Akif Düzenli

The role of inflammation markers in triggering acute coronary events

Studies have shown disparate results in relation to the role of plasma concentrations of inflammation markers such as fibrinogen, cytokines, and cell adhesion molecules in acute coronary syndromes. The differentiation of primary versus secondary alterations of these markers in response to acute coronary syndromes is not clear. The aim of this study was to investigate the effect of soluble cell adhesion molecules and some inflammatory markers on coronary plaque instability. The prospective study consisted of 15 patients with stable angina pectoris (SAP), 16 with unstable angina pectoris (UAP), and 16 who had undergone percutaneous transluminal coronary angioplasty (PTCA). Blood samples were obtained from the SAP group on admission, from the UAP group at the early stage of pain onset within 6 h of pain, and again after 12 h of pain. Samples from the PTCA group were collected before, 2, 14 h after the procedure. Soluble vascular cell adhesion molecule-1 (VCAM-1), endothelial selectin, interleukin-1Β (IL-1Β) and interleukin-2 (IL-2), and C-reactive protein (CRP) were analyzed by enzyme-linked immunosorbent assay. CRP serum levels gradually increased although IL-2 gradually decreased in patients with UAP and PTCA. In addition, VCAM-1 levels were sharply decreased after the PTCA procedure. However, this value returned back to the preprocedure levels 14 h after PTCA. Both CRP and IL-2 are directly involved in the triggering mechanisms of acute coronary events.

The effect of coronary revascularization on new-onset complete atrioventricular block due to acute coronary syndrome.

BACKGROUND Coronary artery disease is one of the most common causes of complete atrioventricular block (AVB) in adults. In this study, we evaluated whether prompt revascularization of the coronary artery occlusion can ameliorate new-onset complete AVB due to acute coronary syndrome (ACS). METHODS Five patients (4 men and 1 woman) with a mean age of 69.8+/-7.1 years with diagnosed new-onset complete AVB and proven coronary artery disease were enrolled in the study. At the time of AVB diagnosis, 3 of the patients had acute myocardial infarction, and the other 2 patients had unstable angina pectoris. All patients underwent complete coronary bypass surgery after the diagnosis of complete AVB. A patient who underwent 2 coronary bypasses also underwent aortic valve replacement. RESULTS No mortality was observed in the study group. All but one of the patients converted back to sinus rhythm after a mean interval of 30+/-13.6 hours following revascularization procedures. Complete AVB persisted in 1 patient, and a permanent pacemaker was implanted. All patients were discharged uneventfully. The mean hospital stay was 11.4+/-4.5 days. All patients are still being followed up after surgery; at a mean follow-up of 27.4+/-0.9 months, there have been no further problems. CONCLUSION Coronary revascularization may ameliorate ACS-related new-onset complete AVB with an acceptable rate of successful reversion to sinus rhythm. An especially appropriate time for surgery, complete coronary revascularization, and management of myocardial protection during surgery might improve the results of coronary bypass procedures in these patients.

Appropriateness for the Current Guidelines on Reperfusion Treatment of Patients Applying to Our Hospital with STEMI

OBJECTIVES This study investigated the appropriateness of treatment for patients admitted with ST-segment elevation myocardial infarction (STEMI) according to the current guidelines. We also aimed to determine in-patient and out-patient factors affecting optimal reperfusion therapy. STUDY DESIGN The reperfusion therapy of 176 patients with STEMI was determined. The time period from first contact with a healthcare provider to the time of balloon inflation (door to balloon time), and from the time period of first contact with a healthcare provider to the time of initiation of a thrombolytic (door to needle time) were calculated. Similarly, the time from admission at the emergency service (ES) of our hospital after referral to the moment of balloon inflation (ES to balloon time) and the period from admission to ES at our hospital to the moment of initiation of a thrombolytic (ES to needle time) were calculated. In order to determine the amount of in-hospital delay, the time from ES admission to the call to the cardiology department and the time for the cardiologist to evaluate the patient and transfer time were recorded. Whether the referring physician was a cardiologist and the effect of work hours on the reperfusion period was also recorded. RESULTS The door to balloon time in the referred patient group was calculated as an average of 228 minutes, while the time for patients directly admitted to ES was calculated as an average of 98 minutes. Patients referred for the mechanical reperfusion period compared to American Heart Association (AHA) guidelines consisted of only 6% of the eligible patients, while according to the European Society of Cardiology (ESC) guidelines 13% of patients were appropriate. Patients who were directly admitted to ES, experienced rates according to AHA guidelines and 73% experienced these rates according to ESC guidelines. We also found no significant effect of working hours or referring physicians specialty (cardiologist or other) on reperfusion time. CONCLUSION Compliance rates of reperfusion therapy for patients presenting with STEMI was very low. We realized, when taking into consideration the reasons for delay in terms of both health community and the policy of the country, it is obvious that we have to take strict measures.