Causes of nonischemic sudden cardiac death in the current era

Causes of nonischemic sudden cardiac death in the current era: Background: Previous data have shown that various nonischemic cardiac diseases account for about 20% of sudden cardiac deaths (SCDs) and that dilated and hypertrophic cardiomyopathy (CM) are major causes of nonischemic SCD.Objective: The purpose of this study was to define the prevalence and causes of SCD due to nonischemic CM in the current era given the substantial change in the diagnosis and treatment of cardiac diseases and in lifestyle patterns.Methods: A total of 2661 consecutive victims of SCD from among a population of approximately 470,000 inhabitants in the Province of Oulu, Northern Finland, were included in the study. The causes of deaths were determined from the uniformly required autopsies of SCD victims in Finland, plus available medical records and standardized questionnaires.Results: Nonischemic cause of SCD was found in 579 victims (21.8% of all the SCDs). Mean age (± SD) was 55 (±12) years; 78% were males. After subgrouping the nonischemic SCDs into various categories, SCDs associated most closely with obesity (23.7%), followed by alcoholic CM (19.0%), hypertensive CM (15.5%), and fibrotic CM (13.6%). Fibrotic CM was the most common association with SCD in subjects younger than 40 years (28.3%), whereas alcoholic CM was the most common cause of death in subjects between 40 and 59 years of age (25.8%).Conclusion: CM related to obesity, fibrotic CM, and alcoholic CM are commonly associated with nonischemic SCD in the current era. The association of SCD with fibrotic CM is notably frequent among victims younger than 40 years.

Comparison of Long-Term Clinical and Angiographic Outcomes Following Implantation of Bare Metal Stents and Drug-Eluting Stents in Aorto-Ostial Lesions

Comparison of Long-Term Clinical and Angiographic Outcomes Following Implantation of Bare Metal Stents and Drug-Eluting Stents in Aorto-Ostial Lesions: Percutaneous coronary intervention (PCI) to aorto-ostial (AO) lesions is technically demanding and associated with high revascularization rates. The aim of this study was to assess outcomes after bare metal stent (BMS) compared to drug-eluting stent (DES) implantation after PCI to AO lesions. A retrospective cohort analysis was conducted of all consecutive patients who underwent PCI to AO lesions at 2 centers. Angiographic and clinical outcomes in 230 patients with DES from September 2000 to December 2009 were compared to a historical control group of 116 patients with BMS. Comparison of the baseline demographics showed more diabetics (32% vs 16%, p = 0.001), lower ejection fractions (52.3 ± 9.7% vs 55.0 ± 11.5%, p = 0.022), longer stents (17.55 ± 7.76 vs 14.37 ± 5.60 mm, p <0.001), and smaller final stent minimum luminal diameters (3.43 ± 0.53 vs 3.66 ± 0.63 mm, p = 0.001) in the DES versus BMS group. Angiographic follow-up (DES 68%, BMS 66%) showed lower restenosis rates with DES (20% vs 47%, p <0.001). At clinical follow-up, target lesion revascularization rates were lowest with DES (12% vs 27%, p = 0.001). Cox regression analysis with propensity score adjustment for baseline differences suggested that DES were associated with a reduction in target lesion revascularization (hazard ratios 0.28, 95% confidence interval 0.15 to 0.52, p <0.001) and major adverse cardiac events (hazard ratio 0.50, 95% confidence interval 0.32 to 0.79, p = 0.003). There was a nonsignificantly higher incidence of Academic Research Consortium definite and probable stent thrombosis with DES (n = 9 [4%] vs n = 1 [1%], p = 0.131). In conclusion, despite differences in baseline characteristics favoring the BMS group, PCI with DES in AO lesions was associated with improved outcomes, with lower restenosis, revascularization, and major adverse cardiac event rates.

Mayo Clinic scientists have demonstrated—for the first time—that patients with skeletal-muscle disease can register "false-positive" troponin tests..

http://www.theheart.org/article/1286567.do

probando desde movil

Probando desde movil

Gouty arthritis: Understanding the disease state and management options in primary care

Gouty arthritis: Understanding the disease state and management options in primary care:

Abstract  

Acute gouty arthritis is an inflammatory response triggered by the release of monosodium urate crystal deposits into the joint
space. The disease is associated with debilitating clinical symptoms and functional impairments as well as adverse economic
and quality-of-life burdens. Because gouty arthritis is typically diagnosed and managed in the primary care setting, clinicians
require a thorough knowledge of the presenting clinical features, risk factors, differential diagnoses, and treatment options
for appropriate management. Although generally effective, the use of currently available therapies to control gouty arthritis
is challenging because many medications used to treat comorbidities can exacerbate gouty arthritis and because current agents
are associated with a number of adverse events, contraindications, or both. Based on an understanding of the underlying inflammatory
pathogenesis of gouty arthritis, several new agents are being developed that may provide improved efficacy.

• Content Type Journal Article
• Category Review
• Pages 748-760
• DOI 10.1007/s12325-011-0058-5
• Authors
  
  
  • Prashanth Sunkureddi, The University of Texas Medical Branch (UTMB), 2060 Space Park Drive, Suite 208, Nassau Bay, TX 77058, USA
  
  

• Journal Advances in Therapy
• Online ISSN 1865-8652
• Print ISSN 0741-238X




• Journal Volume Volume 28




• Journal Issue Volume 28, Number 9