血浆NT-proBNP对≥80岁老年冠心病病人预后价值的研究

目的探讨血浆氨基末端脑利钠肽前体(NT-proBNP)对高龄老年CHD和非CHD病人死亡和主要心血管事件(MACE)风险的预测价值。方法本研究为前瞻性队列研究,人群为在中国人民解放军总医院老年病房住院或查体,病情稳定的高龄(≥80岁)老年CHD和非CHD病人。2007年11月至2010年10月完成基线数据采集,2015年12月至2016年1月完成随访,记录死亡和MACE,采用Cox比例风险回归模型分析NT-proBNP对2组病人死亡和MACE风险的预测价值。结果基线时纳入高龄老年病人712例,CHD组576例,NT-proBNP为(854.5±917.1) pg/m L;非CHD组136例,NT-proBNP为(392.1±343.2) pg/m L,2组间差异有统计学意义(P0.001)。中位随访时间为5.3年,CHD组死亡284例(49.3%),发生MACE 171例(29.7%),非CHD组死亡65例(47.8%),发生MACE 27例(19.9%),2组MACE发生率差异有统计学意义(P0.05)。Cox比例风险回归模型分析显示,血浆NT-proBNP是CHD(HR=2.577,95%CI:1.911～3.476)和非CHD(HR=2.666,95%CI:1.193～5.954)病人死亡的独立预测因素,但NT-pro BNP对2组病人死亡的预测能力差异无统计学意义(P=0.329)。NT-proBNP是CHD病人MACE的独立预测因素(HR=1.869,95%CI:1.251～2.792),但不是非CHD病人MACE的独立预测因素(P=0.171)。结论血浆NT-proBNP水平能独立预测病情稳定的高龄老年CHD病人死亡和MACE的风险,也能预测非CHD病人的死亡风险。     

老年冠心病合并阻塞性睡眠呼吸暂停低通气综合征患者不良预后的影响因素

目的 探讨老年冠心病(CHD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者不良预后的发生情况及影响因素。方法 采用多中心前瞻性队列设计,选择2015年1月至2017年10月经多导睡眠监测诊断为OSAHS且合并CHD的265例患者(≥60岁)为研究对象。收集患者人口学资料、临床特征、睡眠参数指标、血液化验指标,并随访至2020年12月,随访结局为主要不良心血管事件(MACE)。根据患者是否发生MACE,将患者分为MACE组(n=55)和非MACE组(n=210)。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ²检验进行组间比较。采用Spearman相关分析老年CHD合并OSAHS患者MACE与各指标的相关性。采用多因素logistic回归分析老年CHD合并OSAHS发生MACE的影响因素。结果 中位随访时间为43(5~72)个月,累积MACE发病率为20.8%(55/265)。与非MACE组比较,MACE组吸烟(41.8%和27.6%)、心房颤动(27.3%和14.3%)、慢性阻塞性肺疾病比例(92.0%和27.6%)及血小板体积分布宽度[PDW,(13.08±1.40)%和(12.47±1.54)%]显著增加;血红蛋白水平[(129.40±15.85)和(135.24±16.87)g/L]显著降低,差异均有统计学意义(均P＜0.05)。Spearman相关性分析显示,老年CHD合并OSAHS患者MACE与年龄、吸烟史、饮酒史、PDW、总睡眠时间(TST)及心房颤动呈正相关(r=0.075,0.125,0.128,0.145,0.129,0.140;P＜0.05);与血红蛋白水平呈负相关(r=-0.141;P＜0.05)。多因素logistic回归分析显示,PDW(OR=1.304,95%CI 1.046~1.627;P=0.018)、TST(OR=1.274,95%CI 1.037~1.566;P=0.021)及血红蛋白水平(OR=0.975,95%CI 0.954~0.996;P=0.022)是老年CHD合并OSAHS患者发生MACE的独立影响因素。结论 老年CHD合并OSAHS患者MACE发生率较高,PDW和TST是老年CHD合并OSAHS患者发生MACE的独立危险因素,血红蛋白水平则是其保护因素。     

冠状动脉扩张患者淋巴细胞和单核细胞亚型分析

目的：初步确定外周淋巴细胞和单核细胞是否参与了冠状动脉（冠脉）扩张(coronary artery ectasia, CAE)的病理过程,以推测CAE是否为免疫性疾病。方法：纳入2017年1月至2018年1月接受冠脉造影并确诊的34例CAE患者,利用抽签法纳入同日期接受冠脉造影的30例冠心病（coronary heart disease,CHD）患者和32例冠脉相对正常的受试者（对照组）。各组之间年龄、性别和其他基线特征基本平衡,通过流式细胞法检测外周血样中的淋巴细胞和单核细胞亚型。结果：CAE和CHD患者的外周血淋巴细胞亚型差异无统计学意义,但与CHD和对照组相比,CAE组的炎症型（非经典型）单核细胞比例显著增加[26.45%(16.90%～44.55%),13.70%(9.33%～17.60%),7.00%(13.70%～29.40%),P=0.000],经典型单核细胞比例显著降低[66.35%(39.73%～78.83%),82.90%(80.50%～89.40%),78.30%(56.70%～83.80%),P=0.000]。多重线性回归分析进一步证实了非经典单核细胞比例增加与...     

PCI治疗对于2型糖尿病合并冠心病患者的疗效及对心功能的影响

目的:研究PCI对T2DM合并CHD患者的疗效及对心功能的影响。方法:本院2014年3月至8月收治的192例CHD患者,按是否合并T2DM,患者被分为CHD组(96例)和CHD+T2DM组(96例);每组又进一步均分为联合治疗组(接受常规药物治疗+PCI,48例)和药物治疗组(仅接受常规药物治疗,48例),疗程1年。观察比较各组疗效、治疗前后舒张期室间隔厚度(IVSTd)、左室舒张末内径(LVEDd)、左室收缩末内径(LVESd)、LVEF,以及随访3年内的主要不良心血管事件(MACE)发生率。结果:CHD联合治疗组的总有效率显著高于CHD药物治疗组(95.83%比70.83%);CHD+T2DM联合治疗组的总有效率显著高于CHD+T2DM药物治疗组(93.75%比68.75%),P均<0.01。在CHD+T2DM组,与药物治疗组比较,联合治疗组治疗后IVSTd [(9.6±1.8)mm比(8.1±1.9)mm]、LVEDd [(46.8±4.9)mm比(42.9±5.4)mm]、LVESd[(33.8±4.9)mm比(30.9±4.7)mm]减小更显著,LVEF [(46.9±5.6)%比(51.1±6.1)%]增大更显著,P均<0.01。CHD联合治疗组的MACE发生率显著低于CHD药物治疗组(4.17%比27.08%);CHD+T2DM联合治疗组的MACE发生率显著高于CHD联合治疗组(22.92%比4.17%),但显著低于CHD+T2DM药物治疗组(41.67%),P<0.05或<0.01。结论:无论是CHD组,还是CHD+T2DM组都是联合治疗的疗效优于药物治疗,而且CHD联合治疗组的MACE发生率显著低于CHD+T2DM联合治疗组,即CHD组预后好于CHD+T2DM组。     

急性冠脉综合征患者冠状动脉旁路移植术后血清NT-proBNP、Cys-C、cTnⅠ水平变化及其与预后的关系

目的 研究急性冠脉综合征（ACS）患者冠状动脉旁路移植术（CABG）后血清N末端B型脑钠肽前体（NT-proBNP）、胱抑素C(Cys-C)和心肌肌钙蛋白Ⅰ(cTnⅠ)水平变化及其与早期预后的关系。方法 选取2018年1月至2021年12月拟行CABG的179例ACS患者开展前瞻性研究,于术前1 d及术后1～3 d分别采集晨起外周静脉血3 mL,检测血清NT-proBNP、Cys-C、cTnⅠ水平。随访6个月内主要不良心血管事件（MACE）发生情况,并将患者分为MACE组和对照组,比较两组基线资料及术后血清NT-proBNP、Cys-C、cTnⅠ水平变化,采用logistic回归模型分析各指标与预后的关系及其对MACE的预测价值。结果 179例ACS患者CABG术后6个月内发生MACE者43例（24.02%）,包括急性心肌梗死26例（14.53%）,靶血管重建12例（6.70%）及心源性死亡5例（2.79%）。MACE组年龄≥65岁、手术时间≥3.5 h及体外循环患者占比明显高于对照组（P<0.05）,两组其他基线资料比较差异均无统计学意义（P>0.05）;MACE组术后血...     

入院血糖水平对ST抬高急性心肌梗死预后的影响

目的 探讨入院时血糖水平对ST段抬高急性心肌梗死(STEMI)患者30 d死亡和主要心血管不良事件(MACE)发生率的预测价值.方法 对7446例12 h内STEMI患者以入院时不旧的血糖水平和有否糖尿病史分成4组(高血糖定为入院血糖>10 mmol/L),Ⅰ组:无糖尿病史且血糖正常组(对照组);Ⅱ组:有糖尿病史但血糖正常组;Ⅲ组:无糖尿病史但高血糖组;Ⅳ组:有糖尿病史且高血糖组.结果 入院高血糖两组患者30 d病死率和MACE的发生率明显高于对照组(病死率Ⅰ组8.6%比Ⅲ组17.1%、组Ⅳ18.6%;MACE Ⅰ组21.6%比Ⅲ组36.3%、Ⅳ组38.8%;P值均<0.001).Ⅱ组与对照组相比,30 d病死率没有明显增加(11.6%比8.6%,P=0.096).多因素回归分析显示Ⅲ、Ⅳ组的死亡危险分别为Ⅰ组患者的1.51倍(P<0.001)和1.83倍(P<0.1301);入院血糖水平是30 d死亡的独立危险因素,血糖水平每升高1 mmol/L,病死率增加5%(OR 1.05,95%CI1.04～1.07,P<0.001),而糖尿病史对30 d病死率不具有独立预测价值(OR 1.11,95%CI 0.87～1.42,P=0.412).结论 入院高血糖STEMI患者30 d病死率和MACE的发生率显著高于入院血糖正常者,入院高血糖为近期预后不良的独立危险因素,糖尿病史与近期病死率并无明显相关性.     

动脉僵硬度对介入治疗患者的危险分层及预后评价

目的探讨动脉僵硬度对PCI患者的危险分层和预后评价。方法选择冠心病并行PCI的患者316例,均进行颈-股脉搏波传导速度(cfPWV)检测评价动脉僵硬度。根据cfPWV水平将患者分为3组,Ⅰ组67例(cfPWV0-10.0 m/s),Ⅱ组98例(cfPWV)0.1-13.0 m/s),Ⅲ组151例(cfPWV>13.0 m/s)。记录患者临床特征、术后并发症和随访主要心血管事件(MACE)发生率,并行相关分析。结果与Ⅰ组和Ⅱ组比较,Ⅲ组年龄偏大,糖尿病、心肌梗死和高血压所占比例多,C型病变和3支病变多见(p<0.05)。术后并发症发生率、远期非致死性心肌梗死和血运重建发生率显著增加(P<0.05)。cfPWV与MACE发生呈正相关(OP=1.98,95%CI:1.039-3.770)。结论 cfPwV与冠状动脉病变的严重程度及PCI后远期MACE发生率增加密切相关。     

老年冠心病A型性格患者的健康教育干预及随访

目的评价健康教育对于老年冠心病(CHD)A型性格患者的干预效果,分析A型性格对于冠心病患者1年主要心脏不良事件(MACE)的影响及健康教育对MACE的影响。方法选择179例老年CHD患者为研究对象;应用A型行为类型量表分为A型性格和B型性格。将105例A型性格老年CHD患者分为健康教育干预组(53例)和对照组(52例),8 w后评价健康教育对于老年A型性格CHD患者身体功能、角色功能、情绪功能、社会功能及总体生活质量的影响,分析健康教育干预与A型性格CHD患者发生MACE的关系。结果 179例老年CHD患者中A型性格患者105例(58.7%)。A型性格患者分为健康教育组和对照组,8 w后健康教育干预组和对照组患者的身体功能(2.65±0.43 vs 3.07±0.43)、角色功能(1.75±0.61 vs2.45±0.53)、情绪功能(2.40±0.64 vs2.83±0.44)、社会功能(2.60±0.42 vs3.14±0.60)、总体生活质量(6.19±0.49 vs5.13±0.68)评分差别显著(P<0.001)。对179例老年CHD患者随访1年,A型性格患者37例(35.2%)发生MACE,B型性格患者11例(14.9%)发生MACE,差别显著(P<0.05)。105例A型性格患者中,健康教育组患者15例(28.3%)发生MACE,对照组患者中22例(42.3%)发生MACE,未见显著差别(P>0.05)。结论健康教育干预能够明显改善老年A型性格CHD患者的生活质量。老年A型性格CHD患者的MACE发生率明显高于B型性格CHD患者。健康教育未能改善老年A型性格CHD患者的预后。     

冠心病合并糖尿病患者联合抗血小板药物抵抗的相关研究

目的:分析冠心病(CHD)合并糖尿病(DM)患者阿司匹林抵抗(AR)及氯吡格雷抵抗(CR)的影响因素,评价AR、CR与主要不良心血管事件(MACE)的关系以及MACE的相关因素。方法:选择CHD患者270例,其中非DM患者136例(NDM组),DM患者134例(DM组),记录患者临床情况及心电图、超声心动图、冠脉造影等检查结果。检查血常规、凝血功能、生化指标。评价AR及CR。随访1年,记录患者MACE事件并分析其相关因素。结果:NDM组AR(33.8%︰62.7%,P0.05)及CR(33.1%︰58.2%,P0.05)发生率均显著低于DM组。NDM组无抵抗发生率显著高于DM组(54.4%︰22.4%,P0.05),半抵抗(24.3%︰34.3%,P0.05)和抵抗(21.3%︰44.3%,P0.05)发生率显著低于DM组。无抵抗、半抵抗与抵抗患者hs-CRP、CK-MB、TG、TC、LDL-C、ApoA1、CR、UA、WBC计数、病变血管(处)、严重病变(处)等均差异有统计学意义(均P0.05)。随访结果显示:DM组患者发生MACE事件44例(32.8%),NDM组发生MACE事件38例(27.9%)。Logistic分析显示,男性、心率、BMI、TG、LDL、双联抗血小板药物治疗抵抗是CHD合并DM患者发生MACE的影响因素。结论:CHD合并DM患者联合抗血小板治疗抵抗明显增高,药物抵抗与多种因素有关。发生药物抵抗患者MACE事件明显增加。     

代谢综合征对老年血运重建术患者预后的影响

目的分析代谢综合征在老年血运重建患者中的临床特征和预后。方法选择2004年7月~2005年9月在我院接受血运重建治疗的临床资料记录完整的患者2882例,随访时间中位数为1年6个月,随访成功比例92.20%,将≥60岁的1512例患者分为老年组,<60岁的1370例分为中青年组。又将老年组中合并代谢综合征的患者分为Ⅰ组,未合并代谢综合征的患者分为Ⅱ组。记录两组随访期间临床不良心脑血管事件(MACCE)。结果老年组患者的病死率明显高于中青年组(3.40%vs1.02%,P=0.000),老年组合并代谢综合征的比例为39.95%,Ⅰ组随访期间的再住院率、MACCE和病死率均明显高于Ⅱ组的患者(30.80%vs26.32%,P=0.034;12.09%vs8.59%,P=0.018,3.31%vs1.65%,P=0.029)。只有年龄、肌酐水平和合并代谢综合征对病死率有明显影响(P<0.05)。结论合并代谢综合征的老年患者再住院率、MACCE和病死率均明显高于未合并代谢综合征者,合并代谢综合征和年龄、肌酐水平是增加随访期间MACCE和病死率的重要危险因素。     

Left main stem coronary artery dissection during coronary angiography

This paper describes a case of dissection of the main stem of the left coronary artery during coronary angiography with an uneventful clinical course. As far as we know, only one comparable case has been reported before. A brief survey of the pertinent literature is presented. Some possible pathogenetic factors are considered. No specific preventive or therapeutic measurement can be recommended.     

Triple origin of left coronary arteries from right coronary artery: Unusual case of single coronary artery

A rare case of coronary anomaly is presented: all of the coronary arteries originated from a single ostium located in the right coronary cusp. No clinical evidence of coronary pathology was recognized until the age of 57 years when the patient was found to have coronary obstructive disease. The single coronary artery had a main branch corresponding to the usual dominant right coronary artery. Three other branches separated from this and vascularized the areas normally receiving the circumflex and ramus medianus, the left anterior descending, and a large septal branch.     

Sudden coronary death

Many reports have described the amounts of atherosclerotic plaque in victims of sudden coronary death, defining the number of coronary arteries narrowed at some point greater than 75% in cross-sectional area (XSA). In order to quantitate more precisely the amount and distribution of plaque, 70 victims of sudden coronary death aged 22-81 years (mean 50) were studied. The four major epicardial coronary arteries (left main, left anterior descending, left circumflex, and right) from each of 70 victims were cut into 5-mm segments (average 50 per patient) and a histologic section prepared from each segment. The amount of luminal narrowing by plaque was categorized into five groups (0-25%, 26-50%, 51-75%, 76-95%, 96-100%). Of 3,484 five-mm segments, 950 (27%) were narrowed 76-100% in XSA. Comparison of 31 previously symptomatic victims (angina pectoris and/or myocardial infarction) to 39 victims who had been asymptomatic disclosed a higher mean percent of severely narrowed segments (30% vs. 25%, p = less than 0.005) and a lower mean percent of minimally narrowed segments in the symptomatic group. Comparison of the 31 patients with a healed myocardial infarction at necropsy with 39 patients with no left ventricular scar disclosed a higher mean percent of segments severely narrowed (33% vs. 24%, p = less than 0.001) and a lower mean percent of segments narrowed minimally in those with a left ventricular scar (13% vs. 26%, p = less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty

The aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty-two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals. All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

64层CT冠状动脉成像技术和冠状动脉造影对冠状动脉疾病诊断的对照研究

目的比较64层计算机断层摄影扫描冠状动脉成像技术(64-slice computed tomography coronaryangiography,64-SCTCA)和冠状动脉造影(coronary artery angiography,CAG)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的价值。方法回顾性分析126例疑似冠心病的患者64-SCTCA和CAG检查资料,并对两组资料进行对比分析。结果 64-SCTCA和CAG检查结果中可用于评价的病变血管段支数比较,差异无统计学意义(P0.05)。CAG共发现≥50%狭窄节段242个,64-SCTCA共发现≥50%狭窄节段199个,两种检查方法对病变狭窄的显示情况比较,差异无统计学意义(P0.05)。全部126例冠心病患者中有91%通过64-SCTCA发现(110/121)。64-SCTCA诊断冠状动脉病变血管的敏感性、特异性、阳性预测值、阴性预测值分别为81.6%、98.8%、79.5%、99%。结论 64-SCTCA可作为冠心病无创、便捷、可靠的检查方法。     

The incidence of coronary anomalies on routine coronary computed tomography scans

The incidence of coronary anomalies (CCAs) in a typical angiographic study was 1.3%.1 Studies have been conducted on CCAs using conventional invasive coronary angiography in highly selected groups of patients but these studies may not reflect the true incidence of CCAs.Although the majority of CCAs are benign and incidentally detected during conventional angiography, certain CCAs may cause syncope, heart failure or sudden death, especially among young athletes.2,3 The US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry found that CCAs were the second most common cause of sudden cardiac death (out of 17% of the population who died of cardiac-related causes).4Although conventional invasive coronary angiography is considered the gold standard for the diagnosis of CCAs, transthoracic two-dimensional echocardiography, transoesophageal echocardiography, magnetic resonance imaging and multi-slice computed tomography (MSCT) can all identify for diagnosis, CCAs in certain groups of patients.5-10 Transthoracic twodimensional echocardiography may depict the origin of the coronary arteries, especially the left main artery, but successful detection of coronary anomalies depends on the age and size of the patient.5,6Transoesophageal echocardiography has an increased success rate of identifying coronary anomalies in comparison with two-dimensional echocardiography. Nevertheless, the position of the transducer, cardiac motion, and the curvilinear course of the vessel all affect visualisation of coronary anomalies. Moreover, transoesophageal echocardiography is a semi-invasive method and is time consuming.6,7Magnetic resonance (MR) imaging provides an accurate assessment of the course of anomalous coronary arteries.8,9 However, this technique cannot be performed in patients with pacemakers, certain types of arrhythmias or defibrillating devices, and it may be difficult to perform in claustrophobic patients. Furthermore, the spatial resolution of MR imaging is substantially inferior to that of the newest generation of CT scanners.10Myocardial bridging (MB) is defined as the compression of a coronary artery during systole while it is normal in diastole. MB has been linked to serious cardiac events.11 The incidence of myocardial bridging in the population varies substantially according to invasive coronary angiography (13%) and autopsy (15–85%).12,13 The reported incidence of MB has increased up to 44% when using 64-MSCT.14 Because of its ability to cause serious cardiac events, diagnosing MB is clinically important.MSCT is a minimally invasive method that provides excellent temporal and spatial resolution of the coronary arteries. There have been a limited number of studies evaluating CCAs and MB with 64-MSCT. The aim of this study was to assess the incidence of CCAs and MB using 64-MSCT in a relatively large population.     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.     

The disappearing coronary stenosis: reemphasizing the importance of excluding coronary vasospasm before coronary intervention.

We describe a case of resting angina with multiple angiographic stenoses that were highly suitable for stenting. These classic lesions resolved after intracoronary nitroglycerin while positioning a stent. This case reemphasizes the need to exclude vasospasm prior to any interventional coronary procedure.     

Percutaneous transluminal coronary angioplasty of a right coronary artery arising from the left main coronary artery

Angioplasty of anomalous coronary arteries presents unique technical challenges. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and to provide support to cross the lesion. A case of successful PTCA of a lesion in an anomalous right coronary artery arising from the left main coronary artery is presented. © 1993 Wiiey-Liss, Inc.