Usefulness of satisfactory control of low-density lipoprotein cholesterol topredict left ventricular remodeling after a first ST-elevation myocardialinfarction successfully reperfused

Left ventricular (LV) remodeling represents an important determinant in the progression to heart failure in patients after myocardial infarction. The aim of the present study was to evaluate in patients with first ST-segment elevation acute myocardial infarction who were successfully and completely reperfused whether the control of cholesterol is predictive of LV remodeling. A total of 109 patients referred to a coronary care unit for first ST-segment elevation myocardial infarction were analyzed. According to the change in indexed LV end-diastolic volume detected at follow-up visits, patients were divided into nonremodeling (n = 79) and remodeling (n = 30) groups. At coronary care unit admission, the prevalence of cardiovascular risk factors was similar in the 2 groups. Low-density lipoprotein (LDL) cholesterol values were used as criteria for cholesterol control. At follow-up visits, the prevalence of patients with target levels of plasma LDL cholesterol was lower in the remodeling compared to the nonremodeling group (67% and 91%, respectively, p <0.01). After adjusting for age, gender, baseline LV ejection fraction, baseline indexed LV end-diastolic volume, hypertension, diabetes, obesity, smoking status, time from acute event, drugs (β blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and statins), wall motion score index, and troponin levels, logistic regression analysis showed that patients with nontarget LDL cholesterol values at follow-up were significantly more likely to show cardiac remodeling (odds ratio 22.3, 95% confidence interval 2.91 to 171.9, p = 0.003). In conclusion, the present study shows that unsatisfactory control of LDL cholesterol independently predicts LV remodeling in patients with first ST-segment elevation myocardial infarction

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care