Reduced survival in patients with "coronary microvascular disease".

The syndrome of chest pain, abnormal stress test, and nonflow limiting coronary artery disease (CAD) is common and is attributed to coronary microvascular disease (µVD). It is associated with increased hospital admissions and health care costs. But its impact on long-term survival is not known. Of the 9941 consecutive patients who had an exercise stress test for evaluation of chest pain between May 1991 and July 2007, 935 had both a positive stress test and a coronary angiogram within 1 year of their stress test forming the study cohort. Significant angiographic CAD defined as ≥70% stenosis of an epicardial coronary artery or ≥50% stenosis of the left main coronary artery was present in 324 patients. Rest (n = 611) were considered to have coronary µVD. Compared with patients with significant epicardial CAD, patients with coronary µVD were younger (63 ± 11 vs. 65 ± 10 years, p = 0.002), and had lower left ventricular wall thickness (p < 0.02), systolic blood pressure (BP; p = 0.002), pulse pressure (0.0008), systolic BP with exercise (p = 0.0001), and pulse pressure with exercise (p < 0.0001). Those with coronary µVD had a better survival compared with those with significant epicardial CAD, but worse than that expected for age- and gender-matched population (p < 0.0001). Coronary µVD as a cause of chest pain and positive stress test is common. All-cause mortality in patients with coronary µVD is worse than in an age- and gender-matched population control, but better than those with significant epicardial CAD.

Mortality reduction with beta-blockers in ischemic cardiomyopathy patients undergoing coronary artery bypass grafting.

Coronary artery bypass grafting (CABG) in patients with systolic heart failure (HF) carries high morbidity and mortality rates. Reducing perioperative mortality with beta-blockers (BBs) may help improve outcomes. Analysis of 4903 patients who underwent isolated CABG surgery was performed. In-hospital mortality of systolic HF patients who received BBs was 2.03%; systolic HF patients who did not receive BBs had a mortality of 5.20%. Thirty-day mortality was 2.98% in the patients with systolic HF who received BBs and 6.16% in the patients who did not. beta-Blockade did not affect the mortality in patients with preserved systolic function. Cardiogenic shock was a predictor of increased mortality in patients with systolic HF, while BBs reduced mortality. BBs are associated with decreased in-hospital and 30-day mortality in patients with systolic HF. BB therapy should be considered in patients with systolic HF who are undergoing CABG.

Students' and residents' perceptions regarding technology in medical training.

OBJECTIVE: This pilot study provides firsthand feedback from medical students and residents in training regarding their perceptions of technology in medicine. METHOD: The authors distributed an e-mail invitation to an anonymous Web-based survey to medical students and residents in two different U.S. training institutions. RESULTS: Respondents unanimously expressed that technology skills were important in medical training and felt it most important to learn about electronic medical records and accessing scientific information on the Internet. At the point of patient care, trainees' preferred reference sources were the Internet and PDA, in that order. Most clinical trainees felt PDAs were critical in patient care and met their clinical needs, and they were most likely to use them for medication reference. The majority of trainees preferred printed media over digital media for initial learning, but the converse for referencing. Instructor-led small groups were viewed as the best environment in which to receive instruction. CONCLUSIONS: Trainees in medical education are technologically savvy and provide invaluable feedback regarding initiation, development and refinement of technological systems in medical training.