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The antiplatelet effect of atorvastatin in patients with acute coronary syndrome depends on the hs-CRP level.

Acute Card Care. 2008;10(3):181-4

Authors: Vasilieva E, Kasyanova O, Shpektor A

BACKGROUND: In data we published earlier, there is a correlation between platelet aggregation in patients with acute coronary syndrome (ACS) who are receiving aspirin and elevated hsCRP-level. We suggested that antiplatelet action of statins, which are known to lower hsCRP-levels, could be especially pronounced in patients with high levels of hsCRP. METHODS AND RESULTS: 54 patients with ACS without ST-segment elevation were included in this study. All patients received aspirin 160-325 mg daily. In addition to aspirin, some patients received atorvastatin 40-80 mg/d (n=19) or 300 mg of clopidogrel followed by 75 mg/d (n=15). HsCRP-levels and ADP-induced platelet aggregation were assessed on the first and on the eight days of treatment. Patients were divided into subgroups according to initial hsCRP-levels and treatment. In atorvastatin/high-CRP subgroup, the level of aggregation was about three times lower after eight days than it was on the first day. In contrast, in atorvastatin/low-CRP subgroup the level of platelet aggregation did not change during the same period. The effect of clopidogrel did not depend on hsCRP-level. In control group (patients treated with aspirin alone), platelet aggregation did not change with time. CONCLUSION: There is a correlation between antiplatelet effect of atorvastatin and initial hsCRP-level. The antiplatelet effect of clopidogrel does not depend on hsCRP-level.

PMID: 18608041 [PubMed - indexed for MEDLINE]

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Risk prediction in acute coronary syndrome from serial in-hospital measurements of N-terminal pro-B-type natriuretic peptide.

Acute Card Care. 2008;10(3):159-66

Authors: Nørgaard BL, Terkelsen CJ, Riiskjaer M, Holmvang L, Grip L, Heickendorff L, Thygesen K

There is limited information about the in-hospital plasma profile of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (NSTACS) and furthermore, the prognostic influence of the timing of NT-proBNP measurements in NSTACS is unsettled. These subject matters are elucidated in this study composed of 455 patients with NSTACS (symptoms <24 h). NT-proBNP was measured at 0, 6, 12, 24, 36, 48, 72 and 96 h following admission. Any death was registered at follow-up (median: 2.3 years). The study demonstrated a monophasic profile of the plasma NT-proBNP values, reaching a maximum at 6 hours, and it showed an independent prognostic significance of NT-proBNP irrespective of the sampling time. Risk prediction by NT-proBNP was improved by combining the baseline measurement and one value taken between 24 and 96 h (at 48 h, P<0.001). No additional prognostic information was provided by including more than one late in-hospital NT-proBNP value. Conclusions: The in-hospital NT-proBNP measurements exhibit a monophasic profile in patients with NSTACS and these values provide independent prognostic information as regards mortality irrespective of the sampling time. Moreover, risk prediction of NT-proBNP is strengthened by combining the admission measurement with an additional value during the hospitalization.

PMID: 18608042 [PubMed - indexed for MEDLINE]

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Is there still a role for treatment with beta-adrenoceptor antagonists in post-myocardial infarction patients with well-preserved left ventricular systolic function?

Acute Card Care. 2008;10(3):144-7

Authors: Horowitz JD, Arstall MA, Zeitz CJ, Beltrame JF

The utility of beta-adrenoceptor antagonists post myocardial infarction was established in the pre-thrombolytic era. Evidence for improvement in long-term prognosis with metoprolol, timolol and propranolol in particular derives from reduction in event rates in patients who have had substantial left ventricular damage at the time of infarction and probably correlates largely with the more recently demonstrated salutary effects of this group of drugs in patients with chronic heart failure. In all other respects, evidence for beneficial effects of beta-adrenoceptor antagonists in peri-infarct and post-infarct therapeutics is equivocal. They appear to exert no major influence on outcomes in patients with unstable angina, nor do they markedly alter early clinical course in uncomplicated acute myocardial infarction, irrespective of other interventions. Furthermore, the limited available analyses suggest no discernible beneficial effect on long-term outcomes post-uncomplicated infarction. It is possible that in such patients, current recommendations for ‘routine’ long-term beta-adrenoceptor blockade can no longer be justified.

PMID: 18608034 [PubMed - indexed for MEDLINE]

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