Renal impairment and coronary collaterals in patients with acute coronary syndrome

OBJECTIVE

We aimed to elucidate the relationship between mild-to-moderate renal impairment and the development of coronary collateral vessels (CCV) in patients with acute coronary syndrome (ACS).

METHODS

We enrolled 461 patients with ACS who underwent coronary angiography for the first time. The development of CCV was assessed with the Rentrop score. Kidney function was classified according to the estimated glomerular filtration rate (eGFR). The Gensini score was used to show the extent of atherosclerosis.

RESULTS

The mean eGFR value was 89.9 ± 24.3 U/l for patients with no development of collaterals and 82.7 ± 20.5 for patients who had CCV. The mean age was 59 ± 11 years and 349 patients (75.7 %) were male. Rentrop classifications 1-2-3 (presence of CCV) were determined in 222 (48.1 %) patients. The presence of CCV was significantly associated with low levels of eGFR (p = 0.001), increased serum creatinine levels (p = 0.034), high levels of serum albumin (0.036), and the Gensini score (p < 0.001). Multivariate analysis showed that the Gensini score was an independent predictor of the presence of CCV (OR = 1.090, 95 % CI: 1.032-1.151, p = 0.002).

CONCLUSION

We suggest that the association between mild-to-moderate renal impairment and the presence of CCV may be explained by increased myocardial ischemia and severe CAD.

Acute coronary syndrome triggered by honeybee sting: a case report

A 56-year-old previously healthy man was admitted to our hospital with a severe chest pain that started shortly after being stung by a honeybee. He did not have any allergic symptoms and there was no cutaneous or respiratory evidence of allergy on physical examination. Electrocardiographic and biochemical markers were consistent with an acute coronary syndrome. Coronary angiography demonstrated a significant thrombotic lesion in the right coronary artery. Here, a rare and unexpected event is presented, the development of acute coronary syndrome after a bee sting.

A unique double right coronary artery abnormality

Double right coronary artery is a very rare coronary artery abnormality. Two cases have been reported so far. In these cases, both right coronary arteries were giving the same branches, and originated from the same orifice. In our case, both right coronary arteries were giving different branches. We could not find such a case in the literature. Therefore, we consider our case a unique double right coronary artery abnormality.