Re-access complication with a Starclose device.

Diagnostic cardiac catheterizations are predominantly performed using access through the femoral artery. To improve patient comfort and early mobilization, a number of percutaneous closure devices have been developed. One such device using the nitinol clip was developed by Abbott Vascular Devices and was approved for use on the basis of the results of the Clip Closure In Percutaneous Procedures (CLIP) study. The safety of repuncture through a previously deployed device has not been established in humans. We present the case of a patient who had an arterial line placed for post-operative monitoring after cardiac surgery at the site of a previous arteriotomy closed with the Starclose device. The catheter traversed through the central portion, tethered to the periphery of the ninitol clip, and required surgery for extraction.

Effect of statin therapy prior to elective percutaneous coronary intervention on frequency of periprocedural myocardial injury.

This study evaluated whether pretreatment with statins was associated with a decreased incidence of periprocedural myocardial injury. Periprocedural myocardial injury occurs after percutaneous coronary intervention (PCI) and is associated with adverse outcomes. The pleiotropic properties of statins stabilize plaque and decrease the inflammatory milieu of atherosclerotic lesions. Accordingly, we hypothesized that preprocedural statin therapy would decrease periprocedural myocardial injury. We enrolled 425 patients who underwent successful PCI. The control arm (n = 150) included patients not on statin therapy at the time of PCI, and the statin arm (n = 275) included patients who were taking statin medication before PCI. All patients had serial enzymes measured, including creatine kinase (CK), CK-MB, and troponin I. The incidence of increased levels of CK and CK-MB >3 times normal and the absolute increase in CK and troponin I were compared between groups. The control arm had significantly higher periprocedural levels of CK. In the control group, 6% of patients had CK increases >3 times the upper limit of normal compared with 1.8% in the statin group (p = 0.02). The control arm had a higher frequency of CK-MB increases >3 times the upper limit of normal (7.3% vs 2.2%, p = 0.01). There was a trend toward higher levels of troponin I in the control group (3.21 vs 1.85 ng/ml, p = 0.06). Thus, statin therapy before elective PCI was associated with lower levels of periprocedural CK.

Population variations in atherogenic dyslipidemia: A report from the HeartSCORE and IndiaSCORE Studies.

BACKGROUND: Asian Indians and blacks have a higher risk for cardiovascular disease (CVD) events compared to whites. Atherogenic dyslipidemia, comprised of small-dense low-density lipoprotein (LDL), low high-density lipoprotein (HDL) levels, and high triglyceride (TG) levels, constitutes an important risk factor for CVD often seen in the presence of obesity. The contribution of atherogenic dyslipidemia to CVD risk across diverse racial populations is not well established. OBJECTIVE: Our primary aim was to investigate the relationship between race and atherogenic dyslipidemia among whites, blacks, and Asian Indians. A secondary aim was to evaluate the association between obesity and atherogenic dyslipidemia across populations. METHODS: From community-based sampling, 720 whites and 373 blacks underwent evaluation of CVD risk factors, including fasting lipoproteins. An identical protocol was administered to 205 Asian Indians from Chennai, India. Lipid profiles, including those comprising atherogenic dyslipidemia, were compared among populations. RESULTS: The prevalence of small-dense LDL (pattern B) and of TG/HDL ratio >3 was greatest among Asian Indians and smallest among blacks. Compared to whites, the adjusted odds for Indians having a LDL pattern B was 2.06 (P < .001) and TG/HDL ratio >3 was 9.42 (P < .001). The adjusted odds of having LDL pattern B (odds ratio 0.39, P < 0.001) or TG/HDL ratio >3 (odds ratio 0.41, P < .001) was lower in blacks compared to whites. Among Indians, obesity had a weak association with atherogenic dyslipidemia, in contrast to the strong association among whites. CONCLUSIONS: Significant population variations in atherogenic dyslipidemia exist. This may be an important component to explain population differences in cardiovascular risk.