Coronary stenting in diabetic patients is an efficient procedure, with a high angiographic and clinical success rate similar to that in nondiabetic patients. Diabetic patients, however, had a higher incidence of in-hospital myocardial infarction and a greater need for additional myocardial revascularization.

We report the case of a rare anomaly of the right coronary artery originated from the middle third of the left anterior descending (LAD) coronary artery with a proximal atheromatous obstructive lesion immediately before the emergence of the right coronary artery (RCA). The patient underwent successful angioplasty with stent implantation in the left anterior descending coronary artery. Only 7 cases of this anomaly of distribution have been reported in the literature, but none of them was treated with percutaneous revascularization.Anomalies of the coronary arteries occur in 1 to 2% of the population, constituting a rare, but important, type of nonatherosclerotic coronary artery disease. These anomalies may cause sudden death on exertion and increase the risk of coronary arterial trauma during surgical procedures. In addition, certain types of anomaly may lead to myocardial ischemia 1 .The single coronary artery (SCA), described as an isolated coronary artery, has no gender predominance, being a rare entity with an incidence of 0.024% when isolated, and of 0.03 to 0.04% when associated with other cardiac abnormalities 2-4 . Its main characteristic is being originated from the aortic root through a single ostium, with no evidence of a second ostium, being then responsible for the irrigation of the entire heart, independently of its distribution 2 . In these cases, proximal atherosclerotic obstructions may have severe consequences for the patient 4 .We report the case of a patient who underwent percutaneous coronary intervention with stent implantation and whose RCA originated from the LAD. The cases of only 7 patients with that anomaly have so far been reported in the literature, but none of them was treated with coronary angioplasty 5 . Case ReportThe patient is a 73-year-old, white, male, retired lumber jack, bornt and residing in the town of Maria da Fé, in the state of Minas Gerais. The patient has type II diabetes, hypertension and quit smoking 20 years earlier. He was referred to our service for coronary angiography due to a one-year history of oppressive chest pain on exertion, which irradiated to the left upper limb, was relieved with rest, and had no aggravating factors. The patient reported that in the preceding 2 months the pattern of the chest pain evolved progressively until being triggered at rest.On physical examination, the patient had no alterations, except for his cardiac auscultation, which had a regular cardiac rhythm with the presence of S4. The chest teleradiography was normal. The rest electrocardiogram ( fig. 1) showed a sinus rhythm, SÂQRS +70º, heart rate of 75 bpm, with no ventricular repolarization alterations. During the exercise test ( fig. 2), a significant 3-mm depression of the ST segment was observed on the MC5 lead with a load of 1.7 mph 10% at 3 minutes, characterizing an ischemic myocardial response to exercise.The patient underwent coronary angiography according to the Sones technique on July 14th, 2003, which revealed a LAD originating from the left Valsalva sinus, and dividin...

The prevalence of coronary artery disease, especially in its multivessel form, in the population aged less than 50 years has increased. This fact may be partially explained by the current lifestyle favoring sedentary habits, stress, obesity, smoking, and the greater incidence of type II diabetes mellitus, well-known factors of coronary risk [1][2][3] . Before the appearance of stents, the use of coronary angioplasty in the treatment of patients with multivessel disease was limited by the impossibility of approaching more complex lesions and the elevated rate of restenosis [4][5][6] . With the increased use of devices in the treatment of coronary artery disease, several studies have assessed their use in select or unselect groups of patients with multivessel disease 7,8 ; however, the reports on the benefits of these devices in younger patients are scarce.The objective of this study was to assess the in-hospital results and the clinical follow-up of patients with multivessel disease aged less than 50 years undergoing coronary stent implantation in native coronary arteries and to compare them with those of patients with single-vessel disease. MethodsThis study comprised a consecutive series of 462 patients aged less than 50 years, undergoing percutaneous coronary intervention with coronary stent implantation from July 1997 to June 2002 at the Hospital da Beneficiência Portuguesa of São Paulo.The study sample comprised patients with "de novo" lesions in the native coronary artery with clinical findings of stable or unstable angina or documented myocardial ischemia. Patients undergoing angioplasty in the acute phase of myocardial infarction, adjunct procedures of atheroablation, and those with contraindications for antithrombotic or platelet antiaggregating therapy were excluded.The patients were divided into the following 2 groups Objective -To assess the in-hospital results and clinical follow-up of young patients (< 50 years) with multivessel coronary artery disease undergoing stent implantation in native coronary arteries and to compare their results with those of patients with single-vessel coronary artery disease. Methods -We retrospectively studied 462 patients undergoing coronary stent implantation. Patients were divided into 2 groups: group I (G-I) -388 (84%) patients with single-vessel coronary artery disease; and group II (G-II) -74 (16%) patients with multivessel coronary artery disease.Results -The mean age of the patients was 45+4.9 years, and the clinical findings at presentation and demographic data were similar in both groups. The rate of , with no difference in regard to in-hospital evolution between the groups. Death, acute myocardial infarction, and the need for myocardial revascularization during clinical follow-up occurred in 10. respectively. By the end of 24 months, the actuarial analysis showed an event-free survival of . Conclusion -

Diabetic patients with CCD reported similar outcome as compared to the non-diabetics; however, those with ACSNST and AMI presented higher incidence of major adverse cardiac events during hospital stay.

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