Background: Previous studies have pointed out the disproportionate action of clopidogrel in inhibiting platelet aggregation due to smoking more than ten cigarettes per a day. This study was designed to examine whether smoking enhances clopidogrel responsiveness in patients who are clinically diagnosed with coronary artery disease (CAD), following percutaneous coronary intervention (PCI). Methods: A total of 324 IHD participants were enrolled in a case-control study. Platelet function test was performed to all participants two hours before PCI procedure to measure clopidogrel response. Participants were then categorized into a non-responder group (case group n = 111) and responder group (control group n = 213). Each group was subdivided into a smoker group and a non-smoker group. All participants received clopidogrel loading dose equivalent to 600 mg and scheduled for elective PCI. Participants’ age, gender, family history of chronic illnesses was recorded in this study.   Results: Smoking participants displayed a significant higher level of hemoglobin as compared to the non-smoking participants among the responder and the non-responder study groups (14.6±0.55 vs. 13.12±0.38, P < 0.029; 14.3±0.31 versus 12.96±0.39, P < 0.033) but lower AUC level (17±9 vs. 45±6, P < 0.005; 62±3 vs. 95±7, P < 0.008). Additionally, smoking intensity enhanced clopidogrel responsiveness by odd’s ratio 0.4213 at 95% C.I. (0.259 - 0.684), P < 0.0002. Conclusions: Current smokers had a good response to clopidogrel therapy which exerted a beneficial effect when undergoing PCI as compared to non-smokers. The marked difference in AUC between smokers and non-smokers could be related to the variance in hemoglobin level. The smokers’ paradox needs further justification to confirm this concept.

Introduction and aim: Lipid lower drugs have been widely used to prevent atherosclerosis in patients with heart disease. This study aims to compare the findings between the efficacy of 20 mg/day and 40 mg/day atorvastatin supplementation for 16 weeks, on nitric oxide level and lipid profile in clopidogrel resistant and non-resistant patients with coronary heart disease (CAD). Methods: This retrospective study included two hundred and eighty-four participants with CAD. Patients were subjected to platelets function to determine the clopidogrel resistance. 88 patients were included into the clopidogrel resistant group, and 196 patients were included into the clopidogrel non-resistant group. Each group was subdivided into two subgroups depending on the daily dose of atorvastatin therapy (daily intake of 20 mg and 40 mg, orally). Results: Irrelevant to the study group, there was significant increase in serum levels of NO following 40 mg/day clopidogrel supplementation for 16 weeks as compared to 20 mg/day clopidogrel supplementation, P ≤ 0.05. This was associated with a significant reduction in serum lipids (total cholesterol and LDL-C), P ≤ 0.05. Conclusion: Atorvastatin supplementation improves serum nitric oxide level, and serum lipid profile in patients with CAD with and without clopidogrel resistance.

Introduction: Of recognized fact the importance of early diagnosis and early management of ST-elevation myocardial infarction, to regain a normal or at least adequate coronary flow in the Primary Percutaneous Intervention. Slow or no-reflow is suboptimal myocardial reperfusion, without angiographic evidence of mechanical obstruction. Adenosine, Verapamil and saline flush are manoeuvres proved useful. The resolution of ST-segment is associated with successful revascularization and regarded as a predictor for future events. Glycoprotein IIB/IIIA inhibitors are a group of anti-platelets widely used in acute coronary syndrome. Aim: The aim of the study was to investigate that: uses of intra venous Abciximab, does not improve coronary flow in patients with MI that develop sub optimal flow after primary PCI within 30 minutes, but the improvement need 12 to 24 hour as founded in other studies, and its beneficial effect is related to early improvement in LV function and decrease of re-infarction and re-hospitalization. Method: Prospective, case-control study, enrolled fifty patients randomly assigned into two matching groups, first group (25 patients) received an intravenous Abciximab while the second group (25 patients) received intracoronary saline flush. Repeated angiography after 30 minutes, for immediate resultant flow assessment, Electrocardiographic changes resolution, bleeding and death. After a 30 days, a clinical assessment for primary outcome including, death, recurrent Myocardial infarction and Heart failure While the Secondary outcome including stent thrombosis, target vessel revascularization in addition to the primary outcome. Result: There was no significant difference in the flow Improvement and ECG resolution between both groups. These findings not affected by the door to balloon time. However, patients with flow improvement had a significant resolution in their ECG. Bleeding propensity and mortality were not significantly affected. Literatures proved the benefit of Abciximab in acute coronary syndrome. Conclusion: Both intravenous Abciximab and intracoronary saline flush had comparable effect on coronary flow improvement post primary percutaneous intervention, with minimal variation in the bleeding and in-hospital mortality.

Introduction: Still percutaneous coronary intervention (PCI) in elderly people challenging for the interventionist as complications and comorbidities are frequent in them. Methodology: This is a retrospective comparative study enrolled 77 patients divided in to two extremes of age one more than 75 years old (38 patients), second younger than 45 years old (39). statistical Analysis: Both groups analyzed statistically according to their risk factors, angiographic results and in hospital outcome. Chi square taken for level of significance Results: We find hypercholesterolemia ,hypertension and diabetes was frequent in young age people, smoking was more frequent with less significance. The elderly people had complex lesions and multi vessels diseases. Incidence of drug eluting stents was less in elderly.