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Usefulness of the baseline lymphocyte count to predict platelet reactivity during clopidogrel therapy in patients with stable angina pectoris

Results: The exercise ECG showed an abnormal result in 69 patients (50%) (ST- segment depression ≥ 0.1mV and/or reproduction of the patient’s usual symp-toms). The ACH-test revealed abnormal coronary vasomotion (reproduction of the patient’s symptoms, ischemic ECG shifts +/- diffuse distal spasm) in 87 patients (64%). Such a result was signiﬁcantly more often found in patients with a pathologic exercise ECG than in those with a normal exercise ECG (50/69, 72%, vs 37/68, 54%, p=0.034). There were no other statistically signiﬁcant differences between patients with and those without a pathologic exercise ECG. Conclusion: A pathologic exercise ECGdoes not represent a false negative ﬁnd- ing in patients with angina and non-obstructed coronary arteries but is indicative of underlying microvascular disease. Purpose: This study aimed to assess long-term prognosis of stable coronary artery disease (sCAD) in patients aged ≥ 75 years and to identify clinical predictors of cardiovascular and overall mortality. Methods: From February 2000 to January 2007, 391 outpatients aged ≥ 75 years (median 78 years, interquartile range [IQR] 76-81 years, 66% male) with sCAD were recruited in this prospective cohort study. Associations of baseline variables with long-term cardiovascular and all cause death were investigated. Results: Afterup to 11 years of follow-up (median 4 years, IQR 2-6 years), 89 patients died (23%, 5.45%/year), 35 from cardiovascular causes (9%, 2.14%/year). Multivariate analysis identiﬁed family history of coronary disease (HR 4.28, 95% CI 1.22-15.02, p=0.02), baseline atrial ﬁbrillation (HR 3.18, 95% CI 1.37-7.39, p=0.007), age (HR 1.61 per 5 year-increase, 95% CI 1.04-2.50, p=0.03), resting heart rate (HR 1.26 per 5 bpm-increase, 95% CI 1.09-1.47, p=0.003), and previous revascularization (HR 0.17, 95% CI 0.04-0.77, p=0.02) as independent predictors of cardiovascular death; and previous acute coronary syndrome (HR 4.93, 95% CI 1.49-16.30, p=0.009), baseline atrial ﬁbrillation (HR 1.96, 95% CI 1.12-3.43, p=0.02), tobacco use (HR 1.69, 95% CI 1.00-2.84, p=0.049 for ex- smoking and HR 6.78, 95% CI 0.89-51.47, p=0.06 for active smoking), age (HR 1.58 per 5 year-increase, 95% CI 1.18-2.11, p=0.002), resting heart rate (HR 1.10 per 5 bpm-increase, 95% CI 1.00-1.22, p=0.05) and diastolic blood pressure (HR 0.97, 95% CI 0.94-0.99, p=0.01), as independent predictors of overall mortality. Conclusions: In this study, 4-years overall mortality was 23% among elderly patients with sCAD. Simple clinical variables can identify patients at higher risk of mortality. Inﬂammation is one of the major factors affecting Platelet (PLT) function and PLT response to antiplatelet therapy. Routine Complete Blood Count (CBC) is a simple method for assessment of inﬂammatory status.Aim: Our aim was to inves- tigate the predictive value of the preprocedural count of different types of white blood cells on PLT reactivityto Clopidogrel (CLO) in Stable Angina Pectoris (SAP) patients undergoing coronary artery stent implantation. Methods: Ninety consecutive patients with SAP after elective and success- ful (TIMI 3) Percutaneous Coronary Intervention (PCI) with stent implantation were enrolled into the study (F/M=35/55pts, age=65.1 ± 9.3 years). The PLT func- tion analysis was performed 24h after PCI with Clopidogrel (CLO) loading dose (600mg; baseline) and after one month of antiplatelet therapy (CLO 75mg daily, control).The PLT activitywas assessed ina whole blood based on impedance aggregometry (adenosine diphosphate asthe agonist; ADPtest)using multipleelec- trode aggregometry (Multiplate, Dynabyte, Germany). Both the baseline and the control PLT tests were associated with the preprocedural CBC, including: Neu- trophil (N), Lymphocyte (L), Eosynophil (E), Monocyte (M) count and the following ratios (R): N/LR, PLT/LR and PLT/NR. Results: Both the baseline and the control PLT test reactivity to ADP were signif-icantly correlated with the L count (ADP1: r=0,422, p < 0.001 and ADP2: r=0.36, p < 0.001) and inversely correlated with the N/LR (ADP1: r=-0.221, p=0.036 and ADP2: r=-0.226, p=0.032). The PLT/LR or PLT/NR were not associated with PLT test results. Conclusion: Increased preprocedural lymphocyte count is signiﬁcantly corre- lated with the platelet reactivity during clopidogrel therapy and predicts increased platelet reactivity to clopidogrel in stable coronary artery disease patients. Objective: To investigate T-786C polymorphism of eNOs gene in Ukrainian pa- tients with CAD and relationship between this polymorphism and clinical presen-tation. Materials and methods: We examined 120 patients with CAD, stable angina pectoris II–III functional class who had haemodinamically signiﬁcant coronary artery (CA) stenosis on selective coronary angioventriculography (SCVG). Con- trol group included 35 persons without morphologic and atherosclerotic CA pathology. Examination included assessment of ankle-brachial index (ABI), doppler ultrasound of lower extremities vessels and carotid arteries with evalu-ation of intima-media complex thickness (IMCT). Allele polymorphism of eNOs gene was assessed by polymerase chain reaction with electrophoretic scheme of result detection. Results and discussion: Genotyping T -786C polymorphism of eNOs gene in control group showed the following distribution of T/T, C/T and C/C genotypes: 45,7; 48,6 and 5,7%; in patients with CAD - 37,5; 40,8 and 21,7%, T/T C/T infarction the compared withthe 1st group (p in the injury (p CAD and left ventricular systolic function two sequential exercise tests (SET) with 30-minute interval between them. Ischemic parameters were compared between diabetic and non-diabetic patients. Ischemic preconditioning was considered present when time to 1mm ST-segment deviation was greater in the second of two SETs. Tests were analyzed by two independent and experi-enced cardiologists. Results: From 160 CAD patients who underwent SETs, 112 patients developed IP compared with 48 patients who did not (P=0.0001). From all patients, 75 were diabetic (group 1) and 85 were non-diabetic patients (group 2). The two groups were similar in terms of main prognostic parameters, besides previous infarction cholesterol proﬁle. In group 1, 54 (72%) patients developed IPand in group 2, 58 (68.2%) patients developed IP (P=0.35). When we compared the two groups, the in time to 1mm ST-segment deviation was quite similar (76 vs 66 seconds, respectively for groups 1 and 2; P=0.19). in time to the onset of angina during SETs were also similar between the groups (45.2 vs 76.7 seconds, respectively for groups 1 and 2; P=0.56).