Quality of life in high-risk patients with stable multivessel coronary artery disease treated either medically or with coronary artery bypass graft surgery - 12-month follow-up.

BACKGROUND: Treatment of chronic diseases, such as atherosclerosis, usually leads to significant short-term improvement. Mid- and long-term results are not always as satisfactory. That is why improvement of quality of life should be the leading qualification criterion for invasive procedures, which sometimes carry a risk of complications. AIM: To determine the quality of life in patients with stable, multivessel coronary artery disease (MCAD), treated surgically or medically. METHODS: The study group comprised 107 patients (pts; 80 males) suffering from MCAD, assigned to coronary artery bypass grafting (CABG) (55 pts) or to medical treatment alone (52 pts). The mean Gensini score in the whole group was 90 (66-132). To evaluate quality of life we used a Short Form-36 (SF-36) health status survey by the International Quality of Life Assessment Project. RESULTS: During a 12-month follow-up 9 pts died (6 pts in the medically treated group and 3 in the CABG group), all for cardiovascular reasons. Patients treated conservatively were more often hospitalised due to angina symptoms (20 vs. 5, p = 0.003). Analysis of SF-36 showed that pts treated surgically had better improvement of quality of life in comparison with medically treated patients. Significant differences were found for physical functioning, bodily pain, vitality, mental health and mental component summary. CONCLUSIONS: This study has shown that there is a significant difference in health-related quality of life 12 months after CABG surgery and medical treatment alone in high-risk patients with MCAD. Surgical treatment decreases the number of adverse events, better attenuates of anginal and heart failure symptoms, and improves the quality of life, especially the mental component. Our results should encouraged selecting patients with advanced atherosclerosis for revascularisation procedures, even if there is a very high peri-procedural risk.

Acute coronary syndrome or steal phenomenon - a case of right coronary to right ventricle fistula.

We report a case of 53-year-old male admitted to the hospital with severe chest pain and elevation of troponin I levels, who was transferred to our department for a coronary angiography. Contrast injection into the right coronary artery (RCA) demonstrated no evidence of coronary artery disease. However, a double outlet coronary artery fistula which drained into the right ventricle was visualised. With standard 2-dimensional echocardiographic imaging abnormal flow was detected in the inflow part of the right ventricular free wall. Three-dimensional colour Doppler imaging clearly demonstrated the presence of double outlet RCA - right ventricle coronary fistula with sufficient quality.

Nitroglycerin infusion after percutaneous coronary intervention does not influence short- and long-term outcome--a prospective NAPI (Nitroglycerin Administration after Percutaneous Intervention) study.

BACKGROUND: Although the benefit of nitroglycerin infusion in patients after elective coronary angioplasty has not been established, this regimen is routinely used in some centres. AIM: The Nitroglycerin Administration after Percutaneous Intervention (NAPI) study tested the efficacy of routine nitroglycerin infusion on the 1st day after percutaneous coronary intervention (PCI) in a double-blind randomised single-centre clinical trial. METHODS: We randomly assigned 200 patients scheduled for elective PCI to treatment with nitroglycerin (100 patients, age 58+/-6 years, infusion up to 100 microg/min) or placebo (100 patients, age 57+/-5 years, p=NS, NaCl 0.9%) for 12 hours after PCI. Patients with acute myocardial infarction, haemodynamic instability during PCI and known intolerance to nitrates were excluded. Patients who were randomised to the placebo group had the possibility to receive nitroglycerin infusion according to the attending physician's decision. Clinical endpoints (cardiac death, myocardial infarction, postprocedural chest pain, unstable angina and repeated PCI) were assessed in hospital and out of hospital with follow-up extended to 24 months. RESULTS: There were no differences during in-hospital stay between those receiving nitroglycerin and receiving placebo, regarding mortality (0 vs. 0%, NS), myocardial infarction (0 vs. 2%, NS), postprocedural chest pain (10 vs. 8%, NS) or repeated PCI (0 vs. 2%, NS). Similarly, 24-month follow-up also revealed no significant differences between those receiving nitroglycerin and placebo (mortality: 0 vs. 0%, NS; myocardial infarction: 4 vs. 4%, NS; repeated PCI: 10 vs. 8%, NS or CABG: 0 vs. 0%, NS). CONCLUSIONS: Routine use of intravenous nitroglycerin after elective PCI has no influence on in-hospital and long-term outcome, including cardiac death, myocardial infarction, postprocedural chest pain, unstable angina and repeated PCI.

Right coronary artery-to-right ventricle fistula complicating percutaneous transluminal angioplasty: case report and review of the literature.

This case report describes an iatrogenic right coronary artery-to-right ventricle fistula resulting from percutaneous transluminal coronary angioplasty. In this patient transthoracic echocardiography with Doppler color flow mapping allowed direct visualization of the right coronary artery aneurysm and the coronary fistula, enabling us to identify the cardiac chamber into which the fistula drained. Transthoracic echocardiography was used for follow-up of this patient, demonstrating spontaneous closure of the fistula within 3 months of the procedure. In addition, this article provides a brief overview of reported cases of percutaneous transluminal coronary angioplasty-induced coronary fistulae. The clinical course of this complication and therapeutic approaches presented in the literature are also briefly discussed.

Presence of coronary collaterals in ST-elevation myocardial infarction patients does not affect long-term outcome.

INTRODUCTION: The significance of coronary collateral circulation in the prognosis of patients after myocardial infarction remains disputable. OBJECTIVES: The aim of the study was to evaluate the effect of coronary collateral circulation, assessed by the Rentrop score, on long-term prognosis in patients treated with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS: Coronary collateral flow was assessed by angiography in 330 patients with myocardial infarction using the Rentrop score. Patients were followed up for the mean period of 26 ±12 months with the clinical endpoints of cardiac death, nonfatal reinfarction, and repeat percutaneous or surgical revascularization. RESULTS:  Collateral circulation was graded Rentrop 0 in 39%, Rentrop 1 in 36%, Rentrop 2 in 18%, and Rentrop 3 in 7% of the patients. The mortality rate was 8.7%. Reinfarction occurred in 4.7% of the subjects, and repeat coronary revascularization was performed in 10.9% of the patients. These endpoints were not correlated with the degree of collateral circulation. A significant inverse association was observed between the Rentrop score and the infarct-related artery antegrade flow (P <0.001). CONCLUSIONS: The degree of collateral circulation assessed by the Rentrop score during primary PCI is not a useful long-term prognostic factor in the population with STEMI in the current therapeutic approach. This may result from the negative correlation between the Rentrop score and the degree of blood flow in the infarct-related artery. Thus, collateral circulation in a patient with STEMI should not discourage intensive cardiovascular risk factor control in secondary prevention of coronary artery disease.

Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Mean platelet volume (MPV) is a strong predictor of impaired angiographic reperfusion and 6-month mortality in ST-elevation myocardial infarction (MI) treated with primary percutaneous coronary intervention (PCI). No data is available for other platelet volume indices: platelet distribution width (PDW) and platelet large cell ratio (P-LCR). The aim was to assess the impact of 3 platelet volume indices on long-term prognosis in patients treated with primary PCI in acute MI. METHODS: This prospective study enrolled 538 patients who underwent primary PCI in acute MI. Admission blood samples were measured for MPV, PDW, and P-LCR. The patients were followed-up a mean period of 26 ± 11 months with regard to cardiac death, non-fatal reinfarction, re-PCI or coronary artery bypass grafting. RESULTS: Kaplan-Meier survival analysis showed a significantly higher 26-month mortalityrate in patients with high MPV (≥ 11.7 fL) than in those with low MPV (< 11.7 fL) (14.6% vs. 5.5%, p = 0.0008). Similar findings were related to high P-LCR (≥ 38.1%) vs. low P-LCR (< 38.1%) - mortality 13.8% vs. 5.8%, p = 0.0025. Higher PDW values (≥ 16 fL) correlated with higher mortality rate as compared to PDW < 16 fL (17.4% vs. 6.3%, p = 0.0012). PDW was found to be an independent prognostic factor for cardiac mortality and composite endpoint. CONCLUSIONS: Mean platelet volume, platelet distribution width and platelet large cell ratio measured on admission are strong, independent prognostic factors in PCI-treated acute MI.

[Untypical cause of heart failure--right atrial myxoma]. / Nietypowa przyczyna niewydolnosci serca--sluzak prawego przedsionka.

The study presents case of a 62-year-old female patient with symptoms of the heart failure NYHA class III intensifying for the last 2 months. In the physical examination at admission no significant abnormalities were found. In the two- and three-dimensional echocardiography normal thickness and contractility of the left ventricle wall were found, as well as the normal systolic function of the right ventricle. In enlarged right atrium a structure of the oval shape was found with the features of continuity with atrial septum and bulging of a small part of the structure through the orifice of the tricuspid valve to the right ventricle. In the study no features of blocking the tricuspid flow or the inflow from the main veins and coronary sinus were detected. On the basis of the complete echocardiographic examination and clinical presentation tentative diagnosis of right atrium myxoma was made. In coronary angiography no significant abnormalities in coronary arteries were found. After cardio-surgical consultation the patient was scheduled for the surgical removal of the tumor, which was performed without complications. The histopathological examination confirmed the diagnosis of myxoma. In the follow-up echocardiography carried out after 8 months the reduction of the cavity of the right atrium was found and a good function of the ventricles. There were no features of the tumor re-growth.