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The case of 61 year-old woman with congenital coronary artery fistula connecting left main coronary artery and the right atrium is presented. The patient was admitted to the Cardiology Department because of the first atrial fibrillation episode. During hospitalisation the congenital heart defect was diagnosed thanks echocardiography and multi-slice computed tomography. Three months later the percutaneous closure of the fistula with Amplatzer Duct Occluder was performed. The direct and 6-months results were very good.

Background: The purpose of this study was to compare risk predicted using available risk scores and actual outcomes in patients with left main coronary artery disease undergoing percutaneous coronary intervention with stent implantation (PCI LM)., Methods: We studied 204 patients treated with elective or emergent coronary angioplasty. We estimated in-hospital mortality using the EuroSCORE, Parsonnet and GRACE risk scores and compared this data with actual in-hospital mortality., Results: There were no deaths among 62 patients undergoing elective PCI LM regardless of the estimated risk. Acute coronary syndrome (ACS) was diagnosed in all 142 patients undergoing emergent PCI LM. Mortality in this group was 24% (34/142). Area under receiver operating characteristic curve (AUC) values for the EuroSCORE, Parsonnet and GRACE risk scores in patients with ACS were 0.812 (p = 0.0001), 0.857 (p = 0.0001), and 0.870 (p = 0.0001), respectively. No statistically significant differences were found when these AUC values for different evaluated risk scores were compared. Overall, the EuroSCORE and Parsonnet risk scores had no discriminative value, as all deaths occurred in the highest risk group. Only the GRACE risk score discriminated risk among intermediate- and high-risk patients with ACS., Conclusions: The EuroSCORE and Parsonnet scoring systems are of no value in predicting periprocedural mortality risk in patients undergoing elective PCI LM. Overall, discriminative ability of the EuroSCORE, Parsonnet, and GRACE risk scores in unselected patients with ACS undergoing emergent PCI LM was good. In this group of patients, the EuroSCORE and Parsonnet scoring systems had no discriminative value in low and moderate risk patients. Only the GRACE risk score discriminated risk among intermediate and high risk patients.

Background: Numerous trials have reported on the morning increase in the occurrence of myocardial infarction, stroke and sudden cardiac death. Similarly, enhanced morning platelet aggregation has been observed in healthy individuals and in subjects with coronary artery disease without adequate antiplatelet treatment. The purpose of the study was to assess circadian variation in platelet aggregation in patients with first ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary interventions (pPCI) and dual antiplatelet therapy., Methods: Fifteen consecutive patients (12 men and 3 women) were prospectively recruited into the study. Blood samples were collected at 6.00 a.m., 10.00 a.m., 2.00 p.m. and 7.00 p.m. on the third day of hospitalization. Aggregation in response to arachidonic acid and adenosine diphosphate (ADP) was assessed in the whole blood on a new generation impedance aggregometer., Results: A morning increase of 75% in ADP-dependent platelet aggregation was noted in the study population (p < 0.04). In contrast, we failed to show any significant diurnal variation in arachidonic acid-mediated platelet aggregation. The magnitude of the morning surge in platelet aggregation after ADP stimulation did not correlate with its baseline level., Conclusions: Increased morning ADP-dependent platelet aggregation persists despite dual antiplatelet therapy in patients with first STEMI undergoing pPCI. The clinical significance of this finding remains to be demonstrated.

Background: The high in-hospital mortality of patients with cardiogenic shock is being reduced thanks to coronary interventions. The aim of the study was to evaluate the outcomes of angioplasty and stenting in patients with cardiogenic shock caused by left main coronary artery (LMCA) disease., Methods: A group of 71 consecutive patients managed for LMCA disease in an emergency setting (38 patients in cardiogenic shock and 33 without shock symptoms) were followed up clinically and angiographically for one year. Periprocedural and late mortality was assessed as well as the incidence of restenosis and coronary re-interventions., Results: There were 17 deaths in the study population (23.9%). One-year survival in the subgroup with cardiogenic shock was 57.9% (22 patients) with 15 periprocedural deaths and 1 death 3 months after the procedure. Restenosis and associated target lesion revascularization were documented in 5 patients (29.4%) with and 4 patients (16.0%) without cardiogenic shock. Multivariate analysis revealed the following independent predictors of cardiogenic shock in patients undergoing emergency LMCA angioplasty: STEMI as the reason for intervention (OR 14.1; 95% CI 3.71-53.7; p < 0.0002) and a small minimal lumen diameter before the procedure (OR 0.43; 95% CI 0.2-0.93; p < 0.04). The only independent predictor of the death in patients with cardiogenic shock was a small minimal lumen diameter after the procedure (OR 0.31; 95% CI 0.1-0.99, p < 0.05)., Conclusions: High mortality was observed in the study population, especially in the subgroup with cardiogenic shock. Most deaths were periprocedural. Because of the high rate of restenosis, periodical angiographic follow-up is necessary, preferably twice in the first 6 months after stent implantation. (Cardiol J 2007; 14: 67-75).

A case of a patient with left main stem stenosis and significant stenosis in the other coronary arteries is presented. The patient was disqualified from coronary artery bypass grafting (CABG) because of many surgical risk factors and underwent successful coronary angioplasty. Three months later the patient returned to the hospital because of unstable angina. Control coronary angiography revealed in-stent restenosis. The patient underwent CABG and drug-eluting stent implantation with good clinical result.