Primary Cardiac Diffuse Large B-cell Lymphoma Promptly and Safely Diagnosed with Pericardial Effusion Cytology.

Primary cardiac lymphoma is a rare condition with a poor prognosis, and patients are at risk for sudden cardiac death. A prompt diagnosis and early treatment are therefore essential. A 68-year-old woman was admitted for shortness of breath and peripheral edema. Echocardiograms showed massive pericardial effusion and a mass on the free wall of the right atrium and ventricle. Subsequent pericardial effusion cytology revealed diffuse large B-cell lymphoma. We started chemotherapy with rituximab and achieved a good clinical course. This case is made unique by the use of pericardial effusion cytology, which allowed us to diagnose primary cardiac lymphoma promptly and safely.

Impact of Fetuin-A on progression of calcific aortic valve stenosis - The COFRASA - GENERAC study.

BACKGROUND: Aortic stenosis (AS) is an active disease, but the determinants of AS progression remain largely unknown. Low levels of Fetuin-A, a powerful inhibitor of ectopic calcification, have been linked to ectopic calcium tissue deposition but its role in AS progression has not been clearly evaluated. METHODS: In our ongoing prospective cohort (COFRASA/GENERAC), serum Fetuin-A level was measured at baseline and AS severity was evaluated at baseline and yearly thereafter using echocardiography (mean pressure gradient (MPG)) and computed tomography (degree of aortic valve calcification (AVC)). Annual progression was calculated as [(final measurement-baseline measurement)/follow-up duration] for both MPG and AVC measurements. RESULTS: We enrolled 296 patients (74 ±â€¯10 years,73% men); mean follow-up duration was 3.0 ±â€¯1.7 years. No correlation was found between baseline serum Fetuin-A (0.55 ±â€¯0.15 g/L) and baseline AS severity (r = 0.25, p = 0.87 for MPG; r = 0.06, p = 0.36 for AVC). More importantly, there was no correlation between baseline serum Fetuin-A level and AS progression either assessed using MPG or AVC (both r = 0.01, p = 0.82). In bivariate analysis, after adjustment for age, gender, baseline AS severity, or valve anatomy, Fetuin-A was not associated with AS progression (all p > 0.20). The absence of link with AS progression was further confirmed by the absence of link betwen serum Fetuin-A and the occurrence of AS-related events (p = 0.17). CONCLUSIONS: In a large prospective cohort of AS patients, serum Fetuin-A was not associated to hemodynamic or anatomic AS progression. Despite its capacity to inhibit ectopic calcium deposition, Fetuin-A serum level seemed to have minor influence on AS progression.

Prognostic Value of Exercise-Stress Echocardiography in Asymptomatic Patients With Aortic Valve Stenosis.

OBJECTIVES: This study sought to evaluate the prognostic value of mean pressure gradient (MPG) increase and peak systolic pulmonary artery pressure (SPAP) measured during exercise stress echocardiography in asymptomatic patients with aortic stenosis (AS). BACKGROUND: Exercise testing is recommended in asymptomatic AS patients, but the additional value of exercise-stress echocardiography, especially the prognostic value of MPG increase and peak SPAP, is still debated. METHODS: We enrolled all consecutive patients with pure, isolated, asymptomatic AS and preserved ejection fraction ≥50% and normal SPAP (<50 mm Hg) who underwent symptom-limited exercise echocardiography at our institution. Occurrence of AS-related events (symptoms or congestive heart failure) or occurrence of aortic valve replacement was recorded. RESULTS: We enrolled 148 patients (66 ± 15 years of age; 74% males; MPG: 47 ± 13 mm Hg; SPAP: 34 ± 6 mm Hg). No complications were observed. Thirty-six patients (24%) had an abnormal exercise test result (occurrence of symptoms, fall in blood pressure, and/or ST-segment depression) and were referred for surgery. Among the 112 patients with a normal exercise test result, 38 patients (34%) had abnormal exercise echocardiography scores (MPG increase >20 mm Hg and/or SPAP at peak exercise >60 mm Hg). These 112 patients were managed conservatively. During a mean follow-up of 14 ± 8 months, an AS-related event occurred in 30 patients, and 25 patients underwent surgery. Neither MPG increase >20 mm Hg nor peak SPAP >60 mm Hg was predictive of occurrence of AS-related events or aortic valve replacement (all p > 0.20). In contrast, baseline AS severity was an important prognostic factor (all p < 0.01). CONCLUSIONS: In this observational study including 148 patients with asymptomatic AS, we confirmed and extended the importance of exercise testing for unveiling functional limitation. More importantly, neither the increase in MPG nor in SPAP at peak exercise was predictive of outcome. Our results do not support the use of these parameters in risk-stratification and clinical management of asymptomatic AS patients.

Influence of metabolic syndrome and diabetes on progression of calcific aortic valve stenosis.

BACKGROUND: Determinants of the progression of aortic stenosis (AS) remained unclear. Metabolic syndrome (MetS) and diabetes are suspected to play an active role but literature is scarce and results conflicting. We sought to assess their impact in an ongoing prospective cohort of asymptomatic patients with at least mild AS. METHODS: We enrolled 203 patients (73±9years, 75% men) with at least 2years of follow-up. Risk-factors assessment was performed at baseline. Annual progression was calculated as [(final-baseline measurements)/follow-up duration] for both mean pressure gradient (MPG) and degree of aortic valve calcification (AVC) measurements. RESULTS: Ninety-nine patients (49%) had MetS and 50 (25%) had diabetes (including 39 with MetS). After a mean follow-up of 3.2±1.2years, AS progression was not different between patients with and without MetS either using MPG (+3±3 vs. +4±4mmHg/year, p=0.25) or AVC (+211±231 vs. +225±222AU/year, p=0.75). Same results were obtained for patients with diabetes (3±3 vs. 4±4mmHg/year p=0.53, 187±140 vs. 229±248AU/year p=0.99). MetS had no impact on AS progression in all tested subgroups based on age, statin prescription, valve anatomy and AS severity (all p≥0.10). CONCLUSION: In our prospective cohort of AS patients, we found no impact of MetS or diabetes on AS progression. Although MetS and diabetes should be actively treated, no impact on AS progression should be expected. Our results support the theory that if cardiovascular risk-factors may play a role at the early phase of AS disease they have no or limited influence on AS progression.

Mortality risk of triglyceride levels in patients with coronary artery disease.

OBJECTIVE: The association between triglyceride level and the risk of coronary artery disease (CAD) remains controversial. In particular, the prognostic significance of triglyceride levels in established CAD is unclear. We aimed to assess the relationship between triglyceride levels and long-term (>10 years) prognosis in a cohort of patients after complete coronary revascularisation. DESIGN: Observational cohort study. SETTING: Departments of cardiology and cardiovascular surgery in a university hospital. PATIENTS: Consecutive patients who had undergone complete revascularisation between 1984 and 1992. All patients were categorised according to the quintiles of fasting triglyceride levels at baseline. MAIN OUTCOME MEASURES: The risk of fasting triglyceride levels for all-cause and cardiac mortality was assessed by multivariable Cox proportional hazards regression analyses. RESULTS: Data from 1836 eligible patients were assessed. There were 412 (22.4%) all-cause deaths and 131 (7.2%) cardiac deaths during a median follow-up of 10.5 years. Multivariable analyses including total and high-density lipoprotein cholesterol and other covariates revealed no significant differences in linear trends for all-cause mortality according to the quintiles of triglyceride (p for trend=0.711). However, the HR increased with the triglyceride levels in a significant and dose-dependent manner for cardiac mortality (p for trend=0.031). Multivariable analysis therefore showed a significant relationship between triglyceride levels, when treated as a natural logarithm-transformed continuous variable, and increased cardiac mortality (HR 1.51, p=0.044). CONCLUSIONS: Elevated fasting triglyceride level is associated with increased risk of cardiac death after complete coronary revascularisation.

Prognostic impact of chronic kidney disease on 10-year clinical outcomes among patients with acute coronary syndrome.

BACKGROUND: Chronic kidney disease (CKD) is closely associated with a higher risk of cardiovascular disease. However, whether patients with acute coronary syndrome (ACS) and CKD are at increased risk for long-term mortality after coronary revascularization remains unknown. METHODS AND RESULTS: Data from consecutive patients with ACS who had undergone coronary revascularization, including percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) were analyzed. The estimated glomerular filtration rate (eGFR) was calculated using the current Japanese equation and CKD was defined as eGFR < 60 mL/min/1.73 m(2). Among 375 enrolled patients with ACS, 75 (20.0%) had CKD. During a follow-up period of 10.0 ± 3.4 years, the total number of deaths was 80 (21.3%), of which 36 (9.6%) were due to cardiovascular causes. Kaplan-Meier analysis showed that the presence of CKD was associated with a significant increase in mortality from all causes (log-rank test, p<0.001) and cardiovascular mortality (p<0.001). Cox proportional-hazard analysis revealed that CKD increased the risk of mortality with a hazard ratio of 2.31 (95% confidence interval (CI): 1.25-4.29, p=0.008) and of cardiovascular death with a hazard ratio of 3.76 (95% CI: 1.60-8.80, p=0.002) in patients with ACS. CONCLUSIONS: CKD is a powerful determinant of long-term all-cause and cardiovascular mortality after ACS.

Probucol therapy improves long-term (>10-year) survival after complete revascularization: a propensity analysis.

OBJECTIVE: Probucol has anti-atherosclerotic properties and has been shown to reduce post-angioplasty coronary restenosis. However, the effect of probucol therapy on long-term (>10 years) outcome following coronary revascularization is less well established. Accordingly, we sought to determine if probucol therapy at the time of complete coronary revascularization reduces mortality in patients with coronary artery disease (CAD). METHODS: We collected data from 1694 consecutive patients who underwent complete revascularization (PCI and/or bypass surgery). Mortality data were compared between patients administered probucol and those not administered probucol at the time of revascularization. A propensity score (PS) was calculated to evaluate the effects of variables related to decisions regarding probucol administration. The association of probucol use and mortality was assessed using 3 Cox regression models, namely, conventional adjustment, covariate adjustment using PS, and matching patients in the probucol and no-probucol groups using PS. RESULTS: In the pre-match patients, 231 patients were administered probucol (13.6%). During follow-up [10.2 (SD, 3.2) years], 352 patients died (including 113 patients who died of cardiac-related issues). Probucol use was associated with significant decrease in all-cause death (hazard ratio [HR], 0.65; P=0.036 [conventional adjustment model] and HR, 0.57; P=0.008 [PS adjusted model]). In post-match patients (N=450, 225 matched pair), the risk of all-cause mortality was significantly lower in the probucol group than in the no-probucol group (HR, 0.45; P=0.002). CONCLUSION: In CAD patients who had undergone complete revascularization, probucol therapy was associated with a significantly reduced risk of all-cause mortality.

Association of low glomerular filtration rate with the incidence of stroke in patients following complete coronary revascularization.

BACKGROUND: Low glomerular filtration rate (GFR) is associated with a worse outcome after coronary revascularization. Recently, a new specific equation to calculate the estimated GFR (eGFR) in Japanese populations has been reported, and it might be more accurate than the previously used equations. However, the relationship between a low GFR defined using the new equation for the Japanese population and the incidence of stroke following complete coronary revascularization is not yet known. METHODS AND RESULTS: Consecutive patients who underwent complete coronary revascularization (percutaneous coronary intervention and bypass surgery) between 1984 and 1992 were enrolled. Patients on dialysis were excluded. Enrolled patients were divided into 2 groups: the preserved GFR group and the low GFR group. Low GFR was defined as eGFR<60 ml·min⁻¹·1.73 m⁻². The incidence of fatal and non-fatal stroke was compared between the groups. Among the 1,809 patients that were enrolled, 321 were placed in the low GFR group. During follow up (mean, 11.4 [2.9] years), there were 127 (7.0%) stroke events. Multivariable analysis using a Cox proportional hazards regression model revealed that the incidence of stroke was significantly higher in the low GFR group than in the preserved GFR group (hazard ratio, 1.66; 95% confidence interval, 1.10-2.48; P = 0.008). CONCLUSIONS: Low GFR, defined as eGFR <60 ml·min⁻¹·1.73 m⁻², using a new specific equation for the Japanese population was associated with an increased risk of fatal and non-fatal stroke over a 10-year period after complete coronary revascularization.

Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization.

An equation that accurately estimates the glomerular filtration rate (GFR) in the Japanese population has been proposed; however, the prognostic significance of estimated GFR (eGFR) defined according to this equation has not been reported. In addition, the prognostic significance of eGFR during long-term follow-up after complete coronary revascularization remains unclear. We assessed the prognostic significance of eGFR values, estimated by the new Japanese equation, in a cohort of patients following complete coronary revascularization. We studied consecutive patients with complete revascularization from 1984 to 1992. Patients on dialysis were excluded. A novel Japanese equation was used to estimate the GFR: eGFR=194×(serum creatinine)(-1.094)×(age)(-0.287)(×0.739 if female). Multivariate Cox proportional hazards regression analyses were performed to determine all-cause and cardiac mortality. We analyzed data of 1809 patients, of whom 571 (31.6%) had an eGFR of ≥90 mlmin(-1) per 1.73 m(2), 917 (50.7%) had an eGFR of 60-89 mlmin(-1) per 1.73 m(2), 298 (16.5%) had an eGFR of 30-59 mlmin(-1) per 1.73 m(2) and 23 (1.3%) had an eGFR of <30 mlmin(-1) per 1.73 m(2). During follow-up (11.4±2.9 years), there were 397 (22.0%) all-cause and 123 (6.8%) cardiac deaths overall. Patients with an eGFR of 30-59 mlmin(-1) per 1.73 m(2), and <30 mlmin(-1) per 1.73 m(2) revealed significantly greater risk of all-cause mortality than those with eGFR of ≥90 mlmin(-1) per 1.73 m(2) (hazard ratio (HR) 1.91, P<0.001, HR 3.35, P<0.001, respectively). Furthermore, incidence of cardiac death was higher in patients with an eGFR of 30-59 mlmin(-1) per 1.73 m(2) than those with an eGFR of ≥90 mlmin(-1) per 1.73 m(2) (HR 2.89, P<0.001). GFR as estimated using the new Japanese equation had a prognostic significance among patients with complete coronary revascularization.

Synergistic effects of calcium-channel and angiotensin-receptor blockers on endothelial function and inflammatory responses in a porcine drug-eluting stent model.

BACKGROUND: The rate of stent thrombosis is increased in association with drug-eluting stents (DES) due to delayed endothelialization and prolonged inflammation. Clinical studies have shown that either an angiotensin-receptor blocker (ARB) or a calcium-channel blocker (CCB) can improve endothelial dysfunction and inhibit inflammatory reactions in patients with hypertension. The effects of co-administered CCB and ARB on vascular protection after DES implantation, however, remain unknown. METHODS AND RESULTS: Pigs (n=24) were implanted with coronary stents and randomly assigned to control, CCB, ARB or CCB + ARB groups. Endothelium-mediated vasodilation at the distal edge was significantly impaired compared to the intact site in the control group (P<0.05), but the difference between two sites in the CCB + ARB group was not significant. The combination produced a synergistic effect at the distal edge compared to the ARB, CCB and control groups (P<0.05). The expression of tumor necrosis factor-alpha and inflammatory cell adhesion were significantly inhibited in the CCB or ARB monotherapy groups compared with the control (P<0.05). The combination of CCB + ARB also improved inflammation. CONCLUSIONS: Implanted DES exert adverse effects such as endothelial dysfunction and inflammatory reactions. The administration of either a CCB or an ARB reversed this adverse effect. Furthermore, recovery was synergistically enhanced by a CCB combined with an ARB.

Long-term efficacy of pravastatin therapy in diabetic patients undergoing complete coronary revascularization.

AIM: The long-term effect of statin therapy in diabetic patients after coronary revascularization is not well established. Accordingly, we sought to determine if whether statin therapy initiated at the time of complete revascularization including percutaneous coronary intervention (PCI) and/or bypass surgery reduces total and cardiac mortality among diabetic patients. METHODS: We collected data from 1,138 consecutive patients who underwent complete revascularization (PCI and/or bypass surgery). We then compared all-cause and cardiac mortality rates in 499 patients with diabetes mellitus of whom 149 (29.9%) were treated with statin at the time of revascularization. To adjust the variables that would have been related to the decision regarding statin administration, a propensity score was computed and multivariate Cox regression was carried out. RESULTS: During follow-up (8.8+/-2.6 years), 103 patients died (including 43 who died of cardiac causes). The Multivariate analysis showed statin therapy to be significantly associated with reduced cardiac mortality (HR 0.39, 0.16-0.95; p=0.039), but not with all-cause mortality. CONCLUSION: Statin therapy was associated with a significantly reduced risk of cardiac mortality in patients with diabetes mellitus and coronary artery disease after complete revascularization.

The impact of pravastatin therapy on long-term outcome in patients with metabolic syndrome undergoing complete coronary revascularization.

BACKGROUND: Few studies dealing with the efficacy of statin therapy among patients with metabolic syndrome (MS) and coronary artery disease (CAD) have been conducted. In particular, there have been no studies of the efficacy of statins among Asian MS patients with treated CAD. METHODS AND RESULTS: Data from 1,138 consecutive patients who underwent complete revascularization (coronary intervention or bypass surgery) were collected. Of these, 529 patients who satisfied the criteria for MS using the American Heart Association/National Heart, Lung and Blood Institute statement (body mass index >or=25 was used instead of waist circumference) were assessed. All-cause and cardiovascular mortality of patients given statins and those not given statins at least 2 weeks before the complete revascularization were compared. To adjust for the variables that would have been related to the decision to give statins, the propensity score was calculated, and multivariate Cox regression was carried out. Statins were given to 146 patients. During follow-up (9.1 +/-2.5 years), 104 patients died. On multivariate analysis, statin use was significantly associated with reduced all-cause (hazard ratio (HR) 0.56, 0.31-0.99; P=0.049) and cardiovascular (HR 0.53, 0.30-0.96; P=0.042) mortality. CONCLUSIONS: In patients with MS and CAD, statins given at least 2 weeks before the complete revascularization, was associated with a reduced risk of all-cause and cardiovascular mortality.

Relationship between the metabolic syndrome and the incidence of stroke after complete coronary revascularization over a 10-year follow-up period.

OBJECTIVES: The prevalence of the metabolic syndrome, regarded as an important risk factor for coronary artery disease and stroke, is growing. However, the association between the metabolic syndrome and stroke, particularly in patients following coronary revascularization, remains unknown. Therefore, the relationship between the metabolic syndrome and stroke was examined among patients who had achieved complete coronary revascularization. METHODS: 1836 consecutive patients who had achieved complete revascularization from 1984 to 1992 were studied. The patients were categorized according to the presence or absence of the metabolic syndrome using the modified AHA/NHLBI statement (obesity was defined as a body mass index >or=25 kg/m(2)). Multivariate Cox proportional hazards regression was used for adjusted analyses for all-cause and cardiac mortality, as well as for the incidence of fatal and non-fatal stroke. RESULTS: The progress of 826 (45.0%) patients with the metabolic syndrome and 1010 (55.0%) patients without the metabolic syndrome was analyzed. The mean follow-up was 11.4+/-2.9 years. Overall, there were 130 (7.1%) strokes, and the risk of stroke was significantly higher in patients with metabolic syndrome than in those without metabolic syndrome (HR 1.3; 95% CI 1.0-2.1; P=0.045). CONCLUSION: The presence of the metabolic syndrome is a significant predictor of stroke, as well as all-cause and cardiac mortality, among patients who achieve complete coronary revascularization.

Impact of metabolic syndrome on 10-year clinical outcomes among patients with acute coronary syndrome.

BACKGROUND: Metabolic syndrome (MetS) is a risk factor and prognosticator for ischemic heart disease, but its actual effect on long-term mortality after acute coronary syndrome (ACS) remains unknown. METHODS AND RESULTS: All-cause death and cardiovascular death were investigated among patients with ACS upon admission who underwent complete revascularization by either percutaneous coronary intervention or bypass surgery between 1984 and 1992. MetS was defined according to the NCEP/ATPIII criteria modified for waist circumference. From among 1,836 patients who underwent complete revascularization during the study period, 384 (21.0%) with ACS were enrolled, of whom 163 (42.5%) had MetS. During a mean follow-up of 10.4 +/-3.4 years, the total number of deaths was 83 (21.6%), of which 38 (9.9%) were from cardiovascular causes. Cox proportional hazard analysis revealed that MetS increased the risk of mortality by a ratio of 1.62 (95% confidence interval (CI) 1.01-2.59, P=0.046) and of cardiovascular death by 2.40 (95%CI 1.16-4.94, P=0.018) in patients with ACS. CONCLUSIONS: MetS is a powerful determinant of long-term all-cause and cardiovascular death after ACS. Furthermore, MetS and ACS might jointly exacerbate poor long-term outcomes.

The adverse prognostic significance of the metabolic syndrome with and without hypertension in patients who underwent complete coronary revascularization.

OBJECTIVES: The metabolic syndrome is associated with high risk for long-term coronary artery disease mortality. However, few studies have examined the prognostic importance of the metabolic syndrome with and without hypertension. METHODS: The data of 1133 nondiabetic patients who underwent complete revascularization were analyzed. The patients were categorized by the presence of the metabolic syndrome using the modified American Heart Association/National Heart, Lung, and Blood Institute statement and by the presence of hypertension. All patients were divided into four groups: neither the metabolic syndrome nor hypertension (group 1); the metabolic syndrome without hypertension (group 2); hypertension without the metabolic syndrome (group 3); and both the metabolic syndrome and hypertension (group 4). Cox proportional hazards were used in adjusted analyses for all-cause and cardiac mortality, as well as for the composite incidence of fatal and nonfatal stroke. RESULTS: The progress of 276 (24.4%) patients in group 1, 413 (36.5%) in group 2, 105 (9.3%) in group 3, and 339 (29.9%) in group 4 was analyzed. The mean follow-up was 10.4 +/- 3.4 years. Patients in group 4 had a higher risk of all-cause mortality (hazard ratio 1.78, P = 0.004). In addition, patients in groups 2 and 4 had a higher risk of cardiac mortality (group 2: hazard ratio 2.84, P = 0.04, group 4: hazard ratio 3.91, P = 0.001) and stroke (group 2: hazard ratio 2.46, P = 0.03, group 4: hazard ratio 2.09, P = 0.03). CONCLUSION: The metabolic syndrome both with and without hypertension is associated with increased risk of cardiac mortality and stroke incidence in patients who underwent complete coronary revascularization.

Skeletonization with an ultrasonic scalpel is as safe as a non-skeletonized dissection in preserving the endothelial function of the human gastroepiploic artery.

The right gastroepiploic artery (GEA) is frequently used as another in situ artery, other than the internal thoracic artery (ITA) in coronary artery bypass grafting (CABG). Skeletonizing the graft with an ultrasonic scalpel is now regarded as a useful technique; however, this technique may damage the endothelial function during harvesting the graft resulting in postoperative graft stenosis or occlusion. In the present study, GEA segments from nine patients were excised in both a skeletonized and non-skeletonized manner with an ultrasonic scalpel, and then were transported to the laboratory. The vessels were trimmed as rings, and were allotted to the group of skeletonized or non-skeletonized, accordingly. The force development in response to 1 mumol/l norepinephrine did not differ between the skeletonized and non-skeletonized groups. Endothelium-dependent relaxation induced by either acetylcholine or bradykinin was not impaired in the skeletonized group in comparison to the non-skeletonized group. No significant difference was observed in endothelium-independent relaxation elicited by sodium nitroprusside. Therefore, the skeletonization of the GEA with an ultrasonic scalpel was thus found to be as safe as a non-skeletonized dissection in preserving the vascular contractile ability or endothelium-dependent and -independent relaxation of the graft.

Propensity analysis of 12 years outcome after bypass graft or balloon angioplasty in patients with multivessel coronary artery disease.

BACKGROUND: Randomized trials have shown that long-term mortality rates are similar between patients with multivessel coronary artery disease (CAD) treated by percutaneous coronary intervention (PCI) and by coronary artery bypass graft (CABG). However, there are scant data regarding more than 10 years long-term follow-up in Asian populations. Therefore, we performed a pooled analysis of our observational data evaluating long-term outcomes of PCI as compared with CABG in patients with multivessel disease among a Japanese population. METHODS AND RESULTS: We enrolled 1364 patients, of whom 225 (16.5%) and 1139 (83.5%) underwent PCI and CABG, respectively. During follow-up (12.8±3.4 years), 377 patients died (cardiac death, 125; cardiovascular death, 177) and 322 underwent revascularization. We predicted the probability of undergoing PCI using propensity analysis. After adjusting for baseline variables including propensity score, PCI and CABG did not differ in terms of all-cause (hazard ratio (HR) 1.12; 95% confidence interval (CI) 0.72-1.73; p=0.62), cardiac (HR 0.62; 95%CI 0.32-1.23; p=0.17), and cardiovascular mortality (HR 0.83; 95%CI 0.45-1.52; p=0.54). However, the incidence of revascularization was significantly higher in the PCI group than in the CABG group (HR 0.20; 95%CI 0.15-0.28; p<0.0001). CONCLUSION: Although PCI was associated with a significantly higher risk of revascularization than CABG, long-term mortality rates did not significantly differ between the two procedures in this oriental population.

Dipyridamole therapy improves long-term survival after complete revascularization in patients with impaired cardiac function: a propensity analysis.

BACKGROUND: Although dipyridamole is no longer used as a mainstream medication for coronary artery disease because of the coronary steal phenomenon, recent studies have shown that the elevation of serum adenosine levels caused by dipyridamole improves cardiac function in heart failure patients. In the present study it was investigated whether use of dipyridamole at the time of complete revascularization affects long-term mortality in patients with impaired left ventricular (LV) function. METHODS AND RESULTS: The 1,836 consecutive patients who underwent complete revascularization between 1984 and 1992 were assessed; 254 patients with impaired LV function (ejection fraction < 50%) were enrolled. Cox proportional hazards regression adjusted for baseline covariates and the propensity score were used to compare the risks for mortality between patients who did and did not take dipyridamole. The mean follow-up period was 12 years; 178 patients (70.1%) took dipyridamole and there were 66 (37.1%) all-cause and 22 (12.4%) cardiac deaths in that group. In the multivariate analysis, the dipyridamole group had a lower risk for both all-cause (hazard ratio (HR) 0.54; p = 0.005) and cardiac mortality (HR 0.42; p = 0.010). CONCLUSION: The use of dipyridamole reduced both all-cause and cardiac mortality in patients with impaired LV function.

Impact of metabolic syndrome among patients with and without diabetes mellitus on long-term outcomes after percutaneous coronary intervention.

Metabolic syndrome (MS) is highly prevalent and an established key risk factor for coronary artery disease, regardless of the presence or absence of diabetes mellitus (DM). Long-term follow-up studies have addressed the influence of MS with and without DM on the prognosis of patients undergoing percutaneous coronary intervention (PCI). We classified 748 consecutive patients who had undergone PCI into four groups as follows: neither DM nor MS, DM alone, MS alone, and both DM and MS. Post hoc analyses were conducted using prospectively collected clinical data. Multivariate Cox regression was used to evaluate the risk within each group for all-cause mortality and composite cardiac events (cardiac death, non-fatal acute coronary syndrome), adjusting for age, gender, body mass index, low-density lipoprotein (LDL) cholesterol level, hypertension, smoking, prior coronary artery bypass graft, presentation of acute coronary syndrome, left ventricular ejection fraction, multivessel disease, and procedural success. The progress of 321 (42.9%) patients with neither DM nor MS, 109 (14.6%) patients with DM alone, 129 (17.2%) patients with MS alone, and 189 (25.3%) patients with both DM and MS was followed up for a mean of 12.0+/-3.6 years. Patients with both DM and MS had significant risk for increased all-cause mortality (2.10 [1.19-3.70]). Patients with MS alone (2.14 [1.31-3.50]) and with both DM and MS (1.87 [1.18-2.96]) were at significant risk for increased cardiac events. In conclusion, the risk of cardiac events is significantly increased in patients with metabolic syndrome following PCI, irrespective of DM.