Effect of preprocedural statin use on procedural myocardial infarction and major cardiac adverse events in percutaneous coronary intervention: a meta-analysis.

BACKGROUND: Multiple primary and secondary prevention trials demonstrate significant reduction in adverse cardiovascular outcomes in patients with, or at risk of, coronary artery disease as a result of statin therapy. This study was conducted to determine whether statin use prior to elective percutaneous coronary intervention (PCI) is associated with lower procedural myocardial infarction (MI) and major adverse cardiovascular events (MACE) in the form of a meta-analysis. METHODS: Trials were eligible for inclusion if they included patients who received a statin prior to PCI and if appropriate documentation of procedural MI was performed. Studies that included acute coronary syndrome patients were excluded. For each trial, the results immediately post intervention and at the longest follow up (up to 12 months) were extracted and analyzed based on an intention-to-treat principle. Six trials involving 2,996 subjects met the inclusion criteria for periprocedural MI and were included in the analysis. Three trials involving 6,723 subjects had appropriate follow up and were analyzed for MACE (the combined endpoint of death, nonfatal MI or target vessel revascularization) up to 12 months after PCI. RESULTS: When the 6 trials included in the main analysis were combined, the summary effect of statins on reducing procedural MI was -5.44% (95% CI -8.2% to -2.7% [p < 0.0001]). There was no evidence of heterogeneity between trials (p = 0.66). The relative risk reduction was 59.3% (9.17% vs. 3.73%; p < 0.001). Sensitivity analysis did not alter this finding. The MACE rates were 19.5% and 15.5% in the control and statin groups, respectively. The overall MACE risk difference was -4.0%, (95% CI -11.4% to +3.4% [p = 0.2900]). The corresponding overall relative risk reduction was 20.5%.

Myocardial calcification as a rare cause of congestive heart failure: a case report.

Myocardial calcification is a manifestation of either metastatic or dystrophic calcium deposition in the myocardium. Dystrophic calcification of the myocardium is most commonly seen in long-term survivors of substantial myocardial infarctions. Current literature has reported only 3 cases of myocardial calcification with normal coronary arteries. We present a case of an 80-year-old woman with multiple admissions over a 5-year period for congestive heart failure. She was found to have a normal left ventricular ejection fraction and normal coronary arteries on left heart catheterization. A high resolution computed tomography (CT) study of the chest revealed extensive left ventricular myocardial calcifications, which were not present 4 years earlier on CT. The patient's history and clinical presentation revealed no etiologic factors for her calcified myocardium.

Lipid-lowering therapy in patients with peripheral arterial disease.

Peripheral arterial disease (PAD) is a prevalent, chronic, and progressive atherosclerotic disease process involving the conduit vessels of the extremities. Most patients who present with objective signs of PAD are asymptomatic. These patients are at an increased risk of dying from cardiovascular events. Lipid management is the mainstay of risk-factor modification for patients with cardiovascular disease. Some evidence suggests that hypocholesterolemic drugs may halt the progression of atherosclerotic peripheral vascular disease. More recently, treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) inhibitors have demonstrated improved function in patients with symptomatic peripheral vascular disease. This paper reviews the role of lipid therapy in patients with peripheral arterial disease with focus on functional improvement and symptomatic relief based on the available data.