2006;87(4) – ABC CARDIOL

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Artigo Original

Independent predictors of in-hospital outcomes following coronary stent implantation

Antônio José Neri-Souza et al. Bruno Machado Aguiar André Borges Coelho Anderson Jorge Lima Nascimento … Waldemar Souza Oliveira Júnior Antonio Gilson Lapa Godinho Nilson Borges Ramos Álvaro Rabelo Júnior

OBJECTIVE: To identify the clinical and angiographic predictors of early outcome following coronary stent implantation. METHODS: Nine hundred and forty-six patients (pt) [61.04 ± 10.98 years old, range 31 to 91] underwent stent implantation; 580 male (61.3%). Procedural success was defined when a pt had at least one vessel successfully dilated with a residual stenosis < 20%. Clinical success occured when a pt had at least one vessel successfully dilated without a major complication (MC) [death, myocardial infarction (MI), coronary artery bypass graft] during the hospital stay. Clinical and angiographic determinants of outcome were studied. All variables related to early outcome evaluated by univariate analysis were included in a multiple logistic regression analysis (MLR). RESULTS: Procedural success was achieved in 98.9%; clinical success in 95.7%; an unsuccessful uncomplicated outcome in 0.1% and major complications in 4.2%. By MLR, procedural success was related to restenotic lesion, calcification, and irregular contour. Clinical success was related to diabetes mellitus, cardiogenic shock, acute coronary syndromes, age, left ventricular dysfunction, calcification, and total occlusion. Major complications was predicted by diabetes mellitus, cardiogenic shock, acute coronary syndromes, age, multivessel disease, left ventricular dysfunction, calcification, long lesions, and total occlusions. Mortality was predicted by cardiogenic shock, acute coronary syndromes, age, arterial hypertension, and left ventricular dysfunction. CONCLUSION: These results suggest that early outcome was significantly affected by cardiogenic shock, left ventricular dysfunction, age, calcification, and total occlusion.

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Case Report

Acute aortic dissection during pregnancy

Walkiria Samuel Avila et al. Ricardo Dias Renato Takeshi Yamada Adriano Armelin

Acute aortic dissection is one of the most dreaded clinical conditions during pregnancy. Difficulties in establishing a diagnosis and limitations regarding invasive studies increase mortality rates associated with the disease. The limited experience reported in the literature does not allow the determination of guidelines for clinical and/or surgical management of aortic dissection in pregnancy. The authors present a case of acute aortic dissection in a woman in her 33rd week of gestation and discuss the diagnostic approach considering the peculiarities of the disease’s manifestation.

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Artigo Original

Vascular radiolesion as a deleterious effect of high-dose-rate intraarterial brachytherapy with Samarium-153 in hypercholesterolemic rabbits

Dalton Bertolim Précoma et al. Lúcia Noronha Álvaro Vieira Moura Airton Seiji Yamada … José Knopfholz César Lopes Dusilek Rita Perussolo Paulo Roberto Slud Brofman Márcia Olandoski José Cláudio Meneghetti

OBJECTIVE: This study was designed to evaluate vascular morphological and morphometric changes induced by brachytherapy with samarium-153 (Sm-153) at high doses in hypercholesterolemic rabbits. METHODS: Forty-three New Zealand White hypercholesterolemic rabbits were analyzed, and the total of 86 iliac arteries underwent balloon angioplasty injury. The rabbits were divided into three different groups: two irradiation groups (IG) assigned to 15 Gy (n=14) and 60 Gy (n=36) irradiation doses, respectively, and a control group (n = 36). Histomorphometric and qualitative histological analyses were performed for tissue evaluation. RESULTS: Significant reductions were found in neointimal proliferation (NIP) (p< 0.0001), media area (MA) (p<0.0001) and percent stenosis (p<0.0001) in the 15-Gy IG, compared to the other groups. The 60-Gy IG had the higher rate of NIP, increase in media and vessel areas (VA) and percent stenosis. The 60-Gy IG also showed the greatest number of xanthomatous cells (60-Gy IG: 86.11% and 15-Gy IG: 14.29%, p<0.0001) and the highest amount of hyaline amorphous tissue (60-Gy IG:58.33% and 15-Gy IG:0%, p=0.0001) and vascular proliferation (60-Gy IG:30.56% and 15-Gy IG:0%, p=0.0221). No statistically significant differences were found among groups concerning other tissue analyses. CONCLUSION: The high-dose irradiation of 60 Gy resulted in intense cell proliferation considered vascular radiolesion, unlike the 15-Gy dose, which was associated with an excellent inhibition of neointimal proliferation.

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Editorial

Platelet activation in distinct forms of coronary artery disease

Dikran Armaganijan

EDITORIAL

Platelet activation in distinct forms of coronary artery disease

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Artigo Original

Seasonal variation of ventricular tachycardia registered in 24-hour Holter monitoring

Maurício Pimentel et al. Letícia Grüdtner Leandro I. Zimerman

OBJECTIVE: To evaluate the seasonal variation of ventricular arrhythmias and its correlation with ambient temperature in patients submitted to 24-hour Holter monitoring in the city of Porto Alegre, southern Brazil. METHODS: Holter monitoring reports of 3,034 patients from 1996 to 2002 were analyzed. Ventricular tachycardia (VT) was defined as the presence of 3 or more consecutive ventricular beats, at a rate equal to or higher than 100 beats per minute. Percentage distribution of patients presenting VT by seasons and its correlation with ambient temperature were analyzed. RESULTS: Mean age was 59.2 ± 17.4 years, with a predominance of the female sex (61.9%). Patient distribution by season of the year was: 561 (18.5%) in summer, 756 (24.9%) in fall, 843 (27.8%) in winter and 874 (28.8%) in spring. Fifty-two patients (9.3%) presented VT episodes in summer, 39 (5.2%) in autumn, 56 (6.6%) in winter and 60 (6.9%) in spring (p = 0.035). There was a 40% relative increase in the proportion of patients presenting VT during summer in comparison to winter. There was a trend of increase in the proportion of patients presenting VT with rising temperatures (r = 0.57; p = 0.052). CONCLUSION: The occurrence of VT presents seasonal variations in southern Brazil, with a higher proportion of episodes occurring in summer. There is an association trend between VT and temperature increase.

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Artigo Original

Predictive factors for pregnancy hypertension in primiparous adolescents: analysis of prenatal care, ABPM and microalbuminuria

Regina Coeli Marques de Carvalho et al. Henry de Holanda Campos Zenilda Vieira Bruno Rosa Maria Salani Mota

OBJECTIVE: To quantify PH prevalence in primiparous adolescents; define predictive factors for the occurrence of PH and its impact on newborns. METHODS: We followed 29 primiparous adolescents from the prenatal period through the 12th week of the puerperium, with a mean of sixteen years of age, served at the Outpatient Facility for Adolescents of Maternidade Escola Assis Chateaubriand (MEAC) of Universidade Federal do Ceará (Fortaleza, Brazil). The pregnant adolescents were divided into two groups, that is, those who remained normotensive (Group I) and those who developed PH (Group II). The variables investigated in the assessment of the value of predictability for the development of PH were anthropometric measures, socioeconomic aspects, smoking habit, inheritance for SAH (father/mother), prenatal tests requested in the first prenatal care visit in addition to microalbuminuria and ambulatory blood pressure monitoring (ABPM) in the 28th week of gestation. The pregnant adolescents were followed up at delivery and late puerperium (12th week after the puerperium). The newborns to the mothers included in our study were assessed at birth according to the Apgar score and the Capurro method, for weight, height and perinatal hypoxia. RESULTS: The prevalence of PH was 51.7%. Inheritance for SAH presented the highest predictive value for PH with an odds ratio of 10.99. Diastolic arterial pressure equal to or above 70 mmHg at the gestational age of 35 weeks was statistically significant as a predictive value for PH. At ABPM we found a predictive value for PH: diastolic pressure load during alertness, diastolic and systolic pressure load during night sleep, pressure variability and maximum diastolic pressure during sleep. Specifically a maximum diastolic arterial pressure (DAP) at ABPM during the period of night sleep ³64 mmHg presented an odds ratio of 6 for PH with a sensitivity of 80% and a specificity of 60% for the development of PH. CONCLUSION: The research for PH predictive factors in primiparous adolescents showed to be easy to apply and useful to stratify high-risk pregnant women as regards the development of PH.

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Point of view

Mechanical or biological decision?

POINT OF VIEW

Mechanical or biological decision?

[…]

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Artigo Original

The effect of L-arginine on neointimal proliferation and artery remodeling on an iliac artery lesion caused by a balloon catheter in hypercholesterolemic rabbits

José Knopfholz et al. Dalton B. Précoma Paulo Roberto S. Brofman Gabriela Elisete Bier … Ruy Fernando Kuenzer C. da Silva Anna Paula Kuchnir Silva Ana Carolina Lemos Priscila de Oliveira Silva Jacqueline Dompsin de Moraes

OBJECTIVE: It has been implied that neointimal proliferation and remodeling are the major causes of restenosis. The objective of this study is to assess the effect of orally administered L-arginine on these two factors in hypercholesterolemic rabbits that had suffered an injury to their iliac arteries caused by a catheter balloon. METHODS: The study included nineteen rabbits that were divided in two groups: control (CG) and arginine (AG). There were 19 arteries studied from the control group and 17 in the arginine group. The animals were placed on a 2% hypercholesterolemic diet for 15 days and then submitted to a balloon angioplasty in order to produce a lesion in their iliac arteries. Next, the AG animals were given a 1g/kg/day oral dose of a L-arginine solution. The animals were sacrificed 15 days after the angioplasty procedure and histological artery sections were prepared, stained and fixed. The ratio between the neointimal area (in mm²) and the media layer (in mm²) was used to represent lesion development. In order to determine remodeling, the ratio between the total area of the medial portion of the vessel (greater balloon contact) and the total area of the reference segment of the vessel (less balloon contact) was used. RESULTS: Mean neointimal thickness (NI/M) was 0.8151±0.2201 in CG and 0.3296±0.1133 in AG. Remodeling patterns for the two groups studied were similar. CONCLUSION: In the experimental model used, L-arginine was able to reduce intimal tissue thickness in hypercholesterolemic rabbits but did not act on artery remodeling.

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Case Report

A rare association of systemic lupus erythematosus, morbid obesity and Takotsubo Syndrome

João Gaspar Corrêa Meyer Neto et al. Claudio Buarque Benchimol Guilherme Loures Penna Luiz Antônio Ferreira Carvalho Maria Carolina Pessoa

The authors report a 68-year-old white female with long-term systemic lupus erythematosus as well as morbid obesity, characterized by very elevated body mass index, who presented a classical picture of acute coronary failure ascribed to Takotsubo syndrome.

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Review Article

Autonomic dysregulation and the metabolic syndrome: pathologic partners in an emerging global pandemic

Heno Ferreira Lopes et al. Brent M. Egan

REVIEW ARTICLE

Autonomic dysregulation and the metabolic syndrome: pathologic partners in an emerging global pandemic

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Artigo Original

Waist circumference and body mass index as predictors of hypertension

Maria do Rosário Gondim Peixoto et al. Maria Helena D'Aquino Benício Maria do Rosário Dias de Oliveira Latorre Paulo César Brandão Veiga Jardim

OBJECTIVE: To evaluate the association between anthropometric indexes – body mass index (BMI) and waist circumference (WC) – and hypertension, and to evaluate the predictive value of these indexes in detecting hypertension. METHODS: Cross-sectional population study conducted in the city of Goiânia (GO) with a sample of 1,238 adults aged twenty to 64 years, in 2001. Total obesity was defined as BMI > 30 kg/m²; abdominal obesity was defined as level 2 WC > 88 cm for women and > 102 cm for men, and hypertension was defined as systolic pressure > 140 mmHg, or diastolic pressure > 90 mmHg, or utilization of hypotensive drugs). Multiple logistic regression analysis was used to evaluate the associations between anthropometric indexes and hypertension. The Receiver Operating Characteristic (ROC) curve analysis was used to evaluate sensitivity and specificity of BMI (> 30) and level 2 WC as predictive factors of hypertension, and to determine the best predictive cut-off points for hypertension. RESULTS: WC was associated with hypertension in both genders. Level 2 WC and BMI >30 kg/m² showed a low sensitivity in identifying hypertension. The best predictive cut-off points for hypertension coincided with level 1 WC (> 80 cm) and with BMI >25 kg/m² (overweight) for women, and were lower than the values of level 1 WC and of overweight for men. CONCLUSION: Level 2 WC and BMI > 30 kg/m² are not adequate to identify the groups at the highest risk of hypertension, since this risk rises with small increases in adiposity.

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Artigo Original

Criteria for central obesity in a Brazilian population: impact on metabolic syndrome

Paulo José Bastos Barbosa et al. Ínes Lessa Naomar de Almeida Filho Lucélia Batista N. Cunha Magalhães Jenny Araújo

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6 – 25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

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Artigo Original

An evaluation of the rastreometro, a new device for populational screening for high blood pressure in developing countries

Andreas Forsvall et al. Martin Oscarsson Lucelia Batista N. Cunha Magalhães Catia Palmeira … Armênio Costa Guimarães Marco Antonio Mota Gomes Dag Thelle

OBJECTIVE: To test a simplified blood pressure device called Rastreometro that could be used by the Health Agents. METHODS: The Rastreometro has been developed from an ordinary aneroid sphygmomanometer, in which the numeric display is covered by an adhesive with a red zone, indicating pressures equal or above 140 mmHg and a yellow zone indicating pressures below 140 mmHg. The onset of oscillations of the aneroid needle is taken as an indication of the systolic pressure value. The measurements made by the Rastreometro were compared with those made by the auscultatory method, and were carried out in 268 patients, by two operators. The influence on the results of confounding variables such as age, gender, BMI, arm length, upper arm circunference, skin colour and antihypertensive treatment were taken into consideration, as well as intra and interobserver variation. RESULTS: In the whole group, sensitivity was 95.1%, specificity was 63.1%, positive preditive value was 62.4% and negative preditive value was 95.3%. Hypertensive treatment significantly affected specificity, 32.7% as compared to 77.8% for the non-treated group. Both operators improved their results over time. CONCLUSION: This study suggests that the Rastreometro technique, as a screener for hypertension, has good sensitivity. Concerning specificity, it is acceptable, provided the patient is not on regular antihypertensive treatment. In this latter situation, it can be improved by a proper standardization of the method to read the systolic pressure by needle oscillations. Furthermore, the use of this technique requires well trained operators.

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Case Report

Bi-atrial subxiphoid epicardial pacemaker in superior vena cava syndrome

Roberto Costa et al. Maria Inês de Paula Leão Kátia Regina da Silva Paulo Roberto Camargo Regina Valéria Costa

A patient with a bi-atrial-ventricular permanent pacemaker due to paroxystic atrial fibrillation associated to sinus bradycardia, in chronic use of oral anticoagulant, presented clinical signs of superior vena cava syndrome. Digital subtraction venography showed total obstruction of the right brachiocephalic venous trunk and severe stenosis of the connection of the left trunk to the superior vena cava. The therapeutic approach consisted of complete removal of transvenous system followed by re-implant of the bi-atrial-ventricular system using an epicardial subxiphoid access with fluoroscopic assistance

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Case Report

Post-transplantation lymphoproliferative disorder in pediatric patient

Paulo Manuel Pêgo Fernandes et al. Estela Azeka Vicente Odoni Jader Joel Machado Junqueira … Gabriella Paiva Bento Vera Aiello Miguel Barbero-Marcial

Immunosuppressive therapy for transplanted patients exposes them to a high risk of developing posttransplantation lymphoproliferative disorders (PTLD). We report the case of a child undergoing heart transplantation at seven months of age who developed PTLD at nine years of age, diagnosed by resection of a pulmonary nodule.

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Review Article

Magnetic resonance imaging is image diagnosis in heart valve disease

Marcelo Nigri et al. Carlos Eduardo Rochitte Flávio Tarasoutchi Max Grinberg

REVIEW ARTICLE

Magnetic resonance imaging as image diagnosis in heart valve disease

[…]

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Consenso

Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system

Valter C. Lima et al. Luiz Alberto P. Mattos Paulo R. A. Caramori Marco A. Perin … José A. Mangione Bruno M. Machado Wilson M. C. Coelho Ronaldo R. L. Bueno

The authors review percutaneous coronary intervention (PCI) evolution and its growing application in myocardial revascularization for patients with coronary heart disease in Brazil and worldwide. PCI was introduced in 1977 using only the catheter balloon. Limitations of this method (acute occlusion and coronary restenosis) led to the adoption of coronary stents and more recently the advent of drug-eluting stents², which were developed to drastically reduce restenosis rates. These developments allowed the exponential growth of percutaneous coronary intervention (PCI) procedures in Brazil which have replaced many bypass surgery procedures and have become the gold standard for the majority of symptomatic patients suffering from coronary artery disease. The preference for this procedure gained new dimensions in 2000 when the Brazilian Public Healthcare System (SUS) began reimbursing for stent procedures. This measure exemplified the importance of the Public Healthcare System’s participation in incorporating medical advances and offering a high standard of cardiovascular treatment to a large portion of the Brazilian population. It is emphasized that prevention of in-stent restenosis is complex due to its unpredictable and ubiquitous occurrence. Control of this condition improves quality of life and reduces the recurrence of angina pectoris, the need to perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the National Health Surveillance Agency (ANVISA). During this stage the interested company submits to the regulatory agency, results from clinical studies that demonstrate the efficacy and safety of the new device or pharmaceutical product. Frequently, in addition to clinical studies, approval records for clinical use from the regulatory agencies of other countries, mainly the United States of America and the European Community are also submitted. The successful completion of this stage means that the medication or device may be prescribed or used by the physicians in Brazil. The second stage in the incorporation of new healthcare technology involves the reimbursement or financing of the treatment that was approved in the previous stage based on its efficacy and safety. This stage can be more complex than the first one since the new technology, whether a substitution for established treatment methods or the introduction of a new treatment concept, are usually more expensive. The incorporation of new technology requires a cost-effectiveness analysis so that fund administrators can make decisions based on the universal scenario of limited resources to finance healthcare with treatments that are more and more burdensome. The difficulties of funding management are aggravated by medical and social ethical implications that arise when a treatment is approved based on its efficacy and safety but is not made available to patients who could benefit greatly from it. In Brazil, assessment methods for the incorporation of new technology based on reimbursement or financing have not been fully developed for either the private healthcare plans or the Brazilian Public Healthcare System (SUS). The implementation of new technology in both healthcare systems is a slow process and frequently the implementation is a result of the requirements of patients or the organizations that represent them and at times is the result of legal proceedings or political pressure imposed by physicians and their respective scientific societies. Our objective is to review the evolution of percutaneous coronary intervention (PCI) in Brazil and its current status in view of the advent of drug-eluting stents, the growing participation of drug-eluting stents in myocardial revascularization to treat patients with coronary heart disease, as well as, to compare the regulatory standards from Brazil and other countries regarding the incorporation and recommendations for the use of this new technology.

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Clinical Update

Protein-losing enteropathy after the Fontan operation

Fernando Tadeu Vasconcelos Amaral et al. Edmar Atik

CLINICAL UPDATE

Protein-losing enteropathy after the Fontan operation

[…]

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Clinical Update

Cardiovascular, ventilatory, and metabolic parameters during exercise: differences between children and adults

Danilo Marcelo Leite de Prado et al. Rodrigo Gonçalves Dias Ivani Credidio Trombetta

CLINICAL UPDATE

Cardiovascular, ventilatory, and metabolic parameters during exercise: differences between children and adults

[…]

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Artigo Original

Arterial hypertension and family care: care provided to hypertensive individuals in a small municipality in Southern Brazil

Luciano Burigo de Sousa et al. Regina Kazue Tanno de Souza Maria José Scochi

OBJECTIVE: This transversal study was developed from the analysis of indicators which express the desirable approach for programmatic actions, with the objective of evaluating the performance of a Family Healthcare Center in its attendance to patients suffering from arterial hypertension living in a small municipal district. METHODS: The research was carried out starting from the analysis of the records of enrollment in the program, Record A from SIAB (Primary Care Information System), of 418 individuals suffering from arterial hypertension. It was also analyzed the information of 351 files from the health center. In addition, 376 interviews were carried out with individuals living in the vicinity of the health center, in the year of 2003. The following variables were studied: gender, age, family income, home conditions, health services used presence of diabetes mellitus, average number of individuals attended and attendance concentration. RESULTS: Women above 60 years of age prevailed in 65.7% of the cases. The hypertension prevalence rate on individuals who searched for care was of 18%, being different among gender, among women it was of 22.3%. The average number of appointments with a doctor was of 64.1%; 32.4% for appointments with a nurse, and 36.4% for home medical attendance. The information on files revealed that 25.8% of the individuals were not assisted in 2003 and 52.7% received no assistance in the last semester. The concentration of services was below preconization. CONCLUSION: The information revealed no organization on the attention to the preventive health care, focusing the assistance to a spontaneous demand, expressing unpreparedness in the use of information systems for the planning and evaluation of the actions.

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Image

Surgical treatment of the ascending aorta aneurysm: simultaneous echocardiographic observation of coronary ostia reimplanted to vascular prosthesis

Marcelo Luiz Campos Vieira et al. Anderson Benício Wilson Mathias Jr. Noedir A. Stolf

IMAGE

Surgical treatment of the ascending aorta aneurysm. Simultaneous echocardiographic observation of coronary ostia reimplanted to vascular prosthesis

[…]

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Case Report

Sinus node dysfunction in a patient with left atrial isomerism

Sírio Hassem Sobrinho et al. Airton Camacho Moscardini Ulisses Alexandre Croti Carlos Henrique de Marchi Moacir Fernandes de Godoy

We report the case of an asymptomatic six-year-old child with left atrial isomerism and sinus venosus atrial septal defect. The physical examination revealed several periods of bradycardia. During a 24-hour electrocardiographic monitoring the patient presented a significant sinus node dysfunction with sinus pauses of up to 2.4 seconds. A permanent pacemaker was implanted, with a satisfactory outcome.

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Point of view

Complete, incomplete or no myocardial revascularization

Whady Armindo Hueb et al. José Antonio Franchine Ramires

POINT OF VIEW

Complete, incomplete or no myocardial revascularization

[…]

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Artigo Original

Platelet activation in different clinical forms of the coronary artery disease (roll of P-selectin and others platelet markers in the stable and unstable angina)

Margareth L. Venturinelli et al. André Hovnan Alexandre de Matos Soeiro José Carlos Nicolau … José A. F. Ramires Élbio A. D'Amico Carlos Vicente Serrano Júnior

OBJECTIVE: Markers of platelet activation are elevated in coronary artery disease. We sought to identify the presence and the potential associations of different markers of platelet activation. METHODS: We studied patients with unstable angina (n=28), patients with stable angina (n=36) and patients without coronary artery disease (n=30); sex and age matched. Blood levels of the adhesion molecule P-selectin, Thromboxane B2 and Serotonin were measured by enzyme immunoassays. RESULTS: When we compared the groups the results were: sP-selectin, thromboxane B2 and serotonin levels were significantly higher in patients with unstable angina than in patients with stable angina. CONCLUSION: These markers of platelet activation were able to identify unstable forms of coronary artery disease.

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