Tehran University Medical Journal

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Background: Premature coronary artery disease (CAD) has a familial predisposition and occurrence. We determined the prevalence of CAD and related risk factors in individuals with a history of premature CAD in their first-degree relatives.
Methods: This study included 700 healthy individuals with a history of premature CAD in their parents or siblings in Tehran Heart Center in 2003-2004. History of smoking, diabetes mellitus (DM) or hypertension was taken. Fasting levels of blood sugar (FBS), triglycerides (TG), cholesterol, LDL and HDL were measured. Noninvasive studies for CAD were performed with resting echocardiography (ECG) and ECG with exercise tolerance test (ETT). Patients with positive findings for ischemia in these tests underwent a myocardial perfusion scan and if positive proceeded to coronary angiography.
Results: The mean age of our subjects was 35.2 (15-65) years. DM was found in 5.3%, smoking in 14.7%, hypertension in 20.6%, cholesterol above 200 mg/dl in 39.9%, TG above 150 mg/dl in 58.6%, LDL above 130 mg/dl in 38% and HDL below 40 mg/dl in 32.6%. In addition, 6.4% had ECG changes and 3% echocardiographic abnormalities in favor of ischemia. ETT was positive in 7.3% and myocardial perfusion scan in 2.1%. Coronary angiography showed 50-70% stenosis in eight patients (1.1%) and >70% in four patients (0.6%).
Conclusion: High cholesterol, TG and LDL and low HDL were found among our subjects. Risk factor determination in these individuals may prove to be beneficial. Noninvasive tests for CAD yield low true-positive results and are not recommended in the population as a whole. In certain subgroups, including those with persons older than 40 years and diabetic patients, these tests may be useful.

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Background: Several randomized controlled trials have demonstrated the safety and efficacy of drug eluting stents (DES) in selected groups of patients with less complicated diabetes. We conducted this study to determine how an unselected group of diabetic patients in Iran fare following DES implantation.

Methods: Data were collected on 147 consecutive diabetic patients who underwent percutaneous coronary intervention (PCI) with the implantation of at least one DES at the Tehran Heart Center from June 2003 to September 2005. Clinical follow-up was performed by timely scheduled visits at one, four and nine months following DES implantation. Nine months of follow-up was completed for 94.5% of the patients. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which include cardiac death, myocardial infarction and target vessel revascularization (TVR). In-hospital complications were the secondary endpoint.

Results: A total of 158 coronary artery lesions were treated with DES in 147 diabetic patients (mean age = 56.4±8.92 years, 57.1% were men). During the nine-month follow-up, MACE occurred in 3.4% of patients, with a myocardial infarction rate of 1.4% and TVR rate of 1.4%. Considering one patient who underwent TVR due to acute stent thrombosis following angioplasty (during hospitalization) the total number of TVR reached 3 (2%). Only one patient (0.7%) died of cardiac death, which occurred after the procedure and before discharge. In-hospital complications occurred in six patients (4.1%) five patients suffered from myocardial infarction.

Conclusions: PCI with DES seems to be safe and effective in diabetic patients. However, more studies with larger study populations and longer follow-up are required to confirm this issue.