Direct observation of Cu in high-silica chabazite zeolite by electron ptychography using Wigner distribution deconvolution.

Direct observation of Cu in Cu-chabazite (CHA) zeolite has been achieved by electron ptychography using the Wigner distribution deconvolution. The imaging properties of ptychographically reconstructed images were evaluated by comparing the intensities of six-membered-ring columns of the zeolite with and without Cu using simulated ptychography images. It was concluded that although false contrast may appear at Cu-free columns for some acquisition conditions, ptychography can discriminate columns with and without Cu. Experimental observation of CHA with and without Cu was performed. Images obtained from the Cu-containing sample showed contrast at the six-membered-rings, while no contrast was observed for the Cu-free sample. The results show that ptychography is a promising technique for visualizing the atomic structures of beam-sensitive materials.

Decreased mortality associated with statin treatment in patients with acute myocardial infarction and lymphotoxin-alpha C804A polymorphism.

AIMS: We previously reported the association of single nucleotide polymorphisms in the lymphotoxin alpha (LTα) gene with susceptibility to acute myocardial infarction (AMI) and increased mortality after discharge. In the present study, we investigated whether the adverse effect of LTα C804A polymorphism on mortality could be pharmacologically modified by statin treatment after AMI. METHODS AND RESULTS: We conducted a multicenter study that included 3486 post-AMI patients between 1998 and 2008. During a median follow-up period of 1775 days, 247 deaths were recorded. The mortality rate was significantly higher in LTα 804A allele carriers compared to non-804A allele carriers (7.9% vs. 5.7%, p = 0.011). The LTα 804A allele was significantly associated with increased mortality for post-AMI patients not receiving statins (hazard ratio [HR]: 1.48, 95% confidence interval [CI]: 1.03-2.12, p = 0.034), but not for those receiving statins (HR: 1.22, 95% CI: 0.70-2.10, p = 0.486). In-vitro experimental analyses demonstrated that the LTα 804A polymorphic protein, 26Asn-LTα3, induced monocyte-endothelial interaction and endoplasmic reticulum (ER) stress in cardiomyocytes more strongly than the LTα3 804C polymorphic protein 26Thr-LTα3. However, the effects of both LTα3 proteins were decreased and became comparable by the pretreatment of cells with pravastatin. CONCLUSION: LTα C804A polymorphism was associated with an increased risk of mortality for AMI patients, although this effect was masked in patients treated with statins. This finding is supported by the observed attenuation of 26Asn-LTα3-mediated monocyte-endothelial interaction and ER stress in cardiomyocytes treated with pravastatin. LTα C804A polymorphism may have potential as a novel therapeutic target for secondary prevention after AMI.

Elevated serum heart-type fatty acid-binding protein in the convalescent stage predicts long-term outcome in patients surviving acute myocardial infarction.

BACKGROUND: Little is known about the prognostic significance of elevated serum heart-type fatty acid-binding protein (H-FABP) in post-acute myocardial infarction (post-AMI) patients. METHODS AND RESULTS: A total of 1,283 post-AMI patients with available serum samples collected in the convalescent stage were studied. During a median follow-up period of 1,785 days, 176 patients (14%) had adverse events (all-cause mortality, n=81; non-fatal MI, n=44; readmission for heart failure [HF], n=51). Patients were divided into 2 groups according to a serum H-FABP level of 6.08ng/ml, which was determined to be the optimal cut-off for discriminating all-cause mortality based on the maximum value of the area under the receiver operating characteristic curve. Patients with elevated H-FABP (>6.08ng/ml, n=224) had a significantly higher incidence of death (18.3% vs. 3.8%, P<0.001) and readmission for HF (10.3% vs. 2.6%, P<0.001), but not of non-fatal MI (4.5% vs. 3.2%, P=0.187), compared to those with H-FABP <6.08ng/ml. Multivariate Cox regression analysis indicated that elevated serum H-FABP was associated with an increased risk of mortality (hazard ratio [HR], 1.91; 95% confidence interval [CI]: 1.03-3.51, P=0.039) and readmission for HF (HR, 2.49; 95% CI: 1.15-5.39, P=0.020). CONCLUSIONS: Elevated serum H-FABP during the convalescent stage of AMI predicted long-term mortality and readmission for HF after survival discharge in the post-AMI patients.

Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction.

BACKGROUND: In the percutaneous coronary intervention (PCI) era, little evidence exists regarding the incidence, predictors and long-term mortality of recurrent myocardial infarction (Re-MI) following discharge for acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 7,870 patients who survived AMI were studied with a median follow-up period of 3.9 years: 353 patients (4.5%) experienced Re-MI, with 7 of those dying within 30 days, which was classified as fatal Re-MI. The incidence of Re-MI per year was 2.65% for the first year, and 0.91-1.42% thereafter up to 5 years. Multivariate Cox regression analyses revealed that predictors of Re-MI were diabetes mellitus (hazard ratio (HR): 2.079, P<0.001), history of MI (HR: 1.767, P=0.001), and advanced age (HR: 1.021, P=0.001). These 3 predictors remained significant when angiographic and procedural parameters were incorporated into the analyses. The incidence and adjusted risk of Re-MI increased when these variables were clustered (P<0.001). The all-cause mortality rate was significantly higher in patients with Re-MI than in those without (HR: 2.206, P<0.001). CONCLUSIONS: In post-AMI patients treated in the PCI era, the incidence of Re-MI is low compared with that reported during the past 30 years. Patients' clinical factors of diabetes mellitus, history of MI, and advanced age appear to affect the occurrence of Re-MI after hospital discharge, and Re-MI still carries a risk for subsequent mortality.

Impact of beta blockade therapy on long-term mortality after ST-segment elevation acute myocardial infarction in the percutaneous coronary intervention era.

Although clinical guidelines recommend long-term ß-blocker (BB) therapy to decrease mortality after acute myocardial infarction, these recommendations are based predominantly on evidence from before the reperfusion and thrombolytic eras. To investigate the effects of BB therapy for patients with acute myocardial infarctions on mortality in the percutaneous coronary intervention era, a total of 5,628 consecutive patients who were admitted <24 hours after the onset of ST-segment elevation myocardial infarction, treated with emergent percutaneous coronary intervention, and discharged alive were studied. During a median follow-up period of 1,430 days, mortality rates did not differ between patients with and without BB therapy (5.2% vs 6.2%, p = 0.786). Multivariate analysis revealed that BB treatment was not associated with a reduced risk for mortality (hazard ratio 0.935, 95% confidence interval 0.711 to 1.230, p = 0.534). The results of propensity score matching also indicated that the mortality rates did not differ between the 2 groups. However, subgroup analyses among matched populations revealed that BB treatment was associated with a significantly lower mortality risk for high-risk patients, who were defined as those with Global Registry of Acute Coronary Events (GRACE) risk scores ≥121 (hazard ratio 0.596, 95% confidence interval 0.416 to 0.854, p = 0.005) or those administered diuretics (hazard ratio 0.602, 95% confidence interval 0.398 to 0.910, p = 0.016), but not for lower risk patients. In conclusion, BB treatment was associated with reduced long-term mortality in patients after ST-segment elevation myocardial infarction at higher risk, but not in those at lower risk. Although randomized controlled studies are warranted to confirm these results, the implementation of BB therapy for discharged patients with ST-segment elevation myocardial infarction may need to be assessed on the basis of individual mortality risk in the percutaneous coronary intervention era.

A subset of circulating microRNAs are predictive for cardiac death after discharge for acute myocardial infarction.

To investigate the prognostic impact of circulating microRNAs (miRs) in patients who survived acute myocardial infarction (AMI), we compared the circulating miR signature at the time of survival discharge among samples in the serum bank of the Osaka Acute Coronary Insufficiency Study. Using a high-throughput array consisting of 667 miRs, 11 miRs were found to be differentially expressed in the serum among patients at high-risk for cardiac death. Real-time RT-PCR confirmed that the serum levels of miR-155 and miR-380* were approximately 4- and 3-fold higher, respectively, in patients who experienced cardiac death within 1 year after discharge. Accordingly, a subset of circulating miRs might be predictive for cardiac death in post-AMI patients.

Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction.

BACKGROUND: Previous studies showed that nicorandil can reduce coronary events in patients with coronary artery disease. However, it is unclear whether oral nicorandil treatment may reduce mortality following acute myocardial infarction (AMI). METHODS AND RESULTS: We examined the impact of oral nicorandil treatment on cardiovascular events in 1846 AMI patients who were hospitalized within 24 h after AMI onset, treated with emergency percutaneous coronary intervention (PCI), and discharged alive. Patients were divided into those with (Group N, n=535) and without (Group C, n=1311) oral nicorandil treatment at discharge. No significant differences in age, gender, body mass index, prevalence of coronary risk factors, or history of myocardial infarction existed between the two groups; however, higher incidences of multi-vessel disease, and a lower rate of successful PCI were observed in Group N. During the median follow-up of 709 (340-1088) days, all-cause mortality rate was 43% lower in Group N compared with Group C (2.4% vs. 4.2%, stratified log-rank test: p=0.0358). Multivariate Cox regression analysis revealed that nicorandil treatment was associated with all-cause death after discharge (Hazard ratio 0.495, 95% CI: 0.254-0.966, p=0.0393), but not for other cardiovascular events such as re-infarction, admission for heart failure, stroke and arrhythmia. CONCLUSIONS: The results suggest that oral administration of nicorandil is associated with reduced incidence of death in the setting of secondary prevention after AMI.

Longitudinal risk of cardiovascular events in relation to depression symptoms after discharge among survivors of myocardial infarction. Osaka Acute Coronary Insufficiency Study.

BACKGROUND: The purpose of this study was to investigate the association between depression symptoms 1 year after onset and subsequent cardiovascular events among survivors of myocardial infarction (MI). METHODS AND RESULTS: The participants were recruited from respondents to a district-based survey known as the Osaka Acute Coronary Insufficiency Study. Of 4,271 eligible MI patients, 1,951 completed the Zung Self-Rating Depression Scale (SDS) at their 1-year follow-up examination. After excluding patients who experienced cardiovascular events within 1 year, the data for the remaining 1,307 male patients and 280 female patients were analyzed. Among male patients, depression status at 1 year after onset of MI was significantly related to risk of subsequent cardiovascular events throughout the follow-up period (median 2.9 years). The male patients in the top vs. bottom tertiles of SDS scores (top tertile being ≥42) had a multivariable-adjusted hazard ratio (HR) of 1.67 (95% confidence interval (CI) 1.01-2.77, P=0.04), and a 1-SD increment in SDS score was significantly related to a heightened risk of cardiovascular events, with a multivariable-adjusted HR of 1.30 (95%CI 1.07-1.58, P=0.01). There were no significant associations between SDS scores and cardiovascular events among female patients. CONCLUSIONS: Depression symptoms 1 year after onset of MI are a significant predictor of subsequent cardiovascular events for male patients.

Sairei-to therapy on alloimmune recurrent spontaneous abortions and alloimmune-, autoimmune complicated recurrent spontaneous abortions.

Alloimmune recurrent spontaneous abortion (RSA) cases that could not be treated with lymphocyte transfusion due to medical and social reasons were treated with Sairei-to therapy as an emergency measure and all four cases resulted in live births. This may show that Sairei-to treatment is effective in preventing alloimmune RSA. The efficacy of Sojyutsu-Sairei-to and Byakujyutsu-Sairei-to on autoimmune RSA has already been proven. When they were used in the treatment of alloimmune-, autoimmune complicated RSA, the abortion prevention rates were 65.4% and 82.3% respectively. These results indicate that Sairei-to is effective in the treatment of alloimmune RSA and alloimmune-, autoimmune complicated RSA.

Differences in individual efficacy of two Sairei-to preparations (Sojyutu-Sairei-to and Byakujyutu-Sairei-to) on recurrent spontaneous abortions of autoimmune etiologies evaluated by antinuclear antibody and anticardiolipin antibody titers.

The differences in individual efficacy of two Sairei-to preparations (Sojyutu-Sairei-to and Byakujyutu-Sairei-to) on antinuclear antibody (ANA) and anticardiolipin antibody (ACLA) positive recurrent spontaneous abortion (RSA) was analyzed in 52 patients (a total of 61 treatment sessions). Patients who failed to respond to initial treatment with Sojyutu-Sairei-to were additionally treated with Byakujyutu- Sairei-to, and the time course of ANA and ACLA titers in these patients was analyzed. ACLA titers were decreased significantly by the treatment of Byakujyutu-Sairei-to, however, the percentage of successfully prevented abortion cases did not differ significantly between the Sojyutu-Sairei-to treatment group and the Byakujyutu-Sairei-to treatment group. ACLA titer was decreased in all 10 cases where abortion was successfully prevented by the treatment with Sojyutu-Sairei-to or Byakujyutu-Sairei-to. In the cases where both ANA and ACLA were decreased following treatment with Sojyutu-Sairei-to or Byakujyutu-Sairei-to, the percentage of cases rated as "Kyo" and "Rikan" were significantly higher in the Byakujyutu-Sairei-to group. These results indicate that Byakujyutu-Sairei-to is effective against ACLA positive RSA through the antibody-reducing activity, which differs from that of Sojyutu-Sairei-to in individual cases. On the basis of these results, Sairei-to therapy, which is superior to aspirin and heparin in terms of efficacy and safety, is recommended as the first-line therapy for RSA of autoimmune etiologies. Furthermore, to elevate the percentage of successfully prevented abortions, it is advisable to select one of the two Sairei-to preparations (Sojyutu-Sairei-to and Byakujyutu-Sairei-to) on the basis of differential diagnosis using the methods of Oriental medicine.

Effect of intracoronary thrombectomy on 30-day mortality in non-diabetic patients with acute hyperglycemia after acute myocardial infarction.

BACKGROUND: There is limited evidence about useful therapeutic interventions for patients with acute hyperglycemia (AH) after acute myocardial infarction (AMI). METHODS: We studied 2433 consecutive non-diabetic AMI patients who underwent percutaneous coronary intervention (PCI) within 24h after the onset. Patients were divided into two groups according to the presence or absence of AH (admission serum glucose level ≥ 11.1 mmol/l). We assessed the association between intracoronary thrombectomy and the clinical outcome in AMI patients with AH. RESULTS: Patients with AH had more risk factors than those without AH. The 30-day mortality rate of patients with AH was significantly higher than that of those without (11.7% vs 1.7%, p<0.001). Among patients with AH, the 30-day mortality rate was significantly lower for those with intracoronary thrombectomy than those without it (4.9% vs 17.2%, p=0.004). Among patients without AH, however, the 30-day mortality rate was similar between those with and without intracoronary thrombectomy (1.5% vs 1.9%, p=NS). Multivariate analysis showed that intracoronary thrombectomy was associated with an improved 30-day mortality rate for patients with AH (hazard ratio: HR 0.184, 95% CI 0.057-0.598, p=0.005). CONCLUSIONS: In AMI patients with AH, intracoronary thrombectomy prior to PCI might improve the 30-day mortality rate.

Impact of diabetes mellitus on rehospitalization for heart failure among survivors of acute myocardial infarction in the percutaneous coronary intervention era.

BACKGROUND: There is little data regarding the clinical impact of diabetes mellitus (DM) on heart failure (HF) among survivors of acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era. METHODS AND RESULTS: The present study group comprised 4,035 survivors who underwent PCI within 24 h of the onset of symptoms. DM was an independent predictor of rehospitalization for HF by multivariate analysis (hazard ratio (HR) 1.576, P=0.010). The risk of rehospitalization for HF was similar between patients with DM who did not have an enlarged left ventricular diastolic diameter (LVDd<51 mm) before discharge and patients without DM who showed an increase in LVDd (>or=51 mm) (HR 1.020, P=0.959). In the DM group, the hemoglobin A1c level before discharge was similar between patients with and without rehospitalization for HF (7.5+/-1.9% vs 7.4+/-1.6%, P=0.455), whereas high-sensitivity C-reactive protein (hs-CRP) was higher in patients with than without rehospitalization for HF (1.80+/-3.63 vs 0.75+/-2.03 mg/dl, P=0.001). CONCLUSIONS: DM is an independent predictor of rehospitalization for HF after AMI in the PCI era. Diabetic patients without left ventricular remodeling should be treated as a high-risk group for HF. Measurement of hs-CRP level may be useful for predicting rehospitalization because of HF in diabetic patients after AMI.

Lymphotoxin-alpha3 mediates monocyte-endothelial interaction by TNFR I/NF-kappaB signaling.

We recently reported that the single nucleotide polymorphisms of the lymphotoxin-(LT)alpha gene, a member of the tumor necrosis factor (TNF) family, are closely related to acute myocardial infarction; however, the precise mechanism of LTalpha signaling in atherogenesis remains unclear. We investigated the role of LTalpha3, a secreted homotrimer of LTalpha, in monocyte-endothelial cell adhesion using cultured human umbilical vein endothelial cells (HUVEC). We found that LTalpha3 induced cell adhesion molecules and activated NF-kappaB p50 and p65. LTalpha3 also induced phosphorylation of Akt, phosphorylation and degradation of IkappaB, nuclear translocation of p65, and increased adhesion of THP1 monocytes to HUVEC. These effects were mediated by TNF receptor (TNFR) I and attenuated by the phosphatidylinositol triphosphate-kinase (PI3K) inhibitors LY294002 and Wortmannin. Thus, LTalpha3 mediates the monocyte-endothelial interaction via the classical NF-kappaB pathway following TNFR I/PI3K activation, indicating it may play a role in the development of coronary artery disease.

Kampo medicine, based on traditional medicine theory, in treating uncured glossodynia: efficacy in five clinical cases.

Glossodynia, or tongue pain, is resistant to conventional therapies. Kampo medicines were evaluated in patients suffering from incurable glossodynia. Patients were diagnosed by traditional Chinese medicine (TCM) theory in order to determine the appropriate herbal prescriptions. Five Japanese females (50-76 years old) with glossodynia refractory to conventional therapy were enrolled in this study. Small portions of rikkunshito, jiinkokato, hachimijiogan and ryutanshakanto worked for a female diagnosed with "Spleen" and "Heart" Yin deficiency, "Kidney" Yang deficiency and "Liver" Qi stagnation producing heat syndrome. Seishoekkito and bakumondoto were effective for a patient diagnosed with "Spleen Qi" deficiency and "Stomach" Yin deficiency producing heat syndrome. Rikkunshito, kamikihito and chikujountanto worked for a patient diagnosed with "Spleen Qi" and "Heart Yin" deficiency, stagnation of "Liver" Qi producing fire and "Gallbladder" Qi deficiency. Rokumijiogan, kamishoyosan and kambakutaisoto were effective for a patient with Yang rise based on Yin deficiency of "Kidney" and "Liver," and restless organ disorder based on Yin deficiency of 5 viscera. A patient diagnosed with "Spleen" Yang deficiency responded to a combination of anchusan and hangeshashinto. These patients with glossodynia had resolution of pain within 1 month of treatment. Herbal mixtures containing Ganoderam lucidum, not prescribed based on TCM theory, but effective for herpes virus infection, worked for a female suffering from glossodynia for 1 year after artificial teeth were placed, but required about 5 months to note improvement. Kampo medicines, properly prescribed based on TCM theory, quickly resolved the pain of refractory glossodynia.

Up-regulation of cell adhesion molecule genes in human endothelial cells stimulated by lymphotoxin alpha: DNA microarray analysis.

BACKGROUND: We recently reported that the A252G polymorphism of the Lymphotoxin-alpha (LTA) gene, a member of the tumor necrosis factor family, is strongly related with the onset of acute myocardial infarction; however, the roles of LTA in the development of atherosclerosis remain unclear. METHODS AND RESULTS: Changes in gene expression profile in cultured human umbilical vein (HUVEC) and coronary artery endothelial cells (HCAEC) treated with LTA were analyzed with high density oligonucleotide arrays comprised of 8,500 genes. LTA stimulation at 10 ng/mL for 2 hours profoundly induced gene expression associated with signal transduction, cell adhesion and chemoattraction, such as the nuclear factor of kappa light polypeptide gene enhancer in B-cells (NFkB), endothelial adhesion molecule 1 (E-Selectin), vascular cell adhesion molecule 1 (VCAM1), and monocyte chemotactic protein 1 (MCP1) (2.6, 55.7, 45.3 and 2.8 fold in HUVEC, and 2.6, 137.2, 64.0 and 13.0 fold in HCAEC, respectively). Quantitative real-time reverse transcriptase-polymerase chain reaction analysis confirmed that LTA increased the expressions of E-Selectin and VCAM1 in a dose-dependent manner both in HUVEC and HCAEC. CONCLUSION: LTA increased the expression of various genes involved in the process of atherosclerosis or inflammation in human endothelial cells, suggesting the roles of LTA in the development of atherosclerosis.

Effect of early use of low-dose pravastatin on major adverse cardiac events in patients with acute myocardial infarction: the OACIS-LIPID Study.

BACKGROUND: It is unclear whether early initiation of low-dose pravastatin therapy can reduce the occurrence of major adverse cardiac events after acute myocardial infarction (AMI). METHODS AND RESULTS: The study group comprised 353 patients with AMI who had plasma total cholesterol levels of 200-250 mg/dl and triglyceride levels <300 mg/dl. The patients were randomly assigned to either receive pravastatin (10 mg/daily, n=176) or not (n=177). The primary endpoint was a composite of death, nonfatal myocardial infarction (MI), unstable angina (UA), stroke, revascularization, and rehospitalization because of other cardiovascular disease. The follow-up period was 9 months. The primary endpoint occurred in 31 patients (17.9%) in the pravastatin group and 55 patients (31.4%) in the non-pravastatin group (relative risk, 0.56; 95% confidence interval, 0.36-0.87). There were no significant differences in the risk of death, nonfatal MI, UA, and stroke between the 2 groups, although the pravastatin group had a lower risk of need for revascularization. CONCLUSION: For patients with AMI, early and low-dose pravastatin therapy (10 mg/daily) reduces recurrent major adverse cardiac events, mostly the requirement for revascularization.

Effect on outcome of an increase of serum cardiac troponin T in patients with healing or healed ST-elevation myocardial infarction.

Recently, an association between minimally elevated cardiac troponin levels and cardiovascular risk in the general population has been reported. However, the prevalence and clinical importance of elevated cardiac troponin T (cTnT) levels remain unclear in patients with histories of myocardial infarction (MI). In this study, 1,807 consecutive patients with ST-segment elevation MIs were prospectively studied (77.1% men; mean age 64.4 years). Venous blood samples were obtained in the chronic stage of MI (28 +/- 7 days after onset), and serum cTnT levels were determined. During the average follow-up of 1,042 days, 84 patients died and 83 had nonfatal reinfarctions. Patients with cTnT levels in the highest quartile (> or = 0.040 ng/ml [n = 353]) had a higher incidence of all-cause death (8.2% vs 5.2%, p = 0.049) and nonfatal reinfarction (8.3% vs 5.1%, p = 0.048) than patients with cTnT levels from the lower 3 quartiles (<0.040 ng/ml [n = 1,064]). Multivariate Cox regression analysis revealed that a minimally elevated cTnT level (> or =0.040 ng/ml) was a significant predictor of all-cause mortality (hazard ratio 1.79, 95% confidence interval 1.10 to 2.90, p <0.02) and nonfatal reinfarction (hazard ratio 1.50, 95% confidence interval 1.13 to 2.20, p <0.03). Subgroup analysis showed that an elevated cTnT level was also a predictor of all-cause mortality and nonfatal reinfarction in patients without heart failure. In conclusion, minimally elevated cTnT levels in the chronic stage of MI predicted long-term adverse clinical outcomes.

Effect of intracoronary thrombectomy on 30-day mortality in patients with acute myocardial infarction.

Insertion of intracoronary thrombectomy (ICT) devices, as a precedent to percutaneous coronary intervention (PCI), theoretically could have a beneficial effect on the outcome in patients with acute myocardial infarction. To examine whether ICT was associated with a lower 30-day mortality rate in patients with acute myocardial infarction, we studied 3,913 patients who underwent PCI within 24 hours after onset. A total of 990 patients (25.3%) were treated with ICT before PCI. The 30-day mortality rate was lower in the patients receiving ICT than in those without (3.7% vs 6.2%, p = 0.004), but this beneficial effect disappeared after adjustment for baseline characteristics (hazard ratio [HR] 0.658, p = 0.166). We also divided the patients into tertiles according to the Thrombolysis In Myocardial Infarction (TIMI) risk score. After adjustment for baseline characteristics, ICT was associated with a lower 30-day mortality rate in patients from the highest TIMI risk score tertile (HR 0.407, p = 0.029), but not in patients from the lower 2 tertiles. ICT was also an independent predictor of a lower 30-day mortality risk in patients aged > or =70 years (HR 0.239, p = 0.007), patients with diabetes mellitus (HR 0.275, p = 0.039), and those with stent implantation (HR 0.437, p = 0.034). In conclusion, in selected patients with high TIMI risk scores, an age > or =70 years, diabetes mellitus, or stenting, ICT is associated with a lower 30-day mortality rate.

Clinical impact of metabolic syndrome and its additive effect with smoking on subsequent cardiac events after acute myocardial infarction.

Little information is available regarding the clinical effect of metabolic syndrome (MS) or its combined effect with smoking on subsequent cardiac events after acute myocardial infarction (AMI). To examine whether MS independently predicts cardiac events (cardiac death and nonfatal reinfarction) and to assess the combined effect of MS and smoking on cardiac events after AMI, we studied 3,858 survivors of AMI registered in the Osaka Acute Coronary Insufficiency Study (OACIS). During a median follow-up of 725 days, the incidence of cardiac events was higher in patients with MS than in those without MS (p=0.021). After adjustment for baseline characteristics, MS was an independent predictor of cardiac events after AMI (hazard ratio [HR] 1.480, 95% confidence interval [CI] 1.128 to 1.942, p=0.005). Compared with patients who did not have MS and were nonsmokers, the adjusted HR for cardiac events was 2.868 (95% CI 1.573 to 5.227, p=0.001) in patients with MS who continued smoking after AMI. Cessation of smoking after AMI was associated with a significantly lower risk of cardiac events in patients with MS (HR 0.485, 95% CI 0.281 to 0.837, p=0.009) but not in patients without MS (HR 0.618, 95% CI 0.330 to 1.157, p=0.132). In conclusion, MS is independently associated with an increased risk of cardiac events after AMI. Smoking has an additive adverse effect on cardiac events after AMI, and cessation of smoking is beneficial and strongly recommended for AMI, especially in patients with MS.

Impact of atherosclerosis-related gene polymorphisms on mortality and recurrent events after myocardial infarction.

Although previous epidemiologic studies have suggested an association between the onset of myocardial infarction (MI) and some genetic variations, the impact of these variants on recurrent cardiovascular events after MI has not been fully elucidated. We genotyped 87 polymorphisms of 73 atherosclerosis-related genes in consecutive acute MI patients registered in the Osaka Acute Coronary Insufficiency Study and compared the incidence of death and major adverse cardiac events (MACE) among the polymorphisms of each gene. After initial screening in 507 patients, we selected nine polymorphisms for screening in all 1586 patients. Multivariate Cox regression analysis revealed that G allele carriers at the position 252 of the lymphotoxin alpha (LTA) gene were independently associated with an increased risk of death (hazard ratio [HR]: 2.46; 95% CI: 1.24-4.86). In conclusion, a 252G allele of LTA is associated with an increased risk of death after AMI and may be a useful genetic predictor.