Long term tirofiban infusion before percutaneous coronary intervention in patients with angiographically massive intracoronary thrombus

To evaluate the impact of long term tirofiban infusion before percutaneous coronary intervention [PCI] on the angiographic results in the setting of visible intracoronary thrombus and compare this with conventional PCI performed without tirofiban. Out of 2835 PCI procedures performed in Gazi University Hospital, Ankara, Turkey between 1999 and 2006, 156 [5.5%] patients with massive thrombus in whom PCI were applied, were included in this retrospective study. Out of these 156 patients, 82 [53%] had PCI in the presence of angiographically apparent thrombus without tirofiban and named as group A. The remaining 74 [47%] received long term tirofiban infusion before PCI and were named as group B. Although the baseline thrombolysis in myocardial infarction [TIMI] 0-2 flow was no different between the groups, it is significantly lower in group B compared to group A after the PCI [8.1% versus 23.2%, p=0.015]. The decrease in thrombus burden in group B after tirofiban infusion was also statistically significant compared to pre-tirofiban levels [1.77 -/+ 1.05 versus 3.42 -/+ 0.76, p<0.001]. Group B had better flow characteristics with a 91.9% TIMI 3 flow after PCI. Intervention was successful in the majority technically, however, no reflow was observed in 17 patients [20.7%] in group A and in 2 patients [2.7%] in group B [p<0.001]. Major bleeding requiring transfusion was observed in both groups A [3 patients] and B [4 patients] due to gastrointestinal bleeding or access site hematomas [3.7% versus 5.4%, non significant]. Pre-PCI longterm tirofiban infusion strategy in thrombus containing lesions seems to be a safe and feasible approach in avoiding no re-flow and dissolving the massive thrombus

Plasma homocysteine level in cardiac syndrome X and its relation with duke treadmill score

To investigate the plasma homocysteine level and the relationship between plasma homocysteine level and duke treadmill score DTS in cardiac syndrome X CSX patients. Seventy-nine patients 36 male, 43 female, mean age: 50 +/- 8.8 years admitted to Gazi University Hospital, Ankara, Turkey with typical effort angina, positive stress test, and angiographically normal coronary arteries between January and September 2006 were included in this prospective and controlled study. Thirty asymptomatic patients 11 male, 19 female, mean age: 47.6 +/- 8.3 years with 2 cardiovascular risk factors were chosen as a control group. Plasma homocysteine level was measured in both groups and DTS was calculated in the CSX group. Plasma homocysteine was measured with the AxSYM homocysteine immunoassay method in both groups. Plasma homocysteine level was higher in the CSX group compared to the control group 16.5 +/- 4.9 ?mol/L, n=79, versus 12.4 +/- 4.1 ?mol/L, n=30, p<0.001. The DTS was -2.7 +/- 5.3 in the CSX group. There was a negative correlation between the DTS and homocysteine levels in the CSX group. r=-0.506, p<0.001. Plasma homocysteine level, which is known to cause endothelial dysfunction and microvascular ischemia were higher in CSX patients. Also, this increase in homocysteine level inversely correlated with the DTS, which represents the magnitude of ischemia

Corrected thrombolysis in myocardial infarction frame counts in diabetic patients with angiographically normal coronary arteries

To evaluate corrected thrombolysis in myocardial infarction [TIMI] frame count [CTFC] in patients with angiographically normal coronary arteries and diabetes mellitus, a condition known to be associated with microvascular dysfunction. Patients who underwent coronary angiography in Gazi University Hospital, Ankara, Turkey between January 2000 and January 2005 were studied. Corrected TIMI frame count was calculated over the left anterior descending [LAD], left circumflex [Cx] and right coronary arteries [RCA] in 118 diabetic and 122 non-diabetic patients with normal coronary angiogram. The mean CTFC values of the LAD, Cx, and the RCA were similar in diabetics and nondiabetics 21.0 +/= 7.5 versus 21.3 +/= 9.6, 23.3 +/= 9.7 versus 23.5 +/= 10.8, 17.9 +/= 6.7 versus 18.7 +/=7.4 respectively, p>0.05 for all comparisons. In stepwise multivariate linear regression analysis, body surface area had a significant correlation with CTFC of all the 3 coronary arteries. We conclude that CTFC in diabetics and non-diabetics with angiographically normal coronary arteries is similar. Since microvascular disease is an inherent component of diabetes, our finding may reflect the inadequacy of CTFC in predicting microvascular disease in diabetic patients with normal coronary angiograms