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Bugiardini R, Yoon J, Mendieta G, Kedev S, Zdravkovic M, Vasiljevic Z, Miličić D, Manfrini O, van der Schaar M, Gale CP, Bergami M, Badimon L, Cenko E. Reduced Heart Failure and Mortality in Patients Receiving Statin Therapy Before Initial Acute Coronary Syndrome. J Am Coll Cardiol 2022; 79:2021-2033. [PMID: 35589164 DOI: 10.1016/j.jacc.2022.03.354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is uncertainty regarding the impact of statins on the risk of atherosclerotic cardiovascular disease (ASCVD) and its major complication, acute heart failure (AHF). OBJECTIVES The aim of this study was to investigate whether previous statin therapy translates into lower AHF events and improved survival from AHF among patients presenting with an acute coronary syndrome (ACS) as a first manifestation of ASCVD. METHODS Data were drawn from the International Survey of Acute Coronary Syndromes Archives. The study participants consisted of 14,542 Caucasian patients presenting with ACS without previous ASCVD events. Statin users before the index event were compared with nonusers by using inverse probability weighting models. Estimates were compared by test of interaction on the log scale. Main outcome measures were the incidence of AHF according to Killip class and the rate of 30-day all-cause mortality in patients presenting with AHF. RESULTS Previous statin therapy was associated with a significantly decreased rate of AHF on admission (4.3% absolute risk reduction; risk ratio [RR]: 0.72; 95% CI: 0.62-0.83) regardless of younger (40-75 years) or older age (interaction P = 0.27) and sex (interaction P = 0.22). Moreover, previous statin therapy predicted a lower risk of 30-day mortality in the subset of patients presenting with AHF on admission (5.2 % absolute risk reduction; RR: 0.71; 95% CI: 0.50-0.99). CONCLUSIONS Among adults presenting with ACS as a first manifestation of ASCVD, previous statin therapy is associated with a reduced risk of AHF and improved survival from AHF. (International Survey of Acute Coronary Syndromes [ISACS] Archives; NCT04008173).
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Affiliation(s)
- Raffaele Bugiardini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Jinsung Yoon
- Google Cloud AI, Sunnyvale, California, USA; Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Guiomar Mendieta
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Sasko Kedev
- University Clinic of Cardiology, Faculty of Medicine Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Marija Zdravkovic
- University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | | | - Davor Miličić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Olivia Manfrini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Mihaela van der Schaar
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California, USA; Cambridge Centre for Artificial Intelligence in Medicine, Department of Applied Mathematics and Theoretical Physics and Department of Population Health, University of Cambridge, Cambridge, United Kingdom
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Maria Bergami
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Lina Badimon
- Cardiovascular Research Program ICCC, IR-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, Barcelona, Spain
| | - Edina Cenko
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
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Padro T, Manfrini O, Bugiardini R, Canty J, Cenko E, De Luca G, Duncker DJ, Eringa EC, Koller A, Tousoulis D, Trifunovic D, Vavlukis M, de Wit C, Badimon L. ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on 'coronary microvascular dysfunction in cardiovascular disease'. Cardiovasc Res 2020; 116:741-755. [PMID: 32034397 DOI: 10.1093/cvr/cvaa003] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/29/2019] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
Although myocardial ischaemia usually manifests as a consequence of atherosclerosis-dependent obstructive epicardial coronary artery disease, a significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Experimental and clinical evidence highlight the abnormalities of the coronary microcirculation as a main cause of myocardial ischaemia in patients with 'normal or near normal' coronary arteries on angiography. Coronary microvascular disturbances have been associated with early stages of atherosclerosis even prior to any angiographic evidence of epicardial coronary stenosis, as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure. The main objectives of the manuscript are (i) to provide updated evidence in our current understanding of the pathophysiological consequences of microvascular dysfunction in the heart; (ii) to report on the current knowledge on the relevance of cardiovascular risk factors and comorbid conditions for microcirculatory dysfunction; and (iii) to evidence the relevance of the clinical consequences of microvascular dysfunction. Highlighting the clinical importance of coronary microvascular dysfunction will open the field for research and the development of novel strategies for intervention will encourage early detection of subclinical disease and will help in the stratification of cardiovascular risk in agreement with the new concept of precision medicine.
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Affiliation(s)
- Teresa Padro
- Cardiovascular Program-ICCC, Research Institute Hospital Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain.,Cardiovascular Research Chair, Autonomous University Barcelona (UAB), Barcelona, Spain
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - John Canty
- Division of Cardiology, Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam Cardiovascular Science Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Akos Koller
- Department of Translational Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Danijela Trifunovic
- Department of Cardiology, University Clinical Center of Serbia; and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Vavlukis
- University Clinic of Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, Republic of Macedonia
| | - Cor de Wit
- Institut für Physiologie, Universität zu Lübeck, Lübeck, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Lina Badimon
- Cardiovascular Program-ICCC, Research Institute Hospital Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain.,Cardiovascular Research Chair, Autonomous University Barcelona (UAB), Barcelona, Spain
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Wang Y, Zhao HW, Wang CF, Zhang XJ, Tao J, Cui CS, Meng QK, Zhu Y, Luo DF, Hou AJ, Luan B. Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients with Chronic Total Occlusion Who Underwent Percutaneous Coronary Intervention. Ther Clin Risk Manag 2020; 16:95-101. [PMID: 32110027 PMCID: PMC7038390 DOI: 10.2147/tcrm.s233512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/04/2020] [Indexed: 01/17/2023] Open
Abstract
Background The incidence and prognosis of coronary slow-flow (CSF) and no-reflow phenomenon (NRP) in patients with coronary chronic total occlusion (CTO) who underwent percutaneous coronary intervention (PCI) remain unclear. Methods This single-center prospective study aimed to investigate the incidence of CSF/NRP during CTO interventional therapy, determine predictors of CSF/NRP, and evaluate its effect on patient outcomes. Results In this study, 552 patients with CTO who underwent PCI were included. CSF/NRP occurred in 16.1% of them. They had higher incidences of diabetes mellitus (53.9% vs 36.3%, p=0.002) and hypertension (50.6% vs 37.1%, p=0.018) and a lower incidence of retrograde filling grade >2 (34.8% vs 47.1%, p=0.036). Patients with CSF/NRP had a higher neutrophil ratio (55.6±19.4 vs 52.4±18.3, p=0.038) and levels of low-density lipoprotein (LDL; 3.0±0.8 vs 2.8±0.6, p=0.029), fasting glucose (FG; 8.3±1.3 vs 6.8±1.1, p=0.005), uric acid (332.6±82.9 vs 308.2±62.8, p=0.045), and high-sensitivity C-reactive protein (Hs-CRP; 9.8±4.8 vs 7.3±3.9, p=0.036). A multivariate logistic regression analysis revealed that diabetes mellitus (odds ratio [OR], 1.962; 95% confidence interval [CI]: 1.198–2.721; p=0.042), mean platelet volume (MPV; OR,1.284; 95% CI, 1.108–1.895; p=0.046), LDL cholesterol (LDL-C; OR, 1.383; 95% CI, 1.105–2.491; p=0.036), FG (OR, 2.095; 95% CI, 1.495–2.899; p=0.018), Hs-CRP(OR, 2.218; 95% CI, 1.556–3.519; p=0.029), and retrograde filling of grade >2 (OR, 0.822; 95% CI, 0.622–0.907; p=0.037) were independent predictors of CSF/NRP in CTO patients who underwent PCI. Kaplan-Meier analysis revealed that the patients in the CSF/NRP group had a significantly lower cumulative major cardiac and cerebrovascular events (MACCE)-free survival than those in the non-CSF/NRP group (p<0.0001). Conclusion Of the patients with CTO who underwent PCI, 16.1% developed CSF/NRP and had a significantly lower cumulative MACCE-free survival rate. Diabetes mellitus; higher levels of MPV, LDL-C, FG, and Hs-CRP; and a lower incidence of retrograde filling grade >2 were independent predictors of CSF/NRP in CTO patients who underwent PCI. Thus, they can be used for risk stratification.
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Affiliation(s)
- Yong Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Hong-Wei Zhao
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Cheng-Fu Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Xiao-Jiao Zhang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Jie Tao
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Chun-Sheng Cui
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Qing-Kun Meng
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Yu Zhu
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - De-Feng Luo
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Ai-Jie Hou
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Bo Luan
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People's Republic of China
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Vasospastic Angina. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Cenko E, Ricci B, Kedev S, Kalpak O, Câlmâc L, Vasiljevic Z, Knežević B, Dilic M, Miličić D, Manfrini O, Koller A, Dorobantu M, Badimon L, Bugiardini R. The no-reflow phenomenon in the young and in the elderly. Int J Cardiol 2016; 222:1122-1128. [DOI: 10.1016/j.ijcard.2016.07.209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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Cerit L, Duygu H, Gulsen K, Gunsel A. Effect of statins on coronary blood flow after percutaneous coronary intervention in patients with stable coronary artery disease. Neth Heart J 2016; 25:258-263. [PMID: 27561280 PMCID: PMC5355380 DOI: 10.1007/s12471-016-0883-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims Statins have favourable effects on the vascular system. However, few data are available regarding the effect of these drugs on patients undergoing percutaneous coronary intervention (PCI). We sought to determine the impact of prior statin use on coronary blood flow after PCI in patients with stable coronary artery disease (CAD) by using the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). Methods A total of 80 consecutive eligible patients (mean age: 60 ± 7 years, 65 % male) with the diagnosis of stable CAD who were hospitalised for elective PCI were retrospectively enrolled in our study. The study population was divided into two groups according to statin use at least 6 months before PCI. Group 1 comprised of 51 patients (67 % male; mean age: 58 ± 4 years) taking statins and group 2 comprised of 29 patients (62 % male; mean age: 60 ± 3 years) not taking statins. PCI was applied to de novo type A lesions. CTFC was calculated for the treated vessels at baseline and after PCI. Results The two groups had similar characteristics in terms of age, sex, concomitant medications, lesion characteristics, pre-procedural CTFC, lipid parameters, and risk factors for CAD. Post-PCI CTFC (16 ± 3 vs. 22 ± 5, p = 0.01) and hs-CRP (2.1 ± 0.7 mg/l vs. 6.1 ± 2 mg/l, p = 0.01) in patients receiving statins before PCI were significantly lower than in patients without statin therapy. Multiple logistic regression analysis showed that statin pre-treatment (OR 2.5, 95 % CI 1.2 to 3.8, p < 0.001) and hs-CRP level (OR 1.8, 95 % CI 1.2 to 2.4, p = 0.001) were independent predictors of post-PCI CTFC. Conclusions In patients with stable CAD undergoing PCI, receipt of long-term statin therapy was associated with improvement in epicardial perfusion after PCI.
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Affiliation(s)
- L Cerit
- Department of Cardiology, Near East University Hospital, Nicosia, Cyprus
| | - H Duygu
- Department of Cardiology, Near East University Hospital, Nicosia, Cyprus.
| | - K Gulsen
- Department of Cardiology, Near East University Hospital, Nicosia, Cyprus
| | - A Gunsel
- Department of Cardiology, Near East University Hospital, Nicosia, Cyprus
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Park SM, Merz CNB. Women and Ischemic Heart Disease: Recognition, Diagnosis and Management. Korean Circ J 2016; 46:433-42. [PMID: 27482251 PMCID: PMC4965421 DOI: 10.4070/kcj.2016.46.4.433] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
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Affiliation(s)
- Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Manfrini O, Ricci B, Cenko E, Dorobantu M, Kalpak O, Kedev S, Kneževic B, Koller A, Milicic D, Vasiljevic Z, Badimon L, Bugiardini R. Association between comorbidities and absence of chest pain in acute coronary syndrome with in-hospital outcome. Int J Cardiol 2016; 217 Suppl:S37-43. [PMID: 27381858 DOI: 10.1016/j.ijcard.2016.06.221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the impact of comorbidities on the management and outcomes of acute coronary syndrome (ACS) patients without chest pain/discomfort (i.e. ACS without typical presentation). METHODS Of the 11,458 ACS patients, enrolled by the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776), 8.7% did not have typical presentation at the initial evaluation, and 40.2% had comorbidities. The odds of atypical presentation increased proportionally with the number of comorbidities (odds ratio [OR]: 1, no-comorbid; OR: 1.64, 1 comorbidity; OR: 2.52, 2 comorbidities; OR: 4.57, ≥3 comorbidities). RESULTS Stratifying the study population by the presence/absence of comorbidities and typical presentation, we found a decreasing trend for use of medications and percutaneous intervention (OR: 1, typical presentation and no-comorbidities; OR: 0.70, typical presentation and comorbidities; OR: 0.23, atypical presentation and no-comorbidities; OR: 0.18, atypical presentation and comorbidities). On the opposite, compared with patients with typical presentation and no-comorbidities (OR: 1, referent), there was an increasing trend (p<0.001) in the risk of death (OR: 2.00, OR: 2.52 and OR: 4.83) in the above subgroups. However, after adjusting for comorbidities, medications and invasive procedures, atypical presentation was not a predictor of in-hospital death. Independent predictors of poor outcome were history of stroke (OR: 2.04), chronic kidney disease (OR: 1.57), diabetes mellitus (OR: 1.49) and underuse of invasive procedures. CONCLUSIONS In the ISACS-TC, atypical ACS presentation was often associated with comorbidities. Atypical presentation and comorbidities influenced underuse of in-hospital treatments. The latter and comorbidities are related with poor in-hospital outcome, but not atypical presentation, per se.
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Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Maria Dorobantu
- Clinical Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - Oliver Kalpak
- University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Božidarka Kneževic
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Davor Milicic
- Department for Cardiovascular Diseases, University of Zagreb, Zagreb, Croatia
| | | | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
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Bugiardini R, Cenko E. Persisting chest pain in nonobstructive coronary artery disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:69-71. [DOI: 10.1093/ehjqcco/qcw010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Sharma K, Gulati M. Coronary artery disease in women: a 2013 update. Glob Heart 2013; 8:105-12. [PMID: 25690374 DOI: 10.1016/j.gheart.2013.02.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 02/07/2023] Open
Abstract
Coronary artery disease (CAD) is a leading cause of death of women and men worldwide. CAD's impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease. Trial data indicate that CAD should be managed differently in women. In this review, we will examine risk assessment for CAD in women, CAD's impact on women, as well as CAD's female-specific presentation and management strategies.
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Affiliation(s)
- Kavita Sharma
- Department of Medicine (Cardiology), The Ohio State University, Columbus, OH, USA
| | - Martha Gulati
- Department of Medicine (Cardiology), The Ohio State University, Columbus, OH, USA; School of Clinical Public Health (Epidemiology), The Ohio State University, Columbus, OH, USA.
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Abstract
Heart rate variability (HRV) non-invasively assesses the activity of the autonomic nervous system. During the past 30 years, an increasing number of studies have related the imbalance of the autonomic nervous system (as assessed by HRV) to several pathophysiogical conditions, particularly in the setting of cardiovascular disease. Sudden death, coronary artery disease, heart failure, or merely cardiovascular risk factors (smoking, diabetes, hyperlipidemia, and hypertension) are the best-known clinical circumstances that can affect and/or be affected by the autonomic nervous system. Analyses of HRV variables have been proposed as a component of the clinical evaluation for patient risk stratification due to its independent prognostic information. Yet the potential for HRV to be used widely in clinical practice remains to be established.
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Affiliation(s)
- Borejda Xhyheri
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale. University of Bologna, Bologna, Italy
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Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, Di Monaco A, Sestito A, Novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown) 2013; 14:1-18. [DOI: 10.2459/jcm.0b013e328351680f] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Puddu PE, Mariano E, Voci P, Pizzuto F. Prediction of long-term ischemic events by noninvasively assessed coronary flow reserve. J Cardiovasc Med (Hagerstown) 2012; 13:483-90. [PMID: 22193833 DOI: 10.2459/jcm.0b013e32834eecf2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Coronary flow reserve (CFR) by adenosine echocardiography in left anterior descending (LAD) or posterior descending coronary arteries may predict clinical outcome. METHODS We used models accounting (Cox's model) or not (logistic regression and neural network) for time to event and either considered (forced models) or not (stepwise logistic regression and neural network models) all among 21 covariates to predict 1-year composite events after LAD CFR. RESULTS There were 553 consecutive patients with coronary artery disease (CAD): 89 patients had also posterior descending CFR. During 1-year follow-up 328 patients were event-free, 35 had composite ischemic events and 190 underwent short-term revascularization. LAD and posterior descending CFR (respectively, 1.53 ± 0.83, N = 225 and 1.84 ± 0.80, N = 42) were significantly (P < 0.0001) lower in patients with events (or with revascularization following CFR measurement) than in those without (respectively, 3.13 ± 0.84, N = 328, and 2.53 ± 0.72, N = 47). Using LAD CFR as a continuous covariate, by both forced Cox's and logistic regression, coefficients (t values, respectively, -14.11 and -10.19) were significant (both P < 0.00001) to predict outcome. Global predictive accuracies by neural network, adopting a receiver operating characteristic areas under the curve (ROC) assessment, were excellent (>0.91) and the role of LAD CFR among predictors was overwhelming. Other indices of myocardial ischemia and the presence of coronary stenoses or previous infarction did not modify the multivariable predictive role of LAD CFR. When patients with revascularization were discounted, the LAD CFR predictive role was the same. CONCLUSIONS Thus, adenosine echocardiography-based LAD CFR predicts 1-year composite ischemic events in patients with CAD, independent of the multivariable model adopted. Posterior descending CFR also has a role.
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Affiliation(s)
- Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, Sapienza University, Rome, Italy.
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Kiselev AR, Gridnev VI, Prokhorov MD, Karavaev AS, Posnenkova OM, Ponomarenko VI, Bezruchko BP. Selection of optimal dose of beta-blocker treatment in myocardial infarction patients based on changes in synchronization between 0.1 Hz oscillations in heart rate and peripheral microcirculation. J Cardiovasc Med (Hagerstown) 2012; 13:491-8. [PMID: 22343262 DOI: 10.2459/jcm.0b013e3283512199] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Selection of the optimal dose of beta-blocker treatment in myocardial infarction (MI) patients is problematic because of a lack of well-established guidelines. METHODS We evaluated changes in synchronization between 0.1 Hz oscillations in heart rate (HR) and plethysmographic peripheral microcirculation in response to a tilt-table test and to 3-month treatment with the highest tolerated beta-blocker (metoprolol) dose in 43 patients aged between 41 and 77 years with acute MI 6 months prior to the start of the study. Before the study the patients were treated with small doses of beta-blocker. Phase differences between HR and peripheral microcirculation oscillations were used to measure the degree of synchronization (S), and relative change in S from horizontal position was used to characterize the response to vertical tilt. RESULTS Two groups of MI patients matched for clinical characteristics were identified on the basis of the results. The first group was composed of patients with decreased S as a response to vertical tilt at the beginning of the study. The patients with increased S during vertical tilt before treatment with the highest tolerated beta-blocker dose were attributed to the second group. The response to vertical tilt in the first group of patients was postulated to indicate the need to increase beta-blocker dose, and in turn, the response in the second group to indicate an already adequate beta-blocker dose. CONCLUSION Assessment of synchronization of 0.1 Hz HR and peripheral microcirculation oscillations as a response to a tilt test can possibly be used as a guideline for selecting beta-blocker dose in post-MI patients.
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Li YY. Lack of association of A-6G polymorphism of AGT gene with essential hypertension in the Chinese population. J Cardiovasc Med (Hagerstown) 2012; 13:505-10. [PMID: 22710764 DOI: 10.2459/jcm.0b013e328355a726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The angiotensinogen (AGT) A-6G gene polymorphism has been indicated to be related to the susceptibility of essential hypertension. However, the results are still unclear. OBJECTIVE AND METHODS To survey the relationship between AGT A-6G gene polymorphism and essential hypertension, 18 separate studies with 9306 patients were analyzed through meta-analysis. The random-effect model was used to calculate the pooled odds ratio (OR) and its corresponding 95% confidence interval (CI). RESULTS In this AGT A-6G gene polymorphism and essential hypertension meta-analysis of the Chinese population, the distribution of the G-allele frequency was 0.23 for the essential hypertension group and 0.21 for the control group. The association between the AGT A-6G gene polymorphism and essential hypertension in the entire sample population was not significant. The pooled OR for the frequency of the G allele was 1.10 (95% CI 0.96 to 1.27, Pheterogeneity < 0.00001, P = 0.17). In the stratified analysis by ethnicity, a significant association in Li and Mongolian ethnicities (P ≤ 0.05) was achieved. However, no significant association was found in other ethnicities such as Han, Tibetan, Kazakh, Bai and Yi (P > 0.05). CONCLUSIONS The current meta-analysis suggested that AGT A-6G gene polymorphism might not be related to the increased risk of essential hypertension in the entire Chinese population. However, the G-allele of AGT A-6G might predispose to essential hypertension in the Li and Mongolian ethnicities.
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Affiliation(s)
- Yan-yan Li
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Wang A, Chen F, Xie Y, Guo Z, Yu Y. Protective mechanism of nicorandil on rat myocardial ischemia-reperfusion. J Cardiovasc Med (Hagerstown) 2012; 13:511-5. [PMID: 22609873 DOI: 10.2459/jcm.0b013e3283542031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To study the protective mechanism of nicorandil on myocardial ischemia-reperfusion injury. METHODS Fifty rats were randomly divided into five groups, four of which were operated on to produce myocardial ischemia-reperfusion. Nicorandil (5 mg/kg) was administrated by intravenous injection to three of the groups. The myocardial ultrastructure was observed by electron microscope. The expression levels of the antiapoptotic protein Bcl-2 and the pro-apoptotic protein Bax were detected by immunohistochemical staining with rhodamine 123. The mitochondrial membrane potential was detected by spectrophotometry. RESULTS The activity of lactate dehydrogenase (LDH) and malondialdehyde (MDA) content was decreased and the activity of superoxide dismutase (SOD) was increased in the three nicorandil groups, compared with those in the group without nicorandil (P < 0.01, P < 0.05). The positive staining level of the expressed Bcl-2 was increased and the expressed Bax was decreased (P < 0.01) in the three nicorandil groups, compared with those in the group without nicorandil. The mitochondrial inner membrane potential was increased in the three nicorandil groups compared with that in the group without nicorandil (P < 0.05). CONCLUSION A suitable level of nicorandil has a protective effect on rats' myocardial ischemia-reperfusion injury, and is mainly based on the opening of the mitochondrial KATP channel and the lowing of Ca overload.
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Affiliation(s)
- Ailing Wang
- Department of Cardiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Manfrini O, Russo V, Ciavarella A, Ceroni L, Montalti M, Fattori R. Coronary plaque quantification and composition in asymptomatic patients with type II diabetes mellitus. J Cardiovasc Med (Hagerstown) 2012; 13:423-31. [PMID: 22673024 DOI: 10.2459/jcm.0b013e32835593f9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the extent and morphology of coronary lesions in asymptomatic patients with type II diabetes mellitus. METHODS We enrolled 102 asymptomatic patients with type II diabetes mellitus and 97 patients without diabetes as controls. All individuals had no history of ischemic heart disease. They underwent multidetector computed tomography (MDCT). Plaque density and plaque volume were calculated using specific software on axial images. Arterial remodeling was evaluated with semiquantitative assessment on image reconstructions. RESULTS MDCT angiography revealed the presence of 124 coronary plaques in 46 patients with type II diabetes mellitus and 59 plaques in 21 controls (P<0.01). Diabetic patients had a significantly higher proportion of lesions with impaired adaptive remodeling (56.5 versus 35.6%, P<0.01), as compared with nondiabetic individuals. The volume of fibrofatty component was 0.1 cm (0.01-0.72) in diabetic patients and 0.08 cm (0.01-0.33) in controls (P=0.14). The calcium volume was 0.082 cm (0-0.558) in diabetic patients and 0.12 cm (0-0.669) in controls (P=0.21). Plaques with fibrofatty components had a significantly higher density in the diabetic cohort (58.76 ± 9.55 Hounsfield Units), as compared with the control group (47.31 ± 5.42 Hounsfield Units, P<0.001). Plaque density correlated with the duration of type II diabetes mellitus (r=0.37, P=0.044), but was independent of age, sex, hypertension and metabolic profile. In the control group, plaque density was independent of any covariate. CONCLUSION Coronary plaques in type II diabetes mellitus show a tendency to develop impaired adaptive remodeling and to have a higher tissue density.
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Affiliation(s)
- Olivia Manfrini
- Dipartimento di Medicina Interna, dell'Invecchiamento e Malattie Nefrologiche, Italy
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Wei S, Gao C, Wei G, Chen Y, Zhong L, Li X. The level of serum bilirubin associated with coronary lesion types in patients with coronary artery disease. J Cardiovasc Med (Hagerstown) 2012; 13:432-8. [PMID: 21799439 DOI: 10.2459/jcm.0b013e32834a3967] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Serum bilirubin has been proven to be associated with coronary artery disease (CAD). However, how serum bilirubin is related to the complexity of coronary artery lesions is still unknown. METHODS AND RESULTS One thousand two hundred and sixty patients (men 775, 61.5%, mean age, 59.3 ± 8.2 years) diagnosed with unstable angina were enrolled in the study. Patients were categorized into three major groups and group III was further divided into four subgroups according to the guidelines of AHA/ACC 1993 described in the Methods section. The total serum bilirubin levels showed significant differences among the three major groups (group I vs. group II, 14.8 ± 5.8 vs. 13.7 ± 4.7 μmol/l, P=0.017; group I vs. group III, 14.8 ± 5.8 vs. 12.6 ± 4.4 μmol/l, P<0.001; group II vs. group III, 13.7 ± 4.7 vs. 12.6 ± 4.4 μmol/l, P=0.009). The difference was further seen among the subgroups. Logistic regression analysis demonstrated that age, male sex, histories of hypertension and diabetes, and total serum bilirubin were independent risk factors for CAD. However, in the subgroups, only age, male sex, history of hypertension and total serum bilirubin were associated with CAD. Total serum bilirubin showed the strongest relationship (odds ratio=0.95, 95% confidence interval 0.91-0.98, P=0.001). CONCLUSION Total serum bilirubin level is an independent risk factor for CAD. It has a strong relationship with coronary artery lesion types.
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Affiliation(s)
- Shipeng Wei
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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Younas F, Janjua M, Badshah A, DeGregorio M, Patel KC, Cotant JF. Transient complete heart block and isolated ventricular asystole with nitroglycerin. J Cardiovasc Med (Hagerstown) 2012; 13:533-5. [DOI: 10.2459/jcm.0b013e3283416b8b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kumar S, Kaushik S, Nautiyal A, Mostow N, Lazar JM. Pathology findings mimicking acute myocardial infarction in a case of Takotsubo cardiomyopathy complicated by cardiac rupture. J Cardiovasc Med (Hagerstown) 2012; 13:478-80. [DOI: 10.2459/jcm.0b013e3283511eb3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aliyev F, Kiliçkesmez KO, Çeliker C, Türkoğlu C. Cough-induced sinus arrest resulting in recurrent episodes of syncope. J Cardiovasc Med (Hagerstown) 2012; 13:468-70. [DOI: 10.2459/jcm.0b013e32833892c4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Christodoulides T, Ioannides M, Yiangou K, Nicolaides E. Syncope due to prolonged asystole. J Cardiovasc Med (Hagerstown) 2012; 13:465-7. [DOI: 10.2459/jcm.0b013e328335ae70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mangiacapra F, De Bruyne B, Peace AJ, Melikian N, Wijns W, Barbato E. High cholesterol levels are associated with coronary microvascular dysfunction. J Cardiovasc Med (Hagerstown) 2012; 13:439-42. [DOI: 10.2459/jcm.0b013e328351725a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Barillà F, Giordano F, Jacomelli I, Pellicano M, Dominici T. ST-segment elevation during levosimendan infusion. J Cardiovasc Med (Hagerstown) 2012; 13:454-6. [DOI: 10.2459/jcm.0b013e3283559af6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Courand PY, Mouly-Bertin C, Thomson V, Lantelme P. Acute coronary syndrome revealed Cardiobacterium hominis endocarditis. J Cardiovasc Med (Hagerstown) 2012; 13:216-21. [PMID: 20838281 DOI: 10.2459/jcm.0b013e32833daf81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Erdoğan T, Kocaman SA, Çetin M, Çanga A, Durakoğlugil ME, Çiçek Y, Temiz A, Karadağ Z, Uğurlu Y, Şatroğlu Ö, Bostan M. Relationship of fragmented QRS complexes with inadequate coronary collaterals in patients with chronic total occlusion. J Cardiovasc Med (Hagerstown) 2012; 13:499-504. [PMID: 22498998 DOI: 10.2459/jcm.0b013e328353683c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Fragmented QRS (fQRS) complexes are defined as various RSR' patterns (≥1 R' or notching of S wave or R wave) in two contiguous leads corresponding to a major coronary artery territory. In previous studies, fQRS has been associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events (CVEs). The causative relationship between fQRS and cardiac fibrosis has been shown in prior studies. The association between inadequate (poor) coronary collaterals and presence of fQRS has not comprehensively been studied in patients with chronic total occlusion (CTO) until now. We tested the hypothesis that the presence of fQRS is associated with inadequate coronary collateral growth. METHODS This study had a cross-sectional observational design. The study population consisted of patients who underwent coronary angiography with the suspicion of coronary artery disease at our institution in an outpatient manner. Patients who had CTO in at least one major epicardial coronary artery were included. Coronary angiograms of 148 eligible patients from our database were analyzed again. Ninety-three patients had good and 55 had poor collateral development according to the Cohen-Rentrop method. RESULTS Patients with poor collateral development had higher plasma glucose (130 ± 54 vs. 116 ± 33 mg/dl, P = 0.047) and an older age (65 ± 10 vs. 61 ± 10 years, P = 0.042) in comparison to patients with good collateral growth. The presence and number of fQRS were higher in the poor collateral group than the good collateral group (64 vs. 32%, P < 0.001 and 2.3 ± 2.4 vs. 1.2 ± 2.0, P = 0.002, respectively). Left ventricular ejection fraction was significantly lower in the poor collateral group than the good collateral group (45 ± 11 vs. 51 ± 13, P = 0.014). There was a significant correlation between number of fQRSs and the echocardiographic wall-motion abnormality score (r = 0.662, P < 0.001). In multivariate analysis, only the presence of fQRS was independently related to poor collateral development (odds ratio, 3.559; 95% confidence interval, 1.708-7.415, P = 0.001). CONCLUSION We found that fQRS was independently related to inadequate coronary collaterals in patients with CTO. fQRS, which may be derived from the effects of myocardial ischemia or scar on myocardial electricity at the cellular level, can represent inadequate coronary collateral development in patients with CTO.
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Affiliation(s)
- Turan Erdoğan
- Department of Cardiology, Rize University Medical Faculty, Rize Education and Research Hospital, Rize, Turkey
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Şentürk T, Özdemir B, Keçebaş M, Beşli F, Yesilbursa D, Serdar OA. Ascaris-induced eosinophilic myocarditis presenting as acute ST elevation myocardial infarction and cardiogenic shock in a young woman. J Cardiovasc Med (Hagerstown) 2012; 13:211-5. [DOI: 10.2459/jcm.0b013e32833db0ca] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Celik T, Demirkol S, Celik M, Yuksel UC, Iyisoy A. Statins and coronary microvascular dysfunction in patients with acute ST segment elevation myocardial infarction. Int J Cardiol 2012; 155:480-1. [DOI: 10.1016/j.ijcard.2011.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 12/21/2011] [Indexed: 11/27/2022]
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Andreou AY, Georgiou GM, Avraamides PC. Preinfarction angina entailing precordial ST segment depression with positive T wave. J Cardiovasc Med (Hagerstown) 2011; 12:828-32. [DOI: 10.2459/jcm.0b013e3283406413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Balbi M, Fedele M, Bezante GP, Brunelli C, Barsotti A. Acute myocardial infarction related to very late sirolimus-eluting stent thrombosis 6 months after discontinuation of dual antiplatelet therapy. J Cardiovasc Med (Hagerstown) 2011; 12:839-42. [DOI: 10.2459/jcm.0b013e328337d7e7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Russo V, Mineo G, Rinaldi G, Zompatori M, Fattori R. A complex coronary artery fistula with aberrant mediastinic and abdominal feeding arteries and pulmonary artery drainage. J Cardiovasc Med (Hagerstown) 2011; 12:653-4. [DOI: 10.2459/jcm.0b013e32834a397c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Agushi E. No significant interaction between diabetes and clinical presentation in the outcome of percutaneous coronary intervention: have we considered silent ischemia? J Cardiovasc Med (Hagerstown) 2011; 12:695. [PMID: 21792026 DOI: 10.2459/jcm.0b013e3283499635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Boccuzzi GG, Di Maggio L, Massara C, Garbo R, Savio D. Intravascular ultrasound-guided rotational atherectomy for heavily calcified renal artery stenosis. J Cardiovasc Med (Hagerstown) 2010; 13:338-42. [PMID: 20186070 DOI: 10.2459/jcm.0b013e328334341a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shaw LJ, Bugiardini R, Merz CNB. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 2009; 54:1561-75. [PMID: 19833255 PMCID: PMC2789479 DOI: 10.1016/j.jacc.2009.04.098] [Citation(s) in RCA: 472] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/20/2009] [Accepted: 04/27/2009] [Indexed: 12/14/2022]
Abstract
Evolving knowledge regarding sex differences in coronary heart disease is emerging. Given the lower burden of obstructive coronary artery disease (CAD) and preserved systolic function in women, which contrasts with greater rates of myocardial ischemia and near-term mortality compared with men, we propose the term "ischemic heart disease" as appropriate for this discussion specific to women rather than CAD or coronary heart disease (CHD). This paradoxical difference, where women have lower rates of anatomical CAD but more symptoms, ischemia, and adverse outcomes, appears linked to abnormal coronary reactivity that includes microvascular dysfunction. Novel risk factors can improve the Framingham risk score, including inflammatory markers and reproductive hormones, as well as noninvasive imaging and functional capacity measurements. Risk for women with obstructive CAD is increased compared with men, yet women are less likely to receive guideline-indicated therapies. In the setting of non-ST-segment elevation acute myocardial infarction, interventional strategies are equally effective in biomarker-positive women and men, whereas conservative management is indicated for biomarker-negative women. For women with evidence of ischemia but no obstructive CAD, antianginal and anti-ischemic therapies can improve symptoms, endothelial function, and quality of life; however, trials evaluating impact on adverse outcomes are needed. We hypothesize that women experience more adverse outcomes compared with men because obstructive CAD remains the current focus of therapeutic strategies. Continued research is indicated to devise therapeutic regimens to improve symptom burden and reduce risk in women with ischemic heart disease.
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Affiliation(s)
- Leslee J Shaw
- Emory Program in Cardiovascular Outcomes Research and Epidemiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Kulić M, Tahirović E, Lazović Z. Angina pectoris and physiological coronarographic findings. Bosn J Basic Med Sci 2009; 9:250-3. [PMID: 19754483 DOI: 10.17305/bjbms.2009.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Angina pectoris may be associated with normaln coronary arteries. Normal coronary arteries status is defined as absence of visible disease or the irregularity of lumen (less than 50%) as assessed visually on the interventional cardiologists. In our retrospective study among 1130 patients we have identified 181 patients with normal angiographic findings with various risk factors, as male sex, body mass index (BMI), lipid disorders, smoking, hypertension, diabetes mellitus type 2. The analysis results suggest that 56.3% patients of 181 verified normal coronary findings involve female patients with high BMI, unregulated hypertension and lipid disorders. In order to find real causes of chest pain, patients with normal coronary status need careful examination and treatment. The reduction of risk factors and adequate medications are important preconditions for the good quality of life in these patients.
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Affiliation(s)
- Mehmed Kulić
- University of Sarajevo Clinics Centre, Bosnia and Herzegovina
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Fontana F, Bernardi P, Pizzi C, Spampinato S, Bedini A, Pich EM. Plasma nociceptin/orphanin FQ levels rise after spontaneous episodes of angina, but not during induced myocardial ischemia. Peptides 2009; 30:1705-9. [PMID: 19560501 DOI: 10.1016/j.peptides.2009.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
The aim of our study was to evaluate the effects of repeated episodes of angina and induced myocardial ischemia on plasma nociceptin/orphanin FQ (N/OFQ) levels. Patients with unstable angina (23 with new onset severe angina or accelerated angina and 18 with subacute angina at rest) who had had repeated spontaneous episodes of chest pain in the last week before the study underwent myocardial perfusion single-photon emission computed tomography using adenosine infusion. Twenty subjects without clinical symptoms of angina matched for age, sex and cardiac risk factors served as a control group. N/OFQ levels were significantly (P<0.01) higher in the patients (15.2+/-2.1 pg/ml) than in the control group (8.5+/-2.6 pg/ml). Blood pressure and heart rate did not significantly differ. All patients showed transient adenosine infusion myocardial ischemia that did not induce chest pain or significantly modify plasma N/OFQ levels or hemodynamic parameters. Our findings show that unstable angina is associated with a significant increase in circulating N/OFQ levels unrelated to intervening transient myocardial ischemia or hemodynamic changes. This increase is probably related to the chest pain repeatedly occurring in the course of coronary artery disease, but absent during transient adenosine-induced myocardial ischemia.
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Affiliation(s)
- Fiorella Fontana
- Dipartimento di Medicina Interna, dell'Invecchiamento e Malattie Nefrologiche, Ospedale S. Orsola, Via Massarenti 9, Bologna, Italy.
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Mahmarian JJ. Myocardial perfusion imaging to evaluate the efficacy of medical therapy in patients with coronary artery disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fontana F, Bernardi P, Pizzi C, Di Toro R, Spampinato S, Merlo Pich E. Plasma brain natriuretic peptide at rest and after adenosine-induced myocardial ischemia in normotensive and essential hypertensive patients with suspected coronary artery disease. Peptides 2009; 30:385-90. [PMID: 18951935 DOI: 10.1016/j.peptides.2008.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/24/2008] [Accepted: 09/25/2008] [Indexed: 11/30/2022]
Abstract
This study investigated plasma brain natriuretic peptide (BNP) levels in normotensive and hypertensive patients with suspected coronary artery disease during radionuclide pharmacological stress testing. Twenty-seven normotensive patients (15 males, aged 63.0+/-4.5 years and 12 females, aged 63.0+/-4.1 years) and 38 essential hypertensive patients (25 males, aged 63.3+/-3.3 years and 13 females, aged 64.6+/-2.6 years) with chest pain and exercise stress testing inconclusive for coronary artery disease underwent myocardial perfusion single-photon emission computed tomography (SPECT) using adenosine infusion. SPECT identified patients without (16 normotensive and 22 hypertensive) and patients with (11 normotensive and 16 hypertensive) transient perfusion defects. Basal BNP levels in normotensive patients without transient myocardial ischemia (3.1+/-1.2 fmol/ml) were significantly (P<0.01) lower than those observed in normotensive patients with transient ischemia (8.2+/-1.2 fmol/ml), whereas BNP levels in hypertensive patients without transient ischemia (8.2+/-1.0 fmol/ml) did not significantly differ from those in hypertensive patients with transient ischemia (8.1+/-2.0 fmol/ml). No significant difference was found in BNP levels between males or females either in normotensive or hypertensive patients without or with ischemia. Adenosine infusion did not significantly change BNP levels in any subject group without or with myocardial perfusion defects. Our findings show that increases in BNP allow early detection of myocardial ischemia in normotensive patients, but not in hypertensive patients with suspected coronary artery disease. Adenosine-induced myocardial ischemia does not affect BNP production already activated by coronary artery disease in normotensive patients and by hemodynamic changes in hypertensive patients.
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Affiliation(s)
- Fiorella Fontana
- Dipartimento di Medicina Interna, dell'Invecchiamento e Malattie Nefrologiche, Ospedale S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy.
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The Effects of Medications on Myocardial Perfusion. J Am Coll Cardiol 2008; 52:401-16. [PMID: 18672159 DOI: 10.1016/j.jacc.2008.04.035] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 04/14/2008] [Accepted: 04/21/2008] [Indexed: 11/23/2022]
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Manfrini O, Slucca M, Pizzi C, Colombo A, Viecca M, Bugiardini R. Effect of percutaneous coronary intervention on coronary blood flow at rest in myocardial sites remote from the intervention site in patients with stable angina pectoris. Am J Cardiol 2008; 101:776-9. [PMID: 18328839 DOI: 10.1016/j.amjcard.2007.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 11/07/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
Abstract
Little is known about changes in myocardial perfusion of myocardial regions supplied by angiographically normal or near-normal coronary arteries after percutaneous coronary intervention (PCI) of the target lesion. The purpose of this study was to assess the effect of PCI on coronary blood flow at rest in sites remote from the PCI. We studied 85 patients who underwent successful elective PCI for stable angina. We used the Thrombolysis In Myocardial Infarction frame count to provide a simple continuous index of coronary flow and myocardial perfusion in the target and nontarget arteries. Coronary artery diameters of nontarget vessels did not significantly differ before and after PCI and at 6 months' follow-up. At baseline, the greater the percent diameter stenosis in the target artery, the slower the flow in the target (r = 0.22, p <0.01) and nontarget arteries (r = 0.28, p <0.01). Relief of stenosis using PCI did not account for simultaneous changes in epicardial coronary blood flow of the nontarget artery. After 6 months, coronary blood flow improved in both the target (p <0.05) and nontarget arteries (p = 0.007). In conclusion, this study provided evidence of a functional link between coronary blood flow in diseased and nondiseased arteries. Relief of a significant stenosis using PCI globally improved regional and global myocardial blood flow at rest in patients with stable angina. Flow improvement was not apparent at the time of revascularization, but at 6 months' follow-up. Late upturn of the microcirculation may account for delayed recovery of myocardial perfusion.
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Freeman AM, Abbott JD, Jacobs AK, Vlachos HA, Selzer F, Laskey WK, Detre KM, Williams DO. Marked improvements in outcomes of contemporary percutaneous coronary intervention in patients with diabetes mellitus. J Interv Cardiol 2007; 19:475-82. [PMID: 17107360 DOI: 10.1111/j.1540-8183.2006.00211.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We sought to determine if advances in percutaneous coronary intervention (PCI) are associated with better outcomes among patients with diabetes mellitus (DM). Patients with DM enrolled in the National Heart, Lung, and Blood Institute (NHLBI) early PTCA Registry (1985-1986) were compared to those in the subsequent contemporary Dynamic Registry (1999-2002) for in-hospital and one-year cardiovascular outcomes. The study population included 945 adults with DM, 325 from the PTCA Registry and 620 from the Dynamic Registry. Multivariable Cox regression models were built to estimate the risk of clinical events. Dynamic Registry patients were older, had more noncardiac comorbidities, and a lower mean ejection fraction (50.5% vs 57.8%, P < or = 0.001) compared to the PTCA Registry patients. The incidence of in-hospital mortality (1.9% vs 4.3%, P < or = 0.05), myocardial infarction (MI) (1.0% vs 7.4%, P <or = 0.001), and coronary artery bypass grafting (CABG) (0.8% vs 6.2%, P < or = 0.001) were all significantly lower and independent of the use of stents. One-year adverse events including MI (4.9% vs 11.0%, P < or = 0.001), CABG (6.4% vs 15.0%, P < or = 0.001), and need for repeat revascularization (18.7% vs 33.3%, P < or = 0.001) were all lower in the Dynamic Registry. The relative risk of death at 1 year was significantly less for patients in the Dynamic Registry (RR 0.56, 0.34; 0.92, P = 0.02). Although Dynamic Registry patients with diabetes had more advanced coronary disease, in-hospital and late adverse events were lower. A combination of the use of stents and an increase in adjunctive medical therapy are likely responsible for the observed improvements in outcomes in contemporary PCI.
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Affiliation(s)
- Andrew M Freeman
- Brown University, Rhode Island Hospital, Providence, Rhode Island 02903, USA
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Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, Inoue K, Fujii K. Chronic pre-treatment of statins is associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction. Eur Heart J 2006; 27:534-9. [PMID: 16401674 DOI: 10.1093/eurheartj/ehi715] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Early statin treatment has beneficial effects on prognosis after acute coronary syndrome. The no-reflow phenomenon determines the prognosis after acute myocardial infarction. We investigated the effects of statin treatment before admission on the development of the no-reflow after infarction. METHODS AND RESULTS We performed intracoronary myocardial contrast echocardiography in 293 consecutive patients with acute myocardial infarction undergoing successful primary percutaneous coronary intervention. There were no significant differences in the incidence of the no-reflow between the patients with and without hypercholesterolaemia. The 33 patients receiving chronic statin treatment before admission had lower incidence of the no-reflow than those without it (9.1 and 34.6%, P=0.003). They also showed better wall motion, smaller left ventricular dimensions, and better ejection fraction at 4.9+/-2.2 months later. Multivariable logistic regression analysis revealed that statin pre-treatment was a significant predictor of the no-reflow along with anterior wall infarction, ejection fraction on admission, and additional ST-elevation after reperfusion, whereas total cholesterol was not. CONCLUSION Chronic pre-treatment with statins could preserve the microvascular integrity after acute myocardial infarction independent of lipid lowering, leading to better functional recovery.
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Affiliation(s)
- Katsuomi Iwakura
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 5300001, Japan
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Celik T, Kursaklioglu H, Iyisoy A, Kose S, Kilic S, Amasyali B, Kardesoglu E, Isik E. The effects of prior use of atorvastatin on coronary blood flow after primary percutaneous coronary intervention in patients presenting with acute myocardial infarction. Coron Artery Dis 2005; 16:321-6. [PMID: 16000891 DOI: 10.1097/00019501-200508000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Statins exert a variety of favourable effects on the vascular system not directly related to their lipid lowering function known as pleiotropic effects. There are not enough data regarding the effects of prior statin use on coronary blood flow after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Accordingly, in the present study, we aimed to investigate the effects of prior statin use on coronary blood flow after primary PCI in patients with AMI using the Thrombolysis In Myocardial Infarction (TIMI) frame count method. METHODS The study population consisted of 200 patients (161 men; mean age=62+/-7 years) referred to cardiology clinics with AMI who subsequently underwent successful primary PCI. The study population was divided into two groups according to statin use before primary PCI. Group 1 consisted of 98 patients (75 men; mean age=63+/-7 years) not taking statin and group 2 consisted of 102 patients (86 men; mean age=61+/-7 years) taking daily dose of at least 40 mg atorvastatin for at least 6 months. Coronary blood flow was determined by TIMI frame count method using the angiographic images obtained just after PCI and stenting. RESULTS Only mean TIMI frame count was detected to be significantly lower in patients taking at least 40 mg atorvastatin for at least 6 months compared with that of the patients taking no statin (P<0.001). After confounding variables were controlled for, the mean TIMI frame count of patients in group 2 was significantly lower than that of the patients in group 1 (P=0.001). Pain to balloon time and vessel type were detected as important confounding variables of TIMI frame count after analysis of covariances. CONCLUSIONS Prior statin use may improve coronary blood flow after PCI in patients with AMI, possibly by its beneficial effects on microvascular function.
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Affiliation(s)
- Turgay Celik
- Gulhane Military Medical Academy, Department of Cardiology, Etlik-Ankara, Turkey.
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