Renal Transplant Patient Survival Similar After CABG, PCI
A retrospective study in this week’s issue of the journal Circulation (Circulation. 2004;109:2866–2871) found comparable survival rates after coronary artery bypass graft surgery and percutaneous intervention in patients who have had a kidney transplantation.
In this study, led by Charles A. Herzog, MD, of the Cardiovascular Special Studies Center, United States Renal Data System in Minnesota and the University of Minneapolis in Minnesota, researchers analyzed data from the records of renal transplant recipients who underwent a coronary revascularization procedure for the first time between 1995 and 1999. They found that the mortality rate was 2.3% among the 909 stent patients, 4.3% among the 652 percutaneous transluminal angioplasty patients, 9.4% among the 288 coronary artery bypass patients who did not receive the internal mammary graft, and 5% among the 812 bypass patients who did receive the internal mammary artery graft. At 2 years, the survival rate was 82.5% for stent patients, 81.6% for percutaneous transluminal angioplasty patients, 74.4% for coronary artery bypass patients who did not receive the internal mammary artery graft, and 82.7% for those bypass patients who did receive the internal mammary artery graft. There was no significant difference in the relative risks of all-cause and cardiac death among the different groups, the researchers concluded.
“We conclude that renal transplant recipients have comparable long-term survival after surgical and percutaneous coronary revascularization procedures. Our data suggest that the most favorable long-term outcome (after adjustment for comorbid conditions) is associated with CAB [coronary artery bypass] surgery. Any definitive conclusion about the overall superiority of a particular coronary revascularization procedure, however, would require a prospective, randomized clinical trial. Despite the burden of cardiovascular disease in patients with ESRD [end-stage renal disease], renal transplant recipients (compared with dialysis patients) have relatively favorable outcomes after coronary revascularization procedures,” the researchers wrote.
New Tools Give Better Handle on Prognosis After Acute Coronary Syndrome
A new method of calculating heart-related risks could give doctors a better handle on what to tell their patients when they go home after an acute myocardial infarction or sudden angina. The tool is described in the June 9, 2004, issue of the Journal of the American Medical Association (JAMA. 2004;291:2727–2733OpenUrlCrossRefPubMed).
The tool can fit on a pocket card or be programmed into a handheld computer. It is based on information gleaned from the records of 22 645 such patients treated at 94 hospitals in 14 countries. Using the Global Registry of Acute Coronary Events (GRACE), the scientists, led by Kim Eagle, MD, Director of the University of Michigan Cardiovascular Center, identified 9 variables that predicted death at 6 months after the first cardiac event. These included older age, history of myocardial infarction, history of heart failure, increased pulse rate, lower systolic blood pressure, elevated initial serum creatinine level, elevated initial serum cardiac biomarkers, ST-segment depression on the presenting electrocardiogram, and no percutaneous coronary intervention in the hospital. The prognostic tool, which they called the GRACE 6-month postdischarge prediction model, is based on these factors.
The researchers wrote that their model “is a simple robust tool for predicting death in patients with ACS [acute coronary syndrome] and has very good discriminative ability. We believe that clinicians will find it simple to use and applicable to clinical practice.”
Novel Way of Lowering Cholesterol, Homocysteine
Genetically altering the pathways by which the liver makes phosphatidylcholine, an important component of high-density lipoprotein (HDL) and low-density lipoprotein (LDL), decreases lipoprotein levels in mice by as much as half, said Dennis E. Vance, PhD, Professor of Biochemistry at the University of Alberta, on June 13, 2004, at the annual meeting of the American Society of Biochemistry and Molecular Biology in Boston, Mass.
The mice, in which both the CT pathway or the PEMT pathway had been eliminated, appeared to suffer no ill effects. They lived normally and bred normally. However, when one of the pathways was missing, the levels of lipoprotein dropped by one half, said Dr Vance in his presentation. Those animals that lacked the PEMT pathway also showed a 50% decrease in homocysteine levels in the blood.
The finding suggests that inhibiting the manufacture of phosphatidylcholine by using a drug might be an effective way of lowering LDL levels in the blood. If the PEMT pathway could be altered, homocysteine levels would also decrease, another bonus in the search for ways to lower the risk of cardiovascular disease, he said.
High Co-Pays Contribute to Statin Dropouts
Nearly half the patients prescribed statins do not fill their prescriptions regularly or stop taking the drug altogether, and cost is a contributing factor, said researchers from the University of Michigan Health System and the Cleveland Clinic in a report in the June issue of the Journal of General Internal Medicine (JGIM. 2004;19:638–645OpenUrlPubMed).
The researchers, led by Jeffrey Ellis, PharmD, MS, of the Cleveland Clinic, found that patients who had to pay more than $20 for each month’s supply of the pills were 3 times more likely to take the drug irregularly and 4 times more likely to stop taking it altogether than those who paid less than $10 per monthly prescription. They found that approximately half of those prescribed the drug for the first time stopped taking it within 4 years.
They based their report on insurance data from 4802 patients. Patients who had had a heart attack, were diagnosed with diabetes, or had undergone revascularization procedures were almost as likely to stop taking their statins as were those who had high cholesterol and no other adverse symptoms.