The American journal of cardiology
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We aimed to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation for previous CAD events, who were classified using body mass index (BMI) groups and gender-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system. ⋯ Obesity by BMI was not associated with MACE in either men (HR 1.07, 95% CI 0.76, 1.51, p = 0.69) or women (HR 0.98, 95% CI 0.62, 1.56, p = 0.95). In conclusion, WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI in patients with CAD when including nonfatal events.
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In the acute heart failure (AHF) setting, the usefulness of C-reactive protein (CRP) at admission as a risk marker is challenged by the possible confounding effect of an acute-phase response. We thus evaluated the relation of CRP level at discharge (i.e., after stabilization of AHF) with subsequent postdischarge outcome in patients hospitalized for AHF. The acute decompensated heart failure syndromes study prospectively registered 4,269 hospitalized AHF patients with data on CRP levels at discharge. ⋯ However, the HR for CRP levels in the fourth quartile decreased markedly with time, and CRP levels in the second (1.2 to 3.1 mg/L) and third (3.2 to 9.5 mg/L) quartiles were independently associated with poorer survival after the 120-day follow-up period (adjusted HR, 1.41 and 1.63, respectively). In addition, only CRP levels in the third quartile were independently associated with the composite end point of all-cause death and readmission for AHF after the 120 days of long-term follow-up (adjusted HR, 1.31). In conclusion, our results suggest that a modestly elevated CRP level (approximately 3 to 10 mg/L) at discharge had unique long-term prognostic implications in hospitalized patients with AHF.
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Observational Study
Prognostic Significance of Complex Ventricular Arrhythmias Complicating ST-Segment Elevation Myocardial Infarction.
The aim of the study was to assess the clinical significance of complex ventricular arrhythmias (VAs) (sustained ventricular tachycardia [sVT] and ventricular fibrillation [VF]) in patients with ST-segment elevation myocardial infarction (STEMI) depending on timing of arrhythmia. We analyzed 4,363 consecutive patients with STEMI treated invasively between 2004 and 2014. The median follow-up was 69.6 months (range: 0 to 139.8 months). ⋯ Apart from cardiogenic shock on admission, late postreperfusion (hazard ratio 3.39) and prereperfusion VAs (hazard ratio 2.76) were the strongest independent predictors of death in the analyzed population. In conclusion, 1 in 10 patients with STEMI treated invasively was affected by sVT or VF. The clinical impact of VAs was strongly dependent on timing of arrhythmia.