Angiology
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Observational Study
Predictors of blood pressure reduction with nocturnal continuous positive airway pressure therapy in patients with obstructive sleep apnea and prehypertension.
Previous studies showed that treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) significantly reduced the blood pressure (BP) in hypertensive patients. We investigated the predictors of BP change in normotensive patients with OSAS who underwent CPAP. A total of 24 patients with OSAS (19 male; age: 48.7 ± 10.4 years) were enrolled. ⋯ Also, both daytime and nighttime BP showed significant reduction after CPAP. Male gender, Epworth sleepiness scale, body mass index, smoking, alcohol use, and baseline 24 hMPB were the independent predictors of a fall in 24 hMBP. The CPAP therapy may provide benefit even in the absence of overt hypertension by reducing both daytime and nighttime BP.
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We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 ± 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. ⋯ A significant correlation was detected between total bilirubin and SXscore (r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI.
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Preoperative cardiovascular evaluation of patients scheduled to undergo surgery requires a multidisciplinary approach involving anesthetists, surgeons, and cardiologists. Within the last 5 to 10 years, there have been considerable scientific advances in this field, and the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association(ACC/AHA) have updated their guidelines.(1,11) Greater emphasis now lies on preoperative clinical risk stratification and less on routine cardiac testing. Prophylactic coronary revascularization is now also seen as rarely indicated simply to lower the risk of surgery.(1) This review will give a brief summary of the guidelines and suggests a practical stepwise approach to evaluate the patient preoperatively.
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Like the earlier multicenter General Anesthesia (GA) versus Local Anaesthesia (LA) for carotid surgery (GALA) trial, a recent independent study showed no difference in transient ischemic attack, stroke, myocardial infarction, and death rates between carotid endarterectomy (CEA) performed under LA compared with GA. Besides these outcomes, however, several additional issues may be of interest when comparing the 2 modalities. Examples include the occurrence of post-CEA patient delirium, cognitive dysfunction, and health-related quality of life, as well as the cost-effectiveness, length of hospitalization, and resource utilization. This commentary discusses and compares these outcomes of CEA performed under LA versus GA.