Depressed Inflammatory Response to Repeated Angioplasty in Unstable Angina Patients with an In-Stent Restenosis

BACKGROUND: Inflammation plays a key role in the pathogenesis of an in-stent restenosis because it promotes neointimal proliferation. This study was performed to determine responses of the C-reactive protein (CRP) in unstable angina patients with an in-stent restenosis undergoing repeated percutaneous transluminal coronary angioplasty (re-PTCA). METHODS: The study subjects (unstable angina) were classified into 2 groups:Group A (n=30, 15 men, mean age 62 years) had a re-PTCA for an in-stent restenosis lesion and Group B (n=60, 33 men, mean age 63 years) underwent a stent implantation for a de novo lesion. RESULTS: The baseline CRP levels in group A were significantly lower than in group B, as well as 6 and 24 hours after intervention. Twenty four hours after intervention, the CRP levels increased (>4 mg/L) in 3 out of 30 patients (10%) of group A but increased in 32 out of 60 patients (53%) in group B (p<0.001). The differences in the CRP levels between the baseline and 24 hours after intervention were significantly lower in group A than in group B (0.8 and 2.15 mg/L, respectively, p<0.001). In group B, the serum CRP levels 24 hours after intervention were significantly higher than the baseline levels (p<0.05), but not in group A. CONCLUSION: The CRP expression level is significantly lower in unstable angina patients undergoing a re-PTCA for an in-stent restenosis than those undergoing a stent implantation for a de novo lesion.

"Recovery Only" ST-Segment Depressions in an Exercise Treadmill Test and the Prediction of Coronary Artery Disease

BACKGROUND AND OBJECTIVES: "Recovery only" ST-segment depressions are sometimes detected during an exercise treadmill test. We undertook this study in order to clarify the predictive value of exercise-induced ST-segment depression occurring in recovery only. SUBJECTS AND METHODS: The study included 931 patients who had both a sign or symptom -limited treadmill test. Of the 66 patients who demonstrated abnormal ST-segment responses, 43 experienced ST-segment depressions during exercise (Group A) and 23 displayed such responses only during recovery (Group B). RESULTS: The positive predictive value of an exercise treadmill test for significant angiographic disease in group A (81.3%) was statistically different from the predictive value in group B (30.4%). Horizontal ST-segment depression in recovery periods and female sex were statistically significant factors favoring negative coronary angiographic results. CONCLUSION: The occurrence of horizontal mild ST-segment depression during only the recovery periodgenerally represents a "false positive" response, particularly in female patients.

The Optimal Timing to Measure C-Reactive Protein to Predict Cardiac Events in Patients with Unstable Angina

BACKGROUNDS AND OBJECTIVES: C-Reactive protein (CRP) levels are powerful predictors of cardiac complications and death in patients with unstable angina unrelated with myocardial cell damage or myocardial ischemia. This study was performed to determine the optimal timing to measure CRP to predict cardiac events in patients with unstable angina. MATERIALS AND METHOD: The study was comprised 50 patients with unstable angina (Braunwald Class IIIb). We randomized the study subjects by the time of CRP elevation (> 8mg/L): Group A (on admission, 15 patients), Group B (during hospitalization, 19 patients), and Group C (at discharge, 19 patients). RESULTS: 1) CRP levels (median and range) of Group A, B, and C were 10.6 (8.2-24.2), 12.8 (8.1-33.7), and 10.3 (8.1-18.7) mg/L, respectively (p=S). 2) During clinical follow-up at a mean duration of 12 months, there were 1 death, 1 myocardial infarction, 6 revascularization therapy (PTCA or CABG) and 11 recurrent angina. 3) In Group A, 10 cardiac events (1 myocardial infarction, 4 revascularization therapy, and 5 recurrent angina) occurred. The elevated levels of CRP predicted cardiac events during clinical follow-up with sensitivity of 53%(10/19), positive predictive value of 67%(10/15), and negative predictive value of 74%(26/35). In Group C, 13 cardiac events were occurred. Sensitivity, positive and negative predictive value to predict cardiac events of elevated levels of CRP were 68%(13/19), 68%(13/19) and 81%(25/31), respectively. 4) Elevated levels of CRP (>8mg/L) were predictors for cardiac events in patients with unstable angina (Group A; p 8mg/L at discharge were only predictive of cardiac events with odd ratio of 6.01 (95% CI 1.50-44.3, p 8mg/L) was elevated in 38% of patients at discharge and elevated levels of CRP at discharge were only predictive of cardiac events in patients with unstable angina.

The Prognostic Significance of Troponin-T in Patients with Acute Myocardial Infarction: Can Late Peak Concentration of Troponin-T after Myocardial Infarction Predict Cardiovascular Events?

BACKGROUND AND OBJECTIVES: It has been demonstrated that the estimated infarct size is a prognostic variable which significantly influences the short-term and long-term prognosis after an acute myocardial infarction (AMI). Recently, the late peak level of troponin-T has been determined as a reliable and simple non-invasive method for estimation of infarct size. This study was performed to determine whether the late peak level of troponin-T can be used to predict cardiovascular events during in-hospital stay and out-patient follow-up in patients with AMI. MATERIALS AND METHOD: The study was comprised 100 patients (male 91, mean age 57+/-1 years) with AMI and thrombolysis which was initiated within 6 hours after the onset of symptoms. The late peak concentration of troponin-T was defined as a more larger level between 48 and 72 hours after thrombolysis. We investigated the factors influencing on the late peak level of troponin-T and assessed the relation of the late peak level and cardiovascular events. RESULTS: 1) The late peak level of troponin-T was significantly correlated with the peak creatine kinase (CK) level, (r=0.69, p=0.0001) but not ejection fraction of left ventricle (LVEF) at 7 days after AMI. The late peak level of troponin-T was significantly higher in patients with LVEF of <40% at 7 days after AMI (13.49+/-3.62 vs. 6.44+/-0.72, p=0.035) but not different by location of AMI and reperfusion status. 2) During clinical follow-up at a mean duration of 27 months, 1 cardiac death, 10 congestive heart failure, 8 recurrent infarction, and 20 post-myocardial infarction angina were occurred. 3) In patients who occurred cardiac events during in-hospital stay, the peak level of CK (4377+/-938 vs. 2661+/-234, p=0.001) and TIMI forward flow grade < 3 (5/13 vs. 6/55, p=0.022) were significantly higher, but the late peak level of troponin-T (8.69+/-1.22 vs. 6.91+/-0.79, p=0.021) and the peak level of troponin-T (21.09+/-2.29 vs. 13.28+/-1.37, p=0.021) were significantly higher in patients who occurred cardiac events during out-patient follow-up. On multi-variate analysis by logistic regression, the late peak level of troponin-T was predicted the cardiac events during clinical follow-up (CI 1.022-1.196, p=0.022). CONCLUSIONS: The late peak level of troponin-T is significantly correlated with peak CK level and higher in patients with LVEF of