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Abstract: Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is divided into six subgroups in the literature according to the origin and course of the short and long branches of the anomalous artery. We present two distinct cases of dual LAD which are distinguished by two branches of equal length from their counterparts in the literature. [Copyright &y& Elsevier]

Although monocyte chemoattractant protein-1 (MCP-1) levels are increased in patients with ST-segment elevation myocardial infarction, the prognostic value of MCP-1 in primary percutaneous coronary intervention (pPCI) is not clear. The goal of the present study was to investigate the association of MCP-1 levels with myocardial perfusion and prognosis in patients with ST-segment elevation myocardial infarction undergoing pPCI. Consecutive pPCI patients (n[192) were assigned to tertiles according to their admission serum MCP-1 levels. Angiographic no-reflow, Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, and ST-segment resolution were assessed. Mortality and major adverse cardiac events were evaluated during hospitalization and at the 3-year clinical followup visit. Failure of ST resolution was associated with greater admissionMCP-1 levels. The risk of no-reflow (Thrombolysis In Myocardial Infarction flow £2 or Thrombolysis In Myocardial Infarction flow 3 with final myocardial blush grade £2 after pPCI and ST resolution <30%) increased as the admission MCP-1 increased. The 3-year mortality increased as the MCP-1 level increased (8% vs 22% vs 28% for the 3 tertiles, p <0.01). Multivariate logistic regression analysis demonstrated thatMCP-1 levels at admission are a significant independent correlate of 3-year mortality in patients with no-reflow as detected by myocardial blush grade. A receiver operating characteristics analysis identified an optimum cut point of 254 pg/ml, which was associated with a negative predictive value of 95% in association with 1-year mortality. In conclusion, the plasmaMCP-1 levels at admission are independently associated with the development of no-reflow and 3-year mortality in patients with ST-segment elevation myocardial infarction undergoing pPCI. [ABSTRACT FROM AUTHOR]