Lack of association between breast artery calcification seen on mammography and coronary artery disease on angiography.

OBJECTIVES: Some studies have found correlations between the presence of breast artery calcium (BAC) observed on routine mammograms and risk factors for coronary artery disease (CAD). The aim of this study was to investigate whether such calcifications could predict the presence of coronary atherosclerosis. METHODS: A total of 319 female patients between 50 and 70 years of age, 187 with significant CAD and 132 with angiographically normal coronary arteries, were randomly selected from a computerised database of our central catheterisation laboratory. The patients' mammograms were evaluated independently for the presence of BAC in a blinded fashion by an experienced breast radiologist, and additional clinical data were extracted from clinical charts. RESULTS: The women in the CAD group were older (62.5 vs 60.7 years, p=0.05) and had a higher prevalence of hypertension, diabetes mellitus and dyslipidaemia. Although the prevalence of BAC was marginally higher in the CAD group (43.9% vs 37.1%, p=0.138), this tendency was eliminated after controlling for confounders. Multiple regression analyses indicated that only age above 63 years (odds ratio [OR]=3.0, 95% confidence interval [CI]=1.8-4.9) and hypertension (OR=2.2, 95% CI=1.2-4.1), but not angiographic evidence of CAD (OR=1.0, 95% CI=0.6-1.6), predict with BAC on mammography. CONCLUSIONS: Despite correlation with some risk factors for CAD, the presence of BAC does not differentiate between patients with angiographic evidence of CAD and those with angiographically normal coronary arteries.

Significance of balloon imprint during coronary angioplasty.

Balloon imprint during angioplasty is often seen, but not at all inflations. We prospectively studied 235 consecutive patients undergoing 282 PTCAs during a 4-month period, who were divided into two groups: those with balloon imprint during inflation (159 patients, 190 lesions; 67%) and those without (76 patients, 92 lesions; 33%). Clinical and lesion characteristics and immediate outcome were compared. Patients undergoing urgent PTCA had less balloon imprint than those undergoing nonurgent PTCA (14.2% vs. 28.3%; P < 0.005). Although not reaching statistical significance, younger patients and diabetic patients tended toward less balloon imprint (P < 0.06). Patients with observed imprint had less visible thrombus at lesion site (31.1% vs. 42.4%; P < 0.05), and a tendency without statistical significance toward more dissections but less acute closure was observed (P < 0.07). In addition, more stents were implanted in the imprint group (79.5% vs. 66.3%; P < 0.02). Patients needing pressure > 6 atm to break the imprint had more eccentric lesions (68% vs. 27.1%; P < 0.000) and more dissections (13.9% vs. 5.1%; P < 0.03) than those needing lower pressure. Patient and lesion characteristics may determine the appearance of balloon imprint at PTCA, which in turn influences the procedure and its immediate outcome. Cathet Cardiovasc Intervent 2001;53:331-333.

Left anterior descending artery length in left and right coronary artery dominance.

BACKGROUND: Coronary stenosis of the left anterior descending artery (LAD) is respected by cardiologists because of its negative influence on morbidity and mortality. An important anatomical consideration is the length of the LAD. OBJECTIVE: To investigate the relationship between length of LAD and coronary dominance. DESIGN: Retrospective comparison of 100 consecutive angiograms with left coronary dominance with 100 consecutive angiograms with right coronary dominance. The relationship between the length of the LAD and coronary dominance was analyzed. METHODS: We retrospectively compared 100 consecutive angiograms with left coronary dominance (the posterior descending artery being supplied by the circumflex artery) with 100 consecutive angiograms with right coronary dominance (the posterior descending artery being supplied by the right coronary artery). LADs were categorized into three types: type A, LAD terminating before the cardiac apex; type B, LAD reaching the apex but not supplying the inferoapical segment of the left ventricle; and type C, LAD wrapping around the apex and supplying the inferoapical segment. LAD typing was also analyzed in relation to gender. RESULTS: It was found that the LAD wrapped around the apex in 87% of cases of left coronary dominance but only in 47% of patients with right coronary dominance, and that the long LADs were more frequently seen in women than in men, irrespective of coronary dominance. CONCLUSIONS: We found that the LAD in left coronary dominance is usually long and wraps around the apex, and believe that angiographic interventions in such cases have important clinical significance.

Right-sided pulsus alternans in diastolic left ventricular dysfunction.

Pulsus alternans is usually found in patients with reduced systolic ventricular function. We describe a patient with shortness of breath, hypertension, and left ventricular hypertrophy, but with normal left and right systolic function. Pulsus alternans was demonstrated in the pulmonary wedge position, pulmonary artery, and right ventricle, but not in the aorta or left ventricle. Cathet. Cardiovasc. Intervent. 47:336-339, 1999.

Unusual bleeding complications of thrombolytic therapy after cardiopulmonary resuscitation. Three case reports.

The authors present three case reports retrospectively casting doubt on the benefit of thrombolysis after external cardiac massage.

Prolonged catheter-induced coronary artery spasm mimicking fixed stenosis.

Two cases of prolonged catheter-induced right coronary artery spasm, mimicking fixed stenoses, are presented. In one case, the spasm appeared at the same place in sequential catheterizations. This angiographic finding may be easily misinterpreted as a fixed lesion, leading to unnecessary attempts at angioplasty.

Coronary stenting with AVE microstents in acute myocardial infarction.

Of 36 patients with acute myocardial infarction (AMI) who were referred for direct or rescue coronary angioplasty, 11 (31%) needed stent implantation. In 7 of them, the stent was implanted because of severe dissection and in 4, because of elastic recoil. All patients were discharged without clinical or electrocardiographic signs of reocclusion. No death, reinfarction or clinical evidence of ischemia occurred during up to 15 months of follow-up.

[Direct percutaneous transluminal coronary angioplasty].

Early reperfusion in acute myocardial infarction (AMI) effectively reduces mortality. Direct. percutaneous. transluminal coronary angioplasty (PTCA) is a recognized alternative to intravenous thrombolytic therapy in early AMI. Of 289 PTCAs performed during a year, 29 (10%) were direct PTCAs. Indications for direct PTCA in 21 patients (72%) were large infarcts, and in 8 (28%) cardiogenic shock. The left anterior descending artery was involved in 15 patients (52%), the right coronary artery in 10 (34%), the left circumflex in 3 (10%), and the left main artery in 1 (3%). Satisfactory opening of the occlusion was achieved in 26 (90%); there was partial success in 2 (7%) and failure in 1 (3%). 4 patients required stent deployment for treatment of dissection. There was no major complication. A patient in whom success was only partial, and the one in whom PTCA failed, were sent for operation. These data do not differ from our success rate in elective PTCA. It is concluded that direct PTCA is a safe procedure with a high rate of successful reperfusion in AMI.

Unusual coronary collateral circulation: filling of a totally occluded left anterior descending artery by direct continuity from a left posterior descending artery. A case report.

A patient with an unusual coronary collateral circulation is presented. The left anterior descending artery, which was totally occluded proximally, was filled directly by a continuation of the left posterior descending artery. A thallium stress test revealed normal perfusion in the territory of the left anterior descending artery.