International journal of cardiology
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Comparative Study
Acute coronary syndromes--the prognostic impact of hypertension, diabetes and its combination on long-term outcome.
Knowledge about the simultaneous influence of diabetes and hypertension on outcome among patients with ischemic heart disease is limited. The objective of this survey was to describe the characteristics, treatment and outcome among patients with acute coronary syndromes (ACS) in relation to previous history of hypertension (HT), diabetes mellitus (DM) or a combination of the two. ⋯ ACS patients with a history of HT and DM had a higher age-adjusted, long-term mortality risk than ACS patients without such a history. DM appeared to be more strongly associated with mortality than HT, but its combination was additive.
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Letter Comparative Study
Comparison of incidence and angiography patterns in definite thrombosis between drug-eluting and bare-metal stents.
Stent thrombosis is a feared complication of percutaneous coronary intervention due to its catastrophic consequences. We analysed the incidence of angiographically-confirmed thrombosis in 5011 consecutive patients treated with drug-eluting stents or bare-metal stents. Although the incidence of thrombosis was similar between the two groups (0.8%), angiographically-documented late thrombosis was a relatively unusual complication after implantation of either stent, though it was more common with drug-eluting stents than bare-metal stents (0.25 vs. 0.06%, P=.03).
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In the setting of acute coronary syndromes, plasma lipids have not been defined as prognostic variables, however little research has been dedicated to this specific issue. In order to test the independent predictive value for in-hospital events of low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides measured at hospital admission, 97 individuals with unstable angina or non-ST-elevation acute myocardial infarction were evaluated. In-hospital events, defined as death, non-fatal myocardial infarction or recurrent unstable angina, were significantly predicted by HDL-cholesterol (C-statistics=0.69; 95% CI=0.55-0.83, P=0.018), contrary to LDL-cholesterol (C-statistics=0.40; 95% CI=0.24-0.56, P=0.23) and triglycerides (C-statistics=0.48; 95% CI=0.31-0.65, P=0.83). ⋯ Logistic regression analysis showed HDL-cholesterol< or =32 mg/dl (OR=3.6; 95% CI=1.0-14; P=0.05) and TIMI Risk Score (OR=2.3; 95% CI=1.4-2.9, P=0.001) as the independent predictors of events. Furthermore, the addition of HDL-cholesterol to TIMI Risk Score improved its C-statistic from 0.81 to 0.85. In conclusion, as opposed to LDL-cholesterol and triglycerides, HDL-cholesterol level adds prognostic value to the prediction of in-hospital recurrent events during non-ST-elevation acute coronary syndromes.
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Clinical Trial
Remifentanil plus low-dose midazolam for outpatient sedation in transesophageal echocardiography.
The search for optimal sedation for transesophageal echocardiography (TEE) continues. We hypothesized that the ultra-short acting opioid remifentanil combined with very low-dose midazolam would provide a better sedation and recovery profile compared to midazolam alone. ⋯ This is the first report of the use of an ultra-short acting opioid, remifentanil, combined with a low-dose of midazolam, as a sedative technique for outpatient TEE. In this pilot, non-randomized prospective study, remifentanil plus low-dose midazolam provided better sedation than our current practice of higher bolus doses of midazolam alone. This novel approach is associated with improved procedure tolerance, faster recovery and minimal resource utilization. A randomized, controlled study is under way to verify our preliminary results.
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We describe the case of a man with acute aortic dissection detected by contrast transthoracic echocardiography. Conventional echocardiography was not contributory. To our knowledge, this is the first report of the usefulness of contrast echocardiography in ascending aortic dissection at bedside.