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P56 PAI I gene polymorphism in patients with coronary heart disease and malignant ventricular arrhythmias
Session X: Arteriosclerosis
P55 Lesion Morphology and Plasma Levels of C-Reactive Protein after
Coronary Stent Implantation MICHAEL GOTTSAUNER-WOLF, GREGOR ZASMETA, STEPHAN HORNYKEWYCZ, MARIAM NIKFARDJAM, ANAHIT ANVARI, GERLINDE ZORN, GERALD MAURER, AND KURT HUBER Department of Cardiology, University of Vienna, Austria
Aim of the study was to investigate the influence of lesion type morphology on C-reactive protein (CRP) plasma-levels after elective coronary stem implantation. Methods: CRP plasma-levels (NycoMedTM, Heilmittelwerke, Vienna, Austria) were obtained before and serially (up to 120 hours) after successful coronary intervention (percent diamter stenosis _<30%) in 40 consecutive patients. Quantitative coronary angiography was performed pre and post stent implantation. Lesion type morphology was determined according to the ACC/AHA guidelines. Results: CRP-levels increased significantly (P < 0.0001) during the first 120 hours after stem implantation. CRP plasma-levels were significantly higher in patients with lesion type C (n = 10) compared to type A (n = 23) and B (n= 7) (P< 0.017).
+
o
0
Type A ---{]----
, pre
1'2
2'4
j 36
Type B
418
6'0
_
712
Type C
i 916 120
hours after stent implantation Conclusion: Inflammatory reaction to coronary stent implantation, as expressed by temporary CRP-elevation, seems to be related to the initial morphology of the treated coronary lesion.
P56 PAl I gene polymorphism in patients with coronary heart disease and malignant ventricular arrhythmias ANAHIT ANVARI, ZEYNEP TOREL, MICHAEL GOTTSAUNER-WOLF, KURT HUBER Department of Cardiology, University of Vienna, Austria
Background: It has been reported that the 4G/5G polymorphism of the plasminogen activator inhibitor I (PAI-I) gene, as a marker for exposure to different levels of PAId, is involved in the pathogenesis of coronary thrombosis, with greatest risk in subjects possessing the 4G/4G genotype. As reported before myocardial ischemic events, even in the absence of acute myocardial infarction, may play an adjunctive role for generation of the fatal arrhythmias in patients with coronary artery disease. In this setring PAI-I genotype may be of relevance for development of malignant arrhythmias in these patients.
109
Results: The difference in the distribution of the PAI-I genotypes between the two group was statisticaly significant (P< 0.01): PAI-I genotypes
ICD n=97
Control n=117
4G/4G: (%) 4G/5G: (%) 5G/5G: (%)
44 (45) 44 (45) 9 (10)
30 (25) 70 (60) 17 (15)
In Conclusion: our results support the hypothesis that the PAI-I genotype may present an independent risk factor for malignant ventricular arrhythmias in patients suffering from coronary artery disease. Regarding the potential relevance of this gene in the modulation of ventricular arrhythmias, further studies with more statistical power are needed to confirm these findings.
P57 Laboratory-based diagnosis of acute coronary syndromes: Results of the NOW|S pilot study R. GAREIS, T. STORK, M. MOCKEL 1, R. MOLLER2, H. EICHSTJ~D-P Dpt. of Cardiology & Angiology, Karl-Olga-Krankenhaus, Stuttgart, Germany, ~Dpt. of Nephrologylntensive Care, ChariM, Berlin, Germany, 2Dpt. of Public Health, James-Cook-Universit)4 Townsville, Australia
The North-I4rfirttemberg Infarction Study (NOWIS) prospectively evaluates the clinical value of the assessment of CK/CK-MB, troponin T and myoglobin in unstable angina (UAP) and suspected acute myocardial infarction (AMI). Methods: In 55 patients (26 women, 29 men), median age 67 years (range 38-89 years), with acute coronary syndrom (suspected AMI or UAP) CK/CK-MB, myoglobin and troponin T were assessed on admission (0 hours), after 4 and 24 hours and, in patients receiving i.v. thrombolysis, also after 2 hours. Results: (1) AML After 4 hours sens. for the diagnosis AMI was 74% for CK and 86% for myoglobin. The combination of a normal CK and an elevated myoglobin was highly specific for the diagnosis AMI after 4 hours (97%). Troponin showed best spec. with 100%. (2) Risk stratification. MMD (troponin T positiv UAP) was present in 11 out of 19 patients with UAP. Four patients (36%) of whom developed AMI. No AMI was seen in the 8 patients with negative troponin T. (3) Assessment of repe~fusion. Coronary angiography showed successful reperfusion in 14 out of 19 patients. In 13/14 patients with effective thrombolysis the myoglobin ration (hour 2/0) was beyond 5 (sens. 93%, spec. 100%), in 1 patient between 4 and 5. In patients with ineffective reperfusion the myoglobin ratio was less than 4. Conclusions: (1.) CK and myoglobin are sensitive markers for a fast primary diagnosis of AMI. Spec. can be increased by combined interpretation of both markers (>95). (2.) Troponin T is a very good marker for risk stratification in UAP (36% AMI in patients with positive troponin T, MMD). (3.) A myoglobin ratio (hour 2 / hour 0) above 5 indicates a successful thrombolysis of AMI.
Methods: In this study the frequency distribution of the PAI-I gene polymorphism with regard to malignant ventricular arrhythmias in patients with coronary artery disease was determined. Ninty seven patients with a history of malignam ventricular arrhythmias and implantable cardioverter defibrillator (ICD group, mean age 63 + 9 years, 83% male) and 117 patients without a history of malignant arrhythmias (comrol group, mean age 62 + 10 years, 780/0male) were included. The patients were comparable with regard to the duration of the coronary artery disease, the history of previous myocardial infarction and left ventricular ejection fraction.
© Harcourt Brace & Co. Ltd 1998
Fibrinolysis & Proteolysis (1998) 12(Suppl 2), 91-113
P55 Lesion Morphology and Plasma Levels of C-Reactive Protein after
Coronary Stent Implantation MICHAEL GOTTSAUNER-WOLF, GREGOR ZASMETA, STEPHAN HORNYKEWYCZ, MARIAM NIKFARDJAM, ANAHIT ANVARI, GERLINDE ZORN, GERALD MAURER, AND KURT HUBER Department of Cardiology, University of Vienna, Austria
Aim of the study was to investigate the influence of lesion type morphology on C-reactive protein (CRP) plasma-levels after elective coronary stem implantation. Methods: CRP plasma-levels (NycoMedTM, Heilmittelwerke, Vienna, Austria) were obtained before and serially (up to 120 hours) after successful coronary intervention (percent diamter stenosis _<30%) in 40 consecutive patients. Quantitative coronary angiography was performed pre and post stent implantation. Lesion type morphology was determined according to the ACC/AHA guidelines. Results: CRP-levels increased significantly (P < 0.0001) during the first 120 hours after stem implantation. CRP plasma-levels were significantly higher in patients with lesion type C (n = 10) compared to type A (n = 23) and B (n= 7) (P< 0.017).
+
o
0
Type A ---{]----
, pre
1'2
2'4
j 36
Type B
418
6'0
_
712
Type C
i 916 120
hours after stent implantation Conclusion: Inflammatory reaction to coronary stent implantation, as expressed by temporary CRP-elevation, seems to be related to the initial morphology of the treated coronary lesion.
P56 PAl I gene polymorphism in patients with coronary heart disease and malignant ventricular arrhythmias ANAHIT ANVARI, ZEYNEP TOREL, MICHAEL GOTTSAUNER-WOLF, KURT HUBER Department of Cardiology, University of Vienna, Austria
Background: It has been reported that the 4G/5G polymorphism of the plasminogen activator inhibitor I (PAI-I) gene, as a marker for exposure to different levels of PAId, is involved in the pathogenesis of coronary thrombosis, with greatest risk in subjects possessing the 4G/4G genotype. As reported before myocardial ischemic events, even in the absence of acute myocardial infarction, may play an adjunctive role for generation of the fatal arrhythmias in patients with coronary artery disease. In this setring PAI-I genotype may be of relevance for development of malignant arrhythmias in these patients.
109
Results: The difference in the distribution of the PAI-I genotypes between the two group was statisticaly significant (P< 0.01): PAI-I genotypes
ICD n=97
Control n=117
4G/4G: (%) 4G/5G: (%) 5G/5G: (%)
44 (45) 44 (45) 9 (10)
30 (25) 70 (60) 17 (15)
In Conclusion: our results support the hypothesis that the PAI-I genotype may present an independent risk factor for malignant ventricular arrhythmias in patients suffering from coronary artery disease. Regarding the potential relevance of this gene in the modulation of ventricular arrhythmias, further studies with more statistical power are needed to confirm these findings.
P57 Laboratory-based diagnosis of acute coronary syndromes: Results of the NOW|S pilot study R. GAREIS, T. STORK, M. MOCKEL 1, R. MOLLER2, H. EICHSTJ~D-P Dpt. of Cardiology & Angiology, Karl-Olga-Krankenhaus, Stuttgart, Germany, ~Dpt. of Nephrologylntensive Care, ChariM, Berlin, Germany, 2Dpt. of Public Health, James-Cook-Universit)4 Townsville, Australia
The North-I4rfirttemberg Infarction Study (NOWIS) prospectively evaluates the clinical value of the assessment of CK/CK-MB, troponin T and myoglobin in unstable angina (UAP) and suspected acute myocardial infarction (AMI). Methods: In 55 patients (26 women, 29 men), median age 67 years (range 38-89 years), with acute coronary syndrom (suspected AMI or UAP) CK/CK-MB, myoglobin and troponin T were assessed on admission (0 hours), after 4 and 24 hours and, in patients receiving i.v. thrombolysis, also after 2 hours. Results: (1) AML After 4 hours sens. for the diagnosis AMI was 74% for CK and 86% for myoglobin. The combination of a normal CK and an elevated myoglobin was highly specific for the diagnosis AMI after 4 hours (97%). Troponin showed best spec. with 100%. (2) Risk stratification. MMD (troponin T positiv UAP) was present in 11 out of 19 patients with UAP. Four patients (36%) of whom developed AMI. No AMI was seen in the 8 patients with negative troponin T. (3) Assessment of repe~fusion. Coronary angiography showed successful reperfusion in 14 out of 19 patients. In 13/14 patients with effective thrombolysis the myoglobin ration (hour 2/0) was beyond 5 (sens. 93%, spec. 100%), in 1 patient between 4 and 5. In patients with ineffective reperfusion the myoglobin ratio was less than 4. Conclusions: (1.) CK and myoglobin are sensitive markers for a fast primary diagnosis of AMI. Spec. can be increased by combined interpretation of both markers (>95). (2.) Troponin T is a very good marker for risk stratification in UAP (36% AMI in patients with positive troponin T, MMD). (3.) A myoglobin ratio (hour 2 / hour 0) above 5 indicates a successful thrombolysis of AMI.
Methods: In this study the frequency distribution of the PAI-I gene polymorphism with regard to malignant ventricular arrhythmias in patients with coronary artery disease was determined. Ninty seven patients with a history of malignam ventricular arrhythmias and implantable cardioverter defibrillator (ICD group, mean age 63 + 9 years, 83% male) and 117 patients without a history of malignant arrhythmias (comrol group, mean age 62 + 10 years, 780/0male) were included. The patients were comparable with regard to the duration of the coronary artery disease, the history of previous myocardial infarction and left ventricular ejection fraction.
© Harcourt Brace & Co. Ltd 1998
Fibrinolysis & Proteolysis (1998) 12(Suppl 2), 91-113