The Canadian journal of cardiology

Publisher: Pulsus


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    • All articles are available from PubMed Central and open access on publisher website 12 months after publication
    • Papers funded by CIHR are made open access 6 months after publication
    • Publisher last contacted on 10/12/2012
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Publications in this journal

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    ABSTRACT: Current guideline-based recommendations for dual oral antiplatelet therapy in acute coronary syndromes (ACS) include the use of newer ADP receptor inhibitor (ADPri) regimens and agents. The Canadian ACS Reflective Program is a multicenter, observational, quality enhancement project comparing utilization of ADPri therapy in two phases (November 2011-March 2013 and April 2013-November 2013) as well as to previous national data from the Canadian Global Registry of Acute Coronary Events (2000-2008). Of 3,099 ACS patients, 30.6% had ST-segment elevation myocardial infarction (STEMI), 52.3% non-STEMI, and 17% unstable angina. There was high use of dual antiplatelet therapy ≤24 hours, with important increases noted when compared to previous national experience (p for trend <0.0001). Clopidogrel was the most commonly used ADPri (82.2%), with lower use of the newer agents ticagrelor (9.0%) and prasugrel (3.1%). Ticagrelor and prasugrel use was most frequent in STEMI patients undergoing PCI (34.3%). There was relatively lower use of ADPri therapy at discharge, mainly in patients who did not undergo PCI (68.2%) and those with non-ST-elevation ACS (82%). When comparing the two consecutive phases of data collection in the ACS Reflective, there was an approximate 3- and 2-fold increase in the early and discharge use of the newer ADPri, respectively. In conclusion, there has been a temporal increase in ADPri use compared to previous national experience, and increased uptake of newer ADPri agents. Additional work is needed to identify and address barriers limiting optimal implementation of these newer guideline-recommended agents into routine Canadian practice.
    The Canadian journal of cardiology 12/2014;
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    ABSTRACT: There is a paucity of data that compare traditional vitamin K antagonist (VKA) with novel oral anticoagulant regimens in periprocedural management of cardioversion or ablation of atrial fibrillation (AF). We sought to compare outcomes of use of VKA, dabigatran (DABI), and rivaroxaban (RIVA) anticoagulation around the time of intervention. We studied consecutive patients undergoing cardioversion or ablation of AF at our centre from October 2010 to October 2013. There were 3 different anticoagulation groups: warfarin (VKA), DABI, and RIVA. Safety was assessed according to number of strokes, transient ischemic attacks (TIAs), and clinically important and not important bleeding events. Baseline characteristics were well balanced between the groups. Average follow-up was 6 months (± 4 months). A total of 901 patients who underwent cardioversion were studied (VKA [n = 471], DABI [n = 288] and RIVA [n = 141]). In these patients there were no strokes seen during follow-up and 2 TIAs in the DABI group. Bleeding rates were low, with no significant difference between the 3 groups. A total of 680 patients who underwent ablation were studied (VKA [n = 319], DABI [n = 220] and RIVA [n = 171]). There were no strokes reported during follow-up and 3 TIAs: 2 in the VKA group and 1 in the DABI group not resulting in a significant difference between the groups. Bleeding rates were low, with no significant difference between the groups. Overall, there was a low incidence of adverse events for all anticoagulation regimens. Warfarin, DABI, and RIVA use around the time of the procedure are safe and reasonable options for patients who undergo cardioversion or AF ablation. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1541-6.
  • The Canadian journal of cardiology 12/2014; 30(12):1733.e3.
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    ABSTRACT: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March 2014. The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs (P = 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P = 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P = 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications. Published by Elsevier Inc.
    The Canadian journal of cardiology 12/2014; 30(12):1588-94.
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    ABSTRACT: The HeartWare left ventricular assist device (HVAD; HeartWare Inc, Framingham, MA) was first implanted in Canada in 2010. We performed a multicentre analysis of the real world outcomes associated with its use. Between May 2010 and January 2013, 4 Canadian centres inserted a total of 72 HVADs in 71 patients. Data were collected prospectively and analyzed retrospectively for the 1-year estimate of the principal outcome of transplant, explant for recovery, or death in patients who had a bridge to transplantation indication. Adverse event rates were estimated as events per patient-year (PPY). In the 67 patients who received the HVAD with the indication of bridge to transplant, 26 (38.8%) received a successful transplant, 2 (3%) received an explant for recovery, and 10 (14.9%) patients died during support. Median follow-up time with the HVAD was 6.9 months (range, 2 days to 30.4 months). Despite having 74% of the patients with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scores of level 1 and 2 at the time of implantation, the rate estimate for survival at 1 year was 86.3% (95% confidence interval, 76.7-93.3). With 48.2 total patient years of support, the rates of ischemic and hemorrhagic strokes were 0.21 and 0.19 events PPY, respectively. Women made up 40% of the cohort and an adverse neurologic event occurred with an event rate of 0.38 PPY in women. The HVAD adequately supports acutely ill heart failure patients until the time of transplant or recovery. A high incidence of adverse neurologic outcomes might be related to the large percentage of female patients, the high INTERMACS levels, or unknown factors; further surveillance is required. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1662-7.
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    ABSTRACT: This position statement addresses issues in revascularization for multivessel coronary artery disease (CAD) from the perspective of both cardiologists and cardiac surgeons. Recommendations are made based on evidence from clinical trials and observational studies, with an emphasis on the increasing number of individuals with significant comorbid disease burden and functional debilitation who are being referred for definitive management of their multivessel CAD in the context of routine clinical practice. These types of individuals have traditionally not been included in the many clinical trials that have been the basis for guidelines and recommendations, and the objective of the proposed medical intervention or revascularization (or both) would not necessarily be to improve prognosis but to improve quality of life. One purpose of this document is to propose practical multidisciplinary approaches to the management of these patients. Recommendations are made for revascularization in acute coronary syndromes and stable CAD, with specific considerations for individuals with left ventricular dysfunction and heart failure, chronic renal failure, and chronic obstructive pulmonary disease. We also consider the use of various risk scores, including the Society of Thoracic Surgeons score, the EuroSCORE, and the SYNTAX II score. The importance of a heart team approach is also emphasized. The complementary role of coronary bypass surgery and percutaneous coronary intervention is highlighted, along with the importance of optimal medical therapy. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1482-91.
  • The Canadian journal of cardiology 12/2014;
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    ABSTRACT: We tested whether loss of eukaryotic elongation factor 2 kinase (eEF2K) activity in macrophages suppresses development of atherosclerosis by transplanting bone marrow from mice with mutant eEF2K into ldlr(-/-) mice. Sixteen weeks after high-fat diet feeding, mutant eEF2K hematopoietic chimeras had a dramatically reduced level of atherosclerotic plaque formation. M1-skewed macrophages from eEF2K knock-in mice have less tumour necrosis factor-α release and a lesser ability to induce expression of endothelial cell markers, providing a potential explanation for the role of eEF2K. Because eEF2K activity in cells of the hematopoietic compartment contributes to atherosclerosis development, drugs inhibiting eEF2K might have a beneficial effect in treatment of atherosclerosis. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1684-8.
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    ABSTRACT: We aimed to assess whether chronic obstructive pulmonary disease (COPD) is associated with expansion of the myocardial extracellular volume (ECV) using T1 measurements. Adult COPD patients Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 2 or higher and free of known cardiovascular disease were recruited. All study patients underwent measures of pulmonary function, 6-minute walk test, serum measures of inflammation, overnight polysomnography, and a contrast cardiac magnetic resonance study. Eight patients with COPD were compared with 8 healthy control subjects. The mean predicted forced expiratory volume at 1 second of COPD subjects was 68%. Compared with control subjects, patients had normal left ventricular (LV) and right ventricular size, mass, and function. However, compared with control subjects, the LV remodelling index (median, 0.87; interquartile range [IQR], 0.71-1.14; vs median, 0.62; IQR, 0.60-0.77; P ¼ 0.03) and active left atrial emptying fraction was increased (median, 46; IQR, 41-49; vs median, 38; IQR, 33-43; P ¼ 0.005), and passive left atrial emptying fraction was reduced (median, 24; IQR, 20-30; vs median, 44; IQR, 31-51; P ¼ 0.007). The ECV was increased in patients with COPD (median, 0.32; IQR, 0.05; vs median, 0.27; IQR, 0.05; P = 0.001). The ECV showed a strong positive association with LV remodelling (r = 0.72; P = 0.04) and an inverse association with the 6-minute walk duration (r = -0.79; P = 0.02) and passive left atrial emptying fraction (r = -0.68; P = 0.003). Expansion of the ECV, suggestive of diffuse myocardial fibrosis, is present in COPD and is associated with LV remodelling, and reduced left atrial function and exercise capacity. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1668-75.
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    ABSTRACT: Transcatheter aortic valve replacement (TAVR) program experience and advances present opportunities to introduce minimalist clinical pathways. The purpose of this study was to determine the safety and feasibility of preprocedural individualized risk stratification for general anaesthesia and transesophageal echocardiography (GA/TEE) or awake TAVR and the postprocedural standard or rapid discharge TAVR clinical pathways. Standardized screening and multidisciplinary heart team consensus was used to evaluate individual periprocedural risk and requirements. Postprocedural clinical status and criteria guided the timing of discharge. We evaluated standardized TAVR outcomes and length of stay according to periprocedural practice and postprocedural trajectory. In 144 consecutive patients who underwent TAVR in 2013 (mean age, 82.0 ± 7.1 years; 38.2% women; mean Society of Thoracic Surgeons score, 6.5% ± 4.1%), 101 (69.1%) were assigned to the GA/TEE protocol, whereas 43 (29.9%) were assigned to the minimalist awake TAVR protocol. Irrespective of mode of anaesthesia, 94 (65.3%) patients were discharged within the standard time, whereas 50 (34.7%) patients were suitable for rapid discharge. Overall outcomes at 30 days were 2.1% mortality, 1.4% stroke, and 2.1% life-threatening bleeding. Median length of stay was shortest in the awake TAVR group (2 days; interquartile range [IQR], 1-3 days) and rapid discharge group (2 days; IQR, 1-2 days) and longer in the GA/TEE and standard discharge (3 days, IQR, 3-4 days) groups. Excellent outcomes and decreased length of stay can be achieved with individualized risk stratification to select the optimal periprocedural practice and determine the timing of discharge. These findings should be further evaluated in a large long-term clinical study. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1583-7.
  • The Canadian journal of cardiology 12/2014; 30(12):1496-7.
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    ABSTRACT: In current literature the association between statin use and cataracts is inconsistent and controversial. We sought to further examine the effect of statin use on the risk of cataract and need for surgical intervention in 2 North American populations. This retrospective nested case-control study derived data from the British Columbia (BC) Ministry of Health databases from 2000-2007 and the IMS LifeLink database from 2001-2011 to form 2 patient cohorts. The BC cohort was comprised of female and male patients; 162,501 patients were matched with 650,004 control subjects. The IMS LifeLink cohort was comprised of male patients aged 40-85 years; 45,065 patients were matched with 450,650 control subjects. Patients with statin use for > 1 year before the initial ophthalmology visit were identified. Diagnosis and surgical management of cataract were followed. Conditional logistic regression models were used to analyze data. For the BC cohort, the crude rate ratio (RR) for use of any statin was 1.30, and the adjusted RR was 1.27 (95% confidence interval, 1.24-1.30). The adjusted RRs for each individual statin were all statistically significant. For the IMS LifeLink cohort, the crude RR for use of any statin was 1.13, and the adjusted RR was 1.07 (95% confidence interval, 1.04-1.10). This study demonstrates that statin use is significantly associated with cataract requiring surgical intervention. This relationship was consistent in both North American cohorts. Further assessment of this relationship is recommended, especially because of increased statin use and the importance of acceptable vision in old age when cardiovascular disease is common. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1613-9.
  • The Canadian journal of cardiology 12/2014; 30(12):1508-10.
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    ABSTRACT: Calcific aortic valve disease affects 10%-15% of the elderly population, causing considerable morbidity and mortality. There is no imaging technique that allows for the assessment of tissue composition of the valve in vivo. We thus investigated whether multiparametric magnetic resonance imaging (MRI) could characterize and quantify lipid, fibrous, and mineralized tissues within aortic valve (AV) cusps. AV leaflets were explanted from patients with severe aortic stenosis at the time of valve replacement surgery. Aortic cusps were imaged ex vivo using 1.5T MRI using 3 gradient-echo sequences with T1, moderate T2, and proton density weightings (T1w, T2w, and PDw). Histopathologic analysis was performed on coregistered slices to identify and measure mineralized tissue, fibrous tissue, and lipid-rich tissue. Area and mean grey values were measured in all 3 weightings by standardized software. Four hundred ninety-two regions of interest from 30 AV leaflets were studied. Total leaflet surface and the areas of mineralized (P < 0.0001), fibrous (P = 0.002), and lipid-rich (P = 0.0001) tissues measured by MRI matched closely those measured by histopathologic examination. All 3 weightings provided significant discrimination between median grey values for mineralized, fibrous, and lipid-rich tissues (P < 0.0001 for T1w, moderate T2w, and PDw). A best-fit equation integrating the grey value data from all 3 weightings allowed multiparametric MRI to identify valve leaflet components with areas under the receiver operating characteristic curve of 0.92, 0.81, and 0.72, respectively. AV leaflet characteristics, including tissue composition, distribution, and area, may be successfully measured by multiparametric MRI with good to excellent accuracy. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1676-83.
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    ABSTRACT: Serotonin has been implicated in the development of idiopathic pulmonary arterial hypertension (IPAH). Drugs modulating serotonin pathways, including antidepressants, have been associated with the incidence of IPAH, with conflicting reports as to the direction of the effect. We aimed to determine whether antidepressant exposure is associated with the incidence of IPAH. A nested case-control study was conducted using the United Kingdom Clinical Practice Research Datalink and the Hospital Episodes Statistics repository between January 1, 1988 and September 30, 2011. Incident cases of IPAH were identified and matched to all controls in the case's risk set on age, sex, general practice, and date of registration with the practice. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated for the use of antidepressants on the risk of IPAH, with an 18-month lag period before the diagnosis. One hundred ninety-five IPAH cases were identified (incidence 3.84/million per year). Use of any antidepressant was associated with a 67% increased risk of IPAH (RR, 1.67; 95% CI, 1.17-2.37). The rate of IPAH was similar across antidepressant classes, whether with selective serotonin reuptake inhibitors (SSRIs) (RR, 1.67; 95% CI, 1.09-2.57) or non-SSRI antidepressants (RR, 1.66; 95% CI, 1.07-2.59). In sensitivity and exploratory analyses, no change in risk was observed with different lag times, serotonin transporter affinities, or durations of exposure. The use of antidepressants was associated with a significantly increased risk of IPAH. However, the consistency of this risk across all antidepressants and absence of a dose-response relationship suggests a noncausal association. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1633-9.
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    ABSTRACT: Dilated cardiomyopathy (DCM) is a major cause of heart failure that may require heart transplantation. Approximately one third of DCM cases are familial. Next-generation DNA sequencing of large panels of candidate genes (ie, targeted sequencing) or of the whole exome can rapidly and economically identify pathogenic mutations in familial DCM. We recruited 64 individuals from 26 DCM families followed at the Montreal Heart Institute Cardiovascular Genetic Center and sequenced the whole exome of 44 patients and 2 controls. Both affected and unaffected family members underwent genotyping for segregation analysis. We found 2 truncating mutations in BAG3 in 4 DCM families (15%) and confirmed segregation with disease status by linkage (log of the odds [LOD] score = 3.8). BAG3 nonsense mutations conferred a worse prognosis as evidenced by a younger age of clinical onset (37 vs 48 years for carriers and noncarriers respectively; P = 0.037). We also found truncating mutations in TTN in 5 families (19%). Finally, we identified potential pathogenic mutations for 9 DCM families in 6 candidate genes (DSP, LMNA, MYH7, MYPN, RBM20, and TNNT2). We still need to confirm several of these mutations by segregation analysis. Screening an extended panel of 41 candidate genes allowed us to identify probable pathogenic mutations in 69% of families with DCM in our cohort of mostly French-Canadian patients. We confirmed the prevalence of TTN nonsense mutations in DCM. Furthermore, to our knowledge, we are the first to present an association between nonsense mutations in BAG3 and early-onset DCM. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1655-61.
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    ABSTRACT: A right aortic arch with a retroesophageal brachiocephalic artery is a very rare type of vascular ring. We present a case report along with a review of published cases to date. Twelve publications from 1968-2014 describe a retroesophageal brachiocephalic artery in a total of 13 patients. The mean age at diagnosis was 8.7 ± 16 years. Four of the 13 patients were boys. Nearly half of the patients were symptomatic, with dysphagia or respiratory difficulties. Ten patients (77%) had associated congenital heart defects. Of the 13 patients with retroesophageal brachiocephalic artery, 12 had a right aortic arch, and only 1 had a left aortic arch associated with complex congenital heart disease. Investigations used in the diagnosis of the vascular ring include angiography, esophagography, echocardiography, and computed tomography. Only 2 patients had the diagnosis confirmed with magnetic resonance imaging (MRI), but this was in the setting of complex congenital heart disease. In conclusion, a right aortic arch with a retroesophageal left brachiocephalic artery is an extremely rare form of vascular ring and is often seen in association with other forms of congenital heart disease. Cardiac MRI can be used as a primary diagnostic modality for both the assessment of the vascular ring anatomy and the hemodynamics of associated cardiac malformations in the preoperative setting. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1716-1720.
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    ABSTRACT: Recent evidence suggests that an elevated plasma trimethylamine N-oxide (TMAO) level is associated with an increased risk of adverse cardiovascular events in humans; however, the mechanism is not clear. The aims of this study were to establish the plasma TMAO level in rats and to evaluate the effect of TMAO on arterial blood pressure (BP) and the hemodynamic effects of angiotensin II (Ang II). Twelve-week-old, Sprague-Dawley rats were implanted with telemetric transmitters, and continuous recordings of heart rate, systolic BP (SBP), and diastolic BP (DBP) were made for 7 days before and 14 days during osmotic minipump-driven subcutaneous infusion of saline (controls), TMAO, low-dose Ang II, or Ang II + TMAO. Plasma TMAO concentration was evaluated using liquid chromatography coupled with triple-quadrupole mass spectrometry. The plasma TMAO concentration in controls was 0.57 μmol/L, whereas in TMAO-infused rats it was 58 μmol/L. Neither saline nor TMAO infusion affected SBP and DBP. Infusion of Ang II significantly increased SBP and DBP for the first 5 days of infusion only. In contrast, infusion of Ang II + TMAO produced a hypertensive response that lasted until the end of the experiment. TMAO infusions did not affect body weight and motor activity. We showed that physiological plasma TMAO concentration in rats was approximately 10 times lower than that reported in humans. Furthermore, the new finding of the study is that TMAO does not affect BP in normotensive animals. However, it prolongs the hypertensive effect of Ang II. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1700-5.
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    ABSTRACT: Carotid intima-media thickness (CIMT) is associated with an increased risk of cardiovascular disease. We studied whether CIMT predicts the prognosis of Asian patients with acute ST-elevation myocardial infarction (STEMI). A total of 345 patients with STEMI (men, 82.9%; age, 59 ± 13 years) treated with emergent revascularization were prospectively investigated. In all patients, common CIMT was measured with high-resolution ultrasonography. The patients were followed for a median period of 583 days, and the primary end point was major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, heart failure, nonfatal recurrent MI, revascularization, and stroke. Mean CIMT of the patients with STEMI was 0.77 ± 0.14 mm. Of the total patients, 20.6% had carotid plaque and 11.0% experienced MACE. Killip class, left ventricular (LV) function, and carotid plaque were associated with 30-day MACE, whereas CIMT and carotid plaque were related to overall MACE. After adjusting for age, the event rate was 19.0% in the third-tertile CIMT (≥ 0.83 mm) group, 12.1% in the second-tertile (0.70-0.82 mm) group, and 4.3% in the first-tertile (≤ 0.69 mm) group (P = 0.01). Carotid plaque was independently associated with a higher incidence of MACE (adjusted odds ratio [OR], 3.7; 95% confidence interval [CI], 1.327-10.234; P = 0.012). Area under the receiver operating characteristic (ROC) curve for CIMT tertile (0.69 ± 0.05) was significantly larger compared with those for door-to-balloon time (0.55 ± 0.05), LV ejection fraction (LVEF) (0.49 ± 0.05), and Killip class (0.48 ± 0.05) (P < 0.001). CIMT was a useful prognosticator to predict future cardiovascular events (CVEs) in Asian patients with STEMI. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1620-6.
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    ABSTRACT: Background Transfer patterns, procedure rates, and outcomes of Non-ST-segment Elevation Myocardial Infarction (NSTEMI) patients presenting to Canadian community hospitals are not well understood. Methods We documented all patients admitted to British Columbia (BC) hospitals with a primary diagnosis of NSTEMI between 2007 and 2008. Patients were divided by admitting hospital type into tertiary care hospitals, non-remote community hospitals, and remote community hospitals. The aims were to compare transfer rates and time to transfer to a tertiary hospital and to compare procedure rates and outcomes within index admission, at 30 days and at 1 year. Results The mean transfer rates to a tertiary hospital were 72.6% for non-remote and 57.1% for remote community hospitals (p<0.001). Times to and rates of cardiac procedures differed significantly among these 3 hospital types. Admission to a non-remote or a remote community hospital was associated with similar 1-year mortality compared to admission to a tertiary care hospital (adjusted OR = 0.87, p = 0.26 for non-remote and adjusted OR = 1.19, p = 0.33 for remote). At 1 year, admission to a non-remote community hospital was associated with a lower composite outcome of death or re-admission for AMI (adjusted OR = 0.80, p = 0.04). Conclusions One year mortality rates are not different between NSTEMI patients admitted to BC community and tertiary care hospitals, however, the rate of re-admission for AMI or death is significantly less in non-remote community hospital patients. This should prompt the evaluation of key outcomes in NSTEMI in other community hospital settings.
    The Canadian journal of cardiology 12/2014;