Nozari Y, Gaemian A, Safir Mardanloo A,
Volume 65, Issue 3 (2 2007)
Abstract
Background: Percutaneous Coronary Intervention (PCI) for bifurcated lesions is associated with a low rate of success and high rate of complications compared to such treatment of lesions of most other morphologies. Symptoms occurring at the time of procedure caused by PCI may require additional angiography with or without stenting through stent struts, which subsequently increases risks of restenosis and stent thrombosis. The purpose of this study was to evaluate the incidence of major side branch (>1mm) complications during PCI and their clinical, angiographic, and interventional predictors.
Methods: Of 104 consecutive patients, we evaluated 50 lesions with ostial stenosis (group 1) and 54 lesions without ostial stenosis (group 2) as a control group. Age, sex, major coronary artery disease risk factors, and left ventricular ejection fraction (LVEF), were compared between groups. Morphology, location, type of lesion, length of lesion, main and side branch diameters, interventional approach, and clinical and interventional outcomes were the main variables studied during this trial.
Results: Side Branch Compromise (SBC) occurred in 41 (39.4%) of the total number of cases: 52% in group 1 and 27.8% in group 2 (p=0.01). More than 80% of SBC occurred in main branches with stenosis (p=0.02). SBC did not correlate with clinical characteristics, bifurcation location, LVEF, or stent number. Chest pain was reported in 18% of the cases during or after PCI. Three non Q wave myocardial infarctions (MI) occurred after SBC, each with >2 mm branch diameters (p=0.02). SBC was not associated with adverse clinical outcomes.
Conclusion: The risk of MI after losing the side branch of a bifurcation lesion is not usually as high as it is after losing the main branch. Furthermore, it may not be a serious problem as one of the problems of the bifurcation lesion is the high rate of post procedural non Q wave MI associated with SBC. These findings demonstrate that side branch ostial stenosis >50%, and main branch stenosis >80% were important predictors of SBC. Protection of side branches >2mm is highly recommended during coronary intervention.
Nozari Y, Nabati M,
Volume 65, Issue 7 (4 2007)
Abstract
Background: Epidemiological studies have suggested an association between higher body iron stores and coronary artery disease. It is believed that inflammation and oxidation are important mechanisms involved in the complex pathological process of atherogenesis. Free radical production is catalyzed and accelerated in the presence of iron. The determination of plasma ferritin levels is a convenient iron balance assessment method. The purpose of this study was to define the correlation of ferritin levels with severity and extent of coronary artery atherosclerosis.
Methods: In this cross-sectional study, 240 consecutive patients underwent previously indicated coronary artery angiography and were divided into two groups according to their angiographic findings: group 1 with 50% stenosis or less in each of the coronary arteries, and group 2 with more than 50% stenosis of the coronary arteries. Blood samples were taken for routine biochemical tests, including evaluation of serum ferritin levels. The severity and extension of coronary artery stenosis was determined by Gensini score.
Results: Group 1 consisted of 120 patients with a mean age of 52 6.8 years, and group 2 had 120 patients with a mean age of 58.1 10.4 years. We found a correlation between serum ferritin level and severity of coronary artery stenosis among men (p=0.02) however, there was no significant difference in serum levels of ferritin between the two groups (63.88 ng/ml vs. 44.26 ng/ml). Furthermore, there was no significant difference in serum ferritin levels of subgroups of patients with major risk factors such as hypertension, hyperlipidemia, hyperglycemia and smoking.
Conclusion: Overall this study cannot confirm a strong correlation of serum ferritin levels with severity of coronary atherosclerosis in our study population. However, in men it could have a role in the promotion and augmentation of coronary atherosclerosis, suggesting that ferritin could be a comparable index in patients with ischemic heart disease. Therefore, further study is necessary to assess etiological relationship between serum ferritin levels and extension of coronary artery stenosis.
