Erythropoietin Reduces Post-PCI Arrhythmias in Patients With ST-elevation Myocardial Infarction.

BACKGROUND: Arrhythmia is the foremost cause of sudden death after myocardial infarction (MI). Animal models have recently shown that erythropoietin (EPO) can reduce the incidence of arrhythmia after MI. METHODS: We investigated the effects of administrating 33,000 IU EPO on the occurrence of post-MI arrhythmia in 40 patients with ST-elevation MI who were randomly assigned in either EPO or placebo groups. Arrhythmias were blindly documented using full 12-lead configuration during 24 hours after percutaneous coronary intervention (PCI) by a cardiologist. Afterward, CK-MB, hematologic, and hemodynamic data were examined within 2 weeks after MI. RESULTS: A comparison made between the 2 groups showed significant differences in the incidence of arrhythmias (20% in EPO group and 35% in placebo group, P = 0.043). However, no significant differences in type of arrhythmias were observed between the groups. There was no significant difference between levels of CK-MB in the 2 groups during 24 hours (P = 0.186). Hematologic and hemodynamic data showed no significant changes 2 weeks after PCI. CONCLUSION: High-dose administration of EPO in patients with ST-elevation MI who have been treated by primary PCI and standard antiplatelet therapy reduces the occurrence of arrhythmias. For clinical interpretation of the results, further well-designed trials are required.

Global coronary arteries spasm in a young patient.

BACKGROUND: Coronary artery spasm is a transient narrowing of coronary arteries that slows or stops blood flow through the artery. CASE REPORT: We present a 42-year-smoker man without any medical problem who developed syncope. Coronary angiography revealed diffuse significant narrowing of proximal left anterior descending artery (LAD), 90% osteal stenosis of large obtuse marginal (OM), 90% diffuse narrowing of proximal right coronary artery (RCA), which was relieved by intracoronary administration of nitrate. He was discharged on calcium channel blockers and nitrates but one month later developed syncope again and died. CONCLUSION: Multivessel coronary artery spasm should be considered in young smoker patients without any other coronary risk factors who present with syncope.

Percutaneous coronary intervention in a case of afibrinogenemia.

Congenital afibrinogenemia is a rare autosomic recessive blood disorder. A 30-year-old lady, known to have congenital afibrinogenemia, presented with acute anterior myocardial infarction. We managed her with dual antiplatelet therapy and atorvastatin, but her chest pain did not subside and she was transferred to the catheterization laboratory. A proximal left anterior descending artery occlusion was crossed with a floppy wire. Angioplasty was performed successfully with a bare metal stent, and her symptoms resolved completely.

Serum small dense low-density lipoprotein concentrations are elevated in patients with significant coronary artery stenosis and are related to features of the metabolic syndrome.

Serum small dense low-density lipoprotein (sd-LDL) concentrations were measured in patients with angiographically defined coronary artery disease (CAD) and compared to concentrations in healthy subjects. Five hundred and seventy patients with stable CAD were divided into CAD- and CAD+ based on angiography. Patients in whom stenosis was <50 % in diameter were classified as having a 'normal' angiogram (CAD-), otherwise the patients were allocated to the CAD+ group. The CAD+ group was further subcategorized into single-, double- and triple-vessel disease (VD). Serum sd-LDL concentrations were significantly lower in controls compared with CAD+ and CAD- patients (P < 0.001). Moreover, CAD+ patients had higher concentrations of sd-LDL than CAD- patients (P < 0.01). sd-LDL levels were not significantly associated with severity of CAD defined by the number of stenosed coronary arteries (P = 0.245). All participants were also categorized into subgroups with or without metabolic syndrome. Subjects with metabolic syndrome had higher levels of sd-LDL than subjects without metabolic syndrome (P < 0.01). Multiple linear regressions showed that in CAD patients, triacylglycerol, total-cholesterol, body mass index, and waist circumferences were the most important determinants of serum sd-LDL concentrations. We found that sd-LDL levels were significantly higher in patients presenting with symptoms of CAD. Moreover, patients with significant stenosis of their coronary arteries (>50 % stenosis) had higher levels of sd-LDL compared to patients without significant lesions.

Prooxidant-anti-oxidant balance is not associated with extent of coronary artery disease.

OBJECTIVE: We have measured the pro-oxidant-antioxidant-balance (PAB) levels in patients with defined coronary artery disease (CAD) and compared them with concentrations in healthy subjects. DESIGN AND METHODS: Based on angiography results, 400 patients with stable CAD were divided into CAD- and CAD+, this being further subcategorized into groups with single-, double- and triple-vessel disease (VD). RESULTS: The mean PAB values in the healthy subjects, was significantly lower than for other groups (P<0.001). In CAD- patients, PAB levels were 123.2 ± 43.9, which was not statistically different compared to groups with SVD, 2VD and 3VD (P>0.05). In the CAD+ group, PAB values in 1VD, 2VD and 3VD were not significantly different among patients with SVD, 2VD and 3VD (P>0.05). CONCLUSIONS: In conclusion, we found higher levels of oxidative stress in CAD+ patients compared to healthy subjects. The oxidation level was not related to measures of the extent of CAD such as number of stenosed vessels.

Serum inflammatory and immune marker response after bare-metal or drug-eluting stent implantation following percutaneous coronary intervention.

We assessed the changes in serum antiheat shock protein (HSP)-27 antibody and high-sensitivity C-reactive protein (hsCRP) levels, following the placement of a drug-eluting stent (DES) or bare-metal stent (BMS) in patients with stable coronary artery disease. Either a BMS or DES was implanted in 137 patients (82 BMS; 55 DES). Anti-HSP27 and hsCRP levels were measured 24 hours before and 24 hours after stenting. Median hsCRP serum levels increased significantly to 60.78 (10.13-84.87) and 77.80 (50.00-84.84) mg/L for BMS and DES groups (P = .006 and P = .000, respectively); this increase did not differ significantly between the 2 groups. Median anti-HSP27 antibody levels decreased to 0.26 (0.17-0.49) and 0.21 (0.16-0.29) absorbency units in BMS and DES groups (P = .045 and P = < 0.001, respectively). The changes in anti-HSP27 antibody titers were significant between the 2 groups (P = .015). Bare-metal stent and DES differ in stimulation of immune rather than inflammatory responses. Less stent restenosis after DES compared with BMS implantation could, in part, be attributed to differences in immune responses.

Serum antibody titers against heat shock protein 27 are associated with the severity of coronary artery disease.

Antibody titers to several heat shock proteins (anti-Hsps) have been reported to be associated with the severity and progression of cardiovascular disease. However, there are little data regarding anti-Hsp27 titers in patients with coronary artery disease (CAD). A total of 400 patients with suspected CAD were recruited. Based on the results of coronary angiography, these patients were classified into CAD(+) (n = 300) and CAD(-) (n = 100) groups defined as patients with ≥50% and <50% stenosis of any major coronary artery, respectively. Eighty-three healthy subjects were also recruited as the control group. Serum anti-Hsp27 IgG titers were measured using an in-house enzyme-linked immunosorbent assay. CAD(+) patients had significantly higher anti-Hsp27 titers compared with both CAD(-) and control groups. Anti-Hsp27 titers were also higher in the CAD(-) group compared with the control group. With regard to the number of affected vessels in the CAD(+) group, patients with three-vessel disease had higher anti-Hsp27 titers compared with both two-vessel disease (2VD) and one-vessel disease (1VD) subgroups. However, there was no significant difference between 1VD and 2VD subgroups. In multiple linear regression analysis, the number of narrowed vessels and smoking were significant independent determinants of serum anti-Hsp27 titers. The present findings indicate that serum anti-Hsp27 titers may be associated with the presence and severity of coronary artery disease.

Changes in pro-oxidant-antioxidant balance after bare metal and drug eluting stent implantation in patients with stable coronary disease.

OBJECTIVES: In this study we aimed to assess the changes in pro-oxidant-antioxidant balance (PAB) after the placement of either a drug-eluting-stent (DES) or bare-metal-stent (BMS) in patients with stable coronary artery disease. DESIGN AND METHODS: Percutaneous coronary interventions (PCI) with either BMS or DES were undertaken for 152 patients (82 in the BMS and 70 in the DES groups respectively). PAB values were measured 24h before and after PCI. RESULTS: Baseline PAB values were 80.68 (64.98-99.37) and 98.86 (64.70-140.62) for BMS and DES group, respectively, which were not significantly different between the 2 groups (P>0.05). Following PCI, median PAB values decreased to 72.10 (61.40-96.13) and 81.40 (54.15-121.90) in BMS and DES groups, respectively. The reduction was significant in both BMS and DES groups (P<0.05). The changes in PAB values were -2.81 (-12.76 to 2.31) for BMS and -2.82 (-29.88 to 8.93) for DES group, which were not significantly different between the 2 groups (P>0.05). CONCLUSION: We found that the reported difference in clinical outcomes following DES or BMS implantation cannot be attributed to differences in early changes in oxidative stress induction as assessed by changes in PAB values.