One-year outcomes of percutaneous coronary intervention in native coronary arteries versus saphenous vein grafts in patients with prior coronary artery bypass graft surgery.

BACKGROUND: Patients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native saphenous vein graft (SVG) PCI after CABG. METHODS: We performed a retrospective study in a tertiary reference cardiac center of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Arterial graft PCIs were excluded. Multivariable Cox regression analysis with propensity matching was performed, and major adverse cardiac events (MACE) outcomes including death or myocardial infarction (MI) or revascularization were assessed at 1-year after each index procedure. RESULTS: A total of 435 PCI were performed in 401 patients (209 had native PCI and 192 had graft PCI). Target lesions were classified as following: 235 (54%) native coronary arteries and 200 (46%) SVG. Propensity matching resulted in 167 matched pairs. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.725, 95% confidence interval [CI] 1.049-2.837) which was primarily driven by increased incidence in revascularization (HR 2.218, 95% CI 1.193-4.122) and MI (HR 2.248, 95% CI 1.220-4.142) and with no significant difference in mortality (HR 1.118, 95% CI 0.435-2.870). CONCLUSIONS: Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.

Wasp sting induced STEMI with complete coronary artery occlusion: a case of Kounis syndrome.

A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. This patient also has a history of atopy giving a predisposition for developing IgE-mediated allergic reactions. Hymenoptera stings can be severe in atopic individuals and anaphylaxis may ensue. However, it is a rare cause of myocardial infarction (MI) (Kounis syndrome). Multiple wasp stings in the past may have contributed to sensitisation. Kounis syndrome is a rare clinical manifestation which should remain in the minds of physicians, especially with younger patients with no history of ischaemic heart disease or few risk factors.

Energy drinks give you wings but also an abnormal exercise test.

This is the case of a 53-year-old man with known coronary artery disease who underwent two exercise treadmill tests (ETT). The first test, which yielded an abnormal result, was undertaken shortly after he had drunk two cans of Red Bull, a popular energy drink (ED). A second ETT was undertaken 1 week later by the same team without EDs on board and the test result was normal. This case suggests that drinking EDs prior to an ETT could lead to a false positive result and should be discouraged prior to exercise testing.

Patients' attitudes towards the presence of medical students during consultations.

This study analyses the attitudes of patients towards the presence of medical students during consultations. It was conducted in a very culturally and ethnically diverse part of London. The study aimed to investigate the factors, particularly ethnicity, which influence patients' attitudes towards medical students. A total of 422 patients participated in the study, which was conducted in general practice and hospital outpatient waiting areas in the London Boroughs of Tower Hamlets and Hackney. In general, the results demonstrate that patients are positive towards medical student participation during consultations. In particular, older patients, patients born in the UK and patients with prior experience of medical students seem to be particularly favourable towards students. However, compared with the White-British population, the non-White-British population appears to be more negative towards medical student participation. This study highlights the need for patient education regarding the importance, for the training of future doctors, of medical student involvement in consultations.