Complete Occlusion of a Severely Ectatic Coronary Artery With a Ball Thrombus
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".