A case-control study of plasma homocysteine levels in South Indians with and without coronary artery disease.

BACKGROUND: An increased level of plasma homocysteine is being recognized as a new risk factor for coronary artery disease. Since there are not enough data about its importance in Indians with coronary artery disease, we aimed to assess the significance of plasma homocysteine as a coronary risk factor in South Indian patients. METHODS AND RESULTS: In a case-control study, fasting plasma homocysteine levels were estimated in 565 subjects, of whom 221 were cases and 344 were controls. Of the 221 clinically defined cases, 112 underwent coronary angiography while 107 of the 344 controls had angiographically proven normal coronary arteries. Ninety healthy volunteers from the community were also included as controls. Fluorescent polarization immunosorbent assay was used to measure plasma homocysteine levels. In 12 patients, this method was compared to high pressure liquid chromatography and was found to give comparable results. The mean plasma homocysteine level was 18.30 +/- 10.08 micromol/L in clinically defined cases and 18.04 +/- 10.69 micromol/L in controls. Similarly, in angiographicallyproven coronary arterydisease patients, the mean plasma homocysteine levelwas 18.49 +/- 10.04 micromol/L and in individuals with angiographically normal coronary arteries, it was 19.16 +/- 11.38 micromol/L. CONCLUSIONS: There is no statistically significant difference in plasma homocysteine levels between controls and cases with coronary artery disease. The mean plasma homocysteine levels in controls as assessed by fluorescent polarization immunosorbent assay in the present study population are higher as compared to other published reports.

Traumatic distal anterior cerebral artery aneurysm in a child: a case report.

Traumatic intracranial aneurysms constitute less than 1% of all intracranial aneurysms. A case of traumatic distal anterior cerebral artery aneurysm in 18 months old child, treated successfully by microsurgical excision of aneurysm is being reported, along with review of the literature.

Evaluation of efficacy and safety of losartan potassium in the treatment of mild to moderate hypertension as compared to enalapril maleate.

AIM: To study the effect of losartan potassium in the treatment of mild to moderate hypertension and to compare its efficacy and adverse effect profile with enalaparil maleate. MATERIAL AND METHODS: One hundred and forty five patients with mild to moderate essential hypertension were enrolled in this randomized, double blind, controlled, parallel and multicentric study. Seventy two patients received losartan potassium 50 mg and seventy three received enalapril maleate 5 mg. RESULTS: Losartan potassium reduced the DBP to < 90 mm Hg in 59% of the patients at the end of 8 weeks compared to 45% in the enalapril maleate group. DBP was reduced by 10 or > than 10 mm Hg in 89% of the patients with losartan as compared to the baseline whereas it was 80% in the enalapril group. Percentage of side effects seen in losartan and enalapril groups were 12 and 22 respectively. CONCLUSION: Losartan potassium is an efficacious antihypertensive agent in mild to moderate hypertension. It also has fewer side effects when compared to enalapril maleate.

Evaluation Of LP (a) As A Risk Predictor For CAD In Angiorgaphiclly Tested Inividuals And Asymptomatic Controls.

Coronary Artery Disease (CAD) has reached epidemic proportions and has been attributed as the foremost cause of mortality worldwide. In the search for the causative factors, both genetic and non-genetic, Lipoprotein (a) has emerged as a powerful predictor for premature CAD. Lp(a) is a macromolecular complex found in human serum, strictly under genetic control, highly variable and resembling the low density lipoprotein cholesterol. In the present study, an attempt has been made to evaluate its predictive role by estimating its levels in patients with and without coronary artery disease (CAD) diagnosed by angiographic procedure. It was observed that Lp(a) levels increase with increasing severity of the disease albeit insignificantly. The observations made in the present study need to be substantiated by large scale studies.

Prospective observational study of primary angioplasty of the infarct-related artery for acute myocardial infarction.

Primary angioplasty has been shown to reduce rates of in-hospital mortality, recurrent ischaemia and infarction. However, the role of primary stenting and abciximab is presently undergoing evaluation. This study attempted to examine the feasibility, safety and outcomes of primary angioplasty in the treatment of acute myocardial infarction. Data in 100 patients who underwent primary angioplasty for evolving acute myocardial infarction was prospectively analysed to assess the safety and efficacy of various modalities. Twenty patients were in Killip class III and above. Multivessel (2 or more vessels) disease was noted in more than 52 cases. Procedural success was 99 percent; 86 patients received primary stenting, majority of them had Kalam-Raju stent implantation. Adjunct treatment included abciximab infusion in 22 and intra-aortic balloon pump support in 12. Overall mortality rate was six percent with a mortality of 2.2 percent in non-cardiogenic shock patients. Recurrent ischaemic events were noted in five, three of them had successful reperfusion with repeat angioplasty. None of the patients had emergency coronary artery bypass surgery. It is concluded that primary angioplasty is safe and effective with high procedural success. Recurrent ischaemic events are low, possibly due to routine use of stenting and selective use of abciximab.

Clinical evaluation of new balloon mountable coil stent: in-hospital and follow-up results.

The purpose of this study was to determine the feasibility, safety and efficacy of elective deployment of a new coil-stent (KR stent) in patients with coronary artery disease. KR stent deployment was attempted in 100 patients (135 lesions) enrolled prospectively at a single centre from December 1996 to March 1997. Ten, 15, 18, 24, and 32 mm long KR stents were manually crimped onto balloons and deployed in native coronary artery lesions. Majority of the patients had recent acute coronary syndromes (unstable angina 30% and post-myocardial infarction angina 56%). Diabetes was present in 34 percent of the patients. Fifty-six percent had single-vessel and 44 percent multi-vessel disease. In 38 percent, the lesions were located in proximal segments and 40 percent of lesions were long. KR stents were successfully deployed in 98 percent of patients. Mean minimal luminal diameter increased by 2.89 +/- 0.63 mm (from 0.57 +/- 0.38 mm before to 3.45 +/- 0.56 mm after the procedure). Mean percent diameter stenosis decreased from 83.33 +/- 10.84 percent before to 3.38 +/- 5.74 percent after the stent deployment. Mean reference vessel diameter was 3.45 +/- 0.56 mm. There were occasional technical complications including balloon rupture (1), stent migration (2) and distal embolisation of atheromatous material (1). One patient developed subacute stent thrombosis. There were no other major in-hospital cardiovascular events. At the end of six-month follow-up, there were no myocardial infarction or death. Six patients presented with recurrence of symptoms within six-months of the procedure, four of whom underwent target vessel revascularisation procedure. In conclusion, the in-hospital and six-month follow-up clinical results were highly encouraging with KR stent. Successful deployment rates were high despite unfavourable clinical and angiographic background. Low clinical events on follow-up will make it suitable for elective stenting.

Semi-quantitative planar scintigraphy using thallium 201 for detection and localization of coronary artery disease: correlation with coronary angiography.

Thallium 201 exercise redistribution planar myocardial perfusion scan using semiquantitative technique was performed in 80 symptomatic patients undergoing coronary angiography. Out of the 240 vessels studied by angiography, more than 70% luminal narrowing was detected in 87 vessels, borderline stenosis was found in 49 arteries and the remaining 104 vessels were normal. Thallium scan correctly identified the significant stenosis in 76 vessels and the absence of stenosis in 102 vessels. In addition, perfusion abnormality was found in relation with 21 vessels of borderline stenosis. The sensitivity and specificity of Thallium scan were estimated as 92% and 95% for left anterior descending artery (LAD), 79% and 98% for left circumflex artery (LCX), 88% and 100% for right coronary artery (RCA) and 87% and 98% for all coronary arteries combined together (ACA).

Morphometric analysis of coronary lesions in patients with unstable angina--an arteriographic study.

In 100 patients with unstable angina and 50 patients with stable angina qualitative morphology of coronary artery lesions were compared by angiography. The mean age of the patients was 51 years. In the unstable angina group, 50 patients had rest angina, 32 had crescendo angina and 18 had denovo angina; 31 patients had single vessel disease, 33 had two vessel disease, 34 had triple vessel disease and 2 had left main disease. 'Angina-producing' artery could be identified in 90 out of 100 patients. Ten totally occluded vessels were excluded from analysis. Lesions causing diameter stenosis of greater than 50% could be categorised to one of the following groups: a) Concentric stenosis (18 vessels), b) Type I eccentric lesion (asymmetric narrowing with smooth borders and broad neck--20 vessels), c) Type II eccentric lesion (asymmetric narrowing with narrow neck and overhanging irregular edges--47 vessels), and d) Multiple irregularities (15 vessels). Lesions in 9 vessels showed an associated thrombus. It appears that Type II eccentric lesions are frequent in patients with unstable angina; they probably represent ruptured atherosclerotic plaque or partially occlusive thrombi or both.