Thrombotic Occlusion of All Left Coronary Branches in a Young Woman with Severe Ulcerative Colitis

Background. The thrombosis risk is increased in active ulcerative colitis. The limited number of reported complications have predominantly been cerebrovascular but other vessel territories may also be affected. Patient. During a severe attack of ulcerative colitis a 37-year-old woman suffered occlusion of all left coronary artery branches. Serial angiographies showed progressive recanalisation of the coronary arteries during anticoagulation, but no atherosclerotic stenosis. The cause of infarction was thus considered to be an extensive coronary thrombosis. However, a large battery of blood tests failed to identify any procoagulant abnormality. Conclusion. Evidence is now accumulating that the increased thrombosis risk also may involve the coronary arteries, even in young patients. To the best of our knowledge this is the third reported case of myocardial infarction despite angiographically normal coronary arteries in a patient with active ulcerative colitis. The extent of affected myocardium was in this case exceptionally large

Inflammatory activity increases with haemoglobin A(1)c in patients with acute coronary syndrome.

Objective. To study the relationship between inflammation, diabetes and HbA(1)c levels in patients with acute coronary syndrome (ACS). Design. Single-centre cross-sectional study comprising 688 consecutive patients with ACS (108 with diabetes) and 341 with stable coronary artery disease (SCAD) (51 with diabetes). High-sensitive C-reactive protein (hsCRP), albumin and fibrinogen concentrations, erythrocyte sedimentation rates (ESR) and leukocyte counts were measured. Results. hsCRP, fibrinogen and ESR levels were higher and albumin lower in ACS patients. ESR was higher, albumin lower and hsCRP borderline significantly higher (p=0.053) in ACS patient with diabetes compared to those without. All inflammatory markers were associated with HbA(1)c in all 688 ACS patients as well as in 540 non-diabetic ACS patients with normal HbA(1)c. In multivariate analyses, all inflammatory markers were independently associated with HbA(1)c in the entire ACS group, regardless of diabetes being present or not. When non-diabetic ACS patients were analyzed separately, only ESR and leukocyte counts were independently correlated with HbA(1)c. Conclusions. Patients with ACS had increased inflammatory activity, which increased with HbA(1)c levels in patients who neither had a history of diabetes nor HbA(1)c above normal, and was further exaggerated in the presence of diabetes

Troponin I and Creatine Kinase MB do not provide comparable information after PCI

Objectives. To compare cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) after PCI in cases with normal baseline levels of both biomarkers. Design. cTnI and CK-MB after PCI were stratified as multiples of the 99 three times 99%URL were classified as procedure-related infarctions. Results. After PCI, CK-MB was > 3x99%URL in 58/486 patients (12%) and cTnI > 3x99%URL in 292/487 patients (60%). cTnI was > 10x99%URL in all cases with infarction according to CK-MB but CK-MB was often normal despite elevated cTnI. There was an only minimal overlap between two infarction populations, those with cTnI in the range from 1x to 10x99%URL and those with CK-MB 1x to 10x99%URL. Conclusions. With the present quantification scales, infarction rate after PCI is > five-fold higher with cTnI than with CK-MB