetes and hypertension increased the rate
of blood transfusion. According to the high prevalence of blood transfusion in OPCAB, considering factors that
affect the transfusion rate is essential.
Forouzan Nia Skh, Mirhosseini Sj, Moshtaghion Sh, Abdollahi Mh, Hosseini H, Dehghanizadeh H, Bani Fateme Sa, Hosseini Sm,
Volume 68, Issue 12 (3-2011)
Abstract
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Background: Proper drainage of the mediastinal and pleural spaces following Off-Pump Coronary
Artery Bypass (OPCAB) surgery is essential
for the prevention of pleural and pericardial effusions, cardiac tamponade and
late complications such as constrictive pericarditis. Drainage tubes themselves
may induce some complications which can negatively affect the result of the
surgery. In this study we assessed a new technique for chest drainage following
OPCAB.
Methods: In this clinical trial, 171 patients were
allocated to two groups. In the control group, the drainage technique included
one drain in the left pleural cavity and another in the mediastinum, while in
the case group the drainage technique included one drain in the left plural
and one in the right pleural cavity.
Results: The amount of drainage in the case group was more than the control group (p=0.001).
We found significant reductions in the incidence of arrhythmias in the case
group (p=0.005). While one patient (1.2%)
needed reoperation for bleeding control in the control group, no patients
needed reexploration in the case group (p=0.497).
The duration of hospital (p=0.022) and ICU
(p=0.002) stays was shorter in the case group.
Conclusions: Based
on the results of this study, changing the position of mediastinal drains in
patients undergoing OPCAB surgery and shifting it to
the right pleural cavity, reduces complications, such as arrhythmia and
pericardial effusion, aside from establishing a better drainage.
Bolourian Aa, Beheshti Monfared M, Gachkar L, Ghomeisi M, Shahzamani M, Foroughi M, Kazem Arabnia Mk, Ghods K, Dabbagh A,
Volume 69, Issue 1 (4-2011)
Abstract
Background: Atrial fibrillation is the most common but benign arrhythmia following cardiac surgery. Although this arrhythmia is often self-limited and vanishes in about 24 hours upon surgery a number of arrhythmias might ensue among which some might be really life-threatening. A multitude of therapeutic modalities have been proposed for the prevention of this arrhythmia and one of them is posterior pericardiotomy. This method has not been fully accepted by the peers yet and more studies are needed to prove its efficacy and benefits to the patients.
Methods: In this single-blind randomized clinical trial, done over a 2-year period from February 2009 to January 2011, the effects of posterior pericardiotomy were evaluated in 174 patients (87 the case and 87 the control groups) undergoing elective coronary artery bypass grafting (CABG). The case group underwent CABG with posterior pericardiotomy while the control group underwent CABG-only operation. The postoperative incidence of arrhythmia, especially atrial fibrillation, was assessed for a week using statistical methods.
Results: The prevalence of postoperative atrial fibrillations were fewer in the group undergoing CABG with posterior pericardiotomy compared with the CABG-only group (P<0.004).
Conclusion: Posterior pericardiotomy seems to reduce the incidence of atrial fibrillation following elective CABG therefore, its application is suggested for elective
CABGs
Nadia Hatmi Z, Kazemi Said A, Khoshkar Najar Sh,
Volume 69, Issue 8 (11-2011)
Abstract
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Background: Previous studies were suggestive of a good prognosis in patients
with acute coronary syndrome (ACS) and absence of any critical stenosis in coronary angiography but recent
limited reports have revealed that patients with non-obstructive acute coronary
syndrome are at a higher risk of future clinical coronary events.
Methods : A concurrent prospective cohort study was designed and 146 male patients with ACS and non-obstructive coronary
artery disease were regarded as the unexposed group, while 191 female patients with non-obstructive
coronary artery disease were regarded as the exposed group. Coronary events were
recorded within one year of follow-up. Prognostic factors were evaluated at
baseline by using a standardized protocol.
Results : Of the 337 patients with ACS, 191 (56.6%) were female. Coronary events in female patients after one year of
follow-up were: ST EMI 3 (1.6%), unstable angina pectoris 22 (11.5%),
Q-wave MI
1 (0.5%) and no syncope. In male patients the outcomes
were: ST EMI 4 (2.7%), unstable angina pectoris 29 (19.9%),
Q-wave MI 1
(0.7%), and syncope 1 (0.7%). Multivariate adjusted
relationships revealed that physical inactivity (P=0.035),
dyslipidemia (P=0.001), low ankle brachial
index (P=0.024) and
age between 40-50 years (P=0.004) were significantly associated with coronary events in women. In
male patients, body mass index of 30-39.99
(P=0.011) was associated with a higher
rate of ST-segment elevated MI.
Conclusion: Prognostically,
coronary events and clinical endpoints were significantly different between men
and women with acute coronary syndrome. Persistence of symptoms over one year seems
to relate to the development and progression of coronary atherosclerosis.
Mohagheghi A, Panahi A, Kamal Hedayat D, Ghorbani Yekta B,
Volume 69, Issue 9 (12-2011)
Abstract
Background: Left main coronary artery (LMCA) stenosis is a leading cause of mortality and morbidity in many countries. Metabolic syndrome (MS) is a risk factor for coronary artery disease (CAD). The effects of MS on left main coronary artery stenosis are not well-defined. The aim of this study was to examine the effects of MS on left main coronary artery stenosis.
Methods: A total number of 495 patients who underwent elective coronary angiography in the Catheter Laboratory of Cardiovascular in Shariati Hospital 2008-2010 were included in the study. MS definition was based on the National Cholesterol Education Program (NCEP)- Adult Treatment Panel III (ATP III) criteria. The stenosis in left main coronary arteries was determined by examining the coronary angiograms of the patients.
Results: The study population consisted of 249 (50.3%) men, and 246 (49.7%) women. The mean age of the participants was 58.01±10 years. MS was present in 86 (17.4%) of the patients based on NCEP- ATP III criteria. LMCA stenosis was seen in 25 (5%) patients. A positive correlation was found between MS and LMCA stenosis (r=0.305, P=0.012). Moreover, a positive correlation was found between age (r=0.192, P=0.05), sex (r=0.334, P=0.007), smoking (r=0.336, P=0.01) and diabetes (r=0.253, P=0.03) and LMCA stenosis.
Conclusion: The metabolic syndrome correlates with LMCA stenosis. LMCA stenosis and its correlation with MS is precipitated by high FBG, age, male sex, and smoking which may synergistically increase the risk for the disease.
Hassani Ebrahim, Mahoori Alireza, Mehdizadeh Hamid, Noroozinia Heydar, Aghdashi Mir Mousa, Saeidi Mohammad,
Volume 70, Issue 3 (6-2012)
Abstract
Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.
Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.
Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).
Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.
