Prognostic impact of coronary collaterals in acute coronary syndrome (PICC-ACS): A meta-analysis of observational studies

INTRODUCTION: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). The prognostic value of the presence of CCC at the time of acute coronary syndrome (ACS) is undefined with regards to hard outcomes, particularly reduction in mortality. The study's aim is to determine if the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality.  METHODS: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases in all languages and examined reference lists of studies. The inclusion criteria were 1) observational; 2) population included adults >19 years old with an acute coronary syndrome; 3) reported data on mortality in association with the presence or absence of CCC on angiography; and 4) should have controlled for confounders by using logistic regression analysis. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for observational studies. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios. RESULTS: Pooled analysis from 11 identified trials with 8,370 subjects showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality, but was not statistically different from those without CCC [RR 0.65, (95% CI 0.38 to 1.12), p CONCLUSION: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incrementally significant reduction in mortality compared to those without CCC.

Acquired arteriovenous fistula of the right common iliac artery and left common iliac vein and bilateral lower extremity deep venous thrombosis in a woman presenting as high output heart failure

Acquired intraabdominal arteriovenous fistula (AVF) is a rare disorder where the communication most commonly occurs between the abdominal aorta and inferior vena cava. Ilioiliac AVF has been reported previously, but is exceedingly rare. We present a case of acquired arteriovenous fistula of the right common iliac artery and left common iliac vein with extensive collateralization (ilioiliac AVF) in a 36-year-old female who presented with symptoms of high output congestive heart failure 18 years after sustaining an abdominal gunshot wound.

Prevalence of cardio-embolic event among patients with spontaneous echo contrast on transthoracic echocardiography (SMOCC-Heart Study)

CONTEXT: Spontaneous echo contrast (SEC) is a swirling smoke-like image seen inside the heart chambers or in the great vessels. Left Ventricular (LV) dysfunction is known to predispose patients to SEC. The management of SEC is still not as established. Even in patients with atrial fibrillation, SEC does not improve the prediction of cardio-embolic events beyond that of the clinical scoring.METHODS: Retrospective cross-sectional study.RESULTS: The study results included 89 patients with SEC. The mean age was 53.9 ± 14.3, with 67% males. The underlying cardiac condition were ischemic heart disease in 68%, non-ischemic cardiomyopathy in 19.3%, and rheumatic valvular heart disease in 12.5%. The most common comorbities were hypertension (54%), renal insufficiency (34%), and diabetes mellitus (34%). Nineteen percent of the patients were in atrial fibrillation. The location of the SEC was in the left ventricle in 90%. The mean ejection fraction was 34.8 ± 16.3% and the ejection fraction was CONCLUSION AND RECOMMENDATIONS: SEC is an imaging phenomenon that is associated with LV dysfunction with 64% of the patients with an EF of ? 35%. The presence of SEC increases the occurrence of cardio- embolic events in this population with a prevalence of 10% compared to the reported incidence of 1.8 - 2.4% incidence among patients with LV systolic dysfunction. Albeit in higher percentages, the most common co-morbid conditions are also the same risk factors that are independently associated with increased cardiovascular events. That is why the association of SEC with cardio-embolic events as well as its management, is still not well established, and recommendations on anticoagulation still depend on established clinical scoring. Further study that would associate the different characteristics and co-morbid conditions of patients with SEC to cardio-embolic event is in order.