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The recurrence rate of acute coronary syndrome (ACS) in patients after first-time myocardial infarction (MI) is over ten times higher than in the general population. However, it is unclear whether patients with multiple-time MI have an even higher recurrence rate of MI. This study aimed to compare the recurrence rate in patients with multiple-time MI with the rate in patients after first-time MI. We retrospectively studied 794 consecutive MI patients who were discharged. Recurrent ACS was investigated in patients with previous MI (n = 46) and without previous MI (n = 748). During the follow-up periods (mean ± SD: 757 ± 733 days), recurrent ACS occurred in 47 cases without previous MI and in 7 cases with previous MI. Kaplan-Meier analysis revealed that the risk of recurrent ACS was significantly higher in patients with previous MI than in patients without previous MI. ACS recurrence rates one year from the onset were 4.2% in patients without previous MI and 11.9% in patients with previous MI. Landmark analysis revealed that the higher recurrence rate in patients with previous MI was as high as 14.1% from 1 year after the onset to 2 years. In conclusion, the risk of recurrent ACS may be significantly higher in patients with multiple-time MI than in patients after first-time MI.

Background: Impaired glucose tolerance (IGT) patients are known to have a higher risk of cardiovascular events and their prognosis is reported to be poor. We, therefore, aimed to compare the complexity and vulnerability of coronary artery disease (CAD) among normal glucose tolerance (NGT), IGT and diabetes mellitus (DM). Methods: 232 patients (66.4 ± 12.6 years, 201 male) who received percutaneous coronary intervention for coronary artery disease were enrolled in the present study. All of the patients except those already given the diagnosis of DM underwent 75g oral glucose tolerance test (OGTT). The study cohorts were divided into 3 groups; DM (n=118), IGT (n=67), and NGT (n=47). IGT was defined as 2 hour post-load plasma glucose ≥140mg/dl during the OGTT. The lesion complexity was expressed as SYNTAX score. The vulnerability of coronary plaque was determined by optical coherence tomography (OCT). Results: Glycated hemoglobin (HbA1c) level was significantly higher in DM group (6.7±1.3%) than IGT (5.8±0.3%, P Conclusions: The lesion complexity and plaque vulnerability of IGT patients are not inferior to those of DM patients and significantly greater than NTG patients.

Giant left atrium due to mitral stenosis with massive atelectasis: A successful case with perioperative approach☆ Atsushi Tanita , Yusuke Hosokawa ⁎, Takeshi Tomiyama , Maiko Kato , Junya Matsuda , Keisuke Sawai , Yoshie Arita , Toshiyuki Aokage , Hiroomi Suzuki , Hiroshige Murata , Hideki Miyachi , Toshiyuki Shibui , Takahito Nei , Koichi Akutsu , Takeshi Yamamoto , Shinhiro Takeda , Takashi Nitta , Kunio Tanaka , Kyoichi Mizuno , Keiji Tanaka a