The effects of prior beta-blocker therapy on serum C-reactive protein levels after percutaneous coronary intervention

BACKGROUND: There are no studies in the literature related to the effect of beta blockers (BB) on changes in C-reactive protein (CRP) levels after percutaneous coronary intervention (PCI). HYPOTHESIS: We designed a prospective randomized study to investigate the impact of BB therapy on CRP in patients who underwent elective PCI. METHODS: In all, 300 patients with coronary artery disease were included. Patients were randomized to either a metoprolol or to a control group before PCI. Blood samples for CRP levels were obtained before BB treatment, and at the 6th, 24th, and 36th h after PCI. RESULTS: Of 300 patients, 150 received metoprolol 100 mg/day (mean age, 59.0 +/- 10.2 years; 106 men, 44 women), and 150 received no BB (mean age, 59.8 +/- 9.8 years; 114 men, 36 women) and served as the control group. Baseline clinical characteristics of both groups were similar. Basal CRP levels between the two groups were similar. Of the patients included in the study, 40.8% in the BB group and 39.6% in the control group had elevated basal CRP levels. The CRP levels increased above baseline values in 85% of patients in the BB group and in 89.3% of patients in the control group (p > 0.05) during follow-up. The CRP levels in patients in the BB group at the 6th, 24th, and 36th h were lower than those in the control group; however, this difference did not reach statistical significance. CONCLUSIONS: Prior BB therapy seems to have no effect on CRP levels after PCI.     

Associations between C-reactive protein and circulating cell adhesion molecules in patients with unstable angina undergoing coronary intervention and their clinical implication

BACKGROUND: There is growing evidence that C-reactive protein (CRP) may have a direct role in the pathogenesis of atherosclerosis. HYPOTHESIS: The purpose of this study was to assess associations between CRP and adhesion molecules and to determine the prognostic value of adhesion molecules as a predictor of cardiac events in patients with unstable angina. METHODS: Fifty-five consecutive patients (33 males, mean age 61 years) with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting were included in this study. RESULTS: The test for a trend toward increasing intercellular adhesion molecule (ICAM)-1 concentrations by the 75th percentile of CRP levels at 72 h after coronary stenting was significant (p = 0.03). At 72 h after coronary stenting, CRP levels were the only determinants of ICAM-1 concentrations by multiple linear regression analysis. An elevated level of CRP (>5.4 mg/l) (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3-3.7, p < 0.05) and ICAM-1 (>321 ng/ml) (OR 1.2, 95% CI 1.1-2.1, p < 0.05) at 72 h after coronary stenting is an independent risk factor for an adverse cardiac event. CONCLUSIONS: These results suggest that in patients with unstable angina undergoing coronary stenting, the measurements of inflammatory parameters, especially CRP and ICAM-1, may be useful for identifying those at higher risk of a cardiac event, and CRP may play a direct role in promoting the inflammatory component of atherosclerosis by inducing significant expression of ICAM-1.     

冠心病患者血浆组织因子活性及凝血因子Ⅶ水平改变

目的研究汉族冠心病患者血浆中组织因子活性（aTF）、活化凝血因子Ⅶ（FⅦa）和凝血因子Ⅶ抗原（FⅦ：Ag）水平并探讨其与冠脉病变支数之间的关系。方法aTF采用发色底物法，FⅦa和FⅦ：Ag采用ELISA法。结果与对照组相比，冠心病患者血浆中aTF（P〈0．05）、FⅦa（P〈0．01）及FⅦ：Ag（P〈0．05）水平均显著升高；急性冠状动脉综合征（ACS）患者中aTF高于稳定型心绞痛（SAP）组（P〈0．05）和对照组（P〈0．01），后两者之间无显著差异；ACS和SAP患者之间血浆中FⅦa水平无显著差异，但均高于对照组；ACS组中FⅦ：Ag水平明显高于对照组。在不同冠脉病变支数的患者之间，aTF、FⅦa及FⅦ：Ag水平没有差异。结论SAP和ACS患者均可出现外源性凝血途径的激活，血浆中aTF增强可能预示了急性冠脉事件的发生；FⅦa可能可以作为冠心病的早期分子标志物；冠脉病变支数可能不能反映凝血激活的程度。     

冠心病患者血浆组织因子活性及凝血因子VII水平改变

目的研究汉族冠心病患者血浆中组织因子活性（aTF）、活化凝血因子VII（FVIIa）和凝血因子VII抗原（FVII:Ag）水平并探讨其与冠脉病变支数之间的关系。方法aTF采用发色底物法,FVIIa和FVII:Ag采用ELISA法。结果与对照组相比,冠心病患者血浆中aTF（P<0.05）、FVIIa（P<0.01）及FVII:Ag（P<0.05）水平均显著升高;急性冠状动脉综合征（ACS）患者中aTF高于稳定型心绞痛（SAP）组（P<0.05）和对照组（P<0.01）,后两者之间无显著差异;ACS和SAP患者之间血浆中FVIIa水平无显著差异,但均高于对照组;ACS组中FVII:Ag水平明显高于对照组。在不同冠脉病变支数的患者之间,aTF、FVIIa及FVII:Ag水平没有差异。结论SAP和ACS患者均可出现外源性凝血途径的激活,血浆中aTF增强可能预示了急性冠脉事件的发生;FVIIa可能可以作为冠心病的早期分子标志物;冠脉病变支数可能不能反映凝血激活的程度。     

The impact of unfractionated heparin or bivalirudin on patients with stable coronary artery disease undergoing percutaneous coronary intervention

Objectives

To compare bleeding and clinical events of patients with stable angina or silent ischemia undergoing percutaneous coronary intervention (PCI) treated with unfractionated heparin (UFH) or bivalirudin.

Background

Few direct comparisons between UFH monotherapy versus bivalirudin exist for patients with stable ischemic heart disease undergoing PCI.

Methods

A prospective, investigator‐initiated, single‐center, single‐blinded, randomized trial of UFH versus bivalirudin was conducted. The primary endpoint was all bleeding (major and minor) from index‐hospitalization to 30 days post discharge. Secondary endpoints included major adverse cerebral and cardiovascular events (MACCE) and net adverse clinical events (NACE).

Results

Two‐hundred‐sixty patients were randomized for treatment with either UFH (n = 123) (47%) or bivalirudin (n = 137) (53%) There were no significant differences in baseline clinical and angiographic characteristics between the two groups. Primary endpoint was similar in both groups (10.9% with bivalirudin vs 7.3% with UFH [P = 0.31]). Major bleeding rates were 5.8% and 2.4%, respectively (P = 0.17). There was a higher MACCE (3.5% vs 0%, P = 0.03) and NACE (8.8% vs 2.4%, P = 0.03) rate with bivalirudin compared to UFH, respectively. Bivalirudin had increased odds of NACE (OR = 3.65, 95% CI: 1.00‐13.3.6). Death and stent thrombosis rates were low and similar in both groups. Radial access was associated with fewer bleeding events compared to femoral access but not statistically significant (P = 0.29).

Conclusions

Among patients with stable angina or silent ischemia, there was no difference between UFH and bivalirudin in bleeding rates up to 30‐days post‐PCI. MACCE and NACE were higher among the bivalirudin group. Radial access was associated with a numerically lower rate of bleeding compared with femoral access.     

The relation between preprocedural C-reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty

BACKGROUND: Inflammation is an important feature of arteriosclerotic disease, and the vulnerability of coronary plaques in acute myocardial infarction (AMI) may be related to the levels of serum C-reactive proteins (CRP). While some risk factors for early and late complications have been suggested, an accurate and definitive preprocedural risk stratification of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) is still lacking. HYPOTHESIS: The study was undertaken to investigate whether early and late complications after PTCA could be predicted by evaluation of baseline serum CRP levels in patients with AMI. METHODS: Levels of serum CRP were measured in a total of 230 patients with AMI undergoing PTCA and provisional stent. They were divided into two groups: Group 1 (n = 48) with elevated CRP levels (> or = 5 mg/l) and Group 2 (n = 182) with normal CRP levels (< 5 mg/l). RESULTS: There were no significant differences in baseline clinical, angiographic, and procedural characteristics between the two groups. However, the incidence of in-hospital adverse coronary events (reinfarction, coronary reocclusion, target vessel revascularization, and death) and severe left ventricular dysfunction was significantly higher in Group 1 (18.3 vs. 6.1%, p < 0.05 and 20.9 vs. 6.1%, p < 0.05, respectively). In addition, bailout stenting was performed more frequently in Group 1 than in Group 2 (60.4 vs. 36.3%, p < 0.005). No significant late complications were noted. The serum levels of CRP were the only independent predictors of early adverse events. CONCLUSIONS: Preprocedural serum CRP level might be considered a powerful predictor of early but not late complications in patients undergoing PTCA/stent procedures.     

The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty.

AIMS: The acute phase reactant C-reactive protein is an important prognostic risk factor in patients with both stable and unstable coronary artery disease. The potential prognostic implications of an abnormal pre-procedural C-reactive protein concentration in patients undergoing elective coronary angioplasty may be relevant for subsequent treatment. METHODS AND RESULTS: Pre-procedural plasma levels of C-reactive protein were measured in 501 patients with stable coronary artery disease undergoing elective coronary angioplasty. The incidence of death or myocardial infarction during a 2-year follow-up was 10.6% (24/227) in patients with an increased C-reactive protein level (>3 mg. l(-1)) and 2.9% (8/274) in patients with a normal C-reactive protein level (RR 3.9, 95% CI 1.7-8.9). Survival without death, myocardial infarction, urgent revascularization or hospital admission for unstable angina was significantly lower in patients with an increased C-reactive protein vs patients with a normal C-reactive protein (log-rank 14.62, P<0.0001). Logistic regression analysis identified an increased C-reactive protein level as a strong independent predictor of event-free survival (RR 2.54, 95% CI: 1.44-4.47, P=0.001). CONCLUSION: Pre-procedural C-reactive protein levels are increased in 45% of patients undergoing elective coronary angioplasty. An increased C-reactive protein level is a powerful independent prognostic indicator for subsequent cardiac events, suggesting that late clinical outcome is markedly influenced by pre-procedural systemic activation of inflammation.     

经皮冠状动脉介入治疗对不稳定型心绞痛患者血浆M30浓度的影响

目的探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗对不稳定型心绞痛(unstable angina,UA)患者血浆M30浓度的影响。方法从2011年12月至2013年1月在广东省心血管病研究所心内二区住院并行PCI治疗的400例冠状动脉粥样硬化性心脏病(冠心病)患者血浆中,采用完全简单随机方法(随机数表法)抽取73例患者,其中稳定型心绞痛(stable angina,SA)9例、UA38例、心肌梗死(myocardial infarction,MI)26例。采用酶联免疫吸附法(ELISA)测定冠心病患者在PCI治疗前、治疗后第一天的血浆M30浓度。结果冠心病患者PCI治疗后血浆M30浓度比治疗前高,但差异无统计学意义(P>0.05)。亚组分型中,因UA组例数太少,不对其进行统计分析。MI组患者的术前血浆M30抗原浓度比UA组高,但差异无统计学意义(P>0.05)。UA组PCI治疗前、后血浆M30浓度比较,差异有统计学意义[129(109～497)U/L vs.149(83～542)U/L,P=0.037];PCI治疗后血浆M30抗原浓度明显高于PCI治疗前。MI组PCI治疗前、后血浆M30浓度比较,差异无统计学意义(P>0.05)。结论 UA患者血浆M30抗原浓度在PCI治疗后升高,说明PCI治疗会增加UA患者的心肌细胞凋亡。M30可作为细胞凋亡的监测指标并有助于观察UA患者PCI治疗后出现的心肌微损伤。     

强化他汀治疗对择期PCI患者冠脉无复流及血浆APN与炎性因子的影响

目的:观察强化他汀治疗对择期经皮冠状动脉介入治疗（PCI）患者术中出现无复流风险及其血浆脂联素（APN）、血清高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、炎性因子高敏C反应蛋白(hs-CRP)的影响。方法:70例择期PCI患者随机分为强化他汀组（强化组,n=35）及常规他汀组（常规组,n=35）,强化组阿托伐他汀每日80 mg,2 d术前进行预处理,2 d后每日40 mg,服1月,常规组术前每日20 mg, 2 d,术后长期服用。分别检测术前及术后1月、3月hs-CRP、HDL-C、LDL-C、APN;观察术中无复流的发生率;主要终点是30 d内的主要不良心脏事件(MACE;死亡,心肌梗死或计划外的血管重建)。结果:两组均未出现MACE,均无明显不良反应。1月后两组APN、HDL-C均有上升,强化组APN:（8±4）mg/L,常规组:（6±3）mg/L;强化组上升明显（P<0.05）。两组hs-CRP、LDL-C均有下降,强化组hs-CRP:（3.2±2.1）mg/L,常规组:（4.5±2.3）mg/L;强化组显著性下降（P<0.05）;术前与术后比较差异有统计学意义(P<0.05)。强化组术中无复流3例,常规组5例,两组差异未达到统计学意义。结论:强化他汀治疗能够降低择期PCI患者血浆炎性因子水平,升高血浆APN水平。     

Prognostic role of preprocedural glucose levels on short‐ and long‐term outcome in patients undergoing percutaneous coronary revascularization

Objectives : We investigated the prognostic role of preprocedural blood glucose levels (BGLs) on short‐ and long‐term outcome in patients undergoing elective percutaneous coronary intervention (PCI). Background : Hyperglycemia and hypoglycemia, with or without pre‐existing diabetes mellitus, are associated with adverse outcome in patients with coronary artery disease. Moreover, neointimal hyperplasia after coronary stent implantation is increased in presence of suboptimal glycemic control. Methods : Preprocedural BGLs were prospectively measured in 572 patients and predefined groups were considered: hypoglycemia ≤ 80 mg/dl; euglycemia 81–109 mg/dl; mild hyperglycemia 110–125 mg/dl; hyperglycemia ≥ 126 mg/dl. Primary end point was represented by the incidence of peri‐procedural myocardial infarction (MI) and secondary end point was the occurrence of major adverse cardiac events (MACE) at follow‐up. Results : Hypoglycemia was associated with an increased risk of peri‐procedural MI (51% vs 30%, 29%, and 37% in euglycemia, mild hyperglycemia and hyperglycemia groups, respectively; P for trend 0.025). After a mean follow‐up of 15 ± 8 months, the occurrence of MACE was 38% in the hypoglycemia group, 12% in the euglycemia group, 14% in the mild hyperglycemia and 22% in the hyperglycemia group (P < 0.001). The incidence of in‐stent restenosis and target vessel revascularization was also higher in patients with abnormal pre‐procedural BGLs (P for trend 0.007 and <0.001, respectively). Multivariate analysis confirmed hypoglycemia as a predictor of early and long‐term unfavorable cardiac prognosis (OR = 2.53, 95% CI 1.09‐5.81, P = 0.029 for peri‐procedural MI; OR = 2.91, 95% CI 1.26–6.69, P = 0.012 for MACE occurrence). Conclusions : We observed a significant association between preprocedural BGLs and adverse short‐and long‐term outcome in patients undergoing elective PCI. Thus, a careful glycemic monitoring should be recommended in all patients undergoing coronary stenting, irrespective of the diabetic status. © 2011 Wiley Periodicals, Inc.     

Pre‐loading therapy with statins in patients with angina and acute coronary syndromes undergoing PCI

Statins constitute the most powerful class of drugs for cardiovascular risk reduction associated to atherosclerosis. Their important pharmacological properties include reduction of serum lipid concentrations and non‐lipid related, pleotropic effects such as anti‐inflammatory action. Previous largescale randomized studies have demonstrated the beneficial effects of statin loading prior to elective percutaneous coronary intervention (PCI) for the reduction of periprocedural myocardial infarction and prevention of major adverse cardiac events at 30 days. The present review summarizes the data from major randomized trials that evaluated the clinical benefit of statin pretreatment in the setting of PCI resulting in a better understanding of their impact on reduction of interventional complications.

     

冠状动脉介入术后高敏C反应蛋白的变化及其意义

目的　前瞻性研究心绞痛患者经皮冠状动脉介入治疗 (PCI)前后高敏C反应蛋白 (hsCRP)的变化 ,并观察其与术后心性事件的相关性。方法　连续入选行单个原位病变PCI的 30例不稳定性心绞痛 (UAP组 )和 16例稳定性心绞痛 (SAP组 )患者 ,测定术前、术后 2 4、4 8及 72h的hsCRP水平 ,随访术后心性事件 ,观察两者的相关性。结果　(1)UAP组和SAP组术后hsCRP均明显增加 ,UAP组增加幅度明显高于SAP组 (P =0 .0 2 )。 (2 )平均随访 (10 .16±1.76 )个月 ,发生心性事件 12例 (其中UAP组 9例 ,SAP组 3例 ) ,两组心性事件发生率差异无显著性意义 ;UAP组发生心性事件的 9例术后 72h的hsCRP仍保持较高水平 ,而无心性事件的 2 1例则呈下降趋势 ,两者比较差异有显著性意义 (P =0 .0 3)。 (3)应用多因素logistic回归分析发现 ,仅术后hsCRP值、年龄与心性事件显著相关 (RR =1.2 3,P =0 .0 13;RR =1.19,P =0 .0 2 3)。结论　UAP患者PCI术后hsCRP增加幅度明显高于SAP患者 ,在行PCI术后 72h的hsCRP水平持续升高 ,提示术后的不良事件发生率高 ,应加强干预。     

妊娠相关血浆蛋白A对经皮冠状动脉介入治疗后心肌损伤预测价值

目的:探讨经皮冠状动脉介入治疗术(PCI)前血浆妊娠相关血浆蛋白A(PAPP-A)含量对术后心肌损伤的预测价值.方法:95例择期行PCI的不稳定型心绞痛患者,根据手术前24 h PAPP-A是否升高分为高PAPP-A组(30例,PAPP-A≥10 mU/L)和低PAPP组(65例,PAPP-A＜10 mU/L).检测术前高敏C反应蛋白(hs-CRP)水平及术后24 h内肌钙蛋白I(cTnI)阳性率,并进行2组间各观察指标的比较.结果:高PAPP-A组术前PAPP-A及hs-CRP水平,冠状动脉介入治疗后cTnI阳性率均明显高于低PAPP-A组,差异有统计学意义(P＜0.05).多变量逐步Logistic回归分析表明,PCI前血浆PAPP-A及hs-CRP水平是术后cTnI阳性的独立预测指标(P＜0.05).结论:PCI前血PAPP-A含量是术后心肌损伤的独立预测因素.     

阿托伐他汀对冠状动脉介入术后C反应蛋白的影响

目的:测定经皮腔内冠状动脉介入术(PCI)后C-反应蛋白(CRP)的水平并评价阿托伐他汀对其影响。方法:连续选择因冠状动脉狭窄性病变行PCI的冠心病患者60例,随机分为治疗组和对照组,治疗组在对照组治疗的基础上给予阿托伐他汀20mg,qd,术前及术后2d和3周分别测外周动脉血清CRP。结果:术前、术后2d及术后3周,治疗组CRP水平分别为(9.03±0.59)、(23.5±0.71)及(12.8±0.47)mg/L,对照组则分别为(8.8±0.62)、(21.2±0.56)及(19.6±0.53)mg/L,两组术后3周比较,差异有统计学意义(P<0.01);术前、术后2d及术后3周治疗组CK-MB分别为(11.9±3.3)、(14.6±3.2)、(16.0±2.8)IU/L,对照组为(12.1±3.4)、(14.3±2.6)、(15.6±3.0)IU/L,两组术后CK-MB均无升高,两组术前、术后相比较,均P>0.05。结论:PCI后血清CRP水平升高,阿托伐他汀可明显控制血浆炎症因子,有利于动脉粥样硬化斑块的稳定。     

Serum C-reactive protein levels predict survival in hepatocellular carcinoma.

BACKGROUND/AIMS: C-reactive protein (CRP) was recently identified as a prognostic factor for patients with hepatocellular carcinoma (HCC) after surgical resection. We investigated the relationship between the serum levels of high sensitivity CRP (H-CRP) and the prognosis of HCC patients. METHOD: We conducted a cohort study of 90 HCC patients enrolled from 1997 to 1998. All patients were treated and followed for a mean period of 3.2 years. Clinical variables were compared between patients positive for H-CRP (serum H-CRP levels >/=3.0 mg/L, n=47) and those negative for H-CRP (serum H-CRP levels <3.0 mg/L, n=43). We also determined the relationship between serum H-CRP and prognosis in HCC patients. RESULTS: The survival rate of patients of the H-CRP-positive group was lower than that of H-CRP-negative patients. Tumour stage (stages 3 or 4), total bilirubin >/=1.2 mg/dL, albumin (Alb) <3.5 g/dL, des-gamma-carboxy prothrombin >/=40 mAU/mL, positive H-CRP and initial treatment (transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy or best supportive care) were identified as significant poor prognostic factors by univariate analysis, while positive H-CRP [hazard ratio (HR), 1.58; P=0.048], Alb<3.5 g/dL (HR, 2.10; P=0.004), tumour stage (stages 3 or 4; HR, 3.05; P=0.001) and initial treatment (HR, 1.88; P=0.029) were considered to be significant determinants of poor prognosis by multivariate Cox proportional hazards analysis. CONCLUSIONS: The prognosis of H-CRP-positive patients was poorer compared with H-CRP-negative patients. This study confirmed that H-CRP, like CRP, is a marker of poor prognosis in HCC patients.     

妊娠相关血浆蛋白A、高敏C反应蛋白与冠脉再狭窄的关系

目的：探讨妊娠相关血浆蛋白A（PAPP—A）。高敏C反应蛋白（hs—CRP）与经皮冠状动脉介入治疗（PCI）术后再狭窄的关系。方法：选择71例接受PCI治疗并于PCI术后6个月复查冠脉造影的患者,经冠脉造影证实出现支架内再狭窄的患者14例（再狭窄组）,未出现再狭窄的患者57例（无再狭窄组）,测定入选患者PCI术前和术后血浆PAPP-A,hs—CRP水平并分析其支架内再狭窄情况。结果：再狭窄组患者术后血浆PAPP—A,hs—CRP水平较无再狭窄组显著升高（P〈0．01）,且术后PAPP—A,hs—CRP水平与PCI术后冠脉后期内径丢失指数呈正相关（r＝0．57,P〈0．01）。结论：PCI术后血浆PAPP-A,hs—CRP水平可以预测冠脉再狭窄的发生。     

急性心肌梗死行直接PCI患者的预后与超敏CRP水平的关系

目的:研究急性心肌梗死患者行直接冠状动脉介入治疗（PCI）的预后与超敏C反应蛋白（hs-CRP）水平的关系。方法: 回顾我院2007年1月~2011年1月因急性心肌梗死行直接PCI的215例患者,比较了住院期间发生心血管事件组与未发生心血管事件组hs-CRP的水平,并根据hs-CRP水平将这些患者进行分组,比较不同水平hs-CRP组的心血管事件发生率。结果: 急性心肌梗死行直接PCI患者住院期间发生心血管事件组hs-CRP的水平(10±4)mg/L与未发生心血管事件组hs-CRP的水平(6±5)mg/L具有显著差异（P<0.05）。hs-CRP 0~3 mg/L组、3~6 mg/L组、6~9 mg/L组、9~12 mg/L组和12~15 mg/L组心血管事件发生率分别为:23%、24%、47%、52%和70%。采用Logistic回归分析表明:用性别、年龄进行校正后,hs-CRP水平与心血管事件发生具有显著相关性（OR=1.188,P＜0.01）。结论: hs-CRP可作为急性心肌梗死后行直接PCI患者预后的预测因子,hs-CRP水平越高,心血管事件发生率越高。     

Anti-platelet and anti-thrombotic approaches in patients undergoing percutaneous coronary intervention.

Over the past three decades, there has been a tremendous increase in the use of percutaneous coronary interventions (PCI) for the treatment of patients with atherosclerotic coronary artery disease. However, PCI causes disruption of atherosclerotic plaque and denudation of the endothelium, leading to stimulation of platelet aggregation and activation of the coagulation cascade. Therefore, anti-platelet and anti-thrombotic agents have a pivotal role as adjuncts before, during and after PCI, in order to minimize the risk of procedural ischemic complications, such as myocardial infarction, stent thrombosis, and various degrees of myonecrosis. The current article presents a comprehensive review of the evolution of current anti-platelet and anticoagulation regimens used in the setting of PCI. It starts with a summary of the current perspective of the coagulation process along with platelet activation and aggregation. The review then focuses specifically on individual anti-platelet and anti-thrombotic drugs including their mechanism of action and the scientific evidence which led to their use in PCI. Finally, we present summary recommendations from the AHA/ACC guidelines for individual anticoagulant and anti-platelet regimens given peri-PCI.     

C-reactive protein and coronary heart disease: a critical review

Modestly elevated baseline concentrations of C-reactive protein (CRP), the classical acute phase protein, are associated with the long-term risk of coronary heart disease in general populations, whilst the major acute phase response of CRP following myocardial infarction is associated with death and cardiac complications. The pathogenic and clinical significance of these associations is controversial. Here we critically review the evidence and describe large-scale epidemiological studies, novel experiments and possible specific therapies which will rigorously inform the debate. We distinguish between the potential pathogenicity of high acute phase circulating CRP concentrations in individuals with substantial tissue damage and modest but persistent increases in baseline values in generally healthy subjects.