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.

Immediate results and six-month clinical outcome after percutaneous coronary intervention in patients with prior coronary artery bypass surgery

Redo coronary artery bypass grafting surgery [CABG] is associated with a higher risk of mortality than the first operation. However, the impact of percutaneous coronary intervention [PCI] on the outcome in such patients is currently unclear. We evaluated the in-hospital and six-month clinical outcomes of post-CABG patients who underwent PCI in our center. Between April 2008 and July 2009, 71 post-CABG patients [16 women and 55 men] underwent 110 stent implantations [75% drug-eluting stents] for 89 lesions. Sixty percent of the PCI procedures were performed on the native coronary arteries, 32% on graft arteries, and 8% on both types of vessels. Major adverse cardiac events [MACE] were recorded in hospital and at six months' follow-up. The procedural success rate was 93%, and the in-hospital MACE rate was 5.6% [1 death, 3 myocardial infarctions]. At 6 months, the incidence of MACE WAS 5.6% [no death or myocardial infarction, but 4 target lesion revascularizations] and 4 [5.6%] in-stent restenoses. There was no statistically significant difference in the comparison of MACE between the patients treated in either native arteries or in the grafts [15% vs. 12%, p value =0.8]. According to the univariate analysis, hypertension and the use of the bare metal stent vs. the drug-eluting stent were the significant predictors of MACE, whereas the multivariate analysis showed that only hypertension [OR = 3.7, 95% CI 3.44-4, p value < 0.048] was the independent predictor of MACE. The mean of the left ventricular ejection fraction had no effect on the incidence of MACE [p value = 0.9]. The multivariate analysis showed hypertension [p value < 0.048] and the use of the bare metal stent [p value <0.018] were the independent predictors of MACE. The chronic total occlusion [CTO] [p value <0.01] was the independent predictor of the success rate. The prevalence of diabetes had no impact on the incidence of MACE according to the univariate analysis [p value= 0.9]. Our multivariate analysis showed that hypertension and use of the bare metal stent were the independent predictors of MACE and that chronic total occlusion was the independent predictor of the procedural failure rate. PCI is preferable to redo CABG for post-CABG patients. The independent predictors of MACE were hypertension and bare metal stents

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

Carotid artery stenting: a single-center experience

Carotid artery stenting is now used as an alternative to surgical endarterectomy. This study was done to assess the feasibility, safety, and immediate and late clinical outcomes in patients undergoing carotid stenting. Between July 2008 and December 2009, a total of 40 patients [20 male, mean age: 65 +/- 11 years, 19 symptomatic, and 90% high risk for endarterectomy] underwent carotid artery stenting with different embolic protection devices and carotid stents. Thirty-seven patients had coronary artery disease. Technical success rate, stroke/death/ myocardial infarction rate at 30 days, access-site complications, and contrast-induced nephropathy were assessed. For the evaluation of the influence of experience in carotid artery stenting on complications, the patients were divided into two groups: Group I included the first 20 treated patients and Group 2 comprised the remainder of the patients. The overall technical success rate was 100%. The cumulative in-hospital stroke death rate was 7.5% [n = 3:1 deaths and I major stroke]. Complications were more frequent in Group 1 [2/20, 10%; 2 deaths] than in Group 2 [1/20, 5%; 1 major stroke], but this was not statistically significant [p value = 0.09]. No access-site complications occurred, and mild contrast-induced nephropathy occurred in 3 patients [7.5%]. No major stroke or neurological deaths occurred during a mean follow-up of 12 months. Carotid stenting seemed feasible and relatively safe in our experience. Advanced experience in carotid artery stenting appears to confer an acceptable peri-procedural stroke-death rate

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

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