Introduction: Ischemic heart disease is the most common cause of mortality in developed countries. CABG (CORONARY ARTERY Bypass Graft) is one of the therapeutic methods in ischemic heart disease.Methods and Materials: Considering the increased incidence of CORONARY ARTERY disease in Iran, and with increased rate of CABG, we performed a cross sectioned study (1996-1999). In 635 patients 467 male (73.5 percent), 168 female (26.5 percent) about risk factors of mortality after CABG in cardiac surgery department "Imam Khomeini hospital. 20 risk factors were included in our study: age, gender, smoking, family history, diabetes mellitus, morbid obesity, hypercholesterolemia, hypertension, palpitation, renal failure COPD, (chronic obstructive pulmonary disease), history of myocardial infarction, CHF, angina, cerebral vascular disease, pace maker, Ejection fraction<40 percent, history of PTCA, history of CPR, and CORONARY endarterectomy. Results: Cigarette smoking (P=0.40), CHF in female (P=0.003). Endarterectomy in both gender (P=0.0001). Pace maker in both gender (P=0.00006), palpitation in both gender (P=0.0001). CPR in both gender (P=0.0000001), were associated with increased risk of mortality after CABG. Conclusion: We found that, endarterctomy, cigarette smoking, CHF. Pace maker, CPR, and palpitation are important risk factors for mortality after CABG.

Objective(s): To determine One-month survival after CABG in Shariati Hospital.Methods: We followed 340 patients who underwent Isolated-CABG in Shariati Hospital and used survival analysis to compare common CORONARY risk factors and to assess surgical factors related to survival after CABG.Results: Smoking was more prevalent in males than in females but prevalence of hypertension, diabetes and hperlipidemia was greater in women. Female subjects were older, had greater Body Mass Index (BMI) and left ventricular ejection fraction (LVEF) and had undergone more non-elective surgery compared to males. Most patients had received 3 or 4 grafts (range 1-6 grafts). There was no difference in aortic cross clamp and anesthesia time between the two genders. Females were hospitalized for longer periods after surgery and their mortality rates were greater. One-month survival ratio estimated by the Kaplan Meier method was 97.1% and 88.4% in males and females respectively. The overall survival rate was 95.3%.Conclusion: The factors related to poor survival were: female gender, non-elective surgery, lengthy aortic cross clamp and anesthesia time and the history of: hypertension, hyperlipidemia, previous CABG and CCU hospitalization.

Background: Clopidogrel is an adenosine-5' diphosphate (ADP) receptor antagonist that eventually inhibits platelet aggregation. It is used concomitantly with percutaneous CORONARY interventions and in patients with acute CORONARY diseases. This study was conducted to determine the effects of preoperative clopidogrel administration on perioperative blood loss and transfusion requirements in patients undergoing CORONARY ARTERY bypass graft (CABG) surgery.Methods: For 100 patients who underwent nonurgent first-time CORONARY ARTERY bypass grafting surgery participated in this study. clopidogrel was discontinued in 2, 3, 5-6 or 7-8 days before surgery. A cell salvage device was used during surgery and salvaged blood was recorded. After surgery, chest tube output and need for blood transfusion were measured and recorded.Findings: Patients' mean age was 61.7±8.0 years (range: 50 to 77). There was a reverse relation between the time clopidogrel had been discontinued and blood loss and need for transfusion of packed cell and blood products during and after surgery (P<0.05 for all).Conclusion: Preoperative clopidogrel administration increases perioperative blood loss and need for blood transfusion in patients undergoing CORONARY ARTERY bypass grafting surgery.

Purpose: CORONARY ARTERY bypass graft is associated with numbers of physical and psychological problems. One of the aims of the cardiac rehabilitation program is to improve health related physical fitness factors and quality of life. Therefore, the objective of the present study is to investigate the effect of eight weeks pilates exercise on the strength and quality of life in heart patients after CORONARY ARTERY bypass grafting. Methods: Twenty-two women with cardiac problem under CORONARY ARTERY bypass grafting were selected and divided randomly into two equal groups: experimental (mean ± SD, age 60. 4± 8. 8 years, height 157. 5± 6 cm, weight 77. 5± 13 kg) and control groups (mean ± SD, age 62. 8± 8. 1 years, height 154. 4± 3 cm, weight 77. 4± 9. 5 kg). Experimental group performed pilates exercise for eight weeks, three sessions per week and each session took an hour, while the control group did not perform any exercise. The hand grip strength (hand-held dynamometer) and the quality of life (MacNew questionnaire), were measured before and after the pilates exercise intervention in all of patients. The data were analyzed with repeated measures analysis of variance (p<0. 05). Results: Strength of experimental group showed significant improvement after the pilates exercises (p<0. 05, 14. 9 vs 20. 2), however, no significant difference was observed between pretest (17. 1) and posttest (16. 8) in the control group, (p>0. 05). In total, significant differences were observed in strength between experimental and control groups (p<0. 05). Quality of life of experimental group showed significant improvement after the pilates exercises (p<0. 05 4. 3 vs 5. 3), but no significant difference was seen in the control group between pretest (4. 5) and posttest (4. 5), (p> 0. 05). In total, significant differences were observed in quality of life between experimental and control groups (p<0. 05). Conclusion: It can be concluded that Pilates exercise improve strength and quality of life in women with heart disease after CORONARY ARTERY bypass surgery, so it can be recommended as a part of rehabilitation program for these patients.

Introduction: CORONARY ARTERY disease is the most common entity in cardiovascular medicine. There are different modalities for treatment: drug therapy and revascularization (PCI: Percutaneous CORONARY Intervention & CABG: CORONARY ARTERY Bypass). But quite a few patients experience intractable and disabling angina from the beginning due to inappropriate CORONARY anatomy or even after using therapeutic methods (full medical therapy, PCI, CABG). In such cases EECP (Enhanced External Counterpulsation), as an alternative and noninvasive therapy can decrease angina episodes and improve the quality of life.Materials and methods: Forty-four patients were included in this study. All had intractable angina despite full medical therapy and were not appropriate candidates for PCI & CABG, and this problem had notable effect on their life and work. EECP was done in 35 sessions (one hour daily) for all patients in Chamran Hospital-Isfahan. Exercise treadmill test was done before and after completion of the treatment course.Results: Treatment with EECP significantly increased exercise test time in this study. Mean exercise test time before and after completion of treatment was 192.65 and 341.38, respectively. After data analysis, a significant improvement was observed in exercise test time (P<0.001).Discussion: EECP in patients with refractory angina pectoris significantly increased exercise test time and consequently improved the patients' quality of life.

Background: Early diagnosis of CAD could lead to proper treatment of patients and CORONARY ARTERY calcification is considered to be a valuable index in detecting CORONARY ARTERY disease using a noninvasive technique.Objective: To evaluate the relation between calcification and stenosis of CORONARY ARTERY.Methods: This was a cross sectional study in which 760 patients suffering from typical chest pain and as candidates for CORONARY angiography were evaluated for calcification of CORONARY ARTERY by fluoroscopy. All patients signed a consent form while the whole procedures were fully explained in a comprehensible language. Following fluoroscopy and angiography, the results were reviewed by two different cardiologists, separately. The presence of any significant stenosis greater than 75% was considered as a sign for severe CAD. The data were analyzed by X2 followed by determination of sensitivity and specificity.Findings: Abnormal angiogram was found in 402 cases of our patients. In general, the positive and negative predictive values for calcification were 81.8% and 26%, respectively. The positive and negative predictive values were 87.1% and 63.4% in females and 79.7 and 47.3% in males respectively. The highest predictive value was seen in patients below 40 years old (100%). CORONARY calcification in patients with abnormal CORONARY angiogram was found to be 5.4 times higher than those with normal angiogram.Conclusion: According to our results, the noninvasive fluoroscopic technique for detection of CORONARY ARTERY calcification could be regarded as a screening tool to reveal significant CORONARY involvement.

A 70-year-old woman with hypertension presented to our clinic for evaluation of chest pain. A very rare anomaly, in which the right CORONARY ARTERY originated from the left anterior descending ARTERY, was incidentally found on CORONARY angiography. The acute angle made by the anomalous right CORONARY ARTERY may have reduced the flow velocity and led to signs of myocardial ischemia.

Background: It has been shown that CORONARY ARTERY calcium scoring (CACS) can be used as a diagnostic method in CORONARY ARTERY disease (CAD). The relationship between CACS and calcium metabolism in the body has been shown. The arterial calcification is an organized process similar to bone formation which is controled by parathormone (PTH). The relationship between PTH as an osteoregulatory factor and CACS has been also indicated. In this study, we tried to assess the value of serum PTH and CACS in patients planned to undergo CORONARY angiography (CAG) in order to find a simple, cost-benefit, noninvasive way, for ruling in/out obstructive CAD.Methods: In a cross sectional study in Imam Khomeini hospital in 1390, CACS by using non-enhanced multi detector computed tomography (MDCT) and measurement of serum level of PTH, Calcium and Phosphate were done in 178 patients suspected to CAD which were scheduled to undergo CORONARY angiography serum PTH was measured by immuno-radiometric assay (IRMA) and serum Ca and Phosphate were measured by spectrophotometry methods.Results: Of 178 Patients, 50 patients were females and 126 patients were male. Mean age of them was 56.2±11.6. The correlation coefficient between CACS and Gensini score (0.507, P<0.001), PTH (0.037, P=0.693), Ca (0.062, P=0.499) and Phosphate (0.061, P=0.506) were obtained. The level of serum PTH in the patients with and without CORONARY ARTERY disease were 21.8±11.6 pg/dl, 23.2±11.5 pg/dl (P=0.427) respectively.Conclusion: Our study showed association between CACS and CAD that was statistically significant while no relationship was found between PTH, CACS and CAD.