Association between traditional risk factors and coronary artery ectasia: a study on 10057 angiographic procedures among Iranian population

Whether coronary artery ectasia [CAE] is a unique clinical finding or results from other clinical entities is still unknown. We aimed to determine the CAE prevalence, investigate the relationship between CAE and patients' demographic and clinical characteristics, and assess the prognosis at follow-up in a sample of Iranian population. Totally, 10057 patients who underwent coronary angiography were divided into three categories: normal coronary arteries without co-existing coronary artery disease; CAE without co-existing coronary artery narrowing < 50%; and coronary artery stenosis with > 50% luminal narrowing [CAS]. The prevalence of CAE was 1.5%. Compared to the normal individuals, the CAE patients were older, were more frequently male, and had higher rates of myocardial infarction [MI]. The CAE patients had a lower frequency of diabetes and MI than the CAS group. The CAE patients were largely focused between 40 to 60 years of age. The right coronary and left anterior descending arteries were the most involved arteries, and ectasia was located more frequently in the proximal part of these arteries. Patients with ectasia in the three main vessels had higher rates of MI. After a mean follow-up of 54.23 +/- 18.41 months, chest pain and dyspnea on exertion remained the main complaint in more than 97% of the patients, leading to hospital admission in more than 14%. There was no relationship between the presence of ectasia and conventional risk factors. According to our study, pure CAE may be deemed a benign feature of atherosclerosis; however, it can lead to frequent hospital admissions because of the persistence of cardiovascular symptoms

Demographics and angiographic findings in patients under 35 years of age with acute ST elevation myocardial infarction

ST-elevation myocardial infarction [STEMI] is a major cause of cardiovascular mortality worldwide. There are differences between very young patients with STEMI and their older counterparts. This study investigates the demographics and clinical findings in very young patients with STEMI. Through a review of the angiography registry, 108 patients aged 35 years [Group II] who underwent coronary angiography after STEMI. Group I patients were more likely to be male [92.6%], smokers, and have a family history of cardiovascular diseases [34.6%]. The prevalence of diabetes, dyslipidemia, and hypertension was higher in the old patients. Triglyceride and hemoglobin were significantly higher in Group I. Normal coronary angiogram was reported in 18.5% of the young patients, and in 2.1% of the older patients. The prevalence of single-vessel and multi-vessel coronary artery disease was similar in the two groups [34.3% vs. 35.2%]. The younger subjects were more commonly candidates for medical treatment and percutaneous coronary intervention [PCI] [84.2%], while coronary artery bypass grafting [CABG] was considered for the 39.5% of their older counterparts. In the young adults with STEMI, male gender, smoking, family history, and high triglyceride level were more often observed. A considerable proportion of the young patients presented with multi-vessel coronary disease. PCI or medical treatment was the preferred treatment in the younger patients; in contrast to their older counterparts, in whom CABG was more commonly chosen for revascularization

Return to work following cardiac rehabilitation in patients undergoing cardiac procedures with an approach to patient's viewpoints and attitude

To estimate the rate of return to work [RTW] after cardiac rehabilitation and determine the relationship between RTW and clinical and socio-demographic factors with an approach to patient's attitude. Prospective follow-up study. Tehran Heart Center, Iran. Two hundred and forty six consecutive patients undergoing different types of cardiac procedures between May and September 2007 were studied. A checklist was completed for patients according to medical history and physical examination recorded in medical files. A complementary interview was also carried out by phone. Rate of RTW after cardiac rehabilitation and the relationship between RTW and clinical and socio-demographic factors. Two groups were matched for gender, age, occupation type and the type of cardiac procedures. Rehabilitated patients in comparison with control group had higher rates of RTW three month [55.4 Vs 26.2%] and eight months [94.7 Vs 81.0%] after the time of cardiac rehabilitation. Positive attitude toward RTW was observed more in rehabilitated patients three month and eight months after cardiac procedures. Cardiac rehabilitation programs [OR: 3.507, p = 0.027], preoperative functional class [OR: 6.541, p < 0.001], experience of regular physical activity at home before RTW [OR: 3.836, p = 0.004] and job support programs [OR: 4.050, p = 0.022] were main predictors for RTW eight months after cardiac procedures. Patients undergoing cardiac procedures benefit from cardiac rehabilitation to preserve work status. The need for appropriate supportive protocols can guarantee RTW after cardiac rehabilitation and improve patients' attitude toward continuing their jobs

Significant improvement in severely stunned left ventricle after percutaneous coronary intervention

This is a case of severely stunned left ventricle which occurred after a non-ST elevation myocardial infarction in a 76-year-old woman who was a known case of three-vessel disease. Her symptoms and cardiac function responded well to revascularization

Effect of cardiac rehabilitation program on heart rate recovery after percutaneous coronary intervention and coronary artery bypass grafting

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery [HRR] in patients who received percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program [phase 2] after PCI [n=62] or CABG [n=178] at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors [except for diabetes mellitus] was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively [p=0.019]. The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality [i.e. PCI or CABG] after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients