Background-Current National Cholesterol Education Program guidelines recommend that non-high-dens... more Background-Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with triglycerides Ͼ2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease. Methods and Results-Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 [95% confidence intervals, 1.006 to 1.093] for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 [95% confidence intervals, 1.004 to 1.096] for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up. Conclusions-Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease. (Circulation.
BACKGROUND Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-as... more BACKGROUND Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-associated myocardial infarction and remains poorly characterized. OBJECTIVES This study sought to assess presentation, clinical factors, and outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD) compared with spontaneous coronary artery dissection not associated with pregnancy (NP-SCAD). METHODS A Mayo Clinic registry was established in 2010 to include comprehensive retrospective and prospective SCAD data. Records were reviewed to identify women who were pregnant or #12 weeks postpartum at time of SCAD. Complete records were available for 323 women; 54 women met criteria for P-SCAD (4 during pregnancy) and they were compared with 269 women with NP-SCAD. RESULTS Most events occurred within the first month postpartum (35 of 50). Compared with NP-SCAD, P-SCAD patients more frequently presented with ST-segment elevation myocardial infarction (57% vs. 36%; p ¼ 0.009), left main or multivessel SCAD (24% vs. 5%; p < 0.0001; and 33% vs. 14%; p ¼ 0.0027, respectively), and left ventricular function #35% (26% vs. 10%; p ¼ 0.0071). Among women with imaging of other vascular territories, P-SCAD was less likely with a diagnosis of fibromuscular dysplasia and extracoronary vascular abnormalities (42% vs. 64%; p ¼ 0.047; and 46% vs. 77%; p ¼ 0.0032, respectively). Compared with U.S. birth data, women with P-SCAD were more often multiparous (p ¼ 0.0167), had a history of infertility therapies (p ¼ 0.0004), and had pre-eclampsia (p ¼ 0.001). On long-term follow-up (median 2.3 years) recurrent SCAD occurred in 51 patients, with no difference in the Kaplan Meier 5-year recurrence rates (10% vs. 23%; p ¼ 0.18). CONCLUSIONS P-SCAD patients had more acute presentations and high-risk features than women with NP-SCAD did. The highest frequency of P-SCAD occurred during the first postpartum month and P-SCAD patients less often had extracoronary vascular abnormalities. Hormonal, hemodynamic variations, and yet-undefined mechanisms might be
† †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asi... more † †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asian Pacific Society of Cardiology. ‖‖Integrating the Healthcare Enterprise. ¶ ¶Digital Imaging and Communications in Medicine. ##Society of Thoracic Surgeons. ***Clinical Quality Committee representative during this writing effort. Author Recusals: Writing committee members are required to recuse themselves from voting on sections to which their specific relationship with industry and other entities may apply; see Appendix 1 for recusal information.
The American Journal of Clinical Nutrition, May 1, 1990
Consuming substantial quantities of n-3 fatty acids reduces atherogenesis in experimental models ... more Consuming substantial quantities of n-3 fatty acids reduces atherogenesis in experimental models of atherosclerosis. The mechanisms of this beneficial effect remain uncertain. Monocyte-derived tissue macrophages are associated with atherogenesis, and inhibition of monocyte inflammatory activity could, hypothetically, be helpful in preventing atherosclerosis. We observed that stimulated human monocyte and/or macrophage production of superoxide and the occurrence of monocyte chemiluminescence, two indices of monocyte inflammatory activity, were significantly reduced by the ingestion of 6 g n-3 fatty acids/d for 6 wk. This effect was associated with a reduction of stearic and arachidonic acids whereas eicosapentaenoic and docosahexaenoic acid concentrations rose significantly. These results indicate that modest dietary n-3 fatty acid supplementation can reduce stimulated human-monocyte free-radical production and may impair the capability of macrophages derived from monocytes to promote oxidation of low-density-lipoprotein cholesterol and associated cellular toxicity.
Catheterization and Cardiovascular Interventions, Jul 1, 2014
SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chance... more SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chances that these therapies will become a successful part of the armamentarium for treating valvular heart disease in the United States. In addition, these recommendations will hopefully facilitate optimum quality during the delivery of this therapy, which will be important to the development and implementation of future, less invasive approaches to structural heart disease.
Improvement in quality of life following coronary artery bypass surgery is a function of a number... more Improvement in quality of life following coronary artery bypass surgery is a function of a number of complex variables. This outcome, based on objective medical and subjective social criteria, must be assessed to determine the success of this financially expensive surgical intervention for management of patients with coronary artery disease. The majority of patients undergoing coronary artery bypass surgery demonstrate, at least early on, an improved quality of life. Subsets of patients have also been shown to have improved survival. With new surgical techniques aimed at improvement in flow to the areas of ischemic myocardium, even better results can be expected. Future studies will determine the extent of this improvement in quality of life over time and will serve to predict for which patients early surgical intervention will be most beneficial.
Background: Accreditation (A) is an ongoing process to assist facilities in achieving and maintai... more Background: Accreditation (A) is an ongoing process to assist facilities in achieving and maintaining quality in the catheterization laboratory. Independent review of randomly selected cases can provide insight into changes that occur over time. The current analysis assesses the differences between new operators (NO) and those previously reviewed (PO) over a series of reviews at 2 year intervals. Methods: Randomly selected cases from each site and at each timepoint are reviewed by blinded, independent interventional cardiologists and all data are recorded on a standard case report form. After the review was completed, each operator was identified as NO or PO. Statistical analysis was performed using JMP pro (version 15.2.1, SAS Institute Cary NC). Results: 17 facilities underwent initial and as many as 3 reaccreditation visits. A total of 2702 cases were reviewed and this analysis was limited to the 1550 PCI (608 Initial, 663 RA1, 224 RA2, 35 RA3). Selected variables are shown in Table 1. Although many findings are not different between NO and PO, those differences identified are primarily those related to documentation. Conclusions: We have previously identified changes over time from a facility standpoint where after initial improvement, there is a loss of improvement. Similar findings are identified when NO are compared to PO but documentation differences are identified. Locum Tenens physicians are increasing used for coverage. Adequate onboarding is critical to maintaining a quality culture and continued reinforcement will assist existing operators. Table
99mtechnetium diphosphonate was used in 81 patients for myocardial imaging. 46 of the patients su... more 99mtechnetium diphosphonate was used in 81 patients for myocardial imaging. 46 of the patients suffered, 2-6 days prior to the test, from an acute transmural infarction provided by clinical, ECG, and enzymatic evidence; the scintigram was definitely positive in 43, equivocal in 2, and negative in 1. In 16 patients with subendocardial infarctions, in 9 the scintigram showed a positive result, in 1 it was equivocal, and in6 patients negative. In 6 other patients who suffered from acute chest pain, followed by enzyme changes, but no ECG evidence of infarction throughout the hospitalization period, the scan was positive in all. In 13 patients with acute ischemia (unstable 'crescendo' angina), 9 had a positive, 1 an equivocal, and 3 a negative scan. We conclude that radionuclide imaging is a valuable addition to the methods already available for diagnosis of myocardial infarction. With the use of diphosphonate as the tracer, we found that acutely ischemic myocardium that later may recover, gives also positive imaging.
Background-Current National Cholesterol Education Program guidelines recommend that non-high-dens... more Background-Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with triglycerides Ͼ2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease. Methods and Results-Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 [95% confidence intervals, 1.006 to 1.093] for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 [95% confidence intervals, 1.004 to 1.096] for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up. Conclusions-Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease. (Circulation.
BACKGROUND Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-as... more BACKGROUND Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-associated myocardial infarction and remains poorly characterized. OBJECTIVES This study sought to assess presentation, clinical factors, and outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD) compared with spontaneous coronary artery dissection not associated with pregnancy (NP-SCAD). METHODS A Mayo Clinic registry was established in 2010 to include comprehensive retrospective and prospective SCAD data. Records were reviewed to identify women who were pregnant or #12 weeks postpartum at time of SCAD. Complete records were available for 323 women; 54 women met criteria for P-SCAD (4 during pregnancy) and they were compared with 269 women with NP-SCAD. RESULTS Most events occurred within the first month postpartum (35 of 50). Compared with NP-SCAD, P-SCAD patients more frequently presented with ST-segment elevation myocardial infarction (57% vs. 36%; p ¼ 0.009), left main or multivessel SCAD (24% vs. 5%; p < 0.0001; and 33% vs. 14%; p ¼ 0.0027, respectively), and left ventricular function #35% (26% vs. 10%; p ¼ 0.0071). Among women with imaging of other vascular territories, P-SCAD was less likely with a diagnosis of fibromuscular dysplasia and extracoronary vascular abnormalities (42% vs. 64%; p ¼ 0.047; and 46% vs. 77%; p ¼ 0.0032, respectively). Compared with U.S. birth data, women with P-SCAD were more often multiparous (p ¼ 0.0167), had a history of infertility therapies (p ¼ 0.0004), and had pre-eclampsia (p ¼ 0.001). On long-term follow-up (median 2.3 years) recurrent SCAD occurred in 51 patients, with no difference in the Kaplan Meier 5-year recurrence rates (10% vs. 23%; p ¼ 0.18). CONCLUSIONS P-SCAD patients had more acute presentations and high-risk features than women with NP-SCAD did. The highest frequency of P-SCAD occurred during the first postpartum month and P-SCAD patients less often had extracoronary vascular abnormalities. Hormonal, hemodynamic variations, and yet-undefined mechanisms might be
† †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asi... more † †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asian Pacific Society of Cardiology. ‖‖Integrating the Healthcare Enterprise. ¶ ¶Digital Imaging and Communications in Medicine. ##Society of Thoracic Surgeons. ***Clinical Quality Committee representative during this writing effort. Author Recusals: Writing committee members are required to recuse themselves from voting on sections to which their specific relationship with industry and other entities may apply; see Appendix 1 for recusal information.
The American Journal of Clinical Nutrition, May 1, 1990
Consuming substantial quantities of n-3 fatty acids reduces atherogenesis in experimental models ... more Consuming substantial quantities of n-3 fatty acids reduces atherogenesis in experimental models of atherosclerosis. The mechanisms of this beneficial effect remain uncertain. Monocyte-derived tissue macrophages are associated with atherogenesis, and inhibition of monocyte inflammatory activity could, hypothetically, be helpful in preventing atherosclerosis. We observed that stimulated human monocyte and/or macrophage production of superoxide and the occurrence of monocyte chemiluminescence, two indices of monocyte inflammatory activity, were significantly reduced by the ingestion of 6 g n-3 fatty acids/d for 6 wk. This effect was associated with a reduction of stearic and arachidonic acids whereas eicosapentaenoic and docosahexaenoic acid concentrations rose significantly. These results indicate that modest dietary n-3 fatty acid supplementation can reduce stimulated human-monocyte free-radical production and may impair the capability of macrophages derived from monocytes to promote oxidation of low-density-lipoprotein cholesterol and associated cellular toxicity.
Catheterization and Cardiovascular Interventions, Jul 1, 2014
SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chance... more SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chances that these therapies will become a successful part of the armamentarium for treating valvular heart disease in the United States. In addition, these recommendations will hopefully facilitate optimum quality during the delivery of this therapy, which will be important to the development and implementation of future, less invasive approaches to structural heart disease.
Improvement in quality of life following coronary artery bypass surgery is a function of a number... more Improvement in quality of life following coronary artery bypass surgery is a function of a number of complex variables. This outcome, based on objective medical and subjective social criteria, must be assessed to determine the success of this financially expensive surgical intervention for management of patients with coronary artery disease. The majority of patients undergoing coronary artery bypass surgery demonstrate, at least early on, an improved quality of life. Subsets of patients have also been shown to have improved survival. With new surgical techniques aimed at improvement in flow to the areas of ischemic myocardium, even better results can be expected. Future studies will determine the extent of this improvement in quality of life over time and will serve to predict for which patients early surgical intervention will be most beneficial.
Background: Accreditation (A) is an ongoing process to assist facilities in achieving and maintai... more Background: Accreditation (A) is an ongoing process to assist facilities in achieving and maintaining quality in the catheterization laboratory. Independent review of randomly selected cases can provide insight into changes that occur over time. The current analysis assesses the differences between new operators (NO) and those previously reviewed (PO) over a series of reviews at 2 year intervals. Methods: Randomly selected cases from each site and at each timepoint are reviewed by blinded, independent interventional cardiologists and all data are recorded on a standard case report form. After the review was completed, each operator was identified as NO or PO. Statistical analysis was performed using JMP pro (version 15.2.1, SAS Institute Cary NC). Results: 17 facilities underwent initial and as many as 3 reaccreditation visits. A total of 2702 cases were reviewed and this analysis was limited to the 1550 PCI (608 Initial, 663 RA1, 224 RA2, 35 RA3). Selected variables are shown in Table 1. Although many findings are not different between NO and PO, those differences identified are primarily those related to documentation. Conclusions: We have previously identified changes over time from a facility standpoint where after initial improvement, there is a loss of improvement. Similar findings are identified when NO are compared to PO but documentation differences are identified. Locum Tenens physicians are increasing used for coverage. Adequate onboarding is critical to maintaining a quality culture and continued reinforcement will assist existing operators. Table
99mtechnetium diphosphonate was used in 81 patients for myocardial imaging. 46 of the patients su... more 99mtechnetium diphosphonate was used in 81 patients for myocardial imaging. 46 of the patients suffered, 2-6 days prior to the test, from an acute transmural infarction provided by clinical, ECG, and enzymatic evidence; the scintigram was definitely positive in 43, equivocal in 2, and negative in 1. In 16 patients with subendocardial infarctions, in 9 the scintigram showed a positive result, in 1 it was equivocal, and in6 patients negative. In 6 other patients who suffered from acute chest pain, followed by enzyme changes, but no ECG evidence of infarction throughout the hospitalization period, the scan was positive in all. In 13 patients with acute ischemia (unstable 'crescendo' angina), 9 had a positive, 1 an equivocal, and 3 a negative scan. We conclude that radionuclide imaging is a valuable addition to the methods already available for diagnosis of myocardial infarction. With the use of diphosphonate as the tracer, we found that acutely ischemic myocardium that later may recover, gives also positive imaging.
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