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Arabi A, Rafie I, Arafa S, Alqahtani A, Altamimi O, Abujalala S, Hamid T, Ali M, Alkindi F, Alkhani M, Al-Hijji M, Altamimi H, Al Suwaidi J. ST Segment myocardial infarction due to totally occluded unprotected left main coronary artery (TOULM): an insight from nationwide database. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
This study sought to describe the clinical profile, management and short-term outcomes of patients with ST elevation myocardial infraction (STEMI) due to totally occluded unprotected left main coronary artery (TOULM).
Methods
This is a retrospective analysis of nationwide STEMI database of patients who underwent primary percutaneous intervention (PPCI). Patients with TOULM are defined as having 100% acute thrombotic occlusion of the left main artery or subtotal occlusion with no more than TIMI 1 flow.
Results
Between January 2011 and February 2022, 7107 patients underwent Primary Percutaneous Intervention for STEMI. 35 cases (0.5%) of all STEMI were due to TOULM. The average age of patients with TOULM was 51±14 years, predominantly male (94%) and had no prior cardiac history (94%). 11 patients (31%) suffered cardiac arrest and 16 (45%) were on mechanical ventilation prior to arrival to cardiac catheterization laboratory.
The right coronary artery was the dominant vessel in 29 (89%) patients. Right to left collaterals were present in 15 (42%), absent in 8 (23%) and unknown (the right coronary artery was injected after TOULM intervention or not injected) in 12 (34%) patients. Mechanical circulatory support was used in 37% of the cases (IABP 8, ECMO 3 and ECMO plus IABP 2). Revascularization was achieved with PCI and stenting in 30 patients (86%). Five patients underwent urgent CABG after balloon angioplasty. Survival to hospital discharge was 55%.
Conclusions
STEMI due to TOULM is a rare occurrence and involved mainly male with no prior cardiac history. Despite all the patients in our series undergoing revascularization, the in-hospital mortality is almost 50%. One major limitations of our study is we had no post-mortem data of any patient who died prior to coronary angiography, which potentially will lead to higher recorded cases of TOULM related mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Arabi
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - I Rafie
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - S Arafa
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - A Alqahtani
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - O Altamimi
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - S Abujalala
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - T Hamid
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - M Ali
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - F Alkindi
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - M Alkhani
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - M Al-Hijji
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - H Altamimi
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
| | - J Al Suwaidi
- Hamad Medical Corporation Heart Hospital, Cardiology , Doha , Qatar
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Bartl MH, Gatterer K, Fritzer HP, Arafa S. Investigation of phase separation in Nd3+ doped ternary sodium borosilicate glasses by optical spectroscopy. Spectrochim Acta A Mol Biomol Spectrosc 2001; 57:1991-1999. [PMID: 11666079 DOI: 10.1016/s1386-1425(01)00472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Two glasses doped with 1 mol% Nd2O3 and batch compositions inside the miscibility gap of the ternary Na2O-B2O3-SiO2 system were prepared by rapid quenching of the 1,400 degrees C melts. Phase separation was induced by heat-treatment at 600 degrees C for different exposure times and monitored qualitatively by an observation of Rayleigh scattering. The 4I(9/2-->P(1/2) transition of Nd3+ around 23300 cm(-1) recorded for the quenched samples without heat-treatment was used to demonstrate that submicroscopic phase separation in the doped glasses occurs instantaneously upon quenching. The effect of the Nd3+ concentration on this submicroscopic phase separation was investigated.
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Affiliation(s)
- M H Bartl
- Institut für Physikalische und Theoretische Chemie, Graz University of Technology, Austria
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Abstract
Patients with schistosomiasis and portal hypertension have significantly lower levels of hydroxyproline in their saphenous veins and anterior rectus sheaths than do individuals without schistosomal hepatic fibrosis. The stomach of patients with schistosomal portal hypertension demonstrates an increased number of lymphatics by lymphangiography. The disrupted lymph node architecture in these patients could be partially responsible for dilation, tortuosity, and retrograde lymph flow in the gastric lymphatics. These histological and lymphangiographic findings could be attributed to the effect of venous and patients with decompensated schistosomal portal hypertension revealed edema of the entire esophageal wall with lymphatic dilation and tortuosity. Based upon these data, we suggest that the varices that develop in patients with schistosomal portal hypertension occur as a consequence of an increased portal venous pressure together with acquired lymphangiectasia as well as an intrinsic weakness of the walls of the portosystemic venous channels.
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Affiliation(s)
- A Aboul-Enein
- Department of Surgery, School of Medicine, University of Alexandria, Egypt
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Aboul-Enein A, Eshmawy I, Arafa S, Abboud A. The role of lymphovenous communication in the development of postmastectomy lymphedema. Surgery 1984; 95:562-6. [PMID: 6710353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Forty women were investigated 6 to 24 months after radical mastectomy for the presence of functioning lymphovenous communications in the arm; 20 cases were edematous and the rest were not. Ten normal volunteer women were also investigated and served as controls. Iodinated (I125) human serum albumin was injected intralymphatically in the arm, and samples of blood were taken from both basilic veins simultaneously at 5, 10, 15, 30, 45, and 60 minutes. The radioactivity of each sample was determined with a scintillation counter. Lymphangiography was performed in all cases 1 month after the isotopic studies and lymphangiograms were evaluated for the presence of lymphovenous shunts. In the volunteers and the edematous postmastectomy group, there was negligible lymphovenous shunting of labeled albumin. In the nonedematous postmastectomy group, there was an increased quantity of local lymphovenous transfer of iodinated albumin. Lymphovenous shunts were detected radiologically in two patients who did not have edema. On the basis of our observations, the incidence of postmastectomy lymphedema is predetermined and is a consequence of the lack of existence of lymphovenous communications that can allow adequate lymph flow drainage from the arm after radical dissection of axillary lymph nodes.
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