AIMS: The aim of this study was to assess the effect of the angiotensin converting enzyme inhibitor perindopril on cardiovascular events in diabetic patients with coronary artery disease. METHODS AND RESULTS: A total of 1502 diabetic patients with known coronary artery disease and without heart failure of 12 218 overall ...

BACKGROUND: Intracoronary flow and pressure measurements can be used for evaluating intermediate lesions. Studies focussing on short- and medium-term results demonstrated its safety. Long-term results are, however, not available. OBJECTIVE: The goal of this study was to assess the long-term safety and clinical implications of decision making for intermediate coronary ...

We hypothesized that higher neutrophil counts are associated with an increased incidence of major adverse cardiovascular events (MACE) in patients with clinically advanced atherosclerosis. We prospectively studied 398 patients (233 men; median age, 69 years) with symptomatic peripheral artery disease who were admitted to the inpatient ward of the angiology ...

BACKGROUND: Small, uncontrolled studies of dialysis-dependent chronic kidney disease (CKD) patients have demonstrated abnormalities of cardiovascular autonomic control and vascular compliance, which may contribute to adverse cardiovascular morbidity in this population. However, there is little information utilizing newer, noninvasive techniques in predialysis patients with increasing degrees of uremia. METHODS: One ...

OBJECTIVES: Young patients with an ischaemic stroke or transient ischaemic attack (TIA) often have no vascular risk factors. Hyper-homocysteinaemia is an established risk factor for stroke in elderly patients but it is uncertain whether it is also important for the prognosis of young ischaemic stroke and TIA patients. We examined ...

BACKGROUND: Although iodine 123 15-(p-iodophenyl)-3-(R , S) methylpentadecanoic acid (BMIPP) can assess abnormal utilization of fatty acid in the diseased myocardium, the prognostic value of BMIPP imaging at rest in patients with known or suspected coronary artery disease (CAD) remains unclear. METHODS AND RESULTS: A total of 270 patients were ...

Myocardial perfusion imaging (MPI) is frequently utilized for preoperative risk assessment. Results are pertinent for long-term risk. MPI, though most frequently applied in intermediate-risk patients, may also be valuable in selected low- and high-risk individuals. Coronary stenting may alter the timing of noncardiac surgery, which should be considered when performing ...

BACKGROUND: Although practice guidelines do not recommend routine exercise testing of patients after coronary stenting, several small studies have suggested that stress myocardial perfusion imaging can provide prognostic information about future adverse cardiac events. We sought to determine if exercise nuclear testing provides independent prognostic information in patients after coronary ...

BACKGROUND: Prediction of long-term outcomes for patients presenting with cardiac events is important, but few predictive instruments are available. We previously developed an innovative scoring system, the Mid America Heart Institute (MAHI) Coronary Care Unit (CCU) scoring system, for quantifying outcomes of patients admitted to the CCU, using clinical events ...

Mild renal impairment is an important risk factor for late cardiovascular complications. This substudy of the Lescol Intervention Prevention Study (LIPS) assessed the effect of fluvastatin on outcome of patients who had renal dysfunction and those who did not. Complete data for creatinine clearance calculation (Cockcroft-Gault formula) were available for ...

The aim of this paper was to summarise the reported excess in coronary events on Mondays, and examine the evidence for three competing explanations: stress, alcohol consumption, or registration errors. A review of the literature found 28 studies covering 16 countries and over 1.6 million coronary events. The overall Monday ...

Coronary calcifications are specific markers for coronary atherosclerosis. The amount of coronary calcium is related to the likelihood of vulnerable plaques. Vulnerable plaques may rupture and may result in sudden coronary thrombus formation, occlusion, ischemia and ventricular fibrillation and finally cardiac death. Therefore, it is reasonable to believe that the ...

BACKGROUND: The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes. METHODS: Troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted ...

BACKGROUND: Evaluated the efficacy of reducing the risk of cardiac events by a preclinical diagnosis of CAD in subjects with type 2 diabetes mellitus with 2 or more cardiovascular risk factors. METHODS: One hundred forty-one subjects with type 2 diabetes mellitus without known cardiac disease and asymptomatic, aged >45 to ...

Cardiovascular complications remain the principal cause of both morbidity and mortality after major vascular surgery. The well-known coincidence between vascular disease and coronary artery disease provided the rationale for a detailed analysis of major perioperative cardiovascular complications in their relation to preoperative and intraoperative parameter 90 patients scheduled to undergo ...

BACKGROUND: Myocardial imaging is widely used to detect coronary artery disease and to assess its prognosis. In vasospastic angina (VA), cardiac imaging can provide information on disease activity, which is related to cardiac events. The aim of this study was to clarify whether exercise thallium-201 imaging (Tl-SPECT) and 123I-metaiodobenzylguanidine imaging ...

Standardized guidelines are fine, but one size does not fit all when it comes to cardiac patients. In fact, clinicians often struggle with deciding how aggressively to treat a patient who has suffered a heart attack or another form of acute coronary syndrome. However, a new risk-prediction tool can help ...

AIMS: To test the prognostic value of ventricular late potentials (LPs) in a large cohort of post-infarction patients in the modern reperfusion era. METHODS AND RESULTS: 1800 consecutive survivors of acute myocardial infarction in sinus rhythm and under 76 years of age were enrolled. Many (99%) of the patients received ...

BACKGROUND: Renovascular disease is a cause of secondary hypertension and renal insufficiency and is suspected to contribute to morbidity and mortality of coronary heart disease. This investigation prospectively examined associations between renovascular disease and adverse coronary events among a population-based sample of elderly Americans. METHODS: The Cardiovascular Health Study is ...

Perioperative myocardial infarction (PMI) is one of the most important predictors of short- and long-term morbidity and mortality associated with non-cardiac surgery. Prevention of a PMI is thus a prerequisite for an improvement in overall postoperative outcome. The aetiology of PMI is multifactorial. The perioperative period induces large, unpredictable and ...

OBJECTIVE: To review outcomes and quality of life following two surgical strategies for severe left ventricular dysfunction due to ischemic dilated cardiomyopathy. METHODS: Hospital and follow-up records of 111 patients with extensive ischemic cardiomyopathy (mean age 57.3+/-8.4) referring to our institution between January 1996 and December 2003 were reviewed. Group ...

BACKGROUND: Awareness of the significance of peripheral arterial disease is increasing, but quantitative estimates of the ensuing burden and the impact of other risk factors remains limited. The objective of this study was to fill this need. METHODS: Morbidity and mortality were examined in 16,440 index patients diagnosed with peripheral ...

BACKGROUND: Elevated levels of serum uric acid and albuminuria are associated with cardiovascular disease, but the relationships have not consistently been demonstrated to be independent of hypertension, other risk factors, or each other. The purpose of this study was to evaluate people at high risk for cardiovascular disease for the ...

OBJECTIVES: The authors sought to validate a clinical decision rule that young adult (younger than 40 years) chest pain patients without known cardiac disease who had either no cardiac risk factors and/or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day adverse cardiovascular ...

Patients undergoing infrainguinal arterial reconstruction frequently have increased cardiac risk factors. Diabetic patients are often asymptomatic despite advanced cardiac disease. This study investigates whether preoperative cardiac testing improves the outcome in diabetic patients at risk for cardiac disease. We retrospectively reviewed all patients undergoing lower-extremity arterial reconstructions in a 32-month ...

From January 2001 through June 2002, 128 consecutive patients undergoing lung resection for various diseases were evaluated preoperatively by a cardiologist at our institution in order to predict postoperative cardiac complications in pulmonary surgery. Our assessment algorithm consisted of the following: Smoking, hypertension, hyperlipidemia, advanced age, diabetes mellitus, and history ...

OBJECTIVE: To assess the incidence of major cardiac events in critically ill patients with a high risk of cardiac complications presenting with an elevated heart rate. DESIGN AND SETTING: Observational, retrospective study in a 15-bed medical/surgical Intensive Care Unit (ICU) at a university hospital for a period of 12 months. ...

Cardiovascular complications are the major cause of perioperative morbidity and mortality of patients undergoing major vascular surgery. This is related to the frequent presence of an underlying coronary artery disease. This paper reviews the pathology of perioperative cardiac complications and cardiac risk assessment and risk reduction strategies. Guidelines of the ...

BACKGROUND: Limited data are available on the value of quantitative stress myocardial perfusion imaging (MPI) in patients with unstable angina. In this report we sought to study the long-term prognostic value of quantitative stress MPI in patients hospitalized with unstable angina with no new ischemic electrocardiographic changes and negative cardiac ...

In recent years a growing body of evidence has emphasized the role of C-reactive protein (CRP) as a marker of future cardiovascular events. CRP is a pentameric molecule widely utilized as a marker of infections and inflammation. The evidence that inflammation plays an important role in the pathogenesis of coronary ...

Elevated plasma homocyst(e)ine levels have prothrombotic and proatherosclerotic effects. Data from prospective studies indicated that plasma homocyst(e)ine acts as a modest independent predictor of coronary heart disease. At present, no conclusive data are available on the possible interaction between hyperhomocyst(e)inemia and hypertension and the occurrence of cardiovascular events. Recent longitudinal ...

BACKGROUND: Unknown is the predictive value of the coronary artery diameter without the administration of vasomotor stimuli. A small reference diameter of the target vessel has been demonstrated to be an adverse prognostic factor in patients undergoing revascularisation. The present study investigated the prognostic value of the proximal non-stenotic left ...

OBJECTIVE: To determine the baseline (time 0) risk factors associated with the subsequent occurrence of vascular events in a multiethnic US cohort (LUMINA [LUpus in MInorities: NAture versus nurture]) of patients with systemic lupus erythematosus (SLE). METHODS: Five hundred forty-six LUMINA patients were assessed at time 0 for traditional and ...

The risk of perioperative myocardial infarction or cardiac death in patients undergoing non-cardiac surgery may be estimated by clinical risk factor analysis and by myocardial stress testing. While stress testing modalities accurately delineate reversible myocardial ischaemia, their positive predictive value is low, and it is not clear whether their implementation ...

BACKGROUND: This was a single-institutional study about total arterial myocardial off-pump coronary artery bypass grafting (OPCAB) surgery. METHODS: We studied 569 multivessel coronary artery bypass patients who underwent total arterial OPCAB (42.7% of total OPCAB and 42.4% of total coronary artery bypass grafting operations) between June 2000 and June 2003. ...

In 2003, the American Heart Association and the Centers for Disease Control and Prevention issued a scientific statement that suggested the use of high-sensitivity C-reactive protein, a recognized marker of inflammation, as an optional myocardial infarction risk factor measurement (Circulation. 2003;107:499-511). Compared with earlier guidelines, the statement suggested a more ...

Elevated plasma levels of homocysteine (hyperhomocysteinemia) are increasingly recognized as a potential risk for atherothrombotic vascular diseases by numerous epidemiological and clinical studies. There are increasing experimental data that indicate mechanisms by which homocysteine may alter the vasculature in a way that predisposes to atherosclerotic vascular disease. A key event ...

Current consensus guidelines recommend postoperative electrocardiographic surveillance only in patients at relatively high risk of postoperative major cardiac complications, but the usefulness of electrocardiograms after major noncardiac surgery is unknown. We prospectively studied 3,570 patients who underwent major noncardiac procedures and had electrocardiograms performed in the recovery room. Rates of ...

BACKGROUND: Patients with myocardial infarction without angiographically significant coronary artery lesions are considered, as a whole, to have a better prognosis. Different degrees of coronary involvement, within this wide group, may portend different degrees of risk. The aim of this study was to assess which clinical and angiographic covariates are ...

PURPOSE: To identify and characterize the evidence supporting decisions made in the care of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: the elderly, heart transplantation, hyper-reactive airway disease, coronary artery disease, and obstructive sleep apnea. SOURCE: A structured search of MEDLINE ...

STUDY OBJECTIVES: To evaluate the implication of plasma biomarkers to future cardiovascular events in nondiabetic patients with stable coronary artery disease (CAD). Designs and settings: Prospective, follow-up study at a tertiary referral center. Patients and measurement: Serial plasma biomarkers including high-sensitivity C-reactive protein (hsCRP), homocysteine, soluble adhesion molecules, von Willebrand ...

OBJECTIVE: It is not rare for patients with cardiomyopathy to be asymptomatic for long periods or to show improved cardiac function following various medical interventions. Conversely, cardiac events sometimes occur in those patients, requiring close observation. We assessed the usefulness of 123I-metaiodobenzylguanidine myocardial scintigraphy (MIBG) to predict the occurrence of ...

The perioperative management of patients at risk for cardiovascular diseases who undergo non-cardiac surgery has been subject of debate over the past few decades and is still of great interest. An adequate perioperative management may modify postoperative mortality and morbidity and may improve the long-term prognosis. The purpose of this ...

We compared the predictive value of the Rush score with the Thrombolysis In Myocardial Infarction (TIMI) risk score in unselected patients with an acute coronary syndrome and evaluated the effect of compliance with established guidelines on the accuracy of these models. The Registry of Acute Coronary Syndromes is a retrospective ...

We sought to identify specific determinants of long-term cardiac events and survival in patients undergoing major arterial operations after preoperative cardiac risk stratification by American College of Cardiology/American Heart Association guidelines. A secondary goal was to define the potential long-term protective effect of previous coronary revascularization (coronary artery bypass grafting ...

BACKGROUND: The aims of the present study were to determine the prevalence of inducible myocardial ischemia (IMI) in renal transplant recipients (RTR) more than 50 years old, to identify predictors of IMI, and to search for its prognostic value. METHODS: Among the 377 renal transplantations performed between 1989 and 1998 ...

Nursing research has contributed to our knowledge of patients with coronary heart disease (CHD), although much of the research has focused on acute cardiac events. Active and ongoing programs of research into CHD patient outcomes are essential as significant gaps remain. Consistently effective strategies to help patients change risk behaviors, ...

BACKGROUND: Depressed heart rate variability at acute myocardial infarction discharge is associated with poor long-term prognosis. However, its early (<48 h) predictive value has not been extensively investigated. Aim of this Multicenter Italian Study was to investigate, during acute myocardial infarction, in-hospital prognostic value of heart rate variability and its ...

OBJECTIVES: We sought to evaluate a simple risk index based on age and vital signs in a community sample of patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: A simple risk index based on age and vital signs (heart rate x [age/10](2)/systolic blood pressure) developed from patients with STEMI accurately ...

This study was performed to investigate the risk of cardiac events by eccentric or continuous dosing of nitrates in patients with healed myocardial infarction. A total of 573 patients with healed myocardial infarction were assigned to one of two groups: a nitrate-treatment (n =239) and a nontreatment (n =334) group. ...