American Research Journal of Cardiovascular Diseases

Abolfazl Dohaei, M.D.1, Wayne L. Miller, M.D., Ph.D.1

Background: The recognition of the impact of new medications and the synergic effect of new drug combinations is absent in studies comparing coronary artery bypass grafting surgery (CABG) with medical therapy. There are limited review data regarding the contribution of morbidities after CABG on outcomes. Methods: Full texts and data were collected from Mayo Clinic library, PubMed, and Google Scholar sources. We reviewed all pertinent article texts and study designs and identified relevant studies. Because we intended to include all morbidity results, we gathered all systematic reviews relating to specific morbidities and provided a comprehensive explanation of results. Published articles were assessed from 1994 up to the present time considering contemporary studies regarding morbidities. Results: The impact of morbidities and economic costs after CABG go unrecognized in the decision process to pursue CABG while the beneficial effects of newer medications on managing ischemia and cardiovascular outcomes are potentially undervalued. Conclusions: Considering new medications in the light of the deleterious impact of morbidities and costs following CABG should prompt needed studies to evaluate in a more comprehensive manner the impact of coronary surgical revascularization vs. contemporary medical therapy. Condensed Abstract: The impact of morbidities and costs after CABG is significant. New studies comparing CABG with MT based on advances in contemporary medications relative to the morbidities and costs following CABG are needed.

Andreas Karydasa*, Maria Kouteloub, Athanasios Theodorakosc, Athanasios Dritsasd Gregory Pavlides1,e, Demosthenes B. Panagiotakosf, Dennis V. Cokkinosg

Background: Myocardial viability (VIA) prevalence in post myocardial infarction (MI) patients (pts) in association with angina (ANG) or not has not been prospectively evaluated. Methods and Findings: Fifty-five post-MI pts with reduced ejection fraction (EF≤40%) underwent stress thallium-201 scintigraphy (Tl-201) viability (VIA) evaluation. ANG at exercise-treadmill-test (ETT) (Borg scale) and at everyday-life (Canadian Cardiovascular Society – CCS) classification was recorded. Groups VIA (29 pts – 53%) vs non-VIA respectively had similar EF (31 ± 7)% vs (33 ± 8)% (NS), higher diseased vessels number 2.8 ± 1.6 vs 1.9 ± 1.3 (p=0.02), CCS 1.7 ± 0.8 vs 1.3 ± 0.6 (p<0.05), CCS≥2 71% vs 41% (p<0.03). Five pts from each group reported ETT ANG (17% vs 21% – NS), with Borg scale 7.7 ± 3.0 vs 7.2 ± 2.4 (NS). CCS≥2 was associated with greater 201Tl reversibility indices within stress defect (p<0.04) or total myocardial mass reversibility (p<0.02). Binary logistics analysis associated VIA positively with number of diseased vessels and negatively with smoking, while CCS≥2 ANG positively with number of diseased vessels. The main limitation is the relatively small number of pts. Conclusions: Viability, while not significantly correlated to ETT angina, was positively associated only with more frequent everyday-life (CCS) angina. Clinically, in ischemic cardiomyopathy VIA evaluation is indicated, regardless of ANG. 

Abolfazl Dohaei, M.D

 Morbidities following antihyperlipidemic treatmentsuch as muscular and hepatic disorders have been reported in the literature. According to new guidelines high intensity antihyperlipidemic therapy is a class I recommendation for patients with clinical atherosclerotic cardiovascular disease or low density lipoprotein cholesterol ≥ 190 milligram per deciliter, although existing data regarding initiation or continuation of statin therapy in symptomatic heart failure patients (New York Heart Association Class II-IV) are equivocal. I sought to evaluate morbidities associated with unproven treatment in heart failure patients because it may decrease the number of problems in these patients which is very valuable. Based upon the experience of seeing and treating patients with heart failure, I have observed signs and symptoms of skin dryness and pruritus in these patients which was related to their antihyperlipidemic treatment. This relationship was supported by the disappearance of these signs and symptoms after discontinuing their antihyperlipidemic drug and increasing fat in their diet. Improvement was seen by the next visit within one to two months of the intervention. I also observed that some of these patients had been treated for their symptoms with treatments for dermatitis and without response to topical treatment. Evaluation of clinicalsign and symptomsof skin dryness and pruritus related to extreme antihyperlipidemic treatment is important, because it decreases the number of morbiditiesin heart failure patients and prevents inappropriate andpotentiallydeleterious therapies.