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  CORONARY ARTERY DISEASE


 Editor: Asher Kimchi, MD

 
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. MOREĽ

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. MOREĽ

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. MOREĽ

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. MOREĽ


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. MOREĽ


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. MOREĽ


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. MOREĽ


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. MOREĽ


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. MORE…

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

 

 

 

 


 

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