The Clinical Outcome of Acute Myocardial Infarction with Normal Coronary Angiogram

BACKGROUND AND OBJECTIVES: Little data exist concerning the clinical outcome of patients with acute myocardial infarction (AMI) and angiographically normal coronary arteries (NCA). The purpose of this study was to evaluate the clinical outcome, the etiological factors and prognosis of these patients. SUBJECTS AND METHODS: The subjects were divided into two groups according to findings from coronary angiograms performed between January 1999 and December 2001, Group 1 : comprised of 46 patients, 34 males and 12 females, with a mean age of 50.4+/-11.9 years, had AMI with NCA ; Group II : 181 patients, 143 males and 38 females, with a mean age of 59.0+/-10.3 years, with AMI and total occlusion of the coronary arteries. RESULTS: The percentages of smoking and hypertension were similar between the two groups ; a higher prevalence rates of hyperlipidemia and diabetes were observed in group II compared to group I (p=0.03, 0.01). In group I, coronary spasm, combined inflammatory diseases and embolization were demonstrated in 32.6, 6.5 and 4.3% of subjects, respectively. The left ventricular ejection fraction was higher in group I than group II (51.5+/-11.3% vs. 46.2+/-10.5%, p=0.006). In-hospital outcomes, with the combined end-point defined as death, re-infarction and stroke was 0% in group I vs. 7.7% in group II (p=0.07). The mean long-term survival rate during the 26.5-month clinical follow-up were 100 and 92.2% in groups I and II (p=0.04), respectively. CONCLUSION: A coronary spasm is the most common cause of AMI with NCA, but these patients had the higher long-term clinical event-free survival.

The Changes of Fractional Flow Reserve after Intracoronary Nitrate and Nicorandil Injection in Coronary Artery Ectasia

BACKGROUND AND OBJECTIVES: Little data exist relating to the mechanism of myocardial ischemia in patients with coronary artery ectasia (CAE). The purpose of this study was to evaluate the fractional flow reserve (FFR), as an index of myocardial ischemia, in patients with CAE. SUBJECTS AND METHODS: Ten patients (7 males, 54.0+/-12.6 years) who diagnosed as CAE, by coronary angiographies, between March 2002 and July 2002, were analyzed. The clinical diagnosis of all the patients was unstable angina. FFR were performed using a pressure wire on the patients diagnosed with slow flow CAE from their coronary angiograms. After measurement of the baseline FFR using adenosine 20 microgram for the right coronary artery, and 24 microgram for the left anterior descending artery, the changes in the FFR with 500 microgram of intracoronary nitrate and 2 mg of Nicorandil were observed. RESULTS: Smoking was the most frequently associated risk factor. Type I CAE, according to Markis' classification, was the most prevalent at 60.0%. The values of the baseline FFR in the left anterior descending artery and right coronary artery, following the intracoronary injection of adenosine were both normal, and there were no significant changes in the FFR following the intracoronary injections of nitrate and Nicoronadil. CONCLUSION: The value of the FFR with CAE was normal, and an intracoronary injection of vasodilators did not change the FFR in patients with CAE. Therefore, vasodilator therapy might be beneficial for patients with symptomatic CAE.

A myocardial sling in proximal right coronary artery / 대한내과학회지

Myocardial bridge is characterized by systolic compression of a portion of the coronary artery by a segment of overlying myocardium, commonly involves the middle segment of left anterior descending coronary artery. We present a case report of coronary angiographic evidence of systolic short segmental constriction in the proximal right coronary artery (RCA). A 42 year-old man presented with atypical chest discomfort and palpitation. Electrocardiography showed complete AV block with complete AH block on intracardiac electrocardiogram. Myocardial SPECT imaging demonstrated a mild reversible anterior and inferior wall perfusion defect. Diagnostic coronary angiogram revealed short segmental myocardial sling with wedge-shaped systolic compression in the proximal RCA.

The Effects of Serum Homocysteine on the Restenosis after Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Hyperhomocyt(e)inemia is known to be one of independent risk factors for the ischemic heart diseases recently, but the role of hyperhomocysteinemia in restenosis after coronary intervention is unclear. The relationship between plasma homocysteine level and restenosis after coronary intervention was evaluated in Korean patients. MATERIALS AND METHOD: Eighty three patients underwent successful percutaneous coronary intervention (PCI) and follow-up coronary angiography were divided into two groups according to restenosis, and the level of plasma homocysteine was compared between groups with restenosis (n=5, M:F=7:8, 60.6+/-13.5 years) and without restenosis (n=8, M:F=0:8, 60.3+/-12.8 years). RESULTS: The clinical manifestation, atherosclerosis risk factors except for hypertension, and coronary angiographic findings were not significantly different in patients with or without restenosis(P=S). The value of homocysteine was 9.3+/-3.1 micromol/L in 35 patients with restenosis and 8.4+/-2.5 micromol/L in 48 patients without restenosis(P=S). All of 8 patients whose values of plasma homocysteine were more than 13 micromol/L, had angiographic restenosis. Plasma homocysteine was not an independent risk factor of restenosis by means of logistic regression analysis. CONCLUSION: Plasma homocysteine is not a potential risk factor of restenosis after percutaneous coronary intervention.