BACKGROUND AND OBJECTIVES: Unstable angina is an inhomogenous syndrome. A substantial percentage of patients, ranging from 12 to 30% in most series, develops acute myocardial infarction or dies suddenly soon after their hospitalization, while the remainder have a benign prognosis without adverse coronary events. Unstable angina is a complex condition such as angina at rest, crescendo angina, new onset angina and postinfarction angina. These variable clinical presentations suggest that unstable angina have a heterogenous pathogenesis and prognosis. We divided unstable angina into 5 groups and studied the relationship between clinical presentations and coronary angiographic morphology. METHODS: One hundred sixty six patients were selected from the patients who were diagnosed as an unstable angina between January 1989 and March 1991, at Hallym University Hospital. Angiography was performed in patient with typical angina symptoms and transient ECG changes of myocardial ischemia. Coronary angiogram was done as usual method. Calcification of coronary artery as well as the presence of collateral circulation were recorded. Ergonovine test was performed in patients with near normal or normal angiogram. Coronary lesions were morphologically classified as follows; type A is simple lesion such as symmetric, concentric narrowing and smooth border. and type B is complex lesion such as asymmetric, eccentric, ulcerated narrowing and irregular border. RESULTS: These groups were classified as follows; Group I(represented the patients with angina at rest but typical Prinzmetal angina was excluded) 30 patients, Group II(represented the patients with crescendo angina) 24 patients, Group III(represented the patients with new onset angina) 62 patients, Group IVA(represented the patients with early postinfarction angina within 2 weeks after AMI) 34 patients, Group IVB(represented the patients with delayed postinfarction angina) 16 patients, There were no significant differences in age and sex among the 5 groups. Locations of involved vessel were similar among the five groups, and left anterior descending artery was most frequently(mean 60%) involved. Single vessel disease was frequently observed in new onset angina and early postinfarction angina(Group III*, IVa** 48%, 65% VS Group II, IVB 25%, 19% respectively, *p<0.05, **p<0.005) whereas multivessel disease was frequent in crescendo angina and delayed postinfarction angina(Group II, IVB 51%, 76% VS Group II, IVA 16%, 27% respectively, p<0.005). More than two third of patients with unstable angina had complex B lesion of coronary artery (77%), but in new onset angina simple A lesion was frequently observed (Group III 45% VS Group I, IVA, IVB 16%, 10%, 13% respectively, p<0.05). The frequency of calcification increased in early postinfarction angina(Group IVA 18% VS Group III 3%, p<0.05). The frequency of coronary collateral circulation increased in cresendo angina, early postinfarction and delayed postinfarcion angina(Group II*, IVA*, IVB** 38%, 35%, 50% VS Group III 10% respectively, *p<0.005.**p<0.0001). Incidence of coronary vasospasm was higher in resting angina than the others(Group I*, III 30%, 19% VS Group II, IVA 4%, 6% respectively, *p<0.02). The coronary vasospasm was frequently observed in an insignificant lesion(insignificant lesion/total vasopasm: 12/24(50%)). Early postinfarction angina had frequent intracoronary thrombus in infact-related artery(incidence of thrombus : Group IVA*, IVB 21%, 13% VS Group I, II, III 3%, 4%, 5% respectively, *p<0.05). CONCLUSION: This study suggests that patients with unstable angina pectoris may be heterogeneous groups. Coronary angiography must be performed in patients with unstable angina, in order to classify the clinical correlates with each possible angiogrphic finding that could affect treatment modality and outcome of cardiac events.
Angina Pectoris, Variant ; Angina, Unstable* ; Angiography ; Arteries ; Collateral Circulation ; Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Hospitalization ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia ; Prognosis ; Thrombosis ; Ulcer

Essential thrombocythemia is a kind of myeloproliferative disorder characterized by primary elevation in the number of platelet and by multiple episodes of bleeding or thrombotic complications. Rarely, thrombocythemia itself causes coronary arterial occlusion and leads to ischemic heart disease. Fewer than twenty cases of coronary artery occlusive disease in thrombocythemia have been reported since Cheitlin et al had included thrombocythemia in their review of rare causes of myocardial infarction. We experienced a case of coronary artery disease in a 53-year-old woman with thrombocythemia, who had not coronary artery disese risk factors at all. Presence of multiple thrombus in the coronary artery was suggested in coronary angiography.
Angina, Unstable* ; Blood Platelets ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Female ; Hemorrhage ; Humans ; Middle Aged ; Myeloproliferative Disorders ; Myocardial Infarction* ; Myocardial Ischemia ; Risk Factors ; Thrombocythemia, Essential ; Thrombocytosis* ; Thrombosis

BACKGROUND: Patients with ischemic heart disease have many episodes of ischemic attack which is presented as ST-T change in electrocardiogram during ordinary daily life. The purpose of this study was to confirm the presence of a significant circardian variation in transient myocardial ischemia and the difference of the incidence of ischemia according to involved vessel. METHODS: Twenty two patients with angiographically significant coronary stenosis were evaluated. The ambulatory electrocardiography(Holter monitoring) was performed in each patients. RESULTS: One hundred twenty-eight episodes of ischemic ST-T changes occured in 18(82%) of 22 patients and 65(51%) episodes of ischemic ST-T changes occured between 6 A.M. and 12 noon(p<0.005). The mean frequency per patient according to involved vessel was 9 in double vessel disease, 4.5 in diffuse sclerosis with old myocardial infarction, 2.9 in single left anterior descending, 2.3 in single right coronary and 1 in single left main coronary artery disease. The only one episode of T wave change was observed in patients with lesion of left circumflex artery. The mean frequency of ST changes per patient according to type of angina was 4.8 in postinfartion angina, 3.5 in unstable angina and 2.1 in stable angina and the mean frequency of T change was 4.7 in stable angina, 2 in unstable angina and 0.3 in postinfarction angina. CONCLUSIONS: The significant circardian variation of ischemic activity was found in patients with ischemic heart disease. The mean frequency of ST change was higher in double vessel disease and diffuse sclerosis with old myocardial infarction than in other coronary artery lesion. And the episode of ST change was more frequent in postinfarction angina and unstable angina pectoris and the episodes of T change in stable angina pectoris. Also this study suggest 24-hour Holter monitoring has a low detectability of ischemic episodes in patient with lesion of left circumflex artery.
Angina, Stable ; Angina, Unstable ; Arteries ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Electrocardiography ; Electrocardiography, Ambulatory* ; Humans ; Incidence ; Ischemia ; Myocardial Infarction ; Myocardial Ischemia ; Sclerosis

Coronary vasospasm plays an important role in the pathogenesis not only of variant angina, but also of ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarction, and sudden death. Vasoactive events leading to an acute reduction in regional myocardial flow in the presence of a normal or previously compromised circulation are a common cause of arrhythmias. However, coronary vasospasm-induced electrical and mechanical complications are rarely reported in patients with angiographically normal or near-normal coronary arteries. This paper presents our experience with a patient presenting with coronary vasospasm-associated ventricular fibrillation without findings of significant coronary artery disease.
Angina Pectoris ; Angina Pectoris, Variant ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Death, Sudden ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Fibrillation

Coronary vasospasm plays an important role in the pathogenesis not only of variant angina, but also of ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarction, and sudden death. Vasoactive events leading to an acute reduction in regional myocardial flow in the presence of a normal or previously compromised circulation are a common cause of arrhythmias. However, coronary vasospasm-induced electrical and mechanical complications are rarely reported in patients with angiographically normal or near-normal coronary arteries. This paper presents our experience with a patient presenting with coronary vasospasm-associated ventricular fibrillation without findings of significant coronary artery disease.
Angina Pectoris ; Angina Pectoris, Variant ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Death, Sudden ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Fibrillation

BACKGROUND AND OBJECTIVES: This trial evaluated the safety and efficacy of the Genoss drug-eluting coronary stent. METHODS: This study was a prospective, multicenter, randomized trial with a 1:1 ratio of Genoss drug-eluting stent (DES)™ and Promus Element™. Inclusion criteria were the presence of stable angina, unstable angina, or silent ischemia. Angiographic inclusion criteria were de novo coronary stenotic lesion with diameter stenosis >50%, reference vessel diameter of 2.5–4.0 mm, and lesion length ≤40 mm. The primary endpoint was in-stent late lumen loss at 9-month quantitative coronary angiography follow-up. Secondary endpoints were in-segment late lumen loss, binary restenosis rate, death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis during 9 months of follow-up. RESULTS: We enrolled 38 patients for the Genoss DES™ group and 39 patients for the Promus Element™ group. In-stent late lumen loss at 9 months was not significantly different between the 2 groups (0.11±0.25 vs. 0.16±0.43 mm, p=0.567). There was no MI or stent thrombosis in either group. The rates of death (2.6% vs. 0%, p=0.494), TLR (2.6% vs. 2.6%, p=1.000), and TVR (7.9% vs. 2.6%, p=0.358) at 9 months were not significantly different. CONCLUSION: This first-in-patient study of the Genoss DES™ stent showed excellent angiographic outcomes for in-stent late lumen loss and major adverse cardiac events over a 9-month follow-up.
Angina, Stable ; Angina, Unstable ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Ischemia ; Mortality ; Myocardial Infarction ; Polymers* ; Prospective Studies ; Sirolimus ; Stents* ; Thrombosis

BACKGROUND: A small percentage of patients presenting with acute myocardial infarction are found to have angiographically normal or near normal coronary arteries. Thrombus, coronary spasm or coronary embolism have been thought to cause myocardial infarction in these circumstances. Acetylcholine(Ach) may dilate coronary arteries indirectly by releasing EDRF(endothelium derived relaxing factor), but constrict arterial smooth muscle when endothelium is dysfunctional or denuded. In this study, we observed Ach responses of infarct related arteries with and without stenotic leisions to clarify the possible etiologic role of vasospasm in ischemic heart disease. METHODS: Seven to ten days after acute myocardial infarction. Ach(100ug for left and 50ug for right )responses of infarct-related coronary was studied in 16 patients with angiographically normal coronary arteries(Group 1) and 15 patients with significant stenotic lesions(Group 2). Ach responses was also studied in 27 noninfarct related arteries(NIRA) of group 1 and 29 NIRAs of group2. The positive response was defined as total or subtotal occlusion after Ach injection. In 6 patients of group 1 with Ach(+), intravenous ergonovine(Erg) test was also performed after completion of Ach test. RESULTS: 1) Ach(+) responses of IRAs with or without significant coronary artery disease was more frequent(70%) than that of NIRAs(14%). 2) Ach(+) response of IRAs with angiographically normal coronary artery (87.5%) was more common than that with significant fixed disease(45.4%). 3) ACh and ergonovine induced vasospasm at the same site in 4 of group 1. CONCLUSIONS: In the majority of patients with normal coronary artery and acute myocardial infarction(AMI), Ach induced vasospasm in the IRAs. Ach(+) response occured more frequently in normal coronary arteries. These findings suggest that coronary vasospasm might etiologic role for AMI. especially in thoses patients with normal coronary artery. However our investigation failed clarify whether the those responses of IRAs to Ach was a cause or a result of myocardial infarction due to the post-ischemic injured endothelium. Ach and Erg induced vasospasm at the same site in 4 of group 1 which suggests that local hyperreactivity might be related to coronary spasm.
Acetylcholine* ; Arteries ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels* ; Embolism ; Endothelium ; Ergonovine ; Humans ; Muscle, Smooth ; Myocardial Infarction ; Myocardial Ischemia ; Spasm ; Thrombosis

Unstable angina is a critical phase of coronary heart disease, with widely variable symptoms and prognoses. Recently, despite the advances in surgical revascularization, catheter-based revascularization and medical treatment, an increasing number of patients with angina pectoris are refractory to medical therapy and; therefore, can not be considered as candidates for coronary artery bypass grafting or interventional angioplasty. These patients are often treated with narcotics for pain relief, and forced to severely reduce their levels of activity and productivity. It has become clear that alleviating the pain caused by myocardial ischemia may be possible by altering the sympathetic afferent nerve fibers. Sympathetic blockade can be produced using high thoracic epidural analgesia. Herein, the case of a patient with intractable angina and poor ventricular function, who received high thoracic epidural analgesia to relieve ischemic chest pain, is reported.
Analgesia, Epidural* ; Angina Pectoris ; Angina, Unstable* ; Angioplasty ; Chest Pain ; Coronary Artery Bypass ; Coronary Disease ; Efficiency ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Narcotics ; Nerve Fibers ; Prognosis ; Ventricular Function

BACKGROUND AND OBJECTIVES: We previously reported the effects of MAC (Maximum Arterial Re-Creation) stent on stent restenosis in a porcine model. The clinical trial was performed in patients with ischemic heart disease after MAC stent implantation. MATERIALS AND METHOD: We analyzed the clinical and angiographic results in 20 patients in 22 lesions (15 M, 5 F, 59+/-11 year), who underwent MAC stent at Chonnam University Hospital between Nov '97 and Aug '98. Clinical diagnosis was 13 unstable angina (65%), 6 acute myocardial infarction (30%) and 1 old myocardial infarction (5%). RESULTS: Indications for stent were 3 de novo lesion (13.6%), 7 restenosis (31.8%), 8 suboptimal angioplasty result (36.4%) and 4 bail-out procedure (18.2%). Target stented coronary arteries were 15 left anterior descending coronary arteries (67.3%), 2 left circumflex coronary arteries (9.1%) and 5 right coronary arteries (22.7%). Morphologic types were 13 type B1 (59.1%), 5 B2 (22.7%) and 4 C (18.2%). Minimal luminal diameter (MLD) before stent was 0.75+/-0.35 mm and percent diameter stenosis (DS) was 75+/-11.5%, which were improved 2.97+/-0.28 mm in MLD and 2.79+/-5.4% in DS after stent. MAC stent was placed successfully in all patients and one case of acute stent thrombosis was improved after ReoPro infusion. Mean follow-up period was 5.2+/-3.2 months and 100 % event-free survival was observed in all patients. Follow-up coronary angiography was performed in 5 patients and showed no stent restenosis. CONCLUSION: The MAC stent is one of effective and safe devices in the treatment of coronary artery diseases without significant complications and target vessel revascularization.
Angina, Unstable ; Angioplasty ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Jeollanam-do ; Myocardial Infarction ; Myocardial Ischemia ; Phenobarbital ; Stents* ; Thrombosis

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of transradial percutaneous coronary intervention (TRI) compared with transfemoral percutaneous coronary intervention (TFI) in patients with ischemic heart disease. METHODS: We reviewed retrospectively the medical records including imaging data of the patients with ischemic heart disease who underwent TRI or TFI from January 2007 to December 2009 in Soonchunhyang University Seoul Hospital. We compared major adverse cardiac and cerebrovascular events (MACCEs) including death, myocardial infarction, revascularization, stent thrombosis, and cerebrovascular accident during follow-up period. We also compared procedure related vascular complications including hematoma, arteriovenous fistula, pseudoaneurysm, and infection. RESULTS: Total number of patients was 347 (256 patients of TRI and 91 patients of TFI). There were no significant differences in the rate of MACCEs between two groups. There were significantly less procedure-related vascular complications in TRI group (3.1% vs. 11.0%, P=0.010). CONCLUSION: TRI is as effective as TFI with no difference in the rate of MACCEs in patients with ischemic heart disease. TRI is superior to TFI in safety with reduction of vascular complications.
Aneurysm, False ; Arteriovenous Fistula ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart ; Hematoma ; Humans ; Medical Records ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Radial Artery ; Retrospective Studies ; Stents ; Stroke ; Thrombosis