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Park DY, Vemmou E, An S, Nikolakopoulos I, Regan CJ, Cambi BC, Frampton J, Vij A, Brilakis E, Nanna MG. Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction. IJC HEART & VASCULATURE 2023; 45:101186. [PMID: 36852085 PMCID: PMC9957744 DOI: 10.1016/j.ijcha.2023.101186] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Background Intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is associated with improved outcomes, but these techniques have previously been underutilized in the real world. We aimed to examine the change in utilization of intravascular imaging-guided PCI over the past decade in the United States and assess the association between intravascular imaging and clinical outcomes following PCI for myocardial infarction (MI). Methods We surveyed the National Inpatient Sample from 2008 to 2019 to calculate the number of PCIs for MI guided by IVUS or OCT. Temporal trends were analyzed using Cochran-Armitage trend test or simple linear regression for categorical or continuous outcomes, respectively. Multivariable logistic regression was used to compare outcomes following PCI with and without intravascular imaging. Results A total of 2,881,746 PCIs were performed for MI. The number of IVUS-guided PCIs increased by 309.9 % from 6,180 in 2008 to 25,330 in 2019 (P-trend < 0.001). The percentage of IVUS use in PCIs increased from 3.4 % in 2008 to 8.7 % in 2019 (P-trend < 0.001). The number of OCT-guided PCIs increased 548.4 % from 246 in 2011 to 1,595 in 2019 (P-trend < 0.001). The percentage of OCT guidance in all PCIs increased from 0.0 % in 2008 to 0.6 % in 2019 (P-trend < 0.001). Intravascular imaging-guided PCI was associated with lower odds of in-hospital mortality (adjusted odds ratio 0.66, 95 % confidence interval 0.60-0.72, p < 0.001). Conclusions Although the number of intravascular imaging-guided PCIs have been increasing, adoption of intravascular imaging remains poor despite an association with lower mortality.
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Key Words
- BMS, Bare-metal stent
- CI, Confidence interval
- DES, Drug-eluting stent
- HCUP, Healthcare Cost and Utilization Project
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-10-PCS, International Classification of Diseases, 10th Revision, Procedural Coding System
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- ICD-9-PCS, International Classification of Diseases, 9th Revision, Procedural Coding System
- IVUS
- IVUS, Intravascular ultrasound
- Imaging
- Intravascular
- MI, Myocardial infarction
- Myocardial infarction
- NIS, National Inpatient Sample
- NSTEMI, Non-ST-elevation myocardial infarction
- OCT
- OCT, Optical coherence tomography
- PCI
- PCI, Percutaneous coronary intervention
- STEMI, ST-elevation myocardial infarction
- Trend
- U.S, United States
- aOR, Adjusted odds ratio
- cOR, Crude odds ratio
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Evangelia Vemmou
- Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Seokyung An
- Department of Biomedical Science, Seoul National University, Seoul, Republic of Korea
| | | | | | - Brian C. Cambi
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Emmanouil Brilakis
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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Muacevic A, Adler JR. Emotional Stress Induced Broken Heart Syndrome: A Case Report. Cureus 2022; 14:e32384. [PMID: 36632256 PMCID: PMC9828072 DOI: 10.7759/cureus.32384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Takotsubo syndrome (TTS) is a medical condition mostly due to emotional or physical stress which frequently leads to misdiagnosis or late diagnosis. Patients tend to present initially with acute heart failure or acute coronary syndrome to our emergency department. Here we describe a patient with no history of cardiovascular disease, who developed TTS due to emotional stress from the death of her husband and then fully recovered during follow-up.
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Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220213038s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Chest pain (CP) diagnostics accuracy remains
debatable for both general practitioners (GP) or emergency department (ED)
physicians for patients in HEART score (HS) low- and intermediate-risk
groups which prompted us to review our electronic database for all patients
admitted via our center?s ED during 2014 to 2020 for CP and suspect acute
coronary syndrome. Methods. Patients were divided in function of low- or
intermediate-risk HS and assessed during a three month follow up for
angiogram results, MACE, lab results and echo parameters. Results. Of 585
patients included, low-risk HS group (21,4%, 36% were women) had significant
coronary disease on angiogram in 68%, while for intermediate-risk HS group
(78.6%, with 32.6% women) it was for 18.4% of patients (p < 0,0005). Area
under the ROC curve of HS in detecting patients with ischemic heart disease
as a cause of CP was 0.771 (95% CI:0.772-0.820) with best cut-off point HS
was calculated at 3.5. Sensitivity and specificity were 89.2% and 57.6%
respectively. Adjusting for sex, lab results and HS, AUROC curve of this
model was 0.828 (95% CI:0.786-0.869; p < 0,0005) with cut-off of 77.95.
Sensitivity and specificity were 84,9% and 68% respectively. In the
three-month follow-up post-discharge, there was a significant difference in
MACE between groups (low-vs. intermediate-risk HS was 3.4 vs. 16.7% p <
0.05). Conclusion. HS for our CP patients admitted via our ED by GP and ED
physicians? referral, provides a quick and reliable prediction of ischemic
heart disease and MACE.
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Casolo G, Gabrielli D, Colivicchi F, Murrone A, Grosseto D, Gulizia MM, Di Fusco S, Domenicucci S, Scotto di Uccio F, Di Tano G, Orso F, Grippo G, Abrignani M, Valente S, Corda M. ANMCO POSITION PAPER: Prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis. Eur Heart J Suppl 2021; 23:C164-C175. [PMID: 34456643 PMCID: PMC8388609 DOI: 10.1093/eurheartj/suab072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis often affects the coronary arterial tree. Frequently the disease does not translate in significant narrowing of the vessels, thus determining only a non-obstructive disease. This condition that is described as non-obstructive coronary artery disease (NobsCAD) should be distinguished from the absence of disease (i.e. smooth coronary arteries) as it carries a specific prognostic value. The detection and reporting of NobsCAD should prompt preventive measures that can be individualized upon the degree of the underlying burden of disease. The accompanying clinical condition, the other cardiovascular risk factors present, and the description of the severity and extent of NobsCAD should provide the framework for an individualized treatment that should also consider the best available scientific evidence and guidelines. The description of NobsCAD represents important information to be collected whenever a coronary angiogram (both invasive and non-invasive) is performed. Treating the patient according to the presence and extent of NobsCAD offers prognostic benefits well beyond those offered by considering only the traditional cardiovascular risk factors. In order to reach this goal, NobsCAD should not be confused with the absence of coronary atherosclerosis or even ignored when detected as if it was a trivial information to provide.
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Affiliation(s)
- Giancarlo Casolo
- Cardiology Department, Ospedale Versilia, Lido di Camaiore (LU), Via Aurelia 335, 55041 Lido di Camaiore, Italy
| | - Domenico Gabrielli
- Cardiology-CCU Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Adriano Murrone
- Cardiology Department, Ospedali di Castello e Gubbio-Gualdo Tadino, Azienda USL Umbria 1, Perugia, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo Cuore, Heart Care Foundation, Via la Marmora 36, Florence, Italy
| | - Stefania Di Fusco
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | | | | | | | - Francesco Orso
- Cardiology and Geriatric Medicine Department, AOU Careggi, Firenze, Italy
| | | | | | - Serafina Valente
- Clinical-Surgical Cardiology and ICU Department, Ospedale Santa Maria alle Scotte, Siena, A.O.U. Senese, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
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