Mean platelet volume as a predictor of one-year major adverse cardiac events following elective percutaneous coronary interventions

Mean platelet volume [MPV] correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention [PCI] has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV < 9.1 fL, MPV = 9.1 to 10 fL, and MPV > 10 fL, and they were assessed for developing major adverse cardiac events [MACE], comprising death, myocardial infarction [MI], target vessel revascularization [TVR], and target lesion revascularization [TLR] over a one-year follow-up. Of 2539 patients, major adverse cardiac events [MACE] at one year occurred in 77 [3.0%] patients, including mortality in 26 [1.0%]. The patients in the highest tertile [MPV > 10 fL] had no increased frequency of MACE compared to those in the mid [9.1 to 10 fL] and lowest [< 9.1 fL] tertiles [3.3%, 2.2%, and 3.8%, respectively; p value = 0.14]. No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE [OR = 1.10, 95%CI: 0.69-1.77; p value = 0.68], death [OR = 1.14, 95%CI: 0.51-2.54; p value = 0.74], and non-fatal MI [OR = 1.85, 95%CI: 0.73-4.67; p value = 0.19] at one year's follow-up but MPV did not remain in the model in any of the cases. In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% [4 patients] in the highest tertile, 0.8% [2 patients] in the mid tertile, and 0.5% [one patient] in the lowest tertile. There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI

Opium consumption and mid-term outcome of percutaneous coronary intervention in men

Controversy persists over the potential benefits/harms of opium consumption in coronary heart disease. This study investigated the association between 12 months' major adverse cardiac events [MACE] and pre-procedural opium consumption among patients undergoing percutaneous coronary intervention [PCI]. Retrospectively, 1545 consecutive men who underwent PCI between 21[st] June 2009 and 20[th] June 2010 at Tehran Heart Center and were registered in the PCI Databank were entered into this cohort study. The occurrence of MACE, defined as cardiac death, non-fatal myocardial infarction, and need for target vessel revascularization [TVR] or target lesion revascularization [TLR], was compared between two groups of opium consumers and non-consumers in 350 [22.7%] patients. Sixty-four [0.86%] patients expired within 12 months. After adjustment for potential confounders, analysis revealed that opium consumption had no significant relationship with 12 months' MACE [11[3.1%] vs. 53[4.4%]; p value = 0.286, among opium users vs. non users, respectively]. Furthermore, the different components of MACE, including target vessel revascularization, target lesion revascularization, coronary artery bypass graft, and non-fatal myocardial infarction, were not significantly related to opium use. Pre-procedural opium usage in patients undergoing PCI was not associated with 12 months' MACE

Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on mortality of coronary artery bypass grafting

There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs] as regards the postoperative mortality of coronary artery bypass grafting [CABG]. This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 [46.38%] patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. The mean age of the patients was 60.04 +/- 9.51 years and 7364 [73.23%] were male. Eighty-seven [0.86%] patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths in as much as there were 33 [0.70%] vs. 54 [1.0%] deaths in the ACEI/ARB positive and negative groups, respectively [OR: 0.628; p value = 0.09]. Patients without ACEI/ARB were more likely to have a higher global ejection fraction. Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested

Impact of side-branch flow in coronary bifurcation intervention

The optimal strategy in percutaneous coronary intervention [PCI] for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction [TIMI] - III, with a strategy for intervention in both the main vessel and the side branch [MV + SB]. This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event [MACE], i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period. A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions [MV group] and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch [MV + SB group]. The total rate of MACE during the follow-up was 4.3% [11 patients]; the rate was not significantly different between the MV and MV + SB groups [3.7% vs. 4.9%, respectively; p value = 0.622]. There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique.

Outcomes of percutaneous coronary intervention on saphenous vein graft and native coronary vessels

The optimal target for revascularization in patients with history of coronary artery bypass graft surgery [CABG] is unclear. This study was designed to compare the outcome of percutaneous coronary intervention [PCI] on saphenous vein grafts [SVG] and that on native vessels in patients with previous CABG in terms of major adverse cardiac events [MACE]. The study drew upon data on consecutive patients hospitalized for PCI and MACE rate during a nine-month follow- up period. The patients were divided according to the target vessel for PCI into two groups: SVG and native vessel. Between 2003 and 2007, 226 patients underwent PCI 6.57 +/- 4.55 years after CABG. Their mean age was 59.52 +/- 9.38 years, and 176 [77.9%] were male. PCI was performed on the SVG in 63 [27.9%] patients and on the native coronary artery in the rest. During a nine-month follow-up period, 9 [4%] patients suffered MACE; the prevalence of MACE was not significantly different between the SVG group [4.8%] and the native vessel group [4.9%], [p value = 0.999]. PCI on grafted and native vessels did not affect MACE in patients undergoing PCI after CABG

Significant improvement in severely stunned left ventricle after percutaneous coronary intervention

This is a case of severely stunned left ventricle which occurred after a non-ST elevation myocardial infarction in a 76-year-old woman who was a known case of three-vessel disease. Her symptoms and cardiac function responded well to revascularization

Short- term outcomes and mid-term follow-up after coronary angioplasty in patients younger than 40 years of age

Stenting is currently the standard of care in percutaneous coronary intervention [PCI]. Whether young patients remain at increased risk after PCI in the present stent era has not been investigated widely. We evaluated angiographic characteristics and short- and mid-term outcomes in patients younger than 40 years of age who underwent PCI. From April 2003 to March 2005, prospective data were collected in 118 consecutive patients, who were less than 40 years of age and underwent PCI at our referral center. The PCI outcomes in these patients were compared to those in 354 patients, randomly selected from 2493 patients older than 40 years of age in our database. Follow-up was scheduled at 1 month, 5 months, and 9 months through clinic visits, telephone interviews, and reviewing hospital records. Patients<40 years of age were more often male [91.5% vs. 71.8%, P<0.001], current smokers [33.9% vs. 15.2%, P<0.001], and had more family history of coronary artery disease [38.1% vs. 21.8%, P<0.001] and myocardial infarction [44.1 vs. 31.1, p=0.01], while diabetes mellitus [6.8% vs. 22.1%, P<0.001], hypertension [13.6% vs. 35.3%, P<0.001], and hyperlipidemia [34.7% vs. 44.8%, P=0.055] were less common in these patients. There were no significant differences between the two groups regarding vessel involvement, reference vessel diameter, stenosis rate [before and after procedure], and lesion characteristics, with an exception that angulated lesions were more common in the patients. 40 years of age [P<0.05]. The young patients, who underwent PCI, presented more frequently with single-vessel disease [61% vs. 46%, P=0.01].The vessel and lesion sites of PCI and clinical success rates were similar in these age groups. Usage of stent was high and similar, and drug- eluting stent use was not significantly different between the two groups. With a high procedural success [94.9% vs. 91.8%], intra-hospital and late complications were very low and similar in both groups. Percutaneous coronary intervention is a safe and effective procedure for young patients, and major adverse cardiac events are similar in young and older patients