Proteomic characterization of EPCs and CECs "in vivo" from acute coronary syndrome patients and control subjects.

BACKGROUND: Circulating endothelial cells (CECs) and endothelial progenitor cells (EPCs) represent two scarce blood populations that are thought to play important roles in tissue vascularization. They have also been proposed as potential markers for more than a dozen pathologies. Moreover, EPCs have arisen as a new therapeutic option for cardiovascular disease. However nowadays there is certain controversy about their roles and a better understanding of EPC biology is required to develop new strategies for forthcoming therapies. METHODS: Flow cytometry analysis was performed on freshly isolated mononuclear cells from control subjects and Acute Coronary Syndrome (ACS) patients. EPCs and CECs for both groups were isolated and quantified. Statistical analyses were performed to test the potential biomarker usefulness of both populations in ACS together with the first "in vivo" proteomic characterizations of these populations. RESULTS: Our results do not show statistical differences in the quantification of CECs and EPCs in control subjects and ACS patients. The proteomic characterization allowed us to identify 673 proteins associated to CECs (389 in controls and 462 in ACS patients), and another 502 proteins in EPCs (350 in controls and 274 in ACS patients). CONCLUSIONS: Our data show the necessity to obtain a more accurate and specific phenotype of CECs and EPCs cells as well as a flow cytometry "golden standard" protocol, before they can be considered useful clinical markers. GENERAL SIGNIFICANCE: The proteomic data suggest a potential effect of ACS in the protein profiles of these cells.

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.

Mitral valve replacement in a heart transplant recipient with iatrogenic mitral regurgitation.

A 65-year-old cardiac transplant recipient suffered rupture of the mitral valve apparatus during endomyocardial biopsy of the left ventricle. Severe mitral regurgitation resulted, and because of heart failure with progressive clinical deterioration the patient was finally subjected to mitral valve replacement. He had a favorable postoperative course and is now asymptomatic.

Morphologic characteristics of restenotic lesions following coronary interventions: balloon angioplasty versus directional atherectomy: can we speculate about the mechanism of restenosis from morphologic analysis?

In order to compare the processes of restenosis after balloon angioplasty as compared to that after directional coronary atherectomy, we performed qualitative and quantitative analysis of 72 lesions in 68 patients with recurrent ischemia following a successful initial procedure. For each lesion, we reviewed the pre-intervention, immediate post-intervention, and restenosis angiograms. The morphology of the restenotic lesions could not be predicted from pre- or post-intervention angiograms. The restenotic lesions after directional atherectomy, as compared to balloon angioplasty, did not show a statistically significant difference, although there was a trend to more eccentric narrowing.

[Prevalence of IgG antibodies against Cytomegalovirus in patients with angiographically demonstrated coronary atherosclerosis]. / Prevalencia de anticuerpos IgG frente a Citomegalovirus en pacientes con aterosclerosis coronaria demostrada angiográficamente.

BACKGROUND: Over the past 25 years the potential role of herpesvirus and particularly Cytomegalovirus as a factor which contribute to atherogenesis, and more recently in restenosis, has been investigated. OBJECTIVES: To determine the rate of Cytomegalovirus seropositivity in patients with angiographically demonstrated Coronary Artery Atherosclerosis. PATIENTS AND METHODS: The subjects were all adult patients undergoing coronary angiography at the Hospital Virgen de la Salud, Toledo between February, 1997 and May, 1998. From each patient, blood was drawn and collected to be assayed. Also we collected the data from sex, age, classic risk factors for coronary artery disease (hypertension, hypercholesterolemia, diabetes and cigarette smoking) and catheterization. Data from 437 patients who underwent cardiac catheterization were collected. There was 349 (82.3%) patients who underwent catheterization because of Ischemic Heart Disease. SEROLOGIC ASSAYS: Serum IgG antibodies to cytomegalovirus were measured quantitatively with EIA, VIDAS, (bioMérieux). As recommended by the manufacturer a titer over 6 was considered positive. RESULTS: There was 115 female and 319 males. Patients were 24-86 years old. Data from catheterization showed that 113 patients (26%) have no lesions on coronaryography and 321 patients (74%) have Coronary Artery Disease (CAD). The rate of Cytomegalovirus-seropositive was 97.1% in patients with lesions and 98.2% in those without lesions. CONCLUSIONS: There is a high rate of antibodies positive for Cytomegalovirus in the population, in patients with Ischemic Heart Disease and with coronary artery disease as in those without lesions in the coronarigraphy. Our conclusion is that if Cytomegalovirus could have any role in the building of proliferating ateheromas and in view of seroepidemiological studies some other factors must be implicated in the development of plaque growth.

Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective, randomized study. The DISCO trial. DIrect Stenting of COronary Arteries.

AIMS: To assess the safety of direct coronary stenting, its influence on costs, duration of the procedure, radiation exposure, clinical outcome and angiographic restenosis. METHODS AND RESULTS: We randomized 416 patients (446 lesions) to direct stent implant or stent implant following balloon pre-dilation. Patients >75 years old, heavily calcified lesions, bifurcations, total occlusions, left main lesions and very tortuous vessels were excluded. Direct stenting was successful in 217/224 lesions (96.8%). No single loss or embolization of the stent occurred. All stents in the group with pre-dilation were effectively deployed. The immediate post-procedure angiographic results were similar with both techniques. Fluoroscopy and procedural time were significantly lower in direct stenting (6.4+/-0.3 and 21+/-0.9 min) than in pre-dilated stenting (9.1+/-0.4 and 27.5+/-1.1 min) (P>0.001). Major adverse cardiac events during hospitalization were one in direct and four in pre-dilated stenting (P=0.05) but there were no significant differences at follow-ups at 1, 6 and 12 months between the two groups. Angiographic reevaluation at 6 months was performed in 94% of the cases. Restenosis rate was 16.5% in direct stenting and 14.3% in pre-dilated stenting (P=ns). CONCLUSIONS: Direct stenting is as safe as pre-dilated stenting in selected coronary lesions. Acute angiographic results are similar but procedural costs, duration of the procedure and radiation exposure are lower in direct stenting. Overall success rate, mid-term clinical outcome and restenosis are similar with both techniques.