Long-term results following switch from abciximab to eptifibatide during percutaneous coronary intervention

Background:

The usage of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors improves the outcome during high‐risk percutaneous coronary interventions (PCI). The aim of this study was to evaluate the long‐term effects after a planned switch from abciximab to eptifibatide during PCI.

Hypothesis:

A switch from the general use of abciximab to eptifibatide as a GP IIb/IIIa in connection with PCI would not have any negative effects on long‐term clinical outcomes.

Methods:

To reduce costs, a general switch from abciximab to eptifibatide was instituted in 2004 in 2 university hospitals in Sweden. All patients treated 6 months before and 6 months after the switch were followed for 30 months. During the study period, 1038 patients underwent PCI and received a GP IIb/IIIa receptor inhibitor, 481 (46%) before the switch (Group A) and 557 (54%) after the switch (Group B). The 2 groups had similar baseline characteristics. The primary endpoint was the composite of death, myocardial infarction, stroke, or new coronary revascularization (percutaneous or surgical); secondary endpoints were the individual components of this composite. A separate analysis was performed on patients treated for ST‐segment elevation myocardial infarction, non–ST‐segment elevation myocardial infarction/unstable angina, and diabetes, respectively. Data were collected from the Swedish Coronary Angiography and Angioplasty Registry.

Results:

There were no differences between the groups in the primary endpoint (29.7% in Group A vs 29.3% in Group B; P = 0.48) or in any of the secondary endpoints.

Conclusions:

A switch from the general usage of abciximab to eptifibatide as a GP IIb/IIIa receptor inhibitor in connection with PCI did not seem to have any negative effects on long‐term clinical outcomes. Copyright © 2008 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

Unintended stent extraction from a coronary artery during bifurcation coronary angioplasty

We report an elective angioplasty of a left circumflex artery (LCx) bifurcation lesion treated by provisional stenting. With a "jailed" wire in the first obtuse marginal, we deployed a 3.0 x 28 mm drug-eluting stent into the main branch. The jailed wire was tangled up in a tortuous side branch. We were unable to retrieve the wire. Forceful wire removal led to an unintended extraction of the fully deployed stent from the main branch.     

Ostreolysin induces sustained contraction of porcine coronary arteries and endothelial dysfunction in middle- and large-sized vessels

Ostreolysin (Oly), a cytolytic and cardiotoxic protein from the oyster mushroom (Pleurotus ostreatus), is lethal for mice with an LD₅₀ of 1170 μg/kg following intravenous application. Its cardiotoxicity is associated with hyperkalemia, which is probably a consequence of potassium released from the lysed cells. Moreover, sub-micromolar concentrations of Oly induce a concentration-dependent increase in rat aortic ring tension, suggesting that ischaemia, and consequent hypoxic injury of cardiomyocytes, could also derive from vasospasm induced by this toxic protein.The purpose of the present study was to demonstrate histopathological lesions caused by Oly after parenteral application to rats, and to define the mechanisms of Oly-induced vasoconstriction using inhibitors verapamil, lanthanum chloride, and selective endothelin receptor antagonist TBC3214, which have different molecular targets, in vitro on porcine coronary artery rings. We found that Oly causes endothelial injury with perivascular oedema in the heart and lungs, as well as myocardial haemorrhages in rats. Treatment of porcine coronary artery rings with Oly causes concentration-dependent vasoconstriction and prevents endothelium-mediated relaxation. Using TBC3214 as a selective blocker of the endothelin A receptor, we showed that vasoconstriction induced by Oly was independent of endothelin release and its effects. Verapamil (1 μM) greatly reduced Oly-evoked contractions of porcine coronary artery rings, while lanthanum abolished them completely. These results provide evidence that the contraction of coronary arteries by Oly is due mainly to the increased influx of Ca²⁺ from the extracellular space through voltage-dependent L-type Ca²⁺ channels and cation non-selective channels. Experiments suggest that Oly damages endothelial cells both in vitro and in vivo, and probably exhibits direct contractile effects on coronary smooth muscle cells.     

Late coronary stent thrombosis and clopidogrel

The existence of late coronary stent thrombosis is a topical issue in cardiology today. The synoptic article discusses current definition of the above phenomenon, its delimitation in time and actual incidence. Based on data from available observation and randomised studies, long-term safety of conventional bare metal and drug-eluting stents is evaluated, as well as the safety profile following implantation. The length of thienopyridin treatment after percutaneous coronary intervention (PCI) varies according to the type of stent used. While a conventional bare metal stent (BMS) implant provides long-term safety with one month treatment, the implantation of a drug-eluting stent (DES) should be complemented with a 12-month period of clopidogrel administration. This approach may be in the future influenced by further progress in drug-eluting stents development and by prospectively acquired information on long-term administration of clopidogrel to such patients.     

Community Periodontal Index of Treatment Needs (CPITN) in KwaZulu and Namibia in 11-year-old children in 1988

A sample of 603 11-year-old children from four low fluoride (less than 0.15 ppm) and one higher fluoride (1.56 ppm) communities in Namibia and KwaZulu were examined in 1988 using the CPITN. In a rural low fluoride community in Namibia only 6 per cent of children had healthy mouths compared with 42-58 per cent in the other communities. The main periodontal lesion seen was gingival bleeding (19-47 per cent) followed by calculus (6-47 per cent). There is a need for both oral hygiene improvement and simple intervention.     

Sonographic imaging of the soft-tissue thickness of the edentulous maxilla.

For preimplantologic evaluation and diagnosis, there are various mechanical methods for measuring the thickness of the soft tissue and thus indirectly measuring the osseous bed of the implant. This study evaluated the use of real-time sonography for analyzing the soft-tissue thickness of the entire edentulous maxilla in an anatomic examination of human cadaver specimens. The data obtained were compared with findings from the usual needle measurement method. The ultrasound measurement method produced realistic data in all measurement points of all sectional planes selected.     

Expression of GH receptor, IGF-I receptor and IGF-I mRNA in the kidney and liver of rats recovering from unilateral renal ischemia.

The role of the growth-hormone (GH), insulin-like growth factor-I (IGF-I) axis in the kidney has been extensively studied in recent years. To further elucidate the role for GH and IGF-I in renal regeneration, the expression of the GH-rec, IGF-I-rec and IGF-I mRNA was studied in the post-ischemic regenerating kidney and in the liver of the same rats, using a solution hybridization assay. Rats were subjected to 90 min of unilateral renal ischemia followed by reperfusion. The kidneys and livers were collected 1, 3 and 7 days after injury. Five animals were operated on in each group. An additional five animals were sham-operated and killed on day 4. In the kidney, significant alterations were found in the expression of mRNAs for the GH-rec and the IGF-rec. The GH-rec mRNA decreased significantly at day 1 (P < 0.01) to less than one-fifth of the initial value, and normalized at days 3 and 7. The IGF-rec mRNA levels increased more than three-fold at day 3 (P < 0.01) and more than five-fold at day 7 (P < 0.01). In the kidneys there was no significant alteration in the IGF-I mRNA level. In the liver, significant alteration in the level of the GH-rec mRNA was found, while the levels of IGF-rec and the IGF-I mRNA did not change significantly. The levels of GH-rec mRNA increased two-fold at day 3 (P < 0.05), while the levels were unchanged at days 1 and 7. In the early phase of renal regeneration, there is a sharp decrease in the expression of GH-rec mRNA in the kidney. This suggests that there are no direct effects on renal tissue mediated by GH in this situation. There is a significant increase in the intrarenal IGF-I-rec mRNA levels from day 3, suggesting an increased need for IGF-I during regeneration. In the liver, the concentration of GH-mRNA is increased significantly at day 3. These data show on alterations that suggest a role for these factors in renal regeneration.     

Nonattendance is still the main limitation for the effectiveness of screening for cervical cancer in the Netherlands

Although mass screening for cervical cancer has been operational for more than 2 decades in the Netherlands, 700 women are still diagnosed with this cancer each year (9 per 100,000). We investigated these cases, in order to evaluate opportunities to further increase the effectiveness of the programme. We analyzed the screening history of women diagnosed with cervical cancer between 1994-1997 using the Dutch national pathology file that includes cervical cytology and histological results. More than half of the cases did not have previous preventive cervical smears, and another 30% had never been invited to the programme because of their age. In the future, we estimate that two thirds of all Dutch women with invasive cervical cancer will be unscreened or under-screened, based on current screening participation of more than 70%. We conclude that increasing screening participation has much more potential for further reducing cervical cancer incidence than reducing the screening interval, increasing the age range or having a screening test with higher sensitivity.