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 13,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anesthesia during and after off-pump surgery is critical for the outcome of the procedure. Intubation time has been shown to correlate with ICU time and length of stay. This study is to evaluate the extubation time and predictors of prolonged extubation in this institution. One hundred and sixty consecutive patients during Jan 2001-June 2002, excluding pre-operative tracheostomy (n = 1) were retrospectively reviewed. Anesthetic agents include fentanyl, rocuronium Bromide, midazolam and sevoflurane. Phenylephrine and nitroglycerine were used to maintain adequate arterial pressures. Post-operative pain control was mainly with intravenous fentanyl and oral pain medications. The extubation time was divided into 4 groups; 0-2 h, n = 76, mean = 1.11 +/- 0.5 h; 2-4 h, n = 30, mean = 2.91 +/- 0.5 h; 4-24 h, n = 39, mean = 11.44 +/- 7.3 h; > 24 h, n = 5, mean = 33.3 +/- 21 h. The data were collected and analyzed following the guidelines of National STS cardiac surgery database. All pre-operative risk factors included: Age (> 70 yrs vs < or = 70 yrs), gender (male vs female), diabetes (yes vs no), hypertension (yes vs no), morbid obesity (yes vs no), renal insufficiency (yes vs no), chronic obstructive lung disease (yes vs no), history of cerebrovascular accident (yes vs no), smoking (yes vs no), dyslipidemia (yes vs no), history of myocardial infarction (MI) (yes vs no), history of congestive heart failure (CHF) (yes vs no), unstable angina (yes vs no), left ventricular ejection fraction (LVEF) (> 40% vs < or = 40%), left main (LM) lesion (LM > 50% vs LM < or = 50%), intra-aortic balloon pump (IABP) used (yes vs no) and time between operating and closing (> 4.30 h vs < or = 4.30 h) were used to predict failed early extubation (2 h). More than 50 per cent of the patients were extubated in less than 2 h (1.11 +/- 0.5 h) and only 5 patients were extubated after 24 h. Univariate analysis revealed old age, diabetes, MI, CHF, LVEF < or = 0.4 and the use of IABP are the predictors (p < 0.05) of failed early extubation. Multivariate analysis of these variables revealed old age with adjusted odds ratio of 4.6 (95% CI = 1.5-13.7) p < 0.01, diabetes with adjusted odds ratio of 3.2 (95% CI = 1.3-7.5) p < 0.01 and IABP used with adjusted odds ratio of 4.3 (95% CI = 1.3-14.6) p = 0.02 are the predictors of fail early extubation. The findings suggested early extubation is possible in OPCAB surgery and attention should be made when operate in patients who have old age, diabetes, and IABP used.
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PMID:Off-pump coronary artery bypass surgery: evaluation of extubation time and predictors of failed early extubation. 1286 66

During myocardial infarction (MI), high levels of circulating procoagulant microparticles (MP) shed from endothelial cells and platelets diffuse prothrombotic and proinflammatory potentials crucial for the coronary prognosis. In addition to conventional treatments, we evaluated whether vitamin C treatment could modify circulating levels of procoagulant MP. Upon admission, 61 patients with MI were prospectively randomized for immediate additional vitamin C treatment. Circulating MP were quantified by functional prothrombinase assay before and after 5 days of vitamin C administration (1 g day-1). The cellular origin of MP was also assessed. In vitamin C-treated patients, the reduction in platelet-derived MP was 10% higher (P = 0.01). In patients with diabetes mellitus, dyslipidemia or more than two cardiovascular risk factors, vitamin C decreased endothelial and platelet-derived MP levels by approximately 70% and 13%, respectively. This early effect on circulating platelet and endothelial-derived MP, testifies to the importance of oxidative stress during MI. Vitamin C could prove beneficial for the outcome of patients at higher thrombotic risk.
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PMID:Protective effects of vitamin C on endothelium damage and platelet activation during myocardial infarction in patients with sustained generation of circulating microparticles. 1287 55

The aims of this epidemiological population-based cohort study were to examine the prevalence of the multiple modifiable vascular risk factors, their distribution patterns and outcomes among a Bulgarian urban population. A total of 500 volunteers, 200 men and 300 women, without clinical signs and symptoms of cerebrovascular disease, aged 50-79 years, were enrolled in the study. A structured questionnaire, physical examination, electrocardiogram records, a battery of laboratory tests and carotid duplex scanning were employed. Three or more modifiable vascular risk factors were detected in 52% (260/500) of the subjects. Dyslipidemias, hypertension, obesity, cigarette smoking and cardiac diseases were found to be the most prevalent single risk factors. Asymptomatic carotid stenosis (ACS) of 50% or greater was detected in 8.8% (23/260) of the volunteers examined. After a 2-year follow-up, 2.7% (7/260) of the persons with modifiable vascular risk factors reached the end point transient ischemic attacks (TIAs), ischemic stroke and myocardial infarction. The following combinations of risk factors among the subjects enrolled in the study were significantly associated with these outcomes: hypertension and cardiac diseases (OR = 6.82; 95% CI, 1.21-38.41), cardiac diseases and obesity (OR = 6.13; 95% CI, 1.27-29.72), ACS and high low-density lipoprotein (LDL) cholesterol levels (OR = 11.11; 95% CI, 1.58-78.29). The identification of subjects with multiple vascular risk factors may be important for primary medical or surgical stroke prevention.
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PMID:Multiple modifiable risk factors for first ischemic stroke: a population-based epidemiological study. 1294 Aug 42

This article examines the relationships among depression, ischemic heart disease, and erectile dysfunction. Depression is an independent risk factor for the development of ischemic heart disease, and depression in the post-myocardial infarction patient is associated with increased morbidity and mortality. Ischemic heart disease and erectile dysfunction are also frequently comorbid and share many common risk factors including age, hypertension, diabetes, dyslipidemia, obesity, sedentary lifestyle, and smoking. Depression and erectile dysfunction often occur together; however, the causal relation may be difficult to determine because erectile dysfunction may be a symptom of depression, social distress accompanying erectile dysfunction may precipitate depressive symptoms, or both conditions may result from a common factor such as vascular disease.
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PMID:Depression: links with ischemic heart disease and erectile dysfunction. 1297 13

The aging of the population of the United States (US) will bring with it higher numbers of patients with coronary heart disease and heart failure (HF). Because HF already imposes severe economic and medical burdens on our health care system, it is imperative to optimize primary and secondary prevention of cardiovascular (CV) disease. In most cases, HF develops as a result of either long-standing hypertension or a myocardial infarction (MI). Other than cardiac death, HF represents the last stage in the progression of CV disease, which begins with CV risk factors such as hypertension, dyslipidemia, obesity, and smoking. These risk factors lead to the development of left ventricular (LV) hypertrophy or an MI (or both), which lead to LV dysfunction and, finally, to HF. The prognosis of HF is poor, the 5-year survival rate being approximately 25%. Heart failure may be due to either LV systolic or diastolic dysfunction, the latter having a normal ejection fraction. Because CV disease is progressive, interventions are possible at all stages along the CV continuum. Beta-blockers (betaB) are recommended agents at several stages of CV disease. Large-scale trials have shown that betaB significantly reduce risks for morbidity and mortality in patients with HF. Ongoing studies should help to clarify further the optimal cardioprotective therapies in patients with HF.
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PMID:From hypertension to heart failure: update on the management of systolic and diastolic dysfunction. 1451 98

The hypothesis was tested that metabolic syndrome (MS) plays a leading role in approximating the multivariate distribution of thrombogenic and metabolic blood variables in a population of postinfarction patients. The multivariate statistical technique of factor analysis was used to determine blood variable clustering 2 months after myocardial infarction. Five clusters resulted in two separate independent factors, dyslipidemia and metabolic, reflecting MS and the remaining interpreted as cholesterol-lipoprotein, vascular-inflammatory, and coagulation. All five factors accounted for 55% of total variance with MS-associated factors accounting for 20% and individual factor contributions as follows: 11.6, 8.6, 12.9, 11.9, and 9.6%, respectively. There were no interactions of metabolic variables with thrombogenic variables or CRP in any factor. Results of subgroup analysis in males and females and in patients on and not on statins were all similar to the total group. We conclude there is no interaction of variables of MS or cholesterol-lipoprotein factors with those of thrombogenic factors. This independence yields the potential for use of factors in evaluating CVD risk. Further, the importance of MS in this group of postinfarction patients is emphasized, as the largest contribution to total variance was from MS factors, meaning that these variables best approximate the original multivariate distribution.
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PMID:Metabolic syndrome best defines the multivariate distribution of blood variables in postinfarction patients. 1464 7

Dyslipidemia is one of the major cardiovascular risk factors especially for patients with type 2 diabetes mellitus. As a feature of the metabolic syndrome insulin resistance is also associated with an atherogenic lipoprotein phenotype. In type 1 diabetes inadequate glycemic control results in an increase of plasma triglyceride levels. The treatment of diabetic dyslipidemia is based on an improvement of glycemic control, in type 1 and type 2 diabetes, as well as in lifestyle recommendations, including dietary advice and physical exercise. The achievement of strict target levels, especially LDL-cholesterol values below 100 mg/dL, requires lipid lowering drug therapy. This LDL-cholesterol target level is based on the fact that diabetic patients reveal the same risk for myocardial infarction as non-diabetics after their first cardiovascular event. Thus the diagnosis of diabetes is regarded as an equivalent for manifest cardiovascular disease. The re-evaluation of large lipid intervention trials (4 S, CARE, LIPID, VA-HIT, Heart Protection Study) could clearly demonstrate also for the diabetic subpopulation that statin and fibrate therapy results in a significant reduction of the cardiovascular risk.
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PMID:[Diabetes and lipids]. 1467 89

BACKGROUND AND THERAPY: The metabolic syndrome comprises a virulent and lethal group of atherosclerotic risk factors, including dyslipidemia, obesity, systemic hypertension and insulin resistance. The prevalence of the metabolic syndrome has continuously grown in industrialized and developing countries during the last decades, and affects tens of millions of people in Germany and Europe. Particularly prominent as a risk factor for the development of insulin resistance is central obesity, which is causally involved in the pathogenesis of insulin resistance in addition to genetic predisposition. The metabolic syndrome can easily be diagnosed in clinical practice (guidelines of the WHO and ATP III panel), and immediate treatment of the metabolic syndrome is mandatory because those patients are at increased risk to develop overt diabetes mellitus, coronary artery disease and stroke. The high risk for cardiovascular diseases is supported by findings that the risk for myocardial infarction in patients with insulin resistance is as high as the risk of patients after their first myocardial infarction. Intentional weight reduction reduces abdominal obesity and beneficially modulates all features of the metabolic syndrome, while the benefits of aerobic exercise training are discussed controversially. Thus, weight reduction causally undoes essential features of the metabolic syndrome, but effects are often not enduring. Therefore, the treatment of cardiovascular risk factors such as hypertension and dislipidemia is essential. Of note, antihypertensive treatment is more effective than tight glucose control to reduce cardiovascular events. Diuretics, ACE-inhibitors and angiotensin II type 1 receptor antagonists are suggested as first line therapeutics. However, at least two antihypertensives are usually necessary to achieve the suggested goals of blood pressure reduction. In conclusion, the prevalence of the metabolic syndrome is continuously growing. Due to its adverse impact on cardiovascular disease, early detection and aggressive treatment is mandatory to ensure longlasting benefits for affected patients.
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PMID:[Arterial hypertension and metabolic syndrome]. 1468 1

We retrospectively analyzed survival in patients with type 2 diabetes mellitus (DM) after first acute myocardial infarction (AMI). The study was conducted in 5 sites in Poland and involved 521 patients who survived more than 30 days after AMI. In the 5-year period after the acute event, we investigated the following cardiovascular (CV) outcomes: death (overall mortality), next MI, stroke, hospitalization due to acute coronary symptoms (HACS), and composite outcomes (whichever occurred first). We also assessed: age, smoking habit, obesity, hypertension, dyslipidemia and coronary artery disease (CAD) diagnosed before AMI, and gender. 269 patients (52%) suffered one of the outcomes from the composite CV endpoint. HACS was the first event in 164 cases, MI in 59, death in 32, and stroke in 14 patients. Analyzing the prevalence of individual CV events, we found: HACS in 184 patients (35%), next MI in 79 patients (15%), death in 59 patients (11%), and stroke in 30 patients (6%). Only dyslipidemia, arterial hypertension, and CAD were independent risk factors with an impact on composite CV endpoint. Other analyzed risk factors like smoking and obesity did not have independent effects on the CV risk. In the retrospective analysis, we found that HACS was the most frequent CV event in individuals with type 2 DM after AMI. The CV risk in type 2 diabetics who suffered at least one myocardial infarction was further increased in those with coexisting dyslipidemia, arterial hypertension or CAD. These findings support the current guidelines which recommend aggressive management of CV risk factors including hypertension, dyslipidemia and CAD before a first myocardial infarction.
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PMID:Retrospective analysis of cardiovascular outcomes in patients with type 2 diabetes mellitus after the first acute myocardial infarction. 1470 68

The metabolic syndrome (MS) is a frequent cause of coronary artery disease (CAD), and recently the National Cholesterol Education Program Adult Treatment Panel III suggested its diagnosis in the presence of 3 to 5 quantitatively defined markers. Because the consequences of the MS are likely related to the number and diversity of markers, we studied the relation between the number of markers-the MS score-and the degree of abdominal obesity, risk factor profile, and severity of CAD. One thousand one hundred eight subjects of a mostly white population with symptoms of CAD (793 men and 315 women; 58.1 +/- 9.8 years of age) were divided into 6 groups based on their MS scores. A low high-density lipoprotein cholesterol level was the most frequently observed marker, followed by increased blood pressure, triglycerides, waist circumference, and fasting glucose. As the MS score increased so did abdominal obesity, parameters of "nontraditional" dyslipidemia with surrogate markers of dense low-density lipoprotein and high-density lipoprotein particles, blood pressure, fasting glucose, insulin, and the homeostatic model assessment insulin resistance index. Similarly, an increasing MS score was significantly related to more severe coronary angiographic alterations and higher frequencies of unstable angina, myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting. Therefore, the MS score provides a clinically useful index of MS severity and the associated atherosclerotic risk factor profile. It also correlates with the angiographic severity of CAD and its clinical complications.
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PMID:Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. 1471 40


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