Pentraxin 3 Is Highly Specific for Predicting Anatomical Complexity of Coronary Artery Stenosis as Determined by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Score

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score. SUBJECTS AND METHODS: We investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52). RESULTS: The clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng . dL-1. This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92). CONCLUSION: We observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng . dL-1 was highly specific for diagnosing complex coronary artery stenosis.

Comparison between intracoronary abciximab and intravenous eptifibatide administration during primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction

Administration of glycoprotein 2b/3a inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention [PPCI] for ST-segment elevation myocardial infarction [STEMI]. Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab [0.25 microg/kg] bolus or two boluses of intravenous Eptifibatide [0.180 microg/kg] each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution [STR], and post-procedural thrombolysis in myocardial infarction [TIMI] grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect [arrhythmia] and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.61]. The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI [micromol/L/hr], was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 [interquartile range [IQR], 3006.0 to 11112.0] versus 7,294 [IQR, 3795.5 to 11803.5]; p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.87]. No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI

[Prevalence of Clopidogrel resistance in patients candidate for percutaneous coronary intervention]

In patients who undergo coronary angioplasty, Clopidogrel resistance is accompanied with increased risk of cardiovascular events [unstable angina, recurrent MI, death, etc]. In different studies resistance to Clopidogrel has been reported to be up to 30%. Identification of these patients and determining the contributing factors can help us to reduce cardiovascular events. This cross-sectional study was carried out on candidates of elective percutaneous coronary intervention [PCI] in Shahid Modarres Hospital. Resistance to Clopidogrel was evaluated by platelet aggregometry in platelet-rich-plasma [PRP] using a routine aggregometer [Helena Biosciences Europe]. The platelet aggregation was measured before and after exposure to 20 micro mol ADP as a reagent. Contributing factors such as age, gender, metabolic factors and medications were examined by Chi-square test. This study was run on 90 candidates for elective PCI. Their mean age was 62.6 +/- 10.2 years and 52.2% were male. 20% were semi-responder and 7.8% was non-responder. Gender, hypertension, obesity, using angiotensin-converting enzyme inhibitors and calcium channel blockers did not have any role in Clopidogrel resistance, but diabetes, hyperlipidemia, using beta blockers and statins were more common in Clopidogrel resistant patients [p<0.005]. Considering both non-responders and semi-responders, prevalence of resistance to Clopidogrel was 27.8%, so we must be worried about it. Further larger studies should be designed to determine and manage the contributing factors

Changes of left ventricular mass index among end-stage renal disease patients after renal transplantation

The aim of this study was to determine left ventricular [LV] mass index via echocardiography in end-stage renal disease patients [ESRD] before and after renal transplantation, and its association with one-year survival. Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction [EF], LV mass, and LV mass index were determined. All of the patients were followed up for 1 year. Mean LVEF was 51.6% which increased to 53.7% after renal transplantation [P = .001]. Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation [P = .001]. Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m[2] following the operation [P = .002]. All of the patients survived during 1-year follow-up, and no death was reported. Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD

Could mean platelet volume predicts impaired reperfusion and in-hospital major adverse cardiovascular event in patients with primary percutaneous coronary intervention after ST-elevation myocardial infarction?

Due to the positive relation between platelet size and platelet reactivity, a high value of the mean platelet volume [MPV] is an independent risk factor to predict acute myocardial infarction [AMI] and its adverse outcome. Few data are available to determinate the prognostic value of MPV in ST-elevation myocardial infarction [STEMI] patients treated with percutaneous coronary intervention [PCI]. The primary purpose of this study was to evaluate the clinical value of MPV to predict impaired reperfusion and in-hospital major adverse cardiovascular events [MACE] in acute STEMI treated with primary PCI. This study included 203 STEMI patients referring for blood sampling before primary PCI to estimate MPV and determine the thrombolysis in myocardial infarction [TIMI] flow grade, corrected TIMI frame count [CTFC], and in-hospital MACE. The frequency of in-hospital MACE in the group of patients with a high MPV [>/= 10.3 ng/dl] was significantly more than that of the group with a low MPV [<10.3 ng/dl] [37.8% vs. 4.4%, P < 0.001]. The no-reflow phenomenon was more frequent in the patients with a high MPV than that of the patients with a low MPV [17.8% vs. 1.9%, P < 0.001]. The mean MPV in the group of patients with CTFC >/= 40 was significantly more than that of the group of patients with CTFC < 40 [10.9 +/- 0.92 vs. 9.45 +/- 0.85, P = 0.001]. After adjustment for baseline characteristics, a high MPV remained a strong independent factor to predict the no-reflow phenomenon [Odds Ratio [OR]=2.263, 95% Confidence Interval [CI] = 1.47 to 5.97; P < 0.002], in-hospital MACE [OR = 2.49, 95% CI = 1.34 to 4.61; P < 0.004], and CTFC >/= 40 [OR=2.09, 95% CI = 1.22 to 3.39; P < 0.003]. These findings confirmed that not only could admission MPV predict impaired reperfusion and in-hospital MACE in acute STEMI patients treated with PCI, but also it could be considered a practical way to determine higher-risk patients

Primary percutaneous coronary intervention in patients with acute myocardial infarction

Primary percutaneous coronary intervention [primary PCI] is the method of choice in establishing reperfusion in acute myocardial infarction [AMI] patients. The aim of this study was to determine the success rate of primary PCI in a university medical center in Iran with a view to promoting it as a first-line therapy in patients with AMI, especially in centers with established catheterization labs across the country. All cases of AMI admitted between September 2001 and September 2005 underwent primary PCI. The achieved thrombolysis in myocardial infarction [TIMI] flow was recorded, and the patients were followed during the hospital admission for major adverse cardiac events [MACE]. A total of 180 patients, consisting of 36 females and 144 males, with a mean age of 56 +/- 2.1 years were included in the study. The target vessel was the left anterior descending artery in 66.1%, right coronary artery in 27.2%, and left circumflex artery in 6.7% of the cases. The respective rate of anatomical and procedural success was 94.4% and 90%. The rates of mortality, coronary artery bypass grafting [CABG], and reinfarction were 6.7%, 1.1%, and 2.2%, respectively. Most patients were discharged with no complications in less than a week. Anatomical success in patients < 65 years old was 95% versus 92.5% for those >/= 65 years of age. Procedural success in patients < 65 years of age was 93.6% versus 77.5% for those >/= 65 years old [P < 0.05]. No significant relation was detected between the success rate and sex, target vessel, or major coronary artery disease risk factors. More patients in the mortality group had a longer door-to-balloon [DTB] time compared to the surviving group [P < 0.05]. In light of the results of this study, primary PCI may also be practiced as the therapy of choice for AMI patients in centers with established equipment in our region with acceptable rates of MACE and complications. Better procedural success rates are achieved in younger patients and in those with a shorter DTB time

combined approach to severe multi-organ atherosclerosis

Severe coronary artery disease often coexists with peripheral vascular atherosclerosis. The assessment of the supra-aortic circulation is, therefore, of clinical relevance. We herein describe a case of coronary artery disease treated with surgical revascularization using the internal mammary artery and thereafter the progressive atherosclerotic disease of the native coronary arteries as well as the left subclavian and left renal arteries. We also describe and discuss the clinical presentation, the diagnostic procedures, and the therapeutic approach with respect to the percutaneous transluminal angioplasty of the subclavian, renal, and right coronary arteries

Potential role of thermal therapy as an adjunct treatment in congestive heart failure

The clinical and economic importance of heart failure is widely recognized. The incidence of heart failure is on the increase, particularly with the aging of the population around the world. It is time for a paradigm shift in heart failure management. Alternative non-pharmacological strategies to remodel the failing ventricle will shape a major portion of heart failure therapy in the decade ahead. Exposure to heat is widely used as a traditional therapy in many cultures. In this paper, we will review recent data that suggest thermal therapy may be helpful as an adjunctive non-pharmacological treatment for heart failure

Evaluation of underlying coronary stenosis severity in patients with acute MI after thrombus aspiration using export catheter

Early clinical and retrospective angiographic evaluations indicated that in patients with acute myocardial infarction [MI], vulnerable plaques most often represented a mild luminal stenosis. More recent studies drawing upon prospective angiograms, however, have demonstrated that in majority of patients with acute MI, the underlying stenosis is significant. Twenty-eight patients with acute MI candidated for thrombectomy were enrolled in this study. Thrombectomy was performed using export thrombectomy catheters. After the injection of nitroglycerin, the severity of the lesions was determined by two independent operators. Between April 2007 and February 2008, 28 patients, comprised of 26 men and 2 women with acute MI, were evaluated, The underlying stenosis was >/= 50% in 22 [78.6%] patients and <50% in the remaining 6 [20.4%] patients [P value < 0.01]. The right coronary artery was the most common vessel involved in the lesions < 50%. Contrary to the general belief of many cardiologists, the majority cases of myocardial infarction occur in consequence of significant stenosis

Coronary artery perforation after guidewire removal

Coronary artery perforation is a rare, but potentially serious, complication of percutaneous coronary intervention and is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Management is different but requires prompt recognition and treatment. We describe a case of coronary perforation only after guidewire removal and also review the management of vessel rupture and perforation

Prevention of atrioventricular block during radiofrequency ablation by pace mapping of Koch's triangle

Complete atrioventricular block [AV block] is a serious complication of slow pathway ablation therapy in the treatment of atrioventricular nodal re-entrant tachycardia [AVNRT]. The present study was aimed at determining whether the electroanatomical pace mapping of Koch's triangle could significantly improve the safety, efficiency, and efficacy of selective slow pathway ablation in the treatment of AVNRT. A total number of 124 patients were selected to be studied consecutively for radiofrequency [RF] ablation therapy in the treatment of AVNRT. The subjects were divided into two groups: one, designated Group 1, to serve as the control group, and the other, designated Group 2, to serve as the study group. Conventional fluoroscopic slow pathway ablation was performed on the Group 1 subjects [n=66], with the Group 2 subjects receiving slow pathway ablation therapy guided by pace mapping of Koch's triangle. The slow pathway ablation in Group 2 [n=58] was performed with regard to the pace mapping data obtained on the basis of the St-H interval in the anteroseptal [AS], midseptal [MS], and posteroseptal [PS] regions of Koch's triangle. The anterograde fast pathway [AFP] location was determined based on the shortest St-H interval obtained by stimulating the anteroseptal [AS], midseptal [MS], and posteroseptal [PS] aspects of Koch's triangle. In the Group 2 subjects, AFP location was AS in 50 [86.2%] of the cases, MS in 7 [12%] of the cases, and PS in 1 case [1.7%]. One patient with posteroseptal AFP was administered retrograde fast pathway ablation therapy. One patient in the control group [Group 1], representing 1.5% of the group, developed persistent AV block in the course of the treatment, but none of the subjects in the study group [Group 2] developed any complications. It was concluded that an atypical fast pathway location is conducive to the development of atrioventricular block in the ablation therapy in AVNRT, with pace mapping of Koch's triangle having the capacity to eliminate the risk of any such complication developing. It follows that it helps to identify the AFP location before ablation therapy is administered in AVNRT, thereby improving the safety of the treatment

Assessment of anti-streptokinase antibody in patients with heart diseases and normal subjects

Background: Streptokinase, which is injected intravenously with a standard dose of 1.5 MIU, is the most widely used thrombolytic agent around the world. What is so important about this bioproduct is the level of anti-streptokinase [anti-sk] antibody in the population, which is directly correlated to the incidence of streptococcal infections in that population

Objectives: Since Iran is an endemic area for streptococcal infections, this study was conducted to assess the anti-sk level in an Iranian population

Materials and Methods: 97 males and 47 females referred to Modarress Hospital of Tehran for coronary angiography and cardiac catheterization were included. 10 ml of venous blood was taken before angiographies from each patient. According to the angiography reports, the patients were divided into three groups: Coronary Artery Diseases [CAD, n=95], Rheumatic Heart Disease [RHD, n=19] and normal coronaries [n=30]. The anti-sk antibody level was assessed in the serum samples of all patients using Enzyme Linked Immunosorbant Assay

Results: In 23.2% of patients with CAD, 40% of normal coronaries and 73.7% of patients with RHD, the serum samples contained more than 2 arbitrary units [AU] of anti-SK antibody which regarded as high levels. There was no significant difference between the anti-sk level of patients with CAD and normal coronaries [2.03 +/- 3.02 AUs vs. 2.52 +/- 2.23 AU], but the level of antibody in RHD group [8.16 +/- 10.1 AU] was significantly higher than other groups [p<0.05]. No significant correlation was observed between antibody levels and the age or gender of patients

Conclusion: We concluded that the level of anti-sk antibody is high in Iranian population as compared to other endemic areas for streptococcal infections. Also we found no relation between the level of antibody and sex and age of patients. This study accentuated the necessity of assessment of drug efficacy in endemic areas for streptococcal infections especially in those patients with valvular heart disease