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Cristian A. UDROIU

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Articles signed on MÆDICA, JCM:

Predictors of in-Hospital Mortality of ST-Segment Elevation Myocardial Infarction Patients Undergoing Interventional Treatment. An Analysis of Data from the RO-STEMI Registry

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MÆDICA - a Journal of Clinical Medicine | Vol. 10, nr. 4, 2015 CNCSIS - CMR - B+ OBBCSSR

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Predictors of in-Hospital Mortality of ST-Segment Elevation Myocardial Infarction Patients Undergoing Interventional Treatment. An Analysis of Data from the RO-STEMI Registry

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ABSTRACT

Background: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the preferred therapy for STEMI if it is done within 120 min from the first medical contact, by an experienced team in a high-volume center. The aim of this study was to assess the clinical characteristics and predictors of in-hospital mortality of patients with STEMI treated by percutaneous coronary interventions (PCIs).

Methods: We analyzed data from 15,076 STEMI patients enrolled in the RO-STEMI registry (ROmanian ST-Elevation Myocardial Infarction registry). Patients were divided into 2 groups: PCI (11.669; 77%) and conservative treated (3.407; 23%). PCI group includes both pPCI treated patients (84.3%), and patients undergoing rescue PCI (6.4%) and late PCI (9.3%).

Results: The mean age of STEMI patients was 62.7+/-12.7 years. 70% were males. Patients treated by PCI were younger (61.4+/-12.2 versus 67.2+/-13.3, p<0.0001) and more often men (80% versus 71%, p<0.0001). They were less likely to have acute heart failure (Killip class II-IV) at admission (p<0.0001). During admission, patients treated by PCI received more often dual antiplatelet therapy (97.6% versus 90.8%, p<0.0001), statins (96.3% versus 87.5%, p<0.0001), beta-blockers (83.8% versus 73.2%, p<0.0001), and RAAS blockers (82.6% versus 66.4%, p<0.0001). Overall in-hospital mortality was 7.1%: 4.1% in the PCI group and 15.7% in the conservative treated group. Multivariate analysis showed that, after adjusting for all clinical variables, Killip class II-IV at admission (OR: 9.2; 95%CI: 6.2-13.6; p<0.0001), LVEF<35% (OR: 3.8; 95%CI: 2.6-5.4; p<0.0001), age older than 65 years (OR: 2.2; 95%CI: 1.5-3.2; p<0.0001), and anterior location of myocardial infarction (OR: 2.1; 95% CI: 1.5-3; p<0.0001) remained independent predictors for in-hospital mortality for STEMI patients treated interventionally.

Conclusion: Advanced Killip class, depressed LVEF, advanced age, and anterior location were the most powerful independent predictors of in-hospital mortality in STEMI patients who underwent interventional treatment.

Keywords: STEMI, percutaneous coronary interventions, mortality

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Coronary Balloon Angioplasty in a Severe Takotsubo Syndrome

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MÆDICA - a Journal of Clinical Medicine | Vol. 8 (11), no. 3 2013

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Coronary Balloon Angioplasty in a Severe Takotsubo Syndrome

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ABSTRACT

We reported a patient with Takotsubo syndrome, with severe symptoms, prolonged angina with hemodynamic compromise, in the context of severe coronary artery spasm, without response to full medical treatment, which was successfully managed with coronary balloon angioplasty. A 49-year old woman was admitted with chest pain, ECG changes and elevated myocardial necrosis markers suggestive for acute coronary syndrome. First coronary angiography revealed normal epicardial arteries and typical left ventricular apical ballooning, strongly suggestive for Takotsubo syndrome. Forty-eight hours later, with standard medical treatment, patient developed again severe angina with hemodynamic consequences. Second angiography showed total occlusive spasm of one coronary artery, without response to full medical treatment. Coronary balloon angioplasty was performed with final good result. Two month later, angiography revealed normal coronary arteries and normal ventricular shape. The patient is currently asymptomatic.

As far as we know, no other examples of similar cases were published in medical literature. Therefore, interventional treatment can be taken into consideration for some particular types of patients with Takotsubo syndrome, non-responsive to medical treatment; despite of balloon angioplasty or stenting of coronary vasospasm is not a standard of care.

Keywords: Takotsubo syndrome, balloon angioplasty, coronary artery spasm

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Interdisciplinary Approach in a Complex Case of STEMI

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MÆDICA - a Journal of Clinical Medicine | Vol. 9, nr. 4, 2014

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Interdisciplinary Approach in a Complex Case of STEMI

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ABSTRACT

We reported the case of a young man with ST-Segment Elevation Myocardial Infarction (STEMI), with ventricular fibrillation on debut and cardiogenic shock, who needed a complex interdisciplinary approach for a favourable long term outcome.

A 43-year-old man was admitted with inferior STEMI and cardiogenic shock. First coronary angiography revealed total chronic occlusion of left anterior descending artery (LAD) and tight stenosis with thrombus on right coronary artery (RCA). Thrombus aspiration and stent implantation on RCA was performed with good results. LAD couldn’t be opened. Intraaortic balloon pump was implanted. Fortyeight hours later, we try again to open LAD, without success. After a lot of complications, all solved with difficulty, patient was discharged cachectic and with progressive exertion on mild exercise. Two months later an implantable cardioverter-defibrillator (ICD) was decided for persistent ventricular tachycardia and after one year he was referred to a cardiac surgery centre abroad for aneurismectomy with left ventricle (LV) reconstruction and mitral valve repair. The patient is currently asymptomatic with a normal social and professional life.

In conclusion, high performance cardiac surgery, after a complete interventional treatment, can improve quality of life and long-term outcome to a patient with severe cardiovascular disease.

Team work between clinical cardiologists, interventional cardiologists, electrophisyologists, intensivists and cardiac surgeons is the key to success.

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