Early vs Late Coronary Angiography and Intervention Following Thrombolytic Therapy; a Cohort Study

Introduction: The precise time of using percutaneous coronary intervention (PCI) after fibrinolytic therapy for maximum efficiency and minimum side effects is still undetermined. Therefore, the present study was designed to compare the outcome of myocardial infarction (MI) patients who underwent surgical intervention (angiography and PCI) within 48 hours of thrombolytic therapy or after that.Methods: The present study is a prospective cohort study aiming to compare the occurrence of no-reflow phenomenon, unstable angina, bleeding during intervention, and one month major adverse cardiac outcomes (recurrent MI, need for repeating surgical intervention, and mortality) between MI patents undergoing surgical intervention within the first 48 hours of or after 48 hours of thrombolytic therapy.Results: 90 patients with the mean age of 54.97 ± 10.54 were studied (86.67% male). 50 (56%) patients underwent surgical intervention within 48 hours and 40 (44%) after that. The 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon in the < 48 hours group was about twice the > 48 hours group (OR = 0.35; 95% confidence interval: 0.14 – 0.92; p = 0.03), other outcomes were not significantly different. No case of mortality was seen in the 1 month follow up.Conclusion: Based on the results of the present study, it seems that no-reflow phenomenon rate is significantly lower in patients undergoing surgical intervention after 48 hours of fibrinolytic therapy. The difference between the two groups regarding prevalence of major adverse cardiac outcomes was not statistically significant

Genetic Polymorphisms of CYP2C19 and Resistance to Clopidogrel Therapy among Iranian Patients Suffering from Ischemic Heart Disease

Background: Clopidogrel is a standout amongst the most ordinarily recommended medications to avoid ischemic occasions taking after coronary disorder or stant position. However, impaired responses the therapy as well as resistance to the therapy have also been reported. Genetic variants play an important role in clopidogrel biotransformation of its active metabolite that may subsequently influence the antiplatelet effect of clopidogrel. The objective of this study was to evaluate the prevalence of the cytochrome P450 (CYP450) 2C19 enzyme (CYP2C19) genotypes which are involved in the activation of clopidogrel in a random Iranian population of various ethnic groups (Persian, Azari, Kurd, etc.). Molecular analysis of CYP2C19 polymorphisms may be helpful in the determination of optimal antiplatelet therapy. Materials and Methods: CYP2C19 (*1/*2/*3) variants were assessed by Polymerase Chain Reaction-Restriction Length Polymorphism (PCR–RFLP) assays in a representative sample of 154 Iranian patients with ischemic heart disease. Results: The frequencies of CYP2C19 *1 (normal genotype), *2 (heterozygote) and *3 (homozygote) were 112 (72.7%), 36 (23.4%) and 6 (3.9%), respectively. Conclusion: The United States Food and Drug Administration (FDA) recommendations are more useful to be practiced in our country compared with other countries. Physicians should identify poor metabolizers for consideration of other antiplatelet medications or alternative dosing strategies

Evaluation of Underlying Coronary Stenosis Severity in Patients with Acute MI after Thrombus Aspiration Using Export Catheter

Background: Early clinical and retrospective angiographic evaluations indicated that in patients with acute myocardial infarction (MI), vulnerable plaques most often represented a mild luminal stenosis. More recent studies drawing upon prospective angiograms, however, have demonstrated that in majority of patients with acute MI, the underlying stenosis is significant.Methods: Twenty-eight patients with acute MI candidated for thrombectomy were enrolled in this study. Thrombectomy was performed using export thrombectomy catheters. After the injection of nitroglycerin, the severity of the lesions was determined by two independent operators.Results: Between April 2007 and February 2008, 28 patients, comprised of 26 men and 2 women with acute MI, were evaluated. The underlying stenosis severity was ≥50% in 22 (78.6%) patients and <50% in the remaining 6 (20.4%) patients (P value <0.01). The right coronary artery was the most common vessel involved in the lesions <50%.Conclusion: Contrary to the general belief of many cardiologists, the majority cases of myocardial infarction occur in consequence of significant stenoses