FIVE-YEAR-FOLLOW-UP OF PATIENTS WITH UNSTABLE ANGINA: SURGICAL VERSUS MEDICAL TREATMENT

1987 ◽  
Author(s):  
U Nellessen ◽  
S Jost ◽  
H Hecker ◽  
S Specht ◽  
V Danciu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Unstable Angina ◽  
Clinical Course ◽  
Bypass Graft ◽  
Treated Group ◽  
Kaplan Meier ◽  
Acute Mi ◽  
Artery Disease ◽  
Initial Hospitalization

Among patients (pts) with coronary artery disease those with symptoms of an unstable angina pectoris form a subset particularly jeopardized with regard to threatening myocardial infarction (MI) or cardiac death (CD). We analyzed over 5.4±2.1 years (Y) the clinical course of 123 pts, who between 1977 and 1982 had to be admitted to the intensive care unit for reasons of persisting angina at rest. Within the first 24 hours no patient revealed a significant elevation of serum creatine kinase or typical alterations in the ECG due to acute MI (new Q-waves). During their stay in hospital (19±17 days) 43 pts (37 men, 6 women; age 58±7 Y) were subjected to bypass graft surgery, 80 pts (60 men, 20 women; age 58jh10 Y) were medically treated, 13 of whom underwent subsequent bypass graft surgery because of aggravation of symptoms. The table presents a survey of cardiac mortality and incidence of MI in the collectives with medical and surgical treatment during the stay in hospital and 1, 3 and 5 Y after dismissal (calculated according to the life-table method of Kaplan-Meier).Hence, during the initial hospitalization infarction and mortality rate in the medically treated group indeed were smaller than in the surgical collective; however, after dismissal this beneficial mortality rate turned into the opposite in the course of the following years. In this group nearly every MI was fatal.

scholarly journals P976 Can calcium score predict the appropriate treatment for high risk patients? (a 5 years follow up study)

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Stanciu ◽  
M Gurzun ◽  
S Dumitrescu ◽  
F Naftanaila ◽  
A Spanu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Bypass Graft ◽  
Calcium Score ◽  
Agatston Score ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

Abstract Coronary artery calcium score (CAC) measures the calcium contained in the artery wall and it is evaluated using multi-slice cardiac CT and CAC represents a useful tool for appreciating the burden of coronary atherosclerosis and for determining the risk for cardiovascular events. The purpose of this study is that CAC can be use for guiding treatment strategy in patients classified as high risk based on Framingham score . We prospectively enrolled 64 pts (79% male), 62,7+/-5 year, between 2002-2017. All included patients were considered high risk based on EuroSCORE model. A multislice heart CT scan was performed for every patient with CAC score determination quantified with the Agatston score and expressed as Agatston Units (AU). The patients were divided in 3 groups according to the treatment that they received during the 5 years follow up: optimal medical treatment for coronary artery disease (OMT) – 35.9% (23), percutaneous coronary angioplasty (PCA) – 29.7% (19) and coronary artery bypass graft (CABG) – 34.4%. The CAC score for pts treated by OMT vs CABG +/_ PCA were compared using the ROC curves. CAC score was statistically significantly superior in CABG+ PCA patients versus OMT (AUC: 0.96, p < 0.001 vs AUC 0.42, p = 0.212). Also, a comparison of CAC score score for CABG vs OMT revealed the same results (AUC: 0.96, p< 0.001 vs AUC: 0.42, p = 0.264). OMT vs CABG + PCA presented a cut-off value of 382 AU with a specificity of 90% and a sensitivity of 95%. OMT vs CABG presented a cut-off value of 530 AU with a specificity of 89% and a sensitivity of 95%. In conclusion, CAC score has a good predictability and sensitivity in determining the outcome and can be a promising tool to guide therapy in high risk patients, mainly regarding medical vs surgical treatment for coronary artery disease.

scholarly journals Drug therapy of patients with myocardial infarction as the most important component of a polyclinic stage of cardiorehabilitation

2015 ◽  
Vol 6 (3) ◽  
pp. 22-26
Author(s):  
A. A Garganeeva ◽  
E. A Kuzheleva ◽  
E. V Efimova ◽  
O. V Tukish
Keyword(s):  
Myocardial Infarction ◽  
Drug Therapy ◽  
Clinical Course ◽  
Adult Population ◽  
Developed Countries ◽  
Common Causes ◽  
Acute Mi ◽  
Long Term Prognosis

Myocardial infarction (MI) is one of the most common causes of temporary incapacity, disability and mortality in the adult population of developed countries. Despite a trend in recent years to reduce mortality from cardiovascular disease, the indicator remains high in Russia. One of the main conditions to improve immediate and long-term prognosis of patients after MI, is to conduct a comprehensive cardio-rehabilitation, which is an important component of drug therapy. The article presents the characteristics of drug therapy and its influence on the course of post-MI at 5-year follow-up on the basis of "Register of acute MI". As a result of the frequency, VEN-analysis revealed no significant differences in the main groups of drugs prescribed in different periods after acute MI. At the same time it found that patients with unfavorable course of postinfarction period, significantly more often treated with inadequate doses of b-blockers, who were appointed at hospital discharge and then titrated with the annual and 5-year follow-up. The lower frequency of the appointment of vital medicines (based on VEN-analysis) was detected in patients with unfavorable course of postinfarction period as the baseline, and after a year, and 5 years after MI. Installed features of drug use have an impact on the clinical course of postinfarction period and the development of negative cardiovascular events.

scholarly journals Myocardial SPECT Perfusion Defects in Angina Patients, Without Significant Epicardial Coronary Artery Disease. Can Pathological SPECT Affect Long-Term Prognosis?

2021 ◽  
Author(s):  
EVANGELOS LAMPAS ◽  
Kiriaki Syrmali ◽  
Georgios Nikitas ◽  
Emmanouil C. Papadakis ◽  
Sotirios P. Patsilinakos
Keyword(s):  
Mortality Rate ◽  
Nyha Class ◽  
Clinical Problem ◽  
Cardiovascular Prognosis ◽  
Reversible Ischemia ◽  
The Mean ◽  
Artery Disease ◽  
Long Term Prognosis

Abstract Purpose: Patients with angina and a positive SPECT for reversible ischemia, with no or non-obstructive CAD on ICA represent a frequent clinical problem and predicting prognosis is challenging. Methods: A retrospective single center study focused on patients that underwent elective-ICA with angina and a positive SECT with no or non-obstructive CAD in the CathLab, during a seven-year period. Assessment of patients’ cardiovascular morbidity, mortality, and MACE during a follow-up period of at least three years after ICA, with the assist of a telephone questionnaire.Results: Data of all patients that underwent ICA for a period of 7 years (from January 1,2011 until December 31, 2017) in our hospital were analyzed. The patients that fulfilled the prespecified criteria were 569. At the telephone survey, 285(50.1%) were successfully contacted and agreed to participate. The mean age was 67.6 (SD8.8) years (35.4%female) and the mean follow-up time was 5.53years (SD1.85). Mortality rate was 1.7% (4 patients/non-cardiac causes) and 1,7% rate of revascularization. 31(10,9%) were hospitalized for cardiac reasons and 10,9% patients reported symptoms of HF (no patients with NYHA-Class above II). 21 had arrhythmic events and only two mild anginal symptoms. Noteworthy finding was, the mortality rate in the not-contacted group (12 out of 284, 4,2%), derived by public security records, did not differ significantly from the contacted-group. Conclusions: Patients with angina, a positive SPECT for reversible ischemia and no or non-obstructive CAD in ICA have very good long-term cardiovascular prognosis for at least 5 years.

scholarly journals Predictive Value of Circulatingve-catherin in Coronary Artery Disease Patients with Symptomatic Moderate to Severe Chronic Heart Failure

2015 ◽  
Vol 16 (2) ◽  
pp. 73-78
Author(s):  
Alexander E Berezin ◽  
Alexander A Kremzer ◽  
Tatayna A Samura
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Survival Function ◽  
Cumulative Survival ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Recurrent Hospitalization ◽  
Circulating Levels

Aim: To evaluate the prognostic value of circulating VE-catherinfor cumulative survivalin patients with ischemic chronic heart failure (CHF).Methods: A total of 154 patients withischemic symptomatic moderate-to-severe CHF were enrolled in the study on discharge from the hospital. Observation period was up to 3 years. Blood samples for biomarkers measurements were collected. ELISA method for measurements of circulating level of VE-catherin was used. Concentrations of VEcatherinfor cumulative survival cases due to advanced CHF were tested. Additionally, all-cause mortality, and CHFrelated death were examined.Results: During a median follow-up of 2.18 years, 21 participants died and 106 subjects were hospitalized repetitively. Medians of circulating levels of VE-catherin in survived and died patient cohort were 0.63 ng/ml (95% confidence interval [CI] = 0.55-0.64 ng/ml) and 1.03 ng/ml (95% CI = 0.97-1.07 ng/ml) (P<0.001). ROC analysis has been shown that cutoff point of VE-catherin concentration for cumulative survival function was 0.755ng/ml. It has beenfound a significantly divergence of Kaplan-Meier survival curves in patients with high (>0.755 ng/ml) and low (<0.755 ng/ml) concentrations of VE-catherin. Circulating VE-catherin independently predicted all-cause mortality (OR = 1.27; 95% CI = 1.08–1.59; P = 0.002), CHF-related death (OR = 1.16; 95% CI 1.02–1.50; P < 0.001), and also CHF-related rehospitalisation (OR = 1.12; 95% CI = 1.07 – 1.25; P<0.001) within 3 years of observation period.Conclusion: Increased circulating VE-catherinassociates with increased 3-year CHF-related death, all-cause mortality, and risk for recurrent hospitalization due to CHF.J MEDICINE July 2015; 16 (2) : 73-78

scholarly journals Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

2021 ◽  
Author(s):  
Bo Wang ◽  
Jin Liu ◽  
Shiqun Chen ◽  
Ming Ying ◽  
Guanzhong Chen ◽  
...  
Keyword(s):  
Cox Regression ◽  
Cox Model ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
Artery Disease

Abstract Background: Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.Method: A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C < 1.8 mmol/L, n=4,863; LDL-C ≥ 1.8 mmol/L, n = 36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result: In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05-7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (<1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).Conclusion: Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

scholarly journals P1787 Pharmacologic stress test: still an important prognostic factor? a follow-up study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Ferreira ◽  
L Moura Branco ◽  
A Galrinho ◽  
P Rio ◽  
S Aguiar Rosa ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Stress Test ◽  
Bypass Graft ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Introduction Dobutamine stress echocardiography (DSE) is an established exam for evaluation of extent and severity of coronary artery disease. Purpose To analyse the results and complications of DSE and identify prognostic predictors in patients (P) who underwent DSE for myocardial ischemia detection. Methods 220P who underwent consecutive DSE from 2013 to 2017. P with significant valvular disease were excluded. Clinical data, echocardiographic parameters and data from follow up (FU) regarding all-cause mortality and MACEs were analysed. Mean age 64.8 ± 12.0 years(Y), 143 men (65%). Results 88P (40%) had positive, 102 had negative and 30 had inconclusive DSE; complications rate of 15%. Prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, prior MI, percutaneous coronary interventionc (PCI), coronary arterial bypass graft (CABG) and HF was 82.7%, 42.3%, 67.7%, 35.9%, 31.8%, 10.9% and 9.5%, respectively. Mean left ventricular endsystolic (LVSD) and enddiastolic dimensions were 33.7 ± 8.9 and 52.8 ± 7.1 mm. Mean resting wall motion score index (rWMSI) and peak (pWMSI) were 1.16 ± 0.28 and 1.24 ± 0.34. Mean resting GLS (rGLS) and peak GLS (pGLS) were -16.3 ± 4.3 and -16.6 ± 4.3. Mean no. of ischemic segments was 1.7 ± 2.4 and 16.8% had ischemia &gt;3 segments. There was ischemia in left anterior descending (LAD) coronary in 53P and in circumflex and right coronary territories in 18 and 68P. 22.6% had more than one ischemic territory. 43P (49.4%) underwent intervention, 38 with PCI and 5 with CABG. During a mean FU of 38.8 ± 16.8 months, 47 MACEs were observed, including 32 deaths (14.5%). Positive DSE (p = 0.012), no. of ischemic segments (p = 0.019), ischemia in the LAD (p = 0.003), rGLS (p = 0.038) and pGLS (p = 0.038) were related to the occurrence of MACEs. In Cox regression analysis, age (p = 0.005), DM (p = 0.005), HF (p = 0.006), prior CABG (p = 0.015), LVSD (p = 0.026), rWMSI (p = 0.029), pWMSI (p = 0.013) and pGLS (p = 0.038) were associated with increased all-cause mortality. Kaplan–Meier survival analysis showed that survival was significantly worse for ischemia &gt; 3 segments (log rank 0.005), ischemia of more than one territory (log rank 0.025) and pWMSI &gt;1.5 (log rank &lt; 0.0005). With multivariate Cox regression analysis, age &gt;65Y (HR 4.22, p = 0.004), DM (HR 2.49,p = 0.038) and pWMSI &gt; 1.5 (HR 9.73,p = 0.007) were independently associated with all-cause mortality. Conclusion In patients who underwent DSE there were some baseline and DSE-related independent predictors of long-term prognosis: age, DM and peak WMSI. Abstract P1787 Figure. Kaplan–Meier curves

scholarly journals Association of ADAMTS7 gene polymorphism with cardiovascular survival in coronary artery disease

2016 ◽  
Vol 48 (11) ◽  
pp. 810-815 ◽  
Author(s):  
A. Pereira ◽  
R. Palma dos Reis ◽  
R. Rodrigues ◽  
A. C. Sousa ◽  
S. Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cox Regression ◽  
Wild Type ◽  
Therapeutic Goals ◽  
Atherosclerosis Progression ◽  
Functional Studies ◽  
Kaplan Meier ◽  
Artery Disease

Recent genetic studies have revealed an association between polymorphisms at the ADAMTS7 gene locus and coronary artery disease (CAD) risk. Functional studies have shown that a CAD-associated polymorphism (rs3825807) affects ADAMTS7 maturation and vascular smooth muscular cell (VSMC) migration. Here, we tested whether ADAMTS7 (A/G) SNP is associated with cardiovascular (CV) survival in patients with established CAD. A cohort of 1,128 patients with angiographic proven CAD, who were followed up prospectively for a mean follow-up period of 63 (range 6–182) mo, were genotyped for rs3825807 A/G. Survival statistics (Cox regression) compared heterozygous (AG) and wild-type (AA) with the reference homozygous GG. Kaplan-Meier (K-M) survival curves were performed according to ADAMTS7 genotypes for CV mortality. Results showed that 47.3% of patients were heterozygous (AG), 36.5% were homozygous for the wild-type allele (AA) and only 16.2% were homozygous for the GG genotype. During the follow-up period, 109 (9.7%) patients died, 77 (6.8%) of CV causes. Survival analysis showed that AA genotype was an independent risk factor for CV mortality compared with reference genotype GG (HR = 2.7, P = 0.025). At the end of follow-up, the estimated survival probability (K-M) was 89.8% for GG genotype, 82.2% for AG and 72.3% for AA genotype ( P = 0.039). Carriage of the mutant G allele of the ADAMTS7 gene was associated with improved CV survival in patients with documented CAD. The native overfunctional ADAMTS7 allele (A) may accelerate VSMC migration and lead to neointimal thickening, atherosclerosis progression and acute plaque events. ADAMTS7 gene should be further explored in CAD for risk prediction, mechanistic and therapeutic goals.

scholarly journals POS1348 MORTALITY AND ITS RELATED FACTORS IN PATIENTS WITH IGG4-RELATED DISEASE: A JAPANESE SINGLE-CENTER STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 956-957
Author(s):  
I. Mizushima ◽  
H. Kawahara ◽  
T. Yoshinobu ◽  
S. Shin ◽  
R. Hoshiba ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cox Regression ◽  
Clinical Course ◽  
Regression Analyses ◽  
Related Factors ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Crude Mortality Rate ◽  
Crude Mortality

Background:In recent years, IgG4-related disease (IgG4-RD) has become a widely recognized disorder. However, mortality and its related factors in this disease are not well known.Objectives:This study aimed to clarify mortality and its related factors in patients with IgG4-RD.Methods:We retrospectively reviewed the medical records of patients with IgG4-RD diagnosed by experts based on fulfillment of the Japanese comprehensive diagnostic criteria and/or the 2019 ACR/EULAR classification criteria for IgG4-RD at a single center in Japan. Using the collected data, we calculated the crude mortality rate and the standardized mortality ratio (SMR) using national Japan mortality statistics and investigated the cause of death. We performed Cox regression analyses to assess mortality-related factors.Results:A total of 179 patients with IgG4-RD were included: 124 were male (69.3%); the median age was 68 years (interquartile range [IQR] 60-75 years); and the median follow-up from diagnosis was 47 months (IQR 17-84). Ten patients (5.6%) in our cohort died during the follow-up period. Five died of malignancy, one of respiratory failure, two of infectious pneumonia, one of sudden cardiac event, and one of suspected aortic aneurysmal rupture. The crude mortality rate was 11.1 per 1,000 person-years. According to national Japan mortality statistics, 11.6 age- and sex-matched deaths were expected to occur within the follow-up period, resulting in a SMR of 0.86 (95% confidence interval [CI] 0.41-1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio [HR] 1.45, 95% CI 1.02-2.05), serum creatinine levels at diagnosis (HR 1.82, 95% CI 1.06-3.12), and the presence of malignancy during the clinical course (HR 3.93, 95% CI 1.10-14.02) had a significant impact on the time to death, whereas the other factors including age at diagnosis and serum C-reactive protein and IgG4 levels at diagnosis did not.Conclusion:Our findings suggest that the mortality rate of patients with IgG4-RD does not significantly differ from that of the Japanese general population. Multi-organ involvement and renal dysfunction at diagnosis as well as malignancy during the clinical course may be associated with higher mortality. An appropriate clinical evaluation for the early detection of these risk factors is required at first diagnosis and during long-term follow-up.Disclosure of Interests:None declared

scholarly journals Impact of Low Ankle-Brachial Index on the Risk of Recurrent Vascular Events

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 853-858 ◽  
Author(s):  
Halim Abboud ◽  
Linsay Monteiro Tavares ◽  
Julien Labreuche ◽  
Antonio Arauz ◽  
Alan Bryer ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Ankle Brachial Index ◽  
Peripheral Artery ◽  
Vascular Events ◽  
Middle Income ◽  
Middle Income Countries ◽  
Kaplan Meier ◽  
Artery Disease ◽  
Ischemic Attack

Background and Purpose— Low ankle-brachial index (ABI) identifies a stroke subgroup with high risk of recurrent stroke, cardiovascular events, and death. However, limited data exist on the relationship between low ABI and stroke in low and middle-income countries. Therefore, we evaluated the prevalence of ABI ≤0.90 (which is diagnostic of peripheral artery disease) in nonembolic stroke patients or transient ischemic attack and assessed the correlation of low ABI with stroke risk, factors, and recurrent vascular events and death. Methods— Patients ≥45 years with acute transient ischemic attack or minor ischemic strokes were recruited consecutively from over 17 low-income and middle-income countries (Latin America [1543 patients], Middle East [1041 patients], North Africa [834 patients], and South Africa [217 patients]). The ABI measurement was performed at a single visit. Stroke recurrence and risk of new vascular events were assessed after 24 months of follow-up. Results— Among 3487 enrolled patients, abnormal ABI (<0.9) was present in 22.3 %. Patients with an ABI of ≤0.9 were more likely ( P <0.05) to be male, older, and have a history of peripheral artery disease, hypertension, and diabetes mellitus. During 2-year follow-up, the rate of major cardiovascular event was higher in patients with ABI <0.9 than those with ABI ≥0.9 (Kaplan-Meier estimates, 22.5%; 95% CI, 19.6–25.8 versus 13.7%; 21.4–15.1; P <0.001), and when ABI was categorized into 4 groups (≤0.6; 95% CI, 0.6–0.9; 0.9–1; 1–1.4), the rate of major cardiovascular event was higher in those with ABI ≤0.6 than the other groups (Kaplan-Meier estimates, 32.6%; 95% CI, 21.0–48.3 for ABI≤0.6 versus 21.7%; 95% CI, 18.8–25.0 for ABI 0.6–0.9 versus 14.3%; 95% CI, 12.4–16.6 for ABI 0.9–1 versus 13.3%; 95% CI, 11.6–15.2 for ABI 1–1.4; P <0.001). Conclusions— Among patients with nonembolic ischemic stroke or transient ischemic attack, those with low ABI had a higher rate of vascular events and death in this population. Screening for ABI in stroke patients may help identify patients at high risk of future events.

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