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Chen JR, Tatum R, Sanders VL, Ahmad D, Morris RJ, Tchantchaleishvili V. Surgeon and Hospital Factors Associated With Outcomes in the New York State Database. J Surg Res 2024; 300:402-408. [PMID: 38848640 DOI: 10.1016/j.jss.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION We sought to explore the relationship between various surgeon-related and hospital-level characteristics and clinical outcomes among patients requiring cardiac surgery. METHODS We searched the New York State Cardiac Data Reporting System for all coronary artery bypass grafting (CABG) and valve cases between 2015 and 2017. The data were analyzed without dichotomization. RESULTS Among CABG/valve surgeons, case volume was positively correlated with years in practice (P = 0.002) and negatively correlated with risk-adjusted mortality ratio (P = 0.014). For CABG and CABG/valve surgeons, our results showed a negative association between teaching status and case volume (P = 0.002, P = 0.018). Among CABG surgeons, hospital teaching status and presence of cardiothoracic surgery residency were inversely associated with risk-adjusted mortality ratio (P = 0.006, P = 0.029). CONCLUSIONS There is a complex relationship between case volume, teaching status, and surgical outcomes suggesting that balance between academics and volume is needed.
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Affiliation(s)
- Joshua R Chen
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Tatum
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victoria L Sanders
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Danial Ahmad
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Liu C, Zhang H, Yang L, Chen L, Zu C, Wang F, Dai Y, Zhao H. Knowledge and attitude toward postoperative antithrombotic management and prevention in patients with coronary revascularization: a cross-sectional study. Front Cardiovasc Med 2024; 11:1388164. [PMID: 38826816 PMCID: PMC11140389 DOI: 10.3389/fcvm.2024.1388164] [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: 02/29/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Background This study aimed to explore the knowledge and attitude (KA) toward postoperative antithrombotic management and prevention among coronary artery disease (CAD) patients who underwent coronary revascularization. Methods This cross-sectional study enrolled CAD outpatients and inpatients between May and December 2023 at Kailuan Medical Group at Tangshan. Basic demographic characteristics and KA scores were collected through a self-made questionnaire. Results This study included 523 valid questionnaires. The mean knowledge and attitude scores were 13.20 ± 6.20 (range: 0-26) and 43.68 ± 6.01 (range: 21-50), respectively, indicating poor knowledge and favorable attitude. Multivariable logistic regression analysis showed that junior high school education (OR = 2.160, P = 0.035), high school or technical school education (OR = 2.356, P = 0.039), and monthly average income >5,000 RMB (OR = 3.407, P = 0.002) were independently associated with knowledge. Knowledge (OR = 1.095, P = 0.002), BMI ≥ 24.0 kg/m2 (OR = 0.372, P = 0.011), junior high school (OR = 3.699, P = 0.002), high school or technical school (OR = 2.903, P = 0.028), high associate degree or above education (OR = 6.068, P = 0.014), monthly average income 3,000-5,000 RMB (OR = 0.296, P = 0.005), monthly average income > 5,000 RMB (OR = 0.225, P = 0.021), with hypertension (OR = 0.333, P = 0.003), blood tests every 2-3 weeks (OR = 10.811, P = 0.011), blood tests every month (OR = 4.221, P = 0.024), and blood tests every 2-3 months (OR = 3.342, P = 0.033) were independently associated with attitude. Conclusion CAD patients who underwent coronary revascularization had poor knowledge but favorable attitudes toward postoperative antithrombotic management and prevention. The study underscores the need for targeted education, especially for individuals with lower education and income levels, ultimately improving patient compliance and cardiovascular outcomes.
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Affiliation(s)
- Chunlu Liu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Haijun Zhang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Liming Yang
- Department of Cardiology, Tangshan Gongren Hospital, Tangshan, China
| | - Lihua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Changhao Zu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Fangfang Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yunjia Dai
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Haiyan Zhao
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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de Liyis BG, Jagannatha GNP, Kosasih AM, Darma IKSS, Artha IMJR. Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis. Egypt Heart J 2024; 76:49. [PMID: 38630377 PMCID: PMC11024076 DOI: 10.1186/s43044-024-00481-7] [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: 01/17/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The impacts of single high-dose statin preloading in patients undergoing percutaneous coronary intervention (PCI) have not been fully examined. This study aims to evaluate post-procedure impacts of single high-dose statin pretreatment with acute coronary syndrome (ACS). METHODS The meta-analysis reviewed Cochrane, PubMed, and Medline databases for studies comparing single high-dose atorvastatin or rosuvastatin to placebo in ACS patients undergoing PCI. The primary endpoints included major adverse cardiovascular events (MACE), myocardial infarction (MI), all-cause mortality, and target vessel revascularization (TVR) at three months. Secondary endpoints examined were the TIMI flow grade 3 and left ventricular ejection fraction (LVEF). RESULTS Comprehensive analysis was conducted on fifteen RCTs, encompassing a total of 6,207 patients (3090 vs 3117 patients). The pooled results demonstrated that a single high-dose of statin administered prior to PCI led to a significant decrease in the incidence of MACE at three months post-PCI compared to the control group (OR 0.50, 95%CI 0.35-0.71, p = 0.0001). The occurrence of MI (OR 0.57, 95%CI 0.42-0.77, p = 0.0002), all-cause mortality (OR 0.56, 95%CI 0.39-0.81, p = 0.0002), and TVR (OR 0.56, 95%CI 0.35-0.92, p = 0.02) was significantly lower in the statin single high-dose group compared to the control group. No significant effects on TIMI flow grade 3 (OR 1.20, 95%CI 0.94-1.53, p = 0.14) or left ventricular ejection fraction (OR 2.19, 95%CI - 0.97 to 5.34, p = 0.17) were observed. Subgroup analysis demonstrated reduced incidence of MACE with a single dose of 80 mg atorvastatin (OR 0.66, 95%CI 0.54-0.81, p < 0.0001) and 40 mg rosuvastatin (OR 0.19, 95%CI 0.07-0.54, p = 0.002). CONCLUSIONS Single high-dose statin before PCI in patients with ACS significantly reduces MACE, MI, all-cause mortality, and TVR three months post-PCI.
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Affiliation(s)
- Bryan Gervais de Liyis
- Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Diponegoro Street, Denpasar, Bali, 80114, Indonesia.
| | - Gusti Ngurah Prana Jagannatha
- Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Diponegoro Street, Denpasar, Bali, 80114, Indonesia
| | - Anastasya Maria Kosasih
- Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Diponegoro Street, Denpasar, Bali, 80114, Indonesia
| | - I Kadek Susila Surya Darma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - I Made Junior Rina Artha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Matta A, Ohlmann P, Nader V, Levai L, Kang R, Carrié D, Roncalli J. A review of the conservative versus invasive management of ischemic heart failure with reduced ejection fraction. Curr Probl Cardiol 2024; 49:102347. [PMID: 38103822 DOI: 10.1016/j.cpcardiol.2023.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Heart failure is increasing in terms of prevalence, morbidity, and mortality rates. Clinical trials and studies are focusing on heart failure as it is the destiny end-stage for several cardiovascular disorders. Recently, medical therapy has dramatically progressed with novel classes of medicines providing better quality of life and survival outcomes. However, heart failure remains a heavy impactful factor on societies and populations. Current guidelines from the American and European cardiac societies are not uniform with respect to the class and level of treatment recommendations for coronary artery disease patients with heart failure and reduced ejection fraction. The discrepancy among international recommendations, stemming from the lack of evidence from adequately powered randomized trials, challenges physicians in choosing the optimal strategy. Hybrid therapy including optimal medical therapy with revascularization strategies are commonly used for the management of ischemic heart failure. Coronary artery bypass graft (CABG) has proved its efficacy on improving long term outcome and prognosis while no large randomized clinical trials for percutaneous coronary intervention (PCI) are still available. Regardless of the lack of data and recommendations, the trends of performing PCI in ischemic heart failure prevailed over CABG whereas lesion complexity, chronic total occlusion and complete revascularization achievement are limiting factors. Lastly, regenerative medicine seems a promising approach for advanced heart failure enhancing cardiomyocytes proliferation, reverse remodeling, scar size reduction and cardiac function restoration.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France.
| | - Patrick Ohlmann
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | - Vanessa Nader
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France
| | - Laszlo Levai
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France
| | - Ryeonshi Kang
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
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Gharbin J, Winful A, Alebna P, Grewal N, Brgdar A, Rhodd S, Taha M, Fatima U, Mehrotra P, Onwuanyi A. Trends in incidence and clinical outcome of non-ST elevation myocardial infarction in patients with amyloidosis in the United States, 2010-2020. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100336. [PMID: 38511180 PMCID: PMC10945973 DOI: 10.1016/j.ahjo.2023.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 03/22/2024]
Abstract
Study objective To assess temporal changes in clinical profile and in-hospital outcome of patients with amyloidosis presenting with non-ST elevation myocardial infarction, NSTEMI. Design/setting We conducted a retrospective observational study using the National Inpatient Sample (NIS) database from January 1, 2010, to December 31, 2020. Main outcomes Primary outcome of interest was trend in adjusted in-hospital mortality in patients with amyloidosis presenting with NSTEMI from 2010 to 2020. Our secondary outcomes were trend in rate of coronary revascularization, and trend in duration of hospitalization. Results We identified 272,896 hospitalizations for amyloidosis. There was a temporal increase in incidence of NSTEMI among patients aged 18-44 years from 15.5 % to 28.0 %, a reverse trend was observed in 45-64 years: 22.1 % to 17.7 %, p = 0.043. There was no statistically significant difference in rate of coronary revascularization from 2010 to 2020; 16.3 % to 14.2 %, p = 0.86. We observed an increased odds of all-cause in-hospital mortality in patients with NSTEMI compared to those without NSTEMI (aOR = 2.2, 95 % CI: 1.9-2.6, p < 0.001) but there was a decrease trend in mortality from 21.5 % to 11.3 %, p = 0.013 for trend. Hospitalization duration was also observed to decreased from 14.1 days to 10.9 days during the study period (p = 0.055 for trend). Conclusion In patients with amyloidosis presenting with NSTEMI, there was increased incidence of NSTEMI among young adults, a steady trend in coronary revascularization, and a decreasing trend of adjusted all-cause in-hospital mortality and length of hospitalization from 2010 to 2020 in the United States.
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Affiliation(s)
- John Gharbin
- Department of Internal Medicine, Howard University, Washington, DC, USA
| | - Adwoa Winful
- Medical University of South Carolina Health, Orangeburg, SC, USA
| | - Pamela Alebna
- Division of Cardiology, Virginia Commonwealth University, Virginia, USA
| | - Niyati Grewal
- Department of Internal Medicine, Howard University, Washington, DC, USA
| | - Ahmed Brgdar
- Division of Cardiology, Howard University, Washington, DC, USA
| | - Suchelis Rhodd
- Division of Cardiology, Howard University, Washington, DC, USA
| | - Mohammed Taha
- Division of Cardiology, Virginia Commonwealth University, Virginia, USA
| | - Urooj Fatima
- Division of Cardiology, Howard University, Washington, DC, USA
| | | | - Anekwe Onwuanyi
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA
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Smolderen KG, Romain G, Provance JB, Scierka LE, Mao J, Goodney PP, Henke PK, Sedrakyan A, Mena-Hurtado C. Guideline-Directed Medical Therapy and Long-Term Mortality and Amputation Outcomes in Patients Undergoing Peripheral Vascular Interventions. JACC Cardiovasc Interv 2023; 16:332-343. [PMID: 36792257 PMCID: PMC10359106 DOI: 10.1016/j.jcin.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Lack of guideline-directed medical therapy (GDMT) in patients undergoing peripheral vascular interventions (PVIs) may increase mortality and amputation risk. OBJECTIVES The authors sought to study the association between GDMT and mortality/amputation and to examine GDMT variability among providers and health systems. METHODS We performed an observational study using patients in the Vascular Quality Initiative registry undergoing PVI between 2017 and 2018. Two-year all-cause mortality and major amputation data were derived from Medicare claims data. Compliance with GDMT was defined as receiving a statin, antiplatelet therapy, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker if hypertensive. Propensity 1:1 matching was applied for GDMT vs no GDMT and survival analyses were performed to compare outcomes between groups. RESULTS Of 15,891 patients undergoing PVIs, 48.8% received GDMT and 6,120 patients in each group were matched. Median follow-up was 9.6 (IQR: 4.5-16.2) months for mortality and 8.4 (IQR: 3.5-15.4) for amputation. Mean age was 72.0 ± 9.9 years. Mortality risk was higher among patients who did not receive GDMT versus those on GDMT (31.2% vs 24.5%; HR: 1.37, 95% CI: 1.25-1.50; P < 0.001), as well as, risk of amputation (16.0% vs 13.2%; HR: 1.20; 95% CI: 1.08-1.35; P < 0.001). GDMT rates across sites and providers ranging from 0% to 100%, with lower performance translating into higher risk. CONCLUSIONS Almost one-half of the patients receiving PVI in this national quality registry were not on GDMT, and this was associated with increased risk of mortality and major amputation. Quality improvement efforts in vascular care should focus on GDMT in patients undergoing PVI.
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Affiliation(s)
- Kim G Smolderen
- Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Psychology Section, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Gaëlle Romain
- Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeremy B Provance
- Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lindsey E Scierka
- Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jialin Mao
- Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Phillip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Dartmouth College, Lebanon, New Hampshire, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Nelson AJ, Inohara T, Rao SV, Kaltenbach LA, Wojdyla D, Wang TY. Comparing the Classification of Percutaneous Coronary Interventions Using the 2012 and 2017 Appropriate Use Criteria: Insights From 245,196 Patients in the NCDR CathPCI Registry. Am Heart J 2023; 255:117-124. [PMID: 36220357 DOI: 10.1016/j.ahj.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Appropriate use criteria (AUC) have been developed to promote the rational use of percutaneous coronary intervention (PCI) among clinicians and to provide benchmarking feedback to hospitals. The original AUC were published in 2012 and subsequently updated in 2017 to reflect emerging, contemporary evidence however the degree to which the updated guidance re-classifies PCI appropriateness is unknown. METHODS Elective PCI cases from March 1, 2018 until June 30, 2021 were identified from within the NCDR CathPCI database. PCI cases were classified as 'appropriate,' 'uncertain' or 'inappropriate' under 2012 AUC and 'appropriate,' 'may be appropriate' or 'rarely appropriate' under 2017 AUC; those with missing data elements were termed 'not mappable.' Groups that 'remained appropriate' (appropriate in both 2012 and 2017), 'became non-appropriate' ('appropriate' in 2012 but became either 'may be appropriate' or 'rarely appropriate in 2017) and 'became appropriate' ('appropriate' in 2017 but were 'uncertain' or 'inappropriate' in 2012) were descriptively compared. Concordance was assessed by calculation of Cohen's Kappa. RESULTS A total of 245,196 patients underwent elective PCI across 1669 centers. By 2012 AUC, 44% were classified 'appropriate,' 28% were 'uncertain' and 16% were 'inappropriate' compared with 2017 AUC which considered 34% 'appropriate', 56% may be 'appropriate' and 4% 'rarely appropriate'. Overall fair agreement was observed with a Kappa statistic of 0.40 (95%CI 0.396-0.403). Compared with PCI that 'remained appropriate' under the 2017 AUC, PCI that 'became non-appropriate' in 2017 were more likely to be asymptomatic, less likely to be on anti-anginals and less likely to have complex lesions. Compared with PCI that 'became non-appropriate', PCI that 'became appropriate' had a higher proportion of atypical and non-anginal symptoms and were less likely to have had positive functional tests. Procedural related outcomes were similar across all groups. A total of 29 429 PCI (12.0%) were not mappable by 2012 AUC while 16 077 (6.6%) were not mappable by 2017 AUC. CONCLUSIONS In this contemporary analysis of patients undergoing PCI in the United States, only fair agreement between the 2012 and updated 2017 AUC was observed. While some of this reflects the intention of the updated guidance, the large proportion that were considered 'maybe appropriate' or who 'became non-appropriate' reflect the difficulties of documenting and implementing contemporary AUC guidance.
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Affiliation(s)
- Adam J Nelson
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Taku Inohara
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Sunil V Rao
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Lisa A Kaltenbach
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Daniel Wojdyla
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tracy Y Wang
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Deka P, Blesa J, Pathak D, Sempere-Rubio N, Iglesias P, Micó L, Soriano JM, Klompstra L, Marques-Sule E. Combined Dietary Education and High-Intensity Interval Resistance Training Improve Health Outcomes in Patients with Coronary Artery Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811402. [PMID: 36141673 PMCID: PMC9517078 DOI: 10.3390/ijerph191811402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Reducing cardiovascular risk through lifestyle changes that include a heart-healthy diet and regular exercise is recommended in the rehabilitation of patients with coronary artery disease (CAD). We pilot-tested the effectiveness of a dietary-education and high-intensity interval resistance training (DE-HIIRT) program on healthy food choices and associated anthropometric variables in patients with established CAD. METHODS A total of 22 participants, aged 60.0 ± 7.2 years, were enrolled in the study. Over 3 months, under the guidance and supervision of a physiotherapist, participants performed the resistance exercises 2×/week in a group setting (cohort of 11). Participants additionally attended three sessions of dietary education led by a dietician. Participants demonstrated their knowledge and understanding of dietary education by picking heart-healthy foods by reading food labels. Outcomes included change in diet (measured using the tricipital skinfold thickness Mediterranean Diet Adherence questionnaire (MEDAS-14) and the Food Consumption Frequency Questionnaire (FCFQ)) and anthropometric measurements (body composition, body circumference, and tricipital skinfold thickness). A paired t-test was performed to analyze the differences between the baseline and post-intervention results. RESULTS Participants significantly increased their consumption of vegetables (p = 0.04) and lowered their consumption of sweet snacks (p = 0.007), pastries (p = 0.02), and processed food (p = 0.05). Significant improvements in body mass index (p = 0.001), waist circumference (p = 0.0001), hip circumference (p = 0.04), and body fat (p = 0.0001) were also achieved. CONCLUSION Making lifestyle changes that include both diet and exercise is essential in the management of CAD. The HIIRT program combined with dietary changes shows promise in achieving weight-loss goals in this population and needs to be further investigated with appropriate study designs.
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Affiliation(s)
- Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
- Correspondence: ; Tel.: +1-517-432-8309
| | - Jesús Blesa
- Department of Preventive Medicine, Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, 46010 Valencia, Spain
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain
| | - Dola Pathak
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
| | - Nuria Sempere-Rubio
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Paula Iglesias
- University Clinic of Nutrition, Physical Activity and Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Lydia Micó
- University Clinic of Nutrition, Physical Activity and Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - José Miguel Soriano
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, 58185 Linkoping, Sweden
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Sagaydak OV, Oschepkova EV, Chazova IE. Seх differences in treatment of acute coronary syndrome patients. Data from federal registry of acute coronary syndrome 2016–2019. TERAPEVT ARKH 2022; 94:797-802. [DOI: 10.26442/00403660.2022.07.201732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/22/2022]
Abstract
Introduction. Management of patients with acute coronary syndrome (ACS) is usually universal, regardless of gender, age, and ethnicity. But often in practice, gender and age influence medical decisions, and patients do not receive proper medical care. Medical care for patients with ACS was analyzed by gender according to the federal register of ACS data.
Aim. To analyze the influence of the patient's gender on the course of the disease and on the provision of medical care to patients with ACS who underwent treatment in 20162019.
Materials and methods. The data of 95 586 cases was analyzed. Two groups were identified: men (n=59 442, 62.2%) and women (n=36 144, 57.8%).
Results. Anamnesis analysis has revealed, that women were often more burdened with concomitant diseases and had a higher risk on the GRACE scale at admission. It was demonstrated that men underwent revascularization on average significantly more often than women (51.9% versus 32.5%, respectively, p0.001). In women, conservative therapy was more. When compared with the appropriate use criteria for coronary revascularization, it was shown that more than 70% of women in whom a conservative treatment strategy was chosen, it was expedient to undergo myocardial revascularization using percutaneous coronary intervention.
Conclusion. Gender differences were revealed in the course of the disease, as well as in the choice of treatment by doctors. Women are characterized by a later manifestation of the disease, more often in the form of ST-ACS. The course of the disease in women is associated with a higher comorbidity, atypical symptoms and later call for help. A conservative approach prevails in the choice of ACS treatment tactics in women.
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Ramsaran E, Dai Q, Sundaresan D, Leblanc M, Amblihalli V, Muthyala A, Preusse P, Leblanc C, Li P, Andries N, Cai P, Shah N. Mortality in Stable Coronary Disease in Patients With Intermediate- or High-Risk Myocardial Perfusion Imaging. Am J Cardiol 2022; 168:1-10. [PMID: 35074212 DOI: 10.1016/j.amjcard.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 11/01/2022]
Abstract
The management of patients with stable coronary disease and intermediate- or high-risk features on single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) continues to be controversial as to whether they should be treated with an initial invasive strategy (catheterization and revascularization when feasible) or medical therapy alone to improve mortality. We performed a retrospective observational study of 1,946 patients with intermediate- or high-risk SPECT MPI scans performed over a 6-year period (from 2014 to 2019). Each patient was followed from the time of SPECT MPI to 16 months after the last patient was enrolled. The primary end point was all-cause mortality and the secondary end point cardiovascular mortality. Of the eligible 1,697 patients, 1,144 had an intermediate-risk scan, 553 a high-risk scan, 915 had medical therapy alone, and 782 went on an initial invasive strategy. All patients were divided into the following three groups: combined SPECT MPI (both intermediate- and high-risk), high-risk SPECT MPI, and intermediate-risk SPECT MPI groups. After propensity score matching, there was a statistically significant difference in cardiovascular death (5.9% vs 2.7%; p = 0.038) in the medical therapy cohort compared with initial invasive cohort in the combined SPECT MPI group, but no difference in all-cause death (15.7% vs 13%; p = 0.318). On subgroup analysis, in intermediate-risk SPECT MPI group, there was no significant difference in either all-cause death (13.8 vs 11.7%; p = 0.583) or cardiac death (5.4% vs 2.5%; p = 0.16) in conservative cohort compared with invasive strategy cohort. In high-risk SPECT MPI group, conservative therapy cohort had higher cardiac death (11.7% vs 2.5%; p = 0.002) compared with initial invasive strategy cohort, but there was no significant difference in all-cause death (24.5% vs 15.3%; p = 0.052). In conclusion, this study supports that patients with intermediate- or high-risk SPECT MPI scans when considered together or only with high-risk features, derive a cardiovascular mortality benefit with an initial invasive strategy. Patients who had undergone intermediate-risk SPECT MPI had similar outcomes with either medical therapy alone or initial invasive evaluation.
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11
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Yager N, Konduru S, Torosoff M. Nitrates as a Marker of Multiple Co-morbidities and Increased Mortality in Patients Undergoing Percutaneous Coronary Intervention (PCI). Cureus 2022; 14:e23520. [PMID: 35494964 PMCID: PMC9038167 DOI: 10.7759/cureus.23520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background Notwithstanding the guideline endorsement of various anti-anginal medications, there is a paucity of data on whether one anti-anginal regimen or medication is superior to another. It is also unknown how anti-anginal medications affect outcomes of elective percutaneous coronary intervention (PCI). To fill this knowledge gap, we investigated an association between commonly used anti-anginal medications and elective PCI outcomes in stable ischemic heart disease (SIHD) patients. Methods Using the New York State's (NYS) PCI Reporting System, we reviewed data on 33,568 consecutive patients who underwent non-emergent PCI in 2015. The primary endpoint of this study was all-cause in-hospital mortality. Results Regardless of the combination therapy of nitrates with any other non-nitrate anti-anginal therapy, including beta-adrenergic blockers (BB) and/or calcium channel blockers (CCB), nitrate treatment continued to be associated with significantly increased post-elective PCI mortality. Conclusions In this large, all-inclusive state-wide contemporary cohort study of SIHD patients, treatment with nitrates, but not beta-blockers, calcium channel blockers, or ranolazine, was associated with increased post-PCI mortality. Utilization of nitrate therapy is likely reflective of advanced disease burden rather than directly related to the specific medication intolerance. Additional studies investigating optimal anti-anginal medical therapy on PCI outcomes are warranted.
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Sotomi Y, Kozuma K, Kashiwabara K, Higuchi Y, Ando K, Morino Y, Ako J, Tanabe K, Muramatsu T, Nakazawa G, Hikoso S, Sakata Y. Randomised controlled trial to investigate optimal antithrombotic therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention: a study protocol of the OPTIMA-AF trial. BMJ Open 2021; 11:e048354. [PMID: 34907043 PMCID: PMC8671924 DOI: 10.1136/bmjopen-2020-048354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The optimal antithrombotic strategy for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is uncertain. For patients with non-AF, many trials are now evaluating short 1-month dual antiplatelet therapy. In patients with AF undergoing PCI, in contrast, short dual therapy (P2Y12 inhibitor +direct oral anticoagulant (DOAC)) has not yet been evaluated. METHODS AND ANALYSIS The OPTIMA-AF trial (OPTIMAl antiplatelet therapy in combination with direct oral anticoagulants in patients with non-valvular Atrial Fibrillation undergoing percutaneous coronary intervention with everolimus-eluting stent) is an investigator-initiated, open-label, nationwide, multicentre, prospective, randomised controlled trial. The primary objective is to compare the efficacy and safety of short dual therapy (1-month DOAC +P2Y12 inhibitor followed by DOAC monotherapy) against long dual therapy (12-month DOAC +P2Y12 inhibitor followed by DOAC monotherapy) in the treatment of AF subjects undergoing PCI. The primary efficacy endpoint is a composite of death or thromboembolic events (myocardial infarction, definite stent thrombosis, stroke or systemic embolism) at 365 days; and the primary safety endpoint is bleeding (International Society on Thrombosis and Haemostasis major or clinically relevant non-major bleeding) at 365 days. This trial is intended to show the non-inferiority of short dual therapy versus long dual therapy in terms of the primary efficacy endpoint and show superiority in terms of the primary safety endpoint. A total of 1090 subjects will be randomised in a 1:1 ratio at approximately 60 sites. ETHICS AND DISSEMINATION This study received approval from the Certified Review Board of Osaka University (a certified research ethics committee by the Japanese Clinical Research Act). The findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER Japan Registry of Clinical Trials: jRCTs051190053; Pre-results.
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Affiliation(s)
- Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Kozuma
- Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kosuke Kashiwabara
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshihiro Morino
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Iwate, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kengo Tanabe
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kinki University Hospital, Osaka, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Guduguntla V, Redberg RF. Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable coronary artery disease. Eur J Intern Med 2021; 94:15-21. [PMID: 34535375 DOI: 10.1016/j.ejim.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 01/09/2023]
Abstract
Despite limited benefit, percutaneous coronary intervention (PCI) remains a common procedure that is often performed for uncertain or inappropriate indications in patients with stable coronary artery disease (CAD). PCI cases per capita have increased year-over-year in most European countries, and many have higher rates than the U.S. Meanwhile, first-line therapy such as optimal medical therapy (OMT) and lifestyle changes, continue to be under-utilized. This article reviews the evidence on use of PCI in stable CAD. Specifically, we analyzed randomized control trials, systematic reviews, appropriate use criteria, and professional society guidelines that examine the risks and benefits of PCI compared to OMT. We then highlight utilization patterns as well as interventions that better align current practice with evidence-based care.
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Affiliation(s)
- Vinay Guduguntla
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94131, United States.
| | - Rita F Redberg
- Department of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94131, United States
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15
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Inohara T, Kohsaka S. Process of Care Assessment in Patients With Chronic Total Occlusion. Circ J 2021; 86:808-810. [PMID: 34789615 DOI: 10.1253/circj.cj-21-0876] [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: 11/09/2022]
Affiliation(s)
- Taku Inohara
- Department of Cardiology, Keio University of School of Medicine
| | - Shun Kohsaka
- Department of Cardiology, Keio University of School of Medicine
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16
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Chen G, Farris MS, Cowling T, Pinto L, Rogoza RM, MacKinnon E, Champsi S, Anderson TJ. Prevalence of atherosclerotic cardiovascular disease and subsequent major adverse cardiovascular events in Alberta, Canada: A real-world evidence study. Clin Cardiol 2021; 44:1613-1620. [PMID: 34585767 PMCID: PMC8571560 DOI: 10.1002/clc.23732] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality worldwide. Data from Canadian populations regarding the burden of ASCVD are limited. Therefore, we describe the 5-year period prevalence of ASCVD and subsequent major adverse cardiovascular event (MACE) outcomes among patients with ASCVD in Alberta, Canada. METHODS A retrospective, observational study was conducted by linking provincial health services data, vital statistics, and pharmaceutical dispenses data. Five-year period prevalence of clinical ASCVD was captured between 2011 and 2016, and a cohort of adult patients with an initial clinical ASCVD event were identified between 2012 and 2016. One-year incidence rates (IRs) of subsequent MACE outcomes were calculated as composite and individual measures. A subgroup of patients with acute myocardial infarction (AMI) as their index event was examined. RESULTS There were 198 573 patients (mean [standard deviation] age: 63.9 [15.6] years; 56.6% males) identified with clinical ASCVD between 2012 and 2016. Overall, the 5-year period prevalence of ASCVD in Alberta was 89.9 per 1000 persons and the 1-year IR for a primary MACE outcome was 6.15 (95% confidence interval [CI]: 6.03-6.26) per 100 person-years. Among the ASCVD cohort, 9465 had an AMI as their index event and the IR for a primary MACE outcome was 14.30 (95% CI: 13.45-15.20) per 100 person-years. CONCLUSIONS This study found that the prevalence of ASCVD and the rate of subsequent MACE outcomes 1 year following the initial ASCVD event are substantial, particularly among patients with an AMI. Secondary prevention strategies aimed at lowering this risk are needed for patients with ASCVD.
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Affiliation(s)
- Guanmin Chen
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Megan S Farris
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
| | | | | | | | | | - Todd J Anderson
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Yun CH, Hung CL, Wen MS, Wan YL, So A. CT Assessment of Myocardial Perfusion and Fractional Flow Reserve in Coronary Artery Disease: A Review of Current Clinical Evidence and Recent Developments. Korean J Radiol 2021; 22:1749-1763. [PMID: 34431244 PMCID: PMC8546143 DOI: 10.3348/kjr.2020.1277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) is routinely used for anatomical assessment of coronary artery disease (CAD). However, invasive measurement of fractional flow reserve (FFR) is the current gold standard for the diagnosis of hemodynamically significant CAD. CT-derived FFRCT and CT perfusion are two emerging techniques that can provide a functional assessment of CAD for risk stratification and clinical decision making. Several clinical studies have shown that the diagnostic performance of concomitant CCTA and functional CT assessment for detecting hemodynamically significant CAD is at least non-inferior to that of other routinely used imaging modalities. This article aims to review the current clinical evidence and recent developments in functional CT techniques.
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Affiliation(s)
- Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Biomedical Sciences, Mackay Medical College, New Taipei, Taiwan
| | - Ming-Shien Wen
- Department of Cardiology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Aaron So
- Department of Medical Biophysics, University of Western Ontario, Imaging Program, Lawson Health Research Institute, London, Canada
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Yakubov SJ, Arshi A, Stiver K. #PCI2021: The Trend Is Our Friend. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 31:17-18. [PMID: 34391682 DOI: 10.1016/j.carrev.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Steven J Yakubov
- System Chief of Advanced Structural Heart Disease, OhioHealth, Riverside Methodist Hospital, United States of America.
| | - Arash Arshi
- Cardiac Catheterization Lab Director, OhioHealth Riverside Methodist Hospital, United States of America
| | - Kevin Stiver
- Cardiac Catheterization Lab Director, OhioHealth Doctor's Hospital, United States of America
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Chow BJW, Yam Y, Small G, Wells GA, Crean AM, Ruddy TD, Hossain A. Prognostic durability of coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:331-338. [PMID: 33111135 DOI: 10.1093/ehjci/jeaa196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/17/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS This large prospective cohort study sought to confirm the incremental prognostic value of coronary computed tomographic angiography (CCTA) measured over a prolonged follow-up duration. CCTA has diagnostic and prognostic value but data supporting its long-term prognostic value in a large prospectively recruited cohort with suspected coronary artery disease (CAD) has been limited. METHODS AND RESULTS Consecutive patients (without history of myocardial infarction, revascularization, cardiac transplantation, and congenital heart disease) were prospectively enrolled. CCTA was evaluated for CAD severity, total plaque score (TPS), and left ventricular ejection fraction. Patients were followed for major adverse events (MAE) and major adverse cardiac events (MACE).Over a total of 99 months, 8667 consecutive CCTA patients (mean age = 57.1 ± 11.1 years, 52.9% men) were prospectively enrolled and followed for a mean duration of 7.0 ± 2.6 years. At follow-up, there were a total of 723 MAE, 278 MACE, 547 all-cause deaths, 110 cardiac deaths, and 104 non-fatal myocardial infarction. Patients without coronary atherosclerosis at the time of CCTA had a very low annual event rate for both MAE and MACE (0.45%/year and 0.19%/year, respectively). Both MAE and MACE increased with increasing TPS and severity of CAD. In patients with non-obstructive CAD and who were statin-naive, TPS ≥5 had MACE rates >0.75%/year. Patients with high-risk CAD had an annual MAE and MACE rates of 3.52%/year and 2.58%/year, respectively. Adjusted hazard ratio of the severity of CAD based on multivariable analyses indicated that the prognostic values were incremental. CONCLUSION CCTA has independent and incremental prognostic value that is durable over time. The absence of coronary atherosclerosis portends an excellent prognosis. Patients with increasing non-obstructive plaque burden have worse prognosis and a TPS threshold ≥5 may identify a population that may benefit from statin therapy.
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Affiliation(s)
- Benjamin J W Chow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Radiology, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - Yeung Yam
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Gary Small
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Andrew M Crean
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Radiology, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Radiology, University of Ottawa, Ottawa K1G 5Z3, Canada
| | - Alomgir Hossain
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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Chaudhry YP, MacMahon A, Rao SS, Sterling RS, Oni JK, Khanuja HS. Incidence, mortality, and complications of acute myocardial infarction with and without percutaneous coronary intervention in hip fracture patients. Injury 2021; 52:2344-2349. [PMID: 33663802 DOI: 10.1016/j.injury.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a common cause of death following hip fracture surgery. This study aimed to determine the incidence and timing of perioperative AMI treated with percutaneous coronary intervention (PCI) in hip fracture patients, and to compare in-hospital mortality and complications between hip fracture patients who did not have an AMI, those who sustained a perioperative AMI and did not undergo PCI, and those who sustained an AMI and underwent PCI. METHODS The National Inpatient Sample (NIS) was queried from 2010 through the third quarter of 2015 to identify all patients undergoing hip fracture surgery. Patients were stratified into three cohorts: perioperative AMI but no PCI (no PCI cohort), perioperative AMI with PCI (PCI cohort), and no perioperative AMI or PCI (no AMI cohort). Patient demographics, comorbidities, in-hospital mortality, and complications were compared between cohorts. Multivariable logistic regression adjusting for age, sex, procedure, and Elixhauser score was used to assess the relative odds of in-hospital mortality for each cohort. RESULTS A total of 1,535,917 hip fracture cases were identified, with 1.9% in the no PCI cohort, 0.01% in the PCI cohort, and 98.0% in the no AMI cohort. In-hospital mortality was lower in the PCI cohort than in the no PCI cohort (8.8% vs. 14%), and was greater for both than in the no AMI cohort (1.6%, p < 0.001 for all). Both the no PCI cohort (OR, 6.1; 95% CI, 5.6-6.6) and PCI cohort (OR, 4.1; 95% CI, 2.8-6.0) had increased adjusted odds of in-hospital mortality compared to the no AMI cohort. The PCI cohort had a higher rate of bleeding complications than both other cohorts, and the no PCI cohort had a higher rate of transfusion than both other cohorts. CONCLUSIONS Perioperative AMI both with and without PCI independently increases the risk of mortality in hip fracture patients, with the highest risk of mortality in those with AMI without PCI. Providers should understand the increased morbidity and mortality associated with AMI in hip fracture patients, as well as the risks and benefits of perioperative PCI, in order to better counsel and manage these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA.
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21
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De Lima JJG, Gowdak LHW, David-Neto E, Bortolotto LA. Early cardiovascular events and cardiovascular death after renal transplantation: role of pretransplant risk factors. Clin Exp Nephrol 2021; 25:545-553. [PMID: 33506358 DOI: 10.1007/s10157-021-02019-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to verify the risk factors present in patients on the kidney transplant waiting list that may interfere with the incidence of cardiovascular (CV) events and death during the first 12 months after transplantation. METHODS Based on the data collected prospectively during pretransplant workups, a retrospective study was conducted including 665 patients followed up until death or completing 12 months posttransplantation. Endpoints were the composite incidence of CV events and death. RESULTS The prevalence of diabetes, LV hypertrophy, and CV disease at baseline was high; 14% of patients had angina, 26% an abnormal myocardial scan, and 47% coronary artery disease. CV events occurred in 53 patients (8.4%) and in 29 (55%) caused death. The independent predictors of events were age ≥ 50 years (HR 2.292; CI% 1.093-4.806), angina (HR 1.969; CI% 1.039-3.732), and altered myocardial scan (HR 1.905, CI% 1.059-3.428). Altered myocardial scan (HR 2.822, 95% CI 1.095-6.660) was also one of the independent predictor of CV death. CONCLUSION The incidence of CV events and death were predicted by variables associated with myocardial ischemia, a potentially modifiable risk factor. Patients with pretransplantation myocardial ischemia should be considered at a higher risk of developing early CV complications and managed accordingly before, during, and after kidney transplantation.
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Affiliation(s)
- Jose Jayme G De Lima
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil.
| | - Luis Henrique W Gowdak
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil
| | - Elias David-Neto
- Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Bortolotto
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil
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22
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Wu CI, Wu CL, Su FC, Lin SW, Huang WY. Association between Pre-Existing Coronary Artery Disease and 5-Year Mortality in Stroke Patients with High-Grade Carotid Artery Stenosis. Eur Neurol 2020; 84:31-37. [PMID: 33361700 DOI: 10.1159/000512407] [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: 08/12/2020] [Accepted: 10/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. METHODS From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. RESULTS Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (p = 0.017, p < 0.001, p = 0.002, and p < 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35-3.79; p = 0.002). CONCLUSION Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.
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Affiliation(s)
- Ching-I Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shun-Wen Lin
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan, .,Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan,
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23
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Ribeiro MH, Grossi A, Caixeta A, Franken M, Katz M, Seleme V, Ribeiro E, Pesaro AE, Fabri J, Mehta S, Campos CM. Cluster of climatic and pollutant characteristics increases admissions for acute myocardial infarction: Analysis of 30,423 patients in the metropolitan area of Sao Paulo. Heart Lung 2020; 50:161-165. [PMID: 33227571 DOI: 10.1016/j.hrtlng.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of simultaneous adverse climate conditions in the risk of myocardial infarction (MI) was not tested before. The aim of the present study was to investigate the impact of the combination of climate and air pollution features in the number of admissions and mortality due to acute myocardial infarction in 39 municipalities of São Paulo from 2012 to 2015. METHODS Data about MI admissions were obtained from the Brazilian public health system (DataSUS). Daily information on weather were accessed from the Meteorological Database for Teaching and Research. Additionally, daily information on air pollution were obtained from the Environmental Company of the State of São Paulo. A hierarchical cluster analysis was applied for temperature, rainfall patterns, relative air humidity, nitrogen dioxide, particulate matter 2.5 and particulate matter 10. MI admissions and in-hospital mortality were compared among the clusters. RESULTS Data analysis produced 3 clusters: High temperature variation-Low humidity-high pollution (n=218 days); Intermediate temperature variation/high humidity/intermediate pollution (n=751 days) and low temperature variation/intermediate humidity-low pollution (n=123 days). All environmental variables were significantly different among clusters. The combination of high temperature variation, dry weather and high pollution resulted in a significant 9% increase in hospital admissions for MI [30.5 (IQR 25.0-36.0)]; patients/day; P<0.01). The differences in weather and pollution did not have impact on in-hospital mortality (P=0.88). CONCLUSION The combination of atmospheric conditions with high temperature variation, lower temperature, dryer weather and increased inhalable particles was associated with a marked increase of hospital admissions due to MI.
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Affiliation(s)
- Marcelo H Ribeiro
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil; SOS Cárdio Hospital, Florianópolis, Brazil
| | - André Grossi
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
| | - Adriano Caixeta
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 672/701, Morumbi, SP, Brazil
| | - Marcelo Franken
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 672/701, Morumbi, SP, Brazil
| | - Marcelo Katz
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 672/701, Morumbi, SP, Brazil
| | - Vinicius Seleme
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
| | - Expedito Ribeiro
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
| | | | - Jose Fabri
- Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Sameer Mehta
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos M Campos
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil; Insituto Prevent Senior, São Paulo, Brazil.
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24
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Jia Q, Xu L, Shen J, Wei Y, Xu H, Shi J, Jia Z, Zhao X, Liu C, Zhong Q, Tian Y, He K. Detecting Rare Variants and Heteroplasmy of Mitochondrial DNA from High-Throughput Sequencing in Patients with Coronary Artery Disease. Med Sci Monit 2020; 26:e925401. [PMID: 33132382 PMCID: PMC7646198 DOI: 10.12659/msm.925401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Although mutations and dysfunction of mitochondrial DNA (mtDNA) are related to a variety of diseases, few studies have focused on the relationship between mtDNA and coronary artery disease (CAD), especially the relationship between rare variants and CAD. Material/Methods Two-stage high-throughput sequencing was performed to detect mtDNA variants or heteroplasmy and the relationship between them and CAD phenotypes. In the discovery stage, mtDNA was analyzed by high-throughput sequencing of long-range PCR products generated from the peripheral blood of 85 CAD patients and 80 demographically matched controls. In the validation stage, high-throughput sequencing for mtDNA target regions captured by GenCap Kit was performed on 100 CAD samples and 100 controls. Finally, tRNA fine mapping was performed between our study and the reported Chinese CAD study. Results Among the tRNA genes, we confirmed a highly conserved rare variant, A5592G, previously reported in the Chinese CAD study, and 2 novel rare mutations that reached Bonferroni’s correction significance in the combined analysis were found (P=7.39×10−4 for T5628C in tRNAAla and P=1.01×10−5 for T681C in 12S rRNA) in the CAD study. Both of them were predicted to be pathological, with T5628C disrupting an extremely conservative base-pairing at the AC stem of tRNAAla. Furthermore, we confirmed the controversial issue that the number of non-synonymous heteroplasmic sites per sample was significantly higher in CAD patients. Conclusions In conclusion, our study confirmed the contribution of rare variants in CAD and showed that CAD patients had more non-synonymous heterogeneity mutations, which may be helpful in identifying the genetic and molecular basis of CAD.
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Affiliation(s)
- Qian Jia
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Lu Xu
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Juan Shen
- BGI Genomics, Shenzhen, Guangdong, China (mainland)
| | - Yanping Wei
- BGI Genomics, Shenzhen, Guangdong, China (mainland)
| | - Huaiqian Xu
- BGI Genomics, Shenzhen, Guangdong, China (mainland)
| | - Jinlong Shi
- Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Zhilong Jia
- Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xiaojing Zhao
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Chunlei Liu
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Qin Zhong
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Yaping Tian
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Kunlun He
- Core Laboratory of Translational Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).,Beijing Key laboratory of Chronic Heart Failure Precision Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
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25
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Malik AO, Spertus JA, Patel MR, Dehmer GJ, Kennedy K, Chan PS. Potential Association of the ISCHEMIA Trial With the Appropriate Use Criteria Ratings for Percutaneous Coronary Intervention in Stable Ischemic Heart Disease. JAMA Intern Med 2020; 180:1540-1542. [PMID: 32955575 PMCID: PMC7506580 DOI: 10.1001/jamainternmed.2020.3181] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study examines the potential implications of the ISCHEMIA trial on the appropriateness of percutaneous coronary intervention in patients with stable ischemic heart disease.
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Affiliation(s)
- Ali O Malik
- St Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- St Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Manesh R Patel
- Duke University, School of Medicine, Durham, North Carolina
| | | | - Kevin Kennedy
- St Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Paul S Chan
- St Luke's Mid America Heart Institute, Kansas City, Missouri
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26
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Prognostic value of coronary computed tomography angiography in patients with prior percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2020; 15:268-273. [PMID: 32981882 DOI: 10.1016/j.jcct.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to determine the prognostic value of coronary computed tomography angiography (CCTA) in patients with a history of percutaneous coronary intervention (PCI). BACKGROUND Although the prognostic value of CCTA has been well studied, its incremental value in patients with previous PCI has not been robustly investigated. METHODS Consecutive patients with previous PCI were prospectively enrolled and CCTA images were evaluated for coronary artery disease (CAD) severity. Patients were followed for major adverse cardiovascular events (MACE) which was a composite of cardiac death and non-fatal myocardial infarction. All-cause death was assessed as a secondary endpoint. RESULTS A total of 501 patients were analyzed with a mean follow-up time of 59.5 ± 32.0 months and 52 patients (10.4%) experienced MACE. Multivariable Cox regression analysis showed that CAD severity was a predictor of MACE with 0, 1, 2, and 3 vessel disease having annual rates of 1.3%, 2.2%, 2.2%, and 5.3%, respectively. All-cause death was similar in all categories of CAD. CONCLUSIONS In patients with previous PCI, CAD severity as measured with CCTA has independent and incremental prognostic value.
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27
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Dauerman HL, Mack MJ. International Trends in Coronary Intervention: A Bridge Over Rising Coronary Waters. J Am Coll Cardiol 2020; 76:1341-1344. [PMID: 32912448 DOI: 10.1016/j.jacc.2020.07.043] [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: 07/16/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Harold L Dauerman
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont.
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28
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Kandzari DE, Lembo NJ, Carlson HD, Kalynych A, Spertus JA, Gibson CM, Chi G, Morgan J, Rinehart S, Yehya A, Qian Z, Ajose B, Karmpaliotis D. Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from the PERSPECTIVE study. Catheter Cardiovasc Interv 2020; 96:567-576. [PMID: 31512377 DOI: 10.1002/ccd.28494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient-reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus-eluting stents (ZES). METHODS Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in-hospital clinical outcomes were examined in addition to the 1-year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre-specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1-year MACE among patients treated with ZES compared with a performance goal. RESULTS Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J-CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1-year MACE rate, 12.1%. One-year health status significantly improved from baseline with successful CTO-PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1-year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one-sided upper CI, 23.6%, p = .017). CONCLUSIONS Favorable procedural success, health status improvements and late-term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.
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Affiliation(s)
- David E Kandzari
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Nicholas J Lembo
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Harold D Carlson
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Anna Kalynych
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - John A Spertus
- Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, Missouri
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gerald Chi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jayne Morgan
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Sarah Rinehart
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Amin Yehya
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Zhen Qian
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Bola Ajose
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
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29
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Inohara T, Kohsaka S, Spertus JA, Masoudi FA, Rumsfeld JS, Kennedy KF, Wang TY, Yamaji K, Amano T, Nakamura M. Comparative Trends in Percutaneous Coronary Intervention in Japan and the United States, 2013 to 2017. J Am Coll Cardiol 2020; 76:1328-1340. [DOI: 10.1016/j.jacc.2020.07.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
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30
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Xie JX, Kobashigawa JA, Kennedy KF, Henry TD, Tabak SW, Krebbs R, Shaw L, Abbott JD, Book W, Rab ST, Spertus JA, Goyal A. Omission of Heart Transplant Recipients From the Appropriate Use Criteria for Revascularization and the Ramifications on Heart Transplant Centers. JAMA Cardiol 2020; 5:669-676. [PMID: 32267466 DOI: 10.1001/jamacardio.2020.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Guidelines endorse routine coronary angiography and percutaneous coronary intervention (PCI) to screen for and treat cardiac allograft vasculopathy in heart transplant recipients. However, the current Appropriate Use Criteria for Revascularization (AUC-R) do not recognize prior heart transplant as a unique PCI indication. Whether this affects rates of rarely appropriate (RA) PCIs is unknown. Objective To assess the rate of RA PCI procedures in heart transplant recipients and how it pertains to hospital PCI appropriateness metrics and pay-for-performance scorecards. Design, Setting, and Participants This observational study used National Cardiovascular Data Registry CathPCI Registry data on all patients undergoing elective PCIs from 96 Medicare-approved heart transplant centers from quarter 3 of 2009 to quarter 2 of 2017. The data were analyzed in July 2018. Exposures Prior heart transplant. Main Outcomes and Measures Rates of RA elective PCIs in heart transplant recipients compared with nonrecipients and hospital rates of RA PCI before vs after exclusion of heart transplant recipients using paired t tests. In a subset of heart transplant centers participating in the Anthem Blue Cross and Blue Shield's Quality-In-Sights Hospital Incentive Program (Q-HIP), we compared the change in Q-HIP scorecards before vs after excluding heart transplant recipients. Results Of 168 802 participants, 123 124 (72.9%) were men, 137 457 were white, and the mean (SD) age was 66.3 (11.4) years. Of 168 802 elective PCIs performed in heart transplant centers, 1854 (1.1%) were for heart transplant recipients. Heart transplant recipients were less likely to have ischemic symptoms (14.6% vs 61.4%, P < .001), had lower rates of antecedent stress testing (15.0% vs 58.4%, P < .001), and had higher RA PCI rates (66.0% vs 16.9%, P < .001) compared with nonrecipients. In heart transplant centers, the absolute difference in RA rates (before vs after excluding transplant recipients) was directly associated with the proportion of PCIs performed in heart transplant recipients (r = 0.91; P < .001). In the subset of heart transplant centers participating in Q-HIP during the 2016 and 2017 calendar years, 8 of 20 (40%) and 8 of 16 centers (50%), respectively, could have benefited from a change in their Q-HIP scorecards if their RA PCI rates excluded transplant recipients. Conclusions and Relevance Two-thirds of PCIs in heart transplant recipients were deemed RA by the AUC-R. The failure of the AUC-R to consider prior heart transplant as a unique PCI indication may lead to inflated RA PCI rates with the potential for affecting quality reporting and pay-for-performance metrics in heart transplant centers.
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Affiliation(s)
- Joe X Xie
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Kevin F Kennedy
- St Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City
| | | | - Steven W Tabak
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | | | - Leslee Shaw
- Weill Cornell Medical Center, New York, New York
| | - J Dawn Abbott
- Brown University School of Medicine, Providence, Rhode Island
| | - Wendy Book
- Emory University School of Medicine, Atlanta, Georgia
| | - S Tanveer Rab
- Emory University School of Medicine, Atlanta, Georgia
| | - John A Spertus
- St Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City
| | - Abhinav Goyal
- Emory University School of Medicine, Atlanta, Georgia
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31
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Kohsaka S, Kumamaru H, Inohara T, Amano T, Akasaka T, Miyata H, Motomura N, Nakamura M. Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery. J Clin Med 2020; 9:jcm9051267. [PMID: 32349357 PMCID: PMC7287823 DOI: 10.3390/jcm9051267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/02/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is performed in a wide range of institutions. We sought to assess the relationship between coronary artery bypass grafting (CABG) volume relative to PCI volume and clinical outcome using nationally representative PCI and CABG registries in Japan. METHODS This was a collaborative, registry-based cohort study enrolling patients undergoing percutaneous coronary intervention in 2013-2014 using Japanese nationwide registry (J-PCI) with follow up until discharge. The absolute volume of CABG for each hospital was calculated using additional data from Japan CardioVascular Surgery Database (JCVSD). Patients undergoing their first PCI registered in the registry (N = 220,934), at 943 facilities were studied. Main outcomes were in-hospital mortality, and incidence of composite of in-hospital death and postprocedural complications. RESULTS Among the 220,934 patients, 162,411 were men, with a mean age of 69.7 (SD 11.6) years. Patients underwent PCI at hospitals with varying CABG volume: The overall in-hospital mortality and composite event rate for PCI patients was 0.9% and 2.4%, respectively. CABG volume was associated with the in-hospital mortality of PCI at facilities performing less than 200 PCIs per year, but not at facilities performing 200 or more. Similarly, in-hospital mortality or complication was associated with PCI volume <200 only if no CABG is done at the facility. The result remained largely consistent in subgroup of patients presenting with acute coronary syndrome or even after excluding these institutions with extremely low number of PCI (<50 cases/year) or CABG (<15 cases / year). CONCLUSIONS In a nationwide registry-based analysis, the surgical volume was associated with patients' clinical outcome after PCI, when limited number of PCIs were performed at the facility.
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Affiliation(s)
- Shun Kohsaka
- Scientific and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo 104-0033, Japan; (T.I.); (T.A.); (T.A.); (M.N.)
- Correspondence: ; Tel.: +81-3-5843-6702
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan; (H.K.); (H.M.)
| | - Taku Inohara
- Scientific and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo 104-0033, Japan; (T.I.); (T.A.); (T.A.); (M.N.)
| | - Tetsuya Amano
- Scientific and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo 104-0033, Japan; (T.I.); (T.A.); (T.A.); (M.N.)
| | - Takashi Akasaka
- Scientific and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo 104-0033, Japan; (T.I.); (T.A.); (T.A.); (M.N.)
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan; (H.K.); (H.M.)
| | - Noboru Motomura
- Database Committee, Japan Cardiovascular Surgery Database, Tokyo 113-0033, Japan;
| | - Masato Nakamura
- Scientific and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo 104-0033, Japan; (T.I.); (T.A.); (T.A.); (M.N.)
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32
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Gerber Y, Gibbons RJ, Weston SA, Fabbri M, Herrmann J, Manemann SM, Frye RL, Asleh R, Greason K, Killian JM, Roger VL. Coronary Disease Surveillance in the Community: Angiography and Revascularization. J Am Heart Assoc 2020; 9:e015231. [PMID: 32237975 PMCID: PMC7428619 DOI: 10.1161/jaha.119.015231] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Temporal declines in cardiac stress tests results, coronary revascularization, and cardiovascular mortality have suggested a decline in the population burden of coronary disease until the 2000s. However, recent data indicate these favorable trends could be ending. We aimed to assess the evolution of the population burden of coronary disease in the community by examining trends in angiography and revascularization. Methods and Results We analyzed age- and sex-adjusted trends from all coronary angiographic diagnostic procedures and revascularizations performed in Olmsted County, MN from 2000 to 2018. A total of 12 981 invasive angiograms were performed among 9049 individuals (64% men; 55% aged ≥65 years). Adjusted angiography rates decreased by 30% (95% CI, 25%-34%) between 2000 and 2009 and leveled off thereafter. Including computed tomography, angiography uncovered an increase in angiography use in recent years (risk ratio=1.15 [95% CI, 1.07-1.23] for 2018 versus 2014) and a decline in the prevalence of anatomic CAD from 2000 to 2018. CAD severity declined substantially from 2000 to 2009, followed by a plateau. Among 6570 revascularizations (72% men; 57% aged ≥65 years), 77% were percutaneous coronary interventions and 23% coronary artery bypass graft surgeries. The adjusted revascularization rates declined by 34% (95% CI, 27%-39%) from 2000 to 2009, followed by a plateau (risk ratio=1.10 [95% CI, 1.00-1.22]). Conclusions Between 2000 and 2018 in the community, coronary angiography use declined initially, leveled off, and then increased. Trends in CAD severity and revascularization use decreased then plateaued. The most recent trends are concerning as they suggest the burden of coronary disease is no longer declining. This warrants reinvigorated primary prevention and population surveillance.
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Affiliation(s)
- Yariv Gerber
- Department of Health Sciences Research Mayo Clinic Rochester MN.,Department of Epidemiology and Preventive Medicine School of Public Health Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | | | - Susan A Weston
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Matteo Fabbri
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Joerg Herrmann
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Robert L Frye
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Rabea Asleh
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Kevin Greason
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Jill M Killian
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Véronique L Roger
- Department of Health Sciences Research Mayo Clinic Rochester MN.,Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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Imaeda S, Kuno T, Hirano K, Kodaira M, Anzai H, Numasawa Y. Risk of undiagnosed coronary artery disease associated with infrapopliteal artery occlusion from a multicenter study. Heart Vessels 2020; 35:307-311. [PMID: 31473802 DOI: 10.1007/s00380-019-01495-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022]
Abstract
Peripheral artery disease (PAD) is associated with high cardiovascular mortality. Which part of PAD with lower extremities is related to coronary artery disease (CAD) remains unknown. We hypothesized that PAD including infrapopliteal artery (IPA) occlusion was associated with CAD. A total of 260 patients who have no history of CAD or the anginal symptom, complain of the claudication or critical limb ischemia and underwent peripheral angiography were retrospectively analyzed. IPA occlusion was diagnosed with peripheral angiography, and CAD was diagnosed with the coronary angiography. A multivariate logistic regression analysis was performed to determine the predictors of silent CAD. Among them, a total of 146 patients (56.2%) had IPA occlusion. Baseline characteristics were significantly different between two groups as to the proportions of age, male, dyslipidemia (with vs. without IPA occlusion; 72.4 ± 10.8 vs. 69.1 ± 10.2; 62.3% vs. 75.4%; 38.6% vs. 52.6%, respectively, all comparisons P < 0.05). Notably, the prevalence of CAD was significantly higher in patients with IPA occlusion (50.7% vs. 34.2%, P = 0.008). On a multivariate analysis, IPA occlusion was an independent predictor for the presence of silent CAD (OR, 1.94; CI, 1.09-3.44, P = 0.024), but aortoiliac artery occlusion (OR, 1.16; CI, 0.53-2.56, P = 0.71) and femoropopliteal artery occlusion (OR, 1.02; CI, 0.57-1.83, P = 0.96) were not. IPA occlusion was associated with silent CAD. Vascular surgeons, interventional radiologists, as well as interventional cardiologists should recognize IPA occlusion as a risk factor of silent CAD.
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Affiliation(s)
- Shohei Imaeda
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan.
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
| | - Keita Hirano
- Department of Nephrology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hitoshi Anzai
- Department of Cardiology, SUBARU Health Insurance Ota Memorial Hospital, Ota, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
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34
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Saxon JT, Grantham JA, Salisbury AC, Sapontis J, Lombardi WL, Karmpaliotis D, Moses J, Nicholson WJ, Tang Y, Cohen DJ, Spertus JA, Safley DM. Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry. Circ Cardiovasc Interv 2020; 13:e008448. [PMID: 32069112 DOI: 10.1161/circinterventions.119.008448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American College of Cardiology/American Heart Association Appropriate Use Criteria were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion percutaneous coronary intervention (PCI) is unknown. METHODS We analyzed 769 patients with baseline and 1-year health status data after chronic total occlusion PCI. Procedures were categorized as appropriate, may be appropriate, or rarely appropriate. Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across appropriate use criteria categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤10 points), intermediate (10-19 points), large (20-29 points), and very large (≥30 points). RESULTS The appropriate use criteria indication was appropriate in 573 patients (74.5%), may be appropriate in 191 (24.8%), and rarely appropriate in 5 (0.7%). Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3±21.3 points) at 1 year compared with the may be appropriate (22.5±20.9; P=0.01). A similar pattern was noted for SAQ angina frequency (mean change 24.0±27.2 versus 18.7±25.6; P=0.02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% versus 33.3%; P=0.01). CONCLUSIONS Among patients undergoing chronic total occlusion PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well.
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | | | | | | | - Jeffery Moses
- Columbia University Medical Center/New York-Presbyterian Hospital (D.K., J.M.)
| | | | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
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Deo S, Tyagi H, Chatterjee C, Molakapuri H. Did India's price control policy for coronary stents create unintended consequences? Soc Sci Med 2019; 246:112737. [PMID: 31887627 DOI: 10.1016/j.socscimed.2019.112737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
In February 2017, India capped the retail price of coronary stents and restricted the channel margin to bring Percutaneous Transluminal Coronary Angioplasty (PTCA) procedure, which uses coronary stents, within reach of millions of patients who previously could not afford it. Prior research shows that care providers respond to such regulations in a way that compensates for their loss in profits because of price control. Therefore, price control policies often introduce unintended consequences, such as distortions in clinical decision making. We investigate such distortions through empirical analysis of claims data from a representative public insurance program in the Indian state of Karnataka. Our data comprises 25,769 insurance claims from 69 private and seven public hospitals from February 2016 to February 2018. The public insurance context is ideal for investigating distortions in clinical decisions as the price paid by patients, and thereby access to the treatment, does not change after price control. We find that the change in the average volume of PTCA procedures per hospital per month after price control disproportionately increased when compared to the change in the clinical alternative - Coronary Artery Bypass Graft (CABG) procedures. This increase corresponds to 6% of the average number of PTCA procedures and 28% of the average number of CABG procedures before the price control. In addition, disproportionate increase in PTCA procedures occurred only among private hospitals, indicating the possibility of profit-maximization intentions driving the clinical choices. Such clinical distortions can have negative implications for patient health outcomes in the long run. We discuss alternative policies to improve access and affordability to healthcare products and services which are likely to not suffer from similar distortions.
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Affiliation(s)
| | - Hanu Tyagi
- Carlson School of Management, University of Minnesota, United States.
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36
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De Servi S, Olivari Z, Crimi G, Marino M, Alberti LP, Tagliabue E, Leonardi S. Percutaneous coronary interventions for stable ischemic heart disease in Italy. J Cardiovasc Med (Hagerstown) 2019; 20:762-767. [PMID: 31361651 DOI: 10.2459/jcm.0000000000000835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS Although the benefits of percutaneous coronary interventions (PCIs) in patients with stable chronic ischemic heart disease (SIHD) are controversial, a large number of PCIs are currently performed in SIHD patients, frequently after coronary angiography (ad-hoc procedures), without the use of fractional flow reserve (FFR) to identify patients most likely to benefit from PCI. METHODS Assessment of regional variations in PCI for SIHD performed in Italy in 2017 and correlation of the regional number of PCI per million inhabitants with the use of FFR were performed using the data reported in the registry of the Italian Society of Interventional Cardiology (SICI-GISE) registry for the year 2017. RESULTS PCI for SIHD accounted for 44.5% of all PCI performed in Italy with large variations among the Italian regions. There was a significant and inverse relationship between the use of FFR and the PCI number per million inhabitants performed for SIHD in the various Italian regions (P = 0.01). In the Veneto region, where local authorities mandated Heart Team reports to select the most appropriate treatment choice in multivessel disease patients, the rate of ad-hoc procedures was significantly lower than the national average. CONCLUSION PCI for SIHD patients represent almost half of all procedures currently performed in Italy with regional variations inversely related to physiologic guidance use. The mandatory assessment by the Heart Team to select the most appropriate treatment choice in multivessel disease patients is associated with a significantly lower number of ad-hoc procedures.
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Affiliation(s)
| | - Zoran Olivari
- Ospedale Riabilitativo ad Alta Specializzazione, Treviso
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37
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Raising the bar for appropriateness in the care of patients with peripheral artery disease. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:345-349. [PMID: 31334415 PMCID: PMC6614600 DOI: 10.1016/j.jvscit.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/14/2019] [Indexed: 11/22/2022]
Abstract
Advances in endovascular therapy have exponentially increased the number of procedures performed for peripheral artery disease, but public concerns of overuse have placed the vascular community under scrutiny. The appropriateness of care has thus become a focus of discussion within several professional societies, but literature on the topic is limited. This report presents two cases of patients with peripheral artery disease, one patient who did not need revascularization and underwent an intervention and the other who required additional intervention that was not recognized owing to an incomplete diagnostic workup.
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38
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Impaired Recovery of Left Ventricular Function in Patients With Cardiomyopathy and Left Bundle Branch Block. J Am Coll Cardiol 2019; 71:306-317. [PMID: 29348023 DOI: 10.1016/j.jacc.2017.11.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with left bundle branch block (LBBB) often respond to cardiac resynchronization therapy (CRT) with left ventricular ejection fraction (LVEF) improvement. Guideline-directed medical therapy (GDMT), not CRT, is first-line therapy for patients with reduced LVEF with LBBB. However, there are little data on how patients with reduced LVEF and LBBB respond to GDMT. OBJECTIVES This study examined patients with cardiomyopathy and sought to assess rates of LVEF improvement for patients with LBBB compared to other QRS morphologies. METHODS Using data from the Duke Echocardiography Laboratory Database, the study identified patients with baseline electrocardiography and LVEF ≤35% who had a follow-up LVEF 3 to 6 months later. The study excluded patients with severe valve disease, a cardiac device, left ventricular assist device, or heart transplant. QRS morphology was classified as LBBB, QRS duration <120 ms (narrow QRS duration), or a wide QRS duration ≥120 ms but not LBBB. Analysis of variance testing compared mean change in LVEF among the 3 groups with adjustment for significant comorbidities and GDMT. RESULTS There were 659 patients that met the criteria: 111 LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%). Adjusted mean increase in LVEF over 3 to 6 months in the 3 groups was 2.03%, 5.28%, and 8.00%, respectively (p < 0.0001). Results were similar when adjusted for interim revascularization and myocardial infarction. Comparison of mean LVEF improvement between patients with LBBB on GDMT and those not on GDMT showed virtually no difference (3.50% vs. 3.44%). The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB. CONCLUSIONS LBBB is associated with a smaller degree of LVEF improvement compared with other QRS morphologies, even with GDMT. Some patients with LBBB may benefit from CRT earlier than guidelines currently recommend.
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Butman SM. Hey, American College of Cardiology interventionalists: What are you thinking? Catheter Cardiovasc Interv 2019; 93:880-881. [PMID: 30953412 DOI: 10.1002/ccd.28200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/07/2022]
Abstract
There is large variation in the utilization of the appropriate Use-Criteria (AUC). There has been a significant decrease in the number of Percutaneous coronary intervention (PCI) cases deemed rarely appropriate. The value of the AUC remains a questionable tool for many clinicians.
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Affiliation(s)
- Samuel M Butman
- Cardiovascular Research, Verde Valley Medical Center, Cottonwood, Arizona
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40
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He Y, Huang Y, Yang J, Liu J, Sun G, Song F, Chen S, Tan N, Ni Z, Liu Y, Chen J. Novel risk model for predicting acute adverse drug reactions following cardiac catheterization from TRUST study (The Safety and toleRability of UltraviSt in Patients Undergoing Cardiac CaTheterization). J Thorac Dis 2019; 11:1611-1620. [PMID: 31179105 DOI: 10.21037/jtd.2019.04.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Acute drug reactions (ADRs) are common complications of contrast administration following cardiac catheterization. Serious reactions may be life threatening. However, few risk models for predicting ADRs exist. The study aims to develop a novel tool for predicting the risk of ADRs [occurring within 1 hour in patients undergoing coronary angiography or percutaneous coronary intervention (PCI)]. Methods A total of 17,139 consecutive patients included in the TRUST study were randomly (2:1) assigned to a development data set (n=11,426) or a validation data set (n=5,713). Multivariate logistic regression was applied to identify independent predictors of contrast-induced nephropathy (CIN), including age, contrast dose, premedication, and prehydration. The performance of our model was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. Results The overall incidence of ADRs was 42 (0.37%) in the development data set: 0.09% in the low-risk category (score: 0-2), 0.36% in the moderate-risk category (score: 3-4), and 1.78% in the high-risk category (score ≥5). The risk score across the subgroup of the study population exhibited good discrimination and predictive ability for ADRs (c-statistic: 0.694). Meanwhile, the calibration was also demonstrated to be accurate by the Hosmer-Lemeshow goodness-of-fit test (P=0.305). Conclusions Our data showed that our simple risk model showed good discrimination and predictive ability of ADRs following cardiac catheterization.
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Affiliation(s)
- Yibo He
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Yuming Huang
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China.,Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Junqing Yang
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Jin Liu
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Guoli Sun
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Feier Song
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Shiqun Chen
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China.,Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Ning Tan
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Zhonghan Ni
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Yong Liu
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
| | - Jiyan Chen
- Guangdong Cardiovascular Institute, Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital affiliated to South China University of Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
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Al Abdi RM, Alshraideh H, Hijazi HH, Jarrah M, Alyahya MS. The use of echocardiographic and clinical data recorded on admission to simplify decision making for elective percutaneous coronary intervention: a prospective cohort study. BMC Med Inform Decis Mak 2019; 19:46. [PMID: 30885191 PMCID: PMC6421658 DOI: 10.1186/s12911-019-0797-9] [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: 10/08/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD), a leading cause of mortality, affects patient health-related quality of life (HRQoL). Elective percutaneous coronary interventions (ePCIs) are usually performed to improve HRQoL of CAD patients. The aim of this study was to design models using admission data to predict the outcomes of the ePCI treatments on the patients' HRQoL. METHODS This prospective cohort study was conducted with CAD patients who underwent ePCIs at the King Abdullah University Hospital in Jordan from January 2014 through May 2015. Six months after their ePCI procedures, the participants completed the improved MacNew (QLMI-2) questionnaire, which was used for evaluating three domains (physical, emotional and social) of HRQoL. Multivariate linear regression was used to design models to predict the three domains of HRQoL from echocardiographic findings and clinical data that are routinely measured on admission. RESULTS The study included 239 patients who underwent ePCIs and responded to the QLMI-2 questionnaire. The mean age (± standard deviation) of the participants was 55.74 ± 11.84 years, 54.58 ± 11.37 years for males (n = 174) and 59.11 ± 12.49 years for females (n = 65). The average scores for physical, emotional and social HRQoL were 4.38 ± 1.27, 4.4 ± 1.11, and 4.37 ± 1.32, respectively. Out of the 42 factors inputted to the models to predict HRQoL scores, 10, 9, and 9 factors were found to be significant determinants for physical, emotional and social domains, respectively, with adjusted coefficients of determination of 0.630, 0.604 and 0.534, respectively. Basophil levels on admission showed a significant positive correlation with the three domains of HRQoL, while aortic root diameter showed a negative correlation. Scores for the three domains were significantly lower in women than in men. Hypertensive and diabetic patients had significantly lower HRQoL scores than patients without hypertension and diabetes. CONCLUSION The prediction of HRQoL scores 6 months after an ePCI is possible based on data acquired on admission. The models developed here can be used as decision-making tools to guide physicians in identifying the efficacy of ePCIs for individual patients, hence decreasing the rate of inappropriate ePCIs and reducing costs and complications.
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Affiliation(s)
- Rabah M Al Abdi
- Biomedical Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hussam Alshraideh
- Industrial Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba H Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad Jarrah
- Division of Cardiology, Internal Medicine Department, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Grantham JA. Survival and Chronic Total Occlusion Percutaneous Coronary Intervention: The Never-Ending Debate Continues. JACC Cardiovasc Interv 2019; 10:876-878. [PMID: 28473109 DOI: 10.1016/j.jcin.2017.03.010] [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: 03/07/2017] [Revised: 03/11/2017] [Accepted: 03/12/2017] [Indexed: 01/07/2023]
Affiliation(s)
- J Aaron Grantham
- University of Missouri Kansas City and Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
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Pourhosseini H, Lashkari R, Aminorroaya A, Soltani D, Jalali A, Tajdini M. Effects of high dose atorvastatin before elective percutaneous coronary intervention on highly sensitive troponin T and one year major cardiovascular events; a randomized clinical trial. IJC HEART & VASCULATURE 2019; 22:96-101. [PMID: 30671535 PMCID: PMC6328087 DOI: 10.1016/j.ijcha.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/20/2023]
Abstract
Introduction Some studies have demonstrated that post-PCI elevated cardiac enzymes are associated with worse outcomes. In this study, we aimed to determine if high-dose treatment with atorvastatin before planned elective PCI reduces PMI or MACE at 1-year median follow-up. Material and methods Eligible participants were randomly allocated to group A (80 mg atorvastatin 12 h and 40 mg 2 h before PCI) and group B (40 mg atorvastatin daily). Blood samples were obtained before and at 24 h after PCI to measure hsTnT. All patients were followed regarding MACE (combination of death, re-hospitalizations for ACS, and unplanned coronary revascularization) during one year after PCI. Results 207 patients randomly assigned to Group A (n = 97) or group B (n = 110). The rate of PMI was lower in group A (5.2%) compared to group B (10.9%); despite near to 50% lower rate of PMI in group A, binary logistic regression showed no significant association between atorvastatin recapture and PMI. The occurrence of MACE in 97 patients of group A was 11 (11.3%), higher than 11 (10%) cases of 110 patients in group B. Cox proportional hazards regression model shows no significant difference in MACE of study groups. Conclusion Pretreatment of patients with stable angina who were planned to undergo an elective PCI with 120 mg of atorvastatin before the procedure confer them the same benefit in terms of PMI and MACE as 40 mg routine daily dosage of this statin does.
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Affiliation(s)
- HamidReza Pourhosseini
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Lashkari
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Danesh Soltani
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Ave., Tehran, Iran
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44
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De Lima JJG, Gowdak LHW, de Paula FJ, Muela HCS, David-Neto E, Bortolotto LA. Evaluation of a protocol for coronary artery disease investigation in asymptomatic elderly hemodialysis patients. Int J Nephrol Renovasc Dis 2018; 11:303-311. [PMID: 30532578 PMCID: PMC6241684 DOI: 10.2147/ijnrd.s174018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is prevalent in older patients on dialysis, but the prognostic relevance of coronary assessment in asymptomatic subjects remains undefined. We tested the usefulness of a protocol, based on clinical, invasive, and noninvasive coronary assessment, by answering these questions: Could selecting asymptomatic patients for coronary invasive assessment identify those at higher risk of events? Is CAD associated with a worse prognosis? METHODS A retrospective study including 276 asymptomatic patients at least 65 years old on the waiting list, prospectively evaluated for CAD and followed up until death or renal transplantation, were classified into two groups: 1) low-risk patients who did not undergo coronary angiography (n=63) and 2) patients who did undergo angiography (n=213). The latter group was reclassified into patients with significant CAD or normal angiograms/nonsignificant CAD. RESULTS CAD (≥70% stenosis) occurred in 124 subjects (58%). The incidence of death by any cause, coronary death, and major cardiovascular (CV) events were similar in patients selected or not for angiography and in those with or without significant CAD. Myocardial revascularization (surgical/percutaneous) was performed in only 21/276 patients (7.6%) and did not result in a reduction in mortality. CONCLUSION In older patients on renal replacement therapy, the prevalence of CAD was high, but coronary investigation was not useful as a risk stratification tool and also resulted in a rather small proportion of patients eligible for intervention. Therefore, in the elderly, coronary investigation should not be considered routine in asymptomatic patients.
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Affiliation(s)
- Jose Jayme G De Lima
- Heart Institute (InCor) and Renal Transplant Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil,
| | - Luis Henrique W Gowdak
- Heart Institute (InCor) and Renal Transplant Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil,
| | - Flavio J de Paula
- Heart Institute (InCor) and Renal Transplant Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil,
| | | | - Elias David-Neto
- Heart Institute (InCor) and Renal Transplant Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil,
| | - Luiz A Bortolotto
- Heart Institute (InCor) and Renal Transplant Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil,
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45
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A Simple Modified Framingham Scoring System to Predict Obstructive Coronary Artery Disease. J Cardiovasc Transl Res 2018; 11:495-502. [PMID: 30315503 DOI: 10.1007/s12265-018-9837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
Development of simple non-invasive risk prediction model would help in early prediction of coronary artery disease (CAD) reducing the burden on public health. This paper demonstrates a risk prediction scoring system to predict obstructive coronary artery disease (OCAD) in CAD patients. A total of 13,082 patients, referred for coronary angiography (CAG) in TRUST trial, were included in the development of a multivariable diagnostic prediction model. External validation of the model used 1009 patients from PRECOMIN study. The occurrence of OCAD was observed in 73.1% and 75.1% patients in TRUST (development) and PRECOMIN study (validation) cohorts, respectively. Good discrimination and calibration were obtained in both development and validation datasets (C-statistics 0.686 and 0.677; Hosmer-Lemeshow χ2 = 5.19, p = 0.74 and χ2 = 8.60, p = 0.38, respectively). The simple risk prediction model and risk scoring system developed on the basis of routine clinical variables showed good performance for estimation of OCAD in relative high-risk patients with suspected CAD.
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46
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Lee WC, Hsueh SK, Chen CJ, Yang CH, Fang CY, Wu CJ, Fang HY. The Comparison of Clinical Outcomes After Drug-Eluting Balloon and Drug-Eluting Stent Use for Left Main Bifurcation In-Stent Restenosis. Int Heart J 2018; 59:935-940. [PMID: 30101849 DOI: 10.1536/ihj.17-540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increasing evidence is available for the use of percutaneous coronary intervention (PCI) in selected patients with unprotected left main (LM) bifurcation coronary lesions. However, little data have been reported on recurrent in-stent restenosis (ISR) for LM bifurcation lesions. The aim of this study was to evaluate the efficacy of a drug-eluting balloon (DEB) for LM bifurcation ISR compared with that of a drug-eluting stent (DES).Between December 2011 and December 2015, 104 patients who underwent PCI for unprotected LM bifurcation ISR were enrolled. We separated the patients into 2 groups: (1) those underwent PCI with further DEB and (2) those underwent PCI with further DES. Clinical outcomes were analyzed.Patients' average age was 67.14 ± 7.65 years, and the percentage of male patients was 76.0%. A total of 75 patients were enrolled in the DEB group, and another 29 patients were enrolled in the DES group. Similar target lesion revascularization (TLR) rate and recurrent myocardial infarction (MI) rate were noted for both groups. A significantly higher cardiovascular mortality rate was found in the DES group (10.7% versus 0%, P = 0.020), and a higher all-cause mortality rate was noted in the DES group (21.4% versus 6.8%, P = 0.067).It is feasible to use DEB for LM bifurcation ISR. When comparing DEB with DES, similar TLR rates were found, but lower recurrent MI and lower cardiovascular death were noted for DEB treatment.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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47
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Nie JJ, Qiao B, Duan S, Xu C, Chen B, Hao W, Yu B, Li Y, Du J, Xu FJ. Unlockable Nanocomplexes with Self-Accelerating Nucleic Acid Release for Effective Staged Gene Therapy of Cardiovascular Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:e1801570. [PMID: 29920798 DOI: 10.1002/adma.201801570] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/26/2018] [Indexed: 05/24/2023]
Abstract
Nucleic acid (NA)-based therapy is proposed to address serious diseases such as cardiovascular diseases (CVDs). Powerful NA delivery vehicles are essential for effective gene therapy. Herein, a novel type of delivery vehicle, an unlockable core-shell nanocomplex (Hep@PGEA) with self-accelerating NA release, is structurally designed. Hep@PGEA is composed of disulfide-bridged heparin nanoparticle (HepNP) core and low-toxicity PGEA cationic shell. In comparison with NA, heparin, a negatively charged polysaccharide macromolecule, exhibits stronger interactions with cationic species. Upon the breakdown of redox-responsive HepNP cores, unlocked heparin would interact with the outer cationic shells and replace the condensed NA to facilitate NA release. Such unique Hep@PGEA is successfully explored for effective miRNA-pDNA staged gene therapy of myocardial infarction (MI), one of the most serious CVDs. With the progression of MI, glutathione amounts in heart tissues increase. MiR-499 (for the inhibition of cardiomyocyte apoptosis) and plasmid encoding vascular endothelial growth factor (for the promotion of angiogenesis) are sequentially delivered for systemic treatment of MI. Such treatment produces impressive results in restoring heart function and suppressing cardiac hypertrophy. Due to the wide existence of redox agents in cells, the proposed unlockable delivery nanovehicle and staged therapy strategy can provide new methods to effectively treat different serious diseases.
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Affiliation(s)
- Jing-Jun Nie
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Bokang Qiao
- Key Laboratory of Remodeling-Related Cardiovascular Diseases (Ministry of Education), and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Shun Duan
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Chen Xu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Boya Chen
- Key Laboratory of Remodeling-Related Cardiovascular Diseases (Ministry of Education), and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Wenjing Hao
- Key Laboratory of Remodeling-Related Cardiovascular Diseases (Ministry of Education), and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Bingran Yu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Yulin Li
- Key Laboratory of Remodeling-Related Cardiovascular Diseases (Ministry of Education), and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Jie Du
- Key Laboratory of Remodeling-Related Cardiovascular Diseases (Ministry of Education), and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Fu-Jian Xu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
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Wadhera RK, Shen C, Secemsky EA, Strom JB, Yeh RW. State Variation in the Use of Non-Acute Coronary Angiograms and Coronary Revascularization Procedures. JACC Cardiovasc Interv 2018; 11:912-913. [PMID: 29747922 DOI: 10.1016/j.jcin.2018.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 01/09/2023]
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49
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Campos CM, Lemos PA. Merely subintimal coronary plaque modification improves health status: Not all CTO recanalization failures are alike? Catheter Cardiovasc Interv 2018; 91:1043-1044. [PMID: 29737029 DOI: 10.1002/ccd.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/11/2022]
Abstract
Failed CTO angioplasty was divided in two groups: with and without "subintimal plaque modification." At 1-month, patients treated with "subintimal plaque modification" had larger increases in health status as assessed by the Seattle Angina Questionnaire. The relatively small sample size and the lack of a longer follow-up period does not allow definite conclusion in terms of safety or clinical events.
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Affiliation(s)
- Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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50
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Bates ER. The Misinterpretation of Appropriate Use Criteria for Percutaneous Coronary Intervention in Patients With Stable Ischemic Heart Disease. JACC Cardiovasc Interv 2018. [PMID: 29519381 DOI: 10.1016/j.jcin.2018.01.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eric R Bates
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
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