Nephroprotective effects of L-carnitine against contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a randomized open-labeled clinical trial

Background: L-carnitine may prevent the incidence of AKI by its antioxidant effects and improving circulation in ischemic conditions. The goal of this trial was to evaluate the impact of L-carnitine on contrast-induced nephropathy in patients undergoing elective PCI

Methods: totally, the patients were randomly allocated to 2 groups. The treatment group received 1 g of L-carnitine orally 3 times a day, 24 hours before the procedure [3 g before PCI] and 2 g after PCI, whereas the control group did not receive L-carnitine. In both groups, the plasma level of neutrophil gelatinase-associated lipocalin [NGAL] was measured at baseline and 12 hours after PCI

Results: our study was conducted on 202 patients [including 91 vs. 111 patients in the treatment and the control group; 31 [34.1%] vs 33 [29.7%] female in carnitine and control group; and ages include 62.0 +/- 9.0 vs 57.0 +/- 11.2 years]. The median plasma levels of NGAL were not different between the carnitine and control groups at baseline [57 [IQR: 22 - 255] vs. 54 [IQR: 29 - 324]; p value = 0.155] and 12 hours after PCI [71 [IQR: 52 - 129] vs. 70 [IQR: 46 - 153]; p value = 0.925], but the changes in the plasma NGAL from baseline to 12 hours after PCI were different between the 2 groups [5 [IQR:-147 - 30] vs. 17 [IQR: -21 - 41]; p value = 0.010]

Conclusion: our results showed that oral L-carnitine was able to prevent an increase in NGAL following contrast medium administration in patients undergoing PCI. More studies should be performed to fully elucidate the nephroprotective effects of L-carnitine

One-year outcome of everolimus-eluting stents versus biolimus-eluting stents in patients undergoing percutaneous coronary intervention

Background: The biolimus-eluting stent [BES], with a biodegradable polymer, has not been previously compared with the everolimus-eluting stent [EES], as a second-generation drug-eluting stent [DES].We sought to compare the 1-year outcome between the PROMUS[TM] stent [EES type] and the BioMatrix[TM] stent [BES type]

Methods: From March 2008 to September 2011, all patients treated with the PROMUS[TM] stent or the BioMatrix[TM] stent for coronary artery stenosis at Tehran Heart Center were enrolled. The primary end points were 1-year adverse events, comprising death, myocardial infarction, target vessel revascularization, and target lesion revascularization. The secondary end point was stent thrombosis. The Cox proportional hazard model was used to assess the adjusted association between the stent type and the follow-up outcome

Results: From 949 patients [66.3% male, mean age =59.48 +/- 10.46 y] with 1,018 treated lesions, 591 patients [630 lesions, 65.1% male, mean age = 59.24 +/- 10.23 y] received the PROMUS[TM] stent and 358 patients [388 lesions, 68.2% male, mean age = 59.88 +/- 10.83 y] were treated with the BioMatrix[TM] stent. Before adjustment, the rate of the primary end points was 3.2% and 3.4% in the EES and BES, respectively [p value = 0.925, HR [EES to BES] = 1.035, 95% CI: 0.50 to 2.13]. The rate of stent thrombosis was 2% and 1.7% in the EES and BES, respectively [p value = 0.698]. After adjustment on confounder variables, there was no statistically significant difference in major adverse cardiac events between the PROMUS[TM] stent and the BioMatrix[TM] stent [p value = 0.598, HR [EES to BES] = 0.817, 95% CI: 0.39 to 1.73]

Conclusion: At 1 year's follow-up, the BES and EES showed similar safety and efficacy rates in the patients undergoing percutaneous coronary intervention with a relatively low rate of adverse events in the 2 groups

Risk-scoring model to predict one-year major adverse cardiac events after percutaneous coronary intervention

Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events [MACE], including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention [PCI]

Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 [n= 2875] were included as a validation data set

Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score [R[²] = 0.795]. The models had adequate goodness of fit [Hosmer-Lemeshow statistic; p value = 0.601] and acceptable ability of discrimination [c-statistics = 0.63]. The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks

Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care

SYNTAX score can predict major adverse cardiac events following percutaneous coronary intervention

The SYNTAX score is a grading system that evaluates the complexity and prognosis of patients undergoing percutaneous coronary intervention [PCI]. We investigated the association between the incidence of major adverse cardiac events [MACE] following PCI and the SYNTAX score in patients with three-vessel disease. We consecutively enrolled 381 patients with three-vessel disease undergoing PCI and stenting. The SYNTAX score was divided into tertiles as low [22]. The endpoint was the incidence of MACE defined as cardiac death, in-hospital mortality, nonfatal myocardial infarction [MI], or target vessel revascularization. Then, the incidence of MACE was compared among the SYNTAX score tertile groups. The median follow-up was 14 months, and the rate of MACE was 12.6%. The rates of MACE were 7.5%, 9.9%, and 21.6% in patients with low, intermediate, and high SYNTAX score tertiles, respectively. Higher SYNTAX scores significantly predicted a higher risk of MACE [hazard ratio = 2.36; P = 0.02] even after adjustment for potential confounders. The main predictors of MACE were SYNTAX score, advanced age, hyperlipidemia, presentation as recent ST-elevation MI, number of total lesions, and history of renal failure. The SYNTAX score could predict major cardiac outcomes following PCI in patients with three-vessel disease

Mid-term follow-up of drug-eluting stenting for in-stent restenosis: bare-metal stents versus drug-eluting stents

Despite major advances in percutaneous coronary intervention [PCI], in-stent restenosis [ISR] remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent [DES] implantation [[DES sandwich] technique] with DES placement in the bare-metal stent [DES-in-BMS] in a [real world] setting. We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events [MACE], defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization [TVR]. Of the 194 study participants, 130 were men [67.0%] and the mean +/- SD of age was 5 7.0 +/- 10.4 years, ranging from 37 to 80 years. In-hospital events [death and Q-wave myocardial infarction] occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively [p value = 0.702]. Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group [0.9% BMS vs. 5.2% DES; pvalue = 0.16]. Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up

Impact of side-branch flow in coronary bifurcation intervention

The optimal strategy in percutaneous coronary intervention [PCI] for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction [TIMI] - III, with a strategy for intervention in both the main vessel and the side branch [MV + SB]. This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event [MACE], i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period. A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions [MV group] and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch [MV + SB group]. The total rate of MACE during the follow-up was 4.3% [11 patients]; the rate was not significantly different between the MV and MV + SB groups [3.7% vs. 4.9%, respectively; p value = 0.622]. There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique.

Effectiveness of two-year versus one-year use of dual antiplatelet therapy in reducing the risk of very late stent thrombosis after drug-eluting stent implantation

Impact of 12 months' versus 24 months' use of dual antiplatelet therapy on the prevalence of stent thrombosis in patients undergoing percutaneous coronary intervention [PCI] with the drug-eluting stent [DES] is not clear. As a result, duration of dual antiplatelet therapy is still under debate among interventionists. From March 2007 until August 2008, all consecutive patients with successful PCI who received at least one DES and were treated with dual antiplatelet therapy [Clopidogrel + Aspirin] were included. All the patients were followed up for more than 24 months [mean = 35.27 +/- 6.91 months] and surveyed for very late stent thrombosis and major cardiovascular events. From 961 patients eligible for the study, 399 [42%] discontinued Clopidogrel after 12 months and 562 [58%] continued Clopidogrel for 24 months. The clinical and procedural variables were compared between the two groups. In the 12 months' use group, two cases of definite thrombosis occurred at 18 and 13 months post PCI. In the 24 months' use group, 2 cases of definite thrombosis occurred at 14 and 28 months post PCI, one of them with stenting in a bifurcation lesion. Five cases of probable stent thrombosis were detected at 21, 28, 32, 33, and 34 months after the procedure. It is of note that amongst the 10 cases of stent thrombosis, only 1[10%] thrombosis occurred when the patient was on Clopidogrel and Aspirin and all the other 9 [90%] cases of thrombosis appeared after the discontinuation of the dual antiplatelet therapy. Extended use of dual antiplatelet therapy [for more than 12 months] was not significantly more effective than Aspirin monotherapy in reducing the risk of myocardial infarction or stent thrombosis, death from cardiac cause, and stroke

Success rate, procedural complications and clinical outcomes of coronary interventions in octogenarians: a case-control study

Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events [MACE] in a one-year follow-up of octogenarians [age >/= 80 years] with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry. According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention [PCI] procedures were performed in 112 octogenarians. Additionally, 336 younger patients [459 PCI procedures] were selected from the database as the propensity-score matched controls. There were 147 [93.6%] and 441 [96.1%] successful PCI procedures in the elderly group and control group, respectively [p value = 0.204]. Procedural complications were seen in 5 [3.2%] of the elderly group and 16 [3.5%] of the control group [p value = 0.858]. Totally, 7 [6.3%] in-hospital complications occurred in the elderly group and 22 [6.8%] in the control group [p value = 0.866]. One-year MACE was seen in 9 [9.1%] of the elderly and 18 [5.8%] of the control group [p value = 0.26]. Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated

One-year clinical outcomes of ultra long apollo polymer-based paclitaxel-eluting stents in patients with complex, long coronary artery lesions

For all the wealth of research comparing the efficacy of the different types of the drug-eluting stent [DES] such as sirolimus-, paclitaxel-, and zotarolimus-eluting stents, there is still a dearth of data on the different brands of each DES type. We aimed to investigate the one-year clinical outcomes, including major adverse cardiac events [MACE], of the use of the ultra long Apollo paclitaxel-eluting stent in patients with long atherosclerotic coronary artery lesions. According to a retrospective review of the Tehran Heart Center Registry of Interventional Cardiology, a single-center nonrandomized computerized data registry in which all adult patients who undergo single or multi-vessel percutaneous coronary intervention [PCI] are enrolled without any specific exclusion criteria, the mixed use of long Apollo paclitaxel-eluting stents and other types of the DES as well as myocardial infarction within forty-eight hours prior to the procedure was excluded. In total, 122 patients were enrolled in the study, and their baseline clinical, angiographic, and procedural characteristics were obtained. In addition, the patients' follow-up data and, most importantly, MACE during a one-year period after intervention were recorded. The mean follow-up duration was 14.1 +/- 3.8 months. The one-year clinical follow-up data were obtained in 95.9% of all the patients. The incidence of MACE was 5.7% during the entire study period. There was 1 death, which occurred during the initial days after PCI. The incidence of non-fatal myocardial infarction was 2.5% [3 cases], including one patient who underwent target vessel revascularization seven months later. Also, 3 patients with single-vessel disease and in-stent restenosis underwent coronary artery bypass grafting between five to ten months later. Our results showed that the Apollo paclitaxel-eluting stent might be regarded as a safe and effective treatment for long coronary lesions

Outcomes of percutaneous coronary intervention on saphenous vein graft and native coronary vessels

The optimal target for revascularization in patients with history of coronary artery bypass graft surgery [CABG] is unclear. This study was designed to compare the outcome of percutaneous coronary intervention [PCI] on saphenous vein grafts [SVG] and that on native vessels in patients with previous CABG in terms of major adverse cardiac events [MACE]. The study drew upon data on consecutive patients hospitalized for PCI and MACE rate during a nine-month follow- up period. The patients were divided according to the target vessel for PCI into two groups: SVG and native vessel. Between 2003 and 2007, 226 patients underwent PCI 6.57 +/- 4.55 years after CABG. Their mean age was 59.52 +/- 9.38 years, and 176 [77.9%] were male. PCI was performed on the SVG in 63 [27.9%] patients and on the native coronary artery in the rest. During a nine-month follow-up period, 9 [4%] patients suffered MACE; the prevalence of MACE was not significantly different between the SVG group [4.8%] and the native vessel group [4.9%], [p value = 0.999]. PCI on grafted and native vessels did not affect MACE in patients undergoing PCI after CABG

Transcatheter closure of patent ductus arteriosus: initial study on echocardiographic estimation of device size

Transcatheter occlusion of the patent ductus arteriosus [PDA] is a minimally invasive treatment. The appropriate device size is chosen based on the angiographic measurement of the PDA. The current study aimed to assess the relationship between the transthoracic echocardiographic [TTE] measurements of the PDA prior to the occlusion procedure and the actual size of the deployed device. We reviewed the available records of 7 patients [2 male] who underwent the procedure at our institution [mean age: 21 +/- 12.7years, range: 7 to 46years]. PDA closure was performed successfully using the Amplatzer Duct Occluder [n = 5] and its Chinese copycat, Cardi-O-Fix Occluder [n =2]. The TTE measurement of the aortic end diameter of the PDA showed a good linear regression correlation with the size of the implanted duct occluder [duct occluder size = 0.543 + [0.941 x TTE measured diameter], R = 0.907; p value

Measurement of atrial septal defect size: a comparative study between transesophageal echocardiography and balloon occlusive diameter method

Transcatheter closure of atrial septal defect secundum [ASD-II] has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography [TEE] method for measuring atrial septal defect with balloon occlusive diameter [BOD] in transcatheter ASD-II closure. A total of 39 patients [71.1% female, mean age: 35.31 +/- 15.37 years] who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography [TTE] and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1-2 mm larger than the BOD of the defect. The mean defect size obtained by TEE and BOD was 18.50 +/- 5.08 mm and 22.86 +/- 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 +/- 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD=0.773 ASD size by TEE+8.562; r2=67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values [r=-0.394, p value=0.013]. In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure

Effect of cardiac rehabilitation program on heart rate recovery after percutaneous coronary intervention and coronary artery bypass grafting

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery [HRR] in patients who received percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program [phase 2] after PCI [n=62] or CABG [n=178] at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors [except for diabetes mellitus] was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively [p=0.019]. The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality [i.e. PCI or CABG] after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients

Short and Long-Term Outcomes of Percutaneous Coronary Intervention in Patients with Low; Intermediate and High Ejection Fraction : Cardiovascular Topics

Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However; with the advent of stents; procedural complications and restenosis rates have reduced dramatically. The aim of this study was to assess the association between left ventricular (LV) ejection fraction and in-hospital and longterm outcomes using a prospective registry. Methods : After exclusion of patients with acute myocardial infarction (MI) and those with missing data on left ventricular ejection fraction; 2 030 patients undergoing PCI between March 2002 and 2004 remained in our prospective registry. Patients were divided into three categories: group 1: EF 40(n = 293); group 2: EF = 41-49(n = 268) and group 3: EF 50(n = 1 469). The frequency of in-hospital and follow-up outcomes between groups was compared using appropriate statistical methods. Results: Stents were used for over 85of the patients in each group. The mean EF + SD in the lowest to highest EF groups was 35.8 + 5.4; 45.5 + 1.6and 57 + 5.7; respectively. The angiographic and procedural success rates were 91.8; 92.1 and 94.1; (p = 0.16); and 91.1; 90.3 and 92.9; (p = 0.09); respectively. The respective cumulative major adverse cardiac events (MACE) and cardiac death rates at follow-up were 5.8; 2.2 and 3.3(p = 0.04) and 2; 0.4 and 0.3(p = 0.02); respectively. The hazards ratio (95CI) for MACE and cardiac death in the lowest versus highest EF groups were 2.07 (1.03-4.16) and 5.49 (1.29-23.3). Conclusion : Patients with significant left ventricular dysfunction had higher long-term major adverse cardiac events and cardiac death rates. Even the use of newer techniques such as stenting did not compensate for this

In-Hospital and Mid-Term Adverse Clinical Outcomes of a Direct Stenting Strategy Versus Stenting after Predilatation for the Treatment of Coronary Artery Lesions : Cardiovascular Topic

Background : Direct stenting without balloon dilatation may reduce procedural costs and duration; and hypothetically; the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after pre-dilatation (PS) in our routine clinical practice. Methods : The 1 603 patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours; and those with highly calcified lesions; total occlusions; or a lesion in a saphenous graft were excluded. The baseline; angiographic and procedural data; in-hospital outcomes and follow-up data were recorded in our database and analysed with appropriate statistical methods. Results : Eight hundred and fifty-seven patients (53.5) were treated with DS and 746 (46.5) underwent PS. In the DS group; lesions were shorter in length; larger in diameter and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were found less often (p 0.001). With univariate analysis; dissection and non-Q-wave MI occurred less frequently in this group (0.2 and 0.6vs 3.9 and 2.1; p 0.001 and p ; p = 0.79). With multivariate analysis; direct stenting reduced the risk of dissection (OR = 0.07; 95CI: 0.01-0.33; but neither the cumulative endpoint of MACE (OR = 1.1; 95CI = 0.58-2.11; p = 0.7) nor its constructing components were different between the groups. Conclusions : Direct stenting in the real world has at least similar long-term outcomes in patients treated with stenting after pre-dilatation; and is associated with lower dissection rates

Short- term outcomes and mid-term follow-up after coronary angioplasty in patients younger than 40 years of age

Stenting is currently the standard of care in percutaneous coronary intervention [PCI]. Whether young patients remain at increased risk after PCI in the present stent era has not been investigated widely. We evaluated angiographic characteristics and short- and mid-term outcomes in patients younger than 40 years of age who underwent PCI. From April 2003 to March 2005, prospective data were collected in 118 consecutive patients, who were less than 40 years of age and underwent PCI at our referral center. The PCI outcomes in these patients were compared to those in 354 patients, randomly selected from 2493 patients older than 40 years of age in our database. Follow-up was scheduled at 1 month, 5 months, and 9 months through clinic visits, telephone interviews, and reviewing hospital records. Patients<40 years of age were more often male [91.5% vs. 71.8%, P<0.001], current smokers [33.9% vs. 15.2%, P<0.001], and had more family history of coronary artery disease [38.1% vs. 21.8%, P<0.001] and myocardial infarction [44.1 vs. 31.1, p=0.01], while diabetes mellitus [6.8% vs. 22.1%, P<0.001], hypertension [13.6% vs. 35.3%, P<0.001], and hyperlipidemia [34.7% vs. 44.8%, P=0.055] were less common in these patients. There were no significant differences between the two groups regarding vessel involvement, reference vessel diameter, stenosis rate [before and after procedure], and lesion characteristics, with an exception that angulated lesions were more common in the patients. 40 years of age [P<0.05]. The young patients, who underwent PCI, presented more frequently with single-vessel disease [61% vs. 46%, P=0.01].The vessel and lesion sites of PCI and clinical success rates were similar in these age groups. Usage of stent was high and similar, and drug- eluting stent use was not significantly different between the two groups. With a high procedural success [94.9% vs. 91.8%], intra-hospital and late complications were very low and similar in both groups. Percutaneous coronary intervention is a safe and effective procedure for young patients, and major adverse cardiac events are similar in young and older patients

Outcomes of primary percutaneous coronary intervention in acute myocardial infarction at tehran heart center

To describeour experience of primary angioplasty in ST-segment elevation myocardial infarction. During a period of 2 years [April 2003 to May 2005], 83 high-risk patients presenting with acute ST-segment elevation myocardial infarction underwent primary angioplasty subject to availability ofballoon dilation within 90 min of admission. In total, 73 stents were implanted; 69 were bare metal stents, while the remaining 4 were paclitaxel-eluting stents. Of the 83 patients, 8 presented with cardiogenic shock. Follow-up was for a period of 9 months. All angiographic, in-hospital and clinical outcomes were recorded on a database. The procedure was successful in 79 of the 83 patients [95%] and unsuccessful in 4 [5%]. Of these 4 patients, 3 died and 1 was treated medically. In 65 patients with zero perfusion, angioplasty was successful in 61 [93.8%], while it was completely successful [100%] in the remaining 18 patients with thrombolysis in myocardial infarction grade 3 perfusion.Vessel patency was achieved in 95% with thrombolysis in myocardial infarction grade 3 flow present in 93%. A total of 7 [8.5%] patients died while in the hospital. Of the 8 with initial cardiogenic shock on presentation, 4 [50%] died in the hospital and of the remaining 4, 1 was lost at 9-month follow-up. In-hospital reocclusion and reinfarction did not occur in any patient. Theresults suggest that primary angioplasty is logistically feasible in our center with good clinical outcomes

Comparison of Specifications, Short Term Outcome and Prognosis of Acute Myocardial Infarction in Opium Dependent Patients and Nondependents

The effects of opium dependence on prognosis and short term outcome of patients with acute myocardial infarction [AMI] are not clear yet. From March 2004 to August 2004 all male patients admitted with diagnosis of AMI were enrolled. Patients who fulfilled DSM- IV-TR criteria were chosen as opium dependent patients [ODP]. Demographic data, risk factors, peak enzyme levels, location of MI, mortality and ejection fraction were collected and analyzed. We studied the mortality, readmission, functional class, performed revascularizations and coronary angiogram results in a short term follow-up [184 +/- 37 days]. A total number of 160 patients were enrolled, of which 45 [28.1%] were opium dependent. In 137 patients 6 months follow up was completed. Duration of admission was higher in O.D.P [11.3 days versus 8.7, P= 0.03] There was no significant difference in age, EF, location of MI, peak enzymes levels, angiographic findings, risk factors [except for cigarette smoking and triglyceride level], in-hospital mortality, need for readmission, 6 months mortality, functional class, and the need for revascularization. In an unselected cohort of patients admitted with AMI, there was no significant difference in specifications, short term outcome and prognosis of AMI between ODP and nondependents except for duration of hospitalization

Predictors of Long-term Outcome in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a single center registry [THCR]

This study sought to access differences in long-term [9 months] outcomes between Acute Coronary Syndrome [ACS] patients who undergo early intervention compared to Percutaneous Coronary Intervention [PCI] in stable and refractory conditions. Data originated from Tehran Heart Center Registry- interventional cardiology [THCR-IC] and consisted of 1267 patients divided into two categories; 227 patients had features corresponding to acute coronary syndromes [17.9%] and 1040 patients suffered from stable angina [82.1%]. They were admitted between April 3, 2003 and April 25, 2004. The clinical success rate of PCI was higher in ACS [97% vs. 94%; P=0.037], while In-hospital complications was similar in both groups. During the follow-up period, clinical restenosis was not significantly different and the overall number of re-interventions caused by restenosis or progression was not more frequent in ACS patients. Also, 1.3% of ACS and 0.4% of SA patients died, but the difference was not statistically significant [P=0.16]. Finally, Major Adverse Cardiac Events [MACE] showed no significant difference [5.2% vs. 3.9%; P=0.42]. Multivariate analysis showed that female sex [OR=25.6; P=0.003] and previous history of PCI [OR=8.4; P=0.016] were the only strong independent risk factors for major adverse cardiac events. Analyzing ACS patient outcomes using Mantel-Hanzel analysis showed that the female sex was the only factor which strongly increased the incidence of MACE. Both ACS and SA patients who underwent coronary intervention had similar in-hospital and composite major adverse cardiac events, nevertheless female gender must be considered as an independent risk factor for major adverse cardiac events especially in patients with acute coronary syndrome who undergo PCI