Glasgow, United Kingdom
Glasgow, United Kingdom

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Hastie C.E.,University of Glasgow | Padmanabhan S.,University of Glasgow | Slack R.,University of Glasgow | Pell A.C.H.,Monklands Hospital | And 7 more authors.
European Heart Journal | Year: 2010

AimsWe sought to investigate the impact of body mass index (BMI) on long-term all-cause mortality in patients following first-time elective percutaneous coronary intervention (PCI).Methods and resultsWe used the Scottish Coronary Revascularisation Register to undertake a cohort study of all patients undergoing elective PCI in Scotland between April 1997 and March 2006 inclusive. We excluded patients who had previously undergone revascularization. There were 219 deaths within 5 years of 4880 procedures. Compared with normal weight individuals, those with a BMI ≥27.5 and <30 were at reduced risk of dying (HR 0.59, 95 CI 0.39-0.90, 95, P = 0.014). There was no attenuation of the association after adjustment for potential confounders, including age, hypertension, diabetes, and left ventricular function (adjusted HR 0.59, 95 CI 0.39-0.90, P = 0.015), and there were no statistically significant interactions. The results were unaltered by restricting the analysis to events beyond 30 days of follow-up.ConclusionAmong patients undergoing percutaneous intervention for coronary artery disease, increased BMI was associated with improved 5 year survival. Among those with established coronary disease, the adverse effects of excess adipose tissue may be offset by beneficial vasoactive properties.


Reynolds R.M.,University of Edinburgh | Walker B.R.,University of Edinburgh | Haw S.,NHS Health Scotland | Newby D.E.,University of Edinburgh | And 11 more authors.
Critical Care Medicine | Year: 2010

Objective: To determine whether low serum cortisol concentrations are associated with adverse prognosis in patients with acute myocardial infarction. Low serum cortisol concentrations have been associated with adverse prognosis in critical illness of diverse etiology. Design: Nested case-control study. Setting: Prospective cohort study of consecutive patients admitted with acute myocardial infarction to nine Scottish hospitals. Patients: A total of 100 patients who survived 30 days (controls) and 100 patients who died within 30 days (cases). Measurements and Main Results: Admission cortisol concentrations were lower in patients who died than those who survived (median, 1189 nmol/L vs. 1355 nmol/L; p <.001). A cortisol concentration in the bottom quartile (<1136 nmol/L) was a strong predictor of death within 30 days and reMained so after adjustment for age and cardiac troponin concentration (adjusted odds ratio, 8.78; 95% confidence interval, 3.09-24.96; p <.001). Conclusions: Patients who mount a lesser cortisol stress response to acute myocardial infarction have a poorer early prognosis. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

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