RESUMEN
BACKGROUND: The safety and efficacy of clopidogrel therapy in patients with stable coronary artery disease or acute coronary syndromes undergoing percutaneous coronary intervention (PCI) have been demonstrated. OBJECTIVES: To evaluate the safety (primary outcome, defined as any bleeding complication or thrombocytopenia) and adverse outcomes (secondary outcomes, defined as death from cardiovascular causes, myocardial infarction or stroke) of clopidogrel therapy in patients aged ≥75 years with stable or unstable coronary artery disease undergoing PCI, and to compare these outcomes with those in younger controls. METHODS: Patients with both stable coronary heart disease and acute coronary syndromes undergoing PCI were included in the study. Two groups were formed according to age at the time of admission. Patients aged ≥75 years (the study group, n = 149) formed one group; the other group included patients aged <75 years (the control group, n = 298). During an ad hoc PCI procedure, a 600 mg loading and 75 mg/day maintenance dose of clopidogrel in addition to aspirin (acetylsalicylic acid) therapy (300 mg/day) were administrated to both treatment groups. In-hospital outcomes were investigated during a mean ± SD follow-up period of 5.3 ± 3.9 days. RESULTS: The first safety (primary) outcome of any bleeding event occurred in 16.1% of the patients in the study (older) group and 6.0% of the patients in the control (younger) group (odds ratio [OR] 2.987; 95% CI 1.565, 5.701; p = 0.001). The second safety outcome of TIMI (Thrombolysis in Myocardial Infarction) major bleeding occurred in 4.0% of the patients in the study group and 0.7% of the patients in the control group (OR 6.210; 95% CI 1.238, 31.151; p = 0.012). Other safety outcomes of TIMI minor/minimal bleeding and thrombocytopenia were not different between the two groups. The rate of the first adverse (secondary) outcome of the composite of death from cardiovascular causes, myocardial infarction or stroke was higher in older patients (12.1% vs 5.4%) [OR 2.422; 95% CI 1.197, 4.899; p = 0.012], primarily driven by stroke events (2.0% vs 0%; p = 0.014). CONCLUSIONS: Any bleeding and TIMI major bleeding complications increase in patients aged ≥75 years treated with clopidogrel in addition to aspirin.
Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Ticlopidina/análogos & derivados , Síndrome Coronario Agudo/terapia , Administración Cutánea , Factores de Edad , Anciano , Angioplastia Coronaria con Balón , Aspirina/efectos adversos , Aspirina/uso terapéutico , Clopidogrel , Enfermedad de la Arteria Coronaria/terapia , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/inducido químicamente , Estudios Prospectivos , Stents , Accidente Cerebrovascular/inducido químicamente , Trombocitopenia/inducido químicamente , Ticlopidina/efectos adversos , Ticlopidina/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVES: We evaluated the relationship between coronary blood flow and serum gamma-glutamyltransferase (GGT) activity in patients with slow coronary flow (SCF). STUDY DESIGN: The study included 90 patients (47 men, 43 women; mean age 50.8+/-9.4 years) with SCF and 88 patients (45 men, 43 women; mean age 51.4+/-8.8 years) with coronary artery disease (CAD), whose diagnoses were made by coronary angiography. Patients with CAD had normal coronary flow. Coronary flow was quantified using the corrected TIMI frame count (TFC) method and serum levels of gamma-glutamyltransferase were measured. The results were compared with those of a control group consisting of 86 age- and sex-matched patients who had normal coronary arteries and normal coronary flow. RESULTS: The three groups were similar with respect to body mass index, presence of hypertension and diabetes mellitus, lipid profiles, and fasting glucose. The use of medications was significantly more common in the CAD group (p<0.01). Compared to the control group, serum GGT activity was significantly increased in both SCF and CAD groups (p<0.01), but these two groups did not differ significantly in this respect (p=0.71). The TFCs for all the epicardial coronary arteries and the mean TFC were significantly higher in the SCF group (p<0.01). Patients with CAD and the controls had similar TFC parameters. The mean TFC showed a positive and moderate correlation with serum GGT activity (r=0.326; p<0.001). In regression analysis, serum GGT activity was found as the only independent predictor of the mean TFC (beta=0.309; p<0.001). CONCLUSION: We have shown for the first time an association between increased serum GGT activity and SCF. Further clinical studies are needed to clarify the physiopathologic role of serum GGT activity in SCF.
Asunto(s)
Enfermedad de la Arteria Coronaria/sangre , Circulación Coronaria/fisiología , gamma-Glutamiltransferasa/sangre , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Aspirina/uso terapéutico , Índice de Masa Corporal , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/enzimología , Femenino , Frecuencia Cardíaca , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Caracteres SexualesRESUMEN
Atherosclerosis is a dynamic chronic inflammatory process, and some inflammatory biomarkers have roles in this process. The levels of C-reactive protein (CRP) in patients with chronic stable coronary heart disease (CHD) have not been investigated well, and the levels of macrophage colony-stimulating factor (M-CSF) and interleukin-3 (IL-3) in patients with chronic stable CHD and the effects of these cytokines on atherogenesis are not known. To determine whether new inflammatory biomarkers have roles in atherosclerosis, the authors measured the levels of CRP, M-CSF, and IL-3 in patients with chronic stable CHD and in healthy controls. They measured plasma CRP concentrations by using a highly sensitive CRP reagent with immunonephelometric method, and plasma M-CSF and IL-3 concentrations with the help of a commercial enzyme-linked immunoassay test in 31 patients with chronic stable CHD documented by coronary angiography and in 22 age-matched healthy control subjects documented by coronary angiography. Mean plasma CRP, M-CSF, and IL-3 concentrations in patients with chronic stable CHD were significantly higher than those in controls (8.2 vs 4.6 mg/L, 195.3 vs 28.9 pg/mL, 173 vs 118 ng/mL, respectively, ppi.05). CRP, M-CSF, and IL-3 were all increased in patients with chronic stable CHD relative to controls. These findings suggest that these are new inflammatory biomarkers that may have important roles in the development of atherosclerotic lesions.
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Biomarcadores/sangre , Enfermedad Coronaria/sangre , Adulto , Anciano , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Enfermedad Crónica , Femenino , Humanos , Inflamación/sangre , Interleucina-3/sangre , Modelos Lineales , Factor Estimulante de Colonias de Macrófagos/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de RegistrosRESUMEN
OBJECTIVE: To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease. METHODS: The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation. RESULTS: Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9+/-21.7 versus 48.7+/-18.6 ng/ml, P<0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin >57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis. CONCLUSION: In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease.
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Moléculas de Adhesión Celular/sangre , Puente de Arteria Coronaria , Oclusión de Injerto Vascular/sangre , Vena Safena/trasplante , Anciano , Aterosclerosis , Biomarcadores/sangre , Angiografía Coronaria , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/fisiopatología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Activación Plaquetaria , Valor Predictivo de las Pruebas , Vena Safena/patologíaRESUMEN
BACKGROUND: The development of coronary collateral vessels is the physiological response of myocardial tissue to hypoxia or ischemia, which results in an increase in blood supply to the tissue. However, a lack of collateral vessels or the presence of poor collateralization in some patients despite the presence of significant coronary stenosis or obstruction and evidence of myocardial ischemia suggest that some other factors may affect the development of collateral circulation. In the present study we aimed to evaluate coronary collateral circulation in patients with metabolic syndrome with advanced coronary artery disease and compare the results with those of patients without metabolic syndrome. METHOD: The study population comprised 102 patients with metabolic syndrome and advanced coronary artery disease (>or=90% diameter stenosis in at least one major epicardial coronary artery) and 102 control participants without metabolic syndrome who also had >or=90% diameter stenosis in at least one major epicardial coronary artery. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III clinical definition. Coronary collateral vessels were analysed according to the Cohen and Rentrop grading system. Both groups were also divided into two additional groups according to the Rentrop collateral score as patients with poor collateral circulation (Rentrop score 0-1) and good collateral circulation (Rentrop score 2-3). RESULTS: The mean Rentrop collateral score for patients with metabolic syndrome was significantly lower than for those without metabolic syndrome (1.38+/-0.79 compared with 1.99+/-1.08, respectively, P<0.001). When two groups were compared with respect to poor and good collateral circulation, poor collateral circulation was found to be significantly higher in the metabolic syndrome group (70% compared with 32%, respectively, P<0.001). Moreover, multivariate logistic regression analysis revealed a significant relationship between poor collateral circulation and metabolic syndrome (odds ratio=4.29, 95% confidence interval=1.73-10.69, P=0.002). CONCLUSION: We have shown for the first time that the development of coronary collateral vessels is poorer in patients with metabolic syndrome with advanced ischemic heart disease than in control participants without metabolic syndrome. Thus, it can be suggested that metabolic syndrome is one of the significant factors affecting the development of coronary collateral vessels adversely.
Asunto(s)
Circulación Colateral , Circulación Coronaria , Estenosis Coronaria/fisiopatología , Vasos Coronarios/crecimiento & desarrollo , Vasos Coronarios/fisiopatología , Síndrome Metabólico/fisiopatología , Anciano , Biomarcadores/sangre , Glucemia/metabolismo , HDL-Colesterol/sangre , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/metabolismo , Femenino , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/metabolismo , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Índice de Severidad de la Enfermedad , Triglicéridos/sangreRESUMEN
In the present study, we have examined whether increased N-ANP (N-terminal pro-ANP) levels before and after surgery in patients with ASD (atrial septal defect) along with echocardiographic findings provide a better insight into the pathophysiology and increased morbidity and mortality following corrective surgery. Eighteen adult ASD patients (> 20 years of age; six male and 12 female) with shunts (Qp/Qs > or = 2, where Qp/Qs is the pulmonary blood flow/systemic blood flow) had complete echocardiographic, clinical and laboratory parameters evaluated before and 6 months after surgery. Eight age- and sex-matched individuals (three male and five female) were enrolled as a control group. Blood samples for N-ANP analysis were obtained in both groups. N-ANP levels in the peripheral blood sample from ASD patients before surgery were significantly higher than those in the control group. In patients with ASD, mean N-ANP levels obtained from the pulmonary artery were significantly higher than that obtained from the peripheral vein. RA (right atrial) area, adjusted for body surface area, and RA long-axis and short-axis measurements were significantly higher in the patient group than the control group. N-ANP was correlated significantly with these parameters. Following corrective surgery, N-ANP values and RA area, RA long-axis and short-axis normalization decreased significantly and were accompanied by a decrease in systolic mean pulmonary artery pressure. N-ANP levels were normalized following septal closure in most patients, except in those with atrial fibrillation attacks following corrective surgery. In conclusion, we have shown correlations among variables indicating changes in the architecture of the right atrium along with temporal changes in ANP providing insights into the pathophysiology of post-operative atrial arrhythmias.