Congenital coronary artery anomalies in adults: review of 111 cases from a single-centre experience.

BACKGROUND: Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre. METHODS: We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls. RESULTS: Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005). CONCLUSIONS: Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.

Predictors of in-hospital mortality in octogenarian patients who underwent primary percutaneous coronary intervention after ST segment elevated myocardial infarction.

AIM: Octogenarian patients have higher mortality and morbidity rates after acute coronary syndromes. Risk factors for in-hospital mortality in the primary percutaneous coronary intervention (PCI) era were underrepresented in previous studies. In the present study, we aimed to assess the risk factors of in-hospital mortality after primary PCI in this population. METHODS: We analyzed 2353 patients who underwent primary PCI after ST segment elevated myocardial infarction (STEMI). Patients were divided into two groups according to aged: ≥80 years (octogenarian) and <80 years (control). Risk factors for in-hospital mortality were analyzed in the whole group and octogenarian patients. RESULTS: We found that octogenarians have 10.6-fold higher mortality risk after STEMI. After a univariate and multivariate analysis, acute stent thrombosis was the most explicit risk factor for in-hospital mortality in the octogenarian group (OR 21.13, 95% CI 2.11-102.76, P < 0.001). Additionally, anterior myocardial infarction (OR 4.90, 95% CI 1.90-22.10, P = 0.04), ventricular arrhythmias (OR 15.64, 95% CI 2.81-87.12, P = 0.002), multivessel disease (OR 6.5, 95% CI 1.11-38.85, P = 0.04), ejection fraction <30% (OR 1.24, 95% CI 0.26-6.00, P = 0.04) and KILLIP score ≥2 (OR 1.20, 95% CI 0.20- 7.41, P = 0.01) were also significantly associated with mortality. CONCLUSIONS: Acute stent thrombosis, anterior MI, heart failure, low ejection fraction, ventricular arrhythmias and multivessel disease are the independent risk factors for in-hospital mortality among octogenarian patients after primary PCI. Geriatr Gerontol Int 2017; 17: 584-590.

Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease.

BACKGROUND: The prognostic value of baseline SYNTAX (SS) and clinical SYNTAX (cSS) scores has been shown in different populations with coronary artery disease. However, their prognostic value has not been compared in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. METHODS: Patients who had undergone a primary percutaneous coronary intervention (PCI) for STEMI and had at least one critical lesion other than the culprit artery were recruited retrospectively. SS and cSS were calculated from medical records and angiograms and were compared in coronary artery by-pass grafting (CABG) and PCI groups. Long-term major adverse cardiac events (MACE) were defined as mortality, reinfarction, and target vessel revascularization. RESULTS: A total of 460 patients (214 in the CABG group and 246 in the PCI group) were analyzed. The baseline SS and the cSS were significantly higher in the CABG group compared with the PCI group (30.1±6.7 vs. 22.5±5.6; P<0.01 and 41.4±21.2 vs. 27.2±15.9; P<0.01, respectively). During a follow-up period of 32±8 months, 15 patients from the CABG group and 12 patients from the PCI group died (P=0.33), but the rate of MACE was higher in the PCI group (31 vs. 20%, P<0.01). Receiver operating curve analysis and univariate Cox regression analysis indicated that SS and cSS have prognostic value in the CABG group, but not in the PCI group. In the CABG group, SS and cSS showed significant discriminative power for long-term mortality (for SS>33 sensitivity 73.3%, specificity 71.4% and for cSS>38.4 sensitivity 93.3%, specificity 58.3%) and for MACE (for SS>34.5 sensitivity 50%, specificity 81.4% and for cSS>43.5 sensitivity 66.7%, specificity 73.8%). CONCLUSION: SS and cSS scores have prognostic value in STEMI patients with multivessel disease treated with CABG surgery. cSS may be superior to SS for prediction of long-term adverse events in CABG patients.

CHA2DS2-VASc Score is a Predictor of No-Reflow in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Intervention.

Thrombosis and distal embolization play crucial role in the etiology of no-reflow. CHA2DS2-VASc score is used to estimate the risk of thromboembolism in patients with atrial fibrillation. We tested the hypothesis that CHA2DS2-VASc can predict no-reflow among patients who underwent primary percutaneous coronary intervention (PCI). A total number of 2375 consecutive patients with ST-segment elevation myocardial infarction were assessed for the study. Patients were divided into 2 groups as no-reflow (n = 111) and control (n = 1670) groups according to post-PCI no-reflow status. CHA2DS2-VASc scores were calculated for all patients. CHA2DS2-VASc scores were significantly higher in the no-reflow group compared to the control group. After a multivariate regression analysis, CHA2DS2-VASc score remained as an independent predictor (odds ratio: 1.58, 95% confidence interval: 1.33-1,88, P < .001) of no-reflow. Receiver-operating characteristics analysis revealed the cutoff value of CHA2DS2-VASc score ≥2 as a predictor of no-reflow with a sensitivity of 66% and a specificity of 59%. Moreover, in-hospital mortality was also associated with significantly higher CHA2DS2-VASc scores. In conclusion, CHA2DS2-VASc score is associated with higher risk of no-reflow and in-hospital mortality rates in patients who underwent primary PCI.