Vedat Aytekin

The relation between coronary flow rate, plasma endothelin-1 concentrations, and clinical characteristics in patients with normal coronary arteries.

BACKGROUNDnCoronary slow flow (CSF) is characterized by delayed opacification of epicardial arteries in the absence of occlusive disease. In the present study, we aimed to investigate the relation between coronary flow rate, plasma endothelin-1 (ET-1) concentrations, and clinical characteristics in patients with normal coronary arteries.nnnMETHODSnThe study population included 77 patients with angiographically normal coronary arteries who underwent coronary angiography on suspicion of ischemic heart disease due to typical chest pain or ischemic findings on treadmill exercise test or myocardial scintigraphy. Based on the Thrombolysis In Myocardial Infarction frame count (TFC), patients were grouped into those with normal coronary flow and those with slow coronary flow.nnnRESULTSnForty-eight (61.5%) patients were found to have CSF. Plasma ET-1 concentrations were significantly higher with the presence of CSF (P=.03). There were significant differences between plasma ET-1 concentrations, and mean TFC, TFC for left anterior descending coronary artery (LAD), TFC for left circumflex coronary artery (CX), and TFC for right coronary artery separately in patients with and without CSF (P=.033, P<.001, P<.001, P<.001, and P<.001, respectively). Mean TFC, TFC for LAD, and TFC for CX, and ET-1 concentrations were significantly higher in smokers than in nonsmokers (P<.001, P<.001, P=.004, and P=.033, respectively). However, logistic regression analysis suggested that ET-1 concentration was not an independent determinant of CSF.nnnCONCLUSIONSnAlthough there is a significant relation between ET-1 concentrations and coronary flow rate, ET-1 concentrations are not sufficient to determine the presence of CSF. Smoking is strongly associated with CSF, TFC, and increased ET-1 concentrations.

Response to the Letter to the Editor: "The correct number of double right coronary artery reported in the literature".

We would like to respond to the letter written by Sari et al regarding the correct number of published double right coronary artery (RCA) cases [1]. Our case [2] was presented as the second case who had an RCA with separate orifices according to the letter reported by Harikrishnan et al. in 2001 [3]. The case report entitled “Supernumerary right coronary artery” by Gupta et al was published in 1987 and was cited only by Lemburg et al. in 2007 [4] which was unavailable to us at the moment we have submitted the letter. Unfortunately, we could not see any citation of this article by Gupta et al in any of the previously reported cases about double RCA till October 2006, including the letter by Sari et al. published in 2006 [5]. The 3 cases reported by Kunimasa et al. and Lemburg et al. were published in 2007 [4,6] which were also not available for us to cite, since we have submitted our letter in October 2006. Also we observe conflict of data in the table summarizing the cases by year of publication by Sari et al. [5]. The cases presented by Lemburg and Kunimasa were shown to be published in 2006, whereas the articles were published in 2007 [4,6]. In addition, our case had been submitted in October 2006, whereas it was indexed in the table as 2007 by Sari et al. Although online publications serve for faster spread of knowledge it could not always be possible for the readers to review after full publication. The possibility of cases reported in journals not available to be reviewed globally could also change the real number of published cases of double RCA. We agree with the statement about importance of comprehensive literature search. Another crucial issue is to be objective and unbiased, without any conflicts in presented data. In conclusion double RCA is a rare coronary abnormality and awareness is recommended during coronary angiography.

The Comparison between Minimally Invasive Coronary Bypass Grafting Surgery and Conventional Bypass Grafting Surgery in Proximal LAD Lesion.

BACKGROUNDnMinimally invasive bypass grafting surgery has entered the clincal routine in several centers around the world, with an increasing popularity in the last decade. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal left anterior descending artery (LAD) lesions.nnnMETHODSnBetween January 2004 and December 2011, patients with proximal LAD lesions, who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery, were included in the study. In Group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy were applied to 35 patients and in Group 2, robotically assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative, and postoperative data were collected retrospectively.nnnRESULTSnThe mean follow-up time of the conventional bypass group was 5.7 ± 1.7 years, whereas this ratio was 7.3 ± 1.3 in the robotic group. There was no postoperative transient ischemic attack (TIA), wound infection, mortality, or need for intra-aortic balloon pump (IABP) in any of the patients. In the conventional bypass group, blood transfusion and ventilation time were significantly higher (P < .05) than in the robotic group. The intensive care unit (ICU) stay and hospital stay were remarkably shorter in the robotic group (P < .01). The postoperative pneumonia rate was significantly higher (20%) in the conventional bypass group (P < .01). Postoperative day 1 pain score was higher in the robotic group (P < .05), however, postoperative day 3 pain score in the conventional bypass group was higher (P < .05). Graft patency rate was 88.6% in the conventional bypass group whereas this ratio was 91.4% in the robotic bypass group, which was not clinically significant (P > .05).nnnCONCLUSIONSnIn isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

THE INTERACTION BETWEEN ENDOTHELIN-1 AND C-REACTIVE PROTEIN AND THEIR IMPACT ON LONG-TERM PROGNOSIS AFTER PERCUTANEOUS CORONARY INTERVENTION

Introduction: Previous studies have demonstrated unfavourable outcomes in coronary artery disease and percutaneous coronary intervention (PCI) patients with high endothelin-1 (ET-1) or high sensitivity C-reactive protein (hs-CRP) levels. The aim of our study was to investigate the impact of pre-procedural ET-1 and hs-CRP levels on major adverse coronary events (MACE) after PCI and to analyse a possible correlation between ET-1 and hs-CRP in this study population. Material and methods: Eighty consecutive PCI patients with a single de novo, non-occlusive coronary lesion were included. Blood samples were obtained immediately before the procedure. The study endpoint was the occurrence of MACE, which was defined as death (all causes), non-fatal myocardial infarction or repeat coronary revascularization (PCI or surgery). Results: At the end of the 24 months’ follow-up, 28 patients (35%) reached an end-point. We could not observe any correlation between ET-1 and hs-CRP in the overall patient group (r = 0.141, p = 0.213). Neither ET-1 nor hs-CRP levels were found to be predictive for MACE after PCI in multivariate analyses (p = 0.605 and 0.757 respectively). Conclusions: We could not demonstrate a relationship between pre-procedural ET-1 or hs-CRP levels and MACE at 24 months after successful PCI with single stent implantation to single de novo lesions. This study also could not show any correlation between ET-1 and hs-CRP levels in PCI patients.

Common Variants in the ATP-binding Cassette Transporter 1 Gene with Decreased HDL-Cholesterol Levels and Coronary Artery Disease

BACKGROUNDnOur aim was to determine whether the common variants within the coding sequence of ABCA1 gene affects low plasma high-density lipoprotein cholesterol (HDL-C) levels in Turkish patients with coronary artery disease (CAD). The study group was composed of 552 CAD patients, of which 251 had HDL-C levels < or =40 mg/dL, and 301 had HDL-C levels >40 mg/dL.nnnMETHODSnPCR-RFLP was used to determine the A2589G and G3456C DNA polymorphisms of the ABCA1 gene. The study group was analyzed for potential clinical predictors of low HDL-C.nnnRESULTSnThe GG variant of the ABCA1 gene A2589G polymorphism was found in 3.6% patients within the HDL-C < or =40 mg/dL group and in 4% of HDL-C levels >40 mg/dL group. Frequency distributions of the A2589G genotypes were not found to differ significantly among groups. The CC genotype of the G3456C polymorphism was found in 6.8% of HDL-C < or =40 mg/dL group and in 11.6% individuals of the HDL-C levels >40 mg/dL group. Frequency distributions of the G3456G genotypes were not significantly different among groups. The A2589G genotypes were not found to be effective over the analyzed lipid parameters. Among G3456C genotypes, in CAD patients with HDL-C < or =40 mg/dL the low-density lipoprotein (LDL-C) levels were elevated, whereas HDL-C levels decreased in CC genotype carriers compared to GG and GC.nnnCONCLUSIONSnNo significant association was found between cardiovascular endpoints and ABCA1 gene A2589G and G3456C genotypes in this study population.