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1.
Heart Surg Forum ; 23(4): E498-E506, 2020 Jul 20.
Article in English | MEDLINE | ID: mdl-32726216

ABSTRACT

BACKGROUND: Diffuse coronary lesions adversely influence the outcomes of coronary artery bypass grafting (CABG). This study aimed to investigate the influence of diffuse left anterior descending artery (LAD) lesions on the outcomes of CABG. METHODS: The data of 123 patients, who received elective isolated CABG with the left internal mammary artery bypassed to the LAD from January 2011 to June 2017, were collected. According to their lesions (≥50% diameter stenoses) ≤2cm or >2cm in the middle and distal segment of LAD, the patients were classified into a No Diffuse Lesion (NDL) group (69 patients) and a Diffuse Lesion (DL) group (54 patients). The rates of in-hospital mortality, 5-year all-cause mortality, and major cardiac events (MCEs) (i.e. myocardial infarction, angina, acute heart failure, and atrial fibrillation) were analyzed. RESULTS: According to the univariate analyses, the NDL group had fewer diffuse left circumflex artery (LCX) lesions (P = .001) and higher ventricular fibrillation (Vf) after aortic de-clamping (P = .03) than the DL group. According to the multivariate analyses, the in-hospital and 5-year all-cause mortality rates of the two groups did not significantly differ (P = .80 and P = .59). Otherwise, the DL group had a trend toward more MCEs (hazard ratio = 2.07, P = .061), but the difference clearly was insignificant after adjusting for diffuse LCX lesions and Vf after aortic de-clamping (P = .104). CONCLUSIONS: The results demonstrated that diffuse LAD lesions did not influence the risks of in-hospital mortality, 5-year all-cause mortality, or MCEs after CABG.


Subject(s)
Coronary Aneurysm/diagnosis , Coronary Angiography/methods , Coronary Artery Bypass/methods , Coronary Vessels/diagnostic imaging , Aged , Cause of Death/trends , Coronary Aneurysm/mortality , Coronary Aneurysm/surgery , Coronary Vessels/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate/trends , Taiwan/epidemiology
2.
Open Heart ; 7(1)2020 04.
Article in English | MEDLINE | ID: mdl-32515749

ABSTRACT

OBJECTIVE: Determine coronary artery ectasia (CAE) prevalence and clinical outcome in a large cohort of patients underwent coronary angiography. METHODS: In an 11-year period, between 2006 and 2017, 20 455 coronary angiography studies were performed at a large university centre. Patients diagnosed with CAE based on procedure report were included in the final analysis. RESULTS: CAE was diagnosed in 174 out of 20 455 studies (0.85% per total angiograms, 161 patients). Patients' average age was 59.6±11.2 years old with male predominance (90.7%). Diffuse ectasia morphology was most common (78.9%), followed by fusiform (16.1%) and saccular (5%). Mixed CAE and atherosclerotic heart disease (ASHD) was present in 75.2% of the patients and isolated CAE in 24.8%. The most common coronary artery involved was the right coronary artery (RCA) (79%). Following index angiography, all the isolated CAE group was managed conservatively, while 67% of the mixed CAE-ASHD group underwent coronary intervention. In an average follow-up of 6±3.6 years, adverse clinical event (a composite endpoint of any death, cerebrovascular accident, myocardial infarction, thromboembolic event, bleeding and stent thrombosis) occurred in 48.8% of the mixed CAE-ASHD group compared with 25% in the isolated CAE group (p<0.05). CONCLUSIONS: CAE is a rare phenomenon. The most common artery involved was the RCA, and the diffused type of CAE was the most frequent. Most patients with CAE have also concomitant ASHD, and those patients have higher mortality and complications rate, compared with isolated CAE disease.


Subject(s)
Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Coronary Vessels/diagnostic imaging , Adult , Aged , Aged, 80 and over , Conservative Treatment , Coronary Aneurysm/mortality , Coronary Aneurysm/therapy , Dilatation, Pathologic , Female , Humans , Israel/epidemiology , Male , Middle Aged , Predictive Value of Tests , Prevalence , Retrospective Studies , Time Factors , Treatment Outcome
3.
J Surg Res ; 253: 288-293, 2020 09.
Article in English | MEDLINE | ID: mdl-32402854

ABSTRACT

BACKGROUND: Coronary artery aneurysms (CAAs) represent a rare pathology occurring in 1.5%-5% of routine coronary angiograms. Limited data exist on the management of CAA at the time of cardiac surgery. MATERIALS AND METHODS: A single-institution retrospective review was performed on 53 patients who underwent cardiac surgery in the setting of atherosclerotic CAA between 1993 and 2015. Patients were stratified based on treatment strategy: exclusion and distal bypass (n = 26) versus revascularization alone (n = 27). Comparisons were made with respect to mortality, need for further/concomitant interventions, and long-term cardiac function including myocardial infarctions and congestive heart failure. RESULTS: A total of 53 patients underwent cardiac surgery in the setting of CAA disease. Management strategies included ligation and bypass in 26 patients and distal bypass only in 27 patients (with four of the patients in this group undergoing coronary stenting across the aneurysm). There were no significant differences in patient demographics between the two groups. No significant difference was found in either 30-d (P = 0.74) or long-term mortality when exclusion of the CAA was performed compared with revascularization alone (P = 0.20). More exclusion procedures were performed earlier in the experience (median surgical date 2000), whereas revascularization alone predominated later in the experience (median surgical date 2007; P ≤ 0.001). CONCLUSIONS: The practice of CAA exclusion, while still performed in selected cases, has largely been supplanted in patients undergoing revascularization. Exclusion does not appear to offer any advantage over isolated revascularization, supporting the current trends in managing this rare condition.


Subject(s)
Coronary Aneurysm/surgery , Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Percutaneous Coronary Intervention/methods , Adult , Aged , Aged, 80 and over , Coronary Aneurysm/complications , Coronary Aneurysm/diagnosis , Coronary Aneurysm/mortality , Coronary Angiography , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Female , Humans , Ligation/methods , Male , Middle Aged , Retrospective Studies , Treatment Outcome
4.
J Cardiovasc Comput Tomogr ; 14(6): e99-e104, 2020.
Article in English | MEDLINE | ID: mdl-30711513

ABSTRACT

BACKGROUND: Infected coronary artery aneurysms (ICAA) represent a rare but potentially fatal complication of pre-existent atherosclerotic or non-atherosclerotic coronary artery disease, percutaneous coronary artery intervention, endocarditis or extracardiac infection. METHODS: A retrospective analysis of four cases in addition to 51 infected coronary artery aneurysms from the literature, for a total of 55 ICAA was performed. Clinical and morphological information including age, sex, clinical presentation, microbial cultures, size, location and associated abnormalities as well as patient outcome was reviewed. RESULTS: 83% of affected patients were adult males, with an average age of 55.24 years. The right coronary artery was the most commonly affected vessel (40%). In nearly 80% of the time, the responsible organism was either Staphylococcus aureus (53.3%), or Streptococcus (20%) infection. ICAA are typically large, on average 3.4 cm in diameter and can measure up to 9 cm. On contrast enhanced CT, imaging features include lobulated contour or saccular shape (54.2%) with thick wall or mural thrombus (87.5%). Associated abnormal appearance of the pericardium with either pericardial fluid, thickening or loculation is common (79.2%). CONCLUSION: ICAA are typically large, and characterized by a thick wall with a lobulated or saccular shape. Association with mediastinal, chest wall or pericardial abnormalities are common. This combination of findings, in the setting of fever, known infection, or recent coronary intervention should raise concern for ICAA.


Subject(s)
Aneurysm, Infected/microbiology , Coronary Aneurysm/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/mortality , Aneurysm, Infected/surgery , Computed Tomography Angiography , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/surgery , Coronary Angiography , Female , Humans , Infant , Male , Middle Aged , Risk Factors , Young Adult
5.
Catheter Cardiovasc Interv ; 94(4): 555-561, 2019 Oct 01.
Article in English | MEDLINE | ID: mdl-31429192

ABSTRACT

OBJECTIVES: Determine the outcomes of polytetrafluoroethylene (PTFE) covered stents for coronary artery perforation (CAP) and coronary artery aneurysm (CAA). BACKGROUND: PTFE covered stents have been used for treatment of potentially life-threatening CAP and CAA. The short and long-term outcomes of the PTFE covered stent for CAP and CAA have not been well studied. METHODS: We performed a retrospective study of PTFE covered stents that were placed in the patients from 2003 to 2017. Short term outcomes included in-hospital mortality, pericardial effusion, cardiac tamponade, and length of stay. Long-term outcomes included target lesion revascularization (TLR), in-stent restenosis (ISR), and long-term mortality. RESULTS: Fifty-three PTFE covered stents were placed in 32 patients of which there were 24 patients with a CAP with a mean age of 75 ± 8 years. Two patients died in-hospital, with no additional deaths at 30 days. The rate of ISR was 25%, with estimated rates of TLR of 2.6% (3 years) and 17.8% (5 years). The median survival was 55.6 months, with survival at 10 years estimated to be 30.9%. Eight patients received a PTFE covered stent for CAA with a mean age of 59 ± 15 years with no in-hospital or 30-day mortality. Median follow-up of 49 months showed no evidence of TLR. The all-cause mortality was 12% at 1 year and 38% at 3 years. CONCLUSIONS: PTFE covered stents is an effective option in patients with CAP and CAA. The long-term outcomes may be related to the pathology of the disease rather than the stent itself.


Subject(s)
Coronary Aneurysm/therapy , Coronary Vessels/injuries , Heart Injuries/therapy , Percutaneous Coronary Intervention/instrumentation , Polytetrafluoroethylene , Stents , Aged , Aged, 80 and over , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/physiopathology , Coronary Vessels/diagnostic imaging , Coronary Vessels/physiopathology , Female , Heart Injuries/diagnostic imaging , Heart Injuries/mortality , Heart Injuries/physiopathology , Hospital Mortality , Humans , Male , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Prosthesis Design , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
6.
Catheter Cardiovasc Interv ; 93(7): 1219-1227, 2019 06 01.
Article in English | MEDLINE | ID: mdl-30393992

ABSTRACT

OBJECTIVES: To assess the prognostic significance of high vs. low grade coronary artery ectasia (CAE) and the impact of antithrombotic or anticoagulant therapy on adverse cardiac outcomes. BACKGROUND: There is paucity of knowledge on the impact of angiographic characteristics in CAE or that of antithrombotic or anticoagulant therapy on outcomes. METHODS AND RESULTS: In this retrospective study, we reviewed angiograms and medical records of all cases of confirmed CAE (2001-2011). Extent of CAE was categorized using the Markis classification. Types 1 and 2 were categorized as high-grade and types 3 and 4 as low-grade CAE. Angiographic flow was recorded as normal or sluggish (

Subject(s)
Acute Coronary Syndrome/prevention & control , Anticoagulants/therapeutic use , Coronary Aneurysm/drug therapy , Coronary Angiography , Coronary Vessels/drug effects , Fibrinolytic Agents/therapeutic use , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/mortality , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Blood Flow Velocity , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/physiopathology , Coronary Circulation , Coronary Vessels/diagnostic imaging , Coronary Vessels/physiopathology , Dilatation, Pathologic , Electronic Health Records , Female , Fibrinolytic Agents/adverse effects , Humans , Incidence , Male , Middle Aged , Predictive Value of Tests , Prevalence , Retrospective Studies , Risk Factors , Severity of Illness Index , Treatment Outcome
7.
J Cardiovasc Med (Hagerstown) ; 20(1): 10-15, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30418268

ABSTRACT

: Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.


Subject(s)
Aneurysm, Infected/microbiology , Coronary Aneurysm/microbiology , Prosthesis-Related Infections/microbiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/mortality , Aneurysm, Infected/therapy , Anti-Bacterial Agents/therapeutic use , Cardiac Surgical Procedures , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/therapy , Endocarditis/microbiology , Humans , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Predictive Value of Tests , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/mortality , Prosthesis-Related Infections/therapy , Risk Factors , Stents/adverse effects , Treatment Outcome
8.
Cardiovasc Revasc Med ; 19(5 Pt B): 589-596, 2018.
Article in English | MEDLINE | ID: mdl-29276176

ABSTRACT

BACKGROUND: Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms. METHODS: Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013. Among 51,555 consecutive coronary angiograms, 414 patients with aneurysms were reported, of which 256 were considered acute (82% NSTE-ACS). RESULTS: Predominantly male (80%, mean age 65.5years), cardiovascular risk factors were common (hypertension 65%, dyslipidemia 65%, obesity 25%, diabetes mellitus 28.5%, and smokers 67%). With frequent coronary stenoses (94%), mostly with one aneurysm (80%), it was observed more frequently in the anterior descending artery. After a median follow-up of 52months, 53 died (14 cardiac causes) and 42% presented a cardiovascular event. Complications from the aneurysm were found in 4. The duration of dual antiplatelet therapy, LVEF, age and peripheral vascular disease highlighted in the multivariate analysis of death. CONCLUSION: The presence of coronary aneurysms in patients undergoing coronary angiography with an acute event is low. Patients who present them also have a large burden of atherosclerotic risk factors. In the long-term, the probability of cardiovascular complications is high, but only a small proportion are due to the aneurysm itself. A more intense and prolonged antithrombotic treatment may result in lower mortality rates.


Subject(s)
Coronary Aneurysm/epidemiology , Acute Disease , Aged , Comorbidity , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/therapy , Coronary Angiography , Databases, Factual , Disease Progression , Female , Fibrinolytic Agents/therapeutic use , Humans , Incidence , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Prognosis , Registries , Retrospective Studies , Risk Factors , Spain/epidemiology , Time Factors
9.
Catheter Cardiovasc Interv ; 92(3): E235-E245, 2018 09 01.
Article in English | MEDLINE | ID: mdl-29164770

ABSTRACT

OBJECTIVES: We sought to investigate the long-term clinical outcomes of patients with coronary artery aneurysm (CAA) after drug-eluting stent (DES) implantation, compared with patients without CAA. BACKGROUND: CAA developed after DES implantation is a rare but associated with poor clinical outcome. METHODS: We retrospectively compared 78 patients with CAA after DES implantation with 269 patients without CAA who underwent DES implantation for complex lesions (controls). The primary endpoint was defined as major adverse cardiac events (MACE), the composite of all-cause death, nonfatal myocardial infarction (MI), and target lesion revascularization (TLR). RESULTS: Morphologically, CAAs were saccular (32%), fusiform (13%), or microform (55%). The stent types involved were Cypher (n = 56, 71.8%) and Taxus (n = 22, 28.2%). During a median follow-up period of 1164 days, the incidence of MACE was significantly higher in the CAA group (26.9 vs. 2.2%, P < 0.001); the difference was driven mainly by nonfatal MI (11.5 vs. 0%, P < 0.001) and TLR (20.5 vs. 1.9%, P < 0.001). The incidence of stent thrombosis was higher in the CAA group (12.8 vs. 0.74%, P < 0.001), irrespective of the maintenance of dual antiplatelet therapy. In the CAA group, Cox regression analysis showed significantly higher hazard ratios of CAA for MACE during the follow-up period. Further analyses after propensity-score matching of 65 pairs also showed similar results. CONCLUSIONS: The incidence of MACE was higher in patients with CAA compared with patients without CAA after DES implantation. This difference was driven by TLR and nonfatal MI and widened over time.


Subject(s)
Coronary Aneurysm/epidemiology , Drug-Eluting Stents , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Aged , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/therapy , Coronary Angiography , Coronary Thrombosis/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/epidemiology , Percutaneous Coronary Intervention/mortality , Platelet Aggregation Inhibitors/administration & dosage , Prosthesis Design , Retrospective Studies , Risk Factors , Seoul/epidemiology , Time Factors , Treatment Outcome
10.
Int J Rheum Dis ; 21(1): 31-35, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29105353

ABSTRACT

Kawasaki disease (KD) is the commonest vasculitic syndrome. It affects medium-sized arteries, principally the coronary arteries. Histologically, coronary arteritis begins at 6 to 8 days after the onset of KD and the inflammation rapidly involves all layers of the artery. This results in severe damage to the structural components of the artery leading to arterial dilation. The inflammatory infiltrate in KD arteritis is characterized predominantly by infiltration of monocytes and macrophages. Activated neutrophils, monocytes and macrophages are believed to be involved in the initial stage of coronary arteritis. Inflammatory cell infiltration may continue for up to 25 days of disease following which the inflammatory cells gradually decline in number. Inflammatory lesions in the arteries are relatively synchronous as they evolve from an acute to the chronic stage. If a giant aneurysm remains or vessel recanalization occurs after thrombotic occlusion of an aneurysm, the remodeling of vascular structures may continue for a much longer time.


Subject(s)
Coronary Aneurysm/pathology , Coronary Thrombosis/pathology , Coronary Vessels/pathology , Mucocutaneous Lymph Node Syndrome/pathology , Biopsy , Coronary Aneurysm/etiology , Coronary Aneurysm/immunology , Coronary Aneurysm/mortality , Coronary Thrombosis/etiology , Coronary Thrombosis/immunology , Coronary Thrombosis/mortality , Coronary Vessels/immunology , Diagnosis, Differential , Disease Progression , Humans , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/immunology , Mucocutaneous Lymph Node Syndrome/mortality , Polyarteritis Nodosa/pathology , Predictive Value of Tests , Prognosis , Risk Factors , Time Factors
11.
Arterioscler Thromb Vasc Biol ; 37(12): 2350-2355, 2017 12.
Article in English | MEDLINE | ID: mdl-29051141

ABSTRACT

OBJECTIVE: Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown. APPROACH AND RESULTS: We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88-5.66; P<0.001), cardiac death (95% CI, 1.37-5.37; P=0.004), and nonfatal MI (95% CI, 2.20-11.0; P<0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36-10.4; P<0.001) and in a propensity score-matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14-71.0; P=0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE (P=0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy). CONCLUSIONS: The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.


Subject(s)
Coronary Aneurysm/complications , Coronary Circulation , Myocardial Infarction/complications , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Chi-Square Distribution , Coronary Aneurysm/mortality , Coronary Aneurysm/physiopathology , Coronary Aneurysm/therapy , Coronary Angiography , Coronary Vessels/pathology , Coronary Vessels/physiopathology , Dilatation, Pathologic , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Percutaneous Coronary Intervention , Prognosis , Propensity Score , Proportional Hazards Models , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors
12.
J Pediatr ; 188: 70-74.e1, 2017 09.
Article in English | MEDLINE | ID: mdl-28662948

ABSTRACT

OBJECTIVES: To clarify the occurrence of cardiac events based on the maximal diameter of the maximal coronary artery aneurysm (CAA) in Kawasaki disease (KD). STUDY DESIGN: Two hundred fourteen patients (160 male and 54 female) who had had at least 1 CAA in the selective coronary angiogram less than 100 days after the onset of KD were studied. We measured the maximal CAA diameters in the major branches of the initial coronary angiograms. Death, myocardial infarction and coronary artery revascularization were included as cardiac events in this study. We divided the patients into three groups based on the maximal CAA diameter (large ≥8.0 mm; medium ≥6.0 mm and <8.0 mm; small <6.0 mm). Further, we also analyzed the cardiac events based on laterality of maximal CAA (bilateral, unilateral) and body surface area (BSA). RESULTS: Cardiac events occurred in 44 patients (21%). For BSA < 0.50 m2, the 30-year cardiac event-free survival in the large and medium groups was 66% (n = 38, 95% CI, 49-80) and 62% (n = 27, 95% CI, 38-81), respectively. For BSA ≥ 0.50 m2, that in large group was 54% (n = 58, 95% CI, 40-67). There were no cardiac events in the medium group for BSA ≥0.50 m2 (n = 36) and the small group (n = 56). In the large analyzed group, the 30-year cardiac event-free survival in the bilateral and unilateral groups was 40% (n = 48, 95% CI, 27-55) and 78% (n = 48, 95% CI, 63-89), respectively (P < .0001). CONCLUSIONS: The group with the highest risk of cardiac events was the patient group with the maximal CAA diameter ≥6.0 mm with BSA < 0.50 m2 and the maximal CAA diameter ≥8.0 mm with BSA ≥ 0.50 m2. At 30 years after the onset of KD, cardiac event-free survival was about 60%. Given the high rate of cardiac events in this patient population, life-long cardiovascular surveillance is advised.


Subject(s)
Coronary Aneurysm/complications , Coronary Vessels/pathology , Mucocutaneous Lymph Node Syndrome/complications , Adolescent , Child , Child, Preschool , Coronary Aneurysm/mortality , Coronary Angiography , Female , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome/mortality , Survival Rate
13.
BMJ Open ; 7(6): e014424, 2017 06 30.
Article in English | MEDLINE | ID: mdl-28667203

ABSTRACT

OBJECTIVES: Coronary artery aneurysm (CAA) is usually an asymptomatic and rare disease. There are limited epidemiological data for CAA in Asian populations and in the rest of the world. DESIGN: A retrospective case control study. SETTING: A population based, database study from Taiwan's National Health Insurance Research Database, between 2005 and 2011. PARTICIPANTS: CAA patients identified using International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) code 414.11 with CAA examinations. OUTCOME MEASURES: The incidence rate and mortality rate of CAA were calculated. We also matched patients with non-CAA patients according to age, gender and index year at a 1:10 ratio to explore the risk factors for CAA using conditional logistic regression. RESULT: A total of 1397 CAA patients were identified between 2005 and 2011; 41.9% were paediatric patients and 58.1% were adults. The incidence rate and mortality rate of CAA in Taiwan were 0.87 and 0.05 per 105 person-years, respectively. The adjusted odds ratios (aOR) for coronary atherosclerosis, hypertension, dyslipidaemia and diabetes were 7.97, 2.09, 2.48 and 1.51, respectively. Of note, aortic dissection (aOR 6.76), aortic aneurysm (aOR 5.82) and systemic lupus erythematosus (aOR 4.09) were found to be significantly associated with CAA. CONCLUSION: In Taiwan, CAA patients were distributed across both paediatric and adult populations. Apart from cardiovascular risk factors, aortic diseases and systemic lupus erythematosus need to be investigated further in CAA patients.


Subject(s)
Coronary Aneurysm/epidemiology , Adolescent , Adult , Age Distribution , Aged , Case-Control Studies , Child , Comorbidity , Coronary Aneurysm/etiology , Coronary Aneurysm/mortality , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Population Surveillance , Retrospective Studies , Risk Factors , Sex Distribution , Taiwan/epidemiology , Young Adult
14.
JACC Cardiovasc Imaging ; 9(4): 436-50, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27056163

ABSTRACT

Spontaneous coronary artery dissection (SCAD) has gained attention as a key cause of acute coronary syndrome and sudden cardiac death among women. Recent advancements in cardiac imaging have improved identification and accelerated awareness of SCAD. Accurate diagnosis of SCAD through use of imaging is critical, as emerging evidence suggests that the optimal short- and long-term management strategies for women with SCAD differs substantially from that of women with atherosclerotic coronary disease. This review summarizes the application of both invasive and noninvasive imaging for the diagnosis, assessment, surveillance, and treatment of women affected by SCAD.


Subject(s)
Aortic Dissection/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Multimodal Imaging/methods , Women's Health , Adult , Age of Onset , Aortic Dissection/mortality , Aortic Dissection/therapy , Coronary Aneurysm/mortality , Coronary Aneurysm/therapy , Female , Humans , Middle Aged , Predictive Value of Tests , Prognosis , Risk Factors , Sex Factors
15.
Echocardiography ; 33(5): 764-70, 2016 May.
Article in English | MEDLINE | ID: mdl-26711003

ABSTRACT

BACKGROUND: The long-term prognosis of patients with Kawasaki disease (KD) complicated by coronary artery aneurysm (CAA) is unclear. The aim of this study was to evaluate the complications of KD with CAAs. METHOD: We retrospectively analyzed the clinical data and complications of 38 KD patients with CAAs who were treated and underwent regular follow-up with echocardiography between January 1989 and May 2013. RESULTS: During a period of 29 days to 19 years after disease onset, complications seen included coronary stenosis and occlusion (six patients), thrombosis (17 patients), myocardial infarction (six patients), and calcification of CAAs (seven patients). Rupture of giant CAAs occurred in two patients and caused sudden death in one of these patients at 29 days and in the other patient at 5 months after disease onset. A total of seven deaths occurred, with five deaths caused by myocardial infarction. Three of these had undiagnosed incomplete KD or had not received regular treatment, while two experienced sudden death after several asymptomatic myocardial infarctions. CONCLUSION: Cardiac complications of KD with CAAs include thrombosis, coronary stenosis, myocardial infarction, sudden death, and calcification. Although rare, rupture of giant CAAs is fatal and might occur earlier after the onset of disease. Mortality occurred primarily in the earlier cases when anticoagulant therapy was insufficient and in patients who did not receive regular treatment. Echocardiography can provide reliable information for assessing the progression and prognosis of this condition.


Subject(s)
Cardiovascular Diseases/mortality , Coronary Aneurysm/mortality , Mucocutaneous Lymph Node Syndrome/mortality , Adolescent , Causality , Child , Child, Preschool , China/epidemiology , Comorbidity , Coronary Aneurysm/diagnostic imaging , Echocardiography/statistics & numerical data , Female , Humans , Infant , Longitudinal Studies , Male , Mucocutaneous Lymph Node Syndrome/diagnostic imaging , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Survival Rate , Young Adult
16.
Catheter Cardiovasc Interv ; 87(4): 712-9, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26541909

ABSTRACT

BACKGROUND: The use of covered stent grafts during percutaneous coronary intervention (PCI) is a life saving solution to seal acute iatrogenic vessel rupture. However, the presence of an impenetrable mechanical barrier is also appealing during treatment of friable coronary plaques but the synthetic PTFE-membrane that might trigger excessive neointimal proliferation has limited its elective-use. Pericardium tissue may offer an appealing "natural" alternative. Aim of our study is to report the consecutive 5-year single center experience with the use of pericardium-covered stents (PCS) (ITGI-Medical, Israel) in a variety of emergency and elective applications. METHODS: Nineteen consecutive patients undergoing implantation of PCS at the Royal Brompton in the last 5-years. Reasons for PCS implantation included treatment of degenerated vein grafts, large coronary aneurysms, and acute iatrogenic vessel rupture. RESULTS: Angiographic success, defined as the ability of the device to be deployed in the indexed lesion with no contrast extravasation with residual angiographic stenosis <30% and a final thrombolysis in myocardial infarction (TIMI)-3 flow was achieved in all cases. Procedural success, defined as the achievement of angiographic success without any major adverse cardiovascular event (MACE) was achieved in 94.7% of patients. In-stent restenosis (ISR) was observed in 26.3% and all patients underwent successful target vessel revascularization with DES (mean time to restenosis 9.0 ± 4.0 months). At a mean follow-up of 32.5 ± 23.3 months no acute or late stent thrombosis was observed. CONCLUSION: PCSs were effective in the treatment of friable embolization-prone coronary plaques, sealing of acute iatrogenic vessel rupture and exclusion of large aneurysms with no thrombosis but high target lesion revascularization.


Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Coated Materials, Biocompatible , Coronary Aneurysm/therapy , Coronary Artery Disease/therapy , Coronary Vessels , Iatrogenic Disease , Pericardium/transplantation , Saphenous Vein , Stents , Vascular System Injuries/therapy , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/mortality , Animals , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/mortality , Coronary Aneurysm/physiopathology , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Coronary Circulation , Coronary Restenosis/etiology , Coronary Thrombosis/etiology , Coronary Vessels/diagnostic imaging , Coronary Vessels/physiopathology , Coronary Vessels/surgery , Female , Heterografts , Horses , Humans , London , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Risk Factors , Saphenous Vein/diagnostic imaging , Saphenous Vein/physiopathology , Saphenous Vein/transplantation , Time Factors , Treatment Outcome , Ultrasonography, Interventional , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/mortality , Vascular System Injuries/physiopathology
17.
Cardiol J ; 22(2): 135-40, 2015.
Article in English | MEDLINE | ID: mdl-25002114

ABSTRACT

BACKGROUND: The pathophysiology of coronary artery dissection (CD) remains poorly under-stood and little is known about the factors predicting mortality in these patients. We aimed to study the epidemiology of CD and predictors of mortality in these patients. METHODS: All patients diagnosed with CD in the Nationwide Inpatient Sample 2009-2010 database using International Classification of Diseases ninth revision 414.12 were included in the study. Chronic conditions included in the analysis were diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease (CAD), obesity, alcohol use, smoking, heart failure and ventricular arrhythmias. Non-cardiovascular conditions were connective tissue disorders, fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan's syndrome, sarcoidosis, Crohn's disease, polycystic kidney disease, rheumatoid arthritis, vasculitis including giant cell arteritis, polyarteritis nodosa and Takayasu's disease, cocaine use, early or premature labor. RESULTS: The prevalence of CD in the United States was 0.02% (n = 11,255), based on the hospital admissions reviewed in the database. The mean age was 63.25 years with women (64.62 years) being older than men (62.25 years) (p < 0.001). In-hospital mortality rate was 4.2%, with women (5.5%) having higher mortality than men (3.2%) (p = 0.009). Ventricular arrhythmias (OR 5.86, p < 0.001) predicted higher mortality, while hyperlipidemia (OR 0.26, p < 0.001) and CAD (OR 0.31, p = 0.001) predicted lower mortality in multivariate analysis. CONCLUSIONS: Our study demonstrated that CD was more prevalent in men but women had higher mortality than men. Age, heart failure and ventricular arrhythmias were independent predictors of increased mortality but hyperlipidemia CAD predicted lower mortality in patients with CD.


Subject(s)
Aortic Dissection/mortality , Coronary Aneurysm/mortality , Hospital Mortality , Inpatients/statistics & numerical data , Age Factors , Aged , Aortic Dissection/diagnosis , Aortic Dissection/therapy , Comorbidity , Coronary Aneurysm/diagnosis , Coronary Aneurysm/therapy , Databases, Factual , Female , Health Status Disparities , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Prevalence , Retrospective Studies , Risk Assessment , Risk Factors , Sex Factors , United States/epidemiology
18.
Circ Cardiovasc Interv ; 7(6): 777-86, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25406203

ABSTRACT

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic acute coronary syndrome for which optimal management remains undefined. METHODS AND RESULTS: We performed a retrospective study of 189 patients presenting with a first SCAD episode. We evaluated outcomes according to initial management: (1) revascularization versus conservative therapy and (2) percutaneous coronary intervention (PCI) versus conservative therapy stratified by vessel flow at presentation. Demographics were similar in revascularization versus conservative (mean age, 44±9 years; women 92% both groups), but vessel occlusion was more frequent in revascularization (44/95 versus 18/94). There was 1 in-hospital death (revascularization) and 1 late death (conservative). Procedural failure rate was 53% in those managed with PCI. In the subgroup of patients presenting with preserved vessel flow, rates of PCI failure were similarly high (50%), and 6 (13%) required emergency coronary artery bypass grafting. In the conservative group, 85 of 94 (90%) had an uneventful in-hospital course, but 9 (10%) experienced early SCAD progression requiring revascularization. Kaplan-Meier estimated 5-year rates of target vessel revascularization and recurrent SCAD were no different in revascularization versus conservative therapy (30% versus 19%; P=0.06 and 23% versus 31%; P=0.7). CONCLUSIONS: PCI for SCAD is associated with high rates of technical failure even in those presenting with preserved vessel flow and does not protect against target vessel revascularization or recurrent SCAD. A strategy of conservative management with prolonged observation may be preferable.


Subject(s)
Aortic Dissection/therapy , Coronary Aneurysm/therapy , Coronary Artery Bypass , Percutaneous Coronary Intervention , Adult , Aortic Dissection/diagnosis , Aortic Dissection/mortality , Aortic Dissection/physiopathology , Coronary Aneurysm/diagnosis , Coronary Aneurysm/mortality , Coronary Aneurysm/physiopathology , Coronary Angiography , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Circulation , Female , Hospital Mortality , Humans , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Predictive Value of Tests , Propensity Score , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
19.
Int J Cardiol ; 173(2): 209-15, 2014 May 01.
Article in English | MEDLINE | ID: mdl-24631116

ABSTRACT

BACKGROUND: Cardiovascular magnetic resonance (CMR) is ideal for assessing patients with repaired aortic coarctation (CoA). Little is known on the relation between long-term complications of CoA repair as assessed by CMR and clinical outcome. We examined the prevalence of restenosis and dilatation at the repair site and the long-term outcome in patients with repaired CoA. METHODS AND RESULTS: CMR imaging and clinical data for adult CoA patients (247 patients aged 33.0 ± 12.8 years, 60% male), were analyzed. The diameter of the aorta at the repair site was measured on CMR and its ratio to the aortic diameter at the diaphragm (repair site-diaphragm ratio, RDR) was calculated. Restenosis (RDR≤70%) was present in 31% of patients (and significant in 9% [RDR<50%]), and dilatation (RDR>150%) in 13.0%. A discrete aneurysm at the repair site was observed in 9%. Restenosis was more likely after resection and end-end anastomosis, whereas dilatation after patch repair. Systemic hypertension was present in 69% of patients. Of the hypertensive patients, blood pressure (133 ± 20/73 ± 10 mm Hg) was well controlled in 93% with antihypertensive therapy. Mortality rate over a median length of 5.9 years was low (0.69% per year, 95% CI: 0.33-1.26), but significantly higher than age-matched healthy controls (standardised mortality ratio 2.86, CI 1.43-5.72, p<0.001). CONCLUSION: Restenosis or dilatation at the CoA repair site as assessed by CMR is not uncommon. Medium term survival remains good, however, albeit lower than in the general population. Life-long follow-up and optimal blood pressure control are likely to secure a good longer term outlook in these patients.


Subject(s)
Aortic Coarctation/mortality , Aortic Coarctation/surgery , Cardiac Surgical Procedures/mortality , Coronary Restenosis/mortality , Magnetic Resonance Imaging, Cine , Postoperative Complications/mortality , Adolescent , Adult , Aged , Aortic Coarctation/diagnosis , Aortic Diseases/epidemiology , Aortic Valve , Bicuspid Aortic Valve Disease , Cardiac Surgical Procedures/adverse effects , Comorbidity , Coronary Aneurysm/etiology , Coronary Aneurysm/mortality , Coronary Restenosis/diagnosis , Coronary Restenosis/etiology , Female , Heart Defects, Congenital/epidemiology , Heart Valve Diseases/epidemiology , Humans , Hypertension/epidemiology , Male , Middle Aged , Postoperative Complications/etiology , Prevalence , Prognosis , Young Adult
20.
JACC Cardiovasc Interv ; 5(10): 1062-70, 2012 Oct.
Article in English | MEDLINE | ID: mdl-23078737

ABSTRACT

OBJECTIVES: This study sought to assess the long-term clinical outcome of patients with spontaneous coronary artery dissection (SCD) managed with a conservative strategy. BACKGROUND: SCD is a rare, but challenging, clinical entity. METHODS: A prospective protocol, including a conservative management strategy, was followed. Revascularization was only considered in cases with ongoing/recurrent ischemia. Inflammatory/immunologic markers were systematically obtained. RESULTS: Forty-five consecutive patients (incidence 0.27%) were studied during a 6-year period. Of these, 27 patients (60%) had "isolated" SCD (I-SCD), and 18 had SCD associated with coronary artery disease (A-SCD). Age was 53 ± 11 years, and 26 patients were female. Most patients presented with an acute myocardial infarction. SCD had a diffuse angiographic pattern (length: 31 ± 23 mm). In 11 patients, the diagnosis was confirmed by intracoronary imaging techniques. Sixteen patients (35%) required revascularization during initial admission. One patient died after surgery, but no additional patient experienced recurrent myocardial infarction. No significant inflammatory/immunologic abnormalities were detected. At follow-up (median 730 days), only 3 patients presented with adverse events (1 died of congestive heart failure, and 2 required revascularization). No patient experienced a myocardial infarction or died suddenly. Event-free survival was similar (94% and 88%, respectively) in patients with I-SCD and A-SCD. Notably, at angiographic follow-up, spontaneous "disappearance" of the SCD image was found in 7 of 13 (54%) patients. CONCLUSIONS: In this large prospective series of consecutive patients with SCD, a "conservative" therapeutic strategy provided excellent long-term prognosis. Clinical outcome was similar in patients with I-SCD and A-SCD. The natural history of SCD includes spontaneous healing with complete resolution.


Subject(s)
Aortic Dissection/drug therapy , Coronary Aneurysm/drug therapy , Coronary Vessels/pathology , Aortic Dissection/mortality , Aortic Dissection/therapy , Angioplasty, Balloon, Coronary , Anticoagulants/therapeutic use , Coronary Aneurysm/mortality , Coronary Aneurysm/therapy , Coronary Angiography , Coronary Artery Disease/pathology , Female , Humans , Incidence , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Prospective Studies , Spain , Statistics, Nonparametric , Survival Analysis , Time Factors
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