[Unusual intervention of native vessel in patient with coronary artery bypass]. / Neobvyklá intervence na nativní tepne u pacienta po aortokoronárním bypassu.

Coronary artery bypass grafting (CABG) is older method of revascluarization treatment of coronary artery disease (CAD) then percutaneous coronary intervention (PCI), but in some cases, especially in multivessel disease or chronic total occlusions, still used. Extending survival of patients with CAD increases number of recathetrizations and interventions namely in post-CABG subjects. Due to degenerative and atherosclerotic changes of bypasses, especially venous grafts, interventional cardiologists are forced to solve often complicated findings. In other cases patients are reoperated with increased risk. Our task describes unusual, technically challenging and somewhat risk PCI of native vessel through arterial bypass in post-PCI patient with significant angina.

Potential role of selected biomarkers for predicting the presence and extent of coronary artery disease.

INTRODUCTION: Since atherosclerosis may in part be an inflammatory disease, circulatory factors related to inflammation may be predictors of coronary artery disease. The aim of this study was to evaluate the association between the level of some circulating biomarkers and the extent of coronary artery disease. METHODS: Blood samples were taken from 128 patients with stable forms of coronary heart disease. Macrophage chemoattractant protein-1 (MCP-1), matrix-metalloproteinase-3 (MMP-3), soluble CD40 ligand (sCD40L) and soluble tumour necrosis factor receptor-2 (sTNFR2) were measured by ELISA. Coronary angiography and grading with the SYNTAX score followed. RESULTS: There was no significant interdependence of circulating MCP-1, sCD40L, sTNFR2 levels and SYNTAX score. MMP-3 levels were significantly different in subgroup with coronary artery disease (SYNTAX score > 0): 38.1 µg/l (13.6; 84.1) and subgroup without coronary artery disease (SYNTAX score = 0): 20.4 µg/l (13.1; 82.8), p=0.001. According to the Spearman correlation coefficient there was significant association between MMP-3 level and SYNTAX score (0.358, a=0.05). CONCLUSIONS: Our data suggest association between the extent of coronary artery disease and circulating MMP-3. We failed to demonstrate any association with the other investigated biomarkers.

Clinical status and B-type natriuretic peptide levels in patients with heart failure at hospital discharge.

BACKGROUND AND PURPOSE: Levels of natriuretic peptides and their changes in the course of therapy may serve as a prognostic marker of long-term survival in patients with heart failure. The authors compared natriuretic peptide levels in patients with heart failure at admission and at hospital discharge and examined the relationship between their natriuretic peptide levels and clinical status at hospital discharge. PATIENTS AND METHODS: 108 patients with acute heart failure underwent, at admission to hospital and discharge after clinical improvement, an examination consisting of a physical checkup, B-type natriuretic peptide (BNP) measurements, and echocardiography. In addition, each patient was asked to use a 1-100 graphic grading scale to indicate a level of satisfaction with his/her overall health status, as well as quality of breathing at admission and discharge. RESULTS: All patients had elevated BNP levels at admission (1,066 +/- 887.8 pg/ml). In the course of treatment, all patients demonstrated a statistically significant downward trend in BNP levels (p < 0.002). However, BNP levels at discharge still remained in the pathologic range. Both at admission and discharge, patients with left ventricular systolic dysfunction had BNP values statistically significantly higher than those with diastolic dysfunction (1,880 +/- 1,160 vs. 454 +/- 323 pg/ml, and 993 +/- 828 vs. 338 +/- 226 pg/ml, respectively). Patients with repeated attacks of heart failure prior to admission had higher BNP levels compared to those with a first attack (p < 0.001). Both groups showed a statistically significant difference in subjective perception of difficulties which, both at admission and discharge, was reported by patients with a first decompensation attack as being more marked (p < 0.002 and p < 0.009, respectively). CONCLUSION: The question arises, whether one's "objective" assessment of the final degree of compensation at discharge may or may not be premature, and whether a follow-up "prognostic" BNP determination should or should not be performed until the moment of a "subjective optimum" as reported by the patient.