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Background The advantage of using bioresorbable-polymer drug-eluting stent (BP-DES) compared with second-generation durable-polymer drug-eluting stent (2G DP-DES) still remains controversial in clinical situations. The purpose of this study to evaluate the degree of re-endothelialization and the prevalence of high-grade yellow-colored plaque (YCP), which might concern arterial healing after BP-DES and 2G DP-DES implantation using a high-resolution coronary angioscopy (CAS). Methods In total, 104 DESs (52: 2G DP-DES and 52: BP-DES) were prospectively observed using CAS 12 ± 1 months after coronary intervention. The grade of neointimal coverage (NIC) over the stent was scored on a 4-point scale from 0 (no coverage) to 3 (complete coverage). YCP grade was also scored on a 4-point scale as 0 (white) to 3 (intensive yellow). High-grade YCP was defined as maximum grade ≥2. Moreover, the prevalence of high-grade YCP and the incidence of thrombus were investigated. Results BP-DES revealed better dominant NIC grade and less NIC heterogeneity than 2G DP-DES (p = 0.0001 and p = 0.015, respectively). The prevalence of high-grade YCP was lower for BP-DES than for 2G DP-DES (p = 0.05). However, the incidence of thrombus was not significantly different (p = 0.41). Multivariate analysis identified that low-density lipoprotein cholesterol levels [odds ratio (OR), 1.03; 95% Confidence Interval (CI): 1.01–1.06, p = 0.01] and the usage of BP-DES [OR, 0.36; 95% CI: 0.14–0.91, p = 0.03] as independent predictors of high-grade YCP. Conclusions Compared with 2G DP-DES, BP-DES was less heterogeneous and well-covered NIC and less prevalence of the high-grade YCP implying optimal arterial healing.

A 40-year-old man with progressively worsening dyspnea was admitted to our hospital. On physical examination, pulse oximetry results demonstrated 80% oxygen saturation in room air. The lungs sounded clear, and both extremities appeared normal, without pitting edema. His echocardiography revealed a pressure overload in the right ventricle. Suspecting the presence of pulmonary thromboembolism, we performed an enhanced computed tomography (CT). CT results revealed systemic venous thromboembolism (VTE) involving the superior mesenteric vein, inferior vena cava (IVC), right common iliac vein and pulmonary arteries, as well as splenomegaly and edema of the small intestine with ascites. After insertion of a retrievable IVC filter, we prescribed 10 mg of apixaban twice daily for the first 7 days, followed by 5 mg twice daily as long-term therapy. Confirming no exacerbation of the VTE symptoms, we removed the IVC filter 14 days after admission. Additionally, hereditary antithrombin deficiency was unraveled as the etiology of systemic VTE. Although an enhanced CT at 6 months follow-up showed that almost all previous VTE had dissolved, we decided to prescribe apixaban indefinitely. Fortunately, he has not experienced a recurrence of VTE or any bleeding events to date.

Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal "jailed" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.

A 72-year-old male with sudden onset pain and coldness in his left lower limb was referred to our hospital. An emergency angiography of the lower limbs demonstrated the cause of acute limb ischemia as a subsequent acute thromboembolism at the site of a narrowing anastomosis of femoral-popliteal bypass (FPB). In particular, the site of the narrowing anastomosis had already been fixed using a nitinol stent 4 years previously. We confirmed that the severe stent fracture resulted from misalignment. After local lysis therapy, we decided to deploy another nitinol stent to in-stent restenosis (ISR) lesion of the stent fracture. Final angiography confirmed full patency in FPB without flow delay. Additionally, to maintain the patency of arterial flow, we prescribed aspirin and warfarin. After 2 years of operation, his follow-up ankle-brachial pressure index on the left side remained 0.86 and no ischemic leg pain was observed to date. Stent-in-stent procedure using another nitinol stent for ISR treatment for the narrowing anastomosis in FPB indicated feasible and effective results. .

Purpose The purpose of this study was to identify predictors of contrast-induced acute kidney injury (CI-AKI) and the effect of CI-AKI on cardiovascular outcomes after hospital discharge in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods and Materials We retrospectively reviewed 194 STEMI consecutive patients who underwent primary PCI to evaluate the predictors for CI-AKI and 187 survivors to examine all-cause mortality and cardiovascular events. Outcomes were compared between patients with CI-AKI and those without CI-AKI, which was defined as an increase >50% or >0.5mg/dl in serum creatinine concentration within 48hours after primary PCI. Results CI-AKI occurred in 23 patients (11.9%). Multivariate analysis identified pre-procedural renal insufficiency as a predictor of CI-AKI, and this predictor was independent from hemodynamic instability and excessive contrast volume. Receiver-operator characteristics analysis demonstrated that patients with an estimated glomerular filtration rate (eGFR) of ≤43.6ml/min per 1.73m 2 had the potential for CI-AKI. Patients who developed CI-AKI had higher mortality and cardiovascular events than did those without CI-AKI (27.8% vs. 4.7%; log-rank P =.0003, 27.8% vs. 11.2%; log-rank P =.0181, respectively). Cox proportional hazards model analysis identified CI-AKI as the independent predictor of mortality and cardiovascular events [hazard ratio [HR]=5.36; P =.0076, HR=3.10; P =.0250, respectively]. Conclusions The risk of CI-AKI is increased in patients with pre-procedural renal insufficiency, and eGFR is clinically useful in the emergent setting for CI-AKI risk stratification before primary PCI.

Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 - 1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 - 9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 - 9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 - 1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 - 25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.

Background:Interatrial septum pacing (IAS-P) decreases atrial conduction delay compared with right atrial appendage pacing (RAA-P). We evaluate the atrial contraction with strain rate of tissue Doppler imaging (TDI) during sinus activation or with IAS-P or RAA-P. Methods:Fifty-two patients with permanent pacemaker for sinus node disease were enrolled in the study. Twenty-three subjects were with IAS-P and 29 with RAA-P. The time from end-diastole to peak end-diastolic strain rate was measured and corrected with RR interval on electrocardiogram. It was defined as the time from end-diastole to peak end-diastolic strain rate (TSRc), and the balance between maximum and minimum TSRc at three sites (ΔTSRc) was compared during sinus activation and with pacing rhythm in each group. Results:There were no significant differences observed in general characteristics and standard echocardiographic parameters except the duration of pacing P wave between the two groups. The duration was significantly shorter in the IAS-P group compared with the RAA-P group (95 ± 34 vs 138 ± 41; P = 0.001). TSRc was significantly different between sinus activation and pacing rhythm (36.3 ± 35.7 vs 61.6 ± 36.3; P = 0.003) in the RAA-P group, whereas no significant differences were observed in the IAS-P group (25.4 ± 12.1 vs 27.7 ± 14.7; NS). During the follow-up (mean 2.4 ± 0.7 years), the incidence of paroxysmal atrial fibrillation (AF) conversion to permanent AF was not significantly different between the two groups. Conclusions:IAS-P decreased the contraction delay on atrial TDI compared to RAA-P; however, it did not contribute to the reduction of AF incidence in the present study. (PACE 2011; 34:370–376)

Tortuous coronary arteries frequently make percutaneous coronary intervention (PCI) difficult by causing less accessibility of guidewire toward the target lesion. After guidewire has been passed through the target lesion, it often assists a balloon catheter and stent system insertion along the stiff guidewire. However, artificial kinking and wrinkling might induce pseudo-narrowing of coronary arteries, which has been recognized as an "accordion phenomenon." We describe an educational case of an accordion phenomenon with ST-segment elevation of electrocardiogram and anginal chest pain when the stiff guidewire which had been withdrawn was advanced again into the distal site after deploying stents.

The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) is a good predictor of adverse cardiovascular events and mortality in patients with acute coronary syndrome (ACS). The utility of risk stratifying patients with ACS complicated by cardiogenic

A 70-year-old woman was admitted to our hospital for a continuous heart murmur in the fourth intercostal space at the right sternal border. Routine echocardiography demonstrated aneurismal dilatation at the origin of right coronary artery. These findings suggested a coronary artery fistula, although its drainage site could not be identified. By shifting the patient to the right decubitus position, we could observe an abnormal color Doppler signal going from the right coronary artery into the right atrium, confirming coronary artery fistula. The right decubitus position may be helpful for the evaluation of abnormal anatomic and auscultatory findings. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound 2011.

Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

We compared the effects of telmisartan and olmesartan in 20 patients with chronic heart failure and metabolic syndrome. The subjects underwent once-daily 40 mg telmisartan for at least 3 months before switching to once-daily 20 mg olmesartan for the next 3 months (post 1). They were then treated with 3 months of once-daily 40 mg telmisartan (post 2). Systolic and diastolic blood pressure in the early morning, plasma B-type natriuretic peptide, serum total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were increased at post 1 (p