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PubMed2004

Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention.

There are over 1.3 million known diabetic patients in the UK and a similar number who have the disease undiagnosed. Over 90% have non-insulin dependent diabetes mellitus usually characterised by insulin resistance and adult onset. Over half of all diabetic patients die of coronary disease and account for over a fifth of percutaneous coronary intervention (PCI) revascularisation procedures. Despite recent therapeutic advances such as new antiplatelet treatments and drug eluting stents, outcomes for diabetic patients after PCI are still significantly worse than for non-diabetic patients. This article summarises what is known about the pattern and severity of diabetic coronary disease, what mechanisms are responsible for these differences, and whether this information can help explain the poorer prognosis for these patients after PCI and form the basis of interventions to improve outcome.

Angioplasty, Balloon, Coronary↗
PubMed2002

[Percutaneous revascularization of multivessel coronary disease using stents - a multicenter, prospective study].

BACKGROUND AND OBJECTIVE: Symptomatic patients with multivessel coronary disease (MVD) benefit from both coronary artery bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA). The >>German Angioplasty Bypass Investigation<< (GABI-I) trial randomized patients to one of these treatment strategies between 1986 and 1991. In order to evaluate the impact of current technology, in particular coronary stents, the GABI-II trial was initiated, which in 1996 and 1997 prospectively enrolled patients according to the initial GABI-I criteria. PATIENTS AND METHODS: Into the study 136 consecutive patients (108 men, 28 women; 63 +/- 12 years) were included. Patients from GABI-I served as controls. RESULTS: A mean of 2.1 +/- 0.5 vessels were treated per patient (vs. 1.9 +/- 0.5 vessels in the PTCA arm of GABI-I) and 63 % of the lesions were covered with stents. With respect to the primary endpoint less patients remained with a CCS class III or IV in GABI-II after 12 months (1,5 % vs. 8 % in the PTCA arm of GABI-I, p<0,01). No patient required emergency or urgent bypass operation in GABI-II (vs. 9 % in GABI-I, p < 0.01). After 12 months, 8 % of the patients were sent for bypass surgery (CABG) vs. 21 % in GABI-I (p < 0.001), and 20 % (vs. 23 % in GABI-I) of the patients underwent Re-PTCA. The percentage of patients without reinterventions was 72 % vs. 56 % in GABI-I (p < 0.01), but remained lower compared to patients randomized to CABG in GABI-I (94 %, p < 0.001). CONCLUSION: PTCA in patients with MVD is still associated with a higher reintervention rate as compared with CABG. However, in contrast to angioplasty a decade ago, PTCA in conjunction with stents significantly lowered the need for subsequent revascularization, which was mainly driven by the reduced necessity for bypass surgery.

Aged↗
PubMed1991

[Clinical usefulness of the dobutamine test in the diagnosis of coronary disease].

In the diagnostics of the coronary artery disease different exercise tests are well-known to be important. On the basis of the increasing number of publications of the eighties the authors examined the applicability of dobutamin stress test in 89 patients, whose anamnesis did not contain any justification of coronary artery disease. All patients were examined by coronarography. The authors compared the results of different tests with the results of coronarography. They found the sensitivity of dobutamin stress test significantly higher and its specificity--although not significantly--lower, than the dynamic treadmill tests, however the combination of the two methods resulted in very good sensitivity and acceptable specificity.

Coronary Angiography↗
PubMed1988

[Diagnostic significance of angioscopy in patients with coronary heart disease].

Coronary angioscopy (CA) using ultrathin fiberscopes was performed in 30 patients with coronary heart disease during cardiac catheterization and in 11 patients during bypass surgery. For percutaneous CA the angioscope was introduced from the femoral artery through a 9F guiding catheter. During short-time occlusion of the coronary ostium by the tip of the guiding catheter the viewing field was flushed with Ringer's solution. Intraoperative CA was performed both by the retrograde and antegrade way during flushing with cardioplegic solution. Percutaneous CA was successful in 57% of patients. 13 patients showed eccentrically and irregularly shaped stenoses and 3 of these patients had an additional plaque rupture. In 2/5 patients CA after PTCA revealed intimal dissections not visualized by angiography. Intraoperative CA was successful in 9/11 patients. In 3 patients nonocclusive thrombi were found at the site of the coronary lesion. Additionally we studied the efficacy of angioscopic guidance during intravascular radiofrequency application. In 11/11 thrombotically occluded peripheral vessels this new method allowed a nearly complete recanalization. There was only one perforation of the vessel. We conclude, that CA is a powerful diagnostic tool providing prognostically relevant information in the diagnosis of coronary heart disease.

Animals↗
PubMed1999

Low prevalence of Chlamydia pneumoniae in atherectomy specimens from patients with coronary heart disease.

Coronary atherectomy specimens from 50 patients with coronary heart disease were examined for the presence of Chlamydia pneumoniae by two different methods of polymerase chain reaction (PCR) and by in situ hybridization. C. pneumoniae DNA was detected by PCR in atherosclerotic plaques of four patients (8%). Two patients' coronary atheromas were positive, both by a single-step 16S rRNA-based PCR and by an omp1-based nested PCR. The other two patients' specimens were positive only by the nested PCR. In contrast, C. pneumoniae was not detected by in situ hybridization in any of the cardiovascular tissues tested. Of three patients with evidence of C. pneumoniae in coronary atheromas, two had an antibody titer of 1:32 and the third had no specific antibodies detectable. Results of this study demonstrate a low prevalence of C. pneumoniae DNA in coronary atheromas. These findings do not support the hypothesis that the organism plays a major role in atherogenesis.

Aged↗
PubMed2001

A randomised trial of endoluminal reconstruction comparing the NIR stent and the Wallstent in angioplasty of long segment coronary disease: results of the RENEWAL Study.

BACKGROUND: The role of coronary stents in reducing the incidence of acute complications and late restenosis after angioplasty has been established in randomized studies focusing on simple, short coronary lesions. The development of long coronary stents has provided a safe and predictable means of treating long coronary lesions, but this carries with it a higher risk of restenosis. By comparing the outcome of treating long lesions with two different stent types, we aimed to assess the influence of stent design rather than the nature of long lesions per se on the relatively high restenosis rates in this subgroup. METHODS: This study was designed to assess procedural complications and 6-month restenosis rates in a randomized trial comparing a slotted tube stent with a self-expanding stent for the treatment of long coronary lesions. Randomization of vessels to either stent occurred after successful balloon angioplasty. Intravascular ultrasound (IVUS) was used to assess and optimize stent deployment. The patients were restudied angiographically and by IVUS at 6 months. RESULTS: A total of 82 patients (85 vessels) were recruited (slotted tube stent, n = 44 vessels; self-expanding stent, n = 41 vessels). Successful deployment occurred in 41 (100%) of 41 of the self-expanding stent group and 41 (93%) of 44 of the slotted tube stent group. There was no difference in lesion length between the two groups (slotted tube stent, 26.6 +/- 6.9 [SD] mm; self-expanding stent, 28.7 +/- 9.8 [SD] mm; P = .2), but the mean length of the self-expanding stent was greater than that of the slotted tube stent (41.6 +/- 18.8 [SD] mm vs 35.4 +/- 16.2 [SD] mm, respectively; P < .05). There was no significant difference in the rate of major events between the two groups at 6-month follow-up. The angiographic restenosis rate at follow-up was less in the slotted tube stent group, but this did not reach statistical significance (26% vs 46%, respectively; P = .1) and the target lesion revascularization rate was similar for both groups (7.9% vs 7.7%, respectively; P = .8). IVUS assessment of plaque/stent ratios suggested a greater plaque burden in the self-expanding stent compared with the slotted tube stent at follow-up (0.42 +/- 1.2 [SD] vs 0.3 +/- 0.08 [SD]), but this was not statistically significant (P = .1). CONCLUSIONS: Long stents can be safely and successfully deployed in long segment coronary disease, with an acceptable 6-month target lesion revascularization rate. Our results showed a trend toward lower angiographic restenosis and a lesser in-stent plaque burden at follow-up in the slotted tube stent compared with the self-expanding stent. This suggests that stent design may influence the restenotic process in long coronary lesions.

Aged↗
PubMed2004

[Prevention of coronary disease and sudden death by nutrition].

Nutrition influences sudden cardiac death (SCD) not only by determining the development of atherosclerotic coronary disease but possibly also by more specific rhythm stabilizing abilities of some nutrients. QUANTITATIVE ASPECTS: A body mass index >30 is associated with a 2.6-fold risk of SCD, probably via the risk factors diabetes and hypertension. QUALITATIVE ASPECTS: alpha-linolenic acid (ALA) is a substrate for the production of the N-3-fatty acids eicosapentaenoic acid (EPA) und docosahexaenoic acid (DHA). The consumption of ALA correlates with decreased MI risk. Fish consumption is (in case control studies) associated with reduced MI-risk and (in prospective controlled studies) with decreased risk of SCD. Two or more fish meals/week and the estimated N-3-fatty acids (n-3-FA) ingestion of > 1.2 g/week correlate with a reduced SCD-risk. The blood level of the N-3-FA EPA and DHA correlate highly with a reduced risk for SCD. It is likely that the marine production of N-3-FA will not suffice to supply the amount needed for large scale prevention. Industrial farming of algae and genetic modification of mammal muscle cells resulting in improved ability to transform N-6-FA to corresponding N-3-FA could contribute to better availability of N-3-FA for prevention. Nutrition influences sudden cardiac death (SCD) not only by determining the development of atherosclerotic coronary disease but possibly also by more specific rhythm stabilizing abilities of some nutrients.

Animals↗
PubMed2006

Self-rated health among women with coronary disease: depression is as important as recent cardiovascular events.

BACKGROUND: Prior studies have shown an association between depression and self-rated health among patients with coronary disease. However, the magnitude of the effect of depression on self-rated health compared with that of major clinical events is unknown. Our main objective was to clarify the association between depression and self-rated health using longitudinal data. METHODS: We performed a prospective cohort study of 2675 postmenopausal women with coronary disease. The primary predictor variable was a 4-state categorical depression variable based on the Burnam depression screen assessed at sequential visits. The outcome variable was self-rated overall health (excellent, very good, or good vs fair or poor). RESULTS: After adjustment for age, comorbidities, prior self-rated health, and interim events, women with depression at both current and prior annual visits had a >5-fold increased odds of fair/poor self-rated health (odds ratio [OR] 5.1, 95% CI 3.8-6.8). New depression was associated with a >2-fold increased odds of fair/poor self-rated health (OR 2.6, 95% CI 2.0-3.4). Having a history of depression at the preceding annual visit but not at the current visit was associated with a slight increased odds of fair/poor self-rated health (OR 1.3, 95% CI 1.0-1.7). The magnitude of the impact of persistent or new depression was comparable to that of recent angina, myocardial infarction, angioplasty, heart failure, or bypass surgery. CONCLUSIONS: Women with persistent or new depression are more likely to report fair/poor self-rated health. The magnitude of the impact of persistent or new depression is comparable to that of major cardiac events.

Aged↗
PubMed1995

[Anatomic-pathological bases of coronary heart disease].

Coronary artery disease is described by its extreme presentations. At one end we see the slowly growing fibrous plaque gradually occluding the artery. Collaterals develop and confine the loss of myocardium to the inner layer of the left ventricle. At the other end of the spectrum we see the rupture of a soft plaque. Blood breaking in an atheroma occludes a coronary artery suddenly. There is no time to develop collaterals. The myocardial infarction corresponds in its size to the perfusion-area of the occluded artery. Transmural infarctions lead to rupture of the free wall, ventricular septum or papillary muscle. The coronary morphology of our patients suffering from coronary heart disease lies between these two extremes. However, many patients die suddenly due to arrhythmia a long time before the loss of myocardium disturbs left ventricular pump function so severely that lethal heart failure may develop.

Collateral Circulation↗
PubMed1957

Coronary disease.

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Coronary Disease↗
PubMed1951

Coronary disease.

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Coronary Disease↗