Aortic plaque burden predicts vascular events in patients with cardiovascular disease: The EAST-NOGA study.

BACKGROUND: Non-obstructive general angioscopy (NOGA) can be used to diagnose aortic atherosclerotic plaques. We examine the association between the number of aortic plaques detected by NOGA and the risk of subsequent cardiovascular events. METHODS: The Evaluation of AtheroScleroTic and rupture events by Non-Obstructive General Angioscopy (EAST-NOGA) was a prospective cohort study of patients with suspected coronary artery disease who underwent NOGA. RESULTS: Of the 577 patients who underwent NOGA, 532 (92%) completed the follow-up (median follow-up: 13 months, interquartile range: 12-16). The median number of plaques per person was 6 (interquartile range: 3-12), and 567 (98%) had at least one aortic plaque. During the 13-month follow-up, 38 (7.1%) patients had a primary composite endpoint [including cardiovascular death, myocardial infarction, stroke, peripheral artery disease (PAD), or worsening renal function], which was significantly associated with chronic kidney disease, a history of PAD, a lower hemoglobin level, and large numbers of aortic plaques [11 (5-17) vs. 6 (2-11), p = 0.003]. A receiver operating characteristic curve analysis for the number of aortic plaques predicting composite endpoints revealed that the cut-off value of aortic plaques was 12. After multivariate adjustment, the presence of ≥12 aortic plaques remained a significant predictor for composite endpoint events (hazard ratio 2.53, 95% confidence interval 1.26-5.04, p = 0.010). CONCLUSIONS: The number of aortic plaques detected by NOGA may predict subsequent clinical events.

[Basic study to establish medication safety culture with patient-commitment style in community pharmacy: An examination from meeting reports].

Our group conducted a Medication Safety Culture Building Drive, enlisting the cooperation of pharmacy patients to clarify obstacles and verify the effect of the measures implemented. Pharmacists at 38 community pharmacies instituted a 3-month trial period of rigorous prescription confirmation by checking filled prescriptions against the accompanying drug information (DI) in the presence of patients at pharmacy counters, whenever prescription drugs were dispensed. During the first month, 29 pharmacies reported carrying out the program with the rate of patient coverage was over 50%; while 8 others reported that rate of patient coverage was less than 50%. Factors standing in the way of checking filled prescriptions with the patients could be characterized as "physical conditions," "prescription content," or "patient attributes." The measures devised to counter these obstacles all fell within the categories of "education of patients and pharmacists," "advance arrangements made in preparation for checking," "methods of checking and nature of items checked," "checking procedure," and "DI literature." After three month, 34 pharmacies reported that the effort had been effective. During the three months, the average implementation rate (patient coverage rate) was improved from 92.5% in April to 96.5% in June (p<0.001). The specific qualitative effects listed below were among those mentioned in reports compiled from meetings. 1) Improvement of patients' and pharmacists' awareness regarding dispensing error prevention, 2) Increase in patients' interest in, and understanding of, their own prescription medications, 3) Increase in patients' understanding about the efforts and in number of patients cooperating with the effort.

Plaque erosion in the culprit lesion is prone to develop a smaller myocardial infarction size compared with plaque rupture.

BACKGROUND: Acute myocardial infarction (MI) stems from a disruption of the plaque in the coronary artery. Based on postmortem examinations, such plaque disruption has been classified as either a rupture or an erosion. Unfortunately, it has been difficult to clinically identify plaque ruptures and plaque erosions during the development of acute MI. To elucidate the relationships between clinical features and the morphological characteristics of the infarct-related lesions, we observed the culprit lesions in patients with acute MI by coronary angioscopy and intravascular ultrasound. METHODS: We examined culprit lesions in 107 patients with acute MI using coronary angioscopy and intravascular ultrasound immediately before performing percutaneous coronary intervention. The lesions were then classified as plaque ruptures or nonruptured erosions, and their clinical features were compared. RESULTS: Among the lesions studied, 44 were classified as plaque ruptures, 28 were classified as plaque erosions, and 35 were unclassified. Patients with nonruptured eroded plaques had more preinfarction angina before the onset of MI than those with ruptured plaques (53.6% vs 22.7%, P = .0074). They also had less ST-segment elevation MI (71.4% vs 93.2%, P = .0185), lower peak creatine kinase levels (2029 +/- 1517 vs 4033 +/- 2699 IU/L, P = .0009), less distal embolization after percutaneous coronary intervention (3.6% vs 36.4%, P = .0014), and less Q-wave MI 1 month after onset (40.7% vs 88.4%, P < .0001). CONCLUSION: Patients with eroded plaque lesions have smaller infarctions than those with ruptured plaque lesions, suggesting that an eroded plaque is less potently thrombogenic than a ruptured plaque.

Efficacy of coronary angioplasty following conventional coronary thrombolysis in patients with acute myocardial infarction.

The efficacy of combined thrombolysis and angioplasty for the purpose of coronary reperfusion after acute myocardial infarction has been controversial. The present study was conducted, therefore, to evaluate the effects of angioplasty following administration of conventional thrombolytic agents on the long-term prognosis of acute myocardial infarction patients. A total of 409 patients admitted to the hospital within 12 hours of the onset of infarction between January 1990 and May 2001 were studied retrospectively. These included 151 patients treated with thrombolysis alone (group T), 73 patients treated with angioplasty alone (group A), and 35 patients treated with angioplasty after thrombolysis (group T&A). Group T&A had shorter intervals from onset to initial treatment than group A (3.0 hours vs 6.3 hours, p < 0.01), a higher reperfusion success rate than group T (91.4% vs 74.8%, p < 0.01), and more improved left ventricular wall motion than group A. One-year cardiac mortality rates tended to be higher in group T, which had a higher rate of unsuccessful reperfusion than groups T&A or A (8.1% vs 3.4% vs 3.5%). The frequencies of hemorrhagic complications were similar among the 3 groups. From these findings, we conclude that thrombolytic therapy with subsequent angioplasty is an effective strategy for achieving cardiac reperfusion following acute myocardial infarction.