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Showing papers by "Kim A. Eagle published in 2008"


Journal ArticleDOI
TL;DR: Admission NLR is an independent predictor of in-hospital and 6-month mortality in patients with ACS and this relatively inexpensive marker of inflammation can aid in the risk stratification and prognosis of patients diagnosed with ACS.
Abstract: The neutrophil/lymphocyte ratio (NLR) has recently been described as a predictor of mortality in patients who undergo percutaneous coronary intervention. The aim of this study was to investigate the utility of admission NLRs in predicting outcomes in patients with acute coronary syndromes (ACS). A total of 2,833 patients admitted to the University of Michigan Health System with diagnoses of ACS from December 1998 to October 2004 were followed. Patients were divided into tertiles according to NLR. The primary end point was all-cause in-hospital and 6-month mortality. The ACS cohort comprised 564 patients with ST-segment elevation myocardial infarctions and 2,269 patients with non-ST-segment elevation ACS. Patients in tertile 3 had higher in-hospital (8.5% vs 1.8%) and 6-month (11.5% vs 2.5%) mortality compared with those in tertile 1 (p <0.001). After adjusting for Global Registry of Acute Coronary Events risk profile, patients in the highest tertile were at an exaggerated risk for in-hospital (odds ratio 2.04, p = 0.013) and 6-month (odds ratio 3.88, p <0.001) mortality. Admission NLR is an independent predictor of in-hospital and 6-month mortality in patients with ACS. This relatively inexpensive marker of inflammation can aid in the risk stratification and prognosis of patients diagnosed with ACS.

758 citations


Journal ArticleDOI
TL;DR: Advances in the epidemiology, presentation, pathogenesis, diagnosis, and management of acute aortic dissection are summarized.

445 citations


Journal ArticleDOI
07 May 2008-Heart
TL;DR: Women with ACS were more likely to have cardiovascular disease risk factors and atypical symptoms such as nausea compared with men, but were morelikely to have normal/mild angiographic coronary artery disease.
Abstract: Objective: To assess whether sex differences exist in the angiographic severity, management and outcomes of acute coronary syndromes (ACS). Methods: The study comprised 7638 women and 19 117 men with ACS who underwent coronary angiography and were included in GRACE (Global Registry of Acute Coronary Events) from 1999–2006. Normal vessels/mild disease was defined as Results: Women were older than men and had higher rates of cardiovascular risk factors. Men and women presented equally with chest pain; however, jaw pain and nausea were more frequent among women. Women were more likely to have normal/mild disease (12% vs 6%, p Conclusions: Women with ACS were more likely to have cardiovascular disease risk factors and atypical symptoms such as nausea compared with men, but were more likely to have normal/mild angiographic coronary artery disease. Further study regarding sex differences related to disease severity is warranted.

384 citations


Journal ArticleDOI
TL;DR: In the International Registry of Acute Aortic Dissection, the less invasive nature of endovascular treatment seems to provide better in-hospital survival in patients with acute type B dissection; larger randomized trials or comprehensive registries are needed to access impact on outcomes.
Abstract: Objectives Impact on survival of different treatment strategies was analyzed in 571 patients with acute type B aortic dissection enrolled from 1996 to 2005 in the International Registry of Acute Aortic Dissection. Background The optimal treatment for acute type B dissection is still a matter of debate. Methods Information on 290 clinical variables were compared, including demographics; medical history; clinical presentation; physical findings; imaging studies; details of medical, surgical, and endovascular management; in-hospital clinical events; and in-hospital mortality. Results Of the 571 patients with acute type B aortic dissection, 390 (68.3%) were treated medically, 59 (10.3%) with standard open surgery and 66 (11.6%) with an endovascular approach. Patients who underwent emergency endovascular or open surgery were younger (mean age 58.8 years, p l 0.001) than their counterparts treated conservatively, and had male preponderance and hypertension in 76.9%. Patients submitted to surgery presented with a wider aortic diameter than patients treated by interventional techniques or by medical therapy (5.36 ± 1.7 cm vs. 4.62 ± 1.4 cm vs. 4.47 ± 1.4 cm, p = 0.003). In-hospital complications occurred in 20% of patients subjected to endovascular technique and in 40% of patients after open surgical repair. In-hospital mortality was significantly higher after open surgery (33.9%) than after endovascular treatment (10.6%, p = 0.002). After propensity and multivariable adjustment, open surgical repair was associated with an independent increased risk of in-hospital mortality (odds ratio: 3.41, 95% confidence interval: 1.00 to 11.67, p = 0.05). Conclusions In the International Registry of Acute Aortic Dissection, the less invasive nature of endovascular treatment seems to provide better in-hospital survival in patients with acute type B dissection; larger randomized trials or comprehensive registries are needed to access impact on outcomes.

384 citations


Journal ArticleDOI
TL;DR: Although hospital mortality and delays to fibrinolytic reperfusions have improved, over 40% of patients reperfused still receive it outside the time window recommended, and one-third of potentially eligible patients receive no reperfusion.
Abstract: Aim Many patients who are eligible for acute reperfusion therapy receive it after substantial delays or not at all. We wanted to determine whether over the years more patients are receiving reperfusion therapy. Methods and results This analysis is based on 10 954 patients with ST elevation or left bundle-branch block presenting within 12 h of symptom onset and enrolled in the GRACE registry between April 1999 and June 2006. Over this time, there was an increasing trend in use of primary percutaneous coronary intervention (PCI) from 15% to 44% ( P 30 min and 42% of those undergoing primary PCI had door-to-balloon times >90 min. Conclusion Primary PCI is now used much more than fibrinolysis. Although hospital mortality and delays to fibrinolytic reperfusion have improved, over 40% of patients reperfused still receive it outside the time window recommended, and one-third of potentially eligible patients receive no reperfusion.

283 citations


Journal ArticleDOI
TL;DR: Examining the annual costs associated with vascular events and interventions that require hospitalization, as well as long-term medication use for the management of associated risk factors, in a US population of outpatients with multiple atherothrombotic risk factors or a history of symptomatic disease reveals the high economic burden of atherostrombosis-related clinical events and procedures and the especially highEconomic burden associated with polyvascular disease.
Abstract: Background— Atherothrombosis is the underlying cause of cardiovascular, cerebrovascular, and peripheral arterial disease and is the leading cause of death in the industrialized world. The objectives of the present study are (1) to examine the annual costs associated with vascular events and interventions that require hospitalization, as well as long-term medication use for the management of associated risk factors, in a US population of outpatients with multiple atherothrombotic risk factors or a history of symptomatic disease and (2) to compare costs across patient subgroups defined according to specific arterial bed(s) affected and the number of affected arterial beds. Methods and Results— The international REduction of Atherothrombosis for Continued Health (REACH) Registry enrolled outpatients ≥45 years of age who had established coronary artery, cerebrovascular, or peripheral artery disease or ≥3 atherothrombotic risk factors. Data on risk factors, associated medications, and vascular hospitalizations...

185 citations


Journal ArticleDOI
TL;DR: In this model of chronic type B aortic dissection, diastolic false lumen pressure was the highest in the setting of smaller proximal tear size and the lack of a distal tear, suggesting the determinants of inflow and outflow may impactfalse lumen expansion and rupture during the follow-up period.

177 citations


Journal ArticleDOI
TL;DR: The observation of increased late mortality with DES vs. BMS suggests that DES should probably be avoided in STEMI, until more long-term data become available.
Abstract: Aims To assess mortality after drug-eluting stent (DES) or bare-metal stent (BMS) for ST-segment elevation myocardial infarction (STEMI). Methods and results In this multinational registry, 5093 STEMI patients received a stent: 1313 (26%) a DES and 3780 (74%) only BMS. Groups differed in baseline characteristics, type, or timing of percutaneous coronary intervention, with a higher baseline risk for patients receiving BMS. Two-year follow-up was available in 55 and 60% of the eligible BMS and DES patients, respectively. Unadjusted mortality was lower during hospitalization, similar for the first 6 months after discharge, and higher from 6 months to 2 years, for DES patients compared with that of BMS patients. Overall, unadjusted 2-year mortality was 5.3 vs. 3.9% for BMS vs. DES patients ( P = 0.04). In propensity- and risk-adjusted survival analyses (Cox model), post-discharge mortality was not different up to 6 months ( P = 0.21) or 1 year ( P = 0.34). Late post-discharge mortality was higher in DES patients from 6 months to 2 years (HR 4.90, P = 0.01) or from 1 to 2 years (HR 7.06, P = 0.02). Similar results were observed when factoring in hospital mortality. Conclusion The observation of increased late mortality with DES vs. BMS suggests that DES should probably be avoided in STEMI, until more long-term data become available.

123 citations


Journal ArticleDOI
TL;DR: Circulating calponin levels were elevated in acute AD compared with controls, and these biomarkers have the potential for use as an early diagnostic biomarker for acute AD.
Abstract: Aims The early diagnosis of acute aortic dissection (AD) remains challenging. We sought to determine the utility of the troponin-like protein of smooth muscle, calponin, as a diagnostic biomarker of acute AD. Methods and results Immunoassays against calponin (acidic, basic, and neutral isoforms) were developed and the levels were compared in a convenience sample of 59 patients with radiographically proven AD [34 males, age 59 ± 15 (SD) years] vs. 158 patients suspected of having AD at presentation (116 males, age 63 ± 15 years) but whose final diagnosis was not AD. Basic calponin, which is the most specific and abundant in smooth muscle, and acidic calponin, respectively, showed greater than two-fold and three-fold elevations in patients with acute AD. Diagnostic performance as determined by receiver-operating characteristics curve analysis showed that both acidic and basic calponin have the potential to detect AD in the first 24 h [respective areas under the curve (AUCs) 0.63 and 0.58], with superior performance of basic calponin (when compared with acidic) in the initial 6 h (respective AUCs 0.63 and 0.67). Conclusion Circulating calponin levels were elevated in acute AD compared with controls. These biomarkers have the potential for use as an early diagnostic biomarker for acute AD.

86 citations


Journal ArticleDOI
TL;DR: Primary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health.
Abstract: Aims To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG). Methods and results Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline 75% risk factors at goal, respectively; P for trend 0.059). Conclusion Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health.

69 citations


Journal ArticleDOI
TL;DR: The training experience in clinical cardiology is fundamental to the development of the specialist in cardiovascular medicine and should provide a broad exposure to acute and chronic cardiovascular diseases, emphasizing accurate ambulance and bedside clinical diagnosis.

Journal ArticleDOI
TL;DR: Patient beliefs and attitudes regarding medications, along with other social, economic, and demographic factors, help explain differences in self-reported adherence to standard drug therapy following CABG.
Abstract: Background:The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, β-blockers. angio-tensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs ptay a role in adherence.Objective:To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG.Methods:Adults were surveyed 6–24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables).Results:Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and h...

Journal ArticleDOI
TL;DR: Geographic differences in presentation and initial management in type A acute aortic dissection in a large group of consecutive patients did not translate into a difference in early mortality.
Abstract: Although several studies have provided robust evidence about global differences for several cardiovascular emergencies, such as myocardial infarction and stroke, data were limited for aortic disease. The aim was to explore geographic variation in type A acute aortic dissection (TA-AAD) in a large group of consecutive patients. Patients (n = 615) from the IRAD with TA-AAD were studied with respect to presenting symptoms and signs, diagnosis, management, and outcomes in Europe versus North America. Compared with Europeans, North Americans were more likely to be older and present with atypical features and without many of the classic chest X-ray findings of AAD. In the North American cohort, electrocardiographic findings showed higher rates of nonspecific ST changes and a trend toward ST-elevation or new myocardial infarction (North Americans vs Europeans 7.9% vs 4.4%; p = 0.09). Use of imaging studies to confirm the diagnosis of AAD varied between North American and European centers. North American centers performed an average of 1.6 imaging studies compared with 1.8 in the European group (p = 0.002). Furthermore, they were significantly less likely to use computed tomography and significantly more likely to use transesophageal examination as part of the overall diagnostic algorithm. Compared with Europeans, TA-AAD occurred at smaller aortic diameters and there was a substantial delay to presentation and diagnosis in North Americans. No significant differences for early mortality rates were observed between the 2 groups. In conclusion, geographic differences in presentation and initial management were highlighted, but this did not translate into a difference in early mortality.

Journal ArticleDOI
18 Sep 2008-Heart
TL;DR: Very long delay in patients presenting with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS) is suboptimally managed with 43% not undergoing angiography, compared to conservative management.
Abstract: Objective: To test if delay-to-angiography (>72 hours from admission) in patients presenting with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS) is associated with adverse outcomes. Design: GRACE (Global Registry of Acute Coronary Events) is a multinational registry of patients admitted with NSTE-ACS. Setting: 14 countries with varying healthcare systems. Patients: 23 396 high-risk NSTE-ACS patients with complete initial data collection entered into GRACE between 1999 and 2006 were analysed. Interventions: Data were analysed according to delay-to-angiography and subsequent in-hospital or post-discharge adverse outcomes. Main outcome measures: Outcomes recorded included death, myocardial infarction, recurrent ischaemia, stroke, new heart failure and composite major adverse cardiovascular event (MACE) comprising death, cerebrovascular accident and myocardial infarction. Revascularisation procedures were recorded. Results: 10 089 (43.1%) had no in-hospital angiography. Median delay-to-angiography was 46 hours; 3680 (34%) patients waited >72 hours. 9.3% waited >7 days before angiography. Patients waiting longest were more often older, diabetic, women and had a history of heart failure, previous myocardial infarction or hypertension. Recurrent in-hospital ischaemia (33% vs 22%), reinfarction (8.4% vs 5.0%) and heart failure (14% vs 9.1%) were more common with delayed angiography. Delayed angiography was associated with better outcomes than no angiography (MACE 18.9% vs 22.2%, p = 0.015). MACE rates within six months of admission were higher with longer delay-to-angiography and highest of all with no angiography. Conclusions: High-risk NSTE-ACS is suboptimally managed with 43% not undergoing angiography. One-third of those undergoing angiography are delayed >72 hours. Longer delays were more likely with higher risk, sicker patients. These delays were associated with adverse outcomes at six months. Very long delay was associated with lower MACE, but not mortality, compared to conservative management.

Journal ArticleDOI
TL;DR: Although the glycemic efficacy of TZDs is comparable to that of metformin, ad verso effects and higher costs make TZD less appealing for initial therapy and pioglitazone should be considered based on cardiovascular safety data.
Abstract: Objective:To examine the cardiovascular effects of thiazolidinediones (TZDs), discuss concerns regarding this drug class and its relation to heart failure (HF) and myocardial infarction (Ml), and address the clinical implications of HF and Ml.Data Sources:Literature was accessed through MEDLINE (1979-April 2008) using the search terms type 2 diabetes mellitus. thiazolidinediones. cardiovascular events, heart failure, myocardial infarction, and edema. Reviews, meta-analyses, clinical trials, observational studies (case-control, cohort), and descriptive studies (case reports, caso series) were included.Study Selection and Data Extraction:All articles that were written in English and identified from the data sources were reviewed.Data Synthesis:The American Diabetes Association recommends metformin as first-line therapy for type 2 diabetes, with the subsequent addition of a TZD, sulfonylurea, or insulin if the target is not met. Beyond glucose lowering, TZDs improvo various factors associated with cardiovasc...

Journal ArticleDOI
TL;DR: Despite improved secondary prevention efforts, acute coronary syndrome (ACS) recurrence among patients with prior history of coronary events remains high and the differences in presentation, management, and subsequent clinical outcomes remain unexplored.
Abstract: Background: Despite improved secondary prevention efforts, acute coronary syndrome (ACS) recurrence among patients with prior history of coronary events remains high. The differences in presentation, management, and subsequent clinical outcomes in patients with and without a prior myocardial infarction (MI) and presenting with another episode of ACS remain unexplored. Methods: A total of 3,624 consecutive patients admitted to the University of Michigan with ACS from January 1999 to June 2006 were studied retrospectively. In-hospital management, outcomes, and postdischarge outcomes such as death, stroke, and reinfarction in patients with and without a prior MI were compared. Results: Patients with a prior MI were more likely to be older and have a higher incidence of diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease. In-hospital outcomes were not significantly different in the 2 groups, except for a higher incidence of cardiac arrest (4.3% versus 2.5%, p<0.01) and cardiogenic shock (5.7% versus 3.9%, p = 0.01) among patients without a prior MI. However, at 6 mo postdischarge, the incidences of death (8.0% versus 4.5%, p<0.0001) and recurrent MI (10.0% versus 5.1%, p<0.0001) were significantly higher in patients with a prior history of MI compared with those without. Conclusion: Patients with prior MI with recurrent ACS remain at a higher risk of major adverse events on follow-up. This may be partly explained by the patients not being on optimal medications at presentation, as well as disease progression. Increased efforts must be directed at prevention of recurrent ACS, as well as further risk stratification of these patients to improve their overall outcomes.

Journal ArticleDOI
TL;DR: The aorta is the largest artery in the body and carries the blood from the heart to the branch arteries that supply the rest of the body (including the head, arms, abdominal organs, and legs).
Abstract: The aorta is the largest artery in the body. It carries the blood from the heart to the branch arteries that supply the rest of the body (including the head, arms, abdominal organs, and legs). The aorta has the same dimensions as a garden hose and curves up from the heart before extending down to the waist. The aorta is identified by 3 major sections: the ascending aorta, the descending aorta, and the abdominal aorta, as shown in Figure 1. The aortic wall has 3 layers (listed here from inside to outside): the intima, media, and adventitia. These layers are made up of connective tissue and elastic fibers, which allow the aorta to stretch from pressure produced by the flow of blood. Abnormalities of the aortic wall may lead to enlargement of the aorta (aneurysm) and tearing (dissection) of the lining of the aorta.

Journal ArticleDOI
TL;DR: The results showed significant improvement in risk factors for early atherosclerosis among sixth-grade students including total cholesterol, LDL cholesterol, random glucose levels, and diastolic blood pressure.
Abstract: This prospective study aimed to measure the impact of a school-based multidisciplinary education program on risk factors for atherosclerosis in sixth-grade students. A prospective study was performed in which patients served as their own controls. Healthy sixth-grade students from three middle schools in a city of approximately 100,000 were exposed to an educational program promoting healthful habits through behavioral and environmental change. Risk factors including body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), cholesterol panel, and random blood glucose were measured before program initiation, then 5 months afterward. Of 711 sixth-graders at three middle schools, 287 (47% boys; mean age, 11.5 ± 0.37 years) consented to participate in the study. The mean total cholesterol value decreased from 169 ± 26 to 154 ± 26 mg/dl (p < 0.0001). The low-density lipoprotein (LDL) cholesterol value decreased from 86 ± 25 to 84 ± 23 mg/dl (p = 0.01), and the high-density lipoprotein (HDL) cholesterol value decreased from 56 ± 13 to 50 ± 13 mg/dl (p < 0.0001). The random glucose value decreased from 96 ± 13 to 93 ± 15 mm/dl (p = 0.01). The mean SBP did not change, showing 109 ± 12.5 mmHg before the program and 108 ± 11.5 mmHg afterward. The DBP decreased from 63.6 ± 8.6 to 62.3 ± 7.8 mmHg (p = 0.01). The Project Healthy Schools program is feasible and appears to be effective. The results showed significant improvement in risk factors for early atherosclerosis among sixth-grade students including total cholesterol, LDL cholesterol, random glucose levels, and diastolic blood pressure. Further study with a larger group and a longer follow-up period would be valuable.

Journal ArticleDOI
01 Feb 2008-Heart
TL;DR: GP IIb/IIIa inhibitors were markedly underused in the real-world population, irrespective of whether patients were trial-eligible or not and appeared to be no less than in eligible patients.
Abstract: Objective: To compare the characteristics, management, and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) who would have been eligible for inclusion in clinical trials of glycoprotein (GP) IIb/IIIa inhibitors with those of ineligible patients. Design: Multinational, prospective, observational study (GRACE, Global Registry of Acute Coronary Events). Setting: Patients hospitalised for a suspected acute coronary syndrome and enrolled in GRACE between April 1999 and December 2004. Patients: 29 039 patients with NSTE ACS. Main outcome measures: Characteristics and outcomes were compared for trial-eligible (75.0%) and trial-ineligible (25.0%) patients. Results: GP IIb/IIIa inhibitors were administered to 20.0% of eligible and 15.3% of ineligible patients. Compared with eligible patients, ineligible patients who received GP IIb/IIIa inhibitors had significantly higher rates of hospital death (6.8% vs 3.7%) and major bleeding (4.9% vs 2.2%). After adjustment for their higher baseline risk, ineligible patients still experienced higher hospital death rates (adjusted odds ratio (OR) 1.60; 95% confidence interval (CI) 1.01 to 2.39), but not higher bleeding rates, than the eligible group. Use of GP IIb/IIIa inhibitors was associated with a trend towards lower 6-month mortality in eligible (OR 0.86, 95% CI 0.72 to 1.02) and ineligible (OR 0.82, 95% CI 0.65 to 1.05) patients compared with those in whom this therapy was not used. Conclusions: GP IIb/IIIa inhibitors were markedly underused in the real-world population, irrespective of whether patients were trial-eligible or not. Despite the higher risk of ineligible patients, the benefits of GP IIb/IIIa inhibitors appear to be no less than in eligible patients.

Journal ArticleDOI
TL;DR: This study is a superb piece of epidemiological work showing the benefi t of a longstanding and trusting international collaboration that began during the severe acute respiratory syndrome epidemic and is the best chance of combating current and future threats to international health.

Journal ArticleDOI
TL;DR: The HEART group has developed a document that addresses general ethical principles in the conduct of the scientific process with which all of the editors concur as discussed by the authors, and this document presents the ethical tenets accepted by all the undersigned editors that will continue to guide their decisions in the editorial process.
Abstract: Over the past several years, the editors of leading international cardiovascular journals have met to form the HEART group and to discuss areas of growing, common interest. Recently, the HEART group has developed a document that addresses general ethical principles in the conduct of the scientific process with which all of the editors concur. Published essentially simultaneously in all of the participating journals, including this journal, this document presents the ethical tenets accepted by all of the undersigned editors that will (continue to) guide their decisions in the editorial process. These are the general principles on which the HEART Group is based and by which we, as a group, abide; however, please note that individual journal members and their respective societies may have their own rules and regulations that supersede the guidelines of the HEART Group.

Journal ArticleDOI
TL;DR: The temporary decline in statin persistence appeared to be associated with the withdrawal of cerivastatin, while persistence with the other study medications remained constant.
Abstract: Background:Medication-taking behavior is influenced by many factors, as described by the Health Belief Model. Information on withdrawals of drugs from the market may be an example of negative external stimuli that might influence patients' decisions to persist with long-term drug therapy.Objective:To evaluate the association between the withdrawal of cerivastatin from the market and persistence in taking all other statins in patients who recently experienced acute coronary syndrome (ACS).Methods:Patients from a large ACS registry who responded to questions about medication use during a postdischarge telephone survey between November 2000 and February 2002 were categorized into 3 groups: pre- (November 1, 2000–April 30, 2001), peri- (May 1, 2001–August 31.2001), and post- (September 1. 2001–February 28, 2002) cerivastatin withdrawal periods. Patients were considered persistent It, at the time of the survey, they continued to take study medication that had been prescribed at discharge. Persistence with angi...

Journal ArticleDOI
TL;DR: Enoxaparin is currently the only LMWH with FDA approval for use in STEMI patients and should be considered as a preferable alternative to UFH inSTEMI patients treated with fibrinolysis.
Abstract: Introduction Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI), but given logistics, many patients are still managed with thrombolytics. Unfractionated heparin (UFH) is recommended for routine use in STEMI patients treated with thrombolytics. However, other anticoagulants have been evaluated for use in STEMI patients treated with thrombolysis, including the low-molecular-weight heparins (LMWHs, enoxaparin, dalteparin, and reviparin), fondaparinux and bivalirudin.

Journal ArticleDOI
TL;DR: This document presents the ethical tenets accepted by all of the undersigned editors that will (continue to) guide their decisions in the editorial process.
Abstract: Over the past several years, the editors of leading international cardiovascular journals have met to form the HEART Group and to discuss areas of growing, common interest. Recently, the HEART Group has developed a document that addresses general ethical principles in the conduct of the scientific process with which all of the editors concur. Published essentially simultaneously in all of the participating journals, including this journal, this document presents the ethical tenets accepted by all of the undersigned editors that will (continue to) guide their decisions in the editorial process. These are the general principles on which the HEART Group is based and by which we, as a group, abide; however, please note that individual journal members and their respective societies may have their own rules and regulations that supersede the guidelines of the HEART Group. Acta Cardiologica Hugo Ector, MD, PhD Editor-in-Chief Patrizio Lancellotti, MD Editor-in-Chief American Journal of Cardiology William C. Roberts, MD Editor-in-Chief American Journal of Geriatric Cardiology Nanette K. Wenger, MD Editor-in-Chief Annals of Noninvasive Electrocardiology Arthur J. Moss, MD Editor-in-Chief Canadian Journal of Cardiology Eldon R. Smith, MD Editor-in-Chief Cardiology Jeffrey S. Borer, MD Editor-in-Chief Cardiosource Review Journal Kim A. Eagle, MD Editor-in-Chief Cardiovascular Drug Reviews Jane Freedman, MD Incoming Editor-in-Chief Henry Krum, PhD Incoming Editor-in-Chief Chim Lang, MD Incoming Editor-in-Chief Cardiovascular Drugs and Therapy Willem J. Remme, MD, PhD Editor-in-Chief Cardiovascular Research Hans Michael Piper, MD, PhD Editor-in-Chief Catheterization and Cardiovascular Interventions Christopher J. White, MD Editor-in-Chief Circulation Joseph Loscalzo, MD, PhD Editor-in-Chief Circulation Research Eduardo Marban, MD, PhD Editor-in-Chief Coronary Artery Disease Burton E. Sobel, MD Editor Current Opinion in Cardiology Robert Roberts, MD Editor Current Problems in Cardiology Shahbudin H. Rahimtoola, MD Editor Europace A. John Camm, MD Editor-in-Chief European Heart Journal Frans Van de Werf, MD Editor-in-Chief European Journal of Heart Failure Karl Swedberg, MD, PhD Editor-in-Chief Heart Adam D. Timmis, MD Editor Heart & Lung: The Journal of Acute and Critical Care Kathleen S. Stone, PhD, RN Editor-in-Chief Heart Rhythm Douglas P. Zipes, MD Editor-in-Chief International Journal of Interventional Cardioangiology David G. Iosseliani, MD Editor-in-Chief Journal of Cardiovascular Computed Tomography Allen J. Taylor, MD Editor-in-Chief Journal of Cardiovascular Pharmacology Michael R. Rosen, MD Editor Journal of Interventional Cardiology Cindy L. Grines, MD Editor-in-Chief Journal of the American College of Cardiology Anthony N. DeMaria, MD Editor-in-Chief JACC: Cardiovascular Imaging Jagat Narula, MD, PhD Editor-in-Chief JACC: Cardiovascular Interventions Spencer B. King III, MD Editor-in-Chief Journal of Electrocardiology Galen S. Wagner, MD Editor-in-Chief Journal of Interventional Cardiac Electrophysiology Sanjeev Saksena, MD Editor-in-Chief Journal of the American Society of Echocardiography Alan S. Pearlman, MD Editor-in-Chief Journal of Heart Valve Disease Endre Bodnar, MD, PhD Editor-in-Chief Robert W. Emery, MD Incoming Editor-in-Chief Journal of Thoracic and Cardiovascular Surgery Lawrence H. Cohn, MD Editor-in-Chief Netherlands Heart Journal Ernst E. van der Wall, MD Editor-in-Chief Pediatric Cardiology Ra-id Abdulla, MD Editor-in-Chief Progress in Cardiovascular Diseases Michael Lesch, MD Editor Revista Espanola de Cadiologia Fernando Alfonso, MD, PhD Editor-in-Chief Scandinavian Cardiovascular Journal Rolf Ekroth, MD Chief Editor

Journal ArticleDOI
TL;DR: Design OPTIMIZE-HF is a large hospital-based scheme comprising an internet registry of patients with HF, and participating hospitals were provided with a process of care intervention (PrCI) ‘toolkit’ that included discharge checklists and best-practice algorithms.
Abstract: DESIGN OPTIMIZE-HF is a large hospital-based scheme comprising an internet registry of patients with HF. Enrollment took place between 1 March 2003 and 31 December 2004. Patients were eligible for inclusion if they were admitted to one of 259 participating hospitals in the US with new onset or worsening HF, or if symptoms of HF developed during hospital admission for another condition. Data on adherence to four core JCAHO (Joint Commission on Accreditation of Healthcare Organizations) quality of care measures were included in the database. Participating hospitals were provided with a process of care intervention (PrCI) ‘toolkit’ that included discharge checklists and best-practice algorithms.

Journal Article
TL;DR: A Statement on Ethics From the HEART Group has developed a document that addresses general ethical principles in the conduct of the scientific process with which all of the editors concur.
Abstract: Over the past several years, the editors of leading international cardiovascular journals have met to form the HEART Group and to discuss areas of growing, common interest. Recently, the HEART Group has developed a document that addresses general ethical principles in the conduct of the scientific process with which all of the editors concur. Published essentially simultaneously in all of the participating journals, including this journal, this document presents the ethical tenets accepted by all of the undersigned editors that will (continue to) guide their decisions in the editorial process. These are the general principles on which the HEART Group is based and by which we, as a group, abide; however, please note that individual journal members and their respective societies may have their own rules and regulations that supersede the guidelines of the HEART Group. Acta Cardiologica Hugo Ector, MD, PhD Editor-in-Chief Patrizio Lancellotti, MD Editor-in-Chief American Journal of Cardiology William C. Roberts, MD Editor-in-Chief American Journal of Geriatric Cardiology Nanette K. Wenger, MD Editor-in-Chief Annals of Noninvasive Electrocardiology Arthur J. Moss, MD Editor-in-Chief Canadian Journal of Cardiology Eldon R. Smith, MD Editor-in-Chief Cardiology Jeffrey S. Borer, MD Editor-in-Chief Cardiosource Review Journal Kim A. Eagle, MD Editor-in-Chief Cardiovascular Drug Reviews Jane Freedman, MD Incoming Editor-in-Chief Henry Krum, PhD Incoming Editor-in-Chief Chim Lang, MD Incoming Editor-in-Chief Cardiovascular Drugs and Therapy Willem J. Remme, MD, PhD Editor-in-Chief Cardiovascular Research Hans Michael Piper, MD, PhD Editor-in-Chief Catheterization and Cardiovascular Interventions Christopher J. White, MD Editor-in-Chief Circulation Joseph Loscalzo, MD, PhD Editor-in-Chief Circulation Research Eduardo Marban, MD, PhD Editor-in-Chief Coronary Artery Disease Burton E. Sobel, MD Editor Current Opinion in Cardiology Robert Roberts, MD Editor Current Problems in Cardiology Shahbudin H. Rahimtoola, MD Editor Europace A. John Camm, MD Editor-in-Chief European Heart Journal Frans Van de Werf, MD Editor-in-Chief European Journal of Heart Failure Karl Swedberg, MD, PhD Editor-in-Chief Heart Adam D. Timmis, MD Editor Heart & Lung: The Journal of Acute and Critical Care Kathleen S. Stone, PhD, RN Editor-in-Chief Heart Rhythm Douglas P. Zipes, MD Editor-in-Chief International Journal of Interventional Cardioangiology David G. Iosseliani, MD Editor-in-Chief Journal of Cardiovascular Computed Tomography Allen J. Taylor, MD Editor-in-Chief Journal of Cardiovascular Pharmacology Michael R. Rosen, MD Editor Journal of Interventional Cardiology Cindy L. Grines, MD Editor-in-Chief Journal of the American College of Cardiology Anthony N. DeMaria, MD Editor-in-Chief JACC: Cardiovascular Imaging Jagat Narula, MD, PhD Editor-in-Chief JACC: Cardiovascular Interventions Spencer B. King III, MD Editor-in-Chief Journal of Electrocardiology Galen S. Wagner, MD Editor-in-Chief Journal of Interventional Cardiac Electrophysiology Sanjeev Saksena, MD Editor-in-Chief Journal of the American Society of Echocardiography Alan S. Pearlman, MD Editor-in-Chief Journal of Heart Valve Disease Endre Bodnar, MD, PhD Editor-in-Chief Robert W. Emery, MD Incoming Editor-in-Chief Journal of Thoracic and Cardiovascular Surgery Lawrence H. Cohn, MD Editor-in-Chief Netherlands Heart Journal Ernst E. van der Wall, MD Editor-in-Chief Pediatric Cardiology Ra-id Abdulla, MD Editor-in-Chief Progress in Cardiovascular Diseases Michael Lesch, MD Editor Revista Espanola de Cadiologia Fernando Alfonso, MD, PhD Editor-in-Chief Scandinavian Cardiovascular Journal Rolf Ekroth, MD Chief Editor