Outcomes of primary percutaneous intervention of the unprotected left main coronary artery stenosis in myocardial infarction.

OBJECTIVE: The aim of our study was to examine the 30-day and 1-year survival rate for patients undergoing percutaneous coronary artery intervention (PCI) of unprotected left main (ULM) stenosis by the presence (acute myocardial infarction [AMI] group) or absence (non-AMI group) of AMI at the time of hospital admission. METHODS: We retrospectively reviewed 64 patients undergoing PCI of ULM stenosis at our regional heart institute between 2000 and 2008. Patients had no history of coronary artery bypass grafting. RESULTS: Thirty-six men and 28 women underwent PCI for ULM stenosis. Overall Kaplan-Meier survival at 30 days and 1 year was 71.5% and 57.8%, respectively. Thirty-three patients (51.6%) presented with AMI. Those with AMI had lower survival at both 30 days (59.2 vs 83.9%; P = 0.04) and 1 year (45.2 vs 70.2%; P = 0.04) compared with those without AMI. Compared with a lesion involving only the ostial/mid LM, diffuse disease (N = 11) was associated with an increased mortality at 1 year (hazard ratio 0.27; 95% confidence interval 0.09-0.79). A stent size >3 mm was associated with lower mortality at 1 year (hazard ratio 0.42; 95% confidence interval 0.19-0.93). CONCLUSIONS: We found that AMI at presentation was significantly associated with higher mortality in patients undergoing ULM stenting. LM lesion location and stent size were both significantly associated with mortality. ULM stenting is an option in patients who are unable to undergo coronary artery bypass grafting, but patients should understand the overall high risk of mortality, particularly if they present with AMI.

Acetaminophen protects against iron-induced cardiac damage in gerbils.

There are few effective agents that safely remove excess iron from iron-overloaded individuals. Our goal was to evaluate the iron-removing effectiveness of acetaminophen given ip or orally in the gerbil iron-overload model. Male gerbils were divided into 5 groups: saline controls, iron-overloaded controls, iron-overloaded treated with ip acetaminophen, iron-overloaded treated with oral acetaminophen, and iron-overloaded treated with ipdeferoxamine. Iron dextran was injected iptwice/wk for 8 wk. Acetaminophen and deferoxamine treatments were given on Mondays, Wednesdays, and Fridays during the same 8 wk and continued for 4 wk after completion of iron-overloading. Echocardiograms were performed after completion of the iron-overloading and drug treatments. Liver and cardiac iron contents were determined by inductively coupled plasma atomic emission spectrometry (ICP-AES). Iron-overloaded controls had 232-fold and 16-fold increases in liver and cardiac iron content, respectively, compared to saline controls. In iron-overloaded controls, echocardiography showed cardiac hypertrophy, right and left ventricular distension, significant reduction in left ventricular ejection fraction (-22%), and fractional shortening (-31%) during systole. Treatments with acetaminophen (ip or oral) or deferoxamine (ip) were equally effective in reducing cardiac iron content and in preventing cardiac structural and functional changes. Both agents also significantly reduced excess hepatic iron content, although acetaminophen was less effective than deferoxamine. The results suggest that acetaminophen may be useful for treatment of iron-induced pathology.

Effect of experimental hyperhomocysteinemia on cardiac structure and function in the rat.

Male Sprague-Dawley rats were subjected for 2 weeks to daily injections of homocysteine (Hcy), which increased plasma Hcy approximately 2-fold. Echocardiography indicated significant increases in left ventricular diastolic (13%) and systolic (31%) dimensions and decreases in posterior wall thickness (diastolic, -17%; systolic, -20%) in Hcy-treated animals. Slight changes were noted in the ejection fraction, systolic fractional shortening, and maximal aortic valvular blood flow velocity, but they were not statistically significant or were similar to those in vehicle controls. The results suggest that an initial effect of Hcy administration involves loss of myocardial structure without a direct influence on myocardial contractile function. Consistent with this conclusion, in vitro evaluation of the myocardial ring contractile response showed no significant difference in left ventricular maximal isometric force between the control (13.9 +/- 2.7 g/g tissue) and Hcy-injected (11.0 +/- 2.8 g/g tissue) animals.

Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia.

Atrial septal defects (ASDs) are a common congenital abnormality, and operative repair is a routine, safe procedure. Diversion of the inferior vena cava (IVC) into the left atrium is an unusual complication following ASD closure. We report a case that illustrates the problem created by this right-to-left shunt. A middle-aged woman underwent ASD repair. She developed hypoxemia postoperatively. A transthoracic echocardiogram confirmed a right-to-left shunt, found only with agitated saline injected into the femoral vein, not into the basilic vein. Surgical reexploration revealed a residual ASD diverting IVC flow into the left atrium, which was repaired with a pericardial patch. Echocardiography with agitated saline injected from the femoral vein is an easy method to diagnose this uncommon complication.