Optical coherence tomography (OCT) is a high-resolution intravascular imaging technique using near infrared light. This technique is useful for guiding percutaneous coronary intervention (PCI). OCT can predict peri-procedure complications. OCT-derived thin-cap fibroatheroma, which is characterized by large lipid-core and thin fibrous cap < 65 μm, has high risks for PCI-related no-reflow, distal embolization, microvascular obstruction and peri-procedure myocardial infarction. In bifurcation PCI, 3-dimensional OCT imaging is helpful to understand complex morphology of carina, distribution of jailing stent strut at side branch ostium and location of guide wire selecting the side branch through the struts. OCT-estimated long carina tip and small branching angle are predictors of side branch occlusion after main vessel stenting. The near infrared light in OCT penetrates coronary calcium and delineates its shape, size and distribution. OCT can describe calcium fracture induced by high pressure ballooning and cutting surface after rotational atherectomy. Bioresorbable vascular scaffold (BVS) struts are more clearly visualized by OCT than X-ray angiography and intravascular ultrasound. OCT allows us to detect inadequate BVS appearance such as underexpansion, malapposition and fracture. Online co-registration of OCT with angiography will be available soon. The co-registration technology might reduce errors in corresponding OCT findings to the angiogram and then prevent longitudinal geographic miss of PCI. By providing precise information of vessel morphologies and stent architectures, OCT contributes to guidance for PCI.

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Background: The preferred surgical revascularization strategy for patients with acute coronary syndromes and multivessel coronary artery disease is uncertain. We evaluated the outcomes of patients with acute coronary syndrome and multivessel disease managed with coronary artery bypass grafting (CABG). Methods and Results: Between April 2007 and August 2014, 111 patients underwent emargency CABG with acute coronary syndrome. Of those, 92 patients had multivessel disease. Early postoperative outcome was evaluated. Eighty-five patients (92.4%) underwent off-pump CABG and 7 (7.6%) on-pump CABG. Sixty-seven (72.8%) required IABP. The mean number of anastomoses was 3.3±0.9 per patient. All patients received complete revascularization. Thirty-four (37%) underwent with all arterial grafts. There ware two operative death (2.2%) in this study group. Conclusion: We suggest that off-pump CABG can be performed safely and effectively in selected patients with acute coronary syndrome requiring emergency coronary revascularization.

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Aim: The aim of this study is to clarify the prognostic factors for in-hospital and neurological outcomes on arrival at the emergency department ( ED ) in patients resuscitated from out-of hospital cardiac arrest ( OHCA ) due to coronary artery disease ( CAD ). Methods: Seventy-nine patients who were resuscitated from OHCA and transferred to the coronary care unit after exclusion of non-CAD cases in the emergency department were enrolled. Patients were divided into 2 groups, one was survivor ( S ), and the other was non-survivor ( NS ), and neurological outcome was evaluated using cerebral performance categories ( CPC ). We compared baseline characteristics, pre-hospital factors including the presence of witness, by-stander cardiopulmonary resuscitation, the initial rhythm at first contact, pre-hospital defibrillation, time interval from receipt of call to arrival at hospital and time from collapse to return of spontaneous circulation ( TROSC ), vital signs and standard 12-lead electrocardiographic ( ECG ) findings on arrival, and the clinical course afterwards including echocardiographic findings and angiographic findings. Results: The QRS duration was significantly longer and systolic blood pressure ( SBP ) was significantly lower in NS group than in S group ( 157.1±50.3 vs. 119.5±25.3 ms, p<0.001; 81.0±59.3 vs. 137.3±38.8 mmHg, p<0.001 ). Time interval from receipt of call to arrival at hospital was significantly longer and SBP was significantly lower in CPC3-5 group than in CPC1-2 group ( 48.6±11.1 vs. 38.3±13.3 min, p=0.002; 94.9±64.0 vs. 142.5±27.7 mmHg, p<0.001 ). Multiple logistic regression analysis showed the QRS duration ( Odds Ratio=1.070, p=0.043 ) and SBP ( Odds Ratio=0.901, p=0.033 ) were independent prognostic factors of survival and time interval from receipt of call to arrival at hospital ( Odds Ratio=1.082, p=0.021 ) and SBP ( Odds Ratio=0.973, p=0.023 ) were independent prognostic factors of neurological outcome. Conclusion: In patients resuscitated from OHCA due to CAD, independent prognostic factors on arrival at the ED for in-hospital survival were QRS duration on ECG and systolic blood pressure, and those for neurological outcome were time interval from receipt of call to arrival at hospital and systolic blood pressure.

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Coronary artery aneurysm is a relatively rare disease, which may cause angina, myocardial infarction, or sudden death due to thrombosis, embolization or rupture. Coronary angiogram of a 84-year-old man revealed saccular coronary artery aneurysm at left anterior descending coronary artery and coronary artery severe stenosis. He underwent aneurysmorrhaphy of coronary artery aneurysm and coronary artery bypass grafting to left anterior descending coronary artery and diagonal branch without cardiopulmonary bypass. There were no complications and the postoperative course was uneventful. On postoperative coronary angiography, the aneurysm was disappeared and LITA was patent. Surgical approach should be determined by aneurysm size, presence of branching vessels, and degree of stenosis.

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A 71-year-old man, who had undergone total laryngectomy for laryngeal cancer and had a low cervical terminal tracheostoma, complained of anterior chest oppression, dyspnea on exertion and orthopnea. Coronary angiography revealed triple vessel diseases. He underwent off-pump coronary artery bypass grafting through a left thoracotomy to avoid a sternal wound infection with the left internal thoracic artery and right saphenous vein used as grafts. His postoperative course was uneventful. A deep wound infection following a sternotomy is a serious postoperative complication. A left thoracotomy seemed to be a useful alternative approach in a patient with terminal tracheostoma.

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