1
|
Analysis of Coronary Artery Lesion Degree and Related Risk Factors in Patients with Coronary Heart Disease Based on Computer-Aided Diagnosis of Coronary Angiography. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2370496. [PMID: 34950223 PMCID: PMC8691974 DOI: 10.1155/2021/2370496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/13/2021] [Indexed: 12/05/2022]
Abstract
A combination of various risk factors results in the development of coronary heart disease. The earlier that one identifies and deals with reversible risk factors for coronary heart disease, the greater the chance of recovery. The main goal of this research is to learn whether risk variables are associated with greater extent of coronary artery disease in people with coronary heart disease. This article selects 290 patients who had had coronary angiography in our hospital from September 2018 to March 2019 using a retrospective research and analytic methodology. Coronary angiography split the patients into two groups: those with coronary heart disease and those without. To determine the correlation between risk factors and a score related to heart disease, computer-aided statistical analysis of data about the differences in those risk factors was performed. The results were analyzed using the Spearman correlation and partial correlation, and the relationship between risk factors and Gensini score was analyzed by multiple linear regression. For the analysis, binary logistic regression was used to calculate the correlation between the risk factors of coronary heart disease and the probability of developing coronary heart disease. The findings concluded that increased age, smoking, elevated hs-CRP, HbA1c, hypertension, diabetes, and hyperuricemia are all contributors to coronary heart disease. Coronary heart disease is an independent risk factor for this condition. Many of the factors that play a role in the long-term development of the severity of coronary artery disease, such as hypertension, diabetes, smoking, elevated hs-CRP, decreased HDL-C, raised LDL-C, and TG, are commonly found in men. hs-CRP is the primary risk factor for the degree of coronary artery stenosis and could contribute to the progression of the condition by playing a major role in creating more stenosis.
Collapse
|
2
|
Gong X, Zhou L, Ding X, Chen H, Li H. The impact of successful chronic total occlusion percutaneous coronary intervention on long-term clinical outcomes in real world. BMC Cardiovasc Disord 2021; 21:182. [PMID: 33858349 PMCID: PMC8048230 DOI: 10.1186/s12872-021-01976-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary chronic total occlusions (CTOs) are related to increased risk of adverse clinical outcomes. The optimal treatment strategy for CTO has not been well established. We sought to examine the impact of CTO percutaneous coronary intervention (PCI) on long-term clinical outcome in the real world. METHODS A total of 592 patients with CTO were enrolled. 29 patients were excluded due to coronary artery bypass grafting (CABG). After exclusion, 563 patients were divided into the no-revascularized group (CTO-NR group, n = 263) and successful revascularized group (CTO-R group, n = 300). The primary endpoint was cardiac death; secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, re-hospitalization, heart failure, and stroke. RESULTS Percent of Diabetes mellitus (53.2% vs 39.7), Chronic kidney disease (8.7% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease (96.2% vs 90%) and left main coronary artery disease (25.1% vs 13.7%) was significantly higher in the CTO-NR group than in success PCI group (all P < 0.05). Moreover, the CTO-NR group has the lower ejection fraction (EF) (0.58 ± 0.11 vs 0.61 ± 0.1, p = 0.001) and fraction shortening (FS) (0.31 ± 0.07 vs 0.33 ± 0.07, p = 0.002). At a median follow-up of 12 months, CTO revascularization was superior to CTO no-revascularization in terms of cardiac death (adjusted hazard ratio [HR]: 0.27, 95% conference interval [CI] 0.11-0.64). The superiority of CTO revascularization was consistent for MACCE (HR: 0.55, 95% CI 0.35-0.79). At multivariable Cox hazards regression analysis, CTO revascularization remains one of the independent predictors of lower risk of cardiac death and MACCE. CONCLUSIONS Successful revascularization by PCI may bring more clinical benefits. The presence of low left ventricular ejection fraction (LVEF) and LM-disease was associated with an incidence of cardiac death; CTO revascularization was a protected predictor of cardiac death. Successful revascularization by PCI offered CTO patients more clinical benefits, manifested by lower incidence of cardiac death during follow-up. The presence of LVEF < 0.5 and left main coronary artery disease (LM disease) was associated with an incidence of cardiac death; CTO revascularised was a protected predictor of cardiac death.
Collapse
Affiliation(s)
- Xuhe Gong
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Li Zhou
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China. .,Department of Internal Medicine, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China. .,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, 100069, People's Republic of China.
| |
Collapse
|
3
|
Leung W, Roberts V, Gordon LG, Bullen C, McRobbie H, Prapavessis H, Jiang Y, Maddison R. Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial. Tob Induc Dis 2017; 15:21. [PMID: 28360828 PMCID: PMC5371274 DOI: 10.1186/s12971-017-0126-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive ≤10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial. Methods Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease. Results Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or €226; purchasing power parity-adjusted [PPP]). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or €16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (≥7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or €2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER: NZ$4,431; US$2,993 or €2,337 PPP-adjusted) and females (ICER: NZ$2,909; US$1,965 or €1,534 PPP-adjusted). Conclusions The exercise-counselling intervention will only be cost-effective if adherence is a minimum of ≥7 intervention calls, which in turn leads to a sufficient number of quitters for health gains. Trial registration Australasian Clinical Trials Registry Number ACTRN12609000637246
Collapse
Affiliation(s)
- William Leung
- University of Otago, Wellington, PO Box 7343, New Zealand.,University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Vaughan Roberts
- University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | | | | - Hayden McRobbie
- UK Centre for Tobacco Control Studies, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Harry Prapavessis
- School of Kinesiology, Faculty of Medical and Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Yannan Jiang
- University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Ralph Maddison
- University of Auckland, Private Bag 92019, Auckland, New Zealand.,Centre for Physical Activity and Nutrition, Deakin University, Melbourne, VIC Australia
| |
Collapse
|
4
|
Grey C, Jackson R, Wells S, Marshall R, Riddell T, Kerr AJ. Twenty-eight day and one-year case fatality after hospitalisation with an acute coronary syndrome: a nationwide data linkage study. Aust N Z J Public Health 2015; 38:216-20. [PMID: 24890478 DOI: 10.1111/1753-6405.12241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/01/2014] [Accepted: 02/01/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine 28-day and one-year case fatality in patients hospitalised with acute coronary syndromes (ACS) and identify factors associated with mortality. METHODS All New Zealand residents admitted with ACS between 2007 and 2009 were followed for one year using individual patient linkage of national hospitalisation and mortality datasets. Deaths from any cause were used to calculate 28-day and one-year case fatality. Cox-proportional hazards models were constructed to identify factors associated with mortality after an ACS hospitalisation. RESULTS The cohort included 42,920 ACS patients. Case fatality increased steeply with age. Māori and Pacific peoples had 1.5 times the risk of 28-day, and twice the risk of one-year, mortality as Europeans/Others. Low (compared to high) socioeconomic status was associated with significantly higher mortality at 28 days but not one year. Patients with unstable angina had half the risk of short-term mortality as NSTEMI patients, whereas STEMI patients had double the NSTEMI risk. CONCLUSIONS AND IMPLICATIONS The major determinant of increasing case fatality was increasing age. There were also substantial differences in case fatality by ethnicity, deprivation and diagnostic category. Further research is needed to explore the possible mechanisms by which ethnic and deprivation disparities occur and effective strategies to address them.
Collapse
Affiliation(s)
- Corina Grey
- Epidemiology and Biostatistics, Auckland University, New Zealand
| | | | | | | | | | | |
Collapse
|
5
|
Dégano IR, Salomaa V, Veronesi G, Ferriéres J, Kirchberger I, Laks T, Havulinna AS, Ruidavets JB, Ferrario MM, Meisinger C, Elosua R, Marrugat J. Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations. Heart 2015; 101:1413-21. [PMID: 25855798 DOI: 10.1136/heartjnl-2014-307310] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/22/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Due to the burden of coronary heart disease (CHD), the monitoring of CHD trends is required. This study sought to examine the acute myocardial infarction (AMI) trends in attack and mortality rates, and in 28-day case-fatality, in six European populations during 1985-2010. METHODS Data consisted of 78 128 AMI events included in eight population-based registries from Finland (several populations), Italy (Brianza and Varese), Germany (Augsburg), France (Haute-Garonne), Spain (Girona) and Estonia (Tallinn). AMI event rates and case-fatality trends were analysed using the annual percentage change (APC) obtained by negative binomial and joinpoint regression. RESULTS AMI attack and mortality rates decreased in most populations. Finland experienced the steepest decline in attack rates (APC=-4.4% (95% CI -5.1 to -2.9) in men; -4.0% (-5.1 to -2.8), in women). Total-hospital and inhospital case-fatality decreased in all populations except in Tallinn. The steepest decline in total case-fatality occurred in Spain (-3.8% (-5.3 to -2.4) in men; -5.1% (-6.9 to -3.3) in women). Prehospital case-fatality trends differed significantly by population and sex. The trends for all included populations showed a significant decline in AMI event rates and case-fatality, in both sexes and all age groups. However, in women aged 65-74 years, a significant increase in total case-fatality occurred in 2005-2010 (4.7% (0.7 to 8.8)). CONCLUSIONS AMI event rates and inhospital case-fatality declined in 1985-2010 in almost all populations analysed. Prehospital case-fatality declined only in certain population groups, showing differences by sex. These results highlight the need of specific strategies in AMI prevention for certain groups and populations.
Collapse
Affiliation(s)
- Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Veikko Salomaa
- Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Jean Ferriéres
- Department of Cardiology, Toulouse University School of Medicine-Rangueil Hospital, Toulouse, France
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany
| | - Toivo Laks
- Department of Internal Medicine, North Estonia Medical Centre, Tallinn, Estonia Institute of Cardiovascular Medicine, Tallinn University of Technology, Tallinn, Estonia
| | - Aki S Havulinna
- Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland
| | | | - Marco M Ferrario
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | |
Collapse
|
6
|
Smolina K, Wright FL, Rayner M, Goldacre MJ. Incidence and 30-day case fatality for acute myocardial infarction in England in 2010: national-linked database study. Eur J Public Health 2012; 22:848-53. [PMID: 22241758 PMCID: PMC3505446 DOI: 10.1093/eurpub/ckr196] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: There are limited national population-based epidemiological data on acute myocardial infarction (AMI) in England, making the current burden of disease, and clinical prognosis, difficult to quantify. The aim of this study was to provide national estimates of incidence and 30-day case fatality rate (CFR) for first and recurrent AMI in England. Methods: Population-based study using person-linked routine hospital and mortality data on 79 896 individuals of any age, who were admitted to hospital for AMI or who died suddenly from AMI in 2010. Results: Of 82 252 AMI events in 2010, 83% were first. Age-standardized incidence of first AMI per 100 000 population was 130 (95% CI 129–131) in men and 55.9 (95% CI 55.3–56.6) in women. Age-standardized 30-day overall CFRs including sudden AMI deaths for men and women, respectively, were 32.4% (95% CI 32.0–32.9) and 30.3% (95% CI 29.8–30.9) for first AMI and 29.7% (95% CI 28.7–30.7) and 26.7% (95% CI 25.5–27.9) for recurrent AMI. Age-standardized hospitalized 30-day CFR was 12.0% (95% CI 11.6–12.3) for men and 12.3% (95% CI 11.9–12.7) for women. Conclusions: While the majority of AMIs are not fatal, of those that are, two-thirds occur as sudden AMI deaths. About one in six of all AMIs are recurrent events. These findings reinforce the importance of primary and secondary prevention in reducing AMI morbidity and mortality.
Collapse
Affiliation(s)
- Kate Smolina
- Department of Public Health, University of Oxford, Headington, Oxford, OX3 7LF, UK
| | | | | | | |
Collapse
|
7
|
Liew SM, Jackson R, Mant D, Glasziou P. Should identical CVD risks in young and old patients be managed identically? Results from two models. BMJ Open 2012; 2:e000728. [PMID: 22382122 PMCID: PMC3293135 DOI: 10.1136/bmjopen-2011-000728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To assess whether delaying risk reduction treatment has a different impact on potential life years lost in younger compared with older patients at the same baseline short-term cardiovascular risk. DESIGN Modelling based on population data. METHODS Potential years of life lost from a 5-year treatment delay were estimated for patients of different ages but with the same cardiovascular risk (either 5% or 10% 5-year risk). Two models were used: an age-based residual life expectancy model and a Markov simulation model. Age-specific case fatality rates and time preferences were applied to both models, and competing mortality risks were incorporated into the Markov model. RESULTS Younger patients had more potential life years to lose if untreated, but the maximum difference between 35 and 85 years was <1 year, when models were unadjusted for time preferences or competing risk. When these adjusters were included, the maximum difference fell to about 1 month, although the direction was reversed with older people having more to lose. CONCLUSIONS Surprisingly, age at onset of treatment has little impact on the likely benefits of interventions that reduce cardiovascular risk because of the opposing effects of life expectancy, case fatality, time preferences and competing risks. These findings challenge the appropriateness of recommendations to use lower risk-based treatment thresholds in younger patients.
Collapse
Affiliation(s)
- Su May Liew
- Department of Primary Care Medicine and Julius Center UM, University of Malaya, Kuala Lumpur, Malaysia
- Department of Primary Health Care, University of Oxford, Oxford, UK
| | - Rod Jackson
- University of Auckland, Auckland, New Zealand
| | - David Mant
- Department of Primary Health Care, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| |
Collapse
|
8
|
Langørgen J, Igland J, Vollset SE, Averina M, Nordrehaug JE, Tell GS, Irgens LM, Nygård O. Short-term and long-term case fatality in 11 878 patients hospitalized with a first acute myocardial infarction, 1979-2001: the Western Norway cardiovascular registry. ACTA ACUST UNITED AC 2010; 16:621-7. [PMID: 19512933 DOI: 10.1097/hjr.0b013e32832e096b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have direct estimates of long-term survival after acute myocardial infarction (AMI). Our objective was to provide such estimates, and trends in these estimates, using data from a single hospital over a 23-year period. DESIGN A retrospective cohort study. METHODS We examined 28-day, 1-year and 10-year case fatality among 7635 men and 4243 women admitted to Haukeland University Hospital with a first AMI, during 1979-2001. Information on cardiovascular diagnoses and procedures were registered in the Western Norway Cardiovascular Registry, and data on deaths were obtained from the Cause of Death Registry, Statistics Norway. RESULTS From 1979-1985 to 1994-2001, crude 28-day case fatality declined from 31.1 to 19.8% in men and from 37.3 to 26.8% in women (both, P-trend <0.0001). Crude 10-year case fatality declined from 69.5-55.5% in men and from 80.8-66.1% in women (both, P-trend <0.0001). Landmark analysis showed a decline in 1-10-year case fatality, among patients less than 60 years of age from 26.1 to 13.8% in men, and from 33.3 to 6.4% in women. In patients > or =60 years, the 28-day, 1-year and 10-year age-adjusted case-fatality rates were significantly lower in women than men. CONCLUSION Landmark analysis showed substantial improvement in up to 10 years survival after hospitalization for a first AMI. A significantly lower age-adjusted case fatality in women > or =60 years already after 28 days compared with men is specifically noticed.
Collapse
Affiliation(s)
- Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen 5021, Norway.
| | | | | | | | | | | | | | | |
Collapse
|