Predictors of major adverse cardiac events following elective stenting of large coronary arteries

Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.

Association between hepatitis B surface antibody seropositivity and coronary artery disease.

BACKGROUND: Specific infectious agents have been found to be related to the pathogenesis of coronary atherosclerosis. AIMS: We assessed the possible association between angiographically proven coronary artery disease (CAD) and hepatitis B surface antibody (HBS Ab) seropositivity in a population with relatively high prevalence of hepatitis B virus (HBV) infection. SETTING AND DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: We analyzed data from 830 consecutive subjects undergoing coronary angiography, including angiographic results reported by two cardiologists for inter-observer reliability and assessment of HBS Ab status determined by enzyme-linked immunosorbent assay (ELISA). STATISTICAL ANALYSIS USED: Chi-square test or Fisher's exact test, independent two-sample t test and the Pearson's Correlation Coefficient test were used, as required. Statistics were performed using SPSS software version 13 (SPSS, Chicago, IL). RESULTS: Two hundred forty-nine (30%) subjects had normal angiogram or minimal CAD, and 581 (70%) had significant CAD in at least one major coronary artery. In patients with CAD and in patients without angiographic evidence of significant atherosclerosis, 28.7% and 28.9% respectively were positive for HBV (P=0.954). Mean C-reactive protein levels in subjects with positive and negative HBS Ab were 10.77+/-8.37 mg/L versus 10.33+/-7.64 mg/L respectively (P=0.465). However, C-reactive protein levels in CAD group were significantly higher (P<0.001). CONCLUSIONS: Our results suggested hepatitis B surface antibody seropositivity has no relationship with coronary artery disease. Moreover, no significant linear correlation exists between HBS Ab and C-reactive protein levels. However, as previously shown, C-reactive protein level in patients with coronary artery disease is significantly higher than in patients with normal coronary arteries.

Premedication for coronary angiography: effects on anxiety and hemodynamic status.

AIM: This study was designed to compare the outcomes of two current methods of premedication, for coronary angiography with placebo, on the level of anxiety and hemodynamic status. METHODS AND RESULTS: In all, 151 patients referring for coronary angiography were randomized into three groups with equal populations. The first group (group M) received 0.02 mg/kg intravenous midazolam; the second (group DP7rpar; received intramuscular injection of 5mg diazepam + 25 mg promethazine; and the third (group P) received 2cc of intravenous normal saline solution. Vital signs, blood pressure, and peripheral O2 saturation were recorded in specifically-designed questionnaires. The level of anxiety before and after angiography was documented according to the Visual Analog Scale. Patients in the group M accidentally had higher pre-procedural anxiety level (p < 0.05). There was no significant difference in pulse rate, respiratory rate, and mean blood pressure (BP) between these groups prior to angiography. In the group M, diastolic BP decreased more significantly than the other 2 groups during angiography (p < 0.05). Although number of punctures, pain at catheterization site, dose of lidocaine, level of consciousness, and patient satisfaction did not show a significant difference between the three groups; midazolam induced higher level of amnesia than the other 2 groups and the physicians were more satisfied with it only compared with diazepam + promethazine (p < 0.05). CONCLUSION: Because of the importance of hemodynamic stability and comfort during angiography, non-pharmacologic approaches are preferred. In case of severity and persistence of autonomic system stimulation, the least effective dose of midazolam for a short period of time may be used.