Atsushi Kawasaki

Association of remnant-like particle cholesterol with coronary artery disease in patients with normal total cholesterol levels.

BACKGROUND Limited information is available as to whether there is a difference in the association of lipid and fibrinolytic variables with coronary artery disease according to the presence or absence of elevated serum total cholesterol. We examined the levels of various lipid and fibrinolytic variables including remnant-like particle cholesterol (RLP-C). RLP-C is a recently established simple assay method for the estimation of triglyceride-rich lipoprotein remnants. METHODS AND RESULTS Levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride, lipoprotein(a), RLP-C, uric acid, blood glucose, tissue plasminogen activator, tissue plasminogen activator inhibitor type 1, antithrombin III, and protein C were measured in 208 patients who underwent diagnostic coronary angiograms. Of these 208 patients, 57 were hypercholesterolemic (> or =220 mg/dL) and 151 were normocholesterolemic. HDL-C showed significant differences between patients with and those without angiographically determined coronary artery stenosis in both hypercholesterolemic and normocholesterolemic patients (P =.0025 and P =.0003, respectively). Both RLP-C and uric acid showed significant differences only in the normocholesterolemic subgroup (P =.0006 and P =.0060, respectively). This difference in uric acid was not significant by multivariable analysis. The ratio of RLP-C/HDL-C was demonstrated to be highly significantly (P <.0001) associated with coronary artery stenosis in patients with normal total cholesterol, whereas there was no statistically significant association in the hypercholesterolemic patient subgroup. CONCLUSIONS Our current study disclosed that RLP-C levels are strongly associated with coronary artery disease, especially in patients with normal total cholesterol levels. Moreover, RLP-C/HDL-C ratio may be even more significantly associated with the presence of coronary artery stenosis in normocholesterolemic patients.

Exercise-induced coronary spasm: comparison of treadmill and bicycle exercise in patients with vasospastic angina.

Background We investigated whether exercise-induced coronary spasms are influenced by the different exercise modes.Methods We compared ischaemic ECG responses in 67 patients with vasospastic angina who underwent both treadmill and bicycle ergometer exercise and also coronary angiography.Results ECG ST-segment elevation was provoked more frequently during treadmill exercise than it was during bicycle exercise (19 versus 9%, P<0.05). Of 45 patients without significant coronary stenosis (coronary artery luminal diameter narrowing < 75%), 19 patients manifested ST-segment depression during treadmill exercise, whereas only seven patients did during bicycle exercise (42 versus 16%, P<0.01). All patients with ST-segment elevation or depression during bicycle ergometer exercise also had ST-segment changes during treadmill exercise. Although higher systemic blood pressure levels and lower heart rates were found during bicycle exercise compared with during treadmill exercise, the pressure-rate products at peak exercise did not differ between the two exercise tests.Conclusions It seems that treadmill and bicycle exercise are different stressors in patients with vasospastic angina, and that coronary spasms are provoked more frequently during treadmill exercise than they are during bicycle exercise. The cause of this difference is not known, but it may be related in part to the difference in systemic haemodynamic or neurohumoral response.

Ischemia-induced Brugada-type ST-segment alternans and Brugada syndrome.

UNLABELLED The mechanisms of Brugada-type electrocardiographic (ECG) pattern remain unclear. METHODS The ST-segment was evaluated during coronary intervention of proximal right coronary artery (RCA). We measured ST-segment elevation with a drug challenge test with a sodium channel blocker. The ST-segment changes were compared with those in true Brugada syndrome. RESULTS Brugada-type ECG was observed in 6 patients but not in 9 patients during coronary intervention. Five patients demonstrated Brugada-type ST elevation and alternans from coved type to saddleback type during coronary intervention. The patients with ST alternans demonstrated the conus branch occlusion or RV branch occlusion. A drug challenge test developed a significant ST-segment elevation neither in patients with Brugada-type ECG nor in patients without Brugada-type ECG. (0.69±0.48 mv vs. 0.48±0.31 mv, p=NS) There was a significant difference in the ST-segment elevation between patients with Brugada-type ECG during the coronary intervention and patients with true Brugada syndrome (n=5). (0.69±0.48 mv vs. 2.86±0.61 mv, p<0.05). CONCLUSIONS Ischemia of proximal RCA can masquerade as the Brugada syndrome, ST-segment elevation and alternans. Ischemia of proximal RCA could be one of the different entities showing Brugada-type ECG from true Brugada syndrome.

MPS 04-07 SHORT AND MID-TERM OUTCOMES OF ACUTE MYOCARDIAL INFARCTION WITH ELEVATED SYSTOLIC BLOOD PRESSURE ON ADMISSION

Objective: Although lower admission systolic blood pressure (SBP) has been established as a poor prognostic factor in patients with acute myocardial infarction (AMI), the impact of preserved admission SBP on short and mid-term outcomes has not been fully evaluated. Design and Method: From January 2013 to March 2015, 1281 consecutive patients with AMI were registered in Mie ACS Registry, a prospective, multicenter registry in Japan. We evaluated 1122 patients (mean age 68 ± 13 years, male 78%) except for 159 patients with admission SBP < 100 mmHg. Patients were divided into three groups according to admission SBP: 100–139 mmHg (normal admission SBP; NBP group, n = 612), 140–179 mmHg (moderately elevated admission SBP; MBP group, n = 419) and ≥180 mmHg (excessively elevated admission SBP; EBP group, n = 91). The clinical characteristics, 30-day and 1-yaer outcomes (follow-up rate 94.7%) were compared among the three groups. Results: The rate of primary percutaneous coronary intervention and the number of diseased coronary vessels were not significantly different among the three groups. The Killip classification and the peak creatine kinase values were lowest in the MBP group. Heart failure, arrhythmia, shock and multi-organ failure during hospitalization were most often in the NBP group, but myocardial rupture was no significant difference in the three groups. The 30-day cumulative mortality was trend to be high in the NBP group (6.5%, 3.3% and 4.4% for NBP, MBP and EBP group, respectively, Log-Rank P = 0.069), and 1-year cumulative mortality after hospital discharge was significantly high in NBP group (5.5%, 1.6% and 2.4% for NBP, MBP and EBP group, respectively, Log-Rank P = 0.007) than other two groups (Figure). Conclusions: Admission SBP of less than 140 mmHg can be a risk of hemodynamic instability during hospitalization and an indicator of poor outcomes after hospital discharge in patients with AMI and preserved admission SBP.