Predicting coronary events

Cardiology Review

has recently started publishing articles related to cardiovascular imaging and this month we include a report on myocardial perfusion scintography by Drs Poul Flemming Høilund-Carlsen and Allan Johansen from Denmark in the CAD section. The authors evaluated the potential impact of this technique as a “gatekeeper” for invasive examination and treatment in patients with stable angina pectoris. Their subjects were 507 angina patients referred for coronary angiography and the results of this study demonstrated that in their opinion almost 50% of the angiograms could be avoided. As Dr Richard Stewart notes in his commentary, this provocative study eliminated post-test referral bias; still, it has its limitations. He does urge physicians to place more emphasis on myocardial perfusion studies before proceeding to invasive studies. The issue also features an article in the lipid disorders section by Dr Sander J. Robins concerning the predictability of coronary events by lipoprotein particle subclass analysis rather than by conventional lipid parameters. During the Veterans Affairs High-Density Lipoprotein Intervention Trial, Dr Robins notes that changes in conventional lipid risk factors with gemfibrozil therapy did not completely explain the reduction in CAD events observed in 354 patients compared to 697 age-matched controls. He believes these benefits could be explained, however, by changes in the subparticles. The “take-home message for clinicians,” as discussed by Dr Ira Goldberg in his commentary, is simple: gemfibrozil has benefits in this patient group but Dr Goldberg feels more work still needs to be done to establish useful predictability indexes. In an article categorized in both the heart failure and CAD sections, Drs Doron Aronson and Mahmoud Suleiman from Israel prospectively studied the value of C-reactive protein (CRP) in predicting long-term risk of death and congestive heart failure in 1044 survivors of acute myocardial infarction. The mechanisms relating to the poor prognosis associated with elevated CRP levels may be linked to the post-infarction healing and remodeling process.

Despite some caveats noted in his commentary, Dr Steven Borzak concurs about the important clinical and therapeutic implications of this study. Finally, the issue once again contains questions designed to help physicians prepare for the Maintenance of Certification exam in Cardiovascular Disease. We hope you find this helpful as you continue your studies.