Angina, Unstable ; diagnosis ; Humans ; Medicine, Chinese Traditional ; Severity of Illness Index

OBJECTIVETo comparatively analyse the objective characteristics of different syndrome types of qi-disturbance-induced blood stasis syndrome (QDBS) in the pathogenetic evolution of unstable angina coronary heart disease (UA-CHD).

METHODSSeventy-eight patients with UA-CHD of QDBS were differentiated into 2 groups: 55 in the qi-deficiency-induced blood-stasis syndrome group (A) and 23 in the qi-stagnation-induced blood-stasis syndrome group (B). The comparative analysis on them was carried out through comparing their blood pressure, glucose and lipid metabolisms, coagulation function, thyroid function and inflammation reaction changes, etc.

RESULTSIn the pathogenetic process of qi-disturbance induced blood stasis, the initiating age, levels of HbA1c, TSH, PT and APTT between the two groups were significantly different (P < 0.05). Levels of TNF-alpha and LN were higher and levels of sIgA lower in patients than those in healthy subjects (P < 0.05).

CONCLUSIONSInflammation immune reaction may play an important role in the pathogenetic process of blood-stasis syndrome, and the functional disturbance of hypothalamus, pituitary and endocrinal secretion induced by emotional stress is possibly the essence of qi-stagnation induced blood stasis syndrome.

Adult ; Angina, Unstable ; diagnosis ; Coronary Disease ; Diagnosis, Differential ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Qi

BACKGROUND AND OBJECTIVES: Coronary angioplasty of total occlusion is associated with low primary success rate. The most common reason for failure is the inability to cross the lesion with a guidewire. The new nitinol wire consists of an extraordinary flexible nitinol core, a platinum/iridium coil at the distal tip, and a polymer hydrophilic coating providing the wire with an extremely slippery surface after moistening. METHODS AND MATERIALS: We analyzed the angiographic results in 117 patients (86 M, 31 F, 58.5+/-11.7 year), who underwent angioplasty for total occlusion with Crosswire (TM) at Chonnam University Hospital between Oct '97 and Apr '99. Clinical diagnosis was acute myocardial infarction (MI) in 61, old MI in 16, unstable angina in 23, and stable angina in 17 patients. RESULTS: Target coronary arteries were 51 left anterior descending arteries (LAD), 13 left circumflex arteries (LCX) and 53 right coronary arteries (RCA). Lesion morphology was 40 abrupt and 77 tapered lesions, and collateral circulation was observed in 75 cases. The success rate was 80.3% (94/117). The reasons of procedural failure were failure to cross the lesion using wire in 8 and balloon in 6 cases. In the failed cases, clinical diagnosis was acute MI in 10, unstable angina in 8 and stable angina in 5, and target artery was 11 LAD, 2 LCX and 10 RCA, and collateral circulation was observed in 20. In 56 cases of chronic total occlusion, the success rate was 76.8% (43/56) and the reasons of procedural failure were failure to cross the lesion using wire in 6 and balloon in 2 cases. No major cardiac events were developed. There was no predictive factor for the procedural failure with Crosswire (TM) for total occlusion. CONCLUSIONS: A new nitinol wire, Crosswire (TM) was an effective tool for the recanalization of total occlusive coronary artery.
Angina, Stable ; Angina, Unstable ; Angioplasty* ; Arteries ; Collateral Circulation ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Humans ; Jeollanam-do ; Myocardial Infarction ; Polymers

BACKGROUND AND OBJECTIVES: Coronary angioplasty of total occlusion is associated with low primary success rate. The most common reason for failure is the inability to cross the lesion with a guidewire. The new nitinol wire consists of an extraordinary flexible nitinol core, a platinum/iridium coil at the distal tip, and a polymer hydrophilic coating providing the wire with an extremely slippery surface after moistening. METHODS AND MATERIALS: We analyzed the angiographic results in 117 patients (86 M, 31 F, 58.5+/-11.7 year), who underwent angioplasty for total occlusion with Crosswire (TM) at Chonnam University Hospital between Oct '97 and Apr '99. Clinical diagnosis was acute myocardial infarction (MI) in 61, old MI in 16, unstable angina in 23, and stable angina in 17 patients. RESULTS: Target coronary arteries were 51 left anterior descending arteries (LAD), 13 left circumflex arteries (LCX) and 53 right coronary arteries (RCA). Lesion morphology was 40 abrupt and 77 tapered lesions, and collateral circulation was observed in 75 cases. The success rate was 80.3% (94/117). The reasons of procedural failure were failure to cross the lesion using wire in 8 and balloon in 6 cases. In the failed cases, clinical diagnosis was acute MI in 10, unstable angina in 8 and stable angina in 5, and target artery was 11 LAD, 2 LCX and 10 RCA, and collateral circulation was observed in 20. In 56 cases of chronic total occlusion, the success rate was 76.8% (43/56) and the reasons of procedural failure were failure to cross the lesion using wire in 6 and balloon in 2 cases. No major cardiac events were developed. There was no predictive factor for the procedural failure with Crosswire (TM) for total occlusion. CONCLUSIONS: A new nitinol wire, Crosswire (TM) was an effective tool for the recanalization of total occlusive coronary artery.
Angina, Stable ; Angina, Unstable ; Angioplasty* ; Arteries ; Collateral Circulation ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Humans ; Jeollanam-do ; Myocardial Infarction ; Polymers

OBJECTIVETo study the correlation between thrombolysis in myocardial infarction (TIMI) risk stratification and blood stasis syndrome (BSS) score in patients with unstable angina pectoris (UAP), and to analyze the relation of BBS degree and UAP clinical outcomes.

METHODSCollected were general data, demographic data, risk factors, Chinese medical symptoms and syndromes, coronary artery angiography results, relevant physical and chemical examinations from 114 UAP inpatients. Gensini score, TIMI risk score, and BSS score of these patients were calculated.

RESULTSThe BBS score and Gensini score were significantly positively correlated (r = 0.78, P < 0.01). The BBS score was significantly higher in those with lesion in three branches than those with lesion in one branch or in two branches (P < 0.05). The BBS score was significantly higher in the high risk group than in the lower risk group and the medium risk group (P < 0.01). The TIMI risk score was obviously higher in the severe blood stasis group than in the moderate blood stasis group and the mild blood stasis group (P < 0. 05, P < 0.01). The BBS score and TIMI risk score was positively correlated (r = 0.23, P < 0.05).

CONCLUSIONThe BBS score was positively correlated with more coronary arteries involved. The more severe BBS degree, the TIMI risk score more higher, and the BBS degree more syndrome.

Aged ; Angina, Unstable ; diagnosis ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Risk Assessment

BACKGROUND:Rotational atherectomy has been developed for several years. It is a useful tool in complex coronary lesion morphologies such as diffuse, calcific, ostial and angulated lesion. We report initial experience of the rotational atherectomy in complex coronary artery morphology. METHODS: We included 64 patients who was treated with rotational atherectomy since July 1997 to February 1999. Mean age was 56+/-9 years with 47 male patients. Clinical diagnosis was 12 acute myocardial infarction, 49 unstable angina, and 3 stable angina. Rotational atherectomy was done by transfemoral or transradial approach with adjunctive ballooning and/or stenting in all patients. RESULTS: Ninty-one percent of the treated lesions showed complex lesion morphologies (B2/C lesion) with 43 left anterior descending artery and 19 right coronary artery. Rotational atherectomy was done in 37 de novo lesion (58%) and 27 (42%) restenosis patients. Transradial approach was done in 33 patients (52%). Mean maximal burr size was 1.68 mm and mean burr to reference artery ratio was 0.63. Rotastenting were done in 58% of the patients with higher post-procedure minimal lumen diameter, % diameter stenosis and net gain than rotablator with adjunctive balloon angioplasty. Overall procedural success was 94% (62/64). Complications were one non-Q infarction, one coronary artery perforation, two slow flow, and one guidewire fracture. None of the patients showed inhospital mortality or 30 day cardiac event (death, emergency CABG, Q-infarction, or re-intervention). CONCLUSION: Rotational atherectomy is a useful technique with high success rate without showing major cardiac events during inhospital period and within 30 days.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Atherectomy ; Atherectomy, Coronary* ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Emergencies ; Hospital Mortality ; Humans ; Infarction ; Male ; Myocardial Infarction ; Stents

BACKGROUND AND OBJECTIVES: Despite marked advances in the design of percutaneous coronary intervention hardware, total occlusion remains associated with a low primary success rate. The most common cause of failure is the inability to cross the lesion with a guidewire. We report the results of a non-randomized single-center investigation using a hydrophilic coated guidewire (Crosswire NT). SUBJECTS AND METHODS: We analyzed the angiographic results of 92 patients (68 males, 24 females, age 58.8+/-9.7 years-old) who underwent angioplasty utilizing Crosswire NT for either total (TIMI flow 1) or subtotal occlusion at Chonnam National University Hospital between December 2000 and July 2001. RESULTS: Clinical diagnoses of the studied subjects revealed 40 cases of acute myocardial infarction, 15 of myocardial infarction, 29 of unstable angina and 8 of stable angina. The primary success rate was 79.3% (73/92), the success rate in total occlusion was 69.0% (40/58), and that of the chronic total occlusion cases among the total occlusion group was 64.3% (18/28). The success rates in the use of Crosswire NT as the first and second choice were 85.7% and 78.8%, respectively. The abrupt occlusive lesions, complex lesions more than type B 2, and presence of collateral circulation were all associated with a lower success rate. Coronary artery perforation occurred in one case. CONCLUSION: The new nitinol hydrophilic wire, Crosswire NT, is a safe and effective tool for the recanalization of total occlusive coronary lesion.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Collateral Circulation ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention*

Acute coronary syndrome consists of acute myocardial infarction associated with electrocardiographic ST segment elevation (STEMI) and unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). Theses three conditions are differentiated primarily by clinical, electrocardiographic, and laboratory presentations correlating with the duration and extent of thrombotic occlusion as a consequence of plaque rupture. Acute coronary syndrome is now the most prevalent presentation of ischemic heart disease in Korea as well as developed countries. Q-wave acute myocardial infarction is the most easily identified syndrome ; persistent angina and ST-segment elevation are characteristic of sudden total or near-total thrombotic arterial occlusion. Urgent reperfusion is the mainstay of therapy, whereas UA/NSTEMI is usually associated with severe coronary obstruction but not total occlusion of the culprit coronary artery. The distinction between unstable angina and non-Q wave, non-ST segment elevation myocardial infarction is often not clear at the initial presentation of patients. Unstable angina is defined as angina pectoris with at least one of the following three features : ① It occurs at rest usually lasting more than 20 minutes. ② It is severe and described as frank pain and of new onset within 1 month. ③ It occurs with a crescendo pattern (more severe, prolonged, or frequent than previously). Some patients with this pattern of ischemic discomfort, especially those with prolonged rest pain, develop evidence of myocardial necrosis on the basis of the release of cardiac markers and thus have a diagnosis of NSTEMI. This diagnosis has been based on the elevation of serum creatine kinase (CK)-MB, level but recently troponin T and I assays are used to define ischemic myocardial damage based on their higher sensitivity for myocardial necrosis and prognostic implication. Troponin has become the standard myocardial marker. A certain number of patients have elevated levels of troponins in the absence of significant CK elevation. Several studies have shown that despite nondiagnostic CK levels, an elevated troponin level often indicates a poor prognosis. Successful treatment strategies for acute coronary syndrome that improve survival include anticoagulant, antiplatelet, thrombolytic, and interventional approaches.
Acute Coronary Syndrome* ; Angina Pectoris ; Angina, Unstable ; Coronary Vessels ; Creatine Kinase ; Developed Countries ; Diagnosis ; Electrocardiography ; Humans ; Korea ; Myocardial Infarction ; Myocardial Ischemia ; Necrosis ; Prognosis ; Reperfusion ; Rupture ; Troponin ; Troponin T

BACKGROUND: To evaluate the efficacy, complication and restenosis rate of percutaneous transluminal coronary angioplasty(PTCA), we analized the results of PTCA for 277 cases(308 lesions) in 240 patients admitted to Seoul National University Hospital under the diagnosis of stable angina, unstable angina, acute myocardial infarction(AMI)or postinfarction angina between April 1986 and October 1991. METHODS: We performed PTCA with over-the-guidewire technique and followed up for 2-42 months(mean 16.2 months). To evaluate the clinical efficacy, patients without AMI and unstable angina underwent pre- and post-PTCA exercise test. RESULTS: Successful PTCA's were performed in 273 out of 308 lesions(88.6%). The success rate of PTCA for left anterior descending artery(LAD), left circumflex artery(LCX) and right coronary artery(RCA) was 88.5%(177/200), 88.9%(40/44) and 87.5%(56/64), respectively. Simultaneous PTCA for multiple coronary arteries were successfnlly perfomed in 26 out of 27 cases(96.3%). Success rate for individual coronary artery subtypes according to ACC/AHA PTCA subcommitte was 99.1% for type A lesions and 78.2% for type B lesions. Total exercise duration by treadmill test increased from 6.74+/-3.24min to 9.70+/-2.85min after PTCA(p<30.01). There were non-fatal acute coronary occlusions in 8 patients(3.3%), but there was no death related to PTCA nor emergency coronary artery bypass graft(CABG). During the follow-up period of 2 to 42months(mean : 16.2months), restenosis was suspected clinically in 90 patients, and was confirmed in 43 patients with coronary angiography. Among them, we performed second PTCA in 31 patients, and third PTCA in 2 patients. Seventy nine percent of restenosis developed within 6 months after PTCA. CONCLUSION: We conclude that PTCA was an effective and safe treatment modality for patients with coronary artery disease, especially when performed in patients with type A or B lesions and some of selected type C lesions.
Angina, Stable ; Angina, Unstable ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Occlusion ; Coronary Vessels* ; Diagnosis ; Emergencies ; Exercise Test ; Follow-Up Studies ; Humans ; Seoul

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) for long coronary lesion is known to be associated with low success rate,suboptimal outcome,high complication and restenosis rates. Here we report the early clinical and angiographic results of long coronary stent implantations for long coronary lesions. METHOD: We analyzed the clinical,angiographic features and early results after stent implantations in 46 patients who were implanted long coronary stent(> or =20mm in length)among 174 stented patients at Chonnam University Hospital from Jan.through Nov.1996. RESULT: 1) Age was 59+/-7(35-78) years,and sex ratio was 2.5:1(33 male:13 female). clinical diagnosis was as follows; 24 patients with unstable angina, 21 with acute myocardial infarction, 1 with stable angina and 6 with old myocardial infarction. Left ventricular ejection fraction by left venriculogram was 58+/-10(27-87)%. 2) Involved numbers of vessel were single in 27 patients, two in 14 patients, and three in 5 patients. Target stented coronary arteries were 28 left anterior descending arteries, 17 rigtt coronory arteries, and 1 left circumflex artery. Morphologic types of target lesions were type C in 26 patients, type B2 in 20, and diameter stenosis(DS) was 76+/-13%, minimal luminal diameter(MLD) 1.0+/-0.3mm, length 21+/-6(10-38)mm. Indications for stent were 28 denovo lesions, 10 restenoses, 5 suboptimal PTCAs and 3 bailout procedures. Twenty six Microstents 2, 15 Wallstents, 4 Freedom stents, and 1 Wictor stent were used. Stent diameter was 3.2+/-0.3(2.5-5.0)mm and length 30+/-3(20-49)mm, stent diameter/reference diameter(RD) ratio 1.0+/-0.1, and stent minus lesion length 9.0+/-3.7mm. 3) Stents were deployed successfully in all 46 patients. No procedure-related death, myocardial infarction, emergency bypass surgery, and laboratory evidences of acute or subacute stent thrombosis were observed. 4) DS was decreased to 3.5+/-7.5%, MLD was increased to 3.2+/-0.3mm(p<0.0001, respectively). Acute gain was 2.2+/-0.4mm(71.8+/-15.6%,p<0.0001). CONCLUSION: We observed high success rate without major complications in long stent implantations for long coronary arterial lesions. Long-term follow-up should be required to prove long coronary stent as a better treatment modality to reduce acute complications and late restenosis.
Angina, Stable ; Angina, Unstable ; Arteries ; Coronary Vessels ; Diagnosis ; Emergencies ; Follow-Up Studies ; Freedom ; Humans ; Jeollanam-do ; Myocardial Infarction ; Phenobarbital ; Sex Ratio ; Stents* ; Stroke Volume ; Thrombosis