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INTERVENTIONAL CARDIOLOGY DISCUSSION FORUM
FORO DE DISCUSIÓN DE CARDIOLOGÍA INTERVENCIONISTA

Archive - Archivo
Web # 3  (#28-40)

(#14-27)                                                                                                            (>#40)

28
From: Raul Bretal <rbretalo@yahoo.com>
Subject: ATC: Prevencion de embolias?/PTCA: Prevention of embolism
Date: Sat, 23 Oct 1999
To: interven-pcvc@pcvc.sminter.com.ar

Actualmente, en intervenciones endovasculares de diversos territorios (renales, carotidas), se estan utilizando sistemas (filtros, balores oclusores) para prevenir la embolizacion de particulas al lecho distal.
En intervenciones coronarias "no complicadas" se han observado elevaciones de CK en un porcentaje de alrededor del 20% de los pacientes, posiblemente debidas (en parte) a embolizacion distal.
¿Querria saber si existen experiencias con sistemas que previenen embolizacion distal en coronarias, y en que fase de desarrollo se encuentran?
 

Currently, in endovascular interventions of diverse territories (renal, carotids), systems are
being used (filters, balloons, occluders) to prevent embolization of particles to the distal
bed.
In "non complicated" coronary interventions, rises in CK have been observed, in a percentage of around a 20% of the patients, possibly due (in part) to distal embolization.
I would like to know if there are experiences with systems that prevent distal embolization in
coronary arteries, and in what stage of development are they?

Dr Raul Bretal
La Plata - Argentina

Index
 

29
From: "Ernesto Torresani" <etorresani@intramed.net.ar>
Subject: Enfermedad de puente coronario/Coronary bypass disease
Date: Sun, 24 Oct 1999

La pregunta realizada por el Dr.Raul Espindola que origino la discusion de este tema creo que ha sido suficientemente respondida por los colegas.
Solo quiero hacer una consideracion con respecto a los inhibidores IIb-IIIa. En el J Am Coll Cardiol 1999, Vol.34, n=B04, 1163-9, ha aparecido el articulo: "The Influence of Abciximab Use on Clinical Outcome After Aortocoronary Vein Graft Interventions" donde queda claramente establecido que el uso de este tipo de drogas en el tratamiento endovascular de puentes venosos no disminuye los eventos adversos clinicos mayores ni la embolia durante el
procedimiento.
 

The question asked by Dr. Raul Espindola, that originated a discussion on this subject, I
believe has been answered enough by my colleagues. I only want to make a consideration about
inhibitors Iib-IIIa.
In the J Am Coll Cardiol 1999, Vol. 34, No 4, 1163-9, the article " The Influence of Abciximab
Use on Clinical Outcome After Aortocoronary Vein Graft Interventions" has appeared, where it is clearly established that the use of this kind of drugs in endovascular treatment of venous
treatment do not diminish neither major adverse clinical events, nor embolism during
procedures.

Ernesto M.Torresani
Sanatorio Modelo Quilmes, Argentina

Index
 

30
From: "Iravedra Jorge" <instcor@cpsarg.com>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Re: Intervencionismo en ancianos
Date: Sun, 24 Oct 1999

Creo que en el caso planteado por el colega (paciente diabetico de 77 anios que ingresa con IAM inferior no complicado) no se aclara cuantas horas de evolucion llevaba. Creo que la indicacion de coronariografia en agudo es cuando uno plantea una conducta intervencionista endovascular. En este caso, si el paciente llevaba menos de 6 horas podria haber sido factible realizar ATC primaria. Si bien los IAM inferiores son teoricamente de "menos riesgo", no siempre es asi y muchas veces asistimos a un rapido empeoramiento en la clasificacion de K & K, y perdemos la ventana ideal de intervencion.
El riesgo de un IAM aumenta considerablemente con la edad (mas aun si es diabetico). La ATC tambien tiene mas riesgo, pero teoricamente es menor que la evolucion natural. Por supuesto que uno tendra que valorar el estado general del paciente desde el punto de vista clinico y sobre todo neurologico.
En el estudio PAMI 1 el grupo de IAM de no alto riesgo (en los que estaria un IAM inferior compensado hemodinamicamente) no tuvo diferencias significativas de mortalidad (ATC vs. trombolisis), si de menos eventos combinados. En este caso el paciente tiene mas de 70 anios, por lo que uno lo podria incluir tambien en el grupo de alto riesgo (donde si se observaron
diferencias significativas de mortalidad de la ATC con respecto a los tromboliticos).
De no realizarse por alguna razon la intervencion en agudo, creo que ya no tiene sentido realizar la coronariografia en dicho paciente, sobre todo si ha tenido buena evolucion. En ese caso solamente la realizaria a posteriori en caso de complicaciones evolutivas (angor post-IAM, falla de bomba, etc.). En un paciente de 77 anos que sobrevive a un IAM, las conductas posteriores para mejorar pronostico son relativas. Yo actuaria en caso de que sea necesario mejorar calidad de vida.
 

I think that in the case presented by our colleague (diabetic patient, 77 years old, that is
admitted with inferior, not complicated AMI), it is not clear how many hours of evolution he
had. I think that indication for coronary angiography in acute, is done when one considers an
endovascular interventional management. In this case, if the patient had less than 6hs, it
could have been possible to do a primary PTCA. The inferior AMI is theoretically "less risky",
but this is not always so, and many times we see a quick worsening in classification of K & K,
and we lose the ideal window for intervention. The risk of AMI increases notably with age (even more if one is diabetic). PTCA is also more risky, but theoretically, is less than natural
evolution. Of course, one has to assess the general state of the patient from the clinical, and
above all, the neurology point of view.
In the PAMI 1 study, the group of AMI of no high risk (in whom there would be inferior AMI,
hemodynamically compensated), had no significant differences in mortality (PTCA vs.
Thrombolysis), but it did have less combined events. In this case, the patient is more than 70
years old, and due to this one could include him in the high risk group as well (where
significant differences of mortality were observed, of PTCA compared to thrombolysis).
If intervention in acute is not performed for some reason, I think that there is no longer a
reason to make a coronary angiography in the patient, even more if he evolved well. In this
case, I would only do it afterwards, in case of complications in evolution (angina post-AMI,
pump failure, etc.). In a patient that is 77 years old, that survives an AMI, later management
to improve prognosis is relative. I would act in case that it was necessary to improve the
quality of life.

Dr. Jorge Iravedra.
Mar del Plata, Argentina.

Index
 

31
Subject: Re: ATC:Prevencion de embolias?/PTCA: Prevention
of embolism?
From: "Hugo Francisco Londero" <hugolondero@arnet.com.ar>
To: interven-pcvc@pcvc.sminter.com.ar
Date: Tue, 26 Oct 1999

Hace pocos meses tuvimos oportunidad de usar el sistema de Angioguard (filtro para la captura de embolos) en tres casos de obstrucciones de coronarias nativas. El procedimiento resulto bastante dificultoso porque el sistema es demasiado rigido y voluminoso (F 4). De todas formas el sistema de Angioguard aun no esta aprobado para su uso clinico.

El sistema de Balon oclusor de PercuSurge puede ser utilizado en coronarias nativas Habria que estimar bien la cantidad de contraste para la insuflacion para no producir un  mis-match entre el diametro de la arteria/diametro del Balon de oclusion que produzca riesgo de lesionar la pared arterial. No conozco experiencias clinicas en arterias coronarias nativas. Hay abstracts
presentados en congresos sobre puentes venosos y carotidas, y experiencia comunicada sobre arterias renales.
 

A few  months ago, we had the opportunity of using the Angioguard system (filter for seizing
emboli) in three cases of obstructions of native coronary arteries. The procedure resulted
quite difficult because the system is too rigid and massive (F 4). Anyway, the Angioguard
system has not been approved for clinical use yet.

The PercuSurge occlusive balloon system, can be used in native coronary arteries. A good
estimation should be done, of the amount of contrast for insufflation, so as not to produce a
mismatch between the diameter of the artery/diameter of occlusive balloon, that might produce a
risk of injuring the arterial wall. I do not know clinical experiences on native coronary
arteries. There are abstracts presented in congresses on venous and carotid bypasses, and
experiences reported on renal arteries.

Hugo Londero

Index
 

32
From: "Ortiz Baeza" <ortizbaeza@impsat1.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Simposio CACI 99
Date: Fri, 8 Oct 1999

Estimados amigos:
Les recuerdo que durante los días 2, 3  y 4 de diciembre de 1999 se realizara el IX SIMPOSIO INTERNACIONAL DE CARDIOLOGIA INTERVENCIONISTA  organizado por el CACI (Colegio Argentino de Cardiologia Intervencionista), en el hotel Potrero de Funes, Provincia de San Luis.
Esperamos la concurrencia de todos los miembros del CACI, ya que además se realizara la asamblea con elección de nuevas autoridades. Los programas ya fueron enviados. Como invitados extranjeros vendrán  los  Dres. Carlos Macaya y Gary Becker.
Para mayores datos consultar la página web del CACI:
http://usuarios.arnet.com.ar/caci/ ,
o comunicarse con :
Dr. Oscar Ortiz Baeza
ortizbaeza@impsat1.com.ar

Dear friends:
I remind you that during the three days, December 2, 3, and 4, 1999 the IX SIMPOSIO
INTERNACIONAL DE CARDIOLOGIA INTERVENCIONISTA (IX INTERNATIONAL SYMPOSIUM OF INTERVENTIONAL
CARDIOLOGY) will be held, organized by the CACI (Colegio Argentino de Cardiologia
Intervencionista) (Argentine Association of Interventional Cardiology), at the hotel " Potrero
de Funes", in the province of San Luis.
We hope that all members of the CACI will attend, since besides a meeting will be held, to
elect new authorities. The programs were already sent. As foreign guests, Dr. Carlos Macaya,
and Gary Becker will came.
For further information, visit the CACI's web page:
http://usuarios.arnet.com.ar/caci/
Or get in touch with:
Dr. Oscar Ortiz Baeza
ortizbaeza@impsat1.com.ar

Index
 

33
From: "Alvarez Iorio" <caiorio@freenet.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: RE: Enfermedad de puente coronario/Coronary bypass disease
Date: Tue, 26 Oct 1999

Estoy persuadido que la ATC al puente venoso depende a cual?
No hay duda que en manos experimentadas no existen obstaculos tecnicos insalvables, pero si algo esta claro es que en los puentes muy degenerados, a pesar de un resultado clinico y angiografico inicial exitoso, ya  a los 6 meses y/o 1 anio la tasa de eventos mayores es muy alta.
En el ETC98 los franceses colocaban mucho WALLSTENT pero los resultados que presentaron del follow up fueron espantosos en 1999. Creo que debemos ser muy cuidadosos en la indicacion y emplear mucho el "common sense".
En general en el IAM secundario a oclusion de un graft la cosa no es sencilla pues salvo excepciones son en general venas muy emfermas con mucho "material" y coagulos siendo en esos casos la ATC muy compleja y riesgosa. Aun si empleamos un tratamiento combinado con infusion intratrombo de tromboliticos y ATC los resultados son muy malos. En estos casos puntuales estoy convencido que el Reopro no nos ayuda mucho.
 

I am persuaded that the PTCA to venous bridge depends on which?
There is no doubt that in experienced hands there are no technical obstacles that cannot be
surmounted, but if something is clear, is that in bypasses too degenerate, in spite of a
clinical and angiographic result that is initially successful, at 6 months and/or 1 year
already, the rate of greater events is very high.
At the ETC98, the French used a lot of WALLSTENTS, but the results they presented of the follow up were disastrous in 1999. I think that we must be very careful to indicate, and we must apply a lot of common sense.
In general, in secondary AMI or graft occlusion, nothing is simple, since but for a few
exceptions, these are very ill veins, with a lot of "material" and clots, therefore PTCA being
very complex and risky in these cases. Even if we use a mixed treatment with thrombolysis by
intra-thrombus infusion and PTCA, the results are quite bad. In these concrete cases, I am
certain that Reopro does not help very much.

CARLOS ALVAREZ IORIO
Bahia Blanca, Argentina.

Index
 

34
From: "Ortiz Baeza" <ortizbaeza@impsat1.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: RE: Tratamiento de By Pass ocluido
Date: Fri, 8 Oct 1999

Agregando a lo que expresa el Dr. Londero, veo una gran expectativa en el uso del sistema Guardwire sobre todo en el tratamiento de los By Pass ocluidos.
Recordemos que el 25 % de los By Pass  aorto coronarios se taparan dentro del año. En el St. Lukes Medical Center de Chicago se ha iniciado un estudio randomizado multicentrico para valorar el uso de este sistema en relacion a otros procedimientos de revascularizacion como la angioplastia y CABG.
Recientemente tuvimos oportunidad de ver el uso del sistema durante el simposio del IMC en Cordoba. En lo personal estoy muy entusiasmado viendo la posibilidad de tratamiento
tal vez en agudo de tantos pacientes que vemos con oclusión de sus By pass.
 

In addition to what Dr. Londero expressed, I see a great expectation in the use of the
Guardwire system, mostly in treatment of occluded bypasses. We must remember that a 25% of
aorto-coronary bypasses will be blocked within a year. At the St. Lukes Medical Center of
Chicago, a multicentric randomized study has started, to assess the use of this system
regarding other procedures for revascularization, such as angioplasty and CABG. Recently we had the chance to see the system used during the symposium of the IMC (Model Institute of Cardiology) in Cordoba.
Personally, I am very enthusiastic, as I see the possibility of treatment, maybe in acute in so
many patients that we see with occlusion of their bypasses.

Ortiz Baeza
ortizbaeza@impsat1.com.ar

Index
 

35
From: "Dr. Marcelo Bassino" <marbas@teletel.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Angioplastia en Diabeticos/PTCA & Diabetes
Date: Thu, 28 Oct 1999

Estimados colegas :
Seria una obviedad descartar la alta incidencia de cardiopatia isquemica en pacientes diabeticos, mi pregunta va dirigida a la conducta terapeutica a tomar en los pacientes con Talio de alto riesgo y lesiones coronarias significativas dado las recientes publicaciones que muestran la alta tasa de reestenosis que presenta la Angioplastia coronaria .
Se han publicado varios articulos hablando de predictores de reestenosis en los pacientes
diabeticos, recientemente en JACC de Agosto ( Vol 34 N 2 1999) del grupo de Lille (Francia), donde muestra hasta un 62% de reestenosis a los 6 meses.
1) Que tipo de predictores toman en cuenta para decidir que paciente seria de alto riesgo de reestenosis y a que tipo de paciente no le indicarian una Angioplastia en base a lo anterior?
2) De acuerdo a los distintos resultados cual es su opinion de Angioplastia de multiples vasos en pacientes diabeticos vs cirugia ?
 

Dear colleagues:
It would be obvious to disregard the high incidence of ischemic heart disease in diabetic
patients; my question points to therapeutic management to be carried out in patients with
Thallium of high risk, and significant coronary lesions given the recent publications that show
the high rate of restenosis that present coronary angioplasty. Several articles have been
published, that deal with restenosis predictors in diabetic patients, recently in the JACC of
August (Vol 34 N 2 1999) from the Lille group (France), where up to a 62% of restenosis is
shown at 6 months.
1) What kind of predictors take into consideration to decide that the patient will be in high
risk of restenosis, and to what kind of patient you would not indicate an Angioplasty, based on
the former?
2) According to the different results, which is your opinion of Angioplasty of multiple vessels
in diabetic patients vs. surgery?

Dr Marcelo Bassino
Trenque Lauquen - Pcia Bs As - Argentina

Index

36
From: owner-interven-pcvc@pcvc.sminter.com.ar
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Newsletter PCVC/FVCC Newsletter
Date: 1 Nov 1999

Newsletter PCVC
Publicacion electronica quincenal del Primer Congreso Virtual de Cardiologia, destinada a la difusion e intercambio de informaciones de interes cardiologico y noticias referentes al Congreso.
Se distribuye de modo gratuito a los inscriptos de habla hispana y lusitana, y mediante suscripcion voluntaria que puede efectuarse enviando un mail a:
majordomo@pcvc.sminter.com.ar
escribiendo como unico texto en el cuerpo del mensaje el comando: subscribe pcvc-newsletter
Para ser excluido de la lista, utilizar el siguiente: unsubscribe pcvc-newsletter
La version en ingles se distribuye entre los inscriptos de habla inglesa.
Pueden enviarse contribuciones, replicas, comentarios en forma de Cartas de lectores a:
lectores@pcvc.sminter.com.ar

----------------------------------------------------------------------------

FVCC Newsletter
Biweekly electronic publication of the First Virtual Congress of Cardiology, for purposes of promotion and interchange of topics of interest in cardiac sciences and news from the Congress. It is distributed free of charge to everyone subscribed. Those of English speaking origin may subscribe sending an e-mail to:
majordomo@pcvc.sminter.com.ar
with the following message in the body of the e-mail:
subscribe fvcc-newsletter
If you ever want to unsubscribe, you can send the following command in the body of your email message to majordomo@pcvc.sminter.com.ar: unsubscribe fvcc-newsletter

An Spanish version is available for those of Spanish speaking origin.
Contributions are welcomed; also responses to previously published articles, and
commentaries should be send as Letters to:
readers@pcvc.sminter.com.ar

Index

37
From: "Ernesto Torresani" <etorresani@intramed.net.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: Angioplastia en Diabeticos?
Date: Sat, 30 Oct 1999

Sin duda la Diabetes ha sido considerada desde hace anios como un predictor de reestenosis. El estudio al que hace referencia el Dr. Marcelo Bassino (J Am Coll Cardiol 1999;34:476-85) tiene la ventaja de poder analizar Angioplastia Coronaria en 485 pacientes diabeticos, pero con varias desventajas como el hecho de que fue realizado durante 1993 a 1995, solo se realizaron ATC con Balon, se considero Exito Primario al hecho de lograr una obstruccion residual < 50%, etc, elementos estos que influencian la reestenosis en forma independiente de la Diabetes.
El Stent ha tenido un impacto favorable en la reduccion de reestenosis en Diabeticos equiparandola con la de los no Diabeticos (Circulation 1997;96:1454-60) asi como el uso de Abciximab (EPIC, EPILOG, EPISTENT, etc) ha disminuido los eventos en todos los pacientes sean o no Diabeticos.
Con respecto a la enfermedad de Multiples Vasos solo contamos con resultados a largo plazo de varios estudios randomizados de ATC vs. Cirugía (CABRI,BARI,etc)pero tienen la gran desventaja de que fueron realizados con Angioplastia con Balon y sin las nuevas drogas antiagregantes por lo que los resultados en el momento actual tienen un valor "muy relativo", sin embargo hay estudios en curso con Stent con resultados muy promisorios. En mi opinion en la Enfermedad de Multiples Vasos debe ponderarse el riesgo/beneficio (morbimortalidad y costo) de la Cirugia vs Angioplatia y asi decidir en cada caso en particular, pero si las lesiones
son "Angioplastiables" con posibilidad economica de utilizar multiples Stents no tengo dudas que es una opcion excelente.
Con respecto a la Angioplastia en Diabeticos creo que debemos focalizar nuestra atencion  en el grado de afectacion del resto de la arteria, en el sentido de si se trata de una enfermedad difusa (propia de un Diabetico) o solo de lesiones focales(como si no fuese Diabetico) en tal sentido creo que si se trata del primer caso el paciente se beneficiara mas con Cirugia que con ATC, en cambio en el segundo caso creo que se equipararia con un no Diabetico.
 

Undoubtedly, diabetes has been considered since many years ago, as a predictor of restenosis.
The study that Dr. Marcelo Bassino mentioned (J Am Coll Cardiol 1999;34:476-85) had the
advantage of having been able to analyze Coronary Angioplasty in 485 diabetic patients, but
with many disadvantages, like the fact that was carried out during 1993 to 1995, only PTCA with balloon was performed, the achievement of a < 50% residual obstruction was considered a Primary Success, etc.; these being elements that influence on restenosis independently from Diabetes.
The Stent has had a favorable impact in reduction of restenosis in Diabetics, making it equal
to the one of non-Diabetics (Circulation 1997;96:1454-60), just as use of Abciximab (EPIC,
EPILOG, EPISTENT, etc.) has diminished events in all patients whether they are Diabetics or
not.
About the Multiple Vessels disease, we only have results in long term, from several randomized
studies on PTCA vs. Surgery (CABRI, BARI, etc.) but they have the great disadvantage that were carried out with Angioplasty with Balloon, and without the new anti-aggregation drugs,
therefore currently, the results have a "very relative" value; however, there are studies
currently being done with Stents, with very promising results. In my opinion, in the Multiple
Vessels Disease, the risk/benefit (morbimortality and cost) ratio must be considered regarding
Surgery vs. Angioplasty, and thus decide in each particular case, but if lesions can be treated
with angioplasty, with the economic possibility of using multiple Stents, I have no doubts that
this is an excellent option.
About Angioplasty in Diabetics, I think that we must focus our attention on the degree of
compromise of the rest of the artery, in the sense that if it is a diffuse disease (typical of
a diabetics patient), or only focal lesions (as if it was not a diabetics patient), in that
sense, I think that if we deal with the first case, the patient will be more benefited with
Surgery than with PTCA; on the contrary, in the second case I think that it would be equalized
to a non-Diabetics.

Ernesto M.Torresani
Sanatorio Modelo Quilmes, Pcia. Bs. As., Argentina

Index

38
From: Dr. Gustavo R. Bonzon <bonzon@arnet.com.ar>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: RV: Angioplastia en Diabeticos/Angioplasty in diabetics
Date: Wed, 3 Nov 1999

Mi respuesta academica al Dr. Bassino seria que un paciente asi deberia ser operado en los centros que tienen la morbimortalidad de los trabajos como el BARI. No es lo mismo un paciente diabetico de 60 anios de tres vasos con lesiones cortas y accesibles, estable, buen ventriculo, sin nefropatia, controlable con dieta y ejercicio a uno de 78 anios con tres vasos con
lesiones complejas, lechos filiformes, IAM previo, VI moderado a severo, arteriopatia periferica y que requiere insulina y/o HGO. A los primeros los dilataria con stent y a los segundos los enviaria a cirugia. Los cirujanos saben muy bien que para nosotros una lesion larga y calcificada es problematica, pero para ellos tambien lo es el mismo vaso distal con paredes enfermas y con muchas dificultades para cualquier tipo de anastomosis que quieran hacer.
Entonces, hago lo que se puede dentro del mas estricto analisis del paciente individual. Muchas veces, se nos pide, en base a la angiografia o camara gamma, que dilatemos el vaso que seria el responsable del sindrome coronario agudo o el de mayor carga isquemica, para quedarnos con un paciente con revascularizacion incompleta pero adecuada al tratamiento farmacologico y
nivel de vida, dejando a la cirugia como una ultima chance, porque tambien es un mal candidato quirurgico. Una cosa es la morbimortalidad de estos pacientes en angioplastia y otra en cirugia.
 

My academic reply to Dr. Bassino would be that a patient like this should be operated in the
centers with the morbimortality stated in works like BARI. A diabetic 60-year-old patient, with
three vessels with short and accessible lesions, stable, good ventricle, without nephropathy,
controllable with diet and exercise, is not the same than a 78-year-old patient, with three
vessels with complex lesions, filiform beds, previous AMI, mild to severe LV, peripheral
arteriopathy, and that requires insulin and/or oral hypoglycemia agents. The former, I would
dilate with stent, and the latter, I would send to surgery. Surgeons know very well that for
us, a long and calcified lesion is problematic, but so it is for them, the same distal vessel
with diseased walls and with many difficulties for any kind of anastomosis that they want to
perform.
Consequently, I do what I can within the strictest analysis of the individual patient. Many
times we are requested, based in the angiography or scanning, to dilate the vessel that would
be responsible of the acute coronary syndrome, or the one with greatest ischemic load, to have
a patient with incomplete revascularization, but appropriate for the pharmacological treatment
and quality of life, considering surgery as the last chance, because this is also a bad
candidate for surgery. One thing is morbimortality in these patients in angioplasty, and other
in surgery.

Dr. Gustavo R. Bonzón

Index

39
From: "Mario" <mario@femechaco.com>
To: <interven-pcvc@pcvc.sminter.com.ar>
Subject: IAM: Conducta.
Date: Thu, 4 Nov 1999

Amigos de la lista:
Quiero conocer la conducta que ustedes adoptarian ante el siguiente caso:
Paciente de sexo masculino, 50 anios, diabetico, obesidad moderada, dislipemia, fumador,stress, que ingresa a Unidad Coronaria a los 20 minutos de haber comenzado un tipico infarto de cara diafragmatica (D2, D3, y avF), siendo este su primer evento vascular, sin angina previa. El paciente esta aun con dolor, estable hemodinamicamente. Es decir es uno de los habituales infartos de cara diafragmatica, sin complicaciones hasta el momento de la internacion.
Disponemos de Streptokinasa, y tambien de un entrenado servicio de Hemodinamia Intervencionista, que puede  estudiar, y, eventualmente hacer angioplastia, dentro de la proxima hora.
La pregunta es: cual es, para ustedes, la mejor conducta?
-Tratamiento medico?
-Fibrinolisis?
-Angioplastia?
 

Friends of the list:
I want to know the management you would adopt faced with the following case:
Male sex patient, 50 years, diabetic, moderated obesity, dyslipidemia, smoker, stress, that is
admitted in Coronary Unit 20 minutes after a typical inferior infarction  (D2, D3, and avF) had
started, this being his first vascular event, without previous angina.
The patient is still in pain, hemodynamically stable. That is to say, this is one of the usual
inferior infarctions, without complications until the moment of admittance.
We have streptokinase available, as well as a trained service of Interventional Hemodynamics,
that can study, and if necessary proceed with angioplasty within the next hour.
The question is: for you, which is the best management?
-Medical treatment?
-Fibrinolysis?
-Angioplasty?

Dr Mario A Heñin

Index

40
Date: Fri, 05 Nov 1999
To: interven-pcvc@pcvc.sminter.com.ar
From: Hemodinamia Rosario <hemodros@cardio.int.com.ar>
Subject: Re: IAM: Conducta/AMI: Management.

Estimado Mario:
En el caso de referencia opinamos que coniderando los recursos técnicos y humanos disponibles y el nivel de experiencia de los operadores, la estrategia terepeutica debe incluir efectuar cinecoronariografia y con los datos que prevea el estudio angiografico decidir la opcion. De no existir contraindicación, continuar con angioplastia primaria.

Vale la pena considerar que la STK es la misma en todo el mundo. Los operadores entrenados son diferentes y debe disponerse de parametros objetivables a travez de resultados en el corto, mediano y largo plazo que permitan documentar el nivel de experiencia.
 

Dear Mario:
In the referred case, we think that considering technological and human resources available,
and the level of experience of operators, the therapeutic strategy should include a coronary
angiography, and with the data provided by the angiographic study, decide the option. If there
is no contraindication, go on with primary angioplasty.

It is worthwhile to consider that STK is the same all over the world. Trained operators are
different, and there must be parameters available, that could be made objective through results
in short, medium, and long term, that would allow to document the level of experience.

Carlos R. Vozzi
Rosario - Argentina

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