A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotopic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain.
This case series identifies a familial association in spontaneous coronary artery dissection suggesting a genetic predisposition.
This nested case-control analysis of database records found that use of fluoroquinolones was associated with an increased risk of aortic aneurysm and dissection.
This study describes the characteristics, angiographic findings, and treatment patterns of patients with stable angina symptoms undergoing cardiac catheterization and/or percutaneous coronary intervention before noncardiac surgery in a large national registry.
This article examines the role of percutaneous coronary intervention in the treatment of patients with stable ischemic heart disease.
This retrospective analysis of testing strategies for patients with chest pain evaluated in the ED finds that deferral of early noninvasive testing appears to be reasonable.
Safavi et al characterize hospital variation in use of noninvasive cardiac imaging and the association of imaging use with downstream testing, interventions, and outcomes. Amsterdam and Aman provide an Invited Commentary, and Redberg provides an Editor’s Note.
Fröhlich et al determine the effect on long-term survival of using fractional flow reserve and intravascular US during percutaneous coronary intervention (PCI). They performed a cohort study based on the pan-London (United Kingdom) PCI registry. The primary end point was all-cause mortality at a median of 3.3 years. See the Invited Commentary by Malhotra.