Coronary Ischemic Events Research Articles

Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention.

Relative Contribution of Lipids and Apolipoproteins to Incident Coronary Heart Disease and Ischemic Stroke: The PRIME Study

Aim: To compare within the same cohort the association of a large panel of lipids with the risk of incident coronary heart disease (CHD) and ischemic stroke events in participants of the Prospective Epidemiological Study of Myocardial Infarction. Methods: In this binational (Northern Ireland and France) prospective cohort, we considered 9,711 men aged 50–59 years free of CHD and stroke at baseline (1991–1993). The hazard ratios of each lipid marker for CHD and ischemic stroke events were estimated in separate Cox proportional hazard models adjusted for age, study center, systolic blood pressure, antihypertensive treatment, current smoking status, body mass index and diabetes. Results: After 10 years of follow-up, 635 men had a first CHD and 98 a first ischemic stroke event. Total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, triglycerides, apolipoprotein (Apo) A1 and Apo B100, their ratios and lipoprotein (a) [Lp(a)] were all significantly predictive of future CHD. Associations with ischemic stroke followed the same trend as for CHD, but with lower strength, and none were statistically significant. However, none of the differences between the hazard ratios for CHD and for ischemic stroke were statistically significant. Conclusions: In healthy, middle-aged men, total-C, HDL-C, LDL-C, non-HDL-C, triglycerides, Apo A1 and Apo B100, their ratios and Lp(a) are, if anything, weak predictors of ischemic stroke events over a 10-year period.

Atherosclerosis and leukocyte–endothelial adhesive interactions are increased following acute myocardial infarction in apolipoprotein E deficient mice

Objective To determine the effect of myocardial infarction (MI) on progression of atherosclerosis in apolipoprotein E deficient ( ApoE −/−) mice. Methods and results MI was induced following left anterior descending coronary artery (LAD) ligation in wild-type (WT) ( n = 9) and ApoE −/− ( n = 25) mice. Compared to sham-operated animals, MI mice demonstrated increased intravascular leukocyte rolling and firm adhesion by intravital microscopy, reflecting enhanced systemic leukocyte–endothelial interactions. To determine if MI was associated with accelerated atherogenesis, LAD ligation was performed in ApoE −/− mice. Six weeks following surgery, atherosclerosis was quantitated throughout the arterial tree by microdissection and Oil-Red-O staining. There was 1.6-fold greater atherosclerotic burden present in ApoE −/− MI mice compared to sham-operated mice. Conclusions Acute MI accelerates atherogenesis in mice. These results may be related to the increased risk of recurrent ischemic coronary events following MI in humans.

The Difference between Acute Coronary Heart Disease and Ischaemic Stroke Risk with Regard to Gender and Age in Finnish and Swedish Populations

We studied the age and gender difference between acute coronary heart disease and ischaemic stroke risk and examined the extent to which such a difference may be explained by known risk factors. Data from Finnish and Swedish population-based cohorts including 9278 individuals were collaboratively analysed. Hazards ratios (95% confidence intervals) for coronary heart disease and stroke incidence were estimated using the Cox-proportional hazards model. The incidence of coronary heart disease and stroke was higher in all age groups in men than in women, and the gender difference was more marked for coronary heart disease than for ischaemic stroke. There was a 10-year lag in the development of coronary heart disease and stroke in women compared with men. The multivariable adjusted hazard ratios for the incidence of coronary heart disease in men and women were 3.87 (2.49-6.02) and 1.71 (1.07-2.74) at age 50-59 years, and 7.22 (4.59-11.36) and 3.49 (2.18-5.57) at age 60-69 years compared with women aged 40-49 years. For ischaemic stroke, they were 2.64 (1.45-4.82) and 2.17 (1.18-3.97) at age 50-59 years, and 5.19 (2.81-9.58) and 4.89 (2.67-8.97) at age 60-69 years, respectively. Acute coronary heart disease and ischaemic stroke events appeared approximately 10 years earlier in men than in women, and these rates remained higher in men than in women in all age groups. The gender difference was more marked for coronary heart disease than for ischaemic stroke. This may be taken into account when developing interventions and treatment strategies.

Perioperative Medicine

Perioperative Medicine

The common functional polymorphism -50G>T of the CYP2J2 gene is not associated with ischemic coronary and cerebrovascular events in an urban-based sample of Swedes

CYP2J2 is responsible for the production of 5,6 8,9 11,12 and 14,15-epoxyeicosatrienoic acids, vasodilator and anti-inflammatory substances. It is abundantly expressed in human heart and also present in kidney and vasculature. Carriers of a common polymorphism, the CYP2J2 -50G>T, rs890293, have reduced expression of CYP2J2 mRNA level in the heart putatively through the interference with a binding site for a transcription factor with consequently reduced circulating levels of CYP2J2 epoxygenase metabolites in vivo. The aim of the present study was to evaluate the effect of this functional polymorphism on blood pressure (BP) levels, hypertension prevalence, and risk of incident cardiovascular events in middle-aged Swedes. The CYP2J2 polymorphism was genotyped in 5740 participants of the cardiovascular cohort of the 'Malmö Diet and Cancer' study. The incidence of cardiovascular events (coronary events, n = 261; ischemic stroke, n = 185) was monitored over 10 years of follow-up. In the whole population the polymorphism had no effect on BP and hypertension prevalence and no interaction was found between the polymorphism and sex, age or body mass index. Before and after adjustment for major cardiovascular risk factors, the hazard ratio for incident ischemic stroke and coronary events was not significantly different in carriers of different genotypes. Our data do not support a major role for the CYP2J2 -50G>T variant in determining BP level and incident ischemic events. Other studies are needed to elucidate if other polymorphisms in the same gene could have a role in BP homeostasis or incidence of cardiovascular events.

The Efficacy of Statin Therapy in Patients with Acute Coronary Syndromes and Concomitant Carotid Disease

Statins prevent recurrent ischemic coronary events after acute coronary syndrome (ACS) and improve cardiovascular outcome of patients with peripheral artery disease. We sought to evaluate the interrelationship between statin use, phenotype of carotid plaques as assessed by ultrasound, and outcome of patients with ACS and concomitant carotid disease. A total of 337 consecutive patients with ACS were assessed by coronary angiography and Doppler ultrasound of the carotid arteries and followed up for a median period of 19 months. Carotid plaques were detected in 144 (42%) patients. Of these patients, 99 (69%) had echogenic carotid plaques and 45 (31%) had echolucent plaques. The groups did not differ significantly with regard to the lipid profiles, the prevalence of risk factors, and 1-vessel, 2-vessel, or 3-vessel coronary artery disease. During follow-up, 227 (67%) patients were receiving statins. We observed 14 cardiac deaths and 17 myocardial infarctions. After adjustment for treatment strategy (medical therapy or myocardial revascularization), patients with echolucent carotid plaques receiving statin therapy (n = 32, 71%) showed a better event-free survival than did patients with echolucent plaques not treated with statins (log-rank P = .038). In patients with echogenic carotid plaques, the benefit of statin therapy on event-free survival was less evident (log-rank P = .56). In patients with ACS and echolucent carotid plaques, statin therapy is associated with better event-free survival, while in patients with ACS and echogenic carotid plaques no clear benefit of statins is observed.

Artykuł oryginalnyWpływ szczepienia przeciw grypie na przebieg choroby wieńcowej u pacjentów po pierwotnej angioplastyce wieńcowej – obserwacja z badania FLUCAD

Background and aim: We compared the protective effect of influenza vaccination on the clinical course of coronary artery disease (CAD) in patients (pts) with acute coronary syndrome (ACS) treated by primary angioplasty (PCI), and in stable angina pts. Methods: Prospective, randomized 1 : 1, double-blind, placebo controlled study. We included 658 optimally treated CAD pts; 477 men, mean age 59.9 ± 10.3 years. Median follow-up was 298 (interquartile range 263-317) days. Results: There were 157 pts (83 – active vaccine, 74 – placebo) vaccinated after primary PCI in ACS, and 501 pts (242 – vaccine, 259 – placebo) with stable angina. In stable angina pts there were no significant differences in estimated 12-month cumulative event rates between vaccinated and placebo groups for the: primary endpoint (cardiovascular death), secondary endpoints: major adverse cardiac event (MACE) – (cardiovascular death or myocardial infarction or coronary revascularization) and coronary ischemic event (composite of MACE or hospitalization for angina). In ACS group, in vaccinated pts we observed: (1) a significant reduction in the rate of coronary ischemic event with HR 0.37 (95% CI 0.14-0.99, p = 0.047); (2) a statistical trend for reduction of MACE with HR 0.36 (95% CI 0.09-1.39; p = 0.139); (3) no effect on cardiovascular mortality. Conclusions: The protective effect of influenza vaccination on CAD clinical course was observed in pts with ACS but not in those with stable angina. Influenza vaccination may be safely performed immediately after ACS and primary PCI.

Relationship between High-Sensitivity C-Reactive Protein and Clinical Functional Outcome after Acute Ischemic Stroke in a Korean Population

Background: High-sensitivity C-reactive protein (hs-CRP) has been shown to be a powerful predictor of coronary ischemic events. However, the prognosis of functional disability in patients with cerebrovascular disease has not been well established. Therefore, we performed this study to determine the prognostic significance of hs-CRP levels in patients with functional disability after acute ischemic stroke. Methods: A total of 417 Korean patients with ischemic stroke were examined within 24 h after symptom onset. hs-CRP measurements were obtained on admission and on the seventhhospital day. The correlations between the concentration of hs-CRP and functional disability duration 12 months after stroke onset were analyzed. Results: The present study showed that hs-CRP levels on admission and on the seventh hospital day were significantly correlated with the modified Rankin Scale (mRS) score 12 months after stroke onset. These results also demonstrated that mRS scores are more closely associated with hs-CRP levels on the seventh hospital day than hs-CRP levels on admission. Conclusion: This study demonstrated that elevated hs-CRP levels on the seventh hospital day, rather than within 24 h after stroke onset, could strongly predict the prognosis of functional disability. These results supported that hs-CRP is a useful marker of ischemic stroke in the Korean population.

Manual B-Mode Versus Automated Radio-Frequency Carotid Intima-Media Thickness Measurements

Carotid intima-media thickness (CIMT) serves as an indicator of atherosclerosis and cardiovascular risk. Manual measurements of B-mode ultrasound images are the most applied method. Automated measurements with radiofrequency (RF) ultrasound have been suggested as an alternative. The aim of this study was to compare these methods in terms of risk-factor relations and associations with future events. Data from participants of the Second Manifestations of Arterial Disease (SMART) study were used. Far wall common CIMT was measured online with manual B-mode and automated RF ultrasound. Measurements were performed by a group of 6 sonographers. Risk-factor information was obtained. All participants were followed for the occurrence of vascular events (mean follow-up, 2.1 years). CIMT was related to risk factors with linear regression models and to future events with Cox proportional-hazards models. Data were available for 2,146 participants. Agreement between the methods was modest (intraclass correlation coefficient = 0.34). Risk-factor relations with age and systolic blood pressure were stronger for B-mode than for RF ultrasound. Association with future events was better for B-mode than for RF ultrasound (vascular death, 1.27 vs 1.00; ischemic stroke, 1.45 vs 1.03). In participants with CIMT < 0.9 mm (without plaque), the intraclass correlation between the measures was 0.50. In addition, in that subgroup, RF ultrasound showed a stronger association with future events than B-mode ultrasound (all events, 1.59 vs 1.09; vascular death, 1.72 vs 0.93; coronary ischemic events, 1.65 vs 1.05). The preference for either B-mode or RF measurements may be driven by the type of study population, the expected presence of local atherosclerotic abnormalities, and the main aim of the study (assessing risk factors or events). However, in this study, as in many others, the B-mode approach was shown to be robust in risk-factor relations and the prediction of events.

Long-term Follow-up of Atrial Fibrillation Patients in the NASPEAF Study. Prospective Evaluation of Different Antiplatelet Treatments

In the NASPEAF (National Study for Prevention of Embolism in Atrial Fibrillation) trial, combination therapy with an anticoagulant and an antiplatelet was more effective than anticoagulation alone in patients with atrial fibrillation. We report long-term follow-up in these patients, including prospective evaluation of different antiplatelet therapies. This analysis included 574 atrial fibrillation patients. Standard anticoagulation (international normalized ratio [INR] 2.0-3.0) was used as control therapy to compare with anticoagulation (INR 1.9-2.5) plus either triflusal at 600 mg/day, triflusal at 300 mg/day or aspirin at 100 mg/day. The primary endpoint was ischemic or hemorrhagic stroke, a systemic or coronary ischemic event, or cardiovascular death. The mean follow-up was 4.92 years. Long-term follow-up confirmed that combination therapy with an anticoagulant plus triflusal at 600 mg/day gave significantly better results than anticoagulation alone (hazard ratio [HR]=0.33; 95% confidence interval [CI], 0.14-0.80; P=.014). There was a significantly higher incidence of ischemic events with triflusal at 300 mg/day (P=.031) and of severe bleeding events with aspirin at 100 mg/day (P=.008). The mean INR was similar in the three combination therapy groups. The incidence of severe nongastric bleeding during combination therapy with triflusal was very low (0.3% of patients/year). Long-term follow-up confirmed that combination antithrombotic therapy with triflusal at 600 mg/day gave significantly better results than anticoagulant monotherapy. The results obtained with combination therapy with triflusal at 300 mg/day and with aspirin at 100 mg/day should be considered provisional because the treatment groups were small and treatment was not randomly assigned.

Low protein C and incidence of ischemic stroke and coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study.

Protein C is an important plasma natural anticoagulant. Although protein C deficiency increases risk of venous thrombosis, it remains uncertain whether low protein C increases risk of atherothrombosis. To examine whether low protein C may be a risk factor for ischemic stroke or coronary events in a prospective population-based study. The Atherosclerosis Risk in Communities Study assessed protein C antigen by ELISA at baseline in 1987-89 and followed participants (n = 13 879) for incident ischemic stroke or coronary events through 2005. Over a median of 16.9 years of follow-up, 613 ischemic strokes and 1257 coronary heart disease events occurred. Protein C was inversely associated with incidence of ischemic stroke. Adjusted for multiple risk factors, the rate ratios (95% CIs) from highest to lowest quintiles were 1.0, 1.16 (0.90-1.50), 1.22 (0.94-1.58), 1.18 (0.90-1.55) and 1.52 (1.17-1.98). This inverse association was stronger for non-lacunar and cardioembolic stroke than for lacunar stroke. In contrast, there was a positive association between protein C and coronary heart disease in incompletely adjusted models, but no association after adjustment for plasma lipids. In this cohort study, low protein C was a risk factor for incident ischemic stroke but not coronary heart disease. Levels of protein C associated with stroke risk were not restricted to the traditional 'deficient' range for protein C (< 0.5 percentile), suggesting that other etiologies for a lower protein C, or genetic variants associated with more subtle changes in protein C, are playing a role in disease pathogenesis.

Antithrombotic Therapy in Heart Failure

Clarity regarding the role of antithrombotic treatments in patients with heart failure in the absence of atrial fibrillation remains elusive. In an era of an intensified search for personalized medicine, it is instructive to look back at the earliest evidence for a protective effect of anticoagulation, when little else had any promise to reduce morbidity and mortality in heart failure.1–3 It is now evident that those benefits were predominantly driven by effects in subsets of patients with atrial fibrillation and valvular disease. Sixty years later, the role of antithrombotic treatments in the remaining population remains uncertain. The Warfarin and Antiplatelet Therapy in Chronic Heart Failure Trial (WATCH), the results of which are published in the present issue,4 held the promise of providing clear support for one therapeutic approach above the others in reducing the incidence of adverse cardiovascular events. However, the primary WATCH findings provide no clear winner among warfarin, clopidogrel, and aspirin, with the limited statistical power preventing any clear conclusion. WATCH results do suggest that aspirin treatment increases the likelihood of heart failure hospitalization compared with the other approaches. Article p 1616 Evidence exists indicating that heart failure is often accompanied by a hypercoagulable state.5–7 Patients with reduced cardiac output may be predisposed to venous thrombosis and pulmonary embolus. In the sizable percentage of heart failure patients with ischemic heart disease, antiplatelet therapy is expected to decrease the incidence of recurrent coronary ischemic events, as it has been shown to do in the broader ischemic heart disease population.8–12 Among patients without known ischemic heart disease, there is suspicion that many adverse events, including worsening heart failure and sudden cardiac death, may be provoked by myocardial ischemia,13 raising the possibility that antithrombotic treatment may impact natural history in this population as well. On the …

Does the Combination of Warfarin and Aspirin Have a Place in Secondary Stroke Prevention?

The combined use of warfarin plus aspirin for secondary stroke prevention occurs primarily in patients with atrial fibrillation (AF) who have concomitant coronary artery disease (CAD). This drug combination is also used in patients with mechanical heart valves or occasionally in stroke/TIA patients who are deemed to be at high-risk for recurrent events. It is estimated that approximately 20% of patients on warfarin also receive aspirin and aside from patients with mechanical heart valves the use of this combination is tenuous.1,2 The most common clinical scenario for using warfarin plus aspirin is for primary or secondary stroke prevention in AF patients who also have CAD. The rationale for using this combination typically is the widespread belief that the use of warfarin, although clearly of benefit for stroke risk reduction, should be supplemented with aspirin for reducing the risk of coronary ischemic events. The basis for this assumption is unclear, and the combined use of warfarin plus aspirin substantially increases the risk of major bleeding side effects, including intracerebral hemorrhage (ICH).2 The efficacy of aspirin for reducing ischemic …

Inflammasjon og C-reaktivt protein ved hjerte- og karsykdom

This article reviews the role of inflammation in development of atherosclerosis and associated complications and discusses use of the inflammatory marker - high-sensitivity C-reactive protein (hs-CRP) - in risk stratification. The article is based on selected publications retrieved from a non-systematic search of PubMed and the authors' experience within the field. Both chronic inflammatory disease and acute infections are associated with an increased risk of cardiovascular events. Influenza vaccination reduces the risk of coronary ischaemic events in patients with coronary artery disease, but the effect on cardiovascular mortality is not documented. Hs-CRP is an independent predictor of cardiovascular events in populations with and without established cardiovascular disease. Treatment with Rosuvastatin led to decreased hs-CRP-levels and a reduced risk for cardiovascular events in subjects without known cardiovascular disease, with normal serum cholesterol and hs-CRP-levels above 2 mg/l. Individuals with chronic inflammatory disease and those with high risk and acute infection are at risk for cardiovascular events and should be evaluated for primary prevention. In patient groups at moderate risk for cardiovascular disease, hs-CRP can be a valuable supplement to established factors for risk stratification. Despite numerous studies confirming hs-CRP's role as an independent risk marker, hs-CRP has not found its place in international guidelines. This should be reconsidered on the background of new study results.

Tissue Factor Modulation by Angiotensin II: A Clue to a Better Understanding of the Cardiovascular Effects of Renin-Angiotensin System Blockade?

Systemic hypertension, a pathological process to which the renin-angiotensin system contributes importantly, is characterized by a thrombophilic diathesis and an increased risk for acute ischemic coronary events. That apparently contradictory profile might, to some extent, relate to the modulating properties of Angiotensin II, the effector arm of the renin angiotensin system, on tissue factor expression, the physiologic initiator of blood coagulation and a basic mechanism in the pathogenesis of acute thrombosis. In fact, monocytes and macrophages within the atherosclerotic plaque as well as inflamed vascular endothelial cells may locally synthesize Angiotensin II. In turn, the peptide, by binding to its specific membrane receptors, activates a series of intracellular signals eventually converging upon NF-kappaB, a transcription factor that upregulates tissue factor expression. Drugs interfering with the renin-angiotensin system, either by inhibiting conversion of Angiotensin I to Angiotensin II or by blocking its receptors, have the potential to inhibit tissue factor expression and to modulate its procoagulant effect. This property may contribute to the protection exerted by renin-angiotensin blockers from acute ischemic events in patients with hypertension and other cardiovascular diseases.

A Retrospective Literature Review of Erythromelalgia and Myelorpoliferative Disorders

Cutaneous manifestations of myeloproliferative disorders (MPD) herald an uncommon diagnostic clue preceding a diagnosis of Essential Thrombocytosis (ET) and Polycythemia Vera (PV). If left untreated, they may progress towards acrocyanosis and even peripheral gangrene. This clincal entity can present months to years prior to an official diagnosis of a MPD. These atypical skin finding in ET and PV are referred to as Erythromelalgia, characterized by red, congested distal extremities secondary to microvascular complications. The pathophysiology of this skin abnormality involves spontaneous activation and aggregation of hypersensitive thrombocythaemic platelets in the end-arterial microvasculature, involving the peripheral, cerebral, and coronary circulation of thrombocythemia patients. The microvascular disturbances are frequently preceded or followed by atypical transient neurologic, ocular or coronary ischemic events. Thus these atypical skin findings can signal potential limb ischemia and necrosis.We performed an extensive retrospective case review of the entire Engish language medical literature. The first reported case of Erythromelalgia was in 1872 by Weir-Mitchell. By 1938, Smith and Allen advocated the use of acteylsalicyclic acid as they reported pronounced pain relief from the use of 0.65 grams, up to five times daily. In our search, the number of cases reporting signs and symptoms of Erythromelalgia specifically preceding ET or PV, number less than twenty. We wanted to determine from review of the literatue if treatment with aspirin at the time of diagnosis of Erythomelalgia led to improved outcome.The overriding conclusion of our review was that aspirin induced prompt relief of painful symptoms and seemed to prevent thrombotic sequelae in this patient cohort. Clinicians need to consider the underlying presence of a myeloproliferative disorder in patients manifesting vasculopathy associated skin findings, as it may be the harbinger of potentially fatal ischemic events. Earlier diagnosis and treatment may lead to improved outcome.

Differences in risk factors for coronary heart disease in patients from continental and Mediterranean regions of Croatia

There are few data on differences in exposure to risk factors for coronary heart disease (CHD) in relation to geographic areas, especially areas with large differences in terms of continental and Mediterranean climates. To study these differences in Croatia, we analyzed data from the Treatment and Secondary Prevention of Ischemic Coronary Events in Croatia V (TASPIC-CRO V) study, which recruited Croatian CHD patients in two principal regions (Mediterranean and continental) of the country. A total of 31 Croatian research centers participated in the study. We collected information on personal details, demographic characteristics and risk factor exposure from the hospital medical records of 3054 CHD patients. Risk factors included history of cigarette smoking, hypertension, hyperlipidemia (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) and diabetes type 2. Both univariate and multivariate analyses showed that the prevalence of hypertension in examined CHD patients was significantly higher in the continental part of Croatia than in the Mediterranean part (univariate analysis: P < 0.001; multivariate analysis: P = 0.003). Multivariate analysis revealed a higher prevalence of decreased HDL-cholesterol in continental Croatia (P = 0.006) and a higher prevalence of smokers in coastal Mediterranean Croatia (P = 0.007). A significant difference in total cholesterol levels was noted between hospitalized CHD patients in two Mediterranean subregions (P < 0.001). No significant differences between continental and coastal Mediterranean parts of Croatia were found for other CHD risk factors. Higher prevalences of both hypertension and decreased HDL-cholesterol were recorded in hospitalized CHD patients in the continental part of Croatia, but in coastal Mediterranean Croatia there was higher prevalence of smokers. Differences in total cholesterol, LDL-cholesterol and triglycerides between hospitalized CHD patients in continental and coastal Mediterranean Croatia did not follow the expected continental-Mediterranean pattern.

Abstract P26: Intra-CPR Hypothermia with and Without Volume Loading in an Ischemic Model of Cardiac Arrest

Background: Coronary occlusive ischemic events are responsible for 50 –70% of cardiac arrests in adults. We investigated the effects of intra-CPR mild hypothermia (HTM) (target 32–33°C) with and without volume loading on return to spontaneous circulation (ROSC) and infarction size in a severe, mid-LAD occlusion model of cardiac arrest. Methods: 46 (27±2.3kg) pigs had their mid LAD balloon occluded and were divided in 5 groups. After 15 minutes, ventricular fibrillation (VF) was electrically induced and 5 minutes of untreated VF were followed by 5 minutes of pneumatic vest CPR with a set compression pressure (250mmHg). If ROSC was obtained, animals were followed for another 95 minutes for a total LAD occlusion time of 120 min. Subsequently the balloon was deflated and 90 min of reperfusion were followed by myocardial staining to define area at risk (AAR) and myocardial infarct size. Group A had no additional intervention. Group B received immediately post ROSC surface cooling with cooling blankets and ice. Group C received intra-CPR 680±23ml of 28°C 0.9% NS via a central femoral venous catheter. Group D received during CPR 673±26 of 4°C NS followed by post ROSC surface cooling as in group B. Group E received intra-CPR and post ROSC volume-sparing HTM with an Endovascular Therapeutic Hypothermia System (ETHS) placed into the right atrium and set at a target of 32°C. Results: During CPR, coronary perfusion pressure was significantly decreased in groups C and D compared to groups A, B and E but groups D and E had significantly reduced infarct size. Group E had significantly improved EF compared to all other groups. Table . Conclusions: Intra-CPR HTM significantly reduces myocardial infarction size. Volume loading during CPR is detrimental for ROSC due to reduction of coronary perfusion pressure. ETHS intra-CPR application improves ROSC and post-resuscitation LV function and minimizes infarction in this ischemia-reperfusion cardiac arrest model. Results

Relation Between Aspirin Dose, All-Cause Mortality, and Bleeding in Patients With Recent Cerebrovascular or Coronary Ischemic Events (from the BRAVO Trial)

Despite aspirin's established role in the treatment of atherosclerotic vascular disease, considerable controversy exists regarding its most effective dosing strategy. In a retrospective observational study, we examined the relation between prescribed aspirin dose (<162 mg vs > or =162 mg/day aspirin) and clinical outcome in 4,589 placebo-treated patients enrolled in the Blockage of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion (BRAVO) trial over a median follow-up of 366 days. Standard Cox regression analysis was employed because propensity analysis was not feasible. Compared with lower aspirin doses, higher doses were associated with lower unadjusted all-cause mortality (2.9 vs 1.6%, respectively; log rank chi-square 8.6, p = 0.0034). Higher aspirin dose remained independently predictive of lower all-cause mortality in a multivariable Cox proportional hazards model (hazard ratio 0.64, 95% confidence interval 0.42 to 0.97, p = 0.037). However, there was no significant difference in the incidence of the composite endpoint death, nonfatal myocardial infarction, or nonfatal stroke (6.1% vs 6.2%, p = 0.74). Higher aspirin dose was a significant independent predictor of any (hazard ratio 1.32, 95% confidence interval 1.12 to 1.55, p = 0.001) but not serious bleeding. In conclusion, our findings suggest that aspirin doses of > or =162 mg/day may be more beneficial than those <162 mg/day at preventing death.