Episode Of Acute Myocardial Infarction Research Articles

Influence of β-blockers on heart rate recovery and rating of perceived exertion when determining training intensity for cardiac rehabilitation

BackgroundThe influence of β-blockers on heart rate recovery (HRR) and rating of perceived exertion (RPE) during Phase I cardiac rehabilitation (CR) for patients with a recent episode of acute myocardial infarction (AMI) is not clear. MethodsFrom October 2009 to July 2011, 105 patients with a recent episode of AMI who received a successful percutaneous coronary intervention were recruited into this study. Before entering Phase II CR, each patient underwent a cardiopulmonary exercise test (CPET), where RPE was assessed every minute and related parameters were recorded. ResultsThe participants entering CR had relatively low mean peak oxygen consumption (VO2max). However, the peak heart rate and VO2max were lower in those taking β-blockers. The RPE value at the ventilatory threshold (VT) was significantly higher (12.7 ± 1.7) in participants who were taking β-blockers relative to those who were not (11.5 ± 1.4). The HRR value was lower (12.5 ± 8.8) in participants who were taking β-blockers relative to those who were not (17.0 ± 9.1). ConclusionThese findings suggest that use of β-blockers increased the RPE value at the VT. In addition, HRR was attenuated by β-blockers. In patients who do not undergo CPET, the use of β-blockers should be taken into consideration when using RPE for the initial exercise prescription to determine training intensity.

Factors associated with family dysfunction among non-institutionalized older people

The objective of this study was to analyze the factors and their prevalence associated with family dysfunction, as well as the functional capacity of the elderly population, in the capital of the state of Goiás, Brazil. This was a cross-sectional and analytical study, which was developed with elderly people who reported family dysfunction. Global capacity and family dynamics were analyzed. For the 149 elderly people with family dysfunction, there was prevalence of the female gender, aged between 60 to 69, married, multi-person home, normal health, and presence of pain. Functional capacity evaluation revealed partial dependence for self-care. In the family dynamics, dialog and time shared by the family were the most fragile aspects, with moderate satisfaction for all domains. High family dysfunction remained associated with falls (p=0.003) and previous episodes of acute myocardial infarction (p=0.004) using Poisson's analysis. The elderly expressed preserved functional autonomy and capacity regarding self-care and social living.

166 T-tubule remodelling and formation of super-tubules in the border zone of cardiac myocytes in the infarcted pig heart

Background Myocardial infarction (MI) is a common cause of death, with approximately 175000 inpatient episodes of acute myocardial infarction in the UK in 2012. Following an MI the loss of cardiac myocytes triggers a remodelling process depositing extracellular matrix in the infarct region. Hypocontractile, damaged cardiac myocytes surround the infarct, forming a border zone. One of the key structural components regulating excitation-contraction coupling in the heart is the t-tubule network. Conventional confocal microscopy (resolution ˜100 nm) of isolated cardiac myocytes from the border zone post-MI has shown a loss of t-tubules. Here we apply, for the first time to our knowledge, serial block face scanning electron microscopy (SBF-SEM), to investigate the morphology of the t-tubule network within the infarct border zone cardiac myocytes to provide nano-scale structural details of the remodelling process. Methods A porcine model of MI was employed for this study. All animal work was approved by the University of Manchester local ethics committee and was covered by the necessary UK Home Office project and personal licences. Tissue (˜0.5 mm 3 ) was collected from the border and remote zones of the MI pigs and corresponding regions were also taken from control animals and processed for SBF-SEM. Blocks were imaged using an FEI Quanta 250 FEG SEM equipped with a Gatan 3View system. Serial images were collected at different magnifications ranging from 5.4 to 90.0 nm per pixel in the X-Y plane, while the cutting depth along the Z-axis was fixed at 50 nm for all the datasets. Images were segmented and rendered in Fiji or IMOD. Results 3D reconstruction of the t-tubule network from the left ventricle of control animals revealed a spoke-like arrangement, similar to that observed in human cardiac myocytes and other large mammals e.g. the sheep. Cardiac myocytes within the remote region of the infarcted heart have a t-tubule network indistinguishable from that of the control myocytes. In contrast, border zone myocytes showed large areas that were devoid of t-tubules. 3D modelling revealed that the surviving transverse tubules presented gross deformations, appearing to be the result of t-tubules fusing with each other to form a large complex that adopts a variety of orientations within the cardiac myocyte. Conclusion Employing SBF-SEM we have collected 3D datasets of cardiac myocytes in situ within the left ventricle of infarcted pigs at magnifications corresponding to ˜5 nm per pixel in the X-Y plane. This has allowed the resolution of nano-scale details of the remodelled t-tubules, including features such as the basal lamina. Together the loss of t-tubules within parts of the cell, coupled with the formation of super-tubule networks, provide novel structural insights towards unravelling the hypocontractile properties of the border zone cardiac myocytes.

An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction.

Understanding both cost and quality across institutions is a critical first step to illuminating the value of care purchased by Medicare. Under contract with the Centers for Medicare and Medicaid Services, we developed a method for profiling hospitals by 30-day episode-of-care costs (payments for Medicare beneficiaries) for acute myocardial infarction (AMI). We developed a hierarchical generalized linear regression model to calculate hospital risk-standardized payment (RSP) for a 30-day episode for AMI. Using 2008 Medicare claims, we identified hospitalizations for patients 65 years of age or older with a discharge diagnosis of ICD-9 codes 410.xx. We defined an AMI episode as the date of admission plus 30 days. To reflect clinical care, we omitted or averaged payment adjustments for geographic factors and policy initiatives. We risk-adjusted for clinical variables identified in the 12 months preceding and including the AMI hospitalization. Using combined 2008-2009 data, we assessed measure reliability using an intraclass correlation coefficient and calculated the final RSP. The final model included 30 variables and resulted in predictive ratios (average predicted payment/average total payment) close to 1. The intraclass correlation coefficient score was 0.79. Across 2382 hospitals with ≥ 25 hospitalizations, the unadjusted mean payment was $20,324 ranging from $11,089 to $41,897. The mean RSP was $21,125 ranging from $13,909 to $28,979. This study introduces a claims-based measure of RSP for an AMI 30-day episode of care. The RSP varies among hospitals, with a 2-fold range in payments. When combined with quality measures, this payment measure will help profile high-value care.

0374 : Cardioprotection against ischemia-reperfusion injury by heart rate control

Acute myocardial infarction (AMI) is a major cause of mortality worldwide. Early reperfusion is the only treatment recommended to reduce infarct size. However, reperfusion induces also deleterious secondary effects called ischemia-reperfusion (IR) injury due to irreversible apoptotic death of cardiomyocytes. Most ischemic episodes are triggered by an increase in heart rate that induces an imbalance between myocardial oxygen delivery and consumption. The BEAUTIFUL clinical trial has demonstrated that moderate heart rate reduction diminishes the frequency of AMI episodes in patients with stable coronary artery disease having increased heart rate at rest. The HCN-mediated I f current and the Ca v 1.3- mediated L-type Ca 2+ currents play important roles in the generation of automaticity and heart rate, therefore they are interesting targets for selective control of heart rate and cardioprotection during AMI. The aim of this study was to investigate if Ca v 1.3 channels could be a putative target to reduce infarct size. Anesthetized C57BL/6J, Ca v 1.3 -/- and Girk4 -/- mice were subjected to a surgical protocol of myocardial IR (40min ischemia-60 min reperfusion). Heart rate was measured with a one-lead surface ECG recording, and infarct size with triphenyl tetrazolium chloride staining. Selective heart rate decrease (26%) in an in vivo mouse model of AMI is associated with reduced IR injury. Ivabradine administration before ischemia significantly reduced infarct size (–33%). Ca v 1.3 -/- mice presented reduced infarct size (–30%) compared to WT mice. In addition, Girk4 -/- mice, a genetic model of moderate tachycardia (10%) displayed increased infarct size (+30%) compared to control mice. These results show a direct relationship between heart rate and IR injury. Heart rate reduction by inhibition of Ca v 1.3 channels constitutes a promising strategy to reduce infarct size.

Epilepsy-induced electrocardiographic alterations following cardiac ischemia and reperfusion in rats.

The present study evaluated electrocardiographic alterations in rats with epilepsy submitted to an acute myocardial infarction (AMI) model induced by cardiac ischemia and reperfusion. Rats were randomly divided into two groups: control (n=12) and epilepsy (n=14). It was found that rats with epilepsy presented a significant reduction in atrioventricular block incidence following the ischemia and reperfusion procedure. In addition, significant alterations were observed in electrocardiogram intervals during the stabilization, ischemia, and reperfusion periods of rats with epilepsy compared to control rats. It was noted that rats with epilepsy presented a significant increase in the QRS interval during the stabilization period in relation to control rats (P<0.01). During the ischemia period, there was an increase in the QRS interval (P<0.05) and a reduction in the P wave and QT intervals (P<0.05 for both) in rats with epilepsy compared to control rats. During the reperfusion period, a significant reduction in the QT interval (P<0.01) was verified in the epilepsy group in relation to the control group. Our results indicate that rats submitted to an epilepsy model induced by pilocarpine presented electrical conductivity alterations of cardiac tissue, mainly during an AMI episode.

Assessment of right ventricular functional recovery after acute myocardial infarction by 2D speckle-tracking echocardiography.

To assess the pattern of right ventricular (RV) functional recovery in a cohort of patients with successful reperfusion of a first episode of acute myocardial infarction (AMI) with 2D speckle-tracking echocardiography and cardiac magnetic resonance imaging (CMR). Ninety-five revascularized AMI patients were prospectively included (56.8 ± 11.1 years, 48 inferior, 47 anterior). RV function was assessed by echocardiography and CMR within the initial 72 h and 6 months later. A RV global strain was calculated while averaging strain values from septal, lateral and inferior walls. At the acute phase, RVEFCMR was lower in inferior than in anterior AMI patients (52.5 ± 6.8 vs. 56.0 ± 4.8, p = 0.006). Similarly, RV global, inferior and lateral strains were lower in inferior MI patients (p < 0.001 for all) whereas septal strain was not significantly different across groups. At 6 months, RVEFCMR and all strain parameters improved compared to baseline. Improvements were more substantial for patients with inferior than with anterior MI. RV parameters ultimately reached similar levels in the two groups at 6 months except for inferior strain which remained lower in patients with inferior MI (-24.5 ± 6.5 vs. -27.5 ± 5.4, p = 0.03). In low risk patients after AMI, RV function ultimately recovered over the 6 months of follow up. Higher levels of both initial impairment and subsequent recovery were observed for inferior MI. Although RV function was relatively preserved in these patients, RV strain analysis revealed a persistent impairment of RV inferior strain in patients with inferior MI, which may not be identified by RVEFCMR or conventional echocardiographic parameters.

Allopurinol use and risk of non-fatal acute myocardial infarction

ObjectivesTo quantify the risk of non-fatal acute myocardial infarction (AMI) among users of allopurinol.MethodsWe carried out a population-based case–control study over the period 2001–2007 in patients aged 40–90 years. Patients...

Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness.

To investigate the association between acute myocardial infarction (AMI) and recent exposure to antipsychotic agents in people with serious mental illness (SMI), and modifying influences. A case-crossover design was applied using the Taiwan National Health Insurance Research Database (NHIRD) to compare the exposure frequency of antipsychotic agents within individuals of schizophrenia or bipolar disorder between 60-day case and control periods prior to their first AMI episode during 1996-2007. A sample of 834 patients with incident AMI was analysed. AMI was significantly associated with more recent antipsychotic exposure in schizophrenia after adjustment (OR 1.87, 95% confidence interval 1.15-3.03) bipolar disorder (OR 1.06, 0.51-2.21). This association in schizophrenia was significantly stronger in men and in patients without previous diagnoses of cardiovascular risk factors. These findings are consistent with a short-term risk effect of antipsychotic exposure on risk of AMI and identify potentially vulnerable groups. Further research is required to clarify underlying biological mechanisms.

Dietary non-enzymatic antioxidant capacity and the risk of myocardial infarction: A case-control study in Italy

Background and aimsOxidative processes have been related to atherosclerosis, but there is scanty information on the role of dietary antioxidants in the prevention of acute myocardial infarction (AMI). Methods and resultsThe relationship between non-enzymatic antioxidant capacity (NEAC) and the risk of nonfatal AMI was investigated in a case-control study conducted in Milan, Italy, between 1995 and 2003. Cases were 760 patients below 75 years with a first episode of AMI and controls were 682 patients admitted to hospitals for acute conditions, who completed an interviewer-administered food frequency questionnaire, tested for validity and reproducibility. NEAC (excluding coffee) was measured using Italian food composition tables in terms of ferric reducing-antioxidant power (FRAP), Trolox equivalent antioxidant capacity (TEAC) and total radical-trapping antioxidant parameter (TRAP). The odds ratios (OR) of AMI, and the corresponding 95% confidence intervals (CI), were obtained by multiple logistic regression models including terms for main risk factors of AMI and total energy intake. NEAC was inversely related with the risk of AMI. The ORs for the highest quintile compared with the lowest one were 0.41 (95% CI, 0.27–0.63) for FRAP, 0.42 (95% CI, 0.27–0.65) for TEAC and 0.41 (95% CI, 0.27–0.62) for TRAP, with significant trends in risk. The inverse relationship was apparently stronger in women and in subjects aged ≥60 years. ConclusionsOur results support a favorable role of dietary NEAC in the prevention of AMI, and encourage a high consumption of fruit and vegetables and a moderate consumption of wine and whole cereals.

Prenatal influenza exposure and cardiovascular events in adulthood

ObjectivesThis study examined the association between prenatal exposure to pandemic influenza and cardiovascular events in adulthood.DesignUsing Danish surveillance data to identify months when influenza activity was highest during three previous pandemics (1918, 1957, and 1968), persons were defined as exposed/unexposed based on whether they were in utero during peak months of one of the pandemics. Episodes of acute myocardial infarction (MI) and stroke were identified in the Danish National Registry of Patients covering all Danish hospitals since 1977.Setting/SampleInformation from Danish national registries on all persons with a Civil Personal Registry number and birthdates in 1915 through 1922, 1954 through 1960, and 1966 through 1972 was collected.Main outcome measuresCrude incidence rate ratios (IRRs) were calculated per pandemic. Generalized linear models were fit to estimate IRRs adjusted for sex.ResultsFor acute MI, sex-adjusted IRRs for persons in utero during peaks of the 1918, 1957, and 1968 pandemics, compared with those born afterward, were 1·02 (95% confidence interval (CI): 0·99, 1·05), 0·96 (95% CI: 0·87, 1·05), and 1·18 (95% CI: 0·96, 1·45), respectively. For stroke, the corresponding IRRs were 0·99 (95% CI: 0·97, 1·02), 0·99 (95% CI: 0·92, 1·05), and 0·85 (95% CI: 0·77, 0·94), respectively.ConclusionsThere was generally no evidence of an association between prenatal influenza exposure and acute MI or stroke in adulthood. However, survivor bias and left truncation of outcomes for the 1918 pandemic are possible, and the current young ages of persons included in the analyses for the 1957 and 1968 pandemics may warrant later re-evaluation.

Assess the risk factors and knowledge on modification of lifestyle among patients who have experienced acute myocardial infarction in Taif

Background: Patient education programme for cardiac patients is an essential part of quality medical care today. For the diagnosis and therapeutic regimen to be beneficial, patients must be informed about their own health and motivated to share the responsibility. Aims & Objective: This study was conducted to evaluate the risk factors for myocardial infarction in Taif region, Saudi Arabia kingdom and establish a modification in the life style to decrease the incidence of cardiac diseases. Material and Methods: A hospital based cross-sectional study was conducted at governmental hospital at Taif. Thirty nine subjects admitted to Emergency department during the study period with their first episode of Acute Myocardial Infarction participated in this study. Results: A structured questionnaire was used to collect data. They were 31 (79.5%) males and 8 (20.5%) females, the majority of patients (46.2%) under the scope of this study was above the age of 50 years, 87.2% of them was married and 12.8% was divorced. the main risk factors that affect the patients in Taif region, KSA were the presence of hypertension (59%) , diabetes (35.9%), consuming a highly deep fried food (76.9%) , lack of regular exercise (89.7%) and nervous mode (79.5%). the mean knowledge score of patients recruited in this study was either low (51%) or medium score (29%), and little percentage was either high (14%) or very high (6%) knowledge score. Conclusion: It is recommended to encourage health care providers especially nurses and physicians to teach their patients about disease process, risk factors, and preventive measures during providing either medical or nursing care.

Dyselectrolytemia in Acute Myocardial Infarction - A Retrospective Study

Background: Myocardial infarction(MI) is a dreadful complication of cardiovascular disease causing increasing mortality worldwide. Sudden cardiac deaths occur worldwide at rates of around 3 million per year. Electrolyte imbalances after an episode of acute MI are common. Clinical importance of these imbalances in ST elevation Myocardial Infarction (STEMI) in the era of primary intervention has not been fully understood. Objectives: To determine the pattern of dyselectrolytemia in post MI patients and to compare the electrolyte levels among MI and non-MIpatients. Materials & Methods: This was a retrospective case control study including 50 consecutive acute MI patients admitted to the coronary care unit and 50 controls. Plasma sodium, potassium and chloride levels were obtained in all MI patients within 48 hours of admission. Patient history, physical examination, drug history and laboratory results were recorded by chart abstraction. Conclusion: Hypokalemia and hyponatremia were fairly common findings among acute MI patients. Serum chloride levels showed no particular pattern or significant difference among the two groups. Key Words: Myocardial infarction, Serum chloride, Serum creatinine, Serum potassium, Serum sodium.

Dyselectrolytemia in Acute Myocardial Infarction A Retrospective Study

Background: Myocardial infarction(MI) is a dreadful complication of cardiovascular disease causing increasing mortality worldwide.Sudden cardiac deaths occur worldwide at rates of around 3 million per year. Electrolyte imbalances after an episode of acute myocardial infarction are common. Clinical importance of these imbalances in ST elevation myocardial infarction (STEMI) in the era of primary intervention has not beenfully understood. Objectives: To determine the pattern of dyselectrolytemia in post MI patients and to compare the electrolyte levels among MI and non-MIpatients

Income inequalities in case death of ischaemic heart disease in the Netherlands: a national record-linked study

BackgroundSocioeconomic inequalities in ischaemic heart disease (IHD) mortality have been found in most European countries, but it is unclear to what extent inequalities in survival, as opposed to incidence, contribute...

Relationship between circulating soluble Fas ligand and preexisting left ventricular hypertrophy in the setting of left ventricular remodeling after acute myocardial infarction

We aimed to investigate the effects of preexisting left ventricular hypertrophy (LVH) on the circulating concentration of soluble Fas ligand (sFasL) and also the relationship of sFasL to ventricular remodeling in patients with acute myocardial infarction (MI). Forty consecutive patients who presented with their first episode of acute MI were studied. These patients were then divided into two groups with regard to the presence of LVH. All the patients underwent complete transthoracic echocardiography with determination of end diastolic volume index and LV mass index within 24 h and at 6 months. sFasL levels were determined in serum on admission and at 24 h of admission. The serum sFasL concentration did not change significantly after acute MI at 24 h after admission in the study population (P=0.574), however, the serum level of sFasL concentration was significantly increased in the patients with preexisting LVH (P<0.001). There was a strong positive relationship between LV mass index and the serum level of sFasL concentration at 24 h after admission (r=0.611; P<0.001). Moreover, there was a stronger correlation between the change in end-diastolic volume index at 6 months and the serum level of sFasL in the LVH group compared with the group without LVH (r=0.499 and 0.181, respectively). In conclusion, we have shown that serum sFasL concentration at 24 h after admission was significantly higher in patients with LVH, and also, there is a close relationship between the serum level of sFasL and LV enlargement.

A Very Elderly Woman Experiencing Two Episodes of Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention: A Case Report and Literature Review

Advanced age is associated with poor outcome among patients with acute myocardial infarction (AMI). It appears that elderly patients are treated more conservatively because of multiple comorbidities and higher risk of further invasive therapy. Reperfusion therapy for AMI may improve survival, and previous studies have shown that patients receiving percutaneous coronary intervention (PCI) have better clinical outcomes than those given thrombolytic therapy. We report our experience with a 96-year-old woman with anteroseptal wall ST-segment elevation myocardial infarction successfully treated with primary PCI. One stent was implanted in the left anterior descending artery occlusive lesion. The patient survived and was discharged from the hospital 7 days later. She received optimal medical therapy and had no major adverse cardiac events within 1 year. Unfortunately, the patient had non-ST-segment elevation myocardial infarction 18 months later. We discussed with her family about the risk/benefit ratio of PCI, and they agreed with the procedure. We performed PCI successfully and the patient was discharged 5 days later. No major adverse cardiac events occurred within 4 months. In very elderly patients without multiple comorbidities, PCI is safe for AMI and effective in shortening hospital stay, reducing in-hospital and short-term mortality. We also discuss our strategy for this very elderly patient and the present therapy for AMI in nonagenarians.

La pharmacopée de prévention cardiovasculaire est-elle sous-utilisée chez les patients souffrant d’insuffisance rénale chronique après un infarctus du myocarde ?

Chronic kidney disease (CKD) is strongly associated with cardiovascular disease. After a myocardial infarction (MI), the risk of recurrent events is much higher in subjects suffering from CKD, even when traditional risk factors are taken into account. Some data suggest that thrombolysis and coronary revascularization are underused during acute MI episodes in subjects who suffer from CKD. We performed a systematic review of the medical literature to ascertain whether there is also a CKD-associated decrease in the use of cardioprotective medications (aspirin, beta-blockers, ACE inhibitors and lipid lowering drugs) after a MI. We did observe a CKD-associated underuse of these medications in this particular clinical context. The presence of co-morbidities and co-treatments, as well as the relative lack of evidence-based data on the efficacy of cardiopreventive drugs in patients with CKD probably explain much of the reported therapeutic differences. However, recent studies show that the differences in cardioprotective drug use across levels of kidney function tend to diminish over the years. This probably reflects a greater awareness of the high cardiovascular risk associated with CKD amongst clinicians caring for these patients.

Expressed emotion in wives of myocardial infarction patients: an exploratory feasibility study

We assessed the emotional components expressed by the spouses of patients at the first episode of acute myocardial infarction (AMI) and considered potential underlying links among these components and the course of the cardiac symptoms over time. This was an exploratory prospective cohort study. A sample of 50 consecutive male inpatients with a diagnosis of AMI and their wives was studied. At baseline spouses were assessed with the Camberwell Family Interview and ratings of Expressed Emotion were made. Patients completed the State-Trait Anxiety Inventory (STAI XI-X2) and the Beck's Depression Inventory (BDI). After 12 months (T1), during appropriate treatment by a cardiologist blinded to the Expressed Emotion ratings, the existence or absence of serious adverse events (death or hospitalizations because of cardiac causes) were determined as an all-or-none phenomenon. Stepwise logistic regression analysis was performed to estimate associations among illness course and Expressed Emotion subscales, STAI X1-X2, BDI scores and clinical variables. High family Emotional Overinvolvement (EOI) scores were associated with higher study entry levels of depression (P = 0.003) among the patients and high Warmth was related to higher score on state anxiety scale (P = 0.000). Poor illness course at T1 was associated with high EOI [P = 0.005, exp(B) = 0.502, 95% confidence interval 0.308-0.818]. The association among wives' emotional profile, patients' psychological variables and illness course suggested the importance of a family assessment and of interventions directed towards changing emotional behaviours which could threaten the patient's psychological adjustment and the clinical course following a heart attack.

Efficacy and Safety of Combination Acitretin and Pioglitazone Therapy in Patients With Moderate to Severe Chronic Plaque-Type Psoriasis

To evaluate the efficacy and safety of combination therapy with acitretin and pioglitazone hydrochloride in patients with moderate to severe chronic plaque-type psoriasis. Randomized, double-blind, placebo-controlled clinical trial. A tertiary care referral hospital. Patients The study included patients of either sex (age range, 18-65 years) with moderate to severe chronic plaque-type psoriasis. Patients were excluded if they were of child-bearing potential or if they had impaired liver or renal function, hyperlipidemia, diabetes mellitus, coronary artery disease, or a body mass index greater than 30 (calculated as weight in kilograms divided by height in meters squared). Of the 62 patients screened, 41 were randomly assigned to 2 groups: 22 to an acitretin (25 mg) plus placebo group and 19 to an acitretin (25 mg) plus pioglitazone hydrochloride (15 mg) group. Main Outcome Measure Change in Psoriasis Area and Severity Index score between the 2 groups from baseline to 12 weeks. After 12 weeks of therapy, the percentage of reduction in the Psoriasis Area and Severity Index score was 64.2% in the acitretin plus pioglitazone group and 51.7% in the acitretin plus placebo group. The majority of the adverse events were mild to moderate except for 1 possibly unrelated episode of acute myocardial infarction in a 49-year-old woman in the acitretin plus placebo group. Pioglitazone has a potential beneficial antipsoriatic effect and may provide a convenient, efficacious, and relatively safe option to combine with acitretin, although further studies are needed. Trial Registration clinicaltrials.gov Identifier: NCT00395941.