SummaryH~potliesis: The study W L L~ undertaken to characterize acute myocardial infarction (AMI) in young patients.Mtvhods: In all, 108 consecutive Mediterranean patients with AM1 ( 102 men and 6 women), aged I 40 years, were prospectively included in this study over aperiod of6.S years. Coronary angiography was canied out within the first month and data from these patients with normal or diseased coronary arteries were compared. Clinical features, risk factors, and inhospital and late morbidity and mortality were evaluated. Kr.sirlts: Young patients with AM1 represent 4. I % of the 2,644 patients admitted because of definite AM1 during this period. The most coninion risk factors were cigarette smoking (94.5%) and hypercholesteroleinia (48%). Location of the AM1 was anterior in 37%. inferior in 57.5%. and non-Q in 5.5%. A history of previous angina was present in 42.5%' of the patients, including all seven patients with previous myocardial infarction (6.5%). However, in 52% of the patients the anginal episodes started i n the week prior to the AMI. Inhospital mortality and motzality during a mean follow-up of 4 1 -c 13 months were 3.7 and 3.870, respectively. The KaplanMeier actuarial curve assessed on 97 of 104 survivors was 100 a d 94% at I and 5 years, respectively. Coronary arteries were angiographically normal in I7 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer risk factors, reinfarction (p

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(mean, 10 days). Aspirin plus dipyridamole significantly (p=0.017) reduced the occlusion rate of distal anastomoses from 18% (placebo) to 12.9%. Occlusion rate in the aspirin group was 14%, which approached statistical significance (p=0.058). Furthermore, only aspirin plus dipyridamole reduced (p=0.01) the number of patients with occluded grafts (placebo, 33%; aspirin, 27.1%; aspirin plus dipyridamole, 24.3%). Mediastinal drainage was slightly higher (p=0.04) in the aspirin plus dipyridamole group (713±456 ml) than in the other two groups (placebo, 670±437 ml; aspirin, 629±337 ml), but hospital mortality (average, 4.6%) and early reoperation (average, 3.9o) rates were similar among the three groups. Thus, low-dose aspirin plus dipyridamole safely improves early saphenous vein aortocoronary graft patency; this effect is an added benefit to a preoperative regimen of dipyridamole. (Circulation 1990;82:765-773) T he results of several controlled trials have demonstrated that platelet-inhibiting drugs may prevent early aortocoronary vein graft occlusion"2; however, some questions such as the optimal combination and doses of antiaggregant agents remain undetermined.3 Because large doses of aspirin prevent the production of thromboxane A2 but also inhibit the formation of the wall vessel antiaggregant prostacyclin, it has been suggested that a lower dose of aspirin may improve both clinical efficacy and tolerance.45 However, the clinical benefit of such low doses on graft patency has not yet been proved in a large-scale clinical trial.

Summary: To assess the local and systemic intracoronaq (IC) ergonovine maleate (EM), single or repeated 25 pg bolus injections were administered to 108 consecutive patients with chest pain and normal coronary arteriograms. Coronary artery spasm (CAS) was induced in 17 (15.7%) patients. None of these patients developed ST-segment depression, and ST-segment elevation appeared in only 6 (35.3%). In 59 of the 91 patients without CAS, both the IC and the intravenous (IV) EM arteriographic and hernodynamic effects were compared. The mean diameter of the vessels was reduced by 15% (p <0.001) after two single 25 pg ICEM injections. Only insignificant changes were induced in the heart rate (baseline 80f15; after ICEM 79 f 15 beatdmin; p = NS) and systolic aortic pressure (baseline 147k27; after ICEM 149f28 mmHG; p=NS). Following 350 pg of cumulative IVEM, the mean coronary diameter decreased by 20% (p

Summary: A common pathophysiology for the clinical association of variant angina and migraine has been suggested, but the pathogenesis of both illnesses is yet unknown. Our report presents two siblings with both illnesses and a familial history of migraine where coronary artery spasm was documented, spontaneously in one and after the administration of ergonovine maleate in the other one. Our study strongly supports the hypothesis that genetic factors possibly play a role in the etiology of variant angina and migraine at least in some patients.