AIMS: A significant number of patients with cardiac syndrome X (CSX) present frequent episodes of severe chest pain, refractory to maximal multi-drug therapy. A few, small, uncontrolled data suggested that spinal cord stimulation (SCS) may have favourable clinical benefits in these patients. METHODS AND RESULTS: We studied 10 CSX patients ...

OBJECTIVES: The purpose of this study is to determine whether there is clinical significance to elevated troponin I in patients with suspected acute coronary syndromes (ACS) with non-critical angiographic coronary stenosis. BACKGROUND: Elevation of troponin in patients admitted with ACS symptoms with non-critical coronary artery disease (CAD) may result from ...

Recent studies demonstrated that glycoprotein (GP) IIb/IIIa receptor antagonists improve endothelial dysfunction of forearm resistance vessels in patients with stable coronary artery disease. However, it remains unclear whether these findings can be extended to the conductance vessel level. In this study, we aimed to evaluate the acute effect of tirofiban ...

Antithrombotic therapy in patients with cervical artery dissection (CAD) is empiric rather than evidence based. The routine use of anticoagulants in each CAD patient cannot be recommended. A randomized controlled trial comparing antiplatelets with anticoagulation is clearly needed. However, due to the large sample size, which is required to gather ...

BACKGROUND: In uremic patients coronary surgery and the entire perioperative management is demanding. METHODS: We analyzed retrospectively data from all patients requiring chronic hemodialysis who under went coronary artery bypass grafting (CABG) between January 1 2001 and December 31 2004 at the Deutsches Herzzentrum Berlin and compared them to those ...

BACKGROUND: In the elderly, acute coronary syndromes (ACS) without ST elevation are a frequent and important cause of admission. In the UK, practice patterns and outcomes in these patients need to be assessed. METHODS: We enrolled 1,046 patients admitted with ACS without ST elevation to 56 UK centres (20 consecutive ...

This review characterizes the relative effectiveness and safety of drug-eluting stents (DES) compared to bare metal stents. The data evaluated will include clinical and angiographic outcomes from randomized clinical trials as well as observational databases and registries including RESEARCH, e-Cypher, and DYNAMIC, which typically include a much broader spectrum of ...

BACKGROUND: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. METHODS: Between October 1998 and May 2000, 13 patients were referred ...

STUDY OBJECTIVES: To evaluate the frequency of sleep-disordered breathing (SDB) in patients presenting with acute cardiovascular events. DESIGN: Repeat observational study. SETTING: Coronary care unit of a university hospital. PATIENTS: A total of 26 patients presenting with unstable angina, myocardial infarction, or left ventricular failure. MEASUREMENTS: Level 3 portable sleep ...

BACKGROUND: Previous studies have shown that ergonovine stress echocardiography (ESE) may be a valuable noninvasive tool for the diagnosis of vasospasm after the confirmation of no significant fixed stenosis. METHODS AND RESULTS: From May 1999 to January 2002, 52 patients who presented with acute coronary syndrome (ACS) and had normal ...

OBJECTIVE: A neural network system was designed to predict whether coronary arteriography on a given patient would reveal any occurrence of significant coronary stenosis (>50%), a degree of stenosis which often leads to coronary intervention. METHODOLOGY: A dataset of 2004 records from male cardiology patients was derived from a national ...

To evaluate the potential role of intravascular ultrasound (IVUS) in evaluating patients experiencing an episode of acute stent thrombosis. Prospective observational study in a cardiac catheterisation laboratory in a university teaching hospital. IVUS was used to examine 12 patients undergoing coronary interventions for stent thrombosis to gain further mechanistic insights ...

INTRODUCTION: Previous studies showed differences in platelet reactivity in response to exercise in patients with syndrome X (SX) and those with obstructive coronary artery disease (CAD). In this study, we investigated whether similar differences could be detectable in response to a mental stressful stimulus. MATERIALS AND METHODS: We studied 30 ...

Synchronous peripheral arterial disease (PAD) and coronary artery disease (CAD) is common. Standardized questionnaires such as the Rose/WHO questionnaire and later the Edinburgh modification of this questionnaire were developed to screen for PAD. Little data are available on the sensitivity of these questionnaires in hospitalized patients with CAD. The aim ...

Thisstudy examines the potential number of patients who would be diverted from hospitals without percutaneous coronary intervention (PCI) capability, to centers with this capability, as a result of prehospital triage strategies for patients with suspected acute myocardial infarction (AMI). All patients with AMI admitted during a 1-year study period at ...

OBJECTIVE: To identify the effect on door to needle (DTN) time of moving the site of thrombolysis delivery from the coronary care unit (CCU) to the emergency department (ED). To ascertain if moving the site of thrombolysis enables appropriate use of thrombolysis. DESIGN: Prospective cohort study. SETTING: CCU and ED ...

BACKGROUND: Practice patterns for percutaneous coronary interventions (PCIs) may differ between Canada and the United States. Few data are available comparing PCI outcomes between the two countries in the era of coronary stenting and adjunctive glycoprotein IIb/IIIa inhibition. METHODS: In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin ...

CONTEXT: Minimum procedure volume thresholds have been proposed to improve outcomes among patients undergoing percutaneous transluminal coronary angioplasty (PTCA). How regionalization policies would affect patient travel distances is not known. OBJECTIVE: To examine the effect of regionalization of PTCA on patient travel distances. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort ...

OBJECTIVES: The purpose of this study was to evaluate mortality and readmission rates of heart failure (HF) patients after major noncardiac surgery. BACKGROUND: There is a lack of generalizable outcome data on HF patients undergoing major noncardiac surgery because previous studies have been limited to a few academic centers or ...

OBJECTIVES: The purpose of our study was to evaluate the significance of polymorphisms in HLA class II genes in coronary artery ectasia (CAE) patients. METHODS AND RESULTS: Twenty-six patients with CAE without associated cardiac defects were enrolled in the study. CAE was defined as luminal dilation of 1.5- to 2.0-fold ...

BACKGROUND: The potential benefit of cholesterol-lowering therapy for normocholesterolemic patients with coronary artery disease (CAD) has not been clarified. The Prevention of Coronary Sclerosis (PCS) Study was designed to evaluate the effect of pravastatin on secondary prevention of progression of CAD in normocholesterolemic patients for a period of 5 years. ...

To examine the expression and localisation of adrenomedullin in human coronary atherosclerotic lesions from patients with unstable angina (UAP) and stable angina (SAP), and to study the relation between adrenomedullin expression and plaque instability. A retrospective observational study. Directional coronary atherectomy samples were obtained from 15 patients with UAP and ...

BACKGROUND: Both endothelial cell activation and macrophage activation play a significant role in atherogenesis and atheromatous plaque vulnerability and may determine rapid coronary artery disease (CAD) progression. We sought to assess the association between serum inflammatory markers and rapid CAD progression in patients with chronic stable angina pectoris. METHODS AND ...

PURPOSE: Chest symptoms, along with standard cardiovascular risk factors, are commonly factored into pretest risk stratification of patients who are referred for stress testing. We sought to determine the independent prognostic value of chest symptoms. METHODS: We studied the outcomes of 10,870 patients referred for symptom-limited exercise testing who had ...

Although the efficacy of glycoprotein IIb/IIIa inhibition in non-ST-elevation acute coronary syndromes is greatest in patients who undergo percutaneous coronary intervention (PCI), it was hypothesized that high-risk patients managed without PCI also benefit. The TIMI risk score was calculated for 1,570 patients randomized to tirofiban plus heparin versus heparin in ...

BACKGROUND: Shedding of endothelial cells from damaged endothelium into the blood occurs in a variety of vascular disorders. The purpose of this study was to evaluate the utility of circulating endothelial cell (CEC) count as a diagnostic marker of non-ST-elevation acute coronary syndromes (ACSs). METHODS AND RESULTS: CEC counts were ...

INTRODUCTION: Patients presenting with chest pain do so at varying times following its onset. In addition, their histories can be unreliable, making the interpretation of time-dependent biochemical markers difficult. Patients are therefore subsequently managed according to measurements of specific markers, such as troponin, taken many hours following their admission. Earlier ...

OBJECTIVE: The objective of this retrospective analysis of high-risk patients treated with bivalirudin during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was to evaluate the safety and feasibility of direct thrombin inhibitor (DTI) without concomitant glycoprotein (GP) IIb/IIIa inhibition. BACKGROUND: Reperfusion by PCI is the treatment ...

Acetylsalicylic acid (ASA) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of ASA administration in the emergency department (ED) for patients with acute myocardial infarction or unstable angina, and to identify patient characteristics associated with its administration. This is a ...

Chronic angina is a major medical problem in the United States with more than 6 million patients affected, a number that will increase substantially because of the progressive aging of the population. The annual mortality rate for patients with chronic angina is approximately 2%, but is much higher in certain ...

AIM: This study aimed at assessing the impact of attenuation correction performed by means of a new hardware device (Beacon(tm)) in the assessment of coronary artery disease with myocardial SPECT and, afterwards, at identifying what specific risk class of patients would mostly benefit from the technique. METHODS: The first 500 ...

Mycoplasma pneumoniae (MP) seropositivity was reported to be associated with coronary events. MP organisms were detected with Chlamydia pneumoniae (CP) in coronary plaques. We investigated MP and CP seropositivity in 549 patients undergoing coronary angiography. Coronary artery disease (CAD) was found in 396 patients, of whom 154 had myocardial infarction ...

To describe the clinical features, diagnosis, treatment and outcome of children with Kawasaki disease (KD) treated at a large tertiary care Canadian paediatric hospital and to try to identify correlations between clinical features and the development of coronary artery abnormalities. The charts of 176 patients diagnosed with typical, atypical or ...

Drug eluting stents have been shown to reduce the rate of in-stent restenosis in cases where single lesions are treated. The performance of these stents, in patients with multivessel disease and complex lesions, however, remains unknown. Our experience with sirolimus eluting stents in such patients is presented. This study includes ...

BACKGROUND: We evaluated the incidence and predictors of single and multiple plaque ruptures in acute myocardial infarction (AMI) and stable angina pectoris (SAP). METHODS AND RESULTS: We performed 3-vessel intravascular ultrasound (IVUS) examination in 235 patients: 122 had AMI, and 113 had SAP. Plaque rupture of infarct-related or target lesions ...

PURPOSE: Silent myocardial ischaemia--as evaluated by stress-induced perfusion defects on myocardial perfusion scintigraphy (MPS) in patients without a history of chest pain--is frequent in diabetes and is associated with increased rates of cardiovascular events. Its prevalence has been determined in asymptomatic diabetic patients, but remains largely unknown in diabetic patients ...

BACKGROUND: The outcome in patients treated surgically for coronary artery disease is known to be influenced by the extent of the disease. Whether this factor also has an effect in patients undergoing isolated minimally invasive revascularization of the left anterior descending (LAD) artery using the internal thoracic artery (ITA) (MIDCAB) ...

BACKGROUND: Inflammatory reactions within coronary atherosclerotic plaques are increasingly thought to be crucial determinants of the clinical course in patients with coronary artery disease (CAD). Platelet-activating factor-acetylhydrolase (PAF-AH) is considered to reflect the ongoing inflammatory process in patients with CAD. Our objective was to determine the activity of PAF-AH in ...

Patients with non-ST-elevation acute coronary syndromes (ACS) are typically grouped together and treated with similar approaches to therapy despite tremendous variability in clinical presentation and prognosis. The cardiac troponins are biomarkers of myocardial necrosis that have recently been evaluated in conjunction with markers of neurohormonal activation such as brain natriuretic ...

BACKGROUND: Green tea, a popular beverage in Japan, contains many polyphenolic antioxidants, which might prevent atherosclerosis. This study was designed to determine whether the consumption of green tea is proportionately associated with a decreased incidence of coronary artery disease (CAD) and the cardiovascular and cerebrovascular prognosis. METHODS AND RESULTS: The ...

Inflammation plays a key role in coronary artery disease (CAD), but whether it is involved in the pathogenesis of syndrome X (SX) is not known. Thus, we assessed the presence of systemic inflammation in patients with SX and its possible relation to infections from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and ...

OBJECTIVES: The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. BACKGROUND: Little information exists regarding outcome of patients with dyspnea. METHODS: We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise ...

OBJECTIVES: We sought to verify whether the intravascular metabolism of chylomicron-like emulsion may predict the clinical evolution of patients with coronary artery disease (CAD) undergoing secondary prevention therapy of CAD. BACKGROUND: Case-control studies have suggested an association between impaired intravascular catabolism of triglyceride (TG)-rich lipoproteins and CAD. However, evidence is ...

The prevalence of chronic kidney disease (CKD) is increasing in North America, with an attendant increase in cardiovascular complications. The bulk of the mortality and morbidity in CKD patients can be attributed to coronary artery disease (CAD), especially in the presence of diabetes mellitus. Thus, screening and diagnosis of CAD ...

BACKGROUND: Endothelial progenitor cells (EPC) are present in peripheral blood and can develop a functional endothelial phenotype. The number and function of circulating EPCs are altered in atherosclerosis, diabetes, and after myocardial infarction and EPCs have been shown to promote postnatal angiogenesis and vasculogenesis. We investigated the number and adhesive ...

BACKGROUND: Hyperhomocysteinemia, associated with low folate and low B12 levels, is known to be an independent risk factor for atherosclerosis. Only a few available data has been demonstrated in Thai patients. OBJECTIVE: To evaluate serum fasting homocysteine, folate and B12 levels whether to see they are associated with coronary artery ...

We assessed the effect of transradial access (vs transfemoral access) for percutaneous coronary intervention on postprocedure length of stay and patient outcomes (in-hospital complications and all-cause and cardiac death at 6 and 12 months) in 225 elderly patients (> or =80 years old). Raw differences between transradial and transfemoral accesses ...

BACKGROUND: Randomized clinical trials have shown that a sirolimus-eluting stent significantly reduces restenosis after percutaneous coronary revascularization. Diabetic patients are known to have a higher risk of restenosis compared with nondiabetic patients. The purpose of this analysis was to determine the impact of sirolimus-eluting stents on outcomes of diabetic compared ...

The aim of this study was to define the use of a new cardiac troponin I (cTnI) assay for emergency patients with chest pain and no specific electrocardiographic changes consistent with the presence of ischemia. Patients (n = 106) admitted in Emergency/Cardiology Departments for chest pain and suspicion of acute ...

BACKGROUND: To determine the extended results of mechanical connectors we compared the 1-year outcomes of patients having beating heart coronary artery bypass surgery with at least one sutured or mechanically connected proximal vein graft anastomosis. METHODS: From May 2001 to December 2001, 166 patients were identified as having undergone off-pump ...