ABSTRACT
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
ABSTRACT
Although percutaneous coronary intervention [PCI] is an excellent therapy for coronary artery disease, there is a paucity of information on the efficacy of PCI in improving diastolic function, especially in Iran. Because of the high prevalence of left diastolic dysfunction in coronary artery disease patients and its probable progression to heart failure, an evaluation of the role of PCI in improving diastolic function is required. Thirty patients scheduled for elective PCI were enrolled in this study providing that their systolic ejection fraction was > 40%. Before PCI and 48 hours and 3 months after PCI, echocardiography was done to evaluate some diastolic values in these patients. The mean age of all the patients was 54 +/- 10 year, and 20 patients were male. All the patients had a low degree of left ventricular diastolic dysfunction. Isovolumic relaxation time [115 +/- 10 before treatment versus 120 +/- 1 and 119 +/- 3 respectively 48 hours and 3 months after treatment], mitral E wave velocity in septal [0.70 +/- 0.05 before treatment vs. 0.71 +/- 0.15 and 0.72 +/- 0.12 respectively 48 hours and 3 months after treatment], and the peak velocity of late filling due to atrial contraction [mitral A wave velocity] in septal [0.74 +/- 0.02 before treatment vs. 0.73 +/- 0.01 and 0.68 +/- 0.16 respectively 48 hours and 3 months after treatment] showed improvement after PCI. It is notable that early diastolic mitral annulus velocity [E'] wave velocity in the septal part of the mitral annulus improved significantly 48 hours and 3 months after PCI [p value < 0.05]. The early-to-late diastolic tissue velocity ratio of the mitral annulus [E/A] ratio of the mitral inflow improved 48 hours after PCI; it was statistically significant [p value = 0.05]. Also, mitral A wave velocity in septal and the E/A ratio of the mitral inflow improved significantly 3 months after PCI [p value < 0.05]. Improvement in some of values related to left ventricular diastolic function followed by PCI shows thai this method can be used to improve cardiac diastolic function in patients with symptomatic coronary artery disease
Subject(s)
Humans , Male , Female , Coronary Disease/therapy , Angioplasty, Balloon, Coronary , Atherectomy, Coronary , Ventricular Dysfunction, Left , Echocardiography , Treatment OutcomeABSTRACT
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