[Differentiation of acute coronary syndrome and ulcerative colitis as causes of elevated macro creatine kinase in a patient with effort angina pectoris: a case report].

A 65-year-old man had been medically treated under a diagnosis of ulcerative colitis for 12 years as an outpatient at another facility. Two weeks before admission, he complained for the first time of mild chest pain limited to exertion. He was seen again by his previous physician in the morning and admitted to that facility later that day. Laboratory findings showed elevated serum creatine kinase (CK) at that time, so non-ST-elevated acute coronary syndrome was suspected and the patient was referred to our hospital. On admission, CK-MB was elevated but troponin T was negative. No findings of myocardial damage were observed during the admission period. Elective coronary angiography was performed and the diagnosis was effort angina pectoris. Elevated CK activity persisted but was not cardiogenic and instead due to the presence of elevated macro CK-1 associated with ulcerative colitis. Troponin T and isoenzyme electrophoresis were highly specific for the differential diagnosis of non-cardiogenic elevated CK.

[Long-term prognosis in patients with single-vessel or double-vessel coronary artery disease: does successful revascularization achieved by coronary angioplasty improve late outcome?].

OBJECTIVES: It is not clear whether revascularization by coronary angioplasty improves long-term prognosis in patients with stable angina, single- or double-vessel coronary artery disease. This study investigated the extent of late revascularization achieved by percutaneous transluminal coronary angioplasty(PTCA) and evaluated the long-term effect of revascularization in patients with coronary artery disease. METHODS: This study reviewed 178 patients with single-vessel or double-vessel disease and significant coronary diameter stenosis(American Heart Association classification, 75% or more stenosis), but excluded 35 patients with failed revascularization of the target vessels because of initial failed angioplasty(n = 14) or restenosis(n = 21). The remaining 143 patients were available for assessment. Revascularization was successful at follow-up angiography after the last angioplasty in 105 patients(Group A). The remaining 38 patients received conservative medical therapy(Group B). Kaplan-Meier survival curves were used to examine absolute survival difference. RESULTS: One hundred forty-three patients(mean age 64 +/- 9 years) were followed-up for 3.8 +/- 1 years. The patients were 70.6% male, 59.4% had myocardial infarction and 76.9% had single-vessel disease. Anatomical complete revascularization in the chronic phase was accomplished in 80 patients with single-vessel disease(97.6%) and 11 patients with double-vessel disease(47.8%). The event-free survival rate was not significantly different between Group A and Group B(88.6% vs 84.2%, p = NS). Cardiac survival rate decreased significantly in Group B compared to Group A(89.5% vs 99.0%, p < 0.01). This difference in survival rate was due to sudden cardiac death in Group B(7.9% vs 0%, p < 0.05). Non-fatal myocardial infarctions occurred in seven patients(6.7%) with revascularization and in one patient(2.6%) with conservative medical therapy, but with no significant difference. Late successful revascularization improved cardiac survival rate in patients with proximal left anterior descending coronary artery involvement or single-vessel disease. CONCLUSIONS: Cardiac events decreased and long-term prognosis appeared to be a good possibility in patients with single- or double-vessel coronary artery disease if late successful revascularization of target vessel was accomplished.