Background and Objectives There were numerous reports for clinical characteristics and prognosis of patients with variant angina VA but little information is available for patients with VA who presented as acute myocardial infarction AMI . The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI. Materials and Methods The study group comprised 166 patients with VA forty one 25% of whom presented as AMI Group A Male 32, mean age 50 years and 125 presented as typical VA or unstable angina Group B Male 73, mean age 54 years . The diagnosis of VA was made by spontaneous spasm and ergonovine or acetylcholine only Group B provocation. Results 1 Male gender 78% vs. 58%, p 0.05 , smoking 74% vs. 53%, p 0.05 , and disease duration 18 5 vs. 7 1 month, p 0.0001 , and ST-segment elevation during chest pain 71% vs. 23%, p 0.05 were significantly higher in group A than in Group B. 2 Prevalence of fixed stenosis of 50% or greater was higher in Group A than in group B 12% vs. 2%, p 0.05 and the percent stenosis after nitroglycerin injection was also greater in group A than in group B 43 5% vs. 28 2, p 0.01 , but the disease activity such as frequency of resting angina, spontaneous spasm, and multivessel spasm were not different between two groups. 3 During clinical follow-up at a mean duration of 2.7 years, three patient 2% in group B died of a cardiac cause. Non-fatal MI occurred 1 2% and 3 patients 2% in group A and B, respectively. Conclusions Our data show that male gender, smoking, duration of disease, ST-segment elevation during chest pain, and a fixed stenosis of 50% or greater are predictors for initial development of AMI in patients with VA. The prognosis in group A is excellent and this may be associated with less severe atherosclerotic disease and a high rate
Background and ObjectivesThis study was performed to determine the predictive factors for edge dissection ED and clinical significance of ED after coronary stenting. Materials and Methods The study group comprised 215 patients 243 lesions, mean age 59 years, 157 male in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor a very focal segment 5mm from the stent margin , major 5mm with prominent adventitial staining and 50 of lumen compromize , and acute closure. Results 1. ED occurred in 30 12.3 , minor 15, major 12 out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2. Development of ED after stenting significantly correlated with severity of stenosis at the stent margin 30 , 19/30 vs. 33/213, p 0. 0001 , degree of angulation 45 , 16/30 vs. 48/213, p 0.0001 , and calcification in the lesion 2/30 vs. 4/213, p 0.02 . 3. There was no significant difference in clinical success rate between two groups 27/30 vs. 175/185, NS . 4. CRR in major and acute closure EDs n 12 were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents 5/6 vs. 1/8, p 0.02 . Conclusions EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis 30 at the stent margin, angulation 45 , and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.
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