Complete Occlusion of a Severely Ectatic Coronary Artery With a Ball Thrombus
Notice bibliographique
Résumé
An 80-year-old woman presented to the emergency department of a community hospital with a 4-day history of intermittent retrosternal chest discomfort. She had no history of cardiovascular disease. Her cardiac risk factors included age, dyslipidemia, and a remote smoking history. A 12-lead electrocardiogram showed inferoposterior ST elevation. She was administered acetylsalicylic acid, clopidogrel bisulfate (Plavix, Bristol-Myers Squibb, New York, NY), enoxaparin, and metoprolol, and transferred to a university centre for urgent coronary angiography. Angiography (Fig. 1) showed severe, extensive ectasia with complete occlusion of the right coronary artery with a large clot, approximately 17 mm in diameter, and diffuse disease in the left coronary artery. Given the significant ectasia and the late presentation, a conservative approach was taken. She was managed medically without complication and discharged 5 days later. The decision to not perform angioplasty on the right coronary artery was based on the Occluded Artery Trial (OAT) study,1Hochman J.S. Lamas G.A. Buller C.E. et al.Coronary intervention for persistent occlusion after myocardial infarction.N Engl J Med. 2006; 355: 2395-2407Google Scholar which showed no benefit of angioplasty of a total occlusion in asymptomatic patients whose myocardial infarction was more than 72 hours old. The left anterior descending stenosis was not opened up, because we are waiting on the results of the COMPLETE study for guidance in this matter. Coronary artery ectasia (CAE) is commonly defined as dilatation of a coronary artery to 1.5 times greater than that of an adjacent normal segment.2Swaye P.S. Fisher L.D. Litwin P. et al.Aneurysmal coronary artery disease.Circulation. 1983; 67: 134-138Google Scholar It is present in 1% to 3% of patients with obstructive coronary artery disease at autopsy or angiography.3Morrow D.A. De Lemos J.A. Stable ischemic heart disease.in: Zipes D.P. Libby P. Bonow R.O. Heart Disease. Elsevier Inc., 2019: 1209-1270Google Scholar Remodeling due to atherosclerosis is the most common cause of CAE, but other causes include congenital anomalies and inflammatory conditions such as Kawasaki disease. An important diagnosis to consider in the differential of a dilatated coronary artery is coronary artery aneurysm, which rarely occurs in arteries that are not severely stenotic. Aneurysms are usually associated with extensive coronary artery disease and are most commonly found in the left anterior descending artery, whereas CAE is most common in the right coronary artery.2Swaye P.S. Fisher L.D. Litwin P. et al.Aneurysmal coronary artery disease.Circulation. 1983; 67: 134-138Google Scholar Liang et al.4Liang S. Zhang Y. Gao X. et al.Is coronary artery ectasia a thrombotic disease?.Angiology. 2019; 70: 62-68Google Scholar found that CAE is associated with an increased risk of thrombosis. The cause of this association is thought to be due to disruption of laminar flow, spasm, and intimal damage. Additionally, the fact that patients with CAE tend to have a higher mean platelet volume5Moghadam R.H. Shahmohammadi A. Asgari N. et al.Comparison of mean platelet volume levels in coronary artery ectasia and healthy people: systematic review and meta-analysis.Blood Res. 2018; 53: 269-275Google Scholar has led researchers to postulate that antiplatelet medications could be useful in the management of isolated CAE. However, to date no randomized trials have been conducted.4Liang S. Zhang Y. Gao X. et al.Is coronary artery ectasia a thrombotic disease?.Angiology. 2019; 70: 62-68Google Scholar The authors have no conflicts of interest to disclose.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».