Amro Elnagar

Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients.

High-dose aspirin has been reported to aggravate coronary artery spasm (CAS). However, it is unknown whether low-dose aspirin (LDA; 100 mg) has deleterious impact on CAS. We assessed the impact of LDA on CAS induced by intracoronary acetylcholine (ACh) provocation test. A total of 2789 consecutive patients without significant coronary artery disease who underwent ACh test between November 2004 and March 2010 were enrolled. The patients were divided into two groups: the aspirin group taking LDA before ACh test (n=221) and the no aspirin group not taking aspirin (n=2568). At baseline, the prevalence of old age, diabetes mellitus, hypertension, and hyperlipidemia were higher in the aspirin group. During the ACh test, the incidence of significant CAS, ischemic chest pain, as well as severe and multivessel spasm was higher in the aspirin group. The response rate to lower ACh dose was higher in the aspirin group. Multivariate analysis showed that the previous use of LDA was an independent predictor of CAS (adjusted odds ratio, 1.6, 95% confidence interval, 1.0-2.3; p=0.031). However, it is likely that the association of LDA and CAS that we have observed is not causal but may be hypothesis generating due to significant baseline differences. Further, male gender, old age, lipid-lowering drugs, baseline spasm, and myocardial bridge were independent predictors of CAS. LDA was more frequently associated with CAS and ischemic symptoms, as well as severe and multivessel spasm, suggesting the patients who have received LDA would require more intensive medical therapies and close follow up.

Successful Retrieval of a Fractured and Entrapped 0.035-Inch Terumo Wire in the Femoral Artery Using Biopsy Forceps

A 0.035-inch guide wire fracture and entrapment in a peripheral artery is a very rare complication, but when it does occur it may lead to life-threatening complications, such as perforation, thrombus formation, embolization, and subsequent limb ischemia. We describe our experience of successfully retrieving a fractured 0.035-inch Terumo guide wire in the external iliac artery using a biopsy forcep.

Impact of Heterogeneous Overlapping Drug-Eluting Stents on the Arterial Responses of Rabbit Iliac Arteries: A Comparison With Overlapping Bare Metal Stents

Background and Objectives Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. Materials and Methods Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal sirolimus-eluting stent (SES, Cypher™)+proximal paclitaxel-eluting stent (PES, Taxus™) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up angiography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. Results Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39±0.07) and C+T (0.40±0.20) than that in the T+C (0.06±0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C, p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. Conclusion Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the implantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.

Multivessel versus single vessel spasm, as assessed by the intracoronary acetylcholine provocation test, in Korean patients

1. Coronary artery spasm (CAS) is known to be a major cause of myocardial ischaemia. Multivessel coronary spasm (MVS) in particular is likely to induce more severe and prolonged myocardial ischaemia than single vessel spasm (SVS).

FIRST GENERATION VERSUS NEWER GENERATIONS DRUG-ELUTING STENTS IN CHRONIC TOTAL OCCLUSION INTERVENTION

Successful revascularization of chronic total occlusions (CTOs) remains one of the most difficult challenges for interventional cardiologists. Despite of improved long–term outcomes by drug–eluting stents (DES), however, there are limited data regarding outcomes of different DESs

CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF VASOSPASTIC ANGINA IN TEENAGERS

Results: Baseline characteristics were similar between the two groups except that teenagers group had more males (75% vs.47.7%, p=0.001), while older group had more hypertension (47% vs.11.1%, p<0.001) & dyslipidemia (18.8% vs.0%,p=0.004). After the adjustment of baseline differences, there was a trend toward higher incidence of ischemic chest pain in the elderly group during the Ach provocation test. However, other clinical & angiographic characteristics of Ach test were similar between the two groups (Table).

ONE-YEAR OUTCOMES AFTER THE UNRESTRICTED USE OF SIROLIMUS- VERSUS PACLITAXEL-ELUTING STENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Methods: A total of 2474 AMI patients who underwent percutaneous coronary intervention (PCI) with SES (n=1264), or PES (n=1210) were enrolled from Korea Acute Myocardial Infarction Registry (KAMIR). The composite clinical outcomes at 1 year were compared between the 2 groups. Target lesion failure (TLF) was defined as the composite of cardiac death, target lesion recurrent nonfatal myocardial infarction (Re-MI), or target lesion revascularization (TLR). Total major adverse cardiac events (MACE) included total death, Re-MI, and target vessel revascularization (TVR).

BALLOON ANGIOPLASTY ALONE VERSUS STENT IMPLANTATION IN ILIOFEMORAL ARTERY LESIONS

Methods: A total 187 consecutive critical limb ischemia (CLI) patients (pts) underwent PTA. Among these pts, a total 121 (64.7%) CLI pts presented with ilio-femoral artery lesion (156 limbs, 189 lesions) and 75 pts were treated with Stents (100 Limb, 107 lesions). Provisional stenting was done once the balloon angioplasty result is not optimal. Periprocedural complications and clinical outcomes up to 12 months were compared between the two groups.

THE IMPACT OF BIFURCATION LESIONS ON 6-MONTH ANGIOGRAPHIC AND LONG TERM CLINICAL OUTCOMES IN ACUTE MYOCARDIAL INFARCTION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITH DRUG-ELUTING STENTS

Bifurcation lesions remain a challenging lesion subset, often associated with lower success rates. There are limited data regarding the angiographic and clinical outcomes of bifurcation intervention in the acute myocardial infarction (AMI) setting. A total of 903 patients (pts) were underwent