Coronary Artery Disease

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Coronary Artery Disease

NIH - Medical Encyclopedia Coronary heart disease

"Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease. Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms. Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. … Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

There are two main types of chest pain:

• Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.

• Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.

Other symptoms include: • Shortness of breath • Heart attack -- in some cases, the first sign of CHD is a heart attack…

Tips for preventing CHD or lowering your risk of the disease: • Avoid or reduce stress as best as you can. • Don't smoke. • Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables. • Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. If you are overweight or obese, experts say you should get 60 to 90 minutes of exercise every day. • Keep your blood pressure, blood sugar, and cholesterol under control"

Highlighted Articles

[Heart disease and stroke] (Tidsskr Nor Laegeforen. 2007)

"Most cases of heart disease and stroke are caused by atherosclerosis, and the two diseases have much in common with regards to risk factors, treatment and prognosis. Heart disease may also be a direct cause of stroke. About one in four cerebral infarctions are due to embolism from the heart to the brain, mainly because of atrial fibrillation, but also because of diseases such as acute myocardial infarction, dilated cardiomyopathy and prosthetic heart valves (cardioembolic stroke). Stroke can also be caused by a cardiogenic fall in blood pressure in patients with stenoses in pre- or intracerebral arteries (haemodynamic stroke). Patients with symptoms of atherosclerosis in one artery system should be treated as if they have a high risk of developing symptoms from other artery systems. The possibility of a cardiac embolic source should always be considered in patients with acute brain infarctions."

Optimal Medical Therapy with or without PCI for Stable Coronary Disease (NEJM 2007)

"Background In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events. … Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy."

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Coronary Artery Disease

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Defibrillators Not Dangerous While Driving "The defibrillators that are implanted in people for instant correction of abnormal heartbeats pose no special risks for heart patients who drive, researchers report."

Triple therapy of warfarin, aspirin and a thienopyridine for patients treated with vitamin K antagonists undergoing coronary stenting. A review of the evidence. (Intern Emerg Med. 2007)

Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis (The Lancet 2007) "The risks of mortality associated with drug-eluting and bare-metal stents are similar. Sirolimus-eluting stents seem to be clinically better than bare-metal and paclitaxel-eluting stents."

Defibrillators Can Control Dangerous Heart Condition "Implantable defibrillators can reduce the risk of sudden death in high-risk patients with hypertrophic cardiomyopathy, a genetically linked thickening of heart muscle."

Drug Therapy as Effective as Stents for Stable Heart Disease "The follow-up, which lasted from 2 to 7 years, showed that 19% of patients in the angioplasty group either died or had a heart attack, compared with 18.5% of the drug treatment group. Researchers also found little statistical difference between the 2 groups when comparing rates of death, heart attack, stroke, or hospitalization for acute coronary syndrome or heart attack alone. The primary benefit of angioplasty over drug therapy, according to the researchers, is that it reduced chest pains over the long term."

Death Rate High in Drug-Coated Stent Trial "Nearly a third of patients who had drug-coated stents implanted in vein grafts to improve coronary blood flow died within 32 months, Dutch cardiologists report. There were no deaths among those who had similar vein grafts with traditional bare-metal stents, said the report in the July 10 online issue of the Journal of the American College of Cardiology. Although the study was small, with only 75 participants, the results call for more research to determine the safety of drug-coated stents in what are known as saphenous vein grafts, American cardiologists said. "

Implantable Cardioverter Defibrillator

Pacemaker

Sirolimus-eluting stents compared with standard stents in the treatment of patients with primary angioplasty (American Heart Journal 2007)

Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events: is it safe and effective to use just one antiplatelet agent? (Eur Heart J. 2007)

Optimal Medical Therapy with or without PCI for Stable Coronary Disease (NEJM 2007) "Background In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events. … Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy."

Implantable Defibrillator Wires Prone to Failure "The wires through which implanted defibrillators deliver the electric jolts that keep hearts beating normally aren't as reliable as many might think, a German cardiovascular research center reports. Even though the composition of those wires was changed in 1997 to improve reliability, both the newer and older versions of these defibrillators show an annual rate of defect of almost 20 percent a decade after implantation, finds a study in the May 1 issue of Circulation. Given that these devices are used to treat arrhythmias, dangerously irregular heartbeats that can lead to cardiac arrest, the researchers note that such a significant failure rate poses a public health threat."

Late coronary thrombosis in paclitaxel-eluting stents. Case reports. (J Cardiovasc Med (Hagerstown). 2007)

The effect of high-dose aspirin pre-treatment on the incidence of myonecrosis following elective coronary stenting. (Atherosclerosis. 2007) "CONCLUSION: For patients taking daily low-dose aspirin therapy, supplementation with high-dose aspirin before elective coronary stenting does not reduce, but may increase the incidence of peri-procedural myonecrosis."

Drug-eluting coronary stents - a note of caution. (Med J Aust. 2007)

Diabetic retinopathy and coronary implantation of sirolimus-eluting stents. (J Interv Cardiol. 2007) "Conclusions: As compared with diabetic patients without retinopathy, those with nonproliferative retinopathy have an increased risk for target-vessel failure after coronary implantation of sirolimus-eluting stents."

Implantable Defibrillators Offer Heart Patients a Better Quality of Life: Study "Implantable cardioverter-defibrillators (ICDs) help heart disease patients live longer, lead more active lives and enjoy a quality of life comparable to that of average Americans."

Permanent Pacemaker and Implantable Cardioverter Defibrillator Infection (Arch Intern Med. 2007) "Conclusions To our knowledge, this is the first population-based study to describe the incidence of cardiac device infection. Device infection was common during episodes of S aureus BSI. The rate of cardiac device infection was higher in patients with defibrillators than in those with pacemakers."

Angina treatment: Stents, drugs, lifestyle changes — What's best? " What if you already have a stent? You still need to be on intensive medical management to treat remaining coronary artery disease and diseased arteries (atherosclerosis) elsewhere in your body. However, if you've had a stent implanted and need future medical treatment for your clogged arteries, you'll likely need additional stents implanted. You won't be able to rely on medical therapy, such as drugs, alone as treatment. This is because if any future problems, such as blockages or clots, do recur they will likely happen near where your stent was implanted. Doctors will then have to insert one or more stents near those old stent sites to correct the problem. "

Optimal Medical Therapy with or without PCI for Stable Coronary Disease (NEJM 2007) "Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy."

Late Stent Thrombosis Following Implantation of a Drug Eluting Stent Presenting as Acute Myocardial Infarction: A Case Report (The Internet Journal of Cardiology 2007) "We herein report a case that presented as acute anterior wall myocardial infarction three months after drug eluting stent implantation in left anterior descending artery despite continued use of aspirin and clopidogrel."

Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting (EHJ 2007) "Conclusion Our study shows that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used. Aspirin plus warfarin combination seems to be inadequate to prevent stent thrombosis."

Comparison of Effectiveness of Bare Metal Stents Versus Drug-Eluting Stents in Large (=3.5 mm) Coronary Arteries (The American Journal of Cardiology 2007) "In conclusion, implantation of DESs in large coronary arteries confers no additional benefit compared with BMSs, and the 2 approaches are associated with equally favorable clinical outcomes at 1 year."

Drug-Eluting Coronary Stents — Promise and Uncertainty

Safety and Efficacy of Sirolimus- and Paclitaxel-Eluting Coronary Stents (NEJM 2007) "Conclusions Stent thrombosis after 1 year was more common with both sirolimus-eluting stents and paclitaxel-eluting stents than with bare-metal stents. Both drug-eluting stents were associated with a marked reduction in target-lesion revascularization. There were no significant differences in the cumulative rates of death or myocardial infarction at 4 years."

Acute coronary syndrome due to hinge movement of a bare-metal stent. (Int J Cardiol. 2007) "ACS might be caused by chronic mechanical stress due to HM of the BMS."

Comparison of Drug-Eluting Versus Bare Metal Stents on Later Frequency of Acute Myocardial Infarction and Death (The American Journal of Cardiology 2007) "In conclusion, in this single-center observational study, use of DESs in consecutive unselected patients, most of whom would not have been eligible for inclusion in the randomized trials of DES versus BMS, was associated with lower AMI and death rates than in a comparable group of patients treated with BMSs in mid-term (9-month) follow-up."

Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias. (Eur Heart J. 2007)

Coronary collateral function long after drug-eluting stent implantation. (J Am Coll Cardiol. 2007) "CONCLUSIONS: Collateral function long after coronary stenting is impaired with DES (sirolimus and paclitaxel) when compared with BMS. Considering the protective nature of collateral vessels, this could lead to more serious cardiac events in the presence of an abrupt coronary occlusion."

Implantable Defibrillator Not for Every Heart Patient

Drug Side-Effects and Interactions

Adding blood thinners doesn't prevent heart attack "Two drugs are not always better than one when it comes to using blood thinners used to treat clogged arteries in the legs, U.S. researchers reported on Wednesday. They found that adding a blood thinner, such as warfarin, to daily clot-preventing drugs, such as aspirin, is no better -- and sometimes more dangerous -- for preventing heart attacks, strokes and other circulatory problems in people with peripheral artery disease. About 1 in 16 people over 40 have some degree of clogging in the arteries outside their heart. These 8.5 million in the United States face a higher risk of death from heart disease … 4 percent of the people getting combination therapy suffered life-threatening bleeding, compared with just 1.2 percent getting an antiplatelet drug."

Interactions between heparins, glycoprotein IIb/IIIa antagonists, and coronary intervention. The Global Registry of Acute Coronary Events (GRACE). (Am Heart J. 2007)

Risk of major bleeding with concomitant dual antiplatelet therapy after percutaneous coronary intervention in patients receiving long-term warfarin therapy. (Pharmacotherapy. 2007)

Silent myocardial ischemia in coronary artery disease patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. (J Gastroenterol Hepatol. 2007) " Conclusion: Myocardial ischemia is a relatively common complication in CAD patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. A history of CAD with triple vessel disease, higher blood urea nitrogen, lower diastolic blood pressure and lower hematocrit may help identify patients who are at increased risk of myocardial ischemia, which tends to be associated with higher in-hospital mortality and increased length of hospital stay."

Drugs

What Initial Dose of Aspirin Is Right for STEMI Patients? “An initial dose of 162-mg aspirin may be as effective as and perhaps safer than 325 mg for the acute treatment of ST-elevation MI (STEMI), a new study suggests [1].”

Long-Term Follow-up of the West of Scotland Coronary Prevention Study (NEJM 2007) "Conclusions In this analysis, 5 years of treatment with pravastatin was associated with a significant reduction in coronary events for a subsequent 10 years in men with hypercholesterolemia who did not have a history of myocardial infarction."

Meta-analysis of the role of statin therapy in reducing myocardial infarction following elective percutaneous coronary intervention (Am J Cardiol. 2007) "In conclusion, statin therapy initiated at the time of elective percutaneous coronary intervention significantly reduces myocardial infarction."

The Role of Aspirin Resistance in the Treatment of Acute Coronary Syndromes. (Clin Cardiol. 2007)

Statins in elderly patients with acute coronary syndrome: an analysis of dose and class effects in typical practice. (Heart. 2007) "CONCLUSIONS: This analysis of elderly patients with ACS treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin treatment or significant differences among individual statins."

The emerging role of platelet glycoprotein IIb/IIIa inhibitors in managing high-risk patients with non-ST segment elevation acute coronary syndromes. (Curr Med Res Opin. 2007) "CONCLUSIONS: Recent and emerging evidence is clarifying the role of glycoprotein IIb/IIIa inhibitors in treating high-risk patients with NSTE ACS and indicates that these agents are of greatest benefit when given early."

Adjusted indirect meta-analysis of aspirin plus warfarin at international normalized ratios 2 to 3 versus aspirin plus clopidogrel after acute coronary syndromes. (Am J Cardiol. 2007) "In conclusion, after an acute coronary syndrome, A + W and A + C are comparable in the prevention of MAEs, death, and AMI compared with aspirin alone. Allocating 100 patients to A + W (at international normalized ratio 2 to 3) with respect to A + C could prevent 17 thromboembolic strokes while causing 3 major bleeds."

The Use of IIb/IIIa inhibitors in High Risk ACS Patients "Despite advances in the care of high-risk patients with ACS, existing therapies have considerable limitations, including a high risk of bleeding complications. Physicians need to be aware of these limitations and recognize the need to pursue alternative therapies including GP IIb/IIIa for their high-risk patients following ACS. The standard of care for patients with ACS is a polypharmacologic approach consisting of the early administration of thrombolytic agents, aspirin, thienopyridines, GP IIb/IIIa inhibitors, unfractionated heparin (UFH), and/or a low-molecular weight heparin (LMWH). Evidence favors an early invasive strategy combined with GP IIb/IIIa inhibitor use."

Practical regimen for amiodarone use in preventing postoperative atrial fibrillation. (Ann Thorac Surg. 2007) "BACKGROUND: Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing cardiac surgery. Although postoperative atrial fibrillation is often regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including permanent or transient stroke, acute myocardial infarction, and death."

Effects of platelet glycoprotein IIb/IIIa receptor blockers in non-ST segment elevation acute coronary syndromes: benefit and harm in different age subgroups (Heart 2007) "Conclusions: In patients with NSTE-ACS, the relative reduction of death or non-fatal myocardial infarction with platelet glycoprotein IIb/IIIa receptor blockers was independent of patient age. Larger absolute outcome reductions were seen in older patients, but with a higher risk of major bleeding. Close monitoring of these patients is warranted."

Statins in elderly acute coronary syndrome patients: an analysis of dose and class effects in typical practice. (Heart. 2007) "Conclusions Our analysis of elderly ACS patients treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin therapy or significant differences among individual statins."

Clinical use of clopidogrel in acute coronary syndrome. (Int J Clin Pract. 2007)

Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE). (Circulation. 2007) "CONCLUSIONS: Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies' differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterol-lowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy."

Intensive Statin Therapy in Acute Coronary Syndromes and Stable Coronary Heart Disease: A Comparative Meta-Analysis of Randomized Controlled Trials. (Heart. 2007) "Conclusions Compared to moderate statin therapy, intensive statin therapy reduces all-cause mortality in patients with recent ACS but not in patients with stable CHD."

[Acute myocardial infarction after discontinuing aspirin two years after implantation of a drug-eluting coronary stent.] (Dtsch Med Wochenschr. 2007) " CONCLUSION: Discontinuing antiplatelet therapy, even years after implantation of a drug-eluting coronary stent, increases the risk of a late stent thrombosis. This should be taken into account especially before any procedure, even with a low bleeding risk such as tooth extractions. Antiplatelet treatment should be continued, even if there is a risk increasing minor bleeding complications, so that any life-threatening complication of an acute myocardial infarction is avoided."

Exercise

Effect of aerobic vs combined aerobic-strength training on 1-year, post-cardiac rehabilitation outcomes in women after a cardiac event. (J Rehabil Med. 2007)

Effects of exercise training upon endothelial function in patients with cardiovascular disease. (Front Biosci. 2008) "Preservation of normal endothelial function depends on the bioavailability of nitric oxide (NO). In addition, accumulating evidence suggests that bone marrow-derived circulating progenitor cells (CPCs) are required to maintain the integrity of the vasculature. However, in patients with cardiovascular disease (CVD), the impairment of NO production in conjunction with excessive oxidative stress, results in a decline in NO bioavailability, promotes the loss of endothelial cells by apoptosis and, therefore, results in endothelial dysfunction. … At the molecular levels, accumulating evidence suggests that regular physical activity restores the balance between NO production and NO inactivation by ROS. Moreover, ET might have the potential to restore the regenerative capacity of CPCs in CVD."

Land versus water exercise in patients with coronary artery disease: effects on body composition, blood lipids, and physical fitness (American Heart Journal 2007)

Longterm Endurance Exercise decreases the Antiangiogenic Endostatin Signaling in adipose men aged between 50-60 years. (Br J Sports Med. 2007) "Endurance training may decrease the risk for coronary artery disease. It has been speculated that these effects may be due to an exercise-induced stimulation of angiogenesis. The underlying mechanisms are not yet clear. Therefore, we investigated the plasma concentration of the vascular endothelial growth factor (VEGF, angiogenic factor) and of endostatin (antiangiogenic factor) in a group of untrained men aged between 50-60 years with obesity using the ELISA technique."

Exercise training in systolic and diastolic dysfunction: effects on cardiac function, functional capacity, and quality of life. (Am Heart J. 2007) "BACKGROUND: Exercise training improves functional capacity in patients with systolic dysfunction (SD), but the role of exercise training in diastolic dysfunction (DD) is unclear. We compared the responses of patients with exercise intolerance and SD or DD to 16 weeks of exercise training. … CONCLUSIONS: In patients with exercise limitation attributed to DD, the improvement in peak VO2 and quality of life with exercise training is similar to those with SD, but unrelated to changes in diastolic function."

Effects of different intensities of acute exercise on flow-mediated dilatation in patients with coronary heart disease. (Int J Cardiol. 2007)

Physical activity and exercise performance predict long-term prognosis in middle-aged women surviving acute coronary syndrome. (J Intern Med. 2007) "CONCLUSION: In female patients <66 years surviving ACS, important independent predictors of long-term all-cause mortality were sedentary lifestyle, low physical fitness and inadequate pulse rate and SBP increase during exercise. Predictors of cardiovascular mortality were sedentary lifestyle and inadequate blood pressure response during exercise."

Effects of residential exercise training on heart rate recovery in coronary artery patients (Am J Physiol Heart Circ Physiol 2007) "This result confirms the positive effect induced by exercise training on HRR and extends the conclusions of previous studies to different modalities of exercise (i.e., cycle ergometer). HRR might provide an additional simple marker of the effectiveness of physical training programs in cardiac patients."

General Information

Confusion in Revascularization: Are Women Different and Why? (Cardiol Rev. 2008)

Traditional management of chronic stable angina. (Pharmacotherapy. 2007 )

Strokes after cardiac surgery: mostly right hemispheric ischemic with mild residual damage. (J Neurol. 2007) "CONCLUSION : Strokes after cardiac surgery are mostly right hemispheric and exclusively ischemic. Outcome is relatively fair. We suggest an embolic injury to the right hemisphere, procedure related, as a possible mechanism."

Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. (Cochrane Database Syst Rev. 2007)

Doctors Debate Drugs vs. Surgery for Angina "The results of a major trial, called the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE), seemed to indicate that drug therapy was preferable to angioplasty, since only drug therapy reduced patients' risk of heart attack and death. Those findings were published in March. But now, researchers taking a fresh look at the data say the opposite may true. They find that angioplasty is usually the best first line of defense against angina. Will that settle the issue? It's doubtful, experts say."

Improved Treatment of Hospitalized Coronary Artery Disease Patients With the Get With The Guidelines Program. (Crit Pathw Cardiol. 2007)

Current management of acute coronary syndromes in Australia: observations from the acute coronary syndromes prospective audit. (Intern Med J. 2007) "Conclusion: There appears to be an 'evidence-practice gap' in the management of ACS, but this is not matched by an increased risk of in-hospital clinical events. Objective evaluation of local clinical care is a key initial step in developing quality improvement initiatives and this study provides a basis for the improvement in ACS management in Australia."

Use of evidence-based medicine for acute coronary syndromes in the elderly and very elderly: Insights from the Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes trials. (Am Heart J. 2007)

Impact of Prior Peripheral Arterial Disease and Stroke on Outcomes of Acute Coronary Syndromes and Effect of Evidence-Based Therapies (from the Global Registry of Acute Coronary Events). (Am J Cardiol. 2007)

Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of 40% in the Multicenter Lifestyle Demonstration Project. (Eur J Heart Fail. 2007)

Evidence-based medical therapy of patients with acute coronary syndromes. (Am J Cardiovasc Drugs. 2007)

Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery (JAMA 2007) "Conclusion Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery."

Rehabilitation and guidance as reported by women and men who had undergone coronary bypass surgery. (J Clin Nurs. 2007) "Conclusions. A person undergoing rehabilitation needs special guidance from health care professionals, especially when his/her rehabilitation does not proceed optimally. The findings suggest that, especially, the guidance of women should be improved because women seemed to suffer from many problems during their process of rehabilitation, including loneliness, insecurity, uncertainty, fears, depression and anxiety."

Oral antiplatelet therapy for percutaneous coronary revascularization. (Catheter Cardiovasc Interv. 2007) "Today, dual or even triple antiplatelet therapy has become standard of care at the time of PCI followed by dual therapy long-term in the majority of patients. However, currently available oral regimens are hampered by limitations including the need to initiate treatment at least a few hours before the procedure to achieve maximum benefit and the safety issues surrounding irreversible platelet inhibition in the uncommon, but not rare situations when a patient requires surgical revascularization."

Cardiac rehabilitation in Germany. (Eur J Cardiovasc Prev Rehabil. 2007)

[Treatment and prognosis after acute coronary syndrome in an unselected patient population] (Ugeskr Laeger. 2007) "CONCLUSION: Age is an independent predictor of mortality after ACS, and the age of patients hospitalised with ACS has increased. The one-year mortality rate is close to one fourth. For younger patients, the mortality rate has decreased. Compared to randomised clinical trials, a considerable discrepancy in mortality was observed, predominantly due to the restricted patient selection in such studies and the concomitant lack of representation of daily-life patients."

Intensive smoking cessation helps heart patients "Even smokers who've already suffered serious heart problems can improve their outlook by quitting, researchers reported Monday. In a study of more than 200 smokers hospitalized for heart problems, investigators found that intensive smoking-cessation therapy not only helped patients kick the habit, but also lowered their risk of dying over the next 2 years. "

Treatment of carotid artery disease: stenting or surgery. (Curr Neurol Neurosci Rep. 2007)

Early Invasive Therapy or Conservative Management for Unstable Angina or NSTEMI?

Guidelines

NGC - National Heart Foundation of Australia physical activity recommendations for people with cardiovascular disease. (2006)

NGC - Guidelines for the management of acute coronary syndromes 2006. (2006)

SIGN - Management of stable angina (2007)

NGC - Management of stable angina. A national clinical guideline. (2007)

Immunotherapy

Internet Sites

Treatment Information

Anticoagulation Resource

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

The effect of a 12-week low glycaemic index diet on heart disease risk factors and 24 h glycaemic response in healthy middle-aged volunteers at risk of heart disease: a pilot study. (Eur J Clin Nutr. 2007) "Conclusions:This pilot study provides some evidence that consuming a low GI diet in addition to weight loss and healthy eating may reduce cardiovascular risk. Other potential benefits of GI might have been masked by weight loss in the low GI group."

Physical activity and exercise performance predict long-term prognosis in middle-aged women surviving acute coronary syndrome. (J Intern Med. 2007) "Conclusion. In female patients <66 years surviving ACS, important independent predictors of long-term all-cause mortality were sedentary lifestyle, low physical fitness and inadequate pulse rate and SBP increase during exercise. Predictors of cardiovascular mortality were sedentary lifestyle and inadequate blood pressure response during exercise."

Other

Other Treatments

Heart Procedure Reduces Need for Defibrillator Shocks: While study results are promising, they don't address benefits of drug therapy “Ablation is a technique of identifying and eliminating cardiac tissue that can generate the kind of abnormal rhythm that sets the heart beating irregularly, so that a defibrillator shock is needed to restore normal heart rhythm.”

Sustained Benefit of Cardiac Resynchronization Therapy. ( Cardiovasc Electrophysiol. 2007)

Experimental

Effect of Hyperoxia and Vitamin C on Coronary Blood Flow in Patients With Ischemic Heart Disease. (J Appl Physiol. 2007)

Radiotherapy

Supplements-Vitamins-CAM

Mayo researchers: complementary therapies help patients recover after heart surgery "A new Mayo Clinic study shows that massage therapy decreases pain levels for patients after heart surgery."

Effect of coenzyme Q10 administration on endothelial function and extracellular superoxide dismutase in patients with ischaemic heart disease: a double-blind, randomized controlled study. (Eur Heart J. 2007)

Use of dietary supplements among United States adults with coronary artery disease and atherosclerotic risks. (Am J Cardiol. 2007)

Surgery

Ten-Year Survival Similar for PCI and CABG in Patients Eligible for Either Therapy "Patients with significant disease of the left main coronary artery or triple-vessel disease with reduced left ventricular function are generally referred for CABG, whereas patients with most other forms of single-vessel coronary artery disease are referred for PCI. • The current systematic review suggests that overall survival is similar whether patients receive CABG or PCI. Although CABG was associated with a higher risk for stroke after the procedure, patients receiving PCI were more likely to experience angina and revascularization procedures."

An evaluation of octogenarians undergoing percutaneous coronary intervention from the Melbourne Interventional Group registry. (Catheter Cardiovasc Interv. 2007 ) "CONCLUSIONS:: Octogenarians comprise a significant cohort of patients undergoing PCI. Octogenarians have more comorbidities, and higher rates of mortality and MACE, mandating thorough clinical evaluation before acceptance for PCI."

Impact of anemia on nonfatal coronary events after percutaneous coronary interventions. (Heart Vessels. 2007)

[Epidemiology and new predictors of atrial fibrillation after coronary surgery] (ev Esp Cardiol. 2007 )

Results of percutaneous coronary interventions in patients >/=90 years of age. (Catheter Cardiovasc Interv. 2007)

Bedside estimation of risk from percutaneous coronary intervention: the new mayo clinic risk scores. (Mayo Clin Proc. 2007)

Long-term prognosis after coronary artery bypass surgery. (Int J Cardiol. 2007)

Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. (J Am Coll Cardiol. 2007)

Bone mineral loss seen in men after heart surgery "In the year following coronary artery bypass grafting (CABG), bone mineral content declines significantly in men, according to findings published in the American Journal of Cardiology. Declines in bone mineral have been shown to increase the risk of fracture."

Effectiveness of Glycoprotein IIb/IIIa Inhibitor Use During Primary Coronary Angioplasty: Results of Propensity Analysis Using the New York State Percutaneous Coronary Intervention Reporting System (The American Journal of Cardiology 2007) " In conclusion, adjunct GP IIb/IIIa inhibitor use during primary angioplasty is effective and associated with improved in-hospital survival rates."

Cognitive and Cardiac Outcomes 5 Years After Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery (JAMA. 2007)

GP IIb/IIIa blockers reduce mortality in primary PCI? "Results showed that overall, 78.5% of patients who underwent primary angioplasty received GP IIb/IIIa inhibitors. In-hospital mortality was significantly lower with GP IIb/IIIa use (3% vs 6.2%), and this reduction remained significant after adjustment for both propensity score and clinical characteristics."

Predictors of coronary bypass grafting in a population of middle-aged men. (Eur J Cardiovasc Prev Rehabil. 2007)

Predictors of cognitive function in candidates for coronary artery bypass graft surgery. (J Int Neuropsychol Soc. 2007) "Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery."

Discharge to home rates are significantly lower for octogenarians undergoing coronary artery bypass graft surgery. (nn Thorac Surg. 2007) " CONCLUSIONS: Although early outcomes in octogenarians are acceptable, these factors alone are not sufficient to reflect overall success of CABG in these patients, given the strikingly lower discharge to home rates. Attention to full functional recovery in octogenarians is essential."

Angioplasty

Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than 1300 patients. (Ann Thorac Surg. 2007) "CONCLUSIONS: MIDCAB can be safely performed with low postoperative mortality and morbidity. The excellent short-term and long-term survival as well as freedom from major adverse cardiac and cerebral events and angina compare favorably with stenting and conventional surgery."

Transplantation

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