Tag Archives: coronary artery disease

Introduction Depression is a significant cause of morbidity and mortality in patients with coronary artery disease (CAD), with depressive symptoms affecting up to 45% of patients with CAD.1 Cardiac patients with depressive symptoms experience a 2 to 2.5-fold mortality increase when compared with cardiac patients without depressive symptoms.2 Screening tools include the patient health questionnaire (PHQ), which exists in two- and nine-question formats, with PHQ2 being nearly 90% sensitive and 73% specific for depression,3 and PHQ9 being 88% sensitive and 88% specific for depression.4 We examined the records of patients with CAD in an ambulato

Self-monitoring of type 2 diabetes cuts costs Self-monitoring of type 2 diabetes used in combination with an electronic feedback system results in considerable savings on health care costs and also travel costs for patients, especially in sparsely populated areas, a new study shows. The study, carried out in Northern Karelia by the University of Eastern Finland, found that by replacing half of the required follow-up visits for type 2 diabetes with self-measurements and electronic feedback, total costs of glycated haemoglobin monitoring were reduced by nearly 60%. The annual per-patient cost was down from 280 euros to 120 euros. Fewer follow-u

Introduction Invasive coronary angiography (ICA) remains the cornerstone of diagnosis and treatment of patients with a high likelihood of coronary artery disease (CAD), or those with significant or unstable chest pain symptoms. However, there is always a concern that we overutilise ICA and this exposes patients to a small risk.1 Furthermore, ICA is an expensive procedure and overuse of diagnostic ICA can compete with percutaneous coronary intervention (PCI) and device implantations in hospitals with a single catheter lab. The National Institute of Health and Care Excellence (NICE) 2010 guidelines on stable chest pain, recommended that patien

A new gene therapy that targets the heart and requires only one treatment session, has been found safe for patients with coronary artery disease, according to a successful trial carried out in Finland (doi: 10.1093/eurheartj/ehx352). The treatment enhances circulation in ischaemic heart muscle and the effects were still visible one year after treatment. The randomised, blinded, placebo-controlled phase 1/2a trial was carried out in collaboration between the University of Eastern Finland, Kuopio University Hospital and Turku PET Centre. The biological bypass is based on gene transfer in which a natural human growth factor, AdVEGF-DΔNΔC, a ne

Introduction Computed tomography coronary angiography (CTCA) is an established and validated alternative to invasive coronary angiography (ICA).1 The extent to which CTCA can replace ICA is controversial.2 The low diagnostic yield from ICA suggest there is ample scope to select patients more efficiently for investigation.3 In 2010, in the UK, the National Institute for Health and Care Excellence (NICE)4 published new guidelines for the investigation of patients with suspected coronary artery disease (CAD), which incorporated CTCA as a first-line investigation.5 In keeping with these guidelines, we ceased to use exercise testing as a primary t

Introduction Coronary heart disease (CHD) is the leading cause of death worldwide. Chronic subclinical inflammation is a key recognised process in the pathogenesis of CHD, and may play an important role in atherogenesis. Figure 1. Atherosclerotic plaque rupture Atherosclerosis is a complex multi-factorial disease process, which is initiated at the endothelium in response to various forms of injurious stimuli (shear stress, oxidative stress, arterial pressure changes) including inflammation. These factors appear to alter the endothelial cell’s capacity to maintain homeostasis and vascular tone and leads to the so-called endothelial ‘dysfun

Dr Mike Norell I was asked recently to speak at a fringe meeting that was juxtaposed to a major interventional gathering in London. My brief, ‘Gender differences in PCI outcomes’, was not a subject with which I was immediately familiar, and nor was it one upon which I was known to be authoritative, so my initial reaction was along the lines of “why me?”. The four other speakers were all women with both well-established and well-deserved reputations as acknowledged experts in this area. Thus for a number of reasons – some more obvious than others – I was clearly going to be the odd man out.  On the face of it my work was not going

Introduction It is accepted that coronary revascularisation with coronary artery bypass graft surgery (CABG) provides both symptomatic and prognostic benefit in patients with multi-vessel coronary artery disease (mvCAD).1,2 Both percutaneous coronary intervention (PCI) and CABG provide better relief of angina symptoms than medical therapy alone.1,3 Large, randomised-controlled trials (RCTs), in recent years, have demonstrated that CABG offers an improved outcome in patients with complex three-vessel coronary artery disease (CAD), especially in those with co-existing diabetes mellitus.4,5 However, in patients with one- or two-vessel CAD, PCI o

Introduction There is no universal definition for stable angina, as there is for acute coronary syndrome.1 The diagnosis may be based on clinical history alone or on clinical history supplemented by functional testing, or angiography, or both. Angina pectoris is most often due to obstruction to flow in the epicardial coronary arteries, and the ‘gold-standard’ investigation, to date, to detect this, has been invasive coronary angiography.2 A small proportion of patients may have angina with unobstructed coronary arteries secondary to either microvascular coronary disease or coronary spasm.3 Functional ischaemia is not routinely tested for

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