PURPOSE: To evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores. MATERIALS AND METHODS: The 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD. RESULTS: In the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02−1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82−5.34, p<0.001), and CAC 1−9 (OR 1.80, 95% CI 1.08−3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02−1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93−0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14−5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model. CONCLUSION: Smoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.
Angiography ; Asymptomatic Diseases ; Body Mass Index ; Calcium ; Cholesterol, HDL ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Creatinine ; Discrimination (Psychology) ; Dyslipidemias ; Humans ; Hypertension ; Lipoproteins ; Risk Factors ; Smoke ; Smoking

BACKGROUND/AIMS: This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain. METHODS: Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death. RESULTS: The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant. CONCLUSIONS: CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.
Angina, Unstable ; Calcium ; Chest Pain ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Death ; Discrimination (Psychology) ; Electrocardiography* ; Follow-Up Studies ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Odds Ratio ; Prognosis

PURPOSE: Prediction of the proximal right coronary artery (pRCA) through electrocardiography (ECG) is very important because pRCA occlusion has frequently been suspected in right ventricular infarction, which has a high mortality rate. The aim of this study is to investigate characteristic ECG finding of pRCA occlusion distinguishable from mid or distal RCA. METHODS: A review was conducted retrospectively of 630 patients with chest pain in the ED who underwent coronary angiography (CAG) from June 2007 to December 2013 and CAG of 89 among them resulted in only RCA occlusion exempting other coronary vessels. The patients were divided into two groups: subjects with pRCA (n=32) occlusion and below the mid RCA (n=57) occlusion. In each subset, features of ECG were searched and analyzed. RESULTS: ECG of patients with occlusion of the pRCA showed more prominent ST depression in lead I (-0.68 mm vs -0.22 mm, p=0.027) and ST elevation in V1 (0.94 mm vs 0.09 mm, p=0.001) than in the below portion. Both ST depression (< or =0 mm) in I and ST elevation (>0.5 mm) in V1 classified according to cutoff value using Youden index J were closely related to pRCA occlusion other than mid or distal RCA (OR 7.16, p<0.001). CONCLUSION: Discrimination of pRCA occlusion from mid or distal RCA in ECG through ST depression in lead I and ST elevation in lead V1 might be valid as a sentinel of right ventricular infarction.
Chest Pain ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Depression ; Discrimination (Psychology) ; Electrocardiography* ; Humans ; Infarction ; Mortality ; Myocardial Infarction ; Retrospective Studies

PURPOSE: Coronary artery disease is the most common cause of out-of-hospital cardiac arrest (OHCA). Primary percutaneous coronary intervention (PCI) is currently the most effective reperfusion strategy in acute myocardial infarction. The decision to perform PCI in an unconscious resuscitated OHCA patient is challenging because of uncertainty of the clinical course, status of the coronary artery and prognosis. The study evaluated clinical characteristics, angiographic findings and results of OHCA patients who were successfully resuscitated and underwent PCI. METHODS: A retrospective study was performed from January, 2008 to December, 2010. Thirty four OHCA patients who successfully resuscitated and followed by PCI were enrolled. They were divided into significant and nonsignificant coronary artery group. Significant coronary artery group (n=23) was subdivided into survival and mortality subgroup. RESULTS: Twenty three of the 34 patients had significant coronary disease on coronary angiography. There was no significant difference between the two groups in clinical and electrocardiography (ECG) findings based on age, sex, presence of chest pain, initial ECG, and ECG after return of spontaneous circulation (ROSC). The significant coronary artery group displayed higher creatine kinase-MB and troponin-I levels, and more common presence of ventricular fibrillation (VF) prior to PCI. The survival subgroup showed a lower number of significant stenotic coronary arteries, better neurologic finding prior to PCI and lower levels of cardiac biomarkers such as creatine kinase-MB and troponin-I. CONCLUSION: PCI after ROSC in OHCA patients with presumed ischemic cardiac etiology may be reasonable, even in the absence of a definite clinical and ECG finding. The presence of VF or serial cardiac biomarkers is helpful in deciding whether to perform PCI.
Biomarkers ; Cardiopulmonary Resuscitation ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Creatine ; Electrocardiography ; Heart Arrest ; Humans ; Myocardial Infarction ; Neurologic Manifestations ; Out-of-Hospital Cardiac Arrest ; Percutaneous Coronary Intervention ; Prognosis ; Reperfusion ; Retrospective Studies ; Troponin I ; Uncertainty ; Unconscious (Psychology) ; Ventricular Fibrillation

BACKGROUND AND OBJECTIVES: To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). However, often it is not easy to determine such a dose. This study assessed the usefulness of the ratio of CM-dose to estimated glomerular filtration rate (eGFR) in predicting the risks of CIN and sought to determine the safe level of CM-dose/eGFR in patients undergoing non-emergent percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those with ne-phropathy requiring dialysis (NRD) were also evaluated. RESULTS: Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3% and 80%, respectively. Of patients (n=51) with g-I/eGFR > or =1.42, 23.6% (13/51) and 7.8% (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001) and NRD (0%, 0/171, p<0.001). CONCLUSION: It can be concluded that a g-I/eGFR <1.42 is a simple, useful indicator for determining the safe CM-dose based on the pre-PCI eGFR values. Furthermore, g-I/eGFR might have a close relationship with the development of NRD as well as CIN.
Acute Kidney Injury ; Angiography ; Contrast Media ; Dialysis ; Discrimination (Psychology) ; Glomerular Filtration Rate ; Humans ; Incidence ; Iodine ; Percutaneous Coronary Intervention ; ROC Curve ; Sensitivity and Specificity

Hyponatremia is a relatively common electrolyte disorder. Although severe acute hyponatremia following coronary angiography is rare, potentially lethal neurologic manifestations may result. We describe a patient with severe, symptomatic hyponatremia, an unusual complication of coronary angiography. Lack of familiarity with contrast media-related hyponatremia caused a delay in diagnosis and therapy in our case. The diagnosis of acute hyponatremia should be considered in any patient who develops behavioral or neurologic manifestations following coronary angiography. Prompt diagnosis and treatment is essential to avoid permanent neurologic damage or death.
Coronary Angiography ; Humans ; Hyponatremia ; Neurologic Manifestations ; Recognition (Psychology)

A 38-year-old man presented with typical squeezing-type anterior chest pain. An initial electrocardiogram (ECG) showed prominent ST-segment elevation (V1-V4 lead, 3 mm). Suddenly, the patient fell unconscious and had no pulse. At that time, the ECG showed polymorphic ventricular fibrillation (VT). After direct current (DC) cardioversion, the patient regained vital signs and defibrillation converted the VT into an accelerated idioventricular rhythm with resolution of the ST-segment elevation. The patient was referred to our hospital for close observation and further evaluation. At our hospital, an ECG showed normal sinus rhythms and cardiac enzymes were within normal limits. We diagnosed the patient with variant angina rather than ST elevation myocardial infarction (STEMI), because his clinical manifestations were quite distinct; ST-segment elevations disappeared slowly at the reperfusion stage. However, the patient's final diagnosis was STEMI because coronary angiography showed severe eccentric tubular stenosis (85%) with remnant thrombus in the middle left anterior descending artery. Defibrillation likely removed the thrombus, which led to STEMI.
Accelerated Idioventricular Rhythm ; Adult ; Angina Pectoris, Variant ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Electric Countershock ; Electrocardiography ; Humans ; Myocardial Infarction ; Myocardial Revascularization ; Reperfusion ; Thrombosis ; Unconscious (Psychology) ; Ventricular Fibrillation ; Vital Signs

PURPOSE: The purpose of this study was to identify the factors that predict discomfort after coronary angiography or percutaneous coronary intervention (PCI) among hospitalized patients. METHODS: A total of 203 patients who underwent coronary angiography or PCI were recruited from C hospital located in S city, J province, from June through August 2008. The level of discomfort was measured and standardized by two instruments, discomfort questionnaire and the Visual Analogue Scale (VAS). RESULTS: Stepwise multiple regression showed that the factors predicting the level of discomfort were type of angiography, gender, previous angiography, dysuria, pre-information, and sleep satisfaction, which together explained 30.6% of the total variance of the level of discomfort. CONCLUSION: Patients who had previous experience with these procedures, received a pre-information about the upcoming procedure, had no dysuria, and had slept well after the procedure were less likely to complain discomfort. Pre-informed education should be given by nurses to patients who will have an angiography or PCI to reduce their physical and emotional discomforts.
Adult ; Aged ; Aged, 80 and over ; Angioplasty, Transluminal, Percutaneous Coronary ; Coronary Angiography/*psychology ; Coronary Disease/psychology/radiography ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Preoperative Care ; Questionnaires ; Sex Factors ; Sleep ; Urination

PURPOSE: N-13 ammonia uptake and retention in the myocardium is related to perfusion and metabolism. There are several potential advantages of N-13 ammonia positron emission tomography (PET) to detect myocardial ischemia, such as higher spatial resolution, greater counting efficiencies, and robust attenuation correction. But there are few reports comparing Tc-99m myocardial perfusion single photon emission tomography (MPS) and N-13 ammonia PET. We thus compared adenosine stress N-13 ammonia PET/CT and Tc-99m sestamibi MPS in patients with suspected coronary artery stenosis. MATERIALS AND METHODS: Seventeen patients (male 13 : 63+/-11 years old) underwent adenosine stress N-13 ammonia PET/CT (Discovery ST, GE), Tc-99m sestamibi MPS (dual head gamma camera, Hawkeye, GE) and coronary angiography within 1 week. N-13 ammonia PET/CT and Tc-99m sestamibi MPS images were assessed with a 20-segment model by visual interpretation and quantitative analysis using automatic quantitative software (Myovation, GE). RESULTS: Both sensitivities and specificities of detecting an individual coronary artery stenosis were higher for N-13 ammonia PET/CT than Tc-99m sestamibi MPS (PET/CT: 91%/ 89% vs MPS: 65%/ 82%). N-13 ammonia PET/CT showed reversibility in 52% of segments that were considered non-reversibile by Tc-99m sestamibi MPS. In the 110 myocardial segments supplied by the stenotic coronary artery, N-13 ammonia PET/CT showed higher count densities than Tc-99m MPS on rest study (p<0.01), and the difference of count density between the stress and the rest studies was also larger on N-13 ammonia PET/CT. CONCLUSION: Adenosine stress N-13 ammonia PET/CT had higher diagnostic sensitivity and specificity, more reversibility of perfusion defects and greater stress/rest uptake differences than Tc-99m sestamibi MPS. Accordingly, N-13 ammonia PET/CT might offer better assessment of myocardial ischemia and viability.
Adenosine ; Ammonia ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Gamma Cameras ; Head ; Humans ; Myocardial Ischemia ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Retention (Psychology) ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

OBJECTIVETo compare the prior coronary angiography (CAG) psychological status in chest pain patients with and without coronary artery disease (CAD).

METHODSNinety-nine patients with chest pain and scheduled for CAG were selected by cluster sampling method. The mental status was measured by Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale-17 (HAMD-17) 24 hours before CAG, and the risk factors for CAD were also determined.

RESULTSThere were 43 patients with HAMA score > or = 14, 18 patients with HAMD-17 score > or = 14 and 16 patients with both scores > or = 14. CAD was diagnosed in 46 patients by CAG. HAMA score was significantly higher in patients without CAD than patients with CAD (14.1 +/- 7.1 vs. 11.1 +/- 6.7, P < 0.05).

CONCLUSIONSIncidences of anxiety and depression were high in chest pain patients prior CAG and incidence of anxiety prior CAG was significantly higher in chest pain patients without CAD compared to chest pain patients with CAD.

Adult ; Aged ; Chest Pain ; diagnostic imaging ; psychology ; Coronary Angiography ; psychology ; Coronary Artery Disease ; psychology ; Cross-Sectional Studies ; Depressive Disorder ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Stress, Psychological