Serum lipoprotein(a) levels are not associated with restenosis after PTCA, but elevated levels are strongly associated with CAD. Low-serum, high-density lipoprotein-2 cholesterol concentration and elevated apolipoprotein B concentration were found to be associated with restenosis after PTCA.
The Dublin cardiac ambulance service operates two specially-equipped ambulances from a private ambulance station; five metropolitan hospitals provide coronary care beds on a rota system. The service covers an area of 450 square miles (1,165 sq km) and a population of 800,000. The ambulances are staffed solely by trained ambulance personnel. During the first three years 1,973 patients were transported to hospital. Primary ventricular fibrillation was encountered in 20 patients and successfully treated in 17. No deaths occurred in the ambulance.Over 98% of the patients were transferred uneventfully to hospital, so a medical team from the hospital on duty was called on 30 occasions only. A feature of the Dublin service is the low cost of a standard ambulance call, at about pound7.50.
One hundred consecutive patients had fasting lipids and percutaneous fat biopsy performed at the time of percutaneous transluminal coronary angioplasty to determine if there was an association between restenosis and lipids or fatty acids. Angiographic follow-up and complete lipid and fatty acid results were available in 82 patients. Restenosis occurred in 37/82 (45%). Total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, and apolipoproteins A1 and B were not associated with restenosis. There was a significantly lower level of the monounsaturated fat palmitoleic acid (p less than 0.02), a trend towards a lower level of the monounsaturated fat oleic acid (p less than 0.09), and a trend towards a higher level of the saturated fat palmitic acid (p less than 0.08) in the restenosis group. The polyunsaturated fatty acids were not associated with restenosis. We conclude that lipids are not significantly associated with restenosis, and that lower levels of monounsaturated fatty acids may increase the risk of restenosis.
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