Stable Coronary Disease Research Articles

Is the routine exercise test useful in stable coronary disease? An analysis of its value compared to exercise tests performed for prognostic purposes

Is the routine exercise test useful in stable coronary disease? An analysis of its value compared to exercise tests performed for prognostic purposes

Brain natriuretic peptide for prediction of mortality in patients with sepsis

Introduction Worldwide, sepsis is one of the leading causes of morbidity and mortality. Patients are at high risk for irreversible organ failure and a lethal course. About 60 000 individuals die from sepsis annually, and survivors have a reduced quality of life. In addition, sepsis places a considerable economic burden on the society. Early and comprehensive treatment improves outcome significantly. Brain natriuretic peptides (BNPs) are powerful predictors of death and major events in patients with stable coronary disease and pulmonary embolism. Several prospective studies have been carried out to investigate the potential role of BNPs in predicting mortality in septic patients in ICUs. The aim of this prospective study was to evaluate BNP for the prediction of mortality and myocardial dysfunction in severe sepsis and septic shock. Patients and methods This prospective study was carried out on 50 patients including group I, patients with sepsis, group (II), patients with severe sepsis, and group III, patients with septic shock. This study was carried out in the ICU of the Internal Medicine Department, Al-Zahraa University Hospital, in the period between January 2013 and March 2014 with written consents from our patients according to the ethical committee of the university. BNPs were determined by enzyme-linked immunosorbent assay. Results There was a highly statistical difference in the mean±SD of the BNP levels in group III (901.77±259.6) compared with group II (610.84±102.46), P value less than 0.01; also, there was a statistical difference in the BNP levels in group III (901.77±259.6) compared with group I (217.4±81.16), P value less than 0.01, whereas there was a statistically significant difference in group II (610.84±102.46) compared with group I (217.4±81.16), P value less than 0.05. In terms of the correlation between the BNP levels and other parameters of the patient groups, there was a highly positive significant correlation between BNP levels and the acute physiology and chronic health evaluation (APACHE II) score, the Sequential Organ Failure Assessment score, and white blood cells count. A significant positive correlation was found between BNP levels and prothrombin concentration (PC). There was a nonsignificant correlation between BNP and age, creatine phosphokinase, creatine kinase-MB, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, prothrombin time, international normalized ratio, and length of stay. Conclusion Our results suggested that an elevated BNP level may prove to be a powerful predictor of mortality in patients with sepsis. Future larger and more adequately powered prospective studies are warranted to clarify the prognostic value of BNPs in conjunction with other biomarkers.

Angioplasty of bifurcation with one stent: The best technique to optimize the result?

Bifurcation lesions account for 20% of all angioplasty performed. Several studies have shown that single-stent techniques compared to two-stent techniques offer better long-term results with less risk of restenosis and revascularization. However, there are little data about the best technique for optimizing the outcomes when performing single-stent angioplasty. The aim of the study was to compare the results of kissing, proximal optimization technique (POT), or combining the two techniques. Our study was retrospectively carried out over the period from January 2008 to December 2015 and included all patients who underwent true bifurcation angioplasty using the single-stent provisional technique. We compared the rate of restenosis and major cardiovascular events (MCV) in 3 groups: Group 1 = final kissing, group 2 = final POT alone and group 3 = kissing + POT. We included 125 patients with an average age of 61 ± 11 years, a male predominance was noted, 74% of our patients were diabetic and 68% were smokers. Angioplasty was performed in the context of stable coronary disease in 48%. Most of our patients have one vessel disease; the most frequently treated seat was the left anterior descending artery-diagonal bifurcation (72%). Most patients received kissing alone (group 1 = 82), 21 patients received POT alone and 22 patients were treated with kissing + POT. The MCV rate at 1 month ( P = 0.52) and 1 year ( P = 0.06) did not differ between the 3 groups. However, the target lesion revascularization rate was higher in the second group (group 1 = 12.06%, group 2 = 19.04% et group 3 = 13%, P = 0.04), this is because of a higher rate of restenosis in the side branch when performing POT. Our study asserts that during true bifurcation angioplasties, the POT technique is associated with a higher risk of restenosis of the side branch. Performing a final kissing balloon can reduce this risk.

Adequação das indicações de coronariografia eletiva para o diagnóstico de doença arterial coronária no sistema público de saúde brasileiro

ABSTRACT Background: The diagnosis of coronary artery disease is challenging because of the considerable variability in its clinical presentation. It also requires a cautious decision between invasive or conservative stratification. We aimed to evaluate the adequacy of coronary angiography indication in patients from the Unified Health System (SUS, in the Portuguese acronym) based on the guidelines for stable coronary disease. Methods: Consecutive patients who underwent coronary angiography between March 2014 and November 2015 were evaluated. Clinical presentation and functional tests [...]

Indicaciones de revascularización en angina estable

Stable angina is a clinical syndrome characterized by oppressive pain or chest discomfort which presents with physical activity, exercise, or emotional stress, and disappears with rest or the administration of nitrates. The comparison between revascularization (surgical or PTCA) versus medical treatment, with regard to quality of life, has shown a significant benefit from the invasive strategy in diminishing angina and the need for anti-anginal medications, as well as in improving the capacity for exercise and quality of life. In the management of stable coronary disease, it is crucial to understand that today, medical treatment and any revascularization strategy are complementary, rather than competitive, treatments.

IMPACT OF SMOKING STATUS ON SHORT TERM CLINICAL OUTCOMES OF DRUG ELUTING STENTS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

Objective: To evaluate the impact of smoking status on short-term clinicaloutcomes of Drug Eluting Stents (DES) in patients with stable coronary arterydisease. Methodology: This cross sectional study was carried out at the Department ofCardiology, Lady Reading Hospital Peshawar from April 2011 to July 2012. Itincluded all patients with stable coronary disease undergoing DES implantation.Smoking status was assessed on the basis of information obtained from hospitalmedical records at the time of first medical examination and rechecked bytelephone interview. All patients were classified as non-smokers and smokers.Clinical outcomes (Myocardial infarction [MI], unstable angina [UA], and positiveETT) at three months stratified by smoking status were measured in patients whoreceived DES for coronary artery lesions. All patients were followed andreassessed after 3 months from the index procedure. Exercise Tolerance Test(ETT) was performed on every patient and recorded on proforma. Data analysiswas done using SPSS version 16. Result: A total of 376 patients were enrolled in this study. The mean age was57±9.313 years. Males were 271(72.1%). Among 376 patients who werefollowed up, 70 of them were smokers (18.6%) at the index procedure, 306patients (81.4%) were non-smokers. The frequency of dyslipidemia and diabetesmellitus was higher in smokers as compared to non-smokers. Mean stent lengthin smokers was 27.824±6.23mm as compared to 26.592±4.73mm in nonsmokers.Mean stent diameter was 2.91±0.347mm in smoker group while itwas 3.01±0.141mm in non-smoker group. Most of the patients in both groupsunderwent DES implantation to LAD and LCx arteries. There were significantlyhigher rates of myocardial infarction (7.1% vs 2%, p<0.036),unstable angina(22.9% vs 3.3%, p<0.001) and positive ETT (30% vs 5.2%, p<0.001) in thesmoker group as compared to non-smoker group. Conclusion: This study provides evidence that smokers treated with DESexperience higher rates of myocardial infarction, unstable angina and positiveETT at three months as compared to non-smokers, particularly in the setting ofstable coronary artery disease. Key Words: Smokers, Coronary artery disease, Drug eluting stent

Triple Therapy Versus Dual Antiplatelet Therapy for Patients with Atrial Fibrillation and Acute Coronary Syndromes: A Systematic Literature Review.

Background: Patients with acute coronary syndromes (ACS) and a history of atrial fibril-lation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. We examined studies comparing clinical outcomes on DAPT versus TT for patients with AF and ACS.Methods: We searched Medline, Medline pending, EMBASE and Evidence-Based Medicine Re-views databases for studies published between January 2000 to December 2016 in AF patients with ACS that compared DAPT and TT that reported ischaemic and/or bleeding outcomes. Studies that were not purely an AF population were excluded.Results: Ten studies were included in the review, all of which were observational, 8 of which were retrospective. None of the studies detailed the specifics of treatment allocation. All but one were of AF patients with a mix of stable coronary disease and ACS patients. TT was associated with in-creased bleeding when compared to DAPT, with adjusted odds ratios ranging from 1.25 to 6.84. While the largest study reported a reduction in stroke associated with TT (odds ratio 0.67), two other studies reported non-significant increases in stroke with TT. Variable composite ischaemic endpoints were reported, none showing a statistical significant difference between DAPT and TT.Conclusion: In patients with ACS and AF, TT is likely to be associated with increased risk of bleed-ing, without a clear reduction in ischaemic endpoints. The quality of the evidence to support current guidelines for this patient group was generally poor.

TCT-638 Non-pharmaco, Non-invasive approach in treatment of coronary No-reflow phenomenon

No-reflow is a common complication of percutaneous coronary intervention (PCI) (primary, acute coronary syndrome, stable coronary disease and graft vessel disease) with adverse outcomes. Microvascular obstruction of downstream bed is the culprit. Intracoronary administration of various calcium

P851Apolipoprotein ciii and triglyceride correlate with the necrotic core of a lesion plaque in patients with stable coronary disease

P851Apolipoprotein ciii and triglyceride correlate with the necrotic core of a lesion plaque in patients with stable coronary disease

Applicability and procedural success rate of bioresorbable ­vascular scaffolds for percutaneous coronary intervention in an all-comer cohort of 383 consecutive patients

Objectives The purpose of this study was to determine applicability and procedural success of bioresorbable vascular scaffolds (BVS) for percutaneous coronary intervention (PCI) in an all-comer cohort.Background BVS use in bifurcations and severely calcified lesions is not recommended, and a relatively large crossing profile may cause limitations. It is has never been studied how widely BVS can be applied in all-comer cohorts.Methods In 383 consecutive patients (acute coronary syndrome: 124, stable coronary disease 259), a BVS (Absorb) was used as first-line device unless any of the following contraindications were present: bifurcation with side branch >2.0 mm, reference diameter <2.5 mm or >4.0 mm, required device length <12 mm, in-stent stenosis, or contraindications to 6 months of DAPT. Patients and lesions were evaluated regarding suitability for BVS treatment, procedural success (successful BVS placement and residual stenosis <30%), and outcome.Results Of 588 lesions, 303 (52%) were unsuitable for BVS placement due to presence of a bifurcation (30% of unsuitable lesions), reference ­diameter >4.0 mm (13%) or <2.5 mm (12%), contraindication to 6 months DAPT (13%), in-stent stenosis (14%), and desired device length <12 mm (4%). If BVS use was attempted, procedural success with a scaffold was 95% (271/285). Crossing failure occurred in 14 cases (5%), affected lesions were significantly more calcified. After a mean follow-up period of 259 days, definite/probable scaffold thrombosis occurred in 1.1% of patients.Conclusions Approximately one-half of lesions in an all-comer population can successfully be treated with BVS. Crossing failure is rare.

Heart rate and its reduction in chronic heart failure and beyond.

Heart rate (HR) is associated with cardiovascular outcomes in all the stages of the cardiovascular continuum as well as in patients with pulmonary, cerebrovascular, and renal disease, sepsis, cancer, and erectile dysfunction. In patients with cardiovascular disease, but also in the general population, increased HR represents an important indicator of mortality with each acceleration of HR over 70 b.p.m. increasing the risk. In patients in sinus rhythm with chronic heart failure with reduced ejection fraction (HFrEF), a HR >70 b.p.m. increased the risk of hospitalization, and >75 b.p.m. the risk of cardiovascular death as shown in the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT). Reducing HR with ivabradine by 11 b.p.m. (placebo-controlled) reduced the primary composite endpoint (cardiovascular death and hospitalization for worsening heart failure). Ivabradine was well tolerated showing benefit irrespective of age or diabetes status, and also in the presence of low systolic blood pressure and severe heart failure (SHIFT trial). Therefore, HR qualifies as a modifiable risk factor in heart failure. In patients with stable coronary disease, HR is a risk marker but HR reduction with ivabradine does not improve outcomes. The role of selective HR lowering remains unclear in patients with pulmonary, renal, cerebrovascular, and other diseases, as the potential benefit of interventions on HR has not been explored in these conditions. Future studies should scrutinize if HR reduction improves outcomes, defining HR as a potential risk factor and therapeutic target in other conditions beyond heart failure.

Analysis of percutaneous coronary interventions in a 10-year period (2005-2015) - a single center experience.

Background: Medicor was established as the third cardiovascular center in Slovenia and started with percutaneous cardiovascular interventions in 2005. The purpose of our study was to describe the features and results of percutaneous coronary intervention (PCI) performed between 2005 and 2015. Methods: Our retrospective descriptive study included consecutive patients undergoing PCI, who were enrolled in the PCI Registry. Patient characteristics, coronary anatomy, PCI features, use of coronary stents, procedural success and complications were investigated. Special emphasis was put on patients undergoing unprotected left main PCI. Results: During the study period, 1981 PCI procedures were performed. PCI patients were mainly men (73 %), their average age was 65+10 years and a majority (94 %) had stable coronary disease with mutivessel involvement (62 %). PCI was performed on 2978 lesions (1.50 lesion/patient) with an average diameter stenosis of 85+10 %. Target lesion was located either in the left anterior descending artery (42.9 %), right coronary artery (32.4 %), left circumflex artery (18.4 %), left main (3 %), surgical grafs (2.3 %) or in the intermediate artery (1 %). Balloon angioplasty alone was used in 9.6 % while other patients received 1 to 7 stents (1.44+0.86 per patient). Until 2009, drug eluting stents (DES) penetration ranged between 20 % and 30 %. It then increased to 80 % in 2012 and 100 % in 2015. PCI was angiographically successful in 95.2 %. Because of PCI complications, 4 patients (0.2 %) required immediate open-heart surgery and 4 patients (0.2 %) a surgical intervention at the femoral access site. Hospital mortality was 0 %. Stent thrombosis within 30 days was documented in 6 patients (0.3 %). In a subgroup of 58 patients undergoing unprotected lef main PCI, provisional stenting was used in 88 %. DES penetration was 94 %. PCI was angiografcally successful in all patients. Hospital and 30-day mortality rates were 0 %, 1-year mortality 1.7 % (95 % confidence interval 0–11 %) and 5-year mortality 13.8 % (95 % confidence interval 7–33 %). Target vessel revascularization at 5 years was 3.5 % (95 % confidence interval 0–23 %). Conclusion: PCI in patients with predominantly stable coronary artery disease in the Medicor Cardiovascular Center appears to be an effective and safe method of revascularization, which is also true for an intervention in unprotected left main.

Analiza izvajanja perkutanih koronarnih posegov v 10-letnem obdobju (2005–2015) – izkušnje enega centra

Background: Medicor was established as the third cardiovascular center in Slovenia and started with percutaneous cardiovascular interventions in 2005. The purpose of our study was to describe the features and results of percutaneous coronary intervention (PCI) performed between 2005 and 2015.Methods: Our retrospective descriptive study included consecutive patients undergoing PCI, who were enrolled in the PCI Registry. Patient characteristics, coronary anatomy, PCI features, use of coronary stents, procedural success and complications were investigated. Special emphasis was put on patients undergoing unprotected left main PCI.Results: During the study period, 1981 PCI procedures were performed. PCI patients were mainly men (73 %), their average age was 65+10 years and a majority (94 %) had stable coronary disease with mutivessel involvement (62 %). PCI was performed on 2978 lesions (1.50 lesion/patient) with an average diameter stenosis of 85+10 %. Target lesion was located either in the left anterior descending artery (42.9 %), right coronary artery (32.4 %), left circumflex artery (18.4 %), left main (3 %), surgical grafs (2.3 %) or in the intermediate artery (1 %). Balloon angioplasty alone was used in 9.6 % while other patients received 1 to 7 stents (1.44+0.86 per patient). Until 2009, drug eluting stents (DES) penetration ranged between 20 % and 30 %. It then increased to 80 % in 2012 and 100 % in 2015. PCI was angiographically successful in 95.2 %. Because of PCI complications, 4 patients (0.2 %) required immediate open-heart surgery and 4 patients (0.2 %) a surgical intervention at the femoral access site. Hospital mortality was 0 %. Stent thrombosis within 30 days was documented in 6 patients (0.3 %). In a subgroup of 58 patients undergoing unprotected lef main PCI, provisional stenting was used in 88 %. DES penetration was 94 %. PCI was angiografcally successful in all patients. Hospital and 30-day mortality rates were 0 %, 1-year mortality 1.7 % (95 % confidence interval 0–11 %) and 5-year mortality 13.8 % (95 % confidence interval 7–33 %). Target vessel revascularization at 5 years was 3.5 % (95 % confidence interval 0–23 %).Conclusion: PCI in patients with predominantly stable coronary artery disease in the Medicor Cardiovascular Center appears to be an effective and safe method of revascularization, which is also true for an intervention in unprotected left main.

The management of patients with stable coronary syndromes

In coronary artery disease, symptoms and prognosis are not closely linked and sudden unexpected death or devastating acute myocardial infarction may be the first manifestation. In treating patients with stable coronary disease, we wish to both relieve symptoms and prevent adverse outcomes. Percutaneous revascularization provides excellent symptom relief but has no positive prognostic benefit in patients with stable coronary disease. The lesion causing the angina, treated by a stent, is not necessarily the lesion determining prognosis. Simple lifestyle modification and drug therapy are important determinants of prognosis. Coronary bypass graft surgery improves prognosis in well-defined subsets of patients and the application of percutaneous interventions in patients who might be better served by surgery can be questioned. It can be argued that the emphasis placed on percutaneous intervention in patients with stable disease may have adverse consequences.

Patent haemostasis prevents radial artery occlusion in patients with an acute coronary syndrome

BackgroundA haemostatic technique that maintains radial artery flow (“patent haemostasis”) following transradial catheterization reduces rates of radial artery occlusion (RAO) in patients with stable coronary disease. It is unclear whether this benefit extends to patients with an acute coronary syndrome (ACS). MethodsPatients undergoing inpatient transradial catheterization for an ACS were prospectively enrolled in a consecutive cohort study (n=300). Radial haemostasis was obtained using standard radial compression (cohort 1; n=150) or patent haemostasis (cohort 2; n=150). An end-of-case activated clotting time (ACT) was recorded and radial artery patency assessed within 24 hours of sheath removal by reverse Barbeau's test. ResultsThe incidence of RAO was 16.0% following standard radial compression and 5.3% following patent haemostasis (p=0.003). Univariate predictors of RAO were patent haemostasis (OR 0.30; [0.13–0.68], p=0.004), hyperlipidaemia (OR 0.46; [0.21–0.98], p=0.04), history of current smoking (OR 2.86; [1.3–6.0], p=0.015) and longer procedure times (OR 1.03/additional minute; [1.01–1.05], p=0.003). There was no association between the end-of-case ACT and RAO (OR 1.00; [0.9–1.01] p=1.00). After adjusting for covariates, patent haemostasis reduced the risk of RAO by 70% compared to standard compression (OR 0.30; [0.12–0.77], p=0.12). The c-statistic for model discrimination was 0.79 (95% CI [0.71–0.86], p<0.001). Inverse probability treatment weighted analysis also confirmed patent haemostasis as an independent predictor of reduced RAO (OR 0.38 [0.15–0.95], p=0.039). ConclusionPatent haemostasis is highly effective in preventing early RAO in patients with ACS.

A COST-EFFECTIVE ANALYSIS OF SHORT DURATION DUAL ANTI-PLATELET THERAPY (DAPT) WITH A BIOABSORBABLE POLYMER STENT PLATFORM VERSUS LONGER DURATION DAPT WITH A DURABLE POLYMER DRUG-ELUTING STENT IN A PATIENT POPULATION UNDERGOING ELECTIVE PERCUTANEOUS CORONARY INTERVENTION

Background: Guidelines recommend 6 months of dual antiplatelet therapy after PCI with drug-eluting stents (DES) in stable coronary disease (CAD). Whether treatment with bioabsorbable polymer (BP) DES followed by a shorter duration of dual antiplatelet therapy is cost-effective is unknown. Methods:

Safety and Feasibility of Outpatient Percutaneous Coronary Intervention in Selected Patients: A Spanish Multicenter Registry

Introduction and objectivesThe exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. MethodsProspective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24hours and 30 days. Safety and feasibility were analyzed. ResultsOf the 723 patients included (76% male; age, 66.6±10.5 years), 533 (73.7%) were finally discharged after 4 to 12hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. ConclusionsThe application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours’ surveillance is safe and feasible in well-selected patients.

Impact of stent length and diameter on short term clinical outcomes of drug eluting stents in patients with stable coronary artery disease

Background & Objective:The risk of restenosis and other adverse cardiovascular events with bare-metal stents have increased with smaller stent diameters and longer stent lengths. However, the exact impact of stent size on the short-term outcomes of drug-eluting stent (DES) implantations has not been much classified in Pakistani population. This study was designed to evaluate the impact of size (length and diameter) of Drug Eluting Stents on Clinical outcomes in patient with stable coronary artery disease at three months of implantation in Pakistani Population.Methods:This is a prospective study which was carried out in the Department of Cardiology, Lady Reading Hospital Peshawar from April 2011 and July 2012. All consecutive patients with stable coronary disease undergoing Percutaneous Intervention (PCI) with DES implantation at Cardiology Unit Lady Reading Hospital, were included prospectively. Clinical outcomes (Myocardial infarction [MI], unstable angina[UA], and positive ETT) at three months stratified by 3 tertiles of stent length and diameter each, were measured in patients who underwent PCI with DES for coronary artery lesions. All patients were followed and reassessed after three months from the index procedure. Exercise Tolerance Test(ETT) was performed on every patient and recorded on proforma. Data analysis was done using SPSS software version 16.Results:A total of 376 patients were included prospectively in this study. The mean age was 57±9.313 years. Male patients were 271(72.1%). Mean length of drug eluting stent was 27.313±7.235 mm while mean diameter of stent was 2.90±0.2483mm. There were slightly higher rates of MI, U.A and positive ETT in the longest stent length tertile(>28mm) compared with the shortest stent length tertile (<22mm) at three months, but they were statistically not significant. We also observed that for DES, there was no clear relationship between stent diameter and outcome for any of the clinical outcome variables.Conclusion:In our single-center prospective study, stent length and diameter defined in tertiles, had no impact on the short-term clinical outcomes of DES in patients with stable coronary artery disease.

Aortic valve sclerosis is associated with the extent of coronaryartery disease in stable coronary artery disease.

Aortic valve sclerosis (AVS) is characterized by lipid deposition and calcific infiltration on the edge of aortic leaflets without significant restriction of motion. The SYNTAX Score (SS) is an important method for evaluating coronary artery disease (CAD). Many studies showed that there is an important relation between the SS and undesired cardiac outcomes. In our study, we investigated the correlation between the SS and AVS by including both ACS and stable CAD cases. We enrolled 543 patients with CAD who underwent coronary angiography into this cross-sectional study between September 2013 and September 2014. The study population was divided into two groups according to SS values above and below 22. Diabetes mellitus (DM) incidence was greater in the group with high SS values (26.3% vs. 19.2%, P = 0.052.). Left ventricular ejection fraction (LVEF) and glomerular filtration rate were lower. Low-density lipoprotein cholesterol and triglyceride levels were lower while platelet counts were higher. In multivariate analysis, for the stable coronary artery group AVS existence, platelet count, LVEF value, and chronic obstructive pulmonary disease were found as independent predictors. Our study results demonstrated that AVS is significantly associated with the complexity of CAD, especially in patients with stable CAD. This study provides new information regarding the role of AVS in CAD complexity.

The changes of oxidative stress and endothelial function biomarkers after 6 weeks of aerobic physical training in patients with stable ischemic coronary disease

Introduction: Exercise-based cardiac rehabilitation improves endothelialBackground/Aim. Exercise-based cardiac rehabilitation improves endothelial function, reduces cardiac mortality and anginal symptoms in patients with established cardiovascular disease. We evaluated the changes of oxidative stress and endothelial function biomarkers after 6 weeks of aerobic physical training in patients with stable ischemic coronary disease (IHD) participating in a cardiovascular rehabilitation exercise program. Methods. Thirty-five patients with stable IHD engaged in cardiovascular rehabilitation program with the regular aerobic physical activity during 6 weeks were consecutively included together with 37 control, age and sex-matched, IHD patients with a sedentary lifestyle. Clinical data about anthropometric and cardiovascular parameters and laboratory data: serum cell adhesion molecules intracellular (sICAM-1) and vascular (sVCAM-1), reactive carbonyl derivatives (RCD), lipid peroxidation products malondialdehyde (MDA) and nitric oxide (NO) concentration were determined at the beginning and after 6 weeks of aerobic training (45 minutes of continuous exercise up to 80% of maximal heart rate, 3 times a week). Results. The baseline characteristics of examined groups were similar according to age, gender, and cardiovascular risk profiles. The regular aerobic physical activity induced significant reduction of body mass index, blood pressure, heart rate, triglycerides, RCD (1.27 ? 0.48 ?mol/g proteins vs. 1.04 ? 0.22 ?mol/g proteins), sVCAM-1 [100.4, interquartile range (IQR)(78.4?118.3) ng/mL vs. 80.0 IQR(68.5?97.2 ng/mL)] and increasing of NO (64.72 ? 16.06 nmol/mg proteins vs. 74.38 ? 18.57 nmol/mg proteins) and HDL cholesterol (p &lt; 0.05), which was not seen in sedentary control RCD (1.16 ? 0.25 interquartile range vs. 1.12 ? 0.14 interquartile range), sVCAM-1 [92.2 IQR (73.6?106.8 ng/mL) vs. 91.3 IQR (73.0?105.3 ng/mL) and NO (68.5 ? 17.9 nmol/mg vs. 65.7 ? 19.6). The values of sICAM-1 were lower in exercise training group baseline without significant changes during observation [80.74 IQR (54.92?97.3) vs. 80.36 IQR (68.1?95.3)] compared to the control