Renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography

Abstract BACKGROUND Interleukin-6 (IL-6) is an inflammation-related cytokine associated with an elevated risk of cardiovascular events. In a previous study, we demonstrated that increased IL-6 was predictive of sub-clinical atherosclerotic coronary disease in intermediate-risk patients undergoing coronary angiography. In the present study, we investigated whether increased serum IL-6 is predictive of cardiovascular events in high-risk patients. METHODS In this observational study, consecutive patients referred for elective coronary angiography due to stable chest pain/myocardial ischemia had IL-6 measured immediately before the procedure. Long-term follow-up was performed by phone call or e-mail, and their clinical registries were revised. The primary outcome was a composite of new myocardial infarction, new ischemic stroke, hospitalization due to heart failure, new coronary revascularization, cardiovascular death, and death due to all causes. RESULTS From the 141 selected patients, 100 completed the IL-6 analysis and were followed for a mean of 5.5 years. The median age was 61.1 years, 44% were men, and 61% had type-2 diabetes. The median overall time-to-event for the primary outcome was 297 weeks (95% confidence interval [CI] = 266.95–327.16). A receiver operator characteristic curve defined the best cut-off value of baseline serum IL-6 (0.44 pg/mL) with sensitivity (84.37%) and specificity (38.24%) to define two groups. High IL-6 level was moderately predictive of cardiovascular events. ( p for interaction = 0.015) (hazard ratio = 2.81; 95% CI = 1.38–5.72, p=0.01). The subgroup analysis did not find interactions between patients with or without diabetes, obesity, or hypertension. CONCLUSION This preliminary study indicates that, in high-risk symptomatic patients undergoing elective coronary angiography, increased pre-procedure serum levels of IL-6 predicted long-term cardiovascular outcomes. These results were similar irrespective of diabetes, hypertension, or obesity status. IL-6 must be studied in larger long-term follow-up studies as a potential tool to re-classify patients with increased cardiovascular risk.

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The Effect Of Low Dose Intravenous Heparin On Anti-Factor Xa And Antithrombin III

10.1055/s-0038-1653109 ◽

1981 ◽

Author(s):

S A Jennings ◽

B P Heather ◽

R M Greenhalgh

Keyword(s):

High Risk ◽

Low Dose ◽

Antithrombin Iii ◽

Risk Group ◽

Factor Xa ◽

Low Risk ◽

Heparin Infusion ◽

High Risk Patients ◽

Intravenous Heparin ◽

Risk Patients

Preoperative blood samples from 17 patients undergoing major abdominal surgery were examined by the thrombelasto-graph saline dilution test, which has previously been shown to be a predictor of the risk of early postoperative deep vein thrombosis (DVT)(Heather et al 1980). By this test 8 patients were predicted to be at low risk of developing a DVT and received no special prophylaxis. 9 patients were considered to be at risk and were treated with a subcutaneous dose of 1000 units of heparin with the premedication together with a low dose of intravenous heparin infusion from the induction of anaesthesia until 2 hours after operation. Plasma antithrombin III (ATIII) concentration and anti-factor Xa activity were measured preoperatively, on day 1 and on day 3. No early DVT occurred, as assessed by I125 fibrinogen scanning, in either the untreated low risk patients or in the high risk patients receiving heparin infusion. The high risk patients had lower levels of ATIII before operation than the low risk patients (75±9%; 98±39%) and significantly lower levels on day 3 (64±25%; 106±34% p<0.02). However, these lowered levels of ATIII appeared in the high risk group to be augmented by the significant increase in anti-factor Xa activity 127±64%. before operation, 217±89%, on day 1 (p<0.02). Furthermore, on day 3 the high risk patients had significantly greater activity than those patients in the low risk group (212±76%; 106±34% p<0.02).These results show that those patients at risk of developing a postoperative DVT had a significantly enhanced activation of anti-factor Xa, as a result of intravenous low dose heparin with the subsequent abolition of early venous thrombosis.

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