cardiovascular-agents and Angina--Unstable

Chinese herbal injections (CHIs) have been commonly used in the treatment of unstable angina pectoris (UAP) in China. However, there is no consensus or evidence on how to select CHIs for patients with UAP. The choice often depends on the personal experience or preference of clinician. This study aims to compare the effect of different CHIs for UAP using Bayesian network meta-analysis (NMA).. A systematic search will be conducted in PubMed, the Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Data from inception to February 2018. We will include randomized controlled trials (RCT) regarding CHIs in the treatment of UAP. Quality of included RCTs will be assessed according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed with WinBUGS 14 to compare the efficacy of different CHIs. GRADE will be used to assess the quality of evidence.. The results of this NMA will be submitted to a peer-reviewed journal for publication.. Our study will generate evidence for CHIs in the treatment of UAP and help clinicians make more accurate therapeutic schedule. In addition, it might provide suggestions for Chinese medicine clinical practice or guideline.

Topics: Analgesics; Angina, Unstable; Cardiovascular Agents; Drugs, Chinese Herbal; Humans; Injections; Network Meta-Analysis; Systematic Reviews as Topic

Acute coronary syndrome is a common cause of morbidity and mortality, both in the United States and worldwide. The goal of this review is to familiarize clinicians with recent information regarding the diagnosis and treatment of acute coronary syndrome.. PubMed search and review of the relevant medical literature.. Acute coronary syndrome encompasses three clinical diagnoses: unstable angina, non-ST-segment elevation myocardial infarction), and ST-segment elevation myocardial infarction. The definition, pathophysiology, clinical presentation, diagnosis, and treatment of unstable angina/non-ST-segment elevation myocardial infarction are reviewed here. Diagnosing unstable angina/non-ST-segment elevation myocardial infarction is a significant challenge in critically ill patients not initially suspected of having acute coronary syndrome (i.e., noncardiac intensive care unit patients), and diagnostic and treatment strategies for these patients have not been clearly established.. Patients with acute coronary syndrome benefit from intensive medical therapy, including antianginal, antiplatelet, antithrombotic, and statin agents. Depending on their risk for future cardiovascular events as well as their risk of bleeding complications, patients may benefit from either an early invasive treatment strategy, in which routine coronary revascularization is performed, or a conservative strategy, in which revascularization is reserved for patients with recurrent or provocable cardiac ischemia.

Topics: Acute Coronary Syndrome; Angina, Unstable; Biomarkers; Cardiovascular Agents; Critical Illness; Diagnosis, Differential; Electrocardiography; Humans; Myocardial Infarction; Myocardial Revascularization; Thrombosis

The spectrum of acute coronary syndrome (ACS) including unstable angina, non-ST-elevation myocardial infarction and ST-elevation myocardial infarction accounts for increasing numbers of deaths among persons age > or = 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardiac medications as an early-invasive approach among this population.

Topics: Acute Coronary Syndrome; Age Factors; Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Evidence-Based Medicine; Health Services for the Aged; Humans; Myocardial Infarction; Patient Selection; Practice Guidelines as Topic; Thrombolytic Therapy; Treatment Outcome

The American College of Cardiology and American Heart Association have updated their guidelines for the management of non-ST-segment-elevation acute coronary syndrome for the first time since 2002. In the interim, several important studies affecting choices of therapy potentially begun in the emergency department have been completed, and care patterns have changed and matured significantly. In this review, we present the new recommendations that are pertinent to emergency medicine practice and comment on their potential implementation into an evidence-based, multidisciplinary approach to the evaluation and management of this challenging patient population.

Topics: Acute Coronary Syndrome; Angina, Unstable; Angioplasty, Balloon, Coronary; Anticoagulants; Cardiology; Cardiovascular Agents; Coronary Artery Bypass; Emergency Service, Hospital; Humans; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Societies, Medical; United States

Over the last 3 decades, our ability to mechanically dilate obstructive coronary arterial stenoses has fundamentally altered our approach to managing patients with coronary artery disease (CAD). The result has been a swing from an initial pharmacologic approach to anatomically driven revascularization. An accumulation of clinical evidence provides strong support for such intervention in acute coronary syndromes (ACS). In stable CAD, dilative therapy was believed to be superior based on the assumption that high-risk coronary anatomy or myocardial ischemia increases the risk of future death and myocardial infarction. However, there have been major advances in our understanding of the pathophysiology of ACS and the recognition of the significance of predisposing non-flow-limiting coronary stenoses prone to rupture, as well as increasing insight into plaque and patient vulnerability. This improved understanding of the disease has led to the more aggressive use of appropriately targeted pharmacologic agents and an evolution in what constitutes optimal medical therapy (OMT). Data from recent studies, such as the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, support the concept that in patients with stable CAD, OMT alone in this day and age compares favorably with a therapeutic strategy combining OMT with mechanical intervention. Thus, the treatment pendulum may be swinging back to the understanding that "best practice" today requires the judicious use of interventional and medical therapies in the appropriate patient population.

Topics: Acute Coronary Syndrome; Angina, Unstable; Angioplasty, Balloon, Coronary; Benchmarking; Cardiovascular Agents; Chronic Disease; Coronary Disease; Disease Progression; Endothelium, Vascular; Humans; Inflammation; Myocardial Revascularization; Oxidative Stress; Risk Factors; Xanthophylls

Acute coronary syndromes (ACS) present a major health challenge in modern medicine. With new clinical trials being conducted, our knowledge of latest therapies for ACS continually evolves. In this article, we review currently available medical therapies and provide evidence-based rationale for current pharmacologic therapies. Among the antiplatelet therapies, aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors demonstrate significant efficacy in reducing morbidity and mortality. Among the anticoagulants, unfractionated heparin and low molecular weight heparin, particularly enoxaparin sodium, remain the hallmarks of therapy against which newer anticoagulants are often compared. Bivalirudin has recently showed significant efficacy in decreasing cardiovascular events and mortality, but with potentially less risk of bleeding than heparin. Results of trials evaluating warfarin remain inconsistent regarding potential benefits. Finally, fondaparinux sodium, recently tested, shows promise as a powerful yet safe anticoagulant. Fibrinolysis is an acceptable modality for reperfusion if facilities equipped for primary percutaneous revascularization are not available. Regarding anti-ischemic therapy, beta-adrenoceptor antagonists and nitrates remain critical in the early management of ACS. Inhibitors of the renin-angiotensin-aldosterone system have also shown significant reductions in the morbidity and mortality of patients presenting with ACS, particularly in patients with left ventricular dysfunction and clinical heart failure, with ACE inhibitors being first-line agents and angiotensin receptor antagonists being a reasonable substitute if ACE inhibitors are not tolerated. Among the lipid-lowering therapies, statins (HMG-CoA reductase inhibitors) have been documented as being the most well tolerated and most efficacious therapies for ACS patients and data exist that they should be administered early in ACS management. Studies evaluating combination therapy (antiplatelet drugs, beta-adrenoceptor antagonists, ACE inhibitors, and lipid-lowering agents) show a clear benefit in mortality in patients with known coronary artery disease. Efforts to improve these key evidence-based medical therapies are numerous and include such programs as the American College of Cardiology's Guidelines Applied in Practice, international patient registries such as the Global Registry of Acute Coronary Events, and studies such as CRUSADE. Finally, patients with diabetes mellitus pose

Topics: Acute Disease; Angina, Unstable; Anticoagulants; Cardiovascular Agents; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Evidence-Based Medicine; Fibrinolytic Agents; Humans; Hypolipidemic Agents; Myocardial Infarction; Platelet Aggregation Inhibitors; Practice Guidelines as Topic

To increase awareness among nurse practitioners (NPs) of the American College of Cardiology (ACC)/American Heart Association (AHA) 2002 guideline update for the diagnosis and treatment of acute coronary syndrome, and for secondary prevention in patients with unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI).. ACC/AHA 2002 guideline update for the management of patients with UA and NSTEMI, ACC/AHA guidelines for patients with coronary and other atherosclerotic vascular disease, 2006 update, selected research and clinical articles.. Recent research has shown that patients with UA/NSTEMI benefit from the routine, long-term use of dual antiplatelet therapy with aspirin and clopidogrel. In suitable patients, outcome is also improved by adoption of an early invasive strategy combined with aggressive medical therapy.. Familiarity with the patient as well as current management recommendations can improve clinical outcomes for patients with UA/NSTEMI. Thus, NPs can play a pivotal role in the management of coronary disease, both during and following an acute ischemic event.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Cardiovascular Agents; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Nurse Practitioners; Practice Guidelines as Topic; Risk Assessment; Thrombolytic Therapy

Acute coronary syndrome is a major health problem affecting approximately 1.5 million individuals a year. Early diagnosis and appropriate evidence-based therapies improve clinical outcomes significantly. Current data suggest that an early invasive therapy may improve intermediate-term and long-term outcomes, particularly in high-risk individuals. The last few years also have seen significant advances in antiplatelet and antithrombotic therapies for the management of patients who have acute coronary syndrome.

Topics: Acute Coronary Syndrome; Angina, Unstable; Cardiovascular Agents; Clinical Protocols; Humans; Myocardial Infarction; Myocardial Revascularization; Risk Assessment

Stable angina pectoris is a manifestation of ischemic heart disease which frequently leeds to acute coronary syndrome. The patient has a short effort or stress situation induced retrosternal pain which is easing after the elimination of its cause, or taking nitroglycerin. Several new data have appeared in the literature about the pathogenesis and diagnosis of stable angina pectoris. Due to the international guidelines using the new drugs and revascularisation techniques, the primary and secondary prevention of stable angina pectoris was improved.

Topics: Acute Disease; Angina Pectoris; Angina, Unstable; Cardiovascular Agents; Humans; Myocardial Ischemia; Syndrome

Patients with CKD and CAD have traditionally been a difficult population to diagnose and treat in the setting of ACS. In addition to having poorer outcomes post-ACS, data are lacking regarding best treatments available. Aggressive interventional and medical treatments in this group with already poor outcomes are not necessarily contraindicated and should always be considered. The appalling outcome for CKD patients post-ACS is improved by many therapies shown to benefit in the non-CKD patients. Data suggest that troponins are useful markers in CKD patients, that major bleeding is not increased with the use of GP IIb-IIIa antagonists, that thrombolytics have been used successfully in CKD patients, and that PCI electively and as a primary treatment for ACS is successful and probably more beneficial to treatment.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Humans; Kidney Failure, Chronic; Myocardial Infarction

Emergency department (ED) management of patients who present with suspected unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) is especially challenging. Therapies that demonstrate benefit in patients who experience proven disease may not be indicated in patients who present with suspected disease. The emergency practitioner must have a clear understanding of the benefit and harm of each therapy, allowing formulation of a simple approach to treatment selection based on disease presentation. This article reviews current literature and discusses the treatment recommendations from the American College of Cardiology (ACC) and American Heart Association (AHA) for patients who experience UA and ST elevation myocardial infarction (STEMI).

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Decision Making; Electrocardiography; Humans; Myocardial Infarction; Treatment Outcome

NSTE-ACS is a complex clinical event characterized by a variable degree of myocardial ischemia and triggered, in most patients, by a rupture of a vulnerable plaque that leads to acute intraluminal nonocclusive thrombosis. Traditionally, acute management strategies for NSTE-ACS have been aimed at identification of vascular areas with discrete atheroma and revascularization of the affected myocardium. Studies that have evaluated invasive strategies in NSTE-ACS suggest that the rates of hard clinical events are similar for both intensive medical treatment and early invasive management strategies. As shown recently in the Cooperative Cardiovascular Project study, intensive therapy with beta-blockers appears to be a viable management option that has comparable outcomes in most patients with NSTE-ACS. Although several different treatment strategies have been advocated in the management of NSTE-ACS, the available evidence-based information does not fully support some of these traditional approaches. Future prospective, well-controlled trials are needed to fully ascertain the role of invasive and other medical management strategies in patients with NSTE-ACS. Long-term aggressive management of established risk factors for CAD is unquestionably the most prudent and cost-effective therapeutic approach in the long-term management in patients recovering from NSTE-ACS.

Topics: Algorithms; Angina, Unstable; Anticoagulants; Cardiovascular Agents; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myocardial Infarction; Myocardial Revascularization; Platelet Aggregation Inhibitors

Topics: Analgesics, Opioid; Angina, Unstable; Biomarkers; Cardiovascular Agents; Electrocardiography; Europe; Humans; Morphine; Myocardial Infarction; Myocardial Reperfusion; Oxygen Inhalation Therapy; Shock, Cardiogenic

Many advances have been made in the treatment of acute coronary syndromes. Patients with intermediate-risk or high-risk features should receive treatment with the newer pharmacologic agents--enoxaparin, statins and, in selected cases, clopidogrel--in addition to established standard therapies (i.e., aspirin, beta-blockers, nitroglycerin, and oxygen). Use of GpIIb-IIIa inhibitors should also be strongly considered, especially in an early invasive approach. However, there is no substitute for a good physician who has the big picture and knows the individual patient in totality. This physician can best judge the dangers of the patient's acute cardiac condition against the comorbidities that may be exacerbated by revascularization procedures. The ability to weigh the risks of the patient's acute coronary syndrome against the risks of an aggressive invasive approach ultimately provides the best care for each patient.

Topics: Adrenergic beta-Antagonists; Angina, Unstable; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Chest Pain; Clinical Protocols; Hematologic Agents; Humans; Myocardial Infarction; Nitrates

Thiazide diuretics, b-blockers, calcium channel blockers, and angiotensin converting enzyme (ACE) inhibitors are all superior to placebo for the primary prevention of coronary events in patients with hypertension. Recent studies have shown that ACE inhibitors are better than other antihypertensive agents in lowering overall cardiovascular morbidity and mortality, especially stroke. Blood pressure should be aggressively lowered (to < 140/90 mm Hg), especially in diabetic patients (to < 130/80 mm Hg), but care should be exercised in lowering the diastolic blood pressure below 65 mm Hg in patients with significant occlusive coronary artery disease. Hypertension in patients with stable angina should be treated with a b-blocker (alternatively a calcium channel blocker) together with an ACE inhibitor. Patients with hypertension and acute coronary syndrome (unstable angina or myocardial infarction) should be treated with a b-blocker, and with an ACE inhibitor if there is left ventricular dysfunction. A thiazide diuretic and/or a dihydropyridine calcium channel blocker could be added for blood pressure control. Calcium channel blockers should be avoided if there is significant left ventricular dysfunction.

Topics: Angina, Unstable; Blood Pressure; Cardiovascular Agents; Clinical Trials as Topic; Humans; Hypertension; Myocardial Infarction; Myocardial Ischemia

The clinical presentations of ischemic heart disease comprises the term of acute ischaemia syndromes, that include unstable angina pectoris, non-Q-wave myocardial infarction, Q-wave-myocardial infarction and sudden death. Among the different presentations of acute ischemic syndromes, the unstable angina and non-Q-wave myocardial infarction can be regarded together. In both pathologic entity, the plaque rupture, or erosion signifies the primary event, which is the source of the highly thrombogenic substances coming out from the core of the atherosclerotic plaque and entering to the coronary and systemic circulation. They cause a thrombocyte-rich "white" intracoronary thrombus, that is not fully obstructive, or there is adequate collateral circulation, being the pathogenetic substrate that prevents the development of transmural necrosis. The nosologically-bound two clinical entity can be called as "unstable coronary artery disease" (UCAD), since they have uniform etiologic, risk stratification and therapeutic backgrounds and also therapeutic targets that are basically distinct, they are admitted for transmural "ST-elevation" infarction. The review is discussing the therapy and the questions of follow-up of the disease according to the guidelines of the European Society of Cardiology and to the multicenter evidence based studies.

Topics: Angina, Unstable; Antithrombins; Cardiovascular Agents; Coronary Artery Bypass; Death, Sudden, Cardiac; Fibrinolytic Agents; Heart Conduction System; Heparin, Low-Molecular-Weight; Humans; Multicenter Studies as Topic; Myocardial Infarction; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Randomized Controlled Trials as Topic; Vasodilator Agents

Management of acute coronary syndromes has been the focus of increased interest in recent years. This has come about with the recognition that the majority of patients who present to the hospital with chest pain have unstable angina or non-Q-wave myocardial infarction (MI). Further, sensitive biochemical markers of myocardial necrosis, such as troponin and creatine kinase, have improved early diagnosis. Markers of inflammation such as C-reactive protein (CRP), although not in wide clinical practice, may provide an early and important marker of prognosis. The current approach to management of acute coronary syndromes is careful risk stratification so as to select appropriate medical therapies and to guide the clinician to appropriate interventions such as angiography or percutaneous coronary intervention (PCI). Established therapies such as aspirin, heparin, intravenous nitrates, and, in selected patients, beta blockers or calcium antagonists, are being used concomitantly with, or are being supplanted by, newer therapies such as low-molecular-weight heparins and glycoprotein IIb/IIIa inhibitors. The role of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) in patients with acute coronary syndromes is being investigated and shows promise.

Topics: Acute Disease; Adrenergic beta-Antagonists; Algorithms; Angina, Unstable; Biomarkers; Calcium Channel Blockers; Cardiovascular Agents; Coronary Disease; Heparin, Low-Molecular-Weight; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myocardial Infarction; Nitroglycerin; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Randomized Controlled Trials as Topic; Risk; Risk Factors; Severity of Illness Index; Syndrome; Troponin I

This paper provides current information on the pharmacologic management of cardiovascular diseases. It also describes the drugs used to treat five common cardiovascular disorders--heart failure, coronary artery disease, atrial fibrillation, hypertension, and unstable angina--and lists their dental implications. This information can be used to monitor patients for potential adverse drug reactions and drug interactions and to provide an information base for medical consultation.

Topics: Angina, Unstable; Atrial Fibrillation; Cardiovascular Agents; Coronary Disease; Dental Care for Chronically Ill; Heart Failure; Humans; Hypertension

Topics: Acute Disease; Angina, Unstable; Angioplasty, Balloon, Coronary; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Coronary Artery Bypass; Coronary Disease; Coronary Thrombosis; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Middle Aged; Myocardial Infarction; Syndrome

The term unstable angina should only be used to describe patients whose immediate prognosis is uncertain and the nature of the unstable disease may vary on a patient to patient basis, making broad categorization of such patients inappropriate. Unstable angina may be caused by extracardiac factors, such as uncontrolled hypertension and tachycardia, disruption of an atheromatous plaque, dynamic or intermittent coronary artery thrombosis, haemorrhagic dissection into an atheromatous plaque, epicardial coronary spasm or progression of atherosclerosis as a result of plaque healing. Control of symptoms using medical therapy with a combination of nitrates, beta-blockers and calcium antagonists is usually quite successful. In the absence of contra-indications, intravenous heparin, and possibly anti-platelet agents, should also be used in the acute phase of treatment. In addition, one aspirin a day is indicated unless there are definite contra-indications. If symptoms are relieved, evaluation and management should proceed as with chronic stable angina. Identification of patients with a poor prognosis should be the main indication for urgent revascularization. One of the best predictors of a poor prognosis in unstable disease is persistent pain despite optimum therapy. Urgent surgery should be considered in any patient with multivessel coronary artery stenosis who has evidence of persistent myocardial ischaemia, despite adequate medical therapy.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Artery Bypass; Humans; Myocardial Ischemia; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome

Coronary artery disease is a major clinical problem in the elderly. This article discusses the medical management of stable and unstable angina pectoris. A review of the general measures and drug therapy used to treat these disorders, especially as they relate to the elderly patient are presented. In addition, new insights into the pathophysiologic mechanisms of chronic stable angina and unstable angina are reviewed.

Topics: Adrenergic beta-Antagonists; Aged; Angina Pectoris; Angina, Unstable; Calcium Channel Blockers; Cardiovascular Agents; Coronary Disease; Female; Humans; Male; Nitrates; Vasodilator Agents

The primary goals in treatment of unstable angina are to relieve pain and prevent or limit myocardial infarction or ischemia. Patients with distinct, rapid progression of their usual angina pattern should be admitted to a coronary care unit and given heparin and intravenous nitrates as well as aspirin. Cardioselective beta blockers should also be administered when there are no contraindications. Intravenous thrombolytic agents are indicated in patients with objective evidence of ischemia who fit criteria for this therapy. However, thrombolysis is not advocated for routine treatment of unstable angina. Percutaneous transluminal coronary angioplasty or coronary artery bypass grafting should be considered--depending on the location, age, and morphology of the culprit lesion and the degree of left ventricular dysfunction--in patients who have refractory or recurrent ischemia despite aggressive medical therapy. However, in general, high-technology interventions are not a substitute for long-term regimens, such as risk-factor and lifestyle modification, daily aspirin, and pharmacologic therapies aimed at maximizing cardiac function.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Disease; Humans

The currently available antianginal drugs act by reduction of myocardial O2 requirement and/or by coronary vasodilatation. The choice between beta blockers, nitrates, calcium antagonists or their combination depends on the clinical presentation, coexisting disorders and specific factors in individual patients. In addition to symptomatic treatment, secondary prophylactic measures, such as aspirin and reduction of serum cholesterol, are also necessary to prevent progression of the underlying coronary artery disease. In this paper the comparative efficacy and the indications of the various types of antianginal drugs are discussed.

Topics: Angina Pectoris; Angina, Unstable; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Humans; Isosorbide Dinitrate; Myocardial Infarction; Nitroglycerin; Platelet Aggregation Inhibitors; Vasodilator Agents

Topics: Angina, Unstable; Angiography; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Electrocardiography; Humans; Radionuclide Imaging

Atherosclerotic coronary artery disease is an important problem in the elderly and is the leading cause of death. It is a diagnosis that is often difficult to make; signs and symptoms of angina pectoris and myocardial infarction can be atypical in the elderly patient for a variety of reasons. The chest radiograph, electrocardiogram, and echocardiogram can provide diagnostic clues as to the presence of coronary artery disease. Exercise testing is foremost among the noninvasive diagnostic modalities, but it has significant limitations particular to the elderly patient. These include a decreased ability to exercise in the elderly, difficulty in interpretation because of an abnormal resting electrocardiogram, and the nature of an imperfect test that provides a statement of probability rather than an unequivocal diagnosis. Cardiac catheterization can be performed with minimal risk in selected, particularly unstable patients, in whom a surgical alternative is contemplated. The elderly patient can benefit as much from coronary artery bypass graft surgery as younger counterparts, albeit with a modestly increased risk. The medical therapy of coronary artery disease, stable and unstable angina, and myocardial infarction is not substantially different in the older patient. Nitrates, beta blockers, and calcium antagonists provide relief of anginal symptoms. The older patient stands to derive the same benefits from CCU monitoring as does the younger patient. An increased awareness of adverse drug reactions is necessary, however, and as for patients of any age, the particular goals of therapy may differ substantially and require an individualized approach.

Topics: Aged; Angina, Unstable; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiovascular Agents; Coronary Artery Bypass; Coronary Disease; Echocardiography; Exercise Test; Humans; Myocardial Infarction

Danhong injection (DHI)，which is extracted from Salviae miltiorrhizae and Flos carthami，has been widely prescribed to patients with unstable angina pectoris (UAP) in China. However, a high quality clinical trial is needed.. To determine whether DHI can relieve symptoms of transient myocardial ischemia in patients with unstable angina pectoris.. A double-blind, placebo-controlled, randomized clinical trial was conducted in nine hospitals in China. Inpatients with UAP with blood stasis syndrome (BSS) were randomized 1:1 to receive DHI or placebo. The primary outcome was improvement rate in the quantification score of angina pectoris. Secondary outcomes included blood stasis syndrome scale, nitrates use, electrocardiogram recordings, PCI procedures, Seattle Angina Questionnaire (SAQ) and biochemical indexes.. 160 participants were enrolled and 159 were analyzed. There was no significant difference in primary outcome as compared with control group at the end of 7-day treatment, but significant difference at 28-day follow up (70.53% [95% CI, 59.97-81.09%] and 54.34% [95% CI, 42.68-65.99%]; P = 0.0423). The BSS score was significantly lower in the DHI group than that in the control group at day 28 (6.49 [6.96] vs 10.53 [9.07], P = 0.0034). In addition, DHI was significantly superior to placebo in the angina stability score of SAQ (91.10 [17.37] versus 78.21 [22.08], P < 0.001). There were no significant differences in other secondary outcome measures.. A small decrease in the total effective rate and an increase in the angina stability score were observed 28 days after implementation of DHI in UAP with a total blood stasis syndrome score decrease, but the efficacy was not observed at day 7. The findings support that DHI may potentially relieve clinical symptoms and can benefit angina stability.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02007187.

Topics: Adult; Aged; Angina, Unstable; Cardiovascular Agents; Double-Blind Method; Drugs, Chinese Herbal; Female; Humans; Male; Middle Aged; Phytotherapy

Detoxifying and blood-activating Chinese medicine granule formula, which includes 15 g of Polygonum cuspidatum Sieb. et Zucc. (Polygonum cuspidatum) and 10 g of Crataegus pinnatifida Bunge (Hawthorn), can relieve the symptoms and serve as supplementary treatment for unstable angina.. This study aimed to explore the role of detoxifying and blood-activating formulae in the treatment of unstable angina and the potential mechanism involved.. A total of 144 participants with unstable angina were randomly divided into experimental and control groups. Both groups were treated with standardized Western medicine; the experimental group was additionally treated with detoxifying and blood-activating Chinese medicine granules, which included 15 g of P. cuspidatum and 10 g of C. pinnatifida for 4 weeks. The primary endpoint was the frequency of weekly angina pectoris attacks before and after treatment. The secondary endpoints, also observed before and after treatment, included blood glucose, blood lipids, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10, and adiponectin levels, as well as the ratio of pro/anti-inflammatory factors and evaluation scales of symptoms and syndromes in Chinese and Western medicine.. In both experimental and control groups, the frequency of weekly angina pectoris attacks was lower after treatment (P < 0.01), but with no significant intergroup difference (P = 0.10). After intervention, the hs-CRP, TNF-α, and IL-6 levels decreased, while the IL-10 and adiponectin levels significantly increased in the experimental group (P < 0.05 or 0.01). The ratios of the inflammatory factors significantly decreased after treatment, particularly in the experimental group (P < 0.01). Symptoms and syndromes were also ameliorated in the experimental group (P < 0.01), showing a significant difference from the control group (P < 0.01).. Detoxifying and blood-activating formulae can reduce the frequency and relieve symptoms of unstable angina, and this mechanism may be related to a regulation of the balance of pro- and anti-inflammatory factors.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Cardiovascular Agents; Crataegus; Cytokines; Drugs, Chinese Herbal; Fallopia japonica; Female; Gene Expression Regulation; Humans; Inflammation; Male; Middle Aged; Phytotherapy

Polymer-free amphilimus-eluting stents (PF-AES) represent a novel elution technology in the current era of drug-eluting stents. The clinical safety and efficacy of PF-AES as compared with latest-generation permanent-polymer zotarolimus-eluting stents (PP-ZES) have not yet been investigated in a large randomized trial.. In this physician-initiated, prospective, multicenter, randomized, noninferiority trial, an all-comers population requiring percutaneous coronary intervention was enrolled across 3 European sites. Randomization (1:1 ratio) to PP-ZES or PF-AES was performed after stratification for troponin status and diabetes mellitus. In both treatment arms, troponin-positive patients were planned for 12-month dual antiplatelet therapy, whereas troponin-negative patients were planned for 1-month dual antiplatelet therapy. Outcome assessors were blinded to the allocated treatment. The device-oriented primary end point of target-lesion failure was defined as cardiac death, target-vessel myocardial infarction, or target-lesion revascularization at 12-months as analyzed by modified intention-to-treat (80% power, and a 3.5% noninferiority margin).. In total, 1502 patients were randomized and 1491 treated with the assigned stent and available for follow-up. The primary end point occurred in 42 (5.6%) of the 744 patients receiving PP-ZES versus 46 (6.2%) of the 747 patients receiving PF-AES. PF-AES were clinically noninferior to PP-ZES (risk difference, 0.5%; upper limit 1-sided 95% confidence interval, 2.6%; P. PF-AES were noninferior to PP-ZES regarding target-lesion failure at 12 months. Findings regarding the secondary end point and prespecified subgroups were generally consistent with that of the primary end point.. URL: https://www.clinicaltrials.gov . Unique identifier: NCT02328898.

Topics: Acute Coronary Syndrome; Aged; Angina, Stable; Angina, Unstable; Cardiovascular Agents; Coronary Artery Disease; Coronary Thrombosis; Drug-Eluting Stents; Europe; Female; Humans; Male; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Polymers; Prospective Studies; Prosthesis Design; Risk Factors; Sirolimus; Time Factors; Treatment Outcome

The aim of this study was to explore the safety and efficacy of a dedicated drug-eluting stent for the treatment of coronary lesions with very small reference vessel diameter (RVD).. Smaller RVD is associated with increased risk for restenosis and target lesion failure (TLF) after stent implantation.. This was a prospective, single-arm, multicenter trial of the Resolute Onyx 2.0-mm zotarolimus-eluting stent. The primary endpoint was 12-month TLF, which was compared with a pre-specified performance goal. Subjects with stable or unstable angina or ischemia, target lesions ≤27 mm in length, and RVD ≥2.0 and <2.25 mm were eligible for enrollment. A subset of subjects underwent follow-up angiography at 13 months post-procedure.. A total of 101 subjects with 104 lesions were enrolled. The mean age was 67.3 ± 9.6 years, 47% of subjects had diabetes, the mean lesion length was 12.6 ± 6.3 mm, and the mean RVD was 1.91 ± 0.26 mm. The rate of TLF at 12 months was 5.0%, fulfilling the pre-specified performance goal of 19% (p < 0.001). The rates of target lesion revascularization and target vessel myocardial infarction were 2.0% and 3.0%, respectively. There were no episodes of stent thrombosis. In-stent late lumen loss was 0.26 ± 0.48 mm, and the rate of binary restenosis was 12.0%.. In this first report of a drug-eluting stent with a dedicated size to treat lesions with RVD <2.25 mm, the Resolute Onyx 2.0-mm zotarolimus-eluting stent was associated with a low rate of TLF and late lumen loss, without a signal for stent thrombosis. This novel-sized drug-eluting stent appears to be a feasible option for the treatment of coronary lesions in extremely small vessels. (Medtronic Resolute Onyx 2.0 mm Clinical Study; NCT02412501).

Topics: Aged; Angina, Stable; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Restenosis; Coronary Vessels; Drug-Eluting Stents; Female; Humans; Japan; Male; Middle Aged; Percutaneous Coronary Intervention; Prospective Studies; Prosthesis Design; Sirolimus; Time Factors; Treatment Outcome; United States

In acute coronary syndrome (ACS), potassium levels <3.5 mEq/L are associated with ventricular arrhythmias. Current guidelines therefore recommend a potassium target >4.0 mEq/L in ACS. Our study evaluated the association between potassium levels, cardiac arrhythmias, and cardiovascular death in patients with non-ST-segment elevation myocardial infarction or unstable angina.. Potassium levels were measured in 6515 patients prior to randomization to receive either ranolazine or a placebo in the MERLIN-TIMI 36 trial. A seven-day continuous electrocardiographic assessment was obtained to determine the incidence of non-sustained ventricular tachycardia (NSVT) and ventricular pauses. The association between potassium levels and cardiovascular death was evaluated using a Cox proportional hazards regression model with multivariable adjustment.. The lowest risk of cardiovascular death was observed in patients with admission potassium levels between 3.5 and 4.5 mEq/L. Both lower and higher levels of potassium were associated with tachyarrhythmias and bradyarrhythmias, suggesting a potential mechanistic explanation for the increased risk of cardiovascular death at the extremes of potassium homeostasis.

Topics: Aged; Angina, Unstable; Arrhythmias, Cardiac; Cardiovascular Agents; Electrocardiography; Female; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction; Potassium; Ranolazine

Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy.. In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone). A permuted block randomisation was generated by the Centre for Biostatistics and Epidemiology with stratification on the inclusion hospitals in opaque concealed envelopes, and sealed envelopes with consecutive inclusion numbers were made. The primary outcome was a composite of myocardial infarction, need for urgent revascularisation, stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014. An intention-to-treat analysis was used. This study is registered with ClinicalTrials.gov, number NCT01255540.. During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41-0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35-0·76; p=0·0010) for myocardial infarction, 0·19 (0·07-0·52; p=0·0010) for the need for urgent revascularisation, 0·60 (0·25-1·46; p=0·2650) for stroke, and 0·89 (0·62-1·28; p=0·5340) for death from any cause. The invasive group had four (1·7%) major and 23 (10·0%) minor bleeding complications whereas the conservative group had four (1·8%) major and 16 (7·0%) minor bleeding complications.. In patients aged 80 years or more with NSTEMI or unstable angina, an invasive strategy is superior to a conservative strategy in the reduction of composite events. Efficacy of the invasive strategy was diluted with increasing age (after adjustment for creatinine and effect modification). The two strategies did not differ in terms of bleeding complications.. Norwegian Health Association (ExtraStiftelsen) and Inger and John Fredriksen Heart Foundation.

Topics: Aged, 80 and over; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Female; Humans; Kaplan-Meier Estimate; Male; Myocardial Infarction; Myocardial Revascularization; Percutaneous Coronary Intervention; Postoperative Hemorrhage; Reoperation; Stroke; Time-to-Treatment; Treatment Outcome

Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease. Despite considerable epidemiological evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR.. One hundred fifty-one outpatients with coronary heart disease who were 36 to 84 years of age were randomized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and coronary heart disease biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR made up the no-CR comparison group. All participants were followed up for up to 5.3 years (median, 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P=0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in coronary heart disease biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group (18% versus 33%; hazard ratio=0.49; 95% confidence interval, 0.25-0.95; P=0.035), and both CR groups had lower event rates compared with the no-CR group (47%; hazard ratio=0.44; 95% confidence interval, 0.27-0.71; P<0.001).. CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00981253.

Topics: Aged; Angina, Unstable; Baroreflex; C-Reactive Protein; Cardiovascular Agents; Cognitive Behavioral Therapy; Combined Modality Therapy; Coronary Disease; Counseling; Exercise Test; Female; Humans; Lipids; Male; Middle Aged; Myocardial Infarction; Proportional Hazards Models; Psychological Tests; Psychometrics; Psychotherapy, Group; Single-Blind Method; Social Support; Stress, Psychological; Stroke; Vascular Surgical Procedures

Topics: Acupuncture Therapy; Adult; Aged; Angina, Unstable; Cardiovascular Agents; Combined Modality Therapy; Electrocardiography; Female; Heart; Humans; Male; Middle Aged

In the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, some patients with stable ischemic heart disease randomized to optimal medical therapy (OMT) crossed over to early revascularization. The predictors and outcomes of patients who crossed over from OMT to revascularization are unknown.. We compared characteristics of OMT patients who did and did not undergo revascularization within 12 months and created a Cox regression model to identify predictors of early revascularization. Patients' health status was measured with the Seattle Angina Questionnaire. To quantify the potential consequences of initiating OMT without percutaneous coronary intervention, we compared the outcomes of crossover patients with a matched cohort randomized to immediate percutaneous coronary intervention. Among 1148 patients randomized to OMT, 185 (16.1%) underwent early revascularization. Patient characteristics independently associated with early revascularization were worse baseline Seattle Angina Questionnaire scores and healthcare system. Among 156 OMT patients undergoing early revascularization matched to 156 patients randomized to percutaneous coronary intervention, rates of mortality (hazard ratio=0.51 [0.13-2.1]) and nonfatal myocardial infarction (hazard ratio=1.9 [0.75-4.6]) were similar, as were 1-year Seattle Angina Questionnaire scores. OMT patients, however, experienced worse health status over the initial year of treatment and more unstable angina admissions (hazard ratio=2.8 [1.1-7.5]).. Among COURAGE patients assigned to OMT alone, patients' angina, dissatisfaction with their current treatment, and, to a lesser extent, their health system were associated with early revascularization. Because early crossover was not associated with an increase in irreversible ischemic events or impaired 12-month health status, these findings support an initial trial of OMT in stable ischemic heart disease with close follow-up of the most symptomatic patients.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00007657.

Topics: Aged; Angina, Unstable; Cardiovascular Agents; Chi-Square Distribution; Comorbidity; Coronary Stenosis; Cross-Over Studies; Female; Health Status; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; North America; Patient Admission; Patient Satisfaction; Percutaneous Coronary Intervention; Proportional Hazards Models; Quality of Life; Risk Factors; Severity of Illness Index; Surveys and Questionnaires; Time Factors; Treatment Outcome

This first-in-human multicenter study sought to examine prospectively the safety and efficacy of a new, cobalt chromium thin-strut, coronary absorbable polymer-coated, sirolimus-eluting stent.. Bioabsorbable polymers on drug-eluting stents may lower the long-term risks of inflammation, delayed healing, and adverse events.. We enrolled patients with symptomatic coronary artery disease with stable or unstable angina pectoris and >50% diameter stenosis, amenable to coverage with a ≤23-mm long stent in a vessel 2.5 to 3.5 mm in diameter. All patients received dual antiplatelet therapy after implantation. Patients, in groups of 10, underwent repeat angiography, intravascular ultrasound, and optical coherence tomography at 4, 6, or 8 months, and all patients were seen or contacted at 18 months of follow-up.. The median (range) in-stent late lumen loss (LLL) was 0.03 mm (-0.22 to 0.21 mm), 0.10 mm (-0.03 to 1.2 mm), and 0.08 mm (-0.01 to 0.28 mm), at 4, 6, and 8 months, respectively. At 18 months, the median in-stent LLL was 0.08 mm (-0.30 to 0.46 mm). On optical coherence tomography, the proportion of uncovered stent struts decreased from a median of 7.3% (range 0.4% to 46.3%) at 4 months to 0% (range: 0% to 3.4%) at 18 months. The percentage of neointimal volume obstruction by intravascular ultrasound increased from a median of 5.3% to 9.1% between 4 and 6 months and remained nearly unchanged thereafter through 18 months of follow-up. The only recorded major adverse cardiac event was a myocardial infarction.. At 18 months of follow-up, this absorbable polymer-coated, cobalt chromium sirolimus-eluting stent was associated with a low and stable in-stent LLL, complete strut coverage, and no stent thrombosis. (First-In-Human Trial of the MiStent Drug-Eluting Stent [DES] in Coronary Artery Disease [DESSOLVE-I]; NCT01247428).

Topics: Absorbable Implants; Adult; Aged; Aged, 80 and over; Angina, Stable; Angina, Unstable; Australia; Belgium; Cardiovascular Agents; Chromium Alloys; Coronary Angiography; Coronary Artery Disease; Coronary Restenosis; Coronary Stenosis; Coronary Vessels; Drug Therapy, Combination; Drug-Eluting Stents; Female; Humans; Male; Middle Aged; Myocardial Infarction; Neointima; New Zealand; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Polymers; Prospective Studies; Prosthesis Design; Severity of Illness Index; Sirolimus; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Ultrasonography, Interventional

Prostaglandin E1 incorporated into lipid microspheres (lipo-PGE1) is effective in the treatment of peripheral vascular disorders and diabetic neuropathy. It is unknown whether it has protective effects in patients with angina pectoris undergoing percutaneous coronary intervention (PCI).. The goal of this pilot study was to investigate whether lipo-PGE1 has protective effects in patients with angina pectoris undergoing PCI.. A single-blinded, randomized controlled trial was conducted in 79 patients with stable or unstable angina pectoris. The control group received standard medical therapy, and the Lipo-PGE1 group (n = 40) received 20 μg/day of lipo-PGE1 intravenously, starting at least 48 h before PCI and continuing for 5 days. Cardiac troponin T (cTnT) and creatine kinase myocardial isoenzyme (CK-MB) were measured before lipo-PGE1 infusion and at 6, 12 and 24 h after PCI.. The cTnT and CK-MB concentrations were lower in the lipo-PGE1 group than in the control group at 6 h (0.15 ± 0.33 vs. 0.43 ± 0.77; 2.87 ± 3.99 vs. 5.64 ± 6.27, respectively; P < 0.05), 12 h (0.20 ± 0.48 vs. 0.54 ± 0.85; 3.58 ± 5.22 vs. 7.45 ± 9.48; P <  0.05) and 24 h (0.18 ± 0.50 vs. 0.50 ± 0.75; 3.15 ± 4.50 vs. 6.16 ± 6.83; P < 0.05). The incidence of postprocedural myocardial injury, defined as an elevation of cTnT more than 0.1 ng/ml or CK-MB more than 5.0 ng/ml, was less in the PGE1 group than in the control group (30 vs. 54%; 13 vs. 31%, respectively; P < 0.05). Lipo-PGE1 was well tolerated and there were no serious adverse events or side-effects.. Lipo-PGE1 treatment appears to reduce myocardial injury following elective PCI in angina patients.

Topics: Aged; Alprostadil; Analysis of Variance; Angina Pectoris; Angina, Unstable; Angioplasty, Balloon, Coronary; Biomarkers; Cardiovascular Agents; Chi-Square Distribution; China; Coronary Angiography; Creatine Kinase, MB Form; Drug Administration Schedule; Female; Heart Diseases; Humans; Infusions, Intravenous; Liposomes; Male; Microspheres; Middle Aged; Pilot Projects; Single-Blind Method; Time Factors; Treatment Outcome; Troponin T

Our aim was to access clinical effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) in older patients with stable coronary artery disease (CAD).. While older patients with CAD are at increased risk for cardiac events compared with younger patients, it is unclear whether PCI may mitigate this risk more effectively than OMT alone or, alternatively, may be associated with more complications.. We conducted a pre-specified analysis of outcomes in stable CAD patients stratified by age and randomized to PCI+OMT or OMT alone in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial.. A total of 1,381 patients (60%) were <65 years of age (mean 56+/-6 years) and 904 patients (40%) were >or=65 years of age (mean 72+/-5 years). Achieved treatment targets for blood pressure, low-density lipoprotein cholesterol, adherence to diet and exercise, and angina-free status did not differ by age or treatment assignment. Among older patients, there was a 2- to 3-fold higher death rate, but similar rates of myocardial infarction, stroke, and major cardiac events compared with younger patients. The addition of PCI to OMT did not improve or worsen clinical outcomes in patients>or=65 years of age during a median 4.6 year follow-up.. These data support adherence to American College of Cardiology/American Heart Association clinical practice guidelines that advocate OMT as an appropriate initial management strategy, regardless of age. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657).

Topics: Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Blood Pressure; Body Mass Index; Cardiovascular Agents; Combined Modality Therapy; Coronary Artery Disease; Diet; Exercise; Female; Follow-Up Studies; Hospitalization; Humans; Lipoproteins, LDL; Male; Myocardial Infarction; Outcome Assessment, Health Care; Smoking Cessation; Stroke

Inflammatory markers are elevated in acute coronary syndromes, and are also known to play a crucial role in the pathogenesis of neointimal proliferation and stent restenosis. Drug-eluting stents (DESs) have been shown to decrease stent restenosis in different studies. In this study, we aimed to investigate the effect of treatment with DESs on systemic inflammatory response in patients with unstable angina pectoris who underwent percutaneous coronary intervention (PCI). We compared plasma high-sensitivity C-reactive protein (hsCRP), human tumor necrosis factor alpha (Hu TNF-alpha), and interleukin 6 (IL-6) levels after DES (dexamethasone-eluting stent [DEXES], and sirolimuseluting stent [SES]) implantation with levels after bare metal stent (BMS) implantation. We performed PCI with a single stent in 90 patients (62 men; 59 +/- 9 years of age; n = 30 in the BMS group, n = 30 in the DEXES group, n = 30 in the SES group) who had acute coronary syndrome. Plasma hsCRP, Hu TNF-alpha, and IL-6 levels were determined before intervention and at 24 h, 48 h, and 1 week after PCI. The results were as follows. Plasma hsCRP levels at 48 h (11.19 +/- 4.54, 6.43 +/- 1.63 vs 6.23 +/- 2.69 mg/l, P = 0.001) after stent implantation were significantly higher in the BMS group than in the DES group; this effect persisted for 7 days (P = 0.001). Plasma Hu TNF-alpha levels at each time point were higher in the SES group than in the BMS and DEXES groups (P < 0.05). The time course of Hu TNF-alpha values was similar in all groups. Although IL-6 levels at baseline and at 24 and 48 h showed no statistically significant difference between the study groups, postprocedural values at 7 days were slightly statistically significant in the SES group (P = 0.045). Drug-eluting stents showed significantly lower plasma hsCRP levels after PCI compared with BMSs. This may reflect the potent effects of DESs on acute inflammatory reactions induced by PCI.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Anti-Inflammatory Agents; C-Reactive Protein; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Dexamethasone; Drug-Eluting Stents; Female; Humans; Inflammation Mediators; Interleukin-6; Male; Metals; Middle Aged; Prospective Studies; Prosthesis Design; Sirolimus; Systemic Inflammatory Response Syndrome; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha

High-density lipoprotein (HDL) cholesterol is an inverse predictor of coronary atherosclerotic disease. Preliminary data have suggested that HDL infusions can induce atherosclerosis regression.. To investigate the effects of reconstituted HDL on plaque burden as assessed by intravascular ultrasound (IVUS).. A randomized placebo-controlled trial was conducted at 17 centers in Canada. Intravascular ultrasound was performed to assess coronary atheroma at baseline and 2 to 3 weeks after the last study infusion.. Between July 2005 and October 2006, 183 patients had a baseline IVUS examination and of those, 145 had evaluable serial IVUS examinations after 6 weeks.. Sixty patients were randomly assigned to receive 4 weekly infusions of placebo (saline), 111 to receive 40 mg/kg of reconstituted HDL (CSL-111); and 12 to receive 80 mg/kg of CSL-111.. The primary efficacy parameter was the percentage change in atheroma volume. Nominal changes in plaque volume and plaque characterization index on IVUS and coronary score on quantitative coronary angiography were also prespecified end points.. The higher-dosage CSL-111 treatment group was discontinued early because of liver function test abnormalities. The percentage change in atheroma volume was -3.4% with CSL-111 and -1.6% for placebo (P = .48 between groups, P<.001 vs baseline for CSL-111). The nominal change in plaque volume was -5.3 mm3 with CSL-111 and -2.3 mm3 with placebo (P = .39 between groups, P<.001 vs baseline for CSL-111). The mean changes in plaque characterization index on IVUS (-0.0097 for CSL-111 and 0.0128 with placebo) and mean changes in coronary score (-0.039 mm for CSL-111 and -0.071 mm with placebo) on quantitative coronary angiography were significantly different between groups (P = .01 and P =.03, respectively). Administration of CSL-111 40 mg/kg was associated with mild, self-limiting transaminase elevation but was clinically well tolerated.. Short-term infusions of reconstituted HDL resulted in no significant reductions in percentage change in atheroma volume or nominal change in plaque volume compared with placebo but did result in statistically significant improvement in the plaque characterization index and coronary score on quantitative coronary angiography. Elevation of HDL remains a valid target in vascular disease and further studies of HDL infusions, including trials with clinical end points, appear warranted.. clinicaltrials.gov Identifier: NCT00225719

Topics: Aged; Angina, Unstable; Apolipoprotein A-I; Cardiovascular Agents; Cholesterol, HDL; Coronary Angiography; Coronary Artery Disease; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Myocardial Infarction; Phosphatidylcholines; Ultrasonography, Interventional

Evidence-based medications (EBM) are underused in older patients despite potentially larger absolute benefits. Little is known about factors influencing prescribing in the elderly with acute coronary syndromes.. Among the 15,904 patients from the Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes (SYMPHONY) and second SYMPHONY trials, we examined the rates of use of EBM according to age (< 75 or > or = 75 years, and 3 subgroups of 5 year increments among patients > or = 75 years).. Ninety-day mortality increased with age (< 75 years, 1.3%; > or = 75 to < 80 years, 4.4%; > or = 80 to < 85 years, 6.0%; > or = 85 years, 9.6%). Compared with subjects < 75 years (n = 14,043), acute EBM use was lower among patients > or = 75 years (n = 1794): aspirin (83% vs 85%), heparin (73% vs 78%), and beta-blockers (70% vs 76%). Similarly, discharge use of beta-blockers (69% vs 76%) and statins (28% vs 40%) was lower, although this was not the case for angiotensin-converting enzyme inhibitors (44% vs 41%). These patterns persisted among eligible patients. Beyond the age of 75 years, EBM use was not further influenced by age except for statins and angiotensin-converting enzyme inhibitors, which were used less frequently in those > or = 85 years. Among patients aged > or = 75 years, prediction for use of each EBM in multivariable modeling was modest (C indices, approximately 0.7); except for statins, increasing age did not predict lower EBM use.. Despite higher mortality risk, EBM use was lower among older patients even considering eligibility. Among those aged > or = 75 years, age was no longer the major factor predicting EBM use. The modest C indices suggest other factors are associated with prescribing, underscoring the need for treatment algorithms and quality assurance measures in older patients.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Aspirin; Cardiovascular Agents; Evidence-Based Medicine; Female; Humans; Male; Myocardial Infarction; Oximes; Piperidines; Platelet Aggregation Inhibitors

Topics: Aged; Angina, Unstable; Anticholesteremic Agents; Atorvastatin; Cardiovascular Agents; Drug Therapy, Combination; Female; Follow-Up Studies; Heptanoic Acids; Humans; Hypercholesterolemia; Male; Middle Aged; Myocardial Infarction; Pyrroles; Recurrence; Survival Rate

Recent clinical trials have demonstrated a better ability of low-molecular-weight heparin, compared to unfractionated heparin, in reducing ischemic cardiac events in patients with acute coronary syndromes without ST-segment elevation. No data are available concerning the in-vivo comparison of enoxaparin and unfractionated heparin on thrombin generation in patients with unstable angina or non-Q-wave myocardial infarction. We measured the plasma levels of prothrombin fragment 1+2 (a marker of prothrombin activation) and thrombin/antithrombin complex (a marker of thrombin generation) in 45 patients with non ST-elevation acute coronary syndromes who were randomized to receive enoxaparin, 3000 IU anti-Xa as an i. v. bolus, followed by 70 IU anti-Xa/Kg every 8 h for 3 days (23 pts. Group 1) or a bolus of 100 IU/kg of unfractionated heparin followed by infusion for 3 days titrated to maintain the aPTT between 70 and 90 s (22 pts, Group 2). Plasma levels of prothrombin fragment 1+2 reduced significantly at 3rd h of treatment in both groups (-42% in Group 1 and -45% in Group 2), reached the lowest plasma concentration at the 24th h and exhibited a slight increase at the 72nd h; no differences were observed between the two groups at any time points. Plasma thrombin/antithrombin complex levels had a similar behaviour: reduced markedly in both groups at the 3rd h (-52% in Group 1 and -46% in Group 2), remained lower during the first two days and slightly rose at 72nd h. No differences between the two groups in plasma levels of this marker were apparent during drug infusion. In Group 1 the aPTT did not show significant changes: in Group 2 the mean value of aPTT doubled the basal value at any time point of determination. Both enoxaparin and unfractionated heparin produced a marked and similar reduction of thrombin generation. Other unknown mechanisms might explain the different clinical effects of the two heparins.

Topics: Acute Disease; Aged; Angina, Unstable; Anticoagulants; Antithrombin III; Biomarkers; Cardiovascular Agents; Comorbidity; Coronary Thrombosis; Drug Therapy, Combination; Electrocardiography; Enoxaparin; Female; Heparin; Humans; Male; Middle Aged; Myocardial Infarction; Partial Thromboplastin Time; Peptide Fragments; Peptide Hydrolases; Prothrombin; Risk Factors; Thrombin; Treatment Outcome

To investigate the therapeutic effects and mechanisms of garlicin for treatment of unstable angina pectoris (UAP), garlicin injectio was intravenously dripped 60 mg/day in 34 cases for 10 days. Nitroglycerine was used in 21 cases of the control group. The results showed that the total effective rates in improving symptoms and electrocardiogram after garlicin treatment were respectively 82% and 62%, and that the plasma endothelin and blood sugar levels were markedly lowered in cases with hyperglycemia.

Topics: Aged; Allyl Compounds; Angina, Unstable; Blood Glucose; Cardiovascular Agents; Disulfides; Endothelins; Female; Garlic; Humans; Hypoglycemic Agents; Infusions, Intravenous; Male; Middle Aged; Plant Extracts; Plants, Medicinal

We tested the hypothesis that resolution versus persistence of symptomatic ischaemia and/or development of nausea/dizziness on the third day of loading with perhexiline maleate (PM), is correlated with perhexiline plasma concentrations after the standard loading phase in patients with acute coronary syndromes. Forty consecutive patients with either unstable angina pectoris or non-Q-wave myocardial infarction with persistent angina pectoris, despite maximal pharmacological therapy (other than PM), were studied. All patients received PM 400 mg/day for 3 days and 200 mg/day thereafter. On days 2 and 3 observers blinded to the 72-96 h plasma perhexiline concentration assessed the patient regarding episodes of angina and/or nausea/dizziness. On the third day of loading with PM, 12 patients experienced angina and 11 patients had nausea and/or dizziness. Plasma perhexiline concentrations at 72-96 h varied widely: mean 0.46 +/- 0.26 (range 0.11-1.77) microgram/ml. There was a relationship of borderline statistical significance between resolution of anginal symptoms and plasma perhexiline concentration > 0.15 microgram/ml (p = 0.055). There was a close relationship between emergence of nausea/dizziness with plasma perhexiline concentration > 0.06 microgram/ml (p < 0.01). We conclude that this study (a) suggests that PM exerts incremental antianginal effects over those of other antiischaemic agents in patients with acute coronary syndromes and (b) establishes that the development of nausea and/or dizziness in such patients is strongly predictive of accumulation of perhexiline beyond the therapeutic range of the drug.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Calcium Channel Blockers; Cardiovascular Agents; Dizziness; Drug Monitoring; Female; Humans; Male; Middle Aged; Nausea; Perhexiline; Vasodilator Agents

Prognosis of unstable angina pectoris is related to admission EKG changes and prompt symptom control. The aim of this study was to compare the clinical effects of intravenous diltiazem (DTZ) or nitroglycerin (NTG) in patients with unstable angina pectoris. We studied 43 patients admitted to the hospital with a history of rest angina within the last 48 hours, associated with EKG evidence of ischemia. All subjects received intravenous heparin and oral aspirin, 23 were randomly assigned to receive intravenous DTZ and 20 to receive intravenous NTG. Both groups had similar baseline features and the endpoints of treatment were recurrence of angina, myocardial infarction, death during hospitalization and secondary side effects. Treatment with DTZ, when compared to NTG, resulted in a significant reduction of recurrent angina (8.7 and 59% respectively; p < 0.005), number of angina episodes per patient (0.18 +/- 0.5 and 0.9 +/- 1.2 respectively; p < 0.05) and lower need for dose increment to control symptoms (3 and 9 patients respectively; p < 0.05). The most common side effects observed were cephalea with NTG (60% of patients) and asymptomatic sinus bradicardia with DTZ (28% of patients). In each group, one patient had a myocardial infarction and one patient died. It is concluded that intravenous DTZ reduces myocardial ischemia to a greater extent than NTG and can be safely used in patients with unstable angina pectoris.

Topics: Aged; Analysis of Variance; Angina, Unstable; Anticoagulants; Aspirin; Blood Pressure; Cardiovascular Agents; Diltiazem; Female; Heparin; Humans; Injections, Intravenous; Male; Middle Aged; Nitroglycerin; Platelet Aggregation Inhibitors; Prospective Studies; Vasodilator Agents

Shexiang Baoxin Pills (SBP) is widely used for the treatment of unstable angina pectoris (UAP) in China. However, the clinical evidence on the efficacy of SBP for the treatment of UAP is not well concluded.. Seven electronic databases will be searched for eligible studies: MEDLINE, EMBASE, The Cochrane Library, Wanfang database, Chinese National Knowledge Infrastructure database, VIP database, and Chinese Biological and Medicine database. Data of included studies will be extracted, and quality will be evaluated. Data synthesis will be performed using RevMan software. Subgroup analysis and sensitivity analysis will also be carried out. Publication bias will be evaluated using funnel plot if included studies are sufficient.. This systemic review and meta-analysis will provide synthesized result of clinical efficacy of SBP for the treatment of UAP.. This systemic review and meta-analysis will provide high-quality evidence on the clinical efficacy of SBP for the treatment of UAP.. PEROSPERO CRD42019124668.

Topics: Angina, Unstable; Cardiovascular Agents; Drugs, Chinese Herbal; Humans; Meta-Analysis as Topic; Systematic Reviews as Topic

The aim of this single center all-comers retrospective registry study was to assess the efficacy and safety of percutaneous coronary intervention (PCI) using drug-coated balloon (DCB) in de novo lesions including large proximal coronary arteries.. A total of 487 PCIs were performed using paclitaxel-coated DCB in 562 de novo lesions with the possibility for bailout stenting in a patient population presenting with stable coronary artery disease (CAD) or acute coronary syndrome (ACS). Half of the patients had at least one risk factor for bleeding. All of the treated lesions were de novo and 60% of DCBs used were ≥ 3.0 mm in diameter. The median follow-up time was 18 months for MACE and 60 months for survival.. The total mortality after DBC only strategy was 2.3 and 9.3% at 12 months in stable CAD and ACS, respectively. The 12-month MACE rate was 7.1 and 12% in stable CAD and ACS. The rate of ischemia-driven target lesion revascularization was only 1.4% in stable CAD and 2.8% after ACS at 12 months. Median duration of DAPT was one month. The 12 month rate of significant bleeding (Bleeding Academic Research Consortium types 2-5) was 5.9%. Acute vessel closure occurred only in one case (0.2%) after DCB treatment. Bailout stenting was used in 12% of lesions.. PCI using DCB-only strategy with the possibility for provisional stenting is a safe and efficient in de novo coronary artery lesions in both stable CAD and ACS. This strategy may be useful especially in patients with high bleeding risk.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiac Catheters; Cardiovascular Agents; Coated Materials, Biocompatible; Coronary Artery Disease; Female; Hemorrhage; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction; Paclitaxel; Registries; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome

We investigated the safety and efficacy of the bioabsorbable polymer-coated, everolimus-eluting coronary stent (SYNERGY) stent in a real-world study population with acute coronary syndromes (ACS).. A number of clinical trials support the overall efficacy and safety of the SYNERGY stent. However, a recent trial (TIDES-ACS) in the context of ACS reported worrying figures of infarction and definite/probable stent thrombosis in the SYNERGY control arm.. This is a multicenter registry (10 centers) including consecutive patients with ACS (unstable angina, non-ST elevated myocardial infarction, ST elevated myocardial infarction) who underwent percutaneous revascularization with the implantation of SYNERGY stent. The primary endpoint was the composite of cardiac death, myocardial infarction and target lesion revascularization at 12 months.. A total of 1008 patients were included with age 65.4 ± 14.8 years, 23.8% females and a 24.5% diabetics. Regarding presentation, a 15.2% with unstable angina, 43% with non-ST elevated myocardial infarction and 41.8% with ST elevated myocardial infarction. Primary outcome was met in 3% (7% in SYNERGY TIDES-ACS arm, P superiority <0.01 and 6.3% in OPTIMAX TIDES-ACS arm, P superiority <0.01). Cardiac death was 1.3% (1.6%, p = 0.8 and 0.5%, P superiority =0.1 respectively). Myocardial infarction was 1.6% (4.6%, p < 0.01 and 1.8%, P superiority = 0.9 respectively). Target lesion revascularization was 1% (3.4%, p < 0.01 and 5.4%, P superiority <0.01 respectively). Definite or probable thrombosis was 0.9% (2.8%, p ≤ 0.01 and 1.1%, P superiority = 0.8 respectively).. The results of this registry show a very good safety and efficacy profile at 12 months for the SYNERGY stent in patients with ACS.. A recent trial (TIDES-ACS) in the context of acute coronary syndromes (ACS) reported worrying figures of infarction and definite/probable stent thrombosis in the SYNERGY stent control arm. We investigated the safety of SYNERGY stent in a real-world study population with ACS applying the same inclusion/exclusion criteria as used in the TIDES-ACS trial. Primary endpoint was the composite of cardiac death, myocardial infarction and TLR at 12 months. A total of 1008 patients have been included. Primary outcome was met in 3% (7% in SYNERGY TIDES-ACS arm, P superiority <0.01 and 6.3% in OPTIMAX TIDES-ACS arm, P superiority <0.01).

Topics: Absorbable Implants; Acute Coronary Syndrome; Aged; Aged, 80 and over; Angina, Unstable; Cardiovascular Agents; Chromium; Coronary Thrombosis; Drug-Eluting Stents; Everolimus; Female; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction; Percutaneous Coronary Intervention; Platinum; Prosthesis Design; Recurrence; Registries; Retrospective Studies; Risk Factors; Spain; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome

Dazhu Hongjingtian (DZHJT), also named Herba Rhodiolae, has been frequently introduced for patients with angina pectoris in China. However, the add-on effect of DZHJT in unstable angina pectoris (UAP) has not been systematically evaluated. The purpose of this protocol is to provide the methods used to assess the efficacy and safety of DZHJT as adjuvant therapy for management of UAP.. We will extensively search for eligible studies in PubMed, Emase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and VIP databases up to October 2018. Only randomized controlled trials comparing DZHJT in combination with Western medicine vs Western medicine alone were selected.The primary outcomes are above 50% reduction in frequency of angina attacks and weekly frequency of angina attacks reduction. The secondary outcomes are the blood rheology parameters (whole-blood viscosity, plasma viscosity, and fibrinogen) and adverse events. We will use RevMan V.5.0 software to perform meta-analysis.. The pooled results will provide a high-quality of evidence of DZHJT as adjuvant therapy in patients with UAP.. This systematic review and meta-analysis will provide up-to-date evidence to evaluate DZHJT as adjuvant therapy in patients with UAP.. PROSPERO CRD42018111885.

Topics: Angina, Unstable; Cardiovascular Agents; Crassulaceae; Drugs, Chinese Herbal; Humans; Meta-Analysis as Topic; Phytotherapy; Systematic Reviews as Topic

Survey of Assessment and MAnagement of CoRonary Heart Disease PaTients was undertaken to describe profile and management pattern of adult Acute Coronary Syndrome (ACS) patients from presentation till discharge, in private tertiary care Indian hospitals.. This was an observational, prospective study. Based on standard criteria, patients were diagnosed to have ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA). For patients surviving till hospital discharge, demographic characteristics, medical history, time to hospital presentation, investigations, vascular interventions and medical management during the hospital stay were recorded.. In total, 1340 patients with definitive ACS diagnosis and surviving their hospital stay were enrolled. Mean patient age was 58.7 years, 75% were males and 36.9% were diagnosed with STEMI, 8.9% with NSTEMI and 54.2% with UA. 41.9%, 35% and 18.4% patients reached hospital within 6 hours for STEMI, NSTEMI and UA respectively. Pre-existing hypertension and diabetes were observed less frequently in patients with STEMI (54.8%, 31.9%) than in NSTEMI (70.8%, 45.8%) or UA (64.2%, 41.5%). Aspirin, clopidogrel, nitrates, β-Blockers, angiotensin converting enzyme inhibitors and statins were used more frequently in NSTEMI than in STEMI or UA patients. Percutaneous trans-coronary angioplasty was performed more commonly in STEMI (64.2%) than in NSTEMI (41.7%) or UA (41.2%).. UA is the commonest and NSTEMI is the least common type of ACS observed in our study. We observed important differences in patient profile, time to hospital presentation, in-hospital acute pharmacological management and vascular interventions performed between the three different types of ACS.

Topics: Acute Coronary Syndrome; Adult; Aged; Angina, Unstable; Cardiovascular Agents; Coronary Artery Bypass; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; India; Male; Middle Aged; Non-ST Elevated Myocardial Infarction; Percutaneous Coronary Intervention; Prospective Studies; ST Elevation Myocardial Infarction; Time-to-Treatment

Antianginal medications (AAMs) can be perceived to be less important after percutaneous coronary intervention (PCI) and may be de-escalated after revascularization. We examined the frequency of AAM de-escalation at discharge post-PCI and its association with follow-up health status.. In a 10-center PCI registry, the Seattle Angina Questionnaire was assessed before and 6 months post-PCI. AAM de-escalation was defined as fewer AAMs at discharge versus admission or >25% absolute dose decrease. Of 2743 PCI patients (70% male), AAM were de-escalated, escalated, and unchanged in 299 (11%), 714 (26%), and 1730 (63%) patients, respectively. Patients whose AAM were de-escalated were more likely to report angina at 6 months, compared with unchanged or escalated AAM (34% versus 24% versus 21%;. De-escalation of AAM occurs in 1 in 10 patients post-PCI, and it is associated with an increased risk of angina and worse health status, particularly among those with incomplete revascularization.

Topics: Aged; Angina Pectoris; Angina, Unstable; Cardiovascular Agents; Coronary Artery Disease; Drug Administration Schedule; Female; Health Status; Humans; Male; Middle Aged; Non-ST Elevated Myocardial Infarction; Patient Discharge; Percutaneous Coronary Intervention; Prospective Studies; Quality of Life; Registries; Risk Factors; Surveys and Questionnaires; Time Factors; Treatment Outcome; United States

Limited data are currently available on the performance of everolimus eluting bioresorbable vascular scaffold (BVS) for treatment of complex coronary lesions representative of daily practice.. This is a prospective, mono-center, single-arm study, reporting data after BVS implantation in patients presenting with stable, unstable angina, or non-ST segment elevation myocardial infarction caused by de novo stenotic lesions in native coronary arteries. No restrictions were applied to lesion complexity. Procedural results and 12-month clinical outcomes were reported.. A total of 180 patients have been evaluated in the present study, with 249 treated coronary lesions. Device Success per lesion was 99.2%. A total of 119 calcified lesions were treated. Comparable results were observed among severe, moderate and noncalcified lesions in term of %diameter stenosis (%DS) (20.3 ± 10.5%, 17.8 ± 7.7%, 16.8 ± 8.6%; P = 0.112) and acute gain (1.36 ± 0.41 mm, 1.48 ± 0.44 mm, 1.56 ± 0.54 mm; P = 0.109). In bifurcations (54 lesions), side-branch ballooning after main vessel treatment was often performed (33.3%) with low rate of side-branch impairment (9.3%). A total of 29 cases with coronary total occlusions were treated. After BVS implantation %DS was not different from other lesion types (17.2 ± 9.4%, vs. 17.7 ± 8.6%; P = 0.780). At one year, all-cause mortality was reported in three cases. The rate of target lesion revascularization and target vessel revascularization was 3.3%. The rate of definite scaffold thrombosis was 2.6%.. The implantation of the everolimus eluting bioresorbable vascular scaffold in an expanded range of coronary lesion types and clinical presentations was observed to be feasible with promising angiographic results and mid-term clinical outcomes. © 2016 Wiley Periodicals, Inc.

Topics: Absorbable Implants; Aged; Angina, Stable; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Clinical Decision-Making; Coronary Angiography; Coronary Stenosis; Everolimus; Feasibility Studies; Female; Humans; Male; Middle Aged; Netherlands; Non-ST Elevated Myocardial Infarction; Patient Selection; Product Surveillance, Postmarketing; Prospective Studies; Prosthesis Design; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Ultrasonography, Interventional; Vascular Calcification

This case report describes a patient who underwent implantation of a bare-metal stent (BMS) for the treatment of everolimus-eluting stent (EES) restenosis caused by chronic stent recoil, and the BMS successfully escaped from duplicate restenosis and target lesion revascularization (TLR).

Topics: Aged; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Restenosis; Drug-Eluting Stents; Everolimus; Female; Humans; Metals; Percutaneous Coronary Intervention; Stents; Treatment Outcome

Topics: Angina, Unstable; Cardiovascular Agents; Coronary Artery Bypass; Female; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention

Topics: Adult; Angina, Unstable; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Coronary Thrombosis; Drug-Eluting Stents; Humans; Male; Percutaneous Coronary Intervention; Prosthesis Design; Sirolimus; Time Factors; Tomography, Optical Coherence; Treatment Outcome

Topics: Angina, Unstable; Cardiovascular Agents; Coronary Artery Bypass; Female; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention

Topics: Angina, Unstable; Cardiovascular Agents; Coronary Artery Bypass; Female; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention

Topics: Angina, Unstable; Cardiovascular Agents; Coronary Artery Bypass; Female; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention

Topics: Angina, Unstable; Cardiovascular Agents; Coronary Artery Bypass; Female; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention

Topics: Adenosine; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Coronary Stenosis; Coronary Vessels; Female; Fractional Flow Reserve, Myocardial; Humans; Middle Aged; Treatment Outcome; Ventricular Fibrillation

This study sought to report on clinical outcomes beyond 1 year of the BVS Expand registry.. Multiple studies have proven feasibility and safety of the Absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California). However, data on medium- to long-term outcomes are limited and available only for simpler lesions.. This is an investigator-initiated, prospective, single-center, single-arm study evaluating performance of the BVS in a lesion subset representative of daily clinical practice, including calcified lesions, total occlusions, long lesions, and small vessels. Inclusion criteria were patients presenting with non-ST-segment elevation myocardial infarction, stable/unstable angina, or silent ischemia caused by a de novo stenotic lesion in a native previously untreated coronary artery. Procedural and medium- to long-term clinical outcomes were assessed. Primary endpoint was major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization.. From September 2012 to January 2015, 249 patients with 335 lesions were enrolled. Mean number of scaffolds per patient was 1.79 ± 1.15. Invasive imaging was used in 39%. In 38.1% there were American College of Cardiology/American Heart Association classification type B2/C lesions. Mean lesion length was 22.16 ± 13.79 mm. Post-procedural acute lumen gain was 1.39 ± 0.59 mm. Median follow-up period was 622 (interquartile range: 376 to 734) days. Using Kaplan-Meier methods, the MACE rate at 18 months was 6.8%. Rates of cardiac mortality, myocardial infarction, and target lesion revascularization at 18 months were 1.8%, 5.2%, and 4.0%, respectively. Definite scaffold thrombosis rate was 1.9%.. In our study, BVS implantation in a complex patient and lesion subset was associated with an acceptable rate of adverse events in the longer term, whereas no cases of early thrombosis were observed.

Topics: Absorbable Implants; Aged; Angina, Stable; Angina, Unstable; Cardiovascular Agents; Coated Materials, Biocompatible; Coronary Disease; Coronary Thrombosis; Everolimus; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Netherlands; Non-ST Elevated Myocardial Infarction; Percutaneous Coronary Intervention; Prospective Studies; Prosthesis Design; Recurrence; Registries; Risk Factors; Time Factors; Treatment Outcome

Topics: Angina, Unstable; Cardiovascular Agents; Communication Barriers; Early Medical Intervention; Humans; Myocardial Infarction; Translational Research, Biomedical

The use of evidence-based therapies has improved the outcome of patients with acute coronary syndrome (ACS), but there is a time lag between the generation of clinical evidence and its application in routine clinical practice. We sought to quantify temporal lags in the lifecycle of American College of Cardiology (ACC)/American Heart Association (AHA) class IA ACS therapies.. Using current and historical ACC/AHA guideline publications, we retrieved publication dates of pivotal clinical trials (PCTs) and class IA guideline-recommended therapies for patients with ST-elevation myocardial infarction (STEMI) and unstable angina (UA)/non-STEMI (NSTEMI). Clinical practice uptake data for each therapy were retrieved from the National Registry for Myocardial Infarction, Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines, and Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines, which are registries containing publicly available peer-reviewed data. Descriptive data were calculated and compared for each phase of the evidence lifecycle for both STEMI and UA/NSTEMI drug classifications.. We identified 11 class IA- and 4 class IB/IC-recommended therapies for acute, inhospital, and discharge use for patients with STEMI or UA/NSTEMI. The median time lags were 2 years (interquartile range [IQR], 1-4 years) from PCT to practice guideline recommendation, 14 years (IQR, 11-15 years) from guideline recommendation to 90% practice uptake, and overall, a 16-year median (IQR, 13-19 years) from PCT to 90% practice uptake.. The time of PCT publication to meaningful uptake of class IA ACS therapies into clinical practice took a median of 16 years. This significant time lag indicates systemic barriers to the translation of therapeutics into routine clinical practice.

Topics: Angina, Unstable; Cardiovascular Agents; Communication Barriers; Early Medical Intervention; Evidence-Based Practice; Guideline Adherence; Humans; Meaningful Use; Myocardial Infarction; Needs Assessment; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Registries; Risk Assessment; Translational Research, Biomedical

In this case report, we provide the first detailed description of an intermittent mechanical kink of a right internal thoracic artery (ITA) graft to the left anterior descending coronary artery secondary to respiratory movements, and its assessment by pressure wire derived fractional flow reserve (FFR). The patient presented with recurrent unstable angina and documented anterior/anterolateral ischemia. Persistent symptoms were attributed to the ITA kink and stenting was planned on clinical grounds. However, the lesion proved not physiologically significant when FFR was assessed after intermittency related to respiratory movements was documented. Complex stenting was therefore avoided and medical therapy was prescribed for distal diagonal disease. We therefore propose that intermittency should be actively investigated when a kink is documented in a coronary bypass graft by conventional angiography (using dedicated angiographic evaluation in maximal inspiration and expiration). Furthermore, when this type of lesion is encountered, we suggest that it should be assessed physiologically using pressure wire derived FFR before potentially complex interventions are considered.

Topics: Aged; Angina, Unstable; Blood Pressure; Cardiovascular Agents; Coronary Angiography; Fractional Flow Reserve, Myocardial; Graft Occlusion, Vascular; Humans; Internal Mammary-Coronary Artery Anastomosis; Male; Mammary Arteries; Predictive Value of Tests; Recurrence; Respiration; Risk Factors; Time Factors

Topics: Algorithms; Angina, Unstable; Automation; Cardiovascular Agents; Coronary Vessels; Drug-Eluting Stents; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Neointima; Percutaneous Coronary Intervention; Predictive Value of Tests; Prosthesis Design; Sirolimus; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Wound Healing

To study special characteristics and prognostic value of cardiac remodeling in patients with unstable angina (UA).. Throughout 2 years we performed repetitive echocardiographic examinations of 166 patients with Braunwald class IB and IIB-IIIB UA for assessment of left ventricular (LV) structural-functional changes.. More severe form of remodeling (eccentric hypertrophy) was significantly more frequent in patients with IIB-IIB class UA. However in IB class UA during first year after episode of UA we noted rapid progression of remodeling mainly at the account of transition from concentric hypertrophy. Tissue Doppler study revealed more severe type of diastolic dysfunction (type 2 - pseudonormalization) in patients with class IIB-IIIB UA. Changes of some echocardiographic parameters correlated with severity of subsequent remodeling of the heart, development of chronic heart failure (CHF), myocardial infarction, and recurrent episodes of UA. In UA rate of unfavorable outcomes was related to degree of ischemic myocardial remodeling. We established a number of early EchoCG markers of LV remodeling increases of endsystolic dimension and volume, myocardial stress, lowering of ratios of diastolic peaks of filling and relaxation (/ and E`/A`) - preceding the development of systolic, diastolic dysfunction and CHF.. The use of complex therapy with acetylsalicylic acid in patients with UA, perindopril, nebivolol and simvastatin is justified for prevention LV remodeling and lowering of rate of acute ischemia recurrence and CHF development.

Topics: Aged; Angina, Unstable; Aspirin; Benzopyrans; Cardiovascular Agents; Disease Progression; Drug Therapy, Combination; Echocardiography, Doppler; Ethanolamines; Female; Heart Failure; Humans; Male; Middle Aged; Nebivolol; Outcome Assessment, Health Care; Perindopril; Platelet Aggregation Inhibitors; Prognosis; Severity of Illness Index; Simvastatin; Time Factors; Ventricular Remodeling

Topics: Adult; Aftercare; Aged; Angina, Unstable; Biomarkers; Cardiovascular Agents; Comorbidity; Diagnostic Techniques, Cardiovascular; Disease Management; Female; Humans; Inpatients; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Risk Assessment

A 55-year-old male underwent paclitaxel-eluting stent implantation in a bifurcation lesion of his left anterior descending artery (LAD) during an episode of unstable angina in 2008. A late in-stent restenosis developed 15 months after implantation of the drug-eluting stent (DES) and was treated with paclitaxel eluting balloon. Two months later, during angiography for functional assessment of the significance of lesions in the circumflex artery, an aneurysm at the place of drug-eluting balloon (DEB) inflation was observed. The patient was left on double antiplatelet therapy and scheduled for clinical observation after 3 months and control coronary angiography after 6 months for aneurysm progression follow-up.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Aspirin; Cardiac Catheters; Cardiovascular Agents; Clopidogrel; Coronary Aneurysm; Coronary Angiography; Coronary Restenosis; Drug Delivery Systems; Drug Therapy, Combination; Drug-Eluting Stents; Equipment Design; Humans; Male; Middle Aged; Paclitaxel; Platelet Aggregation Inhibitors; Ticlopidine; Time Factors

Topics: Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Coronary Thrombosis; Coronary Vessels; Drug-Eluting Stents; Humans; Hyperplasia; Male; Middle Aged; Neointima; Percutaneous Coronary Intervention; Predictive Value of Tests; Prosthesis Design; Sirolimus; Thrombectomy; Time Factors; Tomography, Optical Coherence; Treatment Outcome

It is assumed that patients with non-ST-elevation myocardial infarctions (NSTEMI) showing an infero- or posterolateral occluded culprit artery (OCA) during diagnostic angiography frequently elude standard 12-lead electrocardiogram diagnosis. In addition, coronary collaterals may have beneficial effects in patients with OCA.. We examined 448 consecutive NSTEMI patients within 72 h of symptom onset. All patients underwent early invasive angiography plus optimal medical therapy. We compared clinical characteristics and 30-days/6-month major adverse cardiovascular events (MACE) between patients with OCA and non-OCA. The secondary objective was to investigate the effect of angiographically visible coronary collaterals on 6-month MACE in patients with OCA.. The angiograms revealed OCA in 130 (29%) of 448 patients. Patients with OCA showed more often infero- or posterolateral lesions (75 vs. 53%, p < 0.001) and more collaterals (57 vs. 8%, p < 0.001) compared with those with non-OCA. Patients with OCA had larger infarcts (peak CK-MB 2.1 ± 2.3 vs. 1.2 ± 1.1 μmol/L/s, p < 0.001), lower left ventricular ejection fraction (42 ± 21 vs. 48 ± 20%, p = 0.01), were more often revascularized (89 vs. 78%, p = 0.005), and had higher risk-adjusted 6-month MACE largely driven by its association with non-fatal reinfarctions (HR 2.16, 95% CI 1.04-4.50, p = 0.04). Patients with OCA and angiographically absent collaterals had significantly higher risk-adjusted 6-month MACE than those with OCA and angiographically visible collaterals (HR 1.96, 95% CI 1.02-3.76, p = 0.04).. Approximately one-fourth of patients with NSTEMI revealed OCA that was more frequently found in coronary arteries supplying the infero- or posterolateral myocardium. Patients with OCA had larger infarcts and more non-fatal reinfarctions than patients with non-OCA. Well-developed collaterals may limit the myocardial damage in these patients.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Angioplasty, Balloon, Coronary; Biomarkers; Cardiovascular Agents; Chi-Square Distribution; Collateral Circulation; Coronary Angiography; Coronary Artery Bypass; Coronary Circulation; Coronary Occlusion; Creatine Kinase, MB Form; Female; Germany; Humans; Incidence; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Myocardial Infarction; Myocardium; Proportional Hazards Models; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; Stents; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left

Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension.. Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all "first percutaneous coronary interventions" between January 1, 2006, and December 31, 2008 (n=44,268; followed an average of 1.9 [± 0.9] years).. Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes.. After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.

Topics: Adult; Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cardiovascular Diseases; Confounding Factors, Epidemiologic; Coronary Disease; Coronary Restenosis; Diabetes Complications; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Heart Failure; Humans; Hypertension; Hypoglycemic Agents; Male; Middle Aged; Myocardial Infarction; Prognosis; Registries; Retreatment; Stroke; Sweden; Treatment Outcome

Aim of the study was to assess effectiveness of early invasive strategy of treatment of angina of new onset (ANO). We conducted comparative assessment on invasive and noninvasive risk estimation in 106 patients admitted to N.V.Sklifosofsky Institute of Urgent Aid in 2003-2007. Percutaneous coronary interventions (PCI) on symptom related artery (SRA) within single procedure were carried out in 74 cases (70%), indications to coronary artery bypass surgery were detected in 16 cases (15%), in 16 more cases conservative treatment was used. The data obtained showed that it is rational to consider ANO as unstable angina in all cases including those without progression. Visualization of coronary arteries gives possibility to define significance of SRA and zone at risk of injury, determine indications to myocardial revascularization, and avoid inadequacy of noninvasive assessment of risk and choice of treatment tactics. The method of choice in the treatment of patients with ANO is PCI performed during single procedure. Detection of indications to coronary artery bypass surgery in low risk patients and in absence of progression confirm necessity of routine use of invasive strategy which provides timely pathogenetic treatment. Absence of indications to myocardial revascularization detected in sporadic cases provides possibility to avoid groundless hospitalizations.

Topics: Adult; Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessels; Disease Progression; Early Medical Intervention; Electrocardiography; Female; Hospitalization; Humans; Male; Middle Aged; Patient Selection; Risk Assessment; Time Factors; Treatment Outcome

This paper studies in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) following bare-metal stent (BMS) and drug-eluting stent (DES) in all consecutive patients between 2004 and 2007 undergoing PCI for ISR lesions at our centre.. We compared the clinical presentation, pattern and angiographic outcomes in 838 patients with BMS ISR (487) and SES ISR (351). About 18% of the patients presented with acute coronary syndrome with 2% presenting as ST elevation myocardial infarction, similar in both groups. Angiographic pattern was predominantly focal with SES ISR (47%SES ISR vs. 19% BMS ISR; p<0.001) and diffuse with BMS ISR (SES ISR 16% vs. BMS ISR 36%; p=0.003). In our series the use of balloon angioplasty was higher for the treatment of SES ISR patients as compared to BMS ISR (41.6% vs. 18.3%; p<0.001) and the usage of stent was higher in BMS ISR patients (38.6% vs. 23.4%; p<0.001). Angiographic recurrent restenosis with conventional treatment in a consecutive series of patients was 38.6% and target lesion revascularisation was seen in 33.6%. These outcomes were seen slightly higher in SES ISR group (41.1% vs. 36.9%, p=ns). We have identified unstable angina at presentation (OR 3.02; 95%CI: 1.58-5.77, p=0.001), focal pattern of ISR (OR 0.50; 95% CI: .25-.99, p=0.04), stent usage (OR .25; 95% CI .13-.47, p<0.001), and baseline% diameter stenosis (OR1.03; 95%CI: 1.03-1.06, p=0.01) as independent predictors of BMS ISR recurrent restenosis. Unstable angina, focal pattern of ISR, reference vessel diameter, and% diameter stenosis were shown to be independent predictors of SES ISR.. ISR is not a benign condition, and one fifth of the patients presented with acute coronary syndrome. The pattern of restenosis is predominantly non-focal with BMS ISR and focal with SES ISR. Recurrent restenosis rates are high following conventional treatment and further optimal therapies mainly with SES ISR needs to defined.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Chi-Square Distribution; Coronary Angiography; Coronary Restenosis; Coronary Stenosis; Drug-Eluting Stents; Female; Humans; Japan; Logistic Models; Male; Metals; Middle Aged; Odds Ratio; Prosthesis Design; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Sirolimus; Stents; Time Factors; Treatment Outcome

Women are at greater risk for worse outcomes associated with acute coronary syndrome (ACS) than are men. One explanation may be that they tend to be treated less aggressively than men even when more aggressive treatment is warranted. The purpose of this analysis was to assess this issue.. We used the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative registry, an observational data collection that began in November 2001, with retrospective data collection from January 2001 to December 2006. A total of 32,888 subjects met the inclusion/exclusion criteria for our study, based on strong biochemical evidence of myocardial infarction and acute onset of typical cardiac chest pain. We stratified subjects into 16 cells for coronary intervention, based on 4 age groups and 4 cardiac catheterization findings (insignificant, 1-vessel disease, 2-vessel disease, 3-vessel disease). We also stratified subjects into 20 cells for medical treatment, based on 4 age groups and 5 medical treatments. In each cell we compared the rate of coronary intervention (coronary artery bypass grafting or percutaneous coronary intervention) or medical treatment (glycoprotein IIb/IIIa inhibitors, aspirin, clopidogrel, beta-blocker, and statins) for men vs women.. Men demonstrated significantly higher rates (P < 0.05) of coronary intervention in 7 of the 16 cells and 9 of the 20 medical treatment cells, compared to no cells in which women had statistically higher rates than men.. These findings suggest that men are more likely than women to receive coronary intervention and to be medically treated when presenting with evidence of non-ST-segment myocardial infarction, controlled for age, cardiac catheterization findings, and biochemical evidence of myocardial infarction.

Topics: Age Factors; Aged; Aged, 80 and over; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Chi-Square Distribution; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Female; Healthcare Disparities; Humans; Male; Middle Aged; Myocardial Infarction; Practice Patterns, Physicians'; Registries; Retrospective Studies; Severity of Illness Index; Sex Factors; Treatment Outcome

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Electrocardiography; Evidence-Based Medicine; Humans; Intra-Aortic Balloon Pumping; Myocardial Infarction; Practice Guidelines as Topic; Risk Assessment

To describe the persistent use of evidence-based cardiovascular medications (EBCMs) 3 months after discharge from an acute coronary syndrome (ACS) event and patient-reported reasons for nonpersistence across age groups.. Medication Applied and Sustained Over Time (MAINTAIN) is a longitudinal follow-up cohort study of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation quality improvement initiative and Acute Coronary Treatment and Intervention Outcomes Network registry.. Forty-one acute care hospitals in the United States from January 2006 to September 2007.. One thousand fifty-four patients with a median age of 60 (interquartile range 52-71), including 27% aged 70 and older, admitted with an ACS.. Three-month posthospital discharge telephone follow-up with EBCMs reviewed and reconciled. Patients who reported nonpersistence were surveyed regarding reasons for EBCM discontinuation.. At 3-month follow-up, overall persistence was 71.2%. There was a significant trend toward lower overall persistence with prescribed EBCMs in older adults than in the other age groups (74.9% for <60, 71.0% for 60-69, 64.5% for > or =70; P=.02). Overall, 112 (10.6%) patients discontinued EBCMs with provider advice, and 178 (16.9%) self-discontinued. Provider discontinuation increased across age groups (9.1%, 10.4%, and 13.6%, respectively). A similar trend was observed for EBCM self-discontinuation (15.2%, 17.0%, and 19.9%, respectively). Reasons for self-discontinuation included adverse effects, cost, and perception that the medication was not needed.. Older patients are less likely to be persistent with EBCMs after an ACS event at 3-month follow-up. Understanding patient-reported reasons for discontinuation can influence intervention strategies to improve long-term adherence to EBCMs.

Topics: Acute Coronary Syndrome; Age Factors; Aged; Angina, Unstable; Cardiovascular Agents; Drug Costs; Evidence-Based Medicine; Female; Humans; Long-Term Care; Longitudinal Studies; Male; Middle Aged; Patient Compliance; Patient Discharge; Patient Education as Topic; Practice Guidelines as Topic; Prospective Studies; Registries; Secondary Prevention; United States

This study aimed to reveal the incremental prognostic implications of perfusion/function variables by stress/rest gated single-photon emission computed tomography (SPECT) over clinical risks in patients with known coronary artery disease (CAD).. Using the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) database, the 3-year follow-up data of 2,200 patients who had established CAD were analyzed. Major cardiac events (cardiac death, myocardial infarction, heart failure, and unstable angina) were observed in 167 (7.6%) patients. Multivariate logistic regression analysis identified peripheral artery disease, diabetes mellitus, no use of statins, typical chest pain, pharmacological stress test, heart rate at rest, left ventricular end-systolic volume index derived from gated SPECT (LVESVI), and summed difference score (SDS) as independent significant predictors of the major cardiac events, with odds ratios of 1.025 to 2.291 (P=0.0309-0.0008). Global chi-square values increased by combining the independent predictors, and the greatest values (nearly 110) were observed when LVESVI or SDS was added to the pre-scan clinical information.. Perfusion/function measures by stress/rest gated SPECT contribute to a significant improvement in risk stratification and secondary prevention strategy in combination with pre-scan clinical risks in patients with known CAD.

Topics: Aged; Angina, Unstable; Asian People; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Cardiovascular Agents; Cardiovascular Diseases; Chi-Square Distribution; Coronary Artery Disease; Databases as Topic; Disease Progression; Exercise Test; Female; Heart Failure; Humans; Japan; Logistic Models; Male; Middle Aged; Myocardial Infarction; Myocardial Perfusion Imaging; Odds Ratio; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Time Factors

A 69 year old man was admitted with unstable angina (Class IIB). He had a history of chronic renal impairment, diabetes mellitus, hypertension and coronary bypass surgery in 1997 (LIMA graft to the LAD anf diagonal branch, saphenous vein grafts to the RCA and first marginal branch of LCx.. Coronary angiography.. Unstable angina (Class IIB). Occlusion of the LCx and RCA. Functionally occluded LIMA on the LAD and diagonal branch. Diffuse disease of the LAD with two significant lesions at the LAD-first diagonal and mid-distal LAD.. Revascularisation.

Topics: Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Chronic Disease; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Diabetes Complications; Drug-Eluting Stents; Everolimus; Graft Occlusion, Vascular; Hemodynamics; Humans; Hypertension; Kidney Diseases; Male; Sirolimus; Treatment Outcome

The aim of the present study was to compare lesion morphologies after sirolimus-eluting stent (SES) implantation between patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) with the use of optical coherence tomography (OCT).. The lesion morphologies before and after coronary stenting have been proposed as important predictors of clinical outcome. The high resolution of OCT provides detailed information of coronary vessel wall.. We enrolled 55 patients (UAP: n = 24, SAP: n = 31), and examined lesion morphologies by using OCT at pre- and post-SES implantation and 9 months' follow-up.. The incidence of plaque rupture (42% vs. 3%, p < 0.001), intracoronary thrombus (67% vs. 3%, p < or = 0.001) and thin-capped fibroatheroma (cap thickness <65 microm; 46% vs. 3%, p < 0.001) at pre-intervention was significantly greater in UAP than that in SAP. Although stent profiles and procedural characteristics were not different between the 2 groups, inadequate stent apposition (67% vs. 32%, p = 0.038) and tissue protrusion (79% vs. 42%, p = 0.005) after percutaneous coronary intervention were observed more frequently in patients with UAP. Plaque rupture was significantly increased after percutaneous coronary intervention in patients with UAP (42% to 75%, p = 0.018), and the persistence of core cavity after plaque rupture (28% vs. 4%, p = 0.031) at 9 months' follow-up was observed more frequently in UAP patients compared with SAP patients. At 9 months' follow-up, the incidence of inadequately apposed stent (33% vs. 4%, p = 0.012) and partially uncovered stent by neointima (72% vs. 37%, p = 0.019) was significantly greater in UAP patients than that in SAP patients. All patients took aspirin and ticlopidine during follow-up period, and no patients had stent thrombosis or adverse coronary events.. Serial OCT examinations demonstrated markedly different vascular response up to 9 months after SES implantation between UAP and SAP patients. Although the inadequate lesion morphologies after stenting were observed more frequently in UAP patients, these findings were not associated with adverse outcomes in patients with antiplatelet therapy.

Topics: Aged; Angina Pectoris; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Female; Humans; Male; Middle Aged; Observer Variation; Platelet Aggregation Inhibitors; Predictive Value of Tests; Prospective Studies; Rupture; Sirolimus; Thrombosis; Time Factors; Tomography, Optical Coherence; Treatment Outcome

Topics: Angina Pectoris; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Humans; Platelet Aggregation Inhibitors; Predictive Value of Tests; Rupture; Sirolimus; Thrombosis; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Wound Healing

The following comment provides another perspective on the COURAGE Trial. A prior Editorial on this subject was by Franklin (Franklin BA. Lessons learned from the COURAGE Trial: generalizability, limitations, and implications. Prev Cardiol. 2007;10(3):117-120.).-Ezra A. Amsterdam, MD, Editor in Chief.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Disease; Humans; Randomized Controlled Trials as Topic

The interaction between the use of percutaneous coronary intervention (PCI) for non-ST-elevation acute coronary syndromes and the use of secondary prevention medications was analysed in the French S-Témoin Registry.. The population consisted of 2433 patients seen by their cardiologists at an outpatient clinic 2-12 months after non ST-elevation ACS; the survey was carried out from September 2004 to April 2005.. Overall, patients undergoing PCI (75% of the population) had higher levels of prescription of recommended secondary prevention medications. Multivariate logistic regression analysis showed that the use and type of coronary intervention (drug eluting versus bare metal stents) was an independent correlate of the use of dual antiplatelet therapy. In addition, time from the acute episode was also a strong correlate of dual antiplatelet therapy. Statins were also more often used in patients with PCI.. Patients not treated with PCI are less likely to receive appropriate secondary prevention medications after non ST-elevation acute coronary syndromes. Specific efforts should be directed towards these patients, in particular as regards the prescription of dual antiplatelet therapy.

Topics: Adrenergic beta-Antagonists; Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Calcium Channel Blockers; Cardiovascular Agents; Chemoprevention; Drug Prescriptions; Female; Follow-Up Studies; France; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Registries; Stents; Syndrome

Age is an important determinant of outcomes for patients with acute coronary syndromes. However, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients who would stand to benefit. Limited trial data are available to guide care of older adults, which results in uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age and complex health status.. Part II of this American Heart Association scientific statement summarizes evidence on presentation and treatment of ST-segment-elevation myocardial infarction in relation to age (< 65, 65 to 74, 75 to 84, and > or = 85 years). The purpose of this statement is to identify areas in which the evidence is sufficient to guide practice in the elderly and to highlight areas that warrant further study. Treatment-related benefits should rise in an elderly population, yet data to confirm these benefits are limited, and the heterogeneity of older populations increases treatment-associated risks. Elderly patients with ST-segment-elevation myocardial infarction more often have relative and absolute contraindications to reperfusion, so eligibility for reperfusion declines with age, and yet elderly patients are less likely to receive reperfusion even if eligible. Data support a benefit from reperfusion in elderly subgroups up to age 85 years. The selection of reperfusion strategy is determined more by availability, time from presentation, shock, and comorbidity than by age. Additional data are needed on selection and dosing of adjunctive therapies and on complications in the elderly. A "one-size-fits-all" approach to care in the oldest old is not feasible, and ethical issues will remain even in the presence of adequate evidence. Nevertheless, if the contributors to treatment benefits and risks are understood, guideline-recommended care may be applied in a patient-centered manner in the oldest subset of patients.. Few trials have adequately described treatment effects in older patients with ST-segment-elevation myocardial infarction. In the future, absolute and relative risks for efficacy and safety in age subgroups should be reported, and trials should make efforts to enroll the elderly in proportion to their prevalence among the treated population. Outcomes of particular relevance to the older adult, such as quality of life, physical function, and independence, should also be evaluated, and geriatric conditions unique to this age group, such as frailty and cognitive impairment, should be considered for their influence on care and outcomes. With these efforts, treatment risks can be minimized, and benefits can be placed within the health context of the elderly patient.

Topics: Acute Disease; Age Factors; Aged; Aged, 80 and over; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Clinical Trials as Topic; Combined Modality Therapy; Disease Management; Disease Susceptibility; Evidence-Based Medicine; Female; Fibrinolytic Agents; Geriatrics; Humans; Male; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction; Myocardial Revascularization; Patient Rights; Practice Guidelines as Topic; Prejudice; Quality of Life; Registries; Risk Factors; Stents; Thrombolytic Therapy; Treatment Outcome

To examine the relation between treatment intensity and level of risk in routine hospital care of patients with acute coronary syndromes (ACS), and to identify independent predictors of use or omission for each of eight evidence-based treatments.. Retrospective cohort study of patients fulfilling case definition for ACS in whom absolute risk of adverse outcomes was quantified (as low, moderate, or high risk) using formal prediction rules, and for whom treatment eligibility was determined using expert-agreed criteria.. 3912 consecutive or randomly selected patients admitted to 21 hospitals in Queensland, Australia between 1 August 2001 and 31 December 2005.. The proportions of eligible patients receiving treatment varied inversely with risk level in regard to reperfusion therapies of fibrinolytic therapy or primary angioplasty (low risk, 88.3%; moderate risk, 61.9%; high risk, 18.2%; P < 0.001), heparin (91.4%; 83.7%; 72.8%; P < 0.001) and early invasive intervention (33.6%; 24.0%; 18.5%; P < 0.001). Significantly more low- and moderate- than high-risk patients received beta-blockers (87.0%; 88.5%; 79.1%; P < 0.001), lipid-lowering agents (87.3%; 84.8%; 65.8%; P < 0.001), and referral to cardiac rehabilitation (51.8%; 46.0%; 34.4%; P < 0.001) at discharge. The most frequent independent predictors of treatment omission in all patients included increasing age (5 of 8 treatments), previous ACS or atrial tachyarrhythmias (4 of 8), and past history of cerebrovascular accident or congestive heart failure (3 of 8).. In routine care of ACS, eligible patients at high risk receive treatment less frequently than those at low and moderate risk. Reforms in professional education, routine use of risk stratification tools, guideline recommendations tailored to population-specific reductions in absolute risk, and better hospital networking with standardised triage and referral procedures for invasive procedures may help reduce selection bias in the delivery of indicated care.

Topics: Aged; Angina, Unstable; Cardiovascular Agents; Cohort Studies; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Myocardial Revascularization; Retrospective Studies; Risk Assessment; Syndrome; Treatment Outcome

Topics: Angina, Unstable; Biomarkers; Cardiology Service, Hospital; Cardiovascular Agents; Humans; Myocardial Infarction; Myocardial Revascularization; Risk Assessment; Syndrome

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Artery Bypass; Data Interpretation, Statistical; Humans; Randomized Controlled Trials as Topic

Stable coronary artery disease (CAD) is classified into 2 types: high-risk (ie, 3-vessel disease, left main trunk lesions, or ostial lesions of the left anterior descending (LAD)) and low-risk (1- or 2-vessel disease other than ostial lesions of the LAD), which comprise the majority of CAD patients. According to ACC/AHA/ACP-ASIM guidelines for low-risk CAD, anti-anginal agents should be initially administered to control attacks, then coronary intervention should be considered when medical therapy is not effective (medical-preceding therapy: M). In Japan, however, the initial treatment is generally percutaneous coronary intervention (PCI) combined with medical therapy (PCI-preceding therapy: P).. In the present study the long-term outcomes of 190 M patients and 192 matched P patients at 34 nationwide hospitals were surveyed over 3 years (mean: 3.4 years) starting in 2000. Age, gender, initial severity of anginal symptoms, number of lesion vessels, risk factors and prescriptions were similar between the 2 groups. During the 3.4-year follow-up, additional PCI or coronary artery bypass grafting was required in 9.4% of the M group and in 33.2% of the P group. The rates of cardiac death were similar (1.6% in M and 2.6% in P). The overall rate of cardiac death and acute coronary syndrome was 2.1% in M and 4.7% in P, but the difference was not significant. The grade of anginal symptoms 12 months later was well improved in both M (1.6+/-1.4 to 0.6+/-0.9) and P (1.7+/-1.4 to 0.3+/-0.7) and there was no significant difference. Averaged annual medical cost was lower in M than in P (4.4-fold lower in the first year and 3.1-fold by the next year).. The present study suggests that M and P for Japanese low-risk CAD may have a similar effect on long-term prognosis, but M is cheaper.

Topics: Aged; Angina, Unstable; Cardiovascular Agents; Case-Control Studies; Coronary Artery Disease; Death; Female; Humans; Japan; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome

Plasma concentrations of anti-inflammatory cytokine interleukin 10 (IL10) have been shown to be decreased in patients with unstable angina (UA) suggesting that reduced concentrations of IL10 may favour plaque instability and the development of acute coronary syndromes. Diltiazem has been shown to exert beneficial effects in patients with acute coronary syndrome. However, the potential influence of diltiazem on the anti-inflammatory cytokine IL10 in patients with UA has not been investigated. This study was designed to find out the effects of diltiazem on IL10 in UA patients.. Thirty patients with UA were divided into two groups: group R and group D (n = 15). Group R was given routine pharmacotherapy for UA, and group D was given routine pharmacotherapy plus diltiazem. Plasma concentrations of IL10 in these groups were measured before the start of the treatment and 28 days after treatment. Plasma concentrations of IL10 in 15 normal subjects (group N) were also measured. Patients with UA had decreased concentrations of IL10 compared with normal group. Four weeks after treatment, plasma concentrations of IL10 significantly increased in group D compared with that before treatment, but the increase in IL10 values in group R was not significant.. These findings showed that concentrations of anti-inflammatory IL10 are considerably decreased in UA patients and diltiazem treatment leads to a significant increase in IL10 concentrations.

Topics: Angina, Unstable; Anti-Inflammatory Agents; Cardiovascular Agents; Case-Control Studies; Diltiazem; Female; Humans; Interleukin-10; Male; Middle Aged

Topics: Angina, Unstable; Cardiology Service, Hospital; Cardiovascular Agents; Guideline Adherence; Hospital Mortality; Humans; Outcome and Process Assessment, Health Care; Patient Transfer; Risk Assessment

Describe the frequency of high degree atrioventricular block (HDAVB) in patients with unstable angina (UA), analyze the variables associated with their appearance and evaluate whether HDAVB is independently associated with increased mortality or increased length of ICU stay.. Retrospective descriptive study of patients with UA included in the ARIAM registry.. ICUs from 129 hospitals in Spain.. From June 1996 to December 2003 a total of 14,096 patients were included in the ARIAM registry with a diagnosis of UA.. Variables associated with the development of HDAVB, variables associated with the mortality of patients with UA, variables associated with the length of ICU stay of patients with UA.. HDAVB frequency was 1%. Development of HDAVB was independently associated with the Killip classification and the presence of sustained ventricular tachycardia or ventricular fibrillation. Crude mortality of patients was significantly increased when HDAVB was present (9% versus 1%, p < 0,001). When adjusted for other variables, HDAVB was not associated with increased mortality. Development of HDAVB in patients with UA was independently associated with an increase in the length of ICU stay (adjusted odds ratio 1.89: 95% confidence interval: 1.33-5.69).. Patients with UA complicated with HDAVB represent a high-risk population with an increased ICU stay.

Topics: Aged; Aged, 80 and over; Angina, Unstable; Cardiovascular Agents; Female; Heart Block; Humans; Male; Middle Aged; Registries; Retrospective Studies; Risk Factors; Spain

In the elderly, acute coronary syndromes (ACS) without ST elevation are a frequent and important cause of admission. In the UK, practice patterns and outcomes in these patients need to be assessed.. We enrolled 1,046 patients admitted with ACS without ST elevation to 56 UK centres (20 consecutive patients per centre) and followed them for 6 months. We compared baseline characteristics, outcomes and treatments in those aged 80 and over (n = 119, 11%), from 70 to 79 (n = 301, 29%), from 60 to 69 (n = 283, 27%) with those below 60 (n = 343, 33%).. The proportions of males were 40, 52, 67 and 70%, respectively (P < 0.001). There were no differences in the proportion of patients with diabetes (17% overall), treated hypertension (38%) or prior myocardial infarction (MI) (48%). The proportions with ST depression or bundle branch block on admission ECG were 40, 39%, and 28, 18% (P < 0.001), respectively. The rates of the composite endpoint of death or new MI at 6 months were 20, 18, 12 and 6% (P < 0.001), respectively. Heparin, beta blockers and statins were used in significantly higher proportions in younger patients compared with older patients. Similarly, older patients had significantly lower rates of angiography and revascularisation compared with younger patients.. In this large population-based registry of UK patients admitted to hospital with ACS without ST elevation, those aged over 70 are at substantially higher risk of adverse events than younger patients. However, they are less likely to receive treatments of proven benefit or to be investigated with a view to revascularisation. A more aggressive approach to these patients may be more appropriate and is likely to result in substantial benefits.

Topics: Age Factors; Aged; Aged, 80 and over; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Electrocardiography; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Survival Rate

A high concentration of plasma asymmetric dimethylarginine (ADMA) has been associated with several risk factors for atherosclerosis, and this may increase the risk for acute coronary syndromes (ACSs). We measured plasma ADMA concentrations in patients who had newly diagnosed ACS (n = 48), and we followed the changes in ADMA concentrations during these patients' short-term medical therapy, which included various combination of drugs with or without percutaneous coronary interventions according to the needs of each patient. Concentrations of plasma ADMA were found to be high in patients who had ACS compared with 48 age-matched healthy control subjects (3.13 +/- 0.85 vs 1.57 +/- 0.85 mumol/L, p <0.0001). Follow-up measurements of ADMA showed dramatic decreases in plasma ADMA concentrations over 2 weeks of medical therapy for ACS (from 3.27 +/- 0.87 to 1.52 +/- 0.47 mumol/L, p <0.0001). Plasma ADMA at baseline showed a significant positive correlation with serum C-reactive protein and plasma insulin and a significant negative correlation with serum levels of high-density lipoprotein and plasma alpha-tocopherol. During therapy, changes in plasma ADMA concentrations were significantly correlated with changes in the ratio of total cholesterol to high-density lipoprotein cholesterol and in serum C-reactive protein concentrations but not with changes in insulin levels. This study provides the first evidence that plasma ADMA concentrations are significantly high in patients who have ACS and that ADMA concentrations rapidly decrease after short-term medical therapy.

Topics: Adult; Aged; alpha-Tocopherol; Angina, Unstable; Angioplasty, Balloon, Coronary; Arginine; C-Reactive Protein; Cardiovascular Agents; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Combined Modality Therapy; Coronary Angiography; Coronary Artery Disease; Enzyme Inhibitors; Female; Follow-Up Studies; Humans; Insulin; Lipoproteins, HDL; Male; Middle Aged; Myocardial Infarction; Statistics as Topic; Treatment Outcome; Triglycerides

Chronic renal insufficiency (CRI) has been identified as an important risk factor for cardiac events. Studies in the United States reported decreased survival and decreased use of surgical and medical interventions after myocardial infarction in patients with CRI.. We studied the impact of renal function on health outcomes in a Canadian cohort of consecutive patients admitted with acute coronary syndrome (ACS) between October 1997 and October 1999. The study design is an observational cohort of 5,549 adult patients who survived to discharge with a discharge diagnosis of ACS. Renal function is classified into 4 levels: (1) normal, glomerular filtration rate (GFR) greater than 80 mL/min/1.73 m2 (>1.33 mL/s); (2) mild CRI, GFR of 60 to 80 mL/min/1.73 m2 (1.00 to 1.33 mL/s); (3) moderate CRI, GFR of 30 to 59 mL/min/1.73 m2 (0.50 to 0.98 mL/s); and (4) severe CRI, GFR less than 30 mL/min/1.73 m2 (<0.50 mL/s). The primary outcome is death.. Advanced and moderate CRI independently predicted death (hazard ratio, 1.06; 95% confidence interval [CI], 1.01 to 1.12; and hazard ratio, 1.23; 95% CI, 1.18 to 1.29). Severe anemia (hemoglobin level < 9.0 g/dL [<90 g/L]) also was an independent risk factor for death (hazard ratio, 1.38; 95% CI, 1.18 to 1.61). Use of beta-blockers (hazard ratio, 0.91; 95% CI, 0.86 to 0.97), acetylsalicylic acid (hazard ratio, 0.90; 95% CI, 0.84 to 0.97), lipid-lowering therapy (hazard ratio, 0.84; 95% CI, 0.78 to 0.89), and medical thrombolysis (hazard ratio, 0.89; 95% CI, 0.81 to 0.97) were associated with reduced risk for death. Medical interventions with beta-blockers, acetylsalicylic acid, lipid-lowering therapy, and thrombolysis and surgical intervention were significantly less likely to be used in patients with CRI.. Despite universal access to health care, Canadian patients with CRI are more likely to die after a cardiac event and less likely to receive important interventions.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Anemia; Angina, Unstable; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiovascular Agents; Cohort Studies; Comorbidity; Drug Utilization; Female; Fibrinolytic Agents; Glomerular Filtration Rate; Humans; Hyperlipidemias; Hypertension; Hypolipidemic Agents; Kidney Failure, Chronic; Life Tables; Male; Middle Aged; Mortality; Myocardial Infarction; Myocardial Revascularization; Nova Scotia; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Smoking; Survival Analysis; Thrombolytic Therapy; Treatment Outcome

Patients' beliefs about their disease may affect their willingness to engage in preventive health behaviors. We sought to determine whether men and women with acute coronary syndrome differ in their perceptions of the severity of cardiac-related illness while controlling for the clinical severity of their condition.. All patients with acute coronary syndrome discharged from a university hospital during a 3-year period were mailed a questionnaire, and medical records were abstracted. The questionnaire assessed perceived severity of cardiac-related illness (5-point scale from "very mild" to "very severe"), symptom frequency, type of acute coronary syndrome event, number of medications, Duke Activity Status Index (DASI), time since most recent cardiac event, Charlson Comorbidity Index, and demographic information. A logistic regression model was constructed with perceived severity of heart disease as the dependent variable. Gender was the key independent variable while controlling for the other patient and disease variables.. The 490 respondents (1217 surveys sent, 40.3% response rate) included 348 men and 142 women who were similar with regard to race and type of acute coronary syndrome event experienced. Women were older, less educated, had a lower DASI score, had more symptoms, and were taking more medications. However, they perceived their cardiac disease as being no more severe than the men. The significant predictors in the regression model of perceived severity included gender, DASI, number of symptoms, type of acute coronary syndrome event, and comorbidity. Female gender was associated with lower perceived severity (odds ratio 0.30-0.80).. Women rate their cardiac disease as less severe than do men when controlling for other measures of cardiac disease severity.

Topics: Acute Disease; Adult; Aged; Angina, Unstable; Attitude to Health; Cardiovascular Agents; Comorbidity; Cross-Sectional Studies; Culture; Female; Gender Identity; Hospitals, University; Humans; Male; Michigan; Middle Aged; Myocardial Infarction; Patient Acceptance of Health Care; Self Concept; Severity of Illness Index; Surveys and Questionnaires; Syndrome; Women

Topics: Acute Disease; Adrenergic beta-Antagonists; Angina Pectoris; Angina, Unstable; Anticoagulants; Cardiac Catheterization; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Electrocardiography; Fibrinolytic Agents; Humans; Myocardial Infarction; Nitrates; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Prognosis; Randomized Controlled Trials as Topic; Risk Factors; Syndrome; Thrombolytic Therapy; Time Factors

Topics: Angina Pectoris; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Electrocardiography; Fibrinolytic Agents; Humans; Myocardial Infarction; Myocardial Revascularization; Prognosis; Time Factors; Treatment Outcome

Decrease of fibrinolytic potential is considered to be a risk factor for arterial thrombosis. The recently described thrombin-activatable fibrinolysis inhibitor (TAFI) attenuates fibrinolysis by cleaving of the C-terminal lysine residues from fibrin, thereby inhibiting tPA mediated plasminogen activation. The role of plasma TAFI antigen (Ag) levels and gene polymorphisms in arterial thrombosis is still not elucidated. In this prospective study, the association between plasma TAFI Ag levels and the TAFI gene polymorphisms, Ala147Thr, Thr325Ile and -438A/G, with refractory unstable angina pectoris (UAP) was determined. The study population consisted of 209 patients with UAP of whom 76 were refractory and 133 non-refractory to medical treatment. In the same study population the contribution of these polymorphisms to plasma TAFI Ag levels was determined. Plasma TAFI Ag levels were significantly higher in non-refractory patients compared to refractory patients (geometric mean 114.4 and 105.6 U/dl respectively, p=0.042). Plasma TAFI Ag levels in the lowest quartile resulted in a 2.6 fold (95% confidence interval 1.2-5.9) increased risk for refractory UAP compared to plasma TAFI Ag levels in the upper quartile. The three studied TAFI polymorphisms had an independent and additive effect on plasma TAFI Ag levels. However, no significant association between the individual TAFI polymorphisms and refractiveness was observed. In conclusion, in this study population plasma TAFI Ag levels are significantly correlated with refractiveness in patients with UAP. Furthermore, all three polymorphisms contribute independently to plasma TAFI Ag levels, but not to refractiveness.

Topics: Aged; Alleles; Angina, Unstable; Biomarkers; Carboxypeptidase B2; Cardiovascular Agents; Drug Resistance; Exons; Female; Genetic Predisposition to Disease; Genotype; Haplotypes; Hemostasis; Humans; Inflammation; Male; Middle Aged; Polymorphism, Genetic; Prospective Studies; Risk Factors; Treatment Outcome

There is evidence that several classes of drugs are beneficial for secondary prevention in patients with coronary artery disease.. To compare the use of secondary preventive drugs in patients with acute coronary syndromes given conservative treatment or percutaneous coronary interventions.. The PREVENIR survey was designed to assess the management of patients with acute coronary syndromes admitted to hospital in France in January 1998. Drugs prescribed at hospital discharge were recorded retrospectively from the hospital records, and treatment at six months was assessed prospectively.. University hospitals, general hospitals, and private clinics throughout the country.. Of 1394 patients participating in the survey, 668 underwent coronary angioplasty during the initial hospital stay and 706 had medical treatment only. At hospital discharge, aspirin, beta blockers, and statins were prescribed significantly more often in patients undergoing angioplasty. Using multivariate logistic regression, coronary angioplasty was an independent predictor of treatment with aspirin (odds ratio 3.55), statins (1.92), and beta blockers (1.41). Compared with treatment at discharge, only statin use differed at six months, with a significant increase both in patients treated medically and in those who had undergone angioplasty. Increased use of statins, aspirin, and beta blockers was significantly correlated with coronary angioplasty during the initial hospital stay.. In this national French survey, patients treated with percutaneous coronary interventions were more likely to receive secondary preventive drugs than patients receiving medical treatment alone.

Topics: Aged; Analysis of Variance; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Artery Bypass; Female; Hospitalization; Humans; Male; Myocardial Infarction; Retrospective Studies

Topics: Acute Disease; Angina, Unstable; Angioplasty, Balloon, Coronary; Atrial Fibrillation; Cardiology; Cardiovascular Agents; Clinical Trials as Topic; Congresses as Topic; Coronary Artery Bypass; Coronary Disease; Echocardiography; Europe; Heart Failure; Humans; Myocardial Infarction; Stents; Syndrome; Thrombolytic Therapy

Topics: Angina, Unstable; Cardiovascular Agents; Clinical Trials as Topic; Critical Care; Defibrillators, Implantable; Evidence-Based Medicine; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lidocaine; Magnesium Sulfate; Myocardial Infarction; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex

Topics: Angina, Unstable; Cardiovascular Agents; Humans; Myocardial Revascularization

Because time to presentation to the hospital affects time to treatment and is known to be important in acute myocardial infarction, we evaluated this variable in patients with unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). Among 2909 consecutive patients with UA/NSTEMI admitted to 35 hospitals in 6 geographic regions of the United States, we compared patients with acute (onset of pain <12 hours before admission) and subacute (onset >12 hours) unstable angina.. Patients with "hot" (acute) unstable angina presented more often to the emergency department and were subsequently admitted more often to an intensive care unit. Hospital administration of medications did not differ between the two groups, with the exception of heparin, which was paradoxically used more often in subacute patients (p<0.001). All cardiac invasive procedures were undertaken less often in the acute patients (catheterization, 41.4% vs. 58.7%, p=0.001; percutaneous coronary intervention, 11.3% vs. 21.1%, p=0.001; coronary artery bypass grafting, 5.6% vs. 12.0%, p=0.001). A greater percentage of acute patients were found to have no significant coronary artery disease at cardiac catheterization (20.1% vs. 15.0%, p=0.006). Mortality did not differ between the two groups; however, the composite endpoint of death and MI favored the acute patients (1.3% vs. 2.2%, p=0.032).. Contrary to our initial hypothesis, "hot" UA patients tended to be at lower risk than patients with subacute presentation, highlighting the fact that patients with UA/NSTEMI remain at high risk even after the initial 12-hour period.

Topics: Acute Disease; Adult; Aged; Angina, Unstable; Cardiovascular Agents; Cardiovascular Surgical Procedures; Emergency Medical Services; Female; Heparin; Humans; Male; Middle Aged; Prospective Studies; Registries; Risk Factors; Severity of Illness Index; Treatment Outcome; United States

The objective of this study was to determine how subgroup analyses are performed in large randomized trials of cardiovascular pharmacotherapy.. We reviewed 67 randomized, double-blind, controlled trials involving pharmacotherapy in at least 1000 patients with unstable angina, myocardial infarction, left ventricular dysfunction, or heart failure with clinical outcomes as primary end points, published between 1980 and 1997. Nine had no subgroup analyses but 43 reported on 5 or more subgroups and 31 reported subgroups without formal statistical tests for treatment-subgroup interactions. In most trials, a rationale for subgroup selection was missing. All but 6 focused on single-factor subgroups.. Trial subgroups should ideally be defined a priori on 2 bases: single-factor subgroups with a strong rationale for biological response modification and multifactorial prognostic subgroups defined from baseline risks. However, single-factor subgroup analyses are often reported without a supporting rationale or formal statistical tests for interactions. We suggest that clinicians should interpret published subgroup-specific variations in treatment effects skeptically unless there is a prespecified rationale and a significant treatment-subgroup interaction.

Topics: Angina, Unstable; Cardiovascular Agents; Data Interpretation, Statistical; Double-Blind Method; Heart Failure; Humans; Myocardial Infarction; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Treatment Outcome; Ventricular Dysfunction, Left

Despite the deleterious and sometimes catastrophic consequences of proximal left anterior descending (LAD) artery occlusion, there is a paucity of data to guide the treatment of patients with such disease. Our aim was to describe outcomes with medical therapy, angioplasty, or left internal mammary artery (LIMA) bypass grafting in patients with 1-vessel, proximal LAD disease. We retrospectively analyzed prospectively collected data from 1,188 patients first presenting only with proximal LAD disease at 1 center over 9 years. We assessed the rates of death, acute myocardial infarction, and repeat intervention by initial treatment over a median 5.7 years of follow-up. Patients undergoing angioplasty or LIMA bypass were more often men and had progressive or unstable angina; those receiving medical therapy had a lower median ejection fraction. Both revascularization procedures offered slightly better adjusted survival versus medicine (hazard ratio for angioplasty, 0.82; 95% confidence interval, 0.60 to 1.11; hazard ratio for bypass, 0.74; 95% confidence interval, 0.44 to 1.23). Bypass, but not angioplasty, was associated with significantly fewer composite end point events (death, infarction, or reintervention, p <0.0001), and angioplasty was associated with a higher composite event rate than bypass or medical therapy (p <0.0001 and p = 0.0003, respectively). The initial advantages of bypass and medicine over angioplasty diminished over time; angioplasty became more advantageous than medicine after 1 year (p = 0.05) and not significantly different from bypass. Treatment of 1-vessel, proximal LAD disease with medicine, angioplasty, or UMA bypass resulted in comparable adjusted survival. However, LIMA bypass alone reduced the long-term incidence of infarctions and repeat procedures.

Topics: Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiac Output, Low; Cardiovascular Agents; Cohort Studies; Confidence Intervals; Coronary Disease; Disease Progression; Female; Follow-Up Studies; Humans; Incidence; Internal Mammary-Coronary Artery Anastomosis; Male; Middle Aged; Myocardial Infarction; Odds Ratio; Proportional Hazards Models; Prospective Studies; Reoperation; Retreatment; Retrospective Studies; Sex Factors; Stroke Volume; Survival Rate; Treatment Outcome

Topics: Angina, Unstable; Cardiovascular Agents; Female; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Middle Aged; Shock, Cardiogenic; Ventricular Outflow Obstruction

The CD40 ligand (CD40L) on activated T cells and platelets may be activating matrix metalloproteinases, inducing procoagulant activity, and be involved in the pathogenesis of acute coronary syndromes by promoting plaque rupture in atheroma.. To study the role of CD40L-CD40 interaction in coronary disease, we analyzed levels of soluble (s) and membrane-bound CD40L in the peripheral blood from 29 patients with stable angina, 26 with unstable angina, and 19 controls. Our main findings follow. (1) Patients with unstable angina had significantly raised serum levels of sCD40L when compared with patients with stable angina and controls. (2) Platelets could release large amounts of sCD40L when stimulated ex vivo with the thrombin receptor-agonist peptide SFLLRN in both patients and controls. (3) Platelets in patients with unstable angina were characterized ex vivo by decreased intracellular levels and decreased SFLLRN-stimulated release of sCD40L, which may possibly represent a higher percentage of degranulated platelets in these patients. (4) T cells in patients with unstable angina had enhanced surface expression of CD40L and increased release of sCD40L on anti-CD3/anti-CD28 stimulation in vitro when compared with patients with stable angina and controls. (5) Recombinant CD40L and serum from patients with unstable angina who had high sCD40L levels induced enhanced release of monocyte chemoattractant peptide-1 from mononuclear cells, a CC-chemokine involved in the pathogenesis of atherosclerosis.. This first demonstration of enhanced levels of soluble and membrane-bound forms of CD40L in angina patients, with particularly high levels in patients with unstable angina, suggests that CD40L-CD40 interaction may play a pathogenic role in both the long-term atherosclerotic process and in the triggering and propagation of acute coronary syndromes.

Topics: Acute Disease; Aged; Angina Pectoris; Angina, Unstable; Blood Platelets; Cardiovascular Agents; CD4-Positive T-Lymphocytes; CD40 Antigens; CD40 Ligand; CD8-Positive T-Lymphocytes; Cell Membrane; Chemokine CCL2; Cholesterol; Coronary Disease; Cytoplasmic Granules; Female; Humans; Male; Membrane Glycoproteins; Metalloendopeptidases; Middle Aged; Peptide Fragments; Platelet Activation; Rupture, Spontaneous; Smoking; Solubility; Syndrome; Triglycerides; Vasculitis

Therapeutic options in acute coronary syndrome (unstable angina pectoris/non-Q-wave myocardial infarction), as also in acute Q-wave infarction, include conservative medical and mechanical-interventional measures. Early hospitalization for surveillance and induction of treatment is always necessary. Administration of oxygen, analgesia, sedation and treatment with nitrates, beta blockers or calcium antagonists, acetylsalicylic acid (ASA) and heparin are the basic measures. As alternatives to ASA, the new ADP antagonists, ticlopidine, clopidogrel, and as an alternative to heparin, hirudin or low-molecular-weight heparins can be used. If this does not result in rapid clinical stabilisation (here, transient ST-T changes in the ECG and the detection of troponine I or T represent major risk indicators) the new glycoprotein-IIb/IIIa receptor antagonists may be employed as highly potent platelet aggregation inhibitors. In addition, the patients should then undergo coronary angiography prior to interventional treatment of the underlying coronary stenosis.

Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Artery Bypass; Coronary Disease; Humans; Myocardial Infarction; Survival Rate; Treatment Outcome

Activated mast cells are present in human coronary atheromas, as well as in the adventitia of patients with variant angina, and may play an important role in plaque rupture and coronary vasomotion. To assess whether or not activation of mast cells is a primary event, we measured serum levels of tryptase, a specific marker of mast cell activation, in 8 patients with unstable angina during a spontaneous ischemic episode (Group 1) and in 5 patients with variant angina (Group 2) during ergonovine-induced coronary spasm. Blood samples were collected as soon as possible after the onset of pain and ECG changes (0 min), and after 5, 15 and 60 min. Tryptase levels in Group 1 were 0.13 U/l (range 0.017-0.44) at the onset of pain and significantly raised to 0.75 U/l (range 0.05-2.49) at 5 min, decreasing to 0.076 U/l (range 0.018-0.16) at 15 min and to 0.085 U/l (range 0.01-0.25) at 60 min (p = 0.035). Conversely, tryptase levels in Group 2 were 0.09 U/l (range 0.07-0.13) at 0 min, 0.11 U/l (range 0.07-0.22) at 5 min, 0.10 U/l (range 0.07-0.18) at 15 min, 0.11 U/l (range 0.07-0.17) at 60 min (NS). In conclusion, tryptase levels raise during spontaneous ischemic episodes in unstable angina, but not after ergonovine-provoked ischemia in variant angina, suggesting that a primary, yet unknown stimulus, may activate mast cells during some ischemic episodes in unstable angina.

Topics: Aged; Angina Pectoris, Variant; Angina, Unstable; Cardiovascular Agents; Chymases; Clinical Enzyme Tests; Ergonovine; Female; Humans; Inflammation Mediators; Male; Middle Aged; Myocardial Ischemia; Radioimmunoassay; Serine Endopeptidases; Time Factors; Tryptases

Topics: Angina, Unstable; Cardiovascular Agents; Diagnosis, Differential; Electrocardiography; Humans; Military Personnel; Myocardial Ischemia; Prognosis; Risk Factors; Russia

Three hundred twenty seven patients with medically stabilized unstable angina and a negative exercise test were followed-up during a mean of 39 months. Male gender, diabetes mellitus, and previous myocardial infarction, but not exercise parameters, were predictors of death or acute myocardial infarction.

Topics: Aged; Angina, Unstable; Cardiovascular Agents; Cause of Death; Exercise Test; Female; Follow-Up Studies; Humans; Male; Myocardial Infarction; Prognosis; Risk Factors; Survival Rate

This study was designed to examine the plasma levels of B-type or brain natriuretic peptide (BNP), as well as A-type or atrial natriuretic peptide (ANP) in patients with unstable angina as compared with those in patients with stable exertional angina and control subjects. We measured the plasma levels of BNP and ANP in 33 patients with unstable angina, 20 patients with stable exertional angina, and 20 control subjects. The plasma levels of BNP were significantly increased in patients with unstable angina compared with those in patients with stable exertional angina and control subjects, respectively (39.5 +/- 29.4 pg/ml vs 15.1 +/- 8.0 pg/ml; p < 0.01 and 39.5 +/- 29.4 pg/ml vs 10.3 +/- 6.4 pg/ml; p < 0.01, respectively). On the other hand, there was no significant difference in the plasma levels of ANP among the three groups. Furthermore, in patients with unstable angina, the plasma levels of BNP decreased significantly after the medical treatment (from 39.5 +/- 29.4 pg/ml to 15.8 +/- 11.0 pg/ ml; p < 0.01), whereas the plasma levels of ANP did not change. We conclude that the plasma levels of BNP are increased in the majority of patients with unstable angina and that the increased levels decrease toward normal after treatment.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Atrial Natriuretic Factor; Cardiovascular Agents; Echocardiography; Electrocardiography; Electrocardiography, Ambulatory; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Physical Exertion

Topics: Angina, Unstable; Cardiovascular Agents; Electrocardiography; Emergencies; Humans; Male

Topics: Angina, Unstable; Anticoagulants; Cardiovascular Agents; Drug Therapy, Combination; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors

Endothelial dysfunctions, nonocclusive coronary thrombi and plaque ruptures cause unstable angina pectoris, an instability of coronary artery disease and are accompanied by an increased risk of sudden death and acute myocardial infarction. Clinical factors, angiography and newer laboratory measurements help to identify patients who should be assigned to surgical or interventional revascularization or to medical therapy. In contrast to revascularization procedures, medical therapy is available everywhere at any time. Monotherapy either by use of betablockers or calcium antagonists can not be recommended while nitrates are a cornerstone in medical therapy for unstable angina. Nitrates in combinations with betablockers and calcium antagonists have been shown to reduce the number and duration of ischaemic episodes. These combinations also reduce the incidence of acute myocardial infarction, sudden death and the need for surgical revascularization.

Topics: Adrenergic beta-Antagonists; Angina, Unstable; Calcium Channel Blockers; Cardiovascular Agents; Drug Therapy, Combination; Humans; Nitrates

The prognostic value of thallium-201 imaging in patients with unstable angina is not well established. Forty consecutive patients with unstable angina who had responded to medical therapy underwent predischarge symptom-limited exercise testing and 39 of them underwent exercise thallium-201 imaging, on average 3 days after the exercise test. Exercise echocardiography was performed in 36 of these patients in conjunction with the predischarge exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle branch block and dilated cardiomyopathy were not included in the study. An echocardiographic wall-motion score index was derived by analyzing left ventricular regional wall motion. During a follow-up period of 30 +/- 6.4 months, 3 patients had a non-fatal myocardial infarction and 20 required revascularization because of a recurrence of severe medically refractory angina. Univariate predictors of cardiac events (non-fatal myocardial infarction or a need for revascularization) during follow-up included ST-depression during exercise, positive exercise echocardiography, a low exercise wall-motion score index, the presence of thallium-201 redistribution and the number of myocardial segments with thallium-201 redistribution. However, stepwise logistic regression analysis revealed that the presence of thallium-201 redistribution was the only significant non-invasive predictor (P < 0.005) of a cardiac event among patients who underwent predischarge exercise testing and exercise thallium-201 imaging. Among patients undergoing exercise echocardiography and exercise thallium-201 imaging, the number of segments with thallium-201 redistribution was the only significant predictor (P < 0.0005) of future cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Angina, Unstable; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Circulation; Echocardiography; Electrocardiography; Exercise Test; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Prospective Studies; Thallium Radioisotopes; Treatment Outcome

The diagnostic and prognostic value of predischarge exercise echocardiography (echo) was assessed prospectively in 36 patients with unstable angina soon after stabilization on medical treatment. Two-dimensional echo was performed at rest and immediately after a symptom-limited exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle-branch block and dilated cardiomyopathy were excluded. Left ventricular regional wall motion was analyzed visually and a wall motion score index (WMSI) was derived. Patients were followed prospectively for an average period of 26 months (range 16-34 months). The study end points were a new cardiac event defined as acute myocardial infarction or a need for coronary revascularization because of a recurrence of severe medically refractory angina. Sixteen patients (44%) had positive exercise electrocardiography (ECG), while exercise echo was positive in 22 patients (61%). Of 28 patients undergoing coronary angiography, 23 had significant coronary artery disease (CAD). The sensitivity of exercise ECG in detecting CAD was 61% while the corresponding result was 83% for exercise echo. Cardiac events occurred in 21 patients (58%). Exercise ECG was positive in 12 of these patients (57%), while a positive exercise echo was found in 17 patients (81%). There were significantly more patients with positive exercise echo among patients experiencing cardiac events than among those without cardiac events (p less than 0.01). In patients with CAD, WMSI decreased significantly after exercise (p less than 0.05). Exercise WMSI was also significantly lower in patients with CAD than in those without CAD (p less than 0.02). Exercise WMSI also discriminated patients with cardiac events from those without such events (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Antagonists; Adult; Aged; Angina, Unstable; Aspirin; Calcium Channel Blockers; Cardiovascular Agents; Echocardiography; Exercise Test; Female; Follow-Up Studies; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Nitrates; Patient Discharge

The diagnostic usefulness of predischarge exercise echocardiography in 35 patients with unstable angina who responded to medical therapy was correlated with exercise thallium-201 single photon emission computed tomography (TI-SPECT) performed, on the average, three days after the exercise echocardiography. None of the patients had myocardial infarction prior to hospitalization or before TI-SPECT and none had left bundle-branch block on their rest electrocardiogram (ECG). Exercise echocardiography was positive in 21 patients and TI-SPECT in 24. The results of the two techniques were concordant in 28 of 35 patients (agreement = 80%, k = 0.57 +/- 0.14, p less than 0.001). Wall-by-wall comparison of the distribution of exercise-induced wall motion abnormalities with reversible thallium defects showed complete or partial correlation in all of 19 patients in whom both the tests were positive. A positive exercise ECG and positive exercise echocardiography identified 11 of 11 patients with angiographically verified significant coronary artery disease (CAD) and 11 of 12 patients (92%) with positive TI-SPECT. Thus, exercise echocardiography is a valuable addition to routine predischarge exercise test in the noninvasive diagnosis of myocardial ischemia and shows a good correlation with TI-SPECT in detecting and localizing ischemia in patients with unstable angina stabilized on medical therapy.

Topics: Angina, Unstable; Cardiovascular Agents; Echocardiography; Exercise Test; Female; Humans; Male; Middle Aged; Patient Discharge; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Unstable angina pectoris, a particular form of acute coronary heart disease is described in two exemplary cases. This article will illustrate problems with definition and further (sub-)classification of the disease. Furthermore etiology and pathophysiologic mechanisms as well as diagnostic tools, current management and prognostic aspects will be discussed.

Topics: Adult; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Electrocardiography; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis

The platelets from 74 patients with acute myocardial infarction or with unstable angina showed decreased prostaglandin E1/I2 receptor activity when compared with that of 56 normal volunteers by using [3H]prostaglandin E1 as a probe. In normals, Scatchard analyses showed the presence of one high-affinity-low-capacity (Kd1 = 9.0 +/- 1.2 nM [mean +/- SD]; n1 = 120 +/- 30 sites/cell) and one low-affinity-high-capacity (Kd2 = 1.1 +/- 0.5 microM; n2 = 1,460 +/- 250 sites/cell) prostaglandin E1/I2 receptor population in platelets. In contrast (p less than 0.01), platelets from patients showed decreased ligand binding (n1 = 40 +/- 20 sites/cell; n2 = 800 +/- 210 sites/cell) with little change in the affinity of the receptors (Kd1 = 7.50 +/- 1.6 nM; Kd2 = 0.68 +/- 0.24 microM). On the other hand, the platelets from the patients with dilated cardiomyopathy (n = 7) who were hospitalized for acute chest pain but had normal coronary arteries did not show any impairment of the receptor activity. The plasma prostacyclin level of the patients with acute ischemic heart disease was similar to that of normal volunteers; this finding indicated that the defective receptor function was not related to the prostaglandin receptors occupancy in vivo. The impaired receptor activity was temporary in nature. The follow-up studies showed that the prostaglandin receptor activity of the patients' platelets improved to "normal" levels within 2-8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adult; Angina, Unstable; Blood Platelets; Cardiomyopathies; Cardiovascular Agents; Coronary Disease; Cyclic AMP; Epoprostenol; Female; Humans; Male; Middle Aged; Prostaglandins E; Receptors, Epoprostenol; Receptors, Prostaglandin; Receptors, Prostaglandin E; Reference Values

Although unstable angina is an extremely common and often initial manifestation of coronary disease, few controlled studies of its treatment have been carried out. This relative dearth of information is due to the methodological problems raised by the evaluation of unstable angina. Unlike the definition of myocardial infarction, that of unstable angina--i.e. of a population of coronary patients who from time to time are at a high risk of myocardial infarction or death--is neither unequivocal nor easy to standardize. It follows that the patient population ultimately selected for controlled trials is but a small part of all unstable angina patients. The representativeness of patients involved in therapeutic trials is probably approximate. Moreover, the current criteria for assessment of effectiveness are either the clinical signs of angina in the short term or the incidence of myocardial infarction and changes in survival curves in the mid- and long terms. A more precise definition of criteria of inclusion, leading to an homogeneous population, and the development of a simple and reliable method for detecting and quantifying myocardial ischaemia, both being used as intermediate criteria of assessment, would undoubtedly improve the quality of therapeutic trials in unstable angina and, mostly, their applicability to daily therapeutic practice.

Topics: Angina Pectoris; Angina, Unstable; Cardiovascular Agents; Clinical Trials as Topic; Coronary Angiography; Coronary Disease; Exercise Test; Humans

Alinidine is a new sinus node inhibitor which does not interact with the beta adrenergic receptors. Its haemodynamic effects were studied in 57 patients; 24 with unstable angina, 9 with myocardial infarction and heart rate greater than 100 bpm but without heart failure. 10 with myocardial infarction treated with vasodilators and 14 with severe heart failure or shock. After dosages up to 40 mg alinidine, heart rate decreased by 14 +/- 7 bpm, mean arterial pressure was reduced by 3 +/- 6 mmHg, stroke volume remained unchanged while cardiac output decreased 0.5 +/- 0.61 min-1 and systemic vascular resistance increased. Signs of heart failure developed in 3 patients, although overall left ventricular filling pressure remained unchanged. The haemodynamic response to alinidine warrants further studies of its efficacy in patients with angina or sinus tachycardia.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Cardiac Output; Cardiovascular Agents; Clonidine; Female; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction

Topics: Angina Pectoris; Angina, Unstable; Cardiovascular Agents; Coronary Disease; Humans; Myocardial Infarction