A case of type†I†variant Kounis syndrome with Samter-Beer triad.

Kounis syndrome is defined as the coexistence of acute coronary syndromes with situations associated with allergy or hypersensitivity, as well as anaphylactic or anaphylactoid reactions, to a variety of medical conditions, environmental and medication exposures. We report a case of Kounis-Zavras syndrome type I variant in the setting of aspirin-induced asthma, or the Samter-Beer triad of asthma, nasal polyps and aspirin allergy. When there is a young individual with no predisposing factors of atherosclerosis and apparent coronary lesion, with or without electrocardiography and biochemical markers of infarction, the possibility of Kounis syndrome should be kept in mind.

In vivo assessment of stent recoil of biodegradable polymer-coated cobalt-chromium sirolimus-eluting coronary stent system.

INTRODUCTION: Immediate and acute stent recoil has been observed following balloon deflation in normal and diseased coronary arteries, and the degree varies by stent design. METHODS: A total of 19 patients, who underwent elective stent implantation for single de novo native coronary artery lesions, were enrolled: all patients treated with the biodegradable polymer-coated sirolimus-eluting cobalt-chromium coronary stent system (Supralimus-Core(®)). The immediate, acute and cumulative stent recoil was assessed by quantitative coronary angiography. The cumulative stent recoil was measured at 24 h of stent implantation. RESULTS: The absolute late loss due to recoil was found 0.08 ± 0.19 mm for Immediate Stent Recoil (ISR), 0.05 ± 0.21 mm for Acute Stent Recoil (ASR) and 0.11 ± 0.25 mm for Cumulative Stent Recoil (CSR) respectively. CONCLUSIONS: In vivo acute stent recoil of the Supralimus-Core(®) has higher radial strength compared to other available standard drug-eluting stents.

Systemic exposure of sirolimus after coronary stent implantation in patients with de novo coronary lesions: Supralimus-Core® pharmacokinetic study.

OBJECTIVES: This study was conducted to assess the systemic drug release and distribution of sirolimus-eluting coronary stents. METHODS: Twenty patients with coronary artery disease (CAD) were treated with 1, 2, or 3 a newly designed metallic stents. Blood samples were drawn at 14 time points to determine the pharmacokinetic of sirolimus. Whole blood concentrations of sirolimus were determined by using a sensitive validated high-performance liquid chromatography mass spectrometry/mass spectrometry method. RESULTS: Minimal measurable blood levels were detectable at 7 days. Across all dose levels, individual T(max) values ranged from 1.00 hour and 12.00 hours; individual C(max) ranged from 0.73 ng/mL and 4.13 ng/mL. CONCLUSION: This study confirms the limited exposure of the systemic circulation of the eluted drug with the use of the Supralimus-Core® Sirolimus-Eluting Coronary Stent System (Sahajanand Medical Technologies Pvt. Ltd., Surat, India). In this study, sirolimus concentration in systemic circulation is to be safe, well-tolerated and short-lived.

Use of enoxaparin in emergency room for improving outcomes of primary percutaneous coronary interventions for acute myocardial infarction.

OBJECTIVE: Outcomes of primary angioplasty can be improved by achieving better pre/post PCI TIMI flows. Earlier administration of antithrombotic and antiplatelet agents may help in achieving better TIMI flows. We evaluated the role of intravenous bolus of enoxaparin administered immediately after the diagnosis of STEMI in the emergency room. METHODOLOGY: We compared the data of 100 consecutive patients in the emergency room, administered intravenous enoxaparin immediately after the diagnosis of STEMI (within 12 hours from the onset of pain). The patients had undergone primary PCI with 100 patients receiving unfractionated heparin administered during primary PCI. All patients received 325 mg Aspirin, 300 mg Clopidogrel on admission and platelet IIb/IIIa antagonist during and after PCI. Enoxaparin group received 0.6 ml IV enoxaparin (0.8 ml if weight > 80 kg). TIMI flows on pre/post PCI angiograms were studied. Clinical end points included death and MACE rates at 30 days. RESULTS: Both the groups were demographically similar. Pre PCI TIMI 2/3 flow increased from 18%-24% (p = 0.385). TIMI 3 flow increased from 8%-17% (p = 0.087). Post PCI TIMI 3 flow increased from 91%-96% (p = 0.251). There was absolute improvement of 9% in pre PCI TIMI 3 flow and 5% in post PCI TIMI 3 flow. There was no significant difference in the mortality and MACE rates at 30 days. CONCLUSION: Enoxaparin administered early in the emergency room after the diagnosis of STEMI improved pre and post PCI TIMI 3 flows with an absolute improvement of 9% in pre PCI TIMI 3 flow. Death and MACE rates showed trends towards improvement although they were not statistically significant.