Risk Coronary Patients Research Articles

Cardiac CT findings in patients with family history of premature CAD: an observational study

Introduction A family history of premature CAD may promote enhanced development of coronary atherosclerosis in a sibling population. Baseline CV algorithms may underestimate the risk of coronary incidents in individuals at familial risk. Cardiac CT provides high diagnostic performance for the detection of coronary plaques. There is little data on the use of this technology in the initial diagnostic approach of these patients. The prognostic value of early detection of coronary plaques by cardiac CT remains unknown in this population. Objectives The study aimed to estimate the global CV risk and the pre-test probability of CAD in patients with a family history of premature CAD. We investigated the potential role of cardiac CT imaging in the assessment of coronary risk in patients from high-risk families. We sought to remind the 2019 ESC guidelines for screening for CAD in asymptomatic subjects. Methods Fifty siblings of patients with premature CAD were investigated. The pre-test probability of CAD was determined with the Clinical Model of the CAD consortium. The risk of CV disease was calculated and compared with three different risk algorithms (SCORE, FRS, PROCAM). All patients underwent cardiac CT with both non-contrast and contrast imaging. Coronary artery calcium (CAC) scoring was calculated and CT angiograms were analyzed. Patients with suspected CT obstructive CAD underwent coronary angiography. Clinical outcomes in terms of treatment were analyzed. Results The pre-test probability of CAD was low: CAD consortium <10% in 60%, SCORE <5% in 100%, FRS <10% in 88%, CAC scoring <100% in 68%. However, PROCAM was <10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA findings. In patients with abnormal CCTA findings (n = 38), PROCAM was higher than FRS in 20 patients (53%). Coronary angiography was performed in 31 cases (62%) for suspected CT obstructive CAD. Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%), 6 of them (75%) presented CAC scoring <100, 4 of them (50%) presented CAC scoring <400. After investigation, lipid-lowering therapy was enhanced by 66%. Conclusion Coronary atherosclerotic-phenotyping using cardiac CT may provide discriminatory information allowing earlier identification of patients at familial risk of premature CAD. This diagnostic workup strategy may help to guide and improve the management of these patients. However, there is a paucity of data concerning the prognostic significance of this technology in relatives at familial risk of premature CAD. Therefore, further randomized controlled trials are needed to assess the incremental risk-predictive value of this approach in this population.

Early Assessed Total Cholesterol Significantly Improves The Prediction Of Cardiovascular Risk In Later Life

Background and Aims: Longtime follow-up (FU) data for coronary risk patients exceeding a 10-year FU and cholesterol measurements being unbiased by statin treatment are scarce. The aim of this study was to investigate the impact of total cholesterol (TC), determined in the course of an early life general health check, compared to TC, measured at advanced age, on the cardiovascular risk.

Mini OPCAB Coronary Artery Bypass Surgery Plus Medical Treatment: An Option for High Risk Coronary Patients

MINI OPCAB surgery (Xiphoid Approach) is a surgical technique in which the left internal mammary artery is bypassed to the Anterior Descending Artery (ADA) by a medial inferior sternotomy Fourteen high risk patients with multiple coronary disease with a preoperative logistic Euroscore of 10.86 were operated and follow up with medical treatment and strictly control of risks factors MACE at 80 months was 0% and Survival at 7 years 82% (KM) Although is an alternative the combination of Mini OPCAB operation plus medical treatment in high risk.

Effects of Resistance Training on Vascular and Hemodynamic Responses to Standardized Workloads in Coronary Patients

PURPOSE: To determine the impact of superimposed resistance training (RT) in aerobically trained coronary patients on systolic blood pressure (SBP), heart rate (HR), rating of perceived exertion (RPE; 6-20 scale), and rate pressure product (RPP) at fixed submaximal workloads following a 12-week RT intervention. Additionally, pre and post RT measures of brachial artery reactivity, an index of endothelial function, were obtained. METHODS: Fifteen low risk coronary patients (13 men, 2 women; mean ± SD age = 66.1 ± 5.1yrs) completed a progressive 12-week RT program that complemented their regular aerobic training regimen. Prior to training, SBP, HR, RPP, and RPE were obtained while subjects performed 1 set (10 repetitions) of 3 different exercises (bicep curl [BC], shoulder press [SP], leg press [LP]) at an intensity ~ 60-80% of 1-repetition maximum. After the training period, testing was repeated while subjects lifted the identical pre-training loads for each exercise following a standardized protocol. Vascular function was assessed by flow-mediated vasodilation (FMD) testing prior to and immediately following the 12-week RT training intervention. RESULTS: Lifting the same pre-training loads evoked attenuated responses for all variables (HR, SBP, RPE, RPP). A statistically significant decrease was shown for RPP ([HR x SBP]/100) during BC (106 ± 27 to 91 ± 22, P < 0.007) and SP (102 ± 24 to 86 ± 17, P < 0.007), whereas the RPP decrease during LP (116±22 to 109 ± 26) did not achieve statistical significance (P = 0.18). RPE for all 3 exercises decreased significantly (P < 0.0001) following the RT intervention: BC (14.3 ± 2.3 to 9.7 ± 1.6), SP (13.9 ± 1.6 to 9.2 ± 1.5), LP (14.3 ± 1.4 to 10.3 ± 1.6). Pre versus post RT measurements for resting HR and resting SBP were unchanged. Peak FMD responses for the 15 subjects were 12.8% and 10.3% dilation pre- and post-training, respectively (P = 0.332). However, 5 of the 15 subjects showed modest improvements in their post-training time to achieve maximum dilation from a mean of 117 seconds to 81 seconds (P = 0.156). CONCLUSION: Among aerobically trained coronary patients, a superimposed resistance training program resulted in decreased hemodynamic and RPE responses to lifting fixed submaximal workloads and improved FMD responses in 5 of the 15 participants.

Systematic detection of polyvascular disease combined with aggressive secondary prevention in patients presenting with severe coronary artery disease: The randomized AMERICA Study

BackgroundThe prevalence and associated-risk of asymptomatic multisite artery disease (MSAD) in high risk coronary patients are unknown. Whether systematic identification and aggressive management of asymptomatic MSAD is clinically relevant in high risk coronary patients has not been evaluated. MethodsWe randomly assigned 521 high risk coronary patients defined by the presence of three-vessel coronary disease (n=304) or recent acute coronary syndrome beyond the age of 75years (n=215) to either a strategy of systematic detection of asymptomatic MSAD combined with an aggressive secondary prevention (n=263) or to a more conventional strategy based on treatment of coronary artery disease only with standard of care (n=258). The primary end point was the time to first occurrence of death, any organ failure or ischemic event leading to re-hospitalization through two years of follow-up. ResultsThe pro-active strategy identified asymptomatic MSAD in 21.7% of patients with few revascularizations (3.6%); the pro-active pharmacological secondary prevention was obtained in >85% of patients and life-style changes in <60% of patients. At 2-year follow-up, the primary end point occurred in 44.9% of patients in the pro-active group and 43.0% of patients in the conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34]. The rate of major bleeding did not differ significantly between groups (4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). ConclusionIn high risk coronary patients, there is no apparent benefit of a systematic detection of asymptomatic extra-coronary atherothrombotic disease and intensified treatment over a 2-year follow-up period. (Funded by the Academic Allies in Cardiovascular Trials Initiatives and Organized Networks and Institut de l'Athérothrombose; AMERICA ClinicalTrials.gov number, NCT00445835).

Mini Off-Pump Coronary Artery Bypass Surgery Plus Medical Treatment: An Option for High Risk Coronary Patients

Mini Off-Pump Coronary Artery Bypass Surgery Plus Medical Treatment: An Option for High Risk Coronary Patients

Effects of extended-release niacin/laropiprant on correlations between apolipoprotein B, LDL-cholesterol and non-HDL-cholesterol in patients with type 2 diabetes.

BackgroundLDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM) and/or high TG. These levels are lowered by extended-release niacin (ERN), and changes in the ratios of these levels may affect ASCVD risk. This analysis examined the effects of extended-release niacin/laropiprant (ERN/LRPT) on the relationships between apoB:LDL-C and apoB:non-HDL-C in patients with T2DM.MethodsT2DM patients (n = 796) had LDL-C ≥1.55 and <2.97 mmol/L and TG <5.65 mmol/L following a 4-week, lipid-modifying run-in (~78 % taking statins). ApoB:LDL-C and apoB:non-HDL-C correlations were assessed after randomized (4:3), double-blind ERN/LRPT or placebo for 12 weeks. Pearson correlation coefficients between apoB:LDL-C and apoB:non-HDL-C were computed and simple linear regression models were fitted for apoB:LDL-C and apoB:non-HDL-C at baseline and Week 12, and the correlations between measured apoB and measured vs predicted values of LDL-C and non-HDL-C were studied.ResultsLDL-C and especially non-HDL-C were well correlated with apoB at baseline, and treatment with ERN/LRPT increased these correlations, especially between LDL-C and apoB. Despite the tighter correlations, many patients who achieved non-HDL-C goal, and especially LDL-C goal, remained above apoB goal. There was a trend towards greater increases in these correlations in the higher TG subgroup, non-significant possibly due to the small number of subjects.ConclusionsERN/LRPT treatment increased association of apoB with LDL-C and non-HDL-C in patients with T2DM. Lowering LDL-C, non-HDL-C and apoB with niacin has the potential to reduce coronary risk in patients with T2DM.

A Randomized Pilot Study on the Effects of Combined Tocotrienol-Tocopherol Mixed Fraction and Vitamin C on Inflammatory Status and Lipid Profile in Statin-Treated High Risk Patients

Previous studies have suggested that combination of Tocotrienol-tocopherol mixed fraction (TTMF) vitamin E and vitamin C supplementation act synergistically in vivo to enhance their anti-oxidant properties. However, additional effects beyond that of anti-oxidation of combined vitamin E and vitamin C in statin-treated high coronary risk patients remains unclear. The aim of this study was to investigate pleiotropic effects of TTMF and vitamin C on inflammatory biomarkers and lipid profile in statin-treated high coronary risk patients. This was a pilot, randomized, double-blind, placebo controlled clinical trial. Twenty nine high coronary risk hypercholesterolaemic subjects were randomized into TTMF+C (160mg TTMF, 75% tocotrienol: 25% alpha-tocopherol plus 500mg vitamin C) intervention or placebo groups for 12 months. Blood samples were collected at entry, baseline, 2 weeks, 3, 6 and 12 months post-randomization for analysis of inflammatory biomarkers [(high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumour necrosis factor alpha (TNFα)] and serum lipid profile [Total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c) and triglycerides (TG)]. There was no significant difference observed between TTMF+C and placebo groups with regards to percent change of hsCRP, IL-6 and TNF-α concentrations (p>0.05) and TC, LDL-c, TG and HDL-c (p>0.05) at baseline, 2 weeks, 3, 6 and 12 months of intervention. There was also no significant change seen in the mean concentration of all inflammatory biomarkers and serum lipid profile between TTMF+C and placebo groups at all timelines. TTMF and vitamin C supplementation did not significantly improve the inflammatory status and lipid profile. This could in part be contributed to the masking effect of statin’s pleiotropic properties and the possibility of alpha tocopherol in the TTMF mixture attenuating the beneficial effects of pure tocotrienols.

Common single nucleotide polymorphisms at the NPC1L1 gene locus significantly predict cardiovascular risk in coronary patients.

Niemann-Pick C1-like 1 (NPC1L1) is involved in dietary cholesterol absorption and is the direct molecular target of the LDL-lowering drug ezetimibe. Recently, genetic variants in NPC1L1 have been associated with the incidence of cardiovascular events, but it remains unclear if the impact of NPC1L1 on cardiovascular risk is dependent on its role in cholesterol absorption. Furthermore, no direct association of genetic variants in NPC1L1 with coronary atherosclerosis has been established. To further address these issues, we determined the impact of 34 single nucleotide polymorphisms (SNPs) at the NPC1L1 gene locus on the presence of coronary atherosclerosis and prospectively on future cardiovascular events in a cohort of 984 angiographied Caucasian patients. Out of investigated SNPs, 24 variants were significantly associated with future cardiovascular events. The highest impact was observed for rs55837134 (sex-and age adjusted additive HR = 1.67 [1.28-2.18]; p = 1.3 e-4). Regression analysis conditioned on rs55837134 showed that significant associations between remaining SNPs at the NPC1L1 locus and vascular events did not persist suggesting their dependence on rs55837134. Its significant association remained almost unchanged after further adjustment for total cholesterol, LDL cholesterol, and other cardiovascular risk factors (additive HR = 1.67 [1.28-2.18]; p = 1.7 e-4). In addition, no significant association of investigated NPC1L1 variants with coronary atherosclerosis could be observed, at least after false discovery rate correction. Genetic variants of NPC1L1, particularly rs55837134, show a predictive impact on cardiovascular events. Further studies to determine the molecular consequences of common genetic variants in NPC1L1 are needed.

Deleted article: 10.1007/BF03262467

The rationale behind combined statin-acetylsalicylic acid therapy is based on the beneficial effects ofacetylsalicylic acid on thrombosis, the leading immediate cause of the majority of occlusive cardiovascular events, and those of statins on atherosclerosis, which is the main underlying cause. The clinical benefits of combined pravastatin-acetylsalicylic acid in the management of coronary patients have been demonstrated by a meta-analysis of five randomized clinical trials for secondary prevention; compared with pravastatin alone, the pravastatin-acetylsalicylic acid combination reduced the risk of fatal or non fatal myocardial infarction by 26%, the risk of ischemic stroke by 31%, and the risk of cardiovascular events at 5 years by 13%. Combined pravastatin-acetylsalicylic acid therefore appears to significantly reduce the cardiovascular risk in coronary patients. Following the AHA/ACC and National Cholesterol Education Program (NCEP) I and II guidelines, the proportion of patients treated by acetylsalicylic acid, beta-blockers and statins increased significantly: 94%, 57% and 91% respectively at one year versus 68%, 18% and 10% before the guidelines were applied. The impact of these treatments on clinical outcomes is statistically significant in terms of recurrent myocardial infarction, the need for re-hospitalization, sudden death or all-cause mortality. Patients treated with combined statin-acetylsalicylic acid therapy have significantly improved clinical outcome and a significantly lower rate of coronary events at 1 year of follow-up. These data therefore confirm the importance of optimizing therapeutic management of coronary patients, and in particular with combined acetylsalicylic acid-statin therapy.

Are high coronary risk patients missing out on lipid-lowering drugs in Australia?

To examine whether high coronary risk patients in Australia, where use of lipid-lowering drugs (LLD) is very high by international standards, are receiving LLD. Assessment of Pharmaceutical Benefits Scheme pharmacy payment claim records between January 2006 and May 2013 for a 10% random sample of Australian concession card holders. Co-prescriptions were used as a surrogate for high coronary risk groups - coronary heart disease (CHD): antiplatelet drugs (not including solo aspirin) and anti-anginal drugs; diabetes: all standard drugs; hypertension: all standard drugs (not including solo diuretics). Proportions of patients in high-risk groups not receiving LLD (statins, fibrates or ezetimibe). The database yielded information on 276,212 patients defined as being at high coronary risk (mean age, 66.1 [SD, 14.8] years; 44% male). Of this group, 115,477 patients (42%) had not received any LLD during the study period. For patients in the risk group for CHD in combination with diabetes and hypertension, only 8% (1111/14,257) were not receiving LLD. Across all risk groups, the proportions not receiving LLD were generally highest in those aged ≥ 81 years and, to a lesser extent, < 41 years, and were lowest in those aged 51-70 years. A large proportion of concession card holders at high coronary risk, especially those in middle age with CHD and multiple risk factors, are being appropriately prescribed LLD in Australia.

Lipoprotein (a) and its association with the metabolic syndrome and vascular risk in coronary patients

Lipoprotein (a) and its association with the metabolic syndrome and vascular risk in coronary patients

Abstract P127: Ayurveda Improves Arterial Stiffness and Cardiometabolic Risk in Coronary Patients: A Prospective Pilot Study

Introduction: Ayurveda is the ancient East Indian holistic approach to health that includes yoga, meditation, breathing exercises, medicinal herbs, and other practices. Although it has been practiced for nearly 5000 years there is little objective data regarding its efficacy in coronary disease. Hypothesis: Can the addition of Ayurveda to usual care improve markers and risk factors of cardiovascular disease? Methods: Twenty-six volunteers with a history of prior myocardial infarction, coronary bypass surgery, or coronary angioplasty/stent were recruited from the University of New Mexico cardiology clinics. Each patient underwent consultation with a single Ayurvedic specialist and received personalized instruction in daily yoga, meditation, breathing, medicinal herbs, and a caloric unrestricted Ayurvedic diet. Standardized measurements of arterial stiffness (pulse wave velocity) and cardiometabolic risk factors were obtained at baseline and after 90 days of therapy. Results: Nineteen patients, mean age 71.6 years, completed the study, six dropped out and one was lost to follow up. Among hypertensive patients (n=15), 60% (9 of 15) had either a &gt;10 mm Hg drop in systolic blood pressure (n=4) or required a reduction in anti-hypertensive medications due to persistent systolic blood pressure &lt; 110 mm Hg (n=5). Statistical analysis was performed using the paired student’s t test. Conclusion: This pilot study suggests that short term Ayurvedic therapy improves arterial stiffness and many cardiometabolic risk factors in patients with coronary artery disease. These findings support the need for a randomized controlled trial to further study the effects of Ayurveda on cardiovascular disease.

Assessment of Coronary Risk Based on Cumulative Exposure to Lipids in Systemic Lupus Erythematosus

To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE). Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age. Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 "first" coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19-2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02-2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32-3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7-97.0) and 93.9% (95% CI 83.1-98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4-16.5). This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.

Abstract 251: Clinical Symptoms and Angiographic Findings of Patients Undergoing Percutaneous Coronary Intervention without Prior Stress Testing: Insights from the NCDR

Background: Many patients undergoing elective percutaneous coronary intervention (PCI) do not have prior stress testing. It is unknown if these patients have more severe angina or obstructive coronary artery disease (CAD), whereby proceeding directly to PCI would represent sound clinical judgment and efficient use of resources. Methods: We identified elective PCIs performed between 1/1/09 - 3/31/11 in the NCDR CathPCI Registry ® and assessed for differences in angina (CCS class) and severity of CAD in those with and without pre-procedural stress testing. To further understand whether proceeding to PCI without prior stress testing could be justified because of a high pre-test probability for obstructive CAD (e.g., &gt;70% stenosis in an epicardial coronary artery), we evaluated cardiac catheterizations performed within the registry during the same period to assess the diagnostic yield of obstructive CAD in patients with and without prior stress testing. Results: Of 246,629 elective PCIs, 89,084 (36.1%) were performed without prior stress testing. A substantial proportion of both groups undergoing PCI were asymptomatic (no stress test group: 28.9% vs. stress test group: 30.7%), with only a modest difference in the frequency of CCS class III/IV angina (16.2% vs. 11.9%; Table). No meaningful differences in the frequency of proximal LAD (29.7 % vs. 29.9%), left main (5.6% vs. 7.2%) or 3-vessel coronary artery disease (21.1% vs. 19.5%) were observed in the 2 PCI groups. Moreover, the diagnostic yield for obstructive CAD on cardiac catheterization for patients without prior stress testing (n=462,611) was 35.4%, as compared with 58.0%, 38.8%, and 24.1% for those with severe, moderate, and mild ischemia, on pre-procedural stress testing. Conclusion: For elective PCI, the current practice of proceeding to coronary angiography and PCI without prior stress testing does not identify higher risk coronary anatomy or more symptomatic patients and may not improve diagnostic yield.

Lipid Management in High Risk Coronary Patients: How Effective are We at Secondary Intervention?

To assess the proportion of patients who achieve and maintain target lipid levels during optimum long term follow up after coronary bypass surgery. From a prospectively compiled database, we identified 440 patients followed for up to 13 years after CABG as part of a radial artery randomised controlled trial. All available lipid assays conducted during the follow-up period were collected from pathology databases. These were used to calculate the annualised mean lipid exposure for each patient. Based upon National Heart Foundation guidelines, we determined the proportion of patients whose mean lipid exposure attained target levels (total cholesterol <4.0 mmol/L, LDL-C <2.0 mmol/L, HDL-C >1.0 mmol/L and triglycerides <1.5 mmol/L). This was compared with the proportion who had achieved these targets pre-operatively and on their most recent cholesterol measurement. 6077 lipid studies (total cholesterol, LDL, HDL and triglycerides) in total were obtained. In those who had baseline data available, target levels for total cholesterol, HDL-C, LDL-C and triglycerides were attained pre-operatively by 16%, 64%, 14% and 39% of patients respectively. Annualised mean lipid exposures during up to 13 years of follow up for all patients revealed somewhat improved but still suboptimal target attainment figures of 24%, 83%, 20% and 53%. The most recent review shows the greatest improvement at 47%, 68%, 43% and 62% respectively. Of 141 diabetic patients, target attainment was significantly higher for total cholesterol (31%; p=0.038) and LDL-C (28%; p=0.006) but lower for HDL-C (75%; p=0.002) and triglycerides (40%; p<0.001). Despite some improvements seen over careful follow up, only HDL-C targets appear attainable for the majority of CABG patients. Over half still do not achieve non-HDL national lipid targets.

Abstract 9923: Circulating Pregnancy-Associated Plasma Protein Levels Reflect Plaque Instability and Predict the No-Reflow Phenomenon After Percutaneous Coronary Intervention

Background and Aims Because coronary no-reflow phenomenon during percutaneous coronary intervention (PCI) is associated with a poor prognosis, it is clinically important to stratify high risk coronary no-reflow patients. Previous study reported that plasma pregnancy-associated plasma protein (PAPP-A) level was a marker of adverse outcome such as cardiac death and myocardial infarction in both acute coronary syndrome (ACS) and non-ACS patients. In the present study, we examined whether serum PAPP-A level could predict incidence of coronary no-reflow during PCI. Results Consecutive 85 patients (ACS, n=37; non-ACS, n=48; mean age 69 ± 11 years old) who were underwent PCI with integrated backscatter intravascular ultrasound (IB-IVUS) were prospectively enrolled. No-reflow, including transient filter no-reflow by using distal protection devices, was observed in 18 (21%) patients. Plasma PAPP-A levels were significantly higher in no-reflow patients compared with normal-reflow patients (8.25 ± 2.28 vs. 6.27 ± 1.54 ng/ml, P&lt;0.001). To predict coronary no-reflow, a receiver operating characteristic (ROC) analysis determined a cut-off plasma PAPP-A value as 7.68 ng/ml (sensitivity of 62%, specificity of 82%, area under curve 0.76). The multivariate logistic regression analysis showed that plasma PAPP-A was an independent predictor of the no-reflow phenomenon (odds ratio 2.27; 95% confidence interval, 1.123-4.602; P = 0.023). Since plasma PAPP-A levels were not correlated (r=0.009, p=0.94) with culprit plaque percentage of lipid volume analyzed by IB-IVUS, they might be associated with not lipid plaque volume but plaque instability. Conclusion Plasma PAPP-A levels is a useful biomarker to stratify high risk coronary no-reflow patients during PCI. Plasma PAPP-A cut-off values determined by present study could help our approach for predicting high risk coronary no-reflow patients.

Differences in Heart Disease Risk Perception and Actual Cardiac Risk in Male vs. Female Cardiac Patients

PURPOSE: To describe gender differences in both risk perception and actual coronary risk in patients with coronary artery disease (CAD). METHODS: 33 females (HT: 164 cm, WT: 80kg) and 67 males (HT: 179 cm, WT: 93kg) with documented CAD completed a questionnaire designed to assess CAD risk perception. They also underwent assessments for all ACSM risk factors. Five-point Likert scale responses to the question "Compared to others of your own age and gender, how would you rate your risk of ever having a heart attack?" were used to quantify CAD risk perception. To quantify actual risk, the number of ACSM risk markers for each subject was tabulated. It should be noted that, since all of the subjects had active CAD, they were all at high risk. Tabulations and Likert scale responses were compared using Chi-square analysis or Fisher's Exact test with significance accepted at p<0.05. To further assess risk perception accuracy, Chi-square analysis with pre-determined expected cell count percentages was used. RESULTS: Likert responses for perceived risk between genders were not significantly different but showed perception inaccuracies of the entire cohort. Only 41% of the subjects perceived their risk as "higher" or "much higher" than their peers while 27% perceived their risk as lower or much lower. 32% of the subjects perceived their risk to be the same as their peers. Comparison of risk marker number between genders was significantly different (Fisher's exact test, p =.046) with males having 33% more markers than females. Chi-square analysis using an expected cell percentage of 75% in the "higher" Likert category, 25% in the "much higher" Likert category, and fractions of 1 in the other categories revealed significance (p<.0001) with only 29.8% of subject responses in the "higher" category and 11.9% in the "much higher" category. The female cohort showed similar results with test percentages of 73% in the "higher" category and 27% in the "much higher" category. Responses were significantly different (p<.0001) with only 30% choosing the "higher" category and 10% choosing the "much higher" category. CONCLUSIONS: Although significant differences in actual cardiac risk exist between genders in a cohort of cardiac patients, perceived risks are not significantly different. Both genders greatly underestimate their risk.

Obesity and coronary risk in patients treated with second-generation antipsychotics

Weight gain leading to obesity is a frequent adverse effect of treatment with atypical antipsychotics. However, the degree of its independent contribution to the risk of coronary heart disease events in patients treated with these drugs has not been elucidated. The aim of this study is to determine whether obesity is an independent risk factor for the 10-year risk of coronary heart disease events in psychiatric patients treated with atypical antipsychotics. We used the Framingham method, which is based on age, gender, blood pressure, smoking, and plasma levels of total and high-density lipoprotein cholesterol, to estimate the 10-year risk of coronary heart disease events in patients treated with second-generation antipsychotics who were obese (N = 44; mean age 38.1 years, 54.5% men) or normal weight (N = 83; mean age 39.9 years, 47.0% men). Excluded were patients with metabolic syndrome and those taking antihypertensive, hypoglycemic, and lipid-lowering drugs. The 10-year risk of coronary artery disease events was very low and virtually identical in the obese and normal weight patients (2.3 ± 3.5 vs. 2.6 ± 4.6, P = 0.68), despite excess of 12 BMI units (P < 0.0001) and 15.7 cm waist circumference (P < 0.0001) in the obese. The risk was similar in obese and normal weight men (3.8 ± 5.9 vs. 2.8 ± 3.4, P = 0.45) and women (1.7 ± 3.7 vs. 1.5 ± 2.5, P = 0.83). The validity of the 10-year prediction for risk of coronary heart disease events in the mentally ill based on the Framingham score system requires prospective confirmation. Obesity does not appear to be an independent predictor for the 10-year risk of coronary heart disease events in patients without metabolic syndrome treated with second-generation antipsychotics.

Risk assessment in coronary patients undergoing abdominal nonvascular surgery

Abstract The aim of our study was to establish that the incidence of perioperative cardiac complications were in direct correlation with level of operative risk in coronary patients undergoing open abdominal nonvascular surgery with general anesthesia. Our prospective observational clinical study was composed of a group of 111 consecutive patients with angiographically-verified coronary artery disease, who were operated on at the University Clinical Center of Serbia. The patients were classified into four stratification subgroups by “Goldman’s Cardiac Risk Index” (CRI) in relation to the incidence of perioperative cardiac complications. Electrocardiography was performed immediately after surgery, on postoperative days 1, 2, 7 and one day before discharge from the hospital. All patients were followed to postoperative day 30. Statistical design was presented by Pearson’s χ2 test and binomial logistic regression. The main result was significant difference between the four stratification subgroups of coronary patients in the incidence of cardiac death up to the 30th postoperative day: I — 0/17 (0.0%) vs. II — 0/40 (0.0%) vs. III — 1/37 (2.7%) vs. IV — 2/17 (11.8%), (p&lt;0.05). We concluded that the incidence of perioperative cardiac complications significantly increased with the degree of Goldman’s CRI. There was significant difference in the incidence of perioperative cardiac complications between the four Goldman’s stratification subgroups.