Anti-inflammatory effect of statins in unstable angina and non st segment elevation myocardial Infarction

Inflammation plays an important role in all stages of inflammation and it appears to be a pivotal component of the process the transform stable to unstable disease because an augmentation of the inflammatory activity takes place during ACS. To study benefits of statins in treatment of unstable angina and non ST segment elevation myocardial infarction during the early days of hospital admission through its anti-inflammatory effect regardless cholesterol level. This study included 50 patients who were divided into two groups, atorvastatin group [group I] [25 patients] and control group [group II] [25 patients]. All patients were subjected to 12 lead electrocardiography, routine laboratory investigations including total cholesterol, LDL-C, HDL-C, triglycerides ,CRP and titre on admission, at the 6[th] and 14[th] day ,also, CPK and CKMB were measured on admission, after 6, 24 and 48 hours respectively. All patients received the traditional treatment of unstable angina and non ST segment elevation myocardial infarction, Atorvastatin 20 mg/day was administered to group I from the first day and continued during the period of follow up. CRP levels decreased significantly at the 6[th]day and 14[th] day in group [I] and increased significantly at the 6[th] day in group [II].Atorvastatin lowered the level of T.C, HDL-C, TO and this decrease was significant as regards LDL-C and TO and increased HDL-C significantly by the end of 14 days. There was no correlation between CRP changes and lipid profile changes. The result of the current study showed that atorvastatin 20 mg had anti- inflammatory effect in addition to its lipid lowering effect appeared in the early days after anti-inflammatory effect appeared in the early days after administration so starting of atorvastatin therapy immediately on admission in patients with UA or NSTEMI, regardless their lipid levels is recommended

IV Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention

The rapid progress in the field of interventional cardiology in the last few years necessitates a continuous search for the most safe and effective methods to gain an optimum results, either equipments or drugs. to examine the use of enoxaparin as an anticoagulant in elective PCI, and compare it with unfractionated heparin regarding the acute procedural complications and the immediate 24-hour post-PCI events. The study was conducted on 84 patients who were classified independently into 2 groups. 50 patients represent group [A], received IV single bolus of enoxaparin in a dose of 0.5mg/kg at the start of the procedure and 34 patients represent group [B], received the usual traditional dose of unfractionated heparin [10000-15000 units].All patients were prepared by clopidogrel or ticlopidin before PCI in addition to aspirin 150 mg daily.Follow up was done for all patients during the immediate 24 hours after PCI for death, myocardial infarction, myocardial ischemia requiring urget coronary intervention and cerobrovascular stroke. There was no statistical significant difference between the two groups regarding the type of vessels treated or number of stents placed. None of the patients of both groups experienced any of the following complications during the procedure or 24 hours after: major bleeding, myocardial infarction, myocardial ischemia requiring urgent surgical or repeat percutaneous coronary revascularization or death. The major difference between the two groups was the immediate sheath removal in the enoxaparin group, without sheath site complication [minor haematoma] which was observed in 9% of the UFH group. Angiographic complications were coronary artery dissection [in one patient in group A [2%] and 3 patients in group B [9%]] and acute closure of the culprit vessel [occurred in one patient in group A [2%] and none in group B. The results were quite encouraging, with no statistical differences between the two arms of the study regarding the acute complications and the clinical outcome. The use of enoxaparin in this reduced dose is feasible in elective PCI with adequate level of anticoagulation without need for monitoring its anticoagulant effect. The early sheath removal in group A necessitates further studies to assess its impact on the duration of hospital stay and the possibility of early discharge of the patients