There have been animal and human studies looking at intracoronary (IC) use of abciximab with good short-term clinical outcomes. There exists no data comparing intracoronary with intravenous (IV) administration of abciximab beyond 30 days. We compared the clinical outcomes between the IC (n = 101) and IV (n = 72) group of patients. Patients who had coronary stenting and received abciximab were included in the study. All the patients received the standard systemic bolus dose of abciximab 0.25 mg/kg either via the IC or IV route, followed by a 12-hr IV infusion at 0.125 microg/kg/min. The 6-month composite endpoint of death or myocardial infarction was slightly higher in the IV (13.9%) than in the IC group (5.9%; P = 0.04). The frequency of bleeding complications was similar in both groups. The IC bolus route of abciximab may be superior to the intravenous route. Prospective randomized trials are warranted to validate these findings.

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This study was designed to determine whether red-cell oxidative stress status and antioxidant enzyme levels can serve as markers in patients predisposed to in-stent stenosis. Blood was collected from patient groups undergoing coronary angiography for chest pain evaluation, namely, group A (without coronary artery disease), group B (previous coronary stents without in-stent stenosis), and group C (previous coronary stents with in-stent stenosis). Thiobarbituric acid reactive substances (measure of lipid peroxidation), glutathione-linked detoxification enzymes, catalase, and superoxide dismutase were determined. Compared with group A, patients in group C showed increased lipid peroxidation products and glutathione-S-transferase but decreased glutathione peroxidase and glutathione reductase activities. Results in group B patients were intermediate between those of groups A and C with significant decreases in glutathione peroxidase versus controls. In-stent stenosis is associated with significant increase in lipid peroxidation and attenuated glutathione-linked detoxification enzymes, consistent with oxidative stress.

Congenital coronary artery fistula is a very rare malformation that may involve any or all coronary artery branches and any cardiac chamber. Elective closure of coronary artery fistulas by surgery or percutaneous transcatheter techniques is generally accepted in the presence of symptoms, but controversies exist in the management of asymptomatic patients. We describe a case where a fistulous communication was present between the proximal left anterior descending coronary artery and the pulmonary artery and provide a review of the available literature concerning management of patients with coronary artery fistulas.

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