Procedural Variations in Performing Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction
| Autor: | Manyoo Agarwal, Rami N. Khouzam, Radhika M. Mehta, Wael W. Rizk, Ikechukwu Ifedili |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Cardiac Catheterization medicine.medical_treatment Femoral artery 030204 cardiovascular system & hematology Coronary Angiography Culprit 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention medicine.artery Internal medicine Medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Radial artery medicine.diagnostic_test Interventional cardiology business.industry Percutaneous coronary intervention Professional Practice General Medicine medicine.disease Femoral Artery Cardiac Imaging Techniques medicine.anatomical_structure Angiography Radial Artery Cardiology ST Elevation Myocardial Infarction Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Current problems in cardiology. 42(2) |
| ISSN: | 1535-6280 |
| Popis: | Multiple variations exist in performing a primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) among various cardiologists. These variations range from the choice of peripheral access artery (radial vs femoral), performance or time of complete angiography including left ventriculography, and nonculprit vessel angiography before or after intervening on the culprit vessel. The reasons for such variations include emphasis on door-to-balloon time, knowledge of cardiac anatomy before proceeding with pPCI, physician expertise, and the level of comfort with radial approach. Over the last 2 decades, the field of interventional cardiology has changed dynamically leading to marked improvements in the clinical outcomes of patients with STEMI. This includes upstreaming of pPCI along with technical advancements ranging from radial artery catheterization to culprit lesion-guided approach. Increased comfort with use of radial access approach by cardiologists and availability of multiuse guide catheters would both reduce door-to-balloon time and enable complete coronary angiography before performance of percutaneous coronary intervention. There are no clear guidelines or consensus dictating on cardiologists a correct sequence of action during STEMI, or even suggesting what the preferred approach is. Lack of guidelines results in a substantive variation in methodology. This review aims to highlight and to better understand the variations in the current practice, and to emphasize the advantages as well as the disadvantages of each approach. It is also perhaps a call out for guidelines that direct cardiologists to the best practice. |
| Databáze: | OpenAIRE |
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