Percutaneous coronary intervention vs. optimal medical therapy--the other side of the coin: medication adherence.

WHAT IS KNOWN AND OBJECTIVE: Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone. METHODS: We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records. RESULTS AND DISCUSSION: Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)]. WHAT IS NEW AND CONCLUSION: In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.

Congenital absence of the left circumflex coronary artery and an unusually dominant course of the right coronary artery.

Congenital absence of the left circumflex artery (LCX) is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report on a 55-year-old female with atypical chest pain. Routine coronary angiography showed a normal left anterior descending coronary artery (LAD), no LCX and a dominant right coronary artery (RCA), which continued beyond the crux, running the full course of the LCX and terminating in the left atrial branch. Neither aortography nor pulmonary angiography showed a separate ostium for the LCX. There were no atherosclerotic lesions in the coronary arteries, or ischaemia on stress myocardial perfusion imaging. Multidetector row computed tomography (MDCT) was performed to confirm the diagnosis.

N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of contrast nephropathy.

BACKGROUND: The use of N-acetylcysteine or theophylline in specific subgroups of patients has been suggested to reduce the incidence of contrast-induced nephropathy (CIN) in patients undergoing angiographic procedures. Our purpose was to compare the use of N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of CIN. MATERIALS AND METHODS: We randomized 217 patients with estimated glomerular filtration rate (eGFR) (calculated by Modification of Diet in Renal Disease formula) between 30 and 60 mL min(-1) 1.73 m(-2) who were undergoing coronary angiography to three prophylactic treatment groups: Group 1: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast, n = 72). Group 2: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine (600 mg p.o. twice daily the preceding day and the day of angiography, n = 73). Group 3: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine + theophylline (600 mg N-acetylcysteine p.o. and 200 mg theophylline p.o. twice daily for the preceding day and the day of angiography, n = 72). The incidence of CIN (0.5 mg dL(-1) increase in serum creatinine from the baseline value 48 h after intravascular injection of contrast) was compared in three groups. RESULTS: Of the 217 patients, 12 patients (5.5%) experienced CIN. Five patients (6.9%) in group 1, seven patients (9.6%) in group 2 and zero (0%) patients in group 3 experienced CIN (P < 0.033). CONCLUSION: Among patients with eGFR between 30 and 60 mL min(-1) 1.73 m(-2) undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.

Diagnosis of Abnormal Subclavian Venous Flow by Radionuclide Venography in Patients with Permanent Pacemaker

In this study, we investigated the role of radionuclide venography in the diagnosis of abnormal subclavian venous flow due to the lead in patients (pts) with permanent pacemakers. The study was conducted with 53 frames in 52 asymptomatic pts (26 females, mean age 64.5 +/- 15; range 25-89 years). The mean time after implant was 67.6 +/- 47.5 months. Technetium 99m pertecnetate (250 MBq) was given to both antecubital veins simultaneously. The images were acquired in 0.25-second frames for 20 seconds. The pts were evaluated visually in terms of the activity flow through the subclavian veins bilaterally. The retrograde flow in the jugular vein, decrease in flow rate, and subtotal and total obstruction of the subclavian veins were accepted as abnormal venous flow patterns. In 17 pts with abnormal findings, 10 (58.8%) had retrograde flow in the jugular vein, 4 had (23.5%) decreased flow rate, 1 (5.8%) had subtotal and 2 (11.7%) total obstruction in the subclavian vein. The mean of the body diameter of the leads was significantly greater and the percentage of the silicone-insulated leads was higher (76% vs 52%) in the group with abnormal flow. No complication due to the procedure was seen. In conclusion, radionuclide venography, a noninvasive method, may be used easily and safely to show the venous flow abnormalities due to the lead in pts with permanent pacemakers. The abnormal subclavian venous flow was especially seen in pts who had larger leads.

Influence of age of onset and patient's sex on the prevalence and severity of manifestations of Behçet's syndrome.

Eye disease, arthritis, folliculitis, and thrombophlebitis were more common among males, and erythema nodosum among females, in 297 patients with Behcet syndrome (BS) at their first visit despite an identical disease duration. Younger males and females (age of onset 24 years or less) had a higher prevalence of eye disease and total clinical activity than did the older patients (age of onset 25 years or more). Among the 51 patients followed up for 52 months (SD 7 months) the total clinical activity became significantly less (p less than 0.05) in the whole group at the end of this period. This was particularly true for older females. While male sex and a younger age of onset are associated with more severe disease in BS, overall, the syndrome ran an improving or stable course over 4 1/2 years.