E. Tsiamis

Simultaneous occlusion of two coronary arteries in a patient with acute myocardial infarction: A result of plaque rupture and plaque erosion

Rupture of the coronary vulnerable plaque is the most common cause of STsegment elevation acute myocardial infarction. In most of these cases a singe culprit lesion is recognized and treated; however multivessel occlusion, although uncommon, can occur. Although previously reported, the exact mechanism of multiple simultaneous coronary occlusions in acute myocardial infarction is still poorly understood. We report a case of a 55 year old male that was admitted to our hospital due to ST-segment elevation acute myocardial infarction (STEMI), and found to have thrombus occlusion of two coronary arteries. A 55 year old male presented to our emergency department due to chest pain after exercise. His past medical history included hypertension treated with angiotensin converting enzyme inhibitor. The auscultatory findings of the examination included galloping rhythm (S4) with no murmurs, his blood pressure was 130/85 mm Hg and he had no signs of heart failure. The electrocardiogram showed sinus rhythm with ST-segment elevation in leads II, III, AVF and V5–V6. The patient was treated with 600 mg clopidogrel and 100 mg aspirin together with intravenous nitrates and was immediately guided for catheterization. Coronary angiography revealed thrombus in the left circumflex artery (LCX) before the bifurcation to the marginal artery (Fig. 1A), as well as an obstructing thrombus in the distal part of the right coronary artery (RCA) (Fig. 1B). Since the lesion in the right coronary artery was the culprit, we firstly treated this lesion with aspiration that was followed with the deployment of a drug eluting stent (Fig. 1C), with an excellent angiographic result (Fig. 1D). Thereafter we aspirated the thrombus in the left circumflex artery, which had been moved more distally just after the bifurcation with the val of the identified; ex artery regression ization he

Prognostic clinical and angiographic characteristics for the development of a new significant lesion in remote segments after successful percutaneous coronary intervention

BACKGROUND The majority of cardiovascular events in patients undergoing PCI arise from the progression of NCL during the long-term follow-up period. The purpose of the study was to investigate the clinical and angiographic factors related to the progression of non-culprit lesions (NCL) of patients undergoing percutaneous coronary interventions (PCI). METHODS One hundred and seventeen patients that underwent two coronary angiograms with a time interval greater than 3 months were enrolled. All patients underwent PCI as a treatment for the culprit lesion. In the second coronary angiography we investigated whether they had a new culprit lesion clearly differentiated from the one of the first angiogram. The demographic characteristics, the clinical syndrome responsible for the first PCI and the procedural characteristics were recorded. Quantitative coronary angiography was performed at the culprit lesion of the second angiography and in the same lesion in the first angiography. RESULTS Multivariate analysis showed that the independent variables for the development of a significant lesion at the follow-up requiring intervention were: the presence of complex lesion (53.78% vs 36.22%, p<0.001, OR=39.42), acute myocardial infarction (AMI) at the initial diagnosis (36.3% vs 32.4%, p<0.001, OR=3.9), and smoking (46.15% vs 53.84%, p=0.03, OR=0.29). CONCLUSIONS Patients with AMI and complex morphology of NCL have increased risk for a new intervention after successful PCI. Smoking at the time of the follow up, was associated with fewer coronary interventions.

Myocardial structure and matrix metalloproteinases.

Metalloproteinases (MMPs) are enzymes which enhance proteolysis of extracellular matrix proteins. The pathophysiologic and prognostic role of MMPs has been demonstrated in numerous studies. The present review covers a wide a range of topics with regards to MMPs structural and functional properties, as well as their role in myocardial remodeling in several cardiovascular diseases. Moreover, the clinical and therapeutic implications from their assessment are highlighted.

Differences in Drug-Eluting Stents Used in Coronary Artery Disease

The introduction of drug-eluting stents (DES) has improved the efficacy of percutaneous coronary intervention by addressing the issue of neointimal proliferation, a pathology contributing to restenosis. First-generation stents eluting sirolimus or paclitaxel were joined by second-generation stents, such as the everolimus- and the zotarolimus-eluting stents, promising increased safety and efficacy. As a result, there is a plethora of drug-eluting stents available, with differences in the stent platform, the polymer coating and the eluted drug, which translate into differences in biological markers of efficacy, such as late loss. However, it remains controversial whether these discrepancies have an impact on clinical markers of safety and efficacy, or if the improved efficacy of DES is a class effect. This article reviews the differences between DES by looking into the biological differences and into trials and registries of DES.

Percutaneous Coronary Intervention in Chronic Stable Angina

Although the therapeutic advantage of percutaneous coronary intervention in acute coronary syndromes have been proved in numerous studies, its position in the treatment of stable angina remains a controversial issue. The results of the recent studies did not lead into definite answers for the proper treatment of chronic coronary artery disease. The identification of the patients that will benefit from the interventional approach is necessary and is probably based on the proper screening for myocardial ischemia with noninvasive diagnostic techniques. In this review article, we mention the most recent studies for the treatment of chronic stable angina with respect to clinical outcome and economical consequences.