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Access type: UnknownSubject: search.filters.subject.ST-segment elevation myocardial infarction

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    Capecitabine-induced Cardiotoxicity Complicated with Acute Coronary Syndrome and Acute Heart Failure: A Case Report and Review of Scientific Data
    (Medicinska Naklada d.o.o., 2025-04)
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    Grueva Nastevska, Elena
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    Shehu, Enes
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    Petkovski, Dushan
    Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications. The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications. We present a case of a 46-yearold male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction. Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed. Two months before admission, the patient had undergone surgery for rectal cancer. The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission. The patient clinically deteriorated during the procedure, with development of cardiogenic shock. An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%). Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation. After all these treatment measures, the patient clinically stabilized. He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function. Control echocardiography after 9 days from admission showed an EF of 58%. Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient. The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.
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    Comparison of distal radial with conventional radial access in patients with ST-segment elevation myocardial infarction, undergoing primary percutaneous coronary intervention.
    (MDPI (Multidisciplinary Digital Publishing Institute), 2021-12)
    Kitanoski, Darko
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    Postadzhiyan, Arman
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    Velchev, Vasil
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    Stoyanov, Nikolay
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    Background: There is limited data available regarding the technique of dTRA, and its potential benefit in patients with STEMI. This study investigated the feasibility, safety, and potential benefit of dTRA in patients with STEMI, compared to conventional TR approach. Methods: This was a prospective single center study that included 292 patients referred for STEMI. 152 (52%) patients had primary PCI through distal transradial access, and 140 (48%) had PPCI through conventional radial access. Exclusion criteria was absence of radial artery pulse and previous RAO. We compared clinical and procedure characteristics, access site bleeding complications, rate of Radial Artery Occlusion (RAO) and failure of primary chosen access site between two groups of STEMI patients. Results: The success rate of the puncture for dTRA was 98.7% (150/152), and for conventional TRA 99.3% (139/140). Successful primary PCI via dTRA and conventional TRA was performed in all patients in both groups. dTRA was associated with lower rate of study clinical outcomes as rate of radial artery occlusion (dTRA: 0%, TRA 5.7%, p=0.0028) and local hematoma according to EASY score (dTRA Grade I: 15.13%, Grade II: 0%, Grade III: 0%, Grade IV: 0%, TRA: Grade I 22.9%, Grade II: 7.1%; Grade III: 0.7%, Grade IV: 0%, p=0.0009). There was no difference recorded in radial artery spasm between two access sites (dTRA: Grade I: 7.2%, Grade II: 2.7%, Grade III: 1.3%, Grade IV: 0%, TRA: Grade I 7.1%, Grade II: 2.1%, Grade III: 0.7%, Grade IV: 0%) and there was no statistically significant difference in access site crossover (dTRA: 2 patients, TRA: 1 patient). dTRA was associated with a longer access time (dTRA 38.6 sec, TRA: 36.3 sec, p=0.0077). Time of hemostasis was significantly shorter with dTRA (dTRA 30-60 min, TRA 120-150 min, p<0.0001). Conclusion: dTRA is safe and successful in STEMI patients, when performed by experienced radial operators, with previous experience with dTRA. It is associated with lower rate of access site complications and early haemostasis in comparison with TRA.