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73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention.

BACKGROUND: The primary objective of primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is not only to restore the blood flow in the infarct-related artery, but also to save the patients' quality and duration of their life. Since left ventricular ejection fraction (LVEF) is a known predictor of clinical outcomes in STEMI patients, the possible association between characteristics of a large group of patients who undergo pPCI with LVEF and death was evaluated. METHODS: This prospective cohort study included 304 patients who had undergone pPCI between 2009 and 2011. The association between LVEF and in-hospital outcomes of patients was assessed. RESULTS: LVEF ≤ 25%, 25% < LVEF < 50%, and LVEF ≥ 50% were presented in 23 (7.6%), 150 (49.3%), and 128 (42.1%) of the patients, respectively. Three patients (0.01%) died before echocardiography. There was no significant difference among aforementioned three groups regarding baseline characteristics, except age (P = 0.012) and sex (P = 0.016). Cumulative number of cardiogenic shock and death were 7 (2.3%) and 22 (7.2%), respectively; with significant differences between three LVEF groups. Age more than 70 years old, pulmonary edema, systolic blood pressure <100 mm Hg, shock, post-PCI thrombolysis in myocardial infarction (MI) flow grade, corrected thrombolysis in MI frame count, angiographic success and ST-segment resolution showed significant association with death (P < 0.050). CONCLUSION: This study not only demonstrates that LVEF ≤ 50% is associated with a higher incidence of in-hospital adverse events, but also identifies characteristics that are strongly correlated with the risk of LVEF ≤ 50% and death after pPCI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stent underexpansion is the most powerful predictor of long-term stent patency and clinical outcome. The purpose of this study was to evaluate the incidence and predictors of stent underexpansion despite adjunctive post-dilatation with non-compliant balloon. METHODS: After elective coronary stent implantation and adjunctive post-dilatation with noncompliant balloon and optimal angiographic result confirmed by the operator, intravascular ultrasound (IVUS) was performed for all the treated lesions. If the treated lesions fulfilled the IVUS criteria, they are considered as the optimal stent group; if not, they are considered as the suboptimal group. RESULTS: From 50 patients enrolled in this study 39 (78%) had optimal stent deployment and 11 (22%) had suboptimal stent deployment. In the suboptimal group 7 (14%) had underexpansion, 2 (4%) malposition, and 2 (4%) had asymmetry. There were no stent edge dissections detected by IVUS. We did not find any correlation between lesion calcification, ostial lesions, stent length, and stent underexpansion. Stent diameter ≤ 2.75 mm had a strong correlation with stent underexpansion. CONCLUSION: Despite adjunctive post-dilatation with noncompliant balloon, using a relatively small stent diameter was a strong predictor for underexpansion. IVUS guided percutaneous coronary intervention (PCI) may be considered for drug eluting stent (DES) implantation in relatively small vessels. [ABSTRACT FROM AUTHOR]

Objective To determine the current state of radiation safety awareness and practice among Iranian radiology/ cardiology residents. Methods In this cross-sectional study, 725 Iranian cardiology/radiology fellows/residents (685 residents and 40 fellows) were studied. Radiation safety awareness and practice were assessed using a 13-item survey questionnaire. Based on academic trainings provided in their medical centres, the subjects were divided into two groups (trained vs untrained). Results Trained residents/fellows had better performance compared with untrained ones regarding awareness of radiation dealing instructions, knowing safety experts of their centres (43.8% vs 20.1%, p<0.001) and their contact information (38.4% vs 11.4%, p<0.001), date of the last CBC (complete blood count) checking (15.1% vs 2.5%, p<0.001), use of lead glass (61.6% vs 41.8%, p=0.003), apron (94.5% vs 90%, p=0.016) and radiation shield (71.2% vs 46.2%, p<0.001). Conclusions Awareness/practice of Iranian cardiology/ radiology residents/fellows about radiation exposure safety issues is not acceptable currently. Those who received formal training courses at their academic centres about the safety measures had significantly better knowledge compared with those who did not. It is suggested that radiation safety training be offered at the beginning of residency/fellowship for residents/fellows in a comprehensive and uniform way throughout medical universities. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to assess the associations between corrected thrombolysis in myocardial infarction frame count (CTFC) of the infarct-related artery (IRA) and ejection fraction (EF) after three-six months in patients who underwent primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). METHODS: CTFC was determined by a digital system for 78 patients. EF was measured through Simpson's method upon discharge and three-six months later. The subjects were divided into two groups of CTFC ≤ 20 (n = 54) and CTFC > 20 (n = 24). Association between CTFC and EF were then specified. RESULTS: CTFC ≤ 20 and CTFC > 20 were present in 69.2% and 30.8% of the patients, respectively. There was no significant difference between the two groups regarding baseline characteristics. EF at the time of discharge was 42.1% ± 10.2% and 43.5% ± 11.4% in groups with CTFC ≤ 20 and > 20, respectively. There was no significant association between EF at discharge and CTFC (P = 0.611). After three months, EF changed to 49.6% ± 8.7% and 41.6 ± 12.4% in the groups with CTFC ≤ 20 and CTFC > 20, respectively. Three months after PPCI, EF and CTFC had a significant relation (P = 0.007). Cumulative number and percentage of shock and death were 3 (3.8%) and 2 (2.6%), respectively. CONCLUSION: Lower CTFC of the infarct-related artery in patients undergoing PPCI for STEMI was associated with higher left ventricular ejection fraction after three months. [ABSTRACT FROM AUTHOR]

Background: Redo coronary artery bypass grafting surgery (CABG) is associated with a higher risk of mortality than the first operation. However, the impact of percutaneous coronary intervention (PCI) on the outcome in such patients is currently unclear. We evaluated the in-hospital and six-month clinical outcomes of post-CABG patients who underwent PCI in our center. Methods: Between April 2008 and July 2009, 71 post-CABG patients (16 women and 55 men) underwent 110 stent implantations (74% drug-eluting stents) for 89 lesions. Sixty percent of the PCI procedures were performed on the native coronary arteries, 32% on graft arteries, and 8% on both types of vessels. Major adverse cardiac events (MACE) were recorded in hospital and at six months' follow-up. Results: The procedural success rate was 93%, and the in-hospital MACE rate was 5.6 % (1 death, 3 myocardial infarctions). At 6 months, the incidence of MACE was 5.6% (no death or myocardial infarction, but 4 target lesion revascularizations) and 4 (5.6 %) in-stent restenoses. There was no statistically significant difference in the comparison of MACE between the patients treated in either native arteries or in the grafts (15% vs.12%, p value = 0.8). According to the univariate analysis, hypertension and the use of the bare metal stent vs. the drug-eluting stent were the significant predictors of MACE, whereas the multivariate analysis showed that only hypertension (OR = 3.7, 95% CI 3.4-4, p value < 0.048) was the independent predictor of MACE. The mean of the left ventricular ejection fraction had no effect on the incidence of MACE (p value = 0.9). The multivariate analysis showed hypertension (p value < 0.048) and the use of the bare metal stent (p value < 0.018) were the independent predictors of MACE. The chronic total occlusion (CTO) (p value < 0.01) was the independent predictor of the success rate. The prevalence of diabetes had no impact on the incidence of MACE according to the univariate analysis (p value = 0.9). Our multivariate analysis showed that hypertension and the use of the bare metal stent were the independent predictors of MACE and that chronic total occlusion was the independent predictor of the procedural failure rate. Conclusion: PCI is preferable to redo CABG for post-CABG patients. The independent predictors of MACE were hypertension and bare metal stents. [ABSTRACT FROM AUTHOR]

Background: Carotid artery stenting is now used as an alternative to surgical endarterectomy. This study was done to assess the feasibility, safety, and immediate and late clinical outcomes in patients undergoing carotid stenting. Methods: Between July 2008 and December 2009, a total of 40 patients (20 male, mean age: 65 ± 11 years, 19 symptomatic, and 90% high risk for endarterectomy) underwent carotid artery stenting with different embolic protection devices and carotid stents. Thirty-seven patients had coronary artery disease. Technical success rate, stroke/death/ myocardial infarction rate at 30 days, access-site complications, and contrast-induced nephropathy were assessed. For the evaluation of the influence of experience in carotid artery stenting on complications, the patients were divided into two groups: Group 1 included the first 20 treated patients and Group 2 comprised the remainder of the patients. Results: The overall technical success rate was 100%. The cumulative in-hospital stroke death rate was 7.5% (n = 3: 2 deaths and 1 major stroke). Complications were more frequent in Group 1 (2/20, 10%; 2 deaths) than in Group 2 (1/20, 5%; 1 major stroke), but this was not statistically significant (p value = 0.09). No access-site complications occurred, and mild contrast-induced nephropathy occurred in 3 patients (7.5%). No major stroke or neurological deaths occurred during a mean follow-up of 12 months. Conclusion: Carotid stenting seemed feasible and relatively safe in our experience. Advanced experience in carotid artery stenting appears to confer an acceptable peri-procedural stroke-death rate. [ABSTRACT FROM AUTHOR]

Background: Early clinical and retrospective angiographic evaluations indicated that in patients with acute myocardial infarction (MI), vulnerable plaques most often represented a mild luminal stenosis. More recent studies drawing upon prospective angiograms, however, have demonstrated that in majority of patients with acute MI, the underlying stenosis is significant. Methods: Twenty-eight patients with acute MI candidated for thrombectomy were enrolled in this study. Thrombectomy was performed using export thrombectomy catheters. After the injection of nitroglycerin, the severity of the lesions was determined by two independent operators. Results: Between April 2007 and February 2008, 28 patients, comprised of 26 men and 2 women with acute MI, were evaluated. The underlying stenosis severity was ⩾50% in 22 (78.6%) patients and <50% in the remaining 6 (20.4%) patients (P value <0.01). The right coronary artery was the most common vessel involved in the lesions <50%. Conclusion: Contrary to the general belief of many cardiologists, the majority cases of myocardial infarction occur in consequence of significant stenoses. [ABSTRACT FROM AUTHOR]

Background: Due to the positive relation between platelet size and platelet reactivity, a high value of the mean platelet volume (MPV) is an independent risk factor to predict acute myocardial infarction (AMI) and its adverse outcome. Few data are available to determinate the prognostic value of MPV in ST-elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention (PCI). The primary purpose of this study was to evaluate the clinical value of MPV to predict impaired reperfusion and in-hospital major adverse cardiovascular events (MACE) in acute STEMI treated with primary PCI. Methods: This study included 203 STEMI patients referring for blood sampling before primary PCI to estimate MPV and determine the thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), and in-hospital MACE. Results: The frequency of in-hospital MACE in the group of patients with a high MPV (≥10.3 ng/dl) was significantly more than that of the group with a low MPV (<10.3 ng/dl) (37.8% vs. 4.4%, P<0.001). The no-reflow phenomenon was more frequent in the patients with a high MPV than that of the patients with a low MPV (17.8% vs. 1.9%, P<0.001). The mean MPV in the group of patients with CTFC≥40 was significantly more than that of the group of patients with CTFC<40 (10.9±0.92 vs. 9.45±0.85, P=0.001). After adjustment for baseline characteristics, a high MPV remained a strong independent factor to predict the no-reflow phenomenon (Odds Ratio [OR]=2.263, 95% Confidence Interval [CI]=1.47 to 5.97; P<0.002), in-hospital MACE (OR=2.49, 95% CI=1.34 to 4.61; P<0.004), and CTFC≥40 (OR=2.09, 95% CI=1.22 to 3.39; P<0.003). Conclusion: These findings confirmed that not only could admission MPV predict impaired reperfusion and in-hospital MACE in acute STEMI patients treated with PCI, but also it could be considered a practical way to determine higher-risk patients. [ABSTRACT FROM AUTHOR]

Background: Primary percutaneous coronary intervention (primary PCI) is the method of choice in establishing reperfusion in acute myocardial infarction (AMI) patients. The aim of this study was to determine the success rate of primary PCI in a university medical center in Iran with a view to promoting it as a first-line therapy in patients with AMI, especially in centers with established catheterization labs across the country. Methods: All cases of AMI admitted between September 2001 and September 2005 underwent primary PCI. The achieved thrombolysis in myocardial infarction (TIMI) flow was recorded, and the patients were followed during the hospital admission for major adverse cardiac events (MACE). Results: A total of 180 patients, consisting of 36 females and 144 males, with a mean age of 56±2.1 years were included in the study. The target vessel was the left anterior descending artery in 66.1%, right coronary artery in 27.2%, and left circumflex artery in 6.7% of the cases. The respective rate of anatomical and procedural success was 94.4% and 90%. The rates of mortality, coronary artery bypass grafting (CABG), and reinfarction were 6.7%, 1.1%, and 2.2%, respectively. Most patients were discharged with no complications in less than a week. Anatomical success in patients <65 years old was 95% versus 92.5% for those ≥65 years of age. Procedural success in patients <65 years of age was 93.6% versus 77.5% for those ≥65 years old (P<0.05). No significant relation was detected between the success rate and sex, target vessel, or major coronary artery disease risk factors. More patients in the mortality group had a longer door-to-balloon (DTB) time compared to the surviving group (P<0.05). Conclusion: In light of the results of this study, primary PCI may also be practiced as the therapy of choice for AMI patients in centers with established equipment in our region with acceptable rates of MACE and complications. Better procedural success rates are achieved in younger patients and in those with a shorter DTB time. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine left ventricular (LV) mass index via echocardiography in end-stage renal disease patients (ESRD) before and after renal transplantation, and its association with one-year survival. Materials and Methods: Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction (EF), LV mass, and LV mass index were determined. All of the patients were followed up for 1 year. Results: Mean LVEF was 51.6% which increased to 53.7% after renal transplantation (P = .001). Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation (P = .001). Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m2 following the operation (P = .002). All of the patients survived during 1-year follow-up, and no death was reported. Conclusion: Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD. [ABSTRACT FROM AUTHOR]

Background: The Primary Percutaneous Coronary Intervention (PPCI) is the preferred therapeutic strategy for patients who experienced ST-Elevation Myocardial Infarction (STEMI)., Objective: We aimed to evaluate the association of hematological indices, including hemoglobin level, platelets, White Blood Cells (WBCs) count, and MPV before PPCI with the TIMI grade flow after PPCI., Methods: STEMI patients who experienced PPCI were included in the present retrospective crosssectional study. Then participants were divided into three groups based on their post-procedural TIMI flow grades. Demographic data and hematologic indices of patients before PPCI were collected and their association with the TIMI grade flow after PPCI was evaluated. To compare the quantitative and qualitative variables, chi-square and t-tests were performed, respectively., Results: We found that elevated levels of hemoglobin and decreased levels of MPV had a significant association with an advanced grade of TIMI flow. Interestingly, in the normal range, there was a significant association between higher platelet count and TIMI-flow grade 1. Besides, TIMI flow grades 2 and 3 had a significant association with low and moderate platelets count, respectively., Conclusion: In conclusion, evaluating MPV, platelets, and hemoglobin levels before PPCI as easy and accessible parameters may be able to identify high-risk STEMI patients undergoing PPCI., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: ST-elevation myocardial infarction (STEMI) is known to be associated with significant arrhythmia and consequent mortality. QT prolongation is a risk factor for arrhythmia in STEMI patients who underwent primary percutaneous coronary intervention (PPCI). The aim of this investigation was to evaluate the association of corrected QT interval (QTc), QT dispersion (QTd), T-wave peak to end (TPE), and fragmented QRS with mortality in these patients., Methods: Eligible patients with the characteristic symptoms of STEMI who underwent PPCI were included. QTc, QTd, TPE, and fragmented QRS were measured before and after the PPCI. These predictors were compared between patients who died during hospitalization and discharged patients., Results: After coronary angiography, 10 patients (4%) died during the hospitalization after PPCI. Comparing the non-survivers and discharged patients in terms of arrhythmia predictors showed that the mean QT dispersion and TPE before intervention were significantly higher in the non-survivors. Also, the number of patients who experienced fragmented QRS before and after the intervention was significantly higher in the non-survivors., Conclusion: These data suggested that evaluating such arrhythmia predictors, especially before PPCI, could be used as a predictor of mortality in STEMI patients who underwent PPCI., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)