Background-Acute ST-elevation myocardial infarction (STEMI) is caused by sudden occlusive coronary thrombosis, after plaque disruption; however, a considerable time interval between plaque disturbance and the onset of symptoms has been suggested. We therefore studied the age of intracoronary thrombi, aspirated during angioplasty in patients with acute STEMI. Methods and Results-Percutaneous intracoronary thrombectomy during angioplasty was performed in 211 consecutive STEMI patients within 6 hours after onset of anginal symptoms. The aspirated material was histologically screened on thrombus and plaque components, and thrombus age was classified as fresh (Ͻ1 day), lytic thrombus (1 to 5 days), and organized thrombus (Ͼ5 days). In all patients, intracoronary-derived material was retrieved in the filter of the collection bottle. Thrombus was identified in 199 (95%) of 211 patients. In 12 patients (5%), only plaque components were identified, and in 85 patients (41%), both thrombus and plaque material were aspirated. In 18 (9%) of 199 patients, the thrombus was organized, and in 70 patients (35%), the thrombus showed lytic changes, whereas in 98 (49%), a completely fresh thrombus was found. In 14 (7%) of 199 patients, the thrombus showed combined features of both fresh thrombus and organized thrombus. Conclusions-In at least 50% of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptoms.

Doppler-derived CFR is a better prognostic marker for LV function recovery after anterior MI than other currently used parameters of myocardial reperfusion.

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Objective-To evaluate triage of patients for short term observation after elective percutaneous transluminal coronary angioplasty (PTCA), as appropriate selection of patients for short term observation after angioplasty may facilitate early discharge. Methods-1015 consecutive patients scheduled for elective PTCA were prospectively included for short term observation. Patients with unstable angina Braunwald class III were excluded. There were no angiographic exclusion criteria. Patients were discharged from the interventional centre when considered stable during 4 hours of observation after PTCA. It was left to the operator's discretion whether to prolong the observation period. Procedural complications were defined as death, coronary bypass surgery, early repeat PTCA, and myocardial infarction. Outcome measures-The need for prolonged observation (> 4 hours) and the occurrence of complications. Predictors for prolonged observation and the occurrence of complications after the 4 hours observation were assessed by univariate and multivariate analysis. Results-Two patients died, including one of six patients who underwent emergency bypass surgery. In all, 922 patients (90.8%) were triaged to short term observation and had an uncomplicated three day follow up. Observation was prolonged in 87 patients (8.6%), and 40 patients had a complicated course. Independent predictors of procedural complications were acute closure (odds ratio (OR) 9.7; 95% confidence interval 4.4 to 21.4), side branch occlusion (OR 8.9; 3.4 to 23.7), no angiographic success (OR 5.1; 2.4 to 11.0), female sex (OR 3.1, 1.7 to 5.7), any unplanned stent (OR 2.8, 1.4 to 5.9), and ostial lesion (OR 2.2, 1.0 to 4.7). Conclusions-A 4 hour observation period is safe after elective coronary angioplasty. As procedural variables are the strongest predictors of postprocedural complications, the immediate procedural results allow eVective triage of patients for short term or prolonged observation in order to anticipate complications. The wide application of percutaneous transluminal coronary angioplasty (PTCA) as a method for myocardial revascularisation has led to increasing logistic constraints.1 Reduction of hospital stay and performance of outpatient procedures are recommended by health care insurers and hospital management in order to reduce costs. Furthermore, early discharge after PTCA may add to the comfort of the patients but may be complicated by unattended subacute occlusion of the treated vessel away from monitoring and angioplasty facilities.Abrupt vessel closure and myocardial infarction are the major acute complications of coronary angioplasty.2-4 The risk of acute or subacute closure has been related to many clinical and angiographic features.4-11 Taking these risk factors into account, only a limited number of patients would be eligible for short term observation after coronary angioplasty. On the other hand, it has been suggested that subacute closure remains largely unforeseeable and occurs out of laboratory in only a minority of pati...

Background: Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. Methods and Results:Atherosclerotic risk factors and carotid intima -media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age- and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81±6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55±0.1 mm vs 0.58±0.08 mm: ∆IMT =0.04 mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4±1 mmol/L vs 4.9±1 mmol/L; P=0.02), as well as lower thrombocyte levels (173±81×10 9 /L vs 255±54×10 9 /L; P<0.01), higher bilirubin levels (18.6±11 μmol/L vs 12.7±6 μmol/L; P<0.01), and lower diastolic and systolic blood pressure (71±9 mmHg vs 76±9 mmHg, P<0.01; 113±14 mmHg vs 124±12 mmHg, P<0.01, respectively). Conclusions:In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels. (Circ J 2010; 74: 1436 - 1441