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Biomedical subjects

T Jared Bunch

Publications and source records attributed to T Jared Bunch.

At least 37 records · Page 2Linked to original sources
PubMed2005

Outcomes after cardiac perforation during radiofrequency ablation of the atrium.

BACKGROUND: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. METHODS: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. RESULTS: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 +/- 5.1 minutes). The total blood volume removed was 848 +/- 880 mL (left atrium/right atrium: 1,074 +/- 1,002 vs right ventricle: 396 +/- 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 +/- 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation. CONCLUSION: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.

Adult↗
PubMed2004

Early effects of statins in patients with coronary artery disease and high C-reactive protein.

Statins improve survival in patients with coronary artery disease, especially those with elevated C-reactive protein (CRP). Although some randomized studies have shown a delay in statin-related survival advantage of up to 2 years, recent studies demonstrated early (<2 months) survival benefit in certain patient groups. We hypothesized that this early benefit relates to baseline CRP concentration. Patients (n = 2,924) with significant, angiographically defined coronary artery disease (>/=70% stenosis in >/=1 coronary artery) were followed for an average of 2.4 years after discharged on a statin prescription. CRP was divided into tertiles (<1.2, 1.2 to 1.7, >1.7 mg/dl), and Kaplan-Meier methods were used to determine timing of statin benefit in both the overall population and a propensity score-matched subgroup. Cox regressions (multivariable and propensity score approaches) were used to predict mortality. Statins were prescribed for 28.4% of patients. In the first CRP tertile, no early statin benefit was observed (adjusted hazard ratio 0.69, 95% confidence interval [CI] 0.30 to 1.6, p = 0.39), and survival curves separated after >2 years. However, in the second and the third tertiles, statin survival curves separated much earlier ( approximately 3 months and 1 week, respectively) and statins predicted improved survival (second tertile: hazard ratio 0.63, 95% CI 0.32 to 1.2, p = 0.17; third tertile: hazard ratio 0.35, 95% CI 0.18 to 0.67, p = 0.002). Propensity score analysis confirmed both statin benefit and early timing. Thus, statin use in patients with high CRP provides not only a larger but also a significantly earlier absolute survival benefit than statin use in patients with lower CRP. This provides further evidence of an anti-inflammatory effect of statins.

Aged↗
PubMed2004

Analysis of catheter-tip (8-mm) and actual tissue temperatures achieved during radiofrequency ablation at the orifice of the pulmonary vein.

BACKGROUND: Many ablative approaches in or near the orifice of the pulmonary vein (PV) have demonstrated success in eliminating atrial fibrillation. Despite current practice, there are no data regarding the in vivo efficacy and safety of an 8-mm catheter tip for ablation at the PV orifice. METHODS AND RESULTS: Ten mongrel dogs were studied. Thermocouples were implanted in the atrial muscle of the PV orifice. Intracardiac echocardiography monitored catheter position, tip/tissue orientation, and microbubble formation. Ninety-four ablations were performed for 120 seconds. A temperature discrepancy >10 degrees C between the catheter tip and tissue occurred during 47 (50%) of the ablations. Despite termination of energy delivery, the average tissue temperature remained within 1 degrees C of the achieved steady state for 9 seconds. A temperature discrepancy >10 degrees C was more common in the right superior PV, with oblique catheter positioning, when tissue temperatures were >60 degrees C or 80 degrees C, and with type 1 or type 2 microbubble formation. However, microbubbles were not present in 7 (13%, type 1) and 10 (40%, type 2) ablations with tissue temperatures >80 degrees C. The maximum tissue temperature achieved with non-full-thickness lesions was 47.3+/-7.4 degrees C vs 75.9+/-11.7 degrees C (P<0.0001) for full-thickness lesions. CONCLUSIONS: Marked discrepancies between catheter-tip and tissue temperatures occurred with higher temperatures, prolonged ablation times, and unfavorable catheter thermistor-tissue contact. Also, these data suggest a conservative approach to atrial ablation, because full-thickness lesions were obtained when tissue temperatures reached 50 degrees C to 60 degrees C and the tissue retained high heat levels despite termination of radiofrequency energy. Finally, microbubbles are inconsistent markers of tissue overheating.

Animals↗
PubMed2004

The prognostic significance of exercise-induced atrial arrhythmias.

OBJECTIVES: The purpose of the study was to determine if atrial ectopy (AE) or atrial arrhythmias during exercise are predictive of an increased risk of cardiac events and death. BACKGROUND: Although stress-induced atrial arrhythmias are common during exercise testing, there is a paucity of data regarding the correlation with underlying heart disease and cardiovascular outcomes. Atrial arrhythmias may reflect underlying left atrial enlargement and diastolic dysfunction, which are prognostic of mortality. We hypothesized that these stress-induced arrhythmias are associated with long-term adverse cardiac events. METHODS: Exercise echocardiography was performed in 5,375 patients (age 61 +/- 12 years) with known or suspected coronary artery disease. An abnormal result was defined as exercise-induced atrial fibrillation (AF)/atrial flutter, supraventricular tachycardia (SVT), or AE. RESULTS: A total of 311 (5.8%) patients died (132 [2.5%] from cardiac causes) over a period of 3.1 +/- 1.7 years. In addition, 193 (3.6%) patients experienced a myocardial infarction (MI) and 531 (9.9%) patients required revascularization. During exercise testing, 1,272 (24%) patients developed AE, 185 (3.4%) developed SVT, and 43 (0.8%) developed AF. The five-year cardiac death rate was not statistically different between groups (none [3.8%], AE [4.3%], SVT [3.7%], AF [0%], p = 0.43). The five-year rate of MI was significantly different between groups (none [5.7%], AE [8.3%], SVT [0%], AF [9.0%], p = 0.005). The five-year rate of revascularization between groups was not significantly different (none [14.2%], AE [17.0%], SVT [11.8%], AF [14.8%], p = 0.50). A composite of all five-year adverse end points was similar between groups (none [22.7%], AE [27.8%], SVT [17.7%], AF [25.7%], p = 0.10). In stepwise multivariate analysis, AE was not predictive of myocardial infarction when taking into account traditional clinical variables and exercise test results. CONCLUSIONS: In this large cohort of patients, the occurrence of AE was predictive of an increased risk of MI. However, the association did not persist after adjustment for clinical and exercise variables known to predict adverse long-term cardiovascular outcomes. The rate of long-term cardiac death or revascularization was not influenced by the development of stress-induced atrial arrhythmias.

Aged↗
PubMed2004

Trends in treated ventricular fibrillation out-of-hospital cardiac arrest: a 17-year population-based study.

OBJECTIVES: The aims of this study were to describe the trends of ventricular fibrillation (VF) out-of-hospital cardiac arrest in Rochester, Minnesota, since 1985 and to determine coexistent trends in implantable cardioverter defibrillator (ICD) placement and termination of potentially lethal ventricular arrhythmias that might explain, at least in part, a declining incidence trend. BACKGROUND: The incidence of VF out-of-hospital cardiac arrest treated by emergency medical services (EMS) personnel has declined over the past decade. Because VF out-of-hospital cardiac arrest occurs primarily in the setting of severe coronary artery disease, primary and secondary prevention strategies may account in part for the decline. In particular, ICD use in large primary and secondary prevention clinical trials in patients at high risk of sudden death has demonstrated that these devices improve survival. METHODS: All residents of the City of Rochester, Minnesota, who presented with a VF out-of-hospital cardiac arrest from 1985 to 2002, identified and treated by EMS, were included in the study. In addition, residents of the City of Rochester who received their first ICD implant from 1989 to 2002 were identified. From the ICD records, general demographics, etiology of heart disease, comorbid medical disease, and indication for ICD placement were abstracted. Follow-up data obtained from this population included ICD shocks, the underlying rhythm disturbance, and death. RESULTS: The overall incidence of EMS-treated VF out-of-hospital cardiac arrest in Rochester during the study period was 17.1 per 100,000 [95% confidence interval (CI) 15.1-19.4]. The incidence has decreased significantly (P < 0.001) over the study period: 1985-1989: 26.3/100,000 (95% CI 21.0-32.6), 1990-1994: 18.2/100,000 (95% CI 14.1-23.1), 1995-1999: 13.8/100,000 (95% CI 10.4-17.9), 2000-2002: 7.7/100,000 (95% CI 4.7-11.9). One hundred ten patients received an ICD. The placement of ICDs also has increased dramatically over the past 10 years: 1990-1994: 5.0/100,000 to 2000-2002: 20.7/100,000 (P < 0.001). ICDs terminated VF or fast ventricular tachycardia (<270 ms) in 22 patients. Termination of these potentially fatal arrhythmias has shown a trend toward an increase over the study period: 1990-1994: 1.1/100,000 to 2000-2002: 3.5/100,000 (P = 0.06). CONCLUSIONS: The incidence of VF out-of-hospital cardiac arrest is declining. In contrast, the rates of ICD placement and ICD termination of ventricular tachycardia or VF are markedly increasing. Sudden death preventive strategies are multifactorial. These observations suggest that ICD termination of potentially lethal ventricular arrhythmias may contribute to the lower incidence of VF out-of-hospital cardiac arrest.

Aged↗
PubMed2004

Long-term subjective memory function in ventricular fibrillation out-of-hospital cardiac arrest survivors resuscitated by early defibrillation.

BACKGROUND: Brain injury after a cardiac arrest remains a major cause of morbidity. Programs focusing on early defibrillation have yielded improved survival of patients after hospital discharge following ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA). Early defibrillation that promptly restores a circulating rhythm should decrease the hypoxic period and subsequent organ injury. Therefore this study was designed to determine if long-term memory complaints persist in VF OHCA survivors resuscitated in an early defibrillation program when compared with a healthy control population not experiencing cardiac arrest. METHODS: All patients with an OHCA between November 1990 and January 2001 who received defibrillation by emergency medical services personnel in Olmsted County, MN, USA, were included. The memory function questionnaire (MFQ), a 64-item, 7-point Likert-scaled instrument to evaluate the perception of everyday memory functioning was sent to all survivors. The MFQ comprises four scales: general frequency of forgetting (rates general forgetting), retrospective functioning (compares current memory with past ability), seriousness of forgetting (rates how memory impairment impacts daily life), and mnemonics usage (measures adaptation). The MFQ is scaled so that high scores reflect less severe memory complaints. The comparison population comprised members of the Mayo Older Americans Normative Studies (MOANS) cohort. Quality of life was ascertained with a short form (SF)-36 survey. RESULTS: Seventy-nine of the 200 VF OHCA patients (40%) were discharged. Twenty-two patients have died since dismissal, with an overall average length of follow-up of 4.9+/-3.0 years. Thirty-eight (67%) of the survivors completed the MFQ. Compared with the normal, there was a significant decrease in the general frequency of forgetting score of 144.2+/-37.4 versus 168.1+/-27.3 ( P<0.001) and the seriousness of forgetting score of 84.8 +/-26.7 versus 95.2+/-19.7 (P=0.004). The retrospective function-scale scores were not significantly different ( 18.4+/-6.8 versus 18.7+/- 5.0 (P=0.74). Younger patients (lesser than 65 years of age) reported an increase in general forgetting and the seriousness of forgetting compared with older survivors. A comparison with SF-36 scores suggested an association between general forgetting and decreased vitality (P=0.03) and the seriousness of forgetting with a decreased general health (P=0.005), mental health (P=0.009), physical functioning ( P=0.02 ), and vitality ( P=0.05). CONCLUSION: In a cohort of VF OHCA patients, survivors report more memory complaints in comparison with a general healthy older population. There were more long-term-memory complaints in younger patients. Patients with higher long-term quality-of-life score have fewer memory complaints.

Adult↗
PubMed2004

Prediction of short- and long-term outcomes by electrocardiography in survivors of out-of-hospital cardiac arrest.

BACKGROUND: Programs focusing on early defibrillation have improved both short- and long-term survival of patients with VF out-of-hospital cardiac arrest (OHCA). Subsequent long-term management of survivors would be facilitated by a straight-forward, non-invasive method of identifying those at highest risk for recurrence. Therefore, we assessed the predictive value of the standard ECG to determine both short- and long-term outcomes in survivors of VF OHCA to assist in risk stratification of those patients at highest risk of sudden death. METHODS: All patients with an OHCA between November 1990 and December 2000 who received early defibrillation for VF in Olmsted County Minnesota (MN) were included. Cox proportional hazards modeling was used to examine ECG variables and subsequent ICD deployment and death. RESULTS: Two hundred patients presented in VF OHCA; of these 138 (69%) survived to hospital admission (seven died in the emergency department prior to admission) and 79 (40%) were discharged. The QRS duration (141 +/- 41ms in nonsurvivors, 123 +/- 35 in survivors, P = 0.004) was predictive of short-term mortality in patients who did not survive to hospital discharge. The ventricular rate, PR interval, presence of right or left bundle branch block, QTc, ST elevation myocardial infarction, and atrial fibrillation/flutter were nonpredictive. The average length of follow up for hospital dismissal survivors was 4.8 +/- 3.0 years. In univariate analysis, each 30 ms interval increase in the QRS width and PR interval was associated with increased mortality and ICD deployment hazard ratio of 1.6 (CI 1.1-2.5, P = 0.02) and 1.12 (CI 1.0-1.2, P = 0.05), respectively. In multivariate analysis accounting for admission ejection fraction, a PR > 200 ms [HR 4.5 (CI 1.7-11.8, P = 0.022)], QRS width increase greater than 30 ms [HR 1.9 (CI 1.3-2.8, P < 0.001)], and a QRS > 120 ms [HR 2.4 (CI 1.1-5.4, P = 0.032)] were predictive of long-term mortality and ICD shocks. CONCLUSION: Careful evaluation of the admitting and discharge ECG provides prognostic information for in-hospital and long-term outcomes, respectively in this cohort of out-of-hospital cardiac arrest survivors. The QRS duration on the dismissal ECG following VF OHCA provides prognostic information which might be useful to identify those at highest risk long-term, and who would benefit from more aggressive antiarrhythmic therapy and cardiac stabilization.

Aged↗
PubMed2004

Less affluent area of residence and lesser-insured status predict an increased risk of death or myocardial infarction after angiographic diagnosis of coronary disease.

PURPOSE: Low socioeconomic status (SES) predicts coronary artery disease (CAD) onset, but its value among patients with CAD is uncertain. Geographic measures (e.g., residential neighborhood) may predict risk, but this requires further evaluation. METHODS: A cohort of 3410 patients with significant, angiographically-defined CAD (> or =1 lesion of > or =70% stenosis) joined a registry during the period between 1993 and 2000 and was followed for 6.7 years (median 3.7 years). A geographic SES measure-residential economic status (RES)-and insurance type were examined for association with mortality or myocardial infarction (MI). RESULTS: In Cox regression adjusting for 17 covariates, lower RES quartile was associated with increased death/MI (p-trend<0.001), death (p-trend=0.001), and MI (p-trend=0.07). First RES quartile (vs. fourth) predicted death/MI (hazard ratio [HR]=1.32, 95% confidence interval [CI]=1.07-1.62, p=0.01) and death (HR=1.46, CI=1.12-1.91, p=0.006), but not MI (HR=1.18, p=0.31). Compared with private insurance, self-pay (HR=1.88, p=0.053), charity care (HR=1.71, p<0.001), and Medicaid (HR=1.43, p=0.24), but not Medicare (HR=0.95, p=0.68), were associated with death/MI. CONCLUSIONS: Both geographic (RES) and economic (insurance) measures of SES independently predicted risk of death/MI in a large population with angiographically-defined CAD. This suggests that SES remains a significant predictor of health outcomes after CAD has developed, and that geographic measures of SES deserve further evaluation.

Adult↗
PubMed2004

Impact of age on long-term survival and quality of life following out-of-hospital cardiac arrest.

OBJECTIVE: Early defibrillation programs have improved long-term outcomes following out-of-hospital cardiac arrest from ventricular fibrillation. Although long-term collective quality of life and survival are favorable, there are subsets of these patients who may be predisposed to worse outcomes. In particular, elderly patients may present with more comorbid medical conditions affecting their outcome. However, the impact of age on mortality rate and quality of life after rapid defibrillation is unknown. DESIGN: Observational study. SETTING: Hospital. SUBJECTS: All patients with an out-of-hospital cardiac arrest between November 1990 and January 2001 who received rapid defibrillation for ventricular fibrillation in Olmsted County, Minnesota. All patients received treatment at one hospital. INTERVENTIONS: Long-term outcome and quality of life were followed. Survival was estimated using the Kaplan-Meier method. The quality of life was established by an SF-36 survey. MEASUREMENTS AND MAIN RESULTS: Two hundred patients presented in ventricular fibrillation out-of-hospital cardiac arrest; of these, 138 (69%) survived to hospital admission, seven (4%) died in the emergency department, and 79 (39%) were discharged neurologically intact. The average age was 62+/-16 yrs, with 51% (n = 40) of the population > or =65. The average length of follow-up was 4.8+/-3.0 yrs. The 5-yr survival in patients <65 was 94% (confidence interval, 86-100%) and 66% (confidence interval, 52-84%) in patients > or =65 (p <.001). The observed survival in the younger group was not different from that expected in a U.S. age- and gender-matched population. However, in the older group, the expected survival was significantly lower compared with an age- and gender-matched U.S. population (p =.01) but similar to an age-, gender-, and disease-matched cohort of patients from Olmsted County not experiencing an arrest. In both age-dependent cohort populations, the quality of life scores crossed the norm in all categories with exception of vitality in patients >65 yrs old (42.6+/-7.2). In direct comparison between the two patient groups, the older cohort reported lower levels of physical functioning (p =.002), role-emotional score (p =.03), and role-physical score (p =.007). Other SF-36 scores were not different between the groups. Sixty-five percent of patients <65 yrs returned to work compared with 56% of older patients. CONCLUSIONS: The survival rate for ventricular fibrillation out-of-hospital cardiac arrest is significantly improved by the presence of a rapid defibrillation program. In patients <65 yrs old, long-term survival is equal to that of normal individuals and quality of life is similar to the general population. The survival, although high, in older patients is less than that in age-matched healthy controls, and physical and emotional quality of life scores are decreased.

Academic Medical Centers↗
PubMed2004

Patent foramen ovale and stroke.

A patent foramen ovale (PFO) is a frequent remnant of embryological development with clinical importance in thromboembolism, paradoxical embolism, stroke, platypnea-orthodeoxia, decompression sickness, and migraine headache. The proposed mechanisms of stroke with PFO include paradoxical embolization, in situ thrombosis within the canal of the PFO, associated atrial arrhythmias, and concomitant hypercoagulable states. Prospective trials using aspirin treatment to reduce recurrent stroke showed a significant recurrence of neurologic events in patients with a PFO and atrial septal aneurysm. Use of warfarin anticoagulation does not further reduce recurrent stroke rates compared with antiplatelet therapy. Both surgical and catheter-based modes of closure have been shown to decrease the rate of subsequent embolic events substantially. Successful closure, defined by transesophageal echocardiography, appears to predict freedom from subsequent embolic events. To our knowledge, no randomized trials comparing anticoagulation with surgical or catheter-based closure have been performed.

Echocardiography, Transesophageal↗
PubMed2004

Fatal coronary artery disease after unrelated donor bone marrow transplantation.

Several factors are responsible for the occurrence of cardiac complications after bone marrow transplantation (BMT). These factors include the cardiotoxic effects of radiation therapy, antineoplastic and immunosuppressive drugs, abnormal immunologic reactions associated with graft-vs-host disease, and infectious agents. We report the case of a 45-year-old woman with T-cell prolymphocytic leukemia and no prior risk factors for coronary artery disease in whom sudden cardiac death occurred 2 1/2 years after allogeneic BMT from an unrelated male donor. Autopsy revealed severe 3-vessel coronary disease with grade 4/4 stenosis. This process was primarily nonatherosclerotic, with intimal hyperplasia of undetermined etiology. Furthermore, fluorescence in situ hybridization to identify the donor Y chromosome with simultaneous immunofluorescence labeling of smooth muscle actin suggested the presence of donor cells that transformed into myocytes. Coronary artery disease is an important, albeit rare, complication of BMT. Donor hematopoietic cells may contribute to its pathogenesis.

Bone Marrow Transplantation↗
PubMed2004

Outcomes and in-hospital treatment of out-of-hospital cardiac arrest patients resuscitated from ventricular fibrillation by early defibrillation.

OBJECTIVE: To describe and evaluate the in-hospital treatment of ventricular arrhythmias and underlying structural heart disease in patients who survive ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) in a region with a high survival rate after hospital discharge. PATIENTS AND METHODS: The study included all patients presenting in Olmsted County, Minnesota, who had experienced OHCA between November 1990 and December 2000 and who underwent defibrillation of VF by an emergency medical service system. RESULTS: Of 200 patients who experienced VF arrest, 138 (69%) survived to hospital admission (7 died in the emergency department before admission), and 79 (40%) were discharged. Of patients who were discharged, 37 (47%) had a reversible cause of the arrest (perimyocardial infarction) and received treatment of the primary process. The other 42 patients who were discharged had ischemic coronary heart disease (CHD) (n=25), nonischemic CHD (n=10), or idiopathic VF (n=7). Four of the patients with CHD but no left ventricular dysfunction were treated with coronary artery bypass grafting or percutaneous coronary intervention alone. A total of 52 patients (66%) were candidates for electrophysiologic testing. Of these patients, 48 (92%) underwent electrophysiologic testing; of these patients, 10 received amiodarone alone, and 35 received an implantable cardioverter-defibrillator (ICD) (of whom 3 also received amiodarone). Patients who did not receive ICD therapy typically presented before 1998 with CHD and underwent coronary artery bypass grafting or percutaneous coronary intervention only. Of 79 patients who were discharged, 14 (18%) with an ICD have received subsequent shocks. Nineteen (24%) of 79 patients have died, 5 of a primary cardiac etiology (including 2 with repeated OHCA). CONCLUSIONS: The VF OHCA survival rate is high in the setting of rapid defibrillation, with 40% of patients being discharged from the hospital. By the end of the 10-year study, more patients were receiving antiarrhythmic therapy, in particular ICD implantation, after hospital admission. Overall, the long-term survival in patients with VF OHCA is favorable.

Aged↗
PubMed2003

Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation.

BACKGROUND: Mortality after out-of-hospital cardiac arrest from ventricular fibrillation is high. Programs focusing on early defibrillation have improved the rate of survival to hospital discharge. We conducted a population-based analysis of the long-term outcome and quality of life of survivors. METHODS: All patients who had an out-of-hospital cardiac arrest between November 1990 and January 2001 who received early defibrillation for ventricular fibrillation in Olmsted County, Minnesota, were included. The survival rate was compared with that of an age-, sex-, and disease-matched (2:1) control population of residents who had not had an out-of-hospital cardiac arrest and with that of age- and sex-matched controls from the general U.S. population. The quality of life was assessed with use of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and compared with U.S. population norms. RESULTS: Of 200 patients who presented with an out-of-hospital cardiac arrest with ventricular fibrillation, 145 (72 percent) survived to hospital admission (7 died in the emergency department) and 79 (40 percent) were neurologically intact (good overall capability or moderate overall disability) at discharge. The mean (+/-SD) length of follow-up was 4.8+/-3.0 years. Nineteen patients died after discharge from the hospital. The expected five-year survival rate (79 percent) was identical to that among age-, sex-, and disease-matched controls (P=0.68) but lower than that among the age- and sex-matched U.S. population (86 percent, P=0.02). Fifty patients completed SF-36 surveys at the end of follow-up, and the majority had a nearly normal quality of life, with the exception of reduced vitality. CONCLUSIONS: Long-term survival among patients who have undergone rapid defibrillation after out-of-hospital cardiac arrest is similar to that among age-, sex-, and disease-matched patients who did not have out-of-hospital cardiac arrest. The quality of life among the majority of survivors is similar to that of the general population.

Aged↗
PubMed2003

Smooth muscle cells in human coronary atherosclerosis can originate from cells administered at marrow transplantation.

Atherosclerosis is the major cause of adult mortality in the developed world, and a significant contributor to atherosclerotic plaque progression involves smooth muscle cell recruitment to the intima of the vessel wall. Controversy currently exists on the exact origin of these recruited cells. Here we use sex-mismatched bone marrow transplant subjects to show that smooth muscle cells throughout the atherosclerotic vessel wall can derive from donor bone marrow. We demonstrate extensive recruitment of these cells in diseased compared with undiseased segments and exclude cell-cell fusion events as a cause for this enrichment. These data have broad implications for our understanding of the cellular components of human atherosclerotic plaque and provide a potentially novel target for future diagnostic and therapeutic strategies.

Adult↗
PubMed2003

Beta-blockers reduce the incidence of clinical restenosis: prospective study of 4840 patients undergoing percutaneous coronary revascularization.

BACKGROUND: Restenosis after percutaneous transluminal coronary intervention (PCI) remains a serious complication in the treatment of coronary artery disease. Although beta-adrenergic receptor blockers (BBs) effectively reduce many cardiac events, no large prospective studies have examined the association of BBs with restenosis. METHODS: We prospectively evaluated the association of BBs (prescribed at hospital discharge) with clinical restenosis in 4840 patients who underwent stent placement (60%), balloon angioplasty (32%), or rotational atherectomy (8%). Clinical restenosis was defined as repeat target lesion revascularization or coronary artery bypass grafting within 6 months of PCI. Other end points included 9-month clinical restenosis, repeat target lesion PCI (only), long-term (5-year) target lesion repeat-PCI, and major adverse cardiac events (MACE). Multivariable regression adjusted the effect of BBs on clinical restenosis for 15 covariables. RESULTS: The average patient age was 63 years, 75% were men, and 37% received a BB prescription. The incidence of clinical restenosis was 12% overall and was lower among those prescribed a BB (10.0% for BB, 13.5% for none, adjusted odds ratio [OR] 0.76, P =.004). Other predictors of decreased restenosis included stent use, age, and smoking; predictors of increased restenosis included diabetes, atherectomy, and number of treated vessels. BBs also reduced 9-month clinical restenosis (10.3% vs 13.5%, OR 0.75, P =.004), MACE (16.5% vs 20.9%, OR 0.75, P <.001), 6-month target lesion restenosis (7.8% vs 10.2%, OR 0.75, P =.006), and 5-year target lesion restenosis (12.0% vs 14.0%, OR 0.83, P =.046). CONCLUSIONS: beta-Adrenergic receptor blockers prescribed after PCI reduced the risk of clinical restenosis, target lesion restenosis, and MACE in this cohort of 4840 patients. The mechanism by which beta-blockers conferred a protective effect against restenosis remains to be determined.

Adrenergic beta-Antagonists↗
PubMed2003

Subepicardial aneurysm of the left ventricle.

Three patients are presented in whom a subepicardial aneurysm developed as a complication of a myocardial infarction. This aneurysm of the left ventricle is unusual and has 3 distinctive traits: an abrupt interruption of the myocardium that comprises the mouth and typically a narrow neck of the aneurysm; aneurysmal wall comprised of epicardium with or without a thin myocardial layer; and a propensity to rupture spontaneously regardless of the wall components or stage of development. All 3 patients were given a diagnosis using echocardiography and underwent immediate surgical aneurysmectomy. One patient died as a result of renal and respiratory failure postoperatively. The long-term outcome of the other 2 patients was favorable without evidence of additional cardiac rupture or instability.

Aged↗