Publications by authors named "Harish R Chandra"

4 Publications

  • Page 1 of 1

Relation of number of complex coronary lesions to serum C-reactive protein levels and major adverse cardiovascular events at one year.

Am J Cardiol 2005 Jul;96(1):56-60

William Beaumont Hospital, Royal Oak, Michigan, USA.

This study investigated the relation among serum C-reactive protein (CRP), number of complex coronary lesions, and adverse cardiovascular events at 1 year. Univariate and multivariate analyses were performed. Of 283 patients who had acute coronary syndrome, a single complex lesion was present in 32%, multiple complex lesions were identified in 23%, and no complex lesion was documented in 45%. On multivariate analysis, CRP was independently associated with the presence of multiple complex coronary lesions (p <0.0001); there was a striking association between increments in CRP titers and number of complex lesions (CRP levels of 0.22 mg/dl in patients who had 0 lesion, 0.53 mg/dl in patients who had 1 lesion, and 1.85 mg/dl in patients who had multiple complex lesions, p <0.0001), and high serum CRP levels independently predicted adverse outcome (p = 0.03). In conclusion, the presence of multiple complex plaques was the most powerful predictor of adverse outcome (hazard ratio 2.88, p = 0.0007), predominantly in those who had high CRP levels (p = 0.004).
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July 2005

Magnitude and impact of treatment delays on weeknights and weekends in patients undergoing primary angioplasty for acute myocardial infarction (the cadillac trial).

Am J Cardiol 2004 Sep;94(5):637-40, A9

Sharp Chula Vista Medical Center, Chula Vista, California, USA.

In 2,082 patients in the CADILLAC trial, the outcomes of patients presenting during peak hours were compared with those presenting during peak hours (Monday to Friday 8a.m. to 8 p.m., n = 1,047, 51%) were compared with those of patients presenting during off-peak hours (weeknights from 8 p.m. to 8 a.m. and weekends, n = 989, 49%). Although treatment times to percutaneous coronary intervention (PCI) were delayed approximately 21 minutes, in patients with acute myocardial infarctions occurring on weeknights and weekends, this modest delay did not adversely affect procedural success, myocardial recovery, or survival after PCI.
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September 2004

Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation.

J Am Coll Cardiol 2004 Jan;43(2):169-75

Division of Cardiology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.

Objectives: The present study was designed to evaluate the relationship between the presence of aortic sclerosis, serologic markers of inflammation, and adverse cardiovascular outcomes.

Background: Aortic sclerosis is associated with adverse cardiovascular outcomes. However, the mechanism by which such nonobstructive valve lesions impart excess cardiovascular risk has not been delineated.

Method: In 425 patients (mean age 68 +/- 15 years, 54% men) presenting to the emergency room with chest pain, we studied the relationship among aortic sclerosis, the presence and acuity of coronary artery disease, serologic markers of inflammation, and cardiovascular outcomes. Patients underwent echocardiography and serologic testing including C-reactive protein (CRP). Aortic valves were graded for the degree of sclerosis, and cardiovascular outcomes including cardiac death and nonfatal myocardial infarction (MI) were analyzed over one year.

Results: Aortic sclerosis was identified in 203 patients (49%), whereas 212 (51%) had normal aortic valves. On univariate analysis at one year, patients with aortic sclerosis had a higher incidence of cardiovascular events (16.8% vs. 7.1%, p = 0.002) and worse event-free survival (normal valves = 93%, mild aortic sclerosis = 85%, and moderate to severe aortic sclerosis = 77%, p = 0.002). However, by multivariable analysis aortic sclerosis was not independently associated with adverse cardiovascular outcomes; the only independent predictors of cardiac death or MI at one year were coronary artery disease (hazard ratio [HR] 3.23, p = 0.003), MI at index admission (HR 2.77, p = 0.008), ascending tertiles of CRP (HR 2.2, p = 0.001), congestive heart failure (HR 2.15, p = 0.02) and age (HR 1.03, p = 0.04).

Conclusions: The increased incidence of adverse cardiovascular events in patients with aortic sclerosis is associated with coronary artery disease and inflammation, not a result of the effects of valvular heart disease per se.
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January 2004

Percutaneous coronary interventions in octogenarians. glycoprotein IIb/IIIa receptor inhibitors' safety profile.

J Am Coll Cardiol 2003 Aug;42(3):428-32

Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.

Objectives: This study was designed to evaluate the safety profile of glycoprotein IIb/IIIa receptor inhibitors (GPI) in octogenarians undergoing percutaneous coronary intervention (PCI).

Background: Patients > or =80 years old constitute the fastest growing segment of the U.S. population and have a high prevalence of coronary artery disease. Few data exist regarding the use of GPI during PCI in octogenarians, as these patients have been excluded from randomized clinical trials of GPI.

Methods: Consecutive patients > or =80 years old undergoing PCI between January 1998 and June 2001 were evaluated for clinical outcomes and bleeding complications.

Results: One thousand three hundred and ninety two of 14,308 patients (9.7%) undergoing PCI were > or =80 years old. Of these, 459 of 1,392 (33%) of the patients were treated with GPI. Octogenarians treated with GPI were more likely to present with acute coronary syndrome or infarction, receive stents, require an intra-aortic balloon pump, or undergo multi-vessel PCI. Glycoprotein receptor inhibitor use was associated with a higher rate of bleeding, but the transfusion rate was similar to that in patients who did not receive GPI (9.8% vs. 8.6%, p = NS). No cases of intracranial hemorrhage were observed. By multivariate analysis, GPI treatment was associated with longer hospitalization but did not independently predict the need for transfusion or affect mortality.

Conclusions: Octogenarians have a high incidence of bleeding and need for transfusion after PCI. Although the use of GPI was associated with more access and non-access site bleeding and longer hospital stay, GPI treatment does not significantly increase the risk of transfusion or intracranial hemorrhage in this non-randomized cohort.
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August 2003