PMID- 29970239
OWN - NLM
STAT- MEDLINE
DCOM- 20190808
LR  - 20190808
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 122
IP  - 4
DP  - 2018 Aug 15
TI  - Status of the Epicardial Coronary Arteries in Non-ST Elevation Acute Coronary 
      Syndrome in Patients with Mechanical Prosthetic Heart Valves (from the TROIA-ACS 
      Trial).
PG  - 638-644
LID - S0002-9149(18)31046-4 [pii]
LID - 10.1016/j.amjcard.2018.04.045 [doi]
AB  - Coronary thromboembolism (CE) is a rare cause of prosthetic valve derived 
      complications. This study investigates the diagnosis and treatment strategies for 
      non-ST elevation acute coronary syndrome (NSTEACS) in patients with prosthetic 
      heart valves. Forty-eight NSTEACS patients with prosthetic heart valves 
      (mitral:27; aortic:14; mitral+aortic:7) were included in this study. All patients 
      underwent transthoracic and transesophageal echocardiographic examination and 
      coronary angiography. Normal coronary angiographic findings, or visible trombus 
      in one of the coronary arteries, international normalized ratio <2, concomitant 
      prosthetic valve thrombosis (PVT) and absence of multivessel atherosclerotic 
      disease favored CE rather than atherothrombosis. Thrombolytic therapy (TT) with 
      low-dose slow-infusion of tissue type plasminogen activator was used in patients 
      with suspected CE and/or PVT. Coronary angiography demonstrated normal coronary 
      arteries in 26 patients, CE in 16 patients and coronary atherosclerosis in 6 
      patients. Transesophageal echocardiography revealed obstructive PVT in 9 and 
      nonobstructive PVT in 28 patients whereas 11 patients had normally functioning 
      prostheses. TT was administered to 24 patients with PVT and/or CE. In these 
      patients, TT was successful in 19 patients, partially successful in 4 patients 
      and failed in 1 patient. In conclusion, NSTEACS in patients with prosthetic heart 
      valves is more likely to be associated with PVT derived CE rather than 
      atherosclerosis. TT with low-dose slow infusion of type plasminogen activator has 
      proved its efficacy and safety in patients with CE and/or PVT.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Yesin, Mahmut
AU  - Yesin M
AD  - Kars Harakani State Hospital, Department of Cardiology, Kars, Turkey. Electronic 
      address: mahmutyesin@yahoo.com.
FAU - Karakoyun, Suleyman
AU  - Karakoyun S
AD  - Kafkas University Medical School, Department of Cardiology, Kars, Turkey.
FAU - Kalcik, Macit
AU  - Kalcik M
AD  - Hitit University, Faculty of Medicine, Department of Cardiology, Corum, Turkey.
FAU - Gursoy, Mustafa Ozan
AU  - Gursoy MO
AD  - Gaziemir State Hospital, Department of Cardiology, Izmir, Turkey.
FAU - Gunduz, Sabahattin
AU  - Gunduz S
AD  - Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, 
      Istanbul, Turkey.
FAU - Astarcioglu, Mehmet Ali
AU  - Astarcioglu MA
AD  - Evliya Celebi Training and Research Hospital, Department of Cardiology, Kutahya, 
      Turkey.
FAU - Bayam, Emrah
AU  - Bayam E
AD  - Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, 
      Istanbul, Turkey.
FAU - Cersit, Sinan
AU  - Cersit S
AD  - Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, 
      Istanbul, Turkey.
FAU - Guner, Ahmet
AU  - Guner A
AD  - Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, 
      Istanbul, Turkey.
FAU - Ozkan, Mehmet
AU  - Ozkan M
AD  - Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, 
      Istanbul, Turkey; Ardahan University, Division of Health Sciences, Ardahan, 
      Turkey.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Video-Audio Media
DEP - 20180511
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Fibrinolytic Agents)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
MH  - Acute Coronary Syndrome/*diagnosis/drug therapy/etiology
MH  - Coronary Angiography/*methods
MH  - Coronary Thrombosis/complications/*diagnosis/drug therapy
MH  - Coronary Vessels/*diagnostic imaging
MH  - Echocardiography, Transesophageal
MH  - Electrocardiography
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/diagnosis/surgery
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Thrombolytic Therapy/*methods
MH  - Tissue Plasminogen Activator/*therapeutic use
MH  - Treatment Outcome
EDAT- 2018/07/05 06:00
MHDA- 2019/08/09 06:00
CRDT- 2018/07/05 06:00
PHST- 2018/01/08 00:00 [received]
PHST- 2018/04/19 00:00 [revised]
PHST- 2018/04/19 00:00 [accepted]
PHST- 2018/07/05 06:00 [pubmed]
PHST- 2019/08/09 06:00 [medline]
PHST- 2018/07/05 06:00 [entrez]
AID - S0002-9149(18)31046-4 [pii]
AID - 10.1016/j.amjcard.2018.04.045 [doi]
PST - ppublish
SO  - Am J Cardiol. 2018 Aug 15;122(4):638-644. doi: 10.1016/j.amjcard.2018.04.045. 
      Epub 2018 May 11.