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

Evaluation of efficacy and complications of N-Acetylglucosamine for hemostasis of femoral arterial catheterization wounds

Reports to the FDA of local vascular complications associated with the use of hemostatis devices following cardiac catheterization and resulting in serious injuries have raised concerns about the safety of these devices. A review of the medical literature also has posed cause for concern. We performed this study to assess the efficacy and risks of local adverse events in hemostatis following cardiac catheterization with N-Acetyglucosamine-facilitated manual compression versus manual compression alone. N-Acetylglucosamine was used for hemostasis in 205 patients who underwent diagnostic cardiac catheterization performed via femoral access at a single site. Another 205 patients underwent diagnostic cardiac catheterization and received routine manual compression and served as the control group. Ambulation was permitted 12 hours after manual compression and 6 hours after using N-Acetylglucosamine. Poisson regression analysis using four different outcomes was used to assess the risk associated with the type of hemostasis, while controlling for confounding variables. Overall, the unadjusted incidence of any vascular complication was 4.8% for the manual compression and 5.4% for the N-Acetylglucosamine group. No serious adverse events were seen in this study. N-Acetylglucosamine does not appear to pose a greater risk for local vascular complications flowing cardiac catheterization than the manual compression method. This method permitted early ambulation and was as safe as manual compression

Correlation between blood levels of adhesion molecules ICAM-1 and VCAM-1 and thrombomodulin with coronary artery disease

The results of studies on coronary artery disease risk factors have demonstrated that some adhesion molecules could be risk factors for coronary artery disease. ICAM-1 and VACM-1 are the most important adhesion molecules. On the other hand, thrombomodulin is an anti-inflammatory factor and can reduce the risk for coronary artery disease. In this study, as well as evaluating these factors, we also studies the effect of the interaction between these factors on coronary artery disease. One hundred twenty-three patients between the ages of 45 and 70 years old who were admitted for coronary angiography in the cardiovascular center and met the inclusion criteria for the research, were selected in the first half of 2008. After recording their personal information and medical history in the questionnaires, blood samples were collected and after routine examination, the blood levels of these factors were measured. WE then entered the acquired results of the blood examination and the angiography in the patients' charts and analyzed the results using statistical methods. The angiography results in patient showed that 18 [14.7%] had normal coronary arteries, 5 [4%] had minimal coronary artery disease, 40 [32.5%] had single-vessel disease, 25 [20.3%] had two-vessel disease, and 35 [28.5%] had three-vessel disease. In laboratory tests, the mean soluble ICAM-1 level in patients with normal coronary arteries was 236 ngr/mL; however, in patients with coronary artery disease, the mean level was 274 ngr/mL. The average amount of VCAM-1 in patients with normal coronary arteries was 697 ngr/mL, whereas patients with coronary artery disase had an average of 108 ngr/mL. Thrombomodulin in the normal coronary artery group was 42 ngr/mL, but in patients with coronary artery disease the average level was 30 ngr/mL. The results in this research showed that increased levels of soluble ICAM-1 and also decreased levels of soluble thrombomodulin increased the risk and intensity of coronary artery disease, with statistical significance. The increase in soluble VCMA-1 also increased the risk of coronary artery disease; this was, however, not statistically significant. The important point is that increased levels of soluble ICAM-1 is a risk factor when the level of thrombomodulin is normal or below normal. When the levels of thrombomodulin and ICAM-1 have both increased, the increased risk and intensity of coronary disease is not statistically important

Coronary artery revascularization in a young adult with solitary coronary aneurysm probably secondary to childhood Kawasaki disease

Surgical revascularization for coronary artery lesions secondary to Kawasaki disease [KD] has been rarely reported in adolescent patients. We report a young adult with no coronary risk factors but with a giant solitary coronary aneurysm with obstructive thrombosis inside, presumably secondary to KD, who underwent coronary artery bypass grafting [CABG] with left internal thoracic artery [LITA] and SVG. Because coronary artery sequelae of KD can be a cause of ischemic heart disease even in young adults, heightened awareness of this entity is required for young adults with coronary lesions but without coronary risk factors

Correlation between blood levels of CRP, TNT-alpha [as inflammatory factors], and IL-10 [as anti-inflammatory factor] and coronary artery disease

The results of a great amount of research done the world over in recent years have indicated that atherosclerosis is an inflammatory disease. Most of these investigations were conducted on the correlation between inflammatory factors such as CRP, Il- and Il-1 and atherosclerosis. In this study, we evaluated inflammatory factors such as CRP and TNF-alpha as well as anti-inflammatory factor IL-10 and analyzed the correlation between the balance of these factors with atherosclerosis. In total, 135 patients between the ages of 45 and 70 years who were admitted for coronary angiography were selected. All of the selected patients met the inclusion criteria for the research. After recording personal information, medical history, and any previous treatment in the questionnaire, blood samples were collected and levels of CRP [high-sensitive quantitative test], TNF-alpha, and IL-10 were measured in all the samples. We entered the acquired results, the routine blood examination, and the angiography results in the patients' charts and analyzed the results using statistical methods. The angiography results in the 135 patients were as follows: 19 [14.1%] cases had normal coronary arteries, 6 [4.4%] had minimal CAD, 43 [31.8%] had single-vessel disease, 29 [21.5%] two-vessel, and 38 [28.1] had three-vessel disease. In the laboratory tests, the mean CRP level in patients with normal coronary arteries was 6 +/- 4 mg/l, however in patients with CAD it was 17 +/- 9 mg/l. Also, the mean IL=10 level in cases with normal coronary arteries was 4.4 pgr/mL, while in patients with CAD it was 2.6 pgr/mL, and serum level of TNF-alpha in patients with CAD was 6.2 +/- 3.8 pgr/mL, whereas in cases with normal coronary arteries, the average serum level of TNF-alpha was 4.5 +/- 2.2 pgr/mL. The obtained results in this research showed a direct correlation between the blood levels of CRP and TNF-alpha with the existence and intensity of coronary artery disease. In addition, we found a reverse significant correlation between blood levels of IL-10 and existence of coronary artery disease. Although we found a correlation between reduced levels of IL-10 and intensity of coronary artery disease, it was not statistically significant. Furthermore, in patients with elevated blood levels of inflammatory and antiinflammatory factors, the intensity of the coronary artery disease was far less than that in patients with high levels of inflammatory factors and reduced levels of antiinflammatory factors. Therefore, we concluded that high levels of CRP and TNF-alpha and low levels of IL-10 had a significant correlation with the intensity of coronary artery disease and also the balance between these factors had a significant correlation with the intensity of the coronary artery disease

Comparative study of pulmonary function tests before and after successful percutaneous transvenous mitral commissurotomy

Mitral stenosis [MS] causes elevation of left atrial and pulmonary venous pressures. Persistent elevation of pulmonary venous pressure causes anatomical and physiological changes in lung vasculature and tissue, and change in lung volumes thereafter. Studies showed improvement of lung function with improvement of mitral stenosis and decrease in left atrial pressure and pulmonary congestion. This study was performed to evaluate lung volumes before and after percutaneous transvenous mitral commissurotomy [PTMC], including FEV1, PVC, SVC, and their percent and FEF of 25, 50, 75, 25-27 percent and PEFR before and within 48 h after PTMC, and to evaluate correlation of each with valve area. 26 from 51 patients with inclusion criteria stayed in the study with non-random consequential selection and the others were excluded. All of the patients had moderate to severe MS, good mitral valve morphology, echo score below 11, and absence of clot in the left atrium. Spirometery was done in all of the patients before and after PTMC and FEV1, FCV, SVC, FEF25%, FEF59%, FEF75%, FEF25-75% FEF1/FVC, and PEFR were measured. There were 26 patients [12 female, 14 male] with a mean age of 38.38 years old, miral valve area was 0.88 cm2 before and 1.46 cm2 after PTMC [mean 0.58 cm2 increase [p<.000]. Mean value of lung volumes and flow changes were: SVC change= 100 ml [p<0.1], FVC= 230 ml [p<0.0005], FEV1= 250 ml [p<0.003], FEF50%= 0.85 [p<0.004], FEF25%= 0.98 [p<0.003], and FEF25-75%= 0.71 [p<0.01]. Values for SVC, PEFR, and FEF75% and PEFR had no significant improvement. This may suggest improvement of small airway function due to a decrease in lung congestion

Presentation of anomalous origin of the left coronary artery from the pulmonary artery with left sided coronary ostium in an adult patient

An anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] is a rare congenital coronary anomaly. It usually presents in infancy with intractable left sided heart failure. Most patients die in infancy, but survival into adulthood is possible. Patients may complain of dyspnea, syncope or effort angina. They may remain asymptomatic; or experience sudden death after exercise. A 56-year-old woman presented with a twomonth history of exertional chest discomfort. Echocardiography showed a coronary anomaly with preserved systolic function and no resting regional wall motion abnormality. The coronary and CT [computed tomography] angiography studies revealed the anomalous origin of the left coronary artery. A review of ALCAPA studies is presented along with images from the echocardiogram, coronary angiogram and CT scan performed for this case

Quantification of aortic regurgitation severity by left ventricular to right ventricular stroke volume ratio

Echocardiography is the most common test used for the evaluation of aortic regurgitation [AR]. However, the role of echocardiography as an available and inexpensive method in the quantification of AR by the left ventricle to right ventricle stroke volume ratio [LV/RV SV ratio] has not been completely investigated. Between June 2005 and December 2007, 132 consecutive patients with AR [mean age: 44.7 +/- 14.6 years, 52.3% male] were enrolled in the study. All the patients underwent echocardiography; and aortography, if indicated, was performed as well. Fifty-two percent of the patients had severe AR. There was almost a perfect agreement between echocardiography and cardiac catheterization in determining the severity of AR [Kappa=0.81]. Associated valvular disease was found in 81.8% of the patients, the most common disease being mitral regurgitation [61%]. The results of our bivariate and multivariate analyses showed a significant relation between the LV/RV SV ratio and the AR severity via either echocardiography or cardiac catheterization [both P=0.001]. The receiver operating characteristic [ROC] curve analysis showed that the LV/RV SV ratio was very accurate in the detection of severe AR utilizing cardiac catheterization as the gold standard [AUC=0.71]. The cut point value of the LV/RV SV ratio