The American journal of cardiology
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It is important to identify the factors related to survival of patients undergoing primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction. Our objective was to determine the interactive effect of the door-to-balloon (DTB) time and onset-to-door (OTD) time on longer term mortality for patients with ST-segment elevation acute myocardial infarction. The present study was a retrospective cohort analysis of the effect of the DTB time and OTD time on longer term (median follow-up 413 days) mortality for patients undergoing primary percutaneous coronary intervention in New York from January 1, 2004 to December 31, 2006, adjusting for the effect of other important risk factors. ⋯ Patients with a DTB time <90 minutes and OTD time of >or =4 hours had significantly greater mortality than patients with an OTD time of <4 hours and DTB time of <90 minutes (adjusted hazard ratio 1.54, 95% confidence interval 1.04 to 2.30), as did patients with a DTB time of > or =90 minutes and OTD time of > or =4 hours (adjusted hazard ratio 1.48, 95% confidence interval 1.05 to 2.09). For an OTD time of <4 hours and DTB time of > or =90 minutes, mortality showed a trend toward being greater compared to shorter OTD and DTB times (adjusted hazard ratio 1.29, 95% confidence interval 0.95 to 1.77). In conclusion, the combination of short (<90 minutes) DTB time and short (<4 hours) OTD time was associated with the lowest longer term mortality rate.
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Pulmonary hypertension (PH) is a well-recognized complication of left-sided heart failure with preserved left ventricular systolic function that portends a worse prognosis. The identification of risk factors may provide insight into possible mechanisms for the development of PH in this population. Targeting these risk factors could possibly attenuate the development of PH. ⋯ Other significant associations were age > or =80 years, chronic obstructive pulmonary disease, and dyspnea on exertion. In conclusion, PH is a frequent finding in patients with elevated LVEDPs and preserved left ventricular systolic function. Factors associated with its development are LVEDP > or =25 mm Hg, morbid obesity, atrial arrhythmias, age > or =80 years, chronic obstructive pulmonary disease, and dyspnea on exertion.
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An in-office linguistic study was conducted to assess physician-patient discussions of mixed dyslipidemia. Naturally occurring interactions among 12 cardiologists, 12 primary care physicians, and 45 of their patients diagnosed with low levels of high-density lipoprotein cholesterol and being treated with prescription niacin extended-release were recorded. The participants were interviewed separately after the visit. ⋯ Also, missing from the dialogue was a balanced discussion of risks and benefits. Communication gaps were observed in the discussions regarding mixed dyslipidemia and its treatment with niacin extended-release. In conclusion, additional research is warranted to assess the efficacy of communication strategies to educate both physicians and patients about this condition and its treatment.