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The Impact of Chronic Lung Disease in MI

The Impact of Chronic Lung Disease in MI

Chronic lung disease (CLD)—including COPD, chronic bronchitis, and emphysema—is common, presenting in approximately one in seven patients presenting with myocardial infarction (MI). Patients with CLD are more likely to die or be hospitalized from cardiovascular disease than from any other disease. Despite this knowledge, few studies have explored the influence of CLD on patient management and outcomes following MI. Gaining a better understanding of this relationship could lead to opportunities for improving quality of care and outcomes for CLD patients. Treatments & Mortality for Chronic Lung Disease In a study published in the American Heart Journal, my colleagues and I utilized the National Cardiovascular Data Registry to determine the association of CLD with treatments and adverse events after MI. Our results showed that CLD patients presenting with non-STEMI had a 20% increased risk for in-hospital death when compared with those who did not have CLD. No such link, however, was found among CLD patients with STEMI. In addition, CLD patients with non-STEMI were markedly less likely to receive invasive procedures, such as cardiac catheterization, PCI, or CABG surgery. They were also slightly less likely to receive evidence-based medical therapies, including thienopyridines, β-blockers, and statins. Conversely, differences in treatment of STEMI patients with CLD were not clinically significant, according to findings in our investigation. Taking a Closer Look at Bleeding Risks This is also the first study to our knowledge indicating that, independent of other factors, CLD patients had a 20% to 25% higher risk of bleeding when compared with those without CLD. Major bleeding is one of the most common in-hospital complications following acute coronary syndromes and is associated...

Revised Guidelines for Evidence-Based PCI

Over the last decade, significant advances and innovations have rapidly evolved in the use of PCI for patients with coronary artery disease (CAD). The American College of Cardiology (ACC)/American Heart Association (AHA), together with the Society for Cardiovascular Angiography and Interventions (SCAI), released a revised clinical guideline for the management of CAD patients undergoing PCI. Published in the December 6, 2011 Journal of the American College of Cardiology, the update emphasizes careful selection of CAD treatment and includes the most extensive section to date on revascularization. The Heart Team Concept for PCI and CABG “The heart team includes an interventional cardiologist and a cardiac surgeon who review patient history and anatomy, discuss whether PCI and/or CABG are appropriate, and explain these options in detail with patients before a treatment option is chosen,” says Glenn N. Levine, MD, who chaired the ACC/AHA/SCAI guideline writing committee. The guidelines include a Class I recommendation for utilizing a heart team approach in patients with unprotected left main CAD and/or complex CAD in cases where the optimal revascularization strategy is not straightforward. New Section on CAD Revascularization For the first time ever, the CAD revascularization section was developed through a collaboration that involved experts from the ACC, AHA, and SCAI on both PCI and CABG. According to the guidelines, CABG is recommended for improving survival in patients with significant left main coronary artery stenosis, as well as those with significant stenoses in three major coronary arteries or in the proximal left anterior descending artery and one other major coronary artery. CABG or PCI is recommended for survivors of sudden cardiac death with presumed ischemia-mediated...

Conference Highlights: The AHA 2008 Annual Meeting

The American Heart Association held its 2008 Scientific Sessions from November 8-12 in New Orleans. The features below highlight just some of the news emerging from the meeting. For more information on these items and other research that was presented, go to http://scientificsessions.americanheart.org/. JUPITER The Particulars: Increased levels of high-sensitivity C-reactive protein (CRP) can help predict cardiovascular events. Statins have been proven to lower CRP levels as well as cholesterol. JUPITER (Justification for Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) was a large, multinational, long-term, double-blind, placebo-controlled, randomized clinical trial intended to evaluate whether healthy individuals with normal LDL cholesterols but elevated CRP levels would benefit from statin therapy (rosuvastatin 20 mg/day). Data Breakdown: Researchers randomly assigned 17,802 healthy men and women with LDL cholesterol levels less than 130 mg/dL and high-sensitivity CRP levels of 2.0mg/L or higher to 20 mg/day of rosuvastatin or placebo. Participants were evaluated for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes. At 12 months follow-up, the rosuvastatin group showed a decrease in median LDL cholesterol levels from 108 mg/dL to 55 mg/dL. CRP levels decreased from 4.2 mg/L to 2.2 mg/L, and triglyceride levels dropped by 17%. At 1.9 years follow-up, rosuvastatin was associated with a 44% reduction in cardiovascular events when compared with placebo. Take Home Pearl: Use of statin therapy in individuals with low LDL but elevated high-sensitivity CRP significantly reduced the incidence of major cardiovascular events. TIMACS The Particulars: Optimal timing of an invasive strategy is still unknown in the management of...
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