Coronary artery disease and its management: influence on survival in patients undergoing aortic valve replacement.

Data from 1,156 patients greater than or equal to 30 years of age who underwent aortic valve replacement alone or with coronary artery bypass grafting from 1967 through 1976 (early series) and 227 similar patients operated on during 1982 and 1983 (late series) were reviewed. In the early series, 414 patients (36%) had preoperative coronary arteriography (group 1): group 1A (n = 224) did not have coronary artery disease, group 1B (n = 78) had coronary artery disease but did not undergo bypass grafting and group 1C (n = 112) had coronary artery disease and underwent bypass grafting. The 742 patients in group 2 did not have preoperative arteriography.

Clinical correlations of antibodies that bind, block, or modulate human acetylcholine receptors in myasthenia gravis.

Acetylcholine receptor (AChR) binding and AChR modulating antibodies were found with approximately the same frequency (86%) in 349 patients with myasthenia gravis (MG). However, the total yield of positive serological results was significantly improved (90%) by assaying AChR modulating antibodies when AChR binding antibodies were not detected, because in 27 patients (8%) only one of the two tests was positive. The immunoprecipitation test for AChR blocking antibodies yielded fewer positive results (52%), but there was a significant correlation between the degree of AChR blockade and generalization of muscle weakness.

Coronary heart disease in residents of Rochester, Minnesota. VII. Incidence, 1950 through 1982.

An epidemiologic study of coronary heart disease in residents of Rochester, Minnesota, has been updated through 1982. Between the time that mortality rates began to decline in the late 1960s and now, the age-adjusted incidence of all types of coronary heart disease in residents of Rochester decreased 11% in men but increased 9% in women. This difference was due mainly to changes in the incidence of myocardial infarction as the initial manifestation of coronary heart disease-in men, the rates declined by 20%, whereas the rates for women increased by 17%.

The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival.

Using the unique data resources of the Rochester Epidemiology Project, a community-based study of clinically diagnosed sarcoidosis was conducted. In this population-based study, the 75 Rochester, Minnesota, residents with sarcoidosis initially diagnosed between 1946 and 1975 (incidence cohort) were followed through their comprehensive medical records in the community to January 1, 1982. The age- and sex-adjusted incidence of sarcoidosis was 6.

Coronary heart disease in residents of Rochester, Minnesota. VI. Hospital and posthospital course of patients with transmural and subendocardial myocardial infarction.

During the period 1960 through 1979, 1,221 residents of Rochester, Minnesota, who were 30 years of age or older had a myocardial infarction as the first manifestation of coronary heart disease. Patients who had a prior diagnosis of congestive heart failure or valvular heart disease were excluded from this study. Of the 1,221 patients, 784 had a transmural infarction, 353 had a subendocardial infarction, and 84 had infarctions that could not be classified (most of the unclassified infarctions were associated with sudden death in patients who were not hospitalized).

Coronary heart disease in residents of Rochester, Minnesota. V. Prognosis of patients with coronary heart disease based on initial manifestation.

During the period 1960 through 1979, 1,014 residents of Rochester, Minnesota, had a diagnosis of classic angina pectoris as the first manifestation of coronary heart disease, and 1,013 had a myocardial infarction as the initial manifestation. In the angina cohort, about 50% were men, and of them, 20% were 70 years old or older. The female patients were an average of 6 years older than the men, and 43% were 70 years old or older.

Mitral regurgitation due to ruptured chordae tendineae. Early and late results of valve repair.

From 1958 through 1980, 131 patients had repair of ruptured chordae tendineae of the mitral valve; 62% were men. Ages ranged from 5 to 70 years (median 57). Chordae to the anterior mitral leaflet were ruptured in 44 patients (34%), to the posterior mitral leaflet in 85 (65%), and to both leaflets in two patients (1%).

Follow-up clinical results in patients undergoing percutaneous transluminal coronary angioplasty.

Complete follow-up data were obtained from 229 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) between 1979 and 1982 (mean follow-up 14 months, range 6 to 37). Single-vessel disease was present in 143 and multivessel disease in 86. PTCA was successful in 153 patients (67%).

Epidemiology of systemic lupus erythematosus and other connective tissue diseases in Rochester, Minnesota, 1950 through 1979.

The incidence and prevalence rates of connective tissue disease syndromes in Rochester, Minnesota, from 1950 through 1979 are reported. The incidence of definite systemic lupus erythematosus (SLE) has not increased since 1960. The incidence of SLE in the elderly population was higher than that in previous reports.

The angiographic spectrum of coronary artery disease.

A wide spectrum of coronary arteriographic anatomic findings exists in patients presenting with clinically stable and unstable angina pectoris. Although some generalizations about the clinical-angiographic correlations can be made, we are continuously reminded of the frequent individual patient whose findings fall well outside of these generalizations. The majority of patients will have double- or triple-vessel coronary disease, with approximately 10 percent having in addition a left main coronary artery stenosis of at least 50 percent luminal diameter narrowing.

Continued high incidence of coronary artery disease at autopsy in Olmsted County, Minnesota, 1950 to 1979.

The autopsy records of all people over 30 years old who died and underwent autopsy in Olmsted County from 1950 through 1979 were reviewed (n = 5558, autopsy rate approximately 50%). The hearts of 530 subjects were reexamined for the severity of coronary artery disease and this determination was compared with the recorded grade. After both record and specimen the three major coronary arteries were graded according to percent reduction in luminal area (1 = 0 to 25%; 2 = 26% to 50%; 3 = 51% to 75%; 4 = 76% to 99%; 5 = occlusion).

Cold pressor test as a predictor of hypertension.

To determine the usefulness of the cold pressor test as a predictor of hypertension, we compared the blood pressure recordings available from 142 patients in 1979 with readings obtained during performance of two cold pressor tests, the first in 1934 when these subjects were children, and the second in 1961. Forty-eight subjects were hyperreactors to the tests in either 1934 or 1961, and 94 were normoreactors. At last follow-up, blood pressures in 14 of the hyperreactors were between 140 and 160 mm Hg systolic or 90 and 100 mm Hg diastolic (Stratum 1) and in 20 exceeded 160 mm Hg systolic or 100 mm Hg diastolic (Stratum 2).

Coronary heart disease in residents of Rochester, Minnesota. IV. Prognostic value of the resting electrocardiogram at the time of initial diagnosis of angina pectoris.

The data in this study were based on the 1,154 Rochester residents in whom a resting electrocardiogram had been obtained at the time of diagnosis of angina pectoris as the initial manifestation of coronary heart disease during the 26-year period 1950 through 1975. The finding of a normal electrocardiogram at the time of the initial diagnosis of angina pectoris was associated with a good prognosis. Survival at 5 years was equal to that expected, for the given age and sex distribution, under a cohort life table for the Minnesota white population.

Aortic and mitral valve incompetence: long-term follow-up (10 to 19 years) of patients treated with the Starr-Edwards prosthesis.

The long-term course (mean 15 years) of 336 patients with valvular incompetence who underwent Starr-Edwards ball valve implantation between 1962 and 1971 was reviewed. Eighteen patients (10%) with aortic valve replacement and 24 (16%) with mitral valve replacement died early postoperatively. Mortality remained high (31%) in the first 3 years after aortic valve replacement; it was highest (13%) in the first year after mitral valve replacement and then approached the normal rate.

ALS and heavy metals: a pilot case-control study.

We conducted a case-control study of suspected risk factors for ALS among referral patients seen at the Mayo Clinic. Responses to questions about demographic factors, diet, medical history, travel, infectious disease, and other variables were similar in ALS patients and controls. In all but a few items, the responses of the cases and controls did not differ significantly.

Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations.

To study the prevention of occlusion of aortocoronary-artery bypass grafts, we concluded a prospective, randomized, double-blind trial comparing long-term administration of dipyridamole (begun two days before operation) plus aspirin (begun seven hours after operation) with placebo in 407 patients. Results at one month showed a reduction in the rate of graft occlusion in patients receiving dipyridamole and aspirin. At vein-graft angiography performed in 343 patients (84 per cent) 11 to 18 months (median, 12 months) after operation, 11 per cent of 478 vein-graft distal anastomoses were occluded in the treated group, and 25 per cent of 486 were occluded in the placebo group.

The dichotomy of myocardial and cerebral infarction.

The Mayo Clinic medical record linkage and indexing system was used to examine changes in incidence and case fatality of myocardial infarction (MI), sudden unexpected death (SUD), and cerebral infarction (CI). The average annual age and sex adjusted incidence rates for MI (including SUD) and CI declined by 14% and 55%, respectively, between 1950-54 and 1975-79. The decline in the incidence of MI was due to a reduction in sudden unexpected death (SUD), greatest in younger persons.

Employment and recreation patterns in patients treated by percutaneous transluminal coronary angioplasty: a multicenter study.

Employment and recreational patterns were analyzed in 279 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) for treatment of symptomatic coronary artery disease. PTCA was successful in 180 patients (65%). When it was unsuccessful, coronary artery bypass graft surgery was usually performed (80%).

Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole.

Despite the use of oral anticoagulation in patients with prosthetic heart valves, persistent thromboembolism over time warrants a search for improved methods of prevention. Thus, patients receiving 1 or more mechanical prosthetic heart valves were randomized to therapy with warfarin plus dipyridamole (400 mg/day) or warfarin plus aspirin (500 mg/day) on the basis of location and type of valve and surgeon, and followed up with a concurrent, nonrandomized control group taking warfarin alone. In 534 patients followed up 1,319 patient-years, excessive bleeding (necessitating blood transfusion or hospitalization) was noted in the warfarin plus aspirin group (23 of 170 [14%], or 6.

Coronary heart disease in residents of Rochester, Minnesota, 1950-1975. III. Effect of hypertension and its treatment on survival of patients with coronary artery disease.

The data in this blood pressure study were obtained from 1,069 patients who had their first manifestation of coronary artery disease during the 16-year period 1960 through 1975. Case fatality rates (death within 30 days) were least in the normotensive and treated hypertensive patients with myocardial infarction and greatest in the untreated hypertensive patients. Women were less likely than men to acquire coronary artery disease, but a higher proportion of women with coronary artery disease had hypertension.

Transient ischemic attack and stroke in a community-based diabetic cohort.

The role of hypertension was evaluated as a factor in the increased frequency of cerebrovascular disease in a community-based diabetic cohort. Hypertension was found to account only in part for the increased frequency of transient ischemic attacks in the diabetic patient but appeared to account entirely for the increased frequency of stroke in these patients. Most transient ischemic attacks were found to arise from the carotid circulation.

Daily and seasonal variation in sudden cardiac death, Rochester, Minnesota, 1950-1975.

Incidence cases of coronary heart disease that occurred in Rochester, Minnesota, during the years 1950 through 1975 were used for a study of the distribution of sudden cardiac death (1,054 cases) by day of the week and season of the year. Overall, sudden cardiac death--that is, death within 24 hours of onset of symptoms--occurred with greater frequency on Saturdays than on other days of the week. The frequency of occurrence of sudden cardiac death by season varied somewhat--the highest frequency was in winter and the lowest in summer-- but no more than expected by chance.