ABSTRACT
BACKGROUND: The study aimed to assess serum RANKL:OPG ratio, Dkk-1 and deposition of calcium in aortic valve in relation to the presence of concomitant coronary atherosclerosis in patients with symptomatic calcified aortic stenosis (CAS). METHODS: OPG, soluble RANKL and Dkk-1 were measured in 218 consecutive patients who were undergoing cardiac catheterization because of symptomatic CAS. Values of studied compounds were compared between patients without (Group A) and with (Group B) coronary atherosclerosis. Computed tomography derived Agatston score was assessed by using 256-slice CT. RESULTS: Presence of coronary atherosclerosis was related to significantly (p = 0.007) higher OPG and to significantly (p = 0.004) lower Dkk-1. Coronary atherosclerosis was also associated with a trend towards a decrease of RANKL. RANKL/OPG Ratios (mean (95% C.I.)) were: 20.04 (16.58; 24.23) in Group A and 12.69 (9.96; 16.17) in Group B, resp., p = 0.018). After adjustment, the difference in RANKL:OPG ratios was no longer significant. Multivariable regression underscored the significance of difference in Dkk-1 (pafter adjustement = 0.020). Group A patients had significantly higher Dkk-1, significantly higher deposition of calcium in aortic valve and were symptomatic in significantly younger age (p < 0.001) as compared to group B patients: Agatston score (mean (95% C.I.)) 4069.9 (3211.8; 5134.5) and 2413.5 (1821.3; 3198.1), p = 0.007. CONCLUSIONS: Dkk-1 and deposition of calcium in aortic valve differ significantly in relation to the presence/absence of coronary atherosclerosis in patients with symptomatic CAS. A positive association was found between Dkk-1 and calcium load in aortic valve in patients with symptomatic CAS and angiographically normal coronary arteries.
Subject(s)
Aortic Valve Stenosis/blood , Aortic Valve/pathology , Calcinosis/blood , Calcium/metabolism , Coronary Artery Disease/blood , Intercellular Signaling Peptides and Proteins/blood , Aged , Aortic Valve/diagnostic imaging , Aortic Valve Stenosis/diagnostic imaging , Bone Development , Calcinosis/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Female , Humans , Male , Models, Biological , Signal Transduction , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The purpose of the present study was to investigate the association between left ventricular systolic function and the response to clopidogrel. METHODS: The efficacy of clopidogrel was measured by the vasodilator-stimulated phosphoprotein phosphorylation 20 ± 4 h after 600 mg of clopidogrel. High on-clopidogrel platelet reactivity (HCPR) was defined as a platelet reactivity index (PRI) ≥50%. The 30-day combined incidence of death, non-fatal acute coronary syndrome, re-percutaneous coronary intervention (PCI), stent thrombosis, and stroke was also investigated. RESULTS: The study group consisted of 519 patients undergoing PCI. The values (mean and 95% confidence interval) of the PRI were as follows: 40.4% (37.8-43.0) in patients with left ventricular ejection fraction (LVEF) >50%, 42.4% (39.3-45.6) in patients with LVEF 35-50%, and 46.7% (40.6-52.9) in patients with LVEF <35% (p = 0.013). The proportions of patients with HCPR were 35.9% in patients with LVEF ≥35 and 51.9% in patients with LVEF <35% (p = 0.022). After adjustment for variables that significantly influenced clopidogrel efficacy, LVEF <35% was found to be independently associated with HCPR (p = 0.039). The 30-day combined clinical endpoint occurred in 18% of patients with LVEF <35% and in 7.3% of patients with LVEF ≥35% (p = 0.026). The 30-day incidence of all-cause mortality was 14% in patients with LVEF <35 and 1.0% in patients with LVEF ≥35% (p < 0.001). CONCLUSION: An LVEF <35% was found to be independently associated with HCPR.
Subject(s)
Blood Platelets/metabolism , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Ventricular Dysfunction, Left/drug therapy , Acute Coronary Syndrome/epidemiology , Aged , Cell Adhesion Molecules/metabolism , Clopidogrel , Female , Humans , Male , Microfilament Proteins/metabolism , Middle Aged , Percutaneous Coronary Intervention , Phosphoproteins/metabolism , Platelet Aggregation Inhibitors/pharmacology , Retrospective Studies , Stents , Stroke/epidemiology , Stroke Volume , Ticlopidine/pharmacology , Ticlopidine/therapeutic use , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/physiopathologyABSTRACT
This article focuses on the incidence, predictors, classification, impact on prognosis, and management of bleeding associated with the treatment of acute coronary syndrome. The issue of bleeding complications is related to the continual improvement of ischemic heart disease treatment, which involves mainly (a) the widespread use of coronary angiography, (b) developments in percutaneous coronary interventions, and (c) the introduction of new antithrombotics. Bleeding has become an important health and economic problem and has an incidence of 2.0% to 17%. Bleeding significantly influences both the short- and long-term prognoses. If a group of patients at higher risk of bleeding complications can be identified according to known risk factors and a risk scoring system can be developed, we may focus more on preventive measures that should help us to reduce the incidence of bleeding.