The American journal of cardiology
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Multicenter Study
Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes.
Although chronic obstructive pulmonary disease (COPD) is common in patients with myocardial infarction (MI), its association with long-term mortality after MI is controversial and little is known about its influence on patients' health status (symptoms, function, and quality of life). We prospectively enrolled 2,481 patients presenting with MI at 19 United States centers to examine the relations between COPD and patients' long-term mortality, rehospitalization rates, and health status after MI. Patients were administered the disease-specific Seattle Angina Questionnaire and the generic Short Form 12 at baseline and 1 year later. ⋯ In addition, COPD was associated with a trend toward a greater prevalence of angina at 1 year (risk ratio 1.12, 95% CI 0.89 to 1.41). In conclusion, patients with COPD have greater mortality, higher rehospitalization rates, and poorer health status 1 year after a MI. Although additional research is needed, clinicians should recognize that patients with COPD are at high risk for poor outcomes after MI.
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Multicenter Study
Possible gender-related differences in the risk-to-benefit ratio of thrombolysis for acute submassive pulmonary embolism.
The indications for thrombolytic treatment in normotensive patients with pulmonary embolism (PE) are still the subject of debate, and it also remains questionable whether the efficacy and safety of thrombolysis are similar in men and women. To address the latter issue, the present study analyzed a large population of 428 women and 291 men with acute submassive PE derived from a prospective multicenter registry. Initial treatment consisted either of thrombolysis (<24 hours after diagnosis) or heparin alone. ⋯ Gender-specific differences were also observed with regard to the reduction of symptomatic PE recurrence (in men, from 21.6% to 8.2%, p = 0.009; in women, from 16.9% to 8.3%, p = 0.049). In contrast, thrombolysis resulted in a more than threefold increase in major bleeding in women (from 8.4% to 27.1%, p <0.001), a more pronounced effect than in men (from 6.9% to 15.1%, p = 0.055). In conclusion, the present study generated the hypothesis that women with submassive PE might benefit less from thrombolytic treatment in terms of survival and PE recurrence and that they could be exposed to a higher bleeding risk compared with men.
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Randomized Controlled Trial Multicenter Study
ST-segment recovery and prognosis in patients with ST-elevation myocardial infarction reperfused by prehospital combination fibrinolysis, prehospital initiated facilitated percutaneous coronary intervention, or primary percutaneous coronary intervention.
Complete ST-segment recovery (STR) is associated with favorable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients presenting soon after symptom onset is still a matter of debate. STR for patients treated by prehospital combination fibrinolysis or prehospital initiated facilitated percutaneous coronary intervention (PCI) compared with primary PCI has not been assessed. ⋯ Complete STR resulted in lower event rates for the combined clinical end point of death, myocardial reinfarction, and stroke compared with intermediate and no STR in groups A (complete 9.8%, intermediate 23.8%, no STR 36.8%, p = 0.04), B (7.7%, 18.2%, and 50.0%, p = 0.01), and C (8.6%, 18.4%, and 42.9%, p <0.001). In conclusion, prehospital initiated facilitated PCI results in the highest percentage of complete STR compared with prehospital combination fibrinolysis or primary PCI. In addition, STR has been confirmed to predict prognosis in timely optimized reperfusion strategies.
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Multicenter Study
Usefulness of clinical evaluation, troponins, and C-reactive protein in predicting mortality among stable hemodialysis patients.
This study prospectively examined the hypothesis that dividing stable dialysis patients into different clinical subsets by presence or absence of coronary disease equivalent will lead to clearer risk stratification by abnormal troponins and highly sensitive C-reactive protein (hs-CRP). Patients with end-stage renal disease have an annual mortality of 18%. Previous studies have shown that elevated cardiac troponins T and I and hs-CRP predict increased mortality, although these studies have not taken clinical parameters into account. ⋯ Conversely, in patients without coronary disease equivalent, neither troponin further predicted the risk for death. In the small subset of patients without coronary disease equivalent who had hs-CRP >or=3 mg/L, mortality was significantly increased (p = 0.01). In conclusion, initial clinical assessment, followed by the addition of biomarkers, can be used to risk-stratify stable patients with end-stage renal disease.
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Multicenter Study
Periannular complications in infective endocarditis involving prosthetic aortic valves.
The periannular extension of infection in prosthetic valve endocarditis (PVE) is a serious complication of infective endocarditis associated with high mortality. Periannular lesions in PVE occasionally rupture into adjacent cardiac chambers, leading to aortocavitary fistulae and intracardiac shunting. It is unknown whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. ⋯ The actuarial 5-year survival rate in surgical survivors was 100% in patients with fistulae and 78% in patients with nonruptured abscesses (log-rank p = 0.14). In conclusion, aortocavitary fistulous tract formation in PVE complicated with periannular complications is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Despite the frequent complications, fistulous tract formation in the current era of infective endocarditis is not an independent risk factor for mortality.