"Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mechanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.
Angioplasty ; Animals ; Apoptosis ; Catheters ; Coronary Artery Disease ; Coronary Disease ; Coronary Restenosis ; Extracellular Matrix ; Humans ; Hyperplasia ; Intercellular Signaling Peptides and Proteins ; Models, Animal ; Myocytes, Smooth Muscle ; Stents ; Thrombosis

Amyloidosis is a disease characterized by deposition of amorphous and insoluble fibrillar protein in various tissues and organs, but its productive mechanism has not been established yet. Enlargement and functional disturbance of infiltrated organs result in various clinical symptoms. Primary amyloidosis usually involve tongue, heart, nerve, gastrointestinal tract, ligament, skin, and bone marrow without underlying disease. Secondary amyloidosis is associated with chronic inflammatory disease such as tuberculosis, urogenital infection, rheumatoid arthritis, chronic ulcerative colitis, myelitis, 3rd syphilis and leprosy. The authors had experienced a case of secondary amyloidosis associated with rheumatoid arthritis, especially involving heart. He had suffered from rheumatoid arthritis for 17 years and admitted because of generalized edema and dyspnea. This case was confirmed by endomyocardial biopsy and immunohistochemical stain showed AA type. We treated him conservatively and he was transferred to other hospital on the 25th day of hospitalization but died suddenly after twelve hours.
Amyloidosis* ; Arthritis, Rheumatoid ; Biopsy ; Bone Marrow ; Colitis, Ulcerative ; Dyspnea ; Edema ; Gastrointestinal Tract ; Heart* ; Hospitalization ; Leprosy ; Ligaments ; Myelitis ; Skin ; Syphilis ; Tongue ; Tuberculosis, Urogenital

Adrenal Cortex Hormones* ; Prospective Studies* ; Stents*

A 36-year-old woman was presented with extensive anterior wall myocardial infarction. We tried to perform direct coronary angiography for the purpose of primary stenting. However, coronary angiogram revealed normal coronary arteries without intracoronary thrombi. We continued further evaluations to find out the cause of normal coronary myocardial infarction. The findings of severe hypertensive retinopathy and concentric left ventricular hypertrophy suggested that she had secondary hypertension. The detailed history, laboratory and radiological findings revealed the pheochromocytoma. The tumor was successfully removed by operation.
Adult ; Anterior Wall Myocardial Infarction ; Coronary Angiography ; Coronary Vessels ; Female ; Humans ; Hypertension ; Hypertensive Retinopathy ; Hypertrophy, Left Ventricular ; Myocardial Infarction* ; Pheochromocytoma* ; Stents

BACKGROUNG AND OBJECTIVES: Diabetes mellitus is a significant risk factor for adverse outcome after PTCA, which is associated with an increased late mortality and target lesion revascularization (TLR) rates. The beneficial role of coronary stenting on the clinical and angiographic outcomes of diabetic patients is not clearly defined. The aim of this study was to evaluate the early and mid-term outcomes in diabetic patients undergoing elective stenting of native coronary lesions compared with those in non-diabetic patients. MATERIALS AND METHODS: Between July 1997 and June 1998, coronary stenting was performed on 46 lesions in 38 diabetic patients and 126 lesions in 117 non-diabetic patients. Follow-up angiography at mean day of 189+/-45 was performed in 58.7% (91 patients) and analysed by quantitative coronary angiography (QCA). RESULTS: There was a higher incidence of multi-vessel disease in diabetic patients than non-diabetic patients but not statistically significant (71.1% vs 51.3%, p=0.106). There were no differences in major procedural complications and in-hospital events (myocardial infarction, angina and death) in diabetics and non-diabetics. During the follow-up, the incidence of target lesion revascularizton (TLR) and cardiac event free survival did not differ between two groups. CONCLUSION: Coronary stenting in diabetics resulted in a low rate of immediate procedural com-plications and early major adverse cardiac event (MACE), similar to non-diabetics. There were no differences in the mid-term clinical and angiographic outcomes in diabetics and non-diabetics.
Angiography ; Coronary Angiography ; Diabetes Mellitus ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Infarction ; Mortality ; Risk Factors ; Stents*

BACKGROUNG AND OBJECTIVES: It was reported that low molecular weight heparin (LMWH) was more effective than unfractionated heparin in patients with acute coronary syndrome. Recent studies have shown that the pathophysiology of restenosis in stented lesions was different from those of nonstented lesions. Treatment strategies designed to limit cellular proliferation that were ineffective in nonstented lesions may be efficacious in reducing in-stent restenosis. This study was aimed to compare the clinical and angiographic results of LMWH (nadroparin) after coronary stenting with those of conventional ticlopidine regimen. MATERIALS AND METHODS: Patients were eligible for inclusion if they had angina and/or objective evidence of myocardial ischemia, and a significant (>50%) stenosis that was documented on a recent coronary angiogram. After stenting, prospective randomized comparison study was performed. Patients were randomly assigned to either nadroparin (200 IU/kg, sc, bid) or ticlopidine (250 mg bid) plus aspirin (200 mg qd) treatment groups. Repeat coronary angiography (KERN=*)was performed at 236+/-90days after stenting, and quantitative coronary angiographic analysis (QCA) was done. RESULTS: Intracoronary stent implantation was performed in eighty five lesions in eighty one patients (ticlopidine:40, nadroparin:41). There was no significant difference in any baseline clinical/angiographic variables between the two treatment groups. There were no subacute stent thrombosis, infarction and death in both groups. Six-month event-free survival was 36 (90%) in the ticlopidine group and 35 (85.4%) in the nadroparin group. Follow-up quantitative angiographic data such as late loss (1.35+/-0.70 vs 1.32+/-0.69), loss index (0.53+/-0.70 vs 0.56+/-0.23) and restenosis rate (36% vs 25.8%) were not different between ticlopidine and nadroparin groups. CONCLUSION: Effects of nadroparin were not different from those with ticlopidine therapy in the prevention of restenosis and subacute stent thorombosis after coronary stenting. Clinical outcomes between two strategies were similar. Low molecular weight heparin may be an alternative to ticlopidine in patients that ticlopidine cannot be administered because of severe adverse effects.
Acute Coronary Syndrome ; Aspirin ; Cell Proliferation ; Constriction, Pathologic ; Coronary Angiography ; Disease-Free Survival ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Infarction ; Myocardial Ischemia ; Nadroparin* ; Prospective Studies ; Stents* ; Thrombosis ; Ticlopidine*

BACKGROUND AND OBJECTIVES: The goal of this study was to examine the safety and feasibility of a primary (direct) stenting in acute myocardial infarction (AMI). In the treatment of AMI, Percutaneous transluminal coronary angioplasty (PTCA) has documented superior reperfusion rate and improved clinical outcomes than thrombolytic therapy. However, there are several limitations of PTCA, such as recurrent ischemia in 10 to 15%, reinfarction in 3 to 5% and restenosis in 30 to 50% of patients. There are several reports that, compared with PTCA, the implantation of coronary stent has been shown to reduce angiographic restenosis and improve late clinical outcomes. But in general, stenting has been contraindicated in thrombus containing lesion due to the risk of subacute thrombosis. With advance in technique and the recognition of the importance of adequate platelet inhibition, the incidence of subacute thrombosis has fallen in patients with acute coronary syndrome and thrombus laden lesion. Methods and Results: In our study, primary stenting was performed in 42 patients of AMI. There are 6 cases (22.5%) target lesion restenosis during the follow up coronary angiography (150+/-86day) and no in-hospital death. Three cases (7.1%) of them require revascularization including two re-PCTA and a coronary artery bypass graft for the recurrent ischemic symptoms. There were no reinfarction and death after discharge. Six-months event free survival reate was 85.7%. CONCLUSION: Primary stenting is safe and feasible in the majority of patients with AMI and results in excellent mid-term outcomes compared with PTCA.
Acute Coronary Syndrome ; Angioplasty, Balloon, Coronary ; Blood Platelets ; Coronary Angiography ; Coronary Artery Bypass ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Reperfusion ; Stents* ; Thrombolytic Therapy ; Thrombosis ; Transplants

BACKGROUND: Neointimal hyperplasia, as the most important mechanism of restenosis after intracoronary artery stenting, its severity is closely correlated with the degree of local inflammatory reaction initiated by vasular injury during stenting procedure. So, we proceeded this study to determine whether inflammatory markers such as CD11b/CD18 (Mac-1) adehsion molecules of neutrophils, sICAM-1 (soluble intercellular adhesion molecule-1), ESR, and CRP increase or not in the peripheral circulation after coronary artery stenting, and whether there is any association between these findings and the degree of later restenosis. METHOD: 32 patients (chronic stable angina 4, unstable angina 17, acute myocardial infarction 11) underwent single vessel coronary artery stenting were enrolled in our study. Blood samples were obtained from peripheral vein just before coronary artery stenting and 48 hours thereafter. The degrees of CD11b/CD18 expression on the surface of neutrophils were analyzed by flow cytometry with monoclonal antibodies, and sICAM-1 by ELISA method. At each times, ESR and CRP were also measured. Follow-up coronary artery angiography was performed with QCA analysis at least 6 months later. We compared the each 48 hours values with the baseline (just before procedure) values. Percentage increments (as a ratio 48 hours values to baseline) of CD11b/CD18 expression, sICAM-1, ESR, and CRP levels were also compared with the results of follow-up QCA analysis. RESULTS: Restenosis (diameter stenosis > or = 50%) occurred in 6 patients (19%) at follow up angiography. 48 hours values of CD11b/CD18 expression, sICAM-1, ESR, and CRP were significantly elevated from the baseline values (each p values, CD11b : < 0.0001, CD18 : 0.01, sICAM-1 : < 0.0001, ESR : 0.005, and CRP : 0.001). The percentage increments of CD11b/CD18 expression were more elevated in restenosis group than nonrestenosis group (CD11b : 341+/-215%/74+/-95%, CD18 : 84+/-60%/17+/-37%, each p < 0.001, 0.001). There was some positive correlation between the percentage increments in the expression of CD11b and the late loss index at the follow up angiography (r=.43, p<0.05). CONCLUSIONS: Through this study, we found that the activation of neutrophils was occurred, and that sICAM-1 level was increased after coronary artery stenting in the peripheral blood. There was some correlations between the degree of CD11b expression on the surface of neutrophils and the severity of late lumen loss of inserted stents. The measurements of increased neutrophil adhesion molecules of CD11b/CD18 levels at 48hrs after coronary stenting may have a value as the predictor of subsequent late restenosis.
Angina, Stable ; Angina, Unstable ; Angiography ; Antibodies, Monoclonal ; Arteries ; Constriction, Pathologic ; Coronary Vessels* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Follow-Up Studies ; Humans ; Hyperplasia ; Myocardial Infarction ; Neutrophils* ; Stents* ; Veins

BACKGROUND AND OBJECTIVES: In this current era of using drug-eluting stents (DES), studies that demonstrate the feasibility and clinical outcome of percutaneous coronary intervention (PCI) using DES in a subset of extremely aged patients are lacking. We investigated the clinical characteristics, therapeutic and clinical outcomes of patients older than 80 years that had been implanted with DES during a PCI. SUBJECTS AND METHODS: Fifty-three "octogenarian" patients (> or =80-years-old) and 1036 "non-octogenarian" patients (<80-years-old) that had been implanted with DES at Chonbuk National University Hospital since March 2003 were enrolled in the study. Medical records of the patients in the two groups were retrospectively reviewed. RESULTS: The mean ages of the patients in the two groups were 83+/-2 years and 62+/-11 years, respectively, and the mean follow-up period was 15.8+/-10.9 months and 21.1+/-10.8 months, respectively. The octogenarian group showed an increased prevalence of female patients (58.5% vs. 35.1%, p=0.001), acute coronary syndrome (98.1% vs. 78.6%, p=0.001), ST-segment elevation myocardial infarction (41.5% vs. 28.3%, p=0.003), shock (17.0% vs. 6.6%, p=0.004), heart failure (22.6% vs. 9.3%, p=0.002) and a higher in-hospital major adverse cardiac event (MACE) rate (13.2% vs. 3.5%, p=0.004) than the non-octogenarian patients. Angiographic restenosis and target lesion revascularization rates were not different in both groups, but overall MACE (18.9% vs. 9.9%, p=0.035) and all-cause mortality (p<0.001) rates were significantly higher in the octogenarian group of patients. CONCLUSION: Although angiographic follow-up results were comparable in octogenarians and non-octogenarians, the occurrence of short- and long-term MACE was significantly higher in the very elderly group owing to a substantial subset of high-risk patients.
Acute Coronary Syndrome ; Aged ; Aged, 80 and over* ; Coronary Disease ; Drug-Eluting Stents* ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Jeollabuk-do ; Medical Records ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prevalence ; Retrospective Studies ; Shock ; Stents

It is often possible to diagnose a pheochromocytoma only when a disastrous cardiac complication like a hypertensive crisis, episodes of unexpected left ventricular failure, myocarditis, arrhythmias, myocardial infarction and sudden death appears secondarily. We revealed that a patient who had been treated with a reversible left ventricular systolic dysfunction with cardiogenic indeed had a pheochromocytoma. Upon initial admission, a 35 years old man had upper respiratory tract infection and abdominal discomfort. Blood pressure was 140/90 mmHg and EKG showed transiently paroxysmal supraventricular tachycardia. Eight hours after admission, he appeared to be in cardiogenic shock. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. Following conservative management he progressively recovered normal cardiac function although we did not discern the etiology of the left ventricular systolic dysfunction. He was readmitted six months later due to episodic headache and high blood pressure. Fortunately, due to the history of reversible left ventricular systolic dysfunction with cardiogenic shock, we were able to quickly assess him as having a pheochromocytoma. The laboratory data and radiological findings were compatible with this tumor, which was subsequently successfully removed through surgery. We suggest that the diagnosis of pheochromocytoma should be considered in young patients presenting with acute heart failure of non-specific origin.
Adult ; Arrhythmias, Cardiac ; Blood Pressure ; Death, Sudden ; Diagnosis ; Echocardiography ; Electrocardiography ; Headache ; Heart Failure ; Humans ; Hypertension ; Hypokinesia ; Myocardial Infarction ; Myocarditis ; Pheochromocytoma* ; Respiratory Tract Infections ; Shock ; Shock, Cardiogenic* ; Tachycardia, Supraventricular