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Amirpour A, Zavar R, Danesh M, Mirbod SM, Zaker E, Moslemi F, Amini Z, Sadeghi M. Anticoagulant and antiplatelet treatment effects on the incidence of major cardiovascular events in patients with coronary artery ectasia: An updated systematic review. Indian Heart J 2024:S0019-4832(24)00153-6. [PMID: 39009077 DOI: 10.1016/j.ihj.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/16/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Coronary artery ectasia (CAE), widenings in sections of the arteries, is a rare condition found in up to 3-5% of angiography cases. Sometimes recurrence of major adverse cardiac events (MACE) has been reported in the CAE subjects. The present systematic review aims to collect and summarize reports on whether the use of anticoagulants in addition to single antiplatelet/dual antiplatelet therapy (SAPT/DAPT) in CAE patients with significant occlusion/heavy thrombus is efficient and safe in decreasing the incidence/recurrence of MACE. MATERIAL AND METHODS A systematically comprehensive search was performed covering PubMed, Scopus, ISI Web of Science, and Google Scholar databases. RESULTS Twenty-five studies were found including 20 case reports, four case series, and one randomized clinical trial. Of 20 case reports 15 were male (75 %), and five were female (25 %). Of the four the case series, all showed positive outcomes after DAPT plus anticoagulant in more than 50 % of patients; two took only DAPT and 13 took anticoagulant ± DAPT, and five compared both. Cases received DAPT only experienced recurrences of MACE. The other cases were uneventful with less MACE and better outcomes after the use of anticoagulant ± DAPT. Results of these case-series included 457 CAE patients showed that more than 80 % of subjects were male, and in all studies tailored pharmacological interventions, including antiplatelet and anticoagulant (warfarin) therapies, resulted in less MACE and mortality. CONCLUSION It can be concluded that antiplatelet (SAPT/DAPT) must be applied in combination with anticoagulants to provide more efficient protection against MACE in CAE patients. However, further high-quality randomized clinical trials are needed to confirm the results.
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Affiliation(s)
- Afshin Amirpour
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihaneh Zavar
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manizheh Danesh
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Erfan Zaker
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Moslemi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zahra Amini
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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2
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Lin Y, Qi H, Liu Y, Wu H, Li Y, Shi L. Etiology and prognosis of non-Kawasaki disease induced coronary aneurysms in children: a retrospective case series study. Eur J Pediatr 2024:10.1007/s00431-024-05666-5. [PMID: 38990385 DOI: 10.1007/s00431-024-05666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
While Kawasaki disease (KD) induced coronary artery aneurysms (KD CAAs) in children are well studied, the features and prognosis of non-KD induced CAAs (non-KD CAAs) in the pediatric population are poorly documented. This case series study is to analyze the etiology and prognosis of non-KD CAAs in children and compare the characteristics of non-KD CAAs and KD CAAs. Non-KD CAA and KD CAA cases at our department from January 2022 to December 2023 were retrospectively collected. Etiologies and prognosis of non-KD CAAs were analyzed. Furthermore, demographic data, biochemical parameters and outcomes between children with Non-KD CAAs and children with KD CAAs were comparatively studied. Fifteen children with non-KD CAAs with a median age of 6 years and 117 children with KD CAAs with a median age of 2.0 years (p = 0.022) were included in this study. The causes of non-KD CAAs include: unknown etiologies (2 cases), coronary artery structural abnormalities (4), Takayasu arteritis (2), virus infection (2), cardiomyopathy (2), aplastic anemia with agranulocytosis (1), ANCA-associated vasculitis (1), and mucopolysaccharidosis (1). In the non-KD CAA group, there were a total of 19 CAAs with 3 being giant, 5 medium, and 11 small; 4 patients had complete CAA regression; an infant with a fistula between the right coronary artery and the coronary sinus complicated with cardiac enlargement died of heart failure. The KD group had significantly higher levels of CRP, white cells counts and ESR with zero mortality. Non-KD CAA cases had a significantly lower regression rate than KD-CAA cases (26.7% vs 66.7%, p = 0.004), and the probability of CAA regression in non-KD patients was 0.341 of that in KD patients (p = 0.006, OR = 0.341, 95% CI: 0.179-0.647). CONCLUSIONS Various etiologies for Non-KD CAAs are identified. Patients with Non-KD CAAs were observed to have lower inflammatory indexes but poorer recovery than patients with KD CAAs. Therapeutic strategies different than those for KD may be needed for non-KD CAAs. WHAT IS KNOWN • Coronary artery aneurysm (CAA) in children is most commonly induced by Kawasaki disease (KD CAA), with a 50 ~ 70% regression rate in 1 to 2 years. • CAA induced by diseases other than KD (non-KD CAA) in children is rare and its prognosis remains largely unknown. WHAT IS NEW • Most non-KD CAA cases are caused by coronary artery structural malformations. • Non-KD CAA in children has poorer prognosis and lower regression rate compared with KD CAA. • In addition to guideline directed anti-platelet and anti-coagulant therapies, treatments targeting the causal factor are necessary for non-KD CAA.
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Affiliation(s)
- Yao Lin
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No 2 Yabao Road, Beijing, 100020, Chaoyang District, China
| | - Huiru Qi
- Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing, China
| | - Yanyan Liu
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No 2 Yabao Road, Beijing, 100020, Chaoyang District, China
| | - Haojie Wu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Yaqi Li
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No 2 Yabao Road, Beijing, 100020, Chaoyang District, China
| | - Lin Shi
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No 2 Yabao Road, Beijing, 100020, Chaoyang District, China.
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3
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Edwin Jonathan GD, Venkatesh S, Baliga BV. A filling defect during primary percutaneous coronary intervention: is it always a thrombus? ASIAINTERVENTION 2024; 10:148-149. [PMID: 39070980 PMCID: PMC11263863 DOI: 10.4244/aij-d-23-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2024] [Indexed: 07/30/2024]
Affiliation(s)
| | | | - B Vivek Baliga
- Department of Internal Medicine, Aster RV Hospital, Bengaluru, India
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4
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Yang X, Zong Y, Zhang Z, Yin H, Zhang X, Miao Y, Xiao B. Risk factors and major adverse cardiovascular events of isolated coronary artery ectasia: An observational study. Medicine (Baltimore) 2024; 103:e38413. [PMID: 38847735 PMCID: PMC11155586 DOI: 10.1097/md.0000000000038413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 05/09/2024] [Indexed: 06/10/2024] Open
Abstract
To evaluate the cardiac index and major adverse cardiovascular events (MACE) events between isolated coronary artery ectasia (CAE) and control groups over 1 year period from diagnosis. A total of 18 patients who were diagnosed with isolated CAE in the Second Hospital of Hebei Medical University from December 2020 to December 2021 were included in CAE group. About 36 patients with non-obstructive coronary artery lesions were included in the control group. All patients in 2 groups completed dobutamine stress echocardiography (DSE) during hospitalization. The chamber size, wall thickness, left ventricular ejection fraction, and left ventricular diastolic function indicators (including E/A ratio, e', and E/e' ratio) were measured. MACE and all-cause death were measured during follow-up after discharge. Interventricular septum thickness (IVSd), left ventricular posterior wall (LVPW) thickness in diastole and E/e' in CAE group were significantly higher than control group (P < .05). No significant differences were found in prognosis including angina, myocardial ischemia (MI), patient readmission and cardiovascular death (P > .05). In CAE group, coronary angiography showed dilation of left anterior descending (LAD) in 1 case, left circumflex (LCX) in 3 cases and right coronary artery (RCA) in 14 cases. Multivariate logistic regression analysis showed that BMI and IVSd were independent risk factors for CAE. IVSd, LVPW thickness in diastole and E/e' in CAE group were significantly higher than control group. BMI and IVSd were independent risk factors for isolated CAE, and had a good predictive value for isolated CAE.
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Affiliation(s)
- Xiuchun Yang
- Department of Cardiology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yijun Zong
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Zhentian Zhang
- Department of Cardiology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongning Yin
- Department of Cardiac Ultrasound, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuqian Zhang
- Department of Cardiac Ultrasound, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yajing Miao
- Department of Cardiac Ultrasound, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bing Xiao
- Department of Cardiology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
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5
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Lamtai M, Fihri Y, Faid S, Nabil L, Britel D, Faliouni H, Mouine N, Lakhal Z, Benyass A. Coronary Artery Ectasia: Case Reports and Literature Review. Cureus 2024; 16:e62011. [PMID: 38983998 PMCID: PMC11233094 DOI: 10.7759/cureus.62011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/11/2024] Open
Abstract
Coronary artery ectasia (CAE) is a rare condition, affecting 3%-8% of patients with atherosclerotic coronary artery disease, and is characterized by the abnormal dilatation of the coronary arteries. While the etiology of coronary artery ectasia encompasses a myriad of acquired and genetic factors, its pathogenesis still remains a subject of investigation. The clinical manifestations are varied, ranging from asymptomatic cases to chest angina and myocardial infarction. Coronary angiography remains the gold standard for diagnosing CAE. We herein report four cases of coronary ectasia: the first involving myocardial infarction, the second associated with bicuspid aortic valve with severe aortic regurgitation, the third detected during coronary angiography for moderate left ventricular dysfunction, and the last one detected during coronary angiography for stable angina. The aims of our study are to highlight the diversity of clinical presentations as well as the challenge of management, given that there are no universal treatments or guidelines.
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Affiliation(s)
- Mouad Lamtai
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | - Youssef Fihri
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | - Soumia Faid
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | - Laktib Nabil
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | - Driss Britel
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | | | - Najat Mouine
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | - Zouhair Lakhal
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
| | - Aatif Benyass
- Cardiology Center, Military Hospital Mohamed V, Rabat, MAR
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6
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Ferruzzi G, Bellino M, Silverio A, Di Maio M, Vassallo M, Vecchione C, Galasso G. Invasive and Non-invasive Assessment of Non-culprit Coronary Lesions in Patients with ST-segment Elevation Myocardial Infarction. Transl Med UniSa 2024; 26:38-45. [PMID: 38957729 PMCID: PMC11218753 DOI: 10.37825/2239-9747.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 07/04/2024] Open
Abstract
The angiographic evidence of coronary multivessel disease (MVD) increases significantly the risk of recurrent ischemic events in patients with ST-segment elevation myocardial infarction (STEMI). Recent evidence suggests that a complete revascularization strategy should be considered the standard of care in these patients and performed for significant non-culprit lesions (NCLs) after careful assessment of the individual risk-benefit ratio. However, the optimal timing and the modality for the assessment of NCLs is not fully standardized. This brief review aims to summarise the management of MVD in patients with STEMI and to provide an overview of the principal techniques used to guide revascularisation in this high-risk clinical setting.
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Affiliation(s)
- Germano Ferruzzi
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mariagiovanna Vassallo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli,
Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
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7
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Şener YZ. Factors Related to Coronary Artery Ectasia. Angiology 2023; 74:704. [PMID: 36651646 DOI: 10.1177/00033197231152942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yusuf Ziya Şener
- Department of Cardiology, Beypazarı State Hospital, Ankara, Turkey
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8
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Tlohi I, Karim F, Elamraoui A, Drighil A, Habbal R. ST-elevation myocardial infarction complicated by ventricular tachycardia revealing coronary artery ectasia: a case report. J Med Case Rep 2023; 17:232. [PMID: 37277850 DOI: 10.1186/s13256-023-03965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Coronary artery ectasia is a rare angiographic finding and results from a disease process that compromises the integrity of the vessel wall. Its prevalence ranges between 0.3% and 5% of patients undergoing coronary angiography (Swaye et al. in Circulation 67:134-138, 1983). Coronary artery ectasia in patients with ST-elevation myocardial infarction is associated with an increased risk of cardiovascular events and death after percutaneous coronary intervention. CASE PRESENTATION We report the case of a 50-year-old male Caucasian patient, admitted for ventricular tachycardia at 200 beats per minute hemodynamically not tolerated that was reduced by external electric shock. Electrocardiogram after cardioversion showed a sinus rhythm with anterior ST-elevation myocardial infarction. Thrombolytic therapy was chosen after exposure to dual antiplatelet therapy and heparin since the expected time to percutaneous coronary intervention was greater than 120 minutes from first medical contact and the patient presented within 12 hours of onset of ischemic symptoms. The electrocardiogram after thrombolysis showed the resolution of the ST segment. The echocardiogram showed a dilated left ventricle with severe dysfunction with left ventricle ejection fraction at 30%. Coronary angiography revealed non-obstructive giant ecstatic coronaries without any thrombus. A check-up to look for possible etiologies for coronary artery ectasia was carried out and returned normal. Since no etiology for coronary artery ectasia was found at the limit of available exams in our center, the patient was discharged with antiplatelet therapy (aspirin 100 mg once a day) and heart failure treatment with an indication for an implantable cardiac defibrillator. CONCLUSIONS Coronary artery ectasia in the context of acute myocardial infarction is a rare condition that may have dangerous complications, especially when an optimal treatment for ecstatic culprit vessels is still controversial.
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Affiliation(s)
- Imane Tlohi
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco.
| | - Fatiha Karim
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
| | - Asmaa Elamraoui
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
| | - Abdenasser Drighil
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
| | - Rachida Habbal
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
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9
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Bellino M, Galasso G, Silverio A, Tedeschi M, Formisano C, Romei S, Esposito L, Cancro FP, Vassallo MG, Accarino G, Verdoia M, Di Muro FM, Vecchione C, De Luca G. Soluble PCSK9 Inhibition: Indications, Clinical Impact, New Molecular Insights and Practical Approach-Where Do We Stand? J Clin Med 2023; 12:jcm12082922. [PMID: 37109259 PMCID: PMC10146045 DOI: 10.3390/jcm12082922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Current research on cardiovascular prevention predominantly focuses on risk-stratification and management of patients with coronary artery disease (CAD) to optimize their prognosis. Several basic, translational and clinical research efforts aim to determine the etiological mechanisms underlying CAD pathogenesis and to identify lifestyle-dependent metabolic risk factors or genetic and epigenetic parameters responsible for CAD occurrence and/or progression. A log-linear association between the absolute exposure of LDL cholesterol (LDL-C) and the risk of atherosclerotic cardio-vascular disease (ASCVD) was well documented over the year. LDL-C was identified as the principal enemy to fight against, and soluble proprotein convertase subtilisin kexin type 9 (PCSK9) was attributed the role of a powerful regulator of blood LDL-C levels. The two currently available antibodies (alirocumab and evolocumab) against PCSK9 are fully human engineered IgG that bind to soluble PCSK9 and avoid its interaction with the LDLR. As documented by modern and dedicated "game-changer" trials, antibodies against soluble PCSK9 reduce LDL-C levels by at least 60 percent when used alone and up to 85 percent when used in combination with high-intensity statins and/or other hypolipidemic therapies, including ezetimibe. Their clinical indications are well established, but new areas of use are advocated. Several clues suggest that regulation of PCSK9 represents a cornerstone of cardiovascular prevention, partly because of some pleiotropic effects attributed to these newly developed drugs. New mechanisms of PCSK9 regulation are being explored, and further efforts need to be put in place to reach patients with these new therapies. The aim of this manuscript is to perform a narrative review of the literature on soluble PCSK9 inhibitor drugs, with a focus on their indications and clinical impact.
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Affiliation(s)
- Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Michele Tedeschi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Ciro Formisano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Francesco Paolo Cancro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Maria Giovanna Vassallo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Giulio Accarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, 13900 Biella, Italy
| | - Francesca Maria Di Muro
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Careggi University Hospital, 50139 Florence, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, Italy
| | - Giuseppe De Luca
- Division of Cardiology, AOU "Policlinico G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98166 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
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Solis-Jimenez F, Gonzalez-Ortiz A, Larios-Lara JH, Castro-Garcia CA, Arteaga-Chan EI, Velazquez-Sanchez F, Vargas-Estrada JL, Ramirez-Marcano EY, Garaygordobil DA, Briseño De La Cruz JL, Gopar-Nieto R, Martinez DSL, Arias-Mendoza A. Case report: Polyarteritis nodosa as a substrate for a massive myocardial infarction. Front Cardiovasc Med 2023; 9:1070378. [PMID: 36712274 PMCID: PMC9877312 DOI: 10.3389/fcvm.2022.1070378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/25/2022] [Indexed: 01/13/2023] Open
Abstract
This report describes a rare case of a global myocardial infarction caused by severe vasospasm of the coronary arteries secondary to the administration of pyridostigmine in a patient with polyarteritis nodosa (PAN). Details about the clinical presentation, the typical electrocardiographic pattern of multivessel disease, the differential diagnoses suspected in the multi-imaging approach, and the treatment of cardiogenic shock are described. The definitive diagnosis of infarction and the histopathological findings compatible with polyarteritis nodosa were made by autopsy.
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Affiliation(s)
- Fabio Solis-Jimenez
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Araceli Gonzalez-Ortiz
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan H. Larios-Lara
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos A. Castro-Garcia
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Eduardo I. Arteaga-Chan
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Jorge L. Vargas-Estrada
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | | | - Rodrigo Gopar-Nieto
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Alexandra Arias-Mendoza
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico,*Correspondence: Alexandra Arias-Mendoza,
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11
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Liu R, Gao X, Liang S, Zhao H. Five-years' prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study. Front Cardiovasc Med 2022; 9:950291. [PMID: 36304544 PMCID: PMC9592902 DOI: 10.3389/fcvm.2022.950291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Most of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI). Objective To determine the overall prognosis for CAE patients. Materials and methods This study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE). Results The Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, P = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, P = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, P = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, P = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, P = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, P = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, P = 0.022). Conclusion The prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.
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12
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Cancro FP, Bellino M, Esposito L, Romei S, Centore M, D'Elia D, Cristiano M, Maglio A, Carrizzo A, Rasile B, Alfano C, Vecchione C, Galasso G. Acute Coronary Syndrome in Patients with SARS-CoV-2 Infection: Pathophysiology and Translational Perspectives. Transl Med UniSa 2022; 24:1-11. [PMID: 36447945 PMCID: PMC9673986 DOI: 10.37825/2239-9754.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023] Open
Abstract
Acute coronary syndromes (ACS) may complicate the clinical course of patients with Coronavirus Disease 2019 (COVID-19). It is still unclear whether this condition is a direct consequence of the primary disease. However, several mechanisms including direct cellular damage, endothelial dysfunction, in-situ thrombosis, systemic inflammatory response, and oxygen supply-demand imbalance have been described in patients with COVID-19. The onset of a prothrombotic state may also be facilitated by the endothelial dysfunction secondary to the systemic inflammatory response and to the direct viral cell damage. Moreover, dysfunctional endothelial cells may enhance vasospasm and platelet aggregation. The combination of these factors promotes atherosclerotic plaque instability, thrombosis and, consequently, type 1 myocardial infarction. Furthermore, severe hypoxia due to extensive pulmonary involvement, in association with other conditions described in COVID-19 such as sepsis, tachyarrhythmias, anemia, hypotension, and shock, may lead to mismatch between oxygen supply and demand, and cause type 2 myocardial infarction. A deeper understanding of the potential pathophysiological mechanisms underlying ACS in patients with COVID-19 could help the therapeutic management of these very high-risk patients.
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Affiliation(s)
- Francesco P. Cancro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Corresponding author at: Department of Medicine, Surgery and Dentistry, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Largo Città di Ippocrate, 84131 Salerno, Italy. Fax: +39 089 089 672805. E-mail address: (M. Bellino)
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mario Centore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Debora D'Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mario Cristiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia,
Italy
| | - Barbara Rasile
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Alfano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia,
Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
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13
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Fujii T, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Yuhara S, Usui A. Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting. SAGE Open Med Case Rep 2022; 10:2050313X221116681. [PMID: 35958880 PMCID: PMC9358548 DOI: 10.1177/2050313x221116681] [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: 04/29/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
A 73-year-old man presented with multiple giant coronary artery aneurysms. Twelve years prior to the presentation, he had undergone coronary artery bypass grafting. At that time, he exhibited small aneurysms (16 mm diameter) in the right coronary artery and a single aneurysm (10 mm diameter) in the left circumflex artery. During follow-up, the aneurysms gradually increased in size (to 45 and 30 mm, respectively, at 12 years after surgery). We resected all of the aneurysms and performed coronary artery bypass grafting of the left circumflex artery through re-sternotomy.
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Affiliation(s)
- Taro Fujii
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Uchida
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yuhara
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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