Self-management of coronary heart disease in older patients after elective percutaneous transluminal coronary angioplasty

Objective To explore how older patients self-manage their coronary heart disease （CHD） aider undergoing elective percutaneous transluminal coronary angioplasty （PTCA）. Methods This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients （n = 93） approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings in- formed the purposive samplhag for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualita- tive data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants （n = 47） classified as 65 years of age or older. Results 78.7% （n = 37） of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% （n = 16） thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% （n = 19） would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less （P = 0.02） and smoked less （P = 0.01） than their younger counterparts in the study. Age did not seem to affect PTCA patients＇ likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption （P = 0.237）. Conclusions The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants＇ likelihood to alter lifestyle factors.

Application of GlycoProtein IIb/IIIa antagonist( Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese

Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then maintained at 2μg/kg·min for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 seconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the pre and post procedure value of PT and platelet count. KPTT was significantly higher than pre procedure value at 2 hours after the procedure .No recurrence of angina pectoris was observed in the first nine patients within one year follow up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPIIb/IIIa receptor antagonist (Integrilin) in peri percutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.

Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS

Long Term Clinical and Angiographic Outcome Following Percutaneous Transluminal Angioplasty and Stent Placement for Iliac and Femoral Artery Stenosis

Objective This study reportsthe initial and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac and femoral arteries. Methods and Results From December 1994 to March 1997, we performed iliac and femoral artery angioplasty and primary intravascular stent placement in 37 vessel of 33 patients (19 men and 14 women; mean age, 70. 5 years). A total of 43 self - expanding Wallstents (Boston, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Clinical follow - up was available for all patients at a mean of 26±14months. All patient clinical is-chemic category (claudication or rest pain) was improved. Angiographic follow - up was completed for 17 of 23 patients at a mean follow-up of 10±5 months, The iliac artery restenosis rate was 0(0/8). The femoral artery restenosis rate was 33 % (3/9), All 3 patients underwent repeat balloon angioplasty successfully. Conclusion The iliac and femoral arteries can be performed and reasonable early and late patency rates.

Safety and efficacy of dalteparin in percutaneous coronary intervention in Chinese patients with non-ST-elevation acute coronary artery syndromes： comparison with unfractionated heparin

Objective To prospectively evaluate the safety and therapeutic efficacy ofdalteparin in patients with high risk non-ST- elevation acute coronary syndromes （ACS） during percutaneous coronary intervention （PCI）. Methods A total of 175 patients with high risk non-ST-elevation ACS were randomly assigned to 2 groups [dalteparin group and unfractionated heparin （UFH） group]. The patients in dalteparin group were given dalteparin at a dose of 5,000U subcutaneously soon after diagnosis and then an additional 60U/ kg intravenous bolus ofdalteparin before emergent PCI. Vascular access sheaths were removed immediately after PCI or coronary artery angiography; the patients in UFH group were given UFH intravenously at a dose of 25mg just before PCI and an additional 65mg bolus was administered if angiographic findings showed that the patients were suitable for percutaneous transluminal coronary angioplasty （PTCA）. Sheaths were removed at 4-6 hours after PCI; Results Eighty-three patients in dalteparin group underwent PCI while 82 patients in UFH group underwent PCI; anti-Xa activities of 52 patients in daltepafin group were measured. The average anti-Xa activity was （0. 83± 0.26） U/ml at 15 minutes after intravenous injection of dalteparin and anti-Xa〉0.SU/ml was obtained in 96.1% of the patients; hematomas at puncture sites were significantly fewer in dalteparin group as compared with UFH group （2.3% vs 9.2%, P 〈 0.05）; none of the patients in 2 groups suffered major bleeding events. No death, acute arterial reocclusion or emergent revascularization events occurred at 30 days after PCI. Conclusions Our study demonstrated that early subcutaneous injection ofdalteparin at a dose 5,000U after diagnosis and an additional 60U/kg intravenous bolus ofdalteparin before PCI is safe and efficacious for patients with high risk non-ST-elevation ACS undergoing emergent PCI.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Retrospective analysis of percutaneous transluminal coronary angioplasty and coronary stenting

Objective To examine long term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy Methods A total of 790 patients who underwent successful PTCA and PTCA+stent in this hospital were followed by direct interview or letter The rate of follow up was 84 2% and the period of follow up was 0 9-12 7 (3 5±2 4) years Results During follow up, 4 (0 5%) patients died, 22 (2 8%) had nonfatal acute myocardial infarction, 10 (1 3%) had coronary artery bypass surgery, and 98 (12 4%) had repeat PTCA The rate of recurrent angina pectoris was 31 1% The cardiac event free survival rate calculated by the Kaplan Meier method was 88 2% at 1 year and 80 6% at 12 7 years Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events Compared to the PTCA group, patients with PTCA+stent had significantly lower rates of total cardiac events Conclusion The long term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA+stent therapy should be the major treatment for revascularization in patients with coronary heart disease

Optimizing care for ST-elevation myocardial infarction patients： application of systems engineering

Timely reperfusion for patients with an ST-elevation myocardial infarction （STEMI） reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significantly lower early and late mortality, while conversely, any delay in reperfusion has a deleterious effect on morbidity and mortality.

Specialty Balloons and Vessel Prepping in Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a global disease that affects more than 200 million individuals worldwide with an ever-increasing prevalence rate from year to year. Peripheral Artery Disease treatments include everything from lifestyle interventions to surgical revascularization or percutaneous angioplasty (PTA). Percutaneous Angioplasty (PTA) has become the primary treatment for this disease with the use of focal force and scoring balloons for vessel prepping. The practice of vessel prepping looks to limit the effect of angioplasty on vessel dissection and recoiling in the infrainguinal region during the treatment of plaque buildup in the vessel. Plaque morphology and rise in incidence of in-stent restenosis can determine which balloon device is best used when restoring a vessel. Some of the different brands we review in this chapter include Peripheral Cutting Balloons by Boston Scientific, Chocolate PTA by Medtronic, Angiosculpt balloon by Philips, and VascuTrak by BARD. In review of Angiosculpt balloon by Philips: The study concluded that the one-year data supports the notion that the AngioSculpt Scoring Balloon is an effective and safe treatment option for infrapopliteal, atherosclerotic lesions in patients with critical limb ischemia. Whereas: Peripheral cutting balloons (PCBs) by Boston Scientific have been used for in-stent restenosis, resistant lesions, small vessels, bifurcations, aortaostial lesions, and saphenous vein graft lesions. This chapter will discuss different focal force and scoring balloon devices available to treat different plaque morphology and usefulness for in-stent restenosis resolution. We will review the evidence associated with each brand of device and the factors that should be accounted for before making a decision on which to use for your patient.

Hepatic venous outflow obstruction after piggyback liver transplantation by an unusual mechanism:Report of a case

Hepatic venous outflow obstruction after piggyback liver transplantation is a very rare complication. An unusual mechanism aggravating it is reported. A 33-year-old man with end-stage hepatitis B liver cirrhosis underwent a piggyback orthotopic liver transplantation using a full-size cadaveric graft. Two months after transplantation, he developed gross ascites refractory to maximal diuretic therapy. Doppler ultrasound showed patent portal and hepatic veins. Serial computed tomography scans revealed a hypoperfused right posterior segment of the liver which subsequently underwent atrophy. Hepatic venography demonstrated a high-grade stenosis with an element of torsion of venous drainage at the anastomosis. The stenosis was successfully treated with repeated percutaneous balloon angioplasty. The patient remained asymptomatic six months afterwards with complete resolution of ascites and peripheral edema. We postulate that liver allograft segmental hypoperfusion and atrophy may aggravate or result in a hepatic venous outflow problem by the mechanism of torsion effect. Percutaneous balloon angioplasty is a safe and effective treatment modality for anastomotic stenosis.

Percutaneous Balloon Angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months： Medium- to Long-term Follow-up

Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.

EXPERIMENTAL WORK AND RESEAROHThe Experimental Study of Xue Guan Tong (血管通)on Preventing Restenosis after Percutaneous Transluminal Angioplasty

The effect of Xue Guen Tong (XGT) granule in preveriting restenosis of atherosclerotic iliacartery after percutaneous transluminal angioplasty (PTA) in rabbits was studied. Forty-two purebred NewZealand rabbits with their endothelium of iliac arteries denuded and fed with high cholesterol diet for sixweeks to form the model of atheresclerotic stenosis. After PTA, the high cholesterol diet was stopped imme-diately and they were divided into 3 groups randomly. the XGT group, the lovastatin group and the controlgroup. Arterial angiogreph and pathological observation were carried out 4 weeks after PTA. The resultesbewed that ( 1 ) The luminal diameter of artery was 1 . 82 0. 46mm in the XGT group, 0 . 96 0. 71mm in thelovastetin grcxjp and 0. 71 0 . 53mm in the control group. The former one was larger than the latter two sig-nificantly ( P< 0. 01 ) . (2) Thickness of intima of artery was 0 . 27 0 . 40mm in the XGT group, it was thinnerthan those in the other two groups (O. 43 0. 04mm in the lovastatin group arid 0. 48 0. 10mm in the controlgroup) . (3) In XGT group, the smooth muscle cells ( SMCs) contained fewer organelles. more muscular fibersand were well differentiated than in the other two groups. The conclusion was XGT has the preventive effecton past-PTA arterial restenosis in rabbits.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ITS SUCCESS RATE AND AFFECTING FACTORS

From December 1987 to October 1983, percutaneous transluminal coronary angioplasty (PTCA) was performed in 302 patients with 392 diseased vessels and 440 lesions. The success rate was 93.71% in 302 patients, 94.90% in 392 diseased vessels and 95.00% in 440 lesions. The success rate was 98.92% in Type A lesion, 95.71% in Type B lesion, and 86.57% in Type C lesion (A vs B P=NS, A vs C P<0.01). There were 55 lesions with total or subtotal occlusion, the success rate was 89.09% (93.10% in Type B lesion and 84.62% in Type C lesion). As to the diseased vessels, the success rate was 95.65% in LAD, 94.38% in LCX and 93.75% in RCA. The results showed no significant difference. In this series, acute ischemic complications were found in 6.59% (29 / 440). Of these 29 lesions, 23 were treated successfully, 5 developed Q wave myocardial infarction and 1 died.

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery:A case report

BACKGROUND Aberrant right subclavian artery(ARSA)is the most common congenital anomaly of the aortic arch.When patients having such anomalies receive transradial intervention(TRI),aortic dissection(AD)may occur.Herein,we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient,that was later salvaged by percutaneous angioplasty.CASE SUMMARY A 73-year-old man presented to our hospital with intermittent chest pain.Coronary computed tomography(CT)angiography revealed significant stenosis in the left anterior descending artery.Diagnostic coronary angiography was performed via the right radial artery without difficulty.However,we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention,while the guidewire tended to go down the descending aorta.The patient suddenly complained of chest and back pain.Emergent CT aortography revealed type B AD propagating to the left renal artery(RA)with preserved renal perfusion.However,after 2 d,the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable.Follow-up CT indicated further progression of dissection to the right external iliac artery(EIA)and left RA with limited flow.We performed percutaneous angioplasty of the right EIA and left RA without complications.Follow-up CT aortography at 8 mo showed optimal results.CONCLUSION A caution is required during right TRI in ARSA to avoid AD.Percutaneous angioplasty can be a treatment option.

Sequential treatment for diabetic foot ulcers in dialysis patients:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.

Prognostic indicator by urinary microglobulin after renal stenting

Objective To evaluate the effect of revascularization of the renal artery on urinary microglobulin in patients with coronaryartery disease and significant renal artery stenosis(RAS).Methods Forty-four patients with coronary artery disease and severe RAS(luminal narrowing>70%)underwent percutaneous transluminal renal artery angioplasty(PTRA)and stenting,as well as percutaneous coronary intervention.The urine-microglobulin(α_(1)-MG)andβ_(2)-Cmicroglobulin(β_(2)-MG)at baseline and at 3 months after the procedures were measured.Procedural success rate,procedural complications,serum creatinine concentration at baseline and at 3-months were also recorded.Results At 3-months after the renal revascularization therapy,there was no significant change of urineα_(1)-MG ompared with that of the baseline,however,the urineβ_(2)-MG decreased significantly 3-months after the treatment(237±187μg/L vs 377±173μg/L,P<0.01).Multivariate analysis revealed that persistent elevation of urine was an independent predictor of severe events(including re-admission and renal failure)after renal revascularization therapy in patients with severe RAS(OR=3.01,95%CI 1.01-8.95,P=0.036).Conclusions In patients with coronary artery disease and severe RAS,revascularization with PTRA and stenting may improve renal tubular function,but a continuous high level of urinary microglobulins after intervention is associated with more frequent re-hospitalization and renal failure.

PERCUTANEOUS TRANSLUMINAL EXCIMER LASER CORONARY ANGIOPLASTY CLINICAL REPORT OF SIX CASES

Six patients with 95% to 100% occluded atheroseleroticlesions underwent percutaneous transluminal excimer lasercoronary angioplasty (PTELCA). Among them, 5 were maleand ! was female; their age ranged from 28 to 66 years. Fourpatients had LAD stenosis and 2 LCX lesions.Acuteangiographic and clinical success was achieved in all patientsbut one, with a success rate Of 83.3%. It was demonstratedthat PTELCA is a safe and effective therapy for selected pa-tients with coronary artery disease.

Direct Coronary Intervention Therapy in Patients with Acute Myocardial Infarction

Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.

Plaque increase may be an important contributor to late restenosis after percutaneous transluminal coronary balloon angioplasty

There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodologically limited since it can not differentiate these different mechanisms. For evaluating the contribution of vessel and plaque changes after PTCA, we analyzed serial intravascular ultrasound (IVUS) studies in 59 lesions. IVUS study (3.5 F, 20 MHz catheter, Boston Scientific Co,; Hewlett Packard console) was performed immediately after PTCA (POST), and at follow up (FU, 6±1 months). At follow up, 40 lesions (Group Ⅰ) did not show restenosis and 19 (32.2%) lesions (Group Ⅱ) developed restenosis (area Department of Cardiology, University of Essen, Essen, Germany (Liu FQ, Ge JB, Baumgart D, Grge G, Haude M and Erbel R) stenosis >50%). Cross sectional vessel area (VA, mm 2), plaque area (PA, mm 2), and percent area stenosis (A%) were measured. [BHDFG1*2,WK3,WK5,WK11,WK11W]GROUP Ⅰ (±s)GROUP Ⅱ (±s) [BHDZ,WK3ZQ,WK5ZQ,WK11,WK11ZQ2W]VAPOST18.1±4.919.1±5.6FU17.7±4.618.9±6.2PAPOST9.9±3.212.0±4.7 *FU10.2±3.415.4±5.0 * A%POST55.6±7.568.4±6.3 *FU58.4±8.781.6±3.4 * * P <0.05, Group I vs Group II. In summary, plaque increase contributed significantly to late restenosis. This may be partly due to “recovery” of the plaque from redistribution (induced by balloon compression) and/or partly due to intimal proliferation. Greater residual plaque burden was also related to higher possibility of rstenosis.

Clinical and angiographic significance of exercise induced ST-segment elevation in patients without previous myocardial infarction

Objective To study the clinical significance of exercise-induced ST-segment elevation(STE)in patients without previous myocardial infarction(MI). Methods Ten patients without previous MI who developed STE during exercise testing were underwent coronary angiography, left ventriculography and rest electrocardiography, and Bruce protocol were used during exercise test. Results The incidence of exercise induced STE in patients without previous MI was 0.28%(10/3564). One of the 10 patients had only a mild coronary lesion (stenosis < 35%in diameter) in left anterior descending artery, but she developed an acute myocardial infarction 4 weeks after coronary angiography,and the leads of myocardial infarction and the leads of exercise induced STE elevation were same, the others all had severe coronary stenosis(90%～100%). There was a good correlation between leads of ST segment elevation and ischemic related artery. Nine patients received invasive therapy. During a period of 28 months (range 8 to 48 months) of follow up, 2 of them received PTCA again at 11 and 19 months after their discharge, prospectively. Conclusions The findings indicats ST elevation during exercise is a specific marker of severe transmural regional ischemia and should be an indication for coronary angiography. Most patients with exercise induced ST segment elevation have critical organic stenosis of the ischemic-related coronary artery and are candidates for myocardial revascularization. In a few patients, ST segment elevation during exercise may be caused by coronary artery spasm in the absence of significant organic lesions, and they may have a poor prognosis.