Diabetes mellitus is considered to be an independent risk factor for the progression of coronary artery disease, due to the associated pro-atherosclerotic status, and also an important predictor of poor outcomes after both coronary artery bypass grafting and percutaneous coronary intervention. Even in the contemporary era of newer-generation stents and despite remarkable technological advances, in-stent restenosis is still a major problem. The aim of our study was to identify risk factors for restenosis in the first year after stent deployment in 95 diabetic patients with coronary heart disease. Our results suggest that a larger stent diameter and the use of statins positively influence the risk of in-stent restenosis in the first year after stent implantation. Systemic statin therapy should be considered in all interventional treated diabetic patients, in order to reduce the risk of in-stent restenosis, particularly in high-risk patients. RezumatDiabetul zaharat este considerat a fi un factor de risc independent pentru progresia bolii coronariene ischemice (BCI), datorită statusului pro-aterosclerotic și, de asemenea, un predictor important al prognosticului terapiilor de reperfuzie coronariană. Chiar și în epoca contemporană, a stenturilor de "nouă generație" și în ciuda progreselor tehnologice remarcabile, restenozarea in-stent rămâne o problemă semnificativă. Scopul studiului nostru a fost identificarea factorilor de risc pentru restenoză în primul an după instalarea stentului la un grup de 95 de pacienți diabetici cu BCI. Rezultatele noastre sugerează că diametrul mai mare al stentului și utilizarea statinelor influențează favorabil riscul de restenozare in-stent în primul an după implantare. Terapia sistemică cu statine trebuie luată în considerare la toți pacienții diabetici cu intervenție, pentru a reduce riscul de restenozare in-stent.

An elevated level of total plasma homocysteine has been associated with a higher risk of atherosclerosis and coronary heart disease. The aim of our research was to study the relation between homocysteine and myocardial infarction (MI) in young patients. We conducted a case-control study in Constanţa County, Romania including 61 patients, divided in two groups. The first group, the MI group, consisted of 28 patients, male (67.9%) and female (32.1%) aged less than 45 years who were consecutively admitted to the Intensive Coronary Care Unit of the Emergency County Hospital of Constanţa from September 1, 2017 to August 31, 2018 (12 months), with an established diagnosis of first acute MI. The second group, the control group, included 33 patients, male (75.8%) and female (24.2%) aged less than 45 years, with cardiovascular risk factors and/or stable angina pectoris that were consecutively addressed for ambulatory cardiac evaluation at the Outpatient Clinic of Emergency County Hospital of Constanţa during the same period. Fasting plasma homocysteine was determined in both groups, within 24 h after MI onset, respectively after first cardiac exam in the controls. High homocysteine was statistically confirmed to be a risk factor in the study group, especially in association with smoking, chronic kidney disease (CKD), and to a lesser extent with diabetes mellitus (DM) and hypertension. Data analysis was performed using IBM SPSS Statistics 23. The procedures used included descriptive statistics, parametric statistical tests (Independent sample t-test), non-parametric statistical tests [Chi-square test of the association, with the evaluation of odds ratio (OR)]; the significance level used in the analysis (P-value) was 0.05. After adjusting for variables, our study results pointed out a strong association between plasma homocysteine and first acute MI among young patients, emphasising plasma homocysteine as a possible risk factor for myocardial infarction.

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We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a "burnout syndrome" in the last few months. The particularity of the presented case is the severe coronary artery disease in a young patient without discovering the main etiology of the advanced atherosclerotic process.

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