Percutaneous Coronary Intervention Did Not Reduce the
Occurrence of Death, Reinfarction, or Heart
Failure in Patients with Occlusion of the
Infarct-Related Artery 3 to 28 Days after Myocardial
Infarction
Current
treatment of acute myocardial infarction (MI) with
ST-segment elevation includes early reperfusion with primary
percutaneous coronary intervention (PCI. For patients with
persistent total occlusion of the infarct-related artery who
have been identified after the currently accepted period
during which reperfusion is administered, the best strategy
for care has been unclear until now. Judith Hochman M.D.,
et al from the New York University School of Medicine,
conducted a 4 year study showing that PCI did not reduce the
occurrence of death, reinfarction or heart failure in
patients with occlusion of the infarct-related artery 3 to
28 days after myocardial infarction. The article was
published in the November 14, 2006 issue of The New England
Journal of Medicine.
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Sirolimus-Eluting Stents Reduce the Rate of Target-Vessel
Revascularization Among Patients with Acute Myocardial
Infarction
While
it has been known that Sirolimus-eluting stents reduce the
rates of restenosis and reintervention, the safety and
efficacy of such stents in primary percutaneous coronary
intervention (PCI) for acute myocardial infarction was not
studied as extensively. Christian Spaulding, M.D. et al from
the Cochin Hospital in Paris, France performed a
single-blind, multicenter, randomized trial to compare
sirolimus-eluting stents with uncoated stents in primary PCI
for patients with acute myocardial infarction with
ST-segment elevation. Their study, published in the
September 14, 2006 issue of The New England Journal of
Medicine, found among selected patients with acute
myocardial infarction, the use of sirolimus-eluting stents
significantly reduced the rate of target-vessel
revascularization at 1 year.
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Mediterranean Diets Supplemented With Olive Oil or Nuts Have
Beneficial Effects on Cardiovascular Risk Factors
The
low incidence of coronary artery disease in Mediterranean
countries has been attributed to the dietary habits of the
people of that region. A multi-center, randomized study by
Ramon Estruch, MD, PhD et al from the Hospital Clinic in
Spain compared the short-term effects of two Mediterranean
diets versus those of a low-fat diet on intermediate markers
of cardiovascular risk. The findings, published in the July
4, 2006 issue of Annals of Internal Medicine, found that
compared to low-fat diets, Mediterranean diets supplemented
with olive oil or nuts have beneficial effects on
cardiovascular risk factors.
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N-Acetylcysteine may Prevent
Contrast-Medium Induced Nephropathy in Patients Treated With
Primary Angioplasty
Patients with acute myocardial infarction undergoing primary
angioplasty are at high risk for contrast-medium-induced
nephropathy. Giancarlo Marenzi M.D. et al from the Institute
of Cardiology at the University of Milan investigated the
use of N-acetylcysteine for the prevention of
contrast-medium-induced nephropathy in patients undergoing
primary angioplasty. The study, published in the June
29,2006 issue of The New England Journal of Medicine,
concluded that intravenous and oral N-acetylcysteine may
prevent contrast-medium-induced nephropathy with a
dose-dependent effect in patients treated with primary
angioplasty and may improve hospital outcome.
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Clopidogrel Plus Aspirin Does Not Significantly
Reduce the Rate of Myocardial Infarction, Stroke
or Cardiovascular Death
Platelets have been
shown to play a central role in atherothrombosis.
Low dose aspirin can reduce ischemic outcomes by
inhibiting the cyclooxygenase pathway.
Clopidogrel inhibits platelet aggregation by
inhibiting the binding of ADP to the platelet
receptor and thereby inhibiting the consequent
activation of the glycoprotein GPIIb/IIIa
complex. A study by Dr. Deepak Bhatt et al from
the Cleveland Clinic in Ohio was published in
the March 14, 2006 issue of The New England
Journal of Medicine indicating clopidogrel plus
aspirin was not significantly more effective
than aspirin alone in reducing the rate of
myocardial infarction, stroke or death from
cardiovascular causes.
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Rosuvastatin Therapy Results in Significant
Regression of Atherosclerosis
The inhibition of
atherosclerotic progression by statin therapy is
a heavily studied area of cardiovascular
medicine today. While there have been many
previous clinical studies showing the benefits
of rosuvastatin, Dr. Steven Nissen et al from
the Cleveland Clinic Foundation used
intravascular ultrasound (IVUS) to monitor
whether intensive statin therapy could regress
coronary atherosclerosis. The study, published
in the March 13, 2006 issue of The Journal of
the American Medical Association, found Very
high-intensity statin therapy using rosuvastatin 40 mg/d achieved an average LDL-C of 60.8
mg/dL and increased HDL-C by 14.7%,
resulting in significant regression of
atherosclerosis.
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Binge Drinking is Associated
With a Higher Rate of Mortality After Acute
Myocardial Infarction
Among patients with
coronary heart disease, moderate drinkers have
been shown to have a better prognosis than
abstainers or heavy drinkers. So, while moderate
drinkers may have lower rates of mortality after
a myocardial infarction (MI), prognosis after MI
is uncertain with episodic or binge drinking. A
recent study by Kenneth J. Mukamal, MD et al.
from Beth Israel Deaconess Medical Center in
Boston, MA published in the December 20/27, 2005
issue of Circulation investigated whether
the potentially detrimental risks of even
occasional binge drinking outweighed the
potential benefits of moderate drinking. They
showed that binge drinking was associated with a
2-fold higher mortality after MI.
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L-Arginine Does Not Improve
Vascular Stiffness and May Even Be Associated
With Higher Post-Infarction Mortality
The amino acid L-arginine,
the substrate for nitric oxide synthase (NOS),
has been publicized as being beneficial for
hypertension, angina and heart failure. Steven
Shulman M.D., et al from John Hopkins Hospital
investigated L-arginine’s efficacy in patients
who experienced ST-segment elevation myocardial
infarction (STEMI). Thus, the Vascular
Interaction with Age in Myocardial Infarction
(VINTAGE MI) was designed to test whether the
administration of L-arginine would decrease
vascular stiffness and improve left ventricular
function during the 6-month period following a
patient’s first STEMI. The results, published in
the January 4, 2006 issue of the Journal of
American Medical Association, indicated L-arginine
does not improve vascular stiffness measurements
or ejection fraction and may be associated with
higher post-infarction mortality.
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Rescue Angioplasty after Failed Thrombolytic
Therapy for Patients with Acute Myocardial
Infarction Results in Higher Survival Rate
In patients who have had a myocardial
infarction, intravenous thrombolysis is the
first-line treatment, but primary percutaneous
coronary intervention (PCI) is increasingly
being used to restore flow to arteries. Until
this study, by Anthony Gershlick M.B, B.S. et al
from the University Hospitals of Leicester in
the United Kingdom, appropriate treatment for
patients in whom reperfusion fails to
occur after thrombolytic therapy for acute
myocardial infarction remained
unclear. The study, published in the December
29, 2005 issue of The New England Journal of
Medicine, found event-free survival after
failed thrombolytic therapy was
significantly higher with rescue PCI than with
repeated thrombolysis or conservative
treatment.
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Intensive Diabetes Therapy Has
Long-Term Beneficial Effects On the Risk of
Cardiovascular Disease
Type 1 Diabetes is
associated with complications of many organ
systems, leading to retinopathy, nephropathy and
neuropathy. There is also a significant amount
of cardiovascular damage as a result of
untreated or long-term diabetes. While the
mechanisms of this damage is still unclear, the
Diabetes Control and Complications
Trial/Epidemiology of Diabetes Interventions and
Complications (DCCT/EDIC) Study Research Group
from Bethesda, Maryland studied how intensive
therapy vs. conventional therapy affected the
long-term incidence of cardiovascular disease.
The study, published in the December 22, 2005
issue of The New England Journal of Medicine
found intensive diabetes therapy to be
beneficial for cardiovascular health.
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Serial Determinations of
B-Type Natriuretic Peptide (BNP) Levels During
Outpatient Follow-Up After Acute
Coronary Syndrome Predict the Risk of Death or New CHF
B-type
natriuretic peptide (BNP) is released from
cardiac myocytes in response to
increased wall stress and is elevated in
response to myocardial ischemia. BNP levels are
used as prognostic markers of Acute Coronary
Syndrome (ACS) and response to therapy for ACS.
David Morrow, MD, MPH et al from Brigham and
Women’s Hospital conducted a study evaluating
serial measurements of BNP during extended
follow-up of patients after ACS, thereby
determining the prognostic value of BNP prior to
hospital discharge, at four months and at 12
months after discharge. The study, published in
the December 14, 2005 issue of the Journal of
the American Medical Association, found serial
determinations of BNP levels during outpatient follow-up after ACS predict the risk
of death or new CHF.
MORE…
Circulating Levels of N-Terminal Pro-Brain Natriuretic
Peptide are a Strong Prognostic Biomarker for Patients
with Chronic Stable Angina
Biomarkers of necrosis,
inflammation and vascular damage have become important
indicators of damage associated with acute coronary
syndromes. However, there are less available biomarkers
for chronic stable angina. Recent studies demonstrated
N-terminal pro-brain natriuretic peptide (NT-proBNP) is
increased in patients with acute myocardial infarction
and stable coronary artery disease. Gjin Ndrepepa, M.D.,
et al from the Technische Universitat Munchen in Munich,
Germany compared plasma levels of NT-proBNP in patients
with chronic stable angina to mortality rate. The study,
published in the October 4, 2005 issue of Circulation
found that circulating levels of NT-proBNP are a strong
prognostic biomarker for patients with chronic stable
angina.
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Administration of Intravenous Nicorandil Before Reperfusion in
Patients With St-Segment-Elevation Myocardial Infarction
Leads to Beneficial Clinical Outcomes - Coronary
reperfusion and percutanous coronary intervention are
commonly performed for patients with acute myocardial
infarction (AMI). The addition of pharmacological treatment
can further ameliorate myocardial dysfunction. Recent
clinical trials have shown that nicorandil, a hybrid of adenosine
triphosphate–sensitive K channel opener and
nitrates, exerts beneficial effects as an
adjunctive therapy for patients with ischemic heart disease.
A study done by Hideki Ishii, MD et al from Nagoya
University in Japan observed the difference seen in patients
who were treated with nicorandil prior to reperfusion
therapy and in patients treated with placebo. The study,
published in the August 30, 2005 issue of Circulation,
found the addition of intravenous nicorandil to PCI leads to beneficial clinical outcomes and prevents
cardiovascular events of long duration and death
in patients with ST-segment–elevation myocardial infarction.
MORE…
Sirolimus-Eluting Stents Cause Fewer Adverse Cardiac Events
Than Paclitaxel-Eluting Stents for Coronary Revascularization
Sirolimus-eluting stents and paclitaxel-eluting stents are used
for coronary revascularization and reduce the risk of
restenosis more than bare metal stents. However, until a study
by Stephan Windecker M.D. et al from the University Hospital
Bern in Switzerland, there has been no comparison between the
two types of drug-eluting stents. This study, published in the
August 18, 2005 issue of The New England Journal of Medicine,
found the use of sirolimus-eluting stents results in fewer
major adverse cardiac events than paclitaxel-eluting stents.
MORE…
Elevated CK-MB
Levels in Patients after Percutaneous Coronary Intervention is
Associated With Increased Two-Year Mortality -
In patients who have ischemic heart disease, an elevated CK-MB
level is indicative of tissue necrosis. Elevated CK-MB levels
are frequently detected after percutaneous coronary
revascularization, but few studies have correlated this
increase to post-procedural mortality rates. A recent study, by
Claudio Cavallini et al from the Piazza Ospedale in Treviso,
Italy, collected and studied blood samples from patients
undergoing percutaenous coronary intervention (PCI). In a study
published in the August 2005 issue of European Heart Journal,
researchers found that post-procedural elevation of CK-MB, but
not cTnI, are associated with an increased two-year mortality.
MORE…
Intervention is Associated With Increased Two-Year Mortality
A High Cortisol
to Testosterone Ratio is Associated With Ischemic Heart Disease
Mortality and Incidence
The contributions of stress to
many disease processes have been studied for many years. While
the stressors and physical symptoms of stress can be
subjective, biological markers have been used to study
stress-associated disease. A prospective cohort study conducted
by George Davey Smith, DSc et al from the University of Bristol
in the United Kingdom, compared cortisol to testosterone ratios
to incidence and mortality of ischemic heart disease (IHD). The
study found a specific association between
cortisol:testosterone ratio and incident ischemic
heart disease, apparently mediated through the
insulin resistance syndrome. This study was published in the
July 19, 2005 issue of Circulation.
MORE...
Elevated
C-Reactive Protein is associated with an increased 10-year risk
of Coronary Heart Disease
C-reactive protein (CRP) is a
marker for inflammation that has been reported to be a risk
factor for myocardial infarction in many studies. High CRP is
associated with increased coronary heart disease. In a study
conducted by Mary Cushman M.D., MSc et al from the Departments
of Medicine and Pathology at the University of Vermont,
baseline CRP and 10-year incidence of first MI or CHD death
were compared. This observational cohort study, published in
the July 5, 2005 issue of Circulation, determined that
in older men and women, elevated CRP measurement was associated
with an increased 10-year risk of CHD. MORE...
Percutaneous Coronary Intervention Does Not Offer any Benefits
Over Conservative Therapy in Nonacute Coronary Artery Disease
In patients
with chronic stable coronary artery disease, percutaneous
coronary intervention (PCI) has shown to improve symptoms
compared with conservative medical treatment. However, the risk
of death, myocardial infarction and revascularization had not
been assessed until recently. Demosthenes
Katritsis MD, PhD and John Ioannidis P.A. MD from the Athens
Euroclinic in Greece performed a meta-analysis of 11 randomized
trials comparing PCI with conservative therapy. In a paper
published in the June 7, 2005
issue of Circulation, this study determined that in
patients with chronic stable coronary artery disease, PCI did
not offer any benefits in terms of death, myocardial infarction
or revascularization when compared to conservative medical
therapy.
MORE…
Anemia is Associated With Adverse Clinical Outcomes in Acute
Coronary Syndromes
Long-Term Antibiotic Treatment of
Chlamydia pneumoniae
After Acute Coronary Syndrome Shows No Reduction in
Cardiovascular Events
Addition
of Clopidogrel to Fibrinolytic Therapy for Myocardial
Infarction with ST-Segment Elevation Improves Patency and
Reduces Ischemic Complications
Intensive Statin Therapy Proven Safe and Effective in Patients
with Coronary Artery Disease
Plasma Resistin Levels, Correlated With Markers of
Inflammation, are Predictive of Atherosclerosis in Human
Coronary-Artery Revascularization before elective vascular
surgery does not significantly alter the long-term outcome
Sirolimus-Eluting Stent Implantation in Native Coronary
Arteries Shows a Reduction of
Angiographic
Restenosis
Mesenchymal
Stem Cells Differentiate into Smooth Muscle and
Endothelial Cells, Enhance
Vascularity and Improve Cardiac Function
Lowering LDL
Cholesterol and C-Reactive Protein Levels With Intensive
Statin Treatment Are Effective in Slowing Atherosclerotic
Disease Progression
Lower
C-Reactive Protein Levels Have Better Clinical Outcomes
after Statin Therapy
Coronary Blood Flow Assessment after Successful
Angioplasty for Acute Myocardial Infarction Predicts the
Risk of Long-term Cardiac Events
Emergency angioplasty OK without surgical back-up
Abciximab More
Effective than Tirofiban in Treating Some Acute Coronary
Syndrome Patients
Coated-Stent Trials Show Mixed Results
Combination Therapy Reduces Risk of Heart Disease in
Diabetic Patients
Stent Strut
Thickness Affects Restenosis Rate
Reduced LDL
Cholesterol, Lower Mortality Among Benefits of Statin
Therapy with PCI
Statin Therapy for Acute Coronary Syndrome May Reduce Plaque
Other Coxibs May
Increase Risk of Heart Attack
Ascorbic Acid
Prevents Contrast-Mediated Nephropathy in Patients with Renal
Dysfunction Undergoing Coronary Angiography or Intervention
ACE Inhibitors
Do Not Show Added Benefit in Patients With Stable Coronary
Artery Disease