Does Routine Sedation Influence Anxiety and CRP levels in Patients Undergoing Elective Coronary Catheterization?

BACKGROUND: Cardiac catheterization is associated with patient anxiety. Benzodiazepines are often used to relieve anxiety in this setting. The association between anxiety level and C-reactive protein (CRP) remains equivocal. We sought to determine whether anxiety and CRP levels in patients undergoing elective left heart catheterization differ when routine sedation with midazolam is administered. METHODS: Patients undergoing elective left heart catheterization were randomly assigned to receive 2 mg of midazolam intravenously or placebo before access insertion in a double-blinded manner. Levels of anxiety were assessed using the State-Trait Anxiety Inventory for Adults (short form) and high-sensitivity CRP at the time of admission and discharge. Surrogate markers for anxiety, such as blood pressure and pulse, were recorded before and after the procedure. Patient-perceived discomfort was measured with a visual analog scale (VAS) on a 0-10 scale. RESULTS: One hundred patients (52 receiving treatment, 48 receiving placebo) participated in the study. Baseline demographic characteristics and previous medical conditions were well balanced between groups. Anxiety level, systolic blood pressure, and diastolic blood pressure were all higher at procedure start than post procedure, but did not differ between the groups. CRP levels were similar at both time points for patients in both groups (0.77 ± 2.53 mg/L pre procedure and 0.70 ± 2.08 mg/L post procedure in the midazolam group vs 0.79 ± 1.39 mg/L pre procedure and 0.83 ± 1.45 mg/L post procedure in the placebo group). Discomfort level assessment was also alike (2.6 ± 2.4 in the treatment group vs 3.4 ± 2.5 in the placebo group; P=.12). CONCLUSIONS: Intravenous midazolam administration does not seem to relieve patient discomfort and anxiety nor does it influence CRP level. Therefore, an approach tailored to the patient is advisable.

Lipid profile as a strong indicator of coronary plaques: noninvasive assessment by multislice computerized tomography.

BACKGROUND: Most acute coronary syndrome disorders occur as a consequence of atherosclerotic plaque rupture. Lipids are involved in atherosclerotic plaque buildup. Advances in image quality of coronary computed tomography have enabled improved characterization of coronary plaques. The aim of our study was to evaluate the association between lipid profile and coronary plaque presence in general and soft plaques in particular. METHODS: In this cross-sectional survey, 258 consecutive patients presenting with chest pain either or both with low-to-moderate risk for coronary artery disease, were included. All patients were tested for lipid profile prior to cardiac imaging on a 64-slice computer tomography. Multivariate logistic regression models were used to assess the odds ratios (ORs) and 95% confidence interval (CI) for the relationship between blood lipid levels and prevalence of coronary plaques. RESULTS: Age, total cholesterol levels, hypertension, hyperlipidemia (dichotomous) and risk factor index, all were independently associated with prevalence all kind of plaques, especially with soft plaques. No significant relationships were detected among BMI, current smoking, diabetes or triglycerides levels. In a multivariate logistic regression, hyperlipidemia was associated with presence of coronary plaque risk with adjusted OR of 2.28 (95% CI 1.30-4.01), total cholesterol with adjusted OR = 1.05 (95% CI 1.01-1.06), and risk factor index (1-6) with adjusted OR = 2.23 (95% CI 1.40-3.55). CONCLUSION: Hyperlipidemia is strongly associated with prevalence of coronary plaques (P < 0.001) in individuals with low-to-intermediate risk for coronary artery disease, based on cardiac CT. Cardiac CT may serve as a noninvasive alternative for the early diagnosis of CAD in such individuals.