Infant survival in Haiti after maternal death from peripartum cardiomyopathy.
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Cardiomyopathies↗
Biomedical subjects
J G Murphy
Publications and source records attributed to J G Murphy.
Kinetics of NO and NO2 evolution from illuminated frozen nitrate solutions.
The release of NO and NO2 from frozen aqueous NaNO3 irradiated at 313 nm was studied using time-resolved spectroscopic techniques. The kinetic behavior of NO and NO2 signals during on-and-off illumination cycles confirms that NO2 is a primary photoproduct evolving from the outermost ice layers and reveals that NO is a secondary species generated deeper in the ice, whence it eventually emerges due to its inertness and larger diffusivity. NO is shown to be more weakly held than NO2 by ice in thermal desorption experiments on preirradiated samples. The partial control of gaseous emissions by mass transfer, and hence by the morphology and metamorphisms of polycrystalline ice, is established by (1) the nonmonotonic temperature dependence of NO and NO2 signals upon stepwise warming under continuous illumination, (2) the fact that the NO, NO2 or NOx (NOx identical with NO + NO2) amounts released in bright thermograms performed under various heating ramps fail to scale with photon dose, due to irreversible losses in the adsorbed state. Because present NO/NO2 ratios are up to 10-fold smaller than those determined over sunlit snowpacks, we infer that the immediate precursors to NO mostly absorb at lambda > lambda(max) (NO3-) approximately 302 nm.
Journal Article↗
A new simplified immediate prognostic risk score for patients with acute myocardial infarction.
BACKGROUND: Immediate risk stratification of patients with myocardial infarction in the emergency department (ED) at the time of initial presentation is important for their optimal emergency treatment. Current risk scores for predicting mortality following acute myocardial infarction (AMI) are potentially flawed, having been derived from clinical trials with highly selective patient enrollment and requiring data not readily available in the ED. These scores may not accurately represent the spectrum of patients in clinical practice and may lead to inappropriate decision making. METHODS: This study cohort included 1212 consecutive patients with AMI who were admitted to the Mayo Clinic coronary care unit between 1988 and 2000. A risk score model was developed for predicting 30 day mortality using parameters available at initial hospital presentation in the ED. The model was developed on patients from the first era (training set--before 1997) and validated on patients in the second era (validation set-during or after 1997). RESULTS: The risk score included age, sex, systolic blood pressure, admission serum creatinine, extent of ST segment depression, QRS duration, Killip class, and infarct location. The predictive ability of the model in the validation set was strong (c = 0.78). CONCLUSION: The Mayo risk score for 30 day mortality showed excellent predictive capacity in a population based cohort of patients with a wide range of risk profiles. The present results suggest that even amidst changing patient profiles, treatment, and disease definitions, the Mayo model is useful for 30 day risk assessment following AMI.
Aged↗
Photochemical production and release of gaseous NO2 from nitrate-doped water ice.
Temperature-programmed NO2 emissions from frozen aqueous NaNO3 solutions irradiated at 313 nm were monitored as function of nitrate concentration and heating rate, H, above -30 degrees C. Emissions increase nonmonotonically with temperature, displaying transitions suggestive of underlying metamorphic transformations. Thus, NO2 emissions surge at ca. -8 degrees C in frozen [NO3-] > 200 microM samples warmed at H = 0.70 degrees C min(-1) under continuous irradiation, and also in the dark from samples that had been photolyzed at -30 degrees C. The amounts of NO2 released in individual thermograms, SigmaN, increase less than linearly with [NO3-] or the duration of experiments, revealing the significant loss of photogenerated NO2. The actual SigmaN proportional, variant [NO3-]1/2 dependence (at constant H) is consistent with NO2 hydrolysis: 2NO2 + H2O --> NO3- + NO2- + 2H+, overtaking NO2 desorption, even below the eutectic point (-18 degrees C for aqueous NaNO3). The increasingly larger NO2 losses detected in longer experiments (at constant [NO3-]) are ascribed to secondary photolysis of trapped NO2. The relevance of present results to the interpretation of polar NO2 measurements is briefly analyzed.
Journal Article↗
Unrecognized peripartum cardiomyopathy in Haitian women.
OBJECTIVE: Haitian women have a high relative incidence of clinical presentation with peripartum cardiomyopathy (PPCM): an incidence estimated at one case per three hundred live births, a ten-fold occurrence compared to American women. Our objective has been to test the hypothesis that some Haitian women may have a forme fruste of PPCM while still without clinical symptoms. METHOD: A preliminary case-control study was conducted at the Hospital Albert Schweitzer (HAS), Deschapelles, Haiti, in which 25 apparently healthy postpartum women, without cardiovascular symptoms and with a normal cardiovascular clinical examination, were selected from a consecutive list of obstetrical deliveries and screened by echocardiography for left ventricular dysfunction. RESULT: Four out of 25 patients (16%) had asymptomatic left ventricular dysfunction that subsequently evolved towards either improvement or deterioration. Supporting evidence for the existence of asymptomatic left ventricular dysfunction or forme fruste PPCM is presented. A hypothetical schema of the pathophysiology of PPCM explains how a latent phase of variable duration may exist prior to onset of detectable clinical heart failure. CONCLUSION: Screening Haitian women during the last month of pregnancy or in the early postpartum period may help to detect asymptomatic left ventricular dysfunction. Early detection and treatment of PPCM in a known high risk population could lead to improvements in maternal and fetal mortality and morbidity.
Adult↗
Strong predictive value of TIMI risk score analysis for in-hospital and long-term survival of patients with right ventricular infarction.
BACKGROUND: While right ventricular myocardial infarction is associated with increased in-hospital morbidity and mortality, prognostic risk factors for in-hospital and long-term mortality are poorly defined. OBJECTIVES: To evaluate the prognostic value of TIMI (Thrombolysis in Myocardial Infarction) risk score analysis in patients with right ventricular myocardial infarction (RVI). DESIGN: Retrospective analysis of a community population. SETTING: Mayo Clinic Coronary Care Unit. PATIENTS: One hundred and two patients with RVI from 580 consecutive patients from Rochester, Minnesota admitted to the Coronary Care Unit with acute inferior or lateral wall myocardial infarction from January 1988 through March 1998. MEASUREMENT: Combined TIMI risk score analysis with in-hospital and long-term mortality. RESULTS: In-hospital morbidity (RVI: 54.9% vs non-RVI: 22.2%; P<0.001) and mortality (RVI: 21.6% vs non-RVI: 6.9%;P <0.001) were increased in patients with RVI. The TIMI risk score predicted risk (per one point increase in TIMI score) for in-hospital mortality (OR 1.23, 95% CI 1.02-1.51, P=0.037) and long-term mortality (OR 1.57, 95% CI 1.25-1.96, P<0.001). Patients with RVI whose TIMI risk score was >or=4 had significantly worse long-term survival compared to those patients with RVI and TIMI score <4 (P=0.006). CONCLUSIONS: In-hospital morbidity and mortality, and long-term mortality are increased by right ventricular infarction and can be accurately predicted by the initial TIMI risk score.
Aged↗
Effect of concomitant or very early statin administration on in-hospital mortality and reinfarction in patients with acute myocardial infarction.
In a retrospective analysis, 66 patients identified as having received a statin drug within 24 hours of admission for acute myocardial infarction were matched 3:1 with a control group of 198 patients not treated with a statin agent. End points of in-hospital mortality and in-hospital reinfarction were significantly lower in the statin-treated group, pointing to a benefit from very early statin treatment in acute myocardial infarction.
Aged↗
Obesity is associated with premature occurrence of acute myocardial infarction.
BACKGROUND: The American Heart Association has classified obesity as a major modifiable risk factor for coronary artery disease, but its relationship with age at presentation with acute myocardial infarction (AMI) is poorly documented. HYPOTHESIS: The study was undertaken to evaluate the impact of obesity on age at presentation, and on in-hospital morbidity and mortality in patients with AMI. METHODS: Our analysis includes a consecutive series of 906 Olmsted County patients (mean age 67.7 years, 51% male) admitted with AMI to the Mayo Clinic Coronary Care Unit (CCU). The patients were entered into the Mayo CCU Database, a prospective registry of data pertaining to patients admitted to the Mayo Clinic CCU with AMI. Age at AMI occurrence and in-hospital morbidity and mortality were noted. RESULTS: Obese patients (body mass index [BMI] >30) with AMI were significantly younger than patients with AMI in the overweight (BMI 25-30) and normal-weight (BMI < 30) groups (62.3+/-13.1 vs. 66.9+/-13.2 and 72.9+/-13.4, respectively. p < 0.001). Obesity and overweight status were associated with male gender, diabetes mellitus, hypercholesterolemia, and smoking history; however, after multivariate adjustment for these risk factors, excess weight and premature AMI remained significantly associated. Compared with normal-weight patients, overweight patients presenting with AMI were 3.6 years younger (p < 0.001, confidence interval [CI] 1.9-5.4) and obese patients 8.2 years younger (p < 0.001, Cl 6.2-10.1). No significant increase in in-hospital morbidity and mortality was seen. CONCLUSION: In this population-based study, overweight and obese status are independently associated with the premature occurrence of AMI, but not with an increased incidence of in-hospital complications.
Age of Onset↗
Relative efficacy of a brief motivational intervention for college student drinkers.
The authors evaluated the efficacy of Brief Alcohol Screening and Intervention for College Students (BASICS - L. A. Dimeff, J. S. Baer, D. R. Kivlahan, & G. A. Marlatt, 1999), a single session of drinking-related feedback intended to reduce heavy drinking and related harm. College student drinkers (N = 99) were assigned to BASICS, an educational intervention, or an assessment-only control group. At 3 months postintervention. there were no overall significant group differences, but heavier drinking BASICS participants showed greater reductions in weekly alcohol consumption and binge drinking than did heavier drinking control and education participants. At 9 months, heavier drinking BASICS participants again showed the largest effect sizes. BASICS participants evaluated the intervention more favorably than did education participants. This study suggests that BASICS may be more efficacious than educational interventions for heavier drinking college students.
Adult↗
A monk's prayer: O Lord what is the answer to in-stent restenosis? Commentary on the TRAPIST Study.
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Angioplasty, Balloon, Coronary↗
[Ca(2+)](i) signaling in renal arterial smooth muscle cells of pregnant rat is enhanced during inhibition of NOS.
Vascular resistance and arterial pressure are reduced during normal pregnancy, but dangerously elevated during pregnancy-induced hypertension (PIH), and changes in nitric oxide (NO) synthesis have been hypothesized as one potential cause. In support of this hypothesis, chronic inhibition of NO synthesis in pregnant rats has been shown to cause significant increases in renal vascular resistance and hypertension; however, the cellular mechanisms involved are unclear. We tested the hypothesis that the pregnancy-associated changes in renal vascular resistance reflect changes in contractility and intracellular Ca(2+) concentration ([Ca(2+)](i)) of renal arterial smooth muscle. Smooth muscle cells were isolated from renal interlobular arteries of virgin and pregnant Sprague-Dawley rats untreated or treated with the NO synthase inhibitor nitro-L-arginine methyl ester (L-NAME; 4 mg. kg(-1). day(-1) for 5 days), then loaded with fura 2. In cells of virgin rats incubated in Hanks' solution (1 mM Ca(2+)), the basal [Ca(2+)](i) was 86 +/- 6 nM. Phenylephrine (Phe, 10(-5) M) caused a transient increase in [Ca(2+)](i) to 417 +/- 11 nM and maintained an increase to 183 +/- 8 nM and 32 +/- 3% cell contraction. Membrane depolarization by 51 mM KCl, which stimulates Ca(2+) entry from the extracellular space, caused maintained increase in [Ca(2+)](i) to 292 +/- 12 nM and 31 +/- 2% contraction. The maintained Phe- and KCl-induced [Ca(2+)](i) and contractions were reduced in pregnant rats but significantly enhanced in pregnant rats treated with L-NAME. Phe- and KCl-induced contraction and [Ca(2+)](i) were not significantly different between untreated and L-NAME-treated virgin rats or between untreated and L-NAME + L-arginine treated pregnant rats. In Ca(2+)-free Hanks', application of Phe or caffeine (10 mM), to stimulate Ca(2+) release from the intracellular stores, caused a transient increase in [Ca(2+)](i) and a small cell contraction that were not significantly different among the different groups. Thus renal interlobular smooth muscle of normal pregnant rats exhibits reduction in [Ca(2+)](i) signaling that involves Ca(2+) entry from the extracellular space but not Ca(2+) release from the intracellular stores. The reduced renal smooth muscle cell contraction and [Ca(2+)](i) in pregnant rats may explain the decreased renal vascular resistance associated with normal pregnancy, whereas the enhanced cell contraction and [Ca(2+)](i) during inhibition of NO synthesis in pregnant rats may, in part, explain the increased renal vascular resistance associated with PIH.
Animals↗
Gender-specific reduction in contractility and [Ca(2+)](i) in vascular smooth muscle cells of female rat.
The hypothesis that vascular protection in females and its absence in males reflects gender differences in [Ca(2+)](i) and Ca(2+) mobilization mechanisms of vascular smooth muscle contraction was tested in fura 2-loaded aortic smooth muscle cells isolated from intact and gonadectomized male and female Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. In WKY cells incubated in Hanks' solution (1 mM Ca(2+)), the resting length and [Ca(2+)](i) were significantly different in intact males (64.5 +/- 1.2 microm and 83 +/- 3 nM) than in intact females (76.5 +/- 1.5 microm and 64 +/- 7 nM). In intact male WKY, phenylephrine (Phe, 10(-5) M) caused transient increase in [Ca(2+)](i) to 428 +/- 13 nM followed by maintained increase to 201 +/- 8 nM and 32% cell contraction. In intact female WKY, the Phe-induced [Ca(2+)](i) transient was not significantly different, but the maintained [Ca(2+)](i) (159 +/- 7 nM) and cell contraction (26%) were significantly less than in intact male WKY. In Ca(2+)-free (2 mM EGTA) Hanks', Phe and caffeine (10 mM) caused transient increases in [Ca(2+)](i) and contraction that were not significantly different between males and females. Membrane depolarization by 51 mM KCl caused 31% cell contraction and increased [Ca(2+)](i) to 259 +/- 9 nM in intact male WKY, which were significantly greater than a 24% contraction and 214 +/- 8 nM [Ca(2+)](i) in intact female WKY. Maintained Phe- and KCl-stimulated cell contraction and [Ca(2+)](i) were significantly greater in SHR than WKY in all groups of rats. Reduction in cell contraction and [Ca(2+)](i) in intact females compared with intact males was significantly greater in SHR ( approximately 30%) than WKY ( approximately 20%). No significant differences in cell contraction or [Ca(2+)](i) were observed between castrated males, ovariectomized (OVX) females, and intact males, or between OVX females with 17beta-estradiol implants and intact females. Exogenous application of 17beta-estradiol (10(-8) M) to cells from OVX females caused greater reduction in Phe- and KCl-induced contraction and [Ca(2+)](i) in SHR than WKY. Thus the basal, maintained Phe- and depolarization-induced [Ca(2+)](i) and contraction of vascular smooth muscle triggered by Ca(2+) entry from the extracellular space exhibit differences depending on gender and the presence or absence of female gonads. Cell contraction and [Ca(2+)](i) due to Ca(2+) release from the intracellular stores are not affected by gender or gonadectomy. Gender-specific reduction in contractility and [Ca(2+)](i) in vascular smooth muscle of female rats is greater in SHR than WKY rats.
Animals↗
Gender differences in Ca(2+) entry mechanisms of vasoconstriction in Wistar-Kyoto and spontaneously hypertensive rats.
We investigated whether putative vascular protection against hypertension in females reflects differences in the Ca(2+) mobilization mechanisms of vasoconstriction depending on the gender and the status of the gonads. Active stress and (45)Ca(2+) influx were measured in aortic strips isolated from intact and gonadectomized male and female Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). In aortic strips of intact male WKY incubated in normal Krebs' solution (2.5 mmol/L Ca(2+)), both phenylephrine (10(-5) mol/L) and membrane depolarization by 96 mmol/L KCl caused significant increases in active stress and (45)Ca(2+) influx. In intact female WKY, the phenylephrine- and KCl-induced stress and (45)Ca(2+) influx were significantly reduced. In Ca(2+)-free (2 mmol/L EGTA) Krebs' solution, stimulation of aortic strips with phenylephrine or caffeine (25 mmol/L) to induce Ca(2+) release from intracellular stores caused a transient increase in stress that was not significantly different between males and females. In SHR, the phenylephrine- and KCl-induced stress and (45)Ca(2+) influx were significantly greater than those in WKY in all groups of rats. The reduction in stress and Ca(2+) entry in intact females compared with intact males was greater in SHR than in WKY. The contractile responses and Ca(2+) entry in castrated male and ovariectomized female WKY or SHR were not significantly different from the respective responses in intact males. The contractile responses and Ca(2+) entry in ovariectomized female WKY or SHR with 17beta-estradiol implant were not significantly different from the respective responses in intact females. Thus, the phenylephrine- and depolarization-induced vascular reactivity and Ca(2+) entry in vascular smooth muscle are dependent on gender and on the presence or absence of functional female gonads. Ca(2+) release from intracellular stores is not affected by gender or gonadectomy. The gender-specific changes in vascular reactivity and Ca(2+) entry are augmented in hypertension.
Animals↗
Decreased [Ca(2+)](i) during inhibition of coronary smooth muscle contraction by 17beta-estradiol, progesterone, and testosterone.
The clinical observation that coronary heart disease is more common in men and postmenopausal women than in premenopausal women has suggested cardiovascular protective effects of female sex hormones including hormone-mediated coronary vasodilation. We investigated whether the sex hormones induced coronary relaxation is due to a decrease in [Ca(2+)](i) as measured in single coronary smooth muscle cells isolated from gonadectomized male and female pigs. In the presence of external Ca(2+), prostaglandin F(2alpha) (PGF(2alpha); 10(-5) M) and membrane depolarization by 51 mM KCl caused significant cell contraction and maintained increase in [Ca(2+)](i) to 297 +/- 4 and 341 +/- 20 nM, respectively. At 10(-9) to 6 x 10(-7) M, 17beta-estradiol, progesterone, and testosterone caused inhibition of PGF(2alpha)- and KCl-induced contraction and [Ca(2+)](i) with 17beta-estradiol being most effective. 17alpha-Estradiol did not affect PGF(2alpha)-induced contraction, and the inhibition of PGF(2alpha) contraction by 17beta-estradiol, progesterone, or testosterone was abolished by tamoxifen and ICI 182, 780, RU-486, or flutamide, respectively. 17beta-Estradiol caused similar inhibition of PGF(2alpha)- and KCl-induced contraction and [Ca(2+)](i). Progesterone and testosterone caused greater inhibition of PGF(2alpha)-induced cell contraction and [Ca(2+)](i) compared with the KCl responses. In Ca(2+)-free (2 mM EGTA) solution, caffeine (10 mM) and carbachol (10(-5) M), which activate Ca(2+) release from intracellular stores, caused small cell contraction and transiently increased [Ca(2+)](i) to 256 +/- 53 and 262 +/- 32 nM, respectively. Sex hormones did not significantly affect caffeine- or carbachol-induced contraction or [Ca(2+)](i). Thus, 17beta-estradiol, progesterone, and testosterone cause relaxation of coronary smooth muscle cells and decrease [Ca(2+)](i) mainly by inhibiting Ca(2+) entry from extracellular space but not Ca(2+) release from intracellular stores. The differences in potency of sex hormones in reducing cell contraction and [Ca(2+)](i) suggest differences in the sensitivity of the PGF(2alpha)- and depolarization-activated Ca(2+) entry pathways to inhibition by sex hormones.
Animals↗
Circumferential hymen elasticity. A marker of physiologic maturity.
OBJECTIVE: To study the relationship between anatomic changes in the peripubertal female and sex hormonal maturation. STUDY DESIGN: Medical records were reviewed on virginal females whose first gynecologic examination occurred between ages 9 and 20 and who were examined at least twice by the same gynecologist. Speculum sizes at each visit were surrogate measures of circumferential hymenal elasticity, the anatomic change of interest. RESULTS: Mean ages at the two visits for the 35 patients were 14.6 and 16.7 years, respectively, with substantial overlap in ages between visits. Average Tanner breast and pubic hair stages and speculum sizes were greater at the second visit (P < .001). At first visit, age, Tanner breast and pubic hair stages, and time elapsed from menarche, thelarche and pubarche correlated positively with larger speculum sizes (P < .10). Change in speculum size between visits was associated with younger age and lower Tanner pubic hair stages at first visit and with increases between visits in age, body mass index and Tanner pubic hair stages. Larger changes were associated with shorter elapsed time between the first visit and menarche, thelarche and pubarche. CONCLUSION: Circumferential hymenal elasticity increases during adolescence. This anatomic change, the surrogate measure of which is specula diameter, can be used along with Tanner staging as a measure of physiologic maturity in adolescent women.
Adolescent↗
Endothelialized biological heart valve prostheses in the non-human primate model.
OBJECTIVE: The main disadvantage of implanted cardiac valve bioprostheses remains primarily tissue failure due to calcification. Coating of bioprostheses with viable autologous endothelial cells may delay or even eliminate tissue calcification and subsequent cardiac dysfunction. METHODS: Glutaraldehyde-preserved Hancock bioprostheses (n = 5), pretreated with glutamic acid (8%) and cryopreserved allografts (n = 5) were lined, using endothelial cells harvested from the external jugular vein. Coated specimens were cultivated for 9 days in Medium 199 supplemented with 20% fetal calf serum and basic fibroblast growth factor. Endothelialized grafts were anastomosed into the descending thoracal aorta of adult Chacma baboons. Untreated valve bioprostheses (n = 4) served as controls. Forty days after implantation the prostheses were examined morphologically and immunohistochemically. RESULTS: After implantation endothelialized prostheses showed a positive Factor VIII related antigen reaction by immunohistochemistry on all valve surfaces. Scanning electron microscopy showed confluently lined leaflets with transplanted endothelial cells and displayed cobblestone morphology on all coated allografts. In contrast, the surface of pretreated xenograft valves revealed uncoated areas with platelet and leucocyte aggregates. No endothelium was observed on the leaflets of untreated controls 40 days after implantation. CONCLUSION: In vitro endothelialization of cardiac valve bioprostheses with autologous endothelial cells is possible. The newly created endothelium is shear stress resistant and the antithrombotic as well as the antiaggregatory capacity of the transplanted cells were retained. Lining with autologous endothelial cells could improve the durability and clinical outcome of biological valve prostheses.
Animals↗
Predictive model to identify trauma patients with blood alcohol concentrations > or = 50 mg/dl.
OBJECTIVE: To develop a simple model for identification of trauma patients who are likely to have a blood alcohol concentration > or = 50 mg/dL (BAC + 50). METHODS: Demographic, clinical, and BAC data were collected from the clinical trauma registry and toxicology data base at a Level I trauma center. Logistic regression was used to analyze data from 11,206 patients to develop a predictive model, which was validated using a subsequent cohort of 3,523 patients. RESULTS: In the model development cohort, alcohol was detected in the blood of 3,180 BAC-tested patients (28.7%), of whom 91.2% had a BAC + 50 status. Preliminary analysis revealed associations between a BAC + 50 status and sex, age, race, injury type (intentional vs. unintentional), and time of injury (night vs. day and weekend vs. weekday). A predictive model using four attributes (sex and injury type) identified patients at low, medium, and high risk for being BAC + 50. The model was validated using the second group of patients. CONCLUSION: Injured patients with a high probability of being alcohol positive can be identified using a simple scoring system based on readily available demographic and clinical information.
Adolescent↗
Restenosis, reocclusion and adverse cardiovascular events after successful balloon angioplasty of occluded versus nonoccluded coronary arteries. Results from the Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MARCATOR).
OBJECTIVES: This study sought to compare the frequency of restenosis, reocclusion and adverse cardiovascular events after angioplasty of occluded versus nonoccluded coronary arteries. BACKGROUND: Angioplasty of chronically occluded coronary arteries is believed to be associated with a higher frequency of restenosis and reocclusion than angioplasty of subtotal stenoses. Whether this leads to adverse cardiovascular events is unknown. METHODS: The Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Restenosis (MARCATOR) was a placebo-controlled trial with angiographic follow-up to determine the effect of the angiotensin-converting enzyme inhibitor cilazapril on the frequency of restenosis. In this trial, restenosis was defined as 1) angiographic reduction of minimal lumen diameter > or = 0.72 mm between angioplasty and the follow-up visit; and 2) > 50% diameter stenosis on the follow-up angiogram. We identified 139 patients with successful angioplasty of a coronary occlusion (Group 1) and compared the frequency of restenosis, reocclusion and adverse cardiovascular events with that in 1,295 patients with successful angioplasty of a subtotal stenosis (Group 2). RESULTS: Restenosis occurred in 36 patients with occluded arteries (29%) versus 264 with nonoccluded arteries (23%, p = 0.177) by definition 1 and in 62 patients with occluded arteries (49%) versus 478 with nonoccluded arteries (42%, p = 0.119) by definition 2. Occlusion was present in 24 Group 1 patients (19%) compared with 74 Group 2 patients (7%) (p < 0.001). During the 6 month follow-up period, two Group 1 patients (1.4%) and six Group 2 patients (0.5%) died; no Group 1 patients and 10 Group 2 patients (0.8%) developed severe congestive heart failure; nonfatal myocardial infarction occurred in 4 Group 1 patients (2.9%) and 31 Group 2 patients (2.4%); repeat coronary angioplasty or bypass surgery was performed in 29 Group 1 patients (21%) and 232 Group 2 patients (18%); and angina was present in 18 Group 1 and 163 Group 2 patients (13% for both). Eighty-six Group 1 patients (62%) and 853 Group 2 patients (66%) remained free of these adverse events during the 6-month follow-up period (p = 0.513). CONCLUSIONS: The frequency of restenosis was slightly but not significantly greater after successful angioplasty of an occluded artery than after angioplasty of a subtotal stenosis. Although reocclusion was more frequent, occurring in 19% of patients, the net clinical benefit of angioplasty in such patients was similar to that in patients with subtotal stenoses over the 6-month follow-up period.
Adult↗