Percutaneous coronary intervention is an alternative to CABG for patients with medically refractory myocardial ischemia and a high risk of adverse outcomes with CABG.

It is concluded that ECG left ventricular hypertrophy has an adverse effect on survival, even in patients who are free of coronary artery disease.

Background It is unclear if achieving multiple risk factor (RF) goals through protocol-guided intensive medical therapy is feasible or improves outcomes in type 2 diabetes (T2DM). Objectives We sought to quantify the relationship between achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation Revascularization 2 Diabetes) trial and cardiovascular events/survival. Methods We performed a nonrandomized analysis of survival/cardiovascular events and control of 6 RFs (nonsmoker, non-HDL-C <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic <130 mm Hg; diastolic <80 mm Hg], hemoglobin A1c <7%) in BARI 2D. Cox models with time-varying number of RFs in control were adjusted for baseline number of RFs in control, clinical characteristics, and trial randomization assignments. Results In 2,265 patients (mean age 62 years, 29% women) followed for 5 years, the mean ± SD number of RFs in control improved from 3.5 ± 1.4 out of 6 at baseline to 4.2 ± 1.3 at 5 years, p < 0.0001. The number of RFs in control during the trial was strongly related to death (global p = 0.0010) and the composite of death, myocardial infarction and stroke (global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs in control during follow-up had a 2-fold higher risk of death (hazard ratio [HR]: 2.0; 95% CI: 1.3 to 3.3, p = 0.0031) and a 1.7-fold higher risk of the composite endpoint (HR: 1.7; 95% CI 1.2 to 2.5, p = 0.0043), compared with those with 6 RFs in-control. Conclusions Simultaneous control of multiple RFs through protocol-guided intensive medical therapy is feasible and relates to cardiovascular morbidity and mortality in patients with coronary disease and T2DM.

The data suggest that postmenopausal estrogen treatment reduces the risk for angiographically significant coronary artery disease.

Objectives-To review the New Zealand coronary artery bypass priority score instituted in May 1996, and specifically to determine whether it prioritises patients at high risk of cardiac events while waiting. The New Zealand score is compared with the Ontario urgency rating score, and waiting times for surgery are compared with the maximum times recommended by the Ontario consensus panel. Design-Retrospective review of patients accepted for isolated coronary artery bypass surgery between 1 January 1993 and 31 January 1996. Setting-Green Lane Hospital, Auckland, New Zealand. Main outcome measures-Waiting time, cardiac death, myocardial infarction, and cardiac readmission. Results-The median waiting times were five days for hospital cases (n = 721) and 146 days for out of hospital cases (n = 701). Of the latter group, 28% waited more than a year, 33% had their surgery expedited because of worsening symptoms, and 19% failed to meet the cut oV point set by the New Zealand score for acceptance onto the list. Twenty two patients died, 18 on the outpatient waiting list (waiting list mortality 2.6%, risk 0.28% per month of waiting), and 132 were readmitted, 12% with myocardial infarction and 76% with unstable angina. Risk factors for a composite end point of death or myocardial infarction and/or cardiac readmission were: previous coronary artery bypass surgery (p = 0.001), class III or IV angina (p = 0.002), and hypertension (p = 0.005). The New Zealand score did not identify those at risk. Excluding hospital cases, 32% had surgery within the time recommended by the Ontario consensus panel. Conclusions-Waiting times for coronary artery bypass surgery in New Zealand are considerably longer than those in Ontario, Canada. By using a numerical cut oV point, implementation of the New Zealand priority scoring system has restricted access to coronary surgery on the basis of funding constraints rather than clinical appropriateness. The score does not add greatly to the clinicians' prioritisation in predicting those patients who will suVer events while waiting. (Heart 1999;81:586-592)