In this study were consecutively included 432 patients who in 2005 have undergone percutaneous coronary intervention (PCI) with one or more drug - eluting stent implantation. Included in  the  study  patients  were divided  into  3 groups by the glomerular filtration rate (GFR):  group 1 - 271 patients  with  GFR  > 60 ml/min/1,73m2,  group  2 - 132 patients with GFR between 30 and 60 ml/min/1,73m2, and group 3  consisted  of  29 patients  with  GFR  less than 30 ml/min/1,73m2. In all the patients only used contrast agent Iodixanol, and the prevention of contrast-induced nephropathy (CIN) was performed without fail. The immediate success of PCI was high and  comparable in all groups. The frequency of CIN was significantly higher in groups 2 and 3 (6,8% and 17,2% against 0,7% in group 1, p <0,001). Within 12 months of observation the frequency of restenosis was higher in groups 2 and 3: 15,9% and 27,6%  against  6,6% in group 1 (p <0,001). Reduced GFR was a predictor of long-term up to 3 years mortality in patients with CKD,  where as for group 2 compared with group 1 the relative risk (RR)  of  death = 1.77  (95% CI 1,19 ÷ 3,74; p = 0.001), and  for group 3 compared with group 1 RR of death = 3.69 (95% CI 1,58 ÷ 6,87; p = 0.001). In addition decreased GFR  was a predictor of nonfatal MI within 3 years: for group 2 vs. group 1 RR = 1.69 (95% CI 1,12 ÷ 3,07; p = 0.009) and  group 3 vs. group 1 RR = 3.44 (95% CI 1,37 ÷ 6,19; p = 0.001).

The study showed that the initially reduced GFR after stenting increases the risk of CIN, leads  to an increase  in the frequency of restenosis and repeated revascularization up to 12 months, and is a predictor of long-term death  and nonfatal MI up to 3 years.

The study included 248 consecutive patients (172 males, 76 females; mean age 59,3±11,6 years) who underwent PCI for STEMI within twelve hours after the onset of symptoms. PCI (balloon angioplasty and / or stent placement) was performed only infarct related artery. The procedural success in acute phase defined as stenos  falling below 50% and TIMI III flow in infract related artery.

Primary PCI was done 248 patients with STEMI at 2010. The most frequent risk factors for coronary artery  disease were cigarette smoking and hypertension. The most common anatomic localization of STEMI was anterior. Success rate was 95.8% for primary PCI. Mortality occurred in 15 (5,8%) patients STEMI.

As a result, primary PCI reperfusion therapy provides a significant reduction in deaths when used with app-ropriate timing. Better use of reperfusion strategies in national and regional more efforts requirement.

Cases were divided into four groups according to  their  left  ventricular  (LV)  inflow  and pulsed  wave  tissue Doppler imaging (pw-TDI). Group 1 (n=112) represented normal diastolic LV inflow while group 2 (n=128) represen-ted impaired LV relaxation, group 3 (n=46) represented pseudonormalization and group 4 (n= 15) represented reversible restrictive LVDDF. We defined a new index (novel index=Ea-Aa/Sa) by using the pw-TDI parameters taken from LV basal-lateral annulus and subtracting late (Aa) velocity from early (Ea) velocity and dividing it by systolic (Sa) velocity. Among the index that evaluate systolic and diastolic functions together, novel index and Tei index were lower in group 1 (control group) compared to other groups. However, while Tei index was not different among the patients with LVDDF, novel index was different. Novel index was lower in group 4 compared to group 1, 2, and 3 (respectively p<0.001, p<0.001, p=0.025). And also, it was lower in group 3 compared to group 2 (p= 0.033).  Another prominent correlation was found between novel index and non-invasively estimated pulmonary capillary wedge pressure (PCWP). Novel index was negatively associated with PCWP alterations (correlation rate= 43 %, p<0.001).

 We concluded that novel index may be useful a diagnostic tool to detection of LVDDF. While Tei index was not different among the patients with LVDDF, novel index was sensitive to determine all of LVDDF.   

Rupture aneurysms of sinus valsalva are relatively rare lesions and usually may cause manifestations of prompt onset. In this case rupture aneurysm of sinus valsalva is diagnosed with echocardiography. We presented a 29 years old Afghan man with effort dyspnea, fatigue, shortness of breath and chest pain for ten years.

Key Words: Sinus of valsalva, Aneurysm

Stenotic lesion was crossed by using a 0.014 inch 260 cm long guidewire. The 8x40mm stent was placed over the lesion. Control angiography shown that dissection of the left subclavian artery before the lesion. After 8x40mm second stent was placed over the dissection. Control angiographic study depicted opening of the segment which had dissection and good arterial flow toward the left subclavian and vertebral artery. However, left internal mamarian artery was occluded after placed of second stent. Patient had a little chest pain due to LIMA occlusion. Although it is not an important problem with the exception of patient will undergo coronary bypass surgery in the future, it was bitter for us that patient had chest pain after the intervention. LIMA should been prevent if dissection occur during the procedure. 

Two distinct types of heparin-induced thrombocytopenia (HIT) have been defined. Type I HIT is a non-immunemediated side effect. In contrast type II HIT is an immune-mediated life-threatening complication. Direct thrombin inhibitors such as lepirudin and argatroban approved by FDA for treating patients with HIT have been studied. Although fondaparinux-a selective, synthetic factor Xa inhibitor- lacks FDA approval for his indication, case reports and series published up to date contribute to growing evidence about it. In this case report, we represented a 77 year-old man with atrioventricular block who had been developed HIT in the course of unfractionated heparin infusion for transient pacemaker and aimed to review current status about the usage of fondaparinux in this patients.

Key Words: Fondaparinux, Heparin, Heparin-induced thrombocytopenia