Therapy In Coronary Patients Research Articles

Cirugía coronaria híbrida y tratamiento con láser y células madre. Anomalías coronarias. Cirugía del remodelado ventricular

In this article we review different aspects beyond the CABG First, we will define the concept of hybrid revascularization and the use of transmyocardial revascularization and stem cell therapy in coronary patients. Secondly, we will define coronary anomalies and when and how they must be managed. Finally, we will focus on left ventricle aneurysm management, Dor surgery and other techniques in left ventricle remodeling.

Effect of Beta-Blocker Therapy in Patients With Coronary Artery Disease in New York Heart Association Classes II and III

The aim of the study was to investigate the effect of β-blocker treatment on a large cohort of patients with coronary artery disease in functional classes II and III according to the New York Heart Association (NYHA) classification. Among 11,575 patients with coronary artery disease screened for participation, but not included in the Bezafibrate Infarction Prevention (BIP) study, 3,225 (28%) were in NYHA classes II and III. In the latter group of patients we compared the prognosis of 1,109 (34%) treated with β blockers with 2,116 counterparts not receiving β-blocker therapy. After a mean follow-up of 4 years, all-cause and cardiac mortality rates were significantly lower among β-blocker users, 9% and 5%, respectively, than among β-blocker nonusers, 17% and 11%, respectively (p <0.01 for both). After multivariate adjustment, treatment with β blockers was associated with a lower all-cause mortality risk (hazards ratio [HR] 0.62, 95% confidence interval [CI] 0.49 to 0.78), and a lower cardiac mortality risk (HR = 0.61, 95% CI 0.45 to 0.83) than was no treatment with a β blocker. Lower total mortality risk was noted among patients in NYHA class II (HR 0.63, 95% CI 0.48 to 0.82) and in NYHA class III (HR 0.57, 95% CI 0.37 to 0.87) as well as in patients with (HR 0.62, 95% CI 0.48 to 0.81) or without (HR 0.70, 95% CI 0.45 to 1.09) a previous myocardial infarction. We conclude that β-blocker therapy in coronary patients in NYHA classes II or III is safe and associated with a lower risk for all-cause and cardiac mortality.

Prevalence and effects of nonpharmacologic treatment of "isolated" low-HDL cholesterol in patients with coronary artery disease.

To determine the the prevalence of isolated low high-density lipoprotein cholesterol and its response to hygienic therapy in coronary patients after major cardiac events. Data before and after phase II cardiac rehabilitation and exercise training were assessed in 275 consecutive patients from two institutions. All patients had known coronary artery disease and underwent a 12-week program of aggressive hygienic therapy. The prevalence of isolated low high-density lipoprotein cholesterol in this cohort was determined and its response to vigorous nonpharmacologic therapy was assessed and compared with that of other coronary patients undergoing similar therapy. At baseline, 113 (41%) had low high-density lipoprotein cholesterol, including 70 (25%) with isolated low high-density lipoprotein cholesterol. In contrast, 147 (53%) had "high-risk" low-density lipoprotein-cholesterol > or = 130 mg/dL. In the subgroup with isolated low high-density lipoprotein cholesterol, improvements occurred in body mass index, metabolic equivalents, high-density lipoprotein cholesterol, and low-density lipoprotein/high-density lipoprotein cholesterol. Compared with 205 patients without isolated low high-density lipoprotein cholesterol, this subgroup had much greater improvements in high-density lipoprotein cholesterol (+17% versus +2%; P < .001) and low-density lipoprotein/high-density lipoprotein cholesterol (-11% versus -6%; P < .02), with similar improvements in most other major coronary artery disease risk factors. These results suggest that isolated low high-density lipoprotein cholesterol is prevalent in patients with coronary artery disease and is sensitive to aggressive hygienic interventions.

Research review: use of activated clotting time to monitor heparin therapy in coronary patients

Successful management of patients after coronary angioplasty requires careful monitoring of the coagulation status in order to titrate heparin therapy and prevent thrombosis or bleeding. Traditionally, the activated partial thromboplastin time was used to monitor heparin therapy. Recently, however, use of activated clotting time is gaining more support because it can be performed at the bedside and is cost-effective. This article reviews the research on the use of activated clotting time in titrating heparin therapy in angioplasty patients. Although the literature supports the use of activated clotting time in angioplasty, limitations of the studies and the different methodologies used preclude generalization of results. More research is needed to confirm the efficiency and effectiveness of the activated clotting time in monitoring heparin therapy.