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OBJECTIVE: Previous studies have demonstrated the importance of intensive optimal medical therapy (OMT) in patients with coronary artery disease (CAD). To investigate our hypothesis that patients with and without OMT achievement differed with respect to the risk of future cardiac events, we investigated the endothelial function in patients with CAD who underwent percutaneous coronary intervention (PCI) and contemporary medical therapy. METHODS: We conducted a prospective longitudinal cohort study to evaluate the endothelial function in 96 consecutive patients at 12 h after admission and 3 months at <12 h after admission and at 3 months after discharge by measuring the brachial artery dilatation after 5 min of forearm ischemia flow-mediated dilation (FMD). OMT achievement was defined as systolic blood pressure of ≤130 mm Hg, low-density lipoprotein cholesterol of ≤100 mg/dl, and hemoglobin A1c level of ≤7.0%. The primary endpoint was the incidence of composite major adverse cardiac or cerebrovascular events (MACCE) at 36 months. RESULTS: Forty-nine (51%) patients achieved all three risk factor targets at 3 months. Although baseline FMD values did not differ between the OMT achievement and non-achievement groups, the 3-month FMD significantly improved in the OMT achievement group (6.6±3.5 vs. 5.2±2.9, p=0.03). Patients with improved FMD at 3 months had a lower rate of 36-month MACCE than those with persistently impaired FMD. A multiple Cox hazards analysis showed that OMT was a protective predictor of MACCE (hazard ratio, 0.19; 95% confidence interval, 0.04-0.88, p=0.03). CONCLUSION: This study demonstrated a significant association between the serial measurement of endothelial function with OMT and the clinical outcome in patients after PCI. [ABSTRACT FROM AUTHOR]

Aims The purpose of this study was to identify determinants of sudden death among clinical information in combination with cardiac fatty acid metabolism for better risk-stratification of haemodialysis patients. Methods and Clinical and imaging data from 677 haemodialysis patients enrolled in the beta-methyl-p-iodophenylpentadecanoicacid results (BMIPP) SPECT Analysis for Decreasing Cardiac Events in Hemodialysis Patients (B-SAFE) study were analysed in this study. During a 3-year prospective follow-up interval, 20 sudden deaths were observed. Compared with non-sudden death patients, sudden death patients more frequently had an increased C-reactive protein level (.2.38 mg/dL), electrocardiographic abnormal Q-wave and increased BMIPP abnormality score (.16). Patients with BMIPP score . 16 and at least one of the other predictors had significantly lower event-free rates than did those without the BMIPP abnormality (P, 0.001). Univariate and multivariate Cox regression analyses revealed increased C-reactive protein level, abnormal Q-wave, and greater BMIPP abnormality as significant sudden death predictors with hazards ratios of 6.83 (95% CI: 1.76-26.47, P = 0.005), 17.73 (95% CI: 4.91-63.98, P, 0.001), and 10.58 (95% CI; 3.84-29.14, P, 0.001), respectively. The addition of BMIPP score .16 to the other clinical predictors increased the hazard ratio and receiver-operating characteristic analysis-area under the curve up to 145.22 (95% CI; 0.34-695.09) and to 0.677-0.690, respectively. Conclusions Increased C-reactive protein, electrocardiographic Q-wave, and impaired myocardial fatty acid metabolism are independently and synergistically related to sudden death risk in haemodialysis patients. The non-invasive strategy presented here might contribute to the identification of haemodialysis patients who can most benefit from a prophylactic treatment against sudden death. [ABSTRACT FROM AUTHOR]

Background. Non-invasive detection of coronary artery disease (CAD) remains difficult in patients with end-stage renal disease (ESRD). This study evaluated the ability of pharmacologic stress myocardial perfusion imaging to predict cardiac events in patients with ESRD.Methods. A prospective study was carried out in 49 consecutive patients with ESRD. Thallium-201 single photon emission computed tomography (SPECT) using high-dose adenosine triphosphate (ATP) was performed within 1 month of the beginning of haemodialysis. The study end-point was a cardiac event or the 1-year anniversary of the SPECT study.Results. Twenty-four patients (17 diabetics, 57% and seven non-diabetics, 37%) had myocardial perfusion defects. The remaining 25 patients had normal perfusion images. Fifteen patients had non-fatal cardiac events and two patients died of a cardiac cause. All patients who had non-fatal cardiac events underwent myocardial revascularization and survived until the end of follow-up. The 1-year cardiac event-free survival rate was 34% among patients with perfusion defects and 96% among patients without perfusion defects (P<0.001). The presence of a myocardial perfusion defect was the only independent predictor of 1-year cardiac events both in overall (HR, 49.91; 95% CI, 5.15–484.00; P<0.001) and in diabetic patients (HR, 33.72; 95% CI, 2.96–383.5; P = 0.005). Diabetes and an increased C-reactive protein were associated with the progression of CAD.Conclusions. Normal myocardial perfusion imaging by stress thallium-201 SPECT using high-dose ATP performed within 1 month after the beginning of haemodialysis treatment is a powerful predictor of cardiac event-free survival in patients with ESRD. [ABSTRACT FROM AUTHOR]