Coronary artery disease multivessel

One patient taking nateglinide had a headache. One patient was withdrawn because of a myocardial infarction and had multivessel coronary artery disease on catheterization. 

SoS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial) a randomised controlled trial. Lancet 2002 360(9338) 965-970. 

Patients with the non-obstructive form of hypetrophic cardiomyopathy should not undergo septal ablation. Patients with congential anomalies of the mitral valve apparatus, associated heart lesions (e.g., advanced multivessel coronary artery disease) requiring surgical correction, unfavorable distribution of septal hypertrophy with mild proximal thickening, basal septal wall thickness < 18 mm, or anatomically unsuitable septal perforators should not be candidates for septal ablation. 

In 12 patients with type 2 diabetes, a combination of nateglinide 120 mg or placebo with metformin 500 mg before each meal on two separate days was well tolerated (31). One patient taking nateglinide had a headache. One patient was withdrawn because of a myocardial infarction and had multivessel coronary artery disease on catheterization. 

Figure 8.22 (A) ECG of 62-year-old patient with multivessel chronic coronary artery disease. (B) During an NSTE-ACS Ml an ST-segment depression in V1-V2 and...

Michaelides A, Psomadakai ZD, Aigyptiadout MN, Richter D, Andrikopoulos G, Dilaveris P. Significance of exercise-induced changes in leads AVR, V5 and VI discrimination of patients with single or multivessel coronary artery disease. Clin Cardiol 2003 26(5) 226-30. 

Multivessel involvement, especially if the patient has left main coronary artery disease or left main equivalent disease, or two- to three-vessel involvement with significant left ventricular dysfunction is best managed with revascularization. 

Weintraub WS, Stein B, Kosinski A, et al. Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease. J Am Coll Cardiol 1998 31 10-19. 

Serruys P, Daemen J, Morice MC, et al. Three-year followup of the ARTS-II sirolimus-eluting stents for the treatment of patients with multivessel coronary artery disease. Eurointervention 2008 3(4) 450-9. 

Chamuleau SA, Meuwissen M et al. (2002) Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis. Am J Cardiol 89 377-380... 

Rodriguez A, Boullon F, Perez-Balino N, et al. Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease in-hospital results and 1 year follow-up. J Am Coll Cardiol 1993 22 1060. 

Serruys PW, Unger F SousaJE, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N EnglJ Med 2001 344(1 5) I I 17-1 124. 

In nondiabetics with multivessel disease, trials comparing PCI and coronary artery bypass graft surgery (CABG) have shown... 

The negative T wave of subepicardial ischaemia is recorded in different leads, depending on the myocardial area affected by the occluded coronary artery (inferolateral or anteroseptal). In general, in case of single-vessel disease ischaemia is regional therefore, a mirror pattern may be observed in the FP (Figures 3.10 and 3.20). Much probably, ischaemia at rest is usually explained by only a culprit artery, even maybe stenosis in other arteries (multivessel disease). 

The electrocardiographic pattern of subendocardial injury in patients with ACSs is recorded in different leads, depending on the coronary artery involved and the location of the injured area. When the ischaemia is due to left main trunk (LMT) subocclusion or equivalent, or 3 proximal vessel diseases, the involvement of the left ventricle is circumferential. In case of single vessel disease or when in presence of multivessel disease, the active ischaemia is due to a culprit artery or two distal occlusions the involvement is considered regional (Sclarovsky 1989). The correlation between these... 

Now we will discuss the importance of the catheterisation laboratory in a patient with multivessel disease, which is the culprit artery responsible of the ACS. In clinical practice, when an STE-ACS occurs, a critical occlusion has developed usually in only one culprit artery. In most cases, due to the fact that multivessel disease is often present, what is most important is that in the catheterisation laboratory, in a patient with STE-ACS and multivessel disease, the interventionist cardiologist may, thanks to the correct and quick interpretation of the ECG, take the correct decision on which coronary artery... 

This ACS with regional involvement is usually secondary to an incomplete coronary artery occlusion in patients frequently presenting with prior predominantly regional subendocardial ischaemia and single- or multivessel disease, but one culprit artery. Any coronary artery may be the culprit one and the occlusion often is not proximal (Table 8.2). 

There appears to be little relationship between the historical features of angina and the severity or extent of coronary artery vessel involvement. Therefore, one may speculate that severe symptoms might be associated with multivessel disease, but no predictive markers exist on a routine basis. 

Serruys FW, Ong AT, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized... 

Abizaid A, Costa MA, Centemero M, et al. Arterial Revascularization Therapy Study Group. Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients insights from the Arterial Revascularization Therapy Study (ARTS) trial. Circulation 2001 104(5) 533—538. 

---