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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.za

DOI: 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