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PubMedDate not supplied

[Exercise myocardial scintigraphy for the positive and topographic diagnosis of coronary disease. Study in 115 patients without antecedents of myocardial infarction].

In a group of 53 subjects (prevalence of the disease = 91%), the sensitivity of stress myocardial scintigraphy is lower (66%); the predictive value of a negative SMS is only 28 per cent: these results can be explained by the clinical profile of the subjects included in this group (men with an average age of 50 with typical effort angina), but also by the high incidence of one vessel stenoses of the right coronary artery or the circumflex artery (19/35) which are less accessible to SMS. For the series as a whole, the combination of the two tests provided optimal results: double positivity (SMS+/stress ECG+) has a predictive value of 97 per cent; double negativity (SMS-/SE-) corresponds to 83 per cent true negatives. Furthermore, the combination of SMS+/SE+ is suggestive of more severe coronary disease (defined by the presence of a tight stenosis of the IVA or multi-vessel disease). Such severe disease is encountered in less than 7 per cent of cases when the two tests are negative.

Adult↗
PubMed1989

[Risk score for coronary disease. A pedagogic model used in the occupational health services].

In our occupational health service, we have worked out a fairly simple model for risk score for coronary heart disease. The occupational nurses give each employee a risk score after health examination and use this figure as a convincing pedagogic tool in preventive health education. The nurses find a measureable scale extremely useful in the follow-up of groups and individuals. The system is also used to measure the difference in coronary disease risk between different occupations and occupational subgroups. After introduction of this risk score system, both employer and employees seem to be more conscious of health hazards, both in the work environment and due to personal lifestyle.

Coronary Disease↗
PubMed1980

AHA Committee Report. Risk factors and coronary disease. A statement for physicians.

Clinical, laboratory and epidemiological studies show that certain readily identifiable lifestyles and biological features characterize those persons who are at high risk to develop coronary heart disease (CHD). The first AHA document on this subject, dealing with primary prevention of the atherosclerotic diseases, was published in 1964. It was based in part on earlier AHA statements on smoking (1959) and diet (1961). This information is incorporated into the 1968 statement, "Risk Factors and Coronary Disease." New research information has been accumulated about risk factors in the intervening 12 years, and continues to show that no single risk factor is etiologic--multiple causal factors play interrelated roles in CHD.

Coronary Disease↗
PubMed1984

[Medical aspects of the treatment of acute coronary disease].

Progress in the drug therapy of arrhythmias and congestive heart failure following acute coronary heart disease and attempted infarct size reduction are discussed. A schedule of diagnostic and therapeutic procedures is proposed. Corresponding to present knowledge of the pathophysiology of "unstable angina pectoris" drug therapy can be more specifically administered in this form of acute coronary heart disease.

Angina, Unstable↗
PubMed2006

Controversies in stable coronary artery disease.

Coronary heart disease is still highly prevalent worldwide, and stable angina pectoris is one of its more common presentations. Three major controversies are risk factor management, drug therapy, and intervention. As well as the major risk factors stated by the Framingham study and European guidelines, other factors include abdominal obesity, metabolic syndrome, and psychological stress. How should these additional factors be rated? With respect to drug therapy, apart from aspirin, all patients with stable angina should be assessed for statin treatment. Although statins will reduce coronary events by about one third in patients with vascular disease, the absolute benefit depends on the absolute risk. Non-controversially, all patients should be considered for angiotensin-converting-enzyme inhibitors. The concept that beta blockers are protective from future coronary events can be disputed. Percutaneous coronary intervention can relieve symptoms without extending lifespan beyond medical therapy. However, strong mortality data favour coronary-artery bypass grafting in individuals with triple-vessel or even double-vessel disease. Thus, effort angina needs comprehensive assessment, lifestyle changes, and treatment tailored to the individual patient.

Adolescent↗
PubMed1993

Decreasing incidence of coronary disease in pediatric cardiac transplant recipients using increased immunosuppression.

BACKGROUND: Coronary artery disease (CAD) is a limiting factor to long-term survival in cardiac transplant recipients, affecting from 30% to 50% of patients by 4 years after surgery. Can the incidence of CAD be lowered with augmentation of immunosuppression? METHODS AND RESULTS: We compared the incidence of CAD in our pediatric transplant population with nine potential risk factors, including immunosuppressive regimen. The study group consisted of 55 patients who survived more than 1 year (or to first angiogram) or had autopsies. Coronary angiograms were performed yearly and compared sequentially. The mean follow-up of 55 patients was 36 months. Mean age was 10.3 +/- 6 years (range, 4 months to 18 years). Thirteen patients received double immunosuppression with cyclosporine and prednisone, and 42 received triple therapy with cyclosporine, prednisone, and azathioprine. Significant CAD occurred in 10 grafts (6 deaths and 3 retransplants). Cause for graft loss in 6 patients with CAD was acute rejection. CAD was detected by angiogram in only 2 patients. Nine of 10 patients received double therapy (P < .001). There was no difference in mean follow-up between immunosuppression groups. There was a higher rejection frequency for double therapy (0.19 +/- 0.16 rejections per patient month) compared with triple therapy (0.07 +/- 0.11). Ten patients were rejection free in the triple therapy group. CONCLUSIONS: We experienced a significant decrease in the incidence of CAD in our pediatric cardiac transplant recipients using increased immunosuppressive therapy. Type of immunosuppressive regimen (double) and rejection frequency were independent predictors for CAD by multivariate analysis.

Azathioprine↗
PubMed1992

Efficacy of lipid profiles in prediction of coronary disease.

National guidelines in the United States and Europe have stimulated interest in controlling blood lipid levels to prevent CHD. In this review, the efficiency of lipid profiles in predicting CHD has been examined, and total cholesterol, HDL and LDL cholesterol, and triglyceride values have been compared on the basis of 12 to 14 years of surveillance in the Framingham Study. The average value of total cholesterol and LDL cholesterol in patients who had coronary disease was at or below values that are considered dangerous, which indicates the need for more specific and sensitive lipid profiles. Measurement of LDL cholesterol levels predicted CHD only marginally better than measurement of serum total cholesterol. Measurement of triglyceride levels was the weakest predictor. The total cholesterol to HDL cholesterol ratio was the most efficient predictor both in those with apparently safe and those with abnormal cholesterol values. Measurement of HDL cholesterol was the best single lipid predictor and use of this measurement avoids needlessly alarming or falsely reassuring persons at risk for CHD who have high total cholesterol values. Since the risk associated with any serum cholesterol value varies over a 10-fold range depending on coexistent cardiovascular risk factors, these lipid factors must be taken into account in judging the hazards and efficacy of treatment needed. Evidence is available that controlling elevated cholesterol by diet and administration of pharmaceutical agents can reduce the rate of coronary events, slow progression of angiographically visualized lesions, and regress xanthomata.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Cost/efficacy ratio in the diagnosis of coronary disease. Bayes' analysis by computer: respective role of the exercise test, isotopic methods and coronarography].

UNLABELLED: Between January 1983 and May 1984, 104 patients with no known cardiac pathology were referred by their cardiologist for diagnosis of chest pain. They all underwent coronary angiography which was used as the reference investigation and the following sequential Bayes' analysis was performed. The percentage probability of coronary artery disease was estimated from clinical date (age, sex, characteristics of the chest pain subdivided into 3 groups); an exercise ECG was performed in all cases (classified as positive, negative or non diagnostic); if the probability of coronary artery disease was greater than 95% (or less than 5%) after exercise stress testing the patients was diagnosed as having (or not having) coronary artery disease. If the probability was between 6 and 94% the patient underwent Thallium myocardial scintigraphy (Thallium dipyridamole; analysis on a colour television screen); the coronary risk probability before Thallium was that calculated after exercise stress testing. If after myocardial scintigraphy the coronary risk remained between 6 and 94%, an exercise angioscintigraphy was performed and interpreted in the same way. The clinical and complementary date was analysed on a mini-computer, the values of the sensitivity and specificity of the tests used for the calculation of the probability of coronary artery disease were those previously published by our group. RESULTS: 31/88 (35%) of patients were classified in the 5% risk groups after exercise stress testing (24 coronary artery disease; 7 normals: no errors of classification). Fifty six out of the 88 patients (65%) were classified in the 5% risk group after myocardial scintigraphy (42 patients with coronary artery disease with 41 abnormal coronary angiographies and 14 normal patients, all of whom had normal coronary angiographies; this represents a 1.8% divergence of classification compared with coronary angiography). Angioscintigraphy only classified 3 of the remaining patients, one wrongly, and did not seem to be useful diagnostically as a third-line investigation after Thallium scintigraphy or as a second-line investigation instead of Thallium scintigraphy. This strategy is less costly than carrying out coronary angiography systematically in these patients: if diagnostic coronary angiography is performed alone in patients with a risk of 6 to 94% the cost is 4 800 FF vs 10 400 FF per patient; if coronary angiography is performed in all patients in whom coronary artery disease is possible or certain (all patients with a risk of over 5%), the cost is 8 400 FF vs 10 400 FF per patient, a saving of 20%.(ABSTRACT TRUNCATED AT 400 WORDS)

Bayes Theorem↗
PubMed2005

Prognostic role of cardiac troponin I after percutaneous coronary intervention in stable coronary disease.

OBJECTIVE: To assess the role of cardiac troponin I (cTnI) in predicting outcome after percutaneous coronary intervention (PCI). METHODS AND RESULTS: cTnI was measured immediately before and at 6, 14, and 24 hours after PCI in 316 consecutive patients with stable symptoms and native coronary artery disease. The study end point was the occurrence of major adverse cardiac events (MACE) at 30 days and at 18 months after PCI: death, Q wave myocardial infarction (MI), or repeat revascularisation in hospital. Postprocedural cTnI increased in 31% of patients. The cumulative MACE rate at 18 months was 25% (17.7% due to repeat PCI procedures). There was a significant association between postprocedural cTnI increase and death, Q wave MI, or both (odds ratio (OR) 3.28, 95% confidence interval (CI) 1.7 to 6.4, p = 0.01). Post-PCI cTnI increase had a positive predictive value (PPV) for adverse events at 18 months of 0.47 and a negative predictive value (NPV) of 0.96 (OR 18.9, 95% CI 9.7 to 37, p < 0.0001). The presence of both a postprocedural cTnI rise and a procedural angiographic complication gave a PPV for adverse events of 0.69 and an NPV of 0.92 (OR 22.6, 95% CI 2.6 to 68.6, p = 0.0005). CONCLUSIONS: cTnI increased post-procedurally in one third of this stable patient population undergoing elective PCI and was independently and significantly predictive of an increased risk of adverse events at 18 months, predominantly in the form of repeat PCI.

Aged↗