Abstract 15360: Coronary Artery Dominance, Anatomical Variants and Anomalies in African American Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hilda M Gonzalez Bonilla ◽  
Nitheesha Ganta ◽  
Ahmad A Awan ◽  
Isaac Opoku Asare
Keyword(s):  
Coronary Artery ◽  
African Americans ◽  
General Population ◽  
Hospital Mortality ◽  
Left Main Coronary Artery ◽  
Coronary Vessels ◽  
Left Main ◽  
Coronary Syndrome ◽  
History Of ◽  
Coronary Dominance

Introduction: Coronary arterial dominance is defined by the vessel which gives rise to the posterior descending artery (PDA). The prevalence of right dominance is 80- 85%, left dominance is 8% and codominance is 7% among the general population. The coronary dominance in African Americans is not well known. The aim of this study was to investigate the coronary dominance in African Americans. Previous studies showed that left dominance and codominance are associated with increased post-percutaneous coronary intervention (PCI) in-hospital mortality in patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of coronary angiograms performed in our facility was done. A total of 556 cases were reviewed from 2018 to 2019. All the data was collected from the electronic medical records. Patients were categorized by race, gender, age, and comorbidities. Angiograms were reviewed and coronary dominance was determined by the vessel which supplied the PDA. Results: From the 556 charts reviewed, 430(77%) cases were performed in African Americans. Of the 430 patients, 220(51%) were male and 210(49%) were female. Mean age was 62.6 years. 370(86%) patients had hypertension, 171(39.7%) had diabetes, 28(6.5%) had peripheral vascular disease, 149(34.6%) had heart failure, 33(7.6%) had history of stroke. 28(6.5%) were on dialysis, 201(46.7%) had dyslipidemia, 14(3.2%) had HIV, 43 (10%) had atrial arrhythmias, 237(55.1%) had history of tobacco use and 21(4.8%) had history of cocaine use. In 390(90.7%) patients, left main coronary artery bifurcated into left anterior descending coronary artery (LAD) and left circumflex artery (LCX). In 40(9.3%) patients, left main coronary artery trifurcated into LAD, LCX and ramus intermedius artery. Among these patients, 303(70.4%) had right coronary dominance, 38(8.8%) had left coronary dominance and 89(20.7%) had codominance. 7 patients had ectasia of the coronary vessels and 8 patients had anomalous origin of coronary vessels. Conclusions: Our study showed that African Americans have higher prevalence of codominance compared to general population. It is important to identify it at the time of coronary angiogram since it has been associated with increased post PCI in-hospital mortality in patients with ACS.

scholarly journals A Case of Left Main Coronary Artery Disease in an Octogenarian Treated Surgically and Complicated by Myocardial Infarction: Decisions, Techniques, Rescue and Final Outcome

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11542
Author(s):  
Antoine Kossaify ◽  
Gilles Grollier
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Left Main ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Main Coronary Artery Disease ◽  
Artery Disease

We report on an octogenarian patient presenting with an acute coronary syndrome due to significant left main coronary artery disease and severe ostial stenosis of the left anterior descending artery disease. Emergent bypass graft performed with “beating heart” consisted of left internal mammary graft to the mid left anterior descending artery with an “over-stent” anastomosis. The immediate post-operative phase was simple, however the patient presented on post-operative day 8 with extensive anterior myocardial infarction and cardiogenic shock. Emergent coronary angiogram showed subocclusive anastomotic stenosis. Percutaneous coronary intervention was performed on left main, proximal left anterior descending, and proximal circumflex arteries. Subsequently, the patient restored a satisfactory hemodynamic condition. A focus on the importance of decision for management of left main disease especially in octogenarian is presented, along with a review of the pertinent literature.

scholarly journals Multiple Giant Coronary Artery Aneurysms Surgically Treated with Bypass Grafting: A Challenging Rarity

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kostas Kostopanagiotou ◽  
Aikaterini Poulou ◽  
Andrew Chatzis ◽  
Mazen Khoury
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Vessels ◽  
Illustrative Case ◽  
Bypass Grafting ◽  
Left Main ◽  
Coronary Artery Aneurysms ◽  
Giant Aneurysms ◽  
Coronary Syndrome

Coronary artery aneurysms are encountered in daily cardiology practise but multiple giant-sized coronary artery aneurysms are extremely rare. We present an illustrative case of multiple giant aneurysms located throughout the coronary system (left main stem and all left, right, and circumflex branches) in a 57-year-old male with acute coronary syndrome. The case was managed successfully with on-pump quadruple coronary artery bypass grafting. To our knowledge, few cases of multiple giant aneurysms in all coronary vessels have been reported.

Abstract 13152: Do Survivors of Acute Coronary Syndrome Due to Unprotected Left Main Coronary Artery Occlusion Treated With Extracorporeal Membrane Oxygenation Have Higher Mortality in Chronic Phase?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Haruko Shiota ◽  
Eisuke Kagawa ◽  
Masaya Kato ◽  
Noboru Oda ◽  
Eiji Kunita ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Phase ◽  
Cardiac Failure ◽  
Left Main Coronary Artery ◽  
Chronic Phase ◽  
Circulatory Support ◽  
Left Main ◽  
Coronary Syndrome

Introduction: Mortality in patients with acute coronary syndrome (ACS) due to unprotected left main coronary artery (LMA) occlusion is high. Extracorporeal membrane oxygenation (ECMO) could rapidly provide circulatory support. Hypothesis: This study aimed to verify the hypotheses that the patient who required circulatory support with ECMO in acute phase of LMA-ACS had greater cardiac function deterioration and had higher mortality in the chronic phase than those who did not require ECMO. Methods: Patients with LMA-ACS who underwent percutaneous coronary revascularization between 2000 and 2020 were enrolled in this study. The patients were divided into two groups based on whether or not they received ECMO. Thirty-day (acute phase) and 30-day to 6-year (chronic phase) survival curves were constructed by Kaplan-Meier method. The cause of death in acute and chronic phase were examined. Results: Among the 85 study patients, 23 (27%) were in the ECMO-group. Median age was younger in the ECMO-group (65 y [57 - 72] vs. 73 y [69 - 83], p < 0.01), and male sex (67% vs. 63%) were similar in ECMO group and non-ECMO groups respectively. The prevalence of ST elevation myocardial infarction (STEMI), non-STEMI, unstable angina were 52%, 48%, and 0% vs. 15%, 42%, and 44% in the ECMO group and non-ECMO group, respectively. The 30-day mortality was significantly higher in ECMO group (61% vs. 15%, p < 0.01); however, the 30-day to 6-year mortality was similar between the two groups (41% vs. 33%, p = 0.59) (Figure). The cause of death in the acute phase were cardiac failure (79% and 67%) and those in chronic phase were cardiac failure (50% and 25%), malignancy (0% and 13%), and infection (50% and 36%). Conclusions: The mortality in chronic phase in LMA-ACS patients who survived up to 30 days were similar in ECMO group and non-ECMO group. Moreover the patients whose cardiac function deteriorated severely and required ECMO in acute phase had similar prognosis to those that did not require ECMO.

scholarly journals Acute Coronary Syndrome With Unprotected Left Main Coronary Artery Culprit　― An Observation From the AOI-LMCA Registry ―

2018 ◽  
Vol 83 (1) ◽  
pp. 198-208 ◽  
Author(s):  
Hirooki Higami ◽  
Mamoru Toyofuku ◽  
Takeshi Morimoto ◽  
Masanobu Ohya ◽  
Yasushi Fuku ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Coronary Syndrome

scholarly journals Two-Year Outcomes after Left Main Coronary Artery Percutaneous Coronary Intervention in Patients Presenting with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Si-Da Jia ◽  
Yi Yao ◽  
Ying Song ◽  
Xiao-Fang Tang ◽  
Xue-Yan Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Left Main ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objectives. We aim to evaluate long-term outcomes after left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). Background. PCI of the LMCA has been an acceptable revascularization strategy in stable coronary artery disease. However, limited studies on long-term clinical outcomes of LMCA PCI in ACS patients are available. Methods. A total of 6429 consecutive patients with ACS undergoing PCI in Fuwai Hospital in 2013 were enrolled. Patients are divided into LMCA group and Non-LMCA group according to whether the target lesion was located in LMCA. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results. 155 (2.4%) patients had target lesion in LMCA, while 6274 (97.6%) patients belong to the non-LMCA group. Compared with non-LMCA patients, LMCA patients have generally more comorbidities and worse baseline conditions. Two-year follow-up reveals that LMCA patients have significantly higher rate of cardiac death (2.6% vs. 0.7%, p=0.034), myocardial infarction (7.1% vs. 1.8%, p<0.001), in-stent thrombosis (4.5% vs. 0.8%, p<0.001), and stroke (7.1% vs. 6.4%, p=0.025). After adjusting for confounding factors, LMCA remains independently associated with higher 2-year myocardial infarction rate (HR = 2.585, 95% CI = 1.243–5.347, p=0.011). Conclusion. LMCA-targeted PCI is an independent risk factor for 2-year myocardial infarction in ACS patients.

scholarly journals Left Main Coronary Artery Hypoplasia in Elderly

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Selma Kenar Tiryakioglu ◽  
Hakan Ozkan ◽  
Hakan Bahadir ◽  
Osman Tiryakioglu
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Left Main Coronary Artery ◽  
Cardiovascular Surgery ◽  
Coronary Risk Factors ◽  
Left Main ◽  
Circumflex Artery ◽  
Cardiac Symptoms ◽  
Different Types ◽  
History Of

Congenital anomalies of the coronary artery causing coronary occlusive disease may be of many different types. A 67-year-old woman with no coronary risk factors was referred for coronary angiography with few months’ history of angina. The patient underwent coronary angiography due to ischemic cardiac symptoms with nondiagnostic exercising test. In coronary angiography, the left main coronary artery was arising from normal anatomical position; however, left anterior descending artery and circumflex artery were hypoplastic. The treatment of patient was discussed in cardiology-cardiovascular surgery council and coronary surgery was found inappropriate due to the hypoplasia of the left coronary system entirely.

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