Current management and quality of life of patients with acute coronary syndrome undergoing percutaneous coronary intervention in Greece: 12-Month results from antiplatelet therapy observational study II (APTOR II).

INTRODUCTION: We describe the current management of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) over 12 months in Greece. METHODS: This was a prospective observational study in ACS patients undergoing PCI from September 2008 to April 2009, capturing practices over 12 months at 22 sites that enrolled 558 eligible patients. RESULTS: A total of 351 patients suffered from unstable angina or non-ST elevation myocardial infarction (UA/ NSTEMI), while 207 patients suffered from ST-elevation myocardial infarction (STEMI). For the UA/NSTEMI group, the median age was 64 years (interquartile range: 55-73), while for the STEMI group the median age was 56 years (interquartile range: 49-66). Stents were placed in 96.4% of patients: bare-metal stents alone were placed in 19% of patients, drug-eluting stents alone in 77.5% of patients, and both types of stent in 3.5% of patients. 74% of UA/NSTEMI patients and 87% of STEMI patients received the first antiplatelet loading dose within 1 day of the episode. 76% of UA/NSTEMI patients underwent PCI within 3 days following the initial ACS symptoms, while 67% of STEMI patients underwent PCI within 1 day of the ACS symptoms. Follow-up data were available for 540 (96.8%) patients. The percentages of patients on antiplatelet therapy and on other medications at the time of hospital discharge and at 12 months post-PCI were as follows: aspirin 98%, 97%; clopidogrel 99%, 96%; statins 81%, 79%; beta-blockers 73%, 72%; calcium blockers 11%, 11%; angiotensin II receptor blockers/angiotensin-converting enzyme inhibitors 64%, 62%; proton-pump inhibitors 39%, 35%. CONCLUSIONS: In ACS patients treated with PCI in Greece, dual antiplatelet treatment is maintained in a very high percentage through 1 year post-procedure, and drug-eluting stent use is also high.

Association of the eNOS E298D polymorphism and the risk of myocardial infarction in the Greek population.

BACKGROUND: Nitric oxide (NO), produced by endothelial nitric oxide synthase (eNOS), plays a key role in the regulation of vascular tone. Endothelium-derived NO exerts vasoprotective effects by suppressing platelet aggregation, leukocyte adhesion and smooth muscle cell proliferation. The E298D polymorphic variant of eNOS has been associated with myocardial infarction (MI), but data relating to this variant are divergent in Greece. Accordingly, we examined a possible association between the E298D polymorphism of the eNOS gene and MI in a subgroup of the Greek population. METHODS: The study population consisted of 204 patients with a history of MI and 218 control subjects. All subjects were of Greek origin and were selected from the general population of the greater Athens area. Genotyping was performed with melting curve analysis (Lightcycler system) of polymerase chain reaction amplified products using hybridization probes. RESULTS: According to the univariate findings, the risk for MI in E298D TT was 2.06 (95%CI: 1.06-4.00, p = 0.032) versus GG+GT and 2.34 (95%CI: 1.17-4.68, p = 0.016) versus GG. The risk for the T allele was estimated at 1.42 (95%CI, 1.06-1.89, p = 0.022) as compared to G allele. Regarding the additive model, one allele increase was associated with 43% higher risk of MI (OR = 1.43, 95%CI: 1.07-1.93, p = 0.018) as compared to the baseline category of homozygous GG. The positive association of TT versus GG+GT with MI risk remained even after adjusting for the main study covariates. Moreover, strong evidence was found for an increased risk for MI among carriers of the TT genotype who were smokers, hypertensive and had a family history of CAD. CONCLUSIONS: This study indicates that E298D polymorphism of the eNOS gene seems to be associated with MI occurrence in the Greek population. It is possible that TT genotype is closely linked to the etiology of MI even after adjusting for known MI risk factors.