Further information: Percutaneous Coronary Intervention for Acute Myocardial Infarction (see p1021)  and Drug-Eluting Coronary Stents (see p1031)  from Cardiovascular Medicine, 3rd Edn*

Authors analyzed results of the German Cypher Registry [1], a prospective, multicenter German cohort of patients, to determine the volume-outcome relationships for percutaneous coronary intervention (PCI) procedures performed with drug-eluting stents (DES). Studies [2] have shown that the volume of PCI procedures performed is significantly correlated with outcome, but the correlation between patient volume and PCI with DES had not been evaluated.

A total of 8201 patients treated with sirolimus-eluting stents (SES) between April 2002 and September 2005 in 51 centers were analyzed. A recruitment of over 400 SES patients was considered a high-volume center; intermediate volume centers recruited between 150–400 SES patients; low-volume centers recruited less than 150 SES patients. The primary end point of this analysis was a combined safety and effectiveness end point composed of all deaths, myocardial infarctions (MI), and target vessel revascularizations (TVR) at 6 months.

Regarding TVR, there was no difference in device effectiveness in the different-volume centers, but there was a significant difference in the safety end point with patients in lower and intermediate-volume centers having higher death and MI. For death and MI in the low-volume centers, the end point occurred in 11.3% of patients; in intermediate-volume centers, the end point occurred in 12.1% of patients; and the end point occurred in high-volume centers in 9.0% of patients. This study clarified results of previous studies [3] that indicated the off-label use of DES was associated with higher rates of early and late stent thrombosis resulting in both fatal and nonfatal MI. The Society of Cardiovascular Angiography and Interventions DES task force reported on patient complications that were associated with increased DES thrombosis, and these included: dual antiplatelet discontinuation, diabetes mellitus, acute coronary syndromes (ACS), low EF, and renal failure. In low-volume centers, more patients with such complicating factors were treated.

In summary, the volume of SES procedures performed at the institutional level was inversely related to death and myocardial infarction, but at the six-month follow-up evaluation, it was not related to target-vessel revascularization. This study indicated that safety issues are better considered at high-volume centers, and the findings impact public health policies.

[1] Khattab AA, Hamm CW, Senges J, et al. Sirolimus-eluting stent treatment at high volume centers confers lower mortality at 6-month follow-up. Circulation 2009;120:600-606

[2] Epstein AJ, Rathore SS, Volpp KG, et al. Hospital percutaneous coronary intervention volume and patient mortality, 1998 to 2000. J Am Coll Cardiol 2004;43:1755-1762

[3] Bavry AA, Kumbhant DJ, Helton TJ, et al. Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. Am J Med 2006;119:1056-1061

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* To view the online text from the book, please navigate to SpringerLink or use the DVD to access electronic content. SpringerLink is a subscription service. For further information, click here.

Further information: Coronary Risk Factors: An Overview (see p2609), Preventive Cardiology: The Effects of Exercise (see p2631), Smoking, Secondhand Smoke, and Cardiovascular Disease (see p2649), and  Cardiovascular Complications of Obesity and the Metabolic Syndrome (see p2693) from Cardiovascular Medicine, 3rd Edn*

The Physicians Health Study1 (PHS 1), conducted from 1982–2008, included a cohort of 20,900 apparently healthy male physicians. The current study [1] used data from the cohort to compare the relationship of modifiable lifestyle factors to the risk of heart failure (HF) for the period of lifetime remaining after 40 years of age. Lifestyle factors that were the focus of this study included adiposity, smoking, physical activity, alcohol consumption, and diet (i.e. consumption of cereals, fruits, and vegetables). Modification of these factors has been shown to reduce heart attacks and strokes, and it is estimated that by age 40, one in every five adults will develop HF. However, it is not clear if a healthy lifestyle could lead to a reduction in the possibility of HF in years of life that remained after 40. Results of the study showed that at 40 years of age, an overall lifetime risk of HF was 13.8% (95% confidence interval [CI], 12.9–14.7%) and remained constant through 70 years of age. Then, between 70 and 80 years of age, the lifetime risk was 10.6% (95% CI, 9.4–11.7%).

The results of the study showed that the lifetime risk of HF was 21% in men who adhere to none of the six desirable factors versus 10% in those men who followed a healthy lifestyle in four or more of the desirable factors, and the greater reduction in risk occurred after age 70.

An editorial [2] was also published that addresses the issues of increased health care expenses and the increased need for individuals and society to assume responsibility for prevention of disease (covered in a previous update http://bit.ly/SP5sD). The original study by Djoussé et al [1] emphasizes that adherence to a healthy lifestyle will help prevent cardiovascular disease, and that the responsibility for such a lifestyle must be assumed by the individual.

[1] Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 2009;302:394-400
[2] Roger VL. Lifestyle and cardiovascular health: Individual and societal choices. JAMA 2009;302:437-439

Note: You may need subscriptions to access content from links on this page. You are responsible for obtaining these subscriptions.

* To view the online text from the book, please navigate to SpringerLink or use the DVD to access electronic content. SpringerLink is a subscription service. For further information, click here.

Further information: Preventive Cardiology: The Effects of Exercise (see p2631), Smoking, Secondhand Smoke, and Cardiovascular Disease (see p2649), and  Cardiovascular Complications of Obesity and the Metabolic Syndrome (see p2693) from Cardiovascular Medicine, 3rd Edn*

The Nurses’ Health Study II began in 1989 and is an ongoing prospective study of 116,671 female registered nurses. This study [1] was limited to 83,882 women from the original cohort who were 27–44 years old and used a baseline year of 1991. At that time, the women did not have hypertension, cardiovascular disease, diabetes, or cancer. Hypertension is responsible for more deaths in women than any other preventable risk factor. The risk factors for the development of hypertension that can be controlled by the individual include being overweight or obese, not being physically active, and having a poor diet. This study sought to determine whether or not adherence to a lifestyle where weight, activity, and diet were controlled could prevent the onset of incident hypertension. To help in the calculation of data from this study, a hypothetical population attributable risk (PAR) was developed to estimate the percentage of new incident hypertension cases that occurred in this population that could have been prevented if all of the women in the study had adhered to the six low-risk factors for prevention of hypertension, i.e. a body mass index (BMI) of less than 25, a daily mean of 30 minutes of vigorous exercise, a high score on the Dietary Approaches to Stop Hypertension (Dash) diet, moderate intake of alcohol, use of nonnarcotic analgesics less than once per week, and 400 µg/d or more of supplemental folic acid.

In total, 12,319 cases of incident hypertension were reported. In an analysis of the data, the authors concluded that a significantly lower incidence of hypertension was associated with adherence to low-risk dietary and lifestyle factors.

An editorial [2] was also published that addresses the issues of increased health care expenses and the increased need for individuals and society to assume responsibility for prevention of disease. The study by Forman et al [1] emphasizes that adherence to a healthy lifestyle will help prevent cardiovascular disease, and that the responsibility for such a lifestyle must be assumed by the individual.

[1] Forman JP, Stampfer MJ, Curham GC. Diet and lifestyle risk factors associated with incident hypertension and women. JAMA 2009;302:401-411
[2] Roger VL. Lifestyle and cardiovascular health: Individual and societal choices. JAMA 2009;302:437-439

Note: You may need subscriptions to access content from links on this page. You are responsible for obtaining these subscriptions.

* To view the online text from the book, please navigate to SpringerLink or use the DVD to access electronic content. SpringerLink is a subscription service. For further information, click here.