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Objective:Neutrophil gelatinase-associated lipocalin (NGAL) is a novel inflammatory marker that is released from neutrophils. In this study, we evaluated the correlation between serum NGAL level and clinical and angiographic risk scores in patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS).Methods:Forty-seven random NSTE-ACS patients and 45 patients with normal coronary arteries (NCA) who underwent coronary angiography were enrolled in the study. GRACE risk score and SYNTAX and Gensini risk scores were used, respectively, for the purpose of clinical risk assessment and angiographic risk scoring. Serum NGAL level was measured via ELISA in peripheral blood samples obtained from the patients at the time of admission.Results:Serum NGAL level was significantly higher in the NSTE-ACS group compared to the control group (112.3±49.6 ng/mL vs. 58.1±24.3 ng/mL, p<0.001). There was a significant positive correlation between serum NGAL levels and the GRACE (r=0.533 and p<0.001), SYNTAX (r=0.395 and p=0.006), and Gensini risk scores (r=0.575 and p<0.001). The intermediate-high SYNTAX (>22) group had statistically significantly higher serum NGAL levels compared to the low SYNTAX (≤22) group (143±29.5 ng/mL vs. 98.7±43.2 ng/mL, p=0.001).Conclusion:NGAL level was positively correlated with lesion complexity and severity of coronary artery disease in patients with NSTE-ACS. Serum NGAL levels on admission are associated with increased burden of atherosclerosis in patients with NSTE-ACS.

Mitral balloon valvuloplasty which has been used for the treatment of rheumatic mitral stenosis (MS) for several decades can cause serious complications. Herein, we presented right atrial clot formation early after percutaneous mitral balloon valvuloplasty which was treated successfully with unfractioned heparin infusion.

Objective: Myocardial bridge (MB), also known as muscular bridge, is a rare congenital disease with relatively good prognosis. However, it has been associated with unstable angina, myocardial infarction, and sudden cardiac death. Incidence and prognosis of patients diagnosed with isolated MB after having undergone coronary angiography are evaluated in the present retrospective study. Methods: Coronary angiograms of 18,250 patients, obtained between 2008 and 2011, were reexamined for presence of MB at the cardiology clinic. Of these patients, 241 (0.95%) had MB, and 181 (0.99%) had it as an isolated finding. Patients with isolated MB were divided into 2 groups according to severity of the lesion in the cardiac systole. Group 1 was comprised of patients with non-critical (<70%) stenosis; group 2 was comprised of patients with critical (≥70%) stenosis. Demographic characteristics, symptoms at initial diagnosis, and coronary angiographic findings regarding localization and severity of stenosis were noted. Follow-up was performed by phone, with outpatient clinic visits, and by reviewing hospital records.Results: Twenty-five patients (13%) had critical stenosis (group 2), and 146 (87%) had non-critical stenosis (group 1). Mean follow-up duration was 38±7 months. Recurrent angina and repeated coronary angiography were reported in 15 group 1 patients (10.2%) and in 2 group 2 patients (8.0%) (p=non-significant). No instance of myocardial infarction was reported. Conclusion:Isolated MB seems to be a relatively benign disease, a conclusion made in accordance with those of previous studies. Symptoms and prognosis are not determined by degree of stenosis generated by the muscular bridge.

Spontaneous coronary artery dissection (SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending (LAD) artery and left circumflex (LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Coronary artery dissection; Myocardial bridge; Myocardial infarction; Coronary artery disease; Acute coronary syndrome Core tip: In this case report, we discussed a patient who had a rare disease called spontaneous coronary artery dissection simultaneously in two different coronary arteries causing acute myocardial infarction. The presence of muscular bridge and spontaneous coronary artery dissection together at the same site of the left anterior descending artery was another interesting point which made us report this case.Aksakal A, Arslan U, Yaman M, Urumdaş M, Ateş AH. Spontaneous coronary artery dissection as a cause of myocardial infarction. World