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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017
AFRICA
405
Keywords:
in-stent restenosis, neo-intimal hyperplasia, optical
coherence tomography
Submitted 2/2/17, accepted 19/4/17
Published online 10/10/17
Cardiovasc J Afr
2017;
28
: 404–405
www.cvja.co.zaDOI: 10.5830/CVJA-2017-024
A 52-year old man was admitted with unstable angina two
months after deployment of a drug-eluting stent (DES) in the
proximal left anterior descending (LAD) artery. Five months
prior to the current admission he had undergone percutaneous
coronary intervention (PCI) with a DES to his proximal right,
proximal circumflex and mid-LAD coronary arteries. The
patient had no cardiovascular risk factors apart from a family
history of premature coronary artery disease.
Coronary angiography demonstrated in-stent restenosis
of the proximal LAD stent (Fig. 1A). Optical coherence
tomography (OCT) demonstrated various tissue responses to
stent implantation (Fig. 1B). High-signal, smooth muscle-rich
mature neo-intimal hyperplasia was present within the stent in the
mid-LAD (Fig. 1C; asterisk) whereas signal-poor homogeneous
aggressive immature neo-intimal hyperplasia was present at the
level of the proximal stent edge, causing sub-total occlusion (Fig.
1D; double arrowhead line), with tissue protrusion clearly visible
below the immature neo-intimal hyperplasia in certain frames
(Fig. 1E; arrowheads). Proximal to the stent, an inhomogeneous-
edge vascular response was observed (Fig. 1F). The focal
restenosis in the proximal stent segment was treated with another
DES and post-dilated with a non-compliant balloon with a good
angiographic result (not shown).
This image illustrates a very unusual pattern of early
and aggressive immature neo-intimal hyperplasia. Although
immature neo-intimal hyperplasia has been described,
1
to our
knowledge this is the first image of such aggressive immature
neo-intimal hyperplasia.
Reference
1.
Malle C, Tada T, Steigerwald K,
et al.
Tissue characterization after
drug-eluting stent implantation using optical coherence tomography.
Arterscler Thromb Vasc Biol
2013;
33
: 1376–1383.
Treatment of heart attack patients depends on history of cancer
Treatment of heart attack patients depends on their history of
cancer, according to research published recently in
European
Heart Journal: Acute Cardiovascular Care
. The study in more
than 35 000 heart attack patients found they were less likely
to receive recommended drugs and interventions and more
likely to die in hospital if they had cancer than if they did not.
‘It is well known that cancer patients may have an
increased risk of cardiovascular disease as a result of their
treatment’, said senior author Dr Dragana Radovanovic,
head of the AMIS Plus Data Centre in Zurich, Switzerland.
‘However, on the other hand, little is known about the
treatment and outcomes of cancer patients who have an
acute myocardial infarction.’
This study investigated whether acute myocardial
infarction patients with a history of cancer received the
same guideline-recommended treatment and had the same
in-hospital outcomes as those without cancer. The study
included 35 249 patients enrolled in the Acute Myocardial
Infarction in Switzerland (AMIS Plus) registry between 2002
and mid-2015. Of those, 1 981 (5.6%) had a history of cancer.
Propensity score matching was used to create two groups
of 1 981 patients each – one with a cancer history and
one without – that were matched for age, gender and
cardiovascular risk factors. The researchers compared the
proportions of patients in each group who received specific
immediate drug therapies for acute myocardial infarction,
and percutaneous coronary intervention (PCI) to open
blocked arteries. They also compared the rates of in-hospital
complications and death between the two groups.
The researchers found that cancer patients underwent PCI
less frequently [odds ratio (OR) 0.76; 95% confidence interval
(CI): 0.67–0.88) and received P2Y12 blockers (OR 0.82; 95%
CI: 0.71–0.94) and statins (OR 0.87; 95% CI: 0.76–0.99) less
frequently. In-hospital mortality rate was significantly higher
in patients with cancer than those without (10.7 vs 7.6%; OR
1.45; 95% CI: 1.17–1.81).
Patients with a history of cancer were more likely to have
complications while in hospital. They had 44% higher odds
of cardiogenic shock, 47% higher chance of bleeding and
67% greater odds of developing heart failure than those with
no history of cancer.
Dr Radovanovic said: ‘Patients with a history of cancer
were less likely to receive evidence-based treatments for
myocardial infarction. They were 24% less likely to undergo
PCI, 18% less likely to receive P2Y12 antagonists and 13%
less likely to receive statins. They also had more complications
and were 45% more likely to die while in hospital.’
‘More research is needed to find out why cancer patients
receive suboptimal treatment for myocardial infarction
and have poorer outcomes’, continued Dr Radovanovic.
‘Possible reasons could be the type and stage of cancer, or
severe co-morbidities. Some cancer patients may have a very
limited life expectancy and refuse treatment for myocardial
infarction’, she added.
Source
: European Society of Cardiology Press Office