scholarly journals Multislice computed tomography in the evaluation of coronary atherosclerosis dynamics: data three-year observation in patients with myocardial infarction-segment elevation ST and stenting of coronary arteries

2021 ◽  
Vol 27 (6) ◽  
pp. 19-30
Author(s):  
L. M. Babii ◽  
V. O. Shumakov ◽  
O. P. Pogurelska ◽  
A. Yu. Rybak ◽  
I. E. Malynovska ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Multislice Computed Tomography ◽  
Atherosclerotic Lesions ◽  
Msct Coronary Angiography ◽  
Coronary Artery Stenting ◽  
Progression Of Atherosclerosis

The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.

INDEPENDENT PREDICTORS AND PROGNOSIS OF LONG-TERM MYOCARDIAL INFARCTION IN PATIENTS WITH UNSTABLE ANGINA AFTER CORONARY ARTERY STENTING

2021 ◽  
Vol 5 (1) ◽  
pp. 1109-1120
Author(s):  
A. Miadzvedzeva ◽  
◽  
L. Gelis ◽  
O. Polonetsky ◽  
I. Russkikh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Coronary Arteries ◽  
C Reactive Protein ◽  
Endogenous Thrombin Potential ◽  
Reactive Protein ◽  
Coronary Artery Stenting

Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7±1.6 years. Results. Repeated UA developed in 91 (55.2%) pts during a 7-year follow-up period, myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent predictors of MI risk included: baseline D-dimer level ≥796 ng/ml AUC 0.766 (RR 5.272; 95% CI 2,125-13,082), endogenous thrombin potential ≥2294.5 nM*min AUC 0.912 (RR 4,769; 95% CI 2,457-10,546), N-terminal fragment of brain natriuretic peptide (NTproBNP) ≥816 pg/ml AUC 0.794 (RR 1,935; 95% CI 1,218-3.075), homocysteine level ≥16 µmol/l AUC 0.707 (RR 1.971; 95% CI 1.140-3.406), highly sensitive C-reactive protein ≥6.4 g/l AUC 0.790 (RR 1.333; 95% CI 1.081-1.644), number of affected arteries≥ 3 AUC 0.714 (RR 2.129; 95% CI 1.237-2.664). The developed model for predicting myocardial infarction included the initial level of endogenous thrombin potential≥2294.5 nM * min, D-dimers ≥796 ng / ml, and the number of affected coronary arteries≥ 3. For the developed model, the AUC was 0.964, which corresponds to the excellent quality of the model. Conclusion. The prognosis of myocardial infarction in patients with unstable angina and stenting of the coronary arteries receiving the standard antiplatelet therapy involves laboratory criteria that reflect the activation of the hemostatic system and the residual thrombogenic risk.

scholarly journals Progression markers of coronary calcification

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Y U Sedykh ◽  
O L Barbarash ◽  
V V Kashtalap ◽  
O N Hhryachkova ◽  
A N Kokov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bone Mineral Density ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Bone Mineral ◽  
Preoperative Period ◽  
Mineral Density ◽  
Msct Coronary Angiography ◽  
Fatal Myocardial Infarction

Abstract Aim To evaluate the relationship between clinical parameters, biomarkers of bone turnover and the progression of coronary artery calcification (CAC) in patients with stable coronary heart disease (CHD) based on long-term (5 years) follow-up. Material and methods The single-center, prospective, non-randomized observational study included 111 men with CHD, admitted for CABG. All patients in the preoperative period underwent the following procedures: color duplex scanning (CDS) of the brachiocephalic arteries (BCA), multi-slice computed tomography (MSCT) coronary angiography to assess the degree of CAC using the Agatson score (calculation of the coronary artery calcium score – CACS), estimation of femoral neck bone mineral density with the T-score calculation and clinical assessment of biomarkers of bone metabolism (calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone). The vital status of patients was ascertained after 3–5 years of follow-up after CABG, CDS of the BCA and MSCT-coronary angiography were repeated. To identify the most significant clinical and anamnestic risk factors and form a model of predictors of CAC progression, patients were divided into two groups depending on the high increase in CACS (an increase in the score of more than 100 Agatston units (AU). Results 16 (14.4%) out of 111 patients failed to establish contact for the next stage of the study. In 4 (3.6%) cases death was registered (3 – fatal myocardial infarction, 1 – fatal stroke). The CAC progression was assessed in 91 patients (81.9%). Patients who showed signs of CAC progression comprised a group of 60 (65.9%) patients; without CAC progression – 31 (34.1%) patients. The “end points” in the groups were comparable and were detected in 18 cases (19.7%): recurrent angina in 16 patients (p=0.368), non-fatal myocardial infarction in 1 (p=0.162) and 1 emergency stenting (p=0,162) of the coronary artery that was not subjected to CABG. The risk model for CAC progression included an initial decrease in femoral neck bone mineral density and nonadherence to statins for 5 years after CABG (p=0.001). Conclusion 65.9% of men with stable CHD showed the signs of CAC progression for 5 years after CABG, according to MSCT. The main predictors of CAC were: low cathepsin K levels and low bone mineral density in the preoperative period, low OPG 5 years post-CABG. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”; 6, Sosnovy Blvd, Kemerovo, 650002, Russia

scholarly journals Spontaneous coronary artery dissection: Rare but challenging

2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

scholarly journals Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

2020 ◽  
Vol 17 (2) ◽  
pp. 39-42
Author(s):  
Ram Chandra Kafle ◽  
Girija Shankar Jha ◽  
Dibya Sharma ◽  
Vijay Madhav Alurkar
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Prior Use

Background and Aims: It is well known that ST segment elevation myocardial infarction results from complete occlusion of a coronary artery supplying that area. However, in up to 15% of patients with clinical diagnosis of myocardial infarction, early angiography reveal either non-obstructive or normal coronary artery. This subgroup of disease, myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), represent a diagnostic and therapeutic challenge to clinicians. We aimed to determine prevalence and clinical profile of patients with MINOCA in current study. Methods: This is a retrospective, observational study conducted in cardiology department of Manipal Teaching Hospital, Pokhara, Nepal from 6th April 2014 to 5th April 2019. Patients with age ≥18 years and clinically diagnosed acute myocardial infarction who underwent coronary angiography without prior use of thrombolytic agents were selected. Data were analyzed using the software SPSS for windows version 18. Results: A total of 177 patients’ underwent early coronary angiography without prior use of thrombolytic agent. The prevalence of MINOCA was 13.5% (n=24) in our study population. MINOCA patients were younger (p<0.001) compared to non-MINOCA. Smoking, systemic hypertension, access through femoral route and depressed left ventricular ejection fraction were significantly lower in MINOCA patients (p<0.05, for all). Conclusion: The prevalence of MINOCA was high (13.5%) in our study. Prospective studies are needed to conclude its high prevalence and to look for other associated factors and etiology.

scholarly journals Myocardial Infarction with Non-obstructive Coronary Arteries-MINOCA

2017 ◽  
Vol 5 (1-2) ◽  
pp. 61-66
Author(s):  
Sahela Nasrin ◽  
Masuma Jannat Shafi
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Clinical History ◽  
Clinical Syndrome ◽  
Artery Disease ◽  
Artery Obstruction ◽  
Diagnostic Investigations

Myocardial Infarction with Non-obstructive Coronary Arteries-MINOCA is a clinical syndrome that encompasses a subgroup of heterogeneous patients who present with myocardial infarction yet do not have any significant coronary artery obstruction on angiogram. From several studies it is understood that MINOCA has a 8.8% prevalence of all Myocardial Infarction (MI) presentations, with no characteristic distinguishing clinical features when compared with MI-CAD( Coronary artery disease), except for patients being younger with a female preponderance & less likely to have hyperlipidemia. The prognosis is extremely variable, depending on the causes of MINOCA. Clinical history, echocardiography, coronary angiography, and left ventriculography represent the first-level diagnostic investigations. Ibrahim Card Med J 2015; 5 (1&2): 61-66

Abstract 1631: Exclusion of Coronary Artery Stenosis by Non-invasive Coronary Angiography Using Multislice Computed Tomography Determines a Good Long-term Prognosis in Patients With Chest Pain - Follow-Up Study in 1017 Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Peter Steinbigler ◽  
Eike Böhme ◽  
Carla Weber ◽  
Andreas Czernik ◽  
Jürgen Buck ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Multislice Computed Tomography ◽  
Coronary Artery Stenosis ◽  
Invasive Coronary Angiography ◽  
Artery Stenosis ◽  
Noninvasive Coronary Angiography

Long-term prognosis following exclusion of coronary artery stenosis by noninvasive coronary angiography using multislice computed tomography (MSCT) up to now has not been determined. We therefore performed noninvasive coronary angiography using MSCT (Philips Brilliance, 4 – 64 slices, retrospective ECG gating, 0.625mm collimation, 0.4sec gantry rotation time) in 1017 consecutive patients (657 male, 360 female, age 64±11years, 240 patients with known coronary artery disease (CAD)) referred to MSCT-study with chest pain. Patients with acute coronary syndromes, stents, atrial fibrillation and calcium scores > 1500 were not included. Based on MSCT results invasive study was recommended or not. All patients or the referring clinician were contacted by telephone or mail at least 6 months after their scan. Diagnostic image quality could be obtained in 992/1017 (98%) patients. In 620 of 992 patients (=63%) coronary artery stenosis could be excluded and invasive study was not recommended. Despite these recommendations invasive study was performed due to other clinical indications in 83/620 patients within < 30 days and in 43/537 patients within > 30days after the scan. Only in 13/126 patients stenoses >50% were found but no treatment was necessary. During the mean follow-up period of 612±192days 7/620 patients died but no patient suffered from cardiac death or acute myocardial infarction. In 372 of 992 patients invasive coronary angiography was recommended and performed in 230 patients (n=167 within < 30days, n=63 within >30days). In 165/230 patients stenoses >50% were found, treated by angioplasty or stents in 139/165 patients. During the mean follow-up period of 602±161days 11/372 patients died, two patients suffered from sudden, two patients from non-sudden cardiac death and one patient survived acute myocardial infarction. Thus, exclusion of coronary artery stenoses by noninvasive coronary angiography using multislice computed tomography determines a good lomg-term prognosis in patients with chest pain.

THU0592 INSIDIOUS CORONARY ARTERY DISEASE IN A YOUNG PATIENT WITH POLYARTERITIS NODOSA: A CASE REPORT AND REVIEW OF LITERATURE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 538-539
Author(s):  
H. Huang ◽  
Z. Zhang
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Polyarteritis Nodosa ◽  
Computed Tomography Angiography ◽  
Coronary Stenosis ◽  
Coronary Computed Tomography Angiography

Background:Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries, with occasional involvement of small muscular arteries[1]. Although overt myocardial infarction is uncommon, myocardial ischemia may result from narrowing or occlusion of the coronary arteries[2].Objectives:Herein, we report a case with 7-year’s history of PAN and unstable angina pectoris due to coronary occlusions of the three main arteries. We also reviewed the literatures regarding coronary artery involvement in PAN.Methods:A 22-year-old Chinese man who presented with chest pain lasting for a few minutes and then subsiding spontaneously for 1 month was admitted to our hospital. He was diagnosed as PAN 7 years ago and during 7-years’ follow-up, he has been in stable condition, without any discomfort or abnormal laboratory findings. In December 2019, he suffered from chest distress accompanied by retrosternal pain, with frequency of about 2-3 times a week. His symptoms were gradually aggravating with dyspnea at night.Results:Coronary computed tomography angiography showed diffuse coronary stenosis (Fig. 1). Further coronary angiography revealed a slight plaque infiltration of the left main coronary artery, and occlusion of all the three major coronary arteries, as well as multiple coronary aneurysms. 95% stenosis of the obtuse margin branch artery was also found and a stent was then implanted (Fig. 2). Prednisone 50mg/day and methotrexate 15mg/week were reinitiated, in combination with anti-anginal medications including aspirin and statin.Fig. 1Coronary computed tomography angiography found diffuse coronary stenosis.Fig. 2Coronary angiography. (a) A 50% stenosis followed by aneurysmal change of the proximal end of left anterior descending (LAD) artery, and totally occluded from the middle segment; A aneurysmal change of the initial part of left circumflex artery (LCX) and then totally occluded (dotted line); A 95% stenosis obtuse margin branch. (b) A totally occluded right coronary artery (dotted line). (c) Final appearance of the LCX after stent implantation.After we reviewed all the English literatures reporting cardiac involvements in adults with PAN from 1990 to 2019, a total of 34 patients from 32 articles were identified. 25 (73.5%) patients were admitted to hospital due to acute coronary syndromes manifesting as chest pain or dyspnea. Coronary stenosis or occlusions were most common on imaging or autopsy. Most of the patients had more than one vessel involved, of whom 7 patients showed evidence of triple vessel lesions. Aneurysm was also common in these patients, especially multiple aneurysms. Spontaneous coronary artery dissections were rare in PAN patients. Most patients received glucocorticoid, and/or immunosuppressant therapy, including cyclophosphamide and azathioprine, with or without invasive operations. 15 patients died from cardiopulmonary arrest, the most frequent cause being death, and 15 patients were stable without symptoms after treatment.Conclusion:We report a young PAN patient with insidious stenosis of three main coronary arteries under the circumstance of stable disease activity for years. This reminds us of the necessity of assessing heart, probably other organs as well, in PAN patients even though their acute phase reactants in serum are normal. But how often to do the screening and which screening examination should be done, remain to be further investigated.References:[1]Jennette, J.C., et al.,2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides.Arthritis Rheum, 2013.65(1): p. 1-11.[2]Kastner, D., M. Gaffney, and T. Tak,Polyarteritis nodosa and myocardial infarction.Can J Cardiol, 2000.16(4): p. 515-8.Disclosure of Interests:None declared

scholarly journals CLINICAL CHARACTERISTICS OF PATIENTS UNDER ROUTINE SEDATION IN ENDOVASCULAR TREATMENT OF ISCHEMIC HEART DISEASE

2020 ◽  
Vol 20 (3) ◽  
pp. 95-102
Author(s):  
D.O. Dziuba ◽  
M.V. Boluk ◽  
A.A. Syvoraksha ◽  
O.V. Loskutov
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Endovascular Treatment ◽  
Clinical Characteristics ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Coronary Artery Atherosclerosis ◽  
Coronary Artery Stenting

In Ukraine, the number of emergency and elective coronary artery stenting operation is steadily growing from year to year, for instance, the number of the operations doubled for the period of 2014 – 2017. We carried out a retrospective study at the Heart Institute of the Ministry of Health of Ukraine in 2017 – 2018. The medical records of 73 patients (58 men and 15 women) aged 35 – 83 who underwent coronary angiography and emergency and elective coronary artery stenting were selected for the study. Surgical interventions were performed under routine sedation (sedation level II-III according to the Ramsay Sedation Score) with diazepam and / or fentanyl and / or morphine. The aim of the study was to characterize the main clinical characteristics of patients with different forms of coronary artery disease who underwent X-ray image-guided endovascular treatment under different modes of routine anesthesia. We have found out overweight men aged 59.93 ± 0.84 prevailed among the patients under the study. We selected patients with different clinical forms of coronary heart disease including acute coronary syndrome (myocardial infarction, unstable angina) and chronic coronary syndromes (angina pectoris of different functional classes, asymptomatic coronary artery atherosclerosis). 29 (39.73%) patients underwent coronary angiography and elective coronary artery stenting; 44 patients (60.27%) had diagnostic coronary angiography and emergence stenting operations. The main comorbidities on admission to the hospital were as follows: 64 patients were diagnosed as having hypertension of various stages and degrees (87.67%); nine patients (13.71%) had diabetes, including 1.37% of newly diagnosed diabetics. Atrial fibrillation was found in 12.33% of the patients. Hyperglycemia at the admission to the hospital was detected in 25 patients that made up a third of all patients (34.25%). Among the patients, who had elected operations, the overwhelming indication for stenting was exertional angina, FC III (21.92%); among the patients who underwent emergency operations, the key indications was myocardial infarction with ST segment elevation (38.36%). In the group of the patients who were admitted for emergency hospitalization, fentanyl was mainly used for intraoperative sedation, while fentanyl and diazepam were used for the patients, who had elective surgeries.

scholarly journals Stress testing-guided assessment of coronary artery bypass grafts patency, at 6 months of follow up. A prospective study

2021 ◽  
pp. 21-29
Author(s):  
Boukhmis Abdelkader ◽  
Nouar Mohamed El-Amin
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Bypass ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Bypass Grafts ◽  
Repeat Revascularization ◽  
Coronary Bypass Grafts

Purpose: To assess the coronary bypass grafts patency and the repeat revascularization rate, six months after coronary artery bypass grafting (CABG). Methods: We prospectively enrolled 145 consecutive patients undergoing isolated CABG between June 2014 and June 2016. We performed at 6 months of follow up a coronary computed tomography angiography (CTA) in patients whose stress tests were negative and an invasive coronary angiography (ICA) in the opposite case. Results: A total of 134 CTA and 11 ICA were performed, allowing the analysis of 321 grafts, including 143 left internal thoracic arteries (LITA), 89 right internal thoracic arteries (RITA) and 89 saphenous veins grafts (SVG). The average graft patency was 95.1% for LITA, 84.3% for RITA and 64% for SVG. The best patencies were obtained when these grafts were anastomosed to the left anterior descending artery (LAD): 96.3% for LITA, and 87.5% for RITA. SVG patency was homogeneous whether between the main right coronary artery and its branches (63.4% versus 65% respectively. p = 1), or between circumflex and RCA (72.7% versus. 63.9% respectively. p=0.6). On the right and circumflex coronary arteries, the patency of the SVG was significantly lower than that of RITA (66.26% versus 83.95% respectively, p = 0.011). At 6 months of follow up, the repeat revascularization rate was 2.07% (n=3/145). Conclusions: 6 months after CABG, RITA and LITA had good patencies especially on LAD, while SVG was occluded in almost a third of cases. On the circumflex and right coronary arteries, SVG patency was significantly lower than that of RITA. Keywords: Coronary Artery Bypass; Exercise Testing; Coronary Angiography; Computed Tomography Angiograph

scholarly journals Myocardial bridge and coronary artery fistulas in a patient with angina

2019 ◽  
Vol 10 (2) ◽  
pp. 137-141
Author(s):  
Aleksandra A. Kholkina ◽  
Yuriy R. Kovalev ◽  
Vladimir A. Isakov ◽  
Natal’ya O. Gonchar
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Angina Pectoris ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Myocardial Bridge

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

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