Lege Artis Medicinae

[Percutaneous coronary intervention in ischaemic heart disease]

VOITH László

APRIL 20, 2001

Lege Artis Medicinae - 2001;11(04)

[In ischaemic heart disease, if the medically treated patient’s anginal complaints and/or ischaemic symptoms are persistent, coronary angiography, and according to its results, coronary intervention (surgery or dilatation) may become necessary. The intervention is required in critical stenosis (>70% diameter) of the main vessels, the emergency depends on the clinical situation. Basic method of coronary angioplasty is the balloon dilatation, other tools (stent, rotablator, laser wire, atherectomy device, etc.) are also available. Periprocedural anticoagulant (heparin) and platelet aggregation inhibitor (aspirin, ticlopidine, GP IIb/III/a receptor blocker) treatment is required, the latter after the procedure as well. After stent implantation the lumen of the vessel is bigger and the incidence of major adverse cardiac events (acute myocardial infarction, repeated intervention, fatal outcome) is diminished. Decrease of serum lipid level improves the outcome of coronary angioplasty. It is applicable successfully for multiple lesions, occluded vessels, stable and unstable angina, in the early phase of myocardial infarction, in patients who underwent coronary surgery, and in old age too. Risk factors of the intervention are: tortuous vessel, significant calcification, stenosis in angle or ostium, luminal thrombus, urgent intervention, old age, female gender, congestive heart failure, unstable condition and acute myocardial infarction. When indicating the intervention, besides the probable results, it is necessary to consider the possibility of complications (myocardial infarction, malignant rhythm disorders, acute heart failure, bleeding, etc.). In left main stem stenosis, 3 vessel disease and in the case of 1 functioning coronary artery surgery would be preferable. With the present facilities the ratio of urgent surgical intervention as well as the mortality is below 1%.]



Further articles in this publication

Lege Artis Medicinae

[Introduction of hepatitis G and TT virus diagnostics in Hungary]

TAKÁCS Mária, RUSVAI Erzsébet, BROJNÁS Judit, TÓTH Gábor, SZOMOR Katalin, TÓTH Etelka, SZENDRŐI Andrea, MEZEY Ilona, BERENCSI György

[INTRODUCTION - The majority of the viral hepatitis is caused by five hepatitis viruses (A, B, C, D, E). In 1995, three new flaviviruses were discovered, the GBV-A, GBV-B and GBV-C (also known as HGV) viruses. The TT virus was discovered in 1997. Based on literature data, it is now supposed that a part of the unknown hepatitis cases is caused by the recently discovered hepatitis G or TT virus. The aim of this study was to determine the occurrence of hepatitis G and TT viruses in Hungary. PATIENTS AND METHODS - To reveal the RNA of the HGV viruses in the sera of patients suffering from hepatitis of unknown origin, RT-PCR was applied using the primers published in the literature. Seminested PCR was used to detect the DNA of TTV. The nucleotide sequences of nested PCR products were determined. Anti-HGV antibodies were detected by ELISA. RESULTS - The sera of 408 healthy persons older than 60 years were tested for the presence of hepatitis G virus antibodies: 113 tested positive. HGV virus antibodies were found in the sera of patients suffering from hepatitis of unknown origin or aplastic anaemia. 51 sera were tested and 20 were found to be positive for GBV-C antibodies, 4 for HGV RNA. Altogether, 213 sera of patients suffering from hepatitis of unknown origin or from aplastic anaemia were tested for HGV RNA and 26 were found to be positive. Eight PCR products were sequenced, and these sequences were found to be different from each other. 154 sera of patients with hepatitis of unknown origin were tested for the presence of TTV-DNA and 72 of them were positive. Seven PCR products were directly sequenced. Genotype 2 was found to be the most frequent one in Hungary.CONCLUSION - Our results show that both HGV and TTV are present in Hungary and none of them can be considered rare. Further studies are needed to reveal the association between the genotypes of these viruses and hepatitis of unknown origin.]

Lege Artis Medicinae

[Type 2 diabetes in children and adolescents: early complications]


[INTRODUCTION - The prevalence of type 2 diabetes mellitus in children and adolescents is increasing worldwide. PATIENTS AND METHODS - Authors have investigated the prevalence of type 2 diabetes mellitus and of impaired glucose tolerance among the patients of the 1st Department of Pediatrics at the Semmelweis University between January 1989 and September 1998. RESULTS - During this period, 161 children with impaired glucose tolerance and 34 patients with type 2 diabetes mellitus were diagnosed. There was a female predominance. 53% of the patients were already in puberty. The majority of the patients were obese. Serum triglyceride and cholesterine levels exceeded normal values as compared to age matched healthy children. Ambulatory blood pressure monitoring revealed relative nocturnal hypertension. 35% of the patients also had microalbuminuria. CONCLUSION - In type 2 diabetes mellitus the early signs of late complications can be detected in the young. It reveals the importance of establishing the diagnosis of this disease as soon as possible.]

Lege Artis Medicinae

[New oral antidiabetic agents - New aspects in the management of type 2 diabetes mellitus]

GERŐ László

[During the past years several new oral antidiabetic agents have become available and more new drugs of this type are expected to appear on the market. New products appeared in both groups of insulin sensitizers and insulin secretagogues. Modern insulin secretagogues are characterized by immediate and short action. As a consequence, insulin secretion will approach the physiological secretory pattern. The rapid, short-term insulin output prevents the abnormal increase of postprandial glucose level and - at the same time - the danger of late hypoglycemia will decrease. The combination of insulin sensitizers with the new insulin secretagogues provides the possibility to apply the basisbolus therapeutical principle to type 2 diabetic patients treated with oral agents.]

Lege Artis Medicinae

[Effectiveness of patients’ rights in Hungary]

VAJDA Angéla

Lege Artis Medicinae

[Weak-hearted composer of monumental forms - Anton Bruckner]


All articles in the issue

Related contents

LAM Extra for General Practicioners



[Beta-blockers are among the most widely used drugs for the treatment of cardiovascular diseases. In the mid-90’s, these drugs were recommended as first-line therapies of hypertension. With the introduction of new drugs, the list of first-choice drugs has been extended. The results of recently published major hypertension trials, which compared conventional agents (beta blockers and/or diuretics) with newer agents (angiotensin converting enzyme inhibitors, Caantagonists, angiotensin receptor blockers), raised concerns regarding the role of beta blockers in cardiovascular primary prevention. Subsequently, a metaanalysis of 13 trials has shown that compared with other drug types, beta-blocker therapy is less beneficial in patients with hypertension who do not have heart disease. Nevertheless, in cardiovascular indications other than hypertension (acute myocardial infarction, heart failure and arrhythmias), betablockers retain their dominant position.]

Lege Artis Medicinae



[The beneficial effects of angiotensin-converting enzyme inhibitors on biochemical and vascular markers have been proven by many experimental studies. Reduction of the angiotensin-II level has a positive effect on oxidative stress, lipid peroxidation, apoptosis, inflammatory and prothrombotic processes. Two large multicentric trials, EUROPA and HOPE, showed that perindopril and ramipril significantly reduce mortality and the risk of both fatal and non-fatal cardiovascular events in patients with atherosclerosis, thereby making them the base drugs of secondary prevention of coronary artery disease.]

Lege Artis Medicinae

[Benefit of combined clopidogrel-aspirin platelet aggregation inhibition in acute coronary syndrome and after percutaneous coronary angioplasty]


[Platelet aggregation inhibition is equally important both in conservative and interventional cardiological treatment of acute coronary syndrome. Recently, results from three important trial were published. All three proved the efficacy of the combined aspirin + clopidogrel treatment. The basic results of the three clinical trials (CURE, PCI-CURE, CREDO) are summarized in the article. In the CURE trial the combined primary endpoint was reached in 11.4% of the patients in the control group and in 9.3% in the clopidogrel group. The relative risk reduction was 20%. The combined primary endpoint included CV mortality, MI and stroke. The treatment effect was mostly detectable in the prevention of MI and stroke. In the PCI-CURE trial 2658 patients of the CURE trial were analysed. All of them were treated by coronary angioplasty. In this group the primary endpoint (CV death, nonfatal MI, urgent revascularisation) was reached in 6.4% of the aspirin treated and in 4.5% of the aspirin + clopidogrel treated patients. The relative risk reduction was 30%. The CREDO trial investigated patients after coronary angioplasty. The indication of angioplasty was either acute or chronic. All patients received combined aspirin + clopidogrel but only for four weeks in the control group or for one year in the treatment group. The combined primary endpoint was decreased by 26.9%. In all the 3 trials the risk of bleeding was slightly but significantly increased by the combined aspirin + clopidogrel treatment. Clinical application: based on the results of the 3 trials it is concluded that combined aspirin + clopidogrel treatment is indicated in all patients with acute coronary syndrome, independently from the treatment strategy. The treatment should be continued for one year. This is also applicable for all patients treated with coronary angioplasty.]

Lege Artis Medicinae

[The importance of hormone replacement therapy in primary and secondary cardiovascular prevention]

KANCZ Sándor

[There has been increasing expectation in hormone replacement therapy (HRT) as a potentially useful preventive intervention. Observational studies indicated 50% relative risk reduction on ischaemic heart disease among current HRT users. Unfortunately, this has not been justified by the results of the large scale, prospective, placebo controlled, double blind secondary prevention trials. Even these trials underscored the potential adverse effects of hormone replacement therapy (thromboembolic complications, gall bladder disease). No results of completed primary prevention trials are available for the moment. Based on these data the AHA/ACC Science Advisory of 2001 recommends: HRT should not be recommended for secondary prevention There are insufficient data to suggest that HRT should be initiated for the sole purpose of primary prevention of cardiovascular diseases.]

Lege Artis Medicinae

[Perioperative management of patients with coronary stent undergoing noncardiac surgical procedures - Part II. - Algorythm of emergency and perioperative treatment decisions]

ZIMA Endre, MEZŐFI Miklós, BECKER Dávid, SZABÓ György, MERKELY Béla, PÉNZES István

[The aim of percutaneous coronary intervention (PCI) is to optimise coronary and cardial status, and thus improve short- and long-term outcomes. It is known from large Western databases that stent implantation is performed during 77-85% of coronary interventions, which means hundreds of thousands of patients with new stent every year. The majority of patients need to take dual platelet aggregation inhibitor, namely acetyilsalicylic acid and thienopyridin - most often clopidrogel - following stent implantation. It presents a major therapeutic dilemma when these patients need noncardiac surgery. First, the surgery should be performed with the least blood loss possible, which would be optimally achieved by suspension of the platelet aggregation inhibitor therapy that cannot be stopped during the critical period after stent implantation. Second, stent thrombosis should be avoided, which can only be achieved if platelet aggregation inhibitor therapy is continued. The aim of our paper is to summarise the current professional guidelines and the current risk estimation in the perioperative management of patients with coronary stent. In the second part of the article, we summarise the preoperative preparation of the patient, assessment of coronary status and cardial medication, and the optimal time and location of the surgery. We present the decision principles regarding the risks of perioperative bleeding and stent thrombosis, and the need to continue platelet aggregation inhibitor therapy.]