BACKGROUND AND OBJECTIVE: Abciximab has been shown to have beneficial effects beyond the improvement in the patency of an infarct-related artery and the microvascular integrity. However, it remains uncertain whether abciximab may lead to beneficial effects on the left ventricular remodeling in patients with an acute myocardial infarction, treated with primary percutaneous coronary intervention (PCI). Therefore, whether abciximab is effective in the left ventricular remodeling in patients with acute myocardial infarction, treated with primary PCI, was investigated. SUBJECTS AND METHODS: The study included 28 patients with an acute myocardial infarction (1 vessel disease) that had received either a primary PCI alone (group A, n=14) or an abciximab+primary PCI (group B, n=14). The baseline characteristics of the two groups were similar, with the exception of a thrombusburden lesion. All patients were examined by echocardiography within 72 hours, and at an average 11.7 months after the acute myocardial infarction. The change in the left ventricular end-diastolic volume index, end-systolic volume index and ejection fraction, between the two groups, were compared. RESULTS: At an average follow-up of 11.7 months, the left ventricular volume indices were smaller, and the left ventricular ejection fraction higher, compared with those at the baseline in each group. The change of the left ventricular end-diastolic volume index (-7+/-3 mL/m2 vs. -9+/-2 mL/m2, p=0.56), the left ventricular end-systolic volume index (-8+/-3 mL/m2 vs. -9+/-2 mL/m2, p=0.73) and the left ventricular ejection fraction (7+/-3% vs. 9+/-2%, p=0.49) did not show significant differences between groups A and B. CONCLUSION: These results suggest that abciximab does not improve the left ventricular remodeling in patient with an acute myocardial infarction, treated with primary PCI.
Arteries ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors ; Stroke Volume ; Ventricular Remodeling*

BACKGROUND AND OBJECTIVES: During coronary angioplasty, a distal embolization of the intracoronary thrombus is associated with an increased risk of myocardial infarction and mortality. Recently, distal protection devices have been tested for distal embolization with varying success. Here we report the experiences with one of the distal protection devices, Percusurge(r). SUBJECTS AND METHODS: From January 2001 to August 2001, 5 cases of a Percusurge(r) being used in patients with intracoronary thrombus were experienced during the angioplasty (male:4, female:1). Both the pre- and post-procedural clinical findings of the patients, the angiographic findings, the number of acute complications, the presence of biochemical marker such as CK-MB, and any in-hospital cardiac events were reviewed. RESULTS: Percusurge(r) was used in the right coronary artery (RCA) in 4 cases and in the saphenous vein graft in 1. The clinical diagnosis included stable angina (2 patients), non-Q wave myocardial infarction (1 patient), and Q-wave myocardial infarction (2 patients). The patients showed a TIMI 0 or 1 flow in 4 patients with a RCA lesion and TIMI 3 flow in 1 patient with a saphenous vein graft lesion. However, the TIMI 3 flow was recovered in all cases after the intervention. The CK-MB level did not show any significant changes between the pre- and post-procedure in 4 cases (11.2 +/- 3.2 U/L vs 10.2 +/- 2.1 U/L). However, one of the distal branchs was totally occluded by the distal embolization of the thrombus, and the CK-MB level increased from 2.1 U/L to 22.7 U/L. Otherwise, no procedure-related complications or major in-hospital cardiac events were observed. CONCLUSION: The use of the distal protection device, Percusurge(r), may reduce both the procedural and clinical complications during a coronary intervention in the thrombus-containing lesion. However, a large prospective study is needed to define the role of the distal protection device.
Angina, Stable ; Angioplasty ; Biomarkers ; Coronary Thrombosis ; Coronary Vessels ; Diagnosis ; Humans ; Mortality ; Myocardial Infarction ; Saphenous Vein ; Thrombosis* ; Transplants

Stress-induced cardiomyopathy is described as an acute cardiomyopathy that occurs under the influence of an excessive level of catecholamine related to intense emotional stress. A 64-year-old woman presented with symptoms of acute myocardial infarction after emotional upset, but her coronary angiographic findings were revealed to be normal. Diffuse T wave inversions were observed in her electrocardiograms with akinetic wall motions sparing the basal segments in her left ventriculography. After four months, her electrocardiogram and echocardiogram findings had completely returned to normal. The precise diagnosis of this acute cardiomyopathy must be emphasized because it can initially be misdiagnosed as acute coronary syndromes. However in complete contrast to acute myocardial infarction, it has a rapid and favorable recovery with hardly any sequelae after a few months.
Case Report ; Electrocardiography ; Female ; Human ; Middle Age ; Myocardial Diseases/*complications ; Myocardial Infarction/*etiology ; Stress, Psychological/*complications

BACKGROUND AND OBJECTIVES: Many western studies have shown that primary percutaneous transluminal coronary angioplasty (PTCA) may have better clinical result over thrombolytic therapy in patients with acute myocardial infarction. There are, however, few reports about the role of primary PTCA in Korea. We reviewed the cases of primary PTCA and thrombolysis with delayed PTCA in Samsung Medical Center to compare the clinical outcomes of two treatment modalities. MATERIALS AND METHOD: This study was a non-randomized and retrospective trial. From August 1995 to March 1998, 80 AMI patients within 12 hours of symptom onset underwent primary PTCA (n=26) or thrombolytic therapy (n=54) in Samsung Medical Center. Patients who had thrombolysis were performed coronary angiography fourth to fifth hospital day routinely. Risk factors and time to treatment (pain-to-needle time and door- to-needle time) were reviewed from patient record. Angiographic data including TIMI flow were obtained from angiography data base and angiographic film. We compared the 30-day and 8-month event rate of death, re-infarction, re-PTCA, and CABG between two groups. RESULTS: Baseline characteristics (sex, age, blood pressure, heart rate, AMI location, ejection fraction of left ventricle) were similar between two groups. There was no statistically significant difference in pain-to-needle time and door-to-needle time between two groups. The 30-day mortality rate was similar between two groups (primary group 3.8%, thrombolysis 5.6%, p=1.0). The 30-day event rate also showed no difference between two groups (primary PTCA 7.7%, thrombolysis 11.1%, p=1.0) and there was similar tendency in 8-month event rate (primary PTCA 19.2%, thrombolysis 14.8%, p=0.62). However, the admission duration of primary PTCA group was shorter than that of thrombolysis (8.7 vs 12 days, p=0.03). CONCLUSION: Primary PTCA have similar clinical outcome except shorter hospital admission duration when compared to thrombolysis with routine elective coronary angiography and delayed PTCA in AMI patients without cardiogenic shock.
Angiography ; Angioplasty, Balloon, Coronary ; Blood Pressure ; Coronary Angiography ; Heart Rate ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors ; Shock, Cardiogenic ; Thrombolytic Therapy ; Time-to-Treatment

PURPOSE: To compare the three-dimensional gadolinium-enhanced MR angiography with digital subtraction angiography (DSA) for evaluation of the pedal artery. MATERIALS AND METHODS: In 12 extremities of 11 patients, both digital subtraction angiography (DSA) and contrast-enhanced MR angiography (CE-MR angiography) were performed during the same week. Among ten of the 11 patients, the following conditions were present: atherosclerosis (n=4), diabetic foot (n=3), Buerger's disease (n=1), calciphylactic arteriopathy (n=1) and arteriovenous malformation of the foot (n=1). The remaining patient underwent angiography prior to flap surgery. For MR angiography, a 1.5T system using an extremity or head coil was used. A three-dimensional FISP (fast imaging with steady state precession) sequence was obtained before enhancement, followed by four sequential acquisitions (scan time, 20 secs; scan interval time, 10 secs) 10 seconds after intravenous bolus injection of normal saline (total 10 cc), following intravenous adminstration of gadolinium (0.02 mmol/kg, 3 ml/sec). Arterial segments of the ankle and foot were classified as the anterior or posterior tibial artery, the distal peroneal artery, the medial or lateral plantar artery, the pedal arch, and the dorsalis pedis artery. Two radiologists independently analysed visualization of each arteraial segment and the mean of visible arterial segments in one extreminty using CE-MR angiography and DSA. RESULTS: Among 84 arterial segments, 16 were invisible at both CE-MR angiography and DSA, while 39 were demonstrated by both modalities. Twenty-six segments were visible only at CE-MR angiography and three only at DSA. CE-MR angiography displayed a higher number of arterial segments than DSA (mean, 5.42 vs. mean 3.50, respectively), a difference which was statistically significant (p<0.000). The difference between each arterial segment was not statistically significant, except for the dorsalis pedis artery (t test, p<0.000). CONCLUSION: In that it provides additional information for the planning of treatment of lower-extremity arterial disease, three-dimensional CE-MR angiography is superior to DSA for evaluation of the pedal artery.
Angiography* ; Angiography, Digital Subtraction* ; Ankle ; Arteries* ; Arteriovenous Malformations ; Atherosclerosis ; Diabetic Foot ; Extremities ; Foot ; Gadolinium ; Head ; Humans ; Thromboangiitis Obliterans ; Tibial Arteries

A 77-year-old man visited our hospital complaining of aggravated exertional chest pain. He was diagnosed with syndrome X 7 years ago and underwent medical treatment in a regional hospital. Coronary angiography and echocardiography did not show any significant abnormalities. On the seventh in-hospital day, cardiogenic shock developed and echocardiography showed a dilated left ventricular (LV) cavity and severe LV systolic dysfunction. We thus inserted an intra-aortic balloon pump for hemodynamic support and were forced to maintain it because of weaning failure several times. Finally, heart transplantation was the decided necessary procedure. After successful heart transplantation, the biopsy specimen revealed a wild-type transthyretin deposition indicating senile systemic amyloidosis in the intramuscular coronary vessels and interstitium. Cardiac biopsy at the 4-year follow-up showed no recurrence of amyloid deposition.
Aged ; Amyloidosis ; Angina Pectoris ; Biopsy ; Cardiomyopathy, Dilated ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Follow-Up Studies ; Heart Transplantation ; Hemodynamics ; Humans ; Microvascular Angina ; Plaque, Amyloid ; Prealbumin ; Recurrence ; Shock, Cardiogenic ; Weaning

BACKGROUND AND OBJECTIVES: ovastatin, a HMG-CoA reductase inhibitor, is known to show antiproliferative effects on VSMC after vessel injury, but a large amount of the drug is needed orally for this purpose. This study investigated the effects of lovastatin given locally to injured carotid arteries of rats on reducing neointimal hyperplasia. MATERIALS AND METHOD: Lovastatin was given perivascularly to balloon-injured carotid arteries of 21 rats in 1 microM to the low-dose group, and 30 microM to the high-dose group. The control group was treated with pluronic gel only. Two weeks later, the lumen area, neointimal areas and the number of actively proliferating cells were obtained and compared. RESULTS: eointimal area was 0.113+/-0.032 mm2, 0.065+/-0.017 mm2, 0.072+/-0.017 mm2 in the control, low-dose and high-dose groups respectively. The area was significantly smaller in the treatment groups (p<0.05), but no significant difference was observed between the treatment groups. The number of actively proliferating cells per mm2 of neointimal area were 714.5+/-227.4, 688.4+/-333.7, and 1526.3+/-744.0 in the groups respectively, and the number was significantly high in the high-dose group (p<0.05). CONCLUSION: Local administration of lovastatin is effective in reducing neointimal hyperplasia after vascular injury, but extremely high doses are not needed locally for this purpose.
Animals ; Carotid Arteries* ; Carotid Artery Injuries* ; Hyperplasia* ; Lovastatin* ; Oxidoreductases ; Rats* ; Vascular System Injuries

BACKGROUND AND OBJECTIVES: It has been well known that the Braunwald classification is an appropriate clinical parameter in the prediction of the outcome in patients with unstable angina. However, the ability of the classification to predict prognosis of unstable angina according to treatment strategy is not established. We evaluated the relation between severity of angina on admission and outcome of primary unstable angina with early invasive strategy. MATERIALS AND METHOD: 148 patients (M 85, F 63, age 61+/-10) with suspected unstable angina were divided into three subgroups on the basis of the Braunwald classification on admission. The patients were followed up to 6 months prospectively if the final diagnosis was primary unstable angina. Early invasive strategy was used for the treatment of unstable angina. Major cardiac events were assessed during hospitalization and 6 months follow-up period according to the Braunwald classification. RESULTS: Unstable angina was diagnosed in 95 patients (64%). Among these patients, 89 patients with primary unstable angina were followed up to 6 months. Clinical characteristics including number of patients, mean age, sex ratio, risk factors, coronary angiographic findings and revascularization rate during hospitalization were not different in three subgroups of these patients. Among these patients, early coronary revascularizations was performed in 67 patients (75%) and 2 (2%) deaths/myocardial infarctions occurred during hospitalization. During the follow-up period, 1 (1%) myocardial infarction/death and 12 (13%) revascularizations occurred. Cardiac event rate (death, myocardial infarction or revascularization) was not different during hospitalization and 6 months follow-up period among subgroups of severity class. CONCLUSION: Clinical outcome should be reevaluated after early coronary intervention to predict cardiac event in patients with unstable angina.
Angina, Unstable* ; Classification ; Diagnosis ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Myocardial Infarction ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Ratio

BACKGROUND: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of bleeding and need for chest reexploration. We summarized a single center's experiences with PCPS in patients with cardiogenic shock or cardiac arrest due to the ischemic heart disease. MATERIAL AND METHOD: Among the 20 consecutive patients with cardiogenic shock or cardiac arrest from May 1999 to June 2005, Biopump(r) (Medtronic, Inc, Minneapolis, MN) was used in 7 patients and the self-priming, heparin-coated circuit of EBS(r) (Terumo, Japan) was applied to remaining 13 patients. Most of cannulations were performed percutaneously via femoral arteries and veins. The long venous cannulas of DLP(r) (Medtronic inc. Minneapolis, MN) or the RMI(r) (Edwards's lifescience LLC, Irvine, CA) were used with the arterial cannulae from 17 Fr to 21 Fr and the venous cannula from 21 Fr to 28 Fr. RESULT: The 20 consecutive patients who were severely compromised and received PCPS for the purpose of resuscitation were comprised of 13 cardiac arrests and 7 cardiogenic shocks in which by-pass surgery was performed in 11 patients and 9 ongoing PCIs under the cardiopulmonary support. The mean support time on the PCPS was 38+/-42 hours. Of the 20 patients implanted with PCPS, 11 patients (55%) have had the PCPS removed successfully; overall, 8 of these patients (40%) were discharged from the hospital in an average surviving time for 27+/-17 days after removing the PCPS and survived well with 31+/-30 months of follow-up after the procedure. CONCLUSION: The use of PCPS appears to provide the hemodynamic restoration, allowing the survival of patients in cardiac arrest or cardiogenic shock who would otherwise not survive, and patients receiving PCPS had a relatively long-term survival.
Catheterization ; Catheters ; Emergencies* ; Femoral Artery ; Follow-Up Studies ; Heart Arrest* ; Hemodynamics ; Hemorrhage ; Humans ; Myocardial Ischemia* ; Perfusion ; Resuscitation ; Shock, Cardiogenic* ; Thorax ; Veins

Although transcatheter aortic valve implantation (TAVI) is generally accepted as an alternative or promising treatment option for patients with decompensated cardiovascular disease in an inoperable or high-risk condition, severe hypotension and/or arrhythmia associated with rapid ventricular pacing still poses a challenge to many clinicians. This report describes a 79-year-old patient who experienced fatal hemodynamic collapse, which suddenly developed after a rapid ventricular pacing in spite of pre-administration of vasopressor. The procedure and anesthesia were uneventful until the first rapid ventricular pacing was applied. Following rapid ventricular pacing, his cardiovascular state was severely compromised and could not be recovered. Despite early initiation of extracorporeal membrane oxygenation device and supportive care, he died from heart failure on post-procedure day four.
Anesthesia ; Aortic Valve ; Arrhythmias, Cardiac ; Cardiovascular Diseases ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemodynamics ; Humans ; Hypotension