Prior History Of Coronary Artery Disease Research Articles

Risk Factors in First Presentation Acute Coronary Syndromes (ACS): How Do We Move From Population to Individualized Risk Prediction?

Patients with acute coronary syndromes (ACS) have a poor short- and long-term prognosis. We sought to examine the presence of established coronary risk factors in contemporary patients presenting with an ACS for the first time and no known coronary artery disease (CAD) in the past. The study was conducted in 3171 consecutive patients admitted with the diagnosis of ACS. Of these, 941 patients (30%) had the admission as the first occurrence of ACS and no prior history of CAD. We studied the degree to which these first presenters with ACS had 1 or more established risk factors. We found that 98% of patients presenting with an ACS for the first time and no previous CAD had at least 1 established risk factor. Current population-based screening efforts must be improved to allow more effective prevention strategies and more individualized risk prediction.

Prognostic value of coronary multidetector CT angiography in patients with an intermediate probability of significant coronary heart disease.

The aim of this study was to determine the prognostic value of coronary multidetector CT angiography (MDCTA) in patients with an intermediate pre-test probability of significant coronary artery disease (CAD). Patients who underwent 64-slice coronary MDCTA and met the selection criteria were identified and assessed for intermediate pre-test probability. Coronary MDCTA scans were preceded by calcium scoring, whereas all MDCTA scans were interrogated for the presence of plaque composition and the distribution and degree of stenosis. Significant stenosis was classified as being >50% of the luminal diameter. All patients were followed up for the occurrence of (i) cardiac death, (ii) non-fatal myocardial infarction, (iii) unstable angina requiring hospital admission and (iv) revascularisation. 138 patients were included (follow-up of 19.9 months); of these, 8 had a cardiac event (all revascularisations) and all had a positive coronary MDCTA. Patients with normal coronary arteries or non-significant stenosis suffered no cardiac events during follow-up. There were significant differences between the two groups regarding the presence of significant stenosis (p<0.001), the presence of plaque (p = 0.011) and a calcium score >10 (p = 0.003); 36.4% of patients with significant stenosis underwent revascularisation. In conclusion, this is the first UK study to investigate survival data in a population of intermediate-risk patients with no prior history of CAD who were investigated with coronary MDCTA. Coronary MDCTA can confidently rule out significant CAD in the intermediate-risk population and guide risk factor modification in patients with demonstrated coronary atheroma.

Detection of occult coronary artery disease in asymptomatic individuals with diabetes mellitus using non-invasive cardiac angiography

Introduction/objectives Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population. Methods We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner. Results The mean age of the study participants was 59 ± 8 years; 66% were men. Diabetes duration was 7 ± 7 years, mean Framingham risk score was 13%, and mean hemoglobin A1C level was 7%. Of the 217 outpatients, 138 (64%) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26%) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45%) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2%) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing. Conclusion Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.

Myocardial Contrast Echocardiography for Distinguishing Ischemic From Nonischemic First-Onset Acute Heart Failure

Distinguishing ischemic from nonischemic origin in patients presenting with acute heart failure (AHF) not resulting from acute myocardial infarction has both therapeutic and prognostic implications. The aim of the study was to assess whether myocardial contrast echocardiography (MCE) can identify underlying coronary artery disease (CAD) as the cause of AHF. Fifty-two consecutive patients with AHF with no prior clinical history of CAD and no clinical evidence of acute myocardial infarction underwent resting echocardiography and MCE both at rest and after dipyridamole stress at a mean of 9+/-2 days after admission. All patients underwent coronary arteriography before discharge. Of the 52 patients, 22 demonstrated flow-limiting CAD (>50% luminal diameter narrowing). Sensitivity, specificity, and positive and negative predictive values of MCE for the detection of CAD were 82%, 97%, 95%, and 88%, respectively. Among clinical, ECG, biochemical, resting echocardiographic, and MCE markers of CAD, MCE was the only independent predictor of CAD (P<0.0001). Quantitative MCE demonstrated significantly (P<0.0001) lower myocardial blood flow velocity reserve in vascular territories subtended by >50% CAD (0.59+/-0.46) compared with patients with normal coronary arteries (1.99+/-1.00). However, myocardial blood flow velocity reserve in patients with no significant CAD was significantly (P=0.03) lower compared with control (2.91+/-0.41). Myocardial blood flow velocity reserve correlated significantly (P<0.0001) with increasing severity of CAD. MCE, which is a bedside technique, may be used to detect CAD in patients presenting with AHF without a prior history of CAD or evidence of acute myocardial infarction. Quantitative MCE may further risk-stratify patients with AHF but no CAD.

Silent myocardial ischaemia in the elderly.

Coronary artery disease (CAD) is a leading cause of death and disability in the elderly. Several recent studies have shown that silent myocardial ischaemia (SMI) is a common manifestation of CAD, especially in the elderly. As many as 40% of elderly patients with no prior history of CAD may have underlying asymptomatic disease and up to 50% of elderly patients with known CAD might have evidence of SMI. The results of studies in elderly patients with CAD have also shown that SMI might exist despite antianginal therapy that is considered adequate for symptom control. In order to diagnose such residual SMI, the clinician would need to perform 24- to 48-hour Holter monitoring in the ambulatory setting while the patient is performing routine daily activities. Although a number of anti-ischaemic drugs have been evaluated for the treatment of SMI, available data suggest that beta-blocker given alone or in combination with a nitrate compound or calcium antagonist provides the best therapeutic choice. The long term benefit of SMI suppression in elderly patients has not been established. Future studies need to evaluate the clinical benefits of therapy given for SMI in the elderly.

Survival of Patients with Preexisting Coronary Artery Disease (CAD) Following Kidney or Kidney/Pancreas Transplantation with

569 Cardiovascular complications remain a major cause of morbidity & mortality following successful kidney (K) or kidney/pancreas (SKP) transplantation. This is particularly true in patients with diabetes and/or preexisting CAD. Many transplant centers have established protocols to assess this risk pre-transplantation yet it has not been determined if cardiovascular intervention in the form of coronary artery bypass graft (CABG) or percutaneous transluminal coronary an`gioplasty (PTCA) +/- stenting prior to transplanting these patients may influence their survival. We conducted a retrospective chart review of 300 K & SKP recipients that were performed between 1990 - 1996. 32 patients had a prior history of CAD or significant risk factors that necessitated coronary angiogram as a part of their pretransplant evaluation. Group I (n=12) included patients who had severe coronary artery stenosis >70% requiring intervention in the form of CABG or PTCA/stenting prior to transplantation. Group II (n=20) had coronary artery stenosis <70% and received medical management only. Both groups were similar in regards to demographics, immunosupressive regimen, HLA mismatch, type of transplant & etiology of ESRD. TableWe conclude that patients with severe coronary artery stenosis identified pre-transplantation who received intervention had a significantly improved survival when compared to patients with mild to moderate disease managed medically. It is unclear if this difference is due to closer monitoring of patients with more advanced CAD or if a more aggressive approach to individuals with less severe CAD is necessary.

Should asymptomatic subjects with silent ischemia undergo further evaluation and follow-up?

Traditionally, clinicians have depended on the clinical manifestation of chest pain before pursuing workup for evaluation of coronary artery disease (CAD). It is, however, now well-recognized that cardiac ischemia can occur frequently without any associated symptoms and, in some cases, sudden cardiac death may be the initial manifestation of CAD [l]. It is also known that advanced obstructive CAD may exist with minimal or no symptoms and progress rapidly to an abrupt closure of the artery which is associated with a fatal event [ 1,2]. An estimated 18% of coronary attacks occur with sudden death as the first event [3]. More than half of sudden deaths occur without a prior history of CAD [l]. These alarming statistics have led to rapidly changing attitudes of clinicians about asymptomatic CAD. An increasing number of physicians are now screening for asymptomatic CAD in an effort towards early detection and intervention to reduce the risk of future coronary events. Although there is a great deal of enthusiasm for detection of asymptomatic CAD, the critical questions are whether the screening for asymptomatic CAD is necessary and meaningful, and can we really alter the long-term outcome in the patient with asymptomatic CAD.

Preparation magnetic and optical properties of ferrimagnets in the RbMgF 3RbCoF 3 system

Brachial-ankle pulse wave velocity (baPWV) and ratio of plasma eicosapentaenoic acid to arachidonic acid (EPA/AA ratio) are surrogate markers for coronary artery disease (CAD). We aimed to evaluate the effects of a fish-based diet and administration of EPA on baPWV and plasma EPA/AA ratio.The changes in baPWV and plasma EPA/AA ratio were compared before and after a 6-month fish-based diet in 191 patients with cardiovascular risk factors. A fish-based diet resulted in significant increment of plasma EPA/AA ratio (0.40 ± 0.18 vs. 0.49 ± 0.27, p < 0.001), with baPWV remaining unchanged. Multivariate analysis revealed that systolic blood pressure (SBP) (6-month SBP-baseline SBP) and CAD were positively associated with increased baPWV (CAD: odds ratio = 2.040, p = 0.0436, SPB: odds ratio = 1.056, p = 0.0003). When the patients were divided into three groups: CAD, low-risk, and high-risk with no prior history of CAD according to the number of risk factors at baseline, comparison among the three groups disclosed an inter-group difference in the magnitude of change in baPWV (low-risk: −35 ± 164 cm/s, high-risk: −14 ± 190 cm/s, CAD: 39 ± 164 cm/s, p = 0.0071 for trend). In 191 patients who had received a 6-month fish-based diet, 21 patients (primarily CAD patients) sequentially received high purity EPA (1800 mg/day) for 6 months. It resulted in marked increment of plasma EPA/AA ratio (0.65 ± 0.57 vs. 1.19 ± 0.46, p < 0.001), accompanied by significant reduction in baPWV (1968 ± 344 cm/s vs. 1829 ± 344 cm/s, p = 0.0061). There was a significant negative correlation between changes in baPWV and changes in plasma EPA/AA ratio in patients with a fish-based diet and sequential administration of EPA (r = −0.446, p = 0.017).A fish-based diet was effective against increased baPWV only in low-risk patients, with slight increment of plasma EPA/AA. In high-risk patients and CAD patients, administration of EPA for preventing progression of baPWV endorsed the validity of high purity EPA administration recommended in the current guidelines.