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Background: Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT. Methods and Results: This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution ≥50 %. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2 %) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, p < 0.001), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p = 0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p = 0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p = 0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction. Conclusions: In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis. [ABSTRACT FROM AUTHOR]

The current study was conducted to determine whether there is a relation between hypertension and two different polymorphisms, including C1562T of the Matrix metalloproteinase-9 (MMP-9) gene and C677T of the methylenetetrahydrofolate reductase (MTHFR) gene. Genomic DNA obtained from 224 persons (125 patients with hypertension and 99 healthy controls) were used in the study. Polymorphisms were determined by using polymerase chain reaction-restriction fragment length polymorphism and electrophoresis. The results were statistically analyzed and were found to be statistically significant. The frequencies of the C1562T genotypes were found to be, in controls CC 75.8 % and CT 24.2 % and in patients CC 71.2 %, and CT 28.8 %. The frequencies of C677T genotype were found to be, in controls CC 56.6 %, CT 38.4 and TT 5.1 % in controls and in patients CC 52 %, CT 30.4 % and TT 17.6 %. In conclusion, we may suggest that there is no relation between the essential hypertension and C1562T polymorphism of MMP-9 gene; on the other hand C677T polymorphism (genotype TT) of MTHFR gene can be regarded as a genetic indicator for the development of essential hypertension. [ABSTRACT FROM AUTHOR]

Background: Aspirin resistance is defined by platelet function testing and presumed clinical unresponsiveness to aspirin. Aspirin-resistant patients are at a greater risk of clinically important adverse cardiovascular events. We aimed to investigate whether end-stage renal disease patients with aspirin resistance are at increased risk for long-term major adverse clinical events. Methods: We prospectively enrolled 78 end-stage renal disease patients between January 2008 and November 2008. The effect of aspirin on platelet functions was determined using a new generation impedance aggregometer (Multiplate analyser, Dynabyte Medical, Munich). The primary end-point was the composite of death, myocardial infarction, unstable angina, or cerebrovascular accident. Mean follow-up was 20.7 ± 6.1 months. Results: Of the patients studied, 34 (43.58 %) were aspirin resistant and 44 (56.42 %) were not aspirin resistant. Among patients who were aspirin resistant, 13 of 34 (38.2 %) experienced death, MI, or CVA, compared to 7 of 44 (15.9 %) patients who were not aspirin resistant ( p = 0.034). Multivariate analyses identified aspirin resistance to be independently associated with major adverse long-term outcomes ([HR] 2.722; 95 % CI, 1.068-6.942; p = 0.04). Conclusion: This study demonstrates that end-stage kidney disease patients resistant to aspirin are at a greater risk of long-term major adverse events than patients who are sensitive to aspirin. [ABSTRACT FROM AUTHOR]

Predictors of aortic dilatation are not well described in patients with bicuspid aortic valves (BAV). This study sought to examine the relationship between proximal aortic dilatation and matrix metalloproteinase-9 (MMP-9) and alpha 1-antitrypsin (α1AT) levels in patients with BAV. All patients underwent echocardiography using a standard protocol, and aortic measurements were taken in end-diastole. We studied 82 patients with BAV and categorized them into two groups according to aortic dimensions corrected for body surface area and age. The plasma level of α1AT was routinely determined using a BN ProSpec analyzer (Siemens Healthcare Diagnostics, Marburg, Germany), and that of MMP-9 were determined by ELISA (RayBiotech Inc. Norcross, GA, USA). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS; SPSS Inc., Chicago, IL, USA) software for Windows version 12. This study included patients with BAV with no or mild valvular impairment. There were no significant differences between groups in terms of gender, body surface area, associated hypertension, diabetes mellitus, hyperlipidemia, or smoking. The mean ascending aortic diameter was 4.38 ± 0.5 mm in group 1 and 3.34 ± 0.35 mm in group 2 ( p < 0.001). Plasma concentration of α1AT in patients with ascending aortic dilatation was significantly lower than that in the non-dilated group (1.32 ± 0.27 and 1.49 ± 0.25 g/l, respectively; p = 0.005). However, no significant difference was found in the MMP-9 level between the two groups (336.49 ± 233.11 and 336.39 ± 268.072 pg/ml, respectively; p = 0.96). We observed a significantly negative correlation between ascending aortic diameter and α1AT level ( r = −0.300, p = 0.006) and a positive correlation between ascending aortic diameter and age ( r = 0.413, p < 0.001). No significant correlation was found between plasma MMP-9 concentration and ascending aortic diameter ( r = −0.008, p = 0.94). A multiple linear regression analysis was performed, including age, α1AT level, MMP-9 level, and left ventricular diastolic diameter. In this analysis, α1AT level and age were the independent predictors of aortic dilatation ( p = 0.03 and p = 0.02, respectively). [ABSTRACT FROM AUTHOR]