Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions.

Background Distal embolization is the detrimental factor in SVG intervention. There is no specific treatment for it except prevention. Guidelines have endorsed the use of embolic protection devices; however, their use is not without complications, and increases the procedural time and cost for the patient. The objective of this study is to analyze the procedural results and immediate outcome in de novo SVG stenting. Methods A retrospective observational study of patients who have undergone SVG-percutaneous coronary intervention at our institute. Baseline clinical, demographic data, intervention details, and in-hospital events are analyzed. Statistical analysis was done using Mini tab version 17. Chi-square testing, odds ratio, and 95% confidence intervals were calculated. Results The study population included 96 lesions in 80 patients. Average age of the graft was 8.2 ± 4 years. Embolic protection devices were used only in 10%. Angiographic and clinical success was seen in 92.5%. Distal embolization was seen in 7.5%. Drug-eluting stent and shorter stents were associated with lesser distal embolization. Stent length (> 20 mm) proved to be an independent predictor of distal embolization. There was no correlation between distal embolization and age of patient, sex, hypertension, diabetes, and smoking, left ventricular function, age of graft, direct stenting, use of embolic device, and glycoprotein 2b/3a inhibitors. Conclusion De novo SVG lesions can be stented with a high rate of angiographic and procedural success. Stent length is the only independent predictor of distal embolization. SVG interventions can be safely done in the absence of embolic protection devices irrespective of the graft age.

Assessment of Oxidative Stress Markers and Carotid Artery Intima-Media Thickness in Elderly Patients Without and with Coronary Artery Disease.

We aimed to assess whether measuring carotid intima-media thickness (CIMT) and oxidative stress markers such as protein carbonyls, malondialdehyde, nitrate and glutathione in plasma of elderly patients without and with coronary artery disease (CAD) identifies early risk for CAD. A total of 50 cases with cardiovascular risk factors over the age of 60 years without CAD, and 50 patients with angiographically documented CAD over the age of 60 years were included in the study. Control group consists of 200 healthy individuals without the risk factors. Demographic details were obtained from all the subjects and CIMT measured by high frequency ultrasound and oxidative stress markers such protein carbonyls, malondialdehyde and total glutathione were determined in plasma by spectrophotometric methods. The distribution of cardiovascular risk factors in without CAD and CAD cases were smokers (16 vs 56 %), hypertension (26 vs 64 %), diabetes (16 vs 56 %) and dyslipidemia (18 vs 58 %) and positive family history (4 vs 38 %). None of the control group had any cardiovascular risk factors. Among the CAD cases, 16 % had single vessel disease, 44 % had double vessel disease and 40 % had triple vessel disease. The CIMT was significantly increased in CAD cases as compared to cases without CAD and healthy controls. On the other hand, CIMT was significantly increased in cases without CAD as compared to healthy controls. CIMT also increased with the duration of diabetes in patients without CAD and severity of disease in CAD cases. The levels of oxidants like plasma malondialdehyde, protein carbonyls, were significantly elevated and antioxidant glutathione levels and nitrate levels were significantly reduced in cases with and without CAD as compared to healthy controls. Oxidative stress markers and CIMT was found to be significantly increased in patients with cardiovascular risk factors like diabetes, family history of CAD, dyslipidemia, hypertension and smoking when compared to patients without risk factors. In patients with diabetes, CIMT increased as duration of disease increases and also in poorly controlled diabetes. In CAD group, when number of vessel involvement (severity of coronary disease) increases, the CIMT also increases confirming that CIMT is a quantifiable risk factor for CAD.

Importance of detection of segmental wall motion abnormalities of left ventricle in nontraumatic subarachnoid hemorrhage: a prospective study.

OBJECT: To find out the incidence and importance of segmental wall motion abnormalities (SWMAs) of the left ventricle in noncoronary artery disease (CAD) and nontraumatic subarachnoid hemorrhage (SAH) patients. METHODS: Nontraumatic SAH patients were evaluated with two-dimensional echocardiogram in addition to detailed clinical and investigative data. In echocardiogram, LV was evaluated as a 16-segment approach and its function was noted. Cerebral angiogram was performed in all the patients. Repeat echocardiograms were performed on day 10 and 6 weeks later. RESULTS: In 56 nontraumatic SAH patients, the average age was 45.8 + or - 9.1 years. Among them 16 were females. Clinical grade was 3-5 in 26 (46.43%) patients and 24 (42.86%) patients had aneurysms. Echocardiogram was normal in 33 patients and in 23 (41.07%) patients there were left ventricular (LV) abnormalities. LV SWMA was present in 15 patients (65.22%) and global hypokinesia in 8 patients (34.78 %). In the SWMA group, preservation of apical function relative to the base was observed in 13 patients. The repeat echocardiogram on day 10 in SWMA group showed normalization of LV abnormalities in 14 patients and one patient died due to rebleed. In global hypokinesia group, four patients recovered and four died. Significant associations were observed between SWMA and presence of aneurysm (P < 0.05) and LV function (P < 0.001), mortality correlated with LV function (P < 0.001) and clinical grade (P < 0.02). CONCLUSION: Transient SWMA can occur due to aneurysmal SAH itself and when associated with LV dysfunction, it had a higher mortality. (Echocardiography 2010;27:496-500).

Autologous bone marrow-derived progenitor cell myocardial delivery for recent myocardial infarction patients following early angioplasty: results from a pilot study.

PURPOSE: Cellular cardiomyoplasty is a potential therapeutic approach to preventing left ventricular remodeling after myocardial infarction and has shown encouraging results such as induction of neoangiogenesis and functional improvement of diseased hearts. We report the results of a pilot study on progenitor cells in five patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: Patients with single-vessel disease who had their first episode of myocardial infarction and underwent angioplasty after 48 h (an average of 17 days following myocardial infarction) were included in the study. Mononuclear cells (MNCs) (1x10(7)) were isolated by Ficoll Hypaque method from 60 ml of bone marrow (BM) obtained from the iliac crest of 5 patients (aspiration was performed under local anesthesia). The mean CD34 count was 1-4%. After confirming the patency of the affected vessel postangioplasty, cellular concentrate was injected into the affected artery in 3-ml boluses (three to four injections), with intermittent occlusion. RESULTS: The mean age of all five male patients was 48.6+13.7 years. At 1 year, five patients were asymptomatic, and one had Class II dyspnea on exertion. The results of an echocardiogram performed at 6 months showed an improvement in ejection fraction (EF) from 35.3% to 43.13% and in fractional shortening from 24.75% to 28.33%. End-systolic volume decreased from 115.5 to 92.3 ml, end-diastolic volume decreased from 177.5 to 170 ml, and end-systolic dimensions also decreased from 4.26 to 4 mm, demonstrating positive left ventricular remodeling. Repeat echocardiogram at 1 year showed persistent improvement in EF. No adverse events were noted either before or after the procedure. CONCLUSION: The injection of autologous BM MNCs is a safe and efficacious therapy following early revascularization in AMI patients.