BACKGROUND Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically.Secondary coronary artery ostial lesions are rare,and cases reported previously were associated with syphilitic va...BACKGROUND Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically.Secondary coronary artery ostial lesions are rare,and cases reported previously were associated with syphilitic vasculitis and aortic dissection.Here,we report three rare cases of secondary coronary ostial lesions.Due to their rareness,these lesions can easily be neglected,which may lead to misdiagnosis and missed diagnosis.CASE SUMMARY We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions.In Case 1,coronary angiography(CAG)revealed 90%stenosis of the left main coronary ostium.Chest contrast computed tomography(CT)suggested thymic carcinoma invading the left main coronary ostium.Coronary artery bypass grafting and tumor resection were performed.In Case 2,echocardiography revealed a sinus of Valsalva aneurysm(SVA)-like dilatation.CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery(RCA)ostium.Aortic contrast CT confirmed these findings.The Bentall procedure was performed.In Case 3,CT CAG identified an anomalous origin of the right coronary artery(AORCA)from the left sinus of Valsalva coursing between the aorta and pulmonary trunk,causing severe RCA ostium stenosis by compression.Surgical correction of the AORCA was performed.CONCLUSION The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.展开更多
Background： Acute aortic dissection is known as the most dangerous aortic disease, with management and prognosis determined as the disruption of the medial layer provoked by intramural bleeding. The objective of this...Background： Acute aortic dissection is known as the most dangerous aortic disease, with management and prognosis determined as the disruption of the medial layer provoked by intramural bleeding. The objective of this study was to evaluate the safety and necessity of antiplatelet therapy on patients with Stanford Type B aortic dissection （TBAD） who underwent endovascular aortic repair （EVAR）. Methods： The present study retrospectively analyzed 388 patients with TBAD who underwent EVAR and coronary angiography. The primary outcomes were hemorrhage, death, endoleak, recurrent dissection, myocardial infarction, and cerebral infarction in patients with and without aspirin antiplatelet therapy at 1 month and 12 months. Results： Of those 388 patients, 139 （35.8%） patients were treated with aspirin and 249 （64.2%） patients were not treated with aspirin. Patients in the aspirin group were elderly （57.0 ± 10.3 years vs. 52.5 ± 11.9 years, respectively, χ2 = 3.812, P 〈 0.001） and had more hypertension （92.1% vs. 83.9%, respectively, χ2 = 5.191, P = 0.023） and diabetes （7.2% vs. 2.8%, respectively, χ2 = 4.090, P = 0.043） than in the no-aspirin group. Twelve patients （aspirin group vs. no-aspirin group; 3.6% vs. 2.8%, respectively, χ2 = 0.184, P = 0.668） died at 1-month follow-up, while the number was 18 （4.6% vs. 5.0%, respectively, χ2 = 0.027, P = 0.870） at 12-month follow-up. Hemorrhage occurred in 1 patient （Bleeding Academic Research Consortium [BARC] Type 2） of the aspirin group, and 3 patients （1 BARC Type 2 and 2 BARC Type 5） in the no-aspirin group at 1-month follow-up （ χ2 = 0.005, P = 0.944）. New hemorrhage occurred in five patients in the no-aspirin group at 12-month follow-up. Three patients in the aspirin group while five patients in the no-aspirin group had recurrent dissection for endoleak at 1-month follow-up （2.3% vs. 2.2%, respectively, χ2 = 0.074, P = 0.816）. Four patients had new dissection in the no-aspirin group at 12-month follow-up （2.3% vs. 3.8%, respectively, χ2 = 0.194, P = 0.660）. Each group had one patient with myocardial infarction at 1-month follow-up （0.8% vs. 0.4%, respectively, χ2 = 0.102, P = 0.749） and one more patient in the no-aspirin group at 12-month follow-up. No one had cerebral infarction in both groups during the 12-month follow-up. In the percutaneous coronary intervention （PCI） subgroup, 44 （31.7%） patients had taken dual-antiplatelet therapy （DAPT, aspirin ＋ clopidogrel） and the other 95 （68.3%） patients had taken only aspirin. There was no significant difference in hemorrhage （0% vs. 1.1%, respectively,χ2 = 0.144, P = 0.704）, death （4.8% vs. 4.5%, respectively, χ2 = 0.154, P = 0.695）, myocardial infarction （2.4% vs. 0%, respectively,χ2 = 0.144, P = 0.704）, endoleak, and recurrent dissection （0% vs. 3.4%, respectively, χ2 = 0.344, P = 0.558） between the two groups at 12-month follow-up. Conclusions： The present study indicated that long-term oral low-dose aspirin was safe for patients with both TBAD and coronary heart disease who underwent EVAR. For the patients who underwent both EVAR and PCI, DAPT also showed no increase in hemorrhage, endoleak, recurrent dissection, death, and myocardial infarction.展开更多
Background： The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection （AAD...Background： The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection （AAD） is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and tong-term. Methods： We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher＇s exact test, and continuous parameters were assessed with Student＇s t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis. Results： A total of 884 patients （76.1% male, mean age 51.4 ± 11.8 years） were inchidcd in this study. There were fewer current smokers in female compared with male （ 17.5% vs. 67.2%,χ^2= 160.06, P〈 0.05）. The percentage of men who reported regular alcohol consumption was significantly higher than that in women （40.6% vs. 3.8%, χ^2== 100.18, P 〈 0.05）. About 6.2% （55 of 884） of patients with AAD died before vascular or endovascular surgery was performed, 34.4% （304 of 884） of patients underwent surgical procedures, and 52.7% （466 of 884） and 12.8% （113 of 884） of patients received endovascular treatment and medication, Postoperative mortality similar （6.0% vs. 5.6%, respectively, χ^2= 0.03, P = 0.91） between men and women. Follow-up was completed in 653 of 829 patients （78.8%）. Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme （ACE） inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age （odds ratios [ORs], 1.04; 95% confidence interval [CI], 1.01-1.07; P 〈 0.05）, using of calcium-channel blockers （OR, 0.37： 95% CI, 0.18-0.74; P 〈 0.05）, at discharge were independent predictors of late mortality, ACE inhibitors （OR, 1.91： 95% CI, 1.03-3.54： P = 0.04） was independent risk factor of late mortality.Conclusions： In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term otitcomes.展开更多
文摘BACKGROUND Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically.Secondary coronary artery ostial lesions are rare,and cases reported previously were associated with syphilitic vasculitis and aortic dissection.Here,we report three rare cases of secondary coronary ostial lesions.Due to their rareness,these lesions can easily be neglected,which may lead to misdiagnosis and missed diagnosis.CASE SUMMARY We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions.In Case 1,coronary angiography(CAG)revealed 90%stenosis of the left main coronary ostium.Chest contrast computed tomography(CT)suggested thymic carcinoma invading the left main coronary ostium.Coronary artery bypass grafting and tumor resection were performed.In Case 2,echocardiography revealed a sinus of Valsalva aneurysm(SVA)-like dilatation.CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery(RCA)ostium.Aortic contrast CT confirmed these findings.The Bentall procedure was performed.In Case 3,CT CAG identified an anomalous origin of the right coronary artery(AORCA)from the left sinus of Valsalva coursing between the aorta and pulmonary trunk,causing severe RCA ostium stenosis by compression.Surgical correction of the AORCA was performed.CONCLUSION The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.
文摘Background： Acute aortic dissection is known as the most dangerous aortic disease, with management and prognosis determined as the disruption of the medial layer provoked by intramural bleeding. The objective of this study was to evaluate the safety and necessity of antiplatelet therapy on patients with Stanford Type B aortic dissection （TBAD） who underwent endovascular aortic repair （EVAR）. Methods： The present study retrospectively analyzed 388 patients with TBAD who underwent EVAR and coronary angiography. The primary outcomes were hemorrhage, death, endoleak, recurrent dissection, myocardial infarction, and cerebral infarction in patients with and without aspirin antiplatelet therapy at 1 month and 12 months. Results： Of those 388 patients, 139 （35.8%） patients were treated with aspirin and 249 （64.2%） patients were not treated with aspirin. Patients in the aspirin group were elderly （57.0 ± 10.3 years vs. 52.5 ± 11.9 years, respectively, χ2 = 3.812, P 〈 0.001） and had more hypertension （92.1% vs. 83.9%, respectively, χ2 = 5.191, P = 0.023） and diabetes （7.2% vs. 2.8%, respectively, χ2 = 4.090, P = 0.043） than in the no-aspirin group. Twelve patients （aspirin group vs. no-aspirin group; 3.6% vs. 2.8%, respectively, χ2 = 0.184, P = 0.668） died at 1-month follow-up, while the number was 18 （4.6% vs. 5.0%, respectively, χ2 = 0.027, P = 0.870） at 12-month follow-up. Hemorrhage occurred in 1 patient （Bleeding Academic Research Consortium [BARC] Type 2） of the aspirin group, and 3 patients （1 BARC Type 2 and 2 BARC Type 5） in the no-aspirin group at 1-month follow-up （ χ2 = 0.005, P = 0.944）. New hemorrhage occurred in five patients in the no-aspirin group at 12-month follow-up. Three patients in the aspirin group while five patients in the no-aspirin group had recurrent dissection for endoleak at 1-month follow-up （2.3% vs. 2.2%, respectively, χ2 = 0.074, P = 0.816）. Four patients had new dissection in the no-aspirin group at 12-month follow-up （2.3% vs. 3.8%, respectively, χ2 = 0.194, P = 0.660）. Each group had one patient with myocardial infarction at 1-month follow-up （0.8% vs. 0.4%, respectively, χ2 = 0.102, P = 0.749） and one more patient in the no-aspirin group at 12-month follow-up. No one had cerebral infarction in both groups during the 12-month follow-up. In the percutaneous coronary intervention （PCI） subgroup, 44 （31.7%） patients had taken dual-antiplatelet therapy （DAPT, aspirin ＋ clopidogrel） and the other 95 （68.3%） patients had taken only aspirin. There was no significant difference in hemorrhage （0% vs. 1.1%, respectively,χ2 = 0.144, P = 0.704）, death （4.8% vs. 4.5%, respectively, χ2 = 0.154, P = 0.695）, myocardial infarction （2.4% vs. 0%, respectively,χ2 = 0.144, P = 0.704）, endoleak, and recurrent dissection （0% vs. 3.4%, respectively, χ2 = 0.344, P = 0.558） between the two groups at 12-month follow-up. Conclusions： The present study indicated that long-term oral low-dose aspirin was safe for patients with both TBAD and coronary heart disease who underwent EVAR. For the patients who underwent both EVAR and PCI, DAPT also showed no increase in hemorrhage, endoleak, recurrent dissection, death, and myocardial infarction.
文摘Background： The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection （AAD） is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and tong-term. Methods： We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher＇s exact test, and continuous parameters were assessed with Student＇s t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis. Results： A total of 884 patients （76.1% male, mean age 51.4 ± 11.8 years） were inchidcd in this study. There were fewer current smokers in female compared with male （ 17.5% vs. 67.2%,χ^2= 160.06, P〈 0.05）. The percentage of men who reported regular alcohol consumption was significantly higher than that in women （40.6% vs. 3.8%, χ^2== 100.18, P 〈 0.05）. About 6.2% （55 of 884） of patients with AAD died before vascular or endovascular surgery was performed, 34.4% （304 of 884） of patients underwent surgical procedures, and 52.7% （466 of 884） and 12.8% （113 of 884） of patients received endovascular treatment and medication, Postoperative mortality similar （6.0% vs. 5.6%, respectively, χ^2= 0.03, P = 0.91） between men and women. Follow-up was completed in 653 of 829 patients （78.8%）. Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme （ACE） inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age （odds ratios [ORs], 1.04; 95% confidence interval [CI], 1.01-1.07; P 〈 0.05）, using of calcium-channel blockers （OR, 0.37： 95% CI, 0.18-0.74; P 〈 0.05）, at discharge were independent predictors of late mortality, ACE inhibitors （OR, 1.91： 95% CI, 1.03-3.54： P = 0.04） was independent risk factor of late mortality.Conclusions： In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term otitcomes.
