Explore the vast range of titles available.

Glycoprotein IIb/IIIa inhibitors are used routinely in patients with acute coronary syndromes who are undergoing invasive procedures, but the optimal timing of administration is unknown. The early, routine use of eptifibatide was found to be no better than the delayed, provisional use of the drug and was associated with more bleeding. The early, routine use of eptifibatide was found to be no better than the delayed, provisional use of the drug and was associated with more bleeding. The optimal timing for the initiation of treatment with glycoprotein IIb/IIIa inhibitors in patients who have acute coronary syndromes without ST-segment elevation and are undergoing invasive procedures has not been determined. It is also not clear whether such treatment should be administered routinely to all such patients before the procedure or whether such treatment should be provisional. The 2007 guidelines of the American College of Cardiology and the American Heart Association 1 recommend that patients with high-risk features receive aspirin and either clopidogrel or a glycoprotein IIb/IIIa inhibitor before angiography (i.e., early therapy) (class I recommendation). The European Society of Cardiology . . .

In the COURAGE trial, percutaneous coronary intervention (PCI), added to optimal medical therapy, did not reduce the subsequent rate of death or myocardial infarction among patients with chronic coronary disease. A quality-of-life analysis showed that measures of health status improved significantly with either strategy, but patients in the PCI group had greater initial improvements. In the COURAGE trial, percutaneous coronary intervention (PCI), added to optimal medical therapy, did not reduce the subsequent rate of death or myocardial infarction among patients with chronic coronary disease. A quality-of-life analysis showed that measures of health status improved significantly with either strategy, but patients in the PCI group had greater initial improvements. Clinical trials involving patients with chronic coronary artery disease, in contrast to those involving patients with acute coronary syndromes, have not shown that percutaneous coronary intervention (PCI) prevents major cardiovascular events. 1 – 5 The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial compared a strategy of PCI plus optimal medical therapy with optimal medical therapy alone and showed no significant difference in the rate of the primary end point (death or myocardial infarction) during a median follow-up period of 4.6 years. 6 Among patients with stable coronary artery disease, PCI is indicated for the relief of angina. 2 , 3 , 7 , . . .

Despite the advances in the treatment of cardiovascular diseases, effective treatment remains to be established to improve the quality of life and prognosis of patients with chronic coronary syndromes. This study was aimed to evaluate the effectiveness and safety of the low-intensity pulsed ultrasound (LIPUS) therapy, which we have developed as a novel non-invasive angiogenic therapy through upregulation of endothelial nitric oxide synthase (eNOS). We conducted a randomized, double-blind, placebo-controlled (RCT) pilot trial of the LIPUS therapy for patients with refractory angina pectoris. The patients who received optimal medical therapy without indication of PCI or CABG due to the lack of graftability or complexity of coronary lesions were enrolled. They were randomly divided into the LIPUS treatment group (N = 31) and the placebo group (N = 25) in a 1:1 fashion. The LIPUS therapy was performed in a transthoracic manner for 20 min for 3 sections each (mitral, papillary muscle, and apex levels) under the conditions that we identified; frequency 1.875 MHz, intensity 0.25 MPa, and 32 cycles. The primary endpoint was weekly use of nitroglycerin. Secondary endpoints included stress myocardial perfusion imaging and others. The average weekly nitroglycerin use (times/week) was decreased from 5.50 to 2.44 in the LIPUS group and from 5.94 to 2.83 in the placebo group. The changes in the average weekly nitroglycerin use were comparable; -3.06 (95% CI: -4.481 to -1.648) in the LIPUS group (P<0.01) and -3.10 (95% CI: -4.848 to -1.356) in the placebo group (P<0.01). No adverse effects were noted. In the present study, the LIPUS therapy did not further ameliorate chest pain as compared with optimal medications alone in patients with refractory angina pectoris. The present findings need to be confirmed in another trial with a large number of patients. (Registration ID: UMIN000012369).

BackgroundAngina, a major manifestation of ischaemic heart disease, affects 3–7% of adults and is a leading cause of cardiovascular morbidity. As an ambulatory care-sensitive condition, its outcomes can be improved through proactive outpatient management. However, the real-world impact of continuity of care (COC) and medication adherence, measured by the medication possession ratio (MPR)—on angina complications in South Korea remains poorly understood.ObjectiveThis study evaluated the effectiveness of COC and MPR in patients with angina using comprehensive national data and examined the outcomes at the hospital level.MethodsThis retrospective cohort study used data from the National Health Insurance Service of Korea between 2002 and 2019. We identified 11 127 patients aged >30 years newly diagnosed with angina, applying strict exclusion criteria to ensure cohort validity. COC was categorised as high (COC index=1.0) or low (<1.0), and MPR was classified as excellent (≥80%), good (60%–79%) or poor (<60%). Complications, defined as the onset of coronary artery disease (International Classification of Diseases, 10th Revision: I20–I25), were analysed using Kaplan-Meier survival curves and Cox proportional hazards models, adjusting for key sociodemographic and clinical covariates.ResultsAmong the study cohort (mean age 63.4 years; 54.3% female), 64.2% had low COC. While patients with low COC had a 20% higher risk of complications compared with those with high COC (HR: 1.20; 95% CI: 0.87 to 1.65; p=0.266), this was not statistically significant. Similarly, patients with poor MPR had a modestly elevated but non-significant risk (HR: 0.96; 95% CI: 0.67 to 1.36). Subgroup analysis revealed significantly elevated complication risk in patients ≥80 years with low COC (HR: 2.00; 95% CI: 1.67 to 2.32; p=0.04). The lowest complication rates were observed in patients receiving care from clinics with high COC and excellent MPR.ConclusionsHigher levels of COC and MPR were associated with reduced angina-related complications, underscoring their importance in chronic disease management. However, the inconsistent statistical significance suggests disease-specific strategies may be needed to optimise continuity and adherence interventions. These findings have implications for refining ambulatory care models and enhancing chronic disease policies within Korea’s single-payer system.

ObjectiveTo assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation.MethodsDuring 2003–2005, all patients with refractory angina referred for SCS treatment at 10 European centres were consecutively included in the European registry for refractory angina (European Angina Registry Link, EARL), a prospective, 3-year follow-up study. In the present study, the SCS-treated patients were followed-up regarding angina symptoms and quality of life assessed was with a generic (Short Form 36, SF-36) and a disease-specific (Seattle Angina Questionnaire, SAQ) quality of life questionnaire.ResultsIn total, 235 patients were included in the study. After screening, 121 patients were implanted and followed up 12.1 months after implantation. The implanted patients reported fewer angina attacks (p<0.0001), reduced short-acting nitrate consumption (p<0.0001) and improved Canadian Cardiovascular Society class (p<0.0001). Furthermore, quality of life was significantly improved in all dimensions of the SF-36 and the SAQ. Seven (5.8%) of the implanted patients died within 1 year of follow up.ConclusionsSCS treatment is associated with symptom relief and improved quality of life in patients with refractory angina pectoris suffering from severe coronary artery disease.

Patients with stable coronary artery disease were randomly assigned to fractional flow reserve–guided PCI or medical therapy. At 5 years, the composite of death, myocardial infarction, or urgent revascularization was significantly less frequent in the PCI group.

The multicentre, randomised Benestent-II study investigated a strategy of implantation of a heparincoated Palmar-Schatz stent plus antiplatelet drugs compared with the use of balloon angioplasty in selected patients with stable or stabilised unstable angina, with one or more de-novo lesions, less than 18 mm long, in vessels of diameter 3 mm or more. 827 patients were randomly assigned stent implantation (414 patients) or standard balloon angioplasty (413 patients). The primary clinical endpoint was event-free survival at 6 months, including death, myocardial infarction, and the need for revascularisation. The secondary endpoints were the restenosis rate at 6 months and the cost-effectiveness at 12 months. There was also one-to-one subrandomisation to either clinical and angiographic follow-up or clinical follow-up alone. Analyses were by intention to treat. Four patients (one stent group, three angioplasty group) were excluded from analysis since no lesion was found. At 6 months, a primary clinical endpoint had occurred in 53 (12·8%) of 413 patients in the stent group and 79 (19·3%) of 410 in the angioplasty group (p=0·013). This significant difference in clinical outcome was maintained at 12 months. In the subgroup assigned angiographic follow-up, the mean minimum lumen diameter was greater in the stent group than in the balloon-angioplasty group, (1·89 [SD 0·65] vs 1·66 [0·57] mm, p=0·0002), which corresponds to restenosis rates (diameter stenosis ≥50%) of 16% and 31% (p=0·0008). In the group assigned clinical follow-up alone, event-free survival rate at 12 months was higher in the stent group than the balloon-angioplasty group (0·89 vs 0·79, p=0·004) at a cost of an additional 2085 Dutch guilders (US$1020) per patient. Over 12-month follow-up, a strategy of elective stenting with heparin-coated stents is more effective but also more costly than balloon angioplasty.

Background/Objectives: A large number of patients with coronary artery disease experience angina that is not suitable for revascularization and is refractory to conventional medical therapy. Laboratory and preclinical studies have provided evidence for the safety and potential efficacy of autologous CD34+ stem cell therapies as treatment for angina. Clinical studies investigating intramyocardial transplantation of autologous CD34+ stem cells by catheter injection for patients with refractory angina show that this is safe and feasible. It remains unclear whether intracoronary infusion of CD34+ stem cells exerts beneficial effects in patients with angina as well. We addressed this question with a controlled clinical trial by enrolling 112 patients with refractory angina. Previous trials have investigated the safety and beneficial effects of CD34+ cells isolated from granulocyte colony-stimulating factor-mobilized peripheral blood; in our trial, we isolated CD34+ cells directly from the patient’s bone marrow. Methods: One hundred and twelve patients with diffuse triple-vessel disease and Canadian Cardiovascular Society class III or IV angina were enrolled in a double-blind, randomized (1:1), placebo-controlled study. Patients received optimal medical treatment but were not candidates for mechanical revascularization (percutaneous coronary intervention or coronary artery bypass grafting). Fifty-six patients (27 women and 29 men aged 42–80 years) were enrolled in the treatment group, and 56 patients (28 women and 28 men aged 43–80 years) who received optimal medical treatment and intracoronary saline injections were enrolled in the placebo control group. Bone marrow was collected from all enrolled patients at a volume of 120–150 ml each in both groups. Selections of CD34+ cells were performed by a CE-marked device approved by the Security, Food and Drug Administration of China. Coronary angiography had been performed before enrollment in this study. Results: No myocardial infarction was observed during intracoronary infusion. The intracoronary infusion of cells or saline did not result in cardiac enzyme elevation, cardiac perforation or pericardial effusion. No arrhythmia, such as ventricular tachycardia or ventricular fibrillation, was induced by intracoronary infusion. No serious adverse events occurred in either group. The reduction in the frequency of angina episodes per week 3 and 6 months after infusion was significantly higher in the treatment group (–14.6 ± 4.8 at 3 months and –15.6 ± 4.0 at 6 months) than in the control group (–4.5 ± 0.3 and –3.0 ± 1.2, respectively; p < 0.01). Other efficacy parameters such as nitroglycerine usage, exercise time and the Canadian Cardiovascular Society class also showed an improvement in the treatment group compared to the control group. A significant improvement in myocardial perfusion was noted in the treatment group compared to the control group, as measured by single-photon emission computed tomography. Conclusions: This randomized trial investigating intracoronary infusion of autologous CD34+ cells in patients with intractable angina shows the safety and feasibility of this therapy and provides evidence for efficacy.

Implantation of a device to narrow the coronary sinus and increase myocardial venous pressure was compared with a sham procedure in patients with refractory angina. The proportion of patients with improvement at 6 months was significantly greater with the device. A growing number of patients with severe and diffuse obstructive coronary artery disease who are not candidates for revascularization have debilitating angina despite medical therapy. 1 – 3 The worldwide prevalence of refractory angina is increasing, and new therapeutic options are needed. 4 An endoluminal, balloon-expandable, stainless steel, hourglass-shaped device designed for percutaneous implantation in the coronary sinus (Reducer, Neovasc) creates a focal narrowing that leads to increased pressure in the coronary sinus, which may relieve angina (Figure 1). A nonrandomized first-in-human study involving 15 patients with refractory angina who were treated with the device showed significant improvement with respect to angina class. . . .

Angina with no obstructive coronary artery disease (ANOCA) presents diagnostic and treatment challenges, significantly burdening healthcare resources. This study assessed emergency department (ED) visits and hospitalizations and factors associated with these outcomes following ANOCA and stable angina (SA) with obstructive coronary artery disease (CAD) diagnoses. A retrospective cohort of individuals who had their first invasive cardiac catheterization for chest pain in Alberta from 2002 to 2017 was extracted retrospectively from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Incidence rates (IRs) were calculated for ED visits and hospitalizations, while factors associated with these outcomes were analyzed using Cox models. Our analysis included 28,881 individuals (ANOCA, 36%). Two-year postcatheterization IRs of ED visits were 100.3-119.3 per 1,000 person-years for ANOCA and increased over time (unstandardized beta coefficient [b] = 2.19 per biennium [95% CI 0.83-3.55]; P = .008); for SA with obstructive CAD the IRs were 209.3-240.2 per 1,000 person-years and remained stable (b = −1.83 per biennium [95% CI −5.73 to 1.70]; P = .25). IRs of hospitalizations were 12.4-25.8 per 1,000 person-years and stable for ANOCA (b = −0.93 per biennium [95% CI −2.49 to 0.64]; P = .20); for SA with obstructive CAD, they were 106.4-171.4 per 1,000 person-years and decreased over time (b = −9.02 per biennium [95% CI −13.27 to −4.77; P = .002). A previous history of heart failure was most associated with ED visits (HR = 1.74 [95% CI 1.41-2.14]; P < .001) and hospitalizations (HR = 2.40 [95% CI 1.82-3.18]; P < .001) for ANOCA. ED visits for ANOCA have risen over time while hospitalizations remain stable, indicating a growing burden despite generally lower rates than SA with obstructive CAD. These findings underscore the need for more effective management strategies to address the significant morbidity and resource utilization in ANOCA.