scholarly journals 691 Distribution of wall motion abnormalities in young patients presenting with acute coronary syndrome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giulia De Santis ◽  
Lorenzo Pistelli ◽  
Marco Franzino ◽  
Claudio Nicolo ◽  
Francesca Parisi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
Young Patients ◽  
Septal Wall ◽  
Coronary Syndrome ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Aims Distribution of wall motion abnormalities (WMA) in young patients presenting with acute coronary syndrome (ACS) is not well described. Methods and results We included 91 consecutive young patients (≤45 years at presentation) with ACS with obstructive or without obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Wall motion abnormalities, wall motion score index (WMSI) and left ventricle ejection fraction (LVEF) were evaluated. A wall motion abnormality in at least one segment was present in 78.7% of patients. Mean LVEF was 50.9 ± 8.8% and mean WMSI was 1.38 ± 0.37%. Akinesia of at least one segment was present in 49.4%, dyskinesia and aneurysm were rare (1.1%, respectively). Ventricular thrombus was observed in 4.7%. Distribution of wall motion abnormalities is presented in Figure A. Most frequently WMA affected the apex and the basal inferior wall. The severity of WMA for each segment is presented in Figure B. The mean highest severity of WMA affected the apex, and the inferior and infero-septal wall. In the subgroup of patients presenting without obstructive coronary artery disease, WMA were less prevalent (37.5%), LVEF was higher (57.1% vs. 50.4% P = 0.032), and WMSI was lower (1.16% vs. 1.40% P = 0.07), but similarly affected with higher frequency the apex area. Conclusions In conclusion, WMA are frequent in young patients presenting with ACS, mostly affecting the apex. More severe abnormalities of wall kinesis affect the apex and the inferior and infero-septal wall.

scholarly journals 686 Coronary lesion distribution in young patient presenting with acute coronary syndrome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Marco Franzino ◽  
Lorenzo Pistelli ◽  
Francesca Parisi ◽  
Giulia Azzurra De Santis ◽  
Claudio Nicolò ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Young Patients ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Coronary Segment ◽  
Coronary Lesions ◽  
Artery Disease

Abstract Aims The distribution of coronary lesions in young patients presenting with acute coronary syndrome (ACS) is not known. Methods and results We included 82 consecutive young patients (≤45 years at presentation) with ACS and obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Significant coronary lesions (>50%) at each segment during coronary angiography were evaluated. A total of 158 lesions have been evaluated. Multivessel disease was observed in 37% of patients. Lesions at proximal and mid left anterior descending (LAD) coronary artery were the most common observation (Figure A). Roughly one in three lesions affected a proximal coronary segment (i.e. segment 1, 5, 6, or 11), and 45.1% of patients presented at least one lesion in these segments. Within each segment, lesions affected the ostium in 15.8%, proximal third in 26.8%, mid-third in 32.9%, and distal-third in 15.9% of cases. Among those presenting with ST-segment elevated myocardial infarction, culprit lesion distribution is presented in Figure B. Proximal segments were affected in 33.9%, while culprit lesion of the LAD, left circumflex, and right coronary artery was observed in 51.8%, 16.1%, and 32.1% respectively. Conclusions In conclusion, coronary artery disease in patients presenting with ACS occur more often in the LAD and in proximal coronary segments. A significant lesion in a proximal coronary segment affected roughly half of young patients presenting with ACS.

Abstract 20047: Validation of the Simple Acute Coronary Syndrome (SACS) Score for Identifying Obstructive Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daniel Matta ◽  
Christina Marsalisi ◽  
Wayne Ruppert ◽  
Ravi Korabathina
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Catheterization ◽  
Obstructive Coronary Artery Disease ◽  
Retrospective Chart Review ◽  
Study Endpoint ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Scoring Tool

Background: Each year, up to 136,000 individuals suffering from acute coronary syndrome (ACS) are misdiagnosed and discharged from our nations’ emergency departments. We developed the Simple Acute Coronary Syndrome (SACS) score that tabulates a patient’s symptoms, ECG findings, risk factors, and cardiac markers (Figure 1). Our aim was to validate this novel scoring tool in its ability to identify the presence of obstructive coronary artery disease (CAD). Methods: A single-center retrospective chart review was performed after institutional review board approval. The charts of 42 consecutive patients who presented with ACS and who were treated with an invasive strategy were reviewed. Scores were calculated for each patient using the SACS tool as well as the Modified Thrombolysis in Myocardial Infarction (TIMI) ACS calculator. The study endpoint was the presence of at least one vessel obstructive CAD at cardiac catheterization. Descriptive statistics were employed. Results: The stratification of SACS and Modified TIMI scores for each of the 42 ACS patients is shown in Figure 2. In patients with a SACS score that was less than 3, none of these patients were found to have obstructive CAD at cardiac catheterization. For patients with a SACS score of 4 or higher, 100% of these patients were shown to have obstructive CAD. For patients with Modified TIMI scores of 1 and 2, 3/11 (27%) were found to have obstructive CAD. Conclusions: The novel SACS scoring system identifies ACS patients who will have obstructive CAD more reliably than more traditional scoring systems. The SACS scoring tool needs to be validated in larger scale studies.

scholarly journals Takotsubo Syndrome Associated with ST Elevation Myocardial Infarction

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Saad Ezad ◽  
Michael McGee ◽  
Andrew J. Boyle
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
Takotsubo Syndrome ◽  
St Elevation ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Background. Takotsubo syndrome is a reversible heart failure syndrome which often presents with symptoms and ECG changes that mimic an acute myocardial infarction. Obstructive coronary artery disease has traditionally been seen as exclusion criteria for the diagnosis of takotsubo; however, recent reports have called this into question and suggest that the two conditions may coexist. Case Summary. We describe a case of an 83-year-old male presenting with chest pain consistent with acute myocardial infarction. The ECG demonstrated anterior ST elevation with bedside echocardiography showing apical wall motion abnormalities. Cardiac catheterisation found an occluded OM2 branch of the left circumflex artery with ventriculography confirming apical ballooning consistent with takotsubo and not in the vascular territory supplied by the occluded epicardial vessel. Repeat echocardiogram 6 weeks later confirmed resolution of the apical wall motion abnormalities consistent with a diagnosis of takotsubo. Discussion. This case demonstrates the finding of takotsubo syndrome in a male patient with acute myocardial infarction. Traditionally, this would preclude a diagnosis of takotsubo; however, following previous reports of takotsubo in association with coronary artery dissection and acute myocardial infarction in female patients, new diagnostic criteria have been proposed which allow the diagnosis of takotsubo in the presence of obstructive coronary artery disease. This case adds to the growing body of literature that suggests takotsubo can coexist with acute myocardial infarction; however, it remains to be elucidated if it is a consequence or cause of myocardial infarction.

scholarly journals Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

2017 ◽  
Vol 39 (2) ◽  
pp. 102-110 ◽  
Author(s):  
Hedvig Bille Andersson ◽  
Frants Pedersen ◽  
Thomas Engstrøm ◽  
Steffen Helqvist ◽  
Morten Kvistholm Jensen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Causes Of Death ◽  
Obstructive Coronary Artery Disease ◽  
Term Survival ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients with non-ST segment elevation acute coronary syndrome

2020 ◽  
pp. 204887262091871
Author(s):  
Gaetano Antonio Lanza ◽  
Eleonora Ruscio ◽  
Gessica Ingrasciotta ◽  
Tamara Felici ◽  
Monica Filice ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Cardiac Autonomic Function ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease

Background A sizeable number of patients with a diagnosis of non-ST segment elevation acute coronary syndrome show non-obstructive coronary artery disease. In this study we assessed whether differences in vascular and cardiac autonomic function exist between non-ST segment elevation acute coronary syndrome patients with obstructive or non-obstructive coronary artery disease. Methods and results Systemic endothelium-dependent and independent vascular dilator function (assessed by flow-mediated dilation and nitrate-mediated dilation of the brachial artery, respectively) and cardiac autonomic function (assessed by time-domain and frequency-domain heart rate variability parameters) were assessed on admission in 120 patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Patients were divided into two groups according to coronary angiography findings: (a) 59 (49.2%) with obstructive coronary artery disease (≥50% stenosis in any epicardial arteries); (b) 61 (50.8%) with non-obstructive coronary artery disease. No significant differences between the two groups were found in both flow-mediated dilation (5.03 ± 2.6 vs. 5.40 ± 2.5%, respectively; P = 0.37) and nitrate-mediated dilatation (6.79 ± 2.8 vs. 7.30 ± 3.4%, respectively; P = 0.37). No significant differences were also observed between the two groups both in time-domain and frequency-domain heart rate variability variables, although the triangular index tended to be lower in obstructive coronary artery disease patients (30.2 ± 9.5 vs. 33.9 ± 11.6, respectively; P = 0.058). Neither vascular nor heart rate variability variables predicted the recurrence of angina, requiring emergency room admission or re-hospitalisation, during 11.3 months of follow-up. Conclusions Among patients admitted with a diagnosis of non-ST segment elevation acute coronary syndrome we found no significant differences in systemic vascular dilator function and cardiac autonomic function between those with obstructive coronary artery disease and those with non-obstructive coronary artery disease.

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