Percutaneous Coronary Intervention in a Patient Presenting With Inferior Myocardial Infarction and an Anomalous Left Main Artery Originating From the Right Coronary Sinus.

We present a case of a patient with inferior myocardial infarction (MI) and anomalous left main artery originating from the right coronary sinus. The left main artery and right coronary artery originated from the right coronary sinus but with separate ostia. The patient underwent revascularization of the right coronary artery with balloon angioplasty and a drug-eluting stent. Despite being rare, these anomalies can be life-threatening depending on the course of the artery, and when atherosclerotic disease is present, a revascularization strategy can be challenging. Knowing the existence of the left main artery anomaly is important to choose the right guide catheter to achieve successful cannulation and decrease the risk of complications, radiation exposure, and contrast usage.

Impact of Temperature and Atmospheric Pressure on Hospitalizations of Patients Presenting With Acute Coronary Syndrome.

AIM:  This study aims to investigate the impact of temperature and atmospheric pressure on hospitalizations of patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: This is a retrospective, observational, analytical study conducted in a single center, University Hospital Center "Mother Teresa," Tirana, Albania, in the period January-December 2018. This study included 1,165 patients with ACS, who performed urgent coronary angiography, from January 2018 to December 2018. Patients were diagnosed with ACS based on clinical and examination findings. The data were collected retrospectively using patient files. Baseline demographic, clinical, and procedural characteristics were collected. Data on atmospheric parameters, measured at the weather monitoring station, were obtained from the National Meteorological Service database. Measurements from the meteorological service provided values ​​for each parameter: average daily temperature and atmospheric pressure in each country district. Atmospheric data measurements were taken for the day under review. The number of inhabitants for the respective districts is taken from the National Institute of Statistics (INSTAT). RESULTS: The study involved 1,165 patients, with a mean age of 63.1 years, ranging from 27 years to 89 years old. The majority of patients (78.6%) were male, while 21.4% were female. A statistically significant relationship was observed between seasonal changes in temperature and atmospheric pressure concerning the number of cases with ACS; the autumn season prevails with 27.9% of the total cases, followed by the spring season with 25.6%, the summer season with 24.2%, and winter season with 22.3% (p = 0.04). Additionally, significant changes in the average monthly values ​​of temperature and atmospheric pressure were accompanied by a statistically significant increase in the number of cases as occurred in March-April and October-November (p ≤ 0.05). Most cases in the cold period (November-March) occurred on days with a change in temperature or atmospheric pressure with a statistically significant value of p < 0.05. CONCLUSION:  An important relationship between seasonal, monthly, and daily changes in temperature and atmospheric pressure concerning the frequency of cases with ACS was observed.

Hepatic Hydatid Cyst Presenting as Right-Sided Heart Failure: A Case Report.

Cystic echinococcosis is a parasitic disease caused by Echinococcus granulosus. The transmission of the parasite to dogs occurs when organs of animals that harbor hydatid cysts are consumed. We present the case of a patient presented in the cardiology outpatient clinic with the signs and symptoms of predominant right-sided heart failure. Upon evaluation, a large hepatic septated cyst was revealed, which was compressing the right chambers of the heart, altering diastolic filling, and causing right-sided heart failure. CT scan confirmed the presence of a hydatid cyst measuring 115 mm × 90 mm. The patient underwent surgical excision of the cyst with immediate relief of the symptoms. Two weeks later, the patient presented again with the same symptoms and was diagnosed with a recurrence of the hydatid cyst. He underwent surgical resection and removal of the cyst again. The patient remained asymptomatic and free of recurrence on further follow-up evaluations. Cardiac echinococcosis typically features intra-myocardial cysts, while our case presented an extracardiac location. Extrinsic compression of the heart's right chambers from a hydatid cyst has been rarely reported. The surgical excision of the cyst brings immediate and full resolution of the symptoms. The recurrence of hydatid cysts is also an important clinical feature that should not be underestimated.

OMI/NOMI: Time for a New Classification of Acute Myocardial Infarction.

Forty percent of patients with acute coronary occlusion myocardial infarction (OMI) do not present with STEMI criteria, which delays their treatment and increases morbidity and mortality. The need to identify these patients promptly is crucial, and this sets the stage for the proposed reclassification. Many of these patients can be identified by other ECG and clinical features. Background/Objectives: We sought to evaluate cases of STEMI and NSTEMI that result in OMI. Additionally, we focused on the consequences of delayed revascularization in NSTEMI patients with acute coronary occlusion (NSTEMI-OMI). Methods: The study is a retrospective analysis conducted on 334 patients who underwent coronary angiography for acute coronary syndrome at UHC "Mother Teresa", Tirana, Albania, during January-May 2023. "OMI was defined as an acute culprit lesion with TIMI 0-2 flow, or an acute culprit lesion with TIMI 3 flow intervened upon and with highly elevated troponin (cTnI > 10.0 ng/mL, hs-cTnI > 5000 ng/L)". The presence or absence of STEMI criteria were determined in the final diagnosis written on the chart by a cardiologist using the third universal definition of MI. Ejection fraction (EF), total ischemia time, length of stay, and complications were compared between groups. Mechanical complications include acute ventricular failure, cardiogenic shock, rupture of the interventricular septum, rupture of the free wall, rupture of the papillary muscle, and pericarditis. Electrical complications include ventricular arrhythmias, supraventricular arrhythmias, and atrioventricular and interventricular blocks. Results: There were 334 patients included, 98 (29.3%) of whom were NSTEMI-OMI patients. Ninety-six patients (40%) of OMI patients did not fulfill the STEMI criteria. Only 11 patients (11%) of STEMI(-)OMI had PCI performed within the first 12 h vs. 76 patients (77%) with STEMI(+)OMI, p < 0.001. There was no difference in the percent of patients requiring PCI between the STEMI(+)OMI 98 patients (93%) and STEMI(-)OMI 87 patients (89%) (p = 0.496). The overall in-hospital mortality was 19 patients (5.7%), with subgroup mortality of 14 patients (4.2%) with STEMI(+)OMI, 2 patients (0.6%) with STEMI(+) NOMI, and 3 patients (0.9%) with STEMI(-)OMI, 0% STEMI(-)NOMI, (p = 0.013). Patients with mechanical complications included 67 patients (46.8%) with STEMI(+)OMI and 45 patients (46.4%) with STEMI(-)OMI. In addition, 26 patients (18.5%) with STEMI(+)OMI and 13 patients (13.1%) with STEMI(-)OMI developed electrical complications. Conclusions: STEMI(-)OMI patients had significant delays in catheterization, yet had angiographic findings, rates of PCI, and complications similar to STEMI(+)OMI. These data add further support to refocusing the paradigm of acute MI to improve recognition and rapid reperfusion of all OMIs, rather than only those with STEMI criteria.

Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients.

AIM: This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclature contrast-associated acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN.  Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity.  Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients. CONCLUSIONS: The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.