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Muacevic A, Adler JR, Torozyan S, Plotnikova K, Ashurov M, Veprintseva A, Kimutsadze V, Kimutsadze V, Hakobova R, Kazaryan N. Total Ischemic Time on In-Hospital Complication Predictor in ST-Elevation Myocardial Infarction (STEMI) Patients With Renal Dysfunction. Cureus 2023; 15:e33903. [PMID: 36819448 PMCID: PMC9937643 DOI: 10.7759/cureus.33903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Aim The purpose of this study was to examine the impact of total ischemic time (TIT) on in-hospital complications in acute ST-elevation myocardial infarction (STEMI) patients with renal dysfunction (RD). Methods The study included a total of 116 patients. All patients underwent percutaneous coronary intervention. Glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2 in all patients. The patients were split into two groups based on the TIT value. All eligible patients were assigned to two groups according to TIT: Group 1 comprised 54 patients with ≤ 6-hour TIT and Group 2 consisted of 62 patients with > 6-hour TIT. The groups' other characteristics were similar. The composite rate of pulmonary edema and cardiogenic shock were compared between groups. Results The mean TIT in Group 1 was 4.37 ± 1.35 and in Group 2 was 9.03 ± 1.59 (p < 0.0001). The incidence of pulmonary edema or cardiogenic shock was higher in Group 2 than in Group 1: 16.1% and 3.7%, respectively (p = 0.034). Conclusion STEMI patients with RD and higher TIT were more likely to develop pulmonary edema and cardiogenic shock.
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Associations between β-Blocker Therapy at Discharge and Long-Term Follow-Up Outcomes in Patients with Unstable Angina Pectoris. Cardiol Res Pract 2022; 2022:5287566. [PMID: 36213457 PMCID: PMC9537036 DOI: 10.1155/2022/5287566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The effects of β-blockers in patients with unstable angina pectoris (UAP) are unclear. We tried to evaluate associations between β-blockers in UAP and long-term outcomes. Methods We enrolled 5591 UAP patients and divided them into 2 groups based on β-blockers at discharge: 3790 did β-blockers and 1801 did not used them. Propensity score matching at 1 : 1 was performed to select 1786 patients from each group. The primary endpoint was major adverse cardiac and cerebral events (MACCE) during the long-term follow-up period. Results 67.8% of patients were on β-blockers at discharge; these patients were more likely to have CHD risk factors, lower ejection fraction, and severity of the coronary artery lesions. Over a median of 25.0 years, the incidence of MACCE was 25.5%. The risk was not significantly different between those on and those not on β-blocker treatment. The multivariate Cox regression analysis showed that no β-blocker use at discharge was not an independent risk factor for MACCE and sequence secondary endpoints. After propensity score matching, the results were similar. Conclusions β-blocker use was not associated with lower MACCE and other secondary composite endpoints in long-term outcomes. This result adds to the increasing body of evidence that the routine prescription of β-blockers might not be indicated in patients with UAP. Trial registration had retrospectively registered.
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Prognostic Value of Admission Mean Corpuscular Volume for Major Adverse Cardiovascular Events following Stent Implantation in Nondiabetic and Diabetic Patients with Acute Coronary Syndrome. DISEASE MARKERS 2020; 2020:7054596. [PMID: 32733619 PMCID: PMC7383318 DOI: 10.1155/2020/7054596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 01/15/2023]
Abstract
Background One of the key concerns of the clinician is to identify and manage risk factors for major adverse cardiovascular events (MACEs) in nondiabetic and diabetic patients with acute coronary syndrome (ACS) undergoing stent implantation. Mean corpuscular volume (MCV) is a marker of erythrocyte size and activity and is associated with prognosis of cardiovascular disease. However, the role of admission MCV in predicting MACEs following stent implantation in diabetes mellitus (DM), non-DM, or whole patients with ACS remains largely unknown. Methods and Results A total of 437 ACS patients undergoing stent implantation, including 294 non-DM (59.08 ± 10.24 years) and 143 DM (63.02 ± 9.92 years), were analyzed. Admission MCV was higher in non-DM than DM patients. During a median of 31.93 months follow-up, Kaplan-Meier curve demonstrated that higher admission MCV level was significantly associated with increased MACEs in whole and non-DM, but not in DM patients. In Cox regression analysis, the highest MCV tertile was associated with higher MACEs in whole ([HR] 1.870, 95% CI 1.113-3.144, P = 0.018), especially those non-DM ([HR] 2.089, 95% CI 1.077-4.501, P = 0.029) patients after adjustment of several cardiovascular risk factors. MCV did not predict MACEs in DM patients. During landmark analysis, admission MCV showed better predictive value for MACEs in the first 32 months of follow-up than in the subsequent period. Finally, the receiver operating characteristic (ROC) curve was conducted to confirmed the value of admission MCV within 32 months. Conclusion In patients with ACS, elevated admission MCV is an important and independent predictor for MACEs following stent implantation, especially amongst those without DM even after adjusting for lifestyle and clinical risk factors. However, as the follow-up period increased, the admission MCV lost its ability to predict MACEs.
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Yekefallah L, Pournorooz M, Noori H, Alipur M. Evaluation of Door-To-Balloon Time for Performing Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Transferred by Pre-Hospital Emergency System in Tehran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:281-285. [PMID: 31333742 PMCID: PMC6621504 DOI: 10.4103/ijnmr.ijnmr_130_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The suggested treatment for patients with ST-segment elevation is the Primary Percutaneous Coronary Intervention (PPCI) for coronary reperfusion. This study aimed to evaluate the contribution of pre-hospital and hospital emergency systems in the interval time for PPCI among patients with the ST-segment elevation myocardial infarction (STEMI) in selected hospitals of Tehran city. Materials and Methods: This cross-sectional study was carried out on patients with typical chest pain transferred to the emergency wards of three large general hospitals in Tehran city by Emergency Medical Services. They received the PPCI. The information about admission time to the triage, time of conducting electrocardiography (ECG), diagnosis time of STEMI, and time of the PPCI were recorded and analyzed using descriptive and inferential statistics. Results: In this study, 121 patients were evaluated, and of which 94 (77.68%) were men and 27 (22.32%) were women. The average time (SD) of patient admission in the triage until to receive the PPCI (door-to-balloon) was 104.60 (62.30) min. Conclusions: The door-to-balloon time was 104.60 min. If ECG is taken by pre-hospital emergency nursing staff and diagnosis of STEMI is performed by the pre-hospital emergency service, and the patient is delivered directly to the angiography department, the door-to-balloon time is significantly reduced.
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Affiliation(s)
- Leili Yekefallah
- Department of Nursing, Social Determinants of Health Research Center, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahdi Pournorooz
- Department of Intensive Care Nursing, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Mahmood Alipur
- Department of Biostatistics, Qazvin University of Medical Sciences, Qazvin, Iran
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Weidner K, Behnes M, Schupp T, Rusnak J, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Hoppner J, El-Battrawy I, Mashayekhi K, Weiß C, Borggrefe M, Akin I. Type 2 diabetes is independently associated with all-cause mortality secondary to ventricular tachyarrhythmias. Cardiovasc Diabetol 2018; 17:125. [PMID: 30200967 PMCID: PMC6130079 DOI: 10.1186/s12933-018-0768-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/25/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The study sought to assess the prognostic impact of type 2 diabetes in patients presenting with ventricular tachyarrhythmias on admission. BACKGROUND Data regarding the prognostic outcome of diabetics presenting with ventricular tachyarrhythmias is limited. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with type 2 diabetes (diabetics) were compared to non-diabetics applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint of long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index, all-cause mortality at 30 days, all-cause mortality in patients surviving index hospitalization at 2 years (i.e. "after discharge") and rehospitalization due to recurrent ventricular tachyarrhythmias at 2 years. RESULTS In 2411 unmatched high-risk patients with ventricular tachyarrhythmias, diabetes was present in 25% compared to non-diabetics (75%). Rates of VT (57% vs. 56%) and VF (43% vs. 44%) were comparable in both groups. Multivariable Cox regression models revealed diabetics associated with the primary endpoint of long-term all-cause mortality at 2 years (HR = 1.513; p = 0.001), which was still proven after propensity score matching (46% vs. 33%, log rank p = 0.001; HR = 1.525; p = 0.001). The rates of secondary endpoints were higher for in-hospital death at index, all-cause mortality at 30 days, as well as after discharge, but not for cardiac death at 24 h or rehospitalization due to recurrent ventricular tachyarrhythmias. CONCLUSION Presence of type 2 diabetes is independently associated with an increase of all-cause mortality in patients presenting with ventricular tachyarrhythmias on admission.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Liu L, Huang J, Zhang X, Tang X. Efficacy and safety of triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing coronary stenting: A meta-analysis. PLoS One 2018; 13:e0199232. [PMID: 29920547 PMCID: PMC6007837 DOI: 10.1371/journal.pone.0199232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 06/04/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The optimal antithrombotic therapy for atrial fibrillation (AF) patients undergoing coronary stenting is unknown. The present meta-analysis sought to investigate the efficacy and safety of triple therapy (TT; warfarin, clopidogrel and aspirin) vs dual antiplatelet therapy (DAPT; clopidogrel plus aspirin) in those patients. METHODS PubMed and Cochrane Library were searched for studies enrolling AF patients undergoing coronary stenting on TT and DAPT up to September 2016, and fourteen studies were included. Efficacy outcomes included ischemic stroke, stent thrombosis, major adverse cardiovascular event (MACE), all-cause mortality and myocardial infarction (MI); safety outcome was major bleeding. We conducted meta-analysis and used odds ratio (OR) with 95% confidence intervals (CI) to compare TT and DAPT. Meta-regression, sensitivity and subgroup analysis were taken to investigate the source of heterogeneity in the outcome of major bleeding. RESULTS 14 eligible observational studies with 11,697 subjects were identified. Compared with DAPT, TT had decreased the risk of ischemic stroke [OR = 0.74, 95% CI (0.59, 0.93), P = 0.009] and stent thrombosis [OR = 0.40, 95% CI (0.18, 0.93), P = 0.033]. While, there was an increased risk of major bleeding [OR = 1.55, 95% CI (1.16, 2.09), P = 0.004] associated with TT. The risk of MACE, all-cause mortality and MI had no significant statistical difference between TT and DAPT. Furthermore, the results of univariate and multivariate meta-regression analysis implicated that there were no obvious correlations between certain baseline characteristics (age, gender, race, hypertension, study design) and risk of major bleeding. Also of major bleeding, the findings of sensitivity analysis were generally robust, and a prespecified subgroup analysis of race demonstrated that the source of heterogeneity might attribute to Asian studies mostly. CONCLUSIONS TT reduced the risk of ischemic stroke and stent thrombosis with an acceptable major bleeding risk compared with DAPT, and TT was considered as a valid alternative in AF patients undergoing coronary stenting. Further prospective randomized trials are needed to ensure the reliability of these data and find the optimal therapeutic strategy in this setting of patients.
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Affiliation(s)
- Liyao Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Jietao Huang
- Department of Cardiology, Chongqing Emergency Medical Center, Chongqing, P. R. China
| | - Xiaogang Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Xiaoman Tang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
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The NLRP3 and CASP1 gene polymorphisms are associated with developing of acute coronary syndrome: a case-control study. Immunol Res 2018; 65:862-868. [PMID: 28456882 DOI: 10.1007/s12026-017-8924-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The protein products of NLRP3 and CASP1 genes are involved in the cleavage of pro-IL-1B and pro-IL-18 leading to the active cytokines, which play an important role in the development of the acute coronary syndrome (ACS). The aim of the present study was to evaluate whether NLRP3 and CASP1 gene polymorphisms are biomarkers of ACS susceptibility in Mexican population. Two polymorphisms of the CASP1 gene [G+7/in6A (rs501192) and A10370-G Exon-6 (rs580253)] and one of the NLRP3 gene [UTR'3 G37562-C (rs10754558)] were genotyped by 5' exonuclease TaqMan assays in a group of 617 patients with ACS and 609 control individuals. Under recessive model, the CASP1 G+7/in6A polymorphism was associated with an increased risk of developing ACS when compared to healthy controls (OR = 1.76, 95% CI 1.08-2.86, P Res = 0.022). In the same way, under recessive model, the CASP1 A10370-G was associated with increased risk of ACS (OR = 1.75, 95% CI 1.07-2.85, P Res = 0.025). Moreover, under co-dominant, dominant, over-dominant, and additive models, the NLRP3 UTR'3 G37562-C was associated with a decreased risk of ACS (OR = 0.45, 95%CI 0.22-0.92, P Co-dom = 0.006; OR = 0.61, 95%CI 0.44-0.84, P Dom = 0.002; OR = 0.67, 95%CI 0.48-0.94, P Over-dom = 0.02; and OR = 0.65, 95%CI 0.50-0.94, P Add = 0.02, respectively). In summary, this study demonstrates that the G+7/in6A and A10370-G polymorphisms of the CASP1 gene are associated with increased risk of developing ACS, whereas the UTR'3 G37562-C polymorphism of the NLRP3 gene is associated with a decreased risk of developing ACS in Mexican population.
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Chen J, Wang LY, Deng C, Jiang XH, Chen TG. The safety and efficacy of oral anticoagulants with dual versus single antiplatelet therapy in patients after percutaneous coronary intervention: A meta-analysis. Medicine (Baltimore) 2017; 96:e8015. [PMID: 28906384 PMCID: PMC5604653 DOI: 10.1097/md.0000000000008015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A growing number of patients require oral anticoagulant (OAC) after undergoing percutaneous coronary intervention (PCI) with stent implantation due to the development of atrial fibrillation, but the optimal antithrombotic regimen remains controversial in these patients. METHODS We systematically searched PUBMED, EMBASE, and CENTRAL from inception until September 2016 for randomized controlled trials or cohort studies that evaluated the comparative effects of TT versus DT. Relative risks (RRs) with 95% confidence intervals (95% CIs) were pooled by a random-effects model or a fixed-effects model. RESULTS Twelve studies with a total of 30,823 patients were included in this analysis, including 6134 in the TT group and 24,689 in the DT group. No significant differences were found between the TT group and the DT group regarding major adverse cardiovascular events (MACE) (RR = 0.82, 95% CI: 0.58-1.17; I = 87.3%), stroke (RR = 1.08, 95% CI: 0.56-2.07; I = 65.5%), all-cause mortality (RR = 0.90, 95% CI: 0.54-1.51; I = 79.1%), or stent thrombosis (RR = 0.71, 95% CI: 0.41-1.24; I = 12.7%), and lower rates were observed for myocardial infarction (RR = 0.59, 95% CI: 0.50-0.70; I = 31.1%) and major bleeding with TT (RR = 0.86, 95% CI: 0.74-0.99; I = 24.3%). Meanwhile, we also found that compared with TT, OAC with clopidogrel treatment shows equal efficacy and safety outcomes. CONCLUSION In patients on OAC undergoing PCI with stent implantation, compared with DT, TT shows equal effectiveness in terms of MACE, stroke, all-cause mortality, and stent thrombosis and lower risks of myocardial infarction and major bleeding. However, similar efficacy and safety outcomes were observed between the TT group and the OAC along with clopidogrel group.
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Affiliation(s)
- Jie Chen
- Department of Cardiology, The Third Hospital of NanChang ,Nanchang, JiangXi
| | - Li-Yu Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chao Deng
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xing-Hua Jiang
- Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tu-Gang Chen
- Department of Cardiology, The Third Hospital of NanChang ,Nanchang, JiangXi
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王 又. 阿司匹林治疗冠心病患者合并上消化道出血的影响因素. Shijie Huaren Xiaohua Zazhi 2017; 25:2155-2160. [DOI: 10.11569/wcjd.v25.i23.2155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
目的 研究老年冠心病患者合并上消化出血应用阿司匹林治疗的影响因素分析.
方法 选取2015-11/2016-11在湖北省汉川市人民医院采用阿司匹林口服治疗的老年冠心病患者纳入214例进行回顾性分析, 对发生上消化道出血51例患者的年龄、性别、服药时间、剂量、消化道病史、胃黏膜保护剂使用情况和吸烟史等进行分析.
结果 患者年龄随着时间逐渐增长, 上消化道出血发生率明显增高(χ2 = 11.526, P<0.01); 服药时间低于3 mo的患者上消化道出血率显著低于服药超过3 mo的患者, 差异具有统计学意义(χ2 = 8.530, P<0.01); 小剂量组患者上消化道出血率明显低于大剂量组, 差异具有统计学意义(χ2 = 5.127, P<0.01); 上消化道出血与患者年龄无相关性(P>0.05), 老年冠心病患者有消化道病史或吸烟史的服用阿司匹林肠溶片容易造成上消化道出血(P<0.05), 阿司匹林联合胃黏膜保护剂同时服用可有效降低上消化道出血发生率(P<0.05).
结论 阿司匹林肠溶片联合胃黏膜保护剂, 可降低上消化道出血发生率.
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Andreou C, Maniotis C, Koutouzis M. The Rise and Fall of Anticoagulation with Bivalirudin During Percutaneous Coronary Interventions: A Review Article. Cardiol Ther 2017; 6:1-12. [PMID: 28105561 PMCID: PMC5446815 DOI: 10.1007/s40119-017-0082-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Indexed: 01/26/2023] Open
Abstract
Bivalirudin is a direct thrombin inhibitor used during percutaneous coronary intervention (PCI). Treatment with bivalirudin compared to heparin plus glycoprotein IIb/IIIa inhibitors (GPI) reduced bleeding complications, but resulted in higher rates of ischemic events, including acute stent thrombosis in ST segment elevation myocardial infarction (STEMI) patients. Thus, it may be considered a reasonable alternative antithrombotic agent in patients at high risk of bleeding undergoing PCI. However its superiority over heparin alone is questioned particularly in the era of novel antiplatelet agents and transradial PCI.
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Affiliation(s)
- Constantinos Andreou
- Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Christos Maniotis
- 2nd Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Michael Koutouzis
- 2nd Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece.
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Puymirat E, Riant E, Aissaoui N, Soria A, Ducrocq G, Coste P, Cottin Y, Aupetit JF, Bonnefoy E, Blanchard D, Cattan S, Steg G, Schiele F, Ferrières J, Juillière Y, Simon T, Danchin N. β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study. BMJ 2016; 354:i4801. [PMID: 27650822 PMCID: PMC5029148 DOI: 10.1136/bmj.i4801] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess the association between early and prolonged β blocker treatment and mortality after acute myocardial infarction. DESIGN Multicentre prospective cohort study. SETTING Nationwide French registry of Acute ST- and non-ST-elevation Myocardial Infarction (FAST-MI) (at 223 centres) at the end of 2005. PARTICIPANTS 2679 consecutive patients with acute myocardial infarction and without heart failure or left ventricular dysfunction. MAIN OUTCOME MEASURES Mortality was assessed at 30 days in relation to early use of β blockers (≤48 hours of admission), at one year in relation to discharge prescription, and at five years in relation to one year use. RESULTS β blockers were used early in 77% (2050/2679) of patients, were prescribed at discharge in 80% (1783/2217), and were still being used in 89% (1230/1383) of those alive at one year. Thirty day mortality was lower in patients taking early β blockers (adjusted hazard ratio 0.46, 95% confidence interval 0.26 to 0.82), whereas the hazard ratio for one year mortality associated with β blockers at discharge was 0.77 (0.46 to 1.30). Persistence of β blockers at one year was not associated with lower five year mortality (hazard ratio 1.19, 0.65 to 2.18). In contrast, five year mortality was lower in patients continuing statins at one year (hazard ratio 0.42, 0.25 to 0.72) compared with those discontinuing statins. Propensity score and sensitivity analyses showed consistent results. CONCLUSIONS Early β blocker use was associated with reduced 30 day mortality in patients with acute myocardial infarction, and discontinuation of β blockers at one year was not associated with higher five year mortality. These findings question the utility of prolonged β blocker treatment after acute myocardial infarction in patients without heart failure or left ventricular dysfunction.Trial registration Clinical trials NCT00673036.
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Affiliation(s)
- Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France
| | - Elisabeth Riant
- Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France
| | - Nadia Aissaoui
- Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France Department of Critical Care, Hôpital Européen Georges Pompidou, Paris, France
| | - Angèle Soria
- Assistance Publique-Hôpitaux de Paris, Paris, France Department of Dermatology and Allergology, Tenon Hospital, Paris, France Sorbonne University, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France INSERM U1135-CIMI, Paris, France
| | - Gregory Ducrocq
- Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Bichat, Paris, France Université Paris Diderot, Paris, France INSERM U 698, Paris, France
| | - Pierre Coste
- Hôpital cardiologique du Haut Levêque, Pessac, France Université Bordeaux Segalen, Bordeaux, France
| | - Yves Cottin
- Hôpital du Bocage, Dijon, France Université de Bourgogne, Dijon, France
| | | | - Eric Bonnefoy
- Hôpital cardiologique Louis Pradel, Lyon, France Université Lyon 1, Lyon, France
| | | | - Simon Cattan
- Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Gabriel Steg
- Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Bichat, Paris, France Université Paris Diderot, Paris, France INSERM U 698, Paris, France
| | - François Schiele
- Hôpital Jean Minjoz, Besançon, France Université de Franche Comté, Besançon, France
| | - Jean Ferrières
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France UMR INSERM 1027, Toulouse, France
| | - Yves Juillière
- Institut Lorrain du Cœur et des Vaisseaux Université de Lorraine, Nancy, France
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France
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Becker S, Florian A, Patrascu A, Rösch S, Waltenberger J, Sechtem U, Schwab M, Schaeffeler E, Yilmaz A. Identification of cardiomyopathy associated circulating miRNA biomarkers in patients with muscular dystrophy using a complementary cardiovascular magnetic resonance and plasma profiling approach. J Cardiovasc Magn Reson 2016; 18:25. [PMID: 27150296 PMCID: PMC4858897 DOI: 10.1186/s12968-016-0244-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/21/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Duchenne and Becker muscular dystrophy (DMD and BMD) are X-chromosomal recessive neuromuscular disorders that are caused by mutations in the dystrophin gene and characterized by cardiac involvement. Circulating microRNAs (miRNAs) have been proposed as diagnostic biomarkers for various cardiovascular diseases. However, circulating miRNAs reflecting the presence and/or disease severity of cardiac involvement in DMD/BMD patients have not been described so far. METHODS Sixty-three male patients with known MD and 26 age-matched healthy male controls were prospectively enrolled. All MD patients and controls underwent comprehensive cardiovascular magnetic resonance (CMR) studies as well as venous blood sampling on the same day. RESULTS An impaired left ventricular (LV) systolic function (defined as LV-EF <55 %) was detected in 29 (46 %) and presence of late gadolinium enhancement (LGE) indicative of myocardial fibrosis in 48 (76 %) MD patients with an exclusively non-ischemic pattern. Whereas no significant differences were observed for the 27 selected circulating miRNAs in MD patients with abnormal CMR findings (comprising structural and/or functional impairments) compared to those with completely normal CMR studies, a significant up-regulation of three miRNAs was observed in LGE-positive MD patients compared to LGE-negative ones: miR-222 (1.8-fold, p = 0.035), miR-26a (2.1-fold, p = 0.03) and miR-378a-5p (2.4-fold, p = 0.026). A signature of these three miRNAs (miR-26a, miR-222 and miR-378a-5p) resulted in an area under the curve (AUC) value of 0.74 for the diagnosis of LGE-positive MD patients. In a multivariable model, three independent predictors for LGE presence were identified comprising not only clinical and laboratory markers (LV-EF: OR 0.47, 95 % CI 0.24-0.89, p = 0.021 and elevated hs-Trop: OR 2559, 95 % CI 2.97-22.04*10(5), p = 0.023) but also the circulating miR-222 (OR 938, 95 % CI 938.46, 3.56-24.73*10(4), p = 0.016). CONCLUSIONS Up-regulation of circulating miRNAs miR-222, miR-26a and miR-378a-5p indicates the presence of myocardial scars in MD patients. Plasma miR-222 appears to be a promising novel biomarker reflecting structural - but not functional - cardiac alterations in MD patients.
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Affiliation(s)
- Svetlana Becker
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Anca Florian
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany
| | | | - Sabine Rösch
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
- Department of Biochemistry and Pharmacy, University Tübingen, Tübingen, Germany
| | - Elke Schaeffeler
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Ali Yilmaz
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany.
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Chandrasekhar J, Hibbert B, Froeschl M, So D, Mehran R, May ML. The impact of switching P2Y12 receptor inhibitor therapy during index hospitalization: a systematic review. Eur J Clin Pharmacol 2015; 72:83-91. [PMID: 26453463 DOI: 10.1007/s00228-015-1949-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE With the availability of novel P2Y12 receptor inhibitors, patients presenting with acute coronary syndrome (ACS) may receive more than one type of this drug during index hospitalization. We sought to determine the effect of switching from clopidogrel to a novel P2Y12 receptor inhibitor on the occurrence of major adverse cardiovascular events (MACE) and bleeding. METHODS We conducted a literature search on SCOPUS for English language entries until 7 March 2015. Out of 188 citations, seven studies encompassing 16,431 patients were selected for analysis of (i) switching to a novel P2Y12 agent (switching group) versus continued clopidogrel or (ii) switching to a novel P2Y12 agent (switching group) versus upfront novel agent initiation during index hospitalization RESULTS MACE was significantly lower in the switching group (odds ratio (OR) 0.77, 95 % confidence interval (CI) 0.63-0.96, p = 0.02), whereas bleeding was higher (OR 1.55, 1.29-1.85, p < 0.01) compared with continued clopidogrel. Conversely, MACE was similar with switching to a novel agent and upfront novel therapy initiation (OR 1.01, 95 % CI 0.8-1.29, p = 0.90), but bleeding was higher in the switching group (OR 1.24, 95 % CI 1.03-1.48, p = 0.02). CONCLUSIONS The current study suggests that switching to a novel P2Y12 agent in patients with ACS and/or patients undergoing coronary stenting is more efficacious than continuing clopidogrel. In this cohort, switching to a novel agent did not result in worse ischemic outcomes than upfront initiation of novel therapies. However, switching was associated with greater bleeding compared with both continued clopidogrel as well as upfront use of novel P2Y12 agents.
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Affiliation(s)
- Jaya Chandrasekhar
- Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada. .,Icahn School of Medicine at Mount Sinai, PO Box 1030, 1 Gustave L Levy place, New York, NY, 10029, USA.
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada
| | - Derek So
- Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada
| | - Roxana Mehran
- Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada
| | - Michel Le May
- Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada
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14
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Liu XJ, Wan ZF, Zhao N, Zhang YP, Mi L, Wang XH, Zhou D, Wu Y, Yuan ZY. Adjustment of the GRACE score by HemoglobinA1c enables a more accurate prediction of long-term major adverse cardiac events in acute coronary syndrome without diabetes undergoing percutaneous coronary intervention. Cardiovasc Diabetol 2015; 14:110. [PMID: 26285575 PMCID: PMC4541750 DOI: 10.1186/s12933-015-0274-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI). Methods We enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman’s rank correlation. Cumulative MACE curve was calculated using the Kaplan–Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results During a median of 42.3 months (interquartile range 39.3–44.2 months), 16 (2.9 %) were lost to follow-up, and patients experienced 69 (12.9 %) MACEs: 51 (9.6 %) all-cause deaths and 18 (3.4 %) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95 % CI 1.020–1.040; p < 0.001; 3.530; 95 % CI 1.927–6.466; p < 0.001, respectively). Furthermore, Kaplan–Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001]. Conclusions HbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0274-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao-Jun Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zhao-Fei Wan
- First Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Na Zhao
- First Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Ya-Ping Zhang
- Department of Ophthalmology Medicine, Xi'an IV People's Hospital, Xi'an, Shaanxi, China.
| | - Lan Mi
- Peking University Cancer Hospital and Institute, Beijing, China.
| | - Xin-Hong Wang
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Dong Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Yan Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zu-Yi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, China.
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Arishta Jhagroe D, Maria Ten Berg J. Managing the Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients on Oral Anticoagulation. Interv Cardiol 2015; 10:139-141. [PMID: 29588690 DOI: 10.15420/icr.2015.10.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In patients on chronic oral anticoagulation (OAC) who are undergoing a percutaneous coronary intervention (PCI), dual antiplatelet therapy (aspirin and a P2Y12 inhibitor) is required. However, combining dual antiplatelet therapy with OAC increases the risk of bleeding. Newer and stronger P2Y12 inhibitors also add more complexity to the regimen, as these antiplatelet agents are currently recommended as standard treatment in patients with acute coronary syndromes (ACS). It remains unclear whether these ACS patients on chronic OAC undergoing PCI should be treated with these new P2Y12 inhibitors as part of the antiplatelet therapy. Another issue to address is that new non-vitamin K oral anticoagulants have emerged as possible alternatives for stroke prevention in patients with AF. Thus, the anticoagulated patient undergoing PCI faces a treatment dilemma. Based on a real-life case, we will discuss the optimal anticoagulant and antiplatelet treatment with a review of the literature.
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Hole LD, Schjøtt J. Myocardial injury in a 41-year-old male treated with methylphenidate: a case report. BMC Res Notes 2014; 7:480. [PMID: 25073534 PMCID: PMC4122030 DOI: 10.1186/1756-0500-7-480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022] Open
Abstract
Background Elevated cardiac troponin levels are consistent with the diagnosis of an acute coronary syndrome, but may also represent adverse drug reactions. Psychostimulating drugs raise both blood pressure and heart rate, and case reports of sudden death, stroke, and myocardial infarction have led to regulatory and public concern about the cardiovascular safety of these drugs. Case presentation We present a case where a 41-year-old Norwegian male with radiating chest pain, elevated troponins, and supraventricular tachycardia was hospitalized. Tentative diagnosis was acute coronary syndrome. Percutaneous coronary angiography, but not cardiac magnetic resonance imaging, was performed and medical antiplatelet treatment started. Because of an attention deficit/hyperactivity disorder the patient had recently increased his dose of methylphenidate, but still within the therapeutic dose range. Apart from venlafaxine, also in a therapeutic dose, the patient took no other drugs. An acute coronary syndrome was excluded during hospitalization, and a drug effect was suspected. Conclusions When interpreting troponin results it is important to take into account the context of the patient’s clinical presentation, including the possibility of adverse drug reactions. The adverse drug reaction could include a combination of vasospasm and/or increased oxygen demand due to tachycardia. This case should be borne in mind before a diagnosis of myocardial infarction is given, or a decision to perform invasive coronary angiography is made in patients that use methylphenidate or related substances. Cardiac magnetic resonance imaging could be of diagnostic value in such cases.
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Affiliation(s)
- Lisa Drange Hole
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021 Bergen, Norway.
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome. World J Cardiol 2014; 6:405-414. [PMID: 24976912 PMCID: PMC4072830 DOI: 10.4330/wjc.v6.i6.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/10/2014] [Accepted: 04/19/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
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Bulj N, Potočnjak I, Sharma M, Pintaric H, Degoricija V. Timing of troponin T measurements in triage of pulmonary embolism patients. Croat Med J 2014; 54:561-8. [PMID: 24382851 PMCID: PMC3893989 DOI: 10.3325/cmj.2013.54.561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim To determine the appropriate timing of cardiac troponin T (cTnT) measurement for the early triage of pulmonary embolism (PE) patients. Methods In this single-center prospective study, PE was confirmed in all patients using computed tomography. 104 consecutive patients were divided into three groups (high-risk, intermediate, and low-risk) based on their hemodynamic status and echocardiographic signs of right ventricular dysfunction. cTnT levels were measured on admission and then after 6, 24, 48, and 72 hours with threshold values greater than 0.1 ng/mL. Results Intermediate-risk PE patients had higher cTnT levels than low-risk patients already in the first measurement (P = 0.037). Elevated cTnT levels significantly correlated with disease severity after 6 hours (intermediate vs low risk patients, P = 0.016, all three groups, P = 0.009). Conclusion In hemodynamically stable patients, increased cTnT level on admission differentiated intermediate from low-risk patients and could be used as an important element for the appropriate triage of patients.
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Affiliation(s)
- Nikola Bulj
- Nikola Bulj, Department of Medicine, Vinogradska cesta 29, 10 000 Zagreb, Croatia,
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Liu Y, Su Q, Li L. Efficacy of short-term high-dose atorvastatin pretreatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a meta-analysis of nine randomized controlled trials. Clin Cardiol 2013; 36:E41-E48. [PMID: 24038054 PMCID: PMC6649596 DOI: 10.1002/clc.22198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/17/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The efficacy of short-term high-dose atorvastatin pretreatment in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) remains unclear. This meta-analysis was undertaken to assess the efficacy of short-term high-dose atorvastatin pretreatment in patients with ACS undergoing PCI. HYPOTHESIS Short-term high-dose atorvastatin pretreatment may be beneficial in reducing major adverse cardiac events (MACEs) and improving myocardial blood flow in patients with ACS undergoing PCI. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically reviewed for randomized controlled trials (RCTs) published up to March 2013, in which short-term high-dose atorvastatin pretreatment was compared with control for patients with ACS undergoing PCI. The primary outcome measure was the incidence of MACEs at 30 days. The meta-analysis was performed with the fixed effect model or random-effects model according to the heterogeneity. Meta-analysis was performed by RevMan 5.0 software (Cochrane Collaboration, Copenhagen, Denmark). RESULTS Nine RCTs incorporating 952 patients met the inclusion criteria and were included in this meta-analysis. Short-term high-dose atorvastatin pretreatment significantly reduced the incidence of MACEs at 30-day follow-up (risk ratio [RR] 0.39, 95% confidence interval [Cl]: 0.25 to 0.61, P < 0.001) and improved the final Thrombolysis in Myocardial Infarction (TIMI) flow grade (RR 1.08, 95% Cl: 1.02 to 1.14, P = 0.01) compared with controls. There were no significant differences in peak creatine kinase-myocardial band and high-sensitivity C-reactive protein level post-PCI between the 2 groups, though there were favorable trends related to statin use. As to the safety end points, no significant difference was observed in elevated liver aminotransferase level between short-term high-dose atorvastatin pretreatment and control groups (RR 1.36, 95% Cl: 0.67 to 2.74). CONCLUSIONS The use of short-term high-dose atorvastatin pretreatment is safe and significantly improves the final TIMI flow grade as well as reduces the 30-day MACEs in ACS patients post-PCI. This finding encourages the use of short-term high-dose atorvastatin pretreatment as an alternative for ACS patients undergoing PCI, but more high-quality randomized clinical trials are still needed to confirm the long-term efficacy and safety.
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Affiliation(s)
- Yangchun Liu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, China
| | - Qiang Su
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, China
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