Curimoto, Y

Fukada, J

Morishita, K

Elsevier - Publisher Connector 

A simple but useful method of screening for mesenteric ischemia secondary to acute aortic dissection 

ABSTRACTS
Gregory L. Moneta, MD, Abstracts Section EditorRadial artery bypass grafts are associated with increased occurrence of
angiographically severe stenosis and occlusion compared with left
internal mammary artery and saphenous vein grafts
Khot UN, Friedman DT, Pettersson OL, et al. Circulation 2004;109:2086-
91.
Conclusion: Patients who have undergone previous coronary artery
bypass grafting who have signs and symptoms of myocardial ischemia have
lower patency rates of radial artery grafts compared to internal mammary
artery and saphenous vein grafts.
Summary: The authors reviewed coronary angiography procedures at
their institution from February 1996 to October 2001. Patients with radial
artery bypass grafts were selected. Angiographic outcomes were divided into
3 groups: occluded, severe disease (70% stenosis), and patent (70%
stenosis). Multivariable analysis was used to determine predictors of severe
disease or occlusion.
There were 310 patients with radial artery grafts. Mean follow-up after
coronary artery bypass grafting was 565 511 days. Radial artery grafts had
a patency rate of 51.3%. This was significantly lower than left internal
mammary artery grafts (90.3%; P .0001) or saphenous vein grafts (84.0%;
P  .0016). Revision rate in radial artery grafts was 33.7%, compared with
4.8% for left internal mammary artery grafts (P .0001). Radial artery grafts
had a severe stenosis rate of 15.1%, compared with 5.9% for saphenous vein
grafts (P  .0002) and 4.8% for left internal mammary artery grafts (P 
.0001). Radial artery graft patency was worse in women than in men
(38.9% vs 56.1%; P  .025). The most powerful multivariable predictor of
severe stenosis or occlusion was a radial artery graft (2  28.82; P 
.0001). The presence of a radial artery graft led to 58 patients requiring
subsequent percutaneous interventions and 26 patients requiring repeat
coronary artery bypass grafting.
Comment: These results are in significant contrast to the widespread
belief that radial artery grafts have a high rate of patency in coronary artery
bypass grafting. The data suggest that improvements in harvesting tech-
niques of radial artery grafting and the postoperative administration of
calcium channel blockers delayed rather than prevented the previously
documented poor outcome of radial artery grafts in the coronary circulation.
A simple but useful method of screening for mesenteric ischemia
secondary to acute aortic dissection
Curimoto Y, Morishita K, Fukada J, et al. Surgery 2004;136:42-6.
Conclusion: Measuring the superior mesenteric vein to superior mes-
enteric artery diameter ratio (SMV-SMA ratio) with computed tomography
scanning is a useful screeningmethod for detection of mesenteric ischemia in
patients with acute aortic dissection.
Summary: The authors sought to develop a screening method to
detect mesenteric ischemia after acute aortic dissection. From 1991 to 2002,
245 patients with acute aortic dissection were admitted to the authors’
hospital; in 3.7% of patients (n  9) the condition was complicated by
mesenteric ischemia. Data analysis was retrospective. The authors deter-
mined the SMV-SMA ratio in the 9 patients with mesenteric ischemia
compared with those patients without mesenteric ischemia. Hematologic
test data, including results of arterial blood gas analysis, were also compared
between patients with or without mesenteric ischemia.
The SMV-SMA ratio in the group withmesenteric ischemia was 1.16
0.33, and in the group without mesenteric ischemia was 1.78  1.29. (P 
.003). A cutoff value for the SMV-SMA ratio of 1.5 predicted mesenteric
ischemia with 89% sensitivity and 89% specificity, with an odds ratio of 64.0.
Patients with and without mesenteric ischemia differed with respect to
glutamate oxaloacetate transaminase, lactate dehydrogenase, creatinine
phosphate kinase, pH, and lactate values. Measurement of lactate was
especially useful (P  .002).
Comment: In essence, the authors suggest that mesenteric venous
volume, as measured by computed tomography scan–derived measurement
of SMV diameter, is an indicator of adequate intestinal perfusion. It makes
sense that if less blood is being returned from the mesenteric circulation less
blood must have been delivered to the mesenteric circulation. The study is
too small to justify using its conclusions to influence clinical practice. It is,
however, intriguing, basically makes sense, and the information required is
routinely available in patients with aortic dissection.
Statin therapy improves cardiovascular outcome in patients with pe-
ripheral arterial disease
Schilinger M, Exner M, Mlekusch W, et al. Eur Heart J 2004;25:742-8.
1258Conclusion: In patients with severe peripheral arterial disease (PAD)
and high C-reactive protein (CRP) activity, statin therapy is associated with
substantially improved intermediate-term survival.
Summary: This was a prospective study of 515 patients with severe
PAD (296 men; median age, 70 years). Cardiovascular risk profile and
laboratory parameters of inflammation (CRP, serum amyloid A, fibrinogen,
serum albumin, neutrophil count) were obtained. Patients were followed up
for a mean of 21 months (interquartile range, 12-15 months). End points
were myocardial infarction and death.
There were 198myocardial infarctions (5 fatal) and 65 deaths. At 6, 12,
and 24months cumulative survival rate was 97%, 95%, and 89%, respectively,
and event-free survival rate (freedom from death and myocardial infarction)
was 96%, 93%, and 87%, respectively. Fifty-two percent of patients (n 269)
received statin therapy. Patients given statin drugs had lower levels of CRP
(P  .001), serum amyloid A (P  .001), fibrinogen (P  .007), and
albumin (P .001); lower neutrophil count (P .049); and better survival
(hazard ratio [HR], 0.52; P .022) and event-free survival rates (HR, 0.48;
P .004), compared with patients not given statin drugs. Patients with low
inflammatory activity (CRP, 0.42 mg/dL) had no benefit from statin
therapy in terms of myocardial infarction or survival (P  .74 for survival;
P  .83 for event-free survival). Patients with high CRP (0.42 mg/dL)
and given statin drugs had a significantly reduced risk for mortality (HR,
0.58; P .046) and the composite of myocardial infarction and death (HR,
0.46; P  .016).
Comment: It has become increasingly clear that statin therapy is
associated with improved survival in patients with PAD. The study suggests
that CRP levels may be used to select patients with PAD who may most
benefit from statin therapy. These results are consistent with previously
documented benefits of statin therapy on levels of inflammatory markers
associated with cardiovascular disease and the association of inflammatory
markers for cardiovascular disease with long-term survival.
Folate therapy and in-stent stenosis after coronary stenting
Lang H, Suryapranata H, DeLuca G, et al. N Engl J Med 2005;350:2673-
81.
Conclusion: Administration of folate, vitamin B6, and vitamin B12
after coronary stenting appears to increase the risk for in-stent recurrent
stenosis and the need for target vessel revascularization.
Summary: There have been conflicting data regarding homocysteine
levels and risk for recurrent stenosis after coronary angioplasty. A previous
study found a decreased rate of coronary recurrent stenosis after lowering
plasma homocysteine levels in patients who underwent percutaneous coro-
nary interventions, primarily angioplasty without stenting (N Engl J Med
2001;345:1593-1600). The current study evaluated the efficacy of vitamin
therapy in prevention of recurrent stenosis in patients undergoing coronary
angioplasty and stenting.
A total of 636 patients who had undergone successful coronary stenting
were randomly assigned to receive 1mg of folic acid, 5mg of vitamin B6, and
1 mg of vitamin B12 intravenously, followed with daily oral doses of 1.2 mg
of folic acid, 48 mg of vitamin B6, and 60 g of vitamin B12 for 6 months,
or to receive placebo. End points were angiographic minimal lumen diam-
eter, recurrent stenosis, and late luminal loss. End points were assessed at 6
months with quantitative coronary angiography.
At follow-up the main (SD) minimal lumen diameter was smaller in
the vitamin group than the placebo group: 1.59  0.62 mL versus 1.74 
0.64 mm (P  .008). The extent of late luminal loss was greater in the
vitamin group than in the placebo group: 0.9 0.55mm versus 0.76 0.58
mm (P .004). Recurrent stenosis was also higher in the vitamin group than
in the placebo group: 34.5% versus 26.5% (P .05). A higher percentage of
patients in the vitamin group required repeat target vessel revascularization:
15.8% versus 10.6% (P .05). Vitamin therapy had an adverse effect on risk
for recurrent stenosis in all subgroups except for women, patients
with diabetes, and patients with markedly elevated homocysteine levels
(15 m/L) at baseline.
Comment: This study indicates that vitamin therapy should not be
administered routinely in patients undergoing coronary artery stenting.
Drug-eluting stents were not used in this trial, and no conclusions can be
drawnwith respect to vitamin therapy and drug-eluting stents. The low need
for repeat target vessel revascularization after coronary artery stenting in
patients with drug-eluting stents suggests that vitamin therapy in these
patients may not be an issue.


file:///data/core-remote/dit/data/elsevier/pdf/7da/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMDc0MTUyMTQwNDAxMjgxOQ==.pdf

A simple but useful method of screening for mesenteric ischemia secondary to acute aortic dissection

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector