171 results on '"Myocardial Infarction"'
Search Results
2. Trajectories of alcohol consumption up to 30 years before and after the diagnosis of cardiovascular diseases: a longitudinal case--control study of 12 502 participants.
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Chengyi Ding, O'Neill, Dara, and Britton, Annie
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CARDIOVASCULAR disease diagnosis ,STATISTICS ,STROKE ,CONFIDENCE intervals ,CASE-control method ,ANGINA pectoris ,MYOCARDIAL infarction ,SEX distribution ,ALCOHOL drinking ,DESCRIPTIVE statistics ,DATA analysis - Published
- 2022
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3. How common are side effects of treatment to prevent gout flares when starting allopurinol?
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Saul, Helen, Deeney, Brendan, Swaithes, Laura, and Roddy, Edward
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DISEASE exacerbation ,NONSTEROIDAL anti-inflammatory agents ,DIARRHEA ,MYOCARDIAL infarction ,ANGINA pectoris ,MYALGIA ,COLCHICINE ,GOUT ,ALLOPURINOL - Published
- 2024
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4. Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation.
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Young Choi, Yunhee Lee, Sung- Hwan Kim, Sunhwa Kim, Ju Youn Kim, Tae- Seok Kim, Youmi Hwang, Ji- Hoon Kim, Sung- Won Jang, Man Young Lee, Yong- Seog Oh, Choi, Young, Lee, Yunhee, Kim, Sung-Hwan, Kim, Sunhwa, Kim, Ju Youn, Kim, Tae-Seok, Hwang, Youmi, Kim, Ji-Hoon, and Jang, Sung-Won
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ATRIAL fibrillation ,NATIONAL health insurance ,SURGICAL stents ,PROPENSITY score matching ,FIBRINOLYTIC agents - Abstract
Objective: Optimal antithrombotic therapy in patients with atrial fibrillation (AF) beyond 1 year after coronary stent implantation has not been well established in the era of direct oral anticoagulant (DOAC).Methods: Using Korean National Health Insurance Service data, we analysed 4294 patients with AF who were prescribed DOAC beyond 1 year after coronary stent implantation. Subjects were classified into the monotherapy group (DOAC single therapy, n=1221) or the combination therapy group (DOAC with an antiplatelet agent, n=3073). The primary ischaemic endpoint was defined as a composite of cardiovascular death, myocardial infarction, stroke or systemic thromboembolism. The secondary endpoints were all-cause death, major bleeding defined as a bleeding event requiring hospitalisation and net adverse clinical events. Propensity score matching was performed to balance baseline covariates.Results: Among included patients, 94% had drug-eluting coronary stents. During a median follow-up of 19 (7-32) months, the monotherapy group had a similar risk of the primary ischaemic endpoint (HR 0.828, 95% CI 0.660 to 1.038) and all-cause death (HR 1.076, 95% CI 0.895 to 1.294) compared with the combination therapy group. Risk of major bleeding was lower in the monotherapy group (HR 0.690, 95% CI 0.481 to 0.989), which was mostly driven by reduced gastrointestinal bleeding (HR 0.562, 95% CI 0.358 to 0.883). There was no significant difference in net adverse clinical events between the two groups.Conclusions: DOAC monotherapy showed similar efficacy in preventing ischaemic events and was associated with lower major bleeding events compared with combination therapy in patients with AF beyond 1 year after coronary stent implantation. [ABSTRACT FROM AUTHOR]- Published
- 2022
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5. Gender differences in use of invasive diagnostic and therapeutic procedures for acute ischaemic heart disease in Chinese adults.
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Levy, Muriel, Yiping Chen, Clarke, Robert, Yu Guo, Jun Lv, Canqing Yu, Liming Li, Zhengming Chen, Mihaylova, Borislava, Chen, Yiping, Guo, Yu, Lv, Jun, Yu, Canqing, Li, Liming, and Chen, Zhengming
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CORONARY angiography ,HEART diseases ,MYOCARDIAL infarction ,POISSON regression ,ADULTS ,MYOCARDIAL infarction treatment ,RESEARCH ,MYOCARDIAL ischemia ,RESEARCH methodology ,ANGINA pectoris ,EVALUATION research ,SEX distribution ,COMPARATIVE studies ,ACUTE diseases - Abstract
Objective: To investigate gender differences in the use of diagnostic and therapeutic procedures for acute ischaemic heart disease (IHD) in Chinese adults and assess whether socioeconomic or health system factors contribute to such differences.Methods: In 2004-2008, the China Kadoorie Biobank recruited 512 726 adults from 10 diverse areas in China. Data for 38 928 first hospitalisations with IHD (2911 acute myocardial infarction (AMI), 9817 angina and 26 200 other IHD) were obtained by electronic linkage to health insurance records until 31 December 2016. Multivariate Poisson regression models were used to estimate women-to-men rate ratios (RRs) of having cardiac enzyme tests, coronary angiography and coronary revascularisation.Results: Among the 38 928 individuals (61% women) with IHD admissions, women were less likely to have AMI (5% vs 12%), but more likely to have angina (26% vs 24%) or other IHD (69% vs 64%). For admissions with AMI, there were no differences in the use of cardiac enzymes between women and men (RR=1.00; 95% CI, 0.97 to 1.03), but women had lower use of coronary angiography (0.80, 0.68 to 0.93) and coronary revascularisation (0.85, 0.74 to 0.99). For angina, the corresponding RRs were: 0.97 (0.94 to 1.00), 0.66 (0.59 to 0.74) and 0.56 (0.47 to 0.67), respectively; while for other IHD, they were 0.97 (0.94 to 1.00), 0.87 (0.76 to 0.99) and 0.61 (0.51 to 0.73), respectively. Adjusting for socioeconomic and health system factors did not significantly alter the women-to-men RRs.Conclusions: Among Chinese adults hospitalised with acute IHD, women were less likely than men to have coronary angiography and revascularisation, but socioeconomic and health system factors did not contribute to these differences. [ABSTRACT FROM AUTHOR]- Published
- 2022
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6. Targeted metabolomic profiling and prediction of cardiovascular events: a prospective study of patients with psoriatic arthritis and psoriasis.
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Colaco, Keith, Ker-Ai Lee, Akhtari, Shadi, Winer, Raz, Welsh, Paul, Sattar, Naveed, McInnes, Iain B., Chandran, Vinod, Harvey, Paula, Cook, Richard J., Gladman, Dafna D., Piguet, Vincent, Eder, Lihi, and Lee, Ker-Ai
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ALANINE metabolism ,CHOLESTEROL metabolism ,TYROSINE metabolism ,CARDIOVASCULAR disease related mortality ,PSORIASIS ,BIOCHEMISTRY ,PSORIATIC arthritis ,UNSATURATED fatty acids ,RESEARCH ,STROKE ,TRANSIENT ischemic attack ,RESEARCH methodology ,CARDIOVASCULAR diseases ,MYOCARDIAL infarction ,NUCLEAR magnetic resonance spectroscopy ,ANGINA pectoris ,MEDICAL cooperation ,EVALUATION research ,RISK assessment ,COMPARATIVE studies ,APOLIPOPROTEINS ,HIGH density lipoproteins ,LONGITUDINAL method ,HEART failure ,PROPORTIONAL hazards models - Abstract
Objective: In patients with psoriatic disease (PsD), we sought serum metabolites associated with cardiovascular (CV) events and investigated whether they could improve CV risk prediction beyond traditional risk factors and the Framingham Risk Score (FRS).Methods: Nuclear magnetic resonance metabolomics identified biomarkers for incident CV events in patients with PsD. The association of each metabolite with incident CV events was analysed using Cox proportional hazards regression models first adjusted for age and sex, and subsequently for traditional CV risk factors. Variable selection was performed using penalisation with boosting after adjusting for age and sex, and the FRS.Results: Among 977 patients with PsD, 70 patients had incident CV events. In Cox regression models adjusted for CV risk factors, alanine, tyrosine, degree of unsaturation of fatty acids and high-density lipoprotein particles were associated with decreased CV risk. Glycoprotein acetyls, apolipoprotein B and cholesterol remnants were associated with increased CV risk. The age-adjusted and sex-adjusted expanded model with 13 metabolites significantly improved prediction of CV events beyond the model with age and sex alone, with an area under the receiver operator characteristic curve (AUC) of 79.9 versus 72.6, respectively (p=0.02). Compared with the FRS alone (AUC=73.9), the FRS-adjusted expanded model with 11 metabolites (AUC=75.0, p=0.72) did not improve CV risk discrimination.Conclusions: We identify novel metabolites associated with the development of CV events in patients with PsD. Further study of their underlying causal role may clarify important pathways leading to CV events in this population. [ABSTRACT FROM AUTHOR]- Published
- 2021
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7. Sex-based impact of carotid plaque in patients with chest pain undergoing stress echocardiography.
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Ahmadvazir, Shahram, Pradhan, Jiwan, Khattar, Rajdeep Singh, and Senior, Roxy
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STRESS echocardiography ,CHEST pain ,CAROTID intima-media thickness ,ATHEROSCLEROTIC plaque ,CORONARY disease ,SEX factors in disease ,PROGNOSIS ,INTERNAL carotid artery ,MYOCARDIAL infarction treatment ,ECHOCARDIOGRAPHY ,RESEARCH ,CAROTID artery diseases ,PREDICTIVE tests ,RESEARCH methodology ,MYOCARDIAL infarction ,ANGINA pectoris ,MEDICAL cooperation ,EVALUATION research ,ATHEROSCLEROSIS ,SEX distribution ,RISK assessment ,COMPARATIVE studies ,CORONARY artery disease ,MYOCARDIAL revascularization ,KAPLAN-Meier estimator ,DISEASE complications - Abstract
Objective: Women with suspected angina without history of coronary artery disease (CAD) less frequently have flow-limiting stenosis (FL-CAD) and more often have microvascular disease, affecting predictive accuracy of stress echocardiography (SE) for detection of FL-CAD. We postulated that carotid plaque burden (CPB) assessment would improve detection of FL-CAD and risk stratification.Methods: Consecutive consenting patients assessed by SE on clinical grounds for new-onset chest pain also underwent simultaneous carotid ultrasound. Patients were followed for major adverse events (MAE): all-cause mortality, non-fatal myocardial infarction and unplanned revascularisation. Carotid plaque presence and burden (CPB) were assessed.Results: After a mean of 2617±469 days (range 17-3740), of 591 recruited patients, 573 (97%) outcome data (314 females) were obtainable. Despite lower pretest probability of CAD in females versus males (14.9±0.8 vs 20.5±1.3, respectively, p<0.0001), prevalence of myocardial ischaemia was similar (p=0.08). Females also had lower prevalence of both carotid plaque (p<0.0001) and FL-CAD (p<0.05). CPB improved the positive predictive value of SE for detection of FL-CAD (from 34.5% to 60%) in females but not in males. Absence of CPB in females with myocardial ischaemia ruled out FL-CAD in 93% versus 57% in males. CPB was the only independent predictor of MAE (p=0.012) in females, whereas in males both SE (p<0.0001) and CPB (p=0.003) remained significant.Conclusion: In females with new-onset stable angina without a history of cardiovascular disease, CPB improved the predictive accuracy of myocardial ischaemia for flow-limiting CAD. However, CPB provided incremental risk stratification in both sexes. [ABSTRACT FROM AUTHOR]- Published
- 2020
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8. Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries.
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Vágó, Hajnalka, Szabó, Liliána, Dohy, Zsófia, Czimbalmos, Csilla, Tóth, Attila, Suhai, Ferenc Imre, Bárczi, György, Gyarmathy, V. Anna, Becker, Dávid, and Merkely, Béla
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CARDIAC magnetic resonance imaging ,CHEST pain ,CORONARY arteries ,HEART disease diagnosis ,HEART injuries ,MAGNETIC resonance ,VENTRICULAR ejection fraction ,MYOCARDIAL infarction treatment ,TREATMENT of cardiomyopathies ,MYOCARDIAL infarction-related mortality ,TROPONIN ,DATABASES ,RESEARCH ,TAKOTSUBO cardiomyopathy ,PREDICTIVE tests ,CARDIOMYOPATHIES ,TIME ,RESEARCH methodology ,MAGNETIC resonance imaging ,ANGINA pectoris ,MYOCARDIAL infarction ,PROGNOSIS ,DIFFERENTIAL diagnosis ,RETROSPECTIVE studies ,MEDICAL cooperation ,EVALUATION research ,RISK assessment ,COMPARATIVE studies ,CORONARY artery disease ,LONGITUDINAL method - Abstract
Objective: We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries.Methods: In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out.Results: CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality.Conclusions: CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population. [ABSTRACT FROM AUTHOR]- Published
- 2020
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9. Gender differences in use of invasive diagnostic and therapeutic procedures for acute ischaemic heart disease in Chinese adults
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Borislava Mihaylova, Zhengming Chen, Yu Guo, Muriel Levy, Yiping Chen, Canqing Yu, Robert Clarke, Liming Li, and Jun Lv
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Myocardial Ischemia ,030204 cardiovascular system & hematology ,Coronary Angiography ,Angina Pectoris ,Angina ,03 medical and health sciences ,symbols.namesake ,Sex Factors ,0302 clinical medicine ,Internal medicine ,Epidemiology ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Poisson regression ,Myocardial infarction ,Socioeconomic status ,Acute ischaemic heart disease ,business.industry ,Percutaneous coronary intervention ,Chinese adults ,medicine.disease ,3. Good health ,Acute Disease ,symbols ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
ObjectiveTo investigate gender differences in the use of diagnostic and therapeutic procedures for acute ischaemic heart disease (IHD) in Chinese adults and assess whether socioeconomic or health system factors contribute to such differences.MethodsIn 2004–2008, the China Kadoorie Biobank recruited 512 726 adults from 10 diverse areas in China. Data for 38 928 first hospitalisations with IHD (2911 acute myocardial infarction (AMI), 9817 angina and 26 200 other IHD) were obtained by electronic linkage to health insurance records until 31 December 2016. Multivariate Poisson regression models were used to estimate women-to-men rate ratios (RRs) of having cardiac enzyme tests, coronary angiography and coronary revascularisation.ResultsAmong the 38 928 individuals (61% women) with IHD admissions, women were less likely to have AMI (5% vs 12%), but more likely to have angina (26% vs 24%) or other IHD (69% vs 64%). For admissions with AMI, there were no differences in the use of cardiac enzymes between women and men (RR=1.00; 95% CI, 0.97 to 1.03), but women had lower use of coronary angiography (0.80, 0.68 to 0.93) and coronary revascularisation (0.85, 0.74 to 0.99). For angina, the corresponding RRs were: 0.97 (0.94 to 1.00), 0.66 (0.59 to 0.74) and 0.56 (0.47 to 0.67), respectively; while for other IHD, they were 0.97 (0.94 to 1.00), 0.87 (0.76 to 0.99) and 0.61 (0.51 to 0.73), respectively. Adjusting for socioeconomic and health system factors did not significantly alter the women-to-men RRs.ConclusionsAmong Chinese adults hospitalised with acute IHD, women were less likely than men to have coronary angiography and revascularisation, but socioeconomic and health system factors did not contribute to these differences.
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- 2023
10. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction.
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Puelacher, Christian, Gugala, Mathias, Adamson, Philip D., Shah, Anoop, Chapman, Andrew R., Anand, Atul, Sabti, Zaid, Boeddinghaus, Jasper, Nestelberger, Thomas, Twerenbold, Raphael, Wildi, Karin, Badertscher, Patrick, Gimenez, Maria Rubini, Shrestha, Samyut, Sazgary, Lorraine, Mueller, Deborah, Schumacher, Lukas, Kozhuharov, Nikola, Flores, Dayana, and du Fay de Lavallaz, Jeanne
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MYOCARDIAL infarction ,ANGINA pectoris ,HEART valve diseases - Abstract
Objective: Assess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI).Design: Two independent prospective multicentre diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30 days and 1 year.Results: 8992 patients were enrolled at 11 centres. UA was adjudicated in 8.9%(95% CI 8.0 to 9.7) and 2.8% (95% CI 2.3 to 3.3) patients in APACE and High-STEACS, respectively, and NSTEMI in 15.1% (95% CI 14.0 to 16.2) and 13.4% (95% CI 12.4 to 14.3). Coronary artery disease was pre-existing in 73% and 76% of patients with UA. At 30 days, all-cause mortality in UA was substantially lower as compared with NSTEMI (0.5% vs 3.7%, p=0.002 in APACE, 0.7% vs 7.4%, p=0.004 in High-STEACS). Similarly, at 1 year in UA all-cause mortality was 3.3% (95% CI 1.2 to 5.3) vs 10.4% (95% CI 7.9 to 12.9) in APACE, and 5.1% (95% CI 0.7 to 9.5) vs 22.9% (95% CI 19.3 to 26.4) in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, 95% CI 7.8 to 14.6 and 7.9%, 95% CI 5.7 to 10.2), and higher than in NCCP (0.6%, 95% CI 0.2 to 1.0).Conclusions: The relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar. [ABSTRACT FROM AUTHOR]- Published
- 2019
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11. Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction.
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Elias, Joëlle, van Dongen, Ivo M., Råmunddal, Truls, Laanmets, Peep, Eriksen, Erlend, Meuwissen, Martijn, Michels, H. Rolf, Bax, Matthijs, Ioanes, Dan, Suttorp, Maarten Jan, Strauss, Bradley H., Barbato, Emanuele, Marques, Koen M., Claessen, Bimmer E. P. M., Hirsch, Alexander, van der Schaaf, René J., Tijssen, Jan G. P., Henriques, José P. S., Hoebers, Loes P., and EXPLORE investigators
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PERCUTANEOUS coronary intervention ,ARTERIAL occlusions ,MYOCARDIAL infarction ,CARDIAC patients ,ANGINA pectoris ,RANDOMIZED controlled trials ,CORONARY heart disease complications ,CORONARY heart disease surgery ,CARDIOVASCULAR system ,HEART ventricle diseases ,CHRONIC diseases ,CORONARY arteries ,CORONARY disease ,MAGNETIC resonance imaging ,MEDICAL care ,STATISTICAL sampling ,SURGICAL complications ,TREATMENT effectiveness ,CORONARY angiography ,DIAGNOSIS - Abstract
Background: During primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.Methods: The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.Results: The median long-term follow-up was 3.9 (2.1-5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).Conclusions: In this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical Trial Registration: EXPLORE trial number NTR1108 www.trialregister.nl. [ABSTRACT FROM AUTHOR]- Published
- 2018
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12. Diagnostic and prognostic benefits of computed tomography coronary angiography using the 2016 National Institute for Health and Care Excellence guidance within a randomised trial.
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Adamson, Philip D., Hunter, Amanda, Williams, Michelle C., Shah, Anoop S. V., McAllister, David A., Pawade, Tania A., Dweck, Marc R., Mills, Nicholas L., Berry, Colin, Boon, Nicholas A., Clark, Elizabeth, Flather, Marcus, Forbes, John, Mcean, Scott, Roditi, Giles, van Beek, Edwin J. R., Timmis, Adam D., Newby, David E., and McLean, Scott
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CORONARY angiography ,CLINICAL trials ,MYOCARDIAL infarction ,FOLLOW-up studies (Medicine) ,ANGINA pectoris treatment ,ANGINA pectoris ,COMPARATIVE studies ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,PROGNOSIS ,RESEARCH ,RESEARCH funding ,STROKE ,EVALUATION research - Abstract
Objectives: To evaluate the diagnostic and prognostic benefits of CT coronary angiography (CTCA) using the 2016 National Institute for Health and Care Excellence (NICE) guidelines for the assessment of suspected stable angina.Methods: Post hoc analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4146 participants with suspected angina randomised to CTCA. Patients were dichotomised into NICE guideline-defined possible angina and non-anginal presentations. Primary (diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and prognostic endpoint comprised fatal and non-fatal myocardial infarction (MI).Results: In 3770 eligible participants, CTCA increased diagnostic certainty more in those with possible angina (relative risk (RR) 2.22 (95% CI 1.91 to 2.60), p<0.001) than those with non-anginal symptoms (RR 1.30 (1.11 to 1.53), p=0.002; pinteraction <0.001). In the possible angina cohort, CTCA did not change rates of invasive angiography (p=0.481) but markedly reduced rates of normal coronary angiography (HR 0.32 (0.19 to 0.52), p<0.001). In the non-anginal cohort, rates of invasive angiography increased (HR 1.82 (1.13 to 2.92), p=0.014) without reducing rates of normal coronary angiography (HR 0.78 (0.30 to 2.05), p=0.622). At 3.2 years of follow-up, fatal or non-fatal MI was reduced in patients with possible angina (3.2% to 1.9%%; HR 0.58 (0.34 to 0.99), p=0.045) but not in those with non-anginal symptoms (HR 0.65 (0.25 to 1.69), p=0.379).Conclusions: NICE-guided patient selection maximises the benefits of CTCA on diagnostic certainty, use of invasive coronary angiography and reductions in fatal and non-fatal myocardial infarction. Patients with non-anginal chest pain derive minimal benefit from CTCA and increase the rates of invasive investigation.Trial Registration Number: ClinicalTrials.gov: NCT01149590;post results. [ABSTRACT FROM AUTHOR]- Published
- 2018
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13. Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials.
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Gongora, Carlos A., Bavishi, Chirag, Uretsky, Seth, and Argulian, Edgar
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ACUTE chest syndrome ,CORONARY angiography ,CHEST pain ,CLINICAL trials ,MYOCARDIAL infarction ,ANGINA pectoris treatment ,ANGINA pectoris ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL quality control ,MEDICAL cooperation ,META-analysis ,MYOCARDIAL revascularization ,RESEARCH ,RISK assessment ,SYSTEMATIC reviews ,EVALUATION research ,ACUTE diseases - Abstract
Objective: Coronary CT angiography (CCTA) has certain advantages compared with stress testing including greater accuracy in identifying obstructive coronary disease. The aim of the study was to perform a systematical review and meta-analysis comparing CCTA with other standard-of-care (SOC) approaches in evaluation of patients with acute chest pain.Methods: Electronic databases were systematically searched to identify randomised clinical trials of patients with acute chest pain comparing CCTA with SOC approaches. We examined the following end points: mortality, major adverse cardiac events (MACE), myocardial infarction (MI), invasive coronary angiography (ICA) and revascularisation. Pooled risk ratios (RR) and their 95% CIs were calculated using random-effects models.Results: Ten trials with 6285 patients were included. The trials used different definitions and implementation for SOC but all used physiologic testing. The clinical follow-up ranged from 1 to 19 months. There were no significant differences in all-cause mortality (RR 0.48, 95% CI 0.17 to 1.36, p=0.17), MI (RR 0.82, 95% CI 0.49 to 1.39, p=0.47) or MACE (RR 0.98, 95% CI 0.67 to 1.43, p=0.92) between the groups. However, significantly higher rates of ICA (RR 1.32, 95% CI 1.07 to 1.63, p=0.01) and revascularisation (RR 1.77, 95% CI 1.35 to 2.31, p<0.0001) were observed in the CCTA arm.Conclusions: Compared with other SOC approaches use of CCTA is associated with similar major adverse cardiac events but higher rates of revascularisation in patients with acute chest pain. [ABSTRACT FROM AUTHOR]- Published
- 2018
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14. Persistent psychological distress and mortality in patients with stable coronary artery disease.
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Stewart, Ralph A. H., Colquhoun, David M., Marschner, Simone L., Kirby, Adrienne C., Simes, John, Nestel, Paul J., Glozier, Nick, O'Neil, Adrienne, Oldenburg, Brian, White, Harvey D., Tonkin, Andrew M., and LIPID Study Investigators
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PSYCHOLOGICAL distress ,CORONARY disease ,HEART disease risk factors ,PRAVASTATIN ,ISCHEMIA treatment ,DRUG therapy for angina pectoris ,MYOCARDIAL infarction-related mortality ,ANTILIPEMIC agents ,ANGINA pectoris ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,MYOCARDIAL infarction ,PROGNOSIS ,QUESTIONNAIRES ,RESEARCH ,RISK assessment ,STATISTICAL sampling ,PSYCHOLOGICAL stress ,TIME ,LOGISTIC regression analysis ,EVALUATION research ,RANDOMIZED controlled trials ,PROPORTIONAL hazards models ,SEVERITY of illness index ,KAPLAN-Meier estimator ,ODDS ratio ,PSYCHOLOGICAL factors ,PSYCHOLOGY ,DIAGNOSIS ,THERAPEUTICS - Abstract
Background: A single assessment of psychological distress, which includes depression and anxiety, has been associated with increased mortality in patients with coronary heart disease, but the prognostic importance of persistence of distress symptoms is less certain.Aim: To determine whether intermittent and/or persistent psychological distress is associated with long-term cardiovascular (CV) and total mortality in patients with stable coronary artery disease.Methods: 950 participants in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial completed at least four General Health Questionnaires (GHQ-30) at baseline and after ½, 1, 2 and 4 years. In a landmark analysis from 4 years, Cox proportional hazards models evaluated the risk of CV and total mortality by increasing levels of psychological distress: never distressed, sometimes any severity (GHQ score >5), persistent mild (GHQ score >5 on three or more occasions) and persistent moderate distress (GHQ score >10) on three or more occasions, over a median of 12.1 (IQR 8.6-12.5) years. The models were both unadjusted and adjusted for known baseline risk factors.Results: Persistent moderate or greater psychological stress was reported on three or more assessments by 35 (3.7%) subjects. These patients had a higher risk of both CV death (adjusted HR 3.94, 95% CI 2.05 to 7.56, p<0.001) and all-cause mortality (adjusted HR 2.85, 95% CI 1.74 to 4.66, p<0.001) compared with patients with no distress. In contrast, patients who reported persistent mild distress (n=73, 7.7%) on three or more visits, and those who met criteria for distress on only one or two assessments (n=255, 26.8%), did not have an increased risk of CV or all-cause mortality during follow-up.Conclusion: In patients with stable coronary artery disease, persistent psychological distress of at least moderate severity is associated with a substantial increase in CV and all-cause mortality. [ABSTRACT FROM AUTHOR]- Published
- 2017
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15. Clinical and prognostic value of poststenting fractional flow reserve in acute coronary syndromes.
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Kasula, Srikanth, Agarwal, Shiv Kumar, Hacioglu, Yalcin, Pothineni, Nagavenkata Krishnachand, Bhatti, Sabha, Ahmed, Zubair, Uretsky, Barry, and Hakeem, Abdul
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ACUTE coronary syndrome ,PERCUTANEOUS coronary intervention ,CORONARY disease ,ISCHEMIA ,MYOCARDIAL infarction ,ANGINA pectoris treatment ,MEDICAL equipment ,TREATMENT of acute coronary syndrome ,ANGINA pectoris ,CARDIAC catheterization ,CARDIOVASCULAR system ,COMPARATIVE studies ,CORONARY circulation ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,PHARMACOKINETICS ,RESEARCH ,RESEARCH evaluation ,SURGICAL stents ,TIME ,DISEASE relapse ,EVALUATION research ,TREATMENT effectiveness ,PREDICTIVE tests ,RETROSPECTIVE studies ,RECEIVER operating characteristic curves ,KAPLAN-Meier estimator ,CORONARY angiography ,DIAGNOSIS - Abstract
Objectives: Fractional flow reserve (FFR) has been suggested to have value in acute coronary syndromes (ACSs). The clinical and prognostic value of ischaemia reduction assessed by post-percutaneous coronary intervention (PCI) FFR has not been studied in this population.Methods: Consecutive stable ischaemic heart disease (SIHD) (N=390) and patients with ACS (N=189) who had pre-PCI FFR and post-PCI FFR were followed for 2.4±1.5 years. Primary endpoint was major adverse cardiac events (MACE) (composite of myocardial infarction, target vessel revascularisation and death).Results: In patients with ACS, PCI led to significant improvement in FFR from 0.62±0.15 to post-PCI FFR 0.88±0.08 (p<0.0001). Post-PCI FFR identified 29 patients (15%) who had persistently low FFR<0.80 (0.75±0.06) despite angiographically optimal results prompting subsequent interventions improving repeat FFR (0.85±0.06; p<0.0001). The difference in MACE events between patients with ACS and patients with SIHD varied according to the post-PCI FFR value (interaction p=0.044). Receiver operator curve analysis identified a final FFR cut-off of ≤0.91 as having the best predictive accuracy for MACE in the ACS study population (30% vs 19%; p=0.03). Patients with ACS achieving final FFR of >0.91 had similar outcomes compared with patients who had SIHD (19% vs 16%; p=0.51). However, in patients with final FFR of ≤0.91 there was increased MACE versus patients with SIHD (30% vs 16%; p<0.01).Conclusions: Post-PCI FFR is valuable in assessing the functional outcome of PCI in patients with ACS. Use of post-PCI FFR in patients with ACS allows for functional optimisation of PCI results and is predictive of long-term outcomes in patients with ACS. [ABSTRACT FROM AUTHOR]- Published
- 2016
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16. Imaging diagnoses and outcome in patients presenting for primary angioplasty but no obstructive coronary artery disease.
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Mittal, Tarun K., Reichmuth, Luise, Ariff, Ben, Rao, Praveen P. G., Baltabaeva, Aigul, Rahman-Haley, Shelley, Kabir, Tito, Wong, Joyce, and Dalby, Miles
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ANGIOPLASTY ,DIAGNOSTIC imaging ,MYOCARDIAL infarction ,MEDICAL protocols ,REVASCULARIZATION (Surgery) ,ECHOCARDIOGRAPHY ,TREATMENT of vascular diseases ,TREATMENT of cardiomyopathies ,ANGINA pectoris ,VASCULAR diseases ,CARDIOVASCULAR system ,HEART valve diseases ,MAGNETIC resonance imaging ,MEDICAL care ,CARDIOMYOPATHIES ,PERICARDITIS ,PROGNOSIS ,PREDICTIVE tests ,DISEASE prevalence ,TROPONIN ,KAPLAN-Meier estimator ,CORONARY angiography ,THERAPEUTICS - Abstract
Objective: A proportion of patients with suspected ST-elevation myocardial infarction (STEMI) presenting for primary percutaneous coronary intervention (PPCI) do not have obstructive coronary disease and other conditions may be responsible for their symptoms and ECG changes. In this study, we set out to determine the prevalence and aetiology of alternative diagnoses in a large PPCI cohort as determined with multimodality imaging and their outcome.Methods: From 2009 to 2012, 5238 patients with suspected STEMI were referred for consideration of PPCI. Patients who underwent angiography but had no culprit artery for revascularisation and no previous history of coronary artery disease were included in the study. Troponin values, imaging findings and all-cause mortality were obtained from hospital and national databases.Results: A total of 575 (13.0%) patients with a mean age of 58±15 years (69% men) fulfilled the inclusion criteria. A specific diagnosis based on imaging was made in 237 patients (41.2%) including cardiomyopathies (n=104, 18%), myopericarditis (n=48, 8.4%), myocardial infarction/other coronary abnormality (n=27, 4.9%) and severe valve disease (n=23, 4%). Pulmonary embolism and type A aortic dissection were identified in seven (1.2%) and four (0.7%) cases respectively. A total of 40 (7.0%) patients died over a mean follow-up of 42.6 months.Conclusions: A variety of cardiac and non-cardiac conditions are prevalent in patients presenting with suspected STEMI but culprit-free angiogram, some of which may have adverse outcomes. Further imaging of such patients could thus be useful to help in appropriate management and follow-up. [ABSTRACT FROM AUTHOR]- Published
- 2016
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17. A novel troponin I rule-out value below the upper reference limit for acute myocardial infarction.
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Goorden, Susan M. I., van Engelen, Rudi A., Wong, Liza S. M., van der Ploeg, Tjeerd, Verdel, Gerard J. E., Buijs, Madelon M., Chapman, Andrew R., Anand, Atul, Shah, Anoop S. V., Adamson, Philip D., and Mills, Nicholas L.
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MYOCARDIAL infarction ,TROPONIN I ,DISEASE prevalence ,MYOCARDIAL infarction complications ,MYOCARDIAL infarction diagnosis ,ANGINA pectoris ,BIOCHEMISTRY ,LONGITUDINAL method ,PHENOMENOLOGY ,PHARMACOKINETICS ,REFERENCE values ,RESEARCH evaluation ,TIME ,PREDICTIVE tests ,RECEIVER operating characteristic curves ,TROPONIN - Abstract
Objective: To determine cut-off values for a recently introduced high sensitive cardiac troponin assay (hs-cTnI) which provide similar sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for acute myocardial infarction (AMI) as known cut-off values for an hs-cTnT assay.Methods: A prospective observational study was performed. Hs-cTnT (Roche) and hs-cTnI (Abbott) were measured in consecutive patients with symptoms suggestive of AMI. Representative measurements (obtained at least 3 h after chest pain has started) and serial measurements with a time delay between 2.5 h and 4.5 h were used to determine cut-off levels. Two independent clinicians adjudicated the final diagnosis.Results: 1490 patients were included in the study of whom 114 (8%) received a final diagnosis of AMI. Receiver operating characteristics analysis showed no statistically significant differences in the areas under the curve between the two assays. Cut-off values for representative hs-TnI were found to be as follows: rule-out: 10 ng/L (sensitivity: 98.2%; 95% CI 95.7% to 100.0% and NPV: 99.8%; 99.5% to 100.0%); rule-in: 70 ng/L (specificity: 90.8%; 89.3% to 92.4% and PPV: 39.7%; 36.1% to 43.3%). For serial measurements we found a Δ rule-out cut-off value of 20 ng/L (sensitivity: 94.9%; 88.0% to 100.0% and NPV: 98.7%; 96.9% to 100.0%) and Δ rule-in cut-off values of 100 ng/L (specificity: 92.7%; 87.9% to 95.8% and PPV: 57.6%; 39.4% to 74.0%) and 300% (specificity: 93.8%; 90.4% to 97.2% and PPV: 61.3%; 51.1% to 71.5%).Conclusions: Cut-off values for hs-cTnI measurements are determined which allow a similar diagnostic classification as compared with hs-cTnT. Importantly, for a rule-out paradigm this cut-off value is unmistakably lower than the upper reference limit. [ABSTRACT FROM AUTHOR]- Published
- 2016
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18. Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.
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Williams, Michelle Claire, Newby, David E., Nørgaard, Bjarne L, Gaur, Sara, Fairbairn, Timothy A, Douglas, Pam S, Jensen, Jesper M, Patel, Manesh R, Ihdayhid, Abdul R, Ko, Brian S H, Sellers, Stephanie L, Weir-McCall, Jonathan, Matsuo, Hitoshi, Sand, Niels Peter R, Øvrehus, Kristian A, Rogers, Campbell, Mullen, Sarah, Nieman, Koen, Parner, Erik, and Leipsic, Jonathon
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PROGNOSIS ,COMPUTED tomography ,CHEST pain ,MYOCARDIAL infarction - Abstract
Objectives: To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).Methods: We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.Results: Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).Conclusions: The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2022
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19. Duration of dual antiplatelet therapy and stability of coronary heart disease: a 60 000-patient meta-analysis of randomised controlled trials
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Mohammed N. Meah, Anda Bularga, Nicholas L. Mills, Kuan Ken Lee, Dimitrios Doudesis, David E. Newby, and Anoop S V Shah
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Acute coronary syndrome ,medicine.medical_specialty ,Subgroup analysis ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Lower risk ,clinical ,acute coronary syndrome ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,angina pectoris ,Internal medicine ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Randomized Controlled Trials as Topic ,business.industry ,Dual Anti-Platelet Therapy ,medicine.disease ,Coronary heart disease ,3. Good health ,Meta-analysis ,RC666-701 ,pharmacology ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
BackgroundDual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain.Methods and resultsWe searched four major databases for randomised controlled trials comparing long-term (≥12 months) with short-term (≤6 months) or shorter (≤3 months) DAPT in patients with coronary syndromes. The primary outcome was all-cause mortality. Secondary outcomes were any bleeding and major bleeding (safety), cardiac death, myocardial infarction, stent thrombosis, revascularisation and stroke (efficacy). Nineteen randomised controlled trials (n=60 111) satisfied inclusion criteria, 8 assessed ≤3 months DAPT. Compared with long-term (≥12 months), short-term DAPT (≤6 months) was associated with a trend towards reduced all-cause mortality (RR: 0.90, 95% CI: 0.80 to 1.01) and significant bleeding reduction (RR: 0.68, 95% CI: 0.55 to 0.83 and RR: 0.66, 95% CI: 0.56 to 0.77 for major and any bleeding, respectively). There were no significant differences in efficacy outcomes. These associations persisted in sensitivity analysis comparing shorter duration DAPT (≤3 months) to long-term DAPT (≥12 months) for all-cause mortality (RR: 0.91, 95% CI: 0.79 to 1.05). In subgroup analysis, short-term DAPT was associated with lower risk of bleeding in patients with acute or chronic coronary syndromes (RR: 0.66, 95% CI: 0.54 to 0.81 and RR: 0.53, 95% CI: 0.33 to 0.65, respectively), but higher risk of stent thrombosis in acute coronary syndrome (RR: 1.49, 95% CI: 1.02 to 2.17 vs RR: 1.25, 95% CI 0.44 to 3.58).ConclusionOur meta-analysis suggests that short (≤6 months) and shorter (≤3 months) durations DAPT are associated with lower risk of bleeding, equivalent efficacy and a trend towards lower all-cause mortality irrespective of coronary artery disease stability.
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- 2021
20. Predicting mortality after acute coronary syndromes in people with chronic obstructive pulmonary disease.
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Rothnie, Kieran J., Smeeth, Liam, Pearce, Neil, Herrett, Emily, Timmis, Adam, Hemingway, Harry, Wedzicha, Jadwiga, and Quint, Jennifer K.
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ACUTE coronary syndrome ,OBSTRUCTIVE lung diseases ,MYOCARDIAL infarction ,ISCHEMIA ,ANGINA pectoris ,DISEASE risk factors ,ANGINA pectoris treatment ,OBSTRUCTIVE lung disease diagnosis ,OBSTRUCTIVE lung disease treatment ,TREATMENT of acute coronary syndrome ,COMPARATIVE studies ,DECISION making ,RESEARCH methodology ,MEDICAL cooperation ,PROGNOSIS ,RESEARCH ,RESEARCH funding ,RISK assessment ,TIME ,LOGISTIC regression analysis ,EVALUATION research ,PREDICTIVE tests ,ACQUISITION of data ,ODDS ratio ,DIAGNOSIS - Abstract
Objective: To assess the accuracy of Global Registry of Acute Coronary Events (GRACE) scores in predicting mortality at 6 months for people with chronic obstructive pulmonary disease (COPD) and to investigate how it might be improved.Methods: Data were obtained on 481 849 patients with acute coronary syndrome admitted to UK hospitals between January 2003 and June 2013 from the Myocardial Ischaemia National Audit Project (MINAP) database. We compared risk of death between patients with COPD and those without COPD at 6 months, adjusting for predicted risk of death. We then assessed whether several modifications improved the accuracy of the GRACE score for people with COPD.Results: The risk of death after adjusting for GRACE score predicted that risk of death was higher for patients with COPD than that for other patients (RR 1.29, 95% CI 1.28 to 1.33). Adding smoking into the GRACE score model did not improve accuracy for patients with COPD. Either adding COPD into the model (relative risk (RR) 1.00, 0.94 to 1.02) or multiplying the GRACE score by 1.3 resulted in better performance (RR 0.99, 0.96 to 1.01).Conclusions: GRACE scores underestimate risk of death for people with COPD. A more accurate prediction of risk of death can be obtained by adding COPD into the GRACE score equation, or by multiplying the GRACE score predicted risk of death by 1.3 for people with COPD. This means that one third of patients with COPD currently classified as low risk should be classified as moderate risk, and could be considered for more aggressive early treatment after non-ST-segment elevation myocardial infarction or unstable angina. [ABSTRACT FROM AUTHOR]- Published
- 2016
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21. Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention.
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Alabas, O. A., Brogan, R. A., Hall, M., Almudarra, S., Rutherford, M. J., Dondo, T. B., Feltbower, R., Curzen, N., de Belder, M., Ludman, P., Gale, C. P., and National Institute for Cardiovascular Outcomes Research
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MYOCARDIAL infarction ,MYOCARDIAL infarction diagnosis ,PERCUTANEOUS coronary intervention ,PATIENTS ,ANGINA pectoris treatment ,DIAGNOSIS ,CORONARY heart disease treatment ,AGE distribution ,ANGINA pectoris ,ARTIFICIAL respiration ,CARDIOVASCULAR system ,CORONARY circulation ,CORONARY disease ,CAUSES of death ,MEDICAL care ,RESEARCH funding ,RISK assessment ,SEX distribution ,TIME ,COMORBIDITY ,TREATMENT effectiveness ,ACQUISITION of data - Abstract
Objective: For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality.Methods: A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI-CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated.Results: Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI-CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI-CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90).Conclusions: Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI-CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deaths. [ABSTRACT FROM AUTHOR]- Published
- 2016
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22. Validation of presentation and 3 h high-sensitivity troponin to rule-in and rule-out acute myocardial infarction.
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Pickering, John W., Greenslade, Jaimi H., Cullen, Louise, Flaws, Dylan, Parsonage, William, George, Peter, Worster, Andrew, Kavsak, Peter A., and Than, Martin P.
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MYOCARDIAL infarction ,MYOCARDIAL infarction diagnosis ,TROPONIN I ,CARDIAC nursing ,PATIENTS ,MYOCARDIAL infarction complications ,ALGORITHMS ,ANGINA pectoris ,BIOCHEMISTRY ,CLINICAL trials ,COMPARATIVE studies ,DECISION making ,LONGITUDINAL method ,PHENOMENOLOGY ,RESEARCH methodology ,MEDICAL cooperation ,PROGNOSIS ,RESEARCH ,RESEARCH evaluation ,TIME ,EVALUATION research ,PREDICTIVE tests ,TROPONIN ,DIAGNOSIS - Abstract
Objective: International guidelines to rule-in acute myocardial infarction (AMI) in patients presenting with chest pain to the emergency department (ED) recommend an algorithm using high-sensitivity cardiac troponin (hs-cTn) sampling on presentation and 3 h following presentation. We tested the diagnostic accuracy of this algorithm by pooling data from five distinct cohorts from three countries of prospectively recruited patients with independently adjudicated outcomes.Method: We measured high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) on presentation (0 h) and 3 h post-presentation samples in adult patients attending an ED with possible AMI to validate the European Society of Cardiology (ESC) Working Group on Acute Cardiac Care rule-in algorithm (ESC-rule-in). Specifically, (i) in patients with a 0 h hs-cTn concentration ≤99th percentile and a 3 h hs-cTn >99th percentile, positive patients are those with an absolute change in troponin ≥50% of the 99th percentile, and (ii) in patients with a 0 and 3 h hs-cTn >99th percentile, positive patients are those with a relative change in troponin of ≥20%. We concurrently assessed the efficacy of the 0 and 3 h hs-cTn <99th percentile to rule-out AMI.Results: 1061 patients with hs-cTnI and 985 with hs-cTnT were included. The ESC-rule-in positive predictive value (PPV) was 83.5% (95% CI 74.9% to 90.1%) for hs-cTnI and 72.0% (95% CI 62.1% to 80.5%) for hs-cTnT. Forty-six AMIs (34.9%) were not ruled in using hs-cTnI and 62 (46.2%) using hs-cTnT. The sensitivity of the 99th percentile to rule-out AMI was 93.2% (95% CI 87.5% to 96.8%) for hs-cTnI and 94.8% (95% CI 89.5% to 97.9%) for hs-cTnT.Conclusions: The ESC-rule-in algorithm has good PPV with hs-cTnI and reasonable with hs-cTnT and can rule-in over 50% of AMIs. However, the sensitivity of the 99th percentile to rule-out AMI is too low for clinical use. [ABSTRACT FROM AUTHOR]- Published
- 2016
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23. Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests.
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Parsonage, W. A., Mueller, C., Greenslade, J. H., Wildi, K., Pickering, J., Than, M., Aldous, S., Boeddinghaus, J., Hammett, C. J., Hawkins, T., Nestelberger, T., Reichlin, T., Reidt, S., Gimenez, M.Rubin, Tate, J. R., Twerenbold, R., Ungerer, J. P., Cullen, L., and Rubin Gimenez, M
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MYOCARDIAL infarction ,MYOCARDIAL infarction diagnosis ,TROPONIN ,CHEST pain ,PATIENTS ,MYOCARDIAL infarction complications ,HEALTH facilities ,ALGORITHMS ,ANGINA pectoris ,BIOCHEMISTRY ,COMPARATIVE studies ,DECISION making ,HOSPITAL emergency services ,LONGITUDINAL method ,PHENOMENOLOGY ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,PROGNOSIS ,RESEARCH ,RESEARCH evaluation ,TIME ,DEPARTMENTS ,EVALUATION research ,SPECIALTY hospitals ,PREDICTIVE tests ,DIAGNOSIS ,STANDARDS - Abstract
Objective: To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain.Methods: International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24 hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30 days.Results: 15% of patients were diagnosed with non-ST elevation myocardial infarction (MI) on admission. The hsTnI algorithm classified 2506/3128 (80.1%) of patients as 'ruled out' with 50 (2.0%) missed MI. 943/3128 (30.1%) of patients had a troponin I level below the limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 1794/3374 (53.1%) of patients were 'ruled out' with 7 (0.4%) missed MI. 490/3374 (14.5%) of patients had a troponin T below the limit of blank on admission with no MI. MACE at 30 days occurred in 10.7% and 8.5% of patients 'ruled out' defined by the hsTnI and hsTnT algorithms, respectively.Conclusions: The NICE algorithms could identify patients with low probability of AMI within 2 hours; however, neither strategy performed as predicted by the NICE diagnostic guidance model. Additionally, the rate of MACE at 30 days was sufficiently high that the algorithms should only be used as one component of a more extensive model of risk stratification.Trial Registration Number: ACTRN12611001069943, NCT00470587; post-results. [ABSTRACT FROM AUTHOR]- Published
- 2016
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24. CT coronary angiographic evaluation of suspected anginal chest pain.
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Moss, Alastair J. and Newby, David E.
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ANGINA pectoris , *CORONARY disease , *CORONARY angiography , *MYOCARDIAL infarction , *PRIMARY care , *PATIENTS , *CORONARY heart disease complications , *CORONARY heart disease treatment , *CORONARY arteries , *MEDICAL protocols , *PROGNOSIS , *PREDICTIVE tests ,ANGINA pectoris treatment ,RESEARCH evaluation - Abstract
Unlabelled: Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac death and non-fatal myocardial infarction appear to be attained through the more appropriate use of preventative therapy and coronary revascularisation when guided by CTCA. With this increasing portfolio of evidence, CTCA should be considered the non-invasive investigation of choice in the evaluation of patients with suspected angina pectoris due to coronary heart disease.Clinical Trial Number: NCT01149590, post-results. [ABSTRACT FROM AUTHOR]- Published
- 2016
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25. Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada.
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Mullen, Kerri-Anne, Coyle, Douglas, Manuel, Douglas, Nguyen, Hai V., Pham, Ba', Pipe, Andrew L., and Reid, Robert D.
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HOSPITAL health promotion programs , *ANGINA pectoris , *CONFIDENCE intervals , *COST effectiveness , *DECISION trees , *HEART failure , *OBSTRUCTIVE lung diseases , *MEDICAL care costs , *MYOCARDIAL infarction , *RESEARCH funding , *SMOKING , *SMOKING cessation , *TOBACCO products , *ACUTE diseases , *DATA analysis software , *DESCRIPTIVE statistics , *ECONOMICS - Abstract
Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking. [ABSTRACT FROM AUTHOR]
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- 2015
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26. The effects of cold and exercise on the cardiovascular system.
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Manou-Stathopoulou, Vasiliki, Goodwin, Christopher D., Patterson, Tiffany, Redwood, Simon R., Marber, Michael S., and Williams, Rupert P.
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CORONARY disease , *PHYSIOLOGICAL effects of cold temperatures , *CARDIOVASCULAR fitness , *ANGINA pectoris , *MYOCARDIAL infarction - Abstract
The article focuses on the impact of winter season and exercise on the cardiovascular health of a individual. It states that in case of patients suffering with coronary artery disease (CAD), angina symptoms get worse in the winter season and they become non tolerant towards exercise. It mentions that cold temperature is associated with higher risks of acute myocardial infarction (AMI), and states that a mismatch in supply and demand of myocardial oxygen leads to AMI.
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- 2015
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27. Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome.
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Burchill, Luke J., Lameijer, Heleen, Roos-Hesselink, Jolien W., Grewal, Jasmine, Ruys, Titia P. E., Kulikowski, Julia D., Burchill, Laura A., Oudijk, M. A., Wald, Rachel M., Colman, Jack M., Siu, Samuel C., Pieper, Petronella G., and Silversides, Candice K.
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CORONARY disease , *ACUTE coronary syndrome , *PREGNANCY complications , *CARDIAC arrest , *HEART diseases in pregnancy , *MYOCARDIAL infarction , *VENTRICULAR arrhythmia , *ANGINA pectoris - Abstract
Objective The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI). Background The physiological changes of pregnancy can contribute to myocardial ischaemia. The pregnancy risk for women with pre-established CAD or a history of ACS/MI is not well studied. Methods This was a retrospective multicentre study. Adverse maternal cardiac, obstetric and fetal/neonatal events were examined. The primary outcome was a composite endpoint of cardiac arrest, ACS/MI, ventricular arrhythmia or congestive heart failure. The prevalence of new or progressive angina during pregnancy was also examined. Results Fifty pregnancies in 43 women (mean age 35 ±5 years) were included. Coronary atherosclerosis (40%) and coronary thrombus (36%) were the most common underlying diagnoses. The primary outcome occurred in 10% (5/50) of pregnancies and included one maternal death secondary to cardiac arrest. Other events included ACS/MI (3/50) and heart failure (1/50). New or progressive angina occurred in 18% of pregnancies. Ischaemic complications of any type (new or progressive angina, ACS/MI, ventricular arrhythmia, cardiac arrest) occurred more commonly in women with coronary atherosclerosis compared with those without (50% vs 10%, p=0.003). A high rate of adverse obstetric (16%) and fetal/neonatal (30%) events was observed. Conclusions Pregnant women with pre-existing CAD or ACS/MI before pregnancy are at increased risk of adverse events during pregnancy. Those with coronary atherosclerosis are at highest risk of adverse maternal cardiac events due to myocardial ischaemia during pregnancy. [ABSTRACT FROM AUTHOR]
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- 2015
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28. Effects of adding ivabradine to usual care in patients with angina pectoris: a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis
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Janus Christian Jakobsen, Naqash J Sethi, Emil Eik Nielsen, Christian Gluud, Si-Hong Yang, Liang Ning, and Mathias Maagaard
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Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,030204 cardiovascular system & hematology ,Risk Assessment ,Angina Pectoris ,Coronary artery disease ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Ivabradine ,030212 general & internal medicine ,Myocardial infarction ,Adverse effect ,Aged ,Randomized Controlled Trials as Topic ,business.industry ,Cardiovascular Agents ,Middle Aged ,medicine.disease ,Clinical trial ,quality of care and outcomes ,Treatment Outcome ,lcsh:RC666-701 ,Meta-analysis ,Relative risk ,Quality of Life ,Female ,Patient Safety ,pharmacology ,Cardiology and Cardiovascular Medicine ,business ,coronary artery disease ,Meta-Analysis ,medicine.drug - Abstract
ObjectiveTo determine the impact of ivabradine on outcomes important to patients with angina pectoris caused by coronary artery disease.MethodsWe conducted a systematic review. We included randomised clinical trials comparing ivabradine versus placebo or no intervention for patients with angina pectoris due to coronary artery disease published prior to June 2020. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane methodology, Trial Sequential Analysis, Grading of Recommendations Assessment, Development, and Evaluation, and our eight-step procedure. Primary outcomes were all-cause mortality, serious adverse events and quality of life.ResultsWe included 47 randomised clinical trials enrolling 35 797 participants. All trials and outcomes were at high risk of bias. Ivabradine compared with control did not have effects when assessing all-cause mortality (risk ratio [RR] 1.04; 95% CI 0.96 to 1.13), quality of life (standardised mean differences −0.05; 95% CI −0.11 to 0.01), cardiovascular mortality (RR 1.07; 95% CI 0.97 to 1.18) and myocardial infarction (RR 1.03; 95% CI 0.91 to 1.16). Ivabradine seemed to increase the risk of serious adverse events after removal of outliers (RR 1.07; 95% CI 1.03 to 1.11) as well as the following adverse events classified as serious: bradycardia, prolonged QT interval, photopsia, atrial fibrillation and hypertension. Ivabradine also increased the risk of non-serious adverse events (RR 1.13; 95% CI 1.11 to 1.16). Ivabradine might have a statistically significant effect when assessing angina frequency (mean difference (MD) 2.06; 95% CI 0.82 to 3.30) and stability (MD 1.48; 95% CI 0.07 to 2.89), but the effect sizes seemed minimal and possibly without any relevance to patients, and we identified several methodological limitations, questioning the validity of these results.ConclusionOur findings do not support that ivabradine offers significant benefits on patient important outcomes, but rather seems to increase the risk of serious adverse events such as atrial fibrillation and non-serious adverse events. Based on current evidence, guidelines need reassessment and the use of ivabradine for angina pectoris should be reconsidered.PROSPERO registration numberCRD42018112082.
- Published
- 2020
29. Long-term cardiovascular consequences of Rose angina at age 20–54 years: 29-years’ follow-up of the Tromsø Study.
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Graff-Iversen, Sidsel, Wilsgaard, Tom, Mathiesen, Ellisiv B., Njølstad, Inger, and Løchen, Maja-Lisa
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MYOCARDIAL infarction risk factors , *ANGINA pectoris , *CARDIOVASCULAR diseases risk factors , *COHORT analysis , *CONFIDENCE intervals , *CORONARY disease , *MYOCARDIAL infarction , *QUESTIONNAIRES , *MATHEMATICAL variables , *PREDICTIVE tests , *PROPORTIONAL hazards models , *DESCRIPTIVE statistics , *ODDS ratio , *PROGNOSIS - Abstract
Background The Rose Angina Questionnaire (RAQ) was constructed in the 1960s for assessing the population burden of angina. Studies have found that screening positivity by RAQ conferred an elevated risk of coronary heart disease (CHD). It is, however, not clear to what extent Rose angina represents early CHD in relatively young adults who are free of known CHD. If representing CHD, Rose angina is expected to carry prognostic information in addition to the risk conferred by other risk factors. Methods The Tromsø Study is a population-based cohort study in Northern Norway. All men aged 20–54 years (n=8238) and women aged 20–49 years (n=8001), free of known cardiovascular disease (CVD), who participated in a survey 1979–1980, were followed throughout 2010 for incident myocardial infarction (MI), and for incident MI or stroke used as proxy for incident CVD. HRs were estimated using a Cox proportional hazard regression model. Results In age-adjusted analyses, Rose angina predicted MI and CVD in both sexes. The excess risk was substantially accounted for by CVD risk factors, leaving no significantly elevated MI risk above the risk explained by these factors (adjusted HR 1.31; 95% CI 0.95 to 1.80 in men, HR 1.20; 95% CI 0.69 to 2.10 in women). A similar pattern was seen for CVD (adjusted HR 1.16; 95% CI 0.87 to 1.55 in men and 1.30; 95% CI 0.82 to 2.06 in women). Conclusions Rose angina predicted MI and CVD in a 29-years’ follow-up of a relatively young population. Established CVD risk factors were important mediators. [ABSTRACT FROM AUTHOR]
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- 2014
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30. Key recommendations and evidence from the NICE guideline for the acute management of ST-segmentelevation myocardial infarction.
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Harker, Martin, Carville, Serena, Henderson, Robert, and Gray, Huon
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MYOCARDIAL infarction , *HOSPITAL mortality , *REPERFUSION , *CARDIOGENIC shock , *ANGINA pectoris , *PREVENTION , *MANAGEMENT , *PATIENTS , *THERAPEUTICS - Abstract
The acute management of ST-segment-elevation myocardial infarction (STEMI) has seen significant changes in the past decade. Although the incidence has been declining in the UK, STEMI still gives rise to around 600 hospitalised episodes per million people each year, with many additional cases resulting in death before hospital admission. In-hospital mortality following acute coronary syndromes has fallen over the past 30 years from around 20% to nearer 5%, and this improved outcome has been attributed to various factors, including timely access to an expanding range of effective interventional and pharmacological treatments. A formal review of the acute management of STEMI is therefore appropriate. The recently published NICE clinical guideline (CG167: The acute management of myocardial infarction with ST-segment elevation) provides evidence-based guidance on the acute management of STEMI, including the choice of reperfusion strategies, procedural aspects of the recommended interventions, the use of additional drugs before and longside reperfusion therapies, and the treatment of patients who are unconscious or in cardiogenic shock. The guideline development methods and detailed reviews of the evidence considered by the Guideline Development Group (GDG) can be found in the full version of the guideline (http://www.nice.org.uk/ CG167), and the priority recommendations are summarised in box 1. Other related NICE clinical guidelines deal with the diagnosis of recent-onset chest pain of suspected cardiac origin http://www.nice.org.uk/ CG95), the early management of unstable angina and non-STEMI (http://www.nice.org.uk/CG94), and secondary prevention after myocardial infarction (http:// www.nice.org.uk/CG48, currently being updated with publication expected end of 2013). [ABSTRACT FROM AUTHOR]
- Published
- 2014
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31. The role of adjuvant carotid ultrasound in women undergoing stress echocardiography for the assessment of suspected coronary artery disease
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Roxy Senior, Rajdeep S. Khattar, Sothinathan Gurunathan, Reinette Hampson, and Mayooran Shanmuganathan
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Carotid Artery Diseases ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Cardiac & Cardiovascular Systems ,Time Factors ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,INTIMA-MEDIA THICKNESS ,Carotid Intima-Media Thickness ,Angina ,Coronary artery disease ,stress ,0302 clinical medicine ,Carotid artery disease ,Dobutamine ,HISTORY ,Myocardial infarction ,Prospective Studies ,Prospective cohort study ,RISK ,OUTCOMES ,Middle Aged ,Prognosis ,ISCHEMIA ,PROGNOSTIC VALUE ,CARDIOVASCULAR-DISEASE ,Adrenergic beta-1 Receptor Agonists ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,Echocardiography, Stress ,medicine.medical_specialty ,CONSENSUS STATEMENT ,HEART-DISEASE ,carotid artery disease ,Risk Assessment ,Angina Pectoris ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,cardiovascular diseases ,Aged ,Science & Technology ,business.industry ,Reproducibility of Results ,medicine.disease ,ATHEROSCLEROSIS ,lcsh:RC666-701 ,Heart Disease Risk Factors ,Heart failure ,Cardiovascular System & Cardiology ,Exercise Test ,business ,Body mass index ,030217 neurology & neurosurgery - Abstract
ObjectiveDue to the low prevalence of obstructive coronary artery disease (CAD) in women, stress testing has a relatively low predictive value for this. Additionally, conventional cardiovascular risk scores underestimate risk in women. This study sought to evaluate the role of atherosclerosis assessment using carotid ultrasound (CU) in women attending for stress echocardiography (SE).MethodsThis was a prospective study in which consecutive women with recent-onset suspected angina, who were referred for clinically indicated SE, underwent CU.Results415 women (mean age 61±10 years, 29% diabetes mellitus, mean body mass index 28) attending for SE underwent CU. 47 women (11%) had inducible wall motion abnormalities, and carotid disease (CD) was present in 46% (carotid plaque in 41%, carotid intima-media thickness >75th percentile in 15%). Women with CD were older (65 vs 58 years, pThe positive predictive value of SE for flow-limiting CAD was 51%, but with the presence of carotid plaque, this was 71% (p70% angiographic stenosis. In women with ischaemia on SE and no carotid plaque, the negative predictive value for flow-limiting disease was 88%.During a follow-up of 1058±234 days, there were 15 events (defined as all-cause mortality, non-fatal myocardial infarction, heart failure admissions and late coronary revascularisation). Age (HR 1.07 (1.00–1.15), p=0.04), carotid plaque burden (HR 1.65 (1.36–2.00), pConclusionCU significantly improves the accuracy of SE alone for identifying flow-limiting disease on coronary angiography, and improves risk stratification in women attending for SE, as well identifying a subset of women who may benefit from primary preventative measures.
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- 2020
32. Almanac 2013: acute coronary syndromes.
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Meier, Pascal, Lansky, Alexandra J., and Baumbach, Andreas
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ACUTE coronary syndrome , *MYOCARDIAL infarction , *TACHYARRHYTHMIAS , *ANGINA pectoris , *HEART disease related mortality , *THERAPEUTICS , *HEART diseases - Abstract
Unstable coronary artery plaque is the most common underlying cause of acute coronary syndromes (ACS) and can manifest as unstable angina, non-ST segment elevation infarction (NSTE-ACS), and ST elevation myocardial infarction (STEMI), but can also manifest as sudden cardiac arrest due to ischaemia induced tachyarrhythmias. ACS mortality has decreased significantly over the last few years, especially from the more extreme manifestations of ACS, STEMI, and cardiac arrest. This trend is likely to continue based on recent therapeutic progress which includes novel antiplatelet agents such as prasugrel, ticagrelor, and cangrelor. [ABSTRACT FROM AUTHOR]
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- 2013
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33. Expression of stanniocalcin-1 in culprit coronary plaques of patients with acute myocardial infarction or stable angina.
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Cheol Whan Lee, Ilseon Hwang, Chan-Sik Park, Hyangsin Lee, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, and Seung-Jung Park
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GLYCOPROTEIN genetics , *ATHEROSCLEROTIC plaque , *MYOCARDIAL infarction , *ANGINA pectoris , *GENE expression , *GENETICS , *PATIENTS - Abstract
Background Stanniocalcin-1 (STC1) is involved in fundamental biological processes such as angiogenesis, inflammation and wound healing, but little is known about its expression in human coronary atherosclerotic plaques or its relationship to plaque instability. Objective STC1 expression was examined in the culprit coronary plaques of 70 patients with acute myocardial infarction (AMI; n=49) or stable angina (n=21) who underwent directional coronary atherectomy. Methods The specimens were stained with H&E, STC1-specific antibodies, and endothelial cells, macrophages and smooth muscle cell markers. Results The baseline characteristics of the two groups of patients were largely similar. CD31-immunopositive and CD68-immunopositive areas, indicative of the presence of endothelial cells and macrophages, respectively, were proportionately larger while areas immunopositive for α-actin, as a smooth muscle cell marker, were proportionately smaller in the AMI group than in the stable angina group. The proportion of STC1-immunopositive areas was significantly greater in the AMI group than in the stable angina group (20.0% (8.2-29.0%) vs 8.8% (3.9-19.4%), p=0.022). Areas positive for STC1 were independently correlated with those immunopositive for CD31 (r=0.42, p<0.001) and CD68 (r=0.40, p<0.001). STC1 immunoreactivity colocalised with CD31-immunopositive and CD68- immunopositive cells. Conclusions STC1 is differentially expressed in the culprit coronary plaques of patients with AMI versus those with stable angina. STC1 may play a role in plaque instability [ABSTRACT FROM AUTHOR]
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- 2013
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34. Comparison of ADAMTS-1, -4 and -5 expression in culprit plaques between acute myocardial infarction and stable angina.
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Cheol Whan Lee, Ilseon Hwang, Chan-Sik Park, Hyangsin Lee, Duk-Woo Park, Su-Jin Kang, Seung-Hwan Lee, Young-Hak Kim, Seong-Wook Park, and Seung-Jung Park
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PROTEOLYTIC enzymes , *ENDARTERECTOMY , *CORONARY artery surgery , *MYOCARDIAL infarction , *ANGINA pectoris , *CARDIAC patients - Abstract
BACKGROUND: ADAMTS (a disintegrin and metalloproteinase with thrombospondin type 1 motifs) proteases might contribute to plaque destabilisation by weakening the fibrous cap. However, little is known about the expression of ADAMTS proteases in coronary atherosclerotic plaques. OBJECTIVE: To examine the expression of ADAMTS proteases in coronary atherectomy samples obtained from patients with acute myocardial infarction (AMI) or stable angina. METHODS: Atherectomy specimens were obtained from 34 patients with AMI (n=23) or stable angina (n=11) who underwent directional coronary atherectomy. The specimens were stained with H&E and analysed immunohistochemically using antibodies specific to ADAMTS-1, -4 and -5; versican cleavage products; and markers for endothelial cells, macrophages and smooth muscle cells. RESULTS: Baseline characteristics were similar between the two groups. The proportion of CD31 and CD68 immunopositive areas did not differ between the two groups, but the area immunopositive for smooth muscle α-actin was smaller in the AMI group. The relative area immunopositive for ADAMTS-1 in AMI (1.04% (IQR 0.59–2.09%)) was significantly greater than that in stable angina (0.24% (0.15–0.39%); p<0.001). In contrast, the proportion of areas immunopositive for ADAMTS-4 or -5 was similar in the two groups. Areas that stained for ADAMTS-1 largely overlapped with those positive for CD68 and versican cleavage products. The areas immunopositive for ADAMTS-1 were significantly correlated with CD68 immunostained areas (r=0.50, p=0.003). CONCLUSIONS: ADAMTS-1, -4 and -5 were present in human coronary atherosclerotic plaques, and ADATS-1 was more strongly expressed in AMI plaques than in stable plaques. ADAMTS-1 may play a role in plaque instability. [ABSTRACT FROM AUTHOR]
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- 2011
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35. Early management of unstable angina and non-ST-segment elevation myocardial infarction: summary of NICE guidance.
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Gray, Huon H., Henderson, Robert A., De Belder, Mark A., Underwood, S. Richard, and Camm, A. John
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ANGINA pectoris , *MYOCARDIAL infarction , *HEART diseases , *CORONARY disease , *ANTITHROMBINS , *PLATELET aggregation inhibitors , *THERAPEUTICS - Abstract
The article offers information on the clinical guidance published by the National Institute for Health and Clinical Excellence (NICE) of Great Britain in October 2010 on the early management of unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). It briefly presents the clinical definition of acute coronary syndromes, acute ST-elevation myocardial infarction (STEMI) and UA. Included in the NICE guidance are risk assessment and its impact on patient management and antiplatelet and antithrombin therapy, among others.
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- 2010
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36. Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987-2006 from the Swedish hospital and death registries.
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Fagring, A. J., Lappas, G., Kjellgren, K. I., Welin, C., Manhem, K., and Rosengren, A.
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MORTALITY , *ANGINA pectoris , *CHEST disease diagnosis , *HEART disease related mortality , *CORONARY disease - Abstract
Objective To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden. Design and setting Register study of all patients aged 25-84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006. Participants A total of 378⇔454 patients, 235⇔855 with UCP and 142⇔599 with angina. Main outcome measures 1-Year mortality and standardised mortality ratios (SMRs). Results From the period 1987-1991 to 2002-2006, the observed 1-year mortality rate in men and women with UCP aged 25-74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33-3.05) and 2.59 (2.06-3.12) to 1.09 (0.93-1.25) and 1.05 (0.81-1.29), respectively. Similar changes occurred in patients aged 75-84 years. Only men with UCP aged 75-84 years still retained a slightly increased mortality (SMR 1.14 (1.01-1.28)). Conclusions The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population. [ABSTRACT FROM AUTHOR]
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- 2010
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37. Relationship between plasma inflammatory markers and plaque fibrous cap thickness determined by intravascular optical coherence tomography.
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Li, Q.-X., Fu, Q.-Q., Shi, S.-W., Wang, Y.-F., Xie, J.-J., Yu, X., Cheng, X., and Liao, Y.-H.
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ATHEROSCLEROTIC plaque , *OPTICAL coherence tomography , *CORONARY disease , *MYOCARDIAL infarction , *ANGINA pectoris , *BIOMARKERS - Abstract
Objective The purpose of this study was to evaluate the relationship between human plaque fibrous cap thickness detected by intravascular optical coherence tomography (OCT) and the plasma levels of inflammatory factors in patients with coronary artery disease (CAD). Methods and Results OCT was used to measure the fibrous cap thickness of coronary artery atherosclerotic plaques in patients with acute myocardial infarction (AMI), unstable angina pectoris (UAP) and stable angina pectoris (SAP). Plasma levels of inflammatory factors including highly sensitive C-reactive protein (hs-CRP), IL-18 and tumour necrosis factor alpha (TNFα) were detected by ELISA, and peripheral white blood cell (WBC) counts were performed. The results demonstrated that the plasma levels of inflammatory factors and WBC count were correlated inversely with fibrous cap thickness (r=-0.775 for hs-CRP, r=-0.593 for IL-18, r=-0.60 for TNFa and r=-0.356 for WBC count). Patients with cap thickness less than 65 μm (defined to be thin cap fibroatheromas; TCFA) had higher plasma levels of inflammatory factors as well as WBC counts than those with thicker fibrous caps. Receiver operator characteristic (ROC) curves for hs-CRP, IL-18, TNFa and WBC count, which displayed the capability of prediction about TCFA, showed the area under the curves were 0.95, 0.86, 0.79 and 0.70 (p<0.05), respectively. ROC curve analysis confirmed that an hs-CRP cut-off at 1.66 mg/l would detect TCFA with a sensitivity of 96% and a specificity of 90%, and was the strongest independent predictor of TCFA. Conclusion There is an inverse linear correlation between fibrous cap thickness and plasma levels of inflammatory markers. The plasma hs-CRP concentration is the strongest independent predictor of TCFA. [ABSTRACT FROM AUTHOR]
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- 2010
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38. Five year prognosis in patients with angina identified in primary care: incident cohort study.
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Buckley, Brian S., Simpson, Colin R., McLernon, David J., Murphy, Andrew W., and Hannaford, Philip C.
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ANGINA pectoris , *PRIMARY care , *PROGNOSIS , *MYOCARDIAL infarction , *MORTALITY , *CORONARY disease , *HEART disease risk factors - Abstract
Objective To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years. Design Incident cohort study of patients with primary care data linked to secondary care and mortality data. Setting 40 primary care practices in Scotland. Participants 1785 patients with a diagnosis of angina as their first manifestation of ischaemic heart disease, 1 January 1998 to 31 December 2001. Main outcome measures Adjusted hazard ratios for acute myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, death from ischaemic heart disease, and all cause mortality, adjusted for demographics, lifestyle risk factors, and comorbidity at cohort entry. Results Mean age was 62.3 (SD 11.3). Male sex was associated with an increased risk of acute myocardial infarction (hazard ratio 2.01, 95% confidence interval 1.35 to 2.97), death from ischaemic heart disease (2.80, 1.73 to 4.53), and all cause mortality (1.82, 1.33 to 2.49). Increasing age was associated with acute myocardial infarction (1.04, 1.02 to 1.06, per year of age increase), death from ischaemic heart disease (1.09, 1.06 to 1.11, per year of age increase), and all cause mortality (1.09, 1.07 to 1.11, per year of age increase). Smoking was associated with subsequent acute myocardial infarction (1.94, 1.31 to 2.89), death from ischaemic heart disease (2.12, 1.32 to 3.39), and all cause mortality (2.11, 1.52 to 2.95). Obesity was associated with death from ischaemic heart disease (2.01, 1.17 to 3.45) and all cause mortality (2.20, 1.52 to 3.19). Previous stroke was associated with all cause mortality (1.78, 1.13 to 2.80) and chronic kidney disease with death from ischaemic heart disease (5.72, 1.74 to 18.79). Men were more likely than women to have coronary artery bypass grafting or percutaneous transluminal coronary angioplasty after a diagnosis of angina; older people were less likely to receive percutaneous transluminal coronary angioplasty. Acute myocardial infarction after a diagnosis of angina was associated with an increased risk of death from ischaemic heart disease and all cause mortality (8.84 (5.31 to 14.71) and 4.23 (2.78 to 6.43), respectively). Neither of the invasive cardiac procedures significantly reduced the subsequent risk of all cause mortality. Conclusions In this sample of people with incident angina from primary care, there were sex differences in survival and age and sex differences in the provision of revascularisation after a diagnosis. Acute myocardial infarction after a diagnosis of angina was strongly predictive of mortality. To minimise adverse outcomes, optimal preventive treatments should be used in patients with angina. [ABSTRACT FROM AUTHOR]
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- 2009
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39. Correspondence on "Association between cardiologist evaluation and mortality in myocardial injury after non-cardiac surgery" by Park et al.
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Müller, Daria, Glarner, Noemi, Lopez-Ayala, Pedro, Puelacher, Christian, Müller, Christian, and Study Group of Basel-PMI
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SURGICAL complications ,MYOCARDIAL injury ,CARDIOLOGISTS ,CARDIOPULMONARY bypass - Published
- 2022
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40. Coronary microvascular dysfunction after myocardial infarction: increased coronary zero flow pressure both in the infarcted and in the remote myocardium is mainly related to left ventricular filling pressure.
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van Herck, P. L., Carlier, S .G, Claeys, M. J., Haine, S. E., Gorissen, P., Miljoen, H., Bosmans, J. M., and Vrints, C. J.
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MYOCARDIAL infarction , *CORONARY disease , *ANGINA pectoris , *CARDIOMYOPATHIES , *LEFT heart ventricle , *BLOOD circulation , *BLOOD flow - Abstract
Objective: To investigate the underlying mechanisms of a decreased coronary flow reserve after myocardial infarction (MI) by analysing the characteristics of the diastolic hyperaemic coronary pressure—flow relationship. Design: Prospective study. Setting: Tertiary care hospital. Patients: 68 patients with a recent MI and 27 patients with stable angina pectoris (AP; control group). Main outcome measures: The intercept with the pressure axis (the zero flow pressure or Pzf) and slope index of the pressure—flow relationship (SIPF) were calculated from the simultaneously recorded hyperaemic intracoronary blood flow velocity and aortic pressure after successful coronary stenting. Results: A stepwise increase in Pzf from AP (14.6 (8.0) mm Hg), over non-Q-wave MI (22.5 (9.1) mm Hg), to Q-wave Ml (37.1(12.9) mm Hg; p<0.001) was observed. Similar changes in Pzf were found in a reference artery perfusing the non-infarcted myocardium. Multivariate analysis showed that in both regions the left ventricular end-diastolic pressure (LVEDP) was the most important determinant of the Pzf. The SIPF was not statistically different in the treated vessel between patients with MI and AP, but was increased in Ml patients with a markedly increased LVEDP. Conclusions: After an Ml, the coronary pressure—flow relationship is shifted to the right both in the infarcted and in the non-infarcted remote myocardium, as shown by the increased Pzf. The correlation with Pzf suggests that elevated left ventricular filling pressures contribute to the impediment of myocardial perfusion in patients with infarction. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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41. Vascular disease in a population-based cohort of individuals hospitalised with coeliac disease.
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Ludvigsson, J. F., de Faire, U., Ekbom, A., and Montgomery, S. M.
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CELIAC disease , *CORONARY disease , *MYOCARDIAL infarction , *VASCULAR diseases , *ANGINA pectoris , *HEART failure , *DISEASE risk factors - Abstract
Objectives: To evaluate the risk of cardiovascular disease in individuals with coeliac disease (CD). Design: Swedish national hospital-based register data were used to identify 13 358 individuals who had been diagnosed with CD (1964-2003) and 64 118 age-matched and sex-matched individuals without CD. Cox regression was used to estimate the risk of vascular disease in subjects with CD. Analyses were restricted to individuals with a follow-up of >1 year and with no vascular disease before study entry. Results: CD was associated with myocardial infarction (HR 1.27; 95% CI 1.09 to 1.48), angina pectoris (1.46; 1.25 to 1.70), heart failure (1.41; 1.22 to 1.62), brain haemorrhage (1.40; 1.05 to 1.88) and ischaemic stroke (1.35; 1.14 to 1.60). These risk estimates were similar when analyses were restricted to adults in whom vascular disease had been listed as the main diagnosis. In post-hoc analyses, where reference individuals were restricted to inpatients, no association was found between CD and later vascular disease, except for a lower risk of heart failure (0.79; 0.68 to 0.92). Conclusions: The positive association between CD and later vascular disease may be explained by ascertainment bias. [ABSTRACT FROM AUTHOR]
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- 2007
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42. Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution.
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Timmis, Adam D., Feder, Gene, and Hemingway, Harry
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ANGINA pectoris , *CHEST pain , *CORONARY disease , *MYOCARDIAL infarction , *CLINICAL trials , *PROGNOSIS - Abstract
The prognosis of angina was described as "unhappy" by the Framingham investigators and as little different from that of 1-year survivors of acute myocardial infarction. Yet recent clinical trials now report that angina has a good prognosis with adverse outcomes reduced to "normal levels". These disparate prognostic assessments may not be incompatible, applying as they do to population cohorts (Framingham) and selected participants in clinical trials. Comparisons between studies are further complicated by the absence of agreed case definitions for stable angina (contrast this with acute coronary syndromes). Our recent data show that for patients with recent onset symptoms attending chest pain clinics, angina remains a high-risk diagnosis and although many patients receive symptomatic benefit from revascularisation, prognosis is usually unaffected. This leaves little room for complacency and, with angina the commonest initial manifestation of coronary artery disease, there is the opportunity for early detection, risk stratification and treatment to modify outcomes. Meanwhile, larger population-based studies are needed to define the patient journey from earliest presentation through the various syndrome transitions to coronary or noncardiac death in order to increase understanding of the aetiological and prognostic differences between the different coronary disease phenotypes. [ABSTRACT FROM AUTHOR]
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- 2007
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43. Lipoprotein(a), a moving target: from the primary to secondary prevention of atherothrombotic events.
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Borovac, Josip A.
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AORTIC stenosis ,ANGINA pectoris ,DISEASE relapse prevention ,LIPOPROTEINS ,MYOCARDIAL infarction ,CORONARY artery disease ,PLATELET aggregation inhibitors - Published
- 2020
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44. Acute coronary syndromes: a success story but still a long way to go.
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Shaw, James A. and Warren, Josephine
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ACUTE coronary syndrome ,CORONARY care units ,ANGINA pectoris ,MYOCARDIAL infarction ,CORONARY angiography - Published
- 2020
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45. Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percuataneous coronary intervention: results from the DANAMI-2 trial.
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Sejersten, M., Birnbaum, Y., Ripa, R. S., Maynard, C., Wagner, G. S., and Clemmensen, P.
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MYOCARDIAL infarction , *ELECTROCARDIOGRAPHY , *THROMBOLYTIC therapy , *CORONARY disease , *ANGINA pectoris - Abstract
Objective: To determine whether ischaemia grade (GI) on the presenting ECG and duration of symptoms can identify subgroups of patients who would derive more benefit than the general population of patients with ST segment elevation acute myocardium infarction (STEMI) from primary percutaneous coronary intervention (pPCI) over thrombolytic treatment (TT) in reducing mortality or reinfarction. Methods: 1319 DANAMI-2 (Danish trial in Acute Myocardial Infarction-2) patients were classified as having grade 2 ischaemia (GI2; ST segment elevation without terminal QRS distortion) or grade 3 ischaemia (GI3; ST segment elevation with terminal QRS distortion in ⩾ 2 adjacent leads), and were divided into early and late groups split by the median time (3 h) from symptom onset to treatment. Outcomes were 30-day mortality and reinfarction. Results: Mortality was significantly higher for GI3 than for GI2 (9.7% v 4.8%, p < 0.00 1) and doubled for patients presenting late (GI2: 6.0% v 3.3%, p = 0.01; GI3: 12.5% v 4.7%, p = 0.05). Overall mortality did not differ significantly between pPCI and TI; however, a 5.5% absolute mortality reduction was seen in GI3 treated early with pPCI (1.4% v 6.9%, p = 0.10). Reinfarction rate was particularly high among GI3 patients presenting late and treated with TT (1 2.2%). pPCI in such patients significantly reduced the rate of reinfarction (0%, p < 0.001). Logistic regression analysis showed that age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.06 to 1.12, p <0.001), prior angina (OR 2.56, 95% CI 1.44 to 4.54, p = 0.001), heart rate (OR 1.03, 95% CI 1.01 to 1.04, p = 0.001) and GI3 (OR 1.91, 95% CI 1.06 to 3.44, p = 0.031) were independently associated with mortality, whereas the sum of SI segment elevation was not. Conclusions: GI3 is an independent predictor of mortality among patients with STEMI. Mortality increased significantly with symptom duration in both GI2 and GI3. pPCI may be especially beneficial for patients with GI3 presenting early, whereas patients with GI3 presenting late and treated with TT are at particular risk of reinfarction. [ABSTRACT FROM AUTHOR]
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- 2006
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46. Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study.
- Author
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Capewell, S., Murphy, N. F., MacIntyre, K., Frame, S., Stewart, S., Chalmers, J. W. T., Boyd, J., Finlayson, A., Redpath, A., and McMurray, J. J. V.
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CORONARY disease , *MYOCARDIAL infarction , *ANGINA pectoris , *EMERGENCY medical services - Abstract
Objective: To analyse short- and long-term outcomes and prognostic factors in a large population-based cohort of unselected patients with a first emergency admission for suspected acute coronary syndrome between 1990 and 2000 in Scotland. Methods: All first emergency admissions for acute myocardial infarction (AMI) and all first emergency admissions for angina (the proxy for unstable angina) between 1990 and 2000 in Scotland (population 5.1 million) were identified. Survival to five years was examined by Cox multivariate modelling to examine the independent prognostic effects of diagnosis, age, sex, year of admission, socioeconomic deprivation and co-morbidity. Results: In Scotland between 1990 and 2000, 133 429 individual patients had a first emergency admission for suspected acute coronary syndrome: 96 026 with AMI and 37 403 with angina. After exclusion of deaths within 30 days, crude five-year case fatality was similarly poor for patients with angina and those with AMI (23.9% v 21 .6% in men and 23.5% v 26.0% in women). The longer-term risk of a subsequent fatal or non-fatal event in the five years after first hospital admission was high: 54% in men after AMI (53% in women) and 56% after angina (49% in women). Event rates increased threefold with increasing age and 20-60% with different co-morbidities, but were 11-34% lower in women. Conclusions: Longer-term case fatality was similarly high in patients with angina and in survivors of AMI, about 5% a year. Furthermore, half the patients experienced a fatal or non-fatal event within five years. These data may strengthen the case for aggressive secondary prevention in all patients presenting with acute coronary syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
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47. Interventional versus conservative treatment in acute non-ST elevation coronary syndrome: time course of patient management and disease events over one year in the RITA 3 trial.
- Author
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Poole-Wilson, P. A., Pocock, S. J., Fox, K. A. A., Henderson, R. A., Wheatley, D. J., Chamberlain, D. A., Shaw, T. R. D., and Clayton, T. C.
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CORONARY disease , *ANGINA pectoris , *DISEASE management , *MYOCARDIAL infarction , *HEART disease related mortality - Abstract
Objective: To determine whether, in acute non-ST elevation coronary syndrome, the benefit from early invasive coronary intervention compared with a conservative strategy of later symptom-guided intervention varies over time. Methods: In RITA 3 (Randomised Intervention Trial of unstable Angina 3) patients were randomly assigned to coronary angiography (median 2 days after randomisation) and appropriate intervention (n = 895) or to a symptom-guided conservative strategy (n = 915). Results: In the first week patients in both groups were at highest risk of death, myocardial infarction (MI) or refractory angina (incidence rate 40 times higher than in months 5-1 2 of follow up). There were 22 MIs and 6 deaths in the intervention group (largely due to procedure-related events, 14 MIs and 3 deaths) versus 17 MIs and 3 deaths in the conservative group. In the rest of the year there were an additional 12 versus 27 MIs, respectively (treatment-time interaction p = 0.021). Over one year in the intervention group there was a 43% reduction in refractory angina; 22% of patients underwent coronary artery bypass surgery and 35% underwent percutaneous coronary intervention only, which reduced refractory angina but provoked some early MIs; and 43% were still treated medically, mostly because of a favourable initial angiogram. Conclusion: Any intervention policy needs to recognise the high risk of events in the first week and the substantial minority of patients not needing intervention. Intervention may be best targeted at higher risk patients, as the early hazards of the procedure are then offset by reduced subsequent events. [ABSTRACT FROM AUTHOR]
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- 2006
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48. Are there socioeconomic differences in myocardial infarction event rates and fatality among patients with angina pectoris?
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Manderbacka, Kristiina, Hetemaa, Tuna, Keskimäki, Limo, Luukkainen, Pekka, Koskinen, Seppo, and Reunanen, Antti
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MYOCARDIAL infarction , *ANGINA pectoris , *CORONARY disease , *MORTALITY , *SOCIAL status - Abstract
Background: Systematic socioeconomic differences in mortality have been reported among myocardial infarction (MI) patients in many countries, including Finland. The findings have been similar irrespective of country, study period, age group, or length of follow up, but few studies have examined the disparities among other groups of coronary patients. This study examined whether similar socioeconomic differences in outcomes exist among patients with angina pectoris (AP). Methods: The data were based on individual register linkages among a population based 40-79 year-old cohort of 61 350 patients with incident AP or MI during 1995-1998 in Finland. Two year coronary heart disease mortality and one year MI incidence and its 28 day case fatality was studied among AP patients using Cox's and logistic regression analysis, and the results compared with those of the MI patient group. Results: A clear socioeconomic pattern was found in two year coronary heart disease (CHD) mortality: the lower the socioeconomic group the higher the mortality risk. The socioeconomic patterning of mortality was similar to that found among MI patients. Controlling for comorbidity or disease severity did not change the results. Among AP patients a similar pattern was also found in MI incidence during the follow up, but no systematic socioeconomic differences were detected in its 28 day case fatality. Conclusions: Socioeconomic differences in CHD outcomes also exist among angina patients. These results suggest that targeted measures of secondary prevention are needed among CHD patients with lower socioeconomic status to reduce socioeconomic disparities in fatal and non-fatal coronary events. [ABSTRACT FROM AUTHOR]
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- 2006
- Full Text
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49. Economic evaluation of the impact of nicorandil in angina (IONA) trial.
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Walker, A., McMurray, J., Stewart, S., Berger, W., McMahon, A. D., Dargie, H., Fox, K., Hillis, S., Henderson, N. J. K., and Ford, I.
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ANGINA pectoris , *CORONARY disease , *CHEST pain , *MYOCARDIAL infarction , *MEDICAL care , *GASTROINTESTINAL agents - Abstract
Objective: To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit. Design: Cost effectiveness analysis Setting: Based on results of the IONA (impact of nicorandil on angina) trial. Patients: Patients with angina fulfilling the entry criteria for the IONA trial Interventions: In one arm of the trial nicorandil was added to existing antianginal treatment and compared with existing treatment alone. Main outcome measures: Costs were for use of hospital resources (for cardiovascular, cerebrovascular, and gastrointestinal reasons), nicorandil, and care after hospital discharge. Benefits were assessed in three ways: (1) IONA trial primary outcome (coronary heart disease (CHD) death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain); (2) acute coronary syndrome (CHD death, non-fatal myocardial infarction, or unstable angina); and (3) event-free survivors at the end of the trial. Results: The net cost for each additional IONA trial end point averted was -£5 (-€7). The net cost for each case of acute coronary syndrome averted was -£8 (-€12). The net cost for each event-free survivor was -£5 (-€7). These figures are based on gastrointestinal events that were judged definitely or probably related to nicorandil. When all gastrointestinal events were included these three ratios rose to £567 (€835), £886 (€1305), and £516 (€760), respectively. Conclusions: A substantial amount of the additional cost of nicorandil is offset by reduced use of hospital services. The limited comparisons possible with other CHD interventions suggest that nicorandil compares favourably. [ABSTRACT FROM AUTHOR]
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- 2006
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50. Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients.
- Author
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Clayton, Tim C., Lubsen, Jacobus, Pocock, Stuart J., Vokó, Zoltán, Kirwan, Bridget-Anne, Fox, Keith A. A., and Poole-Wilson, Philip A.
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HEALTH risk assessment , *ANGINA pectoris , *MYOCARDIAL infarction , *CEREBROVASCULAR disease patients , *MORTALITY , *LEFT heart ventricle , *PATIENTS - Abstract
Objective To derive a risk score for the combination of death from all causes, myocardial infarction, and disabling stroke in patients with stable symptomatic angina who require treatment for angina and have preserved left ventricular function. Design Multivariate Cox regression analysis of data from a large multicenter trial. Setting Outpatient cardiology clinics in western Europe, Israel, Canada, Australia, and New Zealand. Participants 7311 patients with all required data available. Main outcome measure Death from any cause or myocardial infarction or disabling stroke during a mean follow-up of 4.9 years. Results 1063 patients either died from any cause or sustained myocardial infarction or disabling stroke. The five year risk of this composite ranged from 4% for patients in the lowest tenth of risk to 35% for patients in the highest tenth. The risk score combines 16 routinely available clinical variables (in order of decreasing contribution): age, left ventricular ejection fraction, smoking, white blood cell count, diabetes, casual blood glucose concentration, creatinine concentration, previous stroke, at least one angina attack a week, coronary angiographic findings (if available), lipid lowering treatment, QT interval, systolic blood pressure 155 mm Hg, number of drugs used for angina, previous myocardial infarction, and sex. Fitting the same model separately to all cause death, myocardial infarction, and stroke gave similar results. The risk score did not seem to predict the nature of the event (death in 39%, myocardial infarction in 46%, and disabling stroke in 15%) or the incidence of angiography or revascularization, which occurred in 29% of patients. Conclusion This risk score is an objective aid in deciding on further management of patients with stable angina with the aim of reducing serious outcome events. The score can also be used in planning future trials. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
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