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Taguchi Y, Kubo S, Ikuta A, Osakada K, Takamatsu M, Takahashi K, Ohya M, Shimada T, Miura K, Murai R, Tada T, Tanaka H, Fuku Y, Goto T, Komiya T, Kadota K. Percutaneous coronary intervention for left main coronary artery malperfusion in acute type A aortic dissection. Cardiovasc Interv Ther 2021; 37:333-342. [PMID: 34255294 PMCID: PMC8926951 DOI: 10.1007/s12928-021-00793-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/02/2021] [Indexed: 01/16/2023]
Abstract
The clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) malperfusion caused by acute type A aortic dissection (AAAD) remains largely unexplored. The aim of this study was to determine the clinical outcomes of patients undergoing PCI for LMCA malperfusion caused by AAAD. We examined nine consecutive patients undergoing PCI for LMCA malperfusion caused by AAAD between 1995 and 2020. The mean age was 55.4 ± 7.7 years. Eight patients presented cardiogenic shock, and five patients cardiopulmonary arrest. Two patients were diagnosed with AAAD before coronary angiography using computed tomography and transthoracic echocardiography, respectively, and in the other seven patients after coronary angiography using other modalities. Four patients underwent PCI on intra-aortic balloon pumping support, and four patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) support, including one patient on both. PCI was successful in eight patients, with final thrombolysis in myocardial infarction grade 2 or 3. The four patients on VA-ECMO did not undergo aortic dissection repair due to poor recovery of cardiac function and died during the hospital stay, and the other five patients had successful PCI, underwent aortic dissection repair, and remained alive at 5 year follow-up. In conclusion, LMCA malperfusion caused by AAAD seemed to have clinical presentations and electrocardiogram changes similar to acute coronary syndrome. PCI and subsequent surgical aortic repair saved the lives of all AAAD patients with LMCA malperfusion who had not required VA-ECMO.
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Affiliation(s)
- Yuya Taguchi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan.
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Kohei Osakada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Makoto Takamatsu
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Kotaro Takahashi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Katsuya Miura
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Tsuyoshi Goto
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
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Matta A, Elenizi K, Elbaz M, Roncalli J. Left main coronary artery thrombus after cannabis consumption: a case report. Eur Heart J Case Rep 2021; 5:ytab179. [PMID: 34222781 PMCID: PMC8244647 DOI: 10.1093/ehjcr/ytab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/09/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
Background Left main coronary thrombus is a rare angiographic finding associated with serious outcomes such as sudden death and cardiogenic shock. Rupture of an underlying atherosclerotic plaque is the main risk factor. The role of cannabis consumption in the pathophysiology of acute cardiovascular disease is controversial. Case presentation We present a case of non-ST-elevation myocardial infarction characterized by a mobile left main coronary thrombus in a young male cannabis consumer successfully treated with manual aspiration, dual anti-platelet, and unfractionated heparin therapy. Conclusion Cannabis consumption could be a risk factor for coronary artery thrombosis. The pathophysiology mechanism of action is not well understood. Reaching an optimal management is a potential challenge for physicians.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
- Faculty of medicine, Holy Spirit University of Kaslik , Kaslik, Lebanon
| | - Khaled Elenizi
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University , Alkharj 11942, Saudi Arabia
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse , 1 Avenue Jean Poulhès, 31059 Toulouse, France
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D'Angelo C, Zagnoni S, Gallo P, Tortorici G, Casella G, Di Pasquale G. Electrocardiographic changes in patients with acute myocardial infarction caused by left main trunk occlusion. J Cardiovasc Med (Hagerstown) 2018; 19:439-445. [PMID: 29889168 DOI: 10.2459/jcm.0000000000000684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Left main trunk (LMT) occlusion is a rare angiographic finding. The primary purpose was to investigate the ECG pattern of patients with angiographic confirmation of LMT as culprit lesion. METHODS Forty-eight patients (32 men; mean age 73 years) with angiographic total (21 patients; 44%) or subtotal (27 patients; 56%) occlusion of the LMT were analyzed. Twenty patients (42%) were found to have concomitant coronary lesions. Eighteen patients (38%) required intra-aortic balloon pump support. RESULTS A significant left axis deviation was observed in 26 cases (54%) and an intraventricular conduction delay in 32 patients (67%). The average QRS width and QTc interval were 122 and 433 ms, respectively. ST-segment elevation in lead aVR occurred in 32 patients (67%). ST-segment elevation in leads V2-5 and in leads I and aVL [classic left anterior descending (LAD) type] was frequently observed (18 cases; 35%). In six patients (13%), a partial LAD type was observed with ST-segment elevation in leads I and aVL, but not in peripheral leads. The remaining patients showed ST-segment elevation only in peripheral leads (12 cases), in inferior leads III + aVF (six cases), whereas six patients had no ST-segment elevation. Diffuse ST-segment depression only (>6 leads) was observed in 15 cases (31%). Eighteen patients (38%) died during hospitalization. CONCLUSION ST-segment elevation in lead aVR or a LAD-type pattern can be associated with LMT disease. Other relevant aspects are the presence of cardiogenic shock at admission, the left axis deviation and marked prolongation of QTc interval and QRS width.
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Yamauchi T, Masai T, Fujii K, Sawa Y, Shirai S, Kamigaki M, Itou N. Long-term clinical results of acute myocardial infarction at the left main trunk requiring percutaneous cardiopulmonary support. J Artif Organs 2017; 20:303-310. [PMID: 28887708 DOI: 10.1007/s10047-017-0972-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
The clinical results of patients with acute myocardial infarction (AMI) at the left main trunk (LMT) remain unclear, especially in cases requiring percutaneous cardiopulmonary support (PCPS). Twenty seven cases of AMI at the LMT requiring emergent PCPS were retrospectively investigated. These 27 patients were aged 44-83 years (65.6 ± 8.6 years) and 20 (81.5%) were men. Peak creatine kinase (CK) leakage ranged from 538 to 34,010 IU/l (13,553 ± 7656 IU/l). Eight (29.6%) patients were discharged without mechanical support. Ten (37.0%) patients underwent left ventricular assist device (LVAD) implantation, five of whom with preoperative organ failure could not survive more than 6 months after implantation. The other nine (33.3%) patients died of low output syndrome or brain damage. The overall survival rates were 53.7, 41.3, 33.0, and 28.3% at 3 months, 6 months, 1 year, and 2 years, respectively. Multivariate analysis showed that Killip class 3/4 at hospital arrival was an independent risk factor for hospital mortality (odds ratio 20.4). Patients with more than 5 days of PCPS support period (n = 6), ≥ 4 h to revascularization (n = 6) or maximum CK leakage ≥20,000 IU/dl (n = 3) were not associated with successful PCPS or IABP weaning. The long-term clinical outcomes of patients with LMT disease requiring PCPS is devastating. Rapid cardiopulmonary resuscitation and coronary revascularization and timely insertion of LVAD before the onset of complications might lead to better survival.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan.
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, Osaka, 530-0001, Japan
| | - Kenji Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, Osaka, 530-0001, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shinya Shirai
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
| | - Mitsunori Kamigaki
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
| | - Naofumi Itou
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
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Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Clinical outcomes of left main crossover stenting for ostial left anterior descending artery acute myocardial infarction. Heart Vessels 2017; 33:33-40. [PMID: 28776068 DOI: 10.1007/s00380-017-1033-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/30/2017] [Indexed: 11/29/2022]
Abstract
Percutaneous coronary interventions to ostial left anterior descending artery (LAD)-acute myocardial infarction (AMI) were challenging, especially in crossover stenting from left main trunk (LMT) to LAD. The clinical outcomes of ostial LAD-AMI that needed crossover stenting were not well investigated. The objective of this study was to compare the clinical outcomes of LMT crossover stenting with those of ostial LAD just proximal (jp) stenting. Between January 2009 and March 2016, 1499 patients were diagnosed as AMI in our institution. Among them, 76 ostial LAD-AMIs were included in this study, and divided into 30 LMT crossover stenting (the crossover group) and 46 jp stenting (the jp stenting group). The primary endpoint was major cardiovascular events (MACE) defined as the composite of cardiac death, acute myocardial infarction (AMI), stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). The frequency of MACE was comparable between the 2 groups (16.7% in the crossover group and 21.7% in the jp stenting group, P = 0.587). Similarly, the frequency of cardiac death was comparable between the 2 groups (6.7% in the crossover group and 13.0% in the jp stenting group, P = 0.376). The frequencies of TLR (6.7% in the crossover group and 6.5% in the jp stenting group, P = 0.980) and TVR (10.0% in the crossover group and 8.7% in the jp stenting group, P = 0.848) were not significantly different between the 2 groups. In conclusion, the clinical outcomes of the crossover stenting were comparable to the jp stenting in the stenting strategy for ostial LAD-AMI. LMT-LAD crossover stenting would be the acceptable strategy for ostial LAD-AMI.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Naoyuki Akashi
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Masamitsu Noguchi
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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Shikuma A, Shiraishi J, Okawa K, Yashige M, Shoji K, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Takahashi A, Sawada T. Primary Percutaneous Coronary Intervention Followed by Valve Surgery for Acute Coronary Syndrome at Left Main Trunk Complicated With Severe Aortic Stenosis. Int Heart J 2017; 58:125-130. [PMID: 28100876 DOI: 10.1536/ihj.16-186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An 89-year-old woman appeared to have acute coronary syndrome at the left main trunk (LMT) complicated with severe aortic stenosis, moderate-severe mitral regurgitation, depressed left ventricular (LV) function, and multivessel disease. Because of sustained hypotension even under intra-aortic balloon pumping support during emergency coronary angiograhy, we performed primary percutaneous coronary intervention solely for the LMT lesion using a bare metal stent, leading to recovery from the shock state. On the second hospital day, based on our heart-team consensus, we performed aortic valve replacement and coronary artery bypass grafting surgery, and added edge-to-edge repair (Alfieri stitch) of the mitral valve, resulting in complete revascularization and dramatically improved LV function.
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Affiliation(s)
- Akira Shikuma
- Department of Cardiology, Kyoto First Red Cross Hospital
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Ielasi A, Silvestro A, Personeni D, Saino A, Angeletti C, Costalunga A, Tespili M. Outcomes following primary percutaneous coronary intervention for unprotected left main-related ST-segment elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 16:163-9. [PMID: 24892217 DOI: 10.2459/jcm.0000000000000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Unprotected left main (ULM) related ST-segment elevation myocardial infarction (STEMI) is a severe event, often leading to circulatory failure and/or sudden cardiac death. Although high-risk ULM thrombosis populations treated by primary percutaneous coronary intervention (PPCI) have been previously described, very little is known regarding the outcomes following PPCI for ULM-related STEMI in a hospital without on-site surgical back-up. METHODS A retrospective cohort analysis was performed on all consecutive patients who underwent PPCI for ULM-related STEMI in a single center. The primary end-point was to assess in-hospital mortality in the overall population and according to the presence/absence of cardiogenic shock at admission. RESULTS Between October 2006 and December 2012, 1094 patients underwent PPCI for STEMI. PPCI for ULM-related STEMI was performed in 34 (3.1%) patients. Among these, 22 (64.7%) were in cardiogenic shock at admission. Baseline mean ejection fraction was lower (P = 0.008), whereas the prevalence of patients with pre-procedural cardiac arrest and Killip Class III-IV was significantly higher in the cardiogenic shock (P = 0.05 and P < 0.001, respectively) compared with non-cardiogenic shock group. Furthermore, patients with cardiogenic shock had a higher prevalence of pre-procedural thrombolysis in myocardial infarction flow 0-1 (P = 0.05) and associated other vessel chronic total occlusion (P = 0.05) compared with non-cardiogenic shock group. Procedural success rate was lower in the cardiogenic shock compared with non-cardiogenic shock group (77.3 vs. 100%, P = 0.09), whereas in-hospital mortality rate was significantly higher in the cardiogenic shock compared with non-cardiogenic shock group (36.4 vs. 0%, P = 0.02). No deaths were reported among survivors of the acute phase at mid-term follow-up, whereas target lesion revascularization rate was 7.6%. CONCLUSIONS PPCI for ULM-related STEMI in a hospital without on-site surgical back-up was technically feasible in most of the cases. Although the procedural success and in-hospital mortality rates were influenced by cardiogenic shock at admission, an excellent mid-term outcome among patients who survived the hospitalization was reported independently by the severity of clinical presentation.
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Affiliation(s)
- Alfonso Ielasi
- Department of Cardiology, Azienda Ospedaliera 'Bolognini', Seriate (BG), Italy *Drs Ielasi and Silvestro contributed equally to the manuscript and are joint first authors
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Hashimoto S, Shiraishi J, Nakamura T, Nishikawa M, Yanagiuchi T, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Shima T, Sawada T, Matoba S, Yamada H, Matsumuro A, Shirayama T, Kitamura M, Kohno Y, Furukawa K. Survivors of acute myocardial infarction at left main trunk undergoing primary percutaneous coronary intervention. Cardiovasc Interv Ther 2015; 31:89-95. [DOI: 10.1007/s12928-015-0352-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
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Hanaki Y, Yumoto K, I S, Aoki H, Fukuzawa T, Watanabe T, Kato K. Coronary stenting with cardiogenic shock due to acute ascending aortic dissection. World J Cardiol 2015; 7:104-110. [PMID: 25717358 PMCID: PMC4325300 DOI: 10.4330/wjc.v7.i2.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/07/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery (LMCA) to the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection (TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is effective for prompt diagnosis and precise stent deployment in patients with cardiogenic shock due to TAAD with LMCA dissection.
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Talasaz AH, Khalili H, Jenab Y, Salarifar M, Broumand MA, Darabi F. N-Acetylcysteine effects on transforming growth factor-β and tumor necrosis factor-α serum levels as pro-fibrotic and inflammatory biomarkers in patients following ST-segment elevation myocardial infarction. Drugs R D 2014; 13:199-205. [PMID: 24048773 PMCID: PMC3784054 DOI: 10.1007/s40268-013-0025-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Aims Ischemia following acute myocardial infarction (AMI) increases the level of pro-fibrotic and inflammatory cytokines, including transforming growth factor (TGF)-β and tumor necrosis factor (TNF)-α. N-acetylcysteine (NAC) has therapeutic benefits in the management of patients with AMI. To the best of our knowledge, this is the first study that has evaluated the effect of NAC on TNF-α and TGF-β levels in patients with AMI. Methods Following confirmation of AMI, 88 patients were randomly administered NAC 600 mg (Fluimucil®, Zambon, Ticino, Switzerland) or placebo orally twice daily for 3 days. For quantification of TGF-β and TNF-α serum levels after 24 and 72 h of NAC or placebo administration, peripheral venous blood (10 mL) samples were collected at these time points. Results Comparisons between levels of TGF-β and TNF-α after 24 and 72 h within the NAC or placebo groups revealed that there was not any significant difference except for TGF-β levels in the placebo group, which increased significantly over time (p = 0.042). Significant relationships existed between patients’ ejection fraction (p = 0.005) and TGF-β levels. Conclusions Receiving NAC could prevent TGF-β levels from increasing after 72 h as compared with not receiving NAC. As TGF-β had strong correlations with the ejection fraction, its antagonism seems to be important in the prevention of remodeling.
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Affiliation(s)
- Azita Hajhossein Talasaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
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Baek JY, Seo SM, Park HJ, Kim PJ, Park MW, Koh YS, Chang KY, Jeong MH, Park SJ, Seung KB. Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction. Catheter Cardiovasc Interv 2013; 83:E243-50. [DOI: 10.1002/ccd.23420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 09/28/2011] [Accepted: 10/09/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Ju Yeol Baek
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Suk Min Seo
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Hun-Jun Park
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Pum Joon Kim
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Mahn Won Park
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Yoon Seok Koh
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Ki Yuk Chang
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Myung Ho Jeong
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Seung Jung Park
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
| | - Ki-Bae Seung
- Department of Medicine; Division of Cardiology; The Catholic University, Seoul St. Mary's Hospital, Korea; Seocho-Gu Seoul 137-701 Republic of Korea
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Nikus KC. Electrocardiographic presentations of acute total occlusion of the left main coronary artery. J Electrocardiol 2012; 45:491-3. [DOI: 10.1016/j.jelectrocard.2012.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Indexed: 12/25/2022]
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PARMA ANTONIO, FIORILLI ROSARIO, DE FELICE FRANCESCO, CHINI FRANCESCO, ROSSI PAOLOGIORGI, BORGIA PIERO, NAZZARO MARCOSTEFANO, MUSTO CARMINE, GUASTICCHI GABRIELLA, VIOLINI ROBERTO. Early and Mid-Term Clinical Outcome of Emergency PCI in Patients with STEMI due to Unprotected Left Main Coronary Artery Disease. J Interv Cardiol 2012; 25:215-22. [DOI: 10.1111/j.1540-8183.2011.00712.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hurtado J, Bermúdez EP, Redondo B, Ruiz JL, Blanes JRG, de Lara JG, Aguilar RV, Teruel F, Chavarri MV. Emergency Percutaneous Coronary Intervention in Unprotected Left Main Coronary Arteries. Predictors of Mortality and Impact of Cardiogenic Shock. ACTA ACUST UNITED AC 2009; 62:1118-24. [DOI: 10.1016/s1885-5857(09)73326-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hurtado J, Bermúdez EP, Redondo B, Ruiz JL, Blanes JRG, de Lara JG, Aguilar RV, Teruel F, Chavarri MV. Intervencionismo percutáneo urgente sobre el tronco coronario izquierdo no protegido. Factores predictores de mortalidad y análisis del shock cardiogénico. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)72380-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Sakakura K, Kubo N, Hashimoto S, Ikeda N, Funayama H, Hirahara T, Sugawara Y, Yasu T, Ako J, Kawakami M, Momomura SI. Determinants of in-hospital death in left main coronary artery myocardial infarction complicated by cardiogenic shock. J Cardiol 2008; 52:24-9. [PMID: 18639774 DOI: 10.1016/j.jjcc.2008.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 02/17/2008] [Accepted: 03/18/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) due to left main coronary artery disease is associated with significantly elevated morbidity and mortality. The aim of this study was to identify the predictors of in-hospital death from left main AMI complicated by cardiogenic shock. METHODS Clinical record review identified a total of 25 cases of left main AMI with cardiogenic shock. Patients' background characteristics, laboratory data, and angiographic findings were analyzed according to the in-hospital mortality. RESULTS In this patient subset, in-hospital mortality (60%) was associated with a history of hypertension (p=0.02) and a higher heart rate (p=0.02). Furthermore, in-hospital mortality was also associated with a complete right bundle branch block (CRBBB) pattern in the admission ECG (p=0.01) and low HCO(3)(-) (p=0.0004). In stepwise logistic regression analysis, a CRBBB pattern (OR 48.59, 95% CI 1.34-1768.10, p=0.03) and low HCO(3)(-) (OR 0.62, 95% CI 0.40-0.94, p=0.02) were found to be independent predictors of mortality. CONCLUSIONS Left main AMI with cardiogenic shock was associated with high in-hospital mortality. A CRBBB pattern in the ECG on admission and a low HCO(3)(-) concentration were significant independent predictors of in-hospital death.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University Saitama Medical Center, Omiya, Japan
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Mongeon FP, Rinfret S. Left main coronary artery occlusion with myocardial infarction in a cocaine user. Successful angioplasty with a drug-eluting stent. Can J Cardiol 2008; 24:e30-2. [PMID: 18464951 DOI: 10.1016/s0828-282x(08)70607-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A patient presented with acute ST segment elevation myocardial infarction following cocaine abuse. He was transferred for primary angioplasty. The emergent coronary angiography revealed acute left main coronary artery occlusion. Recanalization with balloon angioplasty was performed, followed by thrombectomy and stenting of the left main coronary artery with a paclitaxel-eluting stent. The patient recovered with a left ventricular ejection fraction of 35% at discharge. The pathophysiology of cocaine-induced myocardial infarction includes vasospasm, thrombosis and increased myocardial oxygen demand. Primary percutaneous coronary intervention allows local delivery of vasodilators and mechanical reperfusion in a timely manner. The authors argue that it is the best option for cocaine-induced ST segment elevation myocardial infarction. Recent data from randomized trials comparing bare metal and drug-eluting stents for primary percutaneous coronary intervention are discussed, as is the lack of evidence supporting the use of thrombectomy devices in acute myocardial infarction. The authors believe that primary percutaneous coronary intervention should be considered early for a patient presenting with cocaine-induced ST segment elevation myocardial infarction.
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Cheng CI, Hsueh SK, Lee FY, Wu CJ, Fang CY, Sheu JJ, Chen SM, Yang CH, Hsieh YK, Chen MC, Fu M, Yip HK. Clinical Presentation and Prognostic Factors of Patients With Acute ST-Segment Elevation Myocardial Infarction Following Emergent Revascularization for Left Main Coronary Artery Obstruction. Circ J 2008; 72:1598-604. [DOI: 10.1253/circj.cj-08-0258] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Cheng-I Cheng
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Fan-Yen Lee
- Division of Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Jiunn-Jye Sheu
- Division of Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Shyh-Ming Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Yuan-Kai Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Morgan Fu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center
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Abstract
Patients with stenosis of the left main coronary artery present difficult challenges. The risks associated with this lesion have been known since the early days of angiography when patients were found to have increased mortality during follow-up. This information led to the general guidelines that surgical revascularization should be considered the treatment of choice in patients with significant left main coronary artery stenosis. Current advances in invasive cardiology have brought important information to the field. Intravascular ultrasound is now used routinely to evaluate angiographically indeterminate lesions with criteria now set forward as to what constitutes an indication for revascularization. Stents have even further dramatically changed the landscape. There are substantial issues, however, that need to addressed. These include the following: (1) the effect of specific lesion location on outcome - it is known that patients with distal bifurcation left main disease have worse outcome; (2) the potential for subacute thrombosis of the left main coronary artery; (3) the impact of left ventricular function and patient comorbidities irrespective of the degree and location of left main coronary artery stenosis; and (4) the risk-benefit ratio of stenting versus coronary artery bypass graft surgery. These issues are currently being addressed in two seminally important trials including the SYNTAX trial, which randomizes patients with left main and/or three-vessel disease to either coronary artery bypass graft surgery or a TAXUS drug-eluting stent. This trial is in the final stages of patient recruitment and will have important implications for the field. The other trial is the COMBAT trial, which is focused exclusively on left main coronary artery stenosis and randomizes patients with left main coronary artery disease either to a Sirolimus-eluting stent (Cypher, Johnson and Johnson Cordis, USA) or to coronary artery bypass graft surgery. The field of left main coronary artery disease continues to expand in terms of the evidence available for optimal patient evaluation and selection of treatment modalities.
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Migliorini A, Moschi G, Giurlani L, Valenti R, Vergara R, Parodi G, Carrabba N, Dovellini EV, Antoniucci D. Drug-eluting stent supported percutaneous coronary intervention for unprotected left main disease. Catheter Cardiovasc Interv 2006; 68:225-30. [PMID: 16817178 DOI: 10.1002/ccd.20815] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study sought to determine the clinical and angiographic outcomes of unselected patients receiving drug-eluting stents for unprotected left main disease. BACKGROUND The results of several series of percutaneous coronary intervention (PCI) for left main disease in the pre-drug-eluting stent era have arisen concerns on the safety and mid-term efficacy of PCI. METHODS Consecutive patients with unprotected left main disease were considered eligible for drug-eluting stent supported PCI. The surgical risk score (risk of death within 1 month) of each patient was calculated according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. RESULTS One-hundred and one patients with unprotected left main disease underwent PCI. The mean EuroSCORE was 19 +/- 23. Successfully left main stenting was performed in 98 patients (primary success rate 97%). The overall 1-month mortality rate was 9.9%. The 1-month mortality rate was 50% in patients with acute myocardial infarction (AMI) on presentation, and 4.5% in patients without AMI on presentation. The 1-month mortality rate of patients with a risk score <13 was 3%, while it was 21% in patients with a risk score >or=13. At 6 months, the mortality rate of the entire cohort of patients increased to 12.8%, and the one of the non-AMI patients to 7.8%. Survival rate was 86% +/- 4% (mean follow-up 295 +/- 175 days). Target vessel revascularization was performed in 14 patients (16%). The 6-month in-segment restenosis rate was 16%. CONCLUSION Drug-eluting stent supported PCI may provide early and mid-term outcomes comparable or superior to those expected from coronary artery surgery. (c) 2006 Wiley-Liss, Inc.
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Tanigawa J, Sutaria N, Goktekin O, Di Mario C. Treatment of Unprotected Left Main Coronary Artery Stenosis in the Drug-Eluting Stent Era. J Interv Cardiol 2005; 18:455-65. [PMID: 16336426 DOI: 10.1111/j.1540-8183.2005.00086.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Coronary angiography is often inadequate for estimating the severity of ambiguous left main coronary artery (LMCA) stenoses. Our assessment of these lesions can be improved by the techniques of intravascular ultrasound and fractional flow reserve which provide indices of stenosis severity to enable the prediction of future events and planning of treatment. For patients requiring LMCA revascularization, coronary artery bypass graft (CABG) surgery has been gold standard for decades. However, this technique continues to be limited by factors such as periprocedural mortality, prolonged hospital stay and rehabilitation, and long-term graft patency. LMCA stenosis remains one of the few serious challenges for the interventional cardiologists and, in the bare metal stent era, the long-term results were not sufficient to replace CABG surgery, mainly because of the high restenosis rate. Drug-eluting stents (DES) have dramatically reduced the restenosis rate and early results in small series (approximately 300 patients in total) treated with DES in LMCA have been encouraging, especially for lesions at the ostium and in the left main shaft. Before changes are made in the guidelines for treatment, we must wait for a refinement in the technique and stent design used for bifurcational left main lesion and the results of randomized, specific multicenter studies (SYNTAX trial). It is likely that, for selected patients, LMCA stenosis will be regarded as an indication for PCI.
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Affiliation(s)
- Jun Tanigawa
- Cardiology, 1st Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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22
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Lee SW, Hong MK, Lee CW, Kim YH, Park JH, Lee JH, Han KH, Kim JJ, Park SW, Park SJ. Early and late clinical outcomes after primary stenting of the unprotected left main coronary artery stenosis in the setting of acute myocardial infarction. Int J Cardiol 2004; 97:73-6. [PMID: 15336810 DOI: 10.1016/j.ijcard.2003.07.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Revised: 07/04/2003] [Accepted: 07/25/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute left main coronary artery occlusion is a dramatic condition with very high mortality. The study was aimed to evaluate the effect of primary stenting in patients with left main coronary artery (LMCA) disease in the setting of acute myocardial infarction (AMI). METHODS Between June 1997 and April 2002, primary stenting for left main coronary artery disease was performed in 18 patients with acute myocardial infarction. We evaluated early and late clinical outcomes, and prognostic determinants in this clinical setting. RESULTS Mean ages of patients were 59 +/- 12 years. Fourteen patients had cardiogenic shock on admission. Angiographic success (TIMI flow > or = 2 and diameter stenosis < 30% after stenting) was achieved in 17 patients (94%). In-hospital death occurred in eight patients (44%). Two patients (11%) received emergent bypass surgery because of hemodynamic instability after primary stenting. On univariate analysis, good pre-intervention TIMI flow (grade > or = 2) was identified as a good prognostic determinant of in-hospital survival. During mean follow-up of 39 +/- 22 months, there was no late death and one patient received bypass surgery. Probability of freedom from death at 3-year was 56 +/- 12%. CONCLUSION Primary stenting is a valuable therapeutic strategy for left main coronary disease in the setting of acute myocardial infarction, and it might save the life especially in patients with good pre-intervention TIMI flow (grade > or = 2). Long-term clinical outcome of patients surviving to hospital discharge is favorable.
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Affiliation(s)
- Seung-Whan Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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Mikkelsson J, Eskola M, Nikus K, Pietilä K, Karhunen PJ, Niemelä K. Fatality of myocardial infarction in relation to the coronary anatomy: role of culprit lesion location. Ann Med 2004; 36:474-9. [PMID: 15513298 DOI: 10.1080/07853890410014974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE We set out to study the effect of the location of the culprit coronary lesion on myocardial infarction (MI) fatality by combining data from MI survivors in the coronary care unit (CCU) and autopsied patients with pre-hospital fatal MI. DESIGN We studied two simultaneous series of men under 70 years with fatal pre-hospital MI (n = 36) and men admitted for acute ST-elevation-MI (n = 92). The culprit lesion was identified by the presence of thrombus at autopsy and by coronary angiography in patients admitted to the CCU. RESULTS The culprit lesion was located in the right coronary artery (RCA) in 22 (61%) of 36 men with fatal MI compared to 30 (33%) of 92 men with non-fatal MI (P = 0.01). Seventy-three percent of fatal RCA occlusions were proximal as opposed to only 30% of non-fatal RCA occlusions (P < 0.001). Forty-four percent of all fatal MI were due to proximal RCA occlusion as opposed to only 10% of non-fatal MI (P < 0.005). CONCLUSIONS Proximal RCA occlusions were very often found among men with fatal pre-hospital MI, whereas left-sided coronary occlusions were significantly more frequent in hospital-admitted survivors of MI. Left-sided coronary occlusions may be associated with a more favourable pre-hospital phase of acute MI compared to proximal RCA occlusions.
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Affiliation(s)
- Jussi Mikkelsson
- University of Tampere, Medical School, Dept of Forensic Medicine and Research Unit of the Centre of Clinical Chemistry of Tampere University Hospital, Finland.
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Colombo A. The present is favorable but the future remains grim: hopefully not for so long! Catheter Cardiovasc Interv 2003; 59:475-6. [PMID: 12891611 DOI: 10.1002/ccd.10589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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