Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial.

Objectives: The purpose of this study was to compare the safety and efficacy of percutaneous coronary intervention (PCI) with stenting against coronary artery bypass grafting (CABG) in patients with diabetes and symptomatic multivessel coronary artery disease.

Background: CABG is the established method of revascularization in patients with diabetes and multivessel coronary disease, but with advances in PCI, there is uncertainty whether CABG remains the preferred method of revascularization.

Methods: The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), and stroke, and the main secondary outcome included the addition of repeat revascularization to the primary outcome events.

Enhanced external counterpulsation for treatment of refractory angina pectoris.

Objective: Enhanced external counterpulsation (EECP) is a noninvasive, well-tolerated treatment, effective for managing patients with refractory angina pectoris. The aim of this study was to evaluate the efficacy of EECP to relieve symptoms, to decrease myocardial ischaemia and to improve cardiac performance in patients with intractable angina, refractory to surgical and medical treatment.

Methods: Twenty-five patients (24 men and one woman, mean age 65 years) with persistent ischaemia notwithstanding optimal medical therapy or after interventional or surgical procedure, received EECP sessions for 35 h.

Coronary artery size and disease in UK South Asian and Caucasian men.

Objective: South Asian patients in the UK have a higher mortality rate after coronary artery bypass grafting (CABG) than Caucasian patients. As coronary artery size has been shown to correlate to outcome from bypass grafting, it has been suggested that smaller coronary arteries in South Asians as compared to Caucasians could contribute to a poorer outcome in the Asian population. We aimed to measure coronary artery size and disease in matched South Asian and Caucasian men undergoing first time coronary artery bypass grafting.

Enhanced external counterpulsation does not alter arterial stiffness in patients with angina.

Background: Enhanced external counterpulsation (EECP) is a noninvasive treatment for angina that acutely augments diastolic pressure and reduces cardiac afterload. However, the mechanism of the sustained clinical benefit seen with this therapy is not known.

Hypothesis: The study aimed to determine whether EECP leads to an improvement in arterial stiffness.

Arterial concentration of 99mTc-sestamibi at rest, during peak exercise and after dipyridamole infusion.

Tracers for myocardial perfusion imaging during stress should not only have high cardiac uptake but they should also have a fast blood clearance to prevent myocardial tracer uptake after the ischaemic stimulus. The present study characterize the early phase of the arterial (99m)Tc-sestamibi (MIBI) time-activity curve after venous bolus injection at rest, during peak exercise and after dipyridamole infusion. We included 11 patients undergoing angioplasty for one-vessel disease (rest study) and 20 patients evaluated for the detection of haemodynamic significant coronary stenoses by (99m)Tc-sestamibi single photon emission computed tomography (SPECT) using either bicycle exercise testing (10 patients) or standard dipyridamole testing (10 patients).

Insulin increases glycolysis without further vasodilation in porcine coronary arteries exposed to hypoxia.

In acute ischaemia, glucose-insulin-potassium administration reduces mortality and beta-adrenoceptor antagonists have favourable effects on the outcome of ischaemic heart disease. The present study was designed to investigate whether insulin (1.4x10(-7) M) and the beta-adrenoceptor antagonist, propranolol (10(-5) M), increase hypoxic vasodilation in correspondence with changes in glycolysis.

Postoperative infection with meticillin-resistant Staphylococcus aureus and socioeconomic background.

Infectious disease can be linked to social deprivation. We investigated whether postoperative infection with meticillin-resistant Staphylococcus aureus (MRSA) is related to socioeconomic background. Patients were stratified by social deprivation according to postcode.

Effect of enhanced external counterpulsation on dobutamine-induced left ventricular wall motion abnormalities in severe chronic angina pectoris.

We studied the effect of enhanced external counterpulsation (EECP) in 23 consecutive patients with stable angina pectoris who had a positive dobutamine stress echocardiogram. After EECP, stress-induced wall motion score (WMS) improved by > or =2 grades in 43% of the patients (n = 10); the average improvement was 5.3 +/- 3.

Excess coronary artery bypass graft mortality among women with hypothyroidism.

Background: The impact of thyroid disease on patients undergoing coronary artery bypass grafting has been reported in only small series of selected patients.

Methods: We investigated 30-day mortality of patients on thyroxine replacement therapy undergoing isolated coronary artery bypass grafting from 1993 to 2000 and identified variables of importance for outcome.

Results: A total of 3,631 patients (606 women) had isolated coronary artery bypass grafting of whom 58 patients (30 women) were treated for hypothyroidism.

Coronary collaterals during single-vessel coronary angioplasty: effects of nitroglycerin.

Background: Although the protective role of collaterals in coronary artery disease (CAD) is well known, the influence of drugs on collateral function remains controversial.

Hypothesis: We aimed to investigate prospectively the prevalence of spontaneously visible and recruitable coronary collaterals in consecutive patients with single-vessel CAD and the effect of systemic administration of nitroglycerin on these types of collaterals during percutaneous transluminal coronary angioplasty (PTCA).

Methods: Ipsi- and contralateral coronary artery contrast injections were performed before and during PTCA.

Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery.

We did an observational study in 2059 patients undergoing coronary artery bypass surgery to assess the effect of haemoglobin concentration on in-hospital mortality. We noted that individuals with a preoperative haemoglobin concentration of 100 g/L or less had a five-fold higher in-hospital mortality rate after surgery than those with a higher haemoglobin concentration, despite having had blood transfusions or the pump primed with blood preoperatively as a routine precaution. Our findings suggest that a low haemoglobin concentration is a marker of disease severity or comorbidity that has a major effect on survival rate.

Measurement of interstitial lactate during hypoxia-induced dilatation in isolated pressurised porcine coronary arteries.

Lactate is formed in the coronary arterial wall and in the myocardium as a consequence of ischaemia and infarction. We combined direct measurement of coronary artery diameter and interstitial arterial wall lactate concentration ex vivo in order to ascertain the possible role of lactate in hypoxia-induced vasodilatation. The wall of porcine coronary arteries, precontracted during an intraluminal pressure of 40 mmHg by addition of prostaglandin F2alpha, was cannulated using a microdialysis catheter, and exposed to hypoxia for 60 min, followed by 45 min of reoxygenation.