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Maddox TM, Song Y, Allen J, Chan PS, Khan A, Lee JJ, Mitchell J, Oetgen WJ, Ponirakis A, Segawa C, Spertus JA, Thorpe F, Virani SS, Masoudi FA. Trends in U.S. Ambulatory Cardiovascular Care 2013 to 2017: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 75:93-112. [PMID: 31918838 DOI: 10.1016/j.jacc.2019.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/21/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Abstract
The National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry is the largest outpatient cardiovascular practice registry in the world. It tracks real-world management and quality of 4 common cardiovascular conditions: heart failure, coronary artery disease, atrial fibrillation, and hypertension. In 2013, the PINNACLE Registry contained information on 2,898,505 patients, cared for by 4,859 providers in 431 practices. By 2017, the registry contained information on 6,040,996 patients, cared for by 8,853 providers in 724 practices. During this time period, care processes for PINNACLE patients generally improved. Among patients with heart failure, combined beta-blocker and renin-angiotensin antagonist medication rates increased from 60.7% to 72.8%. Among patients with coronary artery disease, statin medication rates increased from 66% to 80.1%. Among patients with atrial fibrillation, oral anticoagulation rates increased from 52.7% to 65.2%. In contrast, blood pressure control rates among patients with hypertension were largely stable. PINNACLE data also fueled a variety of quality measurement programs and 51 peer-reviewed publications.
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Affiliation(s)
- Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri; Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine; St. Louis, Missouri.
| | - Yang Song
- Baim Institute for Clinical Research, Boston, Massachusetts
| | | | - Paul S Chan
- Mid-America Heart Institute, Kansas City, Missouri
| | - Adeela Khan
- American College of Cardiology, Washington, DC
| | - Jane J Lee
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Joshua Mitchell
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | - Fran Thorpe
- American College of Cardiology, Washington, DC
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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102
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Kwak S, Choi YJ, Kwon S, Lee SY, Yang S, Moon I, Lee HJ, Lee H, Park JB, Han K, Kim YJ, Kim HK. De novo malignancy risk in patients undergoing the first percutaneous coronary intervention: A nationwide population-based cohort study. Int J Cardiol 2020; 313:25-31. [DOI: 10.1016/j.ijcard.2020.04.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/26/2022]
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Earl TJ. Acute Hand Ischemia and Digital Amputation After Transradial Coronary Intervention in a Patient With CREST Syndrome. Tex Heart Inst J 2020; 47:319-321. [PMID: 33472228 DOI: 10.14503/thij-19-6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.
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Affiliation(s)
- Thomas J Earl
- Michigan Heart & Vascular Specialists, McLaren Northern Michigan, Petoskey, Michigan 49770
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Thandra A, Jhand A, Guddeti R, Pajjuru V, DelCore M, Lavie CJ, Alla VM. Sex Differences in Clinical Outcomes Following Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28:25-31. [PMID: 32873519 DOI: 10.1016/j.carrev.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) has emerged as a reasonable alternative to coronary artery bypass graft (CABG) surgery in well-selected patients with unprotected left main coronary disease (LMCD). We conducted a systematic review and meta-analysis with the aim of assessing the impact of sex on outcomes of PCI in patients with unprotected LMCD. METHODS A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the outcomes of men vs. women among patients undergoing PCI for unprotected LMCD. The primary outcome of interest was study defined major adverse cardiac events (MACE) and secondary outcomes were all-cause mortality, cardiac mortality, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis and stroke. For all outcomes, pooled odds ratios (OR) with their corresponding 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model. RESULTS Six studies with a total of 6515 individuals (4954 men, 1561women) with a mean follow up of 36 months were included in the analysis. MACE and MI were significantly higher in women with OR of 1.17 (95% CI 1.01-1.36; p = 0.03) and 1.42 (95% CI 1.07-1.87; p = 0.01) respectively. All-cause mortality, cardiac mortality, and TLR were similar among men and women. CONCLUSION Our meta-analysis suggests that women undergoing PCI for unprotected LMCD have higher rates of MACE and MI compared to men.
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Affiliation(s)
- Abhishek Thandra
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA.
| | - Aravdeep Jhand
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Raviteja Guddeti
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Venkata Pajjuru
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Michael DelCore
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Venkata M Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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105
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Khan SA, Bhattacharjee S, Ghani MOA, Walden R, Chen QM. Vitamin C for Cardiac Protection during Percutaneous Coronary Intervention: A Systematic Review of Randomized Controlled Trials. Nutrients 2020; 12:E2199. [PMID: 32718091 PMCID: PMC7468730 DOI: 10.3390/nu12082199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is the preferred treatment for acute coronary syndrome (ACS) secondary to atherosclerotic coronary artery disease. This nonsurgical procedure is also used for selective patients with stable angina. Although the procedure is essential for restoring blood flow, reperfusion can increase oxidative stress as a side effect. We address whether intravenous infusion of vitamin C (VC) prior to PCI provides a benefit for cardioprotection. A total of eight randomized controlled trials (RCT) reported in the literature were selected from 371 publications through systematic literature searches in six electronic databases. The data of VC effect on cardiac injury biomarkers and cardiac function were extracted from these trials adding up to a total of 1185 patients. VC administration reduced cardiac injury as measured by troponin and CK-MB elevations, along with increased antioxidant reservoir, reduced reactive oxygen species (ROS) and decreased inflammatory markers. Improvement of the left ventricular ejection fraction (LVEF) and telediastolic left ventricular volume (TLVV) showed a trend but inconclusive association with VC. Intravenous infusion of VC before PCI may serve as an effective method for cardioprotection against reperfusion injury.
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Affiliation(s)
- Sher Ali Khan
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85721, USA; (S.A.K.); (S.B.)
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85721, USA; (S.A.K.); (S.B.)
| | | | - Rachel Walden
- Annette and Irwin Eskind Family Biomedical Library, Jean & Alexander Heard Libraries, Vanderbilt University, Nashville, TN 37203, USA;
| | - Qin M. Chen
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin Ave, Tucson, AZ 85721, USA; (S.A.K.); (S.B.)
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A comparison of surgical, total percutaneous, and hybrid approaches to treatment of combined coronary artery and valvular heart disease. Curr Opin Cardiol 2020; 35:559-565. [DOI: 10.1097/hco.0000000000000764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Box LC, Blankenship JC, Henry TD, Messenger JC, Cigarroa JE, Moussa ID, Snyder RW, Duffy PL, Carr JG, Tukaye DN, Ang L, Shah B, Rao SV, Mahmud E. SCAI
position statement on the performance of percutaneous coronary intervention in ambulatory surgical centers. Catheter Cardiovasc Interv 2020; 96:862-870. [DOI: 10.1002/ccd.28991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital Cincinnati Ohio USA
| | | | | | - Issam D. Moussa
- Carle Health System, Carle Illinois College of Medicine Champaign Illinois USA
| | | | - Peter L. Duffy
- Appalachian Regional Healthcare System Boone North Carolina USA
| | - Jeffrey G. Carr
- CardiaStream Tyler Cardiac and Endovascular Center Tyler Texas USA
| | | | - Lawrence Ang
- University of California, San Diego, Sulpizio Cardiovascular Center La Jolla California USA
| | - Binita Shah
- New York University School of Medicine New York New York USA
| | - Sunil V. Rao
- Duke University Health System Durham North Carolina USA
| | - Ehtisham Mahmud
- University of California, San Diego, Sulpizio Cardiovascular Center La Jolla California USA
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Treatment of In-Stent Restenosis Using Excimer Laser Coronary Atherectomy and Bioresorbable Vascular Scaffold Guided by Optical Coherence Tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:44-49. [PMID: 32448779 DOI: 10.1016/j.carrev.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
The rate of in-stent restenosis (ISR) has become increasingly prevalent with the exponential growth in stent implantation due to an aging population and a higher life expectancy, in addition to the high rates of obesity and diabetes. In this prospective, single operator, all-comer study, we sought to analyze the performance of ELCA followed by bioresorbable vascular scaffold (BVS) placement in patients undergoing percutaneous coronary intervention (PCI) for ISR. A total of 13 patients had ISR treated with a combination of ELCA and BVS, with 9 patients having matched OCT pre, post ELCA and post BVS. Mean age was 65 ± 11.22 and 83% of the patients were male. Hypertension and dyslipidemia were present in 100% of the patients and smoking and diabetes in 50%. After the procedure, we did not detect residual stenosis over 10% in any patient, resulting in a technical success of 100%. No patients had MACE during their hospital stay or within the next six months, resulting in a procedure success of 100%. The mean lumen area increased 0.35 mm2 from pre procedure to post ELCA and 3.58 mm2 from post ELCA to post BVS. The final difference, from pre procedure to post BVS, was a 3.93 mm2 lumen area gain. The mean lumen diameter increased 0.11 mm from baseline to ELCA, 0.95 mm from post laser to BVS implantation and 1.06 mm from pre procedure to post BVS. The NIH area reduced 0.48 mm2 from pre to post ELCA, 1.13mm2 from post ELCA to BVS implantation and 1.61 mm2 from baseline to post BVS implantation. We conclude that ELCA is a safe and feasible debulking method to approach ISR, with high rates of post-procedural BVS success, within six months follow-up.
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Vaz J, Abelin AP, Schmidt MM, de Oliveira PP, Gottschall CAM, Rodrigues CG, de Quadros AS. Creation and Implementation of a Prospective and Multicentric Database of Patients with Acute Myocardial Infarction: RIAM. Arq Bras Cardiol 2020; 114:446-455. [PMID: 32267314 PMCID: PMC7792739 DOI: 10.36660/abc.20190036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 05/15/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multicenter registries representing the real world can be a significant source of information, but few studies exist describing the methodology to implement these tools. OBJECTIVE To describe the process of implementing a database of ST-segment elevation acute myocardial infarction (STEMI) at a reference hospital, and the application of this process to other centers by means of an online platform. METHODS In 2009, our institution implemented an Registry of Acute Myocardial Infarction (RIAM), with the prospective and consecutive inclusion of every patient admitted to the institution who received a diagnosis of STEMI. From March 2014 to April 2016, the registries were uploaded to a web-based system using the REDCap software and the registry was expanded to other centers. Upon subscription, the REDCap platform is a noncommercial software made available by Vanderbilt University to institutions interested in research. RESULTS The following steps were taken to improve and expand the registry: 1. Standardization of variables; 2. Implementation of institutional REDCap (Research Electronic Data Capture); 3. Development of data collection forms (Case Report Form - CRF); 4. Expansion of registry to other reference centers using the REDCap software; 5. Training of teams and participating centers following an SOP (Standard Operating Procedure). CONCLUSION The description of the methodology used to implement and expand the RIAM may help other centers and researchers to conduct similar studies, share information between institutions, develop new health technologies, and assist public policies regarding cardiovascular diseases. (Arq Bras Cardiol. 2020; 114(3):446-455).
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Affiliation(s)
- Jacqueline Vaz
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
| | - Anibal Pereira Abelin
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
- Universidade Federal de Santa MariaSanta MariaRSBrasilUniversidade Federal de Santa Maria (UFSM), Santa Maria, RS – Brasil
- Universidade FranciscanaSanta MariaRSBrasilUniversidade Franciscana (UNIFRA), Santa Maria, RS – Brasil
| | - Marcia Moura Schmidt
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
| | | | - Carlos A. M. Gottschall
- Instituto de CardiologiaPorto AlegreRSBrasilInstituto de Cardiologia, Porto Alegre, RS – Brasil
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Understanding the Sex Paradox After Percutaneous Coronary Intervention. J Am Coll Cardiol 2020; 75:1641-1643. [DOI: 10.1016/j.jacc.2020.02.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 12/21/2022]
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111
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Raelson C, Ahmed B. Prevention and Management of Radial Access Complications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-0808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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112
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Bartos JA. A fork in the road after STEMI: Rapid recovery and discharge or cardiac arrest and high mortality. Resuscitation 2020; 148:266-268. [DOI: 10.1016/j.resuscitation.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
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113
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Williams T, Condon J, Davies A, Brown J, Matheson L, Warner T, Savage L, Boyle A, Collins N, Inder K. Nursing-led ultrasound to aid in trans-radial access in cardiac catheterisation: a feasibility study. J Res Nurs 2020; 25:159-172. [PMID: 34394621 DOI: 10.1177/1744987119900374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Trans-radial access is increasingly common for cardiac catheterisation. Benefits include reduced bleeding complications, length of hospital stay and costs. Aims To determine the feasibility of implementing a nurse-led ultrasound programme to measure radial artery diameter before and after cardiac catheterisation; to determine radial artery occlusion (RAO) rates, risk factors for RAO and predictors of radial artery (RA) diameter. Method A prospective observational cohort study design for 100 consecutive patients undergoing cardiac catheterisation, using RA access. Pre- and post-procedural RA diameter were measured using ultrasound, by specialist nurses trained to do so. Logistic regression analyses were performed to determine risk factors for RAO and predictors of RA diameter with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results There were no adverse events, supporting the feasibility of nurse led ultrasound programmes. A 4% (n = 4) rate of occlusion was observed. Haemostasis device application time of greater than 190 min was a predictor of RAO (OR 3.12, 95% CI 0.31-31). Male gender and height were predictors for a RA diameter of >2.2 mm. Conclusions Nurses can lead the assessment of RA occlusion using ultrasound to enhance planning and care, including monitoring compression times to reduce RAO.
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Affiliation(s)
- Trent Williams
- Clinical Nurse Consultant, Department of Cardiology, John Hunter Hospital, Australia
| | - Jeremy Condon
- Registered Nurse, Department of Cardiology, John Hunter Hospital, Australia
| | - Allan Davies
- Interventional Fellow, Cardiology, John Hunter Hospital, Australia
| | - Jennifer Brown
- Registered Nurse, Cardiology, John Hunter Hospital, Australia
| | | | | | - Lindsay Savage
- Clinical Nurse Consultant, Cardiology, John Hunter Hospital, Australia
| | - Andrew Boyle
- Professor of Cardiovascular Medicine, Director of Priority Clinical Centre for Cardiovascular health, Department of Cardiology, John Hunter Hospital, Australia
| | - Nicholas Collins
- Associate Professor, Director, Cardiac Catheterisation Lab, John Hunter Hospital, Australia
| | - Kerry Inder
- Associate Professor of Nursing: Deputy Head of School-Research, School of Nursing and Midwifery, University of Newcastle, Australia
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Dhruva SS, Parzynski CS, Gamble GM, Curtis JP, Desai NR, Yeh RW, Masoudi FA, Kuntz R, Shaw RE, Marinac‐Dabic D, Sedrakyan A, Normand ST, Krumholz HM, Ross JS. Attribution of Adverse Events Following Coronary Stent Placement Identified Using Administrative Claims Data. J Am Heart Assoc 2020; 9:e013606. [PMID: 32063087 PMCID: PMC7070203 DOI: 10.1161/jaha.119.013606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/13/2020] [Indexed: 11/22/2022]
Abstract
Background More than 600 000 coronary stents are implanted during percutaneous coronary interventions (PCIs) annually in the United States. Because no real-world surveillance system exists to monitor their long-term safety, claims data are often used for this purpose. The extent to which adverse events identified with claims data can be reasonably attributed to a specific medical device is uncertain. Methods and Results We used deterministic matching to link the NCDR (National Cardiovascular Data Registry) CathPCI Registry to Medicare fee-for-service claims for patients aged ≥65 years who underwent PCI with drug-eluting stents (DESs) between July 1, 2009 and December 31, 2013. We identified subsequent PCIs within 1 year of the index procedure in Medicare claims as potential safety events. We linked these subsequent PCIs back to the NCDR CathPCI Registry to ascertain how often the revascularization could be reasonably attributed to the same coronary artery as the index PCI (ie, target vessel revascularization). Of 415 306 DES placements in 368 194 patients, 33 174 repeat PCIs were identified in Medicare claims within 1 year. Of these, 28 632 (86.3%) could be linked back to the NCDR CathPCI Registry; 16 942 (51.1% of repeat PCIs) were target vessel revascularizations. Of these, 8544 (50.4%) were within a previously placed DES: 7652 for in-stent restenosis and 1341 for stent thrombosis. Of 16 176 patients with a claim for acute myocardial infarction in the follow-up period, 4446 (27.5%) were attributed to the same coronary artery in which the DES was implanted during the index PCI (ie, target vessel myocardial infarction). Of 24 288 patients whose death was identified in claims data, 278 (1.1%) were attributed to the same coronary artery in which the DES was implanted during the index PCI. Conclusions Most repeat PCIs following DES stent implantation identified in longitudinal claims data could be linked to real-world registry data, but only half could be reasonably attributed to the same coronary artery as the index procedure. Attribution among those with acute myocardial infarction or who died was even less frequent. Safety signals identified using claims data alone will require more in-depth examination to accurately assess stent safety.
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Affiliation(s)
- Sanket S. Dhruva
- University of California, San Francisco, School of Medicine and San Francisco Veterans Affairs Healthcare SystemSan FranciscoCA
- National Clinician Scholars ProgramYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
| | - Craig S. Parzynski
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
| | - Ginger M. Gamble
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
| | - Jeptha P. Curtis
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
- Section of Cardiovascular MedicineDepartment of Medicine, and National Clinician Scholars ProgramYale School of MedicineNew HavenCT
| | - Nihar R. Desai
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
- Section of Cardiovascular MedicineDepartment of Medicine, and National Clinician Scholars ProgramYale School of MedicineNew HavenCT
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBostonMA
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
- Baim Institute for Clinical ResearchBostonMA
| | - Frederick A. Masoudi
- Division of CardiologyDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | | | - Richard E. Shaw
- Department of Clinical InformaticsCalifornia Pacific Medical CenterSan FranciscoCA
| | - Danica Marinac‐Dabic
- Office of Clinical Evidence and AnalysisCenter for Devices and Radiological HealthU.S. Food and Drug AdministrationSilver SpringMD
| | - Art Sedrakyan
- Department of Health Policy and ResearchWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Sharon‐Lise T. Normand
- Department of Health Care PolicyHarvard Medical SchoolBostonMA
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthHarvard UniversityBostonMA
| | - Harlan M. Krumholz
- National Clinician Scholars ProgramYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
- Section of Cardiovascular MedicineDepartment of Medicine, and National Clinician Scholars ProgramYale School of MedicineNew HavenCT
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCT
| | - Joseph S. Ross
- National Clinician Scholars ProgramYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCT
- Section of General MedicineDepartment of Medicine, and National Clinician Scholars ProgramYale School of MedicineNew HavenCT
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Affiliation(s)
- Tanveer Rab
- Interventional Cardiology, Andreas Gruentzig Center, Emory University School of Medicine, Atlanta, Georgia.
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116
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Malekpour M, Dehghani-Tafti F, Ratki SKR, Seifpoor Z, Namiranian N, Shafiee M, Mali S, Seyed Hosseini SM. Yazd Province of Iran ICD Registry for the Years 2014-2016. Crit Pathw Cardiol 2020; 19:90-93. [PMID: 32011358 DOI: 10.1097/hpc.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the trends in the care of patients undergoing implantable cardioverter-defibrillator (ICD) implantation in our region and to analyze whether the quality of care is the same as the other centers or not? METHODS Adult patients with an indication for ICD implants were enrolled in our registry and followed over a 19-43-month period. RESULTS The ICD implantation rate was 100/million per year. The mean age of patients treated with ICD was 62.36 (±12.93) years old and the majority of patients were men (77.6%). Most patients had ischemic heart failure (65.2%). Nearly half of the patients had NYHA class III (53.8%) and the mean of ejection fraction was 26.7 (±9.8%). ICDs were frequently implanted for primary prevention (71.9%). Single chamber ICDs (ICD-VR) were chosen in 25.2%, dual-chamber ICDs in 37.1% (ICD-DR) and biventricular ICDs (CRT-D) in 37.6%, respectively. Complications related to ICD implantation occurred in about 7.49% of all procedures. During follow-up period death occurred in 14.8% of our patients. Also, 13.3% of patients received ICD shock which was appropriate in 71% of patients. CONCLUSIONS In comparison between our registry and NCDR registry, baseline patient characteristics and ICD type were almost the same, but the complication rate was higher. There is still a need to perform a large multicenter registry in our community to improve our knowledge in this Era.
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Affiliation(s)
- Maliheh Malekpour
- From the Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Faezeh Dehghani-Tafti
- From the Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seid Kazem Razavi Ratki
- Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zeinolabedin Seifpoor
- From the Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Shafiee
- From the Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Shahryar Mali
- From the Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Foo FS, Lee M, Looi K, Larsen P, Clare GC, Heaven D, Stiles MK, Voss J, Boddington D, Jackson R, Kerr AJ. Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS-QI 33). J Arrhythm 2020; 36:153-163. [PMID: 32071634 PMCID: PMC7011834 DOI: 10.1002/joa3.12244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects nationwide data on cardiac implantable electronic devices in New Zealand (NZ). We used the registry to describe contemporary NZ use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). METHODS All ICD and CRT Pacemaker implants recorded in ANZACS-QI DEVICE between 1 January 2014 and 31 December 2017 were analyzed. RESULTS Of 1579 ICD implants, 1152 (73.0%) were new implants, including 49.0% for primary prevention and 51.0% for secondary prevention. In both groups, median age was 62 years and patients were predominantly male (81.4% and 79.2%, respectively). Most patients receiving a primary prevention ICD had a history of clinical heart failure (80.4%), NYHA class II-III symptoms (77.1%) and LVEF ≤35% (96.9%). In the secondary prevention ICD cohort, 88.4% were for sustained ventricular tachycardia or survived cardiac arrest from ventricular arrhythmia. Compared to primary prevention CRT Defibrillators (n = 155), those receiving CRT Pacemakers (n = 175) were older (median age 74 vs 66 years) and more likely to be female (38.3% vs 19.4%). Of the 427 (27.0%) ICD replacements (mean duration 6.3 years), 46.6% had received appropriate device therapy while 17.8% received inappropriate therapy. The ICD implant rate was 119 per million population with regional variation in implant rates, ratio of primary prevention ICD implants, and selection of CRT modality. CONCLUSION In contemporary NZ practice three-quarters of ICD implants were new implants, of which half were for primary prevention. The majority met current guideline indications. Patients receiving CRT pacemaker were older and more likely to be female.
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Affiliation(s)
- Fang Shawn Foo
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- Department of CardiologyAuckland City HospitalAucklandNew Zealand
| | - Mildred Lee
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
| | - Khang‐Li Looi
- Department of CardiologyAuckland City HospitalAucklandNew Zealand
| | - Peter Larsen
- Wellington Cardiovascular Research GroupWellington HospitalWellingtonNew Zealand
| | - Geoffrey C. Clare
- Department of CardiologyChristchurch HospitalChristchurchNew Zealand
- University of OtagoChristchurchNew Zealand
| | - David Heaven
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | | | - Jamie Voss
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | - Dean Boddington
- Department of CardiologyTauranga HospitalTaurangaNew Zealand
| | | | - Andrew J. Kerr
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
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Wadhera RK, Bhatt DL, Wang TY, Lu D, Lucas J, Figueroa JF, Garratt KN, Yeh RW, Joynt Maddox KE. Association of State Medicaid Expansion With Quality of Care and Outcomes for Low-Income Patients Hospitalized With Acute Myocardial Infarction. JAMA Cardiol 2020; 4:120-127. [PMID: 30649146 DOI: 10.1001/jamacardio.2018.4577] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Lack of insurance is associated with worse care and outcomes among adults hospitalized for acute myocardial infarction (AMI). It is unclear whether states' decision to expand Medicaid eligibility under the Patient Protection and Affordable Care Act in 2014 were associated with improved quality of care and outcomes among low-income patients hospitalized with AMI. Objective To investigate whether rates of uninsurance, quality of care, and outcomes changed among patients hospitalized for AMI 3 years after states elected to expand Medicaid compared with nonexpansion states. Design, Setting, and Participants Retrospective cohort study completed at hospitals participating in National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry. Participants were patients younger than 65 years hospitalized for AMI from January 1, 2012, to December 31, 2016. Exposures State Medicaid expansion in 2014. Main Outcomes and Measures Rates of uninsured and Medicaid-insured hospitalizations for AMI in states that expanded Medicaid vs those that did not. Comparison of in-hospital care quality, procedure use, and mortality between expansion and nonexpansion states for the years prior to and after Medicaid expansion. Hierarchical logistic regressions models were used to assess the association between Medicaid expansion and outcomes. Results The initial cohort included 325 343 patients. Uninsured AMI hospitalizations declined in expansion states (18.0% [4395 of 24 358 hospitalizations] to 8.4% [2638 of 31 382 hospitalizations]) and more modestly in nonexpansion states (25.6% [7963 of 31 137 hospitalizations] to 21.1% [8668 of 41 120 hospitalizations]) from 2012 to 2016 (P < .001 difference in trend expansion vs nonexpansion). Medicaid coverage increased from 7.5% (1818 of 24 358 hospitalizations) to 14.4% (4502 of 31 382 hospitalizations) in expansion states and 6.2% (1924 of 31 137 hospitalizations) to 6.6% (2717 of 41 120 hospitalizations) in nonexpansion states (P < .001). The low-income cohort included 55 737 patients across 765 sites. In expansion states, low-income adults' odds of receipt of defect-free care increased (76.3% to 75.9%, adjusted odds ratio 1.11; 95% CI, 1.02-1.21) but to a lesser degree than in nonexpansion states (72.8% to 74.5%, adjusted odds ratio, 1.38; 95% CI, 1.30-1.47; P for interaction < .001). There was no change in use of most procedures (ie, percutaneous coronary intervention for non-ST-segment elevation myocardial infarction) in expansion compared with nonexpansion states. Improvement in in-hospital mortality was similar between expansion and nonexpansion states (3.2% to 2.8%, adjusted odds ratio, 0.93; 95% CI, 0.77-1.12 vs 3.3% to 3.0%, adjusted odds ratio, 0.85; 95% CI, 0.73-0.99; P for interaction = .48). Conclusions and Relevance Medicaid expansion was associated with a significant reduction in rates of uninsurance among patients hospitalized with AMI. Quality of care and outcomes did not improve among low-income adults in expansion compared with nonexpansion states. Hospital care for AMI may be less sensitive to insurance than has been recognized in the past.
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Affiliation(s)
- Rishi K Wadhera
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Di Lu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Joseph Lucas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jose F Figueroa
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4842] [Impact Index Per Article: 1210.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Abstract
Mitochondria regulate major aspects of cell function by producing ATP, contributing to Ca2+ signaling, influencing redox potential, and controlling levels of reactive oxygen species. In this review, we will discuss recent findings that illustrate how mitochondrial respiration, Ca2+ handling, and production of reactive oxygen species affect vascular smooth muscle cell function during neointima formation. We will review mitochondrial fission/fusion as fundamental mechanisms for smooth muscle proliferation, migration, and metabolism and examine the role of mitochondrial mobility in cell migration. In addition, we will summarize novel aspects by which mitochondria regulate apoptosis.
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Affiliation(s)
- Isabella M Grumbach
- From the Abboud Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Internal Medicine (I.M.G., E.K.N.), University of Iowa, Iowa City.,Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center (I.M.G.), University of Iowa, Iowa City.,Iowa City VA Health Care System (I.M.G.)
| | - Emily K Nguyen
- From the Abboud Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Internal Medicine (I.M.G., E.K.N.), University of Iowa, Iowa City
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121
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Mattke S, Hanson M, Bentele M, Kandzari DE. Cost and Mortality Implications of Lower Event Rates After Implantation of an Ultrathin-Strut Coronary Stent Compared With a Thin-Strut Stent Over Four Years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:835-842. [PMID: 31954661 DOI: 10.1016/j.carrev.2019.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The recent BIOFLOW V trial (ClinicalTrials.gov: NCT02389946) showed that revascularization with an ultrathin strut, bioresorbable polymer sirolimus-eluting stent (BP SES) was associated with lower rates of clinically driven target lesion revascularization (TLR) and target vessel-related myocardial infarction (TVMI) at 24-month follow-up than that with a thin strut, durable polymer everolimus-eluting stent (DP EES). We simulated the impact on cost and mortality. METHODS AND RESULTS We projected the impact of the lower adverse event rates from a U.S. health system perspective over a 48-month horizon with a Markov model using event data from the BIOFLOW V trial and estimates for costs and excess mortality due to adverse events from published sources. All cost estimates were CPI-adjusted to 2018 US$ and future cost discounted by 3%. We estimated that use of BP SES compared to DP EES was associated with cumulative net reductions in medical cost of $2429 per patient over 48 months. Peri-procedural TVMI contributed $124 (5%), TLR in patients without TVMI $810 (33%) and spontaneous TVMI $1496 (62%) of cost. Use of BP SES compared to DP EES was associated with 2603 fewer deaths in one million patients over four years, corresponding to a relative risk reduction of 6%. CONCLUSIONS Lower adverse event rates associated with revascularization using BP SES translate into reductions in direct medical cost and mortality. Most of the cost reduction is attributed to reduction in spontaneous TVMI. Given the high volume of coronary procedures, such results are an important consideration for patients, clinicians and payers.
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Affiliation(s)
- Soeren Mattke
- University of Southern California, Los Angeles, CA, USA; Benecit Research, Newton, MA, USA.
| | - Mark Hanson
- University of Southern California, Los Angeles, CA, USA; Benecit Research, Newton, MA, USA
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122
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Feldman DA, Shroff AR, Bao H, Curtis JP, Minges KE, Ardati AK. Stent selection among patients with chronic kidney disease: Results from the NCDR CathPCI Registry. Catheter Cardiovasc Interv 2020; 96:1213-1221. [PMID: 31909543 DOI: 10.1002/ccd.28698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/20/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study sought to define contemporary rates of drug eluting stent (DES) usage in patients with chronic kidney disease (CKD). BACKGROUND Among patients with CKD undergoing percutaneous coronary interventions (PCIs), outcomes are superior for those who receive DES compared to those who receive bare metal stents (BMSs). However, perceived barriers may limit the use of DES in this population. METHODS All adult PCI cases from the NCDR CathPCI Registry involving coronary stent placement between July 1, 2009 and December 31, 2015 were analyzed. The rate of DES usage was then compared among four groups, stratified by CKD stage (I/II, III, IV, and V). Subgroup analysis was conducted based on PCI status and indication. Cases were linked to Medicare claims data to assess 1-year mortality. RESULTS A total of 3,650,333 PCI cases met criteria for analysis. DES usage significantly declined as renal function worsened (83.0%, 79.9%, 75.6%, and 75.6%, respectively, in the four CKD stages; p < .001). DES usage was universally lower across the four groups in the setting of ST-Elevation Myocardial Infarction (STEMI) (70.6%, 66.5%, 58.7%, 58.0%; p < .001) and higher in the setting of elective PCI (87.6%, 84.9%, 82.3%, 77.9%; p < .0001). DES was associated with improved 1-year survival, and usage increased over time across each group. CONCLUSIONS DESs are underutilized in patients with advanced renal dysfunction. Although DES usage has increased over time, variation still exists between patients with normal renal function and those with CKD.
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Affiliation(s)
- Daniel A Feldman
- Section of Cardiology, Adventist Health Portland, Portland, Oregon
| | - Adhir R Shroff
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois
| | - Haikun Bao
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Amer K Ardati
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois
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Kwok CS, Amin AP, Shah B, Kinnaird T, Alkutshan R, Balghith M, Ratib K, Nolan J, Bagur R, Mamas MA. Cost of coronary syndrome treated with percutaneous coronary intervention and 30‐day unplanned readmission in the United States. Catheter Cardiovasc Interv 2019; 97:80-93. [DOI: 10.1002/ccd.28660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/07/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Amit P. Amin
- Washington School of Medicine St. Louis Missouri
| | - Binita Shah
- VA New York Harbor Healthcare System (Manhattan Campus) and New York University School of Medicine New York New York
| | | | - Raed Alkutshan
- Royal Commission Health Services Program Jubail Saudi Arabia
| | - Muhammad Balghith
- King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia
| | - Karim Ratib
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - James Nolan
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Rodrigo Bagur
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
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124
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5329] [Impact Index Per Article: 1065.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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125
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Yeo KK, Ong HY, Chua T, Lim ZJ, Yap J, Ho HH, Jaufeerally F, Tong KL, Kojodjojo P, Wong HB, Heng D, Tan KB, Richards AM, Teoh KLK, Sin K, Tan NC, Lee SBM, Lim T, Ta A, Liok E, Lau YH, Gao F, Liman C, Sarkar J, Sahlén A, Koh TH, Chan MY. Building a Longitudinal National Integrated Cardiovascular Database - Lessons Learnt From SingCLOUD. Circ Rep 2019; 2:33-43. [PMID: 33693172 PMCID: PMC7929705 DOI: 10.1253/circrep.cr-19-0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background:
Real world data on clinical outcomes and quality of care for patients with coronary artery disease (CAD) are fragmented. We describe the rationale and design of the Singapore Cardiovascular Longitudinal Outcomes Database (SingCLOUD). Methods and Results:
We designed a health data grid to integrate clinical, administrative, laboratory, procedural, prescription and financial data from all public-funded hospitals and primary care clinics, which provide 80% of health care in Singapore. Here, we explain our approach to harmonize real-world data from diverse electronic medical and non-medical platforms to develop a robust and longitudinal dataset. We present pilot data on patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) between 2012 and 2014. The initial data set had 53,395 patients. Of these, 35,203 had CAD confirmed on coronary angiography, of whom 21,521 had PCI. Eventually, limiting to 2012–2014, 3,819 patients had MI with PCI, while 5,989 had MI. Compared with the quality improvement registry, Singapore Cardiac Data Bank, which had 189 fields for analysis, the SingCLOUD platform generated an additional 313 additional data fields, and was able to identify an additional 250 heart failure events, 664 major adverse cardiovascular events at 2 years, and low-density lipoprotein levels to 1 year for 3,747 patients. Conclusions:
By integrating multiple incongruent data sources, SINGCLOUD enables in-depth analysis of real-world cardiovascular “big data”.
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Affiliation(s)
- Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore Singapore.,Duke-NUS Medical School Singapore
| | - Hean-Yee Ong
- Department of Cardiology, Khoo Teck Puat Hospital Singapore
| | - Terrance Chua
- Department of Cardiology, National Heart Centre Singapore Singapore.,Duke-NUS Medical School Singapore
| | - Zheng Jie Lim
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne Victoria Australia
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore Singapore
| | - Hee Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital Singapore
| | - Fazlur Jaufeerally
- Duke-NUS Medical School Singapore.,Department of Internal Medicine, Singapore General Hospital Singapore
| | - Khim-Leng Tong
- Department of Cardiology, Changi General Hospital Singapore
| | - Pipin Kojodjojo
- Division of Cardiology, Department of Medicine, Jurong Health Singapore
| | - Hwee-Bee Wong
- Biostatistics and Research Branch, Ministry of Health Singapore
| | - Derrick Heng
- Public Health Group, Ministry of Health Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health Singapore
| | - Arthur Mark Richards
- Cardiovascular Research Institute [CVRI], National University Heart Centre [NUHCS], National University Health System Singapore
| | | | - Kenny Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore Singapore
| | | | | | - Terence Lim
- Integrated Health Informatics System, Ministry of Health Holdings Singapore
| | - Andy Ta
- Integrated Health Informatics System, Ministry of Health Holdings Singapore
| | - Edwin Liok
- Infocomm Media Development Authority of Singapore Singapore
| | - Yee How Lau
- Singapore Cardiac Data Bank, National Heart Centre Singapore Singapore
| | - Fei Gao
- NHRIS, National Heart Centre Singapore Singapore
| | | | | | - Anders Sahlén
- Department of Cardiology, National Heart Centre Singapore Singapore.,Karolinska Institute Stockholm Sweden
| | - Tian Hai Koh
- Department of Cardiology, National Heart Centre Singapore Singapore
| | - Mark Y Chan
- Cardiac Department, National University Hospital Singapore
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Tuttle MK, Haroian NQ, Gavin LF, Esposito CA, Ho KKL. Expedited Removal of a Radial Hemostatic Compression Device Following Cardiac Catheterization Is Safe and Associated With Reduced Time to Discharge. Cardiol Res 2019; 10:331-335. [PMID: 31803330 PMCID: PMC6879050 DOI: 10.14740/cr953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Radial access for cardiac catheterization has become increasingly adopted, owing much of its popularity to decreased bleeding complications compared with the femoral approach. Hemostatic compression devices (HCDs) for radial catheterization play a key role in this advantage, but the optimal duration of compression is unknown. A shorter duration of compression is encouraged by guidelines, but removing an HCD too quickly could result in serious bleeding. We aimed to evaluate the safety and effectiveness of expedited removal of a radial HCD after cardiac catheterization. Methods We conducted a prospective study of patients undergoing radial cardiac catheterization and/or percutaneous coronary intervention at a tertiary care academic medical center. Patients underwent HCD application using a TR Band® (Terumo Interventional Systems) which was removed after a prespecified amount of time in each of three sequential temporal cohorts: 2-h, 1-h, or 0.5-h. Each patient was monitored for development of bleeding or hematoma and for serious complications. Results A total of 354 patients participated in our study, with similar numbers in each group. There was a greater rate of minor bleeding in the 0.5-h (12%) and 1-h (19%) groups compared with the 2-h group (8%), but there were no serious complications (need for surgical consultation, transfusion, or unplanned admission) in any group. The average time to discharge was shorter in the 0.5-h and 1-h groups compared with the 2-h group. Conclusions Deflating the radial HCD at 0.5 h is safe with no increase in the observed rate of major complications and is associated with reduced time to discharge after coronary angiography or percutaneous coronary intervention using the radial arterial approach.
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Affiliation(s)
- Mark K Tuttle
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Noah Q Haroian
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Lana F Gavin
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Cheryl A Esposito
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Kalon K L Ho
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.,Harvard Medical School, Boston, MA 02115, USA
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Shin DH, Kang HJ, Jang JS, Moon KW, Song YB, Park DW, Bae JW, Kim J, Hur SH, Kim BO, Jeon DW, Choi D, Han KR. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 & 2016 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2019; 49:1136-1151. [PMID: 31347316 PMCID: PMC6875596 DOI: 10.4070/kcj.2018.0413] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/16/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In this second report from Korean percutaneous coronary intervention (K-PCI) registry, we sought to describe the updated information of PCI practices and Korean practice pattern of PCI (KP3). METHODS In addition to K-PCI registry of 2014, new cohort of 2016 from 92 participating centers was appended. Demographic and procedural information, as well as in-hospital outcomes, of PCI was collected using a web-based reporting system. KP3 class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or bypass-surgery. RESULTS In 2016, total 48,823 PCI procedures were performed at 92 participating centers. Mean age of the patients was 65.7±11.6 years, and 71.7% were males. Overall patient characteristics and PCI practices in 2016 were similar to those in 2014. The biggest change was the decrease in the in-hospital occurrence of myocardial infarction (MI;1.6%→0.7%, p<0.001). Many associations between PCI volumes and demographic/procedural characteristics observed in 2014 have disappeared. The median of door-to-balloon time was 62 minutes, and 83.3% of ST-elevation MI patients received primary PCI within 90 minutes, while the median of total ischemic time was 168 minutes and patients who had total ischemic time within 120 and 180 minutes were 29.1% and 54.1%, respectively. The proportion of KP3 class C cases in non-acute coronary syndrome patients decreased from 13.5% in 2014 to 12.1% in 2016 (p<0.001). CONCLUSIONS In this second report from K-PCI registry, we described the current practices of PCI and changes from 2014 to 2016 in Korea.
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Affiliation(s)
- Dong Ho Shin
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Sik Jang
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Keon Woong Moon
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Juhan Kim
- Department of Cardiovascular Medicine, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Dong Woon Jeon
- Department of Cardiology, National Health Insurance Service (NHIS) Ilsan Hospital, Goyang, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo Rok Han
- Department of Internal Medicine, Gangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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Waldo SW, Gokhale M, O'Donnell CI, Plomondon ME, Valle JA, Armstrong EJ, Schofield R, Fihn SD, Maddox TM. Temporal Trends in Coronary Angiography and Percutaneous Coronary Intervention: Insights From the VA Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv 2019; 11:879-888. [PMID: 29747919 DOI: 10.1016/j.jcin.2018.02.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/16/2018] [Accepted: 02/27/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate temporal trends in characteristics and outcomes among patients referred for invasive coronary procedures within a national health care system for veterans. BACKGROUND Coronary angiography and percutaneous coronary intervention remain instrumental diagnostic and therapeutic interventions for coronary artery disease. METHODS All coronary angiographic studies and interventions performed in U.S. Department of Veterans Affairs cardiac catheterization laboratories for fiscal years 2009 through 2015 were identified. The demographic characteristics and management of these patients were stratified by time. Clinical outcomes including readmission (30-day) and mortality were assessed across years. RESULTS From 2009 to 2015, 194,476 coronary angiographic examinations and 85,024 interventions were performed at Veterans Affairs facilities. The median numbers of angiographic studies (p = 0.81) and interventions (p = 0.22) remained constant over time. Patients undergoing these procedures were progressively older, with more comorbidities, as the proportion classified as having high Framingham risk significantly increased among those undergoing angiography (from 20% to 25%; p < 0.001) and intervention (from 24% to 32%; p < 0.001). Similarly, the median National Cardiovascular Data Registry CathPCI risk score increased for diagnostic (from 14 to 15; p = 0.005) and interventional (from 14 to 18; p = 0.002) procedures. Post-procedural medical management was unchanged over time, although there was increasing adoption of transradial access for diagnostic (from 6% to 36%; p < 0.001) and interventional (from 5% to 32%; p < 0.001) procedures. Complications and clinical outcomes also remained constant, with a trend toward a reduction in the adjusted hazard ratio for percutaneous coronary intervention mortality (hazard ratio: 0.983; 95% confidence interval: 0.967 to 1.000). CONCLUSIONS Veterans undergoing invasive coronary procedures have had increasing medical complexity over time, without attendant increases in mortality among those receiving interventions. As the Department of Veterans Affairs moves toward a mix of integrated and community-based care, it will be important to account for these demographic shifts so that quality can be maintained.
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Affiliation(s)
- Stephen W Waldo
- Department of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado.
| | - Madhura Gokhale
- Department of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Colin I O'Donnell
- Department of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Mary E Plomondon
- Department of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Javier A Valle
- Department of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Ehrin J Armstrong
- Department of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Richard Schofield
- Department of Medicine, Division of Cardiology, VA National Program, Gainesville, Florida
| | - Stephan D Fihn
- Department of Medicine, VA Puget Sound Healthcare System, Seattle, Washington
| | - Thomas M Maddox
- Department of Medicine, Division of Cardiology, Washington University, St. Louis, Missouri
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Alqahtani F, Balla S, AlHajji M, Chaudhary F, Albeiruti R, Kawsara A, Alkhouli M. Temporal trends in the utilization and outcomes of percutaneous coronary interventions in patients with liver cirrhosis. Catheter Cardiovasc Interv 2019; 96:802-810. [PMID: 31713989 DOI: 10.1002/ccd.28593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We sought to assess the national trends in the utilization and outcomes of percutaneous coronary interventions (PCI) in patients with cirrhosis. BACKGROUND Contemporary data on PCI in patients with liver cirrhosis are limited. METHODS The National-Inpatient-Sample was used to identify patients who underwent PCI between 2003 and 2016. We examined the annual PCI rate, and compared the in-hospital morbidity, mortality, resource utilization, and cost following PCI in patients with and without cirrhosis. RESULTS A total of 8,860,178 PCI hospitalizations were identified, of those, 20,339 (0.2%) were performed in patients with cirrhosis. Annual PCI rates decreased overtime in patients without liver cirrhosis but increased in those with cirrhosis (Ptrend < .001). Patients with cirrhosis had a characteristic clinical, demographic, and socioeconomic profile compared with those without cirrhosis. The use of bare-metal stents decreased from 69.1 to 11.4% in the noncirrhosis group, and from 81.9 to 21.3% in the cirrhosis group. Compared with propensity-matched patients without cirrhosis, PCI in cirrhotic patients was associated with higher in-hospital mortality across all indications (STEMI 19.1 vs. 11.5%, p = .002; NSTEMI 8.7 vs. 5.6%, p = .002; and UA/SIHD 7.7 vs. 4.3%, p < .001). Cirrhotic patients also had significantly higher rates of acute kidney injury, but similar rates of vascular complications and stroke. Additionally, cirrhotic patients had longer hospitalizations, were less likely to be discharged home, and accrued higher cost across all PCI indications. CONCLUSIONS Patients with cirrhosis who are deemed "suitable PCI candidates" in current practice remain at high-risk for worse short-term morbidity and mortality, and higher cost of care.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Sudarashan Balla
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Mohamed AlHajji
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Fahad Chaudhary
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ridwaan Albeiruti
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
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Ebinger J, Henry T, Kim S, Inkelas M, Cheng S, Nuckols T. Development and Evaluation of Novel Electronic Medical Record Tools For Avoiding Bleeding After Percutaneous Coronary Intervention. J Am Heart Assoc 2019; 8:e013954. [PMID: 31707946 PMCID: PMC6915282 DOI: 10.1161/jaha.119.013954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Bleeding remains the most common complication of percutaneous coronary intervention. Guidelines recommend assessing bleeding risk before percutaneous coronary intervention to target use of bleeding avoidance strategies and mitigate bleeding events. Cedars‐Sinai Medical Center undertook an initiative to integrate these recommendations into the electronic medical record. Methods and Results The intervention included a voluntary clinical decision alert to assess bleeding risk before percutaneous coronary intervention, a bleeding risk calculator tool based on the NCDR (National Cardiovascular Data Registry) risk prediction model and, when indicated, a second alert to consider 4 bleeding avoidance strategies. We tested for changes in the use of bleeding avoidance strategies and bleeding event rates by comparing procedures performed before versus after implementation of the electronic medical record–based intervention and with versus without use of the bleeding risk calculator tool. Use of radial access increased (47.6% versus 64.8%; P<0.001) and glycoprotein IIb/IIIa inhibitors decreased (12.8% versus 3.17%; P<0.001) from before to after implementation, though risk‐adjusted bleeding event rates were stable (odds ratio, 0.82; P=0.164), even for high‐risk procedures. Use versus nonuse of the bleeding risk calculator tool was associated with increased radial access and reductions in glycoprotein IIb/IIIa inhibitors, but no change in bleeding events. Conclusions Integrating guideline recommendations into the electronic medical record to promote assessments of bleeding risk and use of bleeding avoidance strategies was feasible and associated with changes in clinical practice. Future work is needed to ensure that bleeding avoidance strategies are not overused among lower‐risk patients, and that, for high‐risk patients, the potential benefits of elective percutaneous coronary intervention are carefully weighed against the risk of bleeding.
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Affiliation(s)
- Joseph Ebinger
- Cedars-Sinai Smidt Heart Institute Los Angeles CA.,Department of Medicine Cedars-Sinai Medical Center Los Angeles CA
| | - Timothy Henry
- Christ Hospital Heart and Vascular Center Cincinnati OH
| | - Sungjin Kim
- Biostatistics and Bioinformatics Research Center Cedars-Sinai Medical Center Los Angeles CA
| | - Moira Inkelas
- Fielding School of Public Health University of California Los Angeles CA
| | - Susan Cheng
- Cedars-Sinai Smidt Heart Institute Los Angeles CA.,Department of Medicine Cedars-Sinai Medical Center Los Angeles CA
| | - Teryl Nuckols
- Department of Medicine Cedars-Sinai Medical Center Los Angeles CA
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Evaluation, Management, and Outcomes of Patients Poorly Responsive to Cardiac Resynchronization Device Therapy. J Am Coll Cardiol 2019; 74:2588-2603. [DOI: 10.1016/j.jacc.2019.09.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/15/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022]
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Kikuchi Y, Takahashi J, Hao K, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Shiroto T, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. Usefulness of intracoronary administration of fasudil, a selective Rho-kinase inhibitor, for PCI-related refractory myocardial ischemia. Int J Cardiol 2019; 297:8-13. [PMID: 31611086 DOI: 10.1016/j.ijcard.2019.09.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intra-procedural myocardial ischemia as an iatrogenic complication still remains a critical issue in contemporary interventional cardiology. The aim of this study was to examine the usefulness of fasudil, a selective Rho-kinase inhibitor, for percutaneous coronary intervention (PCI)-related myocardial ischemia. METHODS Among 448 PCI sessions performed between October 2015 and December 2017, we retrospectively examined 36 patients (69.0 ± 9.1 [SD] yrs., M/F 26/10) who underwent intracoronary administration of fasudil during a procedure to resolve myocardial ischemia that was resistant to intracoronary nitrate administration. RESULTS The refractory myocardial ischemia was caused by distal embolization (69%), enhanced vasoconstriction at distal site of chronic total occlusion (11%), coronary spasm (11%), and coronary dissection (8%), most of which occurred immediately after balloon or stent dilatation. Intracoronary fasudil significantly improved corrected TIMI frame count (from 37 [30-56] to 24 [12-36]) and TIMI flow grade (from 2 [1-2.5] to 3 [2-3]) (both P < 0.001). Finally, 86% of all subjects successfully obtained TIMI flow grade 3 at the end of the procedure. Intracoronary fasudil tended to be more effective in patients with an attenuated plaque detected by intravascular ultrasound. Importantly, among the 19 elective cases, fasudil successfully prevented 17 patients from developing post-procedure myocardial infarction. Although fasudil-induced transient hypotension requiring a vasopressor was noted in 22% of the subjects, no other adverse effects were noted. CONCLUSIONS These results indicate that fasudil is a useful and safe therapeutic option for PCI-related myocardial ischemia refractory intracoronary nitrate.
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Affiliation(s)
- Yoku Kikuchi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Borne RT, Randolph T, Wang Y, Curtis JP, Peterson PN, Masoudi FA, Sandhu A, Zipse MM, Thomas K, Kutyifa V, Desai NR, Cha YM, Hsu JC, Russo AM. Analysis of Temporal Trends and Variation in the Use of Defibrillation Testing in Contemporary Practice. JAMA Netw Open 2019; 2:e1913553. [PMID: 31626314 PMCID: PMC6813586 DOI: 10.1001/jamanetworkopen.2019.13553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Defibrillation testing (DFT) is performed during implantable cardioverter-defibrillator (ICD) implantation to assess the capacity of the device to detect and terminate ventricular arrhythmias. However, DFT can result in complications and omission of its use has been shown to be safe. OBJECTIVE To describe temporal trends and variation in the use of DFT in contemporary practice in the United States. DESIGN, SETTING, AND PARTICIPANTS This multicenter cross-sectional study used data from the National Cardiovascular Data Registry ICD Registry. A total of 499 211 patients from 1794 different facilities undergoing first-time ICD implantation from April 2010 to December 2015 were included. Data analysis was performed from May 20, 2015, to August 15, 2019. EXPOSURE Defibrillation testing was assessed using the National Cardiovascular Data Registry ICD Registry. MAIN OUTCOMES AND MEASURES Defibrillation testing rates and median odds ratios (MORs) were assessed over time. The MOR represents the odds that a randomly selected patient receiving testing at a hospital with high testing rates would be tested compared with if he or she had received care at a hospital with low testing rates. RESULTS Of the 499 211 patients from 1794 different facilities included in this analysis, the mean (SD) age of the population was 65.5 (13.4) years and 356 681 patients (71.4%) were men. The use of DFT declined from 71.6% in the first calendar quarter of 2010 to 36.4% in the fourth quarter of 2015 (P < .001). Patients undergoing DFT were more likely than those without testing to have ischemic heart disease (170 569 [58.1%] vs 116 295 [56.6%]), ventricular tachycardia (91 500 [31.2%] vs 58 949 [28.7%]), and less advanced heart failure (New York Heart Association class I and II, 153 188 [52.2%] vs 91 215 [44.4%]) (P < .001 for all). The MOR for the use of defibrillation testing was 3.78 (95% CI, 3.54-4.03) in 2010, increasing to 6.05 (95% CI, 5.61-6.52) in 2015, indicating that by 2015 a randomly selected patient receiving testing at a hospital with high testing rates would have a 6-fold higher odds of being tested than if they had received care at a hospital with low testing rates. CONCLUSIONS AND RELEVANCE Defibrillation testing at the time of ICD placement in the United States may have declined over time; however, institutional variation in its use appears to be marked and increased. This variability in the reduced use of defibrillation testing could reflect differences in individual or institutional cultures of practice.
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Affiliation(s)
- Ryan T. Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Yongfei Wang
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
| | - Jeptha P. Curtis
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
| | - Pamela N. Peterson
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, Denver Health Hospital, Denver, Colorado
| | - Frederick A. Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amneet Sandhu
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew M. Zipse
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kevin Thomas
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Nihar R. Desai
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
| | - Yong-Mei Cha
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jonathan C. Hsu
- Department of Medicine, University of California, San Diego, La Jolla
| | - Andrea M. Russo
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
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Rab T, O'Neill W. Mechanical circulatory support for patients with cardiogenic shock. Trends Cardiovasc Med 2019; 29:410-417. [DOI: 10.1016/j.tcm.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
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Rab T, Ratanapo S, Kern KB, Basir MB, McDaniel M, Meraj P, King SB, O'Neill W. Cardiac Shock Care Centers: JACC Review Topic of the Week. J Am Coll Cardiol 2019; 72:1972-1980. [PMID: 30309475 DOI: 10.1016/j.jacc.2018.07.074] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
Despite advances over the past decade, the incidence of cardiogenic shock secondary to acute myocardial infarction has increased, with an unchanged mortality near 50%. Recent trials have not clarified the best strategies in treatment. While dedicated cardiac shock centers are being established, there are no standardized agreements on the utilization of mechanical circulatory support and the timeliness of percutaneous coronary intervention strategies. In some centers and prospective registries, outcomes after placement of advanced mechanical circulatory support prior to reperfusion therapy with percutaneous coronary intervention have been encouraging with improved survival. Here, we suggest systems of care with a treatment pathway for patients with acute myocardial infarction complicated by cardiogenic shock.
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Affiliation(s)
- Tanveer Rab
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Supawat Ratanapo
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Karl B Kern
- Division of Cardiology, University of Arizona, Tucson, Arizona
| | | | - Michael McDaniel
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Perwaiz Meraj
- Division of Cardiology, Northwell Health, New York, New York
| | - Spencer B King
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Bahiru E, Agarwal A, Berendsen MA, Baldridge AS, Temu T, Rogers A, Farquhar C, Bukachi F, Huffman MD. Hospital-Based Quality Improvement Interventions for Patients With Acute Coronary Syndrome: A Systematic Review. Circ Cardiovasc Qual Outcomes 2019; 12:e005513. [PMID: 31525081 DOI: 10.1161/circoutcomes.118.005513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Quality improvement initiatives have been developed to improve acute coronary syndrome care largely in high-income country settings. We sought to synthesize the effect size and quality of evidence from randomized controlled trials (RCTs) and nonrandomized studies for hospital-based acute coronary syndrome quality improvement interventions on clinical outcomes and process of care measures for their potential implementation in low- and middle-income country settings. METHODS AND RESULTS We conducted a bibliometric search of databases and trial registers and a hand search in 2016 and performed an updated search in May 2018 and May 2019. We performed data extraction, risk of bias assessment, and quality of evidence assessments in duplicate. We assessed differences in outcomes by study design comparing RCTs to nonrandomized quasi-experimental studies and by country income status. A meta-analysis was not feasible due to substantial, unexplained heterogeneity among the included studies, and thus, we present a qualitative synthesis. We screened 5858 records and included 32 studies (14 RCTs [n=109 763] and 18 nonrandomized quasi-experimental studies [n=54-423]). In-hospital mortality ranged from 2.1% to 4.8% in the intervention groups versus 3.3% to 5.1% in the control groups in 5 RCTs (n=55 942). Five RCTs (n=64 313) reported 3.0% to 31.0% higher rates of reperfusion for patients with ST-segment-elevation myocardial infarction in the intervention groups. The effect sizes for in-hospital and discharge medical therapies in a majority of RCTs were 3.0% to 10.0% higher in the intervention groups. There was no significant difference in 30-day mortality evaluated by 4 RCTs (n=42 384), which reported 2.5% to 15.0% versus 5.9% to 22% 30-day mortality rates in the intervention versus control groups. In contrast, nonrandomized quasi-experimental studies reported larger effect sizes compared to RCTs. There were no significant consistent differences in outcomes between high-income and middle-income countries. Low-income countries were not represented in any of the included studies. CONCLUSIONS Hospital-based acute coronary syndrome quality improvement interventions have a modest effect on process of care measures but not on clinical outcomes with expected differences by study design. Although quality improvement programs have an ongoing and important role for acute coronary syndrome quality of care in high-income country settings, further research will help to identify key components for contextualizing and implementing such interventions to new settings to achieve their desired effects. Systematic Review Registration: URL: https://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42016047604.
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Affiliation(s)
- Ehete Bahiru
- Department of Medicine, University of California Los Angeles, CA (E.B.)
| | - Anubha Agarwal
- Department of Medicine (A.A., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark A Berendsen
- Galter Health Sciences Library (M.A.B.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abigail S Baldridge
- Department of Preventive Medicine (A.S.B., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tecla Temu
- Departments of Global Health (T.T.), University of Washington, Seattle
| | - Amy Rogers
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (A.R.)
| | - Carey Farquhar
- Departments of Epidemiology and Medicine (C.F.), University of Washington, Seattle
| | | | - Mark D Huffman
- Department of Medicine (A.A., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Preventive Medicine (A.S.B., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL.,The George Institute for Global Health, Food Policy Division, Sydney, Australia (M.D.H.)
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Wasfy JH, Kennedy KF, Masoudi FA, Ferris TG, Arnold SV, Kini V, Peterson P, Curtis JP, Amin AP, Bradley SM, French WJ, Messenger J, Ho PM, Spertus JA. Predicting Length of Stay and the Need for Postacute Care After Acute Myocardial Infarction to Improve Healthcare Efficiency. Circ Cardiovasc Qual Outcomes 2019; 11:e004635. [PMID: 30354547 DOI: 10.1161/circoutcomes.118.004635] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To improve value in the care of patients with acute myocardial infarction (MI), payment models increasingly hold providers accountable for costs. As such, providers need tools to predict length of stay (LOS) during hospitalization and the likelihood of needing postacute care facilities after discharge for acute MI patients. We developed models to estimate risk for prolonged LOS and postacute care for acute MI patients at time of hospital admission to facilitate coordinated care planning. Methods and Results We identified patients in the National Cardiovascular Data Registry ACTION registry (Acute Coronary Treatment and Intervention Outcomes Network) who were discharged alive after hospitalization for acute MI between July 1, 2008 and March 31, 2017. Within a 70% random sample (Training cohort) we developed hierarchical, proportional odds models to predict LOS and hierarchical logistic regression models to predict discharge to postacute care. Models were validated in the remaining 30%. Of 633 737 patients in the Training cohort, 16.8% had a prolonged LOS (≥7 days) and 7.8% were discharged to a postacute facility (extended care, a transitional care unit, or rehabilitation). Model discrimination was moderate in the validation dataset for predicting LOS (C statistic=0.640) and strong for predicting discharge to postacute care (C statistic=0.827). For both models, discrimination was similar in ST-segment-elevation MI and non-ST-segment-elevation MI subgroups and calibration was excellent. Conclusions These models developed in a national registry can be used at the time of initial hospitalization to predict LOS and discharge to postacute facilities. Prospective testing of these models is needed to establish how they can improve care coordination and lower costs.
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Affiliation(s)
- Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W.)
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., S.V.A., J.A.S.)
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M., V.K., P.P., J.M., P.M.H.)
| | - Timothy G Ferris
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (T.G.F.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., S.V.A., J.A.S.)
| | - Vinay Kini
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M., V.K., P.P., J.M., P.M.H.)
| | - Pamela Peterson
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M., V.K., P.P., J.M., P.M.H.)
| | | | - Amit P Amin
- Washington University School of Medicine, St Louis, MO (A.P.A.)
| | | | | | - John Messenger
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M., V.K., P.P., J.M., P.M.H.)
| | - P Michael Ho
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (F.A.M., V.K., P.P., J.M., P.M.H.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., S.V.A., J.A.S.)
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Prabhakaran D, Singh K, Roth GA, Banerjee A, Pagidipati NJ, Huffman MD. Cardiovascular Diseases in India Compared With the United States. J Am Coll Cardiol 2019; 72:79-95. [PMID: 29957235 DOI: 10.1016/j.jacc.2018.04.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/11/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
This review describes trends in the burden of cardiovascular diseases (CVDs) and risk factors in India compared with the United States; provides potential explanations for these differences; and describes strategies to improve cardiovascular health behaviors, systems, and policies in India. The prevalence of CVD in India has risen over the past 2 decades due to population growth, aging, and a stable age-adjusted CVD mortality rate. Over the same time period, the United States has experienced an overall decline in age-adjusted CVD mortality, although the trend has begun to plateau. These improvements in CVD mortality in the United States are largely due to favorable population-level risk factor trends, specifically with regard to tobacco use, cholesterol, and blood pressure, although improvements in secondary prevention and acute care have also contributed. To realize similar gains in reducing premature death and disability from CVD, India needs to implement population-level policies while strengthening and integrating its local, regional, and national health systems. Achieving universal health coverage that includes financial risk protection should remain a goal to help all Indians realize their right to health.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India; London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Kavita Singh
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation and the Division of Cardiology at the University of Washington School of Medicine, Seattle, Washington
| | - Amitava Banerjee
- Farr Institute of Health Informatics, University College London, London, United Kingdom
| | - Neha J Pagidipati
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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139
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Morimoto Y, Nishii N, Tsukuda S, Kawada S, Miyamoto M, Miyoshi A, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. A Low Critical Event Rate Despite a High Abnormal Event Rate in Patients with Cardiac Implantable Electric Devices Followed Up by Remote Monitoring. Intern Med 2019; 58:2333-2340. [PMID: 31118368 PMCID: PMC6746648 DOI: 10.2169/internalmedicine.1905-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-to-face follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.
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Affiliation(s)
- Yoshimasa Morimoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Saori Tsukuda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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140
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Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Laschinger J, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock S, Price MJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhoevel U, Yeh RW, Krucoff MW, Morice MC. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J 2019; 40:2632-2653. [PMID: 31116395 PMCID: PMC6736433 DOI: 10.1093/eurheartj/ehz372] [Citation(s) in RCA: 316] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Identification and management of patients at high bleeding risk undergoing percutaneous coronary intervention are of major importance, but a lack of standardization in defining this population limits trial design, data interpretation, and clinical decision-making. The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among leading research organizations, regulatory authorities, and physician-scientists from the United States, Asia, and Europe focusing on percutaneous coronary intervention-related bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April 2018 and in Paris, France, in October 2018. These meetings were organized by the Cardiovascular European Research Center on behalf of the ARC-HBR group and included representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, as well as observers from the pharmaceutical and medical device industries. A consensus definition of patients at high bleeding risk was developed that was based on review of the available evidence. The definition is intended to provide consistency in defining this population for clinical trials and to complement clinical decision-making and regulatory review. The proposed ARC-HBR consensus document represents the first pragmatic approach to a consistent definition of high bleeding risk in clinical trials evaluating the safety and effectiveness of devices and drug regimens for patients undergoing percutaneous coronary intervention.
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Affiliation(s)
- Philip Urban
- La Tour Hospital, Geneva, Switzerland
- Cardiovascular European Research Center, Massy, France
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München,
Germany
| | | | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München,
Germany
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti,
Catania, Italy
- Azienda Ospedaliero Universitario “Vittorio Emanuele-Policlinico,”
University of Catania, Italy
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and
Inserm, Inra, Centre de recherche en cardiovasculaire et nutrition, Faculté de Médecine,
Aix-Marseille Université, Marseille, France
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, MA
| | | | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD
| | - C Michael Gibson
- Harvard Medical School, Boston, MA
- Baim Institute for Clinical Research, Brookline, MA
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center,
Uppsala University, Sweden
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Korea
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
of Medicine, Japan
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices
Agency, Tokyo, Japan
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY
- Cardiovascular Research Foundation, New York, NY
| | | | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices
Agency, Tokyo, Japan
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway
| | | | | | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the
Netherlands
- Cardialysis, Clinical Trial Management and Core Laboratories,
Rotterdam, the Netherlands
| | | | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern,
Switzerland
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance publique - hôpitaux
de Paris, Paris, France
- Université Paris Descartes, Sorbonne Paris-Cité, France
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Durham, NC
- Duke University Medical Center, Durham, NC
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141
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Asleh R, Resar JR. Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions. J Clin Med 2019; 8:E1209. [PMID: 31412669 PMCID: PMC6724052 DOI: 10.3390/jcm8081209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/24/2019] [Accepted: 08/08/2019] [Indexed: 01/14/2023] Open
Abstract
Given the tremendous progress in interventional cardiology over the last decade, a growing number of older patients, who have more comorbidities and more complex coronary artery disease, are being considered for technically challenging and high-risk percutaneous coronary interventions (PCI). The success of performing such complex PCI is increasingly dependent on the availability and improvement of mechanical circulatory support (MCS) devices, which aim to provide hemodynamic support and left ventricular (LV) unloading to enable safe and successful coronary revascularization. MCS as an adjunct to high-risk PCI may, therefore, be an important component for improvement in clinical outcomes. MCS devices in this setting can be used for two main clinical conditions: patients who present with cardiogenic shock complicating acute myocardial infarction (AMI) and those undergoing technically complex and high-risk PCI without having overt cardiogenic shock. The current article reviews the advancement in the use of various devices in both AMI complicated by cardiogenic shock and complex high-risk PCI, highlights the available hemodynamic and clinical data associated with the use of MCS devices, and presents suggestive management strategies focusing on appropriate patient selection and optimal timing and support to potentially increase the clinical benefit from utilizing these devices during PCI in this high-risk group of patients.
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Affiliation(s)
- Rabea Asleh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jon R Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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142
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Cheezum MK, Shah NR. Is a Picture Worth a Thousand Guidelines? JACC Cardiovasc Imaging 2019; 13:449-451. [PMID: 31326489 DOI: 10.1016/j.jcmg.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Michael K Cheezum
- Department of Cardiology, Parkview Health, Parkview Research Center, Fort Wayne, Indiana.
| | - Nishant R Shah
- Division of Cardiovascular Medicine, Department of Medicine, Lifespan Cardiovascular Institute, Brown University Alpert School of Medicine, Providence, Rhode Island
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143
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Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Laschinger J, Leon MB, Magee PA, Mitsutake Y, Mylotte D, Pocock S, Price MJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhoevel U, Yeh RW, Krucoff MW, Morice MC. Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention. Circulation 2019; 140:240-261. [PMID: 31116032 PMCID: PMC6636810 DOI: 10.1161/circulationaha.119.040167] [Citation(s) in RCA: 433] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Identification and management of patients at high bleeding risk undergoing percutaneous coronary intervention are of major importance, but a lack of standardization in defining this population limits trial design, data interpretation, and clinical decision-making. The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among leading research organizations, regulatory authorities, and physician-scientists from the United States, Asia, and Europe focusing on percutaneous coronary intervention-related bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April 2018 and in Paris, France, in October 2018. These meetings were organized by the Cardiovascular European Research Center on behalf of the ARC-HBR group and included representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, as well as observers from the pharmaceutical and medical device industries. A consensus definition of patients at high bleeding risk was developed that was based on review of the available evidence. The definition is intended to provide consistency in defining this population for clinical trials and to complement clinical decision-making and regulatory review. The proposed ARC-HBR consensus document represents the first pragmatic approach to a consistent definition of high bleeding risk in clinical trials evaluating the safety and effectiveness of devices and drug regimens for patients undergoing percutaneous coronary intervention.
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Affiliation(s)
- Philip Urban
- La Tour Hospital, Geneva, Switzerland (P.U.)
- Cardiovascular European Research Center, Massy, France (P.U., U.W., M.-C.M.)
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Germany (R.C., R.A.B.)
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
| | - Robert A. Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (R.A.B.)
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti (D. Capodanno), Catania, Italy
- Azienda Ospedaliero Universitario “Vittorio Emanuele-Policlinico,” University of Catania, Italy (D. Capodanno)
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and Inserm, Inra, Centre de recherche en cardiovasculaire et nutrition, Faculté de Médecine, Aix-Marseille Université, Marseille, France (T.C.)
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D. Cutlip)
| | - Pedro Eerdmans
- Head of the Notified Body, DEKRA Certification B.V. (P.E.)
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada (J.E.)
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - C. Michael Gibson
- Baim Institute for Clinical Research, Brookline, MA (C.M.G.)
- Harvard Medical School, Boston, MA (C.M.G.)
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK (J.G., S.P.)
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany (M.H.)
| | - Stefan K. James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (S.K.J.)
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.)
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (T.K.)
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan (A.K., Y.M.)
| | - John Laschinger
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - Martin B. Leon
- Columbia University Medical Center, New York, NY (M.B.L.)
- Cardiovascular Research Foundation, New York, NY (M.B.L.)
| | - P.F. Adrian Magee
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan (A.K., Y.M.)
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway (D.M.)
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, UK (J.G., S.P.)
| | | | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC (S.V.R., M.W.K.)
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (E.S.)
- Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands (E.S.)
| | - Norman Stockbridge
- US Food and Drug Administration, Silver Spring, MD (A.F., J.L., P.F.A.M., N.S.)
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Switzerland (M.V.)
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance publique - hôpitaux de Paris, Paris, France (O.V.)
- Université Paris Descartes, Sorbonne Paris-Cité, France (O.V.)
| | - Ute Windhoevel
- Cardiovascular European Research Center, Massy, France (P.U., U.W., M.-C.M.)
| | - Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Mitchell W. Krucoff
- Duke Clinical Research Institute, Durham, NC (S.V.R., M.W.K.)
- Duke University Medical Center, Durham, NC (M.W.K.)
| | - Marie-Claude Morice
- Cardiovascular European Research Center, Massy, France (P.U., U.W., M.-C.M.)
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize landmark studies and recent evidence in support for and against benefits of routine percutaneous coronary intervention (PCI) in the management of patients with stable ischemic heart disease (SIHD). RECENT FINDINGS Randomized controlled trials have raised uncertainty regarding the prognostic benefits of routine PCI in patients with SIHD. The benefits of PCI to improve symptoms and quality of life (QOL), thought to be more established, was brought into question recently by the ORBITA trial. Two hundred participants with single vessel SIHD optimized first on antianginal therapy were randomized to PCI or sham PCI procedure. At 6 weeks, there was no significant difference in the primary endpoint of exercise time increment (PCI minus sham PCI 16.6 s, 95% confidence interval -8.9 to 42.0 s, P = 0.20), or secondary endpoints of change in angina or QOL scores between the groups. SUMMARY Findings from this first placebo-controlled trial of PCI in patients with single vessel SIHD suggest that PCI need not necessarily be the first line or default strategy for symptomatic improvement. Results from the ongoing ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial will provide further guidance regarding symptomatic and prognostic benefits of early angiography and revascularization for higher risk SIHD patients with moderate-severe ischemia.
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145
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Yang N, Liu J, Liu J, Hao Y, Huo Y, Smith Jr SC, Ge J, Ma C, Han Y, Fonarow GC, Taubert KA, Morgan L, Zhou M, Xing Y, Zhao D. Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non-ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. Am Heart J 2019; 212:80-90. [PMID: 30981036 DOI: 10.1016/j.ahj.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to examine hospital performance on evidence-based management strategies for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and variations across hospitals. METHODS Improving Care for Cardiovascular Disease in China (CCC)-ACS project is an ongoing registry and quality improvement project, with 150 tertiary hospitals recruited across China. We examined hospital performance on nine management strategies (Class I Recommendations with A Level of Evidence) based on established guidelines. We also evaluated the proportion of patients receiving defect-free care, which was defined as the care that included all the required management strategies for which the patient was eligible. The hospital-level variations in the performance were examined. RESULTS From 2014 to 2018, 28,170 NSTE-ACS patients were included. Overall, 16% of patients received defect-free care. Higher-performing metrics were statin at discharge (93%), cardiac troponin measurement (92%), dual antiplatelet therapy (DAPT) within 24 hours (90%), and DAPT at discharge (85%). These were followed by metrics of β-blocker at discharge (69%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) at discharge (59%), and risk stratification (56%). Lower-performing metrics were smoking cessation counseling (35%) and percutaneous coronary intervention (PCI) within recommended times (33%). The proportion of patients receiving defect-free care substantially varied across hospitals, ranging from 0% to 58% (Median (interquartile range):12% (7%-21%)). There were large variations across hospitals in performance on risk stratification, smoking cessation counseling, PCI within recommended times, ACEI/ARB at discharge and β-blocker at discharge. CONCLUSIONS About one in six NSTE-ACS patients received defect-free care, and the performance varied across hospitals.
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146
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Thomas IC, Wang Y, See VY, Minges KE, Curtis JP, Hsu JC. Outcomes following implantable cardioverter-defibrillator generator replacement in patients with recovered left ventricular systolic function: The National Cardiovascular Data Registry. Heart Rhythm 2019; 16:733-740. [DOI: 10.1016/j.hrthm.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 10/27/2022]
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147
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Joyce LC, Baber U, Claessen BE, Sartori S, Chandrasekhar J, Cohen DJ, Henry TD, Ariti C, Dangas G, Faggioni M, Aoi S, Gibson CM, Aquino M, Krucoff MW, Vogel B, Moliterno DJ, Sorrentino S, Colombo A, Chieffo A, Kini A, Guedeney P, Witzenbichler B, Weisz G, Steg PG, Pocock S, Mehran R. Dual-Antiplatelet Therapy Cessation and Cardiovascular Risk in Relation to Age. JACC Cardiovasc Interv 2019; 12:983-992. [DOI: 10.1016/j.jcin.2019.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 01/29/2023]
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148
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Farkouh ME, Godoy LC. Lifestyle Interventions in Diabetes and Coronary Disease: A Timely Reminder. J Am Coll Cardiol 2019; 73:2059-2061. [PMID: 31023429 DOI: 10.1016/j.jacc.2018.12.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Lucas C Godoy
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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149
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Shavadia JS, Chen AY, Fanaroff AC, de Lemos JA, Kontos MC, Wang TY. Intensive Care Utilization in Stable Patients With ST-Segment Elevation Myocardial Infarction Treated With Rapid Reperfusion. JACC Cardiovasc Interv 2019; 12:709-717. [PMID: 31000008 DOI: 10.1016/j.jcin.2019.01.230] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aims of this study were to describe variability in intensive care unit (ICU) utilization for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI), evaluate the proportion of these patients who developed in-hospital complications requiring ICU care, and assess whether ICU use patterns and complication rates vary across categories of first medical contact to device times. BACKGROUND In the era of rapid primary percutaneous coronary intervention, ICUs may be overutilized as patients presenting with STEMI are less likely to develop complications requiring ICU care. METHODS Using data from the Chest Pain-MI Registry linked to Medicare claims, the authors examined patterns of ICU utilization among hemodynamically stable patients with STEMI ≥65 years of age treated with uncomplicated primary percutaneous coronary intervention, stratified by timing of reperfusion: early (first medical contact-to-device time ≤60 min), intermediate (61 to 90 min), or late (>90 min). RESULTS Of 19,507 patients with STEMI treated at 707 hospitals, 82.3% were treated in ICUs, with a median ICU stay of 1 day (interquartile range [IQR]: 1 to 2 days). The median FMC-to-device time was 79 min (IQR: 63 to 99 min); 22.0% of patients had early, 44.8% intermediate, and 33.2% late reperfusion. ICU utilization rates did not differ between patients with early, intermediate, and late reperfusion times (82%, 83%, and 82%; p for trend = 0.44). Overall, 3,159 patients (16.2%) developed complications requiring ICU care while hospitalized: 3.7% died, 3.7% had cardiac arrest, 8.7% shock, 0.9% stroke, 4.1% high-grade atrioventricular block requiring treatment, and 5.7% respiratory failure. Patients with longer FMC-to-device times were more likely to develop at least 1 of these complications (early 13.4%, intermediate 15.7%, and late 18.7%; p for trend <0.001; adjusted odds ratio [early as reference] for intermediate: 1.13 [95% confidence interval: 1.01 to 1.25]; adjusted odds ratio for late: 1.22 [95% confidence interval: 1.08 to 1.37]). CONCLUSIONS Although >80% of stable patients with STEMI are treated in the ICU after primary percutaneous coronary intervention, the risk for developing a complication requiring ICU care is 16%. Implementing a risk-based triage strategy, inclusive of factors such as degree of reperfusion delay, could optimize ICU utilization for patients with STEMI.
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Affiliation(s)
- Jay S Shavadia
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Anita Y Chen
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael C Kontos
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, North Carolina
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Abstract
PURPOSE OF REVIEW Non-ST-elevation myocardial infarction (NSTEMI) is an urgent medical condition that requires prompt application of simultaneous pharmacologic and non-pharmacologic therapies. The variation in patient clinical characteristics coupled with the multitude of treatment modalities makes optimal and timely management challenging. This review summarizes risk stratification of patients, the role and timing of revascularization, and highlights important considerations in the revascularization approach with attention to individual patient characteristics. RECENT FINDINGS The early invasive management of NSTEMI has fostered a reduction in future ischemic events. Risk calculators are helpful in determining which patients should receive early invasive management. As many patients have multivessel disease, identifying the true culprit lesion can be challenging. Special attention should be given to those at the highest risk, such as diabetics, patients with renal failure, and those with left main disease. In patients with acute coronary syndrome, the decision and mode of revascularization should carefully integrate the patient's clinical characteristics as well as the complexity of the coronary anatomy.
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Affiliation(s)
- Bennet George
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, 900 S. Limestone Street, 326 Wethington Bldg, Lexington, KY, 40536-0200, USA
| | - Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, 900 S. Limestone Street, 326 Wethington Bldg, Lexington, KY, 40536-0200, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, 900 S. Limestone Street, 326 Wethington Bldg, Lexington, KY, 40536-0200, USA.
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