BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an...BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an electrocardiogram is considered to be the most important method for determining the infarct-related artery,and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy.In this case,an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.CASE SUMMARY A 96-year-old woman presented with acute chest pain showing precordial STsegment elevation with dynamic changes.Myocardial injury markers became positive.Coronary angiography indicated acute total occlusion of the proximal nondominant RCA,mild atherosclerosis of left anterior descending artery and 75%stenosis in the left circumflex coronary artery.Percutaneous coronary intervention was conducted for the RCA.Repeated manual thrombus aspiration was performed,and fresh thrombus was aspirated.A 2 mm×15 mm balloon was used to dilate the RCA with an acceptable angiographic result.The patient’s chest pain was relieved immediately.A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation.The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed.Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum(ejection fraction of 54%),and the right ventricle was slightly dilated.The patient was asymptomatic during the 9-mo follow-up period.CONCLUSION Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)pandemic unmasked the huge deficit in healthcare resources worldwide.It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.A...BACKGROUND Coronavirus disease 2019(COVID-19)pandemic unmasked the huge deficit in healthcare resources worldwide.It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.AIM To study the applicability of the old,available and affordable nonconventional biomarkers:albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome(ACS).METHODS In this prospective,observational study,166 consecutive patients with ACS were enrolled.Fibrinogen,albumin and their ratio were determined from serum.Patients with underlying chronic liver disease,active malignancy,autoimmune disease,active COVID-19 infection and undergoing thrombolysis were excluded.RESULTS Mean age of the population was 60.5±1.5 years,74.1%being males.ST elevation myocardial infarction(STEMI)was most common presentation of ACS seen in 57%patients.Fibrinogen albumin ratio(FAR)≥19.2,had a sensitivity of 76.9%and specificity of 78.9%[area under the receiver operating characteristic curves(AUROC)=0.8,P=0.001]to predict≤thrombolysis in myocardial infarction(TIMI)1 flow in culprit artery in STEMI patients.Even in non-STEMI patients,FAR≥18.85 predicted the same with 80%sensitivity and 63%specificity(AUROC=0.715,P=0.006).CONCLUSION Novel biomarkers,with their high cost,lack of availability and long turn over time are impractical for real-world use.Identifying≤TIMI 1 flow in the culprit artery has significant impact of management and outcome.Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy.This allows risk-stratification and individualization of treatment in ACS.展开更多
A 53-year-old male with chest pain complicated with cardiogenic shock was presented to the emergency department. The electrocardiogram showed features of acute myocardial infarction due to left main coronary artery oc...A 53-year-old male with chest pain complicated with cardiogenic shock was presented to the emergency department. The electrocardiogram showed features of acute myocardial infarction due to left main coronary artery occlusion,and minor ST-segment deviations followed by tall T waves in precordial leads with concomitant left anterior fascicular block. Emergency coronary angiogram revealed left main coronary artery complete occlusion without collateral circulation. Percutaneous intervention of the left main coronary artery was then carried out. The ECG features of a left main occlusion were discussed with this case report.[S Chin J Cardiol 2019;20(3):197-200]展开更多
目的:探讨经桡动脉介入治疗术后发生桡动脉急性闭塞的危险因素。方法:连续入选我院2017年6月至2018年5月经桡动脉入路进行经皮冠状动脉造影或者介入治疗的患者845例,根据是否发生桡动脉急性闭塞,分为桡动脉闭塞组(n=46)和非桡动脉闭塞组...目的:探讨经桡动脉介入治疗术后发生桡动脉急性闭塞的危险因素。方法:连续入选我院2017年6月至2018年5月经桡动脉入路进行经皮冠状动脉造影或者介入治疗的患者845例,根据是否发生桡动脉急性闭塞,分为桡动脉闭塞组(n=46)和非桡动脉闭塞组(n=799)。采集患者临床资料并进行统计学分析。结果:桡动脉急性闭塞发生率为5.4%(46/845)。桡动脉闭塞组患者的年龄及女性、高血压、糖尿病及高甘油三酯血症的患者比例均高于非桡动脉闭塞组(P均<0.05);桡动脉闭塞组的术后桡动脉置管时间较非桡动脉闭塞组明显延长[41.1(25.5,60.8) h vs 19.9(10.3,26.6) h,P<0.05)。多因素Logistic分析显示,年龄>60岁(OR=4.415,95%CI:2.718~7.172,P<0.001)、桡动脉穿刺置管时间> 20 h(OR=3.078,95%CI:2.332~4.064,P<0.001)、糖尿病(OR=2.855,95%CI:1.286~6.336,P=0.010)为桡动脉闭塞独立危险因素。结论:高龄、糖尿病患者、穿刺置管时间过长均易造成桡动脉急性闭塞,是发生桡动脉闭塞的预测因素。展开更多
基金Natural Science Basic Research Program of Shaanxi Province,No.2020JQ-939.
文摘BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an electrocardiogram is considered to be the most important method for determining the infarct-related artery,and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy.In this case,an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.CASE SUMMARY A 96-year-old woman presented with acute chest pain showing precordial STsegment elevation with dynamic changes.Myocardial injury markers became positive.Coronary angiography indicated acute total occlusion of the proximal nondominant RCA,mild atherosclerosis of left anterior descending artery and 75%stenosis in the left circumflex coronary artery.Percutaneous coronary intervention was conducted for the RCA.Repeated manual thrombus aspiration was performed,and fresh thrombus was aspirated.A 2 mm×15 mm balloon was used to dilate the RCA with an acceptable angiographic result.The patient’s chest pain was relieved immediately.A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation.The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed.Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum(ejection fraction of 54%),and the right ventricle was slightly dilated.The patient was asymptomatic during the 9-mo follow-up period.CONCLUSION Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.
基金American college of Cardiology,No.3445007European society of Cardiology,No.1036629.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)pandemic unmasked the huge deficit in healthcare resources worldwide.It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.AIM To study the applicability of the old,available and affordable nonconventional biomarkers:albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome(ACS).METHODS In this prospective,observational study,166 consecutive patients with ACS were enrolled.Fibrinogen,albumin and their ratio were determined from serum.Patients with underlying chronic liver disease,active malignancy,autoimmune disease,active COVID-19 infection and undergoing thrombolysis were excluded.RESULTS Mean age of the population was 60.5±1.5 years,74.1%being males.ST elevation myocardial infarction(STEMI)was most common presentation of ACS seen in 57%patients.Fibrinogen albumin ratio(FAR)≥19.2,had a sensitivity of 76.9%and specificity of 78.9%[area under the receiver operating characteristic curves(AUROC)=0.8,P=0.001]to predict≤thrombolysis in myocardial infarction(TIMI)1 flow in culprit artery in STEMI patients.Even in non-STEMI patients,FAR≥18.85 predicted the same with 80%sensitivity and 63%specificity(AUROC=0.715,P=0.006).CONCLUSION Novel biomarkers,with their high cost,lack of availability and long turn over time are impractical for real-world use.Identifying≤TIMI 1 flow in the culprit artery has significant impact of management and outcome.Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy.This allows risk-stratification and individualization of treatment in ACS.
文摘A 53-year-old male with chest pain complicated with cardiogenic shock was presented to the emergency department. The electrocardiogram showed features of acute myocardial infarction due to left main coronary artery occlusion,and minor ST-segment deviations followed by tall T waves in precordial leads with concomitant left anterior fascicular block. Emergency coronary angiogram revealed left main coronary artery complete occlusion without collateral circulation. Percutaneous intervention of the left main coronary artery was then carried out. The ECG features of a left main occlusion were discussed with this case report.[S Chin J Cardiol 2019;20(3):197-200]
文摘目的:探讨经桡动脉介入治疗术后发生桡动脉急性闭塞的危险因素。方法:连续入选我院2017年6月至2018年5月经桡动脉入路进行经皮冠状动脉造影或者介入治疗的患者845例,根据是否发生桡动脉急性闭塞,分为桡动脉闭塞组(n=46)和非桡动脉闭塞组(n=799)。采集患者临床资料并进行统计学分析。结果:桡动脉急性闭塞发生率为5.4%(46/845)。桡动脉闭塞组患者的年龄及女性、高血压、糖尿病及高甘油三酯血症的患者比例均高于非桡动脉闭塞组(P均<0.05);桡动脉闭塞组的术后桡动脉置管时间较非桡动脉闭塞组明显延长[41.1(25.5,60.8) h vs 19.9(10.3,26.6) h,P<0.05)。多因素Logistic分析显示,年龄>60岁(OR=4.415,95%CI:2.718~7.172,P<0.001)、桡动脉穿刺置管时间> 20 h(OR=3.078,95%CI:2.332~4.064,P<0.001)、糖尿病(OR=2.855,95%CI:1.286~6.336,P=0.010)为桡动脉闭塞独立危险因素。结论:高龄、糖尿病患者、穿刺置管时间过长均易造成桡动脉急性闭塞,是发生桡动脉闭塞的预测因素。
