The association between exposure to air pollutants including PM10, PM2.5, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration and the relative risk of developing STEMI: A case-crossover design.

BACKGROUND: Unfavorable associations between air pollution and myocardial infarction are broadly investigated in recent studies and some of them revealed considerable associations; however, controversies exists between these investigations with regard to culprit components of air pollution and significance of correlation between myocardial infarction risk and air pollution. METHODS: The association between exposure to PM10, PM2.5, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration of background air that residents of Tehran, the capital city of Iran, which is ranked as the most air polluted city of Iran and the relative risk of developing ST-elevation myocardial infarction (STEMI) were investigated by a case-crossover design. Our study included 208 patients admitted with a diagnosis of STEMI and undergone primary percutaneous intervention. Air pollutant concentration was averaged in 24-h windows preceding the time of onset of myocardial infarction for the case period. Besides, the mean level of each element of air pollution of the corresponding time in one week, two weeks and three weeks before onset of myocardial infarction, was averaged separately for each day as one control periods. Thus, 624 control periods were included in our investigation such that. Each patient is matched and compared with him/herself. RESULTS: The mean level of PM10 in case periods (61.47µg/m3) was significantly higher than its level in control periods (57.86µg/m3) (P-value = 0.019, 95% CI: 1.002-1.018, RR = 1.010). Also, the mean level of PM2.5 in case periods (95.40µg/m3) was significantly higher than that in control days (90.88µg/m3) (P-value = 0.044, 95% CI: 1.001-1.011, RR = 1.006). The level of other components including NO2, SO2, CO and O3 showed no significant differences between case and control periods. A 10µg/m3 increase in PM10 and PM2.5 would result in 10.10% and 10.06% increase in STEMI event, respectively. Furthermore, the results of sub-group analysis showed that older patients (equal or more than 60 year-old), diabetic patients, non-hypertensive ones and patients with more than one diseased vessel may be more vulnerable to the harmful effect of particular matters including PM10 and PM2.5 on development of STEMI. CONCLUSION: Air pollution is a worldwide pandemic with great potential to cause terrible events especially cardiovascular ones. PM2.5 and PM10 are amongst ambient air pollutant with a high risk of developing STEMI. Thus, more restrictive legislations should be applied to define a safe level of indoor and outdoor air pollutant production.

Iatrogenic left main artery dissection: A catastrophic complication.

Iatrogenic left main artery (LM) dissection is a catastrophic complication of coronary angiography and angioplasty that requires prompt management using stenting. Although LM dissection can be prevented, it cannot always be avoided and has a reported incidence rate of 0.02%. In the present report, a case of iatrogenic LM dissection that was successfully treated with multiple stents is presented and followed by a brief review of the literature.

The No-reflow Phenomenon: Is it Predictable by Demographic factors and Routine Laboratory Data?

BACKGROUND: The coronary no-reflow phenomenon is an adverse complication of percutaneous coronary interventions (PCI) which significantly worsens the outcome and survival. In this study, we have evaluated the correlation of no-reflow phenomenon with demographic, biochemical and anatomical factors. METHODS: We included 306 patients (193 male) with acute ST-elevation myocardial infarction (STEMI) who undergone primary PCI in our center. Demographic factors, as well as biochemistry test results were obtained. Also, the Thrombolysis in Myocardial Infarction (TIMI) grade and TIMI frame count (TFC) was measured. The correlation of no-reflow phenomenon with demographic, biochemical and anatomical factors was analyzed. RESULTS: Patients with a mean age of 56.41 ± 11.8 years were divided into two groups depending on the TIMI score (Group 1 or Normal flow and Group 2 or No-reflow). Symptom-to-procedure time, door-to-procedure time, serum creatinine level, hs-CRP level, and Neutrophil to Lymphocyte Ratio (NLR) were significantly higher among group 2. TFC had negative significant correlation with male gender, and positive significant correlation with age, diabetes mellitus, hs-CRP level, WBC count, and NLR. Age of more than 62.5 years and serum creatinine level of more than 0.89 mg/dL can optimally predict the no reflow phenomena. CONCLUSIONS: According to our results, it seems that female gender, older ages, DM, multi-vessel involvement, delayed reperfusion, and increased NLR can predict the risk of no-reflow after primary PCI in the setting of Acute Myocardial Infarction.

Assessment of Admission Time Cell Blood Count (CBC) Parameters in Predicting Post-primary Percutaneous Coronary Intervention TIMI Frame Count in Patients with ST-segment Elevation Myocardial Infarction.

OBJECTIVES: In this study, we aimed to assess the value of admission time CBC parameters in predicting post-primary PCI corrected TIMI frame count. BACKGROUND: Recent years have witnessed a large series of studies evaluating different laboratory variables to predict no-reflow phenomenon following primary PCI (PPCI) in patients with STEMI. However, a general agreement about the most reliable predictor of the no-reflow phenomenon is challenging and also intriguing. METHODS: The current study concluded 208 consecutive patients who underwent primary PCI for ST-Elevation Myocardial Infarction (STEMI) from January 2014 to February 2016. Blood samples were obtained after taking ECG. Complete blood samples were collected and analyzed within 5 minutes from sampling. Post-PCI corrected Thrombolysis in Myocardial Infarction (TIMI) frame count was determined by one interventional cardiologist blinded to patients' clinical data. The correlation between admission time blood parameters and post-primary PCI corrected TIMI frame count in patients with STEMI were assessed. RESULTS: Corrected TIMI frame count was positively correlated with WBC count (R: 0.18, P-value: <0.01), neutrophil count (R: 0.34, P-value: <0.01), and platelet count (R: 0.23, P-value: <0.01) and negatively correlated with lymphocyte count (R: -0.2, P-value: <0.01). Multiple linear regression results demonstrated that corrected TIMI frame count was positively correlated with neutrophil count (P < 0·001) and platelet count (P < 0·001) and negatively correlated with lymphocyte count (p=0.004). CONCLUSION: High counts of WBC, neutrophil, and platelet and low count of lymphocyte may be predictors of no-reflow in STEMI patients undergoing PPCI. The clinical significance of such predictive parameters becomes clear as we consider the treatment approach in STEMI patients. Appropriate risk stratification leads to better treatment planning and allocation of resources.

Oxidant and antioxidant status in coronary artery disease.

Formation of atherosclerotic plaques is the major cause of coronary artery disease (CAD). Several lines of study have revealed the role of oxidative stress in CAD pathogenesis. In the present study the aim was to investigate the oxidative and antioxidative markers in CAD patients and a control population. The study sample comprised of acute coronary syndrome (ACS) patients, chronic CAD patients and healthy controls (n=30/group). Blood samples of patients and control subjects were collected to measure the concentrations of reduced glutathione (GSH), malondialdehyde (MDA) and the percentage of MDA release as well as the activity of erythrocyte glutathione peroxidase (GPx) and total antioxidant capacity (TAC) of plasma. All parameters were measured by spectrophotometric methods. Additionally, oxidant/antioxidant status was compared between CAD patients with single, double or triple-vessel stenosis and in comparison with controls. The results indicated a significant increase in MDA level and the percentage of MDA release (P<0.05), and a marked decrease in GSH concentration (P<0.0001), TAC (P<0.0001) and the activity of erythrocyte GPx (P<0.0001) in the patient groups compared controls. ACS patients exhibited a similar pattern of data when compared with the chronic CAD group. Similar results were also observed when chronic CAD patients with single, double or triple vessel stenosis and controls were compared. The present study indicates that the acute form of CAD is more susceptible to oxidative damage, suggesting that use of antioxidant therapy may be warranted to ameliorate oxidative stress in this condition.

A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score.

Total occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach. This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach. A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97-23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95-17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46-7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28-6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08-6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03-6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate. Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0-8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.

Efficacy of folic acid therapy for prevention of in-stent restenosis: a randomized clinical trial.

BACKGROUND: It is known that there is an association between elevated total plasma homocysteine level and restenosis after percutaneous coronary angioplasty. OBJECTIVE: To evaluate the effect of lowering plasma homocysteine levels on the rate of restenosis after stent-percutaneous coronary angioplasty. METHODS: Folic acid (1 mg) or placebo was administered to 200 patients (mean +/- SD age of 54 +/- 9 years) for 3 months, after successful coronary angioplasty in a double-blind randomized clinical trial. The primary end point was restenosis within six months, as assessed by quantitative coronary angiography after positive exercise tolerance test. The secondary end point was a composite of major cardiac events. RESULTS: Base line characteristics and initial angiographic results after stent-percutaneous coronary angioplasty were similar in the two study groups. The rate of restenosis showed no significant difference in the two groups (5% in placebo vs. 10% in folic acid groups; P = 0.141), as there was the need for revascularization of the target lesion (4% in both groups; P = 0.766). CONCLUSION: Treatment with folic acid does not decrease the rate of restenosis and need for revascularization of the target lesion after stent-percutaneous coronary angioplasty.

Adherence to Antihypertensive Medications in Iranian Patients.

Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP (r = -0.231, P < 0.001) as well as diastolic BP (r = -0.280, P < 0.001). In linear regression model, overweight/obesity (B = -0.52, P = 0.02), previous history of admission to emergency services due to hypertensive crisis (B = -0.79, P = 0.001), and getting medication directly from drugstore without refill prescription in hand (B = -0.51, P = 0.04) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence.

Adherence to Antihypertensives in Patients With Comorbid Condition.

BACKGROUND: Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. OBJECTIVES: We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. PATIENTS AND METHODS: Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. RESULTS: The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. CONCLUSIONS: With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.

Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients.

The reliability and validity of the 8-item Morisky Medication Adherence Scale (MMAS-8) was assessed in a sample of Iranian hypertensive patients. In this multi-center study which lasted from August to October 2014, a total of 200 patients who were suffering from hypertension (HTN) and were taking anti-hypertensive medication(s) were included. The cases were accessed through private and university health centers in the cities of Tehran, Karaj, Kermanshah, and Bafgh in Iran and were interviewed face-to-face by the research team. The validated Persian translation of the MMAS-8 was provided by the owner of this scale. This scale contains 7 questions with "Yes" or "No" response choices and an additional Likert-type question (totally 8 questions). The total score ranges from 0 to 8 with higher scores reflecting better medication adherence. Mean (±SD) overall MMAS-8 score was 5.57 (±1.86). There were 108 (54%), 62 (31%), and 30 (15%) patients in the low, moderate, and high adherence groups. Internal consistency was acceptable with an overall Cronbach's ? coefficient of 0.697 and test-retest reliability showed good reproducibility (r= 0.940); P< 0.001. Overall score of the MMAS-8 was significantly correlated with systolic BP (r= - 0.306) and diastolic BP (r= - 0.279) with P< 0.001 for both BP measurements. The Chi-square test showed a significant relationship between adherence level and BP control (P= 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the scale were 92.8%, 22.3%, 52.9%, and 76.7%, respectively. The Persian version of the MMAS had acceptable reliability and validity in Iranian hypertensive patients. This scale can be used as a standard and reliable tool in future studies to determine medication adherence of Persian-speaking patients with chronic conditions.

The non-hyperemic coronary pressure notch as an indicator of the physiologic significance of coronary artery stenosis.

Myocardial fractional flow reserve (FFR) is a new index of the functional significance of intermediate coronary stenoses that is calculated from pressure measurements made during coronary arteriography. The aim of this study was to evaluate the correlation between non-hyperemic coronary pressure dicrotic notch and fractional flow reserve (FFR). A consecutive of 114 patients (73 men and 41 women) was enrolled in this study. Data were shown as means ± SD. Statistical analyses were performed with SPSS software. The statistical significance of differences was determined by chi-square analysis with Yates correction. Significance was defined as P< 0.05. Positive dicrortic notch was observed in 97 patients (85%). Significant association was detected between coronary pressure notch (dicrotic notch), and FFR as loss of the dicrotic notch was detected in 93.8% (15/16) of patients with FFR less than 0.75 (P=0.001). Upon ROC curve, a cutoff FFR value of approximately 0.75 demonstrated sensivity and specifity of 93.8% and 98%, respectively for loss of the dicrotic notch. The positive predictive value for loss of the dicrotic notch was 88.2%. Our study demonstrated loss of non-hyperemic coronary pressure diacrotic notch correlates significantly with FFR and may predict an FFR < 0.75 with high accuracy. In patients with functionally significant coronary stenosis, loss of non-hyperemic diacrotic notch appears to be a useful index of the functional severity of the stenoses and the need for coronary revascularization.

Evaluation of effective factors in success rate of intervention on CTO.

UNLABELLED: Chronic total occlusion (CTO) intervention is still a challenging problem. The aim of this study is to determine factors that affect PCI results. METHOD AND RESULTS: The study was conducted on 72 patients in two centers. CTO angioplasty was done by the antegrade approach from the femoral and/or radial approach. The role of age, gender, anatomical variations such as calcification, length of the lesion, proximal bending, retrograde filling and occluded coronary artery (LAD, CCK or RCA), and wires were assessed. The success rate was 79.6%, and presence of calcification was an important factor in CTO PCI. Operator's experience, use of appropriate equipment and calcification are important factors in predicting a successful PCI.

Pentraxin 3 Is Highly Specific for Predicting Anatomical Complexity of Coronary Artery Stenosis as Determined by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Score.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score. SUBJECTS AND METHODS: We investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52). RESULTS: The clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng · dL(-1). This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92). CONCLUSION: We observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng · dL(-1) was highly specific for diagnosing complex coronary artery stenosis.

Academic training in radiation safety awareness and practice among Iranian residents/fellows.

OBJECTIVE: To determine the current state of radiation safety awareness and practice among Iranian radiology/cardiology residents. METHODS: In this cross-sectional study, 725 Iranian cardiology/radiology fellows/residents (685 residents and 40 fellows) were studied. Radiation safety awareness and practice were assessed using a 13-item survey questionnaire. Based on academic trainings provided in their medical centres, the subjects were divided into two groups (trained vs untrained). RESULTS: Trained residents/fellows had better performance compared with untrained ones regarding awareness of radiation dealing instructions, knowing safety experts of their centres (43.8% vs 20.1%, p<0.001) and their contact information (38.4% vs 11.4%, p<0.001), date of the last CBC (complete blood count) checking (15.1% vs 2.5%, p<0.001), use of lead glass (61.6% vs 41.8%, p=0.003), apron (94.5% vs 90%, p=0.016) and radiation shield (71.2% vs 46.2%, p<0.001). CONCLUSIONS: Awareness/practice of Iranian cardiology/radiology residents/fellows about radiation exposure safety issues is not acceptable currently. Those who received formal training courses at their academic centres about the safety measures had significantly better knowledge compared with those who did not. It is suggested that radiation safety training be offered at the beginning of residency/fellowship for residents/fellows in a comprehensive and uniform way throughout medical universities.

Comparison between Intracoronary Abciximab and Intravenous Eptifibatide Administration during Primary Percutaneous Coronary Intervention of Acute ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Administration of glycoprotein IIb/IIIa inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. METHODS: A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab (0.25 µg/kg) bolus or two boluses of intravenous Eptifibatide (0.180 µg/kg) each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution (STR), and post-procedural thrombolysis in myocardial infarction (TIMI) grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect (arrhythmia) and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. RESULTS: Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.61). The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI (µmol/L/hr), was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 (interquartile range [IQR], 3006.0 to 11112.0) versus 7,294 (IQR, 3795.5 to 11803.5); p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.87). No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. CONCLUSION: The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI.

Exposure to chronic isolation modulates receptors mRNAs for oxytocin and vasopressin in the hypothalamus and heart.

The goal of our study was to explore the effect of social isolation stress of varying durations on the plasma oxytocin (OT), messenger ribonucleic acid (mRNA) for oxytocin receptor (OTR), plasma arginine vasopressin (AVP) and mRNA for V1a receptor of AVP (V1aR) expression in the hypothalamus and heart of socially monogamous female and male prairie voles (Microtus ochrogaster). Continuous isolation for 4 weeks (chronic isolation) increased plasma OT level in females, but not in males. One hour of isolation every day for 4 weeks (repeated isolation) was followed by a significant increase in plasma AVP level. Chronic isolation, but not repeated isolation, significantly decreased OTR mRNA in the hypothalamus and heart in both sexes. Chronic isolation significantly decreased cardiac V1aR mRNA, but no effect on hypothalamic V1aR mRNA expression. We did not find a gender difference within repeated social isolation groups. The results of the present study reveal that although chronic social isolation can down-regulate gene expression for the OTR in both sexes, the release of the OT peptide was increased after chronic isolation only in females, possibly somewhat protecting females from the negative consequences of isolation. In both sexes repeated, but not chronic, isolation increased plasma AVP, which could be permissive for mobilization and thus adaptive in response to a repeated stressor. The differential effects of isolation on OT and AVP systems may help in understanding mechanisms through social interactions can be protective against emotional and cardiovascular disorders.

Evaluation of asymptomatic peripheral arterial disease by ankle- brachial index in patients with concomitant coronary arterial disease.

BACKGROUND: Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD) improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. OBJECTIVES: The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. METHODS: Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3) with a documented coronary arterial disease. RESULTS: Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. CONCLUSIONS: It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

Comparative study of the reactivity of natural and mutated streptokinase with total antistreptokinase antibodies in human sera.

Streptokinase is widely used as an anticoagulant drug for the treatment of heart attacks. Because of antibody production against injected drug in individuals consuming streptokinase and causing allergic reactions, streptokinase treatment effects become neutral. Recombinant mutant type of streptokinase was prepared by removing of 42 amino acids from the C terminal region. ELISA plates were coated by natural and mutant streptokinase as antigen. Ninety-six normal serum samples as well as 27 streptokinase consumer serum samples (patients with acute myocardial infraction) were analyzed. The results showed that serum antibodies against natural streptokinase were three times more than those against the mutated streptokinase. In case of preserving thrombolytic activity, mutated streptokinase can be used as an alternative of the natural form.

Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients.

BACKGROUND: There is evidence that opium addiction has immunosuppressant effects. Coronary artery disease (CAD) is a condition resulted from atherosclerosis which is dependent on the immune response. PURPOSE: To evaluate plasma levels of interleukin-6 and interleukin-1Ra in 30 patients with three-vessel coronary artery disease, ejection fraction of more than 35% and to evaluate their changes after prognostic treadmill test in 15 opium addicted and 15 non-addicted patients. METHODS: The participants underwent prognostic treadmill test and plasma levels of interleukin-6 (IL-6) and interleukin-1Ra (IL-1Ra) were evaluated with ELISA method before, just after and 4 hours after the test. RESULTS: IL-1Ra (2183 pg/ml) tended to decrease over time in the opium addicted group (1372 pg/ml after prognostic treadmill test and 1034 pg/ml 4 hours after that), although such decrease did not reach the statistical significance. IL-1Ra levels were significantly higher in opium addicted than in non addicted patients. Opium addiction had no significant effect on IL-6 changes. CONCLUSION: Consumption of opium in CAD patients is associated with higher IL-1Ra levels.

Traumatic coronary artery fistula closure with stent graft.

We present a rare case of a symptomatic acquired large coronary fistula and aneurysm secondary to chest trauma that was successfully closed using stent graft. This case is followed by review of the literature.