When invasively assessing coronary artery disease, the primary goal should be to determine whether the disease is causing a patient's symptoms and whether it is likely to cause future cardiac events. The presence of myocardial ischemia is our best gauge of whether a lesion is responsible for symptoms and likely to result in a future cardiac event. In the catheterization laboratory, fractional flow reserve (FFR) measured with a coronary pressure wire is the reference standard for identifying ischemia-producing lesions. Its spatial resolution is unsurpassed with it not only being vessel-specific, but also lesion-specific. There is now a wealth of data supporting the accuracy of measuring FFR to identify ischemia-producing lesions. FFR-guided percutaneous coronary intervention of these lesions results in improved outcomes and saves resources. Non-hemodynamically significant lesions can be safely managed medically with a low rate of subsequent cardiac events.
*Cardiac Catheterization ; Coronary Artery Disease/complications/*diagnosis/physiopathology/therapy ; *Coronary Circulation ; Fractional Flow Reserve, Myocardial ; *Hemodynamics ; Humans ; Patient Selection ; Percutaneous Coronary Intervention ; Predictive Value of Tests ; Treatment Outcome

Arterial stiffness is an important contributor to the development of cardiovascular disease. We investigated the effect of short duration exercise using the treadmill test on arterial stiffness in the presence of coronary artery disease. We enrolled patients with and without coronary artery diseases (CAD and control group, 50 patients each) referred for treadmill testing. Brachial-ankle pulse wave velocity (baPWV) were measured before and after treadmill testing. Values of baPWV were significantly reduced at 10 min after exercise in both groups, more in the CAD group than in the control group (baseline baPWV and post-exercise change [cm/sec]: 1,527+/-245 and -132+/-155 in the CAD group, 1,439+/-202 and -77+/-93 in the control group, respectively, P for change in each group <0.001, P for difference in changes between the two groups <0.001). These findings persisted after adjusting for age, body mass index, systolic blood pressure, mean arterial pressure (MAP), MAP decreases, and baseline baPWV. Significant post-exercise baPWV reductions were observed in both groups, and more prominently in the CAD group. This finding suggests that short-duration exercise may effectively improve arterial stiffness even in patients with stable coronary artery disease.
Adult ; Aged ; Ankle/blood supply ; Ankle Brachial Index ; Arteries/*physiopathology ; Blood Flow Velocity ; Brachial Artery/physiology ; Coronary Artery Disease/diagnosis/*physiopathology/therapy ; Elasticity ; *Exercise Therapy ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests

BACKGROUND/AIMS: Although drug-eluting stents (DESs) effectively reduce restenosis following percutaneous coronary intervention (PCI), they also delay re-endothelialization and impair microvascular function, resulting in adverse clinical outcomes. Endothelial progenitor cell (EPC) capturing stents, by providing a functional endothelial layer on the stent, have beneficial effects on microvascular function. However, data on coronary microvascular function in patients with EPC stents versus DESs are lacking. METHODS: Seventy-four patients who previously underwent PCI were enrolled in this study. Microvascular function was evaluated 6 months after PCI based on the index of microvascular resistance (IMR) and the coronary flow reserve (CFR). IMR was calculated as the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of the hyperemic mean transit time (hTmn). The CFR was calculated by dividing the hTmn by the baseline mean transit time. RESULTS: Twenty-one patients (age, 67.2 +/- 9.6 years; male:female, 15:6) with an EPC stent and 53 patients (age, 61.5 +/- 14.7 years; male:female, 40:13) with second-generation DESs were included in the study. There were no significant differences in the baseline clinical and angiographic characteristics of the two groups. Angiography performed 6 months postoperatively did not show significant differences in their CFR values. However, patients with the EPC stent had a significantly lower IMR than patients with second-generation DESs (median, 25.5 [interquartile range, 12.85 to 28.18] vs. 29.0 [interquartile range, 15.42 to 39.23]; p = 0.043). CONCLUSIONS: Microvascular dysfunction was significantly improved after 6 months in patients with EPC stents compared to those with DESs. The complete re-endothelialization achieved with the EPC stent may provide clinical benefits over DESs, especially in patients with microvascular dysfunction.
Aged ; Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease/diagnosis/physiopathology/*therapy ; *Coronary Circulation ; Coronary Vessels/*physiopathology/radiography ; Drug-Eluting Stents ; *Endothelial Progenitor Cells/radiography ; Female ; Humans ; Male ; Microvessels/*physiopathology/radiography ; Middle Aged ; Percutaneous Coronary Intervention/*instrumentation ; Prosthesis Design ; *Re-Epithelialization ; *Stents ; Time Factors ; Treatment Outcome ; Vascular Resistance

BACKGROUND/AIMS: The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease. METHODS: A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI). RESULTS: Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636). CONCLUSIONS: The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.
Aged ; Aged, 80 and over ; Coronary Artery Disease/complications/diagnosis/mortality/*therapy ; Female ; Glomerular Filtration Rate ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Kidney/physiopathology ; Male ; Middle Aged ; Myocardial Infarction/complications/diagnosis/mortality/*therapy ; Percutaneous Coronary Intervention/adverse effects/*methods/mortality ; Prospective Studies ; Recurrence ; Registries ; Renal Insufficiency/diagnosis/*etiology/mortality/physiopathology ; Republic of Korea ; Risk Factors ; Time Factors ; Treatment Outcome

OBJECTIVEThe study was designed to investigate the clinical characteristics and the effects of therapeutic proposal on Kawasaki disease (KD).

METHODSClinical features, diagnosis and treatment for totally 942 patients with KD hospitalized during Jan, 2000 to Dec, 2004 were reviewed. Clinical features of typical and incomplete KD were compared. Also, influential factors for KD resistant to intravenous immune globulin (IVIG) therapy were analyzed. Five hundred and ten cases were followed up for analyzing the prognosis of coronary artery lesion (CAL).

RESULTS(1) 774 cases were diagnosed as typical KD, and 168 cases as incomplete KD. The incidence of infants with incomplete KD was higher than that of infants with typical KD (18.5% vs. 10.1%, P < 0.01). As compared with typical KD, the cases of incomplete KD had a long duration of fever before final diagnosis [(7.7 +/- 2.9) d vs. (7.0 +/- 2.4) d, P < 0.01], high hemoglobin level [Hb, (106.6 +/- 13.4) g/L vs. (103.5 +/- 12.3) g/L, P < 0.01], high hematocrit [Hct, (32.0 +/- 4.3)% vs. (31.0 +/- 4.0)%, P < 0.01], and high prevalence of CAL (23.8% vs. 16.8%, P < 0.05), respectively. The occurrence rate and emerging time of clinical manifestations in incomplete KD and in typical KD were presented, respectively: non-exudative conjunctivitis [occurrence rate, 64.9% vs. 93.5%; emerging time, (4.4 +/- 1.4) d vs. (4.0 +/- 1.6) d, respectively (P < 0.05 or P < 0.01)], erythema and cracking of lips [occurrence rate, 50.6% vs. 94.8%; emerging time, (4.9 +/- 1.4) d vs. (4.5 +/- 1.6) d, respectively (P < 0.05 or P < 0.01)], rash [occurrence rate, 35.1% vs. 87.7%; emerging time, (3.9 +/- 1.9) d vs. (3.4 +/- 1.7) d, respectively (P < 0.05 or P < 0.01)], erythema and edema of extremity [occurrence rate, 26.8% vs. 71.4%; emerging time, (6.7 +/- 1.5) d vs. (5.3 +/- 1.7) d, respectively (P < 0.01)], cervical lymphadenopathy [occurrence rate, 34.5% vs. 68.0%; emerging time, (4.3 +/- 2.5) d vs. (3.6 +/- 2.2) d, respectively (P < 0.05 or P < 0.01)], strawberry tongue [occurrence rate, 31.0% vs. 59.8%; emerging time, (5.6 +/- 2.2) d vs. (4.9 +/- 1.8) d, respectively (P < 0.05 or P < 0.01)], membranous desquamation of fingertips [occurrence rate, 34.5% vs. 56.3%; emerging time, (11.7 +/- 3.3) d vs. (10.3 +/- 2.7) d, respectively (P < 0.01)], and desquamation peri-anus [occurrence rate, 42.9% vs. 50.0%; emerging time, (6.7 +/- 2.7) d vs. (6.9 +/- 2.5) d, respectively (P > 0.05)]. Except for peri-anus desquamation, other clinical manifestations in incomplete KD were sporadical as compared to typical KD. (2) Six per cent (51/857) of cases were resistant to the IVIG therapy. As compared to the group responding to IVIG therapy, high prevalence of CAL (31.4% vs. 17.1%, P < 0.05), long fever duration [(10.6 +/- 3.9) d vs. (7.5 +/- 2.3) d, P < 0.01], low Hb level [(99.9 +/- 14.1) g/L vs. (104.3 +/- 12.4) g/L, P < 0.01], low Hct [(30.1 +/- 4.5)% vs. (31.2 +/- 4.0)%, P < 0.05], low platelet [PLT, (256.9 +/- 142.4) x 10(9)/L vs. (309.7 +/- 131.5) x 10(9)/L, P < 0.05], and low albumin level [ALB, (27.8 +/- 8.4) g/L vs. (33.5 +/- 6.7) g/L, P < 0.01] were found in the group resistant to IVIG therapy, respectively. (3) In patients who received IVIG 1 g/kg and 2 g/kg, the recovery rates from CAL were 83.1% and 89.7% (P > 0.05), respectively. The prevalence of CAL in those without CAL in acute and subacute stages was 0.9% and 3.5% (P > 0.05), respectively, during 2 year-follow-up period.

CONCLUSION(1) Infants appeared to have more chances to suffer from incomplete KD. Incomplete KD had high prevalence of CAL. The peri-anus desquamation might be an important clue for early diagnosis of incomplete KD. (2) In acute stage, the influential factors for KD resistance to IVIG therapy included prolonged fever, non-elevated PLT, and persistent decrease in Hb, Hct and ALB levels. (3) Children receiving IVIG 1 g/kg and 2 g/kg had the similar effects on recovery and prevention from CAL within the first two years after KD onset.

Adolescent ; Blood Platelets ; drug effects ; Child ; Child, Preschool ; China ; Coronary Aneurysm ; drug therapy ; epidemiology ; etiology ; prevention & control ; Coronary Artery Disease ; complications ; diagnosis ; drug therapy ; physiopathology ; Dose-Response Relationship, Drug ; Female ; Fever ; drug therapy ; physiopathology ; Follow-Up Studies ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; therapeutic use ; Immunologic Factors ; Infant ; Infant, Newborn ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome