BACKGROUND Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. OBJECTIVES In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. METHODS ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3–74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2–111.0 mg/dL). RESULTS In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [Cl]: 0.52–0.90) and 1.11 (95% Cl: 0.83–1.49), with treatment-lipoprotein(a) interaction on MACE ( P interaction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% Cl: 0.72–0.92) and 0.89 (95% Cl: 0.75–1.06), with P interaction = 0.43. CONCLUSIONS In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402 )

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The question arises, whether one's "objective" assessment of the final degree of compensation at discharge may or may not be premature, and whether a follow-up "prognostic" BNP determination should or should not be performed until the moment of a "subjective optimum" as reported by the patient.

Gřiva M, et al. Korelace SYNTAX skóre a sérové koncentrace matrixové metaloproteinázy-3 Cor Vasa 2010;52(4) Korelace SYNTAX skóre a sérové koncentrace matrixové metaloproteinázy-3 u pacientů s chronickými formami ischemické choroby srdeční 4 I. interní kardioangiologická klinika, Fakultní nemocnice u sv. Anny, Brno, Česká republika Gřiva M, Náplava R, Špendlíková M, et al. Korelace SYNTAX skóre a sérové koncentrace matrixové metaloproteinázy-3 u pacientů s chronickými formami ischemické choroby srdeční. Cor Vasa 2010;52:238-243. Cíl: SYNTAX skóre popisuje rozsah postižení koronárního řečiště aterosklerózou. Matrixové metaloproteinázy hrají mimo jiné důležitou roli v patogenezi cévních onemocnění, jako je ateroskleróza, ruptura plátu či aneurysma. Cílem práce bylo zjistit, koreluje-li matrixová metaloproteináza-3 (MMP-3) s hodnotou SYNTAX skóre u pacientů s chronickými formami ICHS. Metodika: U 128 náhodně vybraných pacientů s chronickými formami ICHS (75 % mužů, 69 % diabetiků, vylučovacím kritériem byla pozitivita troponinu I, srdeční selhání, renální insufi cience, systémové a zánětlivé onemocnění) byl proveden odběr krve ke stanovení koncentrace MMP-3 metodou ELISA. Následně byla provedena koronární angiografi e a stanoveno SYNTAX skóre.Výsledky: Hodnoty MMP-3 byly signifi kantně vyšší u diabetiků -37,0 μg/l (13,7-82,5 μg/l) než u nediabetiků -25,8 μg/l (11,9-82,8 μg/l), p = 0,044. Hodnoty MMP-3 byly signifi kantně vyšší u mužů -42,1 μg/l (15,7-85,2 μg/l) než u žen -21,9 μg/l (11,3-44,8 μg/l), p < 0,001. Pomocí Spearmanova korelačního koefi cientu je prokázána statisticky významná korelace mezi hodnotou SYNTAX skóre a MMP-3 v celém souboru i v podskupinách diabetiků a nediabetiků. Závěr: U pacientů s chronickými formami ICHS koreluje hodnota MMP-3 s rozsahem postižení koronárních tepen aterosklerózou bez ohledu na přítomnost diabetes mellitus. Klíčová slova: Ateroskleróza − SYNTAX skóre − Matrixová metaloproteináza-3 Gřiva M, Náplava R, Špendlíková M, et al. Correlation between the SYNTAX Score and serum matrix metalloproteinase-3 levels in patients with chronic coronary heart disease. Cor Vasa 2010;52:238-243.Aim: The SYNTAX Score is designed to describe the extent of coronary artery involvement by atherosclerosis. Among other things, matrix metalloproteinases play an important role in the pathogenesis of vascular diseases such as atherosclerosis, plaque rupture, and aneurysm. The study was conducted to determine whether or not there is a correlation between matrix metalloproteinase-3 (MMP-3) levels and the SYNTAX Score in patients with chronic coronary heart disease. Methods: A total of 128 randomly selected patients with chronic coronary heart disease (CHD) (75% of men, 69% of individuals with diabetes; the exclusion criteria included troponin I positivity, heart failure, renal insuffi ciency, systemic and infl ammatory conditions) had blood samples obtained to determine MMP-3 levels using ELISA. Subsequently, the patients had coronary angiography and their SYNTAX Score was determined. Results: MMP-3 levels...

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