| 1. |
- Bountouris, Ioannis, et al.
(författare)
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Serum leptin levels in patients undergoing carotid endarterectomy: a pilot study.
- 2009
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Ingår i: Angiology. - : SAGE Publications. - 1940-1574 .- 0003-3197. ; 60:6, s. 698-704
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Elevated serum leptin levels are associated with cardiovascular events. We investigated the role of serum leptin in patients undergoing carotid endarterectomy (CEA). METHODS: A total of 74 patients (55 men; 38 symptomatic and 36 asymptomatic; mean age 66.9 +/- 8.2 years) undergoing CEA for >70% carotid artery stenosis were enrolled. RESULTS: Serum leptin levels were lower in symptomatic compared with asymptomatic patients (7.1 +/- 1.3 vs 14.4 +/- 4.7 ng/dL; P < .001). Interleukin-6 (IL-6) levels were higher in symptomatic compared with asymptomatic patients (4.3 +/- 1.7 vs 3.3 +/- 1.1 pg/dL; P = .017). Symptomatic patients had more intense macrophage accumulation (0.7% +/- 0.1% vs 0.3% +/- 0.1%; P < .001). Serum leptin and serum IL-6 levels were independently associated with the presence of symptoms in multivariate analysis. CONCLUSION: Serum leptin levels were decreased in symptomatic carotid artery disease. This finding requires further investigation in larger studies.
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| 2. |
- Kolettis, Theofilos M, et al.
(författare)
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Dose-dependent effects of sildenafil on post-ischaemic left ventricular function in the rat isolated heart.
- 2010
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Ingår i: The Journal of pharmacy and pharmacology. - : Oxford University Press (OUP). - 0022-3573 .- 2042-7158. ; 62:3, s. 346-51
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Sildenafil may be beneficial during myocardial ischaemia/reperfusion, but this effect may be dose-dependent, accounting for previous conflicting results. We have explored the effects of two acute and one chronic administration regimen on left ventricular function. METHODS: The study was conducted on 36 Wistar rats (290 +/- 7 g). Sildenafil was administered 30 min before ischaemia at a low (0.7 mg/kg, n= 8) or high (1.4 mg/kg, n= 8)dosage. The chronic treatment arm (n= 8) consisted of two daily injections of sildenafil (0.7 mg/kg) for three weeks. The control group was formed by 12 rats. Ischaemic contracture, post-ischaemic recovery and hypercontracture were measured in isolated, Langendorff-perfused preparations. KEY FINDINGS: Ischaemic contracture tended to be lower after high-dose sildenafil, while remaining unchanged after low-dose or chronic sildenafil administration. Compared with controls (62.9 +/- 2.0% of baseline developed pressure), post-ischaemic recovery was higher (P= 0.0069) after low dose (75.1 +/- 2.4%), unchanged (P= 0.13) after high dose (69.1 +/- 2.1%), but lower (P < 0.001) after chronic (42.9 +/- 4.5%) sildenafil administration. Compared with controls (71.8 +/- 3.9 mmHg), hypercontracture was higher (P= 0.0052) after chronic sildenafil administration (89.5 +/- 4.1 mmHg), but similar after acute low dose (65.7 +/- 3.3 mmHg, P= 0.33) or high dose (67.1 +/- 4.7 mmHg, P= 0.43). CONCLUSIONS: The effects of sildenafil after ischaemia/reperfusion were strongly dose-dependent. Beneficial actions on left ventricular function were evident after acute pretreatment with a low dosage, but were lost after doubling the dose. Chronic sildenafil administration deteriorated left ventricular function during ischaemia and reperfusion.
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| 3. |
- Koutouzis, Michael, 1973, et al.
(författare)
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Glycoprotein IIb/IIIa inhibitors during percutaneous coronary interventions
- 2010
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Ingår i: Interventional Cardiology. - 1755-5302. ; 2:3, s. 301-318
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Tidskriftsartikel (refereegranskat)abstract
- Intravenous glycoprotein IIb/IIIa inhibitors are widely used during percutaneous coronary interventions (PCIs). There are three commercially available pharmacological agents: abciximab, eptifibatide and tirofiban. This article presents the evidence indicating their use in connection with PCI, and focuses on the differences between the three regimens, as well as on their use in special clinical conditions. The documentation for their use in high-risk PCI (in other words, for acute coronary syndromes and complex coronary anatomy), and in primary PCI for ST-elevation myocardial infarction will be scrutinized, as well as the use of intracoronary administration. Furthermore, the role of glycoprotein IIb/IIIa inhibitors as opposed to, or in combination with, thienopyridines and thrombin inhibitors will be analyzed, as will their use in diabetics, in patients with renal insufficiency and when performing PCI in vein grafts. Finally, the possible effects of glycoprotein IIb/IIIa inhibitors on restenosis and inflammation, as well as dosing and bleeding issues will be discussed.
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| 4. |
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| 5. |
- Koutouzis, Michael, 1973, et al.
(författare)
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Primary percutaneous coronary interventions in nonagenarians.
- 2010
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Ingår i: Clinical cardiology. - : Wiley. - 1932-8737 .- 0160-9289. ; 33:3, s. 157-61
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal treatment of very elderly patients with ST elevation myocardial infarction (STEMI) is not yet defined. The aim of this study is to present the feasibility and safety of primary percutaneous coronary interventions (PCI) in nonagenarians. METHODS: A retrospective analysis of all patients who underwent primary PCI due to STEMI between 2004 and 2008 was performed. Patients age 90 years or older at the time of the procedure were identified and studied. RESULTS: Twenty-two patients fulfilled the study criteria (median age 92 years; range, 90-97 years; 50% women). The procedural success rate was 82%. Bare metal stent implantation was performed in 82% of the procedures, whereas only balloon angioplasty was performed on the rest of them. One patient experienced a minor bleeding complication. Procedural mortality was 9% (2 out of 22 patients), and it was due to "no flow" phenomenon in both patients. In-hospital mortality was 27% (6/22 patients) and 30-day mortality was 32% (7/22 patients). All 3 patients with Killip class III-IV on admission died within 30 days compared with 4 of the 19 patients with Killip class I-II (P = 0.023). Furthermore, of 11 patients with anterior infarction, 7 died within 30 days compared with none of the 11 patients with infarction of other location (P = 0.004). CONCLUSIONS: Although primary PCI is feasible in patients 90 years or older suffering from STEMI, the short-term mortality rate is high especially in patients with anterior infarct location and/or severely depressed myocardial function.
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| 6. |
- Koutouzis, Michael, 1973, et al.
(författare)
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Radial vs. femoral approach for primary percutaneous coronary intervention in octogenarians.
- 2010
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Ingår i: Cardiovascular revascularization medicine : including molecular interventions. - : Elsevier BV. - 1878-0938 .- 1553-8389. ; 11:2, s. 79-83
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The transradial approach is associated with fewer bleeding complications during percutaneous coronary interventions (PCIs) but is more technically challenging and associated with prolonged times during intervention. The aim of this study is to retrospectively compare the results of radial vs. femoral approach in patients >or=80 years old undergoing primary or rescue PCI. METHODS: Between January 2002 and December 2007, 354 interventions were performed in our institution with the indication of primary or rescue PCI in patients over 80 years old, without history of previous bypass operation or cardiogenic shock on presentation. Thirteen patients required a change of the approach during the procedure and were not enrolled in the final analysis. Forty (12%) interventions were performed through the transradial approach and 301 (88%) through the femoral approach. In-hospital major adverse cerebral and cardiac events and access site bleeding complications as well as 30- and 365-day mortality, procedural times, and contrast volume were evaluated. RESULTS: The two groups had similar clinical characteristics, with the exception of serum creatinine that was higher in the transfemoral approach group. There were no differences in procedural times and clinical outcomes, although the transfemoral group had numerically more access site bleeding complications (12/301 vs. 0/40, P=.41). The transradial approach had a higher conversion rate compared with the transfemoral approach (18.3% vs. 1.3%, P<.001). CONCLUSION: The transradial approach is feasible and safe in the octogenarians undergoing primary and rescue PCI, but it is associated with a high conversion rate to another approach.
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| 7. |
- Koutouzis, Michael, 1973, et al.
(författare)
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Recurrent bare metal stent thrombosis: Six years, single center experience
- 2009
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Ingår i: International Journal of Cardiology. - 1874-1754. ; 144:2, s. 234-235
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate clinical characteristics, treatment and outcomes of patients suffering from recurrent bare metal stent thrombosis (RST). METHODS: A retrospesctive evaluation of patients who underwent percutaneous coronary intervention (PCI) with bare metal stent implantation between January 2002 and December 2007 was performed. Patients who experienced more than one in stent thrombotic episode were identified and procedural and clinical outcomes were investigated. RESULTS: Eight thousand eight hundred sixteen patients underwent PCI with bare metal stent implantation during the study period. Ninety five patients (1.1%) underwent PCI due to stent thrombosis and 6 (6.3%) of them [mean age 69+/-14 years (range 43-83 years)] underwent a second procedure due to RST. Emergency PCI was performed in all patients, with a favourable angiographic outcome in 4 (67%) of them. The procedure was complicated by death in 1, major ischemic stroke in 1 and acute coronary by pass grafting in 1 patient. The ejection fraction before the initial intervention and after the second thrombotic episode declined from 52+/-14% to 33+/-15% (p<0.05). CONCLUSION: Recurrent stent thrombosis is a rare, but major complication following stent implantation, which dramatically affects patients' outcomes.
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| 8. |
- Zygalaki, E., et al.
(författare)
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Systemic hypertension augments, whereas insulin-dependent diabetes down-regulates, endothelin A receptor expression in the mammary artery in coronary artery disease patients
- 2009
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Ingår i: Cardiology Journal. - 1897-5593. ; 16:4, s. 348-54
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Endothelin (ET) A receptor antagonism causes decreased vasodilation in hypertensive coronary arteries and decreased effects on coronary artery compliance in diabetic patients. METHODS: We investigate the mRNA expression of ET-1, ET(A) and ET(B) receptors, using real time RT-PCR, in biopsies from the internal mammary artery obtained from 49 patients, 18 diabetics and 34 hypertensives, all undergoing coronary artery bypass grafting. RESULTS: Hypertensive patients had higher ET-1 mRNA expression (16438 [8417, 23917]), than normotensive patients (2974 [2283, 18055], p=0.008). Diabetic patients had significantly lower ET(A) receptor levels than non-diabetic patients (455 [167, 1496] vs. 1660 [700, 3190], respectively, p = 0.003). CONCLUSIONS: Multivariate analysis demonstrated that the presence of systemic hypertension was the only independent predictor of log ET(A) receptor expression and log ET-1 expression, while insulin-dependent diabetes was negatively correlated with ET(A) receptor expression. ETB receptor expression was not correlated with any predictor. Systemic hypertension is associated with increased ET-1 and ET(A) receptor mRNA expression, whereas insulin-dependent diabetes down-regulates ET(A) receptor mRNA expression in the internal mammary artery in patients with coronary artery disease undergoing bypass grafting.
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| 9. |
- Åkerblom, Axel, et al.
(författare)
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Eptifibatide is noninferior to abciximab in primary percutaneous coronary intervention: results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
- 2010
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 1558-3597 .- 0735-1097. ; 56:6, s. 470-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to test the noninferiority of eptifibatide relative to abciximab in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). BACKGROUND: Glycoprotein IIb/IIIa inhibitors are recommended by international guidelines in patients with acute coronary syndromes undergoing PCI. Abciximab is recommended with a higher level of evidence than eptifibatide in patients with STEMI. No large, prospective, randomized trial comparing abciximab and eptifibatide has been published. METHODS: All (n = 11,479) STEMI patients in Sweden who underwent primary PCI and received either eptifibatide or abciximab from 2004 to 2007 were derived from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The primary end point was death or myocardial infarction (MI) during 1-year follow-up, with adjustment for baseline differences with a multivariate logistic regression analysis including propensity score. The pre-specified noninferiority margin was set to 1.29. RESULTS: The combined end point occurred in 353 of 2,355 patients (15.0%) treated with eptifibatide and in 1,432 of 9,124 patients (15.7%) treated with abciximab. The unadjusted odds ratio (OR) for eptifibatide versus abciximab was 0.95 (95% confidence interval [CI]: 0.84 to 1.08). Multivariate adjustment (n = 11,317) confirmed noninferiority, with an OR of 0.94 (95% CI: 0.82 to 1.09). The adjusted secondary end points of death and MI separately also showed noninferiority, with ORs of 0.99 (95% CI: 0.82 to 1.19) and 0.88 (95% CI: 0.73 to 1.05), respectively. CONCLUSIONS: This large registry study suggests that eptifibatide is noninferior to abciximab in patients with STEMI undergoing primary PCI with respect to death or MI during 1 year, thereby supporting the use of either drug in clinical practice.
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