Periprocedural myocardial infarction (MI) is a common complication following percutaneous coronary intervention (PCI) and statins have been shown to reduce MI in statin-naïve patients. We aimed to identify whether a high reloading dose of atorvastatin can prevent MI following PCI in patients who were already being treated with statins. In this triple-blind controlled randomized clinical trial, 190 candidates for elective PCI, who were already using statins and/or other lipid lowering agents such as fibrates, were randomly assigned to two equal groups to receive either atorvastatin (80 mg) or placebo within 24 hours before the procedure. Serum levels of creatinine kinase myocardial isoenzyme (CK-MB), cardiac troponin I (cTNI) and high-sensitive C-reactive protein (hs-CRP) were measured at baseline and then 6 and 12 hours following PCI. Post-procedural MI was defined as troponin elevation>5-fold in patients with normal baseline or >20% in those with elevated baseline measurements with or without chest pain or ST segment or T wave abnormalities. Frequency of MI in the atorvastatin group was 3 (3.1%) vs. 10 (10.5%) in the placebo group (p=0.04). The CK-MB rise within 6 hours following PCI was 0.6±0.3 mg/dl in the intervention group versus 3.0±1.6 mg/dl in the placebo group. Also, the levels of cTNI within 6 and 12 hours in the intervention group was significantly lower than the placebo group (p=0.01 and 0.008, respectively). hs-CRP was significantly lower in the intervention group after 12 hours (p=0.004). Administration of a high reloading dose of atorvastatin within 24 hours before PCI could significantly reduce the frequency of periprocedural MI. CLINICAL TRIAL REGISTRATION CODE: IRCT201205209768N1.

Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients. Methods: In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient’s self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity. Results: The results showed that 75 patients (28%) didn’t adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence. Conclusion: The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society.

Cardiovascular disease is the most-common cause of mortality in patients with end-stage renal disease and renal transplant. Prolongation of QTc(max) and QTc dispersion are risk factors of cardiac arrhythmias and mortality. This study compares the changes of QT parameters before hemodialysis, after hemodialysis, and after renal transplant. Patient candidates for renal transplant were selected. Mean serum electrolyte and 12-lead electrocardiogram were recorded (1) immediately, (2) before and, (3) after the last dialysis session before renal transplant, (4) and 2 weeks after a kidney transplant in 34 patients with normal graft function (plasma Cr ≤ 176.8 μmol/L). Each QT interval was corrected for the patient's heart rate using Bazett's formula. The QT parameters (QTd, QTcd, QTc(max)) were compared between prehemodialysis, posthemodialysis, and 2 weeks after renal transplant using a paired t test and a general liner model repeated measure. The correlation between QT parameter changes and serum electrolyte and acidbase alternation was analyzed. The corrected maximal QT interval (QTc(max)) decreased significantly after successful renal transplant compared to prehemodialysis (P = .002) and posthemodialysis (P = .003) with a paired t test and a General Liner Model Repeated Measure (P < .001) between the 3 groups. Also, the mean of QTc(max) decreased significantly after renal transplant (P = .001) compared to what it was before hemodialysis and after hemodialysis. There was a significant correlation (r= -0.37) between reduction of QTc(max) and serum Ca level (P = .01) in postrenal transplant period. Renal transplant with normal graft function decrease QTc(max) compared to prehemodialysis and posthemodialysis that may correlate with normalization of electrolytes from the uremic state of the normal kidney function.

Background/objective: In the current study, we aimed to explore the effects of rice bran oil (RBO) in adjunct to conventional medical therapy on left ventricular ejection fraction (LVEF), cardiometabolic risk factors, and inflammatory mediators in male patients with coronary artery disease (CAD). Subjects/methods: The present randomized controlled trial included 40 men diagnosed with CAD (mean age = 55.76 years) who were randomly allocated into two groups to receive either 30 grams per day of RBO (intervention group) or sunflower oil (control group) plus a standard diet for eight weeks. At the initial visit, demographic and anthropometric data and blood samples were collected. LVEF levels and serum concentrations of lipid profile, glucose, uric acid, hs-CRP, and TNF-α were investigated. Results: A total of 37 participants completed the study (n = 18 in the intervention group, n = 19 in the control group). Analysis of covariance (ANCOVA) adjusted for baseline values, age and body mass index revealed that RBO significantly improved LVEF (51.34%) and reduced triglyceride (125.01 mg dl⁻¹), blood sugar (110.4 mg dl⁻¹), total cholesterol (123.01 mg dl⁻¹) and low density lipoprotein (56.88 mg dl⁻¹) levels compared to sunflower oil ((45.56%), (155.93 mg dl⁻¹), (128.94 mg dl⁻¹), (163.93 mg dl⁻¹) and (83.79 mg dl⁻¹), respectively) following a 8-week trial (P-values < 0.05). Additionally, the test demonstrated that RBO consuming patients had significantly lower levels of serum uric acid (4.60 mg dl⁻¹), TNF-α (6.99 ng L⁻¹) and hs-CRP (2.11 mg L⁻¹) compared to the control group ((5.92 mg dl⁻¹), (15.23 ng L⁻¹), (4.47 mg L⁻¹), respectively) (P-value < 0.05). However, no significant changes were found regarding weight, blood pressure or serum HDL levels throughout the trial. Conclusion: Consumption of 30 grams per day RBO within a standard diet could be considered an effective non-pharmacological approach in improving LVEF, cardiometabolic risk factors, and inflammatory state in CAD. However, future trials are recommended for more clarification.

Rare disease A coronary artery fistula is an abnormal communication between a coronary artery and one of the cardiac chambers or a great vessel, so bypassing the myocardial capillary network. They are usually discovered incidentally upon coronary angiography. Clinical manifestations are variable depending on the type of fistula, the severity of shunt, site of shunt, and presence of other cardiac condition. We report a 69-year-old man without any previous medical history, who was admitted to our hospital with chest pain. The electrocardiogram (ECG) showed a sinus rhythm with ST depression in V2 to V6 precordial leads. Coronary angiography revealed a coronary artery fistula from left anterior descending coronary artery (LAD) to the main pulmonary artery, right coronary artery blockage and significant stenoses on the LAD and left circumflex artery (LCX). Surgical treatment was chosen because of the total occlusion of the right coronary artery and to relieve of pain to improve quality of life.