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Lee WC, Fang HY, Chen HC, Hsueh SK, Chen CJ, Yang CH, Yip HK, Hang CL, Wu CJ, Fang CY. Effect of improved door-to-balloon time on clinical outcomes in patients with ST segment elevation myocardial infarction. Int J Cardiol 2017; 240:66-71. [PMID: 28390745 DOI: 10.1016/j.ijcard.2017.02.156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/20/2017] [Accepted: 02/21/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Few studies have focused on the effects of an improved door-to-balloon time on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to explore the effect of improving door-to-balloon time on prognosis and to identify major predictors of mortality. METHODS From January 2005 to December 2014, 1751 patients experienced STEMI and received primary percutaneous intervention in our hospital. During a 10-year period, the patients were divided into two groups according to the time period. Since mid-2009, shortening door-to-balloon time has been an important concern of health care. As a result of targeted efforts, as of January 2010, door-to-balloon time shortened significantly. In our study, a total 853 patients were in group 1 during January 2005 to December 2009, and a total 898 patients were in group 2 during January 2010 to December 2014. RESULTS The incidence of major adverse cardiac cerebral events (26.7% vs. 23.2%; p=0.120), the incidence of cardiovascular mortality (9.3% vs. 8.8%; p=0.741), and the incidence of all-cause mortality (12.6% vs. 12.2%; p=0.798) were similar between the two groups. The incidence of target vessel revascularization significantly decreased in group 2 (17.8% vs. 12.6%; p=0.008). However, the incidence of stroke increased in group 2 (1.8% vs. 3.6%; p=0.034). CONCLUSION Improving door-to-balloon time could not improve 1-year cardiovascular mortality whether low-risk or high-risk patients. The improvement in the door-balloon time does not improve outcomes studied, probably because it is not accompanied by a reduction in total reperfusion time, which means from onset of symptoms to reperfusion.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
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Nicholls M. The Andreas Grüntzig lecture at European Society of Cardiology congress 2016. Eur Heart J 2016; 37:3368-3369. [PMID: 28025209 DOI: 10.1093/eurheartj/ehw484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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3
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Abstract
We are entering a new era in the percutaneous treatment of valvular heart disease. Novel techniques and devices have given rise to the possible treatment of a range of valvular heart diseases that previously necessitated surgical therapies, including aortic stenosis, pulmonary regurgitation and mitral regurgitation. Despite the enormous potential of these percutaneous therapies, enthusiasm needs to be balanced by an understanding of the challenges that need to be overcome before such therapies can be widely embraced. This review provides a critical assessment of the status of the major developments in percutaneous valvular intervention to date, and provides the authors' perspective on the current role and future potential of these techniques.
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Affiliation(s)
- Ivan P Casserly
- Director of Cardiovascular Intervention, Denver VA Medical Center, Department of Cardiology, 1055 Clermont Street, Denver, CO 80220, USA.
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Nallu K, Yang DC, Swaminathan RV, Kim LK, Feldman D. Innovations in drug-eluting stents. Panminerva Med 2013; 55:345-352. [PMID: 24434343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Coronary artery disease affects patients worldwide and is a major cause of morbidity and mortality. Historically, the treatment approach for patients with coronary syndromes has been surgical. In the 1970s, percutaneous balloon angioplasty was introduced, leading to creation of a new field of interventional cardiology, which allowed a non-surgical minimally invasive approach to treat patients with coronary artery disease. However, the major limitations of balloon angioplasty were acute vessel closure and later restenosis. The introduction of bare metal stents and then drug-eluting stents (DES) revolutionized the practice of interventional cardiology and allowed for safe treatment of increasingly complex coronary artery lesions. Although drug-eluting coronary stents improve patient outcomes, they still have limitations. These limitations may arise from delayed endothelialization, local vessel hypersensitivity and endothelial dysfunction secondary to the drug elution, the durable polymer coating, or the stent scaffold. This comprehensive review will discuss the evolution of intracoronary stents from their introduction to current utilization of DES as well as future research on bioabsorbable stents and polymers.
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Affiliation(s)
- K Nallu
- Division of Cardiology, Weill Cornell Medical College New York Presbyterian Hospital New York, New York, USA -
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6
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Abstract
BACKGROUND Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI). Door-to-balloon time has become a performance measure and is the focus of regional and national quality-improvement initiatives. However, it is not known whether national improvements in door-to-balloon times have been accompanied by a decline in mortality. METHODS We analyzed annual trends in door-to-balloon times and in-hospital mortality using data from 96,738 admissions for patients undergoing primary PCI for ST-segment elevation myocardial infarction from July 2005 through June 2009 at 515 hospitals participating in the CathPCI Registry. In a subgroup analysis using a linked Medicare data set, we assessed 30-day mortality. RESULTS Median door-to-balloon times declined significantly, from 83 minutes in the 12 months from July 2005 through June 2006 to 67 minutes in the 12 months from July 2008 through June 2009 (P<0.001). Similarly, the percentage of patients for whom the door-to-balloon time was 90 minutes or less increased from 59.7% in the first year to 83.1% in the last year (P<0.001). Despite improvements in door-to-balloon times, there was no significant overall change in unadjusted in-hospital mortality (4.8% in 2005-2006 and 4.7% in 2008-2009, P=0.43 for trend) or in risk-adjusted in-hospital mortality (5.0% in 2005-2006 and 4.7% in 2008-2009, P=0.34), nor was a significant difference observed in unadjusted 30-day mortality (P=0.64). CONCLUSIONS Although national door-to-balloon times have improved significantly for patients undergoing primary PCI for ST-segment elevation myocardial infarction, in-hospital mortality has remained virtually unchanged. These data suggest that additional strategies are needed to reduce in-hospital mortality in this population. (Funded by the National Cardiovascular Data Registry of the American College of Cardiology Foundation.).
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Affiliation(s)
- Daniel S Menees
- University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI 48109, USA.
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7
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Abstract
Over the past five decades, management of acute ST-segment elevation myocardial infarction (STEMI) has evolved substantially. Current treatment encompasses a systematic chain of network activation, antithrombotic drugs, and rapid instigation of mechanical reperfusion, although pharmacoinvasive strategies remain relevant. Secondary prevention with drugs and lifestyle modifications completes the contemporary management package. Despite a tangible improvement in outcomes, STEMI remains a frequent cause of morbidity and mortality, justifying the quest to find new therapeutic avenues. Ways to reduce delays in doing coronary angioplasty after STEMI onset include early recognition of symptoms by patients and prehospital diagnosis by paramedics so that the emergency room can be bypassed in favour of direct admission to the catheterisation laboratory. Mechanical reperfusion can be optimised by improvements to stent design, whereas visualisation of infarct size has been improved by developments in cardiac MRI. Novel treatments to modulate the inflammatory component of atherosclerosis and the vulnerable plaque include use of bioresorbable vascular scaffolds and anti-proliferative drugs. Translational efforts to improve patients' outcomes after STEMI in relation to cardioprotection, cardiac remodelling, and regeneration are also being realised.
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Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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8
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De Felice F, Fiorilli R, Parma A, Musto C, Nazzaro MS, Confessore P, Scappaticci M, Violini R. One-year clinical outcome of patients treated with or without abciximab in rescue coronary angioplasty. Int J Cardiol 2013; 163:294-298. [PMID: 21703701 DOI: 10.1016/j.ijcard.2011.06.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/23/2011] [Accepted: 06/06/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical results of abciximab administration during rescue angioplasty (PCI) are poorly investigated. METHODS We evaluated the outcome of 406 consecutive patients undergoing rescue PCI treated with (n=218) or without (n=188) abciximab and a clopidogrel loading dose of 300 mg. The end point was the incidence of major cardiac adverse events (MACE) defined as death, recurrent acute myocardial infarction (AMI) and target vessel revascularization at 30 days and 1 year. The predictors of MACE were also investigated. RESULTS No differences were found in MACE between the groups treated with or without abciximab at 30 days (15 and 20, p=0.67) and 1 year (23 and 29, p=0.85). Stepwise logistic regression analysis identified: cardiogenic shock (Odds Ratio [OR]=17.8, 95% confidence interval [CI] 5-99, p=0.0001), age (OR=1.099, 95% CI 1.04-1.15, p=0.0001), TIMI flow 0-1 after procedure (OR=5.51, 95% CI 1.72-17.6, p=0.004) as independent predictors of MACE at 30 days. Cox proportional hazards model identified: cardiogenic shock (adjusted hazard ratio [HR]=3.83, 95% confidence interval [CI] 1.76-8.35, p=0.01), age (HR=3.7, 95% CI 1.75-8.3, p=0.01), TIMI flow 0-1 after procedure (HR=1.04, 95% CI 1.01-1.07, p=0.001 as predictors of MACE at 1 year). After propensity score adjustments the predictors of MACE did not change. CONCLUSION There were no differences in MACE at 30 days and 1 year in patients treated with or without abciximab during rescue PCI after a clopidogrel loading dose of 300 mg. Cardiogenic shock, age and TIMI flow 0 and 1 after PCI were predictors of MACE.
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Affiliation(s)
- Francesco De Felice
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy.
| | - Rosario Fiorilli
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
| | - Antonio Parma
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
| | - Carmine Musto
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
| | - Marco Stefano Nazzaro
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
| | - Pierpaolo Confessore
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
| | - Massimiliano Scappaticci
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
| | - Roberto Violini
- UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense n 87, 00152 Roma, Italy
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9
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White CJ. The future of interventional cardiology. Catheter Cardiovasc Interv 2013; 81:4-5. [PMID: 23281080 DOI: 10.1002/ccd.24734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 11/08/2022]
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10
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Murray SW. With FREEDOM comes responsibility. J Invasive Cardiol 2013; 25:1. [PMID: 23293166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Angioi M. [Use of drug-eluting balloons for coronary interventions: current indications and perspectives]. Ann Cardiol Angeiol (Paris) 2012; 61:413-6. [PMID: 23062818 DOI: 10.1016/j.ancard.2012.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The paclitaxel-eluting balloon is an emerging percutaneous coronary angioplasty tool which aim is to prevent restenosis by delivering a high intravessel paclitaxel dose during balloon inflation. It has been already approved in the treatment of bare metal stent restenosis and is being investigated in drug-eluting stent restenosis. For the treatment of de novo lesions, it could be used alone or in combination with bare metal stent implantation. Most interesting results were obtained by a drug-eluting balloon alone strategy in small vessels angioplasty. Current and upcoming results of this evolving technology are reviewed.
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Affiliation(s)
- M Angioi
- Unité d'hémodynamique diagnostique et interventionnelle, Institut Lorrain du coeur et des vaisseaux Louis-Mathieu, hôpitaux de Brabois, CHU de Nancy, allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
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12
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Metzger JP. [Medical progress exemplified by improvements in the safety coronary angioplasty]. Bull Acad Natl Med 2012; 196:1361-1368. [PMID: 23815020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The significant decrease in complications associated with coronary angioplasty is a model of medical progress. Breakthroughs are achieved through individual initiatives, whereas incremental progress results from occasional, anonymous improvements. The two types of improvement are complementary, as pointed out by Claude Bernard as early as 1864.
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Affiliation(s)
- Jean-Philippe Metzger
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 47/83 Bd de l'Hôpital-75013 Paris.
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Jeong HC, Jeong JM, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Effect of single or dual blockade of renin-angiotensin system in acute myocardial infarction patients according to renal function. Int J Cardiol 2012; 157:408-11. [PMID: 22513185 DOI: 10.1016/j.ijcard.2012.03.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 11/27/2022]
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14
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Weintraub WS, Grau-Sepulveda MV, Weiss JM, Delong ER, Peterson ED, O'Brien SM, Kolm P, Klein LW, Shaw RE, McKay C, Ritzenthaler LL, Popma JJ, Messenger JC, Shahian DM, Grover FL, Mayer JE, Garratt KN, Moussa ID, Edwards FH, Dangas GD. Prediction of long-term mortality after percutaneous coronary intervention in older adults: results from the National Cardiovascular Data Registry. Circulation 2012; 125:1501-10. [PMID: 22361329 PMCID: PMC3356775 DOI: 10.1161/circulationaha.111.066969] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention in both patients with ST-segment elevation myocardial infarction and those with more stable coronary disease. METHODS AND RESULTS The American College of Cardiology Foundation CathPCI Registry data were linked to the Centers for Medicare and Medicaid Services 100% denominator file by probabilistic matching. Preprocedure demographic and clinical variables from the CathPCI Registry were used to predict the probability of death over 3 years as recorded in the Centers for Medicare and Medicaid Services database. Between 2004 and 2007, 343 466 patients (66%) of 518 195 patients aged ≥65 years undergoing first percutaneous coronary intervention in the CathPCI Registry were successfully linked to Centers for Medicare and Medicaid Services data. This study population was randomly divided into 60% derivation and 40% validation cohorts. Median follow-up was 15 months, with mortality of 3.0% at 30 days and 8.7%, 13.4%, and 18.7% at 1, 2, and 3 years, respectively. Twenty-four characteristics related to demographics, clinical comorbidity, prior history of disease, and indices of disease severity and acuity were identified as being associated with mortality. The C indices in the validation cohorts for patients with and without ST-segment elevation myocardial infarction were 0.79 and 0.78. The model calibrated well across a wide range of predicted probabilities. CONCLUSIONS On the basis of the large and nationally representative CathPCI Registry, we have developed a model that has excellent discrimination, calibration, and validation to predict survival up to 3 years after percutaneous coronary intervention.
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Affiliation(s)
- William S Weintraub
- Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718, USA.
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Abstract
For several decades of medical history, coronary-artery bypass grafting (CABG) has been regarded as the best treatment option for patients with unprotected left main coronary artery (LMCA) disease, considering lesion priority and its clinical consequences. Over the time, with remarkable advancements in techniques of percutaneous coronary intervention (PCI), supporting devices, and adjunctive pharmacologic therapy, PCI with DES implantation has appeared to be new and alternative option for optimal revascularization therapy for these patients. The available cumulative evidence suggests that the safety outcomes such as mortality or composite of death, myocardial infarction and stroke are similar among PCI and CABG for patients with LMCA disease, the only difference was the rate of repeat revascularization. Current evidence and ongoing large clinical trials may encourage interventional cardiologists to choose PCI with stenting as an alternative revascularization strategy for unprotected LMCA disease in future. Finally, this evidence will change the current clinical practice and the guideline of optimal revascularization strategy for unprotected LMCA disease.
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Affiliation(s)
- Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea,
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Antonsen L, Jensen LO, Thayssen P, Christiansen EH, Junker A, Tilsted HH, Terkelsen CJ, Kaltoft A, Maeng M, Hansen KN, Ravkilde J, Lassen JF, Madsen M, Sørensen HT, Thuesen L. Comparison of outcomes of patients ≥ 80 years of age having percutaneous coronary intervention according to presentation (stable vs unstable angina pectoris/non-ST-segment elevation myocardial infarction vs ST-segment elevation myocardial infarction). Am J Cardiol 2011; 108:1395-400. [PMID: 21890087 DOI: 10.1016/j.amjcard.2011.06.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/19/2022]
Abstract
Patients ≥ 80 years old with coronary artery disease constitute a particular risk group in relation to percutaneous coronary intervention (PCI). From 2002 through 2008 we examined the annual proportion of patients ≥ 80 years old undergoing PCI in western Denmark, their indications for PCI, and prognosis. From 2002 through 2009 all elderly patients treated with PCI were identified in a population of 3.0 million based on the Western Denmark Heart Registry. Cox regression analysis was used to compare mortality rates according to clinical indications controlling for potential confounding. In total 3,792 elderly patients (≥ 80 years old) were treated with PCI and the annual proportion increased from 224 (5.4%) in 2002 to 588 (10.2%) in 2009. The clinical indication was stable angina pectoris (SAP) in 30.2%, ST-segment elevation myocardial infarction (STEMI) in 35.0%, UAP/non-STEMI in 29.7%, and "ventricular arrhythmia or congestive heart failure" in 5.1%. Overall 30-day and 1-year mortality rates were 9.2% and 18.1%, respectively. Compared to patients with SAP the adjusted 1-year mortality risk was significantly higher for patients presenting with STEMI (hazard ratio 3.86, 95% confidence interval 3.08 to 4.85), UAP/non-STEMI (hazard ratio 1.95, 95% confidence interval 1.53 to 2.50), and ventricular arrhythmia or congestive heart failure (hazard ratio 2.75, 95% confidence interval 1.92 to 3.92). In patients with SAP target vessel revascularization decreased from 7.1% in 2002 to 2.5% in 2008. In conclusion, the proportion of patients ≥ 80 years old treated with PCI increased significantly over an 8-year period. Patients with SAP had the lowest mortality rates and rates of clinically driven target vessel revascularization decreased over time.
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MESH Headings
- Aged, 80 and over
- Angina, Stable/mortality
- Angina, Stable/therapy
- Angina, Unstable/mortality
- Angina, Unstable/therapy
- Angioplasty, Balloon, Coronary/statistics & numerical data
- Angioplasty, Balloon, Coronary/trends
- Arrhythmias, Cardiac/mortality
- Cohort Studies
- Comorbidity
- Coronary Artery Disease/mortality
- Coronary Artery Disease/therapy
- Denmark/epidemiology
- Female
- Follow-Up Studies
- Heart Failure/mortality
- Humans
- Male
- Myocardial Infarction/mortality
- Myocardial Infarction/therapy
- Registries
- Regression Analysis
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Affiliation(s)
- Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Saleh N, Ivert T, Tornvall P. [Coronary disease is investigated and treated with advantage via catheter]. Lakartidningen 2011; 108:1108-1112. [PMID: 21815343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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20
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Kern MJ. The rising tide of transradial cardiac catheterization: riding the wave. J Invasive Cardiol 2011; 23:2-95. [PMID: 21364236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Morton J Kern
- Long Beach Veterans Administration Hospital, 5901 East 7th Street, Long Beach, CA 90807, USA.
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Yokoi H. [Role of global vascular intervention on long-term prognosis in patients with coronary artery disease]. Nihon Rinsho 2011; 69:207-214. [PMID: 21387665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although recent advance of coronary intervention therapy for coronary artery disease (CAD) is remarkable, long-term clinical outcomes were similar with the past decade. Recent study demonstrated that poly-vascular disease was associated with a significant higher-risk of major adverse cardiovascular events in patients with CAD. The treatment of peripheral artery disease (PAD) reaches to improvement in exercise performance. Revascularization for atherosclerotic renal artery stenosis (ARAS) is associated with reduction in blood pressure and preservation of renal function. Revascularization for carotid artery stenosis (CAS) is associated with the prevention of stroke. Because systemic vascular diseases are related to cardiovascular events, the targeted screening by non-invasive testing for PAD, ARAS, and CAS would increase the frequency of diagnosis, the chance of revascularization therapies, and reach to the reduction in cardiovascular events.
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Mitsudo K. [History of coronary intervention in Japan]. Nihon Rinsho 2011; 69:197-206. [PMID: 21387664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/history
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/trends
- History, 20th Century
- History, 21st Century
- Humans
- Japan
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Hassan A, Newman A, Ko DT, Rinfret S, Hirsch G, Ghali WA, Tu JV. Increasing rates of angioplasty versus bypass surgery in Canada, 1994-2005. Am Heart J 2010; 160:958-65. [PMID: 21095286 DOI: 10.1016/j.ahj.2010.06.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 06/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly being offered to patients with coronary artery disease. The purpose of this study was to determine the impact of this change in coronary revascularization strategy on PCI and coronary artery bypass grafting (CABG) utilization across Canada. METHODS All cases of PCI and isolated CABG between years 1994 and 2005 were identified through the Canadian Institute for Health Information. Age- and sex-standardized rates of PCI and CABG per 100,000 population as well as PCI-to-CABG ratios were calculated by year and province and across age, sex, income, diabetes, and recent acute coronary syndrome subgroups. In addition, risk-adjusted rates of in-hospital mortality after PCI and CABG were reported by year. RESULTS Between 1994 and 2005, PCI rates increased from 85.6/100,000 to 186.7/100,000 (P < .001), whereas CABG rates remained stable (75.6/100,000-70.8/100,000; P = .43), resulting in an increase in PCI-to-CABG ratio (1.13-2.64; P < .001). Significant increases in PCI-to-CABG ratios were seen across all provinces (except Newfoundland and Alberta), as well as across all age, sex, income, diabetes, and recent acute coronary syndrome categories. Decline in risk-adjusted in-hospital mortality was seen after both CABG (3.9%-2.2%; P < .001) and PCI (1.6%-1.3%; P < .001) but appeared larger after CABG. CONCLUSIONS Since 1994, rates of PCI have increased significantly as compared to CABG. During the same period, greater declines in risk-adjusted rates of in-hospital mortality were seen among CABG versus PCI patients. Further study is needed to determine the appropriateness of PCI and CABG rates in terms of clinical outcomes and resource utilization.
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Affiliation(s)
- Ansar Hassan
- Department of Cardiac Surgery, New Brunswick Heart Center, Saint John, New Brunswick, Canada.
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Groarke JD, Blake G, McCann H, Sugrue D, Mahon N. Increasing cardiac interventions among the aged. Ir Med J 2010; 103:308-310. [PMID: 21560503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Ireland's over 65 year population is growing. As incidence of coronary events rises with age, there is a growing population of elderly patients with cardiac disease. The changing age profile of patients treated by a tertiary hospital's Cardiology service was quantified using Hospital Inpatient Enquiry data. 53% of CCU admissions were aged > or = 65 years, with admissions aged > or = 85 years in 2008 four times greater than in 2002. Percentages of patients undergoing diagnostic coronary angiography and percutaneous coronary interventions in 1997 aged > or = 70 years were 19% and 18% respectively. By 2007, these percentages had risen to 31% and 34% respectively--greatest increases were in the very elderly age categories. The proportion of ICD recipients aged > 70 years increased from 8% in 2003 to 25% by 2008. The proportion of elderly patients receiving advanced cardiac care is increasing. This trend will continue and has clear resource implications. Outcomes of interventions in the very old need further investigation, since the 'old old' are under-represented in clinical trials.
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Affiliation(s)
- J D Groarke
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7.
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25
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Stiefelhagen P. [New study findings in cardiology. The best is the enemy of the good]. Med Monatsschr Pharm 2010; 33:433-435. [PMID: 21166254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Roe MT, Messenger JC, Weintraub WS, Cannon CP, Fonarow GC, Dai D, Chen AY, Klein LW, Masoudi FA, McKay C, Hewitt K, Brindis RG, Peterson ED, Rumsfeld JS. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol 2010; 56:254-63. [PMID: 20633817 DOI: 10.1016/j.jacc.2010.05.008] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 05/17/2010] [Accepted: 05/18/2010] [Indexed: 12/21/2022]
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Shaw RE. Editor's message. J Invasive Cardiol 2010; 22:A6. [PMID: 20469539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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28
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Walker C. Will the transradial approach become the preferred approach in subclavian artery stenting? J Invasive Cardiol 2010; 22:207-208. [PMID: 20440035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Craig Walker
- Vascular Laboratory, Cardiovascular Institute of the South, 225 Dunn Street, Houma, LA 70360, USA.
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Di Mario C. Why so few women in interventional cardiology? EUROINTERVENTION 2010; 5:883-887. [PMID: 20542771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Carlo Di Mario
- Royal Brompton Hospital & Imperial College, London, United Kingdom
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Fox KAA, Carruthers K, Steg PG, Avezum A, Granger CB, Montalescot G, Goodman SG, Gore JM, Quill AL, Eagle KA. Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The global registry of acute coronary events. Eur Heart J 2010; 31:667-75. [PMID: 20007159 PMCID: PMC2838680 DOI: 10.1093/eurheartj/ehp499] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 09/29/2009] [Accepted: 10/27/2009] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine whether changes in practice, over time, are associated with altered rates of major bleeding in acute coronary syndromes (ACS). METHODS AND RESULTS Patients from the Global Registry of Acute Coronary Events were enrolled between 2000 and 2007. The main outcome measures were frequency of major bleeding, including haemorrhagic stroke, over time, after adjustment for patient characteristics, and impact of major bleeding on death and myocardial infarction. Of the 50 947 patients, 2.3% sustained a major bleed; almost half of these presented with ST-elevation ACS (44%, 513). Despite changes in antithrombotic therapy (increasing use of low molecular weight heparin, P < 0.0001), thienopyridines (P < 0.0001), and percutaneous coronary interventions (P < 0.0001), frequency of major bleeding for all ACS patients decreased (2.6 to 1.8%; P < 0.0001). Most decline was seen in ST-elevation ACS (2.9 to 2.1%, P = 0.02). The overall decline remained after adjustment for patient characteristics and treatments (P = 0.002, hazard ratio 0.94 per year, 95% confidence interval 0.91-0.98). Hospital characteristics were an independent predictor of bleeding (P < 0.0001). Patients who experienced major bleeding were at increased risk of death within 30 days from admission, even after adjustment for baseline variables. CONCLUSION Despite increasing use of more intensive therapies, there was a decline in the rate of major bleeding associated with changes in clinical practice. However, individual hospital characteristics remain an important determinant of the frequency of major bleeding.
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Affiliation(s)
- Keith A A Fox
- Cardiovascular Research, Division of Medical and Radiological Sciences, The University of Edinburgh, Edinburgh, UK.
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31
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Bélával M. [I like to see the big bear leaving the patient's chest . . . Interview with Dr. Béla Merkley by Györgyi B.Király]. Orv Hetil 2010; 151:79. [PMID: 20120552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Angina Pectoris/etiology
- Angina Pectoris/therapy
- Angioplasty, Balloon, Coronary/trends
- Athletes
- Cardiology/education
- Cardiology/trends
- Competitive Behavior
- Death, Sudden, Cardiac/prevention & control
- Emergency Service, Hospital/trends
- Emergency Treatment/methods
- Europe
- Faculty, Medical
- Health Services Accessibility/standards
- Health Services Accessibility/trends
- History, 20th Century
- History, 21st Century
- Humans
- Hungary
- Journalism, Medical
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Societies, Medical
- Sports
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Mannan HR, Knuiman M, Hobbs M. Using a Markov simulation model to assess the impact of changing trends in coronary heart disease incidence on requirements for coronary artery revascularization procedures in Western Australia. BMC Cardiovasc Disord 2010; 10:2. [PMID: 20053292 PMCID: PMC2824688 DOI: 10.1186/1471-2261-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 01/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population incidence of coronary heart disease (CHD) has been declining in Australia and many other countries. This decline has been due to reduced population levels of risk factors for CHD and improved medical care for those at higher risk of CHD. However, there are signs that there may be a slowing down or even reversal in the decline of CHD incidence due to the 'obesity epidemic' and other factors and this will have implications for the requirements for surgical treatments for those with CHD. METHODS Using a validated Markov simulation model applied to the population of Western Australia, different CHD incidence trend scenarios were developed to explore the effect of changing CHD incidence on requirements for coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI), together known as coronary artery revascularization procedures (CARPs). RESULTS The most dominant component of CHD incidence is the risk of CHD hospital admission for those with no history of CHD and if this risk leveled off and the trends in all other risks continued unchanged, then the projected numbers of CABGs and PCIs are only minimally changed. Further, the changes in the projected numbers remained small even when this risk was increased by 20 percent (although it is an unlikely scenario). However, when the other CHD incidence components that had also been declining, namely, the risk of CABG and that of CHD death for those with no history of CHD, were also projected to level off as these were declining in 1998-2000 and the risk of PCI for those with no history of CHD (which was already increasing) was projected to further increase by 5 percent, it had a substantial effect on the projected numbers of CARPs. CONCLUSION There needs to be dramatic changes to several CHD incidence components before it has a substantial impact on the projected requirements for CARPs. Continued monitoring of CHD incidence and also the mix of initial presentation of CHD incidence is required in order to understand changes to future CARP requirements.
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Affiliation(s)
- Haider R Mannan
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria; School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Matthew Knuiman
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Michael Hobbs
- School of Population Health, University of Western Australia, Perth, WA, Australia
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Broderick GT. Transradial cardiac catheterization and intervention--observations on its place in the catheterization laboratory. Am Heart Hosp J 2010; 8:19-24. [PMID: 21194044 DOI: 10.15420/ahhj.2010.8.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Charbonneau F. Creating synergy in our health system: The challenges of primary angioplasty. Can J Cardiol 2009; 25:e387-8. [PMID: 19898703 DOI: 10.1016/s0828-282x(09)70167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Al-Housni MB, Hutchings F, Dalby M, Dubowitz M, Grocott-Mason R, Ilsley CDJ, Mason M, Mitchell AG, Kelion AD. Does myocardial perfusion scintigraphy predict improvement in symptoms and exercise capacity following successful elective percutaneous coronary intervention? J Nucl Cardiol 2009; 16:869-77. [PMID: 19588213 DOI: 10.1007/s12350-009-9112-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 06/09/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Elective percutaneous coronary intervention (PCI) without inducible ischaemia may not be beneficial. We investigated the prevalence of inducible hypoperfusion using myocardial perfusion scintigraphy (MPS) in patients undergoing PCI, and its ability to predict functional outcome. METHODS AND RESULTS One hundred and twenty-three patients listed for elective PCI underwent MPS, using treadmill exercise where possible. Seventy-seven patients (63%) described chest pain in daily life. Seventy-four of 103 (72%) exercise ECG tests were positive. Ninety-one (74%) had inducible hypoperfusion on MPS (extensive in 25; 20%). Interventionalists were blinded to the scintigraphic results, and PCI was performed as planned. Six months later, Seattle Angina Questionnaire physical limitation score had improved from 66 to 76 (P < 0.0001), and peak treadmill workload from 7.2 +/- 2.3 to 9.0 +/- 2.7 METS (P < 0.0001). Sex, limiting chest pain on baseline exercise testing, and MPS summed difference score (SDS) were independent predictors of improvement. Patients with both limiting chest pain and SDS > or = 7 demonstrated an increase of 3.3 +/- 1.8 METS, compared with approximately 1.5 METS for other subgroups (P < 0.05). CONCLUSIONS Many patients undergoing elective PCI in a UK centre have little or no evidence of inducible hypoperfusion. The combination of limiting chest pain during exercise testing and significant inducible hypoperfusion on MPS predicts a large increase in exercise capacity after PCI.
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Affiliation(s)
- M Bashar Al-Housni
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex UB9 6JH, United Kingdom
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Freeman MR. Growing evidence that radionuclide imaging identifies management strategies that improve outcome. J Nucl Cardiol 2009; 16:844-5. [PMID: 19636650 DOI: 10.1007/s12350-009-9120-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
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Jedrzkiewicz S, Goodman SG, Yan RT, Welsh RC, Kornder J, DeYoung JP, Wong GC, Rose B, Grondin FR, Gallo R, Huang W, Gore JM, Yan AT. Temporal trends in the use of invasive cardiac procedures for non-ST segment elevation acute coronary syndromes according to initial risk stratification. Can J Cardiol 2009; 25:e370-6. [PMID: 19898699 PMCID: PMC2776566 DOI: 10.1016/s0828-282x(09)70163-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 06/21/2008] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Current guidelines support an early invasive strategy in the management of high-risk non-ST elevation acute coronary syndromes (NSTE-ACS). Although studies in the 1990s suggested that highrisk patients received less aggressive treatment, there are limited data on the contemporary management patterns of NSTE-ACS in Canada. OBJECTIVE To examine the in-hospital use of coronary angiography and revascularization in relation to risk among less selected patients with NSTE-ACS. METHODS Data from the prospective, multicentre Global Registry of Acute Coronary Events (main GRACE and expanded GRACE2) were used. Between June 1999 and September 2007, 7131 patients from across Canada with a final diagnosis of NSTE-ACS were included the study. The study population was stratified into low-, intermediate- and high-risk groups, based on their calculated GRACE risk score (a validated predictor of in-hospital mortality) and according to time of enrollment. RESULTS While rates of in-hospital death and reinfarction were significantly (P<0.001) greater in higher-risk patients, the in-hospital use of cardiac catheterization in low- (64.7%), intermediate- (60.3%) and highrisk (42.3%) patients showed an inverse relationship (P<0.001). This trend persisted despite the increase in the overall rates of cardiac catheterization over time (47.9% in 1999 to 2003 versus 51.6% in 2004 to 2005 versus 63.8% in 2006 to 2007; P<0.001). After adjusting for confounders, intermediate-risk (adjusted OR 0.80 [95% CI 0.70 to 0.92], P=0.002) and high-risk (adjusted OR 0.38 [95% CI 0.29 to 0.48], P<0.001) patients remained less likely to undergo in-hospital cardiac catheterization. CONCLUSION Despite the temporal increase in the use of invasive cardiac procedures, they remain paradoxically targeted toward low-risk patients with NSTE-ACS in contemporary practice. This treatment-risk paradox needs to be further addressed to maximize the benefits of invasive therapies in Canada.
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Affiliation(s)
- Sean Jedrzkiewicz
- Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, University of Toronto, and the Canadian Heart Research Centre, Toronto, Ontario
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, University of Toronto, and the Canadian Heart Research Centre, Toronto, Ontario
| | - Raymond T Yan
- Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, University of Toronto, and the Canadian Heart Research Centre, Toronto, Ontario
| | | | - Jan Kornder
- Surrey Memorial Hospital, Surrey, British Columbia
| | | | - Graham C Wong
- University of British Columbia, Vancouver, British Columbia
| | - Barry Rose
- Health Sciences Centre, St John’s, Newfoundland
| | | | | | - Wei Huang
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Joel M Gore
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, University of Toronto, and the Canadian Heart Research Centre, Toronto, Ontario
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Lombardi WL. Retrograde PCI: what will they think of next? J Invasive Cardiol 2009; 21:543. [PMID: 19805844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- William L Lombardi
- North Cascade Cardiology, and St. Joseph Hospital, 2979 Squalicom Parkway, Suite 101, Bellingham, WA 98225, USA.
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Dani SI, Patel SR. Percutaneous coronary interventions: past, present and future. J Indian Med Assoc 2009; 107:623-635. [PMID: 20337243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Sameer I Dani
- Department of Cardiology, UN Mehta Institute of Cardiology and Research Centre, Ahmedabad
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Stathopoulos I, Jimenez M, Panagopoulos G, Kwak EJ, Losquadro M, Cohen H, Iyer S, Ruiz C, Roubin G, Garratt K. The decline in PCI complication rate: 2003-2006 versus 1999-2002. Hellenic J Cardiol 2009; 50:379-387. [PMID: 19767279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Technical improvements permit the performance of percutaneous coronary interventions (PCI) reliably and safely. However, adverse events during such procedures have still not been eliminated. The purpose of this study was to assess the current rates of complications from PCI, as well as any changes from 1999 to 2006. METHODS Prospectively collected Lenox Hill Hospital data were abstracted from the New York State PCI Report forms and a review of the Quality Improvement office database. The reported complications from 23,399 consecutive PCIs performed during an eight-year period (January 1999 to December 2006) were recorded. The one-month composite endpoint (CEP: death, myocardial infarction, stent thrombosis, stroke, or emergent cardiac surgery within one month of the PCI) and the one-month composite endpoint excluding stent thrombosis (CEPnoST) were evaluated. RESULTS Complications occurred in 3.36% of PCIs. The following complication rates were found: one month death rate 0.6%, death in the catheterization suite 0.047%, stent thrombosis (one month) 0.53%, presumed stent thrombosis (one month) 0.82%, myocardial infarction (MI: either Q or non-Q wave) 0.74%, emergent cardiac surgery 0.15%, stroke 0.29%, cardiac perforation 0.29%, retroperitoneal bleeding 0.18%, acute renal failure 0.28%, need for hemodialysis 0.17%, CEP 1.8% and CEPnoST 1.58%. When the complication rates from the most recent period (2003-2006) were compared with those from the earlier period (1999-2002), a statistically significant difference was found in total complications, CEP, CEPnoST, stroke, MI, and vascular complications. CONCLUSIONS Current rates of PCI complications remain low. The overall PCI complication rate was lower during the last four years of the study.
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Zalewski J, Nycz K, Przewlocki T, Durak M, Cul M, Zajdel W, Zmudka K. Evolution of myocardial perfusion during primary angioplasty in spontaneously reperfused infarct-related artery: impact on long-term clinical outcomes and left ventricular function recovery. Int J Cardiol 2009; 147:25-31. [PMID: 19709768 DOI: 10.1016/j.ijcard.2009.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/06/2009] [Accepted: 07/24/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND TIMI myocardial perfusion grade (TMPG) reflects the integrity of microvasculature in ST-elevation myocardial infarction (STEMI). We sought to investigate whether TMPG evolution during primary angioplasty (pPCI) in spontaneously reperfused STEMI patients might predict long-term outcomes. METHODS 392 patients with TIMI-3 flow before pPCI were analyzed. According to pre- and post-pPCI TMPG four reperfusion patterns were created: A. TMPG deterioration from grade 2/3 to 0/1 after pPCI (n = 55, 14.0%), B. TMPG-0/1 before and after pPCI (n = 111, 28.3%), C. TMPG improvement from grade 0/1 to 2/3 (n = 52, 13.3%), D. TMPG-2/3 before and after pPCI (n = 174, 44.4%). 30-day and 1-year mortality and heart failure requiring hospitalization (HF-hosp) were recorded. Left ventricular ejection fraction (LVEF) was measured at first day (1D) and after 6 months (6M). RESULTS 1D-LVEF was similar in A-D groups. After 6M, LVEF improved in pattern D (7.5 ± 5.4%, p<0.01) and C (3.7 ± 3.4%, p < 0.05), deteriorated in pattern A (5.2 ± 3.9%, p<0.01) and did not change in pattern B. 6M-LVEF increased (p < 0.001) and frequency of 1-year HF-hosp decreased (p < 0.001) in stepwise fashion among A-D patterns. A 30-day mortality rate for A-D patterns was 9.1%, 2.7%, 1.9% and 0%, respectively (p < 0.001). 1-year mortality was 16.3%, 7.2%, 5.8% and 0.6%, respectively (p < 0.001). By multivariate analysis (c-index = 0.79), TMPG evolution was independent predictor of 1-year mortality (HR = 2.5, 95%CI 1.3-4.0, p = 0.006). CONCLUSIONS Maintaining TMPG-2/3 or improving TMPG-0/1 through pPCI in STEMI implies LV function recovery and good long-term survival. In contrast, substantial deterioration of TMPG is associated with lack of LV function recovery, and the highest mortality rate.
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Affiliation(s)
- Jaroslaw Zalewski
- Institute of Cardiology, Jagiellonian University School of Medicine, Cracow, Poland.
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Celik T, Iyisoy A, Kardesoglu E, Isik E. Stenting versus plain old angioplasty in patients with ST segment elevation myocardial infarction: understanding of the randomized trials. Int J Cardiol 2009; 133:394-6; author reply 396. [PMID: 18077019 DOI: 10.1016/j.ijcard.2007.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 08/10/2007] [Indexed: 11/27/2022]
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Cannon CP, Hoekstra JW, Larson DM, Mencia WA, Cornish J, Carter RD, Berry CA, Karcher RB. Individual quality improvement in acute coronary syndromes: a performance improvement initiative. Crit Pathw Cardiol 2009; 8:43-48. [PMID: 19258838 DOI: 10.1097/hpc.0b013e3181980f75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although treatment guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) have been published and widely accepted, barriers to the optimal management of patients with acute coronary syndromes (ACS) still exist. Adherence to guidelines has been correlated with improvements in patient outcomes in ACS, including reduced mortality, yet data demonstrate that 25% of opportunities to provide guideline-recommended care are missed. This article describes a performance improvement (PI) initiative designed to address gaps in process-related ACS care and improve patient outcomes. PI is an American Medical Association-approved, standardized continuing medical education format in which physicians can earn up to 20 American Medical Association PRA category 1 credits by completing 2 phases of self-assessment and developing and implementing a PI plan to address self-identified areas in which patient care can be improved. In this ACS PI initiative, physicians will assess their practice using performance measures defined by the 2007 ACC/AHA ST-segment elevation myocardial infarction and unstable angina or non-ST-segment elevation myocardial infarction guideline updates within 3 general benchmark areas: (1) patient risk assessment, (2) initial pharmacologic management, and (3) time-to-treatment (ie, "door-to-needle," "door-to-balloon," and "door-in-door-out" times). After completing a self-assessment and identifying 1 or more areas of improvement, participants can complete educational interventions and access benchmark-specific tools that provide guidance on improving adherence with the ACC/AHA guidelines. This PI initiative supplements other ongoing quality improvement initiatives in ACS, but is unique in that it is the first to use individual physician self-assessment, benchmark-focused continuing medical education, and self-developed PI plans to improve process-related ACS care.
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MESH Headings
- Acute Coronary Syndrome/diagnosis
- Acute Coronary Syndrome/mortality
- Acute Coronary Syndrome/therapy
- Angioplasty, Balloon, Coronary/standards
- Angioplasty, Balloon, Coronary/trends
- Attitude of Health Personnel
- Benchmarking
- Clinical Competence
- Education, Medical, Continuing
- Emergency Service, Hospital/standards
- Emergency Service, Hospital/trends
- Evidence-Based Medicine
- Female
- Guideline Adherence
- Hospital Mortality/trends
- Humans
- Male
- Outcome Assessment, Health Care
- Platelet Aggregation Inhibitors/therapeutic use
- Practice Guidelines as Topic
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/trends
- Risk Assessment
- Sensitivity and Specificity
- Survival Analysis
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44
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Palmaz JC. Current trends in cardiovascular therapy. J Cardiovasc Surg (Torino) 2009; 50:3-6. [PMID: 19179985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Celik T, Iyisoy A, Yuksel UC, Isik E. Optimal revascularization strategy for diabetic patients with multivessel coronary artery disease: the duel between old hero and young warrior. Int J Cardiol 2009; 131:269-70; author reply 271-2. [PMID: 17692947 DOI: 10.1016/j.ijcard.2007.05.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 05/26/2007] [Indexed: 11/30/2022]
Abstract
Given the results of the BARI and ARTS I trials and a meta-analysis, coronary artery bypass surgery has been preferred to percutaneous coronary intervention in diabetics with multivessel coronary artery disease requiring hypoglycemic treatment and in whom internal mammary artery grafts can be used. This approach was strongly recommended in a 2002 ACC/AHA Task Force on the management of patients with acute coronary syndrome. But, these recommendations were made before the availability of drug-eluting stents. We strongly believe that the ongoing, multi-centre FREEDOM, CARDia and SYNTAX trials will elucidate the optimal revascularization strategy for diabetic patients with multivessel disease in the near future.
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Weerasinghe DP, Yusuf F, Parr NJ. Trends in percutaneous coronary interventions in new South Wales, Australia. Int J Environ Res Public Health 2009; 6:232-245. [PMID: 19440280 PMCID: PMC2672343 DOI: 10.3390/ijerph6010245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 01/08/2009] [Indexed: 12/01/2022]
Abstract
This is the first detailed study on percutaneous coronary intervention (PCI) in New South Wales (NSW), Australia. Hospital data for PCIs carried out between 1 July 1990 and 30 June 2002 are analysed. The study explores trends in PCI rates by selected socio-demographic factors, the utilisation of angioplasties vis-a-vis stents, emergency admissions, and selected coexisting conditions which determine the disease status of PCI patients. Logistic regression models are used to study the medical conditions that require both PCI and coronary artery bypass graft (CABG). The PCI rate has grown rapidly at 12.1% per annum, with a particularly rapid increase for persons aged 75+. The rate of multiple stent utilisation increased at 4.6% per annum. Pacific-born and Middle-Eastern-born patients are more than twice as likely as the Australian-born to have diabetes. Factors affecting failure of PCI requiring CABG include perforation and multi-vessel disease. PCI services in public hospitals need to be increased to facilitate the availability of these procedures to all segments of the population, as do targeted community-level programmes to educate high-risk groups in the control of heart diseases.
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Affiliation(s)
- Daminda P. Weerasinghe
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Farhat Yusuf
- Faculty of Business and Economics, Macquarie University, North Ryde, NSW, Australia; E-mails:
(F. Y.);
(N. J. P.)
| | - Nicholas J. Parr
- Faculty of Business and Economics, Macquarie University, North Ryde, NSW, Australia; E-mails:
(F. Y.);
(N. J. P.)
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May SA, Wilson JM. The comparative efficacy of percutaneous and surgical coronary revascularization in 2009: a review. Tex Heart Inst J 2009; 36:375-386. [PMID: 19876412 PMCID: PMC2763449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Medical, percutaneous, and surgical therapies for coronary atherosclerotic disease are developing rapidly, with many recent breakthroughs in metabolic control, improvements in catheter and stent engineering, and advances in surgical technique. Treatment guidelines are still in their infancy and do not take into account several of these recent innovations. Consequently, determining the most appropriate treatment for many patients remains challenging. In this review, we examine the most recent revascularization guidelines, discuss important new data and trials comparing contemporary stent technology and coronary artery bypass surgery, and conclude with updated revascularization recommendations.
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MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/history
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/mortality
- Angioplasty, Balloon, Coronary/trends
- Comorbidity
- Coronary Artery Bypass/adverse effects
- Coronary Artery Bypass/history
- Coronary Artery Bypass/mortality
- Coronary Artery Bypass/trends
- Coronary Artery Disease/mortality
- Coronary Artery Disease/surgery
- Coronary Artery Disease/therapy
- Drug-Eluting Stents
- Evidence-Based Medicine
- History, 20th Century
- History, 21st Century
- Humans
- Patient Selection
- Practice Guidelines as Topic
- Risk Assessment
- Risk Factors
- Stents
- Treatment Outcome
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Affiliation(s)
- Stephen A May
- Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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49
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Serruys PW. Together, we can truly insure the future. EUROINTERVENTION 2008; 4:301. [PMID: 19110799 DOI: 10.4244/eijv4i3a53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Lucas FL, Siewers AE, Malenka DJ, Wennberg DE. Diagnostic-therapeutic cascade revisited: coronary angiography, coronary artery bypass graft surgery, and percutaneous coronary intervention in the modern era. Circulation 2008; 118:2797-802. [PMID: 19064681 PMCID: PMC2706113 DOI: 10.1161/circulationaha.108.789446] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is wide geographic variation in the use of coronary revascularization in the United States. Rates are closely related to rates of coronary angiography. We assessed the relationship between coronary angiography and coronary artery revascularization by procedure type (coronary artery bypass graft surgery or percutaneous coronary intervention). METHODS AND RESULTS Using Part B claims for a 20% sample of the Medicare population, we calculated population-based rates of testing and treatment by region, using events identified in Part B claims as the numerator and the total number of Medicare beneficiaries residing in the area as the denominator and adjusting for regional differences in demographic characteristics with the indirect method. Cardiac catheterization rates varied substantially across regions, from 16 to 77 per 1000 Medicare beneficiaries. The relationship between coronary angiography rates and total coronary revascularization rates was strong (R(2)=0.84). However, there was only a modest association between coronary angiography rates and coronary artery bypass graft surgery rates (R(2)=0.41) with the suggestion of a threshold effect. The association between coronary angiography rates and percutaneous coronary intervention rates was strong (R(2)=0.78) and linear. CONCLUSIONS The diagnostic-therapeutic cascade for coronary artery disease differs by therapeutic intervention. For coronary artery bypass graft surgery, the relationship is modest, and there appears to be a testing threshold beyond which additional tests do not result in additional surgeries. For percutaneous coronary intervention, the relationship is very tight, and no threshold appears to exist. Given the results of recent studies of medical versus invasive management of stable coronary disease, patients living in high-diagnostic-intensity regions may be getting more treatment than they want or need.
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Affiliation(s)
- F L Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA.
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