Comparison of stenting with minimally invasive bypass surgery for high grade stenosis of the proximal left anterior descending coronary artery: six months follow up of randomized study

High grade stenosis of the proximal left anterior descending coronary artery [LAD] in patients with single-vessel disease is associated with a significantly worse prognosis than lesions at any other location. To compare the merits of stenting with minimally invasive coronary artery bypass [MICAB] surgery for high grade stenosis of isolated proximal LAD. One hundred patients with isolated high grade lesion [stenosis] >75% of laminal diameter in the proximal LAD were included. The patients were classified into two groups: Group A included 50 patients in whom successful stenting was performed. Group B included 50 patients in whom successful MICAB was performed. In group A the mean percentage of stenosis was significantly reduced to 10.48 +/- 4.112. After stenting, non of the patients died, 2Q wave infarction, 2 non Q wave infarction and 1 required coronary bypass surgery, 1 stroke, 3 LAD dissection, 5 angina pectoris, 3 needed revascu-larization, 4 vascular complications and 4 needed blood transfusion. In group B, after surgery 1 patient had Q wave infarction, 1 non Q wave infarction, 2 patients needed necessary sternotomy because of an intramyocardial segment of the LAD, 3 angina pectoris, 2 needed revascularization, 2 vascular complications, 2 needed blood transfusion, 2 developed AF and 2 chest wall hernias. The mean duration of lCU stay after surgery was 2.62 +/- 1.086 days as compared to 1.8 +/- 1.591 days after stenting [p < 0.05], the mean duration of hospitalization after surgery was 8.64 +/- 3.186 days as compared to 2.34 +/- 2.471 days after stenting [p < 0.01], Follow-up was complete for all patients except two patients in each group [2 patients died in group B while in group A one patients traveled and other was excluded, eleven asymptomatic patients refused repeated cardiac catheterization after stenting, as did 13 patients after surgery. No statistically significant difference was found between both groups as regard to positive exercise stress test [p > 0.05]. After stenting, the angina class improved 79.2% were free of angina. After surgery, the mean angina class improved, 91.6% of patients were free of angina. After six months of follow up, in-stent restenosis was detected in 11 patients [29.7%] and subgroup analysis showed a restenosis rate 15.4 for type B lesion and 46.2% for type C lesion. The recurrence of stenosis was more in type C and B than type A in stenting group. In surgical group, 3 patients [8.6%] had stenosis > 50% of the luminal diameter at the anatomic region, and subgroup analysis showed a restenosis rate of 3.6% for type B lesions and 21.4% for type C lesions. The recurrence of stenosis was more in type C and B than type A in surgical group. Secondary end points were 56% in group A vs 26% in group B. Stenting and minimally invasive bypass surgery are safe and effective treatment options for high grade lesions in the proximal LAD; MICAB requires longer hospitalization, more cost but has better an-giographic outcome while stenting has higher target vessel revascularization and secondary adverse cardiac event than MICAB

Incidence and predictors of immediate elastic recoil after percutaneous translumenal coronary angioplasty

To assess the incidence and magnitude of elastic recoil that occurs immediately after coronary angioplasty and to detect the clinical and angiographic predictors of this process. Forty ischaemic heart patients who were scheduled for PTCA: with clinical diagnosis of stable angina, unstable angina or prior myocardial infarction [MI Their ages ranged 31-76 years; with mean age 49.47 +/- 11.89 years. Thirty-six [90%]were males and four [10%]were female Qualitative and Quantitative coronary angiographic evaluation before, during, and immediately after PTCA were done for all patients included in this study to detect the occurrence of elastic recoil, its magnitude, and its predictors. All patients showed different degrees of elastic recoil; with an average of 0.56 +/- 0.43 mm. Elastic recoil was responsible for a mean cumulative loss of 18.48 +/- 14.19% of the theoretically achievable gain immediately after balloon deflation. The following factors were found to have a positive correlation with the increased incidence and degree of recoil: bal loon over sizing, lesion calcification, and eccentricity of lesion. However, elastic recoil was not influenced by age, sex, coronary risk factors or the patient's clinical diagnosis [stable angina, unstable angina or old MI]. Elastic recoil was extremely common and caused loss of nearly 20% of the potential gain obtained during maximal balloon inflation. The present study identified the predictors of this unwanted event: the use of an oversized balloon for dilatation, lesion calcification and lesion eccentricity

Correlation between plasma angiotensin II and coronary angiographic findings in patients with essential hypertension

The aim of this work,was to evaluate plasma Ang II level in essential hypertensive patients and to verify its relation to the presence and severity of coronary artery disease. Fifty eight patients with essential hypertension and ischaemic chest pain [group A] together with twelve healthy normotensive volunteers [group B] were included in this study.Thorough clinical examination, resting ECG, plain chest X ray, routine laboratory investigations, angiotensin II [Ang II] serum level and echo-Doppler were done for all individuals. Coronary angiography was done fore the group A patients only. The statistical analysis of the results pointed out, a sign higher level of Ang II in group A [38.3 +/- 2 pmol/L] than in group B [24.9 +/- 9 pmol/L] and that its level in group A patients were positively correlated sign to left ventricular mass index and left ventricular wall motion score index but negatively to E/A ratio. Ang II level was significantly higher in hypertensive patients with coronary artery disease [group AII] [59.1 +/- 2 pmol/L] than those with normal coronaries [groupAI] [31.9 +/- 1 pmol/L]. Group All patients with three vessels disease had a sign higher Ang II level than those with two or one vessel coronary artery disease. Ang II level was sign higher in group All patients with LAD coronary artery lesion than those without. Concluston:Patients with essential hypertension had a significantly higher Ang II level than normotensives. Ang II Level was positively correlated significantly to the presence, number and severity of coronary artery lesion in hypertensive patients. Patients with LAD lesion sign had a higher Ang II level than those without

Prevalence and determinants of late potentials in patients with unstable angina

To study the factors determining the positivety of late potentials and its prevalence in unstable angina, fifty unstable angina patients together with a sex and age matched twenty stable angina patients serving as control were included in this study. All were subjected to careful history taking and clinical examination, laboratory blood analysis; twelve leads resting surface ECG; echo-Doppler study; 24-hours Holterniortitoring and signal averaged ECG [SAECG] namely filtered QRS complex duration, root of the mean square of signal amplitude in the last 40 msec of the filtered QRS and the duration of terminal filtered low signal amplitude [LAS] with frequency amplitude<40 uv. Echo-Doppler; Holter monitoring and SAECG were repeated two weeks later for the unstable angina patients. Exercise treadmill was done to confirm the diagnosis of stable angina patients. In the present study the incidence of positive LPs was 24% on admission and was significantly reduced to 14% after 2 weeks of medical therapy in unstable angina patients. However, non of the stable angina patients had positive LPs. All the parameters of SAECG were significantly higher in the unstable angina patients. Sex and age had no effect on the incidence of LPs, inferior ischemia had significantly higher positive LPs than anterior ischemia [55% vs 33%/. Holter-reported ischaemic episodes and echo-reported regional wall motion abnormalities were significantly positively correlated with positive LPs. The presence of left ventricular systolic and diastolic dysfunction significantly increase the incidence of positive LPs and their improvement significantly reduce the incidence of positive LPs Positive LPs was recorded in 24% of patients with unstable angina Left ventricular systolic and diastolic dysfunction and the frequency of ischaemic episodes showed significant positive correlation with the incidence of positive LPs Medical therapy significantly reduced the incidence of positive LPs