BACKGROUND/AIMS: In patients with coronary artery stents, the cost of clopidogrel has been cited as a factor in the premature discontinuation of therapy. Thus, the introduction of lower-cost generic clopidogrel may increase patient compliance. However, platelet inhibition by generic clopidogrel has not been compared to the original clopidogrel formulation in patients with coronary artery stents. METHODS: We prospectively enrolled 20 patients receiving chronic therapy with the original clopidogrel bisulfate (Plavix(R)). After assessing patient compliance with Plavix(R), maintenance therapy was switched to generic clopidogrel bisulfate (Plavitor(R)). Platelet reactivity was assessed at baseline and 30-day after the switch using conventional aggregometry and the VerifyNow P2Y12 assay. RESULTS: All patients completed maintenance therapy with Plavitor(R). Before and after switching therapy maximal (36.5 +/- 7.9% vs. 39.8 +/- 16.2%, p = 0.280) and late platelet aggregation (23.5 +/- 10.9% vs. 29.1 +/- 18.3%, p = 0.156) with 5 micromol/L adenosine diphosphate (ADP) stimulus did not differ. Likewise, 20 micromol/L ADP-induced platelet aggregation and P2Y12 reaction unit in patients on Plavitor(R) therapy was comparable to that in patients on Plavix(R) therapy. However, Bland-Altman analysis showed wide limits of agreement between measured platelet reactivity on Plavix(R) vs. Plavitor(R) therapies. CONCLUSIONS: Among patients on Plavix(R) maintenance therapy with coronary stents, replacement with Plavitor(R) shows a comparable inhibition of ADP-induced platelet aggregation. However, due to poor inter-therapy agreement, between two regimens, physicians may be cautious when introducing generic clopidogrel bisulfate.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Combined Modality Therapy ; Coronary Artery Disease/*drug therapy/therapy ; *Drug-Eluting Stents ; Drugs, Generic/*administration & dosage/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Compliance ; Platelet Aggregation/drug effects ; Platelet Aggregation Inhibitors/*administration & dosage/adverse effects ; Prospective Studies ; Receptors, Purinergic P2/metabolism ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives

The post cardiac injury syndrome is characterized by the development of a fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks following trauma to the pericardium or myocardium. According to previous reports, almost all cases develop after major cardiac surgery or a myocardial infarction. Recently, a few reports have described post cardiac injury syndrome as a complication of endovascular procedures such as percutaneous cardiac intervention. Here we describe an unusual case of post cardiac injury syndrome after a percutaneous coronary intervention.
Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Heart Diseases/diagnosis/*etiology ; Humans ; Male ; Middle Aged

Based on data comparing coronary-artery bypass grafting (CABG) with medical therapy, the current guidelines recommend CABG as the treatment of choice for patients with left main coronary artery (LMCA) disease. Percutaneous coronary intervention (PCI) can be selectively performed in patients who are candidates for revascularization but who are ineligible for CABG. Current evidence indicates that stenting results in mortality and morbidity rates compared favorably with those seen after CABG. Data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to choose PCI with stenting as an alternative treatment option for such patients. In addition, these data may inform future guidelines and support the need for well-designed, adequately powered, prospective, randomized trials comparing the two revascularization strategies.
Angioplasty, Transluminal, Percutaneous Coronary/adverse effects/*methods ; Coronary Artery Bypass/*methods ; Coronary Artery Disease/*surgery/*therapy ; Humans ; Stents/adverse effects

Rupture of the sinus of Valsalva is an extremely rare complication after percutaneous coronary intervention (PCI). Because it usually results from the retrograde extension of a dissection of the right coronary artery and may quickly spread to involve the entire aorta, it can cause life-threatening complications such as aortic dissection. If the dissection remains localized, it can resolve spontaneously in the first month. Our patient experienced a delayed rupture of the right sinus of Valsalva into the right atrium at approximately 3 months after PCI.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Aortic Rupture/*etiology ; Echocardiography, Transesophageal ; Heart Atria/*pathology ; Humans ; Male ; *Sinus of Valsalva ; Time Factors

PURPOSE: This study was designed as a multicenter, randomized, open-label study to evaluate the efficacy and tolerability of Clotinab(TM). We expected to obtain same results as with ReoPro(R) in improving ischemic cardiac complications in high-risk patients who were about to undergo percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Patients of 19-80 years of age with acute coronary syndrome (ACS) who were about to undergo PCI were enrolled. After screening and confirmation of eligibility, patients were randomly assigned to different groups. Clotinab(TM) was given to 84 patients (58.7+/-10.6 years, M:F=68:16)and ReoPro(R)(59.0+/-10.5 years, M:F=30:10) was given to 40 patients before PCI. The primary efficacy endpoint was the onset of major adverse cardiac event (MACE) within 30 days from day 1. The tolerability endpoints were assessed based on bleeding, thrombocytopenia, change in Hb/Hct, human antichimetric antibody development, and adverse events. RESULTS: The number of Clotinab(TM) patients experiencing MACE was 0 out of 76 per protocol (PP) patients. The MACE rate was 0%, and its 95% exact CI was [0.00-4.74%]. A major bleeding event developed in 3 patients in the ReoPro(R) group. The probability of MACE onset in Clotinab(TM) was estimated to be less than 5%. There was no clinically significant result in tolerability variables. CONCLUSION: Clotinab(TM) is an effective and safe medicine in preventing ischemic cardiac complications for high-risk patients who will receive PCI.
Acute Coronary Syndrome/surgery ; Adult ; Aged ; Aged, 80 and over ; *Angioplasty, Transluminal, Percutaneous Coronary ; Antibodies, Monoclonal/adverse effects/*therapeutic use ; Drugs, Investigational/adverse effects/therapeutic use ; Female ; Humans ; Immunoglobulin Fab Fragments/adverse effects/*therapeutic use ; Male ; Middle Aged ; Myocardial Ischemia/prevention & control ; Platelet Aggregation Inhibitors/adverse effects/*therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors ; Prospective Studies ; Risk Factors ; Treatment Outcome

Glycoprotein (GP) IIb/IIIa inhibitors, such as abciximab, are used as adjunctive therapy for percutaneous coronary intervention (PCI) in high-risk non-ST-elevation myocardial infarction (NSTEMI) and in ST-elevation myocardial infarction (STEMI), although their effects when used for STEMI are less clear. As the use of GP IIb/IIIa inhibitors becomes more widespread, determining the risks associated with them becomes more important. The major risks associated with the use of GP IIb/IIIa inhibitors are the potential for major bleeding and thrombocytopenia. This is the first reported case in Korea of hemorrhagic pericarditis resulting in cardiac tamponade associated with the use of abciximab, a commonly used GP Ilb/IIa inhibitor, following PCI.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Antibodies, Monoclonal/*adverse effects ; Anticoagulants/*adverse effects ; Cardiac Tamponade/*etiology/therapy ; Emergency Medical Services ; Hemorrhage/*etiology/therapy ; Humans ; Immunoglobulin Fab Fragments/*adverse effects ; Korea ; Male ; Pericardiocentesis ; Pericarditis/*etiology/therapy ; Platelet Aggregation Inhibitors/*adverse effects ; Risk Factors

BACKGROUND: Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. METHODS: The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed. RESULTS: The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1 % vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046). CONCLUSIONS: The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.
Aged ; *Angioplasty, Transluminal, Percutaneous Coronary/adverse effects ; *Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/complications/surgery/*therapy ; *Diabetic Nephropathies/complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome

Insulin resistance is an important risk factor for coronary artery disease. However, there has been no data regarding its clinical effect on the outcomes of percutaneous coronary intervention (PCI) in non-diabetic patients. We analyzed 98 non-diabetic consecutive patients (59+/-11.5 yr, male:female=63:35) who underwent elective coronary angiography. The patients were divided into two groups: Group I (n=71; the value of HOMA-IR [homeostasis model assessment of insulin resistance] <2.6) and Group II (n=27; the value of HOMA-IR > or = 2.6). In-hospital and 30-day major adverse cardiac events (MACE) were compared between the two groups. The concentrations of fasting insulin and triglyceride were significantly higher in Group II than in Group I. Significant correlations were observed between the value of HOMA-IR and body mass index (r=0.489, p<0.001), levels of total cholesterol (r=0.204, p=0.045), triglyceride (r=0.334, p=0.001) and apolipoprotein B (r=0.212, p=0.038). PCI was performed in 59 patients (60.2%). In-hospital and 30-day MACE were higher in Group II than Group I (2.4% vs. 27.8%, p=0.008; 2.4% vs. 27.8%, p=0.008). Multivariate analysis revealed that the value of HOMA-IR > or = 2.6 was an independent predictor of MACE. Increased HOMA-IR level is an important prognostic indicator in non-diabetic patients underwent PCI.
Prognosis ; Models, Biological ; Middle Aged ; Male ; *Insulin Resistance ; Humans ; Homeostasis ; Female ; Coronary Stenosis/blood/physiopathology/therapy ; Coronary Arteriosclerosis/blood/physiopathology/therapy ; *Angioplasty, Transluminal, Percutaneous Coronary/adverse effects ; Aged

We evaluated the feasibility of the transradial coronary intervention (TRCI) in 85 consecutive patients with chronic total occlusion (CTO). Clinical, angiographic and procedural factors were compared between the success and failure groups. An overall success rate of 65.5% (57 of 87 lesions) was achieved with TRCI, and the most common cause of failure was an inability to pass the lesion with a guidewire. A multivariate analysis demonstrated that the most significant predictor of failure was the duration of occlusion (OR 1.064 per month, 95% CI 1.005 to 1.126, p = 0.03). The procedural success rate improved with use of new-generation hydrophilic guidewires. The 6 Fr guiding catheters were used in the majority of the 70 cases (81%). Five cases were crossed over to a femoral artery approach due to engagement failure of the guiding catheter into the coronary ostium because of severe subclavian tortuosity and stenosis in two cases, radial artery looping in one case, and poor guiding support in two cases. There were no major entry site complications. In conclusion, the radial artery might be a feasible vascular route in coronary interventions for CTO, with comparable procedural success and no access site complications.
Treatment Outcome ; Radial Artery/surgery ; Intraoperative Complications ; Humans ; Feasibility Studies ; Coronary Disease/diagnosis/*therapy ; Angioplasty, Transluminal, Percutaneous Coronary/adverse effects/*methods

Acute myocardial infarction (AMI) is rare in patients with idiopathic thrombocytopenic purpura (ITP). We describe a case of an AMI during thrombocytopenia in a patient with chronic ITP. A 47-yr-old woman presented with anterior chest pain and a low platelet count (21,000/microliter) at admission. Urgent coronary angiography revealed total occlusion of proximal right coronary artery and primary percutaneous coronary intervention (PCI) was performed successfully. This case suggests that primary PCI may be a therapeutic option for an AMI in patients with ITP, even though the patient had severe thrombocytopenia.
Purpura, Thrombocytopenic, Idiopathic/*complications/drug therapy ; Myocardial Infarction/*complications/*therapy ; Middle Aged ; Immunoglobulins, Intravenous/administration & dosage/adverse effects ; Humans ; Heparin/administration & dosage/adverse effects ; Female ; Anticoagulants/administration & dosage/adverse effects ; *Angioplasty, Transluminal, Percutaneous Coronary