Association of serum thyrotropin levels with coronary artery disease documented by quantitative coronary angiography: a transversal study

ABSTRACT Objective: The association between coronary artery disease (CAD) and thyroid function remains controversial. We evaluated the thyroid function and graduated well-defined CAD as confirmed by quantitative coronary angiography (CA). Subjects and methods: We evaluated the serum TSH, free thyroxine, free triiodothyronine and thyroid antibody levels in 300 consecutive patients (age 61.6 ± 9.9 years and 54% were male) undergoing CAD diagnosis as confirmed by CA. Plaques with ≥ 50% stenosis being indicative of obstructive CAD, and patients were divided into groups according to main epicardial coronary arteries with plaques (0, 1, 2, 3). Lipid profiles and a homeostasis model assessment (HOMA-IR) were determined. Results: Serum median (25% and 75% percentile) TSH levels in patients with group 2 and 3 (2.25; 1.66-3.12 mU/L and 4.99; 4.38-23.60 mU/L, respectively) had significantly higher TSH concentrations (p < 0.0001) than the group 0 (1.82; 1.35-2.51 mU/L). Furthermore, patients of group 3 had higher TSH concentration (p < 0.0001) than those of group 1 (1.60; 0.89-2.68 mU/L). Group 3 were older (64 ± 8.5 vs. 59 ± 9.5, p = 0.001), had more patients with dyslipidemia (84% versus 58%, p < 0.001), male (54% versus 44%, p = 0.01), hypertension (100% versus 86%, p < 0.001), and smoking (61% versus 33%, p < 0.001) than group 0. Multivariate stepwise logistic analysis showed TSH, age, HbA1c, and HOMA-IR were the CAD associated variables. Conclusions: In this cohort, elevated TSH levels in the high normal range or above are associated with the presence and severity of CAD besides may represent a weak CAD risk factor.

Intervenção coronária percutânea pelas vias radial e femoral: comparação entre desconfortos relacionados ao procedimento e custos / Percutaneous coronary intervention using the radial and femoral approaches: comparison between procedure-related discomforts and costs

INTRODUÇÃO: Escassos são os estudos a respeito da Qualidade de Vida pós-intervenção coronária percutânea (ICP), pelas vias radial e femoral, e dos gastos comparando as duas vias de acesso. Comparamos os desconfortos relacionados ao procedimento e os custos da ICP pelos acessos radial e femoral na fase hospitalar. MÉTODOS: Registro prospectivo, unicêntrico, que incluiu pacientes submetidos à ICP eletiva. As queixas relacionadas ao procedimento foram avaliadas ao final do período de repouso no leito, por meio de um questionário específico. Foram computados os custos por unidade de todo o material utilizado na ICP. RESULTADOS: Os pacientes tratados por via radial eram mais jovens, do sexo masculino e a angina estável foi o quadro clínico mais frequentemente tratado nos dois grupos. O tempo de exame, o número de vasos tratados e stents por paciente foram semelhantes entre os grupos. Não ocorreram complicações vasculares maiores após a ICP. Observamos maior desconforto geral associado ao procedimento (60,3% vs. 81,0%; P = 0,01), dor nas costas (1,7% vs. 17,2%; P < 0,01), dificuldade para urinar (1,7% vs. 12,1%; P = 0,03) e dependência do paciente para desempenhar atividades básicas (70,7% vs. 98,3%; P < 0,01) durante o período de observação no grupo femoral. Na comparação dos gastos, não foram notadas diferenças significantes entre os grupos, com ou sem a inclusão dos custos dos stents. CONCLUSÕES: A ICP por via radial demonstrou trazer maior conforto para o paciente comparada à via femoral, durante a fase hospitalar. Os custos dos procedimentos pelas duas vias de acesso foram semelhantes.

BACKGROUND: There are few studies on quality of life and costs after percutaneous coronary intervention (PCI) using different vascular accesses. We have compared procedure-related discomforts and costs of PCI using the radial or femoral approaches during hospital stay. METHODS: Prospective, single center registry, including patients undergoing elective PCI. Procedure related complaints were assessed at the end of bed rest using a specific questionnaire. Costs per unit of all the materials used in PCI were taken into account. RESULTS: Patients treated by the radial approach were younger, male, and stable angina was the most common clinical presentation in both groups. Procedural duration, number of vessels treated and stents per patient were similar in both groups. There were no major vascular complications after PCI. We observed greater overall discomfort associated with the procedure (60.3% vs. 81.0%; P = 0.01), back pain (1.7% vs. 17.2%; P < 0.01), difficult urination (1.7% vs. 12.1%; P = 0.03) and patient's dependence to carry on basic activities (70.7% vs. 98.3%; P < 0.01) during the post-procedural observation period in the femoral group. No significant differences were observed between groups when costs were compared, with or without taking into account stent-related costs. CONCLUSIONS: PCI using the radial approach demonstrated to provide greater comfort for patients when compared to the femoral approach during hospitalization. Costs of the procedure using the two accesses were similar.

Artéria coronária única e infarto agudo do miocárdio / Single coronary artery and acute myocardial infarction

We describe the rare angiographic finding of the right coronary artery arising from the middle portion of the left anterior descending coronary artery in a patient with atherosclerotic coronary artery disease and acute myocardial infarction. This anatomic variation has been previously described only four times in the modern literature.

Relatamos raro achado angiográfico da artéria coronária direita saindo do terço médio da artéria coronária descendente anterior em paciente com doença aterosclerótica coronariana e infarto agudo do miocárdio. Apenas 4 casos desta variação anatômica foram encontrados na literatura

Origem anômala da artéria circunflexa e espasmo coronariano / Anomalous origin of the circumflex artery and coronary spasm

A 43 year-old female patient with angina pectoris and vasospasm demonstrated in the anomalous left circumflex (Cx) and right coronary (RCD) arteries by coronary angiograph. Origin of the left Cx from the RCD is the most common coronary anomaly and generally, is considered to be benign. Nevertheless, myocardial ischemia in patient with this anomaly has been described. To our knowledge, this is the first reported case of coronary vasospasm occurring simultaneously in the anomalous left Cx and RCD arteries. The diagnostic troubles and the potential danger of this association were emphasized.