Patients undergoing angioplasty

Inclusion Criteria:

• Age: over 18, Sex: male and female.
• Patients who undergo clinically indicated coronary angiography and/or PCI. Patients in Group 1 (elective PCI) include those presented with stable angina (ACC definition for stable angina).
• Coronary angiography reveals severe stenosis (>70%) that requires PCI.
• Patients in Group 2 (elective PCI in subjects with diabetes) include those who present with stable angina, or with findings on non-invasive testing (exercise or pharmacologic stimulation with imaging by nuclear perfusion imaging or stress echocardiography) in whom coronary angiography reveals severe stenosis (>70%) that requires PCI.
• Patients in Group 2 (ACS) include those presented with unstable angina or non-ST elevation myocardial infarction (as defined by the ACC).
• Coronary angiography reveals severe stenosis (>70%) that requires PCI.

Exclusion Criteria:

• Significant left main coronary artery disease.
• Severely impaired left ventricular systolic function (EF<35%).
• Prior treatment with enoxaparin, Bivalirudin (or other thrombin inhibitors), Warfarin, or thrombolytic agents <48 hours.
• Prior history of myocardial infarction (<6 weeks). Prior history of stroke (<6 weeks).
• Prior history of coronary intervention (<6 weeks).
• History of HIV/AIDS.
• The patients will be identified in the following manner:
• All subjects will be picked from a pool of patients diagnosed with stable angina and diabetes from the Vanderbilt Page-Campbell Heart Institute at Vanderbilt University Medical Center and undergo a complete history and physical examination.
• Patients with acute coronary syndrome will be referred from the acute cardiology patient service at Vanderbilt University Medical Center.
• Subjects with hematologic, renal (creatinine > 2.0 mg/dl), hepatic, inflammatory, and neoplastic disorders, and those who sustained a recent (< 1 month) myocardial infarction, ACS, or stroke will be excluded. Patients who used nonsteroidal anti-inflammatory drugs, corticosteroids, or hormone replacement therapy will also be excluded.
• Pregnancy will be excluded in women of child bearing potential by measurement of urine ß-HCG (it is standard of care to determine if a woman is pregnant prior to elective PCI and will be screened as part of their PHI).
• For healthy volunteers, pregnancy will be excluded per verbal report.
• Data will be collected regarding patient demographics including height and weight, abdominal circumference, blood pressure, comorbid medical conditions, triglycerides, HDL, fasting glucose and medication use (including prescription of antithrombotic agents, ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel antagonists and HMG-CoA inhibitors).