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1.  The correlation between early complications of percutaneous coronary intervention and high sensitive C-reactive protein 
ARYA Atherosclerosis  2013;9(4):263-267.
BACKGROUND
Increased incidence of cardiovascular diseases, especially coronary artery disease (CAD), during recent decades shows this disease entity to be the leading cause of death in the world. On the other hand many successes were achieved in the treatment of these diseases with new technology, which has its own side effects and threats for the patient. Among these new strategies is percutaneous coronary intervention (PCI), especially with stent implantation. Although coronary stents are effective in the treatment of dissection and prevention of restenosis, many side effects and even death have been observed, from 5-10% per year. Some studies showed that there is a relation between high sensitivity C-reactive protein (hs-CRP), as a laboratory marker for early detection of thrombosis and/or restenosis, and early complications of percutaneous coronary intervention. The aim of this study is to evaluate hs-CRP level in patients after PCI and to investigate if this can be a prognostic value for detection of early complication.
METHODS
This is a descriptive, analytical study done in Shahid Chamran Hospital (Isfahan, Iran) in 2011-2012. 87 patients who had undergone PCI were studied. Their hs-CRP level was measured before and after the study. Moreover, early stent complications were detected during the first 24 hours after insertion. The data was recorded in a researcher-constructed checklist and analyzed by SPSS for Windows 20.
RESULTS
The mean ± SD of hs-CRP level in patients with and without complication were 1.36 ± 0.97 and 3.09 ± 1.8, respectively. According to Student’s t-test, the hs-CRP level in patients with early complications was higher than patients without early complications of stent implantation; the difference was statistically significant (P < 0.001).
CONCLUSION
The hs-CRP serum concentrations of patients with, and without early stent complications were significantly different. According to the control diseases center (CDC) guideline, patients with a high level of hs-CRP need special care and attention.
PMCID: PMC3746945  PMID: 23970923
High Sensitivity C-reactive Protein (hs-CRP); Percutaneous Coronary Intervention (PCI) Complication
2.  The Predictive Factors of Recurrent Deep Vein Thrombosis 
ARYA Atherosclerosis  2011;7(3):123-128.
BACKGROUND
About 2-5% of people experience deep-vein thrombosis (DVT) during their lives. Death, disease recurrence, post-thrombotic syndrome, and excessive bleeding due to coagulant medications are among the most important DVT complications. Recent research found a high incidence of DVT recurrence after the first attack. Disease recurrence has a multifactorial pathogenesis and its probability is related with the number and severity of risk factors. The present study aimed to investigate DVT recurrence and the associated risk factors.
METHODS
This retrospective cross-sectional study evaluated all DVT patients hospitalized in Alzahra Hospital, Isfahan, Iran, during April 2000 to April 2011. The risk factors were obtained from patients' records including smoking, intravenous drug abuse, having a history of surgery in last four weeks, immobility, obesity, history of cardiac disease, and cancer.
RESULTS
A total number of 2550 DVT patients were hospitalized in Alzahra Hospital during the study period. It was only possible to extract the data from 385 patient records. A history of DVT was reported in 48 individuals (12.5%). The comparison between the risk factors in patients with a first time DVT and those experiencing a recurrent DVT revealed significant differences solely in the prevalence of blood disorders and immobility. Applying stepwise regression indicated immobility (OR: 4.57; 95% CI: 1.26-16.57; P < 0.021) and coagulopathy (OR: 0.33; 95% CI: 0.13-0.81; P < 0.016) with DVT recurrence.
CONCLUSION
Based on our findings, DVT patients are suggested to be mobilized as soon as possible. In addition, they should be advised to increase their activity after discharge.
PMCID: PMC3347857  PMID: 22577459
Deep Vein Thrombosis; Immobility; Risk Factor
3.  The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study 
ARYA Atherosclerosis  2011;7(2):68-73.
BACKGROUND
The current study aims to determine the relation between ankle–brachial index (ABI) and angiographic findings and major cardiovascular risk factors in patients with suspected coronary artery diseases (CAD) in Isfahan.
METHODS
In this cross-sectional descriptive-analytic research, patients with suspected CAD were studied. Characteristics of studied subjects including demographics, familial history, past medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension, hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured in all studied patients. ABI≤0.9 (ABI+) was considered as peripheral vessel disease and ABI>0.9 (ABI-) was considered as normal. Then, all studied patients underwent coronary artery angiography. The results of the questionnaire and angiographic findings were compared in ABI+ and ABI- groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank correlation coefficient, and discriminant analysis.
RESULTS
In this study, 125 patients were investigated. ABI≤0.9 was seen in 25 patients (20%). The prevalence of ABI+ among men and women was 25.9% and 7.5%, respectively (P=0.01). The prevalence of atherosclerotic risk factors was significantly higher in ABI+ patients than in ABI- ones (P<0.05). ABI+ patients had more significant stenosis than ABI- ones. The mean of occlusion was significantly higher in ABI+ patients with left main artery (LMA), right coronary artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex artery (LCX) involvements (P<0.05).
CONCLUSION
The findings of this research indicated that ABI could be a useful method in assessing both the atherosclerotic risk factors and the degree of coronary involvements in suspected patients. However, in order to make more accurate decisions for using this method in diagnosing and preventing CAD, we should plan further studies in large sample sizes of general population.
PMCID: PMC3347847  PMID: 22577449
Ankle–Brachial Index; Angiography; Atherosclerotic Risk Factors.
4.  Can doubling the maintenance dose of clopidogrel prevent from early stent thrombosis after the primary percutaneous coronary intervention? 
ARYA Atherosclerosis  2011;7(1):18-23.
BACKGROUND
Treatment of significant coronary artery disease with primary percutaneous coronary intervention (PCI) seems better than angioplasty balloon; because the incidence of restenosis is lower in this method, however, a serious complication of PCI is stent thrombosis which would lead to repeated myocardial infarction (MI) and increase the mortality and morbidity. One of the frequent medications which is used to prevent from stent thrombosis is clopidogrel, but, stent thrombosis was seen in many of the patients despite given the conventional dosage of this drug. This study aimed to evaluate the effect of doubling the maintenance dose of clopidogrel to prevent from early stent thrombosis, MI and mortality rate.
METHODS
This was a clinical trial study which was done in Shahid Chamran Hospital in winter 2010 in Isfahan, Iran. A total of 400 patients with PCI were prospectively followed-up for 30 days. All the patients were randomly allocated into two groups. The control group received a maintenance dose of 75 mg clopidogrel while the case group received 150 mg clopidogrel after the initial dosage of 600 mg for 30 days after the PCI. The incidence of primary outcome such as total mortality was recorded during the study.
RESULTS
Early stent thrombosis was observed in 4 patients (1%) (One subject in the control group and 3 in the case group) during the first 30 days after PCI, but the difference was not significant between the two groups (P=0.62). Mortality due to stent thrombosis occurred in 2 patients in the case group which showed no significant difference in this group (P=0.5). In addition, MI occurred in 2 patients (1 in each group) which also showed no significant difference between the two groups (P=1). Drug complication such as major bleeding had no significant difference between the two groups (P=0.9).
CONCLUSION
The present study showed that doubling dose of clopidogrel could not reduce the incidence of early stent thrombosis, mortality and myocardial infarction in comparison with conventional dosage; therefore it is recommended that more studies be done in Iranian and Asian race for clinical decision-making to prevent form stent thrombosis using high dose of clopidogrel.
PMCID: PMC3347836  PMID: 22577440
Primary Coronary Intervention; Early Stent Thrombosis; Clopidogrel; Coronary Stenting

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