Prospective randomized comparison of early and late results of a carbonized stent versus a high-grade stainless steel stent of identical design: the PREVENT Trial [corrected].

Background: Restenosis after coronary interventions with stent implantation is still the main obstacle of interventional cardiology. The aim of this study was to compare a carbonized and high-grade stainless steel stent of identical design with regard to early and late adverse events.

Methods: In this prospective randomized trial the carbonized MAC stent (amg GmbH, Raesfeld-Erle, Germany) was compared with the stainless steel MAC stent of identical design.

Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock.

Aims: Mortality in cardiogenic shock (CS) following acute myocardial infarction (AMI) remains unacceptably high despite percutaneous coronary intervention (PCI) of the infarcted artery and use of intra-aortic balloon pump (IABP) counterpulsation. A newly developed percutaneous left ventricular assist device (VAD) (Tandem Heart, Cardiac Assist, Pittsburgh, PA, USA) with active circulatory support might have positive haemodynamic effects and decrease mortality.

Methods And Results: Patients in CS after AMI, with intended PCI of the infarcted artery, were randomized to either IABP (n=20) or percutaneous VAD support (n=21).

Exercise training in chronic heart failure: effects on pro-inflammatory markers.

Background: Acute bouts of exercise have been shown to induce inflammatory cytokine activation and peripheral hypoxia in patients with chronic heart failure (CHF). In this study, we set out to investigate the impact of chronic exercise training on pro-inflammatory cytokines and markers of endothelial damage.

Methods And Results: We measured tumor necrosis factor alpha (TNFalpha), its soluble TNF-receptors 1 and 2, interleukin 6 (IL-6), soluble e-selectin, soluble intracellular adhesion molecule-1 (sICAM) and sCD14 in 18 patients with CHF and 9 age-matched controls in a randomized cross-over study of 8 weeks of exercise training (5 days/week, submaximal bicycle ergometer training, 30 min/day; calisthenics 9 min/day) versus 8 weeks of rest.

Home-based exercise training modulates pro-oxidant substrates in patients with chronic heart failure.

Background: In chronic heart failure, oxidative stress is thought to lead to endothelial dysfunction. In this study, we assessed the effect of home-based exercise training on variables of the NO and purine pathways.

Methods And Results: Eighteen patients and nine controls were randomly assigned in cross-over design to 8 weeks of exercise training (5 days/week, submaximal bicycle ergometer training, 30 min/day; calisthenics 9 min/day) and 8 weeks of sedentary lifestyle.

Impact of diabetes mellitus type 2 on in-hospital outcome after cardiac catheterizations in a large cohort of octogenarians.

Aim: To assess the impact of diabetes mellitus type 2 (DM) in 1085 octogenarians on in-hospital outcome after cardiac catheterization (CATH) and/or percutaneous coronary intervention (PCI).

Methods And Results: We studied 1085 consecutive octogenarians [82.6+/-2.

[Therapeutic options in patients with diabetes mellitus type 2 and coronary artery disease: intensified secondary prevention versus percutaneous or surgical revascularization].

Diabetes mellitus is a major risk factor for coronary artery disease and is associated with accelerated disease progression and adverse prognosis. Although relief of symptoms can quickly be obtained by percutaneous intervention or bypass surgery, it does not change patients' prognoses, with the exception of stenoses of the left main stem or left anterior descending artery. A multifactorial intervention, which consists of a low-fat diet, glucose and arterial blood pressure control, smoking cessation and regular physical exercise, emerges as an alternative strategy since it leads to improvement of the modifiable risk factors, exercise tolerance and quality of life.

Contemporary outcome of cardiac catheterizations in 1085 consecutive octogenarians.

Background: A growing number of patients > or = 80 years require cardiac catheterization. Since little is known about the overall safety of these procedures in this population, we assessed the procedure-related risks and determined predictors for complications.

Methods: We studied 1085 consecutive patients > or = 80 years (82.

Invasive assessment of bacterial endotoxin and inflammatory cytokines in patients with acute heart failure.

Aims: To test the hypothesis that during acute heart failure endotoxin might be increased in hepatic veins as a sign of bacterial or endotoxin translocation from the bowel into the blood stream.

Methods And Results: In patients with acute heart failure (NYHA IV; n=17) levels of endotoxin, soluble (s) CD14, tumor necrosis factor alpha (TNFalpha and interleukin 6 (IL6)) were measured in blood drawn from an antecubital vein on admission and compared with age-matched patients with stable chronic heart failure (n=21) and healthy volunteers (n=9). All levels were systemically elevated during acute heart failure (all P<0.

Short- and long-term hemodynamic effects of intra-aortic balloon support in ventricular septal defect complicating acute myocardial infarction.

In patients with an infarct-related ventricular septal defect, an intra-aortic balloon pump provides immediate and long-term hemodynamic improvement, resulting in an enhanced effective cardiac output and a reduced left-to-right-shunt and shunt flow ration. In patients who can be stabilized or remain stable, there is no habituation to the effects of the intra-aortic balloon pump; thus, later surgical closure of the ventricular septal defect might be possible in some patients.

Prospective randomized comparison of early and late results of 4 different stent designs.

Background: Late results of interventional procedures using coronary stents are largely determined by the rate of restenosis. So far, few data are available addressing the effect of stent design on this crucial variable and on early and late adverse events after stent implantation.

Methods: From 1996 through 1998, a total of 965 lesions in 925 patients with coronary artery disease were randomized to treatment with 1 of 4 different stent designs (Micro stent II [M] AVE, Düsseldorf, Germany; Sito [S] Sitomed, Rangendingen, Germany; Pura Vario [PV], Devon, Hamburg, Germany; Inflow [ID] Inflow Dynamics, München, Germany).

Role of pro-atherogenic adhesion molecules and inflammatory cytokines in patients with coronary artery disease and diabetes mellitus type 2.

Accelerated progression of atherosclerosis in coronary, carotid, cerebral, and peripheral arteries is a phenomenon observed in diabetes mellitus. Pathophysiologic mechanisms are slowly being understood. Pro-atherogenic adhesion molecules and inflammatory cytokines are involved in this process.

NOS inhibition accelerates atherogenesis: reversal by exercise.

In this study, we assessed the effects of chronic exercise training (12 wk) on atherosclerotic lesion formation in hypercholesterolemic apolipoprotein E-deficient mice (n = 31). At the age of 9 wk, mice were assigned to the following groups: sedentary (Sed; n = 9); exercise (Ex; n = 12); sedentary and oral NG-nitro-L-arginine (L-NNA, Sed-NA; n = 4), or exercise and oral L-NNA (Ex-NA; n = 6). Chronic exercise training was performed on a treadmill for 12 wk (6 times/wk and twice for 1 h/day) at a final speed of 22 m/min, and an 8 degrees grade.

Influence of residual stenosis after percutaneous coronary intervention with stent implantation on development of restenosis and stent thrombosis.

The aim of this study was to assess the effects of residual stenosis after single-stent implantation on the rate of stent thrombosis, as well as restenosis within a 6-month follow-up period. Coronary angiograms of 2,157 patients with 2,523 lesions treated with a single stent were analyzed by quantitative coronary angiography before, immediately after stent implantation, and at a planned 6-month follow-up. Lesions were classified into 4 subgroups according to the degree of residual stenosis after stent implantation: group 1, gross oversizing <-15%; group 2, slight oversizing -15% to <0%; group 3, mild residual 0% to <15%; group 4, moderate residual 15% to <30%.

Fighting restenosis after coronary angioplasty: contemporary and future treatment options.

Despite the widespread use of coronary stents, prevention of restenosis after percutaneous transluminal coronary angioplasty (PTCA) remains a major challenge. The restenotic process is even higher after balloon angioplasty without stenting and has been shown to be in the range of 30-50%. Experimental data suggest that 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors ("statins") might have a beneficial effect on restenosis after coronary angioplasty.

Neointima formation after stent implantation in an experimental model of restenosis: polytetrafluoroethylene-covered versus uncovered stainless steel stents.

The aim of the study was to assess whether stents covered with a membrane of polytetrafluoroethylene spanned over the mashes of a sandwich-configured double stent (n = 15) prevent migration of smooth muscle cells through stent spaces, leading to less neointima formation compared with uncovered stainless steel stents (n = 14) in iliac arteries of male Chinchilla Bastard rabbits (n = 18). Lumen stenosis was assessed by quantitative angiography immediately before the animals were killed 5 weeks after stent deployment. Neointima formation was quantified by histomorphometric analysis.

Insulin resistance in moderate chronic heart failure is related to hyperleptinaemia, but not to norepinephrine or TNF-alpha.

Objectives: Chronic heart failure (CHF) has emerged as an insulin-resistant state, independently of ischaemic aetiology. The underlying mechanisms of this finding are not known. Catecholamines, tumor necrosis factor alpha (TNFalpha) and leptin, the adipocyte specific hormone, have all been implicated as mediators of impaired insulin sensitivity.

Effects of stenting on adjacent vascular distensibility and neointima formation: role of nitric oxide.

Intravascular stents increase long-term patency but their effects on the vascular mechanics of adjacent segments have not been studied. In this study, stents were deployed in the rabbit abdominal aorta after 1 week of normal diet, 1% cholesterol diet or 1% cholesterol diet with L-nitro arginine (L-NA 60 mg/l water). Intravascular ultrasound showed a small distal decrease in vessel distensibility (area/pressure * 100) before stenting.

Cholesterol-induced upregulation of angiotensin II and its effects on monocyte-endothelial interaction and superoxide production.

Atherogenesis involves an early endothelial dysfunction hallmarked by elevated free radical production and increased adhesiveness for monocytes. It was hypothesized that activation of the tissue renin angiotensin system may contribute to the endothelial alteration. To test this hypothesis, thoracic aortae were isolated from normocholesterolemic (NC; n = 6) and hypercholesterolemic (HC; n = 6; diet: 0.

[The anti-atherogenic mechanism of action of physical training in patients with coronary heart disease].

In randomized trials, moderate to aggressive lipid-lowering therapy as well as regular physical exercise have both been shown to restore endothelial function, slow progression and in some patients even lead to regression of coronary artery disease. Furthermore, a reduced rate of cardiac events, morbidity and mortality have been documented. Similarly, regular physical exercise training has been identified to contribute independently to beneficial changes in the risk factor profile, retardation of the progression of coronary lesions and has been associated with a reduced rate of mortality.

[Statins do not prevent restenosis after coronary angioplasty: where to go from here?].

Background: Despite the use of intracoronary stents, approximately 15-20% of patients who undergo percutaneous transluminal coronary angioplasty (PTCA) experience symptomatic restenosis. Known mechanisms of restenotic lesion formation are smooth muscle cell proliferation, extracellular matrix production, remodeling and decreased programmed cell death (apoptosis).

Results And Studies: Experimental observations suggest that HMG-CoA reductase inhibitors ("statins") reduce the risk of restenosis.

Prediction of angiographic stabilization/regression of coronary atherosclerosis by a risk factor graph.

Background: The only reason for treating dyslipidaemia is the prevention and/or stabilization of atherosclerosis. Angiographic stabilization/reversal of coronary atherosclerosis predicts a decrease in future atherosclerotic disease manifestations.

Methods: This paper reports on an analysis of eight angiographic trials that use therapy of dyslipidaemia in order to stabilize/reverse coronary atherosclerosis.