Further reports from the ACC 57th Scientific Session

A five-year study of 516 participants with coronary artery disease showed that patients who reduced their anxiety levels or kept them steady were 60% less likely to have a heart attack or die compared with those who had increased anxiety levels.

The association between anxiety and heart attack remained after adjusting for other risk factors, such as age, gender, smoking, hypertension, diabetes, body mass and cholesterol, according to Yinong Young-Xu PhD, of the Lown Cardiovascular Research Foundation, Brookline, Mass. ‘Pay attention to your emotional well-being. If you are having anxiety or depression, get treatment,’ he stressed.

Another trial found that smoking is the greatest predictor of recurrent cardiac events. Young heart attack victims who continue to smoke are three times more likely to have a second heart attack as those who quit smoking, said John Lekakis MD, of the University General Hospital Attikon, in Athens, Greece.

The study of 135 patients under 35 years showed that ejection fraction and smoking were equal risk factors. 95% of the subjects were smokers. Of those, 50% continued to smoke after the first heart attack while the other 50% quit smoking. In the first group, 50% then had a second heart attack. Of those who quit, only 18% suffered a second heart attack. ‘The persistence of smoking is the most powerful predictor of a heart attack,’ Dr Lekakis said.

Other research shows that men are at greater risk than women for cardiovascular problems. That difference disappears when the subjects are morbidly obese, noted Luigi Biasucci MD, of the Catholic University in Rome.

A study of 71 healthy patients with no signs of diabetes or heart disease divided the subjects into two groups. Group 1 involved 48 patients with a body mass index (BMI) of 20 to 39.9. Group 2 had 23 obese patients with a BMI of 40. In group 1, carotid plaques and hypertension were significantly lower in females than in males. In group 2, no significant differences were found.

Vascular protection device evaluated

The Society of Cardiovascular Angiography and Intervention (SCAI) were holding its Annual Scientific Session in conjunction with the ACC congress. The late breaking clinical trials sessions presented studies related to acute myocardial infarction and percutaneous coronary intervention (PCI).

The Angioplasty Balloon-Associated Coronary Debris and the EZ FilterWire (A-F) study evaluated the use of a vascular protection device during PCI among patients with no ST-elevation acute coronary syndromes at high risk for embolisation. In this study, the use of the filter during PCI was not associated with any differences in in-hospital major adverse coronary events (MACE) or post-procedure markers of myocyte necrosis compared with conventional PCI without the filter.

PCI is associated with myonecrosis in about 25% of patients with acute coronary syndrome. Distal embolism of atherosclerotic plaques or thrombi is a frequent cause, said Mark Webster MD, from the cardiac catheterisation lab at Auckland City Hospital, New Zealand.

The high-risk clinical features of the patients included elevated troponin levels, angina at rest and dynamic ST or T waves. While 42% of the patients had emboli recovered by the device, the use of the filter did not significantly reduce in-hospital MACE (11.7% with the device v. 9.5% for the control group) or myocardial damage.

 Several procedural factors are predictors of early stent thrombosis. The most important predictor is residual dissections, said Stephan Windecker MD, of Bern University Hospital, Switzerland. Other predictors include bifurcation stenting and longer stent length. Studies indicate that bifurcation stenting is associated with an increased risk of stent thrombosis. ‘With each centimetre of stent length the risk of early thrombosis increases twofold to threefold,’ he pointed out. 

To avoid these procedural problems, he advises avoiding stent overlays because they are associated with increased inflammation. He also suggests using stent platforms that prevent bifurcation and using a variable stent that prevents implanting overly long stents.

Premature discontinuation of antiplatelet therapy is shown to place patients at high risk for stent thrombosis, he said. Deaths were likely to occur within the first 90 days of discontinuation of antiplatelet therapy.


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