The American journal of cardiology
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Although ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) occurs primarily in the setting of severe ischemic heart disease (IHD), a significant proportion of events occurs in patients who do not have severe IHD. The relative effect of IHD on survival after VF OHCA is unknown. All residents of Rochester, Minnesota, who presented with a VF OHCA from November 1990 to December 2004, treated by emergency medical services, were included in the study. ⋯ In conclusion, compared with patients with non-IHD, those with IHD had similar short- and long-term survival rates. Long-term survival in patients with IHD was primarily influenced by other co-morbid conditions. Nonetheless, in patients with IHD, use of an implantable cardioverter-defibrillator and statin therapy were associated with higher long-term survival rates.
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Although the adverse health consequences of obesity in the general population have been well documented, recent evidence suggests that obesity is associated with better outcomes in patients with heart failure (HF). Studies of patients with HF that specifically examined the impact of body mass index (BMI) on outcomes have suggested the existence of an "obesity paradox." However, closer examination of these studies raises important questions on the validity of the paradox. First, the diagnosis of HF in obese patients, particularly when made using clinical variables, may not be accurate; the obese patients in these studies may actually be "healthier" than their nonobese comparators. ⋯ Furthermore, few studies have specifically examined the more severely obese population (BMI >35 kg/m(2)) when assessing outcomes, and those that have suggest that severely obese patients may have worse outcomes than patients with normal weights or those who are mildly obese. Therefore, a "U-shaped" outcome curve according to BMI for patients with HF may actually exist, in which mortality is greatest in cachectic patients; lower in normal, overweight, and mildly obese patients; but higher again in more severely obese patients. Further prospective studies assessing the impact of more marked degrees of obesity on outcomes in patients with HF are needed to more conclusively determine whether the obesity paradox truly exists.
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Little is known about the prognostic value of leukocyte count on admission for patients with chest pain. In total, 1,461 patients who presented to the emergency department with non-ST-segment elevation chest pain were studied by clinical history, electrocardiography, serial troponin I determination, and leukocyte count on admission. End points were 1-year mortality and major events (mortality or infarction). ⋯ Further, in the subgroup with normal troponin levels, leukocyte count was not significantly different between patients with or without ST depression (7,969 +/- 2,171 vs 8,108 +/- 2,356 cells/ml, p = 0.6) and was not associated with mortality in patients with ST depression (p = 0.7). In conclusion, leukocyte count on admission is predictive of mortality in patients with chest pain and non-ST-segment elevation myocardial infarction. However, in the absence of myocardial necrosis, leukocyte count lacks prognostic value.
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Contrast-induced nephropathy (CIN), usually defined as an increase in serum creatinine of 0.5 mg/dL (44.2 mumol/L), or a 25% increase from the baseline value 48 hours after the procedure, is a common and potentially serious complication of the use of iodinated contrast media in patients at risk of acute renal injury. It is an important cause of hospital-acquired renal failure, responsible for approximately 11% of cases. CIN may be difficult to distinguish from cholesterol embolization, another cause of postprocedure renal impairment. ⋯ A higher incidence of in-hospital and late cardiovascular events, as well as longer hospital stays, has been reported in patients developing CIN. In a small proportion of patients, CIN is severe enough to require dialysis, and these patients have a particularly poor prognosis. Many of the risk markers for CIN are also predictive of a worse prognosis.
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Meta Analysis
Meta-analysis of data from the six primary prevention trials of cardiovascular events using aspirin.
Until recently, 5 major studies have formed the basis for the use of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention has not been established firmly. Six randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial, the Physicians' Health Study, the Thrombosis Prevention Trial, the Hypertension Optimal Treatment study, the Primary Prevention Project, and the Women's Health Study. ⋯ There was no evidence of statistical bias (p >0.05). Given the study size and cohort, aspirin decreased the risk of CV events in this large patient sample. In conclusion, primary prevention with aspirin decreased the risk of total CHD, nonfatal MI, and total CV events, but there were no significant differences in the incidences of stroke or CV mortality.