Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial.

Background: In acute myocardial infarction complicated by cardiogenic shock the use of mechanical circulatory support devices remains controversial and data from randomized clinical trials are very limited. Extracorporeal life support (ECLS) - venoarterial extracorporeal membrane oxygenation - provides the strongest hemodynamic support in addition to oxygenation. However, despite increasing use it has not yet been properly investigated in randomized trials.

Collagen application for sealing of arterial puncture sites in comparison to pressure dressing: a randomized trial.

Unlabelled: One-hundred patients undergoing routine diagnostic or interventional catheterization were randomly assigned to receive either percutaneously applied collagen (group A; n = 50) or conventional pressure dressing (group B; n = 50) for sealing of the femoral artery. Clinical variables were comparable in both groups. The heparin dose was 100 IU/kg in 30 patients and 200 IU/kg in 20 patients of either group.

Chronic coronary occlusions: age, morphology and chance of reopening.

In chronic coronary occlusions the chance of successful reopening by angioplasty can be judged from the age of the occlusion. Often, however, time since occlusion cannot be accurately assessed. Therefore we determined whether the chance of reopening can be predicted from angiographic morphology.

[Evaluation of indications for PTCA].

Unlabelled: Rating the indications for invasive cardiac procedures often is regarded as one key method for quality assessment in cardiology. The aim of this study was to evaluate the validity of the method proposed by the RAND Corporation and the University of California, Los Angeles, appropriateness and necessity rating. Two hypotheses were tested: 1.

[Quality assurance in invasive cardiology. A prospective study for the evaluation of indications for coronary angiography and coronary dilatation using the "Rand Corporation" method].

Objective: To assess the indications for coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) according to the criteria of the RAND Corporation's expert panel ratings; to compare the results with those already published in the literature; and to examine the method with respect to its appropriateness as a measure of quality control.

Patients And Methods: The parameters necessary for rating according to the RAND Corporation's published criteria were prospectively obtained in 116 consecutive patients (89 men, 27 women; mean age 59.4 +/- 10.

Requirements for quality assessment in coronary angiograph and angioplasty.

The application of formal methods of quality assessment in medicine is a relatively new activity. Interventional cardiology is expected to be one of the fields of clinical medicine adopting formal schemes of quality assessment at a relatively early phase because of its invasive nature, the associated risks, the rapid growth of this treatment and the correspondingly increasing total cost. We therefore aim to compile the requirements for the development of quality assessment schemes in angioplasty and coronary angiography.

Long-term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients.

In patients with coarctation of the aorta arterial hypertension frequently persists when surgical repair is performed after age 20 years. There are little data on the long-term effect of angioplasty and the question remains to be determined whether hypertension is sufficiently treated by this procedure. Twenty-nine consecutive patients (9 females and 20 males) 14 to 54 years old (median, 25) underwent angioplasty for native coarctation of the aorta.

[Implantable defibrillator in the long QT syndrome].

A 29-year-old otherwise symptom-free patient had undergone a partial thyroidectomy 5 years ago followed by an episode of ventricular tachycardia and (after lidocaine injection) ventricular fibrillation requiring external defibrillation. No cause for the arrhythmias had been found at that time. Two subsequent syncopes led to her hospitalization.

[Angiography follow-up after transluminal angioplasty of coronary bypass grafts].

Between January 1979 and October 1991, percutaneous transluminal angioplasty of stenosed or occluded coronary bypass grafts was attempted 180 times in 146 patients (180 lesions in 157 bypass grafts); 6/157 grafts were internal mammary grafts. The procedure was successful in 129/157 grafts (82%) and in 151/180 lesions (84%). Failures occurred almost exclusively in recanalization attempts.

[Persistent ductus arteriosus--is closure indicated also in asymptomatic adults with small ductus and minor shunt?].

We hypothetized that conservative treatment might be justified in asymptomatic adults with a small persistent ductus arteriosus. The data of 100 patients (age, 18-72 years) who later underwent non-operative closure were retrospectively analyzed. Left- and right-heart catheterization as well as angiographic measurement of PDA-size had been performed in all patients.

[Main branch stenosis after bypass operation. Indications for elective PTCA].

The unprotected left main stenosis still represents one of the contraindications of PTCA; recently developed concepts using percutaneous bypass techniques have not changed this fact so far. However, following bypass grafting the procedure can be done with low risk and may improve prognosis in case of later bypass occlusion. This study should clarify whether a higher rate of bypass occlusion is caused by postsurgical left main PTCA.

[Chronic coronary artery occlusion--age, morphology and chance of reopening. An attempt to define indications].

In chronic coronary occlusions the rate of successful reopening seems to be improved with the help of new techniques; the chance of success can be judged by the age of occlusion. Frequently this age cannot be fixed exactly. The purpose of the study was therefore to find out, whether the chance of reopening can be judged by morphology.

Collagen application for sealing of arterial puncture sites in comparison to pressure dressing: a randomized trial.

One hundred patients undergoing routine diagnostic or interventional catheterization were randomly assigned to receive either percutaneously applied collagen (group A; n = 50) or conventional pressure dressing (group B; n = 50) for sealing of the femoral artery. Clinical variables were comparable in both groups. The heparin dose was 100 IU/kg in 30 patients and 200 IU/kg in 20 patients of either group.

Long-term follow-up after percutaneous transluminal coronary angioplasty in patients with single-vessel disease.

Seven hundred ninety-eight patients with symptomatic single-vessel disease who underwent percutaneous transluminal coronary angioplasty (PTCA) between 1977 and 1985 were reevaluated by questionnaire 78 +/- 23 months after dilatation. Indication for PTCA was stenosis of > or = 70%, anginal symptoms, and objective signs of myocardial ischemia. The immediate success rate was 81.

[Long-term results of coronary angioplasty].

Recently published studies prove a favourable long term prognosis after coronary angioplasty, especially in patients with single vessel disease. PTCA success, progression of atherosclerosis, cardiac risk factors, extent of coronary artery disease and left ventricular function are determinants of the long term outcome. A lasting PTCA success can be assumed in patients without evidence of restenosis 6 months after PTCA.

A word of caution: reopening chronic coronary occlusions.

Reopening of chronically occluded coronary arteries by angioplasty, initially considered a low risk procedure, may carry similar risks at PTCA of coronary stenoses. We report 3 cases with ventricular fibrillation or sudden death 2-4 days after reopening of 1- to 5-month-old coronary occlusions.

[Long-term results after coronary dilatation].

The angiographic long-term success of percutaneous transluminal coronary angioplasty (PTCA) is 80% for all patients with attempted PTCA, and 90% for all patients with acutely successful intervention. This long-term success rate results from todays acute success rate of more than 90%, even though an increasing number of more and more complex stenoses have been dilated during recent years, from a rate of restenosis of 20-30% and a success-rate exceeding 90% in patients who undergo redilatation due to a restenosis. The long-term clinical course of successfully dilated patients is considerably influenced by the progression of the underlying coronary heart disease, with a development of new hemodynamically significant stenoses in some 5% of the patients per year.

[Long-term clinical follow-up after coronary dilatation].

To determine the long-term clinical course after percutaneous transluminal coronary angioplasty (PTCA), 841 patients, 615 with successful PTCA and 226 without, were restudied by questionnaire 2-9 years after the intervention. After successful PTCA a lasting symptomatic improvement was seen in 78% of patients vs 55% of patients without successful PTCA (p less than 0.0001).

Results of repeat angiography up to eight years following percutaneous transluminal angioplasty.

Percutaneous transluminal coronary angioplasty (PTCA) has become a widely accepted procedure that provides acute and medium-term relief of anginal symptoms and myocardial ischaemia. The acute success rate has risen from about 50% in the early days to approximately 90% in recent years. Serial repeat angiograms obtained in different patient groups have shown a 20% incidence of angiographically defined restenosis in patients who had been successfully treated initially.