Search

Background. Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCAD) have become a feasible and efficient alternative to coronary artery bypass surgery, especially in patients with acute coronary syndrome (ACS). There are limited data regarding early and late outcomes after ULMCAD PCI in patients with ACS and stable angina. The aim of this study was to compare early and four-year clinical outcomes in patients with ULMCAD PCI presenting as ACS or stable angina in a high-volume PCI center. Methods. We conducted a single center retrospective observational study, which included 146 patients with ULMCAD undergoing PCI between 2014 and 2018. Patients were divided in two groups: Group A included patients with stable angina (n = 70, 47.9%) and Group B patients with ACS (n = 76, 52.1%). Results. 30-day mortality was 8.22% overall, lower in Group A (1.43% vs 14.47%, p = 0.02). Mortality and major adverse cardiac events (MACE) rates at 4 years were significantly lower in Group A (9.64% vs 33.25%, p = 0.001, and 24.06% vs 40.11%, p = 0.012, respectively). Target lesion revascularization (TLR) at 4 year did not differ between groups (15% in Group A vs 12.76% in Group B, p = 0.5). Conclusions. In our study patients with ULMCAD and ACS undergoing PCI had higher early and long-term mortality and MACE rates compared to patients with stable angina, with similar TLR rate at 4-year follow-up.

Introduction – Most reports on left main bifurcation lesions have demonstrated that treatment with a singlestent strategy is superior to a two-stent strategy but have excluded patients with acute coronary syndromes (ACS). Aims – The aim of the current study was to compare the four year outcomes of patients with unprotected left main coronary artery disease (ULMCAD) treated by percutaneous coronary intervention (PCI) with a one-stent or two-stent strategies in a population including those presenting as ACS. Methods – A total of 135 patients with ULMCAD treated by PCI were included, of which 75 (55.6%) had a one-stent strategy (Group A) and 60 (44.4%) had a two-stent strategy (Group B). Results – Fewer patients in Group A had a TIMI III flow at the end of the procedure (89.4% vs 100%, p=0.03) and complete revascularization (65.3% vs 88.3%, p=0.002). We found a higher early mortality in Group A without reaching statistical significance (13.4% vs 3.3%, p=0.1). Mortality rate at 4-year follow up was higher with Group A after multivariable analysis (adjusted HR 0.36, CI 0.15-0.85, p=0.02). We found no significant differences between the groups in terms of major adverse cardiac event (MACE) (adjusted HR 0.85, CI 0.34-1.48, p=0.7) or target lesion revascularization (TLR) (adjusted HR 1.37, CI 0.42-4.47, p=0.6) at 4-year follow up. Conclusions – Among unselected patients with ULMCAD PCI, with or without ACS, the early mortality rate is similar between one and two-stent strategy. Although, 4 year TLR and MACE rates were similar between the two groups, the 4-year all-cause mortality rate was lower in the two-stent strategy group.

Pacienti s těžkou stenozou kmene leve koronarni tepny (left main stem, LMS) jsou vzhledem k rozsahu postiženi myokardu ve velmi vysokem riziku zavažných kardiovaskularnich přihod. Po třech letech dosahuje mortalita farmakologicky lecených nemocných s významnou stenozou LMS 50 %. Za zlatý standard lecby významne stenozy LMS, zvlastě při soucasnem postiženi několika koronarnich tepen, je považovan aortokoronarni bypass (CABG). Řada studii prokazala, že perkutanni koronarni intervence (PCI) může u pacientů peclivě vybraných týmem kardiologů a kardiochirurgů představovat bezpecnou a ucinnou alternativu CABG, s podobnou výslednou mortalitou. Výsledky PCI na LMS se diky neustale dale vyvijeným technikam PCI a použivanim novějsich generaci lekových stentů trvale zlepsuji. Tyto výsledky mohou navic dale zlepsovat nově zavaděne různe invazivni zobrazovaci metody (intravaskularni ultrazvuk nebo opticka koherencni tomografie), připadně různe způsoby vysetřeni hemodynamických poměrů (frakcni průtokova rezerva). Tyto novinky v oblasti PCI LMS mohou v budoucnu vest ke změnam soucasných doporucených postupů v lecbě postiženi kmene leve koronarni tepny.

Atherosclerosis represents a systemic disease that affects all major vascular territories. Despite advances in medical therapies to prevent atherosclerosis and better manage patients with established peripheral arterial disease (PAD), the incidence of PAD continues to increase, and associated morbidity remains high, especially as the population ages. Over the past decade, percutaneous revascularization therapies for the treatment of patients with PAD have tremendously evolved, and a great number of patients can be offered treatment options that are less invasive than traditional surgical ones. Here we are presenting the case of a 67-year old diabetic woman with multiple cardiovascular risk factors and oligosymptomatic atherosclerotic involvement in several important territories (severe internal carotid stenosis, severe proximal left subclavian artery stenosis, critical serial stenosis in the mid-segment of the left anterior descending artery). Bilateral staged carotid artery plus left subclavian artery stenting was performed with very good results. Regarding the existence of asymptomatic one vessel coronary artery disease (CAD) with a negative exercise test our attitude was to maximize anti-ischemic medical therapy. In conclusion, the presence of multivascular atherosclerotic disease in a diabetic patient with coexisting risk factors is not surprising and it only reinforces the well known fact that we have to search for the involvement of other territories in an oligosymptomatic patient.

Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin. In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta. This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.