Surgical management for a retained guidewire in vivo during percutaneous coronary interventions following acute myocardial infarction from descending thoracic aorta to external iliac artery: a case report

This case report describes the unique presentation of a 60-year-old woman who was referred from the cardiology department due to the retention of a guidewire following a coronary angiogram. The guidewire was inadvertently left in the right external iliac artery after the angiogram procedure. This report discusses the clinical presentation, diagnostic procedures, and successful management of this case without unusual complication. The successful removal of the retained guidewire culminated in a favourable outcome for the patient. Efforts to extract residual guide-wire fragments from the coronary circulation are generally the preferred course of action. Nevertheless, certain case reports and series have proposed that, in carefully selected patients, leaving the guide-wires in situ without attempting extraction may be a reasonable option when the likelihood of successful removal appears remote, considering anatomical and technical factors. For such cases, a more suitable approach involves administering systemic anticoagulation and antiplatelet agents, coupled with vigilant follow-up.

Relationship between Urinary Albumin Creatinine Ratio and Severity of Coronary Artery Disease in Non-Diabetic Patients

ackground: Coronary artery disease (CAD) is leading cause of mortality worldwide. CAD accounts for 20% of all deaths in the South Asia region. The burden of CAD is emerging as a public health concern in developing countries like Bangladesh. There are some new biomarkers for detection of CAD. The aim of this study was to find out the relationship between ACR and severity of coronary artery disease in non-diabetic.Material & Methods:This cross-sectional analytical study was conducted in the department of cardiology, National Heart Foundation Hospital and Research Institute from April, 2018 to March, 2019. Purposive sampling was done to select a total 101 study subjects. Data were collected in a predesigned data collection form through clinical history, examination, laboratory findings and coronary angiogram report. Study population was divided into two groups: Group朅: Non-diabetic patients with ACR > 30mg/g Group朆: Non-diabetic patients with ACR ? 30mg/g.Results:Participants had a mean age of 52.5 � 9.9 years with 75.24% men. Group A patients had higher ACR level (49.98�.83 vs 13.36�08; p<0.01) than group B patients. Relation between urinary ACR and severity of CAD remained significant. Conclusions:In this study, there found a significant relationship in ACR and severity of coronary artery disease in non-diabetic patients.

Insulin resistance and the severity of coronary artery disease based on obesity status in stable-angina patients: A cross-sectional analysis

The evaluation of coronary artery disease (CAD) concerning the metabolic status and body mass index (BMI) is poorlystudied. This study was designed to observe the relationship between insulin resistance (IR) and the severity of CADon the basis of the metabolic and phenotypic status in stable-angina patients. A cross-sectional study was conductedon 532 patients with stable angina and coronary angiogram was done to diagnose the CAD for all. Determination ofmetabolic obesity was done using the National Cholesterol Education Program-Adult Treatment Panel III criteria.Phenotypic obesity was defined as BMI ≥ 25 kg/m2. Homeostasis model assessment IR in correlation with the severityof CAD was measured using SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for theTreatment of Narrowed Arteries) Score. The average age of the patients was 57.58 ± 10.40 years, and 69.4% weremales. Out of 532 subjects, 51.3% were hypertensive, 14.5% were smokers, 29.1% consumed alcohol, 49.3% weremetabolically obese, and 50% were phenotypically obese. Increase in IR increased the risk of severity of CAD inmetabolically obese subjects (OR = 2.51, p = 0.048). In the phenotypically obese group, the relationship between IRand the severity of CAD was not statistically significant (OR = −2.19, p = 0.08). The study concludes that the increasedIR increases the risk of severity of CAD in metabolically obese subjects.

Angiographic Profile Of Coronary Artery Disease In Women Undergoing Coronary Angiography In A Tertiary Care Hospital

BACKGROUND: Cardiovascular disease still remains the leading cause of death in women. The clinical and angiographic profiles of women undergoing CAG must be clearly understood. However there is not much data regarding the angiographic pattern of CAD in women undergoing CAG. AIM: Our aim was to study the angiographic pattern of coronary artery disease in women undergoing coronary angiogram in our institute. METHODS: The records of 275 consecutive female patients who underwent CAG in our institute from December 2017 to May 2018 were retrospectively analysed. The clinical and angiographic data were taken for detailed analysis from CAG reports and discharge summaries. Baseline characteristics of patients were noted. Angiographic pattern was analysed. All statistical analysis was performed using SPSS17 software. Ap-value <0.05 was considered statistically significant. RESULTS: In our study group, LAD was the most commonly involved vessel, followed by RCA and LCX respectively.26.91% had normal epicardial coronaries. 9.82% had minimal CAD. 28% had SVD;16.36% had DVD; 15.63% had TVD;21.8% had branch vessel disease. In our study, 7.63% had LMD.1.82% had coronary artery anomalies in the form of abnormal origin. In our study, the prevalence of multi vessel disease (DVD and TVD) is 32% among women undergoing CAG. CONCLUSION: There is a significant increase in the number of women diagnosed to have CAD. Understanding the angiographic pattern of CAD in women will give further insight towards aggressive coronary interventions in women.

The correlation of cardiovascular risk factors and angiographic findings with serum vitamin D levels in patients undergoing coronary angiography

Background: Studies regarding correlation of various conventional risks factors for Coronary Artery Disease (CAD) are many. Keeping in mind the scarcity of studies regarding Vit-D Deficiency (VDD), a new risk factor in CAD, present study was conducted to correlate Vit-D level with conventional risk factors and Coronary Angiography (CAG).Methods: Hundred adult patients admitted to Medicine and Cardiology undergoing CAG with suspected or established CAD were kept in study. Patients having renal, hepatic, parathyroid disease, osteomalacia and patients taking drugs interfering with Vitamin D (Vit-D) metabolism were excluded. After detailed history and thorough clinical examination, routine investigations and 25-(OH) D level was estimated. Subsequently patients underwent CAG. Statistical analysis by Mann Whitey test and Chi-square Test was done and inference was drawn.Results: 100 patients in different age groups had hypertension (HTN) in 53, diabetics mellitus (DM) 39, dyslipidemia 62, smokers 38 and family history of CAD 19. CAG showed normal coronaries in 4, Single Vessel Disease (SVD) in 30, double vessel diseases (DVD) 43 and triple vessel disease (TVD) 22. Vit-D level <20ng/ml i.e. Vit-D deficiency (VDD) in 68, 20-30ng/ml i.e. Vit-D insufficiency (VDI) in 22 and >30ng/ml (normal) in 10. VDD was profound in 51-60 and 61-70 years age groups. Statistical correlation of VDD was not significant with conventional risk factors, but statistically significant correlation of VDD was observed with dyslipidemia and CAG findings in our study.Conclusions: Like earlier studies we observed significant correlation of Vit-D levels with CAD. Though dyslipidemia was significantly correlated with VDD, correlation of other conventional risk factors like age, sex, HTN, DM, smoking and family history was not found. We conclude from this study presence of significant association of VDD with severe CAD. DVD and TVD by CAG were common with low Vit-D levels.

Relationship between fasting plasma glucose level and coronary lesions SYNTAX score / 中国介入心脏病学杂志

Objective To analyze the relationship between fasting plasma glucose (FPG) level and complexity of coronary artery lesions in patients with coronary stenosis by angiography. Methods The data of clinic and coronary angiogram (CAG) were retrospectively collected in 929 patients with established coronary stenosis by coronary angiography at Peking University Third Hospital from January 2009 to January 2011. The patients were grouped according to SYNTAX score, and the relationship between FPG level and SYNTAX score were analyzed using bivariate, Multivariate stepwise regression and logistic regression analysis. Results ①929 patients were devided into three groups:47 cases into low risk group (score<22), 189 into moderate risk group (score≥22 and<33) and 639 into high risk group (score≥33). Intergroup analysis showed that age (P=0.000), FPG level [5.20 (4.70,6.30) mmol/L, 5.70 (4.90,7.15) mmol/L, 5.80 (5.30,7.60) mmol/L, P=0.000], proportions of FPG abnormality [283 (40.8%), 100(52.9%), 28(59.6%), P=0.001] and patients with diabetes history (P=0.003) were increased along with SYNTAX score elevated.②Correlation analysis showed correlativity (r=0.167, P=0.000) between SYNTAX score and FPG. In non-diabetes history subgroup, correlation between SYNTAX score and FPG remained signiifcant (r=0.149, P=0.000). However, in diabetes history subgroup, the correlation was not significant. ③ Multivariate stepwise regression analysis showed an independent correlation between FPG and SYNTAX score (β=0.452, P=0.002). In non-diabetes history subgroup, the correlation remained significant (β=1.039, P=0.000).④ When moderate-high risk group serve as dependent variable, and age, gender, CAD risk factors and FPG serve as independent variables, logistic regression analysis screened out two variables:age (whole group:OR 1.033, 95%CI 1.017 ~ 1.049, P=0.000;non-diabetes history subgroup:OR 1.039, 95%CI 1.020 ~ 1.059, P=0.000) and FPG (whole group: OR 1.114, 95% CI 1.038 ~ 1.195, P=0.003; non-diabetes history subgroup:OR 1.299, 95%CI 1.088 ~ 1.387, P=0.001). Conclusions FPG is likely to relfect complexity of coronary artery lesions and predict SYNTAX score in patients with coronary stenosis, especially in patients without diabetes history.

Demographic Profile, Clinical Presentation & Angiographic Findings in 637 Patients with Coronary Heart Disease.

Cardiovascular diseases are the commonest cause of death globally and are the major contributor to the burden of premature mortality and morbidity. This study analyses various clinical presentations, conventional risk factors, pattern and severity of coronary heart disease on angiography among 637 patients with coronary heart disease and adult congenital heart disease who underwent cardiac evaluation at National Institute of Cardiovascular Disease (NICVD), Dhaka between January 2007 to December 2008. Among them 547 (85.9%) were male and 90 (14.1%) were female. All of them were between 22 to 76 years of age with mean age 50.15±8.8. One hundred sixty nine (25.9%) patients had chronic stable angina & 398 (62.48%) patients subjected for coronary angiography for acute coronary syndrome and or old myocardial infarction and 74 (11.62%) patients with vascular and adult congenital heart disease prior to surgical treatment. Most prevalent risk factors were smoking (60%) and dyslipidaemia (60%). Thirty five percent patients were hypertensive and 10% patient had diabetes. Normal epicardial coronaries were documented in 25.59% patients which includes the patients who underwent coronary angiography prior to surgical treatment. Ninety three (14.6%) had single vessel disease, 119 (18.68%) had double vessel disease, 259 (40.66%) had triple vessel disease and 3 (0.47%) had isolated left main disease.

Coronary Angiographic Profile in Patients with Conduction System Disorder Requiring Permanent Cardiac Pacing.

Background: The association between conduction disturbances and atherosclerotic coronary artery disease has been investigated in a few small studies in the early 1970s and the study result was inconclusive. Thereafter some investigators found in their separate study that a group of patients with conduction disturbances that required permanent pacemaker who had coronary atherosclerotic disease that might be responsible for conduction disturbances. Method: 40 consecutive patients that required permanent pacemaker and 40 control patients were investigated. The coronary angiographic study was performed in both groups which included classification of pathological coronary anatomy, qualitative assessment of flow and stenosis severity. Results: The location of the lesions was found significantly different between two groups. 14 patients(35%) of 40 study patients had type IV lesion, whereas only 2 patients(5%) of 40 control patients had type IV lesion (p=0.001). Flow quality was found poor in more patients in study group specially that had type IV lesion. Severity of the lesions in the LAD & RCA was found identical in both groups. Conclusion: It may be concluded that the location of the lesions rather than diffuse coronary atherosclerosis might be responsible for a subset of patients with conduction disturbances that required permanent pacemaker.

Coronary Angiographic Characteristics of Patients with First Myocardial Infarction Admitted in a Tertiary Care Cardiac Hospital in Bangladesh.

Background: Coronary artery lesion characteristics of patients with First myocardial infarction (First MI) of Indian subcontinent origin in UK, is different from indigenous white population. The present study was aimed to observe coronary angiographic profile of first MI patients, hospitalized in a tertiary care hospital, in Bangladesh and to compare the results with published data of study done home and abroad. Methods: This is a prospective observational study. A total of 100 cases of First MI patients were included in this study. Clinical history, physical examination, major risk factors, relevant investigations including ECG & Echocardiogram and coronary angiogram of all patients were recorded. Results: The coronary angiographic features of 100 patients revealed that 88% of the study population had significant coronary artery lesion (stenosis e”70%). Normal coronary arteriogram was found in 5 patients (5%); although they had myocardial infarction previously. Insignificant lesion (stenosis < 70%) was detected in 7 patients (7%). Left anterior descending (LAD) arteries were affected in most of the patients (78%), followed by right coronary artery (62%) and left circumflex artery (55%). Single vessel disease (33%) and triple vessel diseases were equally prevalent among the study population. Conclusion: Present study observed that triple vessel disease, diffuse pattern of lesions and combined type of lesions were more prevalent among the first MI patients. Increase in the number of risk factors was associated with progressive increase in severity of disease as defined by number of significant stenosis. Comparison of results of present study population with that of study done abroad shows that single vessel disease was more prevalent among European white patients who had first MI but triple vessel disease was more prevalent among our patients.

A survey on Patients' Compliance with Follow-up Coronary Angiogram after Coronary Intervention / 성인간호학회지

Coronary intervention is now a well established method for the treatment of coronary artery disease. Coronary restenosis is one of the major limitations after coronary intervention. So medical teams advise the patients to get the follow-up coronary angiogram in 6 months after coronary intervention to know if the coronary artery stenosis recurs or not. This study was done in order to know how many patients complied with the advice, and to identify the relative factors to the compliance with getting the follow-up coronary angiogram. The subjects were 101 patients (male: 58 female: 22, mean age: 61+/-15), who received coronary interventions from Jan. 1st to Mar. 31st 1997, and their data were collected from them by questionnaires one year after intervention. The questionnaires consisted of family support scale, self efficacy scale and compliance with sick role behavior scale. The result may be summarized as follows. 1. The number of patients who complied with getting the follow-up coronary angiogram were 37 people(36.6%) and did not comply with it were 64 people(63.4%). All scores of family support(t=5.56, p.05). 2. The major motivations for getting follow-up coronary angiogram were recurrence of subjective symptom(40.5%), the advice of medical team(32.4%), and fear of recurrence (27.1%). The restenosis rate in patients who got the follow-up coronary angiogram was 37.8%. 3.The restenosis rate was higher in the patients who had subjective symptoms than in those who did not have any subjective symptom. So subjective symptom and restenosis rate showed a high positive correlation(r=39.9, p<.001). However, 27.2% of the patients who did not have any subjective symptom showed coronary restenosis. 4. The reasons why they did not get the follow-up coronary angiogram were economic burden(37.5%), improved symptom(34.4%), busy life schedule(10.9%), fear of invasive procedure(9.4%), negative reaction of family member(3.1%), no helper for patient(3.1%) and worry about medical team's mistake (1.6%). The relative fators on compliance with getting the follow-up coronary angiogram after coronary intervention were family support, self-efficacy and Compliance with sick role behavior. And the most important reason why the patients did not get the follow-up coronary angiogram after coronary intervention was an economic burden.

Comparison between Intravascular Ultrasound and Quantitative Coronary Angiographic Measurements in Coronary Artery Stenting

BACKGROUND: To overcome the limitation of angiography, intravascular ultrasound(IVUS) is widely used to guide coronary stent implantation. We compared the quantitative measurements of IVUS and quantitaitve coronary angiographic(QVA) analysis after stent implantation. METHODS: Thirty nine patients with 39 coronary lesions underwent coronary stent implantation. The implanted stents were CrossFlex stent in 17, NIR stent in 13, Palmaz-Schatz stent in 6, Multilink stent in 2 patients, and Divysio stent in 1 patient. Post-stent IVUS procedure with automatic pullback device was performed successfully in all patients after angiographic optimization. IVUS and QCA measurements included the minimum lumen diameter at proximal and distal reference artery, and stented site after intracoronary administration of 0.2mg nitroglycerin. RESULTS: IVUS and QCA measurement of minimal luminal diameter(MLD) at proximal and distal reference artery, and stented site correlated reliably each other(r=0.62, p<0.01 ; r=0.77, p<0.01 ; r=0.73, p<0.01 respectively). Event if insignificant statistical difference, there was a tendency of larger MLD at proximal and distal reference artery by IVUS measurement than by QCA measurement(3.2+/-0.5mm vs. 3.1+/-0.4mm, p=0.2 : 3.1+/-0.6mm vs. 3.0+/-0.7mm, p=0.2, respectively). The MLD at stented site was significantly larger by QCA measurement than by IVUS measurement(3.2+/-0.6mm vs. 2.9+/-0.5mm, p<0.05). CONCLUSIONS: We concluded 1) the correlation between IVUS and QCA measurements of reference vessel and stented site was reliable. 2) There was a tendency of larger luminal diameter at reference vessel by IVUS than by QCA. 3) The minimal luminal diameter was measured significantly larger at stented site by QCA than by IVUS.

Relationship between Circardian Variation of Acute Myocardial Infarction and Morphologic Characteristics of Coronary Artery Lesions

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.

Relationship between Circardian Variation of Acute Myocardial Infarction and Morphologic Characteristics of Coronary Artery Lesions

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.

Clinical Value of Exercise TI-201 SPECT in Patients with Chest Pain and Normal Coronary Angiogram

BACKGROUND: The interest of patients with chest pain and normal coronary arteries has been increased since 1960. From the year 1973, the syndrome representing these characteristics has been classified as syndrome X. Treadmill test and exercise TI-201 SPECT are important in the diagnosis of syndrome X. This study was designed to evaluate the clinical value of exercise TI-201 SPECT and the difference of clinical characteristics between exercise TI-201 SPECT positive(Group A) and negative (Group B) in patients with chest pain and normal coronary angiogram. METHODS: Twenty seven patients with chest pain and normal coronary angiogram underwent echocardiogram and exercise TI-201 SPECT. Patients received 2 mCi of thallium intravenously during exercise, redistribution images were performed 4 hour later and second dose of 1 mCi of thallium was injected at rest immediately thereafter. These three sets of image(stress, redistribution and reinjection) were analyzed. RESULTS: 1) 12 of 16 patients in Group A, none of 11 patients were positive on exercise treadmill test(p<0.005). 2) The incidence of systemic hypertension in Group A was significant greater than Group B(p<0.05). 3) The left ventricular end diastolic pressure was significantly higher in Group A than in Group B (p<0.05). CONCLUSION: The exercise TI-201 SPECT is a useful method to evaluate the patients with chest pain and normal coronary angiogram and the reversible perfusion defects on the exercise TI-201 SPECT might be related to systemic hypertension and elevated left ventricular end diastolic pressure.

Coronary Angiographic Findings and Risk Factors in Acute Myocardial Infarction Patients before after Age 50

BACKGROUND: A number of studies in western countries have shown that coronary artery disease(CAD) and younger patients with acute myocardial infarction(AMI) is less extensive but more. closely related to cigarette smoking. However, there are some similarities between the characteristics of the CAD and the risk factors analyzed by age subsets in patients with AMI in Korea. METHODS: Pre-discharge coronary angiograms and risk factors in 194 patients with first AMI(male/female : 154/40,79.4%/20.6%) were analyzed. A comparison was made between the lesion characteristics of the infarct related artery(IRA) and the CAD risk factors. Those under 49 years old (Group I, n=54, male/female : 50/4 : 92.6%/7.4%) and those over 50 years old ( Group II, n=140, male/female : 104/36 : 74.3%/25.7%). RESULTS: There are 54 and 140 patients in groups I and II respectively. 92% of group I and 74.1% of group II were male (p<0.01). At the time of study, more group I patients were smoking cigarettes and drinking alcohol(over 3 times per week 22.6% vs 11.5%, p<0.01) and insignificant stenosis was more common in group I than in group II. In both groups, the most common IRA was the left anterior descending artery and concurrently the anterior wall was the most common morphological type of coronary stenosis of IRA was concentric irregular in group I(27.7%) and eccentric smooth in groupII(31.5%). Although group I had the larger minimal cross sectional area of coronary stenosis(0.97+/-1.16mm2 and 0.54+/-0.80mm2, respectively, p<0.05, reference diameters 2.71+/-0.60mm and 2.66+/-0.67mm, respectively),the coronary lesion was shorter in group I patients(3.39+/-4.06cm and 5.49+/-6.13cm respecitively, p=0.03). CONCLUSION: These findings reveal that coronary atherosclerotic lesions of IRA in patients with AMI in the younger age group are less severe. However, they are more closely related to cigarette smoking and alcohol intake, than cases in the older age group.

Coronary Angiographic Findings and Risk Factors in Acute Myocardial Infarction Patients before after Age 50

BACKGROUND: A number of studies in western countries have shown that coronary artery disease(CAD) and younger patients with acute myocardial infarction(AMI) is less extensive but more. closely related to cigarette smoking. However, there are some similarities between the characteristics of the CAD and the risk factors analyzed by age subsets in patients with AMI in Korea. METHODS: Pre-discharge coronary angiograms and risk factors in 194 patients with first AMI(male/female : 154/40,79.4%/20.6%) were analyzed. A comparison was made between the lesion characteristics of the infarct related artery(IRA) and the CAD risk factors. Those under 49 years old (Group I, n=54, male/female : 50/4 : 92.6%/7.4%) and those over 50 years old ( Group II, n=140, male/female : 104/36 : 74.3%/25.7%). RESULTS: There are 54 and 140 patients in groups I and II respectively. 92% of group I and 74.1% of group II were male (p<0.01). At the time of study, more group I patients were smoking cigarettes and drinking alcohol(over 3 times per week 22.6% vs 11.5%, p<0.01) and insignificant stenosis was more common in group I than in group II. In both groups, the most common IRA was the left anterior descending artery and concurrently the anterior wall was the most common morphological type of coronary stenosis of IRA was concentric irregular in group I(27.7%) and eccentric smooth in groupII(31.5%). Although group I had the larger minimal cross sectional area of coronary stenosis(0.97+/-1.16mm2 and 0.54+/-0.80mm2, respectively, p<0.05, reference diameters 2.71+/-0.60mm and 2.66+/-0.67mm, respectively),the coronary lesion was shorter in group I patients(3.39+/-4.06cm and 5.49+/-6.13cm respecitively, p=0.03). CONCLUSION: These findings reveal that coronary atherosclerotic lesions of IRA in patients with AMI in the younger age group are less severe. However, they are more closely related to cigarette smoking and alcohol intake, than cases in the older age group.

Clinical Observation on Acute Myocardial Infarction in Korean Adults

BACKGROUND: Recently, the incidence of acute myocardial infarction increased with prolongation of life spans, improvements in food and life styles in Korea, But only few studies were reported after the newly developed diagnostic methods and treatment modalities were introduced. So, the study on left ventricular ejection fraction, findings in coronary angiography, uses of thrombolytic agents was needed. METHOD: A retrospective clinical study was done on 654 patients with acute myocardial infarction who had been admitted to Severance hospital from January 1985 to December 1991 within 30 days after the onset of symptoms. Coronary angiogram and radionuclide ventriculography was done as usual methods. RESULT: The mean age was 58.5 years, and the ratio of males to females was 3.3:1, The major risk factors were smoking, hypertension and diabetes mellitus in males. and hypertension, diabetes mellitus and obesity in females. Arrhythmias were found in 360 patients(56.4%). The most frequent arrhythmia was premature ventricular contraction. Sinus bradycardia and atrioventricular were more frequent in inferior infarction but sinus tachycardia, ventricular tachycardia were more frequent in anterior infarction. The peak serum CK and CK-MB levels were higher in patients of anterior infarction than in those of inferior and non-Q wave infarction. The left ventricalar ejection fractions were higher in the patients with non-Q wave infarction, inferior infarction than in the patients with anterior infarction. There was no difference in left ventricular ejection fraction between patients who received thrombolytic therapy and not treated patients. Coronary angiograms were performed in 362 patients and 184 patients (50.8%) had one-vessel disease. The short-term mortality rate was 15.1%. The most common cause of death was cardiogenic shock(60.6%). Poor prognosis was found in patients with a history of previous myocardial infarction, those over 60 years old, those with a complete heart block and those of the female sex. The short-term mortality was higher in anterior infarction than inferior infarction and short-term mortality was higher in Q wave infarction than non-Q wave infarction. CONCLUSION: This study suggests that smoking was the most common risk factor but hypercholesterolemia and obesity were less significant. According to coronary angiogram, one-vessel disease was the most common, and the rate of insignificant reduction in luminal diameter was higher than western countries. The short-term mortality rate of acute myocardial infarction was higher than those of western countries. The cause of high mortality rate was considered due to delay in transportation of patients to hospital. The education about acute myocardial infarction should be done to public and transportation system must be improved.

Clinical Evaluation in Patients with Acute Myocardial Infarction with or without Significant Coronary Artery Stenosis

BACKGROUND: It has been recognized for many years that myocardial infarction is almost invariably associated with significant narrowing of one or more coronary arteries. However, the widespread use of selective coronary angiography has resulted in an increasing number of reports of patients with proved infarction and patent coronary arteries. The purpose of this study was to analyze whether any clinical features distinguishes patients with these findings from those having coronary arterial lesions. METHODS: The clinical association of myocardial infarction with no significant stenosis of major coronary artery on cineangiogram was analysed retrospectively. The findings on the 13 patients in this group was compared with those of myocardial infartion with significant coronary artery stenosis. RESULTS: There were no significant differences in risk factors, hemodynamic findings of cardiac catheterization and the site of infarction between both groups. However, the patients with no significant stenosis of coronary artery had fewer complications during hospitalization and lesser ST segment change during exercise test before discharge. CONCLUSION: It could be concluded that the acute myocardial infarction with no significant stenosis of coronary arteries would have the better prognosis. The mechanism of the acute myocardial infarction with no significant stenosis of coronary arteries might be studied in the aspect of the coronary artery spasm and the alternation of function of endothelial cell.

Evaluation of Severity of Coronary Artery Disease by Exercise Electrocardiographic Test

Exercise-induced ischemic ST responses were analyzed in 36 patients who presented with chest pain and had exercise test and the results were compared with their coronary angiographic findings. Among 36 exercise test positives, the incidences of one-, two- and three vessel disease, and left main disease were 25%(9 cases), 30%(11 cases), 25%(9 cases) and 9%(3 cases), respectively. The incidence of multivessel disease(i.e., two-to three vessel disease or left main disease) in patients with ST depression > or =2.0mm was 72% and that in those with ST depression of 1.0-1.9mm was 45%. In patients with downsloping ST depression, the incidence of multivessel disease was significantly higher than that of one vessel disease(86% vs 14%, p<0.001). But both incidences of one vessel disease and multivessel disease were similar in patients with flat and slowly upsloping ST depression. More than two thirds of patients with ischemic ST depression appearing in the first 6 minutes of exercise or those lasting past 7 minutes in recovery were associated with multivessel disease. It is concluded that attention to depth, type, appearance time and duration of ST depression during exercise test is particularly helpful in detecting patients with advanced coronary disease.