The American journal of cardiology
-
Comparative Study Clinical Trial
Usefulness of computed tomographic coronary angiography in patients with acute chest pain with and without high-risk features.
The accuracy of 64-slice computed tomographic coronary angiography (CTA) and its ability to direct revascularization in patients with acute chest pain syndrome (ACPS) was investigated. A total of 107 patients with ACPS presenting to the emergency department and referred to cardiology were prospectively enrolled and underwent CTA. From the clinical features, the patients were categorized as having high-risk acute coronary syndrome features or no high-risk features. ⋯ The agreement between CTA and routine testing (single photon emission computed tomography or ICA) was very good (kappa = 0.94). CTA correctly identified 40 patients (100%) who underwent revascularization and 61 (91.0%) who were treated medically (kappa = 0.88, 95% CI 0.79 to 0.97). In conclusion, CTA might represent a single modality that could be used to triage a wide spectrum of patients with ACPS and could have the potential to rule out coronary disease and identify those who might require revascularization.
-
Pulmonary artery hypertension (PAH) increases mortality in patients with severe aortic stenosis. We hypothesized that left atrial (LA) dysfunction would be related to PAH in patients with severe aortic stenosis complicated by left ventricular (LV) systolic dysfunction. The data from 70 patients with severe aortic stenosis and LV systolic dysfunction were analyzed. ⋯ In conclusion, in patients with severe aortic stenosis and concomitant LV systolic dysfunction, the LA function parameters displayed the strongest correlations with the right ventricular systolic pressure, irrespective of the AV area or gradient and were impaired in patients with PAH. LA function recovered after AV replacement. Additional studies are warranted to determine the prognostic significance of LA function in this setting.
-
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), but no study has yet compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents for multivessel CAD among non-hemodialysis-dependent (HD) patients with CKD. In our institution's registry, we identified 812 patients with CKD (glomerular filtration rate <60 ml/min) who had undergone either CABG or PCI for multivessel CAD from May 2003 to December 2006. Of these patients, 725 had non-HD CKD, and 87 were hemodialysis-dependent. ⋯ However, among patients with non-HD CKD and 3-vessel CAD, those who underwent CABG tended to have a lower long-term mortality rate than those who underwent PCI (hazard ratio 0.61, 95% confidence interval 0.36 to 1.03; p = 0.06). In the patients with non-HD CKD treated for 2-vessel CAD, those who underwent CABG or PCI had a similar long-term mortality risk (hazard ratio 1.12, 95% confidence interval 0.52 to 2.34; p = 0.7). In conclusion, in patients with non-HD CKD and multivessel CAD, CABG led to better survival than PCI with drug-eluting stents, but CABG patients had a greater short-term risk of requiring permanent hemodialysis.
-
Atrial fibrillation (AF) and obesity have reached epidemic proportions. The impact of obesity on clinical outcomes in patients with established AF is unknown. We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. ⋯ In each BMI category, risk of death from any cause was similar for patients randomized to a rhythm- or rate-control strategy. In conclusion, in patients with established AF, overweight and obesity do not adversely affect overall survival. Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy.
-
The aim of the study was to assess the impact of multivessel coronary artery disease (MVD) and noninfarct-related artery (non-IRA) revascularization during index percutaneous coronary intervention (PCI) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI). Data on 1,598 of 1,650 patients with complete angiographic data, with >or=1 significantly stenosed epicardial coronary artery, and without previous coronary artery bypass grafting were retrieved from the EUROTRANSFER Registry database. Patients with 1-, 2-, and 3-vessel disease made up 48.5%, 32.0%, and 19.5% of the registry population, respectively. ⋯ These patients were at higher risk of 30-day and 1-year death compared to patients without non-IRA PCI, but this difference in mortality was no longer significant after adjustment for covariates. In conclusion, patients with MVD have decreased epicardial and myocardial reperfusion success and had worse prognosis after primary PCI for STEMI compared to patients with 1-vessel disease. In this large multicenter registry, non-IRA PCI during the index procedure was performed in 9% of patients with MVD and it was associated with increased 1-year mortality.