Elderly patients with acute myocardial infarction have not been specifically studied in the context of a large randomized clinical trial. Estimates of the efficacy of available treatments are gleaned from subset analyses of clinical trials, retrospective analysis and singlecenter experiences. In western countries the population is aging and a disproportionate number of myocardial infarctions occur in the elderly. Usage of appropriate therapy in this age group is becoming increasingly important given the potential for benefit but also the potential for harm. Recent publications have found steady improvement in outcomes in the elderly population utilizing contemporary interventions.

Most studies related with plaque histopathology and/or morphology are based on the gray scale intravascular ultrasound (IVUS) and autopsy findings, although IVUS is limited for differentiating echolucent areas, and tissue shrinkage almost always occur during tissue fixation. In addition, autopsy studies can not establish the causal relationship between the autopsy findings and the clinical findings. Spectral analysis of the IVUS radiofrequency data may be a new and useful tool because it allows detailed assessment of plaque composition in vivo, with a high predictive accuracy of 87.1% to 96.5% in fibrous, fibrofatty, calcified and necrotic core regions with performing tissue mapping and geometric assessment like that for classic gray scale IVUS. This new imaging technique offers clear benefits compared with the results of classic IVUS and autopsy studies. This review will briefly discuss the methodology of spectral analysis of the IVUS radiofrequency data, the recent clinical studies that have used this technique and the future perspectives.
Autopsy ; Coronary Artery Disease ; Diagnostic Imaging ; Tissue Fixation ; Ultrasonography ; Ultrasonography, Interventional

Most studies related with plaque histopathology and/or morphology are based on the gray scale intravascular ultrasound (IVUS) and autopsy findings, although IVUS is limited for differentiating echolucent areas, and tissue shrinkage almost always occur during tissue fixation. In addition, autopsy studies can not establish the causal relationship between the autopsy findings and the clinical findings. Spectral analysis of the IVUS radiofrequency data may be a new and useful tool because it allows detailed assessment of plaque composition in vivo, with a high predictive accuracy of 87.1% to 96.5% in fibrous, fibrofatty, calcified and necrotic core regions with performing tissue mapping and geometric assessment like that for classic gray scale IVUS. This new imaging technique offers clear benefits compared with the results of classic IVUS and autopsy studies. This review will briefly discuss the methodology of spectral analysis of the IVUS radiofrequency data, the recent clinical studies that have used this technique and the future perspectives.
Autopsy ; Coronary Artery Disease ; Diagnostic Imaging ; Tissue Fixation ; Ultrasonography ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death. RESULTS: In the CAD patients with a uric acid level < or =3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p<0.001). CONCLUSION: The serum uric acid level and multi-vessel disease are associated with subsequent cardiovascular events in the patients with CAD.
Acute Coronary Syndrome ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Stroke ; Transplants ; Uric Acid*

BACKGROUND AND OBJECTIVES: Nitroglycerin-mediated arterial dilation (NMD) was shown to be preserved in most previous studies, and this is possibly due to using a single high dose of nitroglycerin (NTG), which causes maximal arterial dilation. We sought to evaluate the clinical factors of flow-mediated dilation (FMD) and NMD at different doses of NTG in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: Thirty-two consecutive patients (mean age: 61 years old, 18 males) with angiographically proven CAD underwent FMD and NMD at total cumulative doses of 25microgram, 175microgram and 325microgram with using high-resolution ultrasound for the imaging. RESULTS: The FMD, NMD (25microgram), NMD (175microgram) and NMD (325microgram) were 4.72+/-1.82%, 7.08+/-3.02%, 13.33+/-6.14% and 15.89+/-7.24%, respectively (p<0.001 compared with each other). Univariate analysis showed that the FMD is associated with the serum homocysteine level, the NMD (25microgram) is associated with the body mass index, the NMD (175microgram) is associated with the fasting blood sugar and the ejection fraction, and the NMD (325microgram) is associated with the fasting blood sugar, while there was no significant difference of the FMD and NMD according to the presence of CAD risk factors. Multivariate analysis disclosed that the independent factors of FMD were the serum homocysteine and triglyceride levels, and those of NMD (25microgram) were hypertension, a low ejection fraction and severe coronary angiographic findings, while there was no independent factor for NMD (175microgram) and NMD (325microgram). CONCLUSION: This study suggests that hypertension, a low ejection fraction and significant stenotic coronary lesion may be associated with endothelium-independent smooth muscle dysfunction at low dose NTG, while the serum homocysteine and triglyceride levels are associated with endothelium-dependent endothelial dysfunction in the patients with CAD. Using low-dose NTG is important when measuring the NMD.
Blood Glucose ; Body Mass Index ; Coronary Artery Disease* ; Endothelium ; Fasting ; Homocysteine ; Humans ; Hypertension* ; Middle Aged ; Multivariate Analysis ; Muscle, Smooth* ; Nitroglycerin ; Risk Factors ; Triglycerides ; Ultrasonography

Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 +/- 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm2, %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.
Aged ; Coronary Angiography/*methods ; Coronary Circulation ; Coronary Stenosis/etiology/*physiopathology/*radiography ; Female ; *Fractional Flow Reserve, Myocardial ; Humans ; Imaging, Three-Dimensional/*methods ; Male ; Myocardial Ischemia/complications/physiopathology/*radiography ; Radiographic Image Enhancement/methods ; Radiographic Image Interpretation, Computer-Assisted/methods ; Reproducibility of Results ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients. SUBJECTS AND METHODS: The study subjects consisted of 339 consecutive patients (mean 61.7+/-12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period. RESULTS: Patients with high fibrofatty volume (FFV, >8.90 mm3, n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV (FFV< or =8.90 mm3, n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001} and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE. CONCLUSION: FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.
Acute Coronary Syndrome ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Incidence ; Male ; Myocardial Infarction ; Plaque, Atherosclerotic ; Shock, Cardiogenic ; Ultrasonography, Interventional