ABSTRACT
BACKGROUND AND OBJECTIVE: Coronary angioplasty (CAG) has become an acceptable method of treating an acute coronary syndrome (myocardial infarction [MI] or unstable angina [UA]). It was the aim of this study to determine whether the results of such emergency treatment differed from those after elective CAG. PATIENTS AND METHODS: Results of emergency CAG in 581 patients (aged 60 +/- 11 years; 77% males) admitted to the authors' hospital between July 1994 and December 1996 were compared with those of elective CAG in 2,460 patients (aged 61 +/- 10, admitted during the same period. Follow-up information was obtained after 22.4 +/- 11 months in 93.2% of the patients by examination, written answers to annual questionnaires, data being collected on survival, repeat cardia catheterizations, other interventions, aorto-coronary bypass, occurrence of myocardial infarction, the patients' general state and drugs received. RESULTS: 19 of 517 patients (3.7%) of the group who had undergone elective CAG had died during the follow-up period, compared with 107 of 2436 of the emergency cohort (4.4%; not significant). There were also no significant differences regarding repeat cardiac catheterization, interventions, coronary bypass or re-admission. The proportion of subsequent emergency CAG among all CAGs was 16.8% in the emergency cohort, 8.8% after elective angiography (p < 0.001). CONCLUSION: Coronary angiography performed in patients with an acute coronary syndrome has no prognostic significance regarding mortality and morbidity after the acute phase of the disease.
Subject(s)
Angina, Unstable/therapy , Angioplasty, Balloon, Coronary , Emergencies , Myocardial Infarction/therapy , Aged , Angina, Unstable/mortality , Coronary Disease/mortality , Coronary Disease/therapy , Female , Follow-Up Studies , Germany , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Survival Rate , Treatment OutcomeABSTRACT
UNLABELLED: Although there are randomized data for CABG vs. medical therapy and CABG vs. PTCA in primary therapy of CAD, there is few evidence on the appropriate therapy of recurrent angina after prior CABG. We analyzed data from 1265 consecutive patients (pts.) presenting for recurrent angina after previous CABG who required either re-CABG (n = 67), PTCA (n = 768) or medical therapy alone (medRx) (n = 430) at our institution during 1986 through 1996. Outcome after index therapy is monitored during 45 +/- 34 months. The 3 therapeutic groups were similar with respect to gender (84% male), age at therapy (60 years), prevalence of diabetes (22%), and time to first ischemic event after primary CABG (37 months). Actuarial survival was significantly higher in the PTCA-group at 1, 5 and 10 years after therapy of recurrent angina, despite the freedom from subsequent re-intervention was significantly lower (1-year-survival 95% [37%] vs. 95% [3%] medRx vs. 79% [4%] re-CABG, 5-year-survival 87% [57%] vs. 78% [17%] medRx vs. 50% [4%] re-CABG and 10-year-survival 72% [65%] vs. 63% [31%] medRx vs. 50% [15%] re-CABG resp., p < 0.0001, [numbers in brackets represent corresponding values for incidence of re-intervention, p < 0.0001]). These findings were similar after adjustment for different baseline characteristics. Following this adjustment multivariate Cox-analysis identified age beyond 70 years, diabetes mellitus and therapy: redo-CABG as independent correlates for mortality for the entire group. THERAPY: angioplasty was identified as an independent correlate for survival. In contrast, therapy: angioplasty was an independent correlate for re-intervention after therapy. CONCLUSIONS: In this nonrandomized series of patients with recurrent angina after previous CABG, an initial strategy of angioplasty resulted in a significant higher overall survival, although this regimen is associated with a greater need for subsequent revascularization procedures.
Subject(s)
Angina Pectoris/surgery , Coronary Artery Bypass , Coronary Disease/surgery , Postoperative Complications/surgery , Adult , Aged , Angina Pectoris/diagnosis , Angina Pectoris/mortality , Angioplasty, Balloon, Coronary , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Recurrence , Reoperation , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
The activity of the cardiac renin-angiotensin system is altered in human heart failure, but the regulatory mechanisms are unknown. We analyzed whether angiotensin-converting enzyme (ACE) mRNA expression in heart failure is altered in the atrial myocardium, and whether a correlation exists between atrial ACE mRNA expression and the parameters of left ventricular function. We also investigated whether the use of ACE inhibitors or the ACE I/D genotype modulates the atrial ACE mRNA content. For this purpose patients who were to undergo routine cardiac surgery were selected in a prospective manner according to left ventricular function and ACE inhibitor therapy. Samples of atrial myocardium were taken, and ACE mRNA expression was determined by internally standardized reverse transcription polymerase chain reaction. Atrial ACE mRNA expression did not differ in patients with left ventricular ejection fraction higher than 55% (2423+/-199 copies/ng RNA) and those with a value less than 45% (2661+/-143 copies/ng RNA, n.s.). ACE mRNA expression also did not differ in patients using ACE inhibitors (2585+/-175 copies/ng RNA) and those not using ACE inhibitors (2476+/-185 copies/ng RNA). Furthermore, atrial ACE mRNA expression was not affected by the ACE genotype (DD 2573+/-203, ID 2472+/-215, II 2563+/-249 copies/ng RNA). We conclude that the regulation of atrial ACE mRNA expression occurs predominantly by local mechanical or para- or autocrine factors.
