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

effect of curcumin on some of traditional and non-traditional cardiovascular risk factors: a pilot randomized, double-blind, placebo-controlled trial

Numerous interventional studies in clinical and preclinical setting stated that intake of curcumin may provide protection against cardiovascular disease. The aim of this trial was investigation of curcumin efficiency on some cardiovascular risk factors in patients with coronary artery disease [CAD]. A total of 33 patients with CAD who fulfilled inclusion and exclusion criteria were entered the study. Patients were randomly assigned to receive curcumin or placebo, 500 mg capsules, four times daily for 8 weeks. Lipid profile, blood glucose and high sensitive C-reactive protein [hs-CRP] levels were analyzed at baseline and two months after treatment. Serum levels of triglycerides [P=0.01], LDL-cholesterol [P=0.03] and VLDL-cholesterol [P=0.04] significantly decreased in the curcumin group compared to baseline, without significant changes in total cholesterol, HDL-cholesterol, blood glucose and hs-CRP levels. In all mentioned laboratory parameters, significant difference was not detected between curcumin and placebo. Although curcumin improved some of lipid profile components, it did not show appreciable effect on inflammatory markers in patients with CAD. Therefore, more detailed assessment of metabolic effects or anti-inflammatory activities of curcumin need to perform by extensive human study

Plasma vitamin D status and its correlation with risk factors of thrombosis, P-selectin and hs-CRP level in patients with venous thromboembolism; the first study of iranian population

Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism [VTE] subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective study, patients with diagnosis of acute deep vein thrombosis and or pulmonary eboembolism were enrolled. All patients' clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D. In this study, 60 subjects were included. The mean +/- SD plasma 25-hydroxy vitamin D level [25[OH] D] of participants was 21.4 +/- 14.6 ng/mL. The vitamin D deficiency was reported in 60% of patients. No significant relation was found between the plasma 25[OH]D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25[OH]D and the patients' age [beta = 0.452; p = 0.001], diabetes [beta = 0.280; p = 0.036] and positive family history of cardiovascular diseases [beta = 0.373; p = 0.003]. Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with increase level of P-selectin and hs-CRP in VTE patients

Percutaneous mitral valve repair with the edge-to-edge technique: case series of first Iranian experience

Mitral regurgitation [MR] is a common valvular lesion in the general population with considerable impact on mortality and morbidity. The MitraClip System [Abbot Laboratories, Abbot Park, IL, USA] is a novel percutaneous approach for treating MR which involves mechanical edge-to-edge coaptation of the mitral leaflets. We present our initial experience with the MitraClip System in 5 patients. In our series, the cause of MR was both degenerative and functional. Two patients received two MitraClips due to unsatisfactory results after the implantation of the first clip. Acute procedural success was seen in 4 patients. Blood transfusion was required for 2 patients. All the patients, except one, reported improvement in functional status during a 2-month follow-up period. Our initial experience with MitraClip implantation indicates that the technique seems feasible and promising with acceptable results and that it could be offered to a broader group of patients in the near future

Opium consumption and mid-term outcome of percutaneous coronary intervention in men

Controversy persists over the potential benefits/harms of opium consumption in coronary heart disease. This study investigated the association between 12 months' major adverse cardiac events [MACE] and pre-procedural opium consumption among patients undergoing percutaneous coronary intervention [PCI]. Retrospectively, 1545 consecutive men who underwent PCI between 21[st] June 2009 and 20[th] June 2010 at Tehran Heart Center and were registered in the PCI Databank were entered into this cohort study. The occurrence of MACE, defined as cardiac death, non-fatal myocardial infarction, and need for target vessel revascularization [TVR] or target lesion revascularization [TLR], was compared between two groups of opium consumers and non-consumers in 350 [22.7%] patients. Sixty-four [0.86%] patients expired within 12 months. After adjustment for potential confounders, analysis revealed that opium consumption had no significant relationship with 12 months' MACE [11[3.1%] vs. 53[4.4%]; p value = 0.286, among opium users vs. non users, respectively]. Furthermore, the different components of MACE, including target vessel revascularization, target lesion revascularization, coronary artery bypass graft, and non-fatal myocardial infarction, were not significantly related to opium use. Pre-procedural opium usage in patients undergoing PCI was not associated with 12 months' MACE

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.

Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result

The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy [PTMC]. The medical records of 196 patients [48 males, mean age: 42.7 +/- 11.5 years] who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents [thickening, mobility, calcification, and subvalvular thickness] and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area [MVA] >/= 1.5 cm[2] without a post-procedure mitral regurgitation [MR] grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessment and mitral valve morphological scores within both groups. The mean MVA increased from 1.0 +/- 0.2 cm[2] to 1.7 +/- 0.4 cm[2], and mitral valve mean gradient [MVMG] decreased from 11.5 +/- 5.2 to 5.2 +/- 3.3 mmHg [P < 0.001 for both]. Successful results were obtained in 139 [70.9%] patients compared to unsuccessful results in 57 [29.1%]. Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm[2] in 50 [25.5%] patients and post-procedure MR grade >2 in 7 [3.6%]. Multiple logistic regression analysis indicated that young age, lower size of the left atrium [LA], and smaller degree of mitral valve thickness were the predictors of successful result. Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness

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

Frequency and predictors of renal artery stenosis in patients undergoing simultaneous coronary and renal catheterization

Atherosclerotic renal artery stenosis [ARAS] remains underdiagnosed due to its nonspecific demonstrations. We aimed to both estimate the frequency of ARAS in high-risk non-selected patients undergoing simultaneous coronary and renal catheterization and possibly identify a predictive model for ARAS using baseline clinical, laboratory, and coronary angiographic variables. The records of 866 patients aged >/= 21 years undergoing simultaneous coronary and renal angiography were retrieved for analysis from our computerized database. The degree of ARAS was estimated visually by experienced attending interventional cardiologists. Lesions with an estimated stenosis of >/= 50% were considered significant. Multivariable stepwise logistic regression models were used to identify the risk factors predicting the presence and extent of ARAS. Of a total of 866 consecutive patients undergoing renal angiography in conjunction with coronary angiography [mean age +/- SD: 63.06 +/- 10.32, ranging from 24 to 89 years], 454 [57%] were men. A total of 345 [39.8%] cases had significant ARAS, 77 [22.3%] of which were bilateral. Using significant ARAS as the dependent variable, six variables were identified as the independent predictors significantly associated with the presence of ARAS, namely age, female sex [male sex was found to be a protector], hypertension, history of renal failure, left anterior descending artery [LAD] stenosis > 50%, and left circumflex artery [LCX] stenosis > 50%. The Gensini score was not found to be a predictor of the presence of ARAS, but it was more likely associated with a trend towards a more extensive ARAS [adjusted OR = 1.00, 95% CI = 1.00-1.01; p value = 0.039]. Other independent determinants of the ARAS extent were the same as the predictors of the ARAS presence. Although risk versus benefit was not tested in this study, it seems that clinicians could consider renal catheterization in combination with coronary angiography particularly in female patients with advanced age and with significant coronary artery stenoses in the LAD and LCX

Demographics and angiographic findings in patients under 35 years of age with acute ST elevation myocardial infarction

ST-elevation myocardial infarction [STEMI] is a major cause of cardiovascular mortality worldwide. There are differences between very young patients with STEMI and their older counterparts. This study investigates the demographics and clinical findings in very young patients with STEMI. Through a review of the angiography registry, 108 patients aged 35 years [Group II] who underwent coronary angiography after STEMI. Group I patients were more likely to be male [92.6%], smokers, and have a family history of cardiovascular diseases [34.6%]. The prevalence of diabetes, dyslipidemia, and hypertension was higher in the old patients. Triglyceride and hemoglobin were significantly higher in Group I. Normal coronary angiogram was reported in 18.5% of the young patients, and in 2.1% of the older patients. The prevalence of single-vessel and multi-vessel coronary artery disease was similar in the two groups [34.3% vs. 35.2%]. The younger subjects were more commonly candidates for medical treatment and percutaneous coronary intervention [PCI] [84.2%], while coronary artery bypass grafting [CABG] was considered for the 39.5% of their older counterparts. In the young adults with STEMI, male gender, smoking, family history, and high triglyceride level were more often observed. A considerable proportion of the young patients presented with multi-vessel coronary disease. PCI or medical treatment was the preferred treatment in the younger patients; in contrast to their older counterparts, in whom CABG was more commonly chosen for revascularization

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

Doppler tissue imaging: a non-invasive technique for estimation of left ventricular end diastolic pressure in severe mitral regurgitation

Conventional Doppler measurements, including mitral inflow and pulmonary venous flow, are used to estimate left ventricular end diastolic pressure [LVEDP]. However, these parameters have limitations in predicting LVEDP among patients with mitral regurgitation. This study sought to establish whether the correlation between measurements derived from tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral regurgitation. Thirty patients [mean age: 57.37 +/- 13.29 years] with severe mitral regurgitation and a mean left ventricular ejection fraction [EF] of 46.0 +/- 14.95 were enrolled; 16 [53.4%] patients were defined to have EF < 50% and 14 [46.6%] patients had EF >/= 50%. Doppler signals from the mitral inflow, pulmonary venous flow, and Doppler tissue imaging indices were obtained, and LVEDP was measured invasively through cardiac catheterization. The majority of the standard Doppler and Doppler tissue imaging indices were not significantly correlated with LVEDP in the univariate analysis. In the multiple linear regression, however, early [E] transmitral velocity to annular E' [E/E'] ratio [beta=1.09, p value < 0.01], E wave velocity to propagation velocity [E/Vp] ratio [beta=7.87, p value < 0.01], and isovolumic relaxation time [beta=0.21, p value=0.01] were shown as independent predictors of LVEDP [R[2]=91.7%]. The ratio of E/Vp and E/E' ratio and also the isovolumic relaxation time could be applied properly to estimate LVEDP in mitral regurgitation patients even in the setting of severe mitral regurgitation

Efficacy of two streptokinase formulations in acute myocardial infarction: a double-blind randomized clinical trial

We sought to evaluate the efficacy and safety of the different trade forms of streptokinase available in our country, namely Heberkinasa [Heberbiotec, Havana, Cuba] and Streptase [Aventis Behring GmbH, Marburg, Germany]. We conducted a double-blind randomized clinical trial to compare the two streptokinase formulations, i.e. Heberkinasa [HBK] or Streptase [STP], in patients with acute myocardial infarction who needed thrombolysis. Thrombolysis success was evaluated angiographically and/or clinically. Clinical follow-up was done 30 days after thrombolysis. We randomly allocated 221 patients with a mean age of 56.9 +/- 10.8 years [males: 88.2%] to HBK [n = 119] and STP [n=102] groups. Baseline clinical and demographic characteristics were similar between the two groups, and the two groups were not significantly different in terms of door-to-needle and pain-to-needle intervals. The rate of complications was not significantly different between the groups [44.1% [HBK] vs. 42% [STP]]. Angiography was done for 158 [71.5%] patients in the first 24 hours [9%] and in the first 72 hours [38.8%] after thrombolysis. Lesion morphology and lesion/patient ratio were not significantly different between the two groups [1.87[HBK] vs. 1.67[STP]]. The two groups were similar with respect to angiographic patency rate [67.5% [HBK] vs. 67.6% [STP]]. The study groups were also similar as regards clinical outcome and complications of both streptokinase formulations. The present study demonstrated that Heberkinasa is as effective and as safe as a standard streptokinase, namely Streptase, in a clinical setting

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

Coronary artery bypass surgery versus medical treatment in patients with low ejection fraction and coronary artery disease

We compared the outcomes in patients with a low ejection fraction [EF] and multivessel coronary artery disease [CAD] who either underwent coronary artery bypass grafting [CABG] or received medical treatment [MT] after a viability study via dobutamine stress echocardiography [DSE]. We considered patients with CAD and left ventricular ejection fraction [LVEF] 25% [100% vs. 40%, p < 0.05]. The patients with CAD and a low EF had the same survival rate after both CABG and MT at mid-term follow-up. Long-term follow-up is needed to show the survival benefit of CABG in such patients with an acceptable extent of viable myocardium