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Digital panoramic images may have some diagnostic value for detecting CAAs and this early diagnosis could potentially increase the length and quality of life for people with CAAs.

In acute coronary syndromes (ACS), oxidation and inflammation have very important roles and in-vitro studies have demonstrated that gamma-glutamyl transferase (GGT) participates in such oxidative and inflammatory reactions. We aimed to evaluate the prognostic value of baseline serum GGT activity on the development of major adverse cardiac event (MACE) in the follow-up of the patients with ACS in coronary care unit (CCU), after 1 and 6 month periods. We included 117 patients (mean age: 61.2+/-11.3 years, 93 males) hospitalized in CCU with the diagnosis of ACS. All had baseline serum GGT activity and were free of systemic and hepatobiliary disease. MACE was defined as the composite of mortality from cardiac causes, recurrent hospitalization with ACS and nonfatal recurrent myocardial infarction diagnoses, to need for coronary revascularization during CCU, over 1 and 6 month follow-up periods. During the follow-up of CCU, MACE occurred in 17 (14.5%) patients (two died). Serum GGT activity was significantly higher in the patients with MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-CCU [relative hazard: 1.05, 95% confidence interval (CI): 1.01-1.09, P=0.007]. During the follow-up of 1 month, MACE occurred in 23 (20.0%) patients (five died). Serum GGT activity was significantly higher in patients with MACE than those free of MACE (P=0.021) and GGT was found as the independent predictor of the development of MACE-1 month (relative hazard: 1.04, 95% CI: 1.01-1.08, P=0.039). During the follow-up of 6 months, MACE occurred in 24 (21.8%) patients (two died). Again, GGT was significantly higher in patients who developed MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-6 months (relative hazard 1.06, 95% CI: 1.03-1.10, P<0.001). Serum GGT activity was found to be an independent predictor of the development of MACE in the patients with ACS during CCU, over 1 and 6 month follow-up periods.

INTRODUCTIONWith an increasing number of coronary angiography (CAG) procedures, coronary invasive procedures and cardiac bypass surgeries performed each day, knowledge of the variations, anomalies and anatomical pattern of coronary arteries is gaining in importance. Although many individuals have a normal coronary anatomy, variations and anomalies are not unusual, and may lead to complications during procedures. (1) There are two main coronary arteries that supply oxygenated blood to the myocardium -the left main coronary artery (LMCA) and the right coronary artery (RCA). The LMCA originates from the left sinus of Valsalva (SV), while the RCA originates from the right SV. There is typically no artery arising from the posterior SV. The LMCA bifurcates into the left anterior descending (LAD) artery and the circumflex artery (CXA). An additional artery called the intermediate artery (IMA) may arise at the bifurcation of the LMCA, forming a trifurcation.The LAD artery runs in the anterior interventricular sulcus, providing the penetrating septal branches. The left CXA runs along the left atrioventricular sulcus and gives rise to at least one obtuse marginal (OM) branch, while the RCA lies in the right atrioventricular sulcus and gives rise to the acute marginal branch. The IMA, which supplies the left ventricular free wall, is located anterior to the first OM artery and posterior to the first diagonal artery. It can also originate from the proximal part of the LMCA, LAD artery or CXA. In some cases, it is not possible to distinguish between the IMA and OM artery using anatomical or angiographic examinations. However, an important point of distinction is that the left ventricular free wall is supplied by the IMA.(1-3)The artery that supplies the posterior descending artery determines coronary dominance. Approximately 70%-80% of the general population is right-dominant (i.e. supplied by the RCA), while 5%-10% is left-dominant (i.e. supplied by the CXA) and 10%-20% is co-dominant (i.e. supplied by both the RCA and CXA).(3-5) A more accurate definition of dominance refers to the arterial supply to the atrioventricular nodal artery, which is generally supplied by the RCA. (3)(4)(5) Typically, there are two coronary ostia. However, in some cases where the LMCA is absent, three ostia can be detected.In individuals with such a condition, the LAD artery and CXA originate from different ostia. Absence of the LMCA is a common anomaly that can be detected in 0.4%-8% of the population. (4,5) Coronary arteries can be anatomically categorised into three groups based on their anatomical features: normal coronary anatomy, anatomic variations of the coronary artery and coronary artery anomalies (CAAs). CAAs, which are congenital disorders in the coronary anatomy that are observed in less than 1% of the general population, are evaluated using CAG series.

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Serum cardiac enzyme elevation after percutaneous coronary intervention (PCI), a relatively common complication, is a prognostic determinant of long-term outcome in patients who undergo these procedures. Statins are postulated to reduce such complications. This study investigated the short-term effects of pravastatin on serum creatine kinase myocardial isoform (CK-MB) and serum cardiac troponin I (cTpI) levels after elective PCI. Of 93 patients studied, 72 (77.4%) were men, and 21 (22.6%) were women (mean age, 58.9+/-11.0 y). Patients were randomly divided into 3 groups before they underwent elective PCI. Preoperatively, group 1 patients (n=30) received pravastatin 10 mg/d, and group 2 patients (n=29) received pravastatin 40 mg/d. Control group patients (n=34) received no lipid-lowering medication. Serum CK-MB and serum cTpI levels were measured preoperatively and then again at 6, 24, and 36 h postoperatively. Demographic features of patients and characteristics of the PCI procedure, including number of vessels/lesions and duration and number of inflations, did not differ among groups (P>.05). Mean serum CK-MB and serum cTpI levels were significantly increased after PCI in all patients (P<.001). When compared with control group patients, those given pravastatin did not experience significantly lowered postprocedural serum CK-MB or serum cTpI levels (P>.05). Preprocedural pravastatin therapy at dosages of 10 mg/d and 40 mg/d seems inadequate for preventing serum cardiac enzyme elevations during short-term follow-up after PCI. Additional research on this topic is recommended.

Our findings suggest that patients with MetS have higher serum GGT and CRP levels compared with controls. This increased GGT level might be a marker of increased oxidative stress and premature atherosclerosis.