Acute Myocardial Infarction Induced by Thrombi within the Coronary Artery Aneurysms of a Young Male SLE Patient

We describe the case of a 30-year-old man with systemic lupus erythematosus (SLE) and he was struck with non-ST segment elevation myocardial infarction: this was due to the presence of multiple coronary artery aneurysms those were full of thrombi. A diagnostic coronary angiogram revealed huge dilatations in the proximal three coronary arteries with multiple filling defects and a decreased flow rate, and these were suggestive of thrombi within the coronary artery aneurysms. An intravascular ultrasound (IVUS) examination revealed huge aneurysmal dilatations with movable thrombi in three coronary arteries. He had an uneventful recovery without us having to perform any percutaneous coronary intervention.

A Case of Metastatic Intracardiac Rhabdomyosarcoma Arising from Malignant Tumor in Other Site

A 29-year old woman was admitted to the hospital with dyspnea and chest pain. She had undergone a craniotomy due to anaplastic astrocytoma 4 months ago and mass excision of right calf and vagina 3 months ago. The histopathological findings of masses were embryonal rhabdomyosarcoma. Echocardiography showed a highly mobile elongated mass in left atrium and the mass protruded through the aortic valve during systole. Histopathological examination of the resected cardiac tumor showed cells of embryonal rhabdomyosarcoma.

The Clinical Effects of Abciximab Combined with Dalteparin for High-Risk Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The therapeutic efficacy of combined platelet glycoprotein IIb/IIIa receptor blocker with low molecular weight heparin (LMWH) is unknown for patients with acute myocardial infarction (AMI) and who underwent percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: A total of 140 patients with AMI and who underwent high-risk PCI was divided into two groups: UFH (group I: 70 patients, 58.7+/-10.5 years of age), and dalteparin (group II: 70 patients, 59.6+/-9.8 years of age). The major adverse cardiac events (MACE) during hospitalization and during the 4 years after PCI were evaluated. RESULTS: The baseline clinical characteristics and angiographic characteristics were not different between the two groups. There were 62.9% totally occluded lesions with thrombus in both groups. Procedural success was achieved for 91.4% of the group I patients and for 90.0% of the group II patients. Any bleeding and hemorrhagic events were not different between the two groups. No significant intracranial bleeding was observed in both groups. The number of in-hospital MACEs was 7 (10.0%) in group I and 4 (5.7%) in group II. Four-year clinical follow-up was performed for 97% of the patients. As a result of the MACEs during the 4 years after PCI, death occurred in 6 (8.6%) patients in group I and in 7 (10.0%) patients in group II. Myocardial infarction occurred in 4 (5.7%) and 4 (5.7%) patients, respectively, target vessel revascularizations were done in 23 (32.9%) and 16 (22.9%) patients, respectively, and coronary artery bypass surgery was done in 3 (4.3%) and 1 (1.4%) patients, respectively. Overall, MACEs occurred in 33 (47.1%) patients of group I and in 26 (35.1%) patients of group II during the 4-year clinical follow-up (p=0.23). CONCLUSION: The long-term clinical outcome of dalteparin combined with abciximab is comparable with that of UFH plus abciximab for the high risk patients with AMI who receive PCI.

Successful Management of a Patient with Factor XI Deficiency and Unstable Angina by Percutaneous Coronary Intervention

Factor XI deficiency is a very rare congenital coagulation disorder. Bleeding complications should be considered when treating a patient with unstable angina and congenital coagulation disorder during and after percutaneous coronary intervention (PCI). Thrombotic complications can develop after fresh frozen plasma (FFP) transfusion and drug-eluting stent (DES) implantation. We report here on the successful management of a patient having unstable angina with factor XI deficiency, and this patient was treated with PCI under intravascular guidance and with the aid of FFP and hemostatic devices.

Long-Term Clinical Outcomes after Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction Older than 75 Years

BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term follow-up, compared with thrombolytic therapy for acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients. SUBJECTS AND METHODS: Two hundred and twenty three patients (Group I: n=66, age> or =75 years, Group II: n=157, age<75 years), who underwent primary PCI for AMI at Chonnam National University Hospital, between 2000 and 2002, were analyzed according to their clinical, angiographic characteristics, inhospital and one-year survival. RESULTS: Group I had a higher percentage of women (45.5% vs. 19.1%, p=0.00), multi-vessel disease (42% vs. 28%, p=0.031), right coronary artery disease (52% vs. 33%, p=0.021), and more frequent histories of diabetes mellitus (35% vs. 22%, p=0.039) and less smoking (38% vs. 60%, p=0.003) than Group II. Successful reperfusion by PCI was achieved in 97 and 96 %, respectively (p=NS). The rates of in-hospital mortality were similar in both groups (12.1% vs. 8.2%, p=NS). There were no significant differences in the major adverse cardiac events between the two groups during the one-year clinical follow-up (31.4 % vs. 36.9 %, p=NS). CONCLUSION: Primary PCI in AMI patients older than 75 years can be performed with comparable procedural success rates and long-term clinical outcomes to those of younger patients.