Mitral stenosis usually occurs many years after an episode of rheumatic fever and it has an indolent course until its later stages, when it acutely worsens. The rates of mitral stenosis keep declining; nonetheless, the need for advanced...
moreMitral stenosis usually occurs many years after an episode of rheumatic fever and it has an indolent course until its later stages, when it acutely worsens. The rates of mitral stenosis keep declining; nonetheless, the need for advanced and sophisticated treatment modalities still remains. Our group has been applying a novel modified antegrade approach for treating mitral valve stenosis and, although we have limited experience, the results thus far are favorable. We present the preliminary data of three patients who suffered from symptomatic mitral valve stenosis and underwent successful percutaneous mitral valvuloplasty with this novel modified antegrade approach. This method increases the safety and the efficacy of the procedure and has the same clinical results as other available percutaneous techniques.
Balloon aortic valvuloplasty (BAV) is considered to be an essential part of the transcatheter aortic valve implantation (TAVI) procedure and is being performed routinely. At present there is insufficient long-term data as to the benefits...
moreBalloon aortic valvuloplasty (BAV) is considered to be an essential part of the transcatheter aortic valve implantation (TAVI) procedure and is being performed routinely. At present there is insufficient long-term data as to the benefits of routine BAV prior to TAVI. The aim of this study was to evaluate the safety of direct TAVI and the mortality rate at 1-year in patients undergoing TAVI with or without BAV with a self-expanding bioprosthesis. Between January 2008 and September 2013 consecutive patients undergoing TAVI with the Medtronic CoreValve in two experienced centers in Athens, Greece and in Siegburg, Germany were studied. All data were prospectively collected and retrospectively analyzed. Primary endpoint was mortality at 1year. Procedural data and clinical data (bleeding, vascular complications and echocardiographic parameters) were analyzed. A total of 210 patients undergoing TAVI were evaluated (non-direct=120 patients, direct=90 patients). All-cause mortality at 30days...
A 84 year-old Caucasian man without significant coronary artery disease was programmed for transcatheter aortic valve implantation (TAVI) in our hospital, based on severe symptomatic aortic valve stenosis (dyspnea ΝΥΗΑ class III–IV,...
moreA 84 year-old Caucasian man without significant coronary artery disease was programmed for transcatheter aortic valve implantation (TAVI) in our hospital, based on severe symptomatic aortic valve stenosis (dyspnea ΝΥΗΑ class III–IV, aortic valve area of 0.7 cm2 with a mean gradient of 55 mm Hg with an ejection fraction of ~50% on trans-thoracic echocardiography), high estimated surgical risk (estimated logEuroScore of 30.2%) and sound clinical judgment of a multidisciplinary Heart Team. According to our standard practice, a Multi Slice Computed Tomography (MSCT) was performed prior to the procedure showing a severely calcified tricuspid aortic valve and very steep angulation of the aorto-iliac bifurcation.
Recent advances in technology, crossing techniques and learning skills, have significantly increased the success rates of Percutaneous Coronary Interventions (PCIs) in Chronic Total Occlusions (CTOs). Successful PCI for CTO has been...
moreRecent advances in technology, crossing techniques and learning skills, have significantly increased the success rates of Percutaneous Coronary Interventions (PCIs) in Chronic Total Occlusions (CTOs). Successful PCI for CTO has been reported to reduce angina symptoms, improve functional status, decrease the need for bypass surgery, and may improve patient survival. In addition, when an antegrade approach is not feasible or fails, a retrograde approach to CTO has been widely adopted with a high success rate and acceptable complication rate
We present the case of a patient who experienced simultaneous subacute thrombosis of two different drug eluting stents (DESs) in two different coronary vessels, 20 days after implantation. Interestingly, the patient never discontinued the...
moreWe present the case of a patient who experienced simultaneous subacute thrombosis of two different drug eluting stents (DESs) in two different coronary vessels, 20 days after implantation. Interestingly, the patient never discontinued the dual antiplatelet therapy of aspirin plus clopidogrel.
Despite medical and technical advancements stent thrombosis continued to poses a significant risk in patients after drug eluting stent (DES) implantation and clopidogrel resistance has been recognized as an important determinant of this...
moreDespite medical and technical advancements stent thrombosis continued to poses a significant risk in patients after drug eluting stent (DES) implantation and clopidogrel resistance has been recognized as an important determinant of this risk. Novel antiplatelets such as prasugrel and ticagrelor can be used in cases of clopidogrel resistance however bleeding complications remain the Achilles' heel of antiplatelet therapy. Several genetic polymorphisms affect the clopidogrel absorption and bio-activation in the active form of the drug. CYP2C19 is responsible for most of the clopidogrel bio-transformation and loss of function as well as, gain of function polymorphisms of this enzyme has been recognized. Early studies have linked CYP2C19 genetic polymorphisms with clinical events, although, these findings were not confirmed by later studies. However, when the estimated thrombotic risk is high a combination of genetic information and functional platelet tests should be essential for ...
We assessed the effect of left atrial (LA) function index, LA ejection fraction, LA kinetic energy, and maximal LA volume on 6 months clinical outcome in patients with newly diagnosed systolic heart failure (HF). During a 36-month period,...
moreWe assessed the effect of left atrial (LA) function index, LA ejection fraction, LA kinetic energy, and maximal LA volume on 6 months clinical outcome in patients with newly diagnosed systolic heart failure (HF). During a 36-month period, 179 consecutive patients (17% female, mean age 63 ± 14 years) were enrolled. During the follow-up, 46 patients had an event (32% event rate; 15 were fatal). Those with an adverse event were older, had lower creatinine clearance, advanced New York Heart Association stage, higher prevalence of ischemic HF, and lower values for right ventricle systolic wave in the tissue Doppler imaging evaluation, compared with those without an event. Multivariate analysis revealed that LA function and ischemic etiology of HF were the most significant prognostic indicators after index hospitalization. This study reveals the important role of LA function for the short-term prognosis of patients with newly diagnosed systolic HF in sinus rhythm.
New-generation drug-eluting stents have demonstrated the mid-term efficacy and safety, but possible differences between stents may emerge in a long-term period. We compared long-term outcomes of patients with chronic stable angina and an...
moreNew-generation drug-eluting stents have demonstrated the mid-term efficacy and safety, but possible differences between stents may emerge in a long-term period. We compared long-term outcomes of patients with chronic stable angina and an isolated de-novo lesion in the proximal left anterior descending artery that underwent percutaneous coronary intervention with Endeavor-zotarolimus eluting stents (E-ZES) and everolimus eluting stents (EES). We prospectively enrolled 600 patients. Of these, 180 underwent E-ZES and 420 underwent EES implantation. Clinical follow-up was performed up to 7years (median follow-up 61months). The evaluated clinical outcomes were Target Lesion Failure (TLF), a composite of cardiac death, myocardial infarction and Target Lesion Revascularization (TLR), the Patient-Related Outcome (PRO) and stent thrombosis. Differences between groups evaluated with the Kaplan-Meier method and possible independent predictors with Cox proportional hazard regression. At 5years, the cumulative probability for outcomes was: TLF: 13.8% versus 7.5%, p=0.025, cardiac death: 3.1% versus 2.5%, p=0.937, myocardial infarction: 1.2% versus 1.8%, p=0.829, TLR: 10% versus 3.3%, p=0.003, PRO: 19.6% versus 13.8%, p=0.528, ST: 2.5% versus 2.7%, p=0.965, for E-ZES and EES respectively. Differences between stents increased after 30months. In multivariate analysis predictors of TLF adjusted for stent type were Diabetes mellitus and estimated Glomerular Filtration Rate (eGFR). Both stents provided a favorable safety profile, with EES demonstrating better effectiveness. There was a late emergence in difference of endpoints after 30months. Diabetes mellitus and eGFR predicted TLF.
Aortic valve stenosis is becoming a burden to society due to the constantly aging population. After the onset of the first symptoms it usually follows an ominous route with high mortality levels even at two years without any medical...
moreAortic valve stenosis is becoming a burden to society due to the constantly aging population. After the onset of the first symptoms it usually follows an ominous route with high mortality levels even at two years without any medical intervention. The gold standard for treating aortic valve stenosis is surgical replacement; nonetheless, 30% of patients are left untreated due to increased risk of surgery. A less invasive method has been developed in the past decade, transcatheter aortic valve implantation (TAVI), which allows implantation of prosthesis in the native stenosed aortic valve position, using a catheter that enters the body in a transvascular way or through a minimal surgical cut down. In this review, we briefly discuss where the TAVI field begun, focus on the recent valves that are being used and finally look at what lies ahead. The review of the patents will assist in the understanding of how this field evolved, how it became established and what is to be expected in the future.
It is widely accepted that diabetes mellitus (DM) impairs endothelial nitric oxide synthase activity as well as enhances the production of reactive oxygen species, thus resulting in diminished nitric oxide bioavailability and the...
moreIt is widely accepted that diabetes mellitus (DM) impairs endothelial nitric oxide synthase activity as well as enhances the production of reactive oxygen species, thus resulting in diminished nitric oxide bioavailability and the consequent pro-atherogenetic alterations. Important biomarkers of the vasculature are related to endothelial dysfunction, to inflammatory and coagulation processes, and to oxidative stress in DM. Several therapeutic strategies might exert favorable effects on the vasculature of diabetic patients, such as insulin analogues, antihypertensive agents, statins, and hypoglycemic agents, whereas in spite of the prominent role of oxidative stress in diabetes, antioxidant therapy remains controversial. The use of specific biomarkers related to vascular function could be a useful therapeutic approach in such patients.
International Journal of Cardiology, Volume 151, Issue 2, Pages 243-245, 1 September 2011, Authors:Stavroula Papaoikonomou; Dimitris Tousoulis; Nikolaos Tentolouris; Dimitris Papadogiannis; Antigoni Miliou; George Hatzis; Nikolaos...
moreInternational Journal of Cardiology, Volume 151, Issue 2, Pages 243-245, 1 September 2011, Authors:Stavroula Papaoikonomou; Dimitris Tousoulis; Nikolaos Tentolouris; Dimitris Papadogiannis; Antigoni Miliou; George Hatzis; Nikolaos Papageorgiou; Gerasimos Siasos ...
Statins, the most widely prescribed medications in patients with hyperlipidemia and coronary heart disease, have a number of pleiotropic actions beyond cholesterol lowering. They improve endothelial function, they have antioxidant and...
moreStatins, the most widely prescribed medications in patients with hyperlipidemia and coronary heart disease, have a number of pleiotropic actions beyond cholesterol lowering. They improve endothelial function, they have antioxidant and anti-inflammatory effects, they regulate neovascularization and have immunomodulatory activities. Experimental evidence suggests that statins may be beneficial in heart failure as they can inhibit myocardial hypertrophy, reduce cardiomyocyte loss by apoptosis, reduce oxidative stress and restore neurohormonal imbalance. Furthermore small randomised clinical trials showed that short term statin administration may improve key pathophysiological aspects of this syndrome. Finally retrospective analyses of large statin trials imply a long term profit on clinical outcome in this group of patients. These results however need to be reviewed with caution as certain studies have demonstrated that low serum cholesterol is associated with worse prognosis in HF and that ubiquinone levels, a micronutrient with antioxidant actions, reduces significantly following statin administration. Large prospective randomised controlled trials are needed to confirm the beneficial effect of statins on cardiovascular outcome in HF patients and further elucidate the contributing mechanisms. Finally the statin dose and the interaction with co-administered drugs need to be studied.
Unstable coronary syndromes are characterised by increased inflammatory process and endothelial activation. However, the underlying mechanisms of the acute coronary syndromes are still obscure. We evaluated the differences of inflammatory...
moreUnstable coronary syndromes are characterised by increased inflammatory process and endothelial activation. However, the underlying mechanisms of the acute coronary syndromes are still obscure. We evaluated the differences of inflammatory and thrombotic markers, at the acute phase of unstable angina (UA) and acute myocardial infarction (AMI). The population of the study consisted of 216 subjects: 136 patients with UA, 57 patients with AMI and 23 healthy controls. Blood samples were taken by their admission to the hospital. Inflammatory and thrombotic markers were measured by ELISA. Patients with UA had significantly higher levels of interleukin-6 (IL-6), soluble vascular cells adhesion molecule (sVCAM-1) and von Willebrand factor (vWF) (p<0.05 vs controls), and lower levels of antithrombin III (ATIII) (p<0.01 vs controls) and protein C (PrtC) (p<0.05 vs controls). Similarly, patients with AMI had higher levels of IL-6, sVCAM-1, vWF and tissue plasminogen activator (tPA) (p<0.01 vs controls) and lower levels of ATIII (p<0.01 vs controls) and prtC (p<005 vs controls). Patients with AMI had significantly higher levels of vWF, tPA and sVCAM-1 compared to UA patients (p<0.05). Patients with unstable coronary syndromes had increased levels of IL-6, sVCAM-1 and vWF as well as decreased levels of ATIII and PrtC by their admission. However, patients with AMI had higher levels of all the endothelium-derived inflammatory (e.g. sVCAM-1) of thrombotic/fibrinolytic (e.g. tPA and vWF) markers, compared to those with UA. These findings imply that patients with myocardial infarction show further increase of endothelium-derived inflammatory and thrombotic markers compared to patients with unstable angina, in response to a similar proinflammatory stimuli.
Although several common community infections have been associated with the risk for coronary artery disease (CAD), their role in the development of acute myocardial infarction (AMI) is still unclear. We examined the prevalence of IgG and...
moreAlthough several common community infections have been associated with the risk for coronary artery disease (CAD), their role in the development of acute myocardial infarction (AMI) is still unclear. We examined the prevalence of IgG and IgM (or IgA) antibodies against common infections such as HSV, Hepatitis A (HAV), Helicobacter pylori (HP), cytomegalovirus (CMV) and Chlamydia pneumoniae (CP), in CAD and AMI patients, and their relationship with pro-atherogenic inflammatory molecules. A total number of 337 subjects were included in this study: 150 patients with angiographically documented stable CAD, 138 patients admitted with AMI and 49 healthy individuals. Serum IgG and IgM against HAV, CMV and HSV, IgG against HP and IgG/IgA against CP were determined in all participants. Serum tumor necrosis factor alpha (TNF-alpha) and soluble vascular cells adhesion molecule (sVCAM-1), were determined by ELISA. Patients with CAD were more likely to have anti-HAV IgG (94.4%), anti-HSV IgG (97.2%) and anti-HP IgG (55.1%) compared to healthy individuals (70.8%, 89.6% and 39.6% respectively, p<0.05 for all). In multivariate analysis, anti-HAV IgG was an independent predictor of CAD (beta(SE): 0.187(0.075), p=0.015). Among the CAD patients, the presence of anti-CP IgA was more frequent in those admitted with AMI (39%) compared to those with stable CAD (21%, p<0.05). Finally, both patients and controls had significantly higher levels of sVCAM-1 and TNF-alpha in the presence of anti-HAV IgG, compared to those without anti-HAV IgG (p<0.05 for all). Past infections with HAV, HSV and HP are associated with higher risk for coronary atherosclerosis, while the presence of anti-HAV IgG is also associated with higher levels of TNF-alpha and sVCAM-1. Furthermore, the presence of recent infection by CP is associated with higher risk for AMI among CAD patients. These findings are important since they demonstrate that past HAV, HSV and HP infections may affect cardiovascular risk, while recent CP infection may be implicated in the triggering of AMI among CAD patients.
We present a case of a perforation of the saphenous vein graft during percutaneous angioplasty and its subsequent implantation with a polytetrafluoroethylene-covered stent. Angiographic as well as intravascular images of the site of...
moreWe present a case of a perforation of the saphenous vein graft during percutaneous angioplasty and its subsequent implantation with a polytetrafluoroethylene-covered stent. Angiographic as well as intravascular images of the site of perforation are provided.
Corresponding author at: Athens University Medical School, Hippokration Hospital, Vasilissis, Sofias 114, 115 28, Athens, Greece. Tel.: +30 210 7782466; fax: +30 210 7485039. ... Received 3 June 2011; accepted 25 June 2011. published...
moreCorresponding author at: Athens University Medical School, Hippokration Hospital, Vasilissis, Sofias 114, 115 28, Athens, Greece. Tel.: +30 210 7782466; fax: +30 210 7485039. ... Received 3 June 2011; accepted 25 June 2011. published online 18 July ...
Previous studies have demonstrated that patients with heart failure have increased myocardial heat production. Coronary sinus (CS) thermography is a new method for the evaluation of left ventricular heat production. We investigated...
morePrevious studies have demonstrated that patients with heart failure have increased myocardial heat production. Coronary sinus (CS) thermography is a new method for the evaluation of left ventricular heat production. We investigated whether the CS blood temperature is increased in patients with idiopathic dilated cardiomyopathy (DCM) compared to a control group and whether the CS blood temperature correlates with ejection fraction and systemic inflammatory activation. We included 25 patients with DCM and 22 healthy subjects. Temperature measurements were performed using a new thermography catheter. Temperature difference (DeltaT) was defined as the difference between the CS and RA blood temperature. The CRP levels were also measured. DeltaT was significantly greater in patients with DCM compared to the controls (0.25+/-0.09 vs 0.14+/-0.07 degrees C, p<0.01). DeltaT and EF were inversely correlated in patients with DCM (R=0.43). We categorized patients with DCM into two groups using a CRP cut-off value of < or =1 mg/dL. DeltaT in patients with high CRP was less (0.21+/-0.06 degrees C) compared to patients with low CRP (0.30+/-0.08 degrees C, p=0.01). In patients with DCM increased heat production from the myocardium, as estimated from the coronary sinus blood temperature, was demonstrated, interestingly there was no correlation with systemic inflammatory activation.
The purpose of the present analysis was to identify predictors of procedural success of percutaneous transcatheter aortic valve implantation (TAVI). We prospectively assessed in-hospital outcome of patients undergoing TAVI at two...
moreThe purpose of the present analysis was to identify predictors of procedural success of percutaneous transcatheter aortic valve implantation (TAVI). We prospectively assessed in-hospital outcome of patients undergoing TAVI at two institutions. We analysed clinical, morphological, and procedural parameters using univariate and multivariate regression models. Between 2005 and 2008, a total of 168 consecutive patients with symptomatic aortic valve stenosis underwent TAVI using the self-expanding CoreValve Revalving prosthesis. Patients (93%) were highly symptomatic with a New York Heart Association grade III/IV and a mean aortic valve area of 0.66 +/- 0.21 cm(2). Acute and in-hospital procedural success rates were 90.5 and 83.9%, respectively, with an in-hospital mortality, myocardial infarction, and stroke rate of 11.9, 1.8, and 3.6%, respectively. Predictors of in-hospital procedural success were type of access (OR 0.33, 95% CI 0.13-0.82, P = 0.017), prior coronary intervention (OR 5.3, 95% CI 1.20-23.41, P = 0.028) and pre-procedural Karnofsky index using univariate regression. Pre-procedural Karnofsky index emerged as the only independent predictor (OR 1.04, 95% CI 1.00-1.08, P = 0.032) in the multivariate analysis. Pre-procedural functional performance status predicts the in-hospital outcome after TAVI. Patients with a good functional status are likely to benefit more from TAVI than previously reported high-risk patients.
Endothelial dysfunction has been identified as a major mechanism involved in all the stages of atherogenesis. Evaluation of endothelial function seems to have a predictive role in humans, and therapeutic interventions improving nitric...
moreEndothelial dysfunction has been identified as a major mechanism involved in all the stages of atherogenesis. Evaluation of endothelial function seems to have a predictive role in humans, and therapeutic interventions improving nitric oxide bioavailability in the vasculature may improve the long-term outcome in healthy individuals, high-risk subjects, or patients with advanced atherosclerosis. Several therapeutic strategies are now available, targeting both the synthesis and oxidative inactivation of nitric oxide (NO) in human vasculature. Statins seem to be currently the most powerful category of these agents, improving endothelial function and decreasing cardiovascular risk after long-term administration. Other cardiovascular agents improving endothelial function in humans are angiotensin-converting enzyme inhibitors/angiotensin receptors blockers, which increase NO bioavailability by modifying the rennin-angiotensin-aldosterone system. Newer therapeutic approaches targeting endothelial dysfunction in specific disease states include insulin sensitizers, L-arginine (the substrate for endothelial NO synthase [eNOS]) as well as substances that target eNOS "coupling," such as folates or tetrahydrobiopterin. Although there are a variety of strategies to improve NO bioavailability in human endothelium, it is still unclear whether they have any direct benefit at a clinical level.
Arterial hypertension is an epidemic currently affecting almost a billion people worldwide. The consequences from high blood pressure vary, from peripheral arterial disease and chronic kidney failure to acute myocardial infarction and...
moreArterial hypertension is an epidemic currently affecting almost a billion people worldwide. The consequences from high blood pressure vary, from peripheral arterial disease and chronic kidney failure to acute myocardial infarction and stroke. MicroRNAs (miRNAs) are small non-coding RNA molecules comprised of 22-26 nucleotides and provide posttranscriptional protein expression regulation. The many biological processes in which they are implicated, such as cell proliferation, apoptosis, metabolism, cell differentiation and morphogenesis confirms the functional significance of miRNAs. It has been found that miRNAs are expressed in cardiovascular disorders and seem to be important players in the pathogenesis of arterial hypertension. The elucidation of which miRNAs are key players and at what level is of high value since it is necessary in order to better understand the mechanisms underlying hypertension, thus leading to better diagnostic modalities and therapeutic regimes.
The matrix metalloproteinases/tissue inhibitors of metalloproteinases system is involved in the regulation of extracellular matrix metabolism, which plays a crucial role with regards to maintenance of tissue integrity. During the...
moreThe matrix metalloproteinases/tissue inhibitors of metalloproteinases system is involved in the regulation of extracellular matrix metabolism, which plays a crucial role with regards to maintenance of tissue integrity. During the occurrence of vascular pathologies including hypertension, the balance between proteases and their inhibitors is temporally destroyed. Even though there are conflicting data in the literature regarding the expression pattern of the vascular matrix metalloproteinase system, the occurring extracellular matrix turnover leads to the change of arterial mechanical properties. For example, hypertension plays crucial role in the formation of cardiovascular remodeling which seems to be characterized by an increase in extracellular matrix. Changes in arterial stiffness, a predictor for cardiovascular morbidity and mortality, are determined by alterations in vascular extracellular matrix due to hemodynamic, genetic, or other factors. It has become increasingly evident that blockade of the renin-angiotensin-aldosterone system and other pharmacological strategies, seem to be particularly effective in reducing vascular stiffness and collagen content in human and animal models. However, the relationship between extracellular matrix metabolism and the effects of therapy in hypertensive patients needs to be further explored in larger trials over a longer period of time.
High-sensitivity C-reactive protein (hsCRP) and soluble cluster of differentiation 40 ligand (sCD40L) have been established as effective markers of inflammation in predicting the risk for adverse outcomes in patients with acute coronary...
moreHigh-sensitivity C-reactive protein (hsCRP) and soluble cluster of differentiation 40 ligand (sCD40L) have been established as effective markers of inflammation in predicting the risk for adverse outcomes in patients with acute coronary syndromes (ACSs). Activated platelets secrete certain inflammatory mediators such as P-selectin and sCD40L, which play a role in the pathogenesis of ACSs. Although acetylsalicylic acid (ASA) has been found to be an effective treatment of ACSs, the addition of clopidogrel bisulfate has been found tofurther improve clinical outcomes as a result of additional antiplatelet and anti-inflammatory action. Few data exist concerning the effects of dual antiplatelet therapy on these markers in patients with ACSs. The aim of this study was to assess the effectiveness and clinical significance of clopidogrel administration in patients with ACSs without ST segment elevation treated with ASA. This randomized, single-blind, controlled trial was conducted at the First Department of Cardiology, Hippokration Hospital, Athens, Greece. Inpatients aged>or=21 years with ACSs without ST segment elevation were randomly assigned to 1 of 2 groups: ASA 325 mg/d for 1 week, followed by ASA (100 mg/d) plus clopidogrel (300-mg loading dose followed by 100 mg/d) for 36 weeks (ASA+Clop group) or ASA alone (325 mg/d for 1 week, followed by 75 mg/d for 36 weeks) (ASA group). Levels of serum sCD40L, hsCRP, and P-selectin were determined on admission and at 8 hours, 48 hours, and 6 days of treatment. By means of clinical follow-up, Kaplan-Meier free-of-major adverse cardiovascular events (MACES) plots were used to assess the prevalence of MACES, including cardiovascular-related death, in patients with and without high levels of hsCRP (>or=3 mg/L) and sCD40L (>or=5 microg/L) for 52 weeks. A total of 86 patients were enrolled (71 men, 15 women; mean [SD] age, 68 [3] years; mean [SD] weight, 86 [18] kg; white race, 86 [100%]; 43 patients per group). Both groups had similar initial clinical characteristics and P-selectin levels. Baseline hsCRP and sCD40L levels were correlated with baseline P-selectin levels (hsCRP, r2=0.099 The results of this small study suggest that early activation of platelets, as measured using P-selectin levels, was effectively inhibited by the addition of clopidogrel to a regimen of ASA in the subgroup of patients with ACSs and intense activation of platelets (defined as high hsCRP and sCD40L levels). In patients without high hsCRP and sCD40L levels, the addition of clopidogrel did not have a significant effect on P-selectin levels.
