冠心病患者替格瑞洛停药原因及停药对临床转归的影响分析

目的 分析冠心病患者替格瑞洛停药原因及停药对临床转归的影响。方法 连续募集2014年1月至2015年7月在解放军总医院心内科住院并接受替格瑞洛抗血小板治疗的冠心病患者642例，分析患者3个月内替格瑞洛停用的发生情况及停药原因。对入选患者经皮冠状动脉介入术（PCI）后随访6个月，比较患者3个月内停用替格瑞洛与持续服用该药发生缺血事件[包括主要缺血事件（心源性死亡、非致死性心肌梗死、缺血性脑卒中、明确或可能的支架内血栓、冠状动脉血管重建）和次要缺血事件（因不稳定型心绞痛再入院）]及出血终点事件[包括心肌梗死溶栓治疗试验（TIMI）主要和次要出血]的差异。结果 本研究中164例（25.55%）患者分别在住院期间（42例，25.61%）、出院当天（7例，4.27%）和出院至随访3个月时（115例，70.12%）停用替格瑞洛。停药患者在不同冠心病诊断中的分布为不稳定型心绞痛占78.05%、ST段抬高型心肌梗死（STEMI）占13.41%、非ST段抬高型心肌梗死（non-STEMI）占4.27%和稳定型冠心病占4.27%。院内或出院时替格瑞洛停用的原因主要为替格瑞洛相关呼吸困难（32.65%）、出血（22.45%）和非复杂病变的PCI术（18.37%）；院外停用替格瑞洛的原因主要为当地无法购买替格瑞洛（68.70%）和经济原因（16.52%）。停药后，除10例死亡患者，其余患者均在医师指导下更改抗栓治疗方案，其中153例转为氯吡格雷联合阿司匹林抗血小板治疗，1例单独阿司匹林治疗。对完成6个月随访的PCI术后冠心病患者（n＝499）分析发现，3个月内停用替格瑞洛患者发生主要缺血终点事件（4.58% vs 0.82%，HR 6.62，95%CI 1.17～37.36，P＝0.032）及联合缺血事件（11.45% vs 4.89%，HR 2.46，95%CI 1.03～5.89，P＝0.043）的风险均显著高于持续该药治疗的患者。两组患者联合出血终点事件的发生率差异无统计学意义（16.03% vs 17.12%，HR 0.92，95%CI 0.49～1.73，P＝0.795）。结论 替格瑞洛停药在冠心病患者中多见，院内及出院当天停药主要由于替格瑞洛相关呼吸困难、出血副作用及非复杂冠状动脉病变的PCI术，院外停药主要是无法获取药物和经济原因。与未停药患者相比，冠心病患者PCI术后3个月内停用该药可能增加主要缺血事件和联合缺血事件的发生风险。     

真实世界急性冠状动脉综合征或经皮冠状动脉介入治疗术后患者替格瑞洛抗血小板降阶治疗的临床转归

目的 探讨真实世界急性冠状动脉综合征(ACS)或经皮冠状动脉介入治疗(PCI)术后患者由替格瑞洛降阶为氯吡格雷抗血小板治疗的临床转归。方法 连续募集2013年10月至2016年8月于中国人民解放军总医院第一医学中心心血管内科住院期间接受替格瑞洛联合阿司匹林抗血小板治疗,并于住院期间或出院后1年内将替格瑞洛降阶为氯吡格雷的ACS或PCI术后患者746例。根据替格瑞洛降阶治疗时间,将患者分为急性期组(≤1个月,n=212)和非急性期组(1～3个月,n=262;3～6个月,n=156;6～12个月,n=116)。对所有患者进行1年随访。分析各组患者降阶治疗原因,比较各组患者主要终点事件[1年内净临床不良事件:全因死亡、非致死性心肌梗死、非致死性脑卒中、靶血管重建及出血学会研究会(BARC)定义的2、3、5型出血事件构成的复合终点事件]及次要终点事件(心血管缺血事件和BACR 2、3、5型出血事件)发生差异。采用SPSS 26.0软件进行统计分析。多因素logistic回归分析对比不同时间段行替格瑞洛降阶治疗后主要终点事件和次要终点事件的发生风险。结果 急性期组降阶治疗的主要原因是冠状动脉造影未见严重狭窄(23.1%),非急性期组降阶治疗的主要原因是无法获取替格瑞洛(41.9%)。急性期组1年内净临床不良事件发生率略高于非急性期1～3个月组,但差异无统计学意义(14.6% 和 12.2%;HR=0.72,95%CI 0.41～1.26;P=0.252)。非急性期1～3个月组的1年内净临床不良事件显著低于3～6个月组(12.2%和19.2%;HR=1.90,95%CI 1.07～3.37;P=0.029)及6～12个月组(12.2% 和21.6%;HR=1.48,95%CI 1.10～2.00;P=0.010)。各组间1年内心血管缺血事件比较,差异无统计学意义(P≥0.05)。非急性期1～3个月组的1年内出血事件显著低于6～12个月组(9.2%和15.5%; HR＝1.42,95%CI 1.01～2.00;P=0.044)。结论 真实世界中ACS或PCI术后患者在非急性期1～3个月内进行替格瑞洛抗血小板降阶治疗能够获得最佳的临床净获益。     

复杂冠状动脉病变介入治疗患者应用替格瑞洛的临床疗效观察

目的评价复杂冠状动脉病变PCI患者应用替格瑞洛的有效性及安全性。方法选择2013年2月~2015年8月在我院心内科住院的复杂冠状动脉病变PCI患者204例,冠状动脉造影后随机分为替格瑞洛组98例和氯吡格雷组106例。替格瑞洛组术前给予替格瑞洛负荷剂量180mg口服,术后维持剂量90mg口服,2次/d;氯吡格雷组术前给予氯吡格雷负荷剂量300mg口服,术后维持剂量75mg口服,1次/d。观察术后12个月主要不良心血管事件(MACE),包括支架内血栓形成、再发心绞痛、再发心肌梗死和再次血运重建;安全性终点包括TIMI出血事件以及呼吸困难发生率。结果随访12个月,替格瑞洛组MACE发生率低于氯吡格雷组,但差异无统计学意义(14.3%vs 21.7%,P=0.170)。替格瑞洛组再发心肌梗死及支架内血栓形成发生率明显低于氯吡格雷组(1.0%vs6.6%,P=0.039;0vs 4.7%,P=0.029),呼吸困难发生率明显高于氯吡格雷组(6.1%vs 0.9%,P=0.042)。替格瑞洛组出血事件发生率较氯吡格雷组高,但差异无统计学意义(P=0.367)。结论复杂冠状动脉病变PCI患者应用替格瑞洛获益明显,与氯吡格雷比较进一步降低MACE,不增加出血风险,但呼吸困难发生率较高。     

老年ACS患者PCI术后使用替格瑞洛和氯吡格雷的有效性和安全性分析

目的评估真实世界中老年急性冠状动脉综合征(ACS)患者在经皮冠状动脉介入治疗(PCI)术后使用替格瑞洛和氯吡格雷的长期有效性和安全性。方法本研究为一项单中心、回顾性队列研究, 选取2016年3月至2018年3月在北部战区总医院心血管内科住院并接受PCI治疗的老年(年龄≥65岁)ACS患者, 依据患者术后服用的P2Y12受体抑制剂种类分为氯吡格雷组和替格瑞洛组。本研究的主要终点为PCI术后2年的缺血事件, 即包括心原性死亡、心肌梗死和/或缺血性卒中的复合终点。次要终点为2年的全因死亡和出血学术研究联合会(BARC)定义的BARC 2、3、5型出血事件。比较两组患者终点事件的发生情况, 采用多因素Cox风险比例模型探讨不同的抗血小板药物对患者预后的影响, 并采用Kaplan-Meier法绘制生存曲线。结果共纳入4 022例行PCI治疗的老年ACS患者, 年龄为(71.5±5.3)岁, 其中氯吡格雷组3 201例, 替格瑞洛组821例。与氯吡格雷组相比, 接受替格瑞洛治疗的患者2年的缺血事件发生率较低[3.2%(26/821)比5.6%(179/3 201), P=0.005]。两组在2年B...     

不同P2Y12受体拮抗剂对高龄老年急性冠状动脉综合征患者疗效及安全性探讨

目的探讨氯吡格雷与替格瑞洛联合阿司匹林的双联抗血小板治疗对高龄老年急性冠状动脉综合征(ACS)患者的疗效和安全性。方法选择2013年1月~2018年5月沈丘县中医院和郑州人民医院CCU行急诊PCI的高龄老年ACS患者146例,随机分为氯吡格雷组79例和替格瑞洛组67例,分别给予联合阿司匹林的双联抗血小板治疗,观察PCI术后TIMI血流、心肌灌注分级(TMPG)、主要并发症及1年随访出血事件和主要终点的变化。结果替格瑞洛组PCI术后TIMI3级、TMPG 3级比例明显高于氯吡格雷组,梗死后心绞痛、严重心律失常和心功能>Ⅲ级发生率明显低于氯吡格雷组,差异有统计学意义(P<0.05)。替格瑞洛组轻度出血和总出血发生率明显高于氯吡格雷组(37.3%vs 19.1%,P=0.022;54.2%vs 30.9%,P=0.007)。结论替格瑞洛可以改善高龄老年ACS患者PCI术后心肌血流灌注,减少缺血并发症发生,不增加中度和重度出血的发生。     

老年与中年急性冠脉综合征患者不同双联抗血小板方案疗效与出血风险比较

目的比较≥75岁老年急性冠脉综合征(ACS)患者与60岁中年ACS患者"阿司匹林+替格瑞洛"与"阿司匹林+氯吡格雷"两种双联抗血小板治疗(DAPT)方案的疗效与出血风险。方法连续入选2014年3月至2015年5月于解放军总医院心血管内科住院治疗的ACS患者、年龄60岁及≥75岁,并进行血栓弹力图(T7EG)检查的患者416例,分为:(1)年龄60岁阿司匹林+氯吡格雷(60C组),(2)年龄≥75岁阿司匹林+氯吡格雷(≥75C组),(3)年龄60岁阿司匹林+替格瑞洛(60T组),(4)年龄≥75岁阿司匹林+替格瑞洛(≥75T组),随访1年,比较各组主要不良心血管事件(MACE)及出血情况。结果各组MACE事件发生率、TEG检测的最大振幅(MA)值、花生四烯酸抑制率(AA-IPA)差异均无统计学意义(P0.05);相同年龄段"阿司匹林+替格瑞洛"患者二磷酸腺苷抑制率(ADP-IPA)高于"阿司匹林+氯吡格雷"(P0.05),但"阿司匹林+替格瑞洛"在两个年龄段的ADP-IPA差异无统计学意义(P=0.828),≥75C组ADP-IPA较60C组低(P=0.011);相同年龄段"阿司匹林+替格瑞洛"患者出血事件发生率高于"阿司匹林+氯吡格雷"患者(P0.05),但多为I型非致命性出血;"阿司匹林+替格瑞洛"在不同年龄段出血事件发生率差异无统计学意义(P=0.392)。应用Cox回归分析MACE危险因素:血糖(B=0.111,RR=1.117,95%CI:1.014~1.231,P=0.025),eGFR(B=-0.023,RR=0.977,95%CI:0.961~0.993,P=0.005),心率(B=0.040,RR=1.041,95%CI:1.013~1.070,P=0.004)。应用logistic回归分析出血事件危险因素:DAPT方案(B=3.527,OR=34.025,95%CI:9.560~121.101,P0.001),性别(B=1.126,OR=3.085,95%CI:1.083~8.788,P=0.035)。结论在本研究中"阿司匹林+替格瑞洛"的临床疗效不优于"阿司匹林+氯吡格雷",且I型出血风险增高;中、老年人口服"阿司匹林+替格瑞洛"的出血风险无差异。     

低剂量替格瑞洛对老年急性冠脉综合征伴慢性肾功能不全患者的疗效

目的观察低剂量替格瑞洛治疗老年急性冠脉综合征(ACS)伴慢性肾功能不全(CRI)患者的疗效和安全性。方法连续入选2016年10月至2017年2月解放军空军第986医院心血管内科住院治疗的≥75岁老年ACS合并CRI患者148例,根据患者服用替格瑞洛剂量不同分为低剂量替格瑞洛组(45 mg/次,2次/d,n=52)和标准剂量替格瑞洛组(90 mg/次,2次/d,n=96),口服药物3 d后行血栓弹力图(TEG)检测,比较2组患者腺苷二磷酸(ADP)诱导的血小板聚集抑制率(IPA)和随访12个月主要不良心脑血管事件(MACCE)和大出血事件的发生率。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果标准剂量组患者ADP诱导的IPA高于低剂量替格瑞洛组患者[(83. 4±2. 5)%vs(67. 3±4. 7)%,P=0. 043],但2组IPA50%患者比例差异无统计学意义[13. 5%(7/52) vs 5. 2%(5/96),P=0. 219]。2组患者12个月MACCE发生率差异无统计学意义[19. 2%(10/52) vs 13. 5(13/96),P=0. 476]。低剂量替格瑞洛组大出血事件发生率显著低于标准剂量替格瑞洛组[9. 6%(5/52) vs 24. 0%(23/96),P=0. 033]。结论低剂量替格瑞洛与标准剂量替格瑞洛相比同样可发挥较好的抗血小板作用,且降低出血事件风险,可更好地平衡缺血与出血。     

冠状动脉旁路移植术前替格瑞洛停用时间对围术期出血风险的影响

目的探讨冠状动脉旁路移植术(CABG)前停用替格瑞洛的时间对围术期出血风险的影响。方法纳入2013年7月至2017年12月行CABG术前服用替格瑞洛的冠心病患者188例,根据术前替格瑞洛停药时间分为≥5 d组(126例)和<5 d组(62例)。比较两组基线资料及围术期严重出血资料,单因素和多因素logistic回归分析严重出血的危险因素。主要终点为围术期严重出血。结果 31例(16. 5%)患者出现严重出血,其中≥5 d组有15例(11. 9%),<5 d组有16例(25. 8%)。两组的年龄、性别、术前红细胞压积等基线资料无明显差异(均为P> 0. 05)。多因素logistic回归分析显示,急性心肌梗死史(OR=5. 49,95%CI:1. 25～24. 17)和替格瑞洛停药<5 d(OR=2. 50,95%CI:1. 13～5. 56)是严重出血的危险因素。结论替格瑞洛术前停药时间小于5 d可增加CABG患者围术期严重出血风险。     

替格瑞洛在急性冠脉综合征介入治疗中的应用

目的观察替格瑞洛治疗急性冠脉综合征(ACS)患者行PCI治疗的抗血小板聚集起效时间,临床疗效和安全性。方法选择我院ACS并成功完成PCI手术患者90例,随机分为氯吡格雷组(n=45)和替格瑞洛组(n=45),两组患者入院后均接受常规治疗,氯吡格雷治疗组给予氯吡格雷负荷剂600 mg,后给予氯吡格雷标准剂量(75 mg,1次/日,口服)治疗;替格瑞洛治疗组给予替格瑞洛负荷剂量180 mg,后给予替格瑞洛标准剂量(90 mg,2次/日,口服)治疗。对两组患者基线资料、危险因素以及PCI数据进行统计学分析,检测未予负荷剂量治疗前、给予负荷剂量治疗后不同时间的抗血小板聚集能力,观察两组患者6个月后的主要不良心血管事件(MACE)和出血事件的发生情况。结果替格瑞洛组负荷量180 mg比氯吡格雷组负荷量600 mg起效更快;随访术后6个月,替格瑞洛组MACE发生率显著低于氯吡格雷组(P=0.042);替格瑞洛组和氯吡格雷组的出血发生率比较无统计学意义(P0.05)。结论替格瑞洛作为一种新型的抗血小板聚集药物,起效更迅速,能够更好地降低人群中ACS患者冠状动脉介入治疗后不良心脑血管事件的发生率     

氯吡格雷低反应的老年急性冠状动脉综合征患者换用替格瑞洛后的疗效及出血危险因素

目的:观察替格瑞洛对氯吡格雷低反应的择期经皮冠状动脉介入治疗(PCI)后老年急性冠状动脉综合征(ACS)患者的疗效,评估治疗过程中出血并发症的危险因素。方法:入选2014-01至2017-01期间945例年龄≥65岁的ACS患者,患者入院后均给予阿司匹林及氯吡格雷双联抗血小板治疗(DAPT)。用血栓弹力图分别测定DAPT≥5 d后患者的血小板抑制率,根据血小板抑制率筛选出氯吡格雷低反应患者293例,这些患者全部换用替格瑞洛,调整DAPT方案≥5 d后再次检测血小板抑制率,对比患者替格瑞洛更换前后血小板抑制率的变化情况(替格瑞洛组);其余652例患者继续应用氯吡格雷(氯吡格雷组)。采用TIMI出血评估标准,随访3个月,比较氯吡格雷组和替格瑞洛组的出血发生率,并应用Logistic回归分析老年ACS患者应用替格瑞洛发生出血并发症的危险因素。结果:氯吡格雷低反应的293例老年ACS患者换用替格瑞洛后5~7 d、8~14 d、15~90 d,血小板抑制率分别为(51.70±42.90)%、(48.99±41.85)%、(55.08±25.70)%,均显著高于其应用氯吡格雷时的血小板抑制率(14.50±24.15)%,差异均有统计学意义(P均0.05)。替格瑞洛组大出血发生率与氯吡格雷组相比,差异无统计学意义(P=0.96)。Logistic多因素分析提示,女性(OR=4.329,P=0.000)、低体重(OR=0.817,P=0.039)、空腹血糖升高(OR=1.251,P=0.028)是老年ACS患者应用替格瑞洛发生出血并发症的独立危险因素。结论:与应用氯吡格雷相比,老年ACS患者应用替格瑞洛能更快、更有效地抑制血小板聚集,且不增加大出血的发生率,安全性高。女性、低体重、空腹血糖升高是择期PCI后老年ACS患者应用替格瑞洛发生出血并发症的独立危险因素。     

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.     

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.     

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)     

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.