Effect of eicosapentaenoic acid on restenosis rate, clinical course and blood lipids in patients after percutaneous transluminal coronary angioplasty.

In order to study the effects of eicosapentaenoic acid (Maxepa), Maxepa placebo and aspirin/dipyridamole combination on the clinical course and restenosis rate of atherosclerotic lesions after percutaneous transluminal coronary angioplasty 79 men and 29 women were randomly divided into three treatment groups and restudied angiographically within one year of the procedure. Angina recurred less in the Maxepa group than in the other groups, although not statistically so. Restenosis rate was significantly reduced in the Maxepa group (11%) compared to the placebo group (30%) but, while less, was not significantly lower than in the aspirin/dipyridamole group (17%). Maxepa treatment appears to reduce restenosis rate of coronary artery lesions after percutaneous transluminal coronary angioplasty and may be an acceptable and equally effective alternative therapy to aspirin/dipyridamole.

Percutaneous transluminal coronary angioplasty in multilesion disease: complete versus incomplete revascularization.

We report the results of percutaneous transluminal coronary angioplasty (PTCA) in the first 200 consecutive patients to undergo this procedure for multilesion coronary disease at Dunedin Hospital. In Group I, which consisted of 86 patients (67 men and 19 women, with a mean age of 56 years), complete revascularization of 228 lesions (2.7 lesions per patient) was undertaken. Primary success was achieved in 217 lesions (95%) in 78 patients (91%). There were five major complications, including myocardial infarction in four cases (5%) and emergency coronary artery bypass grafting (CABG) for failed PTCA in one case (1%). In Group II, which comprised 114 patients (82 men and 32 women, with a mean age of 57 years), partial revascularization of 186 lesions (1.6 lesions per patient) was attempted. Primary success was achieved in 165 lesions (89%) in 96 patients (84%). There were nine major complications, including myocardial infarction in two cases (2%), emergency CABG for failed PTCA in four cases (4%), and in-hospital death in three cases (3%). During a follow-up period ranging from 3 to 38 months (mean, 11 months), 16 (20%) of the patients in Group I and 16 (18%) of those in Group II have had recurrent angina and/or restenosis. Twenty-five of these patients have undergone repeat PTCA, with primary success in 24 cases (96%), and six have undergone elective CABG. There has been only one late death (0.6%) after successful PTCA. Complications occurred more frequently in patients with unstable angina (10.0%) and postinfarction angina (19.0%) than in those with stable angina (1.4%). However, the complication rate for multilesion PTCA has become increasingly lower until it now equals that associated with single-vessel PTCA at this institution (about 4% overall).

Family history, cigarette smoking and other risk factors in patients with myocardial infarction.

All patients entering a coronary care unit had data collected and stored prospectively on a computer file. Family history and risk factor data have been abstracted for those with confirmed myocardial infarction. These data are compared between those aged less than 50 years and those aged between 50 and 70 years. Cigarette smoking habits are compared with age matched data from the 1976 census population study of cigarette smoking habits. The risk factors of hypercholesteolaemia, obesity, diabetes, hypertension and cigarette smoking greater than 20 per day, do not separate the two age groups although cigarette smoking is more prevalent in the patient groups compared with the census population. Age of fathers' death is not different between the two age groups but death from myocardial infarction, presence of ischaemic heart disease during life in fathers and fewer nonsmokers in the younger age group clearly separate them from older age group patients. This study serves to emphasise that in order to prevent the development of myocardial infarction special attempts sould be made to prevent cigarette smoking in those whose fathers have died of a myocardial infarction or have symptoms of ischaemic heart disease.

Left main stem coronary artery dissection.

Left main stem coronary artery dissection is a rare cause of sudden death. This occurred in a previously asymptomatic 42-year-old white woman; clinical, arteriographic, and necropsy findings are described. Extrathoracic total body perfusion with isolated catheter perfusion of the dissected coronary artery using cold cardioplegic solution may be effective preoperative treatmemt.

Biloculate false aneurysm of the right ventricle after cardiac surgery.

A case of a 12-year-old boy who had double false aneurysms of the right ventricle after incomplete closed pulmonary valvotomy six years earlier is presented. The aneurysms were successfully treated surgically, and the aetiology is discussed.