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Bangalore S, Fayyad R, Messerli FH, Laskey R, DeMicco DA, Kastelein JJP, Waters DD. Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial. Am J Cardiol 2017; 119:379-387. [PMID: 27939230 DOI: 10.1016/j.amjcard.2016.10.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
In patients with previous myocardial infarction (MI), aggressive hypertension control and low-density lipoprotein cholesterol (LDL-C) reduction are important secondary prevention measures. However, residual risk remains despite aggressive treatment. Whether variability in blood pressure (BP) and LDL-C can explain this residual risk is not known. Patients enrolled in the Incremental Decrease in End Points Through Aggressive Lipid-Lowering trial with at least 1 post-baseline measurement of LDL-C and blood pressure (BP) were included. Visit-to-visit LDL-C and BP variabilities were evaluated using various measures of variability. Primary outcome was any coronary event with the secondary outcomes of any cardiovascular event (CV), MI, stroke, death, and CV death. Among the 8,658 patients included, each 1-SD (10.8 mg/dl) increase in LDL-C variability increased the risk of any coronary event (adjusted HR [HRadj] 1.07; 95% CI 1.04 to 1.11; p <0.0001), any CV event, MI, and death (HRadj 1.19; 95% CI 1.14 to 1.25; p <0.0001). Similarly, each 1-SD (7.2 mm Hg) increase in systolic BP variability increased the risk of any coronary event (HRadj 1.15; 95% CI 1.10 to 1.20; p <0.0001), any CV event, MI, stroke, death (HRadj 1.28; 95% CI 1.18 to 1.38; p <0.0001), and CV death. Compared with the group with low variability for both LDL-C and systolic BP, the group with high variability for both had a significant increase in any coronary event (HRadj 1.48; 95% CI 1.30 to 1.70), any CV event (HRadj 1.43; 95% CI 1.27 to 1.61), and MI (HRadj 1.87; 95% CI 1.46 to 2.41). In conclusions, in patients with a history of MI, variabilities in LDL-C and BP are powerful and independent predictors of CV events including death.
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Affiliation(s)
- Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York.
| | | | - Franz H Messerli
- Division of Cardiology, University Hospital, Bern, Switzerland; Division of Cardiology, Mount Sinai, Icahn School of Medicine, New York, New York
| | | | | | | | - David D Waters
- Division of Cardiology, San Francisco General Hospital, San Francisco, California
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102
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Duan C, Cao Y, Liu Y, Zhou L, Ping K, Tan MT, Tan N, Chen J, Chen P. A New Preprocedure Risk Score for Predicting Contrast-Induced Acute Kidney Injury. Can J Cardiol 2017; 33:714-723. [PMID: 28392272 DOI: 10.1016/j.cjca.2017.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Most of the risk models for predicting contrast-induced acute kidney injury (CI-AKI) are available for only postcontrast exposure prediction; however, prediction before the procedure is more valuable in practice. This study aimed to develop a risk scoring system based on preprocedural characteristics for early prediction of CI-AKI in patients after coronary angiography or percutaneous coronary intervention (PCI). METHODS We prospectively recruited 1777 consecutive patients who were randomized in an approximate 3:2 ratio to create a development data set (n = 1076) and a validation data set (n = 701). A risk score model based on preprocedural risk factors was developed using stepwise logistic regression. Validation was performed by bootstrap and split-sample methods. RESULTS The occurrence of CI-AKI was 5.97% (106 of 1777), 5.95% (64 of 1076), and 5.99% (42 of 701) in the overall, developmental, and validation data sets, respectively. The risk score was developed with 5 prognostic factors (age, serum creatinine levels, N-terminal pro b-type natriuretic peptide levels, high-sensitivity C-reactive protein, and primary PCI), ranged from 0-36, and was well calibrated (Hosmer-Lemeshow χ2 = 4.162; P = 0.842). Good discrimination was obtained both in the developmental and validation data sets (C-statistic, 0.809 and 0.798, respectively). The risk score was highly and positively associated with CI-AKI (P for trend < 0.001) in-hospital and long-term outcomes. CONCLUSIONS The novel risk score model we developed is a simple and accurate tool for early/preprocedural prediction of CI-AKI in patients undergoing coronary angiography or PCI. This tool allows assessment of the risk of CI-AKI before contrast exposure, allowing for timely initiation of appropriate preventive measures.
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Affiliation(s)
- Chongyang Duan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, and Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yingshu Cao
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, and Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lizhi Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, and Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Kaike Ping
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, and Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ming T Tan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, and Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China; Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington DC, USA
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Pingyan Chen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, and Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China.
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103
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Zeymer U, Hohlfeld T, Vom Dahl J, Erbel R, Münzel T, Zahn R, Roitenberg A, Breitenstein S, Pap ÁF, Trenk D. Prospective, randomised trial of the time dependent antiplatelet effects of 500 mg and 250 mg acetylsalicylic acid i. v. and 300 mg p. o. in ACS (ACUTE). Thromb Haemost 2017; 117:625-635. [PMID: 28102427 DOI: 10.1160/th16-08-0650] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/26/2016] [Indexed: 11/05/2022]
Abstract
Little is known about the onset of action after intravenous or oral administration of acetylsalicylic acid (ASA) in patients with acute coronary syndromes (ACS). The aim of the study was to compare intravenous 250 or 500 mg acetylsalicylic acid (ASA) with oral 300 mg in ASA naïve patients with ACS concerning the onset of antiplatelet effects measured by time dependent thromboxane inhibition. A total of 270 patients with ACS < 24 hours were randomised into one of three treatment arms comprising administration of a single dose of ASA as soon as possible after admission. The primary endpoint was platelet inhibition assessed by measurement of arachidonic acid (AA)-induced platelet thromboxane release (TXB2) 5 minutes (min) after study drug administration. Both 250 mg and 500 mg ASA i. v. inhibited TXB2 formation nearly completely (geometric means: from 581.7 and 573.9 ng/ml at baseline to 3.9 and 3.1 ng/ml at 5 min, respectively) compared to 300 mg oral ASA (geometric means: from 652.0 to 223.7 ng/ml) (p-value, ANCOVA: < 0.0001). Similar results were obtained for inhibition of AA-induced platelet aggregation (Multiplate ASPItest; from means 86.41 and 85.72 U to 23.04 and 20.57 U at 5 min, respectively) compared to 300 mg oral ASA from mean 87.18 to 75.56 U (p-value, ANCOVA: <0.0001). The rate of bleedings was low and comparable between the groups. In summary, the administration of a single dose of 250 or 500 mg ASA IV compared to 300 mg orally is associated with a faster and more complete inhibition of thromboxane generation and platelet aggregation. Bleeding complications were comparable between the groups.
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Affiliation(s)
- Uwe Zeymer
- Uwe Zeymer, MD, Klinikum Ludwigshafen und Institut für Herzinfarktforschung, Bremserstrasse 79, D-67063 Ludwigshafen/Rhein, Germany, Tel.: +49 621 503 2941, Fax: +49 621 503 4002, E-mail:
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104
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Jiang J, Cong H, Zhang Y, Li Z, Tao G, Li X, Qing L, Tan N, Zhao Z, Dong Y, Ji Z, Chen Y, Ge J, He B, Sun Y, Cao K, Huo Y. Effect of Metoprolol Succinate in Patients with Stable Angina and Elevated Heart Rate Receiving Low-Dose β-Blocker Therapy. Int J Med Sci 2017; 14:477-483. [PMID: 28539824 PMCID: PMC5441040 DOI: 10.7150/ijms.18054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/26/2017] [Indexed: 11/29/2022] Open
Abstract
Aims: β-blockers are underused in Chinese patients with coronary heart disease. The prescribed dose is often low. The aim of this study was to investigate the effect of metoprolol succinate doses of 95 mg and 190 mg on heart rate (HR) control, as well as drug tolerance, in Chinese patients with stable angina, low-dose β-blocker use and unsatisfactory HR control. Methods: This was a multicenter, randomized, open-label, parallel-group trial in 15 clinical sites. Patients with stable angina, taking low-dose β-blockers (equivalent to metoprolol succinate 23.75-47.5 mg/day), and having a resting HR of ≥ 65 bpm were enrolled and randomized to either the metoprolol 95-mg group or the 190-mg group. The change in 24-h average HR from baseline recorded by Holter monitoring and the percentages of patients with resting HR controlled to ≤ 60 bpm were compared between the two groups. Results: Two hundred thirty-one patients entered the intent-to-treat population for the main analysis. The change in 24-h average HR from baseline was -0.62 ± 0.66 bpm in the 95 mg group and -2.99 ± 0.62 bpm in the 190 mg group (p = 0.0077) after 8 weeks of treatment. The percentages of patients with resting HR controlled to ≤ 60 bpm were 24.1% (95% CI: 16.35%, 31.93%) and 40.0% (95% CI: 31.05%, 48.95%), respectively (p = 0.0019). Only 4 and 2 of the patients, respectively, discontinued the study drugs because of hypotension or bradycardia. Conclusions: The metoprolol succinate dose of 190 mg is superior to the 95 mg dose in terms of HR control, in Chinese patients with stable angina, low-dose β-blocker use and unsatisfactory HR control. Both doses were well tolerated.
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Affiliation(s)
- Jie Jiang
- Peking University First Hospital, 8 Xishiku Street., Xicheng District, Beijing, 100034
| | - Hongliang Cong
- Tianjin Chest Hospital, 93 Xian Road, Heping District, Tianjin, 30051
| | - Yan Zhang
- Peking University First Hospital, 8 Xishiku Street., Xicheng District, Beijing, 100034
| | - Zhanquan Li
- The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, Liaoning, 110016
| | - Guizhou Tao
- The First Affiliated Hospital of Liaoning Medical University, 2 Renmin Street, Jinzhou, Liaoning, 121004
| | - Xiaodong Li
- Shengjing Hospital of China Medical University, 36 Sanhao street, Heping District, Shenyang, Liaoning, 110004
| | - Liang Qing
- Taiyuan Chaoyang Hospital, 7 Youdianqian Street, Yingze District, Taiyuan, Shanxi, 030001
| | - Ning Tan
- Guangdong General Hospital, 106 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080
| | - Zhichen Zhao
- Zhengzhou Central Hospital, 195 Tongbai Road, Zhongyuan District, Zhengzhou, Henan, 450007
| | - Yugang Dong
- The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guanzhou, Guangdong, 510080
| | - Zheng Ji
- Tangshan Gongren Hospital, 27 Wenhua Road, Lubei District, Tangshan, Hebei, 63000
| | - Yundai Chen
- Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100039
| | - Junbo Ge
- Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District,Shanghai, 200032
| | - Ben He
- Renji Hospital Shanghai Jiaotong University School of Medicine, 786 Yuyuan Road, Changning District, Shanghai, 200240
| | - Yingxian Sun
- The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, Liaoning, 110001
| | - Kejiang Cao
- Jiangsu Province Hospital, 300 Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029
| | - Yong Huo
- Peking University First Hospital, 8 Xishiku Street., Xicheng District, Beijing, 100034
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105
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Noman A, Balasubramaniam K, Alhous MHA, Lee K, Jesudason P, Rashid M, Mamas MA, Zaman AG. Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus. Catheter Cardiovasc Interv 2016; 89:1195-1204. [PMID: 28029209 PMCID: PMC5484298 DOI: 10.1002/ccd.26882] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 10/13/2016] [Accepted: 11/13/2016] [Indexed: 12/13/2022]
Abstract
Objectives To assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency). Background DM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI. Methods Retrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011. Results About 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings. Conclusion In the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Awsan Noman
- Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | | | - M Hafez A Alhous
- Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Kelvin Lee
- Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Peter Jesudason
- Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, United Kingdom
| | - Mamas A Mamas
- Cardiovascular Institute, Manchester University, Manchester, United Kingdom.,Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, United Kingdom
| | - Azfar G Zaman
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.,Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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106
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Kirtane AJ, Doshi D, Leon MB, Lasala JM, Ohman EM, O'Neill WW, Shroff A, Cohen MG, Palacios IF, Beohar N, Uriel N, Kapur NK, Karmpaliotis D, Lombardi W, Dangas GD, Parikh MA, Stone GW, Moses JW. Treatment of Higher-Risk Patients With an Indication for Revascularization: Evolution Within the Field of Contemporary Percutaneous Coronary Intervention. Circulation 2016; 134:422-31. [PMID: 27482004 DOI: 10.1161/circulationaha.116.022061] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
Abstract
Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.
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Affiliation(s)
- Ajay J Kirtane
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.).
| | - Darshan Doshi
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Martin B Leon
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - John M Lasala
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - E Magnus Ohman
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - William W O'Neill
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Adhir Shroff
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Mauricio G Cohen
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Igor F Palacios
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Nirat Beohar
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Nir Uriel
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Navin K Kapur
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Dimitri Karmpaliotis
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - William Lombardi
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - George D Dangas
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Manish A Parikh
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Gregg W Stone
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
| | - Jeffrey W Moses
- From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.)
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107
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Abstract
Elevated cardiac troponin (cTn) in the absence of acute coronary syndromes (ACS) is associated with increased mortality in critically ill patients. There are no evidence-based interventions that reduce mortality in this group.
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108
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Shiraishi Y, Kohsaka S, Ueda I, Inohara T, Sawano M, Numasawa Y, Hayashida K, Maekawa Y, Momiyama Y, Fukuda K. Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome: A report from Japanese multicenter registry. Int J Clin Pract 2016; 70:978-987. [PMID: 28032431 DOI: 10.1111/ijcp.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/02/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Degree of dyspnoea is almost universally evaluated in the patients presenting with acute coronary syndrome (ACS), but its clinical implications has not been thoroughly investigated. We aimed to describe the relationship between the severity of dyspnoea and in-hospital outcomes in patients with non-ST elevation ACS (NSTE-ACS) complicated with acute heart failure (AHF). METHODS Between 2009 and 2014, 3287 consecutive patients with NSTE-ACS were enrolled in the Japanese prospective multicenter PCI registry. Patients complicated with AHF were subclassified based on the self-reported dyspnoea severity: no dyspnoeic symptoms, dyspnoea during moderate activity, mild activity or at rest. The recorded outcomes included in-hospital death, major cardiovascular (ie, cardiac death, shock, stroke or major bleeding) and renal events (ie, contrast-induced acute kidney injury [CI-AKI] or AKI requiring dialysis). RESULTS In total, 441 (13.4%) patients had AHF upon presentation, including 76 (17.2%) with dyspnoea during moderate activity, 160 (36.3%) with dyspnoea during mild activity, and 205 (46.5%) with dyspnoea at rest. In-hospital mortality as well as major cardiovascular and renal events increased as dyspnoea severity worsened. After multivariate adjustment, dyspnoea at rest was strongly associated with in-hospital mortality (odds ratio [OR] 5.79; 95% confidence interval [CI], 2.56-13.11; P<.001) as well as major cardiovascular (OR, 2.55; 95% CI, 1.46-4.48; P<.001) and renal events (OR, 3.32; 95% CI, 2.05-5.38; P<.001), when compared to the patients without dyspnoea. CONCLUSIONS Among NSTE-ACS patients complicated with AHF, both cardiovascular and renal event rates were associated with presence of dyspnoea, and its incidence increased in parallel with dyspnoea severity.
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Affiliation(s)
- Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yukihiko Momiyama
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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109
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Schoos MM, Mehran R, Dangas GD. The Optimal Duration of Dual Antiplatelet Therapy After PCI. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Roxana Mehran
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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110
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Characterisation of Myocardial Injury via T1 Mapping in Early Reperfused Myocardial Infarction and its Relationship with Global and Regional Diastolic Dysfunction. Heart Lung Circ 2016; 25:1094-1106. [DOI: 10.1016/j.hlc.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/28/2016] [Indexed: 01/31/2023]
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111
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Singh M, Bhatt DL, Stone GW, Rihal CS, Gersh BJ, Lennon RJ, Narula J, Fuster V. Antithrombotic Approaches in Acute Coronary Syndromes: Optimizing Benefit vs Bleeding Risks. Mayo Clin Proc 2016; 91:1413-1447. [PMID: 27712639 DOI: 10.1016/j.mayocp.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 01/06/2023]
Abstract
It is estimated that in the United States, each year, approximately 620,000 persons will experience an acute coronary syndrome and approximately 70% of these will have non-ST-elevation acute coronary syndrome. Cardiovascular disease still accounts for 1 of every 3 deaths in the United States, and there is an urgent need to improve the prognosis of patients presenting with acute coronary syndrome. Cardiovascular mortality and ischemic complications are common after acute coronary syndrome, and the advent of newer antithrombotic therapies has reduced ischemic complications, but at the expense of greater bleeding. The new antithrombotic agents also raise the challenge of choosing between multiple potential therapeutic combinations to minimize recurrent ischemia without a concomitant increase in bleeding, a decision that often varies according to an individual patient's relative propensity for ischemia versus hemorrhage. In this review, we will synthesize the available information to arm health care providers with the contemporary knowledge on antithrombotic therapy and individualize treatment decisions.
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA
| | - Gregg W Stone
- Columbia University Medical Center, New York Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY
| | | | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY
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112
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Soeiro ADM, Silva PGMDBE, Roque EADC, Bossa AS, César MC, Simões SA, Okada MY, Leal TDCAT, Pedroti FCM, Oliveira MTD. Fondaparinux versus Enoxaparin - Which is the Best Anticoagulant for Acute Coronary Syndrome? - Brazilian Registry Data. Arq Bras Cardiol 2016; 107:239-244. [PMID: 27579543 PMCID: PMC5053192 DOI: 10.5935/abc.20160127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/06/2016] [Indexed: 02/03/2023] Open
Abstract
Background: Recent studies have shown fondaparinux's superiority over enoxaparin in
patients with non-ST elevation acute coronary syndrome (ACS), especially in
relation to bleeding reduction. The description of this finding in a
Brazilian registry has not yet been documented. Objective: To compare fondaparinux versus enoxaparin in in-hospital prognosis of non-ST
elevation ACS. Methods: Multicenter retrospective observational study. A total of 2,282 patients were
included (335 in the fondaparinux group, and 1,947 in the enoxaparin group)
between May 2010 and May 2015. Demographic, medication intake and chosen
coronary treatment data were obtained. Primary outcome was mortality from
all causes. Secondary outcome was combined events (cardiogenic shock,
reinfarction, death, stroke and bleeding). Comparison between the groups
were done through Chi-Square test and T test. Multivariate analysis was done
through logistic regression, with significance values defined as p <
0.05. Results: With regards to treatment, we observed the performance of a percutaneous
coronary intervention in 40.2% in the fondaparinux group, and in 35.1% in
the enoxaparin group (p = 0.13). In the multivariate analysis, we observed
significant differences between fondaparinux and enoxaparin groups in
relation to combined events (13.8% vs. 22%. OR = 2.93, p = 0.007) and
bleeding (2.3% vs. 5.2%, OR = 4.55, p = 0.037), respectively. Conclusion: Similarly to recently published data in international literature,
fondaparinux proved superior to enoxaparin for the Brazilian population,
with significant reduction of combined events and bleeding.
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Affiliation(s)
- Alexandre de Matos Soeiro
- Unidade Clínica de Emergência - Instituto do Coração (InCor) do Hospital das Clínicas da Universidade de São Paulo - Brazil
| | | | | | - Aline Siqueira Bossa
- Unidade Clínica de Emergência - Instituto do Coração (InCor) do Hospital das Clínicas da Universidade de São Paulo - Brazil
| | - Maria Cristina César
- Unidade Clínica de Emergência - Instituto do Coração (InCor) do Hospital das Clínicas da Universidade de São Paulo - Brazil
| | | | | | | | | | - Múcio Tavares de Oliveira
- Unidade Clínica de Emergência - Instituto do Coração (InCor) do Hospital das Clínicas da Universidade de São Paulo - Brazil
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113
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Ghantous AE, Ferneini EM. Aspirin, Plavix, and Other Antiplatelet Medications: What the Oral and Maxillofacial Surgeon Needs to Know. Oral Maxillofac Surg Clin North Am 2016; 28:497-506. [PMID: 27595478 DOI: 10.1016/j.coms.2016.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most patients with coronary artery disease and peripheral vascular disease are on long-term antiplatelet therapy and dual therapy. Achieving a balance between ischemic and bleeding risk remains an important factor in managing patients on antiplatelet therapy. For most outpatient surgical procedures, maintenance and continuation of this therapy are recommended. Consultation with the patient's cardiologist, physician, and/or vascular surgeon is always recommended before interrupting or withholding this treatment modality.
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Affiliation(s)
- Andre E Ghantous
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510, USA
| | - Elie M Ferneini
- Private Practice, Greater Waterbury OMS, 435 Highland Avenue, Suite 100, Cheshire, CT 06410, USA; Beau Visage Med Spa, 435 Highland Avenue, Suite 100, Cheshire, CT 06410, USA; Division of Oral and Maxillofacial Surgery, Department of Craniofacial Sciences, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA.
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114
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Zu L, Guo G, Zhou B, Gao W. Relationship between metabolites of arachidonic acid and prognosis in patients with acute coronary syndrome. Thromb Res 2016; 144:192-201. [DOI: 10.1016/j.thromres.2016.06.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/21/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022]
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Hokimoto S, Tabata N, Yamanaga K, Sueta D, Akasaka T, Tsujita K, Sakamoto K, Yamamoto E, Yamamuro M, Izumiya Y, Kaikita K, Kojima S, Matsui K, Ogawa H. Prevalence of coronary macro- and micro-vascular dysfunctions after drug-eluting stent implantation without in-stent restenosis. Int J Cardiol 2016; 222:185-194. [PMID: 27497093 DOI: 10.1016/j.ijcard.2016.07.221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim was to examine the prevalence and characteristics of epicardial vasomotor abnormality (EVA) and coronary microvascular dysfunction (CMD) including endothelium-dependent (EDCMD) or -independent (EICMD) in patients following a second-generation drug-eluting stent (second DES) implantation without in-stent restenosis. METHODS AND RESULTS In 105 patients who underwent second DES implantation in the left anterior descending coronary artery (74 men; mean age, 67.9±9.6years), and in 105 suspected angina patients without stenting (65 men; mean age 66.4±9.1years), we evaluated EVA using the acetylcholine provocation test, EDCMD and EICMD by measuring the coronary flow reserve and the relationship between myocardial ischemia (intracoronary lactate production between aorta and coronary sinus and ST-T changes) or recurrent angina and vascular function. There was no difference in the incidence of EVA between DES and control (49.5% versus 55.2%; P=0.41). Given that the prevalence of CMD was higher in DES than in control (59.0% versus 29.5%; P<0.001), CMD may be associated with stent placement. Of the CMD patients, EDCMD alone, EICMD alone, and both CMDs were found in 40.3%, 22.6%, and 37.1%, respectively. Myocardial ischemia was detected in 42.4% of patients, and recurrent angina was more common in the presence of both EDCMD and EICMD in patients with EVA or CMD compared to patients with normal vascular function (EVA, 42.9% versus 7.7%, P=0.015: CMD, 39.1% versus 7.7%, P=0.007). CONCLUSIONS Myocardial ischemia and recurrent angina may be caused by the presence of both EDCMD and EICMD after a second DES implantation without ISR.
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Affiliation(s)
- Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Megumi Yamamuro
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kunihiko Matsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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116
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Wang H, Wang X. Efficacy and safety outcomes of ticagrelor compared with clopidogrel in elderly Chinese patients with acute coronary syndrome. Ther Clin Risk Manag 2016; 12:1101-5. [PMID: 27471389 PMCID: PMC4948739 DOI: 10.2147/tcrm.s108965] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective This study was designed to investigate the efficacy and safety outcomes of ticagrelor in comparison with clopidogrel on a background of aspirin in elderly Chinese patients with acute coronary syndrome (ACS). Patients and methods A double-blinded, randomized controlled study was conducted, and 200 patients older than 65 years with the diagnosis of ACS were assigned 1:1 to take ticagrelor or clopidogrel. The course of treatment was required to continue for 12 months. Results The median age of the whole cohort was 79 years (range: 65–93 years), and females accounted for 32.5% (65 patients). Baseline characteristics and clinical diagnosis had no significant difference between patients taking ticagrelor and clopidogrel; they were also balanced with respect to other treatments (P>0.05 for all). The risk of cardiovascular death was significantly lower in patients taking ticagrelor compared with clopidogrel, as was the risk of myocardial infarction (P<0.05 for all); there was no difference in the risk of stroke (P>0.05). Ticagrelor was more effective than clopidogrel in decreasing the primary efficacy end point (cardiovascular death, myocardial infarction, and stroke, P<0.05). The all-cause mortality was not significantly different between patients taking ticagrelor and clopidogrel (P>0.05). The difference in the risk of bleeding, platelet inhibition and patient outcomes major bleeding (life-threatening bleeding and others), and platelet inhibition and patient outcomes minor bleeding was not evident between patients taking ticagrelor and clopidogrel (P>0.05 for all). Conclusion The current study in elderly Chinese patients with ACS demonstrated that ticagrelor reduced the primary efficacy end point at no expense of increased bleeding risk compared with clopidogrel, suggesting that ticagrelor is a suitable alternative for use in elderly Chinese patients with ACS.
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Affiliation(s)
- Huidong Wang
- Geriatric Department, The Fourth Clinical College of Harbin Medical University, Harbin
| | - Xin Wang
- Geriatric Department, Daqing Oilfield General Hospital, Daqing, Heilongjiang, People's Republic of China
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Amann U, Kirchberger I, Heier M, Thilo C, Kuch B, Peters A, Meisinger C. Predictors of non-invasive therapy and 28-day-case fatality in elderly compared to younger patients with acute myocardial infarction: an observational study from the MONICA/KORA Myocardial Infarction Registry. BMC Cardiovasc Disord 2016; 16:151. [PMID: 27411983 PMCID: PMC4944313 DOI: 10.1186/s12872-016-0322-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/21/2016] [Indexed: 01/19/2023] Open
Abstract
Background A substantial proportion of patients with acute myocardial infarction (AMI) did not receive invasive therapy, defined as percutaneous coronary intervention and/or coronary artery bypass grafting. Aims of this study were to evaluate predictors of non-invasive therapy in elderly compared to younger AMI patients and to assess the association between invasive therapy and 28-day-case fatality. Methods From the German population-based registry, 3475 persons, consecutively hospitalized with an AMI between 2009 and 2012 were included. Data were collected by standardized interviews and chart review. All-cause mortality was assessed on a regular basis. Multivariable logistic regression analyses were conducted. Results The sample consisted of 1329 patients aged 28–65 years (age category [AC] 1), 1083 aged 65–74 years (AC 2), and 1063 aged 75–84 years (AC 3). The proportion of patients receiving non-invasive therapy was 10.7, 17.7, and 35.8 % in AC 1, 2, and 3, respectively. Predictors of non-invasive therapy in all ACs were non-ST segment elevation MI, bundle branch block, reduced left ventricular ejection fraction, prior stroke, absence of hyperlipidemia, and low creatine kinase. Elderly women (≥65 years) were less likely to receive invasive therapy. Stratifying the models by type of AMI revealed fewer predictors in patients with ST segment elevation MI. Regarding 28-day-case fatality, strong inverse relations with invasive therapy were seen in all AC: odds ratio of 0.35 (95 % confidence interval [CI] 0.15–0.84), 0.45 (95 % CI 0.22–0.92), and 0.39 (95 % CI 0.24–0.63) in AC 1, 2 and 3, respectively. Conclusion In today’s real-life patient care we found that predictors of non-invasive therapy were predominantly the same in all age groups, but differed particularly by type of AMI. Further research is necessary to investigate the real reasons for non-invasive therapy, especially among elderly women. Moreover, we confirmed that receiving invasive therapy was inversely associated with 28-day-case fatality independent of age.
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Affiliation(s)
- Ute Amann
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany. .,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christian Thilo
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany.,Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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118
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Enhanced P-selectin expression on platelet-a marker of platelet activation, in young patients with angiographically proven coronary artery disease. Mol Cell Biochem 2016; 419:125-33. [DOI: 10.1007/s11010-016-2756-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/21/2016] [Indexed: 01/19/2023]
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119
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Ishii M, Kaikita K, Sato K, Yamanaga K, Miyazaki T, Akasaka T, Tabata N, Arima Y, Sueta D, Sakamoto K, Yamamoto E, Tsujita K, Yamamuro M, Kojima S, Soejima H, Hokimoto S, Matsui K, Ogawa H. Impact of aspirin on the prognosis in patients with coronary spasm without significant atherosclerotic stenosis. Int J Cardiol 2016; 220:328-32. [PMID: 27390950 DOI: 10.1016/j.ijcard.2016.06.157] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronary spasm is one of the mechanisms of myocardial infarction with nonobstructive coronary arteries (MINOCA). The aim of this study was to investigate the effects of aspirin on future cardiovascular events in patients with coronary vasospastic angina (VSA) with non-significant atherosclerotic stenosis. METHODS This was the retrospective analysis of the 640 VSA patients with non-significant atherosclerotic stenosis (≤50% stenosis) among 1,877 consecutive patients who underwent acetylcholine (ACh)-provocation testing between January 1991 and December 2010. The patients were divided into 2 groups treated with (n=137) or without (n=503) low-dose aspirin (81-100mg/day). We evaluated major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction, and unstable angina. RESULTS In the study population, 24 patients (3.8%) experienced MACE; there were 6 cases in VSA patients with aspirin and 6 in those without aspirin. Multivariate Cox hazards analysis for correlated factors of MACE indicated that use of statin (HR: 0.11; 95% CI: 0.02 to 0.84; P=0.033), ST-segment elevation during attack (HR: 5.28; 95% CI: 2.19-12.7; P<0.001), but not the use of aspirin as a significant predictor of MACE. After propensity score matching (n=112, each), Kaplan-Meier survival analysis indicated almost identical rate of 5-year survival free from MACE in those with aspirin, compared to those without aspirin in the entire and matched cohort (P=0.640 and P=0.541, respectively). CONCLUSIONS Low-dose aspirin might not reduce future cardiovascular events in VSA patients with non-significant stenosis.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Koji Sato
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashi Miyazaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Megumi Yamamuro
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kunihiko Matsui
- Department of General and Community Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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120
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Twerenbold R, Jaeger C, Rubini Gimenez M, Wildi K, Reichlin T, Nestelberger T, Boeddinghaus J, Grimm K, Puelacher C, Moehring B, Pretre G, Schaerli N, Campodarve I, Rentsch K, Steuer S, Osswald S, Mueller C. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction. Eur Heart J 2016; 37:3324-3332. [PMID: 27357358 PMCID: PMC5177796 DOI: 10.1093/eurheartj/ehw232] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/25/2016] [Accepted: 04/29/2016] [Indexed: 12/13/2022] Open
Abstract
Aims High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI. Methods and results We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002). Conclusion The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge. Clinical Trial Registration Information www.clinicaltrials.gov. Identifier, NCT00470587.
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Affiliation(s)
- Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Cedric Jaeger
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Maria Rubini Gimenez
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Karin Grimm
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Puelacher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Berit Moehring
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Gil Pretre
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Nicolas Schaerli
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Isabel Campodarve
- Servicio de Urgencias y Medicina Interna - Hospital del Mar, Barcelona, Spain
| | | | - Stephan Steuer
- Emergency Department, Kantonsspital Luzern, Luzern, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland .,Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
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Abstract
Certain antithrombotic drugs exhibit high patient-to-patient variability that significantly impacts the safety and efficacy of therapy. Pharmacogenetics offers the possibility of tailoring drug treatment to patients based on individual genotypes, and this type of testing has been recommended for 2 oral antithrombotic agents, warfarin and clopidogrel, to influence use and guide dosing. Limited studies have identified polymorphisms that affect the metabolism and activity of newer oral antithrombotic drugs, without clear evidence of the clinical relevance of such polymorphisms. This article provides an overview of the current status of pharmacogenetics in oral antithrombotic therapy.
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Affiliation(s)
- Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Alexander Duncan
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Charles E Hill
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
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Early Invasive Strategy for Unstable Angina: a New Meta-Analysis of Old Clinical Trials. Sci Rep 2016; 6:27345. [PMID: 27273697 PMCID: PMC4895177 DOI: 10.1038/srep27345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/11/2016] [Indexed: 11/09/2022] Open
Abstract
Randomized controlled trials (RCTs) were conflicting to support whether unstable angina versus non-ST-elevation myocardial infarction (UA/NSTEMI) patients best undergo early invasive or a conservative revascularization strategy. RCTs with cardiac biomarkers, in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1975-2013 were reviewed considering all cause mortality, recurrent non-fatal myocardial infarction (MI) and their combination. Follow-up lasted from 6-24 months and the use of routine invasive strategy up to its end was associated with a significantly lower composite of all-cause mortality and recurrent non-fatal MI (Relative Risk [RR] 0.79; 95% confidence interval [CI], 0.70-0.90) in UA/NSTEMI. In NSTEMI, by the invasive strategy, there was no benefit (RR 1.19; 95% CI, 1.03-1.38). In the shorter time period, from randomization to discharge, a routine invasive strategy was associated with significantly higher odds of the combined end-point among UA/NSTEMI (RR 1.29; 95% CI, 1.05-1.58) and NSTEMI (RR 1.82; 95% CI, 1.34-2.48) patients. Therefore, in trials recruiting a large number of UA patients, by routine invasive strategy the largest benefit was seen, whereas in NSTEMI patients death and non-fatal MI were not lowered. Routine invasive treatment in UA patients is accordingly supported by the present study.
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123
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Galluzzo A, Gallo C, Battaglia A, Frea S, Canavosio FG, Botta M, Bergerone S, Gaita F. Prolonged QT interval in ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 17:440-5. [DOI: 10.2459/jcm.0000000000000317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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124
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Halvorsen S, Jortveit J, Hasvold P, Thuresson M, Øie E. Initiation of and long-term adherence to secondary preventive drugs after acute myocardial infarction. BMC Cardiovasc Disord 2016; 16:115. [PMID: 27246583 PMCID: PMC4886431 DOI: 10.1186/s12872-016-0283-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Secondary preventive drug therapy following acute myocardial infarction (AMI) is recommended to reduce the risk of new cardiovascular events. The aim of this nationwide cohort study was to examine the initiation and long-term use of secondary preventive drugs after AMI. METHODS The prescription of drugs in 42,707 patients < 85 years discharged alive from hospital after AMI in 2009-2013 was retrieved by linkage of the Norwegian Patient Register, the Norwegian Prescription Database, and the Norwegian Cause of Death Registry. Patients were followed for up to 24 months. RESULTS The majority of patients were discharged on single or dual antiplatelet therapy (91 %), statins (90 %), beta-blockers (82 %), and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor II blockers (ARB) (60 %). Patients not undergoing percutaneous coronary intervention (PCI) (42 %) were less likely to be prescribed secondary preventive drugs compared with patients undergoing PCI. This was particular the case for dual antiplatelet therapy (43 % vs. 87 %). The adherence to prescribed drugs was high: 12 months after index AMI, 84 % of patients were still on aspirin, 84 % on statins, 77 % on beta-blockers and 57 % on ACEI/ARB. Few drug and dose adjustments were made during follow-up. CONCLUSION Guideline-recommended secondary preventive drugs were prescribed to most patients discharged from hospital after AMI, but the percentage receiving such therapy was significantly lower in non-PCI patients. The long-time adherence was high, but few drug adjustments were performed during follow-up. More attention is needed to secondary preventive drug therapy in AMI patients not undergoing PCI.
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Affiliation(s)
- Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Postboks 4956, Nydalen, 0424, Oslo, Norway.
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital, Arendal, Norway
| | - Pål Hasvold
- AstraZeneca NordicBaltic, Södertälje, Sweden
| | | | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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125
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Fanning JP, Nyong J, Scott IA, Aroney CN, Walters DL. Routine invasive strategies versus selective invasive strategies for unstable angina and non-ST elevation myocardial infarction in the stent era. Cochrane Database Syst Rev 2016; 2016:CD004815. [PMID: 27226069 PMCID: PMC8568369 DOI: 10.1002/14651858.cd004815.pub4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND People with unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI) are managed with a combination of medical therapy, invasive angiography and revascularisation. Specifically, two approaches have evolved: either a 'routine invasive' strategy whereby all patients undergo coronary angiography shortly after admission and, if indicated, coronary revascularisation; or a 'selective invasive' (also referred to as 'conservative') strategy in which medical therapy alone is used initially, with a selection of patients for angiography based upon evidence of persistent myocardial ischaemia. Uncertainty exists as to which strategy provides the best outcomes for these patients. This Cochrane review is an update of a Cochrane review originally published in 2006, to provide a robust comparison of these two strategies in the early management of patients with UA/NSTEMI. OBJECTIVES To determine the benefits and harms associated with the following.1. A routine invasive versus a conservative or 'selective invasive' strategy for the management of UA/NSTEMI in the stent era.2. A routine invasive strategy with and without glycoprotein IIb/IIIa receptor antagonists versus a conservative strategy for the management of UA/NSTEMI in the stent era. SEARCH METHODS We searched the following databases and additional resources up to 25 August 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE and EMBASE, with no language restrictions. SELECTION CRITERIA We included prospective randomised controlled trials (RCTs) that compared invasive with conservative or 'selective invasive' strategies in participants with acute UA/NSTEMI. DATA COLLECTION AND ANALYSIS Two review authors screened the records and extracted data in duplicate. Using intention-to-treat analysis with random-effects models, we calculated summary estimates of the risk ratio (RR) with 95% confidence intervals (CIs) for the primary endpoints of all-cause death, fatal and non-fatal myocardial infarction (MI), combined all-cause death or non-fatal MI, refractory angina and re-hospitalisation. We performed further analysis of included studies based on whether glycoprotein IIb/IIIa receptor antagonists were used routinely. We assessed the heterogeneity of included trials using Pearson χ² (Chi² test) and variance (I² statistic) analysis. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, we assessed the quality of the evidence and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 (Review Manager) to create Summary of findings (SoF) tables. MAIN RESULTS Eight RCTs with a total of 8915 participants (4545 invasive strategies, 4370 conservative strategies) were eligible for inclusion. We included three new studies and 1099 additional participants in this review update. In the all-study analysis, evidence did not show appreciable risk reductions in all-cause mortality (RR 0.87, 95% CI 0.64 to 1.18; eight studies, 8915 participants; low quality evidence) and death or non-fatal MI (RR 0.93, 95% CI 0.71 to 1.2; seven studies, 7715 participants; low quality evidence) with invasive strategies compared to conservative (selective invasive) strategies at six to 12 months follow-up. There was appreciable risk reduction in MI (RR 0.79, 95% CI 0.63 to 1.00; eight studies, 8915 participants; moderate quality evidence), refractory angina (RR 0.64, 95% CI 0.52 to 0.79; five studies, 8287 participants; moderate quality evidence) and re-hospitalisation (RR 0.77, 95% CI 0.63 to 0.94; six studies, 6921 participants; moderate quality evidence) with routine invasive strategies compared to conservative (selective invasive) strategies also at six to 12 months follow-up.Evidence also showed increased risks in bleeding (RR 1.73, 95% CI 1.30 to 2.31; six studies, 7584 participants; moderate quality evidence) and procedure-related MI (RR 1.87, 95% CI 1.47 to 2.37; five studies, 6380 participants; moderate quality evidence) with routine invasive strategies compared to conservative (selective invasive) strategies.The low quality evidence were as a result of serious risk of bias and imprecision in the estimate of effect while moderate quality evidence was only due to serious risk of bias. AUTHORS' CONCLUSIONS In the all-study analysis, the evidence failed to show appreciable benefit with routine invasive strategies for unstable angina and non-ST elevation MI compared to conservative strategies in all-cause mortality and death or non-fatal MI at six to 12 months. There was evidence of risk reduction in MI, refractory angina and re-hospitalisation with routine invasive strategies compared to conservative (selective invasive) strategies at six to 12 months follow-up. However, routine invasive strategies were associated with a relatively high risk (almost double the risk) of procedure-related MI, and increased risk of bleeding complications. This systematic analysis of published RCTs supports the conclusion that, in patients with UA/NSTEMI, a selectively invasive (conservative) strategy based on clinical risk for recurrent events is the preferred management strategy.
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Affiliation(s)
- Jonathon P Fanning
- The Prince Charles HospitalSchool of Medicine, The University of QueenslandRode RoadChermsideBrisbaneAustralia4032
| | - Jonathan Nyong
- FARR Institute UCLClinical Epidemiology222 Euston RoadLondonGreater LondonUKNW1 2DA
| | - Ian A Scott
- Princess Alexandra HospitalInternal Medicine Department and Clinical Services Evaluation UnitBrisbaneAustralia
| | - Constantine N Aroney
- The Prince Charles HospitalDepartment of CardiologyRode RdChermsideBrisbaneAustralia
| | - Darren L Walters
- The Prince Charles HospitalExecutive Chair Prince Charles Heart and Lung InstituteRoad RdBrisbaneQueenslandAustralia4032
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Wu Z, Jin C, Vaidya A, Jin W, Huang Z, Wu S, Gao X. Longitudinal Patterns of Blood Pressure, Incident Cardiovascular Events, and All-Cause Mortality in Normotensive Diabetic People. Hypertension 2016; 68:71-7. [PMID: 27217407 DOI: 10.1161/hypertensionaha.116.07381] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/25/2016] [Indexed: 01/19/2023]
Abstract
Lower blood pressure (BP) within the normotensive range has been suggested to be deleterious in diabetic people using antihypertensive drugs. We hypothesized that BP <120/80 mm Hg and BP trajectories may predict further risk of all-cause mortality or cardiovascular events in normotensive diabetic individuals. We included 3159 diabetic adults, free of hypertension, atherosclerotic cardiovascular diseases, or cancer in 2006 (baseline), from a community-based cohort including 101 510 participants. A total of 831 participants with BP <120/80 mm Hg and 2328 participants with BP of 120 to 139/80 to 89 mm Hg were included. BP and other clinical covariates were repeatedly measured every 2 years. During 7 years of follow-up, we documented 247 deaths and 177 cardiovascular events. Diabetic people with BP <120/80 mm Hg had a 46% increased risk of all-cause mortality (95% confidence interval, 10%-93%) compared with those with BP of 120 to 139/80 to 89 mm Hg at baseline. We then estimated the association between BP trajectories from 2006 to 2008 and adverse events among 2311 diabetic people who had both BP measures at 2006 and 2008. Relative to stable BP of 120 to 139/80 to 89 mm Hg, having persistently BP <120/80 mm Hg (hazard ratio: 2.35; 95% confidence interval, 1.10-5.01) or a spontaneous decrease in BP from 120 to 139/80 to 89 to <120/80 mm Hg (hazard ratio: 3.04; 95% confidence interval, 1.56-5.92) was significantly associated with an increased risk of all-cause mortality during 2008 to 2014. A rise in BP from 120 to 139/80 to 89 to ≥140/90 mm Hg conferred a high risk of cardiovascular events (hazard ratio: 1.98; 95% confidence interval, 1.24-3.17). In normotensive diabetic people having a low BP or a decline in BP was both associated with an increased risk of all-cause mortality, whereas development of incident hypertension increased the risk of cardiovascular events.
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Affiliation(s)
- Zhijun Wu
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.)
| | - Cheng Jin
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.)
| | - Anand Vaidya
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.)
| | - Wei Jin
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.)
| | - Zhe Huang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.)
| | - Shouling Wu
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.).
| | - Xiang Gao
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China (Z.W., W.J.); Department of Cardiology, Kailuan Hospital, Tangshan, People's Republic of China (C.J., Z.H., S.W.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Department of Nutritional Sciences, Pennsylvania State University, State College, PA (X.G.).
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Impact of an Early Invasive Strategy versus Conservative Strategy for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome in Patients with Chronic Kidney Disease: A Systematic Review. PLoS One 2016; 11:e0153478. [PMID: 27195786 PMCID: PMC4873245 DOI: 10.1371/journal.pone.0153478] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/19/2016] [Indexed: 11/26/2022] Open
Abstract
Background Clinical practice guidelines support an early invasive approach after NSTE-ACS in patients with chronic kidney disease (CKD). There is no direct randomised controlled trial evidence in the CKD population, and whether the benefit of an early invasive approach is maintained across the spectrum of severity of CKD remains controversial. Methods We conducted a systematic review to evaluate the association between an early invasive approach and all-cause mortality in patients with CKD. We searched MEDLINE and EMBASE (1990-May 2015) and article reference lists. Data describing study design, participants, invasive management strategies, renal function, all-cause mortality and risk of bias were extracted. Results 3,861 potentially relevant studies were identified. Ten studies, representing data on 147,908 individuals with NSTE-ACS met the inclusion criteria. Qualitative heterogeneity in the definitions of early invasive approach, comparison groups and renal dysfunction existed. Meta-analysis of the RCT derived and observational data were generally supportive of an early invasive approach in CKD (RR0.76 (95% CI 0.49–1.17) and RR0.50 (95%CI 0.42–0.59) respectively). Meta-analysis of the observational studies demonstrated a large degree of heterogeneity (I2 79%) driven in part by study size and heterogeneity across various kidney function levels. Conclusions The observational data support that an early invasive approach after NSTE-ACS confers a survival benefit in those with early-moderate CKD. Local opportunities for quality improvement should be sought. Those with severe CKD and the dialysis population are high risk and under-studied. Novel and inclusive approaches for CKD and dialysis patients in cardiovascular clinical trials are needed.
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128
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Vogel P, Stein A, Marcadenti A. Visceral adiposity index and prognosis among patients with ischemic heart failure. SAO PAULO MED J 2016; 134:211-8. [PMID: 27191246 PMCID: PMC10496607 DOI: 10.1590/1516-3180.2015.01452111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 07/20/2015] [Accepted: 11/21/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES The obesity paradox has already been established in relation to heart failure, but it is not known which obesity indicator best reflects this phenomenon. The aim of this study was to evaluate the association between obesity indexes and mortality among patients with heart failure. DESIGN AND SETTING Cohort study conducted in the Department of Cardiology of Hospital Nossa Senhora da Conceição (Brazil). METHODS Clinical, demographic, socioeconomic, biochemical and anthropometric data on 116 patients aged 30 to 85 years with a diagnosis of heart failure were evaluated. Arm fat area, body mass index, body surface area, body adiposity index, lipid accumulation product (LAP) and visceral adiposity index (VAI) were calculated. Cox regression was used to perform survival analyses. RESULTS At baseline, the individuals with ischemic heart failure who remained alive showed higher VAI (3.60 ± 3.71 versus 1.48 ± 1.58; P = 0.04) and a trend towards higher LAP, in comparison with the individuals who died. After an average follow-up of 14.3 months, ischemic heart failure patients who had VAI > 1.21 showed 78% lower risk of death (HR 0.12; 95% CI: 0.02-0.67; P = 0.02) and the Kaplan-Meier survival curves showed better prognosis for these individuals (P = 0.005; log-rank test). CONCLUSION Our results suggest that VAI is a good predictor of better prognosis among ischemic heart failure patients.
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Affiliation(s)
- Patrícia Vogel
- BSc. Specialist in Clinical Nutrition, Institute of Education and Research, Hospital Moinhos de Vento (IEP/HMV), Porto Alegre, RS, Brazil.
| | - Airton Stein
- PhD. Professor, Department of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil, Professor, Institute of Health Technology Assessment, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
| | - Aline Marcadenti
- PhD. Professor, Postgraduate Cardiology Program, Institute of Cardiology, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil, Professor, Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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129
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Jia K, Shi P, Han X, Chen T, Tang H, Wang J. Diagnostic value of miR-30d-5p and miR-125b-5p in acute myocardial infarction. Mol Med Rep 2016; 14:184-94. [PMID: 27176713 PMCID: PMC4918561 DOI: 10.3892/mmr.2016.5246] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/02/2016] [Indexed: 11/18/2022] Open
Abstract
Rapid and accurate differential diagnosis of acute myocardial infarction (AMI) is crucial for timely interventions and the improvement of prognosis. However, this is difficult to achieve using current methods. Therefore, the present study aimed to evaluate the suitability of circulating microRNAs (miRNAs) as AMI biomarkers in patients with acute coronary syndrome (ACS). miRNA profiling in plasma samples from patients with AMI (n=3) and healthy controls (n=3) was performed using microarrays. Results were then validated in five patients and five healthy controls. miRNA-125b-5p and miR-30d-5p expression levels were quantified in plasma samples from 230 patients with ACS and 79 healthy controls using reverse transcription-quantitative polymerase chain reaction. Routine diagnostic parameters were assessed, including creatinine kinase MB, cardiac troponin I (cTnI) and myoglobin. A total of 33 miRNAs were differentially expressed in patients with AMI and healthy controls. Following validation based on the previously established roles for these miRNAs, six miRNAs were validated. miR-125b-5p and miR-30d-5p were selected for further investigation. Expression levels of miR-125b-5p and miR-30d-5p in plasma were higher in patients with ACS compared with the healthy controls (P<0.001). Receiver operating characteristic curve analysis revealed that the area under the curve of miR-30d-5p was higher than that of cTnI (0.915 and 0.899). miR-125b-5p (sensitivity, 0.808; specificity, 0.845) and miR-30d-5p (sensitivity, 0.855; specificity, 0.810) were suitable diagnostic predictors of AMI. Kaplan-Meier survival analysis indicated that miR-125b-5p levels were associated with 6 month cardiovascular events in patients with AMI, but not miR-30d-5p. miR-125b-5p and miR-30d-5p presented a diagnostic value for early diagnosis of AMI, and miR-30d-5p may have a higher diagnostic value than cTnI.
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Affiliation(s)
- Kegang Jia
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Ping Shi
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Xuejing Han
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Tienan Chen
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Hongxia Tang
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
| | - Jing Wang
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Tianjin 300457, P.R. China
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Prediction of the filter no-reflow phenomenon in patients with angina pectoris by using multimodality: Magnetic resonance imaging, optical coherence tomography, and serum biomarkers. J Cardiol 2016; 67:430-6. [DOI: 10.1016/j.jjcc.2015.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/18/2022]
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Venkatason P, Zubairi YZ, Hafidz I, Wan WA, Zuhdi AS. Trends in evidence-based treatment and mortality for ST elevation myocardial infarction in Malaysia from 2006 to 2013: time for real change. Ann Saudi Med 2016; 36:184-9. [PMID: 27236389 PMCID: PMC6074549 DOI: 10.5144/0256-4947.2016.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding. OBJECTIVES To investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia. DESIGN Retrospective analysis. SETTINGS STEMI patients from 18 participating hospital across Malaysia included in the National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006 to 2013. PATIENTS AND METHODS Patients were categorized into four subgroups based on the year of admission (2006 to 2007, 2008 to 2009, 2010 to 2011 and 2012 to 2013). Baseline characteristics and clinical presentation, in-hospital pharmacotherapy, invasive revascularization and in-hospital/30-day mortality were analysed and compared between the subgroups. MAIN OUTCOME MEASURE(S) Rate of in-hospital catheterization/percutaneous coronary intervention. RESULTS The registry contained data on 19483 patients. Intravenous thrombolysis was the main reperfusion therapy. Although the overall rate of in-hospital catheterisation/PCI more than doubled over the study period, while the use of primary PCI only slowly increased from 7.6% in 2006/2007 to 13.6% in 2012/2013. The use of evidence-based oral therapies increased steadily over the years except for ACe-inhibitors and angiotensin-receptor blockers. The adjusted risk ratios (RR) for in-hospital mortality for the four sub-groups have not shown any significant improvement. The 30-day adjusted risk ratios however showed a significant albeit gradual risk reduction (RR 0.773 95% CI 0.679-0.881, P < .001). CONCLUSION Adherence to evidence-based treatment in STEMI in Malaysia is still poor especially in terms of the rate of primary PCI. Although there is a general trend toward reduced 30-day mortality, the reduction was only slight over the study period. Drastic effort is needed to improve adherence and clinical outcomes. LIMITATION Retrospective registry data with inter-hospital variation.
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Affiliation(s)
| | | | | | | | - Ahmad S Zuhdi
- Dr. Ahmad S. Zuhdi, Division of Cardiology,, University Malaya Medical Centre,, Faculty of Medicine, Kuala Lumpur, Malaysia, T: 603-79494422, F: 603-79562253, , ORCID ID: orcid.org/0000-0002-5349-0301
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Predictive performance of adding platelet reactivity on top of CRUSADE score for 1-year bleeding risk in patients with acute coronary syndrome. J Thromb Thrombolysis 2016; 42:360-8. [DOI: 10.1007/s11239-016-1366-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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133
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Linden GJ, Herzberg MC. Periodontitis and systemic diseases: a record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2016; 84:S20-3. [PMID: 23631580 DOI: 10.1902/jop.2013.1340020] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been an explosion in research into possible associations between periodontitis and various systemic diseases and conditions. AIM To review the evidence for associations between periodontitis and various systemic diseases and conditions, including chronic obstructive pulmonary disease (COPD), pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer, and to document headline discussions of the state of each field. Periodontal associations with diabetes, cardiovascular disease and adverse pregnancy outcomes were not discussed by working group 4. RESULTS Working group 4 recognized that the studies performed to date were largely cross-sectional or case-control with few prospective cohort studies and no randomized clinical trials. The best current evidence suggests that periodontitis is characterized by both infection and pro-inflammatory events, which variously manifest within the systemic diseases and disorders discussed. Diseases with at least minimal evidence of an association with periodontitis include COPD, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. The working group agreed that there is insufficient evidence to date to infer causal relationships with the exception that organisms originating in the oral microbiome can cause lung infections. CONCLUSIONS The group was unanimous in their opinion that the reported associations do not imply causality, and establishment of causality will require new studies that fulfil the Bradford Hill or equivalent criteria. Precise and community-agreed case definitions of periodontal disease states must be implemented systematically to enable consistent and clearer interpretations of studies of the relationship to systemic diseases. The members of the working group were unanimous in their opinion that to develop data that best inform clinicians, investigators and the public, studies should focus on robust disease outcomes and avoid surrogate endpoints. It was concluded that because of the relative immaturity of the body of evidence for each of the purported relationships, the field is wide open and the gaps in knowledge are large.
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Affiliation(s)
- Gerry J Linden
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
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134
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Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2016; 84:S24-9. [PMID: 23631582 DOI: 10.1902/jop.2013.1340019] [Citation(s) in RCA: 232] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. AIMS This report examined biological plausibility, epidemiology and early results from intervention trials. PLAUSIBILITY: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. EPIDEMIOLOGY In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. INTERVENTION There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles--supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. CONCLUSIONS It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.
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135
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Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol 2016; 40 Suppl 14:S24-9. [PMID: 23627332 DOI: 10.1111/jcpe.12089] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. AIMS This report examined biological plausibility, epidemiology and early results from intervention trials. PLAUSIBILITY: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. EPIDEMIOLOGY In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. INTERVENTION There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles - supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. CONCLUSIONS It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.
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136
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Nishtala PS, Salahudeen MS. Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005–2013. Gerontology 2016; 61:195-202. [PMID: 25428287 DOI: 10.1159/000368191] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Polypharmacy and hyperpolypharmacy are proxy indicators for inappropriate medicine use. Inappropriate medicine use in older people leads to adverse clinical outcomes. OBJECTIVE The objectives of this study were to investigate the prevalence and trends of polypharmacy and hyperpolypharmacy in older people in New Zealand from 2005 to 2013, analyzing the pharmaceutical collections maintained by the Ministry of Health. METHODS A repeated cross-sectional analysis of population-level dispensing data was conducted from January 1, 2005 to December 31, 2013. Polypharmacy and hyperpolypharmacy in individuals were defined as the use of 5-9 medicines and ≥10 medicines, respectively, dispensed concurrently for a period of ≥90 days. Differences in polypharmacy and hyperpolypharmacy between 2005 and 2013 were examined. A multinomial regression model was used to predict sociodemographic characteristics associated with polypharmacy and hyperpolypharmacy. RESULTS Polypharmacy and hyperpolypharmacy were found to be higher in 2013 compared to 2005 (polypharmacy: 29.5 vs. 23.4%, p<0.001; hyperpolypharmacy: 2.1 vs. 1.3%, p<0.001). The risk of polypharmacy and hyperpolypharmacy was higher in females, in those aged 80-84 years, in the Māori population (for polypharmacy) and the Middle Eastern, Latin American, or African population (for hyperpolypharmacy), in people living in the Southern-district health board, and in individuals with increasing deprivation. CONCLUSION The population of New Zealand is aging and the number of older people with multiple chronic conditions is increasing. The proportion of older people exposed to polypharmacy and hyperpolypharmacy has increased in 2013 compared to 2005. Our study provides important information to alert health policy makers, researchers, and clinicians about the dire need to reduce the medication burden in older New Zealanders.
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137
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Li S, Liu H, Liu J, Wang H. Improved predictive value of GRACE risk score combined with platelet reactivity for 1-year cardiovascular risk in patients with acute coronary syndrome who underwent coronary stent implantation. Platelets 2016; 27:650-657. [DOI: 10.3109/09537104.2016.1153618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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138
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Niu L, Zhang Y, Qian M, Xiao Y, Meng L, Zheng R, Zheng H. Standard deviation of carotid young's modulus and presence or absence of plaque improves prediction of coronary heart disease risk. Clin Physiol Funct Imaging 2016; 37:682-687. [DOI: 10.1111/cpf.12359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/05/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Lili Niu
- Paul C. Lauterbur Research Center for Biomedical Imaging; Institute of Biomedical and Health Engineering; Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences; Shenzhen China
| | - Yanling Zhang
- Department of ultrasound; Third affiliated hospital; Sun Yat-sen University; Guangzhou China
| | - Ming Qian
- Paul C. Lauterbur Research Center for Biomedical Imaging; Institute of Biomedical and Health Engineering; Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences; Shenzhen China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging; Institute of Biomedical and Health Engineering; Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences; Shenzhen China
| | - Long Meng
- Paul C. Lauterbur Research Center for Biomedical Imaging; Institute of Biomedical and Health Engineering; Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences; Shenzhen China
| | - Rongqin Zheng
- Department of ultrasound; Third affiliated hospital; Sun Yat-sen University; Guangzhou China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging; Institute of Biomedical and Health Engineering; Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences; Shenzhen China
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139
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Hokimoto S, Tabata N, Sueta D, Akasaka T, Tsujita K, Sakamoto K, Kaikita K, Kojima S, Ogawa H. The real-world prevalence of cardiovascular events related to coronary spasm after percutaneous coronary intervention. J Cardiol 2016; 68:20-8. [PMID: 26993264 DOI: 10.1016/j.jjcc.2016.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/23/2016] [Accepted: 02/10/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is unknown to what extent coronary spasm affects cardiovascular events after percutaneous coronary intervention (PCI) in clinical practice. The aim was to examine the prevalence of cardiovascular events related to coronary spasm following PCI according to stent type. METHODS We enrolled 933 consecutive patients treated with coronary stent implantation, including bare metal stents (BMS; n=238), first-generation drug-eluting stents (1st DES; n=185), and second-generation DES (2nd DES; n=510). We compared stent-oriented endpoints (SOEs; stent thrombosis, target vessel myocardial infarction or unstable angina, target lesion revascularization, and cardiac death) and the differences in SOE related to coronary spasm across stent types. Among the SOEs, spasm-related cardiac event was defined based on JCS guideline. RESULTS The prevalence of SOE for each stent type was 16.8% (BMS), 16.8% (1st DES), and 7.8% (2nd DES) (p<0.001) and the rates of cardiovascular events related to coronary spasm were 2.9%, 3.2%, and 0.4%, respectively (p=0.005). Multivariate analysis identified the non-use of statin (HR, 0.275, 95% CI, 0.087-0.871, p=0.028) and non-use of 2nd DES (hazard ratio, 0.196, 95% confidence interval, 0.043-0.887, p=0.034) as independent predictors of cardiac events related to coronary spasm. CONCLUSION The prevalence of cardiovascular events related to coronary spasm was the lowest in patients with 2nd DES. The 2nd DES may be more efficacious and safer from the point of view of the reduction of cardiac events due to coronary spasm during statin therapy.
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Affiliation(s)
- Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Soeiro ADM, Fernandes FL, Soeiro MCFDA, Serrano CV, Oliveira MTD. Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil. EINSTEIN-SAO PAULO 2016; 13:370-5. [PMID: 26466059 PMCID: PMC4943781 DOI: 10.1590/s1679-45082015ao3381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/20/2015] [Indexed: 12/27/2022] Open
Abstract
Objective In Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population. Methods This is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried out between May 2010 and May 2013. Data were obtained on demographics, laboratory test and angiography results, and the coronary treatment adopted. Statistical analysis was presented as percentages and absolute values. Results Approximately 57% were men and the median age was 50 years (30 to 55). The main risk factors were arterial hypertension (68%), smoking (67%), and dyslipidemia (43%). Typical pain was present in 90% of patients. In young individuals, 25.7% showed ST segment elevation. Approximately 56.5% of patients presented with a single-vessel angiographic pattern. About 7.1% were submitted to coronary bypass surgery, and 42.1% to percutaneous coronary angioplasty. Intrahospital mortality was 1.5%, and the combined event rate (cerebrovascular accident/stroke, cardiogenic shock, reinfarction, and arrhythmias) was 13.8%. After a mean follow-up of 10 months, mortality was 9.8%, while 25.4% of the patients had new ischemic events, and 37.3% required readmission to hospital. Conclusion In the short-term, young patients presented with mortality rates below what was expected when compared to the rates noted in other studies. However, there was a significant increase in the number of events in the 10-month follow-up.
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141
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Silva PGMDBE, Ribeiro HB, Baruzzi ACDA, da Silva EER. When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? Arq Bras Cardiol 2016; 106:236-46. [PMID: 27027367 PMCID: PMC4811279 DOI: 10.5935/abc.20160042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 12/26/2022] Open
Abstract
Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.
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Affiliation(s)
| | - Henrique Barbosa Ribeiro
- Hospital TotalCor, São Paulo, SP - Brazil
- Instituto do Coração - Hospital das
Clínicas - Faculdade de Medicina da Universidade de São Paulo,
São Paulo, SP- Brazil
| | | | - Expedito Eustáquio Ribeiro da Silva
- Hospital TotalCor, São Paulo, SP - Brazil
- Instituto do Coração - Hospital das
Clínicas - Faculdade de Medicina da Universidade de São Paulo,
São Paulo, SP- Brazil
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142
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Gu Q, Dillon CF, Eberhardt MS, Wright JD, Burt VL. Preventive Aspirin and Other Antiplatelet Medication Use Among U.S. Adults Aged ≥ 40 Years: Data from the National Health and Nutrition Examination Survey, 2011-2012. Public Health Rep 2016; 130:643-54. [PMID: 26556936 DOI: 10.1177/003335491513000614] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We estimated the prevalence of preventive aspirin and/or other antiplatelet medication use and the dosage of aspirin use in the U.S. adult population. METHODS We conducted cross-sectional analyses of a representative sample (n=3,599) of U.S. adults aged ≥ 40 years from the National Health and Nutrition Examination Survey, 2011-2012. RESULTS In 2011-2012, one-third of U.S. adults aged ≥ 40 years reported taking preventive aspirin and/or other antiplatelet medications, 97% of whom indicated preventive aspirin use. Preventive aspirin use increased with age (from 11% of those aged 40-49 years to 54% of those ≥ 80 years of age, p<0.001). Non-Hispanic white (35%) and black (30%) adults were more likely to take preventive aspirin than non-Hispanic Asian (20%, p<0.001) and Hispanic (22%, p=0.013) adults. Adults with, compared with those without health insurance, and adults with ≥ 2 doctor visits in the past year, diagnosed diabetes, hypertension, or high cholesterol were twice as likely to take preventive aspirin. Among those with cardiovascular disease, 76% reported taking preventive aspirin and/or other antiplatelet medications, of whom 91% were taking preventive aspirin. Among adults without cardiovascular disease, 28% reported taking preventive aspirin. Adherence rates to medically recommended aspirin use were 82% overall, 91% for secondary prevention, and 79% for primary prevention. Among current preventive aspirin users, 70% were taking 81 milligrams (mg) of aspirin daily and 13% were taking 325 mg of aspirin daily. CONCLUSION The vast majority of antiplatelet therapy is preventive aspirin use. A health-care provider's recommendation to take preventive aspirin is an important determinant of current preventive aspirin use.
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Affiliation(s)
- Qiuping Gu
- Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health and Nutrition Examination Surveys, Hyattsville, MD
| | - Charles F Dillon
- Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health and Nutrition Examination Surveys, Hyattsville, MD
| | - Mark S Eberhardt
- Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health and Nutrition Examination Surveys, Hyattsville, MD
| | - Jacqueline D Wright
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Vicki L Burt
- Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health and Nutrition Examination Surveys, Hyattsville, MD
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143
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Annemans L, Danchin N, Van de Werf F, Pocock S, Licour M, Medina J, Bueno H. Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry. Open Heart 2016; 3:e000347. [PMID: 27127635 PMCID: PMC4847130 DOI: 10.1136/openhrt-2015-000347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/22/2015] [Accepted: 01/24/2016] [Indexed: 01/14/2023] Open
Abstract
Objective The aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) (NCT01171404). Methods EPICOR was a prospective, multinational, observational study that enrolled 10 568 ACS survivors from 555 hospitals in 20 countries in Europe and Latin America, between September 2010 and March 2011. HCRU was evaluated in patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), with or without a history of cardiovascular disease (CVD). Multivariable analysis was performed to determine factors that affected resource use. Results Before hospitalisation, more patients with STEMI than with NSTE-ACS had their first ECG (44.1% vs 36.4%, p<0.0001) and received antithrombotic medication (26.6% vs 15.2%, p<0.0001). Patients with NSTE-ACS with prior CVD were less likely than those without to be catheterised (73.1% vs 82.8%, p<0.0001). More patients with STEMI than with NSTE-ACS had percutaneous coronary intervention (77.1% vs 54.9%, p<0.0001), but fewer underwent coronary artery bypass grafting (1.2% vs 3.7%, p<0.0001). Multivariable analysis showed that resource use, including length of hospital stay and coronary revascularisation, was significantly influenced by multiple factors, including ACS type, site characteristics and region (all p≤0.05). Conclusions In this large-scale, real-life study, findings were generally in line with clinical logic, although site characteristics and region still significantly affected resource use. Moreover, and unexpectedly, resource use tended to be slightly higher in patients without a history of CVD. Trial registration number NCT01171404 (ClinicalTrials.gov).
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Affiliation(s)
- Lieven Annemans
- Department of Public Health , I-CHER Interuniversity Centre for Health Economics Research , Ghent University , Ghent , Belgium
| | - Nicolas Danchin
- Département de Cardiologie , Hôpital Européen Georges Pompidou & Université René Descartes , Paris , France
| | - Frans Van de Werf
- Department of Cardiovascular Medicine , University Hospitals Leuven , Leuven , Belgium
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine , London , UK
| | - Muriel Licour
- Medical Department , AstraZeneca France , Rueil Malmaison Cedex , France
| | - Jesús Medina
- Observational Research Centre, Payer & Real World Evidence, AstraZeneca , Madrid , Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC); Cardiology Department, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre; Universidad Complutense de Madrid, Madrid, Spain
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144
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Fabreau GE, Leung AA, Southern DA, James MT, Knudtson ML, Ghali WA, Ayanian JZ. Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants. J Am Heart Assoc 2016; 5:JAHA.115.002447. [PMID: 26908400 PMCID: PMC4802481 DOI: 10.1161/jaha.115.002447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Metropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system. Methods and Results We studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30‐day and 1‐year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95% CI 0.11–0.46, P<0.001). Among nonmetropolitan patients, when examined by socioeconomic status, each incremental decrease in income quintile was associated with 10% lower adjusted odds of receiving cardiac catheterization within 7 days (P<0.001) and 24% higher adjusted odds of 30‐day mortality (P=0.008) but no significant difference for 1‐year mortality (P=0.12). There were no differences in adjusted mortality among metropolitan patients. Conclusion Within a universal health care system, the association among area income and receipt of cardiac catheterization and 30‐day mortality differed depending on the location of initial medical care for acute coronary syndromes. Care protocols are required to improve access to care and outcomes in patients from low‐income nonmetropolitan communities.
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Affiliation(s)
- Gabriel E Fabreau
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA O'Brien Institute for Public Health, University of Calgary, Alberta, Canada Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Alexander A Leung
- O'Brien Institute for Public Health, University of Calgary, Alberta, Canada
| | | | - Matthew T James
- O'Brien Institute for Public Health, University of Calgary, Alberta, Canada
| | | | - William A Ghali
- O'Brien Institute for Public Health, University of Calgary, Alberta, Canada
| | - John Z Ayanian
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA Department of Health Care Policy, Harvard Medical School, Boston, MA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Abstract
Non-ST elevation acute coronary syndromes (NSTE-ACS) encompass the clinical entities of unstable angina and non-ST elevation myocardial infarction. Several advances have occurred over the past decade, including the emergence of new antiplatelet and antithrombotic therapies and novel treatment strategies, leading to marked improvements in mortality. However, there has also been an increased incidence in NSTE-ACS as a result of the use of high-sensitivity troponins and the increase in cardiovascular risk factors. This article provides a focused update on contemporary management strategies pertaining to antiplatelet, antithrombotic, and anti-ischemic therapies and to revascularization strategies in patients with ACS.
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146
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Gul I, Zungur M, Aykan AC, Gokdeniz T, Kalaycioğlu E, Turan T, Hatem E, Boyaci F. The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients. Arq Bras Cardiol 2016; 106:194-200. [PMID: 26885974 PMCID: PMC4811274 DOI: 10.5935/abc.20160024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/10/2015] [Indexed: 12/22/2022] Open
Abstract
Background GRACE risk score (GS) is a scoring system which has a prognostic significance
in patients with non-ST segment elevation myocardial infarction
(non-STEMI). Objective The present study aimed to determine whether end-systolic or end-diastolic
epicardial fat thickness (EFT) is more closely associated with high-risk
non-STEMI patients according to the GS. Methods We evaluated 207 patients who had non-STEMI beginning from October 2012 to
February 2013, and 162 of them were included in the study (115 males, mean
age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were
measured with echocardiographic methods. Patients with high in-hospital GS
were categorized as the H-GS group (in hospital GS > 140), while other
patients were categorized as the low-to-moderate risk group (LM-GS). Results Systolic and diastolic blood pressures of H-GS patients were lower than those
of LM-GS patients, and the average heart rate was higher in this group.
End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS
group. The echocardiographic assessment of right and left ventricles showed
significantly decreased ejection fraction in both ventricles in the H-GS
group. The highest correlation was found between GS and end-diastolic EFT (r
= 0.438). Conclusion End-systolic and end-diastolic EFTs were found to be increased in the H-GS
group. However, end-diastolic EFT and GS had better correlation than
end-systolic EFT and GS.
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Affiliation(s)
- Ilker Gul
- Department of Cardiology, Faculty of Medicine, Şifa University, Izmir, Turkey
| | - Mustafa Zungur
- Department of Cardiology, Faculty of Medicine, Şifa University, Izmir, Turkey
| | - Ahmet Cagri Aykan
- Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turquia
| | - Teyyar Gokdeniz
- Department of Cardiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ezgi Kalaycioğlu
- Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turquia
| | - Turhan Turan
- Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turquia
| | - Engin Hatem
- Erzurum Region Education and Research Hospital, Erzurum, Turquia
| | - Faruk Boyaci
- Samsun Education and Research Hospital, Samsun, Turquia
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147
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Atreya AR, Sivalingam SK, Arora S, Kashef MA, Fitzgerald J, Visintainer P, Lotfi A, Rothberg MB. Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease. Clin Cardiol 2016; 39:207-14. [PMID: 26848560 DOI: 10.1002/clc.22510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Compared with medical therapy, percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction in patients with stable angina. Therefore, PCI should be guided by refractory anginal symptoms and not just lesion characteristics. HYPOTHESIS We hypothesized that angiographic lesion characteristics and stress test results would have a greater role in the decision to proceed with PCI than would symptom severity. METHODS We performed a retrospective cohort study of patients undergoing elective cardiac catheterization and possible PCI at an academic medical center. Anginal symptoms, optimal medical therapy, antianginal therapy, stress test results, and angiographic lesions (including American College of Cardiology/American Heart Association [ACC/AHA] lesion type) were analyzed. Logistic regression was used to determine predictors of medical management among patients not referred for coronary artery bypass surgery. RESULTS Of the 207 patients with obstructive lesions amenable to PCI, 163 underwent PCI and 44 were referred to medical therapy. In the multivariable logistic model, the following variables were associated with medical management: advancing age (odds ratio [OR] per 1 year: 0.94, 95% confidence interval [CI]: 0.91-0.98), chronic kidney disease (OR: 0.23, 95% CI: 0.06-0.95), distal location (OR: 0.21, 95% CI: 0.09-0.48), and ACC/AHA type C lesion (OR: 0.08, 95% CI: 0.03-0.22). There was no association with sex, race, symptoms, optimal medical therapy, maximal antianginal therapy, referral status, or type of interventional cardiologist (academic vs private practice). CONCLUSIONS For patients undergoing cardiac catheterization for stable angina, the decision to proceed to PCI vs medical management appears to depend largely on patient and angiographic characteristics, but not on symptoms or ischemia. Distal and high-risk lesions (ACC/AHA type C) are more often referred for medical therapy.
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Affiliation(s)
- Auras R Atreya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Senthil K Sivalingam
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Sonali Arora
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Mohammad Amin Kashef
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Janice Fitzgerald
- Faculty and Resident Development, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Paul Visintainer
- Division of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, Massachusetts
| | - Amir Lotfi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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148
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Danese E, Fava C, Beltrame F, Tavella D, Calabria S, Benati M, Gelati M, Gottardo R, Tagliaro F, Guidi GC, Cattaneo M, Minuz P. Relationship between pharmacokinetics and pharmacodynamics of clopidogrel in patients undergoing percutaneous coronary intervention: comparison between vasodilator-stimulated phosphoprotein phosphorylation assay and multiple electrode aggregometry. J Thromb Haemost 2016; 14:282-93. [PMID: 26576037 DOI: 10.1111/jth.13197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/08/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED ESSENTIALS: The reliability of platelet tests as markers of the variable bioavailability of clopidogrel is not yet defined. Kinetics of clopidogrel active metabolite (CAM) and platelet response were studied in ischemic heart disease. CAM plasma maximum concentration (Cmax ) predicted vasodilator-stimulated phosphoprotein (VASP-P). Timely performed VASP-P, not an aggregation-based test, may be a surrogate for clopidogrel bioavailability. BACKGROUND The high inter-individual variability in the inhibition of platelet function by clopidogrel is mostly explained by high variability in its transformation to an active metabolite (CAM). Objective We investigated the relations between pharmacokinetics and pharmacodynamics of CAM by comparing two methods of platelet function. METHODS We enrolled 14 patients undergoing percutaneous coronary interventions for non-ST-segment elevation acute coronary syndrome or inducible myocardial ischemia. Plasma concentrations of clopidogrel and CAM, phosphorylation of vasodilator-stimulated phosphoprotein (VASP-P), expressed as a platelet reactivity index (PRI) and whole-blood platelet aggregation (multiple electrode aggregometer, MEA) were measured before and after a 600-mg clopidogrel loading dose (nine time-points) and before and after 75-mg maintenance doses on days 2, 7 and 30. RESULTS Plasma concentrations of clopidogrel and CAM were highly variable. CAM reached maximal concentration (Cmax ) (median, 110.8 nm; range, 41.9-484.8) 0.5-2 h after the loading dose. A sigmoid dose-response curve defined the relations between CAMCmax and PRI after 3 to 24 h (IC50 , 459.6 nm; 95% confidence interval, 453.4-465.7; R(2) = 0.82). PRI was unchanged from baseline in patients with the lowest CAMCmax (< 83 nm, n = 7), indicating low sensitivity of VASP-P. PRI values were also predicted by CAMCmax at days 2, 7 and 30. Platelet aggregation measured by MEA did not show significant relations with either PRI or with CAM pharmacokinetics at any time-point. CONCLUSIONS After 600 mg clopidogrel, VASP-P, but not whole-blood platelet aggregation measured by MEA, is almost entirely predicted by CAMCmax . VASP-P could be useful in studies aimed at investigating relations between CAM bioavailability and clinical events.
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Affiliation(s)
- E Danese
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - C Fava
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - F Beltrame
- Division of Cardiology, AOUI Verona, Verona, Italy
| | - D Tavella
- Division of Cardiology, AOUI Verona, Verona, Italy
| | - S Calabria
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - M Benati
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - M Gelati
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - R Gottardo
- Unit of Forensic Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - F Tagliaro
- Unit of Forensic Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - G C Guidi
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - M Cattaneo
- Unità di Medicina 3, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - P Minuz
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
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149
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Ujueta F, Weiss EN, Sedlis SP, Shah B. Glycemic Control in Coronary Revascularization. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:12. [PMID: 26820983 DOI: 10.1007/s11936-015-0434-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OPINION STATEMENT Hyperglycemia in the setting of coronary revascularization is associated with increased adverse cardiovascular events in patients with or without diabetes mellitus. Data suggest that acute peri-procedural hyperglycemia causes an increase in inflammation, platelet activity, and endothelial dysfunction and is associated with plaque instability and infarct size. While peri-procedural blood glucose level is an independent predictor of adverse outcomes in patients undergoing coronary revascularization, treatment strategies remain uncertain. Randomized clinical trials of glucose-insulin-potassium infusions have consistently shown no benefit, while those comparing insulin therapy versus standard of care have demonstrated mixed results, likely due to the failure to reach euglycemia with these strategies. Although no glucose-lowering agent has been shown to be superior in peri-procedural glycemic control, the continuation of clinically prescribed long-acting glucose-lowering medications in patients with diabetes mellitus prior to coronary angiography and possible percutaneous coronary intervention may be the simplest and most effective approach to maintain euglycemia and decrease the associated increase in inflammation and platelet activity. However, alternative strategies such as therapies targeted at the underlying mechanism of harm (e.g., more potent anti-platelet therapy, anti-inflammatory therapy) should also be considered and warrant further investigation.
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Affiliation(s)
- Francisco Ujueta
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.,New York University School of Medicine, New York, NY, 10016, USA
| | - Ephraim N Weiss
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.,New York University School of Medicine, New York, NY, 10016, USA
| | - Steven P Sedlis
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.,New York University School of Medicine, New York, NY, 10016, USA
| | - Binita Shah
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA. .,New York University School of Medicine, New York, NY, 10016, USA.
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150
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Outcomes of percutaneous coronary intervention in patients ≥ 75 years: one-center study in a Chinese patient group. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 12:626-33. [PMID: 26788039 PMCID: PMC4712368 DOI: 10.11909/j.issn.1671-5411.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To investigate the clinical and perioperative characteristics of patients ≥ 75 who undergoing percutaneous coronary intervention (PCI) and to evaluate the risk factors related to short-term post-PCI mortality in this specific patients group. Methods 1,035 consecutive subjects who underwent PCI from December 2011 to November 2013 were divided into four categories: (1) patients with stable angina (SA) ≥ 75 years (n = 58); (2) patients with SA < 75 years (n = 218); (3) patients with acute coronary syndrome (ACS) ≥ 75 years (n = 155); (4) patients with ACS < 75 years (n = 604). A multivariable logistic regression analysis was conducted to detect risk factors of six-month mortality in patients ≥ 75 years who had undergone PCI. Clinical comorbidities, in-hospital biochemical indicators, perioperative data, in-hospital and six-month outcomes were analyzed and compared among the four groups. Results Compared with the younger group, patients ≥ 75 years were more likely to have hypertension, history of stroke, chronic obstructive pulmonary disease, peripheral vascular disease, cardiogenic shock and malignant arrhythmia, and they were admitted to hospital with relative lower weight, hemoglobin, albumin, triglyceride, higher creatinine, uric acid, urea nitrogen and pro-BNP. Left main artery lesions, multi-vessel, calcified lesions, chronic totally occlusion were also more likely to be seen in the elderly group. Univariate analysis revealed that age ≥ 85 years, cardiogenic shock or severe arrhythmia at admission, emergency PCI, prior stroke and chronic kidney disease were related to six-month mortality in elderly patients ≥ 75 years who underwent PCI. Multivariable logistic regression showed that cardiogenic shock or severe arrhythmia at admission, chronic kidney disease and prior stroke were independent risk factors predicting six-month mortality in elderly patients ≥ 75 years who had undergone PCI. Conclusions Our data showed that, compared with patients under 75 years, elderly patients (≥ 75 years) who had undergone PCI had a relative higher risk of mortality, and more often accompanied with multi-comorbidities, severer admission conditions and complex coronary lesions. Better evaluation of risk factors and more intensively care should be taken to patients ≥ 75 years who had undergone PCI therapy to reduce complications.
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