Early vectorcardiographic monitoring provides prognostic information in patients with ST-elevation myocardial infarction

OBJECTIVE: To evaluate the prognostic value of specified vectorcardiographic data obtained during the first hours of ST-elevation myocardial infarction for cardiac outcomes up to 5 years. DESIGN: Three hundred and five patients with ST-elevation myocardial infarction and chest pain for less than 12 h were monitored with continuous vectorcardiography. RESULTS: All patients had follow-up for at least 1 year. The mortality was 5.9% at 30 days and 10.8% at 1 year. The estimated 5-year mortality was 24%. A total of 7.9% had recurrent infarction at 30 days and 11.2% at 1 year. Recurrent infarction or death occurred in 12.1% at 30 days and in 19.7% at 1 year. The presence of ST-VM (plateau) >or= 125 microV was highly predictive of the combined endpoint death or recurrent infarction at 1 year, OR 2.69 (95% CI 1.39-5.23). Multivariate analysis showed that age >or=75 years, anterior myocardial infarction, and the presence of ST-VM (plateau) >or= 125 microV, were independently associated with increased risk of recurrent infarction or death at 1 year and with death at 5-year follow-up. A start value of ST-VM 相似文献   

Assessment of Myocardium at Risk in Pigs with Single Photon Emission Computed Tomography and Computerized Vectorcardiography During Transient Coronary Occlusion

Since myocardium at risk (MAR) is the major prognosticator of final infarct size and outcome in patients with acute myocardial infarction, it is highly desirable to estimate the size of the acutely ischemic myocardium, that is the MAR, in these patients. We assessed MAR size by Tc-99m-sestamibi-SPECT and computerized vectorcardiography using autoradiography as reference method. Transient myocardial ischemia was achieved in 12 pigs by coronary artery occlusion with PTCA catheters. During the procedure, computerized vectorcardiography was continuously recorded. After injection of Tc-99m-sestamibi and gadolinium-153-labelled microspheres, MAR size was estimated by SPECT and post-mortem autoradiography. Different cut-off levels (50-70%) were compared with respect to MAR-SPECT. Tc-99m-sestamibi-SPECT showed a good correlation with autoradiography (r = 0.94). Computerized vectorcardiography showed a good correlation with autoradiography as well as with Tc-99m-sestamibi-SPECT (STC-VM: r = 0.75 and 0.80, respectively, ST-VM: 0.75 and 0.87, respectively). It was found that 1) MAR assessed by Tc-99m-sestamibi-SPECT correlates closely with the autoradiographic reference; 2) a lower cut-off point of 60% of maximum uptake for MAR by Tc-99m-sestamibi-SPECT gives the closest correlation with the autoradiographic reference; and 3) ST-VM and STC-VM correlate well with MAR assessed by Tc-99m-sestamibi-SPECT and autoradiography.     

Assessment of myocardium at risk in pigs with single photon emission computed tomography and computerized vectorcardiography during transient coronary occlusion

Since myocardium at risk (MAR) is the major prognosticator of final infarct size and outcome in patients with acute myocardial infarction, it is highly desirable to estimate the size of the acutely ischemic myocardium, that is the MAR, in these patients. We assessed MAR size by Tc-99m-sestamibi-SPECT and computerized vectorcardiography using autoradiography as reference method. Transient myocardial ischemia was achieved in 12 pigs by coronary artery occlusion with PTCA catheters. During the procedure, computerized vectorcardiography was continuously recorded. After injection of Tc-99m-sestamibi and gadolinium-153-labelled microspheres, MAR size was estimated by SPECT and post-mortem autoradiography. Different cut-off levels (50-70%) were compared with respect to MAR-SPECT. Tc-99m-sestamibi-SPECT showed a good correlation with autoradiography (r = 0.94). Computerized vectorcardiography showed a good correlation with autoradiography as well as with Tc-99m-sestamibi-SPECT (STC-VM: r = 0.75 and 0.80, respectively, ST-VM: 0.75 and 0.87, respectively). It was found that 1) MAR assessed by Tc-99m-sestamibi-SPECT correlates closely with the autoradiographic reference; 2) a lower cut-off point of 60% of maximum uptake for MAR by Tc-99m-sestamibi-SPECT gives the closest correlation with the autoradiographic reference; and 3) ST-VM and STC-VM correlate well with MAR assessed by Tc-99m-sestamibi-SPECT and autoradiography.     

Minimal influence of anaesthesia and abdominal surgery on computerized vectorcardiography recordings

Myocardial infarction still represents a major cause of morbidity and mortality following surgical procedures. Continuous computerized on-line vector-ECG has previously been shown to be useful in the detection of myocardial ischaemia, in acute myocardial infarction and unstable angina pectoris and for ischaemia monitoring after PTCA procedures. This method was presently tested for the possible influence of anaesthesia and surgery during cholecystectomy under general anaesthesia (n = 9), and during inguinal hernia repairs using a spinal block (n = 5). The patients had no history, symptoms or signs of ischaemic heart disease. Analyses of vectorcardiographic changes were made in relation to predefined standardized anaesthetic and surgical procedures, all of which potentially could influence the vector-ECG. Three vectorcardiographic trend parameters were studied: QRS-vector difference, ST-vector magnitude and ST-change vector magnitude. The overall vectorcardiographic changes were minimal and smaller than vectorcardiographic changes previously reported during myocardial ischaemia and infarction. Since anaesthetic and surgical procedures per se had only minor effects on the vector ECG recordings, it is concluded that continuous computerized on-line vectorcardiography will not be skewed by these procedures. Hence, vectorcardiography has the potential of becoming a new monitor for the detection of perioperative myocardial ischaemia.     

The electrocardiographic reperfusion peak in patients with ST-elevation myocardial infarction

OBJECTIVES: To analyse the incidence and the prognostic value of the reperfusion peak in a population of patients with AMI treated with thrombolysis. DESIGN: Two hundred and sixty-nine patients with ST-elevation myocardial infarction treated with thrombolysis were monitored with continuous on-line vectorcardiography. RESULTS: A reperfusion peak defined as a transiently increased ST-VM of >50 microV followed by an immediate decrease to a level lower than the starting point was seen in 112 of all 269 (42%) patients and in 111 of 149 (75%) of the patients with successful ST-resolution. A reperfusion peak was an independent predictor of better prognosis both in the short- and the long term but had no implications on the prognosis in the subgroup with successful ST-resolution. CONCLUSION: A reperfusion peak was equally common in patients treated with thrombolysis having a successful ST-resolution as observed in studies of patients with successful primary coronary angioplasty. The reperfusion peak was associated with better prognosis and should be recognised as a possible marker of successful reperfusion but can mimic aggravated ischemia.     

Assessment of myocardium at risk with computerized vectorcardiography and technetium-99m-sestamibi-single photon emission computed tomography during coronary angioplasty

OBJECTIVE: To compare the myocardium at risk (MAR) as estimated by computerized vectorcardiography (cVCG) with MAR determined by Tc-99m-sestamibi-SPECT using coronary angioplasty as the model for transient transmural ischemia in humans. METHODS AND RESULTS: In 37 patients with stable angina pectoris, cVCG was recorded continuously during coronary angioplasty. The scintigraphic defect was quantified using an automated software program (CEqual). The ST vector magnitude (ST-VM) and the ST change vector magnitude (STC-VM) correlated well with MAR estimated by scintigraphy, ST-VM (r = 0.71, p < 0.001) and STC-VM (r = 0.84, p < 0.001). All patients with STC-VM <50 microV during occlusion had defects of less than 10% of the left ventricle. CONCLUSION: 1) ST-VM and STC-VM give a reasonable useful estimate of MAR size during transient coronary occlusion. 2) STC-VM <50 microV is a reliable limit to identify patients with MAR size less than 10%. 3) ST-VM does not add information to STC-VM with respect to detection of ischemia. 4) The existence of collateral vessels has great impact on both ST-vector changes and scintigraphic imaging of myocardial ischemia.     

Assessment of Myocardium at Risk with Computerized Vectorcardiography and Technetium-99m-Sestamibi-Single Photon Emission Computed Tomography during Coronary Angioplasty

Objective - To compare the myocardium at risk (MAR) as estimated by computerized vectorcardiography (cVCG) with MAR determined by Tc-99m-sestamibi-SPECT using coronary angioplasty as the model for transient transmural ischemia in humans. Methods and results - In 37 patients with stable angina pectoris, cVCG was recorded continuously during coronary angioplasty. The scintigraphic defect was quantified using an automated software program (CEqual). The ST vector magnitude (ST-VM) and the ST change vector magnitude (STC-VM) correlated well with MAR estimated by scintigraphy, ST-VM ( r = 0.71, p < 0.001) and STC-VM ( r = 0.84, p < 0.001). All patients with STC-VM <50 &#119 V during occlusion had defects of less than 10% of the left ventricle. Conclusion - 1) ST-VM and STC-VM give a reasonable useful estimate of MAR size during transient coronary occlusion. 2) STC-VM <50 &#119 V is a reliable limit to identify patients with MAR size less than 10%. 3) ST-VM does not add information to STC-VM with respect to detection of ischemia. 4) The existence of collateral vessels has great impact on both ST-vector changes and scintigraphic imaging of myocardial ischemia.     

Outcome of poor initial TIMI flow in patients presenting with acute coronary syndrome

Objectives. We explored the predictors and outcome of poor, versus good, initial TIMI flow in patients with acute coronary syndrome (ACS). Design. We performed post-hoc analysis of a randomized trial of patients presenting with ACS who received 2 comparative stents. Poor initial TIMI flow was defined as baseline TIMI flow grade 0/1 at the initial coronary angiography. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction or ischemia-driven target lesion revascularization. Stent thrombosis (ST) was adjudicated according to the criteria of definite ST described by the Academic Research Consortium. Propensity score-matched analysis was performed. We report data after 5-year follow-up. Results. Of 827 patients enrolled, 279 (33.7%) had initial TIMI 0/1 flow. Median follow-up duration was 5.0 years. Presentation by ST-elevation myocardial infarction and target vessel other than left anterior descending artery predicted initial TIMI 0/1 flow. MACE rate was comparable between the 2 subgroups (14% versus 15.9%, in patients with poor versus good initial TIMI flow, respectively, p?=?.46). Individual endpoints were comparable (p?>?.05 for all). Definite ST was more frequent in patients with initial TIMI 0/1 flow (3.6% versus 1.5%, respectively, p?=?.048). This was driven by more frequent early events (30 days) (p?=?.036); late/very late events were comparable (p?=?1.0). Conclusions. Predictors of poor initial TIMI flow included presentation by ST-elevation myocardial infarction, and target vessel other than left anterior descending artery. Definite ST occurred more in patients with poor, versus good, initial TIMI flow, mainly driven by difference in early events.     

Don't forget the defibrillator in the dialysis unit.

Dialysis patients are a group at extraordinarily high risk formortality. The death rate for prevalent US dialysis patientsin 1999–2001 was 235 deaths/1000 patient-years [1]. Cardiacdisease is the major cause of death, accounting for 43% of all-causemortality [1]. Dialysis patients have poor long-term survivalafter acute myocardial infarction, with a 2 year mortality of74%, which is essentially unchanged over the past two decades[2,3]. Approximately 20% of cardiac deaths in US dialysis patientsare attributed to acute myocardial infarction [1]. The singlelargest cause of death in dialysis patients, however, is potentiallyascribable to arrhythmic mechanisms as 61% of cardiac     

Diagnosis of acute myocardial infarction in patients with chronic left bundle-branch block. Standard 12-lead ECG compared to dynamic vectorcardiography

Standard 12-lead electrocardiogram (ECG) criteria were evaluated and compared with dynamic vectorcardiography for diagnosing acute myocardial infarction in 33 patients with chronic left bundle-branch block. In 14 patients a clinical diagnosis of acute myocardial infarction was made, but it was found that none of the seven most promising ECG criteria suggested in the literature could alone or in combination diagnose acute myocardial infarction. QRS vector difference evolution showed the same kind of pattern as that for patients with narrow QRS-complex. By using a predefined specific pattern, a diagnostic accuracy of 79% was achieved. The results indicate that dynamic vectorcardiography is a better tool for diagnosing and monitoring acute myocardial infarction in patients with left bundle-branch block than standard 12-lead ECGs taken on admission and after 12-24 h.     

Five‐year cardiovascular and all‐cause mortality,and myocardial infarction in all subjects referred for exercise testing in two Danish counties

Objective—To examine the association between exercise test results and the 5‐year cardiovascular and all‐cause mortality, and myocardial infarction, in patients referred for exercise testing because of known or suspected coronary heart disease.

Design—A study of all patients (N?=?2763) who in 1996 had an exercise test in two Danish counties (900?000 inhabitants). Data and follow‐up were based on medical records and general administrative healthcare and population registries.

Results—Abnormal tests, compared with normal ones, were associated with an increased adjusted cardiovascular mortality ratio of 1.77 (95% confidence interval (CI): 1.19–2.63), all‐cause mortality ratio of 1.46 (95% CI: 1.11–1.93), and myocardial infarction ratio of 1.71 (95% CI: 1.28–2.28). Inconclusive tests, compared with normal ones, were associated with an increased adjusted all‐cause mortality ratio of 1.52 (95% CI: 1.05–2.20) and myocardial infarction ratio of 1.67 (95% CI: 1.12–2.56). A history of myocardial infarction increased the cardiovascular death ratio by 1.51 (95% CI: 1.05–2.16) and the myocardial infarction ratio by 2.39 (95% CI: 1.84–3.10).

Conclusion—Over a 5‐year period, the result of the bicycle exercise test was clearly associated with both mortality and risk of myocardial infarction. An inconclusive test may deserve special attention.     

Reduction of Myocardial Ischemia‐Reperfusion Injury by Mechanical Tissue Resuscitation Using Sub‐Atmospheric Pressure

Abstract Background: Reperfusion‐induced injury after myocardial infarction is associated with a well‐defined sequence of early and late cardiomyocyte death. Most present attempts to ameliorate this sequence focus on a single facet of the complex process in an attempt to salvage cardiomyocytes. We examined, as proof of concept, the effects of mechanical tissue resuscitation (MTR) with controlled negative pressure on myocardial injury following acute myocardial infarction. Methods: Anesthetized swine were subjected to 75 minutes of left coronary artery occlusion and three hours of reperfusion. Animals were assigned to one of three groups: (A) untreated control; treatment of involved myocardium for 180 minutes of MTR with (B) ?50 mmHg, or (C) ?125 mmHg. Results: All three groups were subjected to equivalent ischemic stress. Treatment of the ischemic area with MTR for 180 minutes significantly (p < 0.001) reduced infarct size (area of necrosis/area at risk) in both treatment groups compared to control: 9.3 ± 1.8% (?50 mmHg) and 11.9 ± 1.2% (?125 mmHg) versus 26.4 ± 2.1% (control). Total area of cell death was reduced by 65% with ?50 mmHg treatment and 55% in the ?125 mmHg group. Conclusions: Treatment of ischemic myocardium with MTR, for a controlled period of time during reperfusion, successfully reduced the extent of myocardial death after acute myocardial infarction. These data provide evidence that MTR using subatmospheric pressure may be a simple, efficacious, nonpharmacological, mechanical strategy for decreasing cardiomyocyte death following myocardial infarction, which can be delivered in the operating room. (J Card Surg 2010;25:247‐252)     

Short and long-term outcome in diabetic patients with acute myocardial infarction in the invasive era

OBJECTIVES: To investigate the outcome after acute myocardial infarction in diabetic patients compared with non-diabetic patients in a period with invasive treatment as the preferred treatment for acute myocardial infarction (MI). DESIGN: Patient records for all patients admitted with an acute MI in a two-year period from July 1, 2001 to June 30, 2003 were reviewed. RESULTS: A total of 334 patients entered the study: 48 with diabetes mellitus (DM) and 286 without diabetes. ST-elevation infarction occurred in 49% of non-diabetic patients and 36% of diabetic patients. In-hospital mortality was 23% among diabetic patients compared to 5% among non-diabetic patients (p < 0.001). Long-term mortality (median 2 years and 10 months) was 44% in diabetic-patients and 23% in non-diabetic patients (p = 0.001). Diabetic patients were older, more frequently had hypertension and three-vessel disease, but DM was found to be an independent risk factor for death after MI (p = 0.005). CONCLUSIONS: In an era of invasive therapy as the preferred therapy for acute MI, DM is still associated with considerably increased mortality after an acute MI.     

Incidence of Subsequent Hip Fracture and Mortality in Elderly Patients: A Multistate Population-Based Cohort Study in Eastern Spain

Osteoporotic hip fractures in older people may confer an increased risk of subsequent hip fractures and death. The aim of this study was to estimate the cumulative incidence of both recurrent hip fracture and death in the Valencia region. We followed a cohort of 34,491 patients aged ≥65 years who were discharged alive from Valencia Health System hospitals after an osteoporotic hip fracture between 2008 and 2015, until death or end of study (December 31, 2016). Two Bayesian illness-death models were applied to estimate the cumulative incidences of recurrent hip fracture and death by sex, age, and year of discharge. We estimated 1-year cumulative incidences of recurrent hip fracture at 2.5% in women and 2.3% in men, and 8.3% and 6.6%, respectively, at 5 years. Cumulative incidences of total death were 18.3% in women and 28.6% in men at 1 year, and 51.2% and 69.8% at 5 years. One-year probabilities of death after recurrent hip fracture were estimated at 26.8% and 43.8%, respectively, and at 57.3% and 79.2% at 5 years. Our analysis showed an increasing trend in the 1-year cumulative incidence of recurrent hip fracture from 2008 to 2015, but a decreasing trend in 1-year mortality. Male sex and age at discharge were associated with increased risk of death. Women showed higher incidence of subsequent hip fracture than men although they were at the same risk of recurrent hip fracture. Probabilities of death after recurrent hip fracture were higher than those observed in the general population. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Coronary artery bypass grafting after acute ST-elevation myocardial infarction

ObjectivesThe study objectives were to describe the trends and outcomes of isolated coronary artery bypass grafting after ST-elevation myocardial infarction using a nationwide database.MethodsWe queried the 2002-2016 National Inpatient Sample database for hospitalized patients with ST-elevation myocardial infarction who underwent isolated coronary artery bypass grafting. We report temporal trends, predictors, and outcomes of coronary artery bypass grafting in the early (2002-2010) and recent (2011-2016) cohorts.ResultsOf 3,347,470 patients hospitalized for ST-elevation myocardial infarction, 7.7% underwent isolated coronary artery bypass grafting. The incidence of isolated coronary artery bypass grafting after ST-elevation myocardial infarction decreased over time (9.2% in 2002 vs 5.5% in 2016, P_trend < .001), whereas perioperative crude in-hospital mortality did not change (5.1% in 2002 vs 4.2% in 2016, P_trend = .66), coinciding with an increase in the burden of comorbidities. There was an increase in performing isolated coronary artery bypass grafting on hospitalization day 3 or more, as well as an increase in the use of mechanical support devices and precoronary artery bypass grafting percutaneous coronary intervention. In the early cohort, isolated coronary artery bypass grafting on days 1 and 2 was associated with higher in-hospital mortality. In the recent cohort, coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more and lower rates of acute kidney injury, ischemic stroke, ventricular arrhythmia, and length of hospital stay.ConclusionsIn this nationwide analysis, there has been a decline in the use of isolated coronary artery bypass grafting after ST-elevation myocardial infarction. Isolated coronary artery bypass grafting on day 1 was performed in sicker patients and was associated with higher in-hospital mortality than coronary artery bypass grafting performed on day 3 or more. In the recent cohort, isolated coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more.     

Similar five-year outcome with paclitaxel- and sirolimus-eluting coronary stents

Objective. Millions of patients were treated with the sirolimus-eluting Cypher? and the paclitaxel-eluting Taxus? coronary stents with potential late-occurring increase in event rates. Therefore, the long-term outcome follow-up is of major clinical interest. Design. In total, 2.098 unselected patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI, stable or unstable angina pectoris were randomized to receive Cypher? (n = 1.065) or Taxus? (n = 1.033) stents and were followed for 5 years. Results. The primary end-point; the composite of cardiac death, myocardial infarction and target vessel revascularization (major adverse cardiac event, MACE), occurred in 467 patients (22.3%); Cypher? n = 222 (20.8%), Taxus? n = 245 (23.7%), ns. Definite and probable stent thrombosis occurred in 107 patients (5.1%); Cypher? n = 51 (4.8%), Taxus? n = 56 (5.4%), ns. No statistically significant differences were found in the elements of the primary end-point or in other secondary end-points between the two stent groups. After one year, the annual rates of stent thrombosis and MACE remained constant. Conclusions. During 5-year follow-up, the Cypher? and the Taxus? coronary stents had similar clinical outcome with no signs of increasing rates of adverse events over time.     

Gender and carotid endarterectomy: does it matter?

Objective: Multiple large series have retrospectively identified female gender as a risk factor for perioperative stroke and death after carotid endarterectomy (CEA).Methods: Data for all patients who underwent CEA at a single institution from January 1990 to December 1998 were entered into a computerized vascular registry and form the basis of this report.Results: A total of 1298 CEA procedures were performed, of which 520 (40%) were in women and 778 (60%) in men. The mean age was 69.8 ± 8.7 years for men and 71.2 ± 8.5 years for women (P < .001). Cardiac risk factors significantly varied among the two groups, with women more likely to have diabetes (42% vs 36%) and hypertension (77% vs 66%), whereas tobacco history was higher among men (85% vs 71%) (P < .05 for all). Female patients were more likely to be asymptomatic at presentation (men, 44% vs women, 51%; P = .022). Postoperative myocardial infarction occurred in eight patients (0.6%) with no differences between men (0.4%) and women (1.0%) (P = not significant). For all adverse postoperative cardiac events (myocardial infarction, congestive heart failure, or arrhythmia), the incidence was 1.9% (25 patients), again with no differences between men (1.5%) and women (2.5%) (P = not significant). There were 25 postoperative neurologic events (19 strokes, six transient ischemic attacks) among the entire cohort (1.9%), of which 16 were in men (2.1%) and nine in women (1.6%; P = not significant). The overall postoperative stroke rate was 1.5% (13 [1.7%] of 778 men; 6 [1.2%;] of 520 women; P = not significant). Total operative mortality was 0.3% (3 [0.4%] of 778 men; 1 [0.2%] of 778 women; P = not significant). Late recurrent stenosis requiring operation developed in 14 patients (1.1%) during follow-up (6 [0.8%] of 778 men; 8 [1.5%] of 520 women; P = .19).Conclusions: Although there is significant variability in cardiac risk factors and presentation, female gender is not a risk factor for stroke, death, or cardiac morbidity after CEA. Women are not at higher risk for reoperation for recurrent stenosis.     

Early diagnosis and exclusion of acute myocardial infarction by two hours' vector-ECG and determination of either myoglobin or CK-mb. BIOMACS-study. BIOchemical Markers in Acute Coronary Syndromes

This retrospective study assesses the early diagnostic potential of a combination of multilead continuous vectorcardiography (VCG) and biochemical markers (myoglobin, troponin-t and CK-mb mass) in patients with chest pain who present with suspected acute myocardial infarction (AMI), but without ST-elevation on resting 12-lead ECG on admission. Within a multicenter study 56 patients admitted for chest pain (< 12 h) and with a non-diagnostic 12-lead ECG on admission and a VCG recording were included. Venous blood samples were drawn on admission and the continuous VCG was monitored for 2 h. The results were related to the clinical diagnosis of AMI. Neither the biochemical markers nor VCG alone permitted the diagnosis or exclusion of AMI at admission. However, if either analysis of myoglobin on admission or 2 h of VCG recording were positive, they would have a sensitivity for detection of AMI of 100% and specificity of 69%. In a subset of patients with more than 4 h delay since start of chest pain, CK-mb could replace myoglobin and give a sensitivity of 100% and a specificity of 81%. Determination of myoglobin or CK-mb at admission and VCG monitoring for 2 h can reliably confirm or exclude AMI within 2 h. This combination seems useful for early stratifications of patients in chest pain or coronary care units.     

High osteoprotegerin levels predict MACCE in STEMI patients,but are not associated with myocardial salvage

Objectives. High circulating levels of osteoprotegerin (OPG) carry prognostic impact in cohorts with various cardiovascular diagnoses. With the present study, we aim to investigate the role of OPG within the scale of myocardial damage. Design. This study includes 219 consecutive patients with acute ST-elevation myocardial infarction randomized to primary percutaneous coronary intervention (pPCI) or pPCI and remote ischemic per-conditioning. Salvage index via myocardial single-photon emission CT assessment (data available in 61% of the patients) was performed, and derived from Day 1 (myocardial area at risk) and Day 30 (final infarct size). Plasma OPG levels were measured using an in-house immunoassay. A combined end-point of all-mortality, myocardial infarction, stroke, readmission for heart failure and ischemic stroke/transient ischemic attack (Major Adverse Cardiac and Cerebrovascular Events [MACCE]) was used for follow-up; 45 (38–48 months). Results. High OPG levels were associated with the severity of cardiovascular disease. During follow-up, OPG was a predictor of MACCE (unadjusted, HR: 2.1, 95% CI: 1.14–3.85, P = 0.017). Adjustments for age, gender, and body mass index preserved the independent predictive power of OPG. However, OPG levels were neither associated with salvage index nor with the final infarct size. Remote ischemic per-conditioning had no effect on OPG levels. Conclusion. Despite absent association between OPG levels and the scale of myocardial damage, high OPG levels predict a significantly increased risk of MACCE.     

Cardiovascular disease in rheumatoid arthritis: single-center hospital-based cohort study in France

IntroductionRheumatoid arthritis (RA) was independently associated with cardiovascular events in several studies, most of which were conducted in the US.ObjectivesTo estimate the risk of cardiovascular events in a cohort of RA patients recruited at a hospital in France, to identify cardiovascular risk factors, and to measure the severity of cardiovascular events.MethodsTwo hundred and thirty-nine patients admitted between January 1, 1998, and March 31, 1999, for RA meeting American College of Rheumatology criteria, with a negative history for cardiovascular events, were sent a questionnaire in 2004 to evaluate the occurrence of myocardial infarction, stroke, or cardiovascular death.ResultsDuring the mean follow-up of 5.4 ± 1.8 years, there were 10 cases of myocardial infarction (0.8%/year), 3 cases of stroke (0.2%/year), and 9 cardiovascular deaths (0.7%/year). Of the 10 patients who experienced myocardial infarction, 5 had clinical symptoms of heart failure and 4 died from cardiovascular causes. Independent risk factors for cardiovascular events were older age (relative risk [RR], 2.5/10 years; 95% confidence interval [95%CI], 1.4–4.2), male gender (RR, 5.1; 95%CI, 1.8–14.6), treated hypertension (RR, 4.3; 95%CI, 1.4–13.2), and treated hypercholesterolemia (RR, 6.0; 95%CI, 1.8–20.7).ConclusionOur data suggest a higher risk of cardiovascular events in patients with RA compared to the general population in France (0.1–0.5%/year for myocardial infarction and 0.07%/year for stroke in the age group covered by our cohort). Cardiovascular events in the patients with RA seemed unusually severe. Patients with RA should be carefully screened for conventional cardiovascular risk factors.