Additional Coronary Artery Disease Research Articles

OP0212 The Risk of Myocardial Infarction and Cerebrovascular Accident in Patients with SjÖGren's Syndrome: A General Population-Based Cohort Study

BackgroundThere is limited data on the risk of myocardial infarction (MI) and cerebrovascular accident (CVA) in patients with Sjögren's Syndrome (SjS).ObjectivesTo fill this knowledge gap we estimated the future risk...

Angiographic morphology impacts outcomes in STEMI patients with LAD occlusion

Acute proximal occlusion of the left anterior descendent coronary artery (LAD) is a critical medical condition often leading to heart failure and death. Our objective was to investigate how additional angiographic findings might influence prognosis. In a single center setting by using consecutive data from the Swedish angiography and angioplasty registry (SCAAR), we identified all patients with acute myocardial infarction (AMI) related to the proximal LAD referred for primary coronary angioplasty. Clinical and angiographic data were collected from January 2004 to December 2008. In the study period, 359 patients (mean age 67.9 ± 12.3 years, 111 women) were identified as having proximal LAD-related culprit lesion. Follow-up was up to 5.5 years. Compared to patients with LAD occlusion only, having both a small conus branch (<0.5 mm in diameter) and an occluded first septal perforator was associated with increased risk of death after adjustment for age, diabetes mellitus and prior AMI (hazard ratio 4.5, 95% CI; 1.1-18, P = 0.033). A small conus branch in itself was not important. Multivessel coronary artery disease in addition to occlusion of the first septal perforator branch and having a small conus branch was also associated with increased risk of death (hazard ratio 5.2, 95% CI; 1.3-20), P = 0.018). In patients with STEMI because of a proximal LAD lesion treated by primary PCI, the combination of a small conus branch and an occluded first septal perforator branch is associated with a poorer outcome. Additional presence of multivessel coronary artery disease further aggravates outcome.

Myocardial bridge: a bridge to atherosclerosis.

Myocardial bridge (MB) is a congenital anomaly characterized by narrowing during systole of some of the epicardial coronary arterial segments running in the myocardium. Although, it is considered as a benign anomaly, it may lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. In this study, we aimed to investigate demographic, clinical and angiographic characteristics of the patients with MB found on coronary angiography. The present study included 71 patients with MB found on coronary angiographies performed in our institution between January 1999 and September 2003. Based on the findings on angiography, the patients were subdivided into group A (n=41) and group B (n=30). The patients in the group A had no atherosclerotic lesion and the patients in the group B had coronary artery disease in addition to MB. Angiographic, demographic and clinical characteristics of both groups were compared. There were no differences between two groups in distribution of gender and risk factors of coronary artery disease whereas mean age of the patients in the group A was lower (47+/-5 years vs 55+/-11 years, p=0.01). Frequency of two or more risk factors for coronary artery disease in a particular patient was significantly higher in the group B (55% vs 30%, p=0.03). Myocardial bridge was located at proximal or mid segments of left anterior descending artery (LAD) in 40 patients whereas its presence in both LAD and right coronary artery was found only in one patient in group A. Mean bridging percent was 43+/-27% in group A. Localization of MB was LAD in 29 patients of group B. One patient with severe aortic valve stenosis in this group had MB at first septal branch. Mean bridging percent was 70+/-25% in group B, which was significantly higher than in group A (p<0.05). Atherosclerotic narrowing developed in only LAD in 14 patients, LAD and other vessels in 7 patients and in the vessels without MB in 9 patients. In patients with MB in LAD atherosclerotic narrowing of vessel developed proximally to the MB. Clinically, stable angina pectoris was seen more frequently in group A than group B (70% vs 35%, p=0.01), whereas the frequency of acute coronary syndrome was higher in group B (65% vs 30%, p=0.04). In regard to therapeutic approach, more patients in the group A received medical management (80% vs 50%, p=0.01), while more patients in the group B underwent surgical and percutaneous interventions (50% vs 18%, p=0.04). Myocardial bridge probability should be considered in young patients presenting with angina or if the same symptoms are persistent in the patients without more than one risk factor for coronary artery disease. Myocardial bridge may initiate the development of atherosclerotic lesion or may facilitate progression of atherosclerosis in the proximal segment of the vessel. The risk of acute coronary syndrome rises when atherosclerosis is superimposed on MB. Myocardial bridge should be considered in the young patients, presenting with angina or its equivalents without atherosclerotic lesions on coronary angiography.

Impaired Endothelial Function in Patients with Myocardial Bridge

The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. In this study, we aimed to evaluate the existing atherosclerosis and noninvasive endothelial function of brachial artery in patients with MB. The present study included 50 patients (group I) who had MB in left anterior descending (LAD) on coronary angiography. All of the coronary artery segments were evaluated by intravascular ultrasound (IVUS). Endothelial function was assessed with measurement of flow-mediated dilatation (FMD) and nitrate-dependent dilatation in the brachial artery. The study also included 30 healthy control subjects (group II). Patients in the group I were further subdivided into two subgroups based on the findings on IVUS: group IA included 20 patients without atherosclerotic lesions and group IB included 30 patients with atherosclerotic coronary artery disease in addition to MB. FMD values were found to be significantly lower in the patients with MB (group I) than in the control (6.4 +/- 3% vs 11 +/- 4%, P <0.001). In regard to FMD values in subgroups, FMD was 7 +/- 2% in the group IA and 5.8 +/- 1% in the group IB (P = 0.023). On IVUS, atherosclerotic plaque was found proximal to the bridge in the same coronary artery segment in addition to MB in 75% of the patients in group I (group IB). No atherosclerotic plaque was found in within or distal segments of MB. Endothelial function is impaired in patients with MB and there is an increased tendency for atherosclerosis proximal to the bridge in the patients with MB. Endothelial dysfunction is more severe in the patients with atherosclerosis proximal to the bridge.

Effect of sublingual nitroglycerine on the compliance of large and small arteries

Decreased arterial compliance is well recognized indicator of coronary artery disease. Nitroglycerine (NTG) is widely used in the setting of acute coronary syndrome. Although hemodynamic and pharmacological effects of NTG are well established its effect on the arterial compliance is not well studied. The purpose of the study was to examine effects of sublingual NTG on the small and large arterial compliances. The study group consisted of 14 healthy, normotensive individuals (6 females and 8 males). All were non-smokers. Mean age was 27±9 years. SBP, DBP, HR, large artery elasticity index (LAEI), small artery elasticity index (SAEI) and systemic vascular resistance (SVR) were obtained using HDI/Pulse wave CR-2000. The readings were made from the radial artery blood pressure waveform. Each subject rested in a supine position for 10 minutes before the baseline readings were taken. One sublingual NTG tablet (0.4 mg NTG) was administered. Readings were obtained at 1, 3, 5, 7, 10, 15, 20, 25 and 30 minutes after NTG. The results at baseline and postdrug are summarized in following table. Values are (Mean ± SD). *P< 0.05 from baseline. In conclusion, sublingual NTG has significant effects on BP, HR and systemic vascular resistance. These hemodynamic effects appeared a couple of minutes after the administration of NTG and persisted 10 to 30 minutes. Large arterial compliance increased briefly but remained unchanged. NTG markedly increased small arterial compliance and this effect persisted for 15 minutes. Thus, sublingual NTG significantly improves small arterial compliance and this may help coronary circulation in patients with coronary artery disease in addition to improve angina.