Background and aim: Obstructive coronary disease is one of the most important causes of death worldwide. Percutaneous coronary intervention is one of the most important treatments of this pathology. Using of coronary artery stents represented a major advance in interventional cardiology. While bare metal stents (BMS) set the reference point for improved safety over balloon-angioplasty, first-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Methods: We studied 228 patients with STEMI in the last 6 months, divided in 2 groups – in the first group are 122 patients (53.5%) who developed in stent restenosis and the second group has 106 patients had no signs of restenosis (46.5%). The mean time of performing the angiographic reevaluation was 111 days for the first group and 154 days for the second group. The clinical signs that indicate the need of coronary reevaluation was stable angina (116, 50.87%), acute coronary syndrome (58, 25.4%) and asymptomatic patients (64, 28.9%). The cardiovascular risk factors correlate with high risk of restenosis was diabetes (24.3% in first group and 12.2% in the second one, p=0.004), active smoking (p=0.010) and metabolic syndrome (p=0.003). The stent’s length >28mm, stent’s diameter ≤ 2.5 mm and chronic occlusion correlate with high risk of in-stent restenosis in BMS. Conclusion: Understanding the importance of risk factors control, will reduce the risk of restenosis, of other cardiovascular event, even sudden death.
Fractal dimension (FD) analysis of ambulatory blood pressure monitoring (ABPM) may provide more information than conventional blood pressure variability (BPV) parameters. This study aims to assess the FDs of ABPM temporal series as a measure of BPV and its impact on optimized blood pressure (BP) control in patients(pts) with hypertension (HT) and type 2 diabetes mellitus (DM). Systolic (SBP) and diastolic (DBP) BP, dipping status, coefficient of variation (CV), and pulse pressure (PP) were analyzed on 24h-ABPM in pts with DM and HT. FDs were determined separately during daytime and nighttime for SBP, DBP, and pulse pressure (PP). 117 pts, 62.8±10.3 yo, 46% male, were divided into G1 (uncontrolled HT, 60 pts) and G2 (controlled HT, 57 pts). 61% were non- dippers or reverse-dippers, mean dipping % was 4.9 ± 8.7 in G1 and 9.6 ± 7.4 in G2 (p=0.002). 46 pts in G1 and 39 had CV > 10% (p=0.31). The mean diurnal SBP FDs were 1.229 ± 0.03 in G1 and 1.2431 ± 0.03 in G2 (p=0.02), associated with DM complications (p=0.005) and HT treatment (p<0.04). In conclusion, fractal analysis revealed a more complex, convoluted BP curve in diabetics with controlled HT, adding complementary data to conventional BPV parameters.
