Baseline Characteristics and Prescription Patterns of Standard Drugs in Patients with Angiographically Determined Coronary Artery Disease and Renal Failure (CAD-REF Registry)

BACKGROUND: Chronic kidney disease (CKD) is strongly associated with coronary artery disease (CAD). We established a prospective observational nationwide multicenter registry to evaluate current treatment and outcomes in patients with both CKD and angiographically documented CAD. METHODS: In 32 cardiological centers 3,352 CAD patients with ≥50% stenosis in at least one coronary artery were enrolled and classified according to their estimated glomerular filtration rate and proteinuria into one of five stages of CKD or as a control group. RESULTS: 2,723 (81.2%) consecutively enrolled patients suffered from CKD. Compared to controls, CKD patients had a higher prevalence of diabetes, hypertension, peripheral artery diseases, heart failure, and valvular heart disease (each p<0.001). Myocardial infarctions (p = 0.02), coronary bypass grafting, valve replacements and pacemaker implantations had been recorded more frequently (each p<0.001). With advanced CKD, the number of diseased coronary vessels and the proportion of patients with reduced left ventricular ejection fraction (LVEF) increased significantly (both p<0.001). Percutaneous coronary interventions were performed less frequently (p<0.001) while coronary bypass grafting was recommended more often (p = 0.04) with advanced CKD. With regard to standard drugs in CAD treatment, prescriptions were higher in our registry than in previous reports, but beta-blockers (p = 0.008), and angiotensin-converting-enzyme inhibitors and/or angiotensin-receptor blockers (p<0.001) were given less often in higher CKD stages. In contrast, in the subgroup of patients with moderately to severely reduced LVEF the prescription rates did not differ between CKD stages. In-hospital mortality increased stepwise with each CKD stage (p = 0.02). COMCLUSIONS: In line with other studies comprising CKD cohorts, patients’ morbidity and in-hospital mortality increased with the degree of renal impairment. Although cardiologists’ drug prescription rates in CAD-REF were higher than in previous studies, they were still lower especially in advanced CKD stages compared to cohorts treated by nephrologists

Unmet medical needs in intermittent Claudication with diabetes and coronary artery disease—A “real‐world” analysis on 21 197 PAD patients

BACKGROUND: Peripheral artery disease (PAD) is frequently co‐prevalent with coronary artery disease (CAD) and diabetes (DM). The study aims to define the burden of CAD and/ or DM in PAD patients at moderate stages and further to evaluate its impact on therapy and outcome. METHODS: Study is based on health insurance claims data of the BARMER reflecting an unselected “real‐world” scenario. Retrospective analyses were based on 21 197 patients hospitalized for PAD Rutherford 1‐3 between 1 January 2009 to 31 December 2011, including a 4‐year follow‐up (median 775 days). RESULTS: In PAD patients, CAD is prevalent in 25.3% (n = 5355), DM in 23.5% (n = 4976), and both CAD and DM in 8.2% (n = 1741). Overall, in‐hospital mortality was 0.4%, being increased if CAD was present (CAD alone: OR 1.849; 95%‐CI 1.066‐3.208; DM alone: OR 1.028; 95%‐CI 0.520‐2.033; CAD and DM: OR 3.115; 95%‐CI 1.720‐5.641). Both, CAD and DM increased long‐term mortality (CAD alone: HR 1.234; 95%‐CI 1.106‐1.376; DM alone: HR 1.260; 95%‐CI 1.125‐1.412; CAD and DM: HR 1.76; 95%‐CI 1.552‐1.995). DM further increased long‐term amputation risk (DM alone: HR 2.238; 95%‐CI 1.849‐2.710; DM and CAD: HR 2.199; 95%‐CI 1.732‐2.792), whereas CAD (alone) did not. CONCLUSIONS: In a greater perspective, the data identify also mild to modest stage PAD patients at particular risk for adverse outcomes in presence of CAD and/or DM. CAD and DM both are related with a highly increased risk of long‐term mortality even in intermittent claudication, and DM independently increased amputation risk

Nuclear spin relaxation of Li-8 in a thin film of La0.67Ca0.33MnO3

We report beta-NMR measurements of the nuclear spin relaxation rate (1/T-1) in a thin film of La0.67Ca0.33MnO3 (LCMO) using a low-energy beam of spin-polarized Li-8. In a small magnetic field of 150 G, there is a broad peak in 1/T-1 near the Curie temperature (T-c = 259 K) and a dramatic decrease in 1/T-1 at lower temperatures. This is attributed to a critical slowing down of the spin fluctuations near T-c and freezing of the magnetic excitations at low temperatures, respectively. In addition, there is a small amplitude, slow relaxing component at high temperatures, which we attribute to Li-8 in the SrTiO3 substrate. There is an indication that the spin relaxation rate in the substrate is also peaked at T-c due to close proximity to the magnetic film. These results establish that low-energy beta-NMR can be used as a probe of magnetic fluctuations in magnetic thin films over a wide range of temperatures. (c) 2005 Elsevier B.V. All rights reserved