RESUMEN

BACKGROUND AND AIM: Epidemiological studies have shown that increased serum uric acid (SUA) level is associated with coronary artery disease (CAD). Leukocytes have been shown to play an important role in the atherosclerotic process. The aim of the study was to investigate whether there is any relationship among SUA, leukocyte counts and coronary atherosclerotic burden in patients who are suspected of having CAD. METHOD AND RESULTS: We enrolled 690 eligible patients who had undergone coronary angiography between October 2005 and June 2006 in a consecutive manner. The relationship of SUA with total and differential leukocyte counts and CAD was investigated. Serum uric acid levels (5.57+/-1.64 vs 4.63+/-1.27 mg/dl, p<0.001) and leukocytes were higher in patients with CAD than those with normal coronary arteries (NCA). When we divided the patients into four groups according to the quartiles of SUA, we found that the monocyte count was prominently related with SUA (478+/-165, 553+/-177, 565+/-199 and 607+/-229 mm(-)(3), Q1-Q4, p<0.001). In multivariate analysis, SUA was an independent predictor of CAD (OR, 1.270; 95% CI, 1.087-1.484, p=0.003). When we performed multiple linear regression analyses to determine the independent predictors of inflammatory cells in blood, we found a strong, positive and independent relationship between SUA with neutrophils (beta+/-SE: 206+/-60, p=0.001) and monocytes (beta+/-SE: 35+/-7, p<0.001). CONCLUSION: Our study results demonstrated that neutrophils and monocytes which play an important role in inflammation and atherosclerosis were independently related with SUA. This finding suggests an important epidemiologic relation and may provide a possible causative mechanism of SUA in atherosclerotic process.

Asunto(s)

Asunto(s)

RESUMEN

The data regarding the potential benefits of direct stenting in the setting of angiographically apparent thrombus-containing lesions are scarce. The aim of this study was to evaluate the impact of direct stenting on the angiographic results in the setting of thrombus. We reviewed our institutional interventional database and identified 30 patients who had undergone stenting in the setting of angiographically apparent thrombus-containing lesions (33% unstable angina pectoris, 67% acute myocardial infarction). The majority of patients had a baseline TIMI 2 and 3 flow (80%). Of the 6 patients (20%) who had TIMI 0-1 flow at baseline, four of them achieved a TIMI 2 flow immediately after crossing the lesion with a 0.014 guidewire. Although the remaining 2 patients had TIMI 1 flow, as distal opacification beyond the stenosis was obtained we successfully implanted the stents directly. All stents were successfully implanted without any crossing failure or stent loss. There was no "no re-flow", with a final TIMI 3 flow rate in 93%. In 1 patient with TIMI 2 flow after stenting, TIMI 3 flow was obtained after intracoronary verapamil. In 2 patients (7%, TIMI 2 flow), a final TIMI 3 flow could not be achieved despite intracoronary nitroglycerin and verapamil. There was no stent loss and imprecise stent placement. There were no in-hospital deaths, repeat interventions or coronary artery bypass graft surgeries. However, two patients had undergone mitral valve replacement due to severe mitral regurgitation. Eight patients with recurrent ischemia had control angiography; stents were found to be patent in all 8 patients. Two patients experienced recurrent myocardial infarction (6.6%). Direct stenting strategy in thrombus-containing lesions seems to be a safe and feasible approach in avoiding no re-flow. We believe that benefits observed with direct stenting in this study should be compared to conventional stenting in the same setting with a randomized study.

Asunto(s)

RESUMEN

We report perforation of two side branches of the right coronary artery during selective coronary angiography. We suppose that forceful injection of contrast into a non-dominant artery with severe proximal stenosis could have led to this complication. To the best of our knowledge this is the second reported case of coronary perforation during angiography.

Asunto(s)

RESUMEN

This report describes the first application of intracoronary stenting to the septal perforator coronary artery in a patient with a totally occluded left anterior descending coronary artery (LAD) and a patent venous graft to the distal LAD. The procedure was successful and resulted in almost complete relief of class III angina. Therefore, diseased large septal perforators may cause angina and be treated effectively by intracoronary stenting in selected cases.

Asunto(s)

RESUMEN

The two structurally related thienopyridines, ticlopidine and clopidogrel in addition to aspirin, have become the standard regimen for prevention of subacute thrombosis (SAT) after coronary stent implantation. Although both regimens are highly effective, ticlopidine suffers from severe hematologic side effects. Recent trials encourage shorter duration of therapy with these agents. However, the optimal duration of antiplatelet therapy after stenting is still not clear. We report a case of SAT developing 12 days after discontinuation of 2 weeks of aspirin plus ticlopidine therapy. We believe that the present data are still not clear regarding the optimum duration of antiplatelet therapy after stenting.

Asunto(s)

RESUMEN

By inhibiting platelet aggregation, glycoprotein IIb/IIIa inhibitors prevent arterial occlusion and reduce ischemic complications in the setting of acute ischemic coronary syndromes associated with intracoronary thrombus. There are also accumulating data in the literature regarding the local use of these agents for thrombus dissolution. We report a case with massive right coronary artery thrombus in which the thrombus was successfully dissolved with intracoronary tirofiban infusion. To the best of our knowledge, this is the first case of this kind.

Asunto(s)

RESUMEN

Antiphospholipid syndrome is characterized by venous and arterial thrombosis, thrombocytopenia, stroke and, rarely, acute coronary syndromes. However, there are no data available regarding the management of acute myocardial infarction in primary antiphospholipid syndrome with accompanying severe thrombocytopenia and cardiogenic shock. We describe such a case, which was managed by successful primary percutaneous transluminal coronary angioplasty and stent implantation with accompanying immunosuppression therapy.

Asunto(s)

RESUMEN

Congenital aortic valve anomalies are quite a rare finding in echocardiographic examinations. A case of a 19 year old man with a pentacuspid aortic valve without aortic stenosis and regurgitation, detected by transoesophageal echocardiography, is presented.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Left atrial thrombus, which is a frequent finding in patients with mitral valve disease, is generally attached to the atrial wall. Left atrial free-floating thrombus has rarely been reported. Since the risk of peripheral emboli is fairly high, patients with such a thrombus are candidates for emergency surgery. Our first case was a 45-year-old female with mitral stenosis and regurgitation. The typically appearing free floating thrombus with a diameter of 3.4 cm was detected by two-dimensional and M-mode echocardiography, and an appropriate surgical procedure was performed. The surgical findings were consistent with the echocardiographic findings. Our second case was a 59-year-old female. A free floating thrombus with a diameter of 2 cm was detected by echocardiography when this patient with mitral stenosis was hospitalized because of right hemiplegia and aphasia. The thrombus was extracted by an immediate surgical procedure. Transthoracic echocardiographic (TTE) study was definitely specific in both cases; no other study was thus required.

Asunto(s)