ABSTRACT
Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia. SCAD complicated by coronary artery aneurysm (CAA) is rare and seldom reported. Coronary angiography is the gold standard for the diagnosis of SCAD. However, an obscure intimal flap may not be recognized with a conventional coronary angiogram, and intravascular imaging modalities are important in the diagnosis of SCAD. Optical coherence tomography contributes to providing information about the size, shape, and location of CAAs. Herein, we are presenting a challenging and unique case of a woman presenting with SCAD complicated by a CAA.
ABSTRACT
Introduction: Primary percutaneous coronary intervention (PPCI) represents a timely procedure that requires speedy revascularization. Moreover, PPCI in diffuse coronary lesions remains to be challenging even in the hands of experienced operators as the use of a long stent may increase the difficulty of the procedure in terms of stent delivery, deployment, and optimization. However, the practicability and clinical outcomes of deployment of a 60-mm-long stent in the setting of PPCI remain to be determined. Methods: The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients from June 2016 to December 2019, who underwent PPCI with BioMime sirolimus-eluting stents 2.5-3.0/60 mm or 3.0-3.5/60 mm were analyzed at 1 year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE) and target lesion revascularization (TLR). Results: A total of 88 cases were included in the study; 23 cases underwent PPCI, whereas 65 underwent nonPPCI. The PPCI group had a mean age of 65.7 ± 10.9 years compared with 63.3 ± 9.6 years (P = 0.34) in the nonPPCI group. Eighty-three percentage of PPCI were males compared with 94% of their nonPPCI counterparts (P = 0.20). In addition, the prevalence of hypertension was more common in the PPCI group (87% vs. 63%, P = 0.03). There was no statistically significant difference between the two groups regarding other comorbidities. The most common culprit vessel was the left anterior descending artery (57%) in the PPCI group and the right coronary artery (58%) in the nonPPCI. The use of a stent with a diameter of 2.5-3.0 mm was more common in both groups (61% in PPCI vs. 66% in nonPPCI, P = 0.8). MACCE occurred in four patients during a year of follow-up. One occurred in the PPCI group (4%) compared with three in the nonPPCI group (5%) (P = 1.00). TLR was required in two cases, one in each group (4% vs. 2%, P = 0.46). Conclusion: The use of a 60-mm-long stent in the setting of PPCI has an excellent 12-month outcome in procedural success, MACCE, and TLR. Large randomized studies are required to confirm these results.
ABSTRACT
INTRODUCTION: When the baseline anatomical syntax score-I (SxSI) is more than or equal to 33, percutaneous coronary intervention (PCI) of unprotected left main (UPLM) is discouraged and considered as high-risk of adverse cardiac events. We designed this study to compare the outcomes of UPLM-PCI between the low to intermediate-syntax score (SxSIlow/int.) group (defined as SxSI <33) and the high-syntax score (SxSIhigh) group (defined as SxSI more than or equal 33) with a subanalysis to explore the predictive role of intravascular images (IVI). METHODS: The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients, who were enrolled from January 2018 to December 2018, were analyzed at 1-year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE). An independent committee calculated the SxSI and reviewed all the events. RESULTS: Baseline data of 2144 patients were considered for analysis. 1245 underwent PCI and 32 (2.57%) had PCI of UPLM; of these, 24 (75%) were in SxSIlow/int. group and 8 (25%) in SxSIhigh group. The mean SxSI was 20.3 ± 6.5 and 37.1 ± 4.9 for SxSIlow/int. and SxSIhigh groups, respectively. Compared with patients in the SxSIlow/int., patients in SxSIhigh group had a greater syntax score-II (<0.0001), which reflects the expected 4-year mortality after PCI by combining the SxSI and clinical variables.Interestingly, despite the fact that the proportion of subjects who sustained MACCE was almost three times more among the SxSIhigh compared to their SxSIlow/int. counterparts [1 (12.5%) vs. 1 (4.2%), P = 0.444], this difference was not statistically significant.It was noted that a higher proportion of patients in whom intravascular imaging (IVI) was not used to guide PCI sustained MACCE compared with that in whom IVI was utilized (2 [50%] vs. [0%], P = 0.012). There is a strong, negative, statistically significant association between the use of IVI and the occurrence of MAACE (Phi=-0.681), which reflects that the use of imaging is associated with significantly lower probability of developing MACCE. CONCLUSION: As demonstrated in this real-world cohort, PCI of UPLM provides excellent outcome at one year regardless of the initial anatomical syntax score. Furthermore, it appears that IVI utilization during the index PCI procedure of UPLM is a potent and independent predictor of MACCE.
ABSTRACT
We present a case of a 24-year-old male patient who presented to our institution five days after receiving his first dose of Pfizer-BioNTech vaccine to rule out acute coronary syndrome due to chest pain along with troponin increase and ECG changes. Acute coronavirus disease 2019 (COVID-19) infection was excluded based on a negative real-time reverse transcription-polymerase chain reaction (RT-PCR) test of specimens acquired using nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and all other viral serologies were found to be negative. Coronary angiogram showed normal coronaries, and the presence of late gadolinium enhancement, which is indicative of myocarditis, was identified using cardiac magnetic resonance imaging (MRI). Our case report raises concern that the COVID-19 vaccine may cause myocarditis as a rare side effect.
