Coronary angiogram

Percutaneous coronary intervention A minimally invasive procedure whereby access to the coronary arteries is obtained through the femoral artery up the aorta to the coronary os. Contrast media is used to visualize the coronary artery stenosis using a coronary angiogram. A guidewire is used to cross the stenosis and a small balloon is inflated and/or stent is deployed to break up atherosclerotic plaque and restore coronary artery blood flow. The stent is left in place to prevent acute closure and restenosis of the coronary artery. Newer stents are coated with antiproliferative drugs, such as paclitaxel and sirolimus, which further reduce the risk of restenosis of the coronary artery. 

Yang EH, Lerman A. Angina pectoris with a normal coronary angiogram. Herz. 2005 30 17-25. 

Alpha-tocopherol acetate (vitamin E) has no effect on lipid levels but is a powerful antioxidant. Considerable evidence points to oxidation of LDL as an essential step in the development of atheroma, and therefore interest has centred on the role of either endogenous or therapeutic vitamin E in prevention of atheroma. Reduced concentrations of vitamin E in both blood and fat (vitamin E is a fat soluble vitamin) are found in inhabitants of countries with a high prevalence of ischaemic heart disease, and (within these countries) in patients who develop ischaemic heart disease. A high dose reduced by half the risk of myocardial infarction in 2000 patients with angina and positive coronary angiogram. However most other studies have failed to confirm this finding and there is no indication at present for routine prescribing of a-tocopherol in the treatment or prevention of atherosclerosis. 

Fuj ita H, Yamabe H, Yokoyama M. 2000. Effect of L-arginine administration on myocardial thallium-201 perfusion during exercise in patients with angina pectoris and normal coronary angiograms. J. Nucl. Cardiol. 7 97-102... 

A typical example of this type of STE-ACS is shownin Figure4.21 A, along with its correlation with the coronary angiogram (Figure 4.2IB) before and after fibrinolytic therapy. 

A typical electrocardiographic example of this type of STE-ACS is shown in Figure 4.34A along with the correlation with coronary angiogram before and after a PCI (Figure 4.34B). 

All these situations will be dealt with now, with a special focus on the clinical evolution and the coronary angiogram correlation in each case, and with emphasis on the prognostic implications and risk stratification. 

In all these situations, the therapeutic approach (emergent coronary angiogram, if possible) should be decided upon with the clinical history and the ECG. 

A coronary angiogram may be advisable, especially in young patients. 

From the prognostic standpoint, Mis of inferolateral zone with RV involvement - proximal occlusion of RCA - especially when the artery is dominant, have worst prognosis in the acute phase, as they potentially involve a very large myocardial area at risk. Consequently, carrying out an urgent coronary angiogram is mandatory (Figures 4.31 and 9.6). 

TV1 > TV6 criterion in patients with chest pain with or without other ECG changes had been considered to be specific, but not very sensitive for one or more vessel diseases. However, prognostic value of TV1 > TV6 criterion is controversial. For some authors it may only be used as a marker of CHD and, especially, of LAD involvement in patients with chest pain or in those undergoing a coronary angiogram. Furthermore, the presence of a TV 1 > TV 6 did not have any statistically significant prognostic value for other authors. 

Roque M, Heras M, Roig E, et al. Short-term effects of transdermal estrogen replacement therapy on coronary vascular reactivity in postmenopausal women with angina pectoris and normal results on coronary angiograms. J Am Coll Cardiol 1998 31 139-143. 

Galbraith JE, Murphy ML, Desoyza N (1981) Coronary angiogram interpretation interobserver variability. JAMA 240 2053-2059... 

A soft plaque at the initial stage of calcification may have an overall density of less than 400 HU. Should we now fill the vascular lumen with more than 400 HU of iodine contrast, some of the calcified structures adjacent to the lumen might be obscured and undiscernible from lumen territory on cross-sectional cuts (Fig. 16.3). This may potentially result in false-negative findings on coronary angiograms, which would constitute a worst-case scenario for the current clinical appHcation of the modahty. 

Fig. 16. 7a-d. Representative coronary angiogram with PGA. a, b 3D Global views at different projection angles. No disease is apparent in the left and right coronary arteries. Volmne renderings of the same dataset with coronary tree isolation (c) and... 

Hertzer NB, Beven EG, Young JR, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Sur 1984 199 223. 

Absolute contraindications for using a potential donor include previous myocardial infarction, severe echocardiographic ventricular dysfunction, severe coronary artery disease (detected by coronary angiogram), intractable ventricular arrhythmia and positive HIV status. Relative contraindications include, among others, positive hepatitis B or C serology, sepsis, history of metastatic cancer, evidence of cardiac contusion, prolonged hypotension, non-critical coronary artery disease, and a history of intravenous drug abuse (Miniati and Robbin 2002). 

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