Acute coronary syndrome in young adult and old age [comparative study]

Clinical characteristics as well as biochemical profile and angiographic findings in patients with acute coronary syndrome may differ in young compared to old patients. We compared clinical, laboratory and angiographic characteristics in forty four patients with acute coronary syndrome at age 50 years [group II]. All patients presented by acute coronary syndrome and admitted to the coronary care unit at Bab-Elsharia University Hospital. The two patients groups were compared in coronary risk factors and angiographic features. STEMI were [43.2% vs 28.6%], NSTEMI [9.1% vs 7.l%] and UA [47.7% vs 643%] with no statistical significance. Smokers were high in GI [47.7% vs 35.7%] and non smokers were high in GII[45.5% vs 62.5%] with no statistical significance and the smoking index is more in Gil [1262.1 + 618.9] than GI [946.67 +/- 514.3] mostly due to longer duration of smoking. No statistical significance as regard hypertension [27.3 vs 42.9%] and DM [25% vs 32.1%] but the duration of DM has great trend in GII [7.94 +/- 6.08 II vs 5.91 +/- 4.39] [p value 0.06]. Among the diabetic patients; five [8.9%] in GII had retinopathy [p value < 0.05]. No statistical significance as regard past history of ischemic events or family history of premature coronary artery disease. There is significant correlation between LDL level and age of the patients [56.8% vs 76.8%] [p value = 0.05]. Serum TG was [59% vs 44.6%] with no statistical significant difference were detected [p value > 0.05]. The mean number of risk factors was 2.068 +/- 1.265 vs 2.143 +/- 1.368 with no statistical significance. In coronary angiography ectatic vessels with no significant stenotic lesions were [13.6% vs 5.4%] while myocardial bridge were [11.4% vs 7.1%]. Ostial and/or proximal lesions present in [31.8% vs 51.7%] while twenty six mid and/or distal lesions in [59.l% vs 78.6%] with no statistical significance. One vessel disease in [34.1% vs 30.3%], 2 vessels [11.4% vs 25%], three vessels [13.6% vs 12.5%] and more than three diseased vessels [6.8% vs 12.5%] p value > 0.05. Mean% narrowing of significant stenosis was in GI 82.915 +/- 15.821 vs 1181.114 +/- 16.286 with [p value > 0.05] but the number of segments was more in GI with p value 0.049. We still have much to learn about the pathophysiology of the acute coronary syndrome especially among thee young Egyptian patients. Age difference in acute coronary syndrome of Egyptian patients has no influence on other traditional risk factors although high prevalence of other risk factors in old age group especially serum level of low density lipoprotein [LDL-c], duration of diabetes mellitus and its micro-vascular complications may be related to long duration of these factors

Recent stents in patients of acute myocardial infarction clinically and angiographic results

Conronary thrombosis plays a major role in the pathogenesis of acute myocardial infarction. Between December 1998 to November 2000. 57 patients with acute myocardial infarction who were admitted at coronary care unit [CCU] of Sayed Galal and Al Housein University Hospital were included in this study. The patients were divided into two groups: G1: they had primary PCI. G2: [25 patients] they had received streptokinase followed by percutaneaus coronary intervention [PCI] within 24hs after failed thrombolysis [Persistent chest pain and/or extension of ST segment elevation]. The primary goal of therapy for acute myocardial infarction is rapid, complete and sustained restoration of infarct related artery [IRA] blood flow. Both fibrinolytic and mechanical restoration of antegrade coronary blood flow in patients have been shown to improve left ventricular function, reduce infarct size and reduce mortality. Although intravenous fibrinolytic therapy is effective in improving outcome after myocardial infarction and can be administered early to a great proportion of patients than is possible with percutaneaus coronary intervention, its effectiveness profile is disappointing to most cardiologists. The advantages of PCI include immediate visual assessment of reperfusion success and identification of the entire coronary and ventricular anatomy. This assessment often obviate the need for noninvasive testing befor hospital discharge and can lead to an accelerated discharge and recovery of low risk patients. The benefit of primary angioplasty seems greatest in elderly and those with high risk characteristics. The presence of the platelet rich thrombus in acute myocardial infarction and the central role of platelet activation in stent thrombosis suggest a potentially, advantagious role for the new class glycoprotein Ilb; llla receptor antagonists during PCI. Stenting in acute MI and in thrombus containing lesion has become a feasible and safer procedure in an expert hands, with new devices, high pressure deployment and with the use of [GPIIbIIIa blockers

Instent restenosis predictors of long coronary lesions

Balloon angioplasty of long coronary stenoses has been reported to be associated with a lower rate of acute clinical and procedural success and a higher rate of restenosis compared to short lesions. Intracoronary stenting has been shown to reduce restenosis, however, instent restenosis remains a major clinical problem despite improved stent flexibility and wall coverage and operator experience. The purpose of this study was to identify clinical, angiographic, and procedural predictors of restenosis after coronary stent placement in lesions longer than 15 millimeter. We analyzed the 6 month angiographic outcome of 378 patients [420 lesions]. All patients with successful coronary stent deployment and 6 month follow up were eligible for this study. Quantitative coronary coronary angiography [QCA] and intravascular ultrasound [IVUS] analyses were obtained immediately after stent deployment, and QCA at 6 months follow up. Restenosis was observed in 33.3% of lesions. By univariate analysis, stent length, number of stents per patient and per lesion, final IVUS lumen cross sectional area [CSA], and patients with multivessel disease were identified as the potential predictors of restenosis. Multivariate analysis identified final lumen CSA [OR= 0.85;95% CI=0.74-0.98, p=0.031] and stent length [OR=1.04;95% CI= 1.02-106, p=0.0001] as the only independent predictors of restenosis. Coronary stenting is associated with acceptable restenosis rate in this highly vulnerable cohort of lesions. Achieving an optimal final stent lumen CSA, and minimizing stent length as possible may help to reduce incidence of restenosis in this high risk group of lesions

Left ventricular diastolic filling dynamics during isometric exertion in patients with microvascular angina assessed with transmitral doppler flow velocities

The patients in this study were divided into three groups. The first group included 34 patients [22males and 12 females with a mean age of 48 +/- 3.21 years] with documented microvascular angina [typical anginal pain, positive electrocardiography on exercise with ST-T segment depression >1 mm, abnormal perfusion scans, normal coronary angiography]. The second group included 27 patients [19 males and 8 females having a mean age of 50 +/- 4.1 years with documented coronary artery disease. The third group included 15 healthy subjects of the same age group as controls [8 males and 7 females, mean age was 47 +/- 6.26 years]. Moderate isometric exertion [one half-maximal effort in one minute] produced approximately one-third increase in the mean arterial pressure and 30% increase in heart rate in all studied groups. In conclusion, isometric exertion, in form of firm sustained hand grip, induced left ventricular diastolic filling indices abnormalities in patients with microvascular angina. Similar changes were observed in patients with established diagnosis of coronary artery disease. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular abnormality in patients with microvascular angina