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At least 1,171 records · Page 65Linked to original sources
PubMed1999

[Prevention of sudden death due to coronary disease].

Out-of-hospital cardiac arrest remains a serious clinical problem with a survival rate of less than 5%. A recent study showed that acute coronary artery occlusion is found in almost half of survivors of out-of-hospital cardiac arrest and occurs most often in patients with no past history of coronary artery disease. Detection and management of risk factors for coronary artery disease and screening of high-risk patients may therefore be effective in reducing the rate of sudden death. Furthermore, optimal management of patients with overt coronary artery disease including changes in life style, up-to-date drug regimens, revascularization when necessary and implantable defibrillators in selected cases may also lower the incidence of sudden death. Primary and secondary prevention of coronary artery disease should be included in out-of-hospital cardiac arrest training programs to increase their efficacy and diffusion.

Adult↗
PubMed1997

Angiotensin-I-converting enzyme DD genotype is a risk factor of coronary artery disease.

Coronary artery disease (CAD) is a polygenic disease whose phenotypic manifestation depends on the interaction of a number of environmental factors. A number of genes, including the angiotensin-I-converting enzyme (ACE) gene, have been implicated in the pathogenesis of CAD. ACE could affect smooth muscle cell and fibroblast migration and proliferation, low-density lipoprotein (LDL) oxidation and endothelial cell function; these are all important factors in atherosclerosis. A polymorphic variant of the ACE gene correlates with higher circulating ACE levels and carries an increased risk of myocardial infarction, and cardiomyopathies. In this study, we sought to determine the distribution of ACE genotypes and the frequency of allele D in patients undergoing coronary angiography at our institution. DNA from 196 patients with angiographically proven CAD and 96 controls without CAD was amplified by polymerase chain reaction (PCR). The primers flanked the region of the ACE gene (intron 16) where the insertion (I) or deletion (D) of a 287-bp fragment results in the I/D polymorphism. PCR amplification of alleles I and D resulted in 490- and 190-bp products, respectively. In the control group, the relative allele frequencies of the polymorphism were similar to those of previously published European studies. The ACE genotype DD was present in 37.3% of patients with CAD as compared to 23.4% in the controls (p < 0.001, odds ratio 1.95, 95% confidence intervals (CI) 1.06-3.57). There was no association with the history of prior myocardial infarction. The genotype distribution in patients with single-vessel involvement was not significantly different from controls (p = 0.14). However, the DD genotype was significantly more common in patients having multivessel CAD when compared to single-vessel disease, indicating an association of this polymorphism with the extent of CAD. ACE genotype DD is more common in patients with multivessel CAD as compared to controls and to patients with single-vessel involvement, indicating that genotype DD is a genetic risk factor for extensive, multivessel CAD.

Aged↗
PubMed1990

A critical perspective on coronary artery disease and coronary bypass surgery.

This paper examines coronary artery disease and coronary artery bypass graft (CABG) surgery from a critical medical anthropological perspective. It explores the issue of why an expensive, individualistic, and mechanistic treatment for the symptoms of coronary artery disease (CABG surgery) has come to be so widely used to treat a condition which is so clearly related to occupational, social and environmental stresses and to behavioral factors. The paper also addresses the issue of why CABG surgery has proliferated in the absence of firm evidence from controlled studies that it is an effective long-term mode of treatment for many patients with this disease. Through this analysis of the growth and continued overuse of CABG surgery the social nature of biomedical knowledge and the socio-cultural, political and economic nature of biomedical decision making are revealed.

Coronary Artery Bypass↗
PubMed1984

[Nutrition--a factor in preventing arteriosclerosis, coronary disease and disorders of the blood coagulation system. I. An imbalance in food fats and carbohydrates and atherogenesis].

The analysis of the literary data and the results of own research testifies that the lipids and carbohydrates metabolism disturbance in food is one of the decisive factors of pathogenetic arteriosclerosis and coronary disease. A long balanced diet in particular in fats and carbohydrates favours the normalization of the metabolic processes in stabilization of the organism.

Adult↗
PubMed1987

Multiple (more than eight) bypass grafts in severe diffuse coronary disease: improved exercise tolerance and functional classification in seventy-seven consecutive patients.

During a 43-month period (May 1981 to December 1984), 77 consecutive patients underwent multiple (eight or more) coronary artery bypass procedures using saphenous vein conduits for severe diffuse triple-vessel coronary artery disease. Patients received from 8 to 14 grafts (average 9). All coronary arteries and branches that were at least 1.5 mm in diameter and greater than 50% obstructed were bypassed. The operative mortality rate was 1.3%. Seventy-six of 77 (98.7%) patients are alive at a mean follow-up of 2 years. According to the Canadian Cardiovascular Society Angina Criteria, before surgery 5 patients (6%) were classified class I, 8 (10%) class II, 43 (56%) class III, and 21 (27%) class IV. After surgery all 76 patients were class I. Of 59 patients who had undergone bypass surgery who were followed by exercise testing according to the modified Bruce protocol, 47 exercised to greater than or equal to 85% heart rate. Among these patients, 44 (94%) had a normal exercise test result and only 3 had greater than or equal to 1 mm ST segment depression. Thus, patients with severe diffuse coronary disease can undergo multiple (eight or more) bypass grafting procedures with low mortality rates and improved exercise tolerance and functional classification.

Adult↗
PubMed1975

[Proceedings: Evaluation of the hemodynamic condition during the recuperative phase after the diagnostic isoproterenol test in a patient with coronary disease].

Previous investigations concerning isoproterenol infusion (PI) in the diagnosis of myocardial ischemia have shown that ischemic ECG changes are only significant if they persist or appear after discontinuing PI. In an effort to explain the mechanisms of this delayed response, hemodynamic parameters were measured in 10 patients with angiographically proven coronary disease before, during and after PI. It was found that the principal determinants of myocardial oxygen consumption (TTI and contractility) remain significantly elevated in the recuperation phase, but that aortic pressure and systemic arterial resistance, which diminish during PI, return to pre-infusion levels immediately after halting PI. The combined effects favor the late appearance of ischemic changes in the ECG. The coronary vasodilatation with resultant increased oxygen delivery to the myocardium seen during PI may be sufficient to meet the increased myocardial oxygen demand during PI but disappears immediately if PI is discontinued.

Adult↗
PubMed1996

[Should individuals without evidence of coronary disease and with risk factors receive continuous treatment with aspirin? Arguments in favor].

There is general agreement on the efficacy of aspirin treatment in patients with coronary heart disease, but the indications of aspirin in individuals without coronary heart disease are debated. This paper analyses data from the main studies which investigated the usefulness of aspirin in the primary prevention of coronary heart disease. Particular attention is paid to the risks and benefits of aspirin treatment in different clinically relevant subgroups of patients. It is concluded that, according to available information, the use of aspirin must be integrated in a global strategy for the primary prevention of coronary heart disease and should be probable recommended in males older than 50 years old presenting a higher risk of coronary heart disease (due to the number and intensity of risk factors) and low risk of adverse effects.

Age Factors↗
PubMed2004

Transcription factor MEF2A mutations in patients with coronary artery disease.

Coronary artery disease (CAD), including its most serious complication myocardial infraction (MI), is the leading cause of death in the US and developed countries. We recently discovered that a seven-amino acid deletion in MEF2A, a transcription factor with a high level of expression in the endothelium of coronary arteries, co-segregates with CAD/MI in one family, and it suppresses transcription activation activity of MEF2A by a dominant-negative mechanism. In this study, we used single-strand conformation polymorphism and DNA sequence analyses to identify mutations in MEF2A in 207 independent CAD/MI patients and 191 controls with normal angiograms. We identified three novel mutations in exon 7 of MEF2A in four of 207 CAD/MI patients (1.93%). No mutations were detected in the 191 controls. The mutations identified here include N263S identified in two independent CAD patients, P279L in one patient and his father with the diagnosis of CAD and G283D in one patient. These mutations are clustered within or close to the major transcriptional activation domain of MEF2A. They significantly reduce the transcriptional activation activity of MEF2A and act by a loss-of-function mechanism. The gene carriers with loss-of-function mutations appear to be associated with less severe CAD. These results suggest that CAD/MI can result from a spectrum of MEF2A transcription dysfunctions ranging from loss-of-function to dominant-negative suppression and that a significant percent of the CAD/MI population (1.93%) may carry mutations in MEF2A, although further definition of the prevalence of MEF2A mutations is warranted.

Adult↗
PubMed2001

[The path taken by surgery in the treatment of coronary disease. Posthumous tribute to Dr. René Favaloro].

The first surgical procedure for the treatment of coronary artery disease, in 1933, was total thyroidectomy. Some years later, procedures to increase heart irrigation such as pectoral or great epiplon grafting and cardiopeumopexy were attempted. In 1940, the ligation of great cardiac vein or coronary sinus were introduced. Five years later, pericoronary neurectomy was used. In 1945, Beck used an arteriovenous fistula between the descending aorta and the coronary sinus and, from 1954, be used the erosion of heart surface with asbestos application, complemented with the occlusion of the coronary sinus and the application of parietal pericardium. In 1958, Glover introduced the bilateral ligation of mammary arteries and Vineberg, developed the internal mammary artery implant, that consisted in the tunneling of the free portion of such artery in the myocardium. En 1956, Lillehei and Bailey introduced coronary endarterectomy and finally in 1967, Favaloro introduced systematically the aortocoronary bypass using saphenous vein, that became the definitive surgical treatment for coronary artery disease. In Chile the first coronary surgery was done by Torwall and Uribe in 1950 and modern coronary surgery was initiated by Salvestrini in 1970.

Cardiovascular Surgical Procedures↗
PubMed2004

[Multiple coronary endarteriectomy in patients with diffusial coronary disease].

UNLABELLED: In recent years the profile of patients with CAD is continuously changing, often with previous operation or stenting. Multiple coronary endarterectomies have been utilized as an adjunct to CABG in this select group of patients to achieve complete revascularization because of the diffuse CAD. METHODS: Between January 1997 and December 2001 eighty eight consecutive patients undergoing first time CABG with more than two CE were compared with a control group of 967 patients undergoing CABG without CE. RESULTS: More than 9% of the CABG patients need two or more endarterectomies, with involvement of the RCA in 96% and LAD in 59%. The extended time of aortic clamping and the higher rate of perioperative MI lead to higher mortality in Group 1 without significant difference between groups. The 5 years survival was 69% in Group 1 and 84% in Group 2. CONCLUSIONS: The operative results--mortality and morbidity, are similar in both groups instead of the highest complexity of the procedures with multiple endarterectomies. The use of this method together with CABG allows complete revascularization in 10% of the operated patients with diffuse atherosclerosis.

Coronary Disease↗
PubMed1993

[Atrial fibrillation and coronary disease].

OBJECTIVE: To study the incidence of atrial fibrillation in patients (pts) with angiographic coronary artery disease and its relation with clinical and angiographic parameters. DESIGN: Retrospective study. SETTING: Six hundreds consecutive pts, submitted to diagnostic coronary angiography, performed in Hemodynamic Laboratory of Santa Marta Hospital (from 88/04/03 to 90/05/04). MATERIAL AND METHODS: From six hundreds pts were excluded 43 because they had also valvular heart disease and/or minimal coronary artery lesions. Two groups were considered: Group I-pts with atrial fibrillation (n = 7) and Group II-pts in sinus rhythm (n = 549). We evaluated the following parameters: age, sex, clinical history, basal ECG, cardiac enlargement in chest X-ray, angiographic score of LVF, left ventricular diastolic pressure (LVDP), ventricular aneurysm, mitral regurgitation and number of vessels disease. RESULTS: We only found significant statistically differences between the two groups concerning the following parameters: a) age-mean age was superior in group I (Group I-64.2 +/- 8.2 versus 56.3 +/- 9.6), the number of pts older than 60 years in group I was 75% vs 33.8% in group II (p < 0.02); b) heart failure-the incidence was superior in group I, 37.5% vs 9% in group II (p < 0.03); c) cardiac enlargement in chest X-ray-75% pts of group I vs 22% of group II (p < 0.002); d) moderate to severe mitral regurgitation-25% of pts in group I vs 5% of pts of group II (p < 0.05). CONCLUSIONS: Atrial fibrillation is an unusual rhythm in pts with angiographic coronary artery disease. Its presence is related with age, clinical evidence of heart failure, cardiac enlargement and moderate to severe mitral regurgitation.

Age Distribution↗
PubMed2003

Benefits of optimising drug treatment in home-dwelling elderly patients with coronary artery disease.

Coronary artery disease (CAD) is prevalent in the elderly and often leads to disability. Consequently, strategies for optimising the prevention and treatment of CAD in the elderly are important from both the individual and societal perspectives. Although it is common knowledge that the elderly are heavy consumers of drugs, there is evidence to show that there is under-prescribing of evidence-based medical therapies in the home-dwelling elderly coronary patient and there may be overuse of some non-evidence-based (antioxidants) and purely symptomatic treatments. In particular, aspirin (acetylsalicylic acid), beta-adrenoceptor antagonists, ACE inhibitors and HMG-CoA reductase inhibitors are under-utilised. Although the evidence base is largely drawn from trials including patients younger than 75 years, it is reasonable to assume that the data applies to patients aged over 75 years and that better use of evidence-based medicines would provide benefits to the home-dwelling aged patient. Evidence from the few multifactorial studies available suggest possible benefits including reduction of cardiovascular events, less disability and better quality of life in old age. At the societal level, this would be reflected in fewer hospitalisations and institutionalisations, which means decreased cost of elderly care.

Adrenergic beta-Antagonists↗
PubMed2003

The ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the Framingham Study.

BACKGROUND: A low ankle-brachial index (ABI) is associated with an increased risk of death and cardiovascular disease. Limited data exist regarding the relation between a low ABI and stroke. We sought to examine the relation between a low ABI and stroke, coronary heart disease, and death in the elderly. METHODS: We examined 251 men and 423 women with a mean age of 80 years who had a Framingham Study examination from 1994 to 1995. A low ABI was defined as less than 0.9. Persons were followed up for 4 years for occurrence of stroke or transient ischemic attack, coronary disease, and death. Cox proportional hazards models were used to assess the relation between a low ABI and each outcome after adjusting for age, sex, and prevalent cardiovascular disease. RESULTS: A low ABI was detected in 20% of our sample. Only 18% of the participants with a low ABI reported claudication symptoms. One third of those with a normal ABI and 55% of those with a low ABI had cardiovascular disease at baseline. Results of multivariable Cox proportional hazards analysis demonstrated a statistically significant increase in the risk of stroke or transient ischemic attack in persons with a low ABI (hazards ratio, 2.0; 95% confidence interval, 1.1-3.7). No significant relation between a low ABI and coronary heart disease (hazards ratio, 1.2; 95% confidence interval, 0.7-2.1) or death (hazards ratio, 1.4; 95% confidence interval, 0.9-2.1) was observed. CONCLUSIONS: A low ABI is associated with risk of stroke or transient ischemic attack in the elderly. These results need to be confirmed in larger studies.

Aged↗
PubMed1985

[Outcome of patients with inoperable multivessel coronary disease].

The authors studied the clinical course of 100 patients with two or three vessel coronary artery disease who were unsuitable for surgery because of the poor quality of the distal vascular bed or excessively depressed left ventricular function. The 6 year actuarial survival was 58 per cent; 43 of the 100 patients did not present any serious cardiac events causing death or requiring further admission to hospital, over this follow-up period. The severity of the clinical course in women and the presence of heart failure prior to coronary angiography were considered to be among the most important clinical prognostic factors. On the basis of the haemodynamic survey, the probability of survival or the risk of a further coronary accident appears to depend more on the extent of the left ventricular kinetic abnormalities than on the ejection fraction or the severity of the coronary lesions.

Adult↗
PubMed2005

Linking erectile dysfunction and coronary artery disease.

Coronary artery disease (CAD) and erectile dysfunction (ED) are both highly prevalent conditions that frequently coexist. Additionally, they share mutual vascular risk factors, suggesting that they are both manifestations of systemic vascular disease. The role of endothelial dysfunction in CAD is well established. Normal erectile function is primarily a vascular event that relies heavily on endothelially derived, nitric oxide-induced vasodilation. Accordingly, endothelial dysfunction appears to be a common pathological etiology and mechanism of disease progression between CAD and ED. The risk factors of diabetes mellitus, hypertension, hyperlipidemia, obesity and tobacco abuse contribute to endothelial dysfunction. This article reviews the role of vascular endothelium in health, the abnormalities resulting from vascular risk factors, and clinical trials evaluating the role of endothelial dysfunction in ED.

Coronary Artery Disease↗