Factors affecting platelet reactivity 2 hours after P2Y12 receptor antagonist loading in primary percutaneous coronary intervention for ST-elevation myocardial infarction: Impact of pain-to-loading time
Xanthopoulou I.,University of Patras |
Davlouros P.,University of Patras |
Tsigkas G.,University of Patras |
Koutsogiannis N.,University of Patras |
And 4 more authors.
Background: Delay in the onset of antiplatelet action occurs in patients with ST-elevation myocardial infarction (STEMI) and is likely due to disturbed absorption. We hypothesized that patients presenting relatively late after the onset of symptoms would have faster antiplatelet action. Methods and Results: We analyzed patient-level data from 5 studies of 207 P2Y12 receptor antagonist-naïve patients with STEMI undergoing primary percutaneous coronary intervention (PCI). All patients had available platelet reactivity (PR) assessment with the VerifyNow assay (in P2Y12 reaction units; PRU) prior to and 2 h after loading. High PR (HPR) was defined as ≥208 PRU. Pain-to-antiplatelet loading time independently predicted PR at 2 h after loading: every 1-h increase in pain-to-antiplatelet loading time produced a 7% decrease in PR (P=0.001). Pretreatment PR, body mass index, morphine and novel P2Y12 receptor antagonist also affected PR 2 h after loading. Novel P2Y12 receptor antagonist use and per hour increase in pain-to-antiplatelet loading time were independently associated with lower probability for HPR with an OR (95% CI) of 0.145 (0.095–0.220) and 0.776 (0.689–0.873), P<0.001 for both (C-statistic, 0.752; 95% CI: 0.685–0.819). Conclusions: In STEMI patients undergoing primary PCI, pain-to-antiplatelet loading interval is a newly described factor affecting PR shortly after P2Y12 receptor antagonist loading, according to patient-level data pooled analysis. © 2016, Japanese Circulation Society. All rights reserved. Source
Paraskevis D.,National and Kapodistrian University of Athens |
Nikolopoulos G.,Hellenic Center for Diseases Control and Prevention |
Tsiara C.,Hellenic Center for Diseases Control and Prevention |
Paraskeva D.,Hellenic Center for Diseases Control and Prevention |
And 7 more authors.
A significant increase (more than 10-fold) in the number of newly diagnosed HIV-1 infections among injecting drug users (IDUs) was observed in Greece during the first seven months of 2011. Molecular epidemiology results revealed that a large proportion (96%) of HIV-1 sequences from IDUs sampled in 2011 fall within phylogenetic clusters suggesting high levels of transmission networking. Cases originated from diverse places outside Greece supporting the potential role of immigrant IDUs in the initiation of this outbreak. Source
Koutourousiou M.,Athens General Hospital G. Gennimatas |
Seretis A.,Athens General Hospital G. Gennimatas
Aseptic meningitis after transsphenoidal surgery (TSS) for treatment of Rathke's cleft cyst (RCC) is a rare complication caused by the leakage of the cyst contents within the subarachnoid space. We present a case of aseptic meningitis occurring after TSS for a RCC. During surgery, the cyst wall was subtotally removed, and intraoperative cerebrospinal fluid (CSF) leakage was observed. The patient developed meningeal signs and symptoms on the first postoperative day. CSF examinations were highly suggestive of aseptic meningitis. Histological examination confirmed a granulomatous inflammatory reaction of the RCC wall. Preexisting inflammation, subtotal cyst wall resection, intraoperative erosion of the diaphragma sellae and placement of a lumbar drain may be risk factors for the development of aseptic meningitis. © 2010 Springer-Verlag. Source
Deftereos S.,Athens General Hospital G. Gennimatas |
Giannopoulos G.,Athens General Hospital G. Gennimatas |
Giannopoulos G.,Yale University |
Raisakis K.,Athens General Hospital G. Gennimatas |
And 10 more authors.
Journal of the American College of Cardiology
Objectives: This study sought to test the hypothesis that colchicine treatment after percutaneous coronary intervention (PCI) can lead to a decrease in in-stent restenosis (ISR). Background: ISR rates are particularly high in certain patient subsets, including diabetic patients, especially when a bare-metal stent (BMS) is used. Pharmacological interventions to decrease ISR could be of clinical relevance. Methods: Diabetic patients with contraindication to a drug-eluting stent, undergoing PCI with a BMS, were randomized to receive colchicine 0.5 mg twice daily or placebo for 6 months. Restenosis and neointima formation were studied with angiography and intravascular ultrasound 6 months after the index PCI. Results: A total of 196 patients (63.6 ± 7.0 years of age, 128 male) were available for analysis. The angiographic ISR rate was 16% in the colchicine group and 33% in the control group (p = 0.007; odds ratio: 0.38, 95% confidence interval: 0.18 to 0.79). The number needed to treat to avoid 1 case of angiographic ISR was 6 (95% confidence interval: 3.4 to 18.7). The results were similar for IVUS-defined ISR (odds ratio: 0.42; 95% confidence interval: 0.22 to 0.81; number needed to treat = 5). Lumen area loss was 1.6 mm2 (interquartile range: 1.0 to 2.9 mm2) in colchicine-treated patients and 2.9 mm2 (interquartile range: 1.4 to 4.8 mm2) in the control group (p = 0.002). Treatment-related adverse events were largely limited to gastrointestinal symptoms. Conclusions: Colchicine is associated with less neointimal hyperplasia and a decreased ISR rate when administered to diabetic patients after PCI with a BMS. This observation may prove useful in patients undergoing PCI in whom implantation of a drug-eluting stent is contraindicated or undesirable. © 2013 American College of Cardiology Foundation. Source
Michailidis C.,Athens General Hospital G. Gennimatas |
Giannopoulos G.,Athens General Hospital G. Gennimatas |
Vigklis V.,Athens General Hospital G. Gennimatas |
Armenis K.,Athens General Hospital G. Gennimatas |
And 2 more authors.
Clinical and Experimental Immunology
In patients with human immunodeficiency virus (HIV) infection, neutrophil and monocyte functions, including phagocytosis, are impaired. The purpose of this study was to investigate changes of phagocytic function and respiratory burst occurring over the course of patients infected by the HIV-1 virus. Treatment-naive patients (group B), patients receiving highly active anti-retroviral treatment (HAART) (group C) and patients in which HAART has failed (group D) were studied and compared with healthy volunteers (group A). Phagocytosis and oxidative burst were evaluated using commercially available kits. Results clearly denote a significant decrease of the phagocytic function of both cell types of groups B and C compared with group A. Among group C patients, those in the upper quartile of CD4 increase had higher oxidative burst compared with patients of the other quartiles. In addition, comparisons clearly showed a lower degree of phagocytic function and of oxidative burst of both monocytes and neutrophils of group D compared with group B. Finally, it was found that monocyte and neutrophil function was correlated inversely to the change in viral load, i.e. the greater the decrease of viral load, the better the phagocytic and oxidative activity. Innate immunity defects appear to be present in HIV-positive patients, regarding phagocytic activity and oxidative burst of monocytes and neutrophils. These defects are greatly influenced by the level of treatment efficacy, with emphasis on CD4 cell counts and viral load. © 2011 The Authors. Clinical and Experimental Immunology © 2011 British Society for Immunology. Source