American heart journal
-
American heart journal · Apr 2005
Exploring the role of enoxaparin in the management of high-risk patients with non-ST-elevation acute coronary syndromes: the SYNERGY trial.
In patients with non-ST-elevation acute coronary syndromes (NSTE ACS), enoxaparin has been shown to be superior to unfractionated heparin (UFH) and is associated with a reduction in ischemic end points with nonsignificant increases in bleeding. However, the critical trials comparing enoxaparin with UFH were conducted before the widespread use of early invasive management and the availability of clopidogrel and glycoprotein IIb/IIIa receptor antagonists. ⋯ In patients with NSTE ACS, including high-risk patients proceeding rapidly to catheterization, enoxaparin is an effective and safe alternative to UFH.
-
American heart journal · Apr 2005
Comparative StudyEffect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: a ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) substudy.
Obesity is associated with lower B-type natriuretic peptide (BNP) levels in healthy individuals and patients with chronic congestive heart failure (CHF). Neither the mechanism of natriuretic peptide suppression in the obese patient nor whether obesity affects natriuretic peptide levels among patients with acute CHF is known. ⋯ When adjusted for relevant covariates, compared with normal counterparts, overweight and obese patients with acute CHF have lower circulating NT-proBNP and BNP levels, suggesting a BMI-related defect in natriuretic peptide secretion. NT-proBNP fell below the diagnostic cutoff for CHF less often than BNP in overweight and obese individuals; however, when used as a diagnostic tool to identify CHF in such patients, both markers may have reduced sensitivity.
-
American heart journal · Mar 2005
Randomized Controlled Trial Clinical TrialAtorvastatin has an important acute anti-inflammatory effect in patients with acute coronary syndrome: results of a randomized, double-blind, placebo-controlled study.
C-reactive protein (CRP) levels are associated with cardiovascular risk. We assessed the hypothesis that atorvastatin might have anti-inflammatory effects in acute coronary syndromes (ACS) as shown by CRP reduction. ⋯ C-reactive protein levels in ACS were rapidly reduced with atorvastatin. These data provide evidence that statins have fast and early anti-inflammatory effects in addition to lipid-lowering effects in ACS.
-
Patients with end-stage heart failure experience disability, dyspnea, pain, and suffering at the end of life despite progress in treatment approaches. Little is known about the patients with heart failure in hospice and the impact of hospice care on health-related outcomes. ⋯ Further research including prospective study is needed to clearly articulate the impact of hospice care on patients and families affected by heart failure.
-
American heart journal · Feb 2005
Randomized Controlled Trial Clinical TrialEarly cardiac catheterization is associated with lower mortality only among high-risk patients with ST- and non-ST-elevation acute coronary syndromes: observations from the OPUS-TIMI 16 trial.
Early cardiac catheterization has been shown to improve outcomes in patients with non-ST-elevation acute coronary syndromes but not yet in those with ST-elevation myocardial infarction (STEMI). The benefit of catheterization in both syndromes may depend on patient risk for adverse clinical outcomes. ⋯ Inhospital cardiac catheterization is associated with lower mortality in high-risk patients and no difference in mortality in low-risk and intermediate-risk patients after STEMI and NSTEMI. These data support the hypothesis that high-risk patients with either STEMI or NSTEMI may benefit from an early invasive strategy. New prospective randomized trials are warranted, particularly in the STEMI population.