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Matthias Rief Sarah Feger Peter Martus Michael Laule Marc Dewey Eva Sch?nenberger 《PloS one》2015,10(9)
Objectives
To evaluate how well patients with coronary stents accept combined coronary computed tomography angiography (CTA) and myocardial CT perfusion (CTP) compared with conventional coronary angiography (CCA).Background
While combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined.Methods
A total of 90 patients with coronary stents prospectively underwent CTA/CTP (both with contrast agent, CTP with adenosine) and CCA as part of the CARS-320 study. In this group, an intraindividual comparison of patient acceptance of CTA, CTP, and CCA was performed.Results
CTP was experienced to be significantly more painful than CTA (p<0.001) and was associated with a higher frequency of dyspnea (p<0.001). Comparison of CTA/CTP with CCA revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377). Concern before CTA/CTP and CCA and overall satisfaction were likewise not significantly different (p = 0.097 and p = 0.123, respectively). Nevertheless, about two thirds (n = 60, 68%) preferred CTA/CTP to CCA (p<0.001). Moreover, patients felt less helpless during CTA/CTP than during CCA (p = 0.026). Lack of invasiveness and absence of pain were the most frequently mentioned advantages of CTA/CTP over CCA in our patient population.Conclusions
CCA and combined CTA/CTP are equally well accepted by patients; however, more patients prefer CTA/CTP. CTP was associated with more intense pain than CTA and more frequently caused dyspnea than CTA alone.Trial Registration
ClinicalTrials.gov NCT00967876 相似文献3.
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In a group of clinically normal male executives subjected to maximal treadmill stress testing, the occurrence of ischemic st segment responses was in all cases unaccompanied by pain, while in a clinically suspect group a large proportion of those having ischemic st segment responses did not have chest pain.While a significant number of persons have no subjective sensation of pain while having ischemic st segment changes on the electrocardiograph during or after maximal treadmill exercise, occasionally atypical pain may occur during or following exercise. Maximal treadmill stress testing is useful in discovering “silent” coronary artery disease. 相似文献
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Gitsios Gitsioudis Waldemar Hosch Johannes Iwan Andreas Voss Edem Atsiatorme Nina P. Hofmann Sebastian J. Buss Stefan Siebert Hans-Ulrich Kauczor Evangelos Giannitsis Hugo A. Katus Grigorios Korosoglou 《PloS one》2014,9(4)
Aims
To investigate the value of coronary calcium scoring (CCS) as a filter scan prior to coronary computed tomography angiography (CCTA).Methods and Results
Between February 2008 and April 2011, 732 consecutive patients underwent clinically indicated CCTA. During this ‘control phase’, CCS was performed in all patients. In patients with CCS≥800, CCTA was not performed. During a subsequent ‘CCTA phase’ (May 2011–May 2012) another 200 consecutive patients underwent CCTA, and CCS was performed only in patients with increased probability for severe calcification according to age, gender and atherogenic risk factors. In patients where CCS was not performed, calcium scoring was performed in contrast-enhanced CCTA images. Significant associations were noted between CCS and age (r = 0.30, p<0.001) and coronary risk factors (χ2 = 37.9; HR = 2.2; 95%CI = 1.7–2.9, p<0.001). Based on these associations, a ≤3% pre-test probability for CCS≥800 was observed for males <61 yrs. and females <79 yrs. According to these criteria, CCS was not performed in 106 of 200 (53%) patients during the ‘CCTA phase’, including 47 (42%) males and 59 (67%) females. This resulted in absolute radiation saving of ∼1 mSv in 75% of patients younger than 60 yrs. Of 106 patients where CCS was not performed, estimated calcium scoring was indeed <800 in 101 (95%) cases. Non-diagnostic image quality due to calcification was similar between the ‘control phase’ and the ‘CCTA’ group (0.25% versus 0.40%, p = NS).Conclusion
The value of CCS as a filter for identification of a high calcium score is limited in younger patients with intermediate risk profile. Omitting CCS in such patients can contribute to further dose reduction with cardiac CT studies. 相似文献7.
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Master has proposed a test for detection of latent coronary artery disease by means of electrocardiograms made after standard exercises consisting of walking back and forth over two steps. This test was used in routine examinations of airline employees, with the special purpose of evaluating the test for use on apparently normal persons.Of 526 males tested, 283 were under 40 years of age and 243 were aged 40 years or more. Coronary artery disease was indicated in 16 males in whom there was no other evidence of the disease, five of whom had hypertension. No electrocardiographic evidence of coronary artery disease was obtained for three males in whom the disease was diagnosed or was strongly suspected. The test gave nagative results for 16 males whose electrocardiograms made at rest were compatible with coronary artery disease. The percentage of positive results in men under 40 years of age was 4.3; in men over 40, 0.6.Of a control group of 60 women under the age of 35 years, in none of whom coronary artery disease was detected by other means, six had positive response to the test.It is concluded that Master''s criterion for the most common positive finding, a depression in the ST segment of over 0.5 mm., allows too many false positive findings and that a figure of 1.0 mm. to 1.5. mm. would be a better index. A negative finding apparently does not exclude the possibility of coronary artery disease or of coronary occlusion. The usual 12-lead electrocardiogram made at rest appeared to be of greater value in detection of latent coronary artery disease in apparently normal persons. 相似文献
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D. A. Tchoudakova L. O. Minushkina D. A. Zateyshchikov V. V. Nosikov 《Russian Journal of Genetics》2004,40(10):1159-1162
Patients with coronary artery disease (CAD), including those who have had myocardial infarction (MI), and control subjects have been compared with respect to the distributions of the alleles and genotypes of polymorphic marker G(–455)A of gene FGB encoding the fibrinogen -chain. The groups studied do not differ significantly with respect to the distributions of G(–455)A alleles and genotypes. This indicates that this marker is not associated with CAD in the Moscow population. Allele A of the G(–455)A polymorphic marker has been found to be associated with an increased fibrinogen content of blood plasma in women with CAD. 相似文献
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Thomas W. Johnson Andrew D. Mumford Lauren J. Scott Stuart Mundell Mark Butler Julian W. Strange Chris A. Rogers Barnaby C. Reeves Andreas Baumbach 《PloS one》2015,10(12)
Background
Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI) requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure (‘door-to-end’) time and baseline platelet activity on platelet inhibition within 24hours post-STEMI.Methods and Findings
108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE), bleeding and stent thrombosis (ST) were recorded. Baseline ADP activity was high (88.3U [71.8–109.0]), procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40–70] and infusion duration 30minutes [20–42]). Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U) was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%). Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention.Conclusions
Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity. 相似文献15.
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Wei-Chieh Lee Tzu-Hsien Tsai Yung-Lung Chen Cheng-Hsu Yang Shyh-Ming Chen Chien-Jen Chen Cheng-Jei Lin Cheng-I Cheng Chi-Ling Hang Chiung-Jen Wu Hon-Kan Yip 《PloS one》2014,9(10)
Background
This study evaluated the feasibility, safety, and prognostic outcome in patients with significant unprotected left main coronary artery (ULMCA) disease undergoing stenting.Method and Results
Between January 2010 and December 2012, totally 309 patients, including those with stable angina [13.9% (43/309)], unstable angina [59.2% (183/309)], acute non-ST-segment elevation myocardial infarction (NSTEMI) [24.3% (75/309)], and post-STEMI angina (i.e., onset of STEMI<7 days) [2.6% (8/309)] with significant ULMCA disease (>50%) undergoing stenting using transradial arterial approach, were consecutively enrolled. The patients’ mean age was 68.9±10.8 yrs. Incidences of advance congestive heart failure (CHF) (defined as ≥ NYHA Fc 3) and multi-vessel disease were 16.5% (51/309) and 80.6% (249/309), respectively. Mechanical supports, including IABP for critical patients (defined as LVEF <35%, advanced CHF, or hemodynamically unstable) and extra-corporeal membrane oxygenator (ECMO) for hemodynamically collapsed patients, were utilized in 17.2% (53/309) and 2.6% (8/409) patients, respectively. Stent implantation was successfully performed in all patients. Thirty-day mortality rate was 4.5% (14/309) [cardiac death: 2.9% (9/309) vs. non-cardiac death: 1.6% (5/309)] without significant difference among four groups [2.3% (1) vs. 2.7% (5) vs. 9.3% (7) vs. 12.5% (1), p = 0.071]. Multivariate analysis identified acute kidney injury (AKI) as the strongest independent predictor of 30-day mortality (p<0.0001), while body mass index (BMI) and white blood cell (WBC) count were independently predictive of 30-day mortality (p = 0.003 and 0.012, respectively).Conclusion
Catheter-based LM stenting demonstrated high rates of procedural success and excellent 30-day clinical outcomes. AKI, BMI, and WBC count were significantly and independently predictive of 30-day mortality. 相似文献18.
A “no refusal” coronary care service (for one year) was offered to a selected sample of 10 general practices (total list 74,657). The patients were admitted to a three-bedded unit in Doncaster Royal Infirmary and data were collected to enable estimation of the size of unit necessary to serve the whole population in the area (census estimate 268,560; total G.P. list 315,811). This estimation was based on:1. The frequency of admission to hospital of suspected acute myocardial infarction in one year, estimated at 978 from the total population.2. The average duration of stay in the unit, which was 2·45 days.3. The distribution of observed occupancy was approximately Poissonian.From these the average expected bed occupancy was calculated as 6·56 and reference to probability tables gave the frequency of overload for different numbers of beds provided. The incidence of acute myocardial infarction in the area is estimated at 275 per 100,000 per annum, on calculations based on the practice list size, and at 323 per 100,000 per annum, on calculations based on census figures. 相似文献
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Background
Newly formed platelets are associated with increased aggregation and adverse outcomes in patients with coronary artery disease (CAD). The mechanisms involved in the regulation of platelet turnover in patients with CAD are largely unknown.Aim
To investigate associations between platelet turnover parameters, thrombopoietin and markers of low-grade inflammation in patients with stable CAD. Furthermore, to explore the relationship between platelet turnover parameters and type 2 diabetes, prior myocardial infarction, smoking, age, gender and renal insufficiency.Methods
We studied 581 stable CAD patients. Platelet turnover parameters (immature platelet fraction, immature platelet count, mean platelet volume, platelet distribution width and platelet large cell-ratio) were determined using automated flow cytometry (Sysmex XE-2100). Furthermore, we measured thrombopoietin and evaluated low-grade inflammation by measurement of high-sensitive CRP and interleukin-6.Results
We found strong associations between the immature platelet fraction, immature platelet count, mean platelet volume, platelet distribution width and platelet large cell ratio (r = 0.61–0.99, p<0.0001). Thrombopoietin levels were inversely related to all of the platelet turnover parameters (r = −0.17–−0.25, p<0.0001). Moreover, thrombopoietin levels were significantly increased in patients with diabetes (p = 0.03) and in smokers (p = 0.003). Low-grade inflammation evaluated by high-sensitive CRP correlated significantly, yet weakly, with immature platelet count (r = 0.10, p = 0.03) and thrombopoietin (r = 0.16, p<0.001). Also interleukin-6 correlated with thrombopoietin (r = 0.10, p = 0.02).Conclusion
In stable CAD patients, thrombopoietin was inversely associated with platelet turnover parameters. Furthermore, thrombopoietin levels were increased in patients with diabetes and in smokers. However, low-grade inflammation did not seem to have a substantial impact on platelet turnover parameters. 相似文献20.