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The spectrum of coronary artery disease and risk of myocardial infarction  

20 Dec, 14 | by Alistair Lindsay

Clinicians often dichotomize coronary artery disease (CAD) on the basis of obstruction to blood flow given the implications of this threshold on considerations for revascularization. As a result, nonobstructive CAD is often characterized as less significant, although this may oversimplify the risks associated with nonobstructive disease. In this retrospective cohort of patients who underwent elective coronary angiography in the Veterans Affairs health care system, the authors evaluated the relationship between gradations of CAD burden and 1-year outcomes of non-fatal myocardial infarction (MI) and mortality. CAD burden was defined by both thresholds for no CAD, nonobstructive CAD, and obstructive CAD as well as the number of vessels involved (1-vessel, 2-vessel, or 3-vessel/left main). Among 37,674 patients who underwent elective angiography, 22.3% had non-obstructive CAD and 55.4% had obstructive CAD. more…

Kidney stones linked with modest increased risk of coronary disease

14 Aug, 13 | by Alistair Lindsay

Nephrolithiasis (kidney stones) is an increasingly common condition occurring more frequently in men than women;  over the last three decades the overall prevalence in the US population has risen to 8.8%.  Links between nephrolithiasis and other systemic diseases have been noted, including subclinical atherosclerosis, hypertension, diabetes, metabolic syndrome, and cardiovascular disease.  However, previous studies looking at the association between kidney stones and CHD have often not controlled for important risk factors and have shown inconsistent results. more…

Benefits of beta-blockade in stable coronary disease may be overestimated

8 Nov, 12 | by Alistair Lindsay

While the benefits of beta-blockade following myocardial infarction (MI) are well known, these benefits have been extrapolated to all patients with coronary artery disease (CAD), and even to high risk patients without coronary artery disease. However, beta-blockers also have a number of side effects and their tolerability is not ideal. Therefore, the objective of this study was to evaluate the differential association of beta-blocker use on long-term cardiovascular outcomes in patients with known prior MI, in patients with CAD without MI, and in patients with only risk factors for CAD. more…

CE-MARC shows strength of perfusion MRI

19 Feb, 12 | by Alistair Lindsay

In recent years it has become clear that treatment of coronary artery disease – and in particular percutaneous coronary intervention (PCI) – must be guided by imaging techniques that give some information on the extent of myocardial ischaemia.  While nuclear medicine techniques such as SPECT (single-photon emission computed tomography) have become widespread, and have a high negative predictive value, they still expose patients to ionising radiation.  Furthermore, the sensitivity of SPECT has been noted to vary.  Cardiac Magnetic Resonance Imaging (MRI), is a potential alternative that uses no ionising radiation, provides high-resolution images, and is capable of assessing various cardiac parameters in one comprehensive examination. more…

No benefit from screening asymptomatic type 2 diabetics for CAD

17 May, 09 | by Alistair Lindsay

Should patients with type 2 diabetes be screened for coronary artery disease if asymptomatic? In the DIAD study (Detection of Ischemia in Asymptomatic Diabetics), 1123 patients with type 2 diabetes and no symptoms of coronary artery disease (CAD) were randomly assigned to be screened with adenosine-stress myocardial perfusion imaging (MPI) or to no screening. The main outcome measure was the incidence of cardiac death or nonfatal myocardial infarction (MI) during long-term follow-up. more…

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