Red cell distribution width can predict the significance of angiographically intermediate coronary lesions

Objective: In the present study, the association between red cell distribution width [RDW] with functional significance of intermediate coronary artery lesions was investigated

Materials and Methods: Two hundred and forty-six consecutive patients, 168 males and 78 females, who underwent fractional flow reserve [FFR] measurement for angiographically intermediate coronary stenosis [40-70% in quantitative coronary analysis] in the left anterior descending coronary artery were enrolled into the study. The functional significance of intermediate coronary artery lesions was determined by FFR measurement. An FFR value <0.75 was defined as functionally significant. Venous blood samples were taken within 48 h before the FFR measurement, and RDW levels were determined by a Coulter LH Series hematology analyzer. Logistic regression analysis was used to examine the association between functional significance in FFR measurement and other variables

Results: Of the 246 patients, 62 [25.2%] exhibited significant functional stenosis [FFR <0.75] in the FFR measurement. The mean RDW level was significantly higher in patients with significant stenosis [14.19 +/- 0.73 vs. 13.69 +/- 0.77, p < 0.001]. In stepwise multivariate logistic regression analysis, RDW [OR = 2.489, 95% CI = 1.631-3.799, p < 0.001] and male gender [OR = 2.826, 95% CI = 1.347-5.928, p = 0.006] were independent predictors of significant functional stenosis

Conclusion: Increased RDW levels were associated with functional significance of angiographically intermediate coronary artery stenoses

Gemcitabine-induced acute coronary syndrome: a case report

To report a case of metastatic leiomyosarcoma, in which a patient developed chest pain accompanied by acute left bundle-branch block [LBBB] after gemcitabine infusion. Clinical Presentation and Intervention: A 59-year-old woman admitted with bilateral pulmonary nodules had classic risk factors for coronary heart disease and coronary stenosis as demonstrated by previous coronary angiography. She was treated with gemcitabine infusion, and 30 min later she experienced severe chest pain accompanied by acute LBBB confirmed by ECG. We suspected gemcitabine-induced coronary vasospasm exacerbated by the preexisting coronary artery disease as the cause of the acute coronary syndrome. The patient was subsequently treated with antianginal therapy and percutaneous coronary intervention. Her chest pain resolved and LBBB disappeared. She was discharged 2 days later without any further cardiac events. No additional cancer therapy was given and she died 5 months later, due to disease progression. This case showed that chemotherapeutic agents must be administered with intensive cardiac monitoring especially in patients with cardiac disease and well-known risk factors to prevent the development of cardiac complications, despite an agent not being known to be 'cardiotoxic'