Platelet reactivity and a proinflammatory chemokine were reduced more by the higher atorvastatin dose than by ezetimibe plus low-dose atorvastatin. In patients with coronary artery disease, it might be important to combine ezetimibe with higher statin dosages to benefit from cholesterol-independent pleiotropic effects.

Untreated nonculprit lesions in STEMI patients frequently have TCFA morphology that does not change during 13-month follow-up and is accompanied by a decrease in MLA and an increase in necrotic core. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).

SUMMARYAim: A major concern of stent implantation after percutaneous coronary intervention (PCI) is acute stent thrombosis. Effective inhibition of periprocedural platelet function in patients with coronary artery disease (CAD) leads to an improved outcome. In this study, we examined the periprocedural platelet reactivity after administrating bivalirudin during PCI compared to unfractionated heparin (UFH) administration. Further, the effect of bivalirudin on induced tissue factor (TF) expression in smooth muscle cells (SMC) was determined. Methods: Patients with CAD (n = 58) and double antithrombotic medication were treated intraprocedural with UFH (n = 30) or bivalirudin (n = 28). Platelet activation markers were flow cytometrically measured before and after stenting. The expression of TF in SMC was determined by real-time PCR and Western blotting. The thrombogenicity of platelet-derived microparticles and SMC was assessed via a TF activity assay. Results: Bivalirudin significantly diminished the agonist-induced platelet reactivity post-PCI. Compared to UFH treatment, the adenosine diphosphate (ADP) and thrombin receptor-activating peptide (TRAP)-induced thrombospondin expression post-PCI was reduced when bivalirudin was administrated during intervention. In contrast to UFH, bivalirudin reduced the P-selectin expression of unstimulated and ADP-induced platelets post-PCI. Moreover, bivalirudin inhibited the thrombin-, but not FVIIa-or FVIIa/FX-induced TF expression and pro-coagulant TF activity of SMC. Moreover, bivalirudin reduced the TF activity of platelet-derived microparticles postinduction with TRAP or ADP. Conclusions: Bivalirudin is better than UFH in reducing periprocedural platelet activation. Moreover, thrombin-induced TF expression is inhibited by bivalirudin. Thus, bivalirudin seems to be a better anticoagulant during PCI than UFH.

Objective: We investigated in a pilot study whether telemedicine is beneficial in mild to moderate chronic heart failure. Methods: A total of 128 patients with an ejection fraction ≤60% and NYHA class II or III chronic heart failure were evaluated. Thirty-two patients were enrolled prospectively in a staged telemedical service program. Ninety-six controls were matched 3:1 to each telemedicine patient. Results: Median follow-up was 307 days (range 104–459). All-cause hospitalization duration [317 vs. 693 days/100 patient years; relative risk (RR) 0.46; 95% confidence interval (CI) 0.37–0.58; p < 0.0001) and rate (38 vs. 77/100 patient years; RR 0.49; 95% CI 0.25–0.95; p = 0.034) as well as cardiac hospitalization duration (49 vs. 379 days/100 patient years; RR 0.13; 95% CI 0.08–0.23; p < 0.0001] were significantly lower, cardiac hospitalization rate (11 vs. 35/100 patient years; RR 0.31; 95% CI 0.11–1.02; p = 0.058) tended to be lower in the telemedicine compared with the control group. Conclusion: These preliminary data suggest that telemedical care and monitoring may reduce morbidity in patients with NYHA class II and III chronic heart failure.

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