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PubMed2004

[Prevalence of abdominal aortic aneurysm and peripheral arterial diseases in ambulatory patients with coronary disease].

Presence of peripheral arterial disease in patients with coronary artery disease is associated with worse outcome. The aim of this epidemiological study was to evaluate the prevalence of different manifestation of atherothrombosis and its risk factors in the group of 2969 ambulatory patients with coronary artery disease. Mean age of investigated group was 61.2 +/- 10.5 years and 64% patients were male. Abdominal aortic aneurysm was diagnosed in 1.2% of patients, intermittent claudication in 13%, carotid stenosis in 5%. History of stroke was given in 4.4% cases and history of TIA in 7%. Only in 8% of patients with intermittent claudication ankle-brachial index was assessed. We conclude that among patients with coronary artery disease other arteries atherothrombotic involvement is diagnosed in our country infrequently and efforts to recognize other symptoms of atherothrombosis should be encouraged.

Aged↗
PubMed1989

[Risk of developing coronary disease in relation to the level of education and type of work in a male population of Warsaw factories. I. Evaluation of the relation of the level of education and analyzed risk factors of coronary disease].

5426 males aged 40-59 of 14 Warsaw factories underwent the study to evaluate the relationship between coronary artery disease risk factors and education levels. Greater mean body mass, total cholesterol level and greater mean value of Rose's coefficient were significantly more frequently observed in men with secondary and university education. Persons with technical or elementary education have been significantly more frequently smoking cigarettes and overweighted.

Adult↗
PubMed2001

Predictors of coronary disease in patients with end stage renal disease.

Patients with end stage renal disease have a high prevalence of cardiovascular disease and coronary arteriography is often routinely performed prior to kidney transplantation. However, the value of the conventional risk factors and non-invasive markers of coronary artery disease (CAD) in triaging patients for coronary arteriography has not been fully examined. 116 patients with end stage renal disease were evaluated. Coronary arteriography was performed in all patients either for a suspicion of CAD or as part of a routine pre-transplant evaluation. Lesions causing > or = 50% luminal diameter stenosis in any of the three major coronary artery systems were considered significant. The mean age was 53.3 +/- 9.3 years. Significant CAD was present in 69 patients (60%). Increasing age, family history of premature ischemic heart disease, the presence of angina, abnormal Q waves on the ECG or abnormal ST segment depression and the presence of coronary calcification were significant markers of coronary artery disease. However male gender, diabetes mellitus and obesity did not correlate with coronary disease. Even though hypertension, hypercholesterolemia and smoking were also not useful predictors these could have been modified by the renal failure. In conclusion increasing age, a family history of premature ischemic heart disease and some non-invasive markers were useful predictors of coronary disease.

Adult↗
PubMed1989

Comparison of coronary angioplasty with medical treatment for single- and double-vessel coronary disease with left anterior descending coronary involvement: long-term outcome based on an Emory-CASS registry study.

The 3 to 5-year clinical outcomes of 627 consecutive patients selected for treatment with percutaneous transluminal coronary angioplasty (PTCA) at Emory University Hospital for one- or two-vessel coronary artery disease with involvement of the left anterior descending coronary artery, between July 1981 and June 1983, and 865 patients in the Coronary Artery Surgery Study with similar coronary artery disease involvement selected for medical therapy between 1975 and 1979 were compared. Cox analyses and stratified life table analyses were used to adjust for differences in 13 variables including concurrent medical therapy. Complete follow-up was obtained in 97% of PTCA patients and 99% of medically treated patients. After correction for baseline differences in significantly predictive variables, there was no difference between the relative risk of death after PTCA vs medical therapy (RR = 0.7; p = 0.36). However, results of analysis of prospectively defined subsets showed a potential survival benefit after PTCA for patients with an ejection fraction less than 50% (RR = 0.2; p = 0.02) and also for patients with two-vessel disease (RR = 0.2; p = 0.04). For the groups as a whole there was no difference in risk of infarction after PTCA and medical therapy (RR = 0.8; p = 0.58). However, for patients with 90% to 99% LAD stenosis there was a trend toward lessened risk of infarction after PTCA (RR = 0.6; p = 0.15). No patient subset had a higher risk of death or infarction with PTCA (p less than or equal to 0.15). The likelihood of later surgery was increased after PTCA (RR = 1.5; p = 0.002). Angina, employment, and activity levels were improved after PTCA. Thus PTCA compared to medical therapy was associated with improved functional status and may decrease the risk of death and infarction in certain patient subsets. However, bypass surgery was more often performed in patients initially treated with PTCA. These data should be interpreted in light of their nonrandomized study origin and generation from different clinical sites.

Activities of Daily Living↗
PubMed1989

Complex angioplasty: single versus multiple dilatations in multivessel coronary disease patients.

Percutaneous transluminal coronary angioplasty (PTCA) has become an accepted therapy in the management of selected patients with obstructive coronary disease, including selected patients with multivessel disease. This article reports the authors' experience with PTCA in patients who underwent single or multiple dilatation angioplasty, their outcome, and follow-up. It also provides an additional perspective to the multivessel coronary disease patient.

Adult↗
PubMed1991

Use of Doppler's echocardiography for the examination of Nitromint spray in coronary disease patients and in patients who underwent coronary bypass surgery.

The changes of "E" and "A" waves of mitral inflow have been measured before, and 1,2,3,5 and 10 minutes after the use of Nitromint spray (EGIS) in coronary disease patients (14 cases), and in patients who had undergone bypass surgery (7 cases), by pulsatile wave Doppler's echocardiography. The "E" wave gave more information on the preload decreasing effect of the drug, than the "A" wave (significant decrease in minutes 1,2,3,5 and 10 following spraying). On the basis of the changes of the "E" wave compared in the two patient groups a difference in the responses to Nitromint spray could be revealed: the non-operated coronary disease patients responded with a more marked decrease of preload to Nitromint spray than the revascularize patients.

Adult↗
PubMed2003

Statin use is associated with enhanced collateralization of severely diseased coronary arteries.

BACKGROUND: The presence of coronary collateral vessels has been associated with improved clinical outcome in patients with coronary artery disease. Animal experiments have shown that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) can promote angiogenesis in ischemic tissues in a cholesterol-independent manner. We hypothesized that statin therapy is associated with increased coronary collateral formation in patients with severe coronary artery disease. METHODS AND RESULTS: Patients undergoing clinically indicated coronary angiography at the Tufts-New England Medical Center from September 2000 to April 2001 who had at least 1 major coronary artery occlusion, or a stenosis of > or =95% with Thrombolysis In Myocardial Infarction (TIMI) trial grade < or =1 anterograde flow on their angiograms, were included. Fifty-one patients were taking statins before admission, and 43 patients were not. Their angiograms were reviewed and coronary collaterals were graded from 0 to 3 according to the Cohen-Rentrop method. The statin-treated group had a significantly higher mean collateral score compared with the patients not taking statins (2.05 vs 1.52, P =.005). Multivariate analysis supported the significance of the effect of statin therapy on the collateral score. There was no relation between collateral score and low-density lipoprotein levels (r = -0.06, P =.64). The statin-treated group also had a significantly higher left ventricular ejection fraction compared to the patients not taking statins (51% vs 44%, P <.05). CONCLUSIONS: Statin therapy is associated with enhanced coronary collateral formation in patients with severely diseased coronary arteries.

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PubMed1998

[The dipyridamole test in coronary disease diagnosis].

One of the coronary disease diagnostic methods of big sensitivity and specificity is perfusive effort scintrigraphy of myocardium by means of thallium-201. For few years the dipyridamole test has been applied instead of the effort test. Perfusive scintigraphy of myocardium after provocative treatment by means of dipyridamole and then selective coronary arteriography of coronary vessels, have been carried out at 25 patients with ischemia. These studies showed almost 100% of conformability with exposing the ischemia zones in scintigraphy and coronary arteriography in cases of coronary vessels contraction over 50%. The dipyridamole test also revealed the ischemzones in myocardium that are in agreement with coronary vascularization deficiency. That test can be utilized in revealing the coronary disease and is helpful in qualifying patients for coronary arteriography. At the same time studies that have been carried out prove that applying dipyridamole is absolutely contraindicated in treating of coronary disease of the organic background.

Adult↗
PubMed1999

Effects of L- and D-arginine on the basal tone of human diseased coronary arteries and their responses to substance P.

OBJECTIVE: To assess the effects of substance P administration alone and in combination with L- and D-arginine in patients with normal angiograms and in patients with coronary artery disease. DESIGN: Intracoronary infusions of (a) normal saline, (b) the receptor mediated nitric oxide stimulant substance P (5.6 and 27.8 pmol/min) before and after L- or D-arginine (50 and 150 micromol/min), and (c) glyceryl trinitrate (250 microg bolus) were given to 17 patients with coronary artery disease and stable angina, and to six patients with normal angiograms. The diameter of angiographically normal proximal and distal segments and coronary stenoses were measured by computerised quantitative angiography. RESULTS: L-arginine administration was associated with significant dilatation of stenoses (p < 0.01) of proximal segments of both "normal" (p < 0.05) and diseased (p < 0.01) arteries, and of distal segments of diseased arteries (p < 0.01). No significant changes were associated with D-arginine administration. Dose dependent dilatation of all segments including stenoses, was observed with substance P both before and after L-arginine infusion (p < 0.01). The magnitude of dilatation of stenoses and all segments of both "normal" and diseased coronaries was greater after L-arginine (p < 0.05) but not D-arginine and substance P infusion, than it was after saline and substance P infusion. Administration of D- or L-arginine did not change the magnitude of substance P induced dilatation. CONCLUSIONS: Diseased and "normal" coronary arteries dilated in response to substance P and L-arginine but were unaffected by D-arginine infusion. The magnitude of the response to substance P was not increased by L-arginine administration, indicating that it is not critically dependent on the availability of substrate for nitric oxide synthase.

Analysis of Variance↗
PubMed2003

Poor sleep increases the prospective risk for recurrent events in middle-aged women with coronary disease. The Stockholm Female Coronary Risk Study.

OBJECTIVE: We investigated the prognostic impact of sleep complaints in women with CHD and also examined whether the association between sleep problems and cardiac events could be explained by depression. METHODS: All women patients, aged 65 or under who were admitted with an acute coronary syndrome between 1991 and 1994 in Stockholm, were followed for 5 years for recurrent coronary events. Sleep complaints and depression were measured at baseline using standardized questionnaires. Quality of sleep, restorative function of sleep, and snoring were assessed by the Karolinska Sleep Questionnaire (KSQ), and depressive symptoms by a questionnaire developed by Pearlin. RESULTS: Poor sleep quality was associated with recurrent cardiac events. After multivariate adjustment for age, and standard risk factors, the hazard ratio (HR) for women with poor as compared with good sleep quality was 2.5 (95% CI: 1.2-5.2). Controlling for depression did not change this result substantial. Not waking up well-rested yielded a similarly increased risk (HR = 2.4; 95% CI: 1.2-4.6). Women with both poor sleep quality and depression had a worse prognosis than women free from these complaints (HR = 2.6; 95% CI: 1.0-6.4). Heavy snoring was not related to prognosis. CONCLUSIONS: Our results indicate that poor sleep and sleep without a restorative function are associated with poor prognosis in female coronary patients. This association is not explained by depressive symptoms or by standard coronary risk factors.

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