Correlation of lipoprotein(a) with the extent of coronary artery disease in patients with established coronary atherosclerosis: gender differences.

OBJECTIVE: To assess the gender differences in correlation lipoprotein(a) concentration with the extent of coronary artery disease in patients with established coronary artery disease. PATIENTS AND METHODS: Blood lipids and lipoprotein(a) concentrations were measured in 351 consecutive patients (256 men and 95 women) who underwent coronary angiography between January and May 2010, and who had established coronary atherosclerosis (angiography score >1). A modified angiographic Gensini Score was used. RESULTS: Mean angiographic score was 19.6 in men and 15.0 in women. Men had lower mean high-density lipoprotein cholesterol level than women (1.05 vs. 1.18 mmol/l) and lower mean apolipoprotein A level (1.41 vs. 1.53 g/l). Mean lipoprotein(a) level was higher in men than women (307.1 vs. 282.7 mg/l). Significant inverse correlation between high-density lipoprotein cholesterol and apoA with angiographic score was identified in women (r = -0.23, p = 0.028 and r = -0.26, p = 0.025), but not in men. Lipoprotein(a) level correlated significantly with angiographic score only in men (r = 0.168, p = 0.0185). CONCLUSIONS: Gender differences were identified in patients with established coronary atherosclerosis in the relation of blood lipids and lipoprotein(a) levels with the extent of coronary artery disease.

Correlation of lipoprotein (a) concentration with the extent of coronary artery disease in patients on lipid lowering therapy.

OBJECTIVES: Lipoprotein (a) [Lp(a)], together with other serum lipoproteins have an important role in the pathogenesis of coronary heart disease. The objective of the study was to assess the association between plasma levels of Lp(a) with the extent of angiographically defined coronary artery disease (CAD). PATIENTS AND METHODS: A total of 518 consecutive patients (66 % males) underwent coronary angiography in connection with lipids and lipoprotein determinations between 1st January and 31st May 2010. Most of the patients were treated with lipid lowering therapy (77 % statins). Modified angiographic Gensini Score (GS) and adjusted angiographic score (AS) were used to reflect the extent of coronary atherosclerosis. RESULTS: Both GS and AS angiographic scores correlated significantly with age, male gender, statin therapy and inversely with left ventricular ejection fraction (p<0.05-0.01 for all). The results showed significant inverse correlation of HDL cholesterol levels with GS and AS (r=-0.16, p<0.001), and apolipoprotein A levels with GS and AS (r=-0.20, p<0.0001) and a positive correlation of Lp(a) levels with angiographic score (r=0.13, p<0.01) and with adjusted angiographic score (r=0.16, p<0.01). Regression analysis showed only Lp(a) concentration was an independent lipid factor that correlated with the extent of CAD. CONCLUSION: Only Lp(a) levels correlated with the extent of coronary artery disease as assessed with coronary angiography in patients treated with lipid lowering therapy.

Temporary (short-term) percutaneous left ventricular assist device (Tandem Heart) in a patient with STEMI, multivessel coronary artery disease, cardiogenic shock and severe peripheral artery disease.

Cardiogenic shock remains the leading cause of mortality among patients admitted for acute myocardial infarction (AMI). Percutaneous left ventricular assist devices (pVAD) represent one possible means of supporting these critically ill patients during interventional procedures. Tandem Heart is one such pVAD, which uses transseptal cannulation and a paracorporal centrifugal pump to maintain active circulation to the descending aorta. Despite its overall effectiveness in clinical use, the use of the Tandem Heart has several potential limitations, including a contraindication for patients with peripheral artery disease. This case report describes the successful use of the Tandem Heart in one such patient requiring a high-risk coronary intervention procedure with otherwise prohibitive peripheral arterial disease, by employing peripheral artery angioplasty.