Background: Mean platelet volume (MPV) is a strong predictor of impaired angiographic reperfusion and 6-month mortality in ST-elevation myocardial infarction (MI) treated with primary percutaneous coronary intervention (PCI). No data is available for other platelet volume indices: platelet distribution width (PDW) and platelet large cell ratio (P-LCR). The aim was to assess the impact of 3 platelet volume indices on long-term prognosis in patients treated PDW < 16 fL (17.4% vs. 6.3%, p = 0.0012). PDW was found to be an independent prognostic factor for cardiac mortality and composite endpoint. Conclusions: Mean platelet volume, platelet distribution width and platelet large cell ratio measured on admission are strong, independent prognostic factors in PCI-treated acute MI. (Cardiol J 2013; 20, 5: 491-498)

INTROduCTION The significance of coronary collateral circulation in the prognosis of patients after myocardial infarction remains disputable.ObjECTIvEs The aim of the study was to evaluate the effect of coronary collateral circulation, assessed by the Rentrop score, on long-term prognosis in patients treated with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI).PATIENTs ANd mEThOds Coronary collateral flow was assessed by angiography in 330 patients with myocardial infarction using the Rentrop score. Patients were followed up for the mean period of 26 ±12 months with the clinical endpoints of cardiac death, nonfatal reinfarction, and repeat percutaneous or surgical revascularization.REsuLTs Collateral circulation was graded Rentrop 0 in 39%, Rentrop 1 in 36%, Rentrop 2 in 18%, and Rentrop 3 in 7% of the patients. The mortality rate was 8.7%. Reinfarction occurred in 4.7% of the subjects, and repeat coronary revascularization was performed in 10.9% of the patients. These endpoints were not correlated with the degree of collateral circulation. A significant inverse association was observed between the Rentrop score and the infarct-related artery antegrade flow (P <0.001).CONCLusIONs The degree of collateral circulation assessed by the Rentrop score during primary PCI is not a useful long-term prognostic factor in the population with STEMI in the current therapeutic approach. This may result from the negative correlation between the Rentrop score and the degree of blood flow in the infarct-related artery. Thus, collateral circulation in a patient with STEMI should not discourage intensive cardiovascular risk factor control in secondary prevention of coronary artery disease.

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Coronary artery disease (CAD) remains a major cause of death in developed countries. Both environmental and, less known, genetic factors contribute to progression of CAD to myocardial infarction (MI). Immune system is activated in patients with CAD through dendritic cells (DCs), which present plaque antigens to T lymphocytes. Production of proinflammatory cytokines by activated T cells contributes to plaque rupture in MI. Chemokine receptor 7 (CCR7) on DCs is required for their chemotaxis from plaque to lymph nodes. This makes possible an interaction of DCs with T lymphocytes and initiation of specific immune response. We hypothesized that single nucleotide polymorphisms (SNPs) in CCR7 gene locus are associated with previous MI in patients with CAD. To test this hypothesis, we genotyped six SNPs from the CCR7 gene locus in 300 consecutive patients, admitted for elective coronary angiography. We performed univariate-, multivariate- (including potential confounders) and haplotype-based tests of association of SNPs with previous MI and results of angiography. Allele A of rs17708087 SNP was associated with previous MI. This association remained significant after adjustment for age, sex, smoking, hypercholesterolaemia and drugs used by patients (odds ratio 2.13, 95% confidence interval: 1.13-3.86). Therefore, we conclude that CCR7 gene locus harbours a polymorphism that modifies risk of MI in patients with CAD. Replication of this association could be sought in a prospective cohort of initially healthy individuals.

The study presents case of a 62-year-old female patient with symptoms of the heart failure NYHA class III intensifying for the last 2 months. Physical examination at admission showed no significant abnormalities. In two-and three-dimensional echocardiography normal thickness and contractility of the left ventricle wall were found, as well as the normal systolic function of the right ventricle. In enlarged right atrium a structure of the oval shape was found with the features of continuity with atrial septum and bulging of a small part of the structure through the orifice of the tricuspid valve to the right ventricle. In the study no features of blocking the tricuspid flow or the inflow from the main veins and coronary sinus were detected. On the basis of the complete echocardiographic examination and clinical presentation, tentative diagnosis of right atrium myxoma was made. Coronary angiography showed no significant abnormalities in coronary arteries. After cardio-surgical consultation the patient was scheduled for surgical removal of the tumor, which was performed without complications. The histopathological examination confirmed the diagnosis of myxoma. In the follow-up echocardiography carried out after 8 months reducted size of the right atrium and a normal function of the ventricles were demonstrated. There were no features of tumor re-growth.