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Giubbini R, Paghera B, Dondi M, Estrada Lobato E, Peix A, Paez D. Critical Appraisal of the Current Role of Myocardial Perfusion Imaging in the Management of Acute Chest Pain. Semin Nucl Med 2023; 53:733-742. [PMID: 37722928 DOI: 10.1053/j.semnuclmed.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
This paper describes the evolution of nuclear cardiology techniques in the setting of acute coronary syndromes. Since the 1970s, the contribution of nuclear cardiology has been fundamental in delineating the physiopathology and diagnosis of acute myocardial infarction, when electrocardiogram (ECG) did not provide the diagnosis and when cardiac enzyme assessments were at a very early stage. In this clinical situation, at that time the role of pyrophosphate scintigraphy and antimyosin antibodies was important in ensuring diagnostic precision. However, these methods showed limitations and were abandoned in the late 80s and early 90s when therapeutic applications such as thrombolytic therapy, and primary-and rescue-percutaneous coronary intervention (PCI) were introduced. Beginning in the mid-80s, the introduction and widespread use of perfusion tracers such as 99mTc labelled compounds and technological advances such as SPECT, allowed to assess the efficacy of thrombolysis and early revascularization, as well as to assess in depth myocardial salvage. Currently, perfusion SPECT, especially using fast imaging techniques and dedicated cardiac SPECT with solid-state detectors, allows a quick confirmation or exclusion of acute coronary syndromes, particularly in low-to-intermediate likelihood of coronary artery disease (CAD), especially when there are absolute or relative contraindications to the use of coronary computed tomographic angiography (CCTA).
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Affiliation(s)
- Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Barbara Paghera
- Department of Nuclear Medicine, Nuclear Medicine Unit, University of Brescia, Brescia, Italy
| | - Maurizio Dondi
- Department of Nuclear Medicine, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada Lobato
- Department of Nuclear Medicine, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Amalia Peix
- Department of Nuclear Medicine, Institute of Cardiology, Havana, Cuba
| | - Diana Paez
- Department of Nuclear Medicine, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
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Gul R, Opolski MP, Akif M, Dar MA, Beshir Y, Sakr H, Khalaf H, Eldesoky A, Smettei OA, Soomro TI, Saied M, Ganawa A, Abazid RM. Safety of returning patients immediately to their originating hospitals after primary percutaneous coronary intervention. J Saudi Heart Assoc 2020; 32:2-7. [PMID: 33154884 PMCID: PMC7640601 DOI: 10.37616/2212-5043.1001] [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: 08/24/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction The objective of this study was to evaluate the safety and feasibility of the immediate return of patients with ST-elevation myocardial infarction (STEMI) to their originating hospitals after primary percutaneous coronary intervention (PPCI). Methods This was a prospective study, conducted between January 2014 and December 2017. All patients with STEMI who were transferred for PPCI and returned back to their referring hospitals (RB group) were included and compared to the onsite STEMI population (OS group). Patient’s demographics, PPCI data, bleeding and adverse cardiovascular events (ACEs) occurring during transfer, hospital stay, and at 1-month follow-up were recorded. Results A total of 156 patients in the OS group were compared against 350 patients in the RB group. We found that first medical contact to balloon time and onset of symptoms to balloon time were significantly longer in the RB group than in the OS group [110 ± 67 min vs. 46 ± 35 min (p < 0.0001) and 366 ± 300 min vs. 312 ± 120 min (p = 0.04)], respectively. There were no differences between the RB and OS groups in in-hospital ACEs: 0.3% versus 0% (p = 0.8) for death, 0.3% versus 0.6% (p = 0.79) for reinfarction, 0.6% versus 2% (p = 0.72) for bleeding, and no reported cases of repeat revascularization; and 30-day ACEs: 0.3% versus 0.6% (p = 0.82) for death, 0.3% versus 1.2% (p = 0.68) for reinfarction, 0.6% versus 2% (p = 0.74) for bleeding, and 1.1% versus 1.2% (p = 0.9) for repeat revascularization. Conclusion The immediate return of patients with noncomplicated STEMI after PPCI to their referring hospitals is safe and feasible, and can be used as part of an effective reperfusion strategy.
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Affiliation(s)
- Rahim Gul
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mufti Akif
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Mehboob Ali Dar
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Yasir Beshir
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Haitham Sakr
- Department of Cardiology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Hassan Khalaf
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Akram Eldesoky
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Osama A Smettei
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Tariq I Soomro
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Mohammed Saied
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Asim Ganawa
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
| | - Rami M Abazid
- Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia
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Fanari Z, Weiss S, Weintraub WS. Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review. Am J Cardiovasc Drugs 2015; 15:415-27. [PMID: 26068886 PMCID: PMC4661116 DOI: 10.1007/s40256-015-0131-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute coronary syndromes (ACS) are associated with high rates of morbidity and mortality. The advances of antiplatelet and anticoagulation therapy over several years time have resulted in improved in cardiac outcomes, but with increased health care costs. Multiple cost-effectiveness studies have been performed to evaluate the use of available antiplatelet agents and anticoagulation in the setting of both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Early on, the use of glycoprotein IIb/IIIa receptor inhibitors (GPIs) proved to be economically attractive in the management of ACS; however, the introduction of P2Y12 receptor antagonists limited their use to a bail out agents in complex interventions. Generic clopidogrel is probably still an economically attractive P2Y12 receptor antagonist choice, especially in low-risk ACS, while both ticagrelor and prasugrel present an economically attractive alternative option, especially in high-risk ACS and patients at risk for stent thrombosis. While enoxaparin presents an economically dominant alternative to heparin in NSTE-ACS, its role in STEMI in the contemporary era is unclear. During percutaneous coronary intervention (PCI), bivalirudin monotherapy was shown to be an economically dominant alternative to the combination of heparin and GPI in ACS. However, new studies may suggest that using heparin monotherapy may offer an attractive alternative. The comparative and cost effectiveness of different combinations of antiplatelet and antithrombotic therapy will be the focus of future expected clinical and economic assessments.
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Affiliation(s)
- Zaher Fanari
- Section of Cardiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA.
| | - Sandra Weiss
- Section of Cardiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA
| | - William S Weintraub
- Section of Cardiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA
- Value Institute, Christiana Care Health System, Newark, DE, USA
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Callea G, Tarricone R, Lara AM. Economic evidence of interventions for acute myocardial infarction: a review of the literature. EUROINTERVENTION 2014; 8 Suppl P:P71-6. [PMID: 22917795 DOI: 10.4244/eijv8spa12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aims of this review are to identify and evaluate studies exploring the cost-effectiveness of primary angioplasty (PPCI) vs. thrombolysis (TL) for treating acute myocardial infarction (AMI). METHODS AND RESULTS A comprehensive free-text searching identified economic evaluation studies that were reviewed with respect to their effectiveness data, identification, measurement and valuation of resource data, measurement and valuation of health outcomes (clinical and QALYs) and uncertainty analysis. A total of 14 studies were included in the review: seven were economic evaluations alongside RCTs, two community-based studies or registries and five decision-analytical models. PPCI was found to be cost-effective when compared with TL in eight studies, cost-saving in three, cost-neutral in one, and not significantly different in terms of both cost and benefits in two studies. CONCLUSIONS The cost-effective evidence available is mainly derived from RCTs with stringent inclusion criteria using established catheter laboratories for providing PPCI treatment; these two components might restrict the generalisability of their "for managing patients with STEMI in hospital" settings. In order to aid policy makers on the real costs and benefits of the PPCI and TL, it is necessary to conduct more analyses with data from the real world in which there are more strategies evaluated for delivering PPCI than merely those in established catheter laboratories.
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Affiliation(s)
- Giuditta Callea
- Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bøhmer E, Kristiansen IS, Arnesen H, Halvorsen S. Health and cost consequences of early versus late invasive strategy after thrombolysis for acute myocardial infarction. ACTA ACUST UNITED AC 2011; 18:717-23. [DOI: 10.1177/1741826711398425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Ellen Bøhmer
- Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
| | | | - Harald Arnesen
- Center for Clinical Heart Research,Oslo University Hospital,Ulleval, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
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O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Aasa M, Henriksson M, Dellborg M, Grip L, Herlitz J, Levin LA, Svensson L, Janzon M. Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial. Am Heart J 2010; 160:322-8. [PMID: 20691839 DOI: 10.1016/j.ahj.2010.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 05/08/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
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Affiliation(s)
- Mikael Aasa
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
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Safety and feasibility of returning patients early to their originating centers after transfer for primary percutaneous coronary intervention. Rev Esp Cardiol 2009; 62:1356-64. [PMID: 20038401 DOI: 10.1016/s1885-5857(09)73529-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES At present, little information is available on returning patients with ST-elevation myocardial infarction (STEMI) to their originating centers after transfer for primary percutaneous coronary intervention (PPCI). The objective of this study was to evaluate the safety and feasibility of the early return of these patients to their originating centers. METHODS The cohort study involved 200 consecutive STEMI patients (age 62+/-13 years, 83% male) who were returned to their originating centers after PPCI. They were compared with a group of 297 patients with similar characteristics from our healthcare catchment area. The length of stay in the intervention hospital and major adverse cardiovascular events occurring within 30 days were recorded. RESULTS The median length of stay in the intervention hospital was 8 hours. No adverse events occurred during transport in the group who returned to their originating centers. At 30-day follow-up, no significant difference was observed between patients who returned and the control group in either mortality (1.0% vs. 3.7%; P=.064), readmission (5.0% vs. 4.5%; P=.657), ischemic complications (2.5% vs. 2.0%; P=.721), re-catheterization (5.0% vs. 2.5%; P=.112), stroke (1% vs. 1%; P=.936) or the composite end-point (11% vs. 9.2%; P=.540). Multivariate analysis showed that returning patients after PPCI was not associated with a significantly greater number of major adverse cardiovascular events (odds ratio=1.32; 95% confidence interval, 0.62-2.80). CONCLUSIONS The early return of patients with low-risk STEMI to their originating centers after PPCI was safe and feasible.
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Seguridad y viabilidad del retorno precoz de pacientes transferidos para angioplastia primaria a sus centros de origen. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73120-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Larson DM, Henry TD. Regional transfer programs for primary percutaneous coronary intervention. Crit Pathw Cardiol 2006; 5:147-152. [PMID: 18340229 DOI: 10.1097/01.hpc.0000234778.48054.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- David M Larson
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN 55407, USA.
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Clemmensen P, Jurlander B. Primary PCI for ST elevation AMI save lives and money--what more do we want? SCAND CARDIOVASC J 2005; 39:264-6. [PMID: 16269395 DOI: 10.1080/14017430510036014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Krumholz HM. The Year in Epidemiology, Health Services, and Outcomes Research. J Am Coll Cardiol 2005; 46:1362-70. [PMID: 16198857 DOI: 10.1016/j.jacc.2005.06.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Accepted: 06/14/2005] [Indexed: 01/19/2023]
Affiliation(s)
- Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut 06520-8088, USA.
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