Left main trunk coronary artery dissection as a consequence of inaccurate coronary computed tomographic angiography.

A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations.

Coronary chronic total occlusion.

Chronic total coronary occlusions (CTOs) are a frequent finding in patients with coronary disease and remain one of the most challenging target lesion subsets for intervention. CTOs have been reported in approximately one-third of patients undergoing diagnostic coronary angiography. By nature of their complexity, CTO percutaneous interventions (PCIs) are associated with lower rates of procedural success, higher complication rates, greater radiation exposure, and longer procedure times compared with interventions in non-CTO stenoses.

Bare metal stent thrombosis 13 years after implantation.

There has been a great deal of recent controversy regarding the risk of very late stent thrombosis with drug eluting stents, especially in the context of antiplatelet therapy cessation. We report a case of very late stent thrombosis of a bare metal stent initially implanted for treatment of a myocardial infarction. The patient presented thirteen years later with a recurrent myocardial infarction three days after discontinuing aspirin.

Pharmacologic therapy for coronary atherosclerosis in patients with Type 2 diabetes mellitus.

Accelerated progression of coronary atherosclerosis underlies the heightened cardiovascular risk observed in diabetic patients. As the worldwide prevalence of diabetes escalates in association with the incidence of abdominal obesity, the global burden of cardiovascular disease will continue to rise. Therapeutic strategies that have had the greatest cardiovascular benefit in diabetes have focused on lowering LDL-cholesterol and blood pressure, rather than glucose-lowering specifically.

Late diagnosis of multiple fibroelastomas in a 41-year-old woman with hypertrophic cardiomyopathy and atrial fibrillation.

A 39 year old woman with hypertrophic cardiomyopathy with severe latent obstruction and mitral regurgitation, presented with symptoms of dyspnea and atrial fibrillation, and developed an acute embolic stroke. After thrombolysis and complete neurologic recovery, a transesophageal echo revealed six mobile densities, on her mitral and aortic valves, and in the outflow tract. Surgical resection of multiple fibroelastomas, with septal myectomy, aortic and mitral valve replacement, and pulmonary vein ablation, led to clinical improvement.

Long-term impact of drug-eluting stents versus bare-metal stents on all-cause mortality.

Objectives: Our purpose was to examine the incidence of all-cause mortality among drug-eluting stents (DES) and bare-metal stents (BMS) while adjusting for many confounding factors generally not considered in prior studies.

Background: DES use in the U.S.

Brain natriuretic peptides as biomarkers for atherosclerosis.

Identification of atherosclerotic risk factors provides targets for development of preventive therapies. Risk factor assessment permits evaluation of an individual's prospective risk of coronary heart disease (CHD). However, it has become apparent that traditional risk factors may not predict CHD in some patients.

Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients.

Coronary artery bypass grafting (CABG) has been the recommended treatment for patients with significant left main coronary artery (LMCA) stenosis. Advances in stent technology have invigorated investigations into the suitability of a percutaneous approach for these patients. Favorable short-term results from nonrandomized comparisons were previously reported.

The role of clopidogrel in the management of ischemic heart disease.

Purpose Of Review: Platelet inhibition remains a key component in the prevention and treatment of ischemic heart disease. This review documents recent advances in the use of clopidogrel for the management of myocardial ischemia.

Recent Findings: For the prevention of ischemic heart disease, the addition of clopidogrel is not superior to aspirin alone at reducing short or long-term major adverse cardiac events.

Elevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with acute coronary syndromes: results from 4 large clinical trials.

Background: The degree to which elevated creatine kinase (CK)-MB in the presence of normal CK is predictive of outcome is not well understood despite having been studied for decades. This analysis examined whether normal CK with elevated CK-MB in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) is an independent predictor of worse outcomes. A concomitant goal was to contribute insight to the debate over how patients with NSTE ACS should be managed.

Clinical use of enoxaparin in the management of non-ST segment elevation acute coronary syndromes.

Enoxaparin (Lovenox; Roule-Poulenc Rorer, Inc.), a low molecular weight heparin (LMWH), is commonly used in the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) based on clinical trial outcomes. It is one of a group of glycosaminoglycan compounds that accelerate the inactivation of factor Xa by inducing a conformational change in antithrombin.