Plasma homocysteine level and its genotypes as a risk factor for coronary artery disease in patients undergoing coronary angiography

Hyperhomocysteinemia has recently been identified as a risk for coronary artery disease [CAD]. Some genetic variants such as C677T polymorphism are postulated in this regard. We studied the relation between hyperhomocysteinemia and the above genetic variant and the risk of CAD and also the number of involved vessels. In total, there were 90 patients: 45 with angiographically documented CAD and 45 with the clinical manifestations of CAD but negative angiography. The blood homocystein level was measured using the ELISA and C677T polymorphism using the PCR method. The homocystein level was significantly higher in the case group [p value=0.00], but it did not show any correlation between its level and the extent of CAD. The case group was more homozygote in C677T allele but again it had no relation to the extent of CAD. Hyperhomocysteinemia acts as a CAD risk factor and whilst its presence increases the risk, it does not predict the extent of it

comparison of outcomes of routine early angiography versus delayed ischemia-guided angiography after thrombolytic therapy in ST segment-elevation myocardial infarction

Thrombolytic therapy continues to be the common treatment in acute ST elevation myocardial infarction in the majority of heart centers worldwide. However, thrombolytic therapy is associated with high re-occlusion and re-infarction rates. So, most patients now undergo early diagnostic angiography and possibly angioplasty of the culprit artery but the controversy about the timing of angiography after thrombolysis continues to remain unresolved. In this prospective cohort study, we compared the outcome of early invasive strategy versus delayed invasive approach in ST-elevation MI patients who had received successful thrombolytic therapy. Primary endpoint of the study was Major Adverse Cardiovascular Events or MACE [the combined rate of death, re-infarction, major bleeding and cerebrovasular events. Secondary endpoints were re-infarction and re-hospitalization rate. The study comprised 142 patients of which 87 had a routine angiography in less than 10 days of acute event and 55 underwent ischemia-guided angiography after 10 days of index event. Stenting of the culprit vessel was done in 60% of the routine angiography group and 63% of the ischemia-guided group. The patients were followed for 8.8 +/- 2.8 months after the index event. The primary endpoint occurred in 6.9% of routine angiography patients and 10.9% of the control group [P= 0.4]. The rate of re-infarction was significantly higher in the delayed invasive arm than routine early invasive arm [10.9% vs. 1.1, P:0.01],and mostly occurring before angiography. Routine angiography as soon as possible after thrombolysis can reduce re-infarction and was not associated with any increased risk of adverse events in our study

In-hospital course of early invasive strategy in acute coronary syndromes

Unstable angina is emerging as a major public health problem worldwide. Two approaches - an early invasive strategy or a conservative strategy - are used of the management of non-ST elevation acute coronary syndrome [MSTE-ACS]. An early invasive strategy involves the use of early coronary angiography and revascularization with percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]. A conservative strategy involves initial treatment with aggressive pharmacologic treatment, and coronary angiography with revascularization is used if there is evidence of spontaneous or provoked ischemia within the hospital stay. Two hundred sixty-one patients coronary syndrome were enrolled in this study for early invasive strategy. Patients received aspirin, heparin, clopidogrel, and lipid-lowering therapy. The primary endpoint was a composite of death, non-fatal myocardial infarction, cerebrivascular accident, and recurrent chest pain. Angiograms were assessed qualitatively by two expert invasive cardiologists. Sixty-seven percent of the patients underwent percutaneous [33%] or surgical [34%] revascularization. The overall death rate was 1.1%. In-hospital major adverse cardiac event [MACE] rate was 3.2% in the revascularization groups. According to the favorable in-hospital course in patients referred for PCI or CABG, it seems that accurate selection of patients who may be candidates for early invasive strategies is of paramount importance. We found that diabetes, cardiac enzyme elevations [Troponin T], ST/T changes, and the presence of two or more risk factors besides diabetes are powerful predictors of the patients who will undergo revascularization. Proper selection of patients admitted with ACS for invasive strategy is warranted. Positive cardiac enzymes [Troponin T], diabetes mellitus, and presence of two or more major CAD risk factors are helpful for patient selection