A large clinical-genetic study has unravelled novel genotype-to-phenotype correlations in HCM and DCM which warrant future investigation of both the underlying mechanisms and the prognostic use.

Coronary artery fistulas are incidentally diagnosed during coronary artery angiographies in adults and should be closed to prevent complications.

No abstract

Background: It could be shown in various investigations that a reduced response to clopidogrel (Clo) after PCI and stent placement is associated with a significantly worse cardiovascular outcome. At the moment no generally accepted normal values for clopidogrel-response exist. Methods: The clopidogrel-response was investigated in 2847 patients (mean age 63,5 +/− 10 years, 67% male, 33% female) undergoing PCI with stent placement in a prospective clinical study over 34 months (elective PCI by chronic stable angina: n=1907 (67%) and acute PCI by acute coronary syndrome (STEMI, NSTEMI): n=940 (33%). The platelet aggregation was analysed conventionelly using an aggregometer 6 –24 hours after application of 600 mg clopidogrel (loading dose) by adding 20 μmol/L adenosine diphosphate (ADP) to citrate plasma (Aggregometer PAP 4 MOELAB, Hilden, Germany). Results: In a follow-up period of 30 days after the intervention a subacute stent thrombosis occured in n=51 pts (1,8%). In n=46 (90%) of these patients the ADP-induced platelet final aggregation after Clo (post-treated) was >30% compared with the baseline of each patient without Clo (pre-treated). This corresponds to a platelet inhibition <70%. Taking this value as “cutoff value” results in a responder rate of 68,7% (n=1958) and a hyporesponder rate of 31,2% (n=889) of the entirety of patients. 5,2% (n=46) of the hyporesponders developed a subacute stent thrombosis. Conclusions: Clopidogrel (Clo) hyporesponders have a significantly increased risk of developing a subacute stent thrombosis after coronary stent placement. 90% of these endangered patients are identified with a cutoff value of platelet inhibition <70% respectively final aggregation > 30% showing the importance of periinterventional evaluation of the Clo-response status of each patient. If these patients would profit from an intensified antiplatelet strategy (for example increased doses of Clo) should be investigated in further studies.