Technetium-99m-sestamibi SPECT to detect restenosis after successful percutaneous coronary angioplasty.

UNLABELLED: This study evaluated the accuracy of 99mTc SPECT in predicting restenosis after primary successful PTCA. METHODS: Thirty-seven patients with equivocal symptom-limited exercise stress testing were evaluated. All patients underwent separate day exercise-rest 99mTc-sestamibi SPECT. The perfusion studies were evaluated using three different methods of analysis: visual inspection, semiquantitative and quantitative polar map analysis. The perfusion studies were interpreted in absence of a pre-PTCA scan. All patients underwent a control coronary angiography within 1 mo. RESULTS: Sensitivity and specificity of 99mTc-sestamibi SPECT in predicting restenosis were 87.5-78%, 50-65% and 75-74% for visual inspection, semiquantitative and quantitative polar map analysis, respectively. Sensitivity and specificity related to the vascular territories were: LAD territory 93-73% (qualitative analysis), 53-60% (semiquantitative analysis), 80-67% (quantitative analysis); LCX territory 83-100% (qualitative analysis); and 33-100% (semiquantitative analysis), 67-100% (quantitative analysis); and RCA territory 67-80% (qualitative analysis), 67-60% (semiquantitative analysis), 67-80% (quantitative analysis). CONCLUSION: These data suggest that 99mTc-sestamibi SPECT is a useful noninvasive tool in the follow-up evaluation of patients who have undergone angiographically successful coronary angioplasty even in the absence of a pre-PTCA perfusion study.

[Coronary angioplasty in chronic total occlusion: angiography results, complications, and predictive factors]. / L'angioplastica coronarica nelle occlusioni totali croniche: risultati angiografici, complicanze e fattori predittivi.

The results of coronary angioplasty of chronic total occlusions are still controversial. We examined baseline clinical and angiographic parameters and the success and complication rates of 142 consecutive procedures of coronary angioplasty of chronic occlusions selected among 1084 total procedures performed between January 1989 and May 1993. Procedural success was obtained in 109 procedures (77%) with 4 major cardiac complications (2.8%) consisting in one cardiac death caused by left main artery occlusion following an attempt of dilatation of an occluded left anterior descending artery, two non Q wave myocardial infarctions caused by distal embolization and one cardiac tamponade following artery perforation, successfully treated by pericardiocentesis. Extensive coronary dissection occurred in 24 procedures (17%): 5 caused vessel reocclusion and 19 were successfully treated by prolonged balloon inflation and/or use of long balloons or stent implantation. Among 15 baseline clinical and angiographic variables, none was predictive of cardiac complications or coronary artery dissection. In contrast, procedural success was significantly related with absence of bridging collaterals, duration of occlusion < 3 months and a tapered or thrombotic morphology of occlusion. Presence or absence of collaterals was the most significant variable selected by multivariate discriminant analysis. When patients with bridging collaterals were excluded from the analysis, occlusion morphology was the most important determinant. Success rates were 95% and 82% in patients with a tapered morphology lesion with < 3 months and > 3 months duration, respectively (ns); in contrast, success rates were 79% and 36% in patients with abrupt occlusion morphology of < and > 3 months duration (p = 0.001).

[Stable angina: long-term results]. / Angina stabile: risultati a lungo termine.

We report on 345 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) for stable angina in a 5-year period, with an average follow-up of 34 months (range 12-72). The primary success rate was 94.5%. The late mortality and incidence of myocardial infarction were 1.5% and 2.1% respectively. The rate of recurrence of angina was 34.5% and required PTCA (28.5%) and/or coronary artery bypass grafting (7%). At the end of follow-up 79.5% of patients were free from angina and a further 10% had improved. Our data confirm the importance of PTCA in stable angina.

[Prognosis in patients with myocardial infarction and angiographically normal coronaries]. / La prognosi nei pazienti con infarto miocardico e coronarie angiograficamente normali.

From a survey on 8,000 coronary angiographic studies performed in our Institute between January 1980 and June 1990, 105 patients were identified as having angiographically normal coronary arteries and myocardial infarction (MI). Coronary arteries considered as normal were subdivided in completely normal (Group I), or slightly abnormal, with minimal lesions resulting in less than 30% narrowing of a major artery, defined as mild coronarosclerosis (Group II). Thirty-five patients were excluded from the study, because of the lack of complete follow-up data; the remaining 70 patients represent the study group we examined. The following parameters were examined: sex, age at the time of acute MI, family of ischemic heart disease, hypertension, dyslipidemia, diabetes, smoking, stable or unstable angina before MI, location of the MI, ejection fraction (EF), presence of completely normal coronary arteries or mild coronarosclerosis. Follow-up was obtained by contacting the patients or their families; post infarction angina, reinfarction, sudden death or cardiac death were noted. The subjects were divided in 2 groups, according to the coronary anatomy; Group I consisted of 41 patients with completely normal coronary arteries and Group II consisted of 29 patients with mild coronarosclerosis. No significant statistical difference was noted between the 2 groups regarding age, sex and coronary risk factors (except for dyslipidemia which was significantly more prevalent in the subjects with mild coronarosclerosis). Prevalence of left ventricular impairment (EF < 45%) and coronary events (angina, reinfarction and death) were significantly higher in Group II. There was no significant difference in age or clinical risk factor prevalence between patients with complicated and non complicated clinical course.(ABSTRACT TRUNCATED AT 250 WORDS)

Invasive and echocardiographic evaluation of non-Q myocardial infarction with isolated stenosis of descending anterior coronary artery.

Prognostic and clinical characteristics of acute myocardial infarction (AMI) can usually justify surgical and/or angioplastic approach if the residual ventricular function is still good. Multivessel disease frequently complicates results interpretation. We studied with 2D echocardiography and coronary angiography two groups of patients with one vessel stenosis located on anterior descending (AD) and previous AMI (means 19 days): 23 patients with spontaneous non-Q infarction (group 1), and 23 patients with Q infarction. Left ventricular function was better in group 1. Percent occlusion of AD was lower in group 1 and angiographic AD caliber was significantly higher. Differences between groups were much more evident in subgroups with proximal stenosis of AD: patients of non-Q subgroups had very good left ventricular function but frequently had post-AMI instable angina (88%). Our results underline the usefulness of aggressive diagnostic and therapeutic approach in non-Q AMI, because of higher amount of myocardium at risk.

[Lower myocardial infarct with depression of the ST segment in anterior precordial leads. Correlation of the electrocardiogram, coronarography and ventriculography performed in the acute phase]. / Infarto inferiore con sottoslivellamento del tratto ST nelle derivazioni precordiali anteriori. Correlazione fra elettrocardiogramma, coronarografia e ventricolografia eseguiti in fase acuta.

We report on 11 pts affected by acute inferior myocardial infarction (group A: 4 pts without precordial ST-segment depression; group B: 7 pts with ST precordial ST-segment depression). These pts underwent left and right coronarography and left ventriculography in the course of intracoronary thrombolysis. We did not observe, in the group B pts, an involvement of the LAD branch of the left coronary, neither contractility abnormalities of the left ventricular anterior wall. ST depression in the precordial leads was associated with severe and extensive abnormalities of left ventricular inferior wall contractility.

[Acute myocardial infarction in a 13-year-old boy with Duchenne's disease]. / Infarto acuto del miocardio in un tredicenne con malattia di Duchenne.

A 13-year-old boy with Duchenne's muscular dystrophy suffered an acute myocardial infarction as shown by typical electrocardiographic and enzyme changes, and by the results of radionuclide studies. this is the third reported case of the acute myocardial infarction in a patient with Duchenne's muscular dystrophy.