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Purpose: To demonstrate the possible association of statin therapy with C reactive protein (CRP) serial measurements in ST elevation myocardial infarction (STEMI) patients. Materials and methods: STEMI patients between 2008 and 2016 with available CRP data from admission were divided into two groups according to pre-admission statin therapy. A second CRP measurement was noted following primary coronary intervention (within 24 h from admission). The difference between the two measurements was designated ΔCRP. Results: The cohort consisted of 1134 patients with a median age of 61 (IQR52–70), 81% males. Patients on statins prior to admission (336/1134, 26%) were more likely to have CRP levels within normal range (≤5 mg/l) compared to patients without prior treatment, both at admission (75 vs. 24%, p = 0.004) and at 24 h (70 vs. 48%, p = 0.029). The prevalence of patients with pre-admission statin therapy decreased as ΔCRP increased (p = 0.004; n = 301). The likelihood of ΔCRP to be above 5 mg/l in patients with pre-admission statin therapy was reduced after age and gender adjustments (OR 0.54, 95% CI 0.32–0.92, p = 0.023) and in multivariate (OR 0.57, 95% CI 0.33–0.99, p = 0.048) analysis. Conclusions: Pre-admission statin therapy is associated with a less robust inflammatory response in STEMI patients, highlighting statin's pathophysiological importance. [ABSTRACT FROM AUTHOR]

Context:There is a known association between C-reactive protein (CRP) levels and adverse outcomes in patients presenting with ST-elevation myocardial infarction (STEMI). The optimal time frame to measure CRP for risk stratification is not known. Objective:The aim of the current study was to evaluate the relation between the change in CRP velocity (CRPv) and 30-d mortality among STEMI patients. Material and methods:We included consecutive patients with a diagnosis of STEMI who presented to Tel-Aviv Medical Center between 2008 and 2014 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in hours) between the two measurements. Results:The study population comprised of 492 patients, mean age was 62 ± 14, 80% were male. CRPv was significantly higher among patients who died within 30 d of admission (1.42 mg/l versus 0.18 mg/l,p < 0.001). In a multivariate regression model adjusted to multiple confounders, CRPv was independently associated with 30-d mortality (OR 1.39, 95% CI: 1.20–1.62,p < 0.001). Conclusion:CRPv might be an independent and rapidly measurable biomarker for short-term mortality in patients presenting with STEMI. [ABSTRACT FROM AUTHOR]

Background: Preclinical carotid atherosclerosis is associated with future risk of stroke. Data regarding the correlation between carotid atherosclerosis and biomarkers, which might predict the risk for the disease has been inconsistent and conflicting. Red blood cell distribution width (RDW) is also related to adverse clinical outcomes. Studies examining the relationship between RDW and preclinical and clinical carotid atherosclerosis were non-conclusive. Objective: To study the association between RDW and preclinical carotid atherosclerosis in a large heterogeneous cohort. Methods: Patients underwent Doppler ultrasound of the common carotid artery and Carotid Intima Media Thickness (CIMT). Advanced CIMT software analyzed over 100 samples in each exam. Blood samples for RDW were obtained on the same day. Logistic regression was used to evaluate the correlation between RDW and preclinical carotid atherosclerosis. Results: Five hundred and twenty-two consecutive patients were included, with a mean age of 6.6 ± 11. A cut-off value of 14.1% was used to differentiate between high and low RDW groups. The higher RDW group (RDW above 14.1%) was significantly older and with more cardiovascular risk factors. In a multivariate analysis, in all the patients including those treated by lipid modifying therapies, high RDW was significantly associated with advanced CIMT (OR = 2.35, CI 95% 1.28–4.30,p = 0.006). This association remained significant in subgroups of non-diabetic patients as well as patients not treated by lipid modifying drugs. RDW was also associated with significant carotid artery stenosis (OR = 1.77, CI 95% 1.12–2.82,p = 0.015). Conclusions: High RDW correlates with increased risk for preclinical and clinical carotid atherosclerosis. [ABSTRACT FROM PUBLISHER]

Background: The 3D configuration of the aortic‐coronary junction is decisive in stenting ostial coronary lesions. We hypothesized that it varies between straight to funnel–shaped tubes and studied arterial orifices using computerized tomographic coronary angiography (CTCA). Methods and Results: Axial and sagittal 2‐D and volumetric 3‐D reconstructions of the aorto‐coronary junction were performed in 25 patients who underwent CTCA. The following measurements of the left main (LM) and right coronary (RCA) arteries ostia were obtained: the coronary orifice broad base diameter, the diameter of the coronary vessel most proximal segment, the distance between them, and the angles of the aortic‐coronary junction. All patients exhibited a funnel–shaped aortic‐coronary junction in at least one plane, and none had an entirely straight tube shape. The RCA take–off had symmetric angling in both the axial and sagittal planes in only one patient, while the LM did not have a symmetric origin in either plane in any patient. The mean coronary orificial funnel depth and ostial cross–sectional diameters were measured. Conclusion: The frequency of funnel‐shaped and asymmetry of the aortic‐coronary junction configuration needs to be considered in designing stents for aortic–ostial coronary lesions in order to achieve optimal results and reduce restenosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: The heat shock protein (HSP) family comprises approximately 24 proteins displaying a high degree of sequence homology between different species. The induction of self‐HSP immune reactivity is thought to be involved in the pathogenesis of several diseases. Antibodies to HSP60/65 have been demonstrated in the sera of patients with coronary artery disease. Moreover, the target antigens of the antibodies HSP60 and HSP70 are both expressed in smooth muscle cells and macrophages within atherosclerotic lesions. In this retrospective, case control study, we investigated whether patients with established atherosclerosis, with either stable or unstable angina have high levels of antibodies to HSP70. METHODS AND RESULTS: Patients with stable angina (n = 40) were from the outpatient clinic whereas patients with unstable angina (n = 91) were recruited upon admission and prior to performance of coronary angiography. Control patients (n = 18) were healthy subjects with no evidence of coronary artery disease. Serum levels of anti‐HSP70 antibodies were assayed by ELISA. Patients with stable and unstable angina exhibited lower serum levels of antibodies to HSP70 (0.202±0.113 and 0.201±0.115, respectively) in comparison to control subjects (0.364±0.199, P = 0.0001 for both comparisons). Serum levels of antibodies to HSP70 did not differ significantly between patients with stable and unstable angina. No differences in serum levels of antibodies to HSP70 were evident between baseline and follow up in the patients with unstable angina. CONCLUSIONS: Patients with coronary atherosclerosis possess lower levels of anti‐HSP70 antibody levels. Further research is required to explore whether higher levels of anti‐HSP70 antibodies have a predictive value in coronary atherosclerosis [ABSTRACT FROM AUTHOR]

OBJECTIVES. Herein, we investigated the percentage of T‐helper (Th1) and Th2 cells among the general T‐cell population in the peripheral blood of patients with stable angina (SA) and unstable angina (UA). BACKGROUND. Recent evidence suggests that Th1 cells and the cytokines that they secrete (especially IFN‐γ) have a role in the activation of macrophages, promotion of clot formation and destabilization of atherosclerotic plaques. Thus, Th1 cytokines may contribute to the initiation and progression of UA. In contrast, cytokines secreted by Th2 cells (e.g. IL‐10) are known to inhibit activation and proliferation of Th1 cells and the secretion of IFN‐γ, lysosomal enzymes and metalloproteinases. Therefore, we sought to examine whether the ratio of IFN‐γ to IL‐10 secreting cells is altered in patients with UA. METHODS. The percentage of Th1 and Th2 cells among the general T‐cell population was determined by fluorescent intracellular cytokine staining (IFN‐γ and IL‐10, out of the total CD3 positive cells). RESULTS. The percentage of T‐cells positive for intracellular IFN‐γ was significantly higher in patients with UA ( n = 22) in comparison with SA ( n = 20) patients (39.0±2.8% and 29.6±2.7%, respectively. P = 0.02). There was no significant difference in intracellular IL‐10 positive cells between the two groups. In addition, there was no significant difference in the ratio between the intracellular IFN‐γ positive cells and the intracellular IL‐10 positive cells. CONCLUSIONS. There is an increased activity of Th1 cells in patients with UA in comparison with patients with SA. There is no evidence of heightened activity of Th2 cells in either group. Thus, IFN‐γ secreted by peripheral blood T‐lymphocytes,may be an important immunomodulator contributing to destabilization of the atheromatous plaque lying at the base of the etiopathogenesis of unstable angina. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multi-detector row spiral CT (MDCT) can be applied as a noninvasive tool for the assessment of coronary artery stenoses. Few, confounding reports have been published using 16 detector rows. The aim of the present study was to determine the accuracy of 16-detector row MDCT for the detection of significant stenoses in the coronary arteries, in comparison to conventional invasive coronary angiography. METHODS: Twenty-two patients with suspected coronary artery disease, were prospectively evaluated by 16-slice retrospectively ECG-gated CT coronary angiography and quantitative invasive coronary angiography. The findings were compared for the detection of significant coronary artery stenoses (>50%) in all segments with diameter >1.5 mm. RESULTS: MDCT correctly classified all 14 patients (100%) that were found to have significant coronary artery disease on conventional angiography. Overall, 288 segments were included in the analysis, regardless of their image quality. Significant stenoses were detected in 24 segments by CT and in 28 segments by conventional angiography. Out of 260 segments that were negative for significant stenoses on conventional angiography, 255 were correctly identified on CT. The sensitivity, specificity, positive and negative predictive values were 86, 98, 83 and 98%, respectively. MDCT also revealed supplementary findings that invasive angiography was unable to visualize, including anomalous vessel course, the course of vessels filling via collaterals, intramyocardial course of vessels and non-stenotic plaques. CONCLUSIONS: MDCT coronary angiography utilizing 16-detector rows shows promising results for reliable detection of coronary artery stenoses and particularly for ruling out significant disease. [ABSTRACT FROM AUTHOR]

Subacute stent thrombosis (SAST) is a major thrombotic complication of coronary stenting. Its occurrence has been substantially reduced by thienopyridine treatment. However, information on clinical profile of patients with SAST in clopidogrel era is limited. In order to define the incidence and factors predisposing to stent thrombosis, we analyzed the computerized angiographic database of three interventional cardiology centers. Out of a total number of 5903 percutaneous coronary interventions (PCIs) with stent implantation, we found 10 patients with SAST (0.17%). The indication for PCI was usually an early invasive approach (90%) during an acute coronary syndrome . All patients were treated with an apparently optimal antithrombotic regimen (90% received heparin or LMWH and 70% received IIb/IIIa receptor inhibitors and all given aspirin). In each of the patients, we could identify high-risk angiographic findings. SAST presentation was always clinically significant with definite myocardial infarction in 100% of cases. 80% of cases occurred during the first six days post PCI. Two patients had a recurrent event. Finally, despite earlier reports of atorvastatin-mediated inhibition of clopidogrel activation we did not find any patient with SAST taking both drugs. Thus, patients with stent thrombosis during thienopyridine treatment usually exhibit high-risk angiographic features. Prospective studies should be performed to elucidate drug interactions that may reduce clopidogrel efficacy and contribute to stent thrombosis. (Int J Cardiovasc Intervent 2004; 6: 160-164) [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the correlation between clinical parameters and the occurrence of in-stent restenosis in a cohort of patients from the Tel Aviv Medical Center who underwent repeat angiograms for clinical indications following stenting. BACKGROUND: After stenting, recurrences of symptoms or ischemia on functional tests are considered to be clinical signs of restenosis. METHODS: The authors' study group consisted of 149 out of 1469 patients (10%) who underwent stent implantation between 1996 and 1998 and were under clinical follow-up. This group had a repeat angiogram for clinical indications: chest pain or a positive functional test (thallium study or ergometry). RESULTS: Sixty-eight patients (45%) had in-stent restenosis (ISR), 32 (21%) had a patent stent site with a significant coronary atherosclerosis elsewhere requiring revascularization (NTLR), and 51 (34%) had a patent stent site and did not require additional revascularization (PS). Baseline characteristics were similar in all the groups. There was a 63% rate of objective evidence of ischemia in the PS group, similar to the ISR (63%) and NTLR (74%) groups. In the ISR versus the NTLR and PS groups the stents were longer (22 ± 10 versus 17 ± 7 and 16 ± 6 mm, p < 0.001) with a smaller diameter (3 ± 0.4 versus 3.3 ± 0.5 and 3.2 ± 0.4 mm, p < 0.05) and a higher rate of multiple stents in the target lesion (34% versus 19% and 14%, p < 0.05) CONCLUSIONS: In the cohort of patients who underwent angiography following stenting for chest pain or a positive functional test, 55% were found to have a patent stent site. The 5% total in-stent restenosis is significantly lower than the rate in angiography-based reports. On the other hand, the group with a patent stent had a higher than expected rate of objective evidence of ischemia. Therefore clinical parameters and functional tests are not predictive for in-stent restenosis. (Int J Cardiovasc Intervent 2003; 5: 151-155) [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Martin B. Leon on the cardiovascular interventions.

Inhibitors of the IIB-IIIA integrin are widely used to prevent stent thrombosis. Abciximab has been shown to attenuate the inflammatory response in patients undergoing PCI. Herein, we tested the effect of eptifibatide infused during PCI on peripheral lymphocyte activation and CRP levels before, and one month after the procedure showing no noticeable effect. These results may explain the differences in clinical outcome following PCI by use of different IIB-IIIA agents. (Int J Cardiovasc Intervent 2004; 6: 107-109) [ABSTRACT FROM AUTHOR]

Editorial. Introduces various topics that have been discusses in the March 2003 issue of the journal 'International Journal of Cardiovascular Interventions.' Significance of drug eluting stents in cardiology; Properties of stents that have been discusses; Contributors of the articles.

Editorial. Points out the prevention of adverse cardiac arrests by fluvastatin in patients with transcatheter therapy for coronary heart disease. Increase in the incidence of surgical complications; Improvement of the revascularization methods for the disease; Introduction of several forms of therapy for the disease.

Editorial. Discusses the articles published in the December 2000 issue of the 'International Journal of Cardiovascular Interventions' about the practical and research aspects in interventional cardiology. Treatment of intermediate coronary artery stenosis; Medical costs of intravascular ultrasound; Multicenter evaluation of the phosphorylcholine-coated stent; Techniques for injection of myogenic cells into the myocardium.