The American journal of cardiology
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Randomized Controlled Trial
Baseline characteristics of participants in the JUPITER trial, a randomized placebo-controlled primary prevention trial of statin therapy among individuals with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein.
The Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) is a randomized, double-blind, placebo-controlled primary prevention trial of statin therapy among persons with average to low levels of low-density lipoprotein (LDL) cholesterol who are at increased cardiovascular risk due to elevated plasma concentrations of the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP). A total of 17,802 persons with LDL cholesterol<130 mg/dl (3.36 mmol/L) and hs-CRP>or=2 mg/L were recruited from 26 countries and randomly allocated to 20 mg/day rosuvastatin or placebo. ⋯ Thus, in addition to broadening our understanding of statin therapy and inflammation, the JUPITER trial will provide important and clinically relevant information on primary prevention among patients who do not currently qualify for lipid-lowering therapy. In conclusion, as 20 mg of rosuvastatin can reduce LDL cholesterol by up to 50%, JUPITER will also provide crucial safety data for several thousand patients who should achieve LDL cholesterol levels<50 mg/dl on a long-term basis.
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Despite current selection criteria, 20% to 30% of patients treated with cardiac resynchronization therapy (CRT) do not benefit. It has been suggested that QRS duration may not be the optimal criterion to select patients for CRT. The objective of this study was to systematically evaluate the predictive value of QRS duration for response to CRT in a large group of consecutive patients. ⋯ No significant relation was demonstrated between baseline QRS duration and improvement in clinical and echocardiographic variables at 6-month follow-up. In conclusion, baseline QRS duration is not predictive for clinical and echocardiographic responses to CRT at 6-month follow-up. Better predictors for CRT response are needed.
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This study reports long-term follow-up of the on- and off-label implantation of drug-eluting stents (DESs) in a retrospective study of 1,044 patients. Off-label implantation of DESs was performed for left main coronary artery lesions, bifurcation lesions, bare metal stent restenosis, ostial disease, chronic total occlusions, saphenous vein graft lesions, internal mammary artery graft lesions, left ventricular ejection fraction <30%, and acute myocardial infarction. End points examined were procedural complications, in-hospital myocardial infarction, and acute stent thrombosis; end points examined at follow-up were subacute stent thrombosis, late stent thrombosis, target vessel revascularization, myocardial infarction, death, and major adverse clinical events (MACEs; a composite of death, myocardial infarction, and target vessel revascularization). ⋯ Multivariate analysis showed associations between target vessel revascularization and MACEs (respective p values) with bare metal stent restenosis (p=0.001 and p=0.001), diabetes mellitus (p=0.002 and p=0.001), and previous coronary artery bypass grafting (p=0.04 and p=0.01), but not off-label DES implantation (p=1.36 and p=1.16). In conclusion, DES use in the off-label situations studied was safe and was not associated with increased stent thrombosis, myocardial infarction, or death. Multivariate analysis showed that off-label DES implantation was not a risk factor for target vessel revascularization or MACEs.
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The influence of body mass on outcome after cardiac surgery remains controversial. The aim of this study was to analyze the impact of body mass index (BMI) on early and late outcomes in a large series of patients who underwent cardiac surgery. We retrospectively analyzed 5,950 consecutive patients who underwent cardiac surgery between January 1998 and September 2006. ⋯ Obesity was associated with an increased risk for sternal infection (OR 1.8, 95% CI 1.1 to 2.9, p=0.013), whereas underweight correlated with postoperative bleeding (OR 2.0, 95% CI 1.1 to 3.6, p=0.017). Underweight was an independent predictor for decreased long-term survival (OR 1.8, 95% CI 1.3 to 2.5, p<0.001). In conclusion, cardiac surgery can be performed safely in both underweight and obese patients but carries a higher postoperative rate of major complications.
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N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and anemia are predictors of outcome in systolic heart failure. It is currently unclear how these 2 markers interact in particular with regard to the prognostic information carried by each risk marker. We therefore tested the hypothesis that anemia (World Health Organization criteria, hemoglobin levels <7.5 mmol/L for women and <8.0 mmol/L for men) and NT-pro-BNP are associated and evaluated how a possible association affects the prognostic value of each risk marker. ⋯ Patients with anemia and high NT-pro-BNP levels had a fivefold increased risk for mortality (hazard ratio 4.77, 95% confidence interval 2.47 to 9.18, p <0.001). In conclusion, anemia is closely associated with NT-pro-BNP in patients with systolic heart failure, and anemia and NT-pro-BNP carry independent prognostic information. Patients with anemia and high levels of NT-pro-BNP have a markedly increased mortality risk.