Significant narrowing of the circumflex artery leads to worse outcomes than right coronary artery narrowing in patients with anterior myocardial infarction treated invasively.

BACKGROUND: Occlusion of the circumflex artery (Cx) often does not present signs in the ECG. It can lead to delayed angiography during ST-elevation myocardial infarction (STEMI). The aim of this analysis was to determine if Cx narrowing is related to diverse outcomes in comparison with right coronary artery (RCA) stenosis in patients with STEMI, treated with percutaneous coronary intervention (PCI) of the left descending artery (LAD). METHODS AND RESULTS: Inclusion criteria were as follows: first STEMI treated with PCI of the LAD and additional significant (≥ 70 %) Cx or RCA narrowing-two-vessel disease. A total of 234 consecutive patients with STEMI were included. Total mortality was estimated during long-term follow-up, at mean 639 (± 224) days after STEMI. Patients with Cx narrowing constituted 46 % (N = 108) of the study population, and patients with RCA narrowing amounted to 54 % (N = 126). Patients with narrowing of the Cx had worse long-term outcomes in terms of mortality than patients with RCA narrowing (22 vs. 11 %, p < 0.05, respectively). Multiple regression analysis showed independent risk factors for death during long-term follow-up such as: age, ejection fraction and Cx narrowing. CONCLUSION: Significant Cx narrowing leads to worse outcomes than RCA narrowing in patients with STEMI treated with PCI of the LAD.

Usefulness of automatic measurement of contrast flow intensity: an innovative tool in contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization. A pilot study.

AIM: Contrast-enhanced ultrasound imaging of the carotid arteries (CECU) permits direct, real-time visualization of neovascularization in atherosclerotic plaques and is a confirmed predictor of unstable atheromatous lesions. The aim of the study was the assessment of a new, automatically measured index of intensity in quantitative estimation of the contrast flow through the carotid plaque (till now assessed only visually). METHODS: Forty-four patients (mean age 70.4±11.4) with ultrasound diagnosed significant stenosis of internal carotid artery (ICA), after cerebrovascular or cardiovascular events, qualified for carotid artery stenting (CAS) were examined. The carotid ultrasound examinations with contrast agent Sonovue were performed. RESULTS: Visually in 22 patients (50%) contrast flow through the atherosclerotic plaques was found. In 17 patients (38.6%) massive, calcified atherosclerotic plaques were present. Patients with preserved contrast flow through the plaque more frequently had a history of cerebral stroke (P=0.04). Massive calcifications of atherosclerotic plaques correlated with a previous MI (P=0.03) and the degree of advancement of coronary artery disease (P=0.04), but not with a previous cerebral stroke. Contrast flow through the atherosclerotic plaque positively correlated with values of the index of intensity (r=0.69, P<0.00001). In patients with preserved contrast flow the mean value of the index of intensity was 22.24±3.55 dB as compared with 12.37±7.67 dB - a value present in patients without preserved contrast flow. No significant relation for the degree of calcifications and the value of the index of intensity was found. CONCLUSION: The assessment of the index of intensity is a novel, simple and automatic method to estimate the degree of contrast flow through the carotid plaque. The values of the index of intensity correlate with the contrast flow through the atherosclerotic plaque, but not with its calcification.

Early and long-term prognosis of patients with coronary artery disease treated with percutaneous coronary interventions in 2005. Experience of single large-volume PCI center.

PURPOSE: The progress which has been made in interventional cardiology contributes to the gradual improvement of the results of CHD (coronary heart disease) therapy. The aim of the study was the assessment of early and long-term prognosis in all the patients with CHD treated invasively in one large-volume PCI center in 2005. MATERIAL AND METHODS: 1390 consecutive patients with CHD treated with PCI in 2005 were included in the analysis. Patients with ST-elevation myocardial infarction (STEMI) accounted for 50% of cases, patients with stable angina (SA) amounted to 25%, and patients with non-ST elevation acute coronary syndromes (NSTE-ACS) constituted 25%. Mean follow-up was 738 (±237) days. RESULTS: The highest mortality during the hospitalization was noted within the STEMI group(SA vs. NSTE-ACS vs. STEMI; 0% vs. 0.3% vs. 4.1%, respectively; p<0.001). The highest mortality during a 2-year follow-up was also observed in the STEMI group (SA vs. NSTE-ACS vs. STEMI, 6.3% vs. 8.5% vs. 13.8%, respectively; p<0.001). Multiple regression model showed that independent risk factors for death during the follow-up were: age, glycaemia at admission, heart rate, blood pressure, ejection fraction, STEMI, ineffective PCI (R=0.3613; F(10.131)=19.672; p<0.0001 for the model). CONCLUSIONS: The highest relative increase of mortality after the discharge of patients with CHD undergoing PCI referred to the patients with NSTE-ACS. However, in the real life PCI practice STEMI patients have the worst hospital and long-term prognosis. Well recognized risk factors for death in patients with CHD are still of great importance in negative prognosis of patients undergoing PCI.

Oxidative stress and antioxidative defense parameters early after reperfusion therapy for acute myocardial infarction.

Reperfusion of ischemic myocardium evokes rapid release of free radicals in experimental models. The aim of the study was to investigate the oxidative stress and antioxidative defense during first minutes after reopening of the infarct related artery in patients treated for acute myocardial infarction. The study group consisted of 15 patients with first ST elevation myocardial infarction (STEMI) due to left anterior descending artery occlusion. The control group included ten patients with stable ischemic heart disease (IHD). Blood samples from coronary sinus were drawn before, immediately after and about 15 min after angioplasty. Activity of superoxide dysmutase (SOD), concentration of glutathione as well as the concentrations of lipid peroxides, malodialdehyde (MDA) and 4-hydroxy-2-nonenal (HNE) were measured. There was significantly higher concentration of MDA and HNE and higher SOD activity in STEMI patients before the reperfusion, as compared to the stable IHD group. After the reperfusion concentration of HNE in erythrocytes from STEMI patients was higher than in IHD group. At the same time the activity of SOD significantly decreased in patients with impaired tissue perfusion (myocardial blush grade <2). In conclusion, there is a slightly higher concentration of oxidative stress parameters in patients with STEMI. Diminished antioxidative defense after reperfusion is associated with impaired myocardial perfusion.

Low dose rofecoxib, inflammation and prostacyclin synthesis in acute coronary syndromes.

PURPOSE: To assess the influence of low dose rofecoxib on inflammatory mediators and prostacyclin synthesis in patients with acute coronary syndromes (ACS) in a short-term follow up. MATERIAL AND METHODS: Twenty nine patients with ACS without ST elevation were randomized to simvastatin alone or together with low dose rofecoxib. Serum levels of interleukin 6 (IL-6), 6-keto-PGF-1alpha--stable product of prostacyclin (PGT2) and hs-C-reactive protein (hs-CRP) were assessed on enrollment and after 30-day follow up. RESULTS: Combination of rofecoxib with statin significantly decreased levels of hs-CRP after one month therapy (5.21 mg/l +/- 4.12 vs 2.11 mg/l +/- 2.1; p=0.0092). This effect was not evident in a group on statin alone (3.95 mg/l +/- 3.33 vs 2.48 mg/l +/- 2.39; p=0.31). 6-keto-PGF-1alpha increased not significantly in both groups. IL-6 concentration has not changed during follow up. CONCLUSIONS: Low dose of selective COX-2 inhibitor exerts significant anti-inflammatory effect and does not diminish PG12 synthesis in study group of patients with ACS.

Relationship between gastroesophageal reflux disease and myocardial ischemia. Effect of reflux on temporary activity of autonomic nervous system.

PURPOSE: Assessment of the gastroesophageal reflux disease (GERD) influence on myocardial ischemia and autonomic nervous system (ANS) activity. MATERIAL AND METHODS: In 50 patients with angiographically confirmed ischemic heart disease (IHD) in I-III CCS class, simultaneous 24-hour ECG and esophageal pH-metry monitoring was performed. We assessed: (1) GERD occurrence in patients with IHD, (2) influence of pathological reflux (PR) on myocardial ischemia--number and total duration of ST depression episodes in GERD and non-GERD patients, (3) temporary activity of ANS was determined according to the dynamics of spectral HRV (Heart Rate Variability) analysis components (LF, HF, VLF, LF/HF). RESULTS: 23 patients (46%) fullfilled the GERD criteria. Patients with GERD had significantly higher number of ST depression episodes (4.13 vs 2.85, p = 0.013) as well as longer total duration of ischemia (64.73 vs 35.2 min, p = 0.034). Spectral HRV analysis showed the significant decrease of LF/HF ratio (p < 0.035), which indicates the sympathovagal balance shift towards the parasympathetic system caused by PR. CONCLUSIONS: 1. GERD is frequent condition in patients with angiographically confirmed IHD. Coexistence of GERD may predispose to the myocardial ischemia. 2. Gastroesophageal reflux may cause the shift of sympathovagal balance towards its parasympathetic component. This mechanism may induce esophago-cardiac reflex, leading to diminished myocardial perfusion.

Kallikrein-kinin system in patients with neoplastic diseases.

The concentrations of kininogens, prokallikrein, fibrinogen, plasma protein, proteinase inhibitor antigens, and the kininase, fibrinolytic and antipapain activities in plasma of 29 patients with various tumours (lung cancers, lymphomas, and others) during chemotherapy were measured. The same studies were performed on blood plasma of female patients operated on because of cervical or endometrial carcinoma (37 subjects) and submitted to subsequent local radiotherapy (before and after radiotherapy). A weak activation of kallikrein-kinin system and significant decrease in kininase and fibrinolytic activities were found in those patients. It may suggest a role of bradykinin in prevention of therapy-induced hypercoagulability in patients with neoplastic diseases.