Acute myocardial infarction among smokers of oriental tobacco

The incidence of heavy smokers of Oriental cigarettes among 300 cases of acute coronary thrombosis has been compared to that of non-coronary controls. The calculated risk factor of 1.69 was similar to the risk factor found in Western populations using American blends of tobacco. This similarity, which existed in spite of differences in the chemical components of the cigarettes, is discussed. © 1974, Sage Publications. All rights reserved

Residence in mountainous compared with lowland areas in relation to total and coronary mortality. A study in rural Greece

Study objective: To investigate the association of residence in mountainous or lowland areas with total and coronary mortality, in a cohort with 15 years of follow up. Design and setting: Prospective study, based on the adult population of two lowland and one mountainous village in rural Greece. Baseline measurements on sociodemographic, lifestyle, somatometric, clinical, and biochemical variables were recorded in 1981 during a health survey and total and coronary deaths were ascertained on the basis of death certificates up to 1996. Participants: 1198 men and women, who had participated in the 1981 survey. Analyses are based on 504 men and 646 women with complete data. Main results: There were 150 deaths among men and 140 among women (coronary deaths: 34 and 33 respectively). In multivariate analysis with Cox regression, after adjustment for age, education, body weight, smoking, alcohol consumption, systolic blood pressure, serum total cholesterol, blood glucose, serum triglycerides, and serum uric acid, total and coronary mortality were lower for residents of the mountainous village in comparison with residents of the lowland villages (hazard ratios (95% confidence intervals) for men and women, respectively: total mortality, 0.57 (0.38 to 0.84) and 0.69 (0.47 to 1.02); coronary mortality, 0.39 (0.16 to 0.98) and 0.46 (0.20 to 1.05)). Conclusions: Residence in mountainous areas seems to have a "protective effect" from total and coronary mortality. Increased physical activity from walking on rugged terrains under conditions of moderate hypoxia among the mountain residents could explain these findings

Residence in mountainous compared with lowland areas in relation to total and coronary mortality. A study in rural Greece

Study objective: To investigate the association of residence in mountainous or lowland areas with total and coronary mortality, in a cohort with 15 years of follow up. Design and setting: Prospective study, based on the adult population of two lowland and one mountainous village in rural Greece. Baseline measurements on sociodemographic, lifestyle, somatometric, clinical, and biochemical variables were recorded in 1981 during a health survey and total and coronary deaths were ascertained on the basis of death certificates up to 1996. Participants: 1198 men and women, who had participated in the 1981 survey. Analyses are based on 504 men and 646 women with complete data. Main results: There were 150 deaths among men and 140 among women ( coronary deaths: 34 and 33 respectively). In multivariate analysis with Cox regression, after adjustment for age, education, body weight, smoking, alcohol consumption, systolic blood pressure, serum total cholesterol, blood glucose, serum triglycerides, and serum uric acid, total and coronary mortality were lower for residents of the mountainous village in comparison with residents of the lowland villages ( hazard ratios (95% confidence intervals) for men and women, respectively: total mortality, 0.57 (0.38 to 0.84) and 0.69 ( 0.47 to 1.02); coronary mortality, 0.39 (0.16 to 0.98) and 0.46 (0.20 to 1.05)). Conclusions: Residence in mountainous areas seems to have a “protective effect” from total and coronary mortality. Increased physical activity from walking on rugged terrains under conditions of moderate hypoxia among the mountain residents could explain these findings

The role of Dextran on the blood level of35S-Calcium Dobesilate in humans

The concomitant administration of Dextran and Calcium Dobesilate might be foreseen in clinical practice since the former is used as a blood volume restorer, and the latter as a protector of the capillary blood vessel walls. The aim of this study is to investigate if the intravenous administration of Dextran is liable to influence the pharmacokinetics of orally administrated 35S Calcium Dobesilate. The maximum blood level values in the group treated simultaneously with Calcium Dobesilate and Dextran were similar to those obtained after the administration of Calcium Dobesilate alone. The rate of protein binding was practically identical in both Dextran-treated groups, whether Calcium Dobesilate was given before or after Dextran. This experiment showed that Dextran does not affect the blood level of Calcium Dobesilate in man. © 1976 Springer-Verlag

Anatomic characteristics of culprit sites in acute coronary syndromes

Background: A detailed analysis of the anatomic relationships of the site of culprit lesions that have resulted in acute coronary syndromes (ACS) has not been reported. Methods: Coronary angiograms of consecutive patients who presented with ACS were analyzed according to multiple anatomic criteria. Results: In left anterior descending artery (LAD) (n = 85), 85% of culprit lesions were located in the first 40 mm from the ostium. The presence of angulation on the lesion increased the risk of an ACS 1.92 times (95% confidence interval [CI] 1.9-3.07), and the presence of bifurcation after the lesion increased the risk 1.65 times (95% CI 1.04-2.62). Angulated lesions located within the first 40 mm from the ostium and before a bifurcation presented an 11-fold increased risk for an ACS. In right coronary artery (RCA) (n = 58), the risk of plaque rupture was almost 2.5 times higher in lesions located between 10 and 50 mm from the ostium compared to those located in 90-130 mm (relative risk [RR] 2.38, 95% CI 1.25-4.56). In left circumflex (LCx) (n = 40), the risk of plaque rupture was almost 4.5 and 5 times higher in the first 20 mm, and between 20 and 40 mm from the ostium, respectively, compared to 60 and 80 mm (relative risk [RR] 4.58, 95% CI 1.01-20.68 for 0-20 mm, and RR 4.95, 95% CI 1.14-21.47 for 20-40 mm) after adjustment for the presence of curve on the lesion. The presence of lesion angulation increased the risk of plaque rupture almost three times (RR 3.22, 95% CI 1.49-6.93). Conclusion: Specific anatomic features of the coronary arteries predispose to development and/or subsequent rupture of vulnerable plaques. © 2008, the Authors

Three-dimensional analysis of the left anterior descending coronary artery: Comparison with conventional coronary angiograms

Objective: This study aimed at comparing three-dimensional (3-D) reconstruction with two-dimensional coronary angiograms with respect to anatomical parameters that might affect plaque formation and rupture. Methods: Sixty patients with stable left anterior descending (LAD) lesions and 60 patients with an anteroseptal myocardial infarction and recanalized LAD were studied. Results: Conventional angiography significantly underestimated the distance of the stenosis from the ostium of the LAD, 29.4 ±14.5 versus 35.3±18.5 mm, P<0.001. Vessel curvature at the site of the lesion was overestimated by conventional angiography compared with 3-D reconstruction, 147.6±30.6° versus 162.3±11.2°, P<0.001, as was axial bending of the LAD owing to ventricular contraction (17.8±7.78° vs. 8.9±8.9°, P<0.001). No agreement was observed between two-dimensional and 3-D analysis for either curvature on lesion or axial bending assessment, with intraclass correlation coefficient values 0.155 (-0.009, 0.315) and -0.022 ( -0.183, 0.174), respectively. No significant agreement was found between the two methods in the detection of on-stenosis bifurcations (1.7%, κ = 0.086, P=0.349). Conclusion: Conventional coronary angiography cannot provide accurate estimates of anatomical parameters, such as distance of a coronary stenosis from the ostium of the vessel, coronary artery curvature at the site of stenosis, axial deformity and bending because of ventricular contraction, and classification of bifurcations. Reconstruction of the coronary tree in 3-D space is necessary for such estimations. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Three-dimensional analysis of vulnerable segments in the left anterior descending artery

OBJECTIVES: Analysis of conventional angiograms has suggested that specific anatomic parameters of particular segments of a coronary artery render them prone to vulnerable plaque development, plaque rupture, and consequent thrombosis. This study aimed at performing a three-dimensional analysis of recanalized left anterior descending (LAD) coronary arteries in patients who had suffered an anterior ST-elevation myocardial infarction (STEMI). METHODS: Coronary angiograms of 76 consecutive patients with an anterior STEMI and a recanalized LAD were reconstructed in the three-dimensional space, and compared with angiograms of 76 patients with stable coronary artery disease (SCAD) and significant LAD stenosis. RESULTS: In both groups the majority of lesions occurred between 20 and 40 mm (P=0.745), but the number of lesions beyond 60 mm from the ostium was significantly higher in SCAD compared with STEMI (P=0.045). Culprit lesions were statistically significantly longer in patients with STEMI compared with SCAD (18.3±7.5 vs. 12.7±6.2 mm, P<0.001). Cut-off point analysis indicated a lesion length of ≥ 12.5 mm as discriminating threshold between SCAD and STEMI (sensitivity 79% and specificity 63%). Bifurcation branches on the culprit lesion were seen in 79% of the patients with STEMI and 58% of those with SCAD (P=0.026). Lesion angulation was significantly sharper in STEMI compared with SCAD patients in diastole (155±15 vs. 160±14 degrees, P=0.037). Multiple logistic regression model including these parameters had a high discriminating ability with c-statistic 0.78 (95% confidence intervals: 0.71-0.86), sensitivity 72.4%, and specificity 75%. CONCLUSION: Specific anatomic characteristics of LAD segments predispose to development of plaque rupture and thrombosis. © 2009 Lippincott Williams & Wilkins, Inc