2017 Vol. 14, No. 6
Objective To assess whether the low-density lipoprotein cholesterol (LDL-C) target value and preventive effect of statins are different between elderly and younger patients. Methods We investigated 304 patients with previous percutaneous coronary intervention who underwent coronary angiography from January 2007 to December 2016 for examination of recurrent ischemia beyond the early restenosis. Patients were classified into two groups: age ≥ 75 years (elderly group: n = 140) and n = 164). Relationships between the achieved LDL-C level, incidence of late coronary events, and the effectiveness of statins were evaluated. Results During follow-up, 179 patients underwent late coronary revascularization. Recurrent ischemia presenting as acute coronary syndrome (ACS) occurred in 83 cases. Kaplan-Meier curve analysis revealed that in the younger group, recurrent ACS was significantly lower in patients with LDL-C P = 0.035); however, there was no difference between these in the elderly group (P = 0.863). Instead, recurrent ACS was less frequent in patients with LDL-C ranging from 70 mg/dL to P = 0.005); moreover, only using statins was an independent predictor in the elderly group (HR: 0.375; P = 0.007). Conclusions Strict control of LDL-C to < 70 mg/dL was effective for reducing the incidence of recurrent ACS in younger patients. However, LDL-C < 100 mg/dL might be sufficient as the target value of LDL-C-lowering therapy for secondary prevention of ischemic events in Japanese elderly patients.
Objective To evaluate the associations between the serum anion gap (AG) with the severity and prognosis of coronary artery disease (CAD). Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation: AG = Na+ [(mmol/L) + K+ (mmol/L)] ? [Cl? (mmol/L) + HCO3? (mmol/L)]. Results A total of 4510 (24.9%) participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD (P P = 0.004). Patients in the 4th quartile of serum AG (≥ 15.92 mmol/L) had a 5.171-fold increased risk of 30 days all-cause death (P P P = 0.009). Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.
Objective To study prognostic characteristics of cardiac troponin I (cTnI) elevation in acute ischemic stroke. Methods We retrospectively studied patients (n = 248) with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group (cTnI > 0.034 ng/mL) or the no cTnI elevation group (cTnI ≤ 0.034 ng/mL). Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke (n = 178), acute ST-segment elevation myocardial infarction (n = 35), and acute non-ST-elevation myocardial infarction (n = 35), patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.
Objective To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. Methods As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use (identified using the Anatomical Therapeutic Classification System) using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Results Participants included 541 residents with a mean age of 85.5 years (± 8.5), a mean Psychogeriatric Assessment Scale–Cognitive Impairment (PAS-Cog) score of 13.3 (± 7.7), a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower (better) PAS-Cog scores [Coefficient (β) = -3.7; 95% CI: -5.2 to -2.2; P P = 0.0022). Analysis by subgroups of medications showed cardiac therapy medications (C01), beta blocking agents (C07), and renin-angiotensin system agents (C09) were associated with lower PAS-Cog scores (better cognition) and lower dementia diagnosis probability. Conclusions This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.
Aortic dissection is relatively uncommon occurring at about 3 cases per 100,000 per year. Most of inciting event in aortic dissection is intimal tearing. The dissection propagates antegrade or retrograde manner due blood flow, which responsible for clinical manifestations such as tamponade, aortic valve insufficiency, coronary artery involvement. Risk factors are hypertension, smoking, trauma, connective tissue disorders, vasculitis and other iatrogenic events. Most frequent presentation is sudden onset severe chest pain or back pain. However, some patients present with painless or variety of symptoms and manifestations such as myocardial infarction, aortic regurgitation, intrathoracic hemorrhage and fever of unknown origin (FUO), resulting in a delayed diagnosis. The Diagnosis of aortic dissection depends upon demonstration on imaging studies include computed tomography, echocardiography, magnetic resonance imaging. They identify the extent of aortic involvement, entry and reentry sites, aortic insufficiency, coronary artery involvement, pericardial or mediastinal hemorrhage as well. We presented a case of delayed progressed asymptomatic aortic dissection in patient with STEMI.
We describe a case of a 67-year-old women who reported symptoms of fever and arthritis following initiation of therapy with clopidogrel(300mg loading dose). Physical examination and laboratory testing were normal. Incidentally, she reported experiencing the same symptoms after she received a loading dose of clopidogrel prior to a diagnostic coronary angiography in the past. The symptoms improved dramatically on discontinuation of clopidogrel.
A 61-year-old patient suffered sudden acute ST-segment elevation myocardial infarction (STEMI) after stool, who only took thrombus aspiration by percutaneous coronary intervention (PCI) and got reperfusion totally, without balloon dilatation or stenting. While bilateral pulmonary embolism and deep venous thrombosis (DVT) was found on this patient, warfarin and inferior vena cava filter were used to antithrombotism. From the results of echocardiography, we noticed right ventricular enlargement and pulmonary hypertension, and the retrograde flow was detected at the foramen ovale, which meant patent foramen ovale (PFO), so it was considered that the thrombus caused acute myocardial infarction (AMI) was origianted from DVT through the foramen ovale. This rare case showed the importantce to define the source of the thrombus to find appropriate treatments and effective preventive measures.