PURPOSE: The aim of the study is to evaluate the clinical usefulness of a TWI in the lead aVL of 12-lead ECG for predicting the left ascending artery (LAD) lesion, high risk, and 30-days mortality in patients with acute coronary syndrome (ACS). METHODS: A total of 275 patients who underwent coronary angiography under the diagnosis of ACS were analyzed retrospectively from Jan 2012 to December 2013. RESULTS: A total of 355 patients underwent coronary angiography. Of these, 275 patients (77.5%) were diagnosed with ACS. Of these, 187 patients (68.0%) had a left LAD lesion. Of these, 111 patients (59.3%) had a mid-LAD lesion. Of these, only 23 patients (22.5%) showed a TWI in the aVL lead. However, regarding the prediction of the high risk group, if there is a TWI in the aVL, when compared with patients without a TWI in the aVL, the high risk rate is four times higher in the univariable logistic regression analysis and 2.687 times higher in the multivariable logistic regression analysis. CONCLUSION: A TWI in the lead aVL of ECG of patients with chest pain in the ER was closely associated with high risk of ACS patients.
Acute Coronary Syndrome* ; Arteries ; Chest Pain ; Coronary Angiography ; Diagnosis ; Electrocardiography* ; Humans ; Logistic Models ; Mortality ; Retrospective Studies

BACKGROUND/AIMS: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. METHODS: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128). RESULTS: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487). CONCLUSIONS: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.
Acute Coronary Syndrome ; Chest Pain ; Diagnosis ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Propensity Score ; Reperfusion

BACKGROUND: Surgical role for acute coronary syndrome has been reduced in recent years due to development of drug eluting stent. We evaluated the surgical results of acute coronary syndrome in our hospital. MATERIAL AND METHOD: Between January 2001 and August 2005, 416 patients underwent coronary artery bypass grafting (CABG) under diagnosis of non-ST-elevation acute coronary syndrome (NSTE ACS). Mean age was 61.8+/-9.0 years and 276 (66.3%) patients were male. 324 (77.9%) patients had triple vessel disease and 92 (22.1%) had left main disease at angiographic study. 236 (56.7%) patients had hypertension and 174 (41.8%) had diabetes mellitus. Conventional on-pump CABG was performed in 194 patients (46.6%) and off-pump CABG in 222 (53.4%). Total arterial revascularization with no touch technique was done in 97 patients (23.3%). The number of total distal anastomosis was 1,306 and the number per patient was 3.21+/-1.71. RESULT: Surgical mortality rate was 1.0% (4 patients) and postoperative complication rate was 15.6% (65 patients). Graft patency was checked at mean 3.7+/-7.6 months (from 1 to 37 months) postoperatively with multi-directional computed tomography in 152 patients. Left internal mammary artery was patent in 95.3%, right internal mammary artery in 98.1%, radial artery in 92.2% and saphenous vein in 89.0%. CONCLUSION: The surgical treatment of NSTE ACS showed relatively low mortality rate and good graft patency rate. Further study is needed to compare the long term results with drug eluting stent.
Acute Coronary Syndrome* ; Coronary Artery Bypass ; Diabetes Mellitus ; Diagnosis ; Humans ; Hypertension ; Male ; Mammary Arteries ; Mortality ; Postoperative Complications ; Radial Artery ; Saphenous Vein ; Stents ; Transplants

BACKGROUND: The mortality rate of cardiovascular patients has been decreased after the introduction of coronary care unit (CCU), however data about that of Korean patients is rare. METHODS: Two thousand and eighty one patients (63.6+/-14.6 years, 1,295 male), who were admitted at CCU of Chonnam National University Hospital between January 2002 and June 2004, were analyzed. The admitted patients were divided into two groups: the survival group (Group I: n=1,926, 1,205 male, 62.3+/-13.9 years) and the death group (Group II: n=155, 90 male, 64.9+/-15.3 years). Clinical characteristics, risk factors for atherosclerosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups. RESULTS: The overall mortality at CCU was 7.4% (155 out of 2,081 patients). Mean age and sex ratio were not different between the two groups. Coronary artery disease was the most common causes of both admission (1,606 out of 2,081 patients) and death (107 out of 155 patients). The clinical diagnoses of group II were myocardial infarction (n=70), unstable anginas (n=30), variant angina (n=2), congestive heart failure (n=17), aortic dissection (n=14) and arrhythmia (n=34). Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (56.2+/-20.7% vs. 42.6+/-17.1%, p<0.001). Predictive factors for mortality according to multiple logistic regression analysis were low LVEF, use of intra-aortic balloon pump (IABP), inability to perform percutaneous coronary intervention (PCI) and high level of myoglobin. CONCLUSIONS: Death due to acute coronary syndrome was most common cause of CCU mortality. Decreased LVEF, insertion of IABP, inability to perform PCI and high myoglobin were associated with mortality of CCU admitted patients.
Acute Coronary Syndrome ; Angina, Unstable ; Arrhythmias, Cardiac ; Atherosclerosis ; Coronary Artery Disease ; Coronary Care Units* ; Coronary Disease ; Diagnosis ; Echocardiography ; Heart Failure ; Humans ; Jeollanam-do ; Logistic Models ; Male ; Mortality* ; Myocardial Infarction ; Myoglobin ; Percutaneous Coronary Intervention ; Prognosis* ; Risk Factors ; Sex Ratio ; Stroke Volume

BACKGROUND AND OBJECTIVES: Besides the acute coronary syndrome (ACS), the left ventricular failure (LVF) is the next important determinant of morbidity and mortality after acute coronary syndrome (ACS). The prediction of high risk groups for LVF may be in the initial management of patients with unstable angina (UA) or acute non-ST elevation myocardial infarction (NSTEMI). SUBJECTS AND METHODS: 179 patients (60.4+/-11.6 years, 121 male) who underwent diagnostic coronary angiography under the diagnosis of UA/NSTEMI between January and December, 2000, in the Chonnam National University Hospital Heart Center were enrolled for evaluation of relationship between the development LVF and various parameters, including clinical features, initial electrocardiogram, laboratory findings and coronary angiographic findings. RESULTS: Unstable angina was clinically diagnosed in 124 patients, and NSTEMI in 55 patients. During a 12-month follow-up period, less than 40% of the left ventricular ejection fraction (EF), a low amount, was observed in 28 patients (15.7%). In diabetic patients, the incidence of LVF was significantly higher than in non-diabetics (p<0.05). Patients with elevated C-reactive protein (CRP) or positive troponin I had LVF more frequently (p<0.05). On the initial electrocardiogram, the total summation of ST segment change inversely correlated with EF (p<0.05). Patients whose QT dispersion was longer than 80 ms had a higher incidence of LVF (p<0.05). Coronary angiographic findings of total occlusion correlated with the development of LVF (p<0.05), but not with other characteristics. On multiple logistic regression analysis, high CRP level (p=0.024), summation of ST change (p=0.021), total occlusion of the coronary artery (p=0.008) were independent prognostic factors of LVF. CONCLUSION: Elevated CRP, summation of ST change and total coronary artery occlusion are important predictive factors for LVF in UA/NSTEMI.
Acute Coronary Syndrome ; Angina, Unstable* ; C-Reactive Protein ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Follow-Up Studies ; Heart Failure* ; Heart* ; Humans ; Incidence ; Jeollanam-do ; Logistic Models ; Mortality ; Myocardial Infarction* ; Prognosis ; Stroke Volume ; Troponin I

BACKGROUND AND OBJECTIVES: Without typical electrocardiographic (ECG) changes, and the elevation of cardiac enzymes, the early identification of high risk chest pain patients remains a major challenge. We hypothesized that myocardial contrast echocardiography (MCE) was more sensitive than conventional echocardiography (Echo) for the identification of high risk patients. SUBJECTS AND METHODS: We prospectively enrolled 75 consecutive patients (age ; 62+/-11 yrs, 34 men), presenting to the emergency room, with suspected cardiac chest pain at rest. The exclusion criteria for enrolment were : age <40 yrs, the presence of a Q wave or ST segment elevation, an initial troponin I level >1.5 ng/mL and a poor Echo window. Echo and MCE were performed to evaluate regional wall motion abnormalities (RWMA), and assess myocardial perfusion defects (PD), using a continuous infusion of PESDA during intermittent power Doppler harmonic imaging. The Echo and MCE studies were interpreted by different reviewers, blinded to the clinical data. We defined major adverse cardiac events (MACE) as mortality, myocardial infarction (MI) and severe ischemia requiring revascularization. RESULTS: There were 35 MACE, including 12 MI, during hospitalization. No significant differences were found in the clinical characteristics between patients with, or without, MACE. A RWMA or a PD were seen in 18 (24%) and 27 (36%) of patients, respectively, and the sensitivity, specificity of RWMA were 46 and 95% for a MACE, and 59 and 86% for a MI. The sensitivity and specificity of a PD were 69 and 93% for MACE, and 88 and 79% for MI, respectively. CONCLUSION: The assessment of a PD by MCE is clinically feasible, and a MCE can improve the sensitivity of Echo in identifying high risk chest pain patients.
Acute Coronary Syndrome* ; Chest Pain ; Early Diagnosis* ; Echocardiography* ; Electrocardiography ; Emergency Service, Hospital ; Hospitalization ; Humans ; Ischemia ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Prospective Studies ; Sensitivity and Specificity ; Troponin I

PURPOSE: Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS: AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration > or =0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are > or =0.35 ng/mL.
Acute Coronary Syndrome/blood/complications/*diagnosis/mortality ; Aged ; Biological Markers/blood ; Female ; Humans ; Kidney Failure, Chronic/blood/complications/*diagnosis/mortality ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Troponin T/*blood

PURPOSE: Right heart failure (RHF) is not a infrequant disease entitiy, but it is difficult to diagnose and mortality rate increases with worsening right heart failure. The utility of Nterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department for differentiating right heart failure from left heart failure (LHF), and optimal cut-off points for its use, are not well established. METHODS: One hundred thirty-six consecutive patients with acute dyspnea, who visited our emergency medical center from August 2005 to August 2006 were recruited prospectively. Patients with acute coronary syndrome and chronic renal failure were excluded. The diagnosis of RHF was based on echocardiographic evidence of right ventricular dysfunction. The diagnostic accuracy of NT-proBNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean patient age was 68+/-13 years, and 64% were women. The median NT-proBNP level among 68 patients (50%) who had LHF and 29 patients (21%) who had RHF were 2524 1572 pg/ml, respectively, versus 520 pg/ml for 39 patients (29%) who did not have heart failure (HF) (p = 0.01). NT-proBNP levels correlated well with right ventricular systolic pressure. However, although patients with RHF exhibited significantly higher NT-proBNP levels than did patients without HF, NT-proBNP levels did not differentiate left from right heart failure. The area under the receiver operating characteristic curve was 0.71 (95% CI 0.63~0.85). At a cutoff of 700 pg/ml, NT-proBNP had a sensitivity of 68%, a specificity of 35%, an overall accuracy of 58%, a false negative rate of 32%, a false positive rate of 66% in differentiating between LHF from RHF (p = 0.03). CONCLUSION: NT-proBNP is elevated in majority of cases of right heart failure, but NT-proBNP could not differentiate RHF from LHF. Therefore, this underscores that NTproBNP is not a stand-alone test and that correct clinical evaluation and echocardiography is still of highest importance.
Acute Coronary Syndrome ; Blood Pressure ; Diagnosis ; Diagnosis, Differential* ; Dyspnea* ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Failure* ; Heart* ; Humans ; Kidney Failure, Chronic ; Mortality ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ventricular Dysfunction, Right

BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. METHODS: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. RESULTS: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33-163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. CONCLUSIONS: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.
Acute Coronary Syndrome/diagnosis/*mortality ; Aged ; Area Under Curve ; Biomarkers/analysis ; Chest Pain ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Interleukin-1 Receptor-Like 1 Protein/*analysis ; Male ; Middle Aged ; Odds Ratio ; Prognosis ; ROC Curve ; Troponin I/*analysis

OBJECTIVETo improve the awareness of acute coronary artery thrombosis in Kawasaki disease (KD).

METHODSix KD patients with acute coronary artery thrombosis (Jan. 2004 to Jan. 2013) were studied retrospectively. The basic information, clinical manifestations, laboratory data, echocardiography and electrocardiography (ECG), method and consequence of thrombolytic therapy were analyzed.

RESULTThe mean age of patients with coronary artery thrombosis (5 males and 1 female) was (17.2 ± 11.3) months.Five cases had thrombosis in left coronary artery (LCA), and four cases had thrombosis in aneurysm of left anterior descending artery (LAD). One case had thrombosis in both left and right coronary artery (RCA).One case died. Maximum thrombus was about 1.60 cm × 0.80 cm, locating in LAD. The diameter of LCA and RCA was (0.44 ± 0.07) cm and (0.45 ± 0.07) cm. Two patients showed abnormal ECG. Case 3 showed ST segment depression in lead V5. Case 6 showed myocardial infarction.In acute phase of KD, three patients received treatment with intravenous immunoglobin (IVIG), five patients were treated with aspirin.In sub-acute and convalescent phase of KD, all patients were treated with low-dose aspirin.Warfarin and dipyridamole were applied in 5 patients. All cases were treated with thrombolytic therapy using urokinase and/or heparin. After thrombolytic therapy, echocardiography showed thrombolysis in four cases and no change in one.One patient died of myocardial infarction.

CONCLUSIONMost of acute coronary thrombosis in KD occurred in LAD. KD patients with coronary artery thrombosis are at risk of sudden death due to myocardial infarction.

Acute Disease ; Anticoagulants ; administration & dosage ; therapeutic use ; Aspirin ; administration & dosage ; therapeutic use ; Child, Preschool ; Coronary Aneurysm ; diagnosis ; drug therapy ; etiology ; Coronary Thrombosis ; diagnosis ; drug therapy ; etiology ; Echocardiography ; Electrocardiography ; Female ; Fibrinolytic Agents ; administration & dosage ; therapeutic use ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; therapeutic use ; Infant ; Infant, Newborn ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; drug therapy ; Myocardial Infarction ; diagnosis ; etiology ; mortality ; Retrospective Studies