Pavel Kukla

Increased levels of MMP-3, MMP-9 and MPO represent predictors of in-stent restenosis, while increased levels of ADMA, LCAT, ApoE and ApoD predict bare metal stent patency.

AIMS We sought to identify biochemical predictors that indicate susceptibility to in-stent restenosis (ISR) after coronary artery bare-metal stenting. METHODS A total of 111 consecutive patients with post-percutaneous coronary intervention (PCI) in-stent restenosis of a target lesion within 12 months were matched for age, sex, vessel diameter, and diabetes with 111 controls without post-PCI ISR. Plasma or serum levels of biochemical markers were measured: matrix metalloproteinases (MMP) 2, 3, 9; myeloperoxidase (MPO); asymmetric dimethylarginine (ADMA); lipoprotein (a) (Lp[a]); apolipoproteins E and D (ApoE and D); and lecitin-cholesterol acyltransferase (LCAT). Multivariable logistic regression association tests were performed. RESULTS Increased plasma MMP-3 (OR: 1.013; 95% CI: 1.004-1.023; P = 0.005), MMP-9 (OR: 1.014; 95% CI: 1.008-1.020; P < 0.0001) or MPO (OR: 1,003; 95% CI: 1.001-1.005; P = 0.002) was significantly associated with increased risk of ISR. Increased levels of ADMA (OR: 0.212; 95% CI: 0.054-0.827; P = 0.026), ApoE (OR: 0.924; 95% CI: 0.899-0.951; P < 0.0001), ApoD (OR: 0.919; 95% CI: 0.880-0.959; P = 0.0001), or LCAT (OR: 0.927; 95% CI: 0.902-0.952; P < 0.0001) was associated with risk reduction. No correlation was found between plasma MMP-2 or Lp (a) and ISR risk. CONCLUSIONS Increased levels of MMP-3, MMP-9, and MPO represent predictors of ISR after bare-metal stent implantation. In contrast, increased ADMA, LCAT, and Apo E and D indicate a decreased in-stent restenosis occurrence.

The prognostic effect of different types of cardiac rehabilitation in patients with coronary artery disease.

AIM The purpose of this study was to access and compare the prognostic effects of different types of cardiac rehabilitation (CR) in patients with chronic coronary artery disease. METHODS One hundred fifty-two patients were retrospectively divided into 4 groups according to their adherence to physical activity recommendations. Patients in groups 1 and 2 participated in the guided 3-month exercise programme. Patients in group 1 then continued with individual exercise training, while patients in the group 2 stopped exercising after finishing the guide exercise programme. Patients in group 3 participated only in individual exercise training throughout the whole follow-up period, and patients in group 4 declined all exercise recommendations and did not exercise. The prognostic outcome of different types of cardiac rehabilitation was compared among the groups. In addition, patients who participated in individual exercise training according to recommendations (cohort IT+) were compared with patients who declined these activities (cohort IT-). RESULTS During a median follow-up of 94 months, 33 deaths occurred: 17 cardiovascular and 16 non-cardiac deaths. A Kaplan-Meier survival analysis demonstrated significantly better survival rates for patients who followed a long-term aerobic exercise training (IT+) than for those who did not participate or who had only a short-term exercise programme (IT-) (P = 0.009). CONCLUSION In our study, long-term exercise training had a higher impact on patient survival than short-term guided CR.

The long-term effects of individual cardiac rehabilitation in patients with coronary artery disease

Uvod: Pozitivni vliv kardiorehabilitace byl opakovaně popsan a je dobře znam z hlediska kratko- a střednědobeho casoveho useku. Meně je znamo o dlouhodobých ucincich u pacientů s chronickou stabilni ischemickou chorobou srdecni.Cil: Cilem prace bylo vyhodnoceni dlouhodobeho ucinku individualni kardiorehabilitace u pacientů s ischemickou chorobou srdecni.Metodika: Sto padesat dva pacientů se stabilni ischemickou chorobou srdecni bylo retrospektivně rozděleno do dvou skupin podle dodržovani doporuceni stran individualni fyzicke aktivity, bez ohledu na absolvovani vedeneho treninku kardiorehabilitace. Skupina IT+, ktera provaděla individualni trenink podle doporuceni, byla srovnavana s pacienty, kteři toto odmitli (skupina IT-). Průměrna delka sledovani dosahovala 12,7 roku.Výsledky: Individualni trenink neměl žadný vliv na delku přežiti po upravě na dalsi faktory, ale multivariantni analýza ukazala významnou souvislost mezi výskytem kardialnich přihod, jako jsou infarkt myokardu, nestabilni angina pectoris, koronarni revaskularizace a hospitalizace pro srdecni selhani: HR (95 % CI) 0,51 (0,30-0,89); p = 0,017.Zavěr: Domaci kardiorehabilitace a pravidelna fyzicka aktivita významně snižuji dlouhodobou kardialni morbiditu u pacientů s chronickou ischemickou chorobou srdecni.

Long-term outcomes after treatment of bare-metal stent restenosis with paclitaxel-coated balloon catheters or everolimus-eluting stents: 3-year follow-up of the TIS clinical study

The efficacy of paclitaxel‐eluting balloon catheters (PEB) and drug‐eluting stents for treatment of bare‐metal stent restenosis (BMS‐ISR) have been demonstrated in several studies with follow‐up times of 9 to 12 months; however, the long‐term outcomes of ISR treatment are less defined.

The prognostic eff ect of diff erent types of cardiac rehabilitation in patients with coronary artery disease

Aim The purpose of this study was to access and compare the prognostic eff ects of diff erent types of cardiac rehabilitation (CR) in patients with chronic coronary artery disease. Methods One hundred fi fty-two patients were retrospectively divided into 4 groups according to their adherence to physical activity recommendations. Patients in groups 1 and 2 participated in the guided 3-month exercise programme. Patients in group 1 then continued with individual exercise training, while patients in the group 2 stopped exercising after fi nishing the guide exercise programme. Patients in group 3 participated only in individual exercise training throughout the whole follow-up period, and patients in group 4 declined all exercise recommendations and did not exercise. The prognostic outcome of diff erent types of cardiac rehabilitation was compared among the groups. In addition, patients who participated in individual exercise training according to recommendations (cohort IT+) were compared with patients who declined these activities (cohort IT-). Results During a median follow-up of 94 months, 33 deaths occurred: 17 cardiovascular and 16 non-cardiac deaths. A Kaplan-Meier survival analysis demonstrated signifi cantly better survival rates for patients who followed a long-term aerobic exercise training (IT+) than for those who did not participate or who had only a short-term exercise programme (IT-) (P = 0.009). Conclusion In our study, long-term exercise training had a higher impact on patient survival than short-term guided CR.