Intracoronary OCT appears to be feasible and safe. Optical coherence tomography identified most architectural features detected by IVUS and may provide additional detailed structural information.

Backgrounds:The causes and prognosis of pericardial effusion (PE) may be different according to time, region, economy, and hospital. This study was performed to evaluate the etiology, clinical outcome, and prognosis of patients with large, symptomatic PE treated by echo-guided pericardiocentesis at Kangnam St. Mary's Hopital (the Catholic University of Korea, Seoul, Korea). Hypothesis: According to etiologies of large, symptomatic PE, the prognosis of patients may be different. Methods: We reviewed 116 consecutive patients who underwent echo-guided pericardiocentesis due to large, symptomatic PE over the last 12 y. The Kaplan-Meier survival curve with log-rank method was applied for the survival analysis.Results: Procedural success rate of echo-guided pericardiocentesis was 99.1%. Common causes of PE requiring pericardiocentesis were lung cancer (27.6%), tuberculosis (TB) (13.8%), and uremia (6.9%). The mortality rate of 6 mo after the pericardiocentesis was 80.3% in malignant PE, whereas the over-all mortality rate was 18.2% in nonmalignant PE (p<0.0001). Among the malignant PE, lung cancer (27.6%) and breast cancers (6.9%) were the most common causes. The mean cytologic detection rate and mean life expectancy of malignant PE were 44% and 5-7 mo. Patients with breast cancer and lymphoma had relatively better life expectancy (11.4 and 7.7 mo), whereas those with stomach cancer and metastases of unknown origin (MUO) had poorer prognosis (1.2 and 2.3 mo). The most common causes of nonmalignant PE were TB, uremia, and iatrogenic, and their mean life expectancy was approximately 54 mo. Conclusions: Malignancy, especially lung cancer and TB, were the most common causes of large symptomatic PE. The prognosis of large symptomatic PE was related to the underlying disease. Malignant PE was associated with the poorest prognosis.

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lthough acute myocardial infarction (AMI) is mostly associated with obstructive coronary artery disease, myocardial infarction with normal epicardial coronary arteries has been documented. [1][2][3][4][5] The overall prevalence of myocardial infarction (MI) with a normal coronary angiogram is low, approximately 3%, but the incidence of this condition appears to vary with age, with higher rates in younger patients. 4,5 In some patients with a diagnosis of vasospastic angina (VA), dangerous complications such as AMI, or a high-degree of atrioventricular block, ventricular tachycardia, fibrillation or electromechanical dissociation, are observed during an ischemic attack, and all of these maladies can lead to sudden death. Coronary artery spasm has been proposed as a classic etiologic factors for AMI with normal coronary arteries, 6 but the actual prevalence of this event has remained ill-defined because of a lack of data from spasm provocation tests in a large series of patients.In the present study we evaluated the clinical and angiographic characteristics of VA with AMI in patients without organic coronary heart disease. Circulation Journal Vol.71, September 2007 Methods PatientsBetween January 2003 and June 2005, 672 coronary spasm provocation tests were performed at Kangnam St Mary's hospital and 292 patients were diagnosed with VA. Among these 292 patients, 21 had an AMI. In this study, the diagnosis of VA was made when patients met all of the following criteria: (1) burning or squeezing retrosternal chest pain, (2) positive spasm provocation test, and (3) no significant organic lesion (<50% narrowing of the coronary luminal diameter according to quantitative coronary angiography (QCA)). AMI with VA was defined by elevation of the cardiac markers (troponin-I >upper normal limit and creatine kinase-MB >3-fold the upper normal limit) with no organic coronary heart disease being identified on angiography. We excluded patients with takotsubo cardiomyopathy.After the procedure was explained, written informed consent for the spasm provocation test was given by all the patients. Spasm Provocation TestAll the patients' medications, except for nitroglycerin, were discontinued for >48 h before the start of the study, and nitroglycerin was discontinued at least >4 h before the start of the study. Cardiac catheterization was performed through the right femoral artery while the patient was in a fasting state. Control angiograms of the left coronary artery (LCA) were obtained in the right anterior oblique view with caudal projection, before imaging of the right coronary artery (RCA) in the left anterior oblique view with straight projection after the injection of 4-6 ml of contrast medium.Circ J 2007; 71: 1383 -1386 (Received June 7, 2006 revised manuscript received April 6, 2007; accepted May 24, 2007 There were 20 patients who initially visited the emergency room for AMI without suffering prior VA. One patient with a history of VA had an AMI when he discontinued his medication. Among the 21 VA patients with AMI, 14 ha...