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2.
Am J Ther ; 21(3): 148-51, 2014.
Article in English | MEDLINE | ID: mdl-22820716

ABSTRACT

Warfarin inhibits the synthesis and function of matrix Gla protein, a vitamin K-dependent protein, which is a potent inhibitor of tissue calcification. We had earlier reported the association of warfarin use with valvular calcification in patients with nonvalvular atrial fibrillation. The aim of our present study was to investigate the association of warfarin use with the presence and severity of coronary artery calcification. A total of 233 patients underwent computed tomography scan (CT) at our institution for the assessment of coronary artery calcium score (CACS). Of 233 patients, the mean age was 63 years, 28 patients (12%) were treated with warfarin, and 205 patients (88%) were not on warfarin. Based on their total CACS, the patients were subsequently stratified into 59 with no coronary calcium (CACS = 0), 63 with low CACS (1-100), 49 with moderate CACS (101-400), 33 with severe CACS (410-1000), and 29 with very severe CACS (>1000). The χ test and Student t-test were used for the comparison of categorical and continuous variables, respectively, between warfarin users and nonusers. Using the variables age, gender, race, smoking, hypertension, diabetes, dyslipidemia, glomerular filtration rate, calcium-phosphorus product, alkaline phosphatase, use of aspirin, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins, stepwise logistic regression analysis did not show any association of coronary calcification with use of warfarin. In our study, warfarin use was not associated with a higher prevalence or severity of CACS assessed by coronary computed tomography.


Subject(s)
Anticoagulants/adverse effects , Calcinosis/chemically induced , Coronary Artery Disease/chemically induced , Warfarin/adverse effects , Aged , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Calcinosis/epidemiology , Calcinosis/pathology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/pathology , Female , Humans , Logistic Models , Male , Middle Aged , Multidetector Computed Tomography/methods , Prevalence , Retrospective Studies , Risk Factors , Severity of Illness Index , Warfarin/therapeutic use
3.
Int J Cardiol ; 168(4): 3683-90, 2013 Oct 09.
Article in English | MEDLINE | ID: mdl-23838593

ABSTRACT

BACKGROUND: Elderly patients with ST-elevation myocardial infarction (STEMI) are often underrepresented in major percutaneous coronary intervention (PCI) trials. Use of PCI for STEMI, and associated outcomes in patients aged ≥65 years with STEMI needed further investigation. METHODS: We used the 2001-2010 United States Nationwide Inpatient Sample (NIS) database to examine the temporal trends in STEMI, use of PCI for STEMI, and outcomes among patients aged 65-79 and ≥80 years. RESULTS: During 2001-2010, of 4,017,367 patients aged ≥65 years with acute myocardial infarction (AMI), 1,434,579 (35.7%) had STEMI. Over this period, among patients aged 65-79 and ≥80 years, STEMI decreased by 16.4% and 19%, whereas the use of PCI for STEMI increased by 33.5% and 22%, respectively (Ptrend<0.001). There was a significant decrease in age-adjusted in-hospital mortality (per 1000) in patients aged ≥80 years (150 versus 116, Ptrend=0.02) but not in patients aged 65-79 years (63 versus 59, Ptrend=0.886). Stepwise logistic regression identified intra-aortic balloon pump use, acute renal failure, acute cerebrovascular disease, age ≥80 years, peripheral vascular disease, gastrointestinal bleeding, female gender, congestive heart failure, chronic lung disease, weekend admission and multivessel PCI as independent predictors of in-hospital mortality among all patients ≥65 years of age who underwent PCI for STEMI. CONCLUSIONS: In this large, multi-institutional cohort of elderly patients, a decreasing trend in STEMI, an increasing trend in PCI utilization for STEMI, and reduction in in-hospital mortality were observed from 2001 to 2010.


Subject(s)
Myocardial Infarction/epidemiology , Myocardial Infarction/surgery , Percutaneous Coronary Intervention/statistics & numerical data , Percutaneous Coronary Intervention/trends , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Incidence , Male , Myocardial Infarction/diagnosis , Retrospective Studies , Time Factors , Treatment Outcome , United States/epidemiology
4.
Curr Clin Pharmacol ; 8(1): 59-66, 2013 Feb 01.
Article in English | MEDLINE | ID: mdl-22946865

ABSTRACT

Dual antiplatelet therapy (DAPT) with a thienopyridine and aspirin has been the standard of care post coronary stent implantation. DAPT has been shown to reduce the risk of stent thrombosis (ST) and complications of myocardial infarction and death after placement of a drug-eluting stent (DES) and bare-metal stent (BMS). This article reviews the available clinical efficacy and safety data of antiplatelet therapies. The aim of this review is to highlight not only the importance of antiplatelets in the prevention of early and late thrombosis but also emphasize the importance of newer more potent antiplatelet agents and their role in the setting of clopidogrel resistance. MEDLINE, and EMBASE were searched for studies related to the clinical efficacy and safety of antiplatelet therapy after DES and BMS placement using the terms dual antiplatelet therapy, thienopyridine, aspirin, clopidogrel, prasugrel, ticagrelor,elinogrel, bare-metal stents, drug-eluting stent, stent thrombosis and myocardial infarction.


Subject(s)
Drug-Eluting Stents , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors/therapeutic use , Stents , Blood Platelets/physiology , Humans , Metals , Platelet Aggregation Inhibitors/pharmacokinetics , Platelet Aggregation Inhibitors/pharmacology
5.
Am J Ther ; 18(3): e78-80, 2011 May.
Article in English | MEDLINE | ID: mdl-20027103

ABSTRACT

Psoriasis is a papulosquamous disease of multifactorial etiology. A combination of genetic and environmental agents is implicated in its pathogenesis. A variety of triggers, including infection, stress, and medications, have been recognized as precipitants of this disease. Nonsteroidal anti-inflammatory drugs, beta-blockers, lithium, synthetic antimalarials, and gold are the most common drugs implicated in precipitating psoriasis. We report a patient with psoriasis induced by initiation of losartan therapy, which resolved with discontinuation of the drug. The Naranjo adverse drug reaction probability scale score indicated that the association between losartan use and psoriasis was probable.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/adverse effects , Losartan/adverse effects , Psoriasis/diagnosis , Adrenergic beta-Antagonists/adverse effects , Adrenergic beta-Antagonists/pharmacology , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Antimalarials/adverse effects , Antimalarials/pharmacology , Antimanic Agents/adverse effects , Antimanic Agents/pharmacology , Humans , Lithium/adverse effects , Losartan/therapeutic use , Male , Middle Aged , Psoriasis/chemically induced , Psoriasis/drug therapy
6.
Med Sci Monit ; 16(12): CR588-92, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21119576

ABSTRACT

BACKGROUND: The aim of the study was to investigate the prevalence of a planar QRS-T angle >90° in patients with ischemic stroke versus transient ischemic attack (TIA). MATERIAL/METHODS: In a prospective study of 279 consecutive patients who had ischemic stroke (197 patients) or TIA (82 patients), the planar QRS-T angle was measured from a 12-lead electrocardiogram taken at the time of the stroke or TIA. All QRS-T angle measurements were made by 3 authors who agreed on the measurements and who were blinded to the clinical findings. A QRS-T angle >90° was considered abnormal. RESULTS: The mean age was 66±6 years in patients with ischemic stroke versus 62±6 years in patients with TIA (p=0.04). The mean body mass index and the prevalence of gender, smoking, hypertension, diabetes mellitus, dyslipidemia, and coronary artery disease were not significantly different between patients with ischemic stroke versus TIA. A QRS-T angle >90° was present in 55 of 197 patients (28%) with ischemic stroke and in 10 of 82 patients (12%) with TIA (p=0.004). CONCLUSIONS: The prevalence of a planar QRS-T angle >90° was higher in patients with ischemic stroke than in patients with TIA (p=0.004).


Subject(s)
Ischemic Attack, Transient/physiopathology , Stroke/physiopathology , Ventricular Function/physiology , Aged , Body Mass Index , Electrocardiography , Humans , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk Factors
7.
Am J Cardiol ; 105(3): 293-6, 2010 Feb 01.
Article in English | MEDLINE | ID: mdl-20102937

ABSTRACT

No data are available comparing the long-term outcome of sirolimus-eluting stents (SESs) versus paclitaxel-eluting stents (PESs) in patients with moderate to severe renal insufficiency. The incidence of major adverse cardiac events (MACE), including death, myocardial infarction, and target vessel revascularization, during long-term follow-up were studied in patients with a glomerular filtration rate of <60 ml/min/1.73 m(2), as measured by the Modification of Diet in Renal Disease (MDRD) study equation, who also underwent percutaneous coronary intervention with drug-eluting stents. Of 428 patients studied, PESs were placed in 287 patients and SESs in 141 patients. Stepwise Cox regression analyses were performed to identify significant independent risk factors for MACE. At 47 + or - 19 months of follow-up, MACE had occurred in 49 (17%) of 287 patients in the PES group (mean age 71 + or - 11 years, 55% men) and in 31 (22%) of 141 patients in the SES group (mean age 71 + or - 12 years, 53% men). No significant difference was found in the MACE rate between the PES and SES groups. This persisted even after controlling for stent length, lesion complexity, and other co-morbidities. Also, all-cause mortality was not significantly different between the PES and SES groups (7.1% vs 8.5%, respectively). In conclusion, during long-term follow-up of patients with moderate to severe renal insufficiency, the rates of MACE and all-cause mortality were similar in the PES and SES groups.


Subject(s)
Cardiovascular Diseases/therapy , Drug-Eluting Stents , Paclitaxel/administration & dosage , Renal Insufficiency/complications , Sirolimus/administration & dosage , Aged , Aged, 80 and over , Cardiovascular Diseases/complications , Coronary Artery Disease/etiology , Coronary Artery Disease/therapy , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Retrospective Studies
8.
Am J Ther ; 17(5): 529-32, 2010.
Article in English | MEDLINE | ID: mdl-19636245

ABSTRACT

Tricyclic antidepressants (TCAs) remain a common cause of fatal drug poisoning as a result of their cardiovascular toxicity manifested by electrocardiographic abnormalities, arrhythmias, and hypotension. The principal mechanism of toxicity is cardiac sodium channel blockade. Brugada electrocardiographic pattern (BEP) has also been described in TCA overdose. Currently, very little is known about the relationship between the Brugada syndrome and TCAs. We report the case of a patient who presented with BEP after intake of a high dose of amitriptyline. The patient was treated with continuous sodium bicarbonate infusion leading to resolution of BEP.


Subject(s)
Amitriptyline/poisoning , Antidepressive Agents, Tricyclic/poisoning , Brugada Syndrome/chemically induced , Electrocardiography , Amitriptyline/adverse effects , Antidepressive Agents, Tricyclic/adverse effects , Arrhythmias, Cardiac/drug therapy , Drug Overdose/drug therapy , Humans , Male , Middle Aged , Sodium Bicarbonate/antagonists & inhibitors
9.
Am J Ther ; 17(6): e179-81, 2010.
Article in English | MEDLINE | ID: mdl-19352143

ABSTRACT

We investigated the prevalence of in-hospital complications in 500 patients undergoing percutaneous coronary intervention (PCI) treated with heparin 5000 IU administered systemically (group 1) at the time of PCI versus in 500 age-matched and sex-matched patients undergoing PCI treated with heparin 70 IU/kg administered systemically (group 2) at the time of PCI. There was no significant difference in baseline characteristics, indications for PCI, cardiovascular drug therapy at the time of PCI, prevalence of 1-vessel, 2-vessel, and 3-vessel obstructive coronary artery disease, and in-hospital complications between the 2 groups. In-hospital death occurred in 0.2% of group 1 patients versus 0.8% of group 2 patients. Non-ST-segment elevation myocardial infarction occurred in 0.2% of group 1 patients versus 0.4% of group 2 patients. Stroke occurred in 0.2% of group 1 patients versus 0.2% of group 2 patients. Stent thrombosis occurred in 0.2% of group 1 patients versus 0.8% of group 2 patients. Occlusion of a side branch occurred in 0.2% of group 1 patients versus 0.4% of group 2 patients. A hematoma needing intervention occurred in 0.2% of group 1 patients versus 0.2% of group 2 patients. Regression analysis showed that none of the differences between the 2 groups were significant. The sample size was adequate to conclude that a fixed low dose of heparin 5000 IU administered systemically at the time of PCI is noninferior to standard therapy with heparin.


Subject(s)
Angioplasty, Balloon, Coronary , Anticoagulants/pharmacology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/therapy , Heparin/pharmacology , Aged , Anticoagulants/therapeutic use , Coronary Artery Disease/mortality , Dose-Response Relationship, Drug , Female , Heparin/therapeutic use , Humans , Inpatients , Male , Middle Aged , Myocardial Infarction/chemically induced , Myocardial Infarction/drug therapy , Prevalence , Stroke/chemically induced , Stroke/drug therapy
10.
Med Sci Monit ; 15(12): MS31-4, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19946243

ABSTRACT

BACKGROUND: The aim of the study was to investigate the severity of coronary artery disease (CAD) in patients who had a planar QRS-T angle >90 degrees versus 50% obstruction of >or=1 major coronary artery. All QRS-T angle measurements were made from a 12-lead electrocardiogram by 2 authors who agreed on the measurement and who were blinded to the coronary angiographic findings. A QRS-T angle >90 degrees was considered abnormal. RESULTS: Obstructive CAD of 2 or 3 vessels was present in 309 of 495 patients (62%) with a planar QRS-T angle >90 degrees and in 250 of 734 patients (34%) with a planar QRS-T angle or=30 kg/m2 (odds ratio =1.5). CONCLUSIONS: The prevalence of 2- or 3-vessel obstructive CAD was significantly higher in patients with a planar QRS-T angle >90 degrees than in patients with a planar QRS-T angle

Subject(s)
Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/diagnosis , Electrocardiography , Aged , Coronary Artery Disease/complications , Coronary Vessels/pathology , Female , Humans , Hypertrophy, Left Ventricular/complications , Logistic Models , Male , Middle Aged , Risk Factors
11.
J Interv Cardiol ; 22(5): 427-30, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19627434

ABSTRACT

BACKGROUND: Although insertion of multiple stents into a single coronary vessel during single-vessel percutaneous coronary intervention (PCI) is common, there are no data on long-term occurrence of major adverse cardiac events (MACE) in patients treated with multiple stents versus a single stent. METHODS: The incidence of MACE (death, myocardial infarction, or target vessel revascularization) during long-term follow-up was investigated in 634 patients who underwent single-vessel PCI. Of the 634 patients, 319 (50%) had a single stent, and 315 (50%) had multiple stents inserted. Stepwise Cox regression analyses were performed to identify significant independent prognostic factors for MACE. RESULTS: At 47-month follow-up, MACE occurred in 61 of 319 patients (19%) who had a single stent versus in 57 of 315 patients (18%) who had multiple stents (P not significant). Significant independent predictors of MACE were use of vein grafts (hazard ratio = 1.94; 95% CI, 1.24-3.03; P = 0.0038) and use of drug-eluting stents (hazard ratio = 0.49; 95% CI, 0.34-0.72; P = 0.0002). CONCLUSIONS: At long-term follow-up of single-vessel PCI, the incidence of MACE was similar in patients with multiple or single stents inserted even after controlling for the length of stents.


Subject(s)
Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis/adverse effects , Coronary Disease/surgery , Myocardial Revascularization/instrumentation , Stents/adverse effects , Aged , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Coronary Disease/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Myocardial Revascularization/adverse effects , Myocardial Revascularization/methods , Myocardial Revascularization/mortality , Reoperation , Severity of Illness Index , Treatment Outcome
12.
Am J Cardiol ; 103(12): 1672-4, 2009 Jun 15.
Article in English | MEDLINE | ID: mdl-19539074

ABSTRACT

After thrombolytic therapy with tenecteplase for ST-segment elevation acute myocardial infarction, 376 patients were transferred from their hospital to Westchester Medical Center for percutaneous coronary intervention with stenting. Of 376 patients, 102 (27%) received bare-metal stents and 274 (73%) received drug-eluting stents with sirolimus-eluting or paclitaxel-eluting stents. At 43 months of follow-up, major adverse cardiac events occurred in 25 (25%) of 102 patients treated with bare-metal stents versus 40 (15%) of 274 patients treated with drug-eluting stents (p = 0.024). Cox regression analysis showed that significant independent prognostic factors for major adverse cardiac events were previous coronary artery bypass surgery (hazard ratio 2.2, p = 0.019), width of stent (hazard ratio 0.44, p = 0.006), and bare-metal stent (hazard ratio 1.8, p = 0.019). In conclusion, patients with bare-metal stents had a 1.8 times greater risk of developing major adverse cardiac events than did those using drug-eluting stents after controlling the confounding effects of previous coronary artery bypass surgery and stent width.


Subject(s)
Angioplasty, Balloon, Coronary/methods , Drug-Eluting Stents , Electrocardiography , Graft Occlusion, Vascular/epidemiology , Myocardial Infarction/surgery , Female , Follow-Up Studies , Graft Occlusion, Vascular/etiology , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , New York/epidemiology , Prognosis , Risk Factors , Survival Rate/trends , Time Factors
13.
Coron Artery Dis ; 20(2): 91-3, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19106796

ABSTRACT

OBJECTIVE: To investigate the severity of coronary artery disease by coronary angiography in age-matched and sex-matched patients with diabetes mellitus with atrial fibrillation versus sinus rhythm. METHODS: The patients included 245 men and women, mean age of 70 years, with diabetes and atrial fibrillation and 245 age-matched and sex-matched patients with diabetes and sinus rhythm who underwent coronary angiography. Baseline characteristics and indications for coronary angiography were similar in both groups. RESULTS: Greater than 50% narrowing of one, two, or three major coronary arteries were present in 229 of 245 patients (94%) with diabetes and atrial fibrillation and in 211 of 245 patients (86%) with diabetes and with sinus rhythm (P<0.01). Greater than 50% narrowing of three major coronary arteries were present in 150 of 245 patients (61%) with diabetes and atrial fibrillation and in 75 of 245 patients (31%) with diabetes and sinus rhythm (P<0.001). CONCLUSION: Patients with diabetes and atrial fibrillation have a significantly higher prevalence of greater than 50% narrowing of one or more major coronary arteries and of three major coronary arteries than patients with diabetes and sinus rhythm.


Subject(s)
Atrial Fibrillation/diagnostic imaging , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Diabetes Complications/diagnostic imaging , Diabetes Mellitus, Type 2/complications , Aged , Atrial Fibrillation/epidemiology , Atrial Fibrillation/etiology , Case-Control Studies , Coronary Stenosis/epidemiology , Coronary Stenosis/etiology , Diabetes Complications/epidemiology , Diabetes Complications/etiology , Diabetes Mellitus, Type 2/epidemiology , Female , Humans , Male , Middle Aged , Prevalence , Severity of Illness Index
14.
Am J Cardiol ; 101(4): 467-70, 2008 Feb 15.
Article in English | MEDLINE | ID: mdl-18312759

ABSTRACT

The prevalence of >70% narrowing of 1, 2, or 3 major coronary arteries and of 3 major coronary arteries was investigated in 2,465 patients (1,437 men, 1,028 women; mean age 69 +/- 13 years) with severe, moderate, mild, or no mitral annular calcium (MAC) diagnosed by 2-dimensional echocardiography who underwent coronary angiography for suspected coronary artery disease. Greater than 70% narrowing of 1, 2, or 3 major coronary arteries was present in 259 of 315 patients (82%) with severe MAC (group 1), in 835 of 1,052 patients (79%) with moderate or mild MAC (group 2), and in 756 of 1,098 patients (69%) with no MAC (group 3) (p <0.001 comparing group 1 with group 3 and group 2 with group 3). Greater than 70% narrowing of 3 major coronary arteries was present in 149 of 315 patients (47%) in group 1, in 366 of 1,052 patients (35%) in group 2, and in 325 of 1,098 patients (30%) in group 3 (p <0.001 comparing group 1 with group 3 and group 1 with group 2; p <0.01 comparing group 2 with group 3). In conclusion, MAC is associated with obstructive >or=1-vessel coronary artery disease and with obstructive 3-vessel coronary artery disease.


Subject(s)
Calcinosis/diagnostic imaging , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Heart Valve Diseases/diagnostic imaging , Mitral Valve/diagnostic imaging , Aged , Female , Humans , Male , Prevalence , Severity of Illness Index , Ultrasonography
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