Association of Lipoprotein Subfractions With Presence and Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography.

Lipoprotein subfractions (LS) can be used for better risk stratification in subjects deemed not at high risk for coronary artery disease (CAD). In this study, we evaluated the correlation between LS with CAD presence and severity. This is a prospective case-control study of 157 patients referred for coronary angiography who were not on lipid-lowering therapy and had LS measured by nuclear magnetic resonance spectroscopy. Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) scores were calculated to estimate CAD severity. Univariate and multivariable regression analysis was performed to determine correlation of LS with CAD presence and severity and acute coronary syndrome (ACS). There was significant association of certain LS (positive for total low-density lipoprotein particle [LDL-P], small LDL-P and apolipoprotein B, negative for large high-density lipoprotein particle [HDL-P] and apolipoprotein A1 [ApoA1]) with the presence of obstructive CAD and CAD severity. Small LDL-P and HDL-P were still predictive for obstructive CAD after adjusting for traditional risk factors, 10-year atherosclerotic cardiovascular disease risk score and in those with low-density lipoprotein cholesterol <100 mg/100 ml. Total LDL-P and ApoA1 were predictive of CAD severity on multivariable analysis. Higher small LDL-P and lower large HDL-P were associated with ACS presence, although only large HDL-P had a significant inverse correlation with ACS on adjusted analysis (odds ratio 0.74 95% confidence interval 0.58, 0.95) In conclusion, in our cohort of patients referred for coronary angiography, total LDL-P, small LDL-P, and apolipoprotein B had significant direct correlation, and large HDL-P and ApoA1 had significant inverse correlation with obstructive CAD and CAD severity.

Successful use of anakinra for colchicine-intolerant, corticosteroid-dependent recurrent pericarditis secondary to postcardiac injury syndrome after pacemaker placement.

A 54-year-old woman was referred to our centre for the third recurrence of colchicine-intolerant, corticosteroid dependent iatrogenic post-traumatic pericarditis after pacemaker placement 3 months prior to the first episode. The initial episode and each recurrence were associated with a pericardial effusion requiring drainage. Evaluation for pericardial infection, malignancy, autoimmune disease and pacemaker lead perforation was negative. After fourth recurrence and fifth pericardial drainage in 3 months, a trial of anakinra (interleukin-1 inhibitor), in addition to swift symptom resolution successfully prevented subsequent symptomatic and echocardiographic recurrence. Corticosteroids were tapered and eventually discontinued. At 4-month follow-up, the patient continues to be on daily anakinra 100 mg subcutaneous (SQ) daily without adverse effects.