Preliminary experience with drug-coated balloon angioplasty in primary percutaneous coronary intervention

We evaluated the clinical feasibility of using drugcoated balloon(DCB) angioplasty in patients undergoingprimary percutaneous coronary intervention(PPCI). Between January 2010 to September 2014,89 STelevation myocardial infarction patients(83% male,mean age 59 ± 14 years) with a total of 89 coronary lesions were treated with DCB during PPCI. Clinical outcomes are reported at 30 d follow-up. Left anterior descending artery was the most common target vessel for PCI(37%). Twenty-eight percent of the patients had underlying diabetes mellitus. Mean left ventricular ejection fraction was 44% ± 11%. DCB-only PCI was the predominant approach(96%) with the remaining 4% of patients receiving bail-out stenting. Thrombolysis in Myocardial Infarction(TIMI) 3 flow was successfully restored in 98% of patients. An average of 1.2 ± 0.5 DCB were used per patient,with mean DCB diameter of 2.6 ± 0.5 mm and average length of 23.2 ± 10.2 mm. At 30-d follow-up,there were 4 deaths(4.5%). No patients experienced abrupt closure of the infarctrelated artery and there was no reported target-lesion failure. Our preliminary experience showed that DCB angioplasty in PPCI was feasible and associated with a high rate of TIMI 3 flow and low 30-d ischaemic event.

Acute myocardial infarction: Clinical features and outcomes in young adults in Singapore

AIM: To investigate the clinical features and in-hospital outcomes of young adults with acute myocardial infarction (AMI) in Singapore. METHODS: Between January 2005 to September 2010, 333 consecutive patients aged ≤ 45 years old were diagnosed to have AMI at our institution. As Singapore is a multi-ethnic society, we also analysed whether ethnic differences exist between the three dominant ethnic groups, Malay, Chinese and Indian with regards to the clinical features. Clinical data was collected retrospectively on demographic characteristics, presenting signs and symptoms, blood investigation, angiographic findings and in-hospital clinical outcomes. RESULTS: The mean age at presentation was 40.2 ± 4.0 years with male predominance (94%). The majority of patients were Chinese (51%) followed by Indians (31%) and Malays (18%). The most common risk factor was smoking (74%) followed by hypertension (28.5%) and hyperlipidemia (20.0%). 37% of patients were obese. The majority of patients had single vessel disease (46%) on coronary angiography. The mean total cholesterol, low-density lipoprotein and highdensity lipoprotein levels were 5.6±1.2 mmol/L, 3.8±1.1 mmol/L and 0.93±0.25 mmol/L respectively. The mean left ventricular function was 44%±10% with the incidence of heart failure 3% and cardiogenic shock 4.5%. Overall in-hospital mortality was low with 4 deaths (1.2%). For ethnic subgroup analysis, Indians have a 3-fold risk of developing premature AMI when compared to other ethnic groups. CONCLUSION: Young AMI patients in Singapore are characterized by male predominance, high incidence of smoking and obesity. Overall in-hospital clinical outcomes are favourable. Among the 3 ethnic groups, Indians have the highest risk of developing premature AMI.

Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST- elevation myocardial infarction

Objective To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary pereutaneous coronary intervention （PPCI）. Methods From January 2009 to December 2012, 1268 patients （86.4% male, mean age of 58,4 ± 12.2 years） presented to our hospital for ST-elevation myocardial infarction （STEMI） and underwent PPCI. They were divided into two groups： elderly group defined as age _〉 70 years and non-elderly group defined as age 〈 70 years. Data were collected retrospectively on baseline clinical characteristics, door-to-balloon （D2B） time, angiographic findings, therapeutic modality and hospital course. Results The elderly group constituted 19% of the study population with mean age 76.6 ± 5.0 years. There was a higher proportion of female gender and ethnic Chinese patients in the elderly group when compared with the non-elderly group. The former was less likely to be smokers and have a significantly higher prevalence of hypertension. The mean D2B time was significantly longer in the elderly group. They also had a significantly higher incidence of triple vessel disease and obstructive left main disease. The use of radial artery access, glyeoprotein 2b/3a inhibitors and drug-eluting stents during PPCI were also significantly lower. In-hospital mortality was significantly higher in the elderly group. The rate of cardiogenic shock and inhospital complications were also significantly higher. Conclusions Our registry showed that in-hospital mortality rate in elderly South-East Asian patients undergoing PPCI for STEMI was high. Further studies into the optimal STEMI management strat- egy for these elderly patients are warranted.

Left ventricular pseudoaneurysm

A 72-year-old elderly male smoker with a known history of hypertension presented with a six day history of chest pain. His blood pressure at presentation was 110/70 mmHg and there was no audible murmur. ECG showed Q waves in the inferior leads （Figure IA） and troponin level was elevated （14 /.tg/L）.

Isolated right coronary artery bypass grafting via minimally invasive approach in two elderly patients with failed percutaneous coronary intervention

Coronary artery bypass grafting(CABG)tra-ditionally involves revascularization of the left anterior descending artery(LAD)as it is usually of greater prognostic value.[1]Isolated CABG for non-LAD lesions have also been descri-bed in literature.However,these were often in the setting of re-do CABG[2,3]or in patients with isol-ated right sided coronary lesion and concomitant valvular heart disease.