Left main coronary artery compression by the right pulmonary artery in a patient with congenital pulmonic stenosis / Compresión del tronco coronario izquierdo por la arteria pulmonar derecha en un paciente con estenosis pulmonar congénita

Abstract Congenital pulmonary stenosis (PS) can be associated with pulmonary artery (PA) dilatation. In some cases, this can cause compression of nearby structures including the left main coronary artery (LMCA). This compression causes angina and is considered an indication for surgical treatment. We present the case of a patient with PS and angina secondary to LMCA compression by the right PA and review the main indications and options for surgical treatment.

Resumen La estenosis pulmonar congénita se asocia a dilatación de la arteria pulmonar. En algunos casos esto puede causar compresión de las estructuras adyacentes incluyendo el tronco de la coronaria izquierda. Esta compresión causa angina y es considerada una indicación para tratamiento quirúrgico. Presentamos el caso de un paciente con estenosis pulmonar y angina secundaria a compresión del tronco de la coronaria izquierda por la arteria pulmonar derecha y revisamos las indicaciones y opciones de tratamiento quirúrgico.

Diagnostic value of circulating lncRNA ANRIL and its correlation with coronary artery disease parameters

This study aimed to detect the expression of the long non-coding RNA (lncRNA) antisense non-coding RNA in the INK4 locus (ANRIL) and evaluate its correlation with disease risk, stenosis degree, inflammation, as well as overall survival (OS) in coronary artery disease (CAD) patients. A total of 230 patients who underwent diagnostic coronary angiography were consecutively recruited and assigned to CAD group (n=125) or control group (n=105) according to presence or absence of CAD. Gensini score was calculated to assess the severity of coronary artery damage. Plasma samples were collected and the expression ANRIL was detected in all participants. High-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and cytokines including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10, and IL-17 in CAD patients were measured and OS was calculated. The relative expression of ANRIL was higher in CAD patients compared to controls (P<0.001). Receiver operating characteristic disclosed that ANRIL could distinguish CAD patients from controls with an area under the curve of 0.789 (95%CI: 0.731-0.847). Spearman's rank correlation test revealed that expression of ANRIL was positively correlated with Gensini score (P=0.001), levels of hs-CRP (P=0.001), ESR (P=0.038), TNF-α (P=0.004), and IL-6 (P<0.001), while negatively correlated with IL-10 level (P=0.008) in CAD patients. Kaplan-Meier curve revealed that high expression of ANRIL was associated with shorter OS (P=0.013). In conclusion, circulating ANRIL presented a good diagnostic value for CAD, and its high expression was associated with increased stenosis degree, raised inflammation, and poor OS in CAD patients.

The Influence of Comorbid Conditions on Graft Stenosis in Patients with Coronary Artery Bypass Graft Operation / A influência das condições comórbidas na estenose do enxerto em pacientes com coronariopatia Operação de enxerto de artéria

The primary goal of coronary artery bypass grafting is to achieve complete revascularization with grafts that will remain patent throughout the patient's lifetime. This study investigated the association between bypass graft patency and comorbidity burden determined by Charlson comorbidity index (CCI) among patients with previous bypass operation who underwent a control angiography. One-hundred and two patients who had undergone CABG in the past were included to the study. Critical stenosis was defined as 50% or greater coronary luminal obstruction of any coronary vessel or its lateral branch. Patients were divided into 2 groups group 1; critical graft stenosis; (54 pts; 41M, mean age 66.5 ± 7.8 years), group 2; graft patent (48 pts; 31M, mean age; 65.9 ± 8.2 years). Charlson comorbidity index (CCI) and modified CCI scores were used for detecting comorbidities. The comparison of continuous variables between the control and critical CAD groups was performed by the independent sample test. A p value less than 0.05 was considered statistically significant. The two groups were statistically similar with respect to demographic properties, time since bypass operation, cardiovascular risk factors, systolic blood pressure, heart rate, medications used, complete blood counts parameters, and lipid profiles. CCI was significantly higher in Group 1 compared to Group 2 (7.14 ± 2.02 vs4.72 ± 1.58; p < 0.001). Modified CCI scores were also higher in Group 1 than in Group 2 (6.14 ± 2.02 vs 3.73 ± 1.60; p < 0.001). Graft occlusion was more common among patients with a high comorbidity burden. CCI scoring system may be helpful for determining patients at increased risk at both the preoperative and postoperative periods

Off-pump coronary artery bypass grafting in moyamoya disease: a case report

Abstract Moyamoya disease is a rare, idiopathic, progressive, occlusive disease of the internal carotid artery characterized by the development of collateral vasculature in the brain base. In patients with accompanying coronary artery disease, cardiopulmonary bypass posses a potential risk for perioperative cerebral ischemic complication. Herein, we report a 53-year-old male case of Moyamoya disease and coronary artery disease who was treated with off-pump coronary artery bypass grafting.

Which Coronary Lesions Are More Prone to Cause Acute Myocardial Infarction? / Quais Lesões Coronarianas São Mais Propensas a Causar Infarto Agudo do Miocárdio?

Abstract Background: According to common belief, most myocardial infarctions (MIs) are due to the rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data from recent trials challenge this belief, suggesting that the risk of coronary occlusion is, in fact, much higher after severe stenosis. The aim of this study was to investigate whether or not acute ST-elevation MIs result from high-grade stenoses by evaluating the presence of coronary collateral circulation (CCC). Methods: We retrospectively included 207 consecutive patients who had undergone primary percutaneous coronary intervention for acute ST-elevation MI. Collateral blood flow distal to the culprit lesion was assessed by two investigators using the Rentrop scoring system. Results: Out of the 207 patients included in the study, 153 (73.9%) had coronary collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in 54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively. Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and neutrophil count were significantly lower in the group with good collateral vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively). Conclusion: More than 70% of the patients with acute MI had CCC with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenoses, challenging the common believe. Higher serum triglycerides levels, greater MPV, and increased WBC and neutrophil counts were independently associated with impaired development of collateral vessels.

Resumo Fundamento: Há uma crença geral de que a maioria dos infartos agudos do miocárdio (IAM) ocorrem devido à ruptura de placas vulneráveis, não graves, com obstrução < 70%. Dados de ensaios recentes desafiam esta crença, sugerindo que o risco de oclusão coronariana é, na realidade, muito maior após estenose grave. O objetivo deste estudo foi investigar se a presença ou não de IAM com supradesnível do segmento ST resulta de estenoses de alto grau através da avaliação da presença de circulação colateral coronariana (CCC). Métodos: Nós incluímos retrospectivamente 207 pacientes consecutivos submetidos à intervenção coronariana percutânea primária devido à ocorrência de IAM com supradesnível do segmento ST. O fluxo sanguíneo colateral distal à lesão culpada foi avaliado por dois investigadores com utilização do sistema de escores de Rentrop. Resultados: Dos 207 pacientes incluídos no estudo, 153 (73,9%) apresentavam vasos coronarianos colaterais (Rentrop 1-3). Os escores Rentrop foram de 0, 1, 2 e 3 em 54 (26,1%), 50 (24,2%), 51 (24,6%) e 52 (25,1%) pacientes, respectivamente. Triglicérides, volume plaquetário médio (VPM), contagem de células brancas (CCB) e contagem de neutrófilos estiveram significativamente mais baixos no grupo com bons vasos colaterais (p = 0,013, p = 0,002, p = 0,003 e p = 0,021, respectivamente). Conclusão: Mais de 70% dos pacientes com IAM apresentaram CCC com escores de Rentrop de 1-3 durante angiografia coronariana primária. Isto demonstra que a maioria dos casos de IAM em nosso estudo originou a partir de estenoses subjacentes de alto grau, contrariamente à sabedoria comum. Níveis séricos mais elevados de triglicérides, maior VPM e elevação na CCB e na contagem de neutrófilos estiveram independentemente associados com comprometimento no desenvolvimento de vasos colaterais.

Grado de estenosis y vulnerabilidad de las lesiones coronarias / Degree of stenosis and vulnerability of coronary artery lesions

La angiografía coronaria ha sido y continúa siendo el pilar sobre el cual se deciden las intervenciones terapéuticas en la enfermedad coronaria constituyendo el grado de estenosis de las placas ateromatosas uno de los principales marcadores de isquemia miocárdica y por lo tanto del pronóstico de la enfermedad. Sin embargo, es un hecho repetidamente documentado que los fenómenos coronarios agudos se producen con mayor frecuencia en placas con estenosis angiográficamente no significativas; por lo tanto, la vulnerabilidad de las placas no parece tener relación con su grado de estenosis y en consecuencia tampoco con la producción de isquemia miocárdica. Esta conclusión no concuerda con los hallazgos histopatológicos ni con los grados de severidad de las estenosis que comprometen el flujo coronario. El objetivo de la presente comunicación es tratar de aclarar esta controversia analizando la información entregada por la histopatología de las lesiones agudas culpables de los infartos. Precisar si las lesiones coronarias crónicas que producen isquemia (probables causantes de futuros infartos) se correlacionan con el grado de estenosis anatómica; proponer el posible mecanismo que vincula el grado de estenosis a la vulnerabilidad de las placas y esbozar una explicación para conciliar los hallazgos angiográficos con los his-topatológicos y funcionales.

Coronary angiography has long been and is still the basic method for deciding coronary interventions, and the severity of stenosis remains the main prognostic marker of the disease. However, plaque vulnerability does not appear to be associated with a greater degree of angiographic stenosis, which is not consistent with histopathological findings or with physiological assessment of ischemia-producing lesions. The purpose of this article is to briefly review this controversy while suggesting that plaques vulnerability correlate with the degree of anatomical and functional stenosis, and to describe the potential mechanism that could determine this vulnerability as well as to give likely explanations that reconcile angiographic findings with histopathological and functional observations.

Type 4 dual left anterior descending coronary artery

No abstract available.

Trombose muito tardia de stent pela angiografia: um caso de progressão da aterosclerose pela OCT / Very late stent thrombosis by angiography: a case of atherosclerosis progression by OCT

Em pacientes submetidos à intervenção coronária percutânea, a natureza progressiva da doença coronária aterosclerótica é frequentemente negligenciada. Geralmente, infartos muito tardios (> 1 ano) acometendo o território tratado são atribuídos a complicações relacionadas ao dispositivo. Apresentamos o caso de uma paciente com infarto agudo do miocárdio com supradesnivelamento do segmento ST na parede inferior, que apresentava oclusão trombótica de um stent não farmacológico implantado 8 anos antes. Apesar do diagnóstico angiográfico de trombose muito tardia, a tomografia de coerência óptica revelou que a etiologia foi a ruptura de placa aterosclerótica no leito distal, fora do segmento previamente tratado.

The progressive nature of coronary atherosclerotic disease is often neglected in patients submitted to percutaneous coronary intervention. Very late (> 1 year) myocardial infarctions affecting the treated myocardial territory are usually attributed to device related complications. We report the case of a patient with acute inferior wall ST-elevation myocardial infarction, who had a thrombotic occlusion of a bare-metal stent implanted 8 years before. Despite the angiographic diagnosis of very late stent thrombosis, optical coherence tomography revealed that the acute myocardial infarction was caused by rupture of an atherosclerotic plaque outside of the previously stented segment.

Utilização da Tomografia de Coerência Ótica na Abordagem de Lesão Intermediária em Paciente com Síndrome Coronariana Aguda / Optical Coherence Tomography in the Management of Intermediate Lesion in a Patient with Acute Coronary Syndrome

A tomografia de coerência ótica fornece imagens tomográficas da microestrutura coronária em alta resolução, possibilitando detalhada caracterização dos componentes e da morfologia da placa aterosclerótica, além de acurada determinação das dimensões vasculares. Relatamos aqui o caso de um paciente com lesão intermediária, na fase subaguda de um infarto do miocárdio, no qual a tomografia de coerência ótica foi utilizada como método diagnóstico complementar para a tomada de decisão e para guiar o procedimento...

Optical coherence tomography provides high-resolution tomography imaging of the coronary microstructure, allowing for detailed characterization of atherosclerotic plaque components and morphology, in addition to an accurate determination of vascular dimensions. We report the case of a patient with an intermediate coronary lesion, presenting in the subacute phase of a myocardial infarction, in whom optical coherence tomography was used as an adjunctive diagnostic method to aid in the decision-making process and to guide the interventional procedure...

Utilização do fluxo fracionado de reserva do miocárdio para identificar variáveis preditoras de pior prognóstico após intervenções coronárias percutâneas / Use of myocardial fractional flow reserve to identify predictors of poor prognosis after percutaneous coronary interventions

INTRODUÇÃO: Vários estudos foram realizados para definir preditores de eventos adversos pós-intervenção coronária percutânea (ICP). Pacientes cujo fluxo fracionado de reserva do miocárdio (FFR) pós-procedimento é < 0,90 apresentam índice de eventos cardíacos adversos maiores em 6 meses pelo menos 3 vezes maior do que aqueles cujo FFR é ≥ 0,90. Este estudo teve por objetivo identificar fatores clínicos, angiográficos e do procedimento associados a FFR pós-ICP < 0,90. MÉTODOS: Foram incluídos 193 pacientes (256 lesões) tratados entre 2004 e 2005, e o FFR foi medido antes e depois da ICP em todos os vasos tratados. Os pacientes foram divididos nos grupos FFR < 0,90 e FFR ≥ 0,90. Análise multivariada por regressão logística foi utilizada para determinar as razões de chances (odds ratio - OR) ajustadas. RESULTADOS: Foi possível obter o FFR em todas as lesões. Não se observou diferença nos parâmetros clínicos entre os dois grupos de pacientes. Houve diferença em alguns parâmetros angiográficos e do procedimento, porém, ao aplicarmos o modelo de regressão logística, a única variável que se associou com FFR pós-ICP < 0,90 foi o tratamento da artéria descendente anterior (OR = 12,1; IC 95% 6,4-22,9; P < 0,01). CONCLUSÕES: A única variável preditora de FFR pós-ICP < 0,90 foi o tratamento da artéria descendente anterior.

BACKGROUND: Several studies were performed to define predictors of adverse events after percutaneous coronary intervention (PCI). Patients whose post-procedure myocardial fractional flow of reserve (FFR) is < 0.90 have an incidence of major cardiac events at 6 months at least 3 times higher than those whose FFR is ≥ 0.90. The aim of this study was to identify clinical, angiographic and procedure-related factors associated with a post-PCI FFR < 0.90. METHODS: One hundred and ninety-three patients (256 lesions) treated between 2004 and 2005 were included, and FFR was measured before and after PCI in all of the treated vessels. Patients were divided into groups with FFR < 0.90 and FFR ≥ 0.90. Logistic regression multivariate analysis was used to determine the adjusted odds ratio (OR). RESULTS: FFR was measured in all lesions. No difference was observed in clinical parameters between groups. There were differences in angiographic and procedure-related parameters, however, when the logistic regression model was used, the only variable associated to post-PCI FFR < 0.90 was the treatment of the left anterior descending artery (OR, 12.1; 95% CI, 6.4-22.9; P < 0.01). CONCLUSIONS: The only predictor of a FFR < 0.90 after PCI was the treatment of the left anterior descending artery.

Significance of Microalbuminuria in Relation to Subclinical Coronary Atherosclerosis in Asymptomatic Nonhypertensive, Nondiabetic Subjects

We aimed to investigate the significance of microalbuminuria and its relationship with subclinical atherosclerosis in nonhypertensive and nondiabetic patients, by using coronary artery computed tomography (CT). A total of 1,318 nonhypertensive and nondiabetic subjects who had taken coronary artery CT and measured spot urine albumin to creatinine ratio (UACR) were evaluated. The atherosclerotic changes of coronary arteries were greater in subjects with microalbuminuria, reflected by coronary artery calcium score (CACS) and significant coronary artery stenosis (CACS > or = 100 in 15.3% vs 7.6% and stenosis > or = 50% in 11.5% vs 4.9% of patients with vs without microalbuminuria, P = 0.008 and P = 0.011, respectively). Among various parameters that are known as a risk factor or possible biomarkers of coronary artery disease, presence of microalbuminuria, age and Framingham risk score were significantly related to coronary artery stenosis. Among them the presence of microalbuminuria showed stronger correlation than others to the coronary artery stenosis detected by CT, even after adjusting confounding factors (OR 3.397, 95% confidence interval 1.138 to 10.140, P = 0.028). The presence of microalbuminuria by UACR was significantly associated with presence of coronary artery stenosis > or = 50% in asymptomatic, nonhypertensive and nondiabetic general population. Our study suggests that the presence of microalbuminuria may imply subclinical coronary artery disease, even in asymptomatic population.

Impacto da pré-dilatação do ramo lateral no procedimento de intervenção coronária percutânea em lesões de bifurcação coronária complexas / Impact of side branch predilation on percutaneous coronary intervention in complex coronary bifurcation lesions

Introdução: O tratamento de lesões de bifurcação com implante de stent único no vaso principal e stent provisional no ramo lateral pode ser limitado pelo grau de complexidade anatômica/morfológica da lesão. A pré-dilatação do ramo lateral, um passo do procedimento geralmente evitado, pode ser necessária para manter a patência do ramo lateral. Investigamos o impacto da pré-dilatação do ramo lateral nos resultados imediatos de intervenção coronária percutânea em lesões de bifurcação coronária complexas. Métodos: Entre maio de 2008 e agosto de 2009, 59 pacientes com lesão de bifurcação coronária única e comprometimento significativo de vaso principal e ramo lateral foram incluídos no estudo. Os principais critérios de exclusão foram: envolvimento do tronco de coronária esquerda, infarto agudo do miocárdio com elevação do segmento ST(< 72 horas) e reestenose intrastent. Resultados: A média de idade foi de 61,2 ± 11 anos, 25,4% eram do sexo feminino e 30,1% tinham diabetes. As lesões mais frequentemente se localizaram em artéria descendente anterior/ramo diagonal (86,4%). Durante o procedimento, 8,5% (5/59) das lesões tiveram pré-dilatação do ramo lateral sem sucesso, e 4 dessas bifurcações foram tratadas com 2 stents. No modelo multivariado, a estenose do ramo lateral no pré-procedimento foi o único preditor significativo de pré-dilatação sem sucesso do ramo lateral (odds ratio 1,15, intervalo de confiança de 95%1,01-1,30; P = 0,04), e estenose > 87,6% no ramo lateral foi identificada na curva ROC como valor de corte com maior acurácia para predizer o insucesso. Conclusões: A pré-dilatação do ramo lateral esteve associada a falência imediata do ramo lateral em < 10% dos casos e o único preditor significativo na análise multivariada foi a gravidade da estenose (> 85%)no ramo lateral no pré-procedimento.

Técnica "Mother and child" com um novo cateter: experiência inicial / "Mother and Child" technique with a new catheter: initial experience

Relatamos nossa experiência inicial com o GuideLinerTM, uma extensão de cateter-guia de rápida troca tipo “child”, desenvolvido para facilitar a entrega de stents e balões em intervençõesarteriais percutâneas complexas. Descrevemos sua utilização em um caso com lesão coronária complexa, em outro com anatomia complexa, e em um terceiro caso com dissecção do enxerto de artéria torácica interna esquerda. Todos os procedimentos foram realizados com sucesso. O GuideLinerTMpode auxiliar no tratamento de lesões arteriais complexas e de complicações durante o procedimento.

Incidência, manejo e prognóstico de perfurações coronárias / Incidence, management and prognosis of coronary perforations

INTRODUÇÃO: A perfuração coronária na atualidade é complicação rara, mas potencialmente catastrófica. Nosso objetivo foi avaliar a incidência, os preditores, o manejo e o prognóstico das perfurações coronárias na experiência de um serviço de cardiologia intervencionista com grande volume de intervenções coronárias percutâneas (ICPs). MÉTODOS: Comparamos as características clínicas, angiográficas e do procedimento e a evolução intra-hospitalar de pacientes que apresentaram ou não perfuração coronária. Análise univariada foi realizada para determinar os preditores dessa complicação. RESULTADOS: No período de dezembro de 2007 a janeiro de 2012, 5.585 pacientes consecutivos foram submetidos a ICP e 18 apresentaram perfuração coronária (0,32%), dos quais 55,5% eram do sexo feminino e 38,9% eram diabéticos. Nesse grupo, a artéria descendente anterior foi o vaso mais frequentemente tratado (61,1%), assim como a lesão do tipo C (61,1%), e as oclusões crônicas foram abordadas em 27,8% desses casos. A maioria das perfurações coronárias (11/18) apresentou menor complexidade de acordo com a classificação de Ellis modificada, enquanto as demais foram qualificadas como graus III (6/18) ou IV (1/18). O cateter-balão foi o dispositivo responsável pela perfuração em 61,1% dos casos. Realizou-se insuflação prolongada com cateter-balão e inativação da heparina com protamina em 72,2% e 88,9% dos casos, respectivamente. Apenas 1 paciente (5,6%) necessitou de abordagem cirúrgica de emergência em decorrência de tamponamento cardíaco. Não houve óbito associado à perfuração coronária. Na análise univariada, os preditores de perfuração coronária foram: sexo feminino (P = 0,03), doença pulmonar obstrutiva crônica (P = 0,006) e oclusão crônica (P < 0,01). CONCLUSÕES: Em nossa experiência, a perfuração coronária foi evento raro, controlada conservadoramente na maioria dos casos e com evolução hospitalar satisfatória.

BACKGROUND: Coronary perforation is currently a rare, but potentially catastrophic complication. The aim of the study was to evaluate the incidence, predictors, management and prognosis of coronary perforations at a hospital with a large number of percutaneous coronary interventions (PCIs). METHODS: Clinical, angiographic, procedural and in-hospital outcomes of patients with or without coronary perforations were compared. Univariate analysis was performed to determine the predictors of this complication. RESULTS: From December 2007 to January 2012, 5,585 consecutive patients were submitted to PCI and 18 had coronary perforation (0.32%), of whom 55.5% were female and 38.9% were diabetic. In this group, the left anterior descending artery was the most frequently treated vessel (61.1%) as well as type C lesion (61.1%) and chronic occlusions were approached in 27.8% of these cases. Most of the coronary perforations (11/18) had a lower complexity according to the modified Ellis classification, whereas the remaining perforations were classified as grades III (6/18) or IV (1/18). The balloon-catheter device was responsible for perforation in 61.1% of the cases. Prolonged inflation with a balloon-catheter and heparin reversal with protamine was performed in 72.2% and 88.9% of the cases, respectively. Only 1 patient (5.6%) required an emergency surgery due to cardiac tamponade. There were no deaths associated with coronary perforation. According to the univariate analysis, coronary perforation predictors were: female gender (P = 0.03), chronic obstructive pulmonary disease (P = 0.006) and chronic occlusion (P < 0.01). CONCLUSIONS: In our experience, coronary perforation was a rare event, which was managed conservatively in most of the cases and was associated with a good in-hospital outcome.

Avaliação ultrassonográfica intracoronária de imagem angiográfica duvidosa durante intervenção percutânea em bifurcação / Intravascular ultrasound evaluation of equivocal angiographic imaging during percutaneous coronary intervention of bifurcation lesions

O uso do ultrassom intracoronário (USIC) para guiar o implante do stent em bifurcações, especialmente na detecção de complicações relacionadas ao procedimento, tem diminuído as taxas de desfechos clínicos maiores. Neste artigo, reportamos o caso de um paciente submetido a intervenção em bifurcação, em que o fio-guia ultrapassou inadvertidamente por trás das hastes proximais do stent, levando à deformação de sua borda. A complicação foi suspeitada na angiografia e confirmada com o USIC. O USIC foi fundamental no diagnóstico, na confirmação do reposicionamento correto do fio-guia, e na avaliação da ótima expansão e da aposição completa das hastes do stent, prevenindo possível desfecho trombótico precoce e garantindo o resultado a longo prazo.

The use of intravascular ultrasound (IVUS) to guide stent implantation in bifurcation lesions, especially for the detection of procedure-related complications, has decreased the rates of major clinical outcomes. We report a case of a patient undergoing bifurcation intervention, where the guidewire inadvertently was passed behind the proximal stent struts, deforming the stent edge. This complication was suspected at the angiography and was confirmed by IVUS. IVUS was crucial for the diagnosis, to confirm the correct repositioning of the guidewire, and to assess the optimal expansion and complete apposition of stent struts, thus preventing a possible early thrombotic event and ensuring a good long-term outcome.

Prognosis in Patients Having Chronic Obstructive Pulmonary Disease with Significant Coronary Artery Lesion Angina

BACKGROUND/AIMS: Many studies have investigated angina and its relationship with chronic obstructive pulmonary disease (COPD). However, angina was diagnosed only by noninvasive tests or only by clinical symptoms in most of these studies. The aim of this study was to compare the prognosis, including rate of hospitalization and death from significant coronary artery lesion and nonsignificant coronary artery lesion angina, in patients with COPD. METHODS: Patients with COPD who underwent coronary angiography (CAG) due to angina were reviewed retrospectively at a tertiary referral hospital. COPD is defined as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) of < 70%. A significant coronary lesion is defined as at least 50% diameter stenosis of one major epicardial artery in CAG. RESULTS: In total, 113 patients were enrolled. Mean follow-up duration was 39 +/- 21 months. Of the patients, 52 (46%) had mild COPD and 48 (42%) had moderate COPD. Sixty-nine (61%) patients had significant stenosis in CAG. The death rate in the follow-up period was 2.21 per 100 patient-years. No significant difference was observed among the all-cause mortality rate, admission rate, or intensive care unit admission rate in patients who had COPD with or without significant coronary artery disease. Pneumonia or acute exacerbation of COPD was the most common cause of admission. CONCLUSIONS: In patients having COPD with angina who underwent CAG, no significant difference was observed in mortality or admission events depending on the presence of a significant coronary artery lesion during the 2-year follow-up period.

Acurácia do escore de cálcio na detecção de estenose coronária significativa em pacientes com dor torácica aguda subanálise do estudo multicêntrico CORE64 / Accuracy of coronary calcium score to detect significant coronary stenosis in patients with acure chest pain a CORE64 substudy

Objetivo: Avaliar a prevalência de estenose coronária significativa e de calcificação coronária, em pacientes com suspeita de síndrome coronária aguda (SCA), em estudo multicêntrico. Métodos: Pacientes do estudo CORE64 foram classificados em grupos SCA e não SCA de acordo com critérios clínicos, eletrocardiográficos e laboratoriais. As imagens obtidas pela tomografia computadorizada de 64 colunas de detectores (Aquilion 4, Toshiba), para avaliação do escore de cálcio (EC), pelo método de Agatston, foram adquiridas antes da angiografia coronária invasiva (ACI), sendo utilizados os seguintes parâmetros: sincronização prospectiva (colimação 4 x 3,0mm; voltagem de tubo de Raio X de 120kV e corrente de tubo de 300A). Redução luminal coronária >- 50%, definida pela ACI, foi considerada significativa. Resultados: Dos 291 pacientes (59,3 + 10 anos, 74% homens), 80 foram classificados no grupo SCA (41 casos de infarto sem supradesnível de ST e 39, de angina instável). A média do EC, no grupo SCA, foi de 120 +- 159 e 148 +- 166 no não SCA (pns). Escore de cálcio zero esteve presente em 16 pacientes (20%) do grupo SCA, dos quais 6 (8%) tinham lesão coronária significativa. No grupo não SCA, 8 (4%)...

Volumen de placas coronarias calcificadas por tomografía computarizada y presencia de estenosis significativa por angiografía coronaria / Volume of coronary calcified plaques by computed tomography and presence of significant stenosis by coronary angiography

Introducción: La presencia de calcio en las arterias coronarias es prácticamente patognomónica de aterosclerosis. En 1990, Agatston diseñó un método para cuantificar el puntaje de calcio coronario a través de la tomografía computarizada. Nuestro objetivo fue determinar la asociación entre el volumen de las placas calcificadas en las arterias coronarias determinado por tomografía de 64 cortes y la presencia de estenosis coronaria significativa diagnosticada por coronariografía invasiva. Método: Se estudiaron consecutivamente 150 pacientes, 66.6% varones, programados para coronariografía invasiva. Previo a este procedimiento, se les cuantificó el puntaje de calcio por arteria y por paciente a través de la tomografía. Se incluyeron 128 placas calcificadas, a las que se les determinó el volumen a través del método de Callister introducido en el año 1998. Las placas se consideraron pequeñas si el volumen era ≤ 10 mm³ y grandes si >10 mm³. Resultados: Se asociaron a estenosis coronaria significativa 79% de las placas con volumen mayor a 10 mm³, contra 17% con volumen pequeño (p < 0.0001). Más de 75% de las placas con volumen mayores de 10 mm³ en las arterias circunfleja, descendente anterior y coronaria derecha, se asociaron a estenosis coronaria significativa en el segmento de la placa (p < 0.0001). Correlación de Spearman 0.8. La sensibilidad y especificidad diagnóstica de estenosis coronaria significativa fueron 98.7% y 71.7 % respectivamente para un valor de corte 6.5 mm³ con un área bajo la curva de 0.88 ± 0.32 (IC 95%, 0.815 a 0.940). Conclusiones: Se observó asociación entre el volumen de las placas calcificadas circunscritas en las arterias coronarias diagnosticada por tomografía computada y la presencia de estenosis coronaria significativa diagnosticada por coronariografía invasiva.

Background: Coronary artery calcium is almost patognomonic of atherosclerosis. In 1990, Agatston designed a method to measure the coronary calcium score by computed tomography. Our aim was to establish the association between coronary calcified plaque volumes calculated by 64 slice computed tomography and the presence of significant coronary stenosis diagnosed by invasive coronary angiography. Method: 150 consecutive patients, 66.6% male, scheduled for invasive coronary angiography were studied. Coronary calcium score was measured per patient and per artery by computed tomography previous to invasive coronary angiography. 128 calcified plaques were enrrolled and volume was determined by Callister method introduced in 1998. According to the volume, the plaques were classified in two groups: small if volume ≤ 10 mm³ and big if > 10 mm³. Results: In 79% of plaques with a volume > 10 mm³, significant coronary stenosis was detected by invasive coronary angiography versus 17% with small volume (p < 0.0001). More than 75% of plaques with volume > 10 mm³ in circumflex artery, anterior descending artery and right coronary artery were associated with significant coronary stenosis (p < 0.0001). Spearman correlation was 0.8. The sensitivity and specificity of significant coronary stenosis were 98.7% and 71.7% respectively for a cut off value of 6,5 mm³, area under the curve of 0,88 ± 0,32 (CI 95%, 0.815 to 0.940). Conclusions: Association between coronary calcified plaque volume diagnosed by computed tomography and the presence of significant coronary stenosis diagnosed by invasive coronary angiography was observed.