Risk Factors Associated with Failure to Achieve the Low Density Lipoprotein Cholesterol Therapeutic Target in Patients with Acute Coronary Syndrome: A Longitudinal, Single Centre Investigation.

INTRODUCTION: Reducing low-density lipoprotein cholesterol (LDL-C) to target < 100 mg/dL is considered as a critical therapeutic goal after acute coronary syndrome (ACS). AIM: To evaluate the factors associated with reaching or not this LDL-C target after 6 months of statin therapy. METHODS: Demographic features and other clinically relevant information from a cohort of patients enrolled from April 3, 2016 through March 20, 2017 were analyzed in the current investigation. All included cases had baseline LDL-C levels ≥ 100 mg/dL. LDL-C levels were determined once again after 6-month of statin therapy for each patient. RESULTS: Two hundred and thirty two participants were included in the final analysis. One third of patients (33.2%) with ACS with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Spearman correlation test showed that the age, diabetes mellitus, lipid lowering therapy and statin daily dose were among the influential factors associated with LDL-C goal achievement. Furthermore, multiple logistic regression analysis revealed that diabetes mellitus and statin treatment before admission were the only independent predictors of achieving LDL-C goal. CONCLUSIONS: According to our findings, the drug adherence and use of higher intensity as recommended in secondary prevention are needed to increase the achievement of LDL-C treatment targets.

Association of endothelial dysfunction and cytotoxin-associated gene A-positive Helicobacter pylori in patients with cardiac syndrome X.

BACKGROUND: Existence of coronary endothelial dysfunction has been demonstrated in patients with cardiac syndrome X (CSX). In addition, Helicobacter pylorus (H. pylori) has been associated with CSX. We aimed to assess the possible association of endothelial dysfunction and cytotoxin-associated gene A-positive H. pylori (CagA+) infection in CSX patients. METHODS: Fifty-six patients with CSX (23 male/33 female; age: 51.25 ± 8.86 years) who were anti-H. pylori IgG-positive [H. pylori(+)] and 24 CSX patients (7 male/17 female; age: 52.79 ± 9.88 years) who were H. pylori(-) were included. Also, anti-H. pylori IgG-positive patients were determined by the presence of IgG antibody to CagA. Levels of endothelin-1 (ET-1), E-selectin and intercellular adhesion molecule-1 (ICAM-1) were measured. RESULTS: Endothelial dysfunction biomarkers were higher in H. pylori(+) than in H. pylori(-) patients (ET-1: 54.60 ± 25.39 vs. 42.59 ± 18.37 pg/ml, p = 0.04; E-selectin: 42.68 ± 14.26 vs. 31.72 ± 8.26 ng/ml, p = 0.001; ICAM-1: 339.68 ± 135.8 vs. 266.51 ± 125.1 ng/ml, p = 0.02). Among H. pylori(+) subjects, 28 cases were CagA(+) and 28 cases were CagA(-). There were significant differences in measured levels of E-selectin between CagA(+) and CagA(-) groups (48.00 ± 16.37 vs. 37.37 ± 9.37 ng/ml, p = 0.004). For ET-1 and ICAM-1 levels, the difference between CagA(+) and CagA(-) was insignificant (p = 0.174 and p = 0.07, respectively). CONCLUSION: High levels of endothelial dysfunction biomarkers are found in CSX patients with anti-CagA(+). These findings suggest the infection with CagA(+) H. pylori strain may play a role as a risk factor in development of CSX through provocation of endothelial dysfunction. Therefore, a long term follow up to investigate the outcomes of these patients is proposed.

Activated clotting time level with weight based heparin dosing during percutaneous coronary intervention and its determinant factors.

INTRODUCTION: Percutaneous coronary intervention (PCI) may be associated with Thrombotic complications. Unfractionated heparin (UFH) is a potent and preferable antithrombotic agent during this procedure. Activated clotting time (ACT) is a good assay for accurate titration of UFH during PCI. The aim of this study was to evaluate ACT levels 10 minutes after administration of 100U/kg IV heparin and determining its associated factors. METHODS: This study was performed in Madani hospital, Tabriz, Iran between January 2013 to January 2014. One hundred and two patients candidates for elective PCI were enrolled in the study. Data including demographic and risk factors were collected. RESULT: The range of ACT was between 165 to 750 seconds (mean 319.8 seconds), 52 (51%) patients had ACT levels lower than 300sec and 12 (11.8%) patients had ACT levels between 300 to 350 seconds which is known optimal range and 38 (37.2%) cases had ACT levels above this value. Major risk factors had no effect on ACT value, but there was a trend to higher levels with increasing age (P=0.06). There was no difference in the rate of major or minor bleeding with respect to ACT levels (P=0.52). There was a trend to higher rate of minimal bleeding in those with ACT >350 sec (P=0.06). CONCLUSION: Weight based UFH injection may result in suboptimal anticoagulation during the procedure. Routine ACT measurement may be necessary to ascertain adequate anticoagulation. Major risk factors had no effect on ACT level and it was not associated with the rate of bleeding.

Patient's Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections.

INTRODUCTION: We aimed to determine angiography projections with lower Dose Area Product (DAP) rate by measuring the mean DAP and fluoroscopy times in coronary angiography (CAG) and percutaneous coronary intervention (PCI) and calculating DAP rate in different projections. METHODS: DAP and fluoroscopy times were measured in all employed projections in real-time in 75 patients who underwent CAG or PCI by a single cardiologist in Madani Cardiovascular University Hospital (45 in CAG group and 30 in PCI group). DAP rate was calculated in both groups and in all projections. The projections with highest and lowest DAP rate were determined. RESULTS: Mean DAP was 436.73±315.85 dGy×cm(2) in CAG group and 643.26±359.58 dGy×cm(2) in PCI group. The projection 40° LAO/0° had the highest DAP rate in CAG group (28.98 dGy×cm(2)/ sec) and it was highest in 20° RAO/30° CR in PCI group (29.83 dGy×cm(2)/sec). The latter projection was also the most employed projection in PCI group. CONCLUSION: The amount of radiation dose in this study is in consistent with the previous reports. Specific angiographic projections expose patients to significantly higher radiation and they should be avoided and replaced by less irradiating projections whenever possible.