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The article analyzes studies comparing rates of in-hospital mortality and emergency percutaneous coronary artery bypass grafting (CABG) surgery at centers with and without on-site surgery. Analysis revealed a 4.6 percent average mortality rate in patients undergoing primary percutaneous coronary intervention (PCI) across studies for sites with on-site surgery and 5.1 percent for sites with on-site surgery. The average mortality rate in patients undergoing non-primary PCI for sites without on-site surgery was 0.9 percent and 0.8 percent for sites with on-site surgery. Evaluation showed low incidence of emergency CABG for both primary and non-primary PCI at centers without on-site surgery.

Abstract: Objectives: To evaluate the feasibility of an assay for urinary levels of matrix metalloproteinases (MMPs) and the potential usefulness of urinary MMPs as a marker of coronary atherosclerosis or acute coronary syndromes (ACS). Methods and results: We measured urine and plasma MMP-9, MMP-2 and urine tissue inhibitor of metalloproteinase (TIMP-1) in patients with ACS (n =27), patients with coronary artery disease (CAD), but no clinical instability (n =47) and a group of healthy volunteers (n =15) who were <35 years of age, had no risk factors for CAD and did not undergo angiography. Compared with volunteers, patients with ACS and CAD had higher urine MMP-9, urine TIMP-1, plasma MMP-9 and plasma MMP-2 levels, but these did not differ between those with CAD and ACS. Using the volunteers to roughly establish an upper limit of normal, 84% of the urine TIMP-1 values and 95% of the urine MMP-9 values were abnormally elevated among those with CAD and ACS. Conclusions: Urine MMP-9 and TIMP-1 levels are elevated in patients with CAD and ACS compared with healthy volunteers. A high percent of patients with CAD or ACS had elevated urine values of MMP-9 and TIMP-1 suggesting these variables might be a useful marker of atherosclerotic disease. [Copyright &y& Elsevier]

Abstract: Mast cells may participate actively in the inflammatory process of atherosclerotic plaques by releasing proteolytic enzymes and various other pro-inflammsatory substances. We hypothesized that increased levels of mast cell tryptase, could be an important biomarker in patients with stable coronary artery disease (CAD). We measured tryptase in 102 patients without acute coronary syndromes undergoing cardiac catheterization. Patients with significant CAD [≥50% stenosis in ≥1 artery (n=66)] had significantly higher serum tryptase than patients with normal angiography (n=13) or non-significant CAD [<50% stenosis (n=23)]. The median, 25th and 75th percentiles for tryptase in these two groups were 8.38 (6.4 and 10.7)μg/L versus 6.78 (5.61 and 9.72)μg/L, p=0.014. Patients in the highest quartile of tryptase levels had a 4.3-fold risk for CAD [Odds ratio (OR): 4.3; 95% confidence interval (CI): 1.08–17.19; p=0.04]. In a multivariate regression analysis, tryptase remained an independent predictor for CAD along with age (OR: 1.178; 95% CI: 1.021–1.359, p=0.025). High circulating tryptase levels may be a result of chronic low-grade inflammatory activity present in atherosclerotic plaques. Tryptase measurements may emerge as a novel way of identifying asymptomatic patients with CAD, and represent a new biomarker of therapeutic efficacy in patients with CAD. [Copyright &y& Elsevier]

Coronary artery revascularization by either percutaneous coronary intervention or coronary artery bypass graft surgery in patients ≥80 years of age can be accomplished with acceptable in-hospital and 2-year clinical outcomes. However, up to 20% of patients have a prolonged recovery and are unable to immediately return home. It is important that this information become part of the discussion with patients and their families so realistic expectations can be developed. [Copyright &y& Elsevier]