Background Few studies have investigated optimal revascularization strategies in non–ST‐segment–elevation myocardial infarction with multivessel disease. We investigated 3‐year clinical outcomes according to revascularization strategy in patients with non–ST‐segment–elevation myocardial infarction and multivessel disease. Methods and Results This retrospective, observational, multicenter study included patients with non–ST‐segment–elevation myocardial infarction and multivessel disease without cardiogenic shock. Data were analyzed at 3 years according to the percutaneous coronary intervention strategy: culprit‐only revascularization (COR), 1‐stage multivessel revascularization (MVR), and multistage MVR. The primary outcome was major adverse cardiac events (MACE: a composite of all‐cause death, nonfatal spontaneous myocardial infarction, or any repeat revascularization). The COR group had a higher risk of MACE than those involving other strategies (COR versus 1‐stage MVR; hazard ratio, 0.65; 95% CI, 0.54–0.77; P <0.001; and COR versus multistage MVR; hazard ratio, 0.74; 95% CI, 0.57–0.97; P =0.027). There was no significant difference in the incidence of MACE between 1‐stage and multistage MVR (hazard ratio, 1.14; 95% CI, 0.86–1.51; P =0.355). The results were consistent after multivariate regression, propensity score matching, inverse probability weighting, and Bayesian proportional hazards modeling. In subgroup analyses stratified by the Global Registry of Acute Coronary Events score, 1‐stage MVR lowered the risk of MACE compared with multistage MVR in low‐to‐intermediate risk patients but not in patients at high risk. Conclusions MVR reduced 3‐year MACE in patients with non–ST‐segment–elevation myocardial infarction and multivessel disease compared with COR. However, 1‐stage MVR was not superior to multistage MVR for reducing MACE except in low‐to‐intermediate risk patients.

Background: Selecting angiotensin converting enzyme inhibitor (ACEI) or angiotensin II type I receptor blocker (ARB) in patients diagnosed as acute myocardial infarction (AMI) with non-obstructive coronary arteries (MINOCA) is not established. The purpose of this study is to compare the clinical effect of ACEI vs. ARB in MINOCA patients. Methods and results: A total of 273 patients between November 2011 to June 2015, diagnosed with MINOCA who were registered in the Korea AMI Registry-National Institute of Health were enrolled. Patients were divided into ACEI (n = 112) and ARB groups (n = 161). The primary endpoint was cumulative incidence of major adverse cardiac events (MACE) defined as cardiac death, recurrent MI, any new revascularization during 2 years 2 clinical follow-up. Secondary endpoint was heart failure requiring re-hospitalization. Propensity score matching analysis was done. The incidence of primary endpoint was similar (10.4% vs. 15.6%, HR: 0.65; 95% CI: 0.29-1.47; p = 0.301) among both groups. However, the incidence of recurrent MI was significantly lower in ACEI group compared to ARB group (2.1% vs. 10.4%, HR: 0.18, 95% CI: 0.04-0.86; p = 0.031). Conclusions: In the present study, the risk and incidence of MACE was similar between ACEI and ARB therapy in MINOCA patients. However, ACEI significantly reduced the risk of recurrent MI. Further larger scale multi-center randomized clinical trials are needed to clarify the proper use of renin angiotensin aldosterone system blocker in these patients.

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Aortic saddle embolus accounts for approximately 10% of all peripheral arterial emboli. The most common sources of emboli are left atrial thrombi associated with atrial fibrillation and vegetation. A 22-year-old male patient was admitted due to acute onset of orthopnea, tachypea and cough. Transthoracic and transesophageal echocardiography showed huge vegetation 3 2cm of the posterior mitral valve leaflet which was associated with severe mitral regurgitation. On 14th hospital day, he suffered from sudden onset of weakness, pain, and coldness on both lower extremities. Follow up echocardiography showed marked size reduction of the original mitral valve vegetation. Angiography showed aortic saddle embolus. The embolectomy of aortic saddle embolus was performed through the transfemoral approach with a Forgarty catheter. At the same time, removal of the infected mitral valve and mitral valve replacement were performed. KEY WORDS Aortic saddle embolism·Mitral valve vegetation·Echocardiography.증 례