"iDoctor – Medical Blog"

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
John C., LaRosa , Prakash C., Deedwania , James, Shepherd , Nanette K., Wenger , Heiner, Greten , …

Analyses of randomized clinical trials are usually restricted to examination of time to first event. However, because many patients have multiple events, this approach precludes much potentially useful clinical and economic data. To assess the effect on overall disease burden in the Treating to New Targets (TNT) study, we evaluated the effect of treatment with atorvastatin 80 versus 10 mg in the period after the occurrence of a first cardiovascular event. In TNT, 10,001 patients with stable coronary heart disease received double-blind therapy with atorvastatin 80 or 10 mg and were followed for 4.9 years. Post hoc time-to-event analysis was…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Cedric, Delhaye , Gabriel, Maluenda , Kohei, Wakabayashi , Itsik, Ben-Dor , Sara D., Collins , …

Chronic dialysis-dependent patients undergoing percutaneous coronary intervention (PCI) are at a greater risk of bleeding and ischemic events. Bivalirudin has been associated with fewer bleeding complications than unfractionated heparin (UFH) in patients undergoing PCI in various clinical settings. These studies, however, have systematically excluded patients dependent on chronic dialysis. We sought to assess the safety, bleeding rates, and in-hospital outcomes of bivalirudin use compared to UFH use alone in patients requiring dialysis and undergoing PCI. A retrospective analysis of 396 dialysis-dependent patients undergoing PCI from January 2000 to March 2009 was performed. Patients treated with a dose-adjusted bivalirudin regimen (n…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Olivier, Muller , Michalis, Hamilos , Jozef, Bartunek , Hans, Ulrichts , Fabio, Mangiacapra , …

Platelet reactivity is greater in patients with stable angina and with more extensive peripheral vascular atherosclerosis. We sought to evaluate whether impaired peripheral microcirculatory endothelial function might correlate with platelet reactivity after clopidogrel and therefore predispose to an unfavorable outcome after percutaneous coronary intervention (PCI). In 52 consecutive patients with stable angina undergoing elective PCI, endothelial function was assessed by (1) endothelial peripheral arterial tonometry (measuring the “Endoscore”); (2) the von Willebrandt factor antigen level and ristocetin co-factor activity. Basal platelet reactivity was assessed by soluble P-selectin. Patients then received a 600-mg clopidogrel loading dose ≥12 hours before PCI. A…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Takashi, Kubo , Toshio, Imanishi , Manabu, Kashiwagi , Hideyuki, Ikejima , Hiroto, Tsujioka , …

Autopsy studies have suggested that acute myocardial infarction (AMI) represents a pan-coronary process of vulnerable plaque development. We performed multifocal optical coherence tomographic (OCT) examination to compare coronary lesion instability between AMI and stable angina pectoris (SAP). A total of 42 patients with AMI (n = 26) or SAP (n = 16) who had multivessel disease and underwent multivessel coronary intervention were enrolled in the present study. The OCT examination was performed not only in the infarct-related/target lesions, but also in the noninfarct-related/nontarget lesions. OCT-derived thin-cap fibroatheroma (TCFA) was defined as a lesion with a fibrous cap thickness of <65…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Rishi, Sukhija , Wilbert S., Aronow , Chandrasekar, Palaniswamy , Tarunjit, Singh , Rashmi, Sukhija , …

No data are available comparing the long-term outcome of sirolimus-eluting stents (SESs) versus paclitaxel-eluting stents (PESs) in patients with moderate to severe renal insufficiency. The incidence of major adverse cardiac events (MACE), including death, myocardial infarction, and target vessel revascularization, during long-term follow-up were studied in patients with a glomerular filtration rate of <60 ml/min/1.73 m2, as measured by the Modification of Diet in Renal Disease (MDRD) study equation, who also underwent percutaneous coronary intervention with drug-eluting stents. Of 428 patients studied, PESs were placed in 287 patients and SESs in 141 patients. Stepwise Cox regression analyses were performed to…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Dmitriy N., Feldman , Foluso, Fakorede , Robert M., Minutello , Geoffrey, Bergman , Issam, Moussa , …

Current guidelines recommend pretreatment with a loading dose of clopidogrel before percutaneous coronary intervention (PCI) to reduce the incidence of periprocedural myocardial infarctions in patients undergoing PCI. However, because of concerns about postoperative bleeding, clopidogrel loading is frequently administered either immediately before or after PCI. Using the 2004/2005 Cornell Angioplasty Registry, we analyzed 1,041 consecutive patients undergoing urgent PCI for non–ST-elevation acute coronary syndrome. The patients were divided into 2 groups. The first group was the “preangiography clopidogrel therapy” group for those receiving chronic 75-mg clopidogrel therapy or receiving a clopidogrel loading dose (300 mg ≥12 hours or 600 mg…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Pathmaja, Paramsothy , Ronit, Katz , David S., Owens , Gregory L., Burke , Jeffrey L., Probstfield , …

Although abnormal lipoproteins and lipoprotein ratios are powerful risk factors for clinical cardiovascular events, these associations are stronger in younger than in older subjects. Whether age modifies the relation of lipoproteins and lipoprotein ratios to the relative risk of subclinical cardiovascular disease (CVD), as assessed by coronary artery calcium (CAC) scores, has not been examined in a contemporary, multiethnic cohort. We performed multivariate relative risk regression analyses to determine the relative risks for associations of lipoproteins and lipoprotein ratios with prevalent CAC in participants in Multi-Ethnic Study of Atherosclerosis (MESA). The participants were community-dwelling adults aged 45 to 84 years…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Martin, Schmidt , Johannes, Rieber , Marcos, Daccarett , Harald, Marschang , Anil-Martin, Sinha , …

Angiotensin II exerts proinflammatory effects leading to atrial fibrosis that is associated with persistence of atrial fibrillation (AF). Renal function plays a major role in activation of the renin–angiotensin–aldosterone system. We examined whether the level of impaired renal function, defined by glomerular filtration rate (GFR), would influence the maintenance of sinus rhythm after successful external electric cardioversion (ECV). One hundred two consecutive patients with persistent AF underwent successful ECV. Patients were prospectively followed for recurrence of AF by telephone interviews, Holter electrocardiograms, and electrocardiograms sent by primary care providers. Repeated GFR assays were performed before and 1 month after ECV….

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Gregg S., Pressman , Ashish, Agarwal , Leonard E., Braitman , Salman M., Muddassir

Mitral annular calcium (MAC) is a common finding at echocardiography, although it is an unusual cause of severe mitral stenosis. Although MAC is known to be associated with atherosclerosis and chronic kidney disease, little is known about its natural history as affects mitral valve function. This report describes a cohort of 37 outpatients with severe MAC (>5 mm) of whom 32 were followed longitudinally with echocardiography (mean follow-up 2.6 ± 1.6 years). Progression of the mitral valve gradient occurred in 16 of 32 (50%). There was wide variation in rate of progression with a few subjects demonstrating a rapid increase…

Publication year: 2009
Source: The American Journal of Cardiology, In Press, Corrected Proof, Available online 22 December 2009
Kamran, Shamsa , Joseph K., Perloff , Eric, Lee , Robert S., Wirthlin , Irena, Tsui , …

The retinal arteriolar abnormality that accompanies aortic isthmic coarctation is as distinctive as it is unique but has thus far been virtually ignored. Accordingly, 10 patients (4 men and 6 women) were recruited for a study from the Ahmanson/UCLA Adult Congenital Heart Disease Center Outpatient Clinic. Patient age at enrollment was 35 ± 4 years (range 25 to 66). The inclusion criterion was postoperative coarctation of the aortic isthmus, simple or complex. Coarctation gradients were absent, mild, or moderate, as determined by standard echocardiographic criteria. Ophthalmic investigations were done ≥3 years after the last coarctation repair and included visual acuity,…