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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.

The studies in the literature of the past years have noticed the particular characteristics of the ischemic heart disease in women, who seem to be lacking early diagnosis and invasive treatment of coronary heart disease. They especially emphasize that the evolution, complications and mortality in myocardial infarction in women are more severe.The evaluation of clinical, investigational and therapeutic aspects in a lot of women with acute myocardial infarction (AMI) versus a lot of men with the same pathology, hospitalised in the same period.78 women hospitalised in the Emergency Institute of Cardiovascular Diseases between 1st January 1999 and 30th October 2001 with acute myocardial infarction. 109 men hospitalised in the Emergency Institute of Cardiovascular Diseases with acute myocardial infarction in the same period.acute myocardial infarction, coronary angiography +/=left ventriculography. The lot of study and the witness lot were divided into 3 subgroups based on the severity of coronary lesions: Group I: left main stenoses, Group II: stenoses60% on the other epicardial coronary vessels, Group III: stenoses60% on the other epicardial coronary vessels. The risk factors, clinical data, cardiac performance indices and medical and invasive treatment were compared between the two groups.The women hospitalised with AMI were older than men, had more diabetes and hypertension as main risk factors than men, with the exception of smoking, had more frequent heart failure and diastolic dysfunction of left ventricle. The favorite invasive treatment in women was the angioplasty with application of stent and in men--coronary bypass.

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.

Use of qualitative assessment of coronary artery flow (TIMI), although widely spread, represents a subjective method, a quantitative assessment (CTFC) being necessary in order to standardize and facilitate comparisons and communications of angiographic trials. This study aims at appreciating whether myocardial infarction represents a global phenomenon that affects the whole myocardium, also affecting the coronary artery flow in non-culprit arteries.66 patients that underwent primary PCI with stent and 66 patients with normal angiographic coronary arteries were studied. The number of frames necessary for the dye to reach certain standardized landmarks was registered, in order to objectively assess the coronary artery flow as a continuous variable. The statistical evaluations revealed that the quantitative assessment of the coronary flow through CTFC (corrected TIMI frame count) pins up a difference between the flow on non-culprit coronary arteries (23.54+/-9.235) and the flow on normal angiographic coronary arteries (17.46+/-4.1) (p0.005), the result being also valid for each of the three coronary arteries separately analyzed: LAD (23.88+/-8.08 vs. 18.575+/-4.59 - p0.005), CX (20.7+/-7.34 vs. 15.62+/-3.35 - p0.005) and RCA (26.45+/-11.91 vs. 18.2+/-3.69 - p0.005).There are significant differences regarding the flow on non-culprit coronary arteries in patients that suffered acute myocardial infarction (AMI) and the flow on the coronary arteries of the patients with normal angiographic results; these data might be the expression of global myocardial suffering.

It is a well known fact that during the course of RA and rA, due to some cellular and molecular mechanisms, a number of proteolytic enzymes and membranal phospholipases are either activated or their concentration rises significantly. With this aim in view in the present work we have aimed to investigate if, in an inflammatory process associated to RA and rA, the human organism produces or not anti-enzyme antibodies. Using an enzyme-linked immunosorbent assay (ELISA), in the sera of 19 patients of RA and 19 of rA, the presence of the following antibodies has been ascertained: antiplasminogen (antiPAb), antitrypsin (antiTAb) and antiphospholipase C (antiPLCAb). Out of RA cases, 47.3% presented antiPAb, 36.8% antiTAb and 26.3% antiPLCAb. As it was expected, in the rA cases, these antibodies were found in a higher proportion of cases, i.e.: 85.7%, 71.4% and 57.1% respectively. When following the same cases before and during or after the treatment with nonsteroidal antiinflammatory agents (NSAIAs), the antibodies levels were significantly decreased especially in the RA cases. The results obtained indicated a significant rise of seric concentration of antiPAb, antiTAb and antiPLCAb, as well in RA as in rA. While the rise of antiPLCAb in RA and especially in rA could be explained due to microbial infections, the rise of the antiproteolytic enzymes antibody levels as well as the decrease of the antibody titres during or after NSAIAs treatment could be explained, in our opinion, on the basis of some autoimmune processes.

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.