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care unit/acute coronary admissions and for percutaneous coronary intervention
(PCI) were used to record information. From October 2005, 16 (4 Male) consecutive
patients (pts.) (mean age 50±11; range 30-68 years) were enrolled. Thirteen
(81.2%) pts. had one or more risk factors for coronary artery disease (CAD). In the
female, no association with peripartum period was detect. The clinical presentation
was typical chest pain in 13 (81.5%) patients; 1 (6,25%) had an aborted sudden
cardiac death; the last two was asymptomatic. The SCAD diagnosis was made by
an angiogram performed on the same day of hospital admission in all patients. Of
the 4 men, 2 (50%) had SCAD of left anterior coronary artery (LAD); 2 had a
dissection of right coronary artery (RCA) and left circumflex artery (LCA),
respectively. Of the 12 women, 7 (58,3%) showed SCDA of LAD; 4 (33%) had a
dissection of RCA and 1 of LCA. The classification for culprit SCAD types were: 7
(48.8%) type B (parallel double lumen); 5 (31.2%) type D (spiral luminal filling
defects); 3 (18.8%) type F (total occlusion); 1 (6.25%) type C (extraluminal cap). No
correlation was detect between culprit artery and type of dissection. Only 4 (25%)
patients had a significant atherosclerotic stenosis of a vessel different from culprit
artery. Six (37.7%) patients were treated with PCI; 2 (12.5%) underwent CABG; 8
(50%) received medical treatment. The final diagnoses were: 9 (56.2%) STEMI; 4
(25%) NSTEMI; 2 (12.5%) Unstable Angina and 1 (6.25%) Stable CAD. The left
ventricular ejection fraction during the hospital stay was normal in 11, slightly
reduced in 4 and moderately reduced in 1 patient. An other interesting field of
deepening will regard the accurate study of multi vessel dissection (syncronous or
less): 4 pts. (25%) in our first results. All patients were discharged alive.
Conclusions. Our series demonstrates the female prevalence among pts. with
SCAD. Almost all patients were admitted with an acute coronary syndrome and
completed a myocardial infarction. Invasive treatment with PCI or CABG is not
mandatory and the early outcome is favourable.
C87
STEM-AMI TRIAL: FATTIBILITÀ E DATI PRELIMINARI
C. Malafronte*, G. Pompilio°, S. Maggiolini*, M. Pesce°, G. Mannino§, L. Piatti*,
G. Tiberti*, F. Gentile§, A. DiLelio§, J. Baglivo*, C. Addamiano*, D. Skouse*,
F. Achilli*
*A.O. A. Manzoni, Lecco, °Centro Cardiologico Fondazione Monzino (CCFM)
Milano, §A.O. San Gerardo, Monza
Razionale. I Pazienti (Pz) con infarto miocardico acuto (IMA) anteriore e
sopraslivellamento del tratto ST (STEMI), presentano prognosi severa,anche
quando sottoposti ai trattamenti raccomandati (PTCA primaria e terapia medica
ottimizzata), con tempi di intervento ”ideali”. Lo sviluppo di disfunzione e
rimodellamento ventricolare, che rappresenta l’evento prognosticamente più
rilevante in tale popolazione, ha prevalenza elevata soprattutto nei Pz con
intervallo “symptom-balloon” >3 ore. Lo studio STEM-AMI (prospettico, fase II,
randomizzato, “open-label”), prevede l’arruolamento di 50 Pz con STEMI
anteriore, >3h, sottoposti a PTCA primaria efficace, con disfunzione Vsx residua
(FE ≤40%). I Pz sono randomizzati a terapia con G-CSF (5 mcg/kg/bid s.c.) per
5 giorni (gg) consecutivi dopo la procedura, oppure a terapia convenzionale (Anti
IIb/IIIa, ACEI, betabloccante, ASA).
Scopo. Valutare l’efficacia clinica della mobilizzazione di cellule staminali da
midollo osseo nel sangue periferico, in termini di incremento di FE del Vsx di
almeno il 5%, nei trattati vs controlli, misurata alla RMN a 6 mesi di follow-up (f.u.).
End point secondari:a)evidenza di nuovo miocardio vitale al f.u. (Wall Motion
Score Index e Wall Thickening all’eco, Late Enhancement alla RMN;
b)correlazione tra efficacia del GCSF e caratteristiche delle cellule CD133+ in
vitro e in un modello murino;c)incidenza di restenosi del vaso target.
Metodi. Misura basale (440 ms) in 9 cases (mean 455 ± 42 ms).
Mean peak troponin I was moderately elevated (5.4 ± 5.8 ng/dl). The mean
echocardiographic LV ejection fraction was 40.7 ± 8.1% on admission and
increased significantly to 62.2 ± 4.5% at 1-month follow-up (P27 frames) in at least 1 major
epicardial coronary artery. We observed 1 case with an atypical presentation of the
syndrome without involvement of the apex, but transient LV mid-ballooning. Two
cases presented an apical thrombus formation. All patients were alive and without
MACE at a median follow-up of 14 months (range 2 to 19). In conclusion: 1) The
apical ballooning syndrome should be considered in the differential diagnosis of
patients presenting with suspected acute coronary syndromes particularly in postmenopausal
women with a history of recent unusual stress, as it may account for
approximately 2% of hospital admissions; 2) Other causes of transient LV “apical
ballooning” such as myocarditis, hypertrophic cardiomyopathy, head trauma,
intracranial bleeding and pheochromocytoma must be excluded; 3) Since there are
atypical presentations of the syndrome without involvement of the apex, the name
of this syndrome may need to be re-evaluated in the future; 4) Till this moment no
data are available about the treatment of this disease, but the use of anticoagulant
therapy until the complete resolution of the wall motion abnormalities seems correct.
C90
EARLY VERSUS LATE ABCIXIMAB IN PRIMARY PCI: IMPROVEMENT OF
REPERFUSION AND FUNCTIONAL RECOVERY IN PATIENTS WITH
OCCLUDED INFARCT-RELATED ARTERY (A RELAX-AMI SUB-STUDY)
D. Tedeschi, M. Maioli, M. Leoncini, A Toso, F. Bellandi
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy
Background. In a prospective randomized trial (RELAx-AMI study) on patients
with acute myocardial infarction (IMA) treated with primary angioplasty (PCI), we
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