المؤلفون: Hlatky, Mark A., Rogers, William J., Johnstone, Iain, Boothroyd, Derek, Brooks, Maria Mori, Pitt, Bertram, Reeder, Guy, Ryan, Thomas, Smith, Hugh, Whitlow, Patrick, Wiens, Robert, Mark, Daniel B., Rosen, Allan D., Detre, Katherine, Frye, Robert L.

المصدر: New England Journal of Medicine. 1/9/97, Vol. 336 Issue 2, p92-99. 1p.

مصطلحات موضوعية: *MEDICAL care costs, *ANGIOPLASTY, *CORONARY disease, *CORONARY artery bypass, *HEART diseases

مستخلص: Background: Randomized trials comparing coronary angioplasty with bypass surgery in patients with multivessel coronary disease have shown no significant differences in overall rates of death and myocardial infarction. We compared quality of life, employment, and medical care costs during five years of follow-up among patients treated with angioplasty or bypass surgery. Methods: A total of 934 of the 1829 patients enrolled in the randomized Bypass Angioplasty Revascularization Investigation participated in this study. Detailed data on quality of life were collected annually, and economic data were collected quarterly. Results: During the first three years of follow-up, functional-status scores on the Duke Activity Status Index, which measures the ability to perform common activities of daily living, improved more in patients assigned to surgery than in those assigned to angioplasty (P<0.05). Other measures of quality of life improved equally in both groups throughout the follow-up period. Patients in the angioplasty group returned to work five weeks sooner than did patients in the surgery group (P<0.001). The initial mean cost of angioplasty was 65 percent that of surgery ($21,113 vs. $32,347, P<0.001), but after five years the total medical cost of angioplasty was 95 percent that of surgery ($56,225 vs. $58,889), a difference of $2,664 (P = 0.047). The five-year cost of angioplasty was significantly lower than that of surgery among patients with two-vessel disease ($52,930 vs. $58,498, P<0.05), but not among patients with three-vessel disease ($60,918 vs. $59,430). After five years of follow-up, surgery had an overall cost-effectiveness ratio of $26,117 per year of life added, but unacceptable ratios of $100,000 or more per year of life added could not be excluded (P = 0.13). Surgery appeared particularly cost effective in treating patients with diabetes because of their significantly improved survival. Conclusions: In patients with multivessel coronary disease, coronary-artery bypass surgery is associated with a better quality of life for three years than coronary angioplasty, after the initial morbidity caused by the procedure. Coronary angioplasty has a lower five-year cost than bypass surgery only in patients with two-vessel coronary disease. (N Engl J Med 1997;336:92-9.) [ABSTRACT FROM AUTHOR]

المؤلفون: Grayston, J. Thomas, Kronmal, Richard A., Jackson, Lisa A., Parisi, Alfred F., Muhlestein, Joseph B., Cohen, Jerome D., Rogers, William J., Crouse, John R., Borrowdale, Sandra L., Schron, Eleanor, Knirsch, Charles

المصدر: New England Journal of Medicine. 4/21/2005, Vol. 352 Issue 16, p1637-1645. 1p.

مصطلحات موضوعية: *AZITHROMYCIN, *PLACEBOS, *CORONARY heart disease treatment, *CARDIAC patients, *CLINICAL trials

مستخلص: Background: Epidemiologic, laboratory, animal, and clinical studies suggest that there is an association between Chlamydia pneumoniae infection and atherogenesis. We evaluated the efficacy of one year of azithromycin treatment for the secondary prevention of coronary events. Methods: In this randomized, prospective trial, we assigned 4012 patients with documented stable coronary artery disease to receive either 600 mg of azithromycin or placebo weekly for one year. The participants were followed for a mean of 3.9 years at 28 clinical centers throughout the United States. Results: The primary end point, a composite of death due to coronary heart disease, nonfatal myocardial infarction, coronary revascularization, or hospitalization for unstable angina, occurred in 446 of the participants who had been randomly assigned to receive azithromycin and 449 of those who had been randomly assigned to receive placebo. There was no significant risk reduction in the azithromycin group as compared with the placebo group with regard to the primary end point (risk reduction, 1 percent [95 percent confidence interval, –13 to 13 percent]). There were also no significant risk reductions with regard to any of the components of the primary end point, death from any cause, or stroke. The results did not differ when the participants were stratified according to sex, age, smoking status, presence or absence of diabetes mellitus, or C. pneumoniae serologic status at baseline. Conclusions: A one-year course of weekly azithromycin did not alter the risk of cardiac events among patients with stable coronary artery disease. N Engl J Med 2005;352:1637-45. [ABSTRACT FROM AUTHOR]

المؤلفون: Herrington, David M., Reboussin, David M., Brosnihan, K. Bridget, Sharp, Penny C., Shumaker, Sally A., Snyder, Thomas E., Furberg, Curt D., Kowalchuk, Glen J., Stuckey, Thomas D., Rogers, William J., Givens, David H., Waters, David

المصدر: New England Journal of Medicine. 08/24/2000, Vol. 343 Issue 8, p522-529. 1p.

مصطلحات موضوعية: *ATHEROSCLEROSIS treatment, *ESTROGEN replacement therapy, *THERAPEUTIC use of progestational hormones, *HORMONE therapy

مستخلص: Background: Heart disease is a major cause of illness and death in women. To understand better the role of estrogen in the treatment and prevention of heart disease, more information is needed about its effects on coronary atherosclerosis and the extent to which concomitant progestin therapy may modify these effects. Methods: We randomly assigned a total of 309 women with angiographically verified coronary disease to receive 0.625 mg of conjugated estrogen per day, 0.625 mg of conjugated estrogen plus 2.5 mg of medroxyprogesterone acetate per day, or placebo. The women were followed for a mean (±SD) of 3.2±0.6 years. Base-line and follow-up coronary angiograms were analyzed by quantitative methods. Results: Estrogen and estrogen plus medroxyprogesterone acetate produced significant reductions in low-density lipoprotein cholesterol levels (9.4 percent and 16.5 percent, respectively) and significant increases in high-density lipoprotein cholesterol levels (18.8 percent and 14.2 percent, respectively); however, neither treatment altered the progression of coronary atherosclerosis. After adjustment for measurements at base line, the mean (±SE) minimal coronary-artery diameters at follow-up were 1.87±0.02 mm, 1.84±0.02 mm, and 1.87±0.02 mm in women assigned to estrogen, estrogen plus medroxyprogesterone acetate, and placebo, respectively. The differences between the values for the two active-treatment groups and the value for the placebo group were not significant. Analyses of several secondary angiographic outcomes and subgroups of women produced similar results. The rates of clinical cardiovascular events were also similar among the treatment groups. Conclusions: Neither estrogen alone nor estrogen plus medroxyprogesterone acetate affected the progression of coronary atherosclerosis in women with established disease. These results suggest that such women should not use estrogen replacement with an expectation of cardiovascular benefit. (N Engl J Med 2000;343:522-9.) [ABSTRACT FROM AUTHOR]

المؤلفون: Canto, John G., Every, Nathan R., Magid, David J., Rogers, William J., Malmgren, Judith A., Frederick, Paul D., French, William J., Tiefenbrunn, Alan J., Misra, Vijay K., Kiefe, Catarina I., Barron, Hal V.

المصدر: New England Journal of Medicine. 05/25/2000, Vol. 342 Issue 21, p1573-1580. 1p.

مصطلحات موضوعية: *MYOCARDIAL infarction, *ANGIOPLASTY, *THROMBOLYTIC therapy, *CARDIOVASCULAR services in hospitals, *PATIENTS

مستخلص: Background: There is an inverse relation between mortality from cardiovascular causes and the number of elective cardiac procedures (coronary angioplasty, stenting, or coronary bypass surgery) performed by individual practitioners or hospitals. However, it is not known whether patients with acute myocardial infarction fare better at centers where more patients undergo primary angioplasty or thrombolytic therapy than at centers with lower volumes. Methods: We analyzed data from the National Registry of Myocardial Infarction to determine the relation between the number of patients receiving reperfusion therapy (primary angioplasty or thrombolytic therapy) and subsequent in-hospital mortality. A total of 450 hospitals were divided into quartiles according to the volume of primary angioplasty. Multiple logistic-regression models were used to determine whether the volume of primary angioplasty procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Similar analyses were performed for patients receiving thrombolytic therapy at 516 hospitals. Results: In-hospital mortality was 28 percent lower among patients who underwent primary angioplasty at hospitals with the highest volume than among those who underwent angioplasty at hospitals with the lowest volume (adjusted relative risk, 0.72; 95 percent confidence interval, 0.60 to 0.87; P<0.001). This lower rate, which represented 2.0 fewer deaths per 100 patients treated, was independent of the total volume of patients with myocardial infarction at each hospital, year of admission, and use or nonuse of adjunctive pharmacologic therapies. There was no significant relation between the volume of thrombolytic interventions and in-hospital mortality among patients who received thrombolytic therapy (7.0 percent for patients in the highest-volume hospitals vs. 6.9 percent for those in the lowest-volume hospitals, P=0.36). Conclusions: Among hospitals in the United States that have full interventional capabilities, a higher volume of angioplasty procedures is associated with a lower mortality rate among patients undergoing primary angioplasty, but there is no association between volume and mortality for thrombolytic therapy. (N Engl J Med 2000;342:1573-80.) [ABSTRACT FROM AUTHOR]

المؤلفون: Buchthal, Steven D., den Hollander, Jan A., Merz, C. Noel Bairey, Rogers, William J., Pepine, Carl J., Reichek, Nathaniel, Sharaf, Barry L., Reis, Steven, Kelsey, Sheryl F., Pohost, Gerald M.

المصدر: New England Journal of Medicine. 03/23/2000, Vol. 342 Issue 12, p829-835. 1p.

مصطلحات موضوعية: *CORONARY disease, *ISCHEMIA, *CARDIOLOGY, *WOMEN'S health

مستخلص: Background: After hospitalization for chest pain, women are more likely than men to have normal coronary angiograms. In such women, myocardial ischemia in the absence of clinically significant coronary-artery obstruction has long been suspected. Most methods for the detection of the metabolic effects of myocardial ischemia are highly invasive. Phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy is a noninvasive technique that can directly measure high-energy phosphates in the myocardium and identify metabolic evidence of ischemia. Methods: We enrolled 35 women who were hospitalized for chest pain but who had no angiographically significant coronary-artery obstructions and 12 age- and weight-matched control women with no evidence of heart disease. Myocardial high-energy phosphates were measured with 31P-NMR spectroscopy at 1.5 tesla before, during, and after isometric handgrip exercise at a level that was 30 percent of the maximal voluntary grip strength. We measured the change in the ratio of phosphocreatine to ATP during exercise. Results: Seven (20 percent) of the 35 women with chest pain and no angiographically significant stenosis had decreases in the phosphocreatine:ATP ratio during handgrip that were more than 2 SD below the mean value in the control subjects without chest pain. There were no significant differences between the two groups with respect to hemodynamic variables at rest and during handgrip, risk factors for ischemic heart disease, findings on magnetic resonance imaging and radionuclide perfusion studies of the heart, or changes in brachial flow during the infusion of acetylcholine. Conclusions: Our results provide direct evidence of an abnormal metabolic response to handgrip exercise in at least some women with chest pain consistent with the occurrence of myocardial ischemia but no angiographically significant coronary stenoses. (N Engl J Med 2000;342:829-35.) [ABSTRACT FROM AUTHOR]