March 2008

A 42-year-old man was admitted to the hospital with severe chest pain that started 2 hours earlier.

A 66-year-old man with a history of nonischemic dilated cardiomyopathy and an ejection fraction of 20% presented to the outpatient heart failure clinic for routine follow-up.

Following are 2 cases of angiographically documented very late stent thromboses that occurred in patients enrolled in the Reduction of Restenosis in Saphenous Vein Grafts with Cypher Stent (RRISC) trial.

There is scant systematic literature available on acute aortic occlusion. A review of 46 cases in a single center found 2 primary causes, including embolism (65%) or thrombosis (35%).1 Smoking and diabetes were found to be the risk factors for thrombotic occlusion and pre-existing cardiac disease and female gender risk factors for embolism. Acute aortic occlusion due to embolization of a large thrombus from left atrial appendage occurred in a patient with atrial fibrillation at our institution recently (Radha Sharma,MD, personal communication, February 2008). Case reports have described embolization of atrial myxoma to the abdominal aorta resulting in aortoiliac occlusion.2,3

In a secondary post-hoc analysis of the Reduction of Restenosis in Saphenous Vein Grafts with Cypher (RRISC) trial, we compared the long-term safety of sirolimus-eluting stents (SES) with bare-metal stents (BMS) in diseased saphenous vein grafts

Progressive disease in saphenous vein grafts remains a major short-term and long-term clinical challenge after surgical revascularization.

We conducted a prospective, double-blind, randomized, multicenter study among 241 patients who underwent their first on-pump coronary artery bypass graft (CABG) surgery, aortic valve replacement (AVR), or combined CABG and AVR surgery to determine whether the use of hydrocortisone prevents atrial fibrillation after cardiac surgery. Results showed that the incidence of postoperative atrial fibrillation was significantly lower in the hydrocortisone group compared with the placebo group.

Atrial fibrillation (AF) is common after cardiac surgery, occurring in 11% to 40% of patients after coronary artery bypass grafting (CABG)1-8 and in more than 50% of patients after valvular heart surgery.

Triglyceride levels are usually measured after the patient has fasted, and then exclude remnant lipoproteins. Except for the first few hours of the morning, individuals are usually in a nonfasting state for most of the day. We investigated whether nonfasting triglyceride levels predicted the risk of myocardial infarction (MI), ischemic heart disease, and death in the general population. Results showed that increased nonfasting triglyceride levels were associated with an increased risk of MI, ischemic heart disease, and death.

Cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) have been used to estimate prognosis in heart failure. However, most studies have evaluated decompensated patients using single measurements. To determine the value of serial measurements, we evaluated 190 stable chronic heart failure patients every 3 months during 2 years.

Assessing prognosis in heart failure poses a challenge in clinical practice.