Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart / Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart

OBJETIVO: Evaluar el impacto del género sobre el pronóstico y el manejo en una red regional de atención al infarto agudo de miocardio con elevación del segmento ST. DISEÑO: Estudio observacional sobre una base de pacientes consecutivos recogida prospectivamente. Ámbito: Red catalana de atención al infarto agudo de miocardio con elevación del segmento ST. PACIENTES: Pacientes atendidos entre enero de 2010 y diciembre de 2011. INTERVENCIONES: Angioplastia primaria, fibrinólisis o manejo conservador. Variables de interés: Se compararon, según el género, intervalos de tiempo, proporción y tipo de reperfusión, mortalidad global y complicaciones intrahospitalarias y mortalidad global a 30 días y un año. RESULTADOS: De 5.831 pacientes atendidos, 4.380 tenían diagnóstico de infarto agudo de miocardio con elevación del segmento ST, siendo 961 (21,9%) de ellos mujeres. Estas tenían mayor edad (69,8±13,4 frente a 60,6±12,8 años, p < 0,001), mayor prevalencia de diabetes (27,1 frente a 18,1%, p < 0,001), Killip>I (24,9 frente a 17,3%, p < 0,001) y ausencia de reperfusión (8,8 frente a 5,2%, p < 0,001) que los hombres. Además, las mujeres presentaban mayores retrasos en la atención (primer contacto médico-balón: 132 frente a 122min, p < 0,001; inicio de síntomas-balón: 236 frente a 210min, p < 0,001), más complicaciones intrahospitalarias (20,6 frente a 17,4%, p = 0,031) y mortalidad intrahospitalaria, a 30 días y un año (4,8 frente a 2,6%, p = 0,001; 9,1 frente a 4,5%, p < 0,001; 14,0 frente a 8,3%, p < 0,001). Sin embargo, tras el análisis multivariado no hubo diferencias en mortalidad a 30 días y un año. CONCLUSIONES: A pesar del peor perfil de riesgo y el peor tratamiento recibido, las mujeres presentaron similares resultados a 30 días y un año que sus homólogos masculinos atendidos por una red de atención al infarto

OBJECTIVE: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN: An observational study was made of consecutive patients entered in a prospective database. Scope: The Catalan acute ST-elevation myocardial infarction management network. PATIENTS: Patients treated between January 2010 and December 2011. INTERVENTIONS: Primary angioplasty, thrombolysis or conservative management. Variables of interest: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. RESULTS: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network

Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart. / Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart.

OBJECTIVE: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN: An observational study was made of consecutive patients entered in a prospective database. SCOPE: The Catalan acute ST-elevation myocardial infarction management network. PATIENTS: Patients treated between January 2010 and December 2011. INTERVENTIONS: Primary angioplasty, thrombolysis or conservative management. VARIABLES OF INTEREST: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. RESULTS: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network.

The TITAN-AMI multicenter registry evaluating the usage of Titan2 stent in patients with ST segment elevation myocardial infarction. Final result at 12-month follow-up.

AIM: Primary percutaneous coronary intervention with stent implantation is the recommended treatment for patients with ST elevation myocardial infarction (STEMI). Data from randomised trials showed good performance by a titanium-nitric-oxide coated stent in this context. The aim of this study was to confirm these data. METHODS: A multicentre registry was compiled in 23 hospitals in Spain in an all-comers population. We selected patients with STEMI from a global Titan AMI registry that included patients with acute coronary syndrome. Primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, stent thrombosis and target lesion revascularisation, at 12-month follow-up. RESULTS: The study included 893 patients with STEMI. We included all possibilities for PCI: 86.6% primary, 5% facilitated after successful fibrinolysis and 8.4% rescue PCI after failed fibrinolysis. The primary endpoint was reached in 8.4% of the patients: cardiac death 2.7%, reinfarction 3.4%, target lesion revascularisation 3.5% and definite or probable stent thrombosis 2.8%. The majority of stent thromboses presented in the first 30 days after PCI. CONCLUSION: A bioactive stent (titanium-nitric-oxide coated stent) is a possible alternative for the treatment of patients with STEMI. One-year follow-up showed better results than those presented by a regular bare-metal stent or first-generation drug-eluting stent in terms of stent thrombosis.

Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort.

OBJECTIVES: To compare clinical presentation and short-term prognosis of acute coronary syndrome (ACS) in HIV-infected and uninfected adults. DESIGN: Retrospective analysis of a prospectively collected cohort. METHODS: HIV-infected patients with myocardial infarction or unstable angina were identified by clinical history and specific characteristics of HIV infection were consecutively registered. Surviving patients were followed for at least one month after discharge. Risk factors for cardiovascular disease, clinical symptoms at admission, type of ACS, delivery of care, and factors associated with prognosis were compared between HIV-infected and uninfected adults. RESULTS: Among 627 patients included, 44 (7%) were HIV-infected patients. HIV-infected patients were younger, more frequently men, and had higher prevalence of cardiovascular risk factors than uninfected patients. HIV-infected patients persisted frequently with less pain at Emergency Department (ED) (34% vs 82%, P<0.001) and complained of dyspnea (2% vs 15%, P<0.05) persisted in respect to HIV-uninfected patients. ST-elevation myocardial infarction was the most frequent ACS in HIV-infected patients (59% vs 24%) whereas non-ST-elevation myocardial infarction (23% vs 38%) and unstable angina (18% vs 38%) were the predominant ones in uninfected patients (P<0.001). Catheterism was performed more commonly in HIV-infected patients (75% vs 62%, P<0.01) and similarly admitted in the coronary care unit (38% vs 41%, P=0.81). The evolution was similar in both groups. When HIV-infected patients were matched by age and sex with a subgroup of 88 HIV-uninfected patients, most of the differences disappeared. CONCLUSIONS: HIV-infected adults presenting with ACS are younger and have fewer symptoms than uninfected. Despite having a more established disease, short-term prognosis is similar.

Lymphocyte subsets and cytokines in women with gestational diabetes mellitus and their newborn.

This study aimed to identify potential immunological markers for predicting type 1 diabetes in patients with gestational diabetes mellitus (GDM) and any immunological impairment in their newborn. In 62 GDM patients and 74 women with normal glucose tolerance (NGT), and their babies, we assessed total lymphocytes, T lymphocyte subsets CD3 and CD8 expressing T cell receptor (TCR) alpha/beta or gamma/delta, CD16 and CD19, pancreatic autoantibodies and cytokines (IL-5, IL-2, soluble receptor IL-2). At delivery, umbilical cord blood samples were taken for lymphocyte subpopulations and cytokine measurements. GDM mothers had higher levels of total lymphocytes, CD8 expressing TCR gamma/delta, and lower levels of CD3 expressing TCR alpha/beta than NGT controls. Insulin-treated GDM mothers had lower CD4 and CD4/CD8 ratios, and higher CD8 and IL-5 than diet-treated GDM or controls. Five women were positive for pancreatic autoantibodies, with lower CD4 (p<0.01) and CD4/CD8 ratios (p<0.05), and higher CD8 (p<0.03) and CD19 than GDM and control mothers negative for autoantibodies. GDM newborn had higher CD8 gamma/delta and lower CD16 than NGT babies. There were no significant differences in TNF-alpha concentrations in the cord blood obtained from the GDM and NGT newborn. In conclusion, GDM women and their newborn have lymphocyte subset impairments, which are more important in patients positive for autoantibodies and/or treated with insulin.

Acute and mid-term combined hormone replacement therapy improves endothelial function in post-menopausal women with angina and angiographically normal coronary arteries.

AIMS AND BACKGROUND: Coronary endothelial dysfunction improves after acute oestradiol treatment in women with angina and normal coronary angiograms. We sought to analyse whether this effect is also seen in the peripheral circulation and whether it is sustained after a mid-term period of treatment. METHODS: We studied 20 women with angina, signs suggestive of myocardial ischaemia and normal coronary angiograms. In five of them, coronary and peripheral endothelial functions were studied at baseline. Brachial artery flow-mediated dilation was reanalysed after 24 h of transdermal oestradiol treatment. In the other 15 women, brachial artery vasoreactivity was studied at baseline and after a 6-week period of treatment with transdermal oestradiol and medroxyprogesterone (HRT) or placebo in a double-blinded crossover fashion. RESULTS: An abnormal coronary artery response to acetylcholine was observed in all women as well as impaired brachial flow-mediated dilation. Brachial flow-mediated dilation significantly increased after 24 h of oestradiol treatment (4.8+/-0.8% vs 0.06+/-0.6%, P<0.001). Peripheral flow-mediated dilation also increased after a 6-week period of HRT compared with baseline (4.1+/-3% vs 0.4+/-1%, P<0.01) and placebo treatment (4.1+/-3% vs 0.6+/-1.7%, P<0.01). CONCLUSION: Impaired endothelium-dependent vasodilation exists both at the coronary and peripheral circulation in post-menopausal women with angina and normal coronary angiograms. Flow-mediated dilation improves in these women after short and mid-term therapy with transdermal oestradiol irrespective of concomitant progesterone use.

Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START): a four-year follow-up.

OBJECTIVE: The purpose of this study was to test the hypothesis that stent implantation in de novo coronary artery lesions would result in lower restenosis rates and better long-term clinical outcomes than balloon angioplasty. BACKGROUND: Placement of an intracoronary stent, as compared with balloon angioplasty, has proven to reduce the rate of restenosis. However, the long-term clinical benefit of stenting over angioplasty has not been assessed in large randomized trials. METHODS: We randomly assigned 452 patients with either stable (129 patients) or unstable (323 patients) angina pectoris to elective stent implantation (229 patients) or standard balloon angioplasty (223 patients). Coronary angiography was performed at baseline, immediately after the procedure and six months later. End points were the rate of restenosis at six months and a composite of death, myocardial infarction (MI) and target vessel revascularization over four years of follow-up. RESULTS: Procedural success rate was achieved in 84% and 95% (balloon angioplasty vs. stent, respectively). The increase in the minimal luminal diameter was greater in the stent group both after the intervention (2.02 +/- 0.6 mm vs. 1.43 +/- 0.6 mm in the angioplasty group; p < 0.0001), and at six-month follow-up (1.98 +/- 0.7 mm vs. 1.63 +/- 0.7 mm; p < 0.001). The corresponding restenosis rates were 22% and 37%, respectively (p < 0.002). After four years, no differences in mortality (2.7% vs. 2.4%) and nonfatal MI (2.2% vs. 2.8%) were found between the stent and the angioplasty groups, respectively. However, the requirement for further revascularization procedures of the target lesions was significantly reduced in the stent group (12% vs. 25% in the angioplasty group; relative risk 0.49, 95% confidence interval 0.32 to 0.75, p = 0.0006); most of the repeat procedures (84%) were carried out within six months of entry into the study. CONCLUSIONS: Patients who received an intracoronary stent showed a lower rate of restenosis than those treated with conventional balloon angioplasty. The benefit of stenting was maintained four years after implantation, as manifested by a significant reduction in the need for repeat revascularization.

Relation between the osmolality trend and ornithynedecarboxylase activity in red blood cells of uremic patients during hemodialytic treatment.

In uremic patients during chronic hemodialysis an increase in the volume of red blood cells is observed. Contemporaneously there is an increase in intraerythrocytic ornithynedecarboxylase activity beyond the normal content (P < 0.01), a high level of seric and plasmatic polyamines (P < 0.01) and a decrease in seric osmolality (P < 0.01) with pH improvement. The trends of osmolality, ornithynedecarboxylase, mean cell volume and pH are significantly related. Our data support the hypothesis that, during hemodialysis, red blood cell volume changes and increased ornithynedecarboxylase activity are dependent on the general improvement of plasma tonicity. Moreover, the absence of inhibition of ornithynedecarboxylase activity by high levels of putrescine is noted.

Short-term effects of transdermal estrogen replacement therapy on coronary vascular reactivity in postmenopausal women with angina pectoris and normal results on coronary angiograms.

OBJECTIVES: This study sought to analyze the effect of short-term transdermal estradiol treatment on in vivo coronary endothelial function in postmenopausal women with angina and normal results on coronary arteriograms. BACKGROUND: The incidence of coronary heart disease increases in women after menopause. Estrogen replacement therapy has been associated with a global reduction in cardiovascular disease incidence and mortality. In addition, coronary endothelial dysfunction has been demonstrated in a group of postmenopausal women. It has been shown that intravenous or intracoronary estrogens improve endothelial function in postmenopausal women with coronary atherosclerosis. However, the efficacy of this treatment is unknown in patients with angina and normal coronary arteries. METHODS: Endothelium-dependent coronary reactivity was analyzed in 15 postmenopausal women with angina and normal coronary arteries at baseline and after 24 h of estradiol transdermal administration (100 microg). RESULTS: Estradiol concentration increased from 22 +/- 8 pg/ml (mean +/- SEM) at baseline to 76 +/- 13 pg/ml (p < 0.01) at 24 h. At baseline, acetylcholine induced vasoconstriction, with a mean diameter reduction of -23 +/- 6% (p = 0.002). After estrogen treatment, there was no vasoconstriction with acetylcholine, with a mean diameter change of 0 +/- 4%, significantly different from the pretreatment diameter reduction observed (p = 0.003). Similarly, estimated coronary blood flow significantly increased in response to acetylcholine after estrogen treatment, with a mean change of 50 +/- 30% compared with 5 +/- 24% before estradiol administration (p = 0.04). CONCLUSIONS: Early after transdermal estrogen administration, endothelium-dependent coronary vasomotion is improved in postmenopausal women with angina and normal coronary arteries.

[Stents and de novo coronary lesions. Meta-analysis]. / Stent en lesiones coronarias de novo. Metaanálisis.

OBJECTIVES: The purpose of this investigation was to provide an overview of the effect of coronary artery stent and balloon angioplasty on major clinical outcomes and restenosis from 3 trials (BENESTENT, STRESS and START) comparing the two treatments in the novo lesions. METHODS: The trials included a total of 1,374 patients, 693 of whom were randomized to stent and 682 to conventional angioplasty. Relative risk, 95% confidence interval and p values were calculated for death, infarction and need for revascularization at 6 month follow-up. Restenosis was assessed by using the binary definition. RESULTS: The incidence of combined clinical outcomes was similar to the two treatment strategies (relative risk 0.96; 95% CI 0.64-1.45). However, the odds for needing a new revascularization procedure were reduced by 35% in patients treated with stents (relative risk 0.65; 95% CI 0.51-0.82; p < 0.001). Restenosis rates were 25% and 36.6% (stent vs angioplasty, respectively), which represents a reduction of 31% (relative risk 0.69; 95% CI 0.58-0.81; p > 0.0001). CONCLUSIONS: Compared with balloon angioplasty, coronary stents of de novo lesions in native coronary arteries decreases restenosis at 6 months. This translates into clinical benefit, as shown by a reduction in the number of new revascularization procedures.

Comparison of serum total sialic acid, C-reactive protein, alpha 1-acid glycoprotein and beta 2-microglobulin in patients with non-malignant bowel diseases.

Total sialic acid (TSA), C-reactive protein (CRP); alpha 1 acid glycoprotein (alpha 1-AG), and beta 2-microglobulin were determined in 84 patients affected by non-malignant intestinal diseases, Crohn's disease (CD) and ulcerative colitis (UC), active and in remission; non-ulcerative proctosigmoiditis; diverticulosis; diverticulitis (ie, inflammatory complication of diverticulosis). Only in patients with acute phase CD, TSA was statistically higher than those in remission, as well as in controls. In patients with acute CD and in those with diverticulitis, CRP was significantly higher than in the controls. alpha 1-AG was found significantly increased in acute UC and CD patients versus the respective groups in remission, as well as versus controls. Moreover, alpha 1-AG was higher in patients with diverticulitis. beta 2-microglobulin did not differ in any group of patients. In five patients with CD in acute phase, investigated before and during the pharmacological treatment (5-aminosalycilic acid and steroids), CRP values fell into the normal range after the second week of therapy, whereas TSA values reached the higher limit of the normal range after the third week, except for two CD patients with a larger location (ileocolonic) of the disease. The results are briefly discussed.

CCK-containing paraneurons in human adenomatous prostate.

The presence of CCK-containing neuroendocrine cells in human adenomatous prostates, and the colocalization of CCK together with serotonin in the same cell, have been demonstrated by means of an immunohistochemical technique and by a double labeling immunofluorescent staining. CCK-containing neuroendocrine cells had a focal distribution in the prostates and sometimes showed dendrite-like cytoplasmic processes. The major part of CCK (96.55%) colocalized with serotonin. CCK probably stimulates muscle contraction and endocrine/exocrine secretions in the urogenital tract.

Effects of adrenaline on ventricular function and coronary haemodynamics in relation to catecholamine handling in transplanted human hearts.

We investigated cardiovascular and coronary responses to intravenous infusions of adrenaline, which raised arterial concentrations in a stepwise fashion from basal to about 5-6 nmol.l-1, in 11 non-rejecting heart transplanted patients, and in eight intact innervated subjects. Cardiac adrenaline extraction and noradrenaline release rate were also measured. The transplanted patients showed larger increases in heart rate (36 +/- 11% vs 16 +/- 6%, P < 0.0001) and cardiac index (80 +/- 30% vs 56 +/- 19%, P < 0.05), while stroke volume increments were similar in the two groups (32 +/- 17% vs 35 +/- 13%). The study groups did not differ with respect to changes in arterial pressure, cardiac work or peripheral resistances. Coronary sinus blood flow increased to a greater extent in the transplanted group (75 +/- 35% vs 48 +/- 31%, P < 0.05) and myocardial oxygen consumption also tended to increase more in these patients (78 +/- 42% vs 48 +/- 34%, NS). Myocardial adrenaline extraction was greatly reduced in the transplant patients (-6 +/- 25% vs 64 +/- 18%, P < 0.001), while forearm adrenaline extraction was similar in the two groups (41 +/- 22% vs 40 +/- 23%, NS). Cardiac noradrenaline overflow tended to be lower in the transplanted group (12 +/- 62 vs 48 +/- 43 pmol.min-1, NS). There was a wide range of noradrenaline overflow values (-64 to 147 pmol.min-1) and definite high values in three patients. Cardiac noradrenaline overflow was not correlated to heart rate responsiveness to adrenaline. We conclude that patients with cardiac transplantation respond to adrenaline with exaggerated increases in heart rate and thus in cardiac output. High values of cardiac noradrenaline overflow are seen in some transplant recipients and may suggest reinnervation. Signs of reinnervation are not associated with consistently lower heart rate responses to beta-adrenergic stimulation.

Development of myocardial beta-adrenergic receptor density and adenylate cyclase activity after human heart transplantation.

An increase in basal heart rate caused by a lack of vagal control and chronotropic supersensitivity to epinephrine has been shown in transplanted human hearts. Prejunctional and/or postjunctional origins for this supersensitivity have been suggested, the latter involving changes in the number of myocardial beta-adrenergic receptors or in the receptor adenylate cyclase system. To directly determine the time course of change, serial determinations were performed during the first 3 months after heart transplantation. The beta-adrenergic receptor density measured by iodine 125-labelled iodocyanopindolol binding in 61 endomyocardial biopsy specimens (a mean of 6.1 +/- 0.58 biopsies from each of 10 patients) showed great intraindividual and interindividual variability (56.6 +/- 6.8 fmol/mg protein) with no mean trend toward gradually changing receptor densities. Isoproterenol-stimulated adenylate cyclase activity measured in 33 biopsy specimens (a mean of 5.5 +/- 0.67 biopsy specimens from each of six patients) varied considerably (112.5 +/- 13.8 pmol cyclic adenosine monophosphate/mg protein/min), again with no definite tendency with regard to the development over time. The beta-adrenergic receptor densities showed no statistical correlation with the degree of rejection as assessed by histologic criteria and antimyosin ration. These results suggest that in the first 3 months after heart transplantation beta-adrenergic receptor density and adenylate cyclase responses to 10 mumol/L isoproterenol do not change and that beta-adrenergic receptor density in the transplanted myocardium does not seem to be affected by the degree of rejection.

Two-year follow-up after laser thermal balloon angioplasty (LTBA) in lower extremities: initial experience.

We describe the results obtained with the use of laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans of the lower limbs in 37 patients (34 males, 3 females, mean age 58 +/- 9 years) with occlusive arterial disease (Fontaine stages II-IV) presenting 39 significant lesions. Immediate results and two years of clinical follow-up are analyzed. Initial ankle/brachial Doppler index was 0.51 +/- 0.17. Eighteen lesions were located in the iliac area (13 stenoses 2.3 +/- 1 cm and 5 occlusions 4.2 +/- 3 cm) and 21 lesions in the femoropopliteal area (5 stenoses 2.6 +/- 2 cm and 16 occlusions 5.7 +/- 3 cm). A percutaneous procedure was used in 38 cases. In only one case was femoral dissection needed. The laser source was argon in 26 cases and Nd-YAG in 13. Initial success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0.01) and/or calcium (p less than 0.05) negatively influenced the immediate results. No major complications were observed; seven (17%) minor complications occurred. Ankle/brachial Doppler index after treatment was 0.82 +/- 0.21. Cumulative clinical patency for successfully treated patients after two-year follow-up was 91%. LTBA thus represents an effective and less aggressive way of treating peripheral atherosclerosis obliterans. In spite of some limitations, it is useful in selected patients. The results of this study are very much like those in the literature for similar series and early experience.

Antiplatelet agents and their effect on complications during or soon after percutaneous transluminal coronary angioplasty.

In a retrospective study, during which 179 patients had undergone percutaneous transluminal coronary angioplasty (PTCA), the overall initial success rate fell suddenly and unexpectedly from more than 90% to 70.4%: 54.9% in patients not receiving antiplatelet therapy and 86.4% in patients treated orally with 300 mg triflusal three times daily or 300 mg acetylsalicylic acid plus 75 mg dipyridamole three times daily. The initial success rate was similar in patients with unstable (66.0%) and stable (77.6%) angina. The overall incidence of severe complications (mainly occlusion) was 16.2% and was significantly (P less than 0.01) greater in the patients not receiving antiplatelet therapy (23.1% versus 9.1%). There was no significant difference between incidence according to antiplatelet therapy used. It is concluded that antiplatelet therapy during the peri-angioplasty period (from 2 days before to 2 days after) may prevent periprocedural events in patients undergoing PTCA.