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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.10.039 Byline: Abdullah Dogan, Mustafa Ozgul, Mehmet Ozaydin, Suleyman M. Aslan, Omer Gedikli, Ahmet Altinbas Abstract: Current reperfusion strategies may fail to achieve optimal tissue perfusion in ST-elevation myocardial infarction (STEMI). We investigated the effect of clopidogrel plus aspirin on tissue perfusion and coronary flow in infarct patients treated with fibrinolytic agents. Author Affiliation: Department of Cardiology, Sevket Demirel Heart Center, Suleyman Demirel University, Isparta, Turkey Article History: Received 12 May 2004; Accepted 15 October 2004

Summary: Background and purpose: Mean platelet volume (MPV), an indicator of platelet activation, has been shown to be elevated in patients with coronary artery disease (CAD) in some studies. Insulin resistance contributes to increased platelet activation and it is one of the risk factors for CAD. The aim of this study was to assess the relationship between insulin resistance and MPV in non-obese, non-diabetic patients with CAD. Methods and subjects: Seventy-seven non-obese, non-diabetic CAD patients were divided into two groups, insulin resistant and insulin sensitive according to the homeostasis model assessment insulin resistance index (HOMA-IR). The insulin-resistant group was composed of 45 patients (30 males/15 females; mean age 59.8±11.1 years). The insulin-sensitive group was composed of 32 patients (17 males/15 females; mean age 58.9±12.2 years). Results: Insulin and HOMA-IR values were significantly higher in insulin-resistant CAD patients than in insulin-sensitive CAD patients. The MPV values were significantly higher in insulin-resistant CAD patients than in insulin-sensitive CAD patients (8.6±1.0fl vs. 8.0±0.7fl; respectively, p =0.01). The MPV was poorly correlated with HOMA-IR (r =0.30, p =0.054) and insulin (r =0.22, p =0.053). Conclusions: We have shown that MPV was significantly elevated in insulin-resistant non-obese, non-diabetic CAD patients when compared to insulin-sensitive non-obese, non-diabetic CAD patients. [Copyright &y& Elsevier]

Abstract: Background: There is an increasing evidence linking inflammation to some cardiovascular conditions, such as coronary artery disease and hypertension. Similarly, there is emerging data to support the association between inflammation and atrial fibrillation (AF). We also investigated the role of systemic inflammation in different categories of AF. Methods: Eighty five consecutive patients with AF were enrolled in this study. AF was categorized as new onset, chronic (persistent and permanent) and lone. Age- and sex-matched 30 healthy people consisted of control group. Serum level of high sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) was measured. Results: Serum hs-CRP level was higher in overall AF patients than in controls (0.63±0.57 vs 0.23±0.1 mg/dL, p =0.001). Similarly, IL-6 level was also higher in all AF patients compared with controls (29±36 vs 11.6±9.7 pg/mL, p =0.008). In subgroup analysis, hs-CRP and IL-6 levels were significantly higher in both chronic (0.69±0.62 vs 0.23±0.1 mg/dL, p =0.001; 30±39 vs 11.6±9.7 pg/mL, p =0.001, respectively) and new onset AF patients (0.51±0.46 vs 0.23±0.1 mg/dL, p =0.003; 28.4±31 vs 11.6±9.7 pg/mL, p =0.009, respectively) compared with controls. These markers were not different in new onset and chronic AF subgroups. On the other hand, hs-CRP and IL-6 levels tended to be high in lone AF patients (p =0.06). The presence of AF was an independent factor for hs-CRP (OR=0.35, 95%CI=0.1–0.61, p =0.005) and IL-6 (OR=17, 95%CI=1–37, p =0.037). Conclusions: Our results support that inflammation may have an important role in the AF pathogenesis. [Copyright &y& Elsevier]

P-wave measurements and left atrial function were investigated to predict the maintenance of sinus rhythm after cardioversion of atrial fibrillation. Left atrial dimension <45 mm (p = 0.02) and P-wave dispersion <46 ms (p <0.001) were independent predictors of sinus rhythm maintenance, with a sensitivity of 89% and 96%, respectively. Duration of atrial fibrillation, maximum P-wave duration, and no spontaneous echocardiographic contrast were also univariate predictors. [Copyright &y& Elsevier]

Abstract: Primary or de novo spontaneous coronary dissection has been reported in many cases; however, in-stent dissection was demonstrated in the previously stented segment of coronary artery only in an autopsy study. Therefore, we report a 78-year-old female presenting with angina pectoris and dyspnea for the last 20 days. She had undergone stent implantation for a significant stenosis in the left anterior descending artery 3 years ago. In-stent dissection flap limiting coronary flow was noted at the coronary angiography and successfully treated with coronary re-stenting. She had no symptoms at follow-up. [Copyright &y& Elsevier]

It is not known whether taking atorvastatin in the morning versus in the evening has a different effect on major cardiac event and restenosis rates in patients undergoing percutaneous coronary intervention. Therefore, the aim of the present study was to investigate the effects of morning versus evening intake of atorvastatin on major cardiac events and restenosis rates and also on serum lipid and high sensitivity C-reactive protein levels in patients with single-vessel disease who underwent first elective percutaneous coronary intervention. [Copyright &y& Elsevier]

Abstract: Aims: To examine the association between statin use and the development of atrial fibrillation (AF) in patients presenting with acute coronary syndrome (ACS). Methods: From a total of 1000 patients presenting with ACS 241 were on and 759 were not on statin. An AF episode was accepted as endpoint. Results: The incidence of AF was less frequent in statin group compared to non-statin group (5% vs 10%, respectively, p =0.01). Independent predictors of AF were left atrial diameter, use of statin, age, hypertension, previous AF and use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Conclusions: In ACS patients, statin treatment was associated with lower incidence of AF. [Copyright &y& Elsevier]

To study the effect of atorvastatin on recurrence of atrial fibrillation (AF) after electrical cardioversion (EC), 48 patients with AF lasting 48 hours who were scheduled for EC were randomized to the atorvastatin (group I) and control (group II) groups. Six patients in group I (25%) and 2 patients in group II (8.3%) had spontaneous conversion before EC (p >0.05). The end point was the recurrence of AF during 3 months of follow-up. Eighteen patients in group I (12.5%) and 11 patients in group II (45.8%) had recurrence (p = 0.01, log-rank test). With the Cox proportional model, the predictors of recurrence included a body mass index of 25 to 30 kg/m2 (relative risk [RR] 0.07, 95% confidence interval [CI] 0.008 to 0.59), body mass index ≥30 kg/m2 (RR 0.24, 95% CI 0.08 to 0.72), AF duration of ≥3 months (RR 0.28, 95% CI 0.09 to 0.83), diabetes mellitus (RR 0.34, 95% CI 0.12 to 0.98), and left atrial diameter of ≥45 mm (RR 0.23, 95% CI 0.07 to 0.74). Atorvastatin was associated with a significantly reduced risk of developing AF (unadjusted RR 0.23, 95% CI 0.064 to 0.82, p = 0.024). This association remained significant after adjustment for these predictors (adjusted RR 0.19, 95% CI 0.052 to 0.72, p = 0.01). High-sensitivity C-reactive protein levels at baseline were not different between the 2 groups (p = 0.92). Although the high-sensitivity C-reactive protein levels decreased significantly 48 hours after EC compared with the baseline levels in group I (2.82 ± 1.46 vs 2.56 ± 1.3 mg/dl, p = 0.02), no significant change occurred in group II (2.87 ± 0.8 vs 2.84 ± 0.8 mg/dl, p = 0.09). In conclusion, atorvastatin decreased the recurrence rate of AF after EC. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the association between statins, N-acetylcysteine (NAC) and angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and postoperative atrial fibrillation (AF). Methods: A total of 590 patients undergoing coronary artery bypass and/or valve surgery were studied. An AF episode lasting >5 min during hospitalization was accepted as endpoint. Results: AF rate was 18% (n =106). Multivariable positive predictors of AF included age ≥65, left atrial diameter ≥45 mm, cross clamp time; negative predictors included use of left internal mammarian artery, NAC, and ACEIs or ARBs. Conclusions: ACEIs or ARBs and NAC is associated with low incidence of postoperative AF, however, this association was not found with statin or combined use these agents. [ABSTRACT FROM AUTHOR]