Double-vessel Coronary Artery Disease Research Articles

Angioplastie coronaire dans la prise en charge des syndromes coronariens Aigus au Sénégal : défis et résultats

IntroductionPercutaneous coronary intervention (PCI) remains a major therapeutic tool in the management of acute coronary syndromes (ACS). However, it is not widely practiced in sub-Saharan Africa, particularly for the management of ACS. The availability of a catheterization laboratory for 24-hour management of ACS in Dakar is an important step in improving the prognosis of patients. The objective of our study was to evaluate the clinical and prognostic profile of patients presenting an ACS and treated by PCI. Patients and methodsThis is a retrospective study that included all patients who underwent PCI for ACS at hospital principal Dakar during the period from January 2019 to December 2020. ResultsOur study included 112 patients with a mean age of 60 years (extremes 31–96 years) and a male predominance (sex ratio 4.09). Cardiovascular risk factors were dominated by hypertension (47.3%) and smoking (39.3%). Chest pain was present in 97% of patients. Left ventricular systolic function was impaired in 56 patients with a mean of 50% and extremes of 20 and 78%. Thrombolysis with streptokinase was used in 13 patients with STEMI. The majority of coronary angiogram (95%) were performed between 8 am and 5 pm. The radial route was the most commonly used (85.7%). Double vessel coronary artery disease was predominant (39,3%) and the left anterior descending artery was the most affected (60.7%). The PCI was performed in all patients and in more than half of the cases (55%) within 12 hours of delay. The PCI success rate was 96.4%. Sixty-seven patients (59.8%) underwent balloon predilation. PCI was performed with a drug-eluting stent in the majority of patients (92.8%). The outcome was favorable in 96.4% of the patients, but there were 3 deaths (2.7%). ConclusionTreatment of ACS by PCI is a reality in Senegal with a considerable success rate. However, intervention delays remain one of the major challenges of this management.

The mir-21 Inhibition Enhanced HUVEC Cellular Viability during Hypoxia-Reoxygenation Injury by Regulating PDCD4.

The purpose of this study was to explore the clinical value of altered plasma mir-21 expression level as a biomarker for the severity of coronary artery disease (CAD) and its molecular impact on HUVEC cellular injuries. Angiographically validated 56 patients with single-vessel CAD disease, 92 patients with double-vessel CAD, 139 complex coronary artery stenosis patients, and 56 healthy individuals (n = 343) were enrolled in this study. The expressions of plasma mir-21 were evidently and progressively higher while PDCD4 levels were significantly and steadily lower in single-, dual-, and multivessel occluded CAD patients than in healthy participants (P < 0.001). The relative expressions of mir-21 in hypoxia-reoxygenation- (HR-) exposed HUVECs were markedly upregulated, but PDCD4 concentrations were obviously downregulated as compared with normal control cells (P < 0.001). Moreover, altered circulatory mir-21 expression levels were able to significantly differentiate single- (AUC 0.893), double- (AUC 0.914), and multivessel stenosis CAD (AUC 0.933) patients from healthy subjects. Besides, the plasma mir-21 expressions in elderly (66-85 years) groups were remarkably higher than those in younger aged (25-45 years) subjects. Caspase-3 and ROS expression levels were remarkably elevated, but cellular viability noticeably declined in HR-induced HUVECs than in normoxic cells (P < 0.001). In contrast, mir-21 inhibition markedly reduced caspase-3 activity and ROS concentrations while significantly ameliorating HUVEC cellular viability in HR conditions. PDCD4 expressions in HR-exposed HUVECs were prominently decreased whereas mir-21 inhibition significantly enhanced PDCD4 levels (P < 0.001). Upregulated plasma mir-21 can be a valuable clinical biomarker for the detection of the severity of coronary artery stenosis patients. Elevated circulatory mir-21 concentrations have a positive correlation with aging. Inhibitory mir-21 evidently increased HUVEC cellular viability through upregulation of targeting PDCD4 and recommended a newer possible therapeutic molecule for the management of CAD patients.

Frequency of new onset right bundle branch block in acute myocardial infarction and its coronary angiographic findings in patients presenting at Tertiary Care Hospital, Peshawar

Background: Right bundle branch block has prognostic significance in the setting of acute myocardial infarction; this research is intended to determine the incidence of new-onset right bundle branch block in acute myocardial infarction and its angiographic findings.&#x0D; Methodology: This descriptive cross-sectional study was conducted in a tertiary care hospital, i.e., the Cardiology Department, Lady Reading Hospital, Peshawar, from 13/5/2016 to 13/11/2016. A total of 91 patients were included in the study. Baseline investigation, including ECG (Nihan Koden), Coronary angiography (Siemens Healthineers), on patients who qualify for early invasive therapy and angiographic findings. All the information, like age and gender, was recorded. 91 patients with acute myocardial infarction who presented within 24 hours were observed, in which male to female ratio was 1.17:1. The study enrolled the age group from 30 up to 75 years.&#x0D; Results: Average age was52.6±7.71 years. New onset right bundle branch block (RBBB) was found in 13(14.29%) patients in acute myocardial infarction.&#x0D; Conclusion: In conclusion, RBBB was observed in 13% of patients where angiographic findings showed triple vessel disease 38.5%, double vessel coronary artery disease 30.8%, single vessel disease 15.4%, and left main stem disease15.4% respectively, there is a high rate of severe CAD in patients presenting with RBBB in the setting of the acute coronary syndrome, so early reperfusion is recommended.

Frequency of Significant Non-Infarct Related Multi-Vessel Coronary Artery Disease in Patients after the first Presentation with St-Elevation Myocardial Infarction

Objective: To determine the frequency of significant non-infarct related multi-vessel coronary artery disease in patients after the first presentation with ST-elevation myocardial infarction. Methodology: A minimum of 100 consecutive patients from the department of cardiology, Mayo Hospital Lahore, who fulfilled the inclusion/exclusion criteria were selected. Percentage stenosis in non-IRA was calculated by using quantitative coronary analysis (QCA) software. Results: A total of 100 patients were enrolled in this study. There were 73(73.0%) males and 27(27.0%) females. The mean age of patients was 47.6±19.2 years. Out of 100 patients with STEMI, 42(42.0%) had non-IRA. Among non-IRA, 24(57.1%) had double vessel CAD and 18(42.9%) had triple vessel CAD. Conclusion: Significant non-infarct related multivessel coronary artery disease was common among patients after the first presentation with ST-elevation myocardial infarction. Keywords: ST Elevation Myocardial Infarction (STEMI),Coronary vessels, Coronary artery disease (CAD).

Phonocardiogram signal analysis for classification of Coronary Artery Diseases using MFCC and 1D adaptive local ternary patterns

Coronary Artery Diseases (CADs) are a dominant cause of worldwide fatalities. The development of accurate and timely diagnosis routines is imperative to reduce these risks and mortalities. Coronary angiography, an invasive and expensive technique, is currently used as a diagnostic tool for the detection of CAD but it has some procedural hazards, i.e., it requires arterial puncture, and the subject gets exposed to iodinated radiation. Phonocardiography (PCG), a non-invasive and inexpensive technique, is a modality employing heart sounds to diagnose heart diseases but it requires only trained medical personnel to apprehend cardiac murmurs in clinical environments. Furthermore, there is a strong compulsion to characterize CAD into its types, such as Single vessel coronary artery disease (SVCAD), Double vessel coronary artery disease (DVCAD), and Triple vessel coronary artery disease (TVCAD) to assist the cardiologist in decision making about the treatment procedure followed. This paper presents a computer-aided diagnosis system for the categorization of CAD and its types based on Phonocardiogram (PCG) signal analysis. The raw PCG signals were denoised via empirical mode decomposition (EMD) to remove redundant information and noise. Next, we extract MFCC and proposed 1D-Adaptive Local Ternary Patterns (1D-ALTP) and fused them serially to get a strong feature representation of multiple PCG signal classes. Features were further reduced through Multidimensional Scaling (MDS) and subjected to several classification methods such as support vector machines (SVM), Decision Tree (DT), and K-nearest neighbors (KNN) in a comparative fashion. The best classification performances of 98.3% and 97.2% mean accuracies were obtained through SVM with the cubic kernel for binary and multiclass experiments, respectively. The performance of the proposed system is comprehensively tested through 10-fold cross-validation and hold-out train-test techniques to avoid model overfitting. Comparative analysis with existing approaches advocates the superiority of the proposed approach.

STUDY OF RISK FACTORS,CLINICAL PROFILES AND ANGIOGRAPHIC PATTERNS IN PATIENTS OF CORONARY ARTERY DISEASE IN A TERTIARY CARE CENTRE IN KOLKATA

BACKGROUND:Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity in both developed and developing countries. It is a leading cause of death in India, and its contribution to mortality is rising. Considering the increasing burden of coronary artery disease and its mortality and the usefulness of identifying risk factors, studying the clinical profile and angiographic pattern will help us intervene the disease at various levels which can help control the morbidity and mortality of coronary artery diease. MATERIALS AND METHOD: The present study was conducted in the Department of Cardiology,IPGMER &amp; SSKM Hospital,Kolkata during the period of January 2019 to December 2019.This is a hospital based observational prospective study with prospective data collection,where all patients of coronary artery disease who had undergone coronary angiography has been taken into consideration to find out the risk factors,clinical profiles and angiographic patterns in coronary artery disease patients in Kolkata. RESULTS: Maximum patients were present in the age group 51-60 years of age.Mean age is 56.7+11.6sd.Male patients were 70% and female patients were 30%.Most common symptom was chest pain,90% of patients had it during the time of presentation.The next frequent symptom was shortness of breath which was seen in 52% of patients. Most common risk factor was smoking which was seen in 58% of patients.Next frequent risk factor being hypertension seen in 43.5% of patients.Obesity was seen in 59.2% of patients.On coronary angiography,40% of patients had Single vessel CAD,27.3% had double vessel CAD,23.5% had Double vessel CAD,6.5% had Non-Significant CAD and 2.7% had Normal coronaries(recanalized epicardial coronaries).LAD was involved in 73.5% of patients,51.7 % had RCA involved,43.5 % had LCX involved and LMCA was involved in 1.7% of patients. CONCLUSION:Smoking and hypertension are the most common risk factors.Single vessel disease is the most common angiographic pattern.Risk factors should be addressed properly to decrease the morbidity and mortality of coronary artery disease

A two-stage classification model integrating feature fusion for coronary artery disease detection and classification

According to the World Health Organization, Coronary Artery Disease (CAD) is a leading cause of death globally. CAD is categorized into three types, namely Single Vessel Coronary Artery Disease (SVCAD), Double Vessel Coronary Artery Disease (DVCAD), and Triple Vessel Coronary Artery Disease (TVCAD). At present, angiography is the most popular technique to detect CAD that is quite expensive and invasive. Phonocardiogram (PCG), being economical and non-invasive, is a crucial modality towards the detection of cardiac disorders, but only trained medical professionals can interpret heart auscultations in clinical environments. This research aims to detect CAD and its types from PCG signatures through feature fusion and a two-stage classification strategy. The self-developed low-cost stethoscope was used to collect PCG data from a local hospital. The PCG signals were preprocessed through an iterative signal decomposition method known as Empirical Mode Decomposition (EMD). EMD decomposes the raw PCG signal into its constituent components called Intrinsic Mode Functions (IMFs). Preprocessed PCG signal was generated exclusively through combining those signal components that contain high discriminative characteristics and less redundancy. Next, Mel Frequency Cepstral Coefficients (MFCCs), spectral and statistical features were extracted. A two-stage classification framework was devised to identify healthy and CAD types. The first stage framework relies on the fusion of MFCC and statistical features with the K-nearest neighbor classifier to predict normal and CAD cases. The second stage is activated only when the first stage detects CAD. The fusion of spectral, statistical, and MFCC features was employed with Support Vector Machines classifier to categorize PCG signatures into DVCAD, SVCAD, and TVCAD classes in the second stage. The proposed method yields mean accuracy values of 88.0%, 89.2%, 91.1%, and 85.3% for normal, DVCAD, SVCAD, and TVCAD, respectively, through 10-fold cross-validation. Comparative analysis with existing approaches confirmed the reliability of the proposed method for categorizing CAD in general clinical environments. The proposed model enhances the diagnosis performance by providing a second opinion during the medical examination.

IN STENT RESTENOSIS (ISR) IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) FOR CORONARY ARTERY DISEASE (CAD)

Objective: To study the frequency of In-Stent Restenosis and its treatment in patients undergoing Percutaneous Coronary Intervention for coronary artery disease.&#x0D; Study Design: Descriptive cross sectional study.&#x0D; Place and Duration of Study: Department of Cardiology, Armed Forces Institute of Cardiology &amp; National Institute of Heart disease (AFIC/NIHD) Rawalpindi, from Jul 2017 to Jul 2019.&#x0D; Methodology: All the patients who underwent Percutaneous Coronary Intervention for Coronary Artery Disease at our institute were considered for this study. A consecutive sampling method was used and inclusion/exclusion criteria was applied. Following data was obtained; 1) Demographic information and clinical risk factors like history of hypertension, hyperlipidemia, diabetes mellitus, smoking, coronary artery disease characteristics(number of diseased arteries, bifurcation lesions, calcification, chronic total occlusions-CTO and tortuosity) 3), Stent factors (under expansion, fracture, longitudinal miss, stent gap). Data recording, storage, assessment and analysis was done by using SPSS software version 21.&#x0D; Results: Among 1332 cases, 50 had In-Stent Restenosis with overall prevalence of 3.75%. Mean age of the patients with In-Stent Restenosis was 58.76 (± 9.97), with 45 (90%) male and 5 (10%) female. Diabetes Mellitus was the commonest risk factor (22.9%) followed by Hypertension (18%). Sixty four percent of the patients (n=32) had Single Vessel Coronary Artery Disease, 14 (28%) had Double Vessel Coronary Artery Disease and 4 (8%) had Tripple Vessel Coronary Artery Disease. Left Anterior Descending was the commonest coronary artery that developed In-Stent Restenosis, followed by Right Coronary Artery and Left Circumflex respectively. Previously deployed stents which developed In-Stent Restenosis showed longitudinal geographical miss in 16%, stent under expansion in 6% and stent gap in 4%. There was statistically significant association (p-value=0.02) between stent length and frequency of In-Stent Restenosis and it was commonest in stents longer than 30 mm. Eighty six percent(n=43) of In-Stent Restenosis cases in our study group was treated with Drug Eluting Stent followed by Drug Eluting Balloon in 32% and Plain Old Balloon Angioplasty in 22%.&#x0D; Conclusion: History of diabetes mellitus and greater stent length were major risk factors in developing In-Stent Restenosis in our study. DES was the commonest treatment modality used.Keywords: , , .

SHORT TERM AND LONG-TERM OUTCOMES OF LEFT MAIN PCI AT AFIC-NIHD

Objective: To study the short-term and long-term outcomes of left main angioplasty at AFIC-NIHD.&#x0D; Study Design: Descriptive cross-sectional study.&#x0D; Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD) in 2018.&#x0D; Methodology: All cases of left main angioplasty done in 2018 were included in the study. The patients were followed up in clinic or on telephone and mortality (in-hospital, 30 days) outcomes and survival duration were recorded. Kaplan Meier curves were generated to show the survival difference between those who underwent primary or elective LMPCI and survival difference between patients based on extent of coronary artery disease.&#x0D; Results: A total of 73 patients underwent elective or primary left main angioplasty. The extent of coronary artery disease was: single vessel coronary artery disease (26%), double vessel coronary artery disease (37%), and three vessel coronary artery disease (37%). Thirteen patients (17.8%) had primary left main angioplasty, and 60 patients (82.2%) had elective left main angioplasty. Intravascular ultrasound was performed in only 3 patients. The mean duration of follow up was 395 days. A total of 6 (8.2%) patients died. Three patients died in-hospital, another 2 within the first 30 days, and the remaining beyond 30 days. Two of the dead patients had double vessel coronary artery disease, and 4 had three vessel coronary artery disease. The survival difference between the primary vs elective groups was insignificant (Log Rank (Mantel-Cox) (p=0.27). The survival difference between the 3 groups with different extent of coronary artery disease was insignificant (p=0.15).&#x0D; Conclusion: Left main PCI is a safe procedure with acceptable outcomes. Patients with more severe coronary artery disease tend to fare worse.

Fluoroscopic “calcium sign” or reverse “c” sign of the aortic knuckle in a case of chronic total occlusion of left anterior descending coronary artery

We describe an interesting fluoroscopic calcification of the aortic knuckle assuming a reverse “C” shape in an atherosclerotic aorta in a 42-year-old male presenting with anterior wall ST-elevation myocardial infarction with dyslipidemia. Although calcification of the aortic knuckle and dilatation of the aorta is a common phenomenon in the elderly population, otherwise known as the “unfolding of aorta,” we observed this interesting pattern of calcification in a middle-aged person in an atherosclerotic aorta with calcification. The patient had double-vessel coronary artery disease with chronic total occlusion in the left anterior descending coronary artery and significant stenosis in the mid-segment of the right coronary artery, which we revascularized with drug-eluting stents and achieved TIMI III flow. Although calcium sign or C sign is described in aortic dissection and it is not specific to it, we observed this interesting pattern of calcification in a middle-aged person in the atherosclerotic aorta with dyslipidemia.

P47 Case Report - Hybrid Repair of an Aberrant Right Subclavian Artery with Kommerell’s Diverticulum With Contained Rupture and Associated Double-Vessel Coronary Artery Disease

A Kommerell's diverticulum arises due to an embryological defect and results in abnormal development of the aortic arch [1]. Multiple approaches for repair including open, hybrid endovascular and total endovascular have been described [2].

Study on Serum Markers of Morphology and Peripheral Neuropathy in Patients with Type 2 Diabetic Nephropathy Evaluated by Ultrasound Image Based on Optimized Denoising Algorithm

The paper uses an optimized denoising algorithm, combined with spiral CT coronary angiography (CCTA) in conjunction with carotid ultrasound, serological markers relevance for the assessment of coronary artery disease was analysed early T2DM and coronary heart disease (CHD) in patients with coronary and carotid artery disease to provide diagnostic evidence. Papers selected from January 2017 to December 2019 in hospital diagnosed 95 patients CHD, CHD were divided into three groups (n = 45) and T2DM with CHD group (n depending on whether T2DM disease = 50), were compared coronary arteries, the degree of carotid lesions, high-sensitivity C- reactive protein (hsC-RP) and the difference of FFA. CCTA display, combined with CHD of T2DM in double-vessel coronary artery disease and three main right coronary artery, left circumflex artery plaques appear more CHD combined group of T2DM, and three double-vessel coronary disease carotid plaque compared with the number of single-vessel disease and more. Spearman correlation analysis showed, hsC-RP positively correlated with FFA, hsC-RP and coronary artery lesion count was positively correlated. CCTA display, T2DM with CHD in coronary plaque with soft plaque and mixed plaque mainly extensive coronary artery disease, carotid artery ultrasound prompted the more peripheral vascular plaque number, the more the number of diseased vessels, the more severe the disease. Joint CCTA Clinically, carotid ultrasound and hsC-RP, FFA level detection can improve the rate of diagnosis of T2DM with CHD, reduce false positives, should be widely applied.

Correlation between Echocardiographic Epicardial Fat Thickness and Angiographic Severity of Coronary Artery Disease

Background: Epicardial adipose tissue (EAT) is a visceral adipose tissue surrounding the heart and the coronary arteries. Because of its endocrine and paracrine activity, secreting pro-inflammatory and antiinflammatory cytokines and chemokines, it has been suggested to influence coronary atherosclerosis development.Objectives: To identify the relationship between echocardiographic epicardial fat thickness and the extent of coronary artery disease (CAD). Methods: Considering the inclusion and exclusion criteria, a total 87 patients with established or suspected coronary artery disease admitted for coronary angiogram were included in this study. After taking written consent, initial evaluation of the patients was done by history, clinical examination and relevant investigation. Variables, risk factors for CAD and investigation reports were recorded in data sheet. Echocardiography and coronary angiography were done. EAT thickness measurements by echocardiography were compared with coronary angiographic findings.Results: Echocardiographic EAT thickness was significantly higher in patients with CAD in comparison to those with normal coronary arteries 7.14±1.81 mm vs 4.08±1.06mm (p &lt;0.001). Furthermore, EAT thickness increase with the severity of CAD. EAT is 4.08±1.06 mm in patients with normal/non-significant CAD (n=20), 5.75±0.96 mm in single vessel CAD (n=24), 6.54±1.09 mm in double vessel CAD (n=16) and 8.75±1.45 mm in patients with triple vessel CAD (n=27).Conclusions:EAT thickness was significantly higher in patients with angiographically detected CAD in comparison to those with normal coronary arteries. Furthermore, EAT thickness increased with the severity of CAD; i.e. it was thicker in multivessel coronary artery disease than in single vessel or non-significant coronary artery disease.Bangladesh Heart Journal 2018; 33(1) : 47-53

Proarrhythmic influence of flecainide in coronary artery disease

A 61-year old man with a double-vessel coronary artery disease presented an electrical storm 5 days after flecainide introduction. On the basis of 12-lead ECG, and consequently electrophysiologic examination a bundle branch reentrant tachycardia with left bundle branch block morphology was diagnosed. Right bundle branch ablation was performed and the tachycardia was uninducible.

CORONARY ARTERY DISEASE;

Objectives: To determine the frequency of multivessel coronary artery disease(CAD) in patients suffering from inferior wall acute myocardial infarction (AMI) having STsegment depression in anterior chest leads. Study Design: Cross Sectional Survey. Setting:Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: December2013 to June 2014. Materials and Methods: After fulfilling the inclusion criteria, 120 patientswith acute inferior wall MI were studied. Patients were divided in two groups. Group I includedpatients with ST segments depression in leads V1-V3 and Group II with ST segment depressionin leads V4-V6. Age of patients ranged from 25 to 70 years. Results: The mean age was52.5±10.5 years. As regards sex distribution, 100 patients were male, 54 in Group I and 46in Group II. There were 20 female patients, 11 in Group I and 9 in Group II. Thirty six (30%)patients were diabetic, 22(33.8%) in Group I and 14(25.5%) in Group II. Forty five (37.5%)patients were hypertensive. Fifty two (43.3%) patients were smokers. Forty three (35.8%)patients had family history of ischemic heart disease, 25(38.5%) in Group I and 18(32.7%) inGroup II. Thirty five (29.2%) had hyperlipidemia, 20 (30.8%) in Group I and 15(29.2%) in GroupII. All patients underwent coronary angiogram. Thirty eight (31.7%) patients had single vesseldisease, 29(44.6%) patients in Group I and 9(16.4%) in Group II. Forty three (35.8%) patientshad double vessel coronary artery disease, 23 patients (35.4%) in Group I and 20(36.4%) inGroup II. Thirty nine (32.5%) had three vessel coronary artery disease, 13 (20%) in Group I and26 (47.3%) in Group II. Eighty three (69.2%) patients had multivessel coronary artery disease37(56.8%) in Group I and 46 (83.6%) in Group II (p value &lt;0.002). Conclusion: The presence ofprecordial ST depression during acute inferior wall myocardial correlates well with multivesselCAD. Precordial ST-segment depression in acute inferior wall MI is related to anterior injury dueto LAD stenosis and these patients tend to have more severe CAD.

Preoperative percutaneous coronary intervention in patients undergoing open thoracoabdominal and descending thoracic aneurysm repair

Current guidelines have recommended against coronary revascularization before noncardiac surgery in patients with asymptomatic coronary artery disease. However, myocardial infarction after thoracic aneurysm (TA) repair dramatically increases the morbidity and mortality. Revascularization with coronary artery bypass grafting before TA repair minimizes the incidence of perioperative ischemia. However, the recovery can be prolonged, and a percentage of patients will either never return for aneurysm repair or will develop a rupture during convalescence. Percutaneous coronary intervention (PCI) before TA repair might be preferable. Previousstudies examining PCI before major vascular surgery included few patients with TAs. We examined the outcomes of patients undergoing PCI before TA repair. From 1997 to 2012, 592 patients underwent TA repair. Patients presenting for elective repair underwent cardiac catheterization before surgery. Those with significant single- or double-vessel coronary artery disease underwent PCI. The perioperative outcomes were examined and compared with those of patients undergoing TA repair without revascularization. A total of 44 patients (7.4%) underwent PCI with bare metal stents before surgery. No PCI-related complications occurred. Dual antiplatelet therapy was administered for 4 to 6 weeks. No instances of aneurysm rupture occurred in the interval between PCI and surgery. The incidence of stent thrombosis, myocardial infarction, and mortality for those undergoing PCI was 0. No bleeding complications occurred. PCI is safe and efficacious in patients undergoing TA repair. Aneurysm rupture did not occur intheinterval before surgery. Antiplatelet therapy did not increase the risk of bleeding complications. Stent thrombosis was not seen. We recommend PCI those with significant single- or double-vessel coronary artery disease before elective TA repair.

The SYNTAX score and its clinical implications

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are both treatment options for coronary revascularisation in selected patients with stable coronary artery disease and ischaemia. Current European and...

Anesthetic management of spinal decompression in double vessel coronary artery disease

Anesthetic management of spinal decompression in double vessel coronary artery disease

Novel Combined GPIHBP1 Mutations in a Patient with Hypertriglyceridemia Associated with CAD

Lipoprotein lipase (LPL) deficiency is a rare autosomal recessive disorder characterized by severe hypertriglyceridemia. Similar clinical phenotypes have been reported with respect to defects in several LPL-associated proteins. However, it remains controversial whether severe hypertriglyceridemia itself is atherogenic. We herein present a case of LPL deficiency due to novel combined mutations of glycosylphosphatidylinositol (GPI)-anchored high-density lipoprotein (HDL)-binding protein 1 (GPIHBP1) in a patient with coronary artery disease (CAD). We evaluated a 54-year-old woman with severe hypertriglyceridemia and double vessel CAD. Although the LPL mass and activity in the postheparin plasma were extremely low, no mutations were detected in the LPL gene itself. Genetic analyses revealed that the patient had double homozygous mutations at 41 bp (c.41 G > T) and 202 bp (c.202 T > C) in the GPIHBP1 gene, resulting in C14F and C68R, respectively. Although the C14F/C68R GPIHBP1 exhibited a normal LPL-binding activity, the levels of mutant proteins were extremely reduced compared to those of the wild-type proteins in vitro. We found novel combined mutations of GPIHBP1 in a patient with hypertriglyceridemia and severe CAD. The present case provides important insight into the pathogenesis of severe hypertriglyceridemia associated with atherosclerosis.

Cardiac Surgery in Patients with Systemic Lupus Erythematosus: A Medical Center's Experience in Taiwan

Objective: To analyze the clinical outcomes of systemic lupus erythematosus (SLE) patients who underwent cardiac surgery and to investigate the appropriateness of cardiac valve surgery in SLE patients with lupus nephropathy-related chronic kidney disease (CKD) and valvular heart disease (VHD). Methods: It was a retrospective review to evaluate SLE patients who underwent cardiac surgery because of VHD or coronary artery disease (CAD) between January 2000 and January 2010. Clinical outcome measurements included in-hospital mortality rate and postoperative complications such as vascular events and infections. The outcomes of SLE patients with VHD who did not undergo cardiac valve surgery were analyzed simultaneously. Results: Seven patients who underwent cardiac surgery were identified: five women and two men. The median duration of SLE from diagnosis to the surgery was 7.3 years (range 1-20 years). The median age was 58 years (range 28-72 years). Five patients received cardiac valve surgery; all five demonstrated stage III, IV, or V CKD and New York Heart Association class III or IV heart failure. Three patients underwent coronary artery bypass grafting (CABG) for double-vessel CAD, one of whom received concurrent mitral annuloplasty. Twenty-six patients presenting with VHD who did not undergo cardiac valve surgery were also evaluated as control cases. Two of the seven SLE patients who underwent cardiac surgery died, giving a mortality rate of 28.6%. Two of the five SLE patients who underwent cardiac valve surgery died while hospitalized, giving a mortality rate of 40%. One of the three patients who underwent CABG who also received cardiac valve surgery at the same time died. Two of the SLE patients with VHD who did not have surgery died (p=0.02 compared with SLE patients with VHD who received an operation). Both the one-year and five-year survival rates were 92.3% among SLE patients with VHD without surgery and 60% in those who underwent cardiac valve surgery. Conclusions: Cardiac surgery is performed rarely in SLE patients. The poor outcomes of cardiac surgery probably reflect the older age, poor heart function, severe renal insufficiency, and more frequent hemolytic anemia. SLE patients often demonstrate lupus nephropathy-related CKD concomitantly with VHD with symptomatic heart failure, both of which share similar clinical manifestations, including fluid overloading and limited daily performance status. Before cardiac surgery, we should optimize medical treatment and cardiac rehabilitation for SLE patients with VHD and symptomatic heart failure.