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Afrouzi M, Azar FEF, Aboutorabi A, Hajahmadi M, Ebadi SJ. Mortality probabilities after revascularization and medical therapy in CAD patients under 60 years old: a meta-analysis study. Egypt Heart J 2021; 73:99. [PMID: 34735671 PMCID: PMC8568744 DOI: 10.1186/s43044-021-00225-x] [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: 06/24/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
To estimate death probabilities after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and medical therapy (MT) in patients under 60 years old. We conducted a search systematic on PubMed, Embase, Cochrane Library, and Web of Science up to January 2021. The study included three parts. In the probabilities part (A), Comprehensive Meta-Analysis, and in the comparison parts (B and C), Review Manager was used in conducting meta-analyses. Nine studies consisting of 16,410 people with a mean age of 51.2 ± 6 years were included in the meta-analysis. Over a mean follow-up of 3.7 ± 2 years, overall mortality after CABG, PCI and MT was 3.6% (95% CI 0.021–0.061), 4.3% (95% CI 0.023–0.080) and 9.7% (95% CI 0.036–0.235), respectively. The length of follow-up periods was almost the same and did not differ much (p = 0.19). In Part B (without adjustment of baseline characteristics), 495 (4.0%) of 12,198 patients assigned to CABG died compared with 748 (4.5%) of 16,458 patients assigned to PCI (risk ratio [RR]: 0.77, 95% CI 0.50–1.20; p = 0.25). Seventy-four (3.5%) of 2120 patients assigned to CABG and 68 (4.2%) of 1621 patients assigned to PCI died compared with 103 (9.5%) of 1093 patients assigned to MT in equal follow-up periods (CABG-MT: RR 0.34; 95% CI 0.23–0.51; p < 0.002) (PCI-MT: RR 0.40; 95% CI 0.30–0.53; p = 0.02). In Part C, overall mortality after PCI in PACD patients with STEMI was higher in elderly versus young (RR 2.64; 95% CI 2.11–3.30) and is lower in men versus women (RR 0.61; 95% CI 0.44–0.83). Mortality probabilities obtained are one of the most important factors of effectiveness in the economic evaluation studies; these rates can be used to determine the cost-effectiveness of procedures in CAD patients aged < 60 years.
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Affiliation(s)
- Mohammad Afrouzi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Aboutorabi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Hajahmadi
- Cardiovascular Department, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Ahmad M, Asghar M, Joshi U, Neilson NA, Tye M, Divecha C, Kim M, Mungee S. Study of Association Between Different Coronary Artery Disease Presentations and Its Effect on Short-Term Mortality, Readmission, and Cost in Patients Undergoing Percutaneous Coronary Interventions. Cureus 2021; 13:e16862. [PMID: 34513438 PMCID: PMC8411994 DOI: 10.7759/cureus.16862] [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] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Atherosclerotic coronary artery disease (CAD) is the major cause of mortality in the USA. CAD requiring percutaneous coronary intervention (PCI) can have a wide spectrum of presentations. We reviewed the cost of admission and PCI at the tertiary care center stratified for different CAD presentation types. Methods We performed a retrospective study of 7,389 patients undergoing coronary angiogram at our facility from 2015 to 2017. Patients were selected from CathPCI registry. Chart review was done for readmission and death data. Cost data were provided by the finance department. Patients going for coronary artery bypass surgery (CABG) were excluded. We split the patients based on their need for PCI. Cost analysis was based on CAD presentation types (No symptoms, atypical symptoms, stable angina, unstable angina, NSTEMI [non-ST segment elevation myocardial infarction], STEMI [ST-segment elevation myocardial infarction]). Adjusted linear regression was run for the outcomes. Primary outcomes were 30-day readmission and death. The secondary outcome was cost of admission. Results The final sample size was 6,403. The mean age was 65.6 years (SD: 12.5; male: 63.8%). 2444 required PCI (38%; p < 0.001). PCI group had lower mean age (62.5 years; SD: 12.3, p<0.001) with lower BMI (30.6 vs 31.1, p=0.015). PCI group had significantly lower odds for 30-day readmission (OR: 0.63; CI: 0.45-0.89; p=0.009) and 30-day mortality (OR:0.60; CI: 0.41-0.89; p = 0.011). A severe presentation increased the odds of getting PCI. Cost of admission was higher in all groups receiving PCI. Conclusions PCI group had better 30-day readmission and mortality rates. PCI increases the cost of admission in all CAD types.
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Affiliation(s)
- Mansoor Ahmad
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Muhammad Asghar
- Internal Medicine, University of Illinois Chicago, College of Medicine at Peoria, Peoria, USA
| | - Udit Joshi
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Nathan A Neilson
- Cardiology, University of Illinois Chicago, College of Medicine at Peoria, Peoria, USA
| | - Michael Tye
- Cardiology, University of Illinois Chicago, College of Medicine at Peoria, Peoria, USA
| | - Chirag Divecha
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Minchul Kim
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sudhir Mungee
- Cardiology, University of Illinois College of Medicine, Order of St. Francis Medical Centre, Peoria, USA
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Chu X, Wang R, Song G, Jiang X. Predictive value of inflammatory factors on coronary restenosis after percutaneous coronary intervention in patients with coronary heart disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25356. [PMID: 33787637 PMCID: PMC8021324 DOI: 10.1097/md.0000000000025356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence reveals that inflammatory factors can predict coronary restenosis in patients suffering from coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Perhaps, inflammatory factors are promising biomarkers for the diagnosis of coronary restenosis after PCI. However, the accuracy of inflammatory factors has not been systematically evaluated. Therefore, it is necessary to perform a meta-analysis to certify the diagnostic values of inflammatory factors on coronary restenosis after PCI. METHODS China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine disc (CBM), PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies to explore the potential diagnostic values of inflammatory factors on coronary restenosis after PCI from inception to January 2021. All data were extracted by 2 experienced researchers independently. The risk of bias about the meta-analysis was confirmed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The data extracted were synthesized and heterogeneity was investigated as well. All of the above statistical analyses were carried out with Stata 16.0. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study clarified confusions about the specificity and sensitivity of inflammatory factors on coronary restenosis after PCI, thus further guiding their promotion and application. ETHICS AND DISSEMINATION Ethical approval will not be necessary since this systematic review and meta-analysis will not contain any private information of participants or violate their human rights. TRIAL REGISTRATION NUMBER DOI 10.17605/OSF.IO/N28JX.
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Affiliation(s)
| | | | | | - Xiaohan Jiang
- Department of Medical Genetics and Prenatal Diagnosis, Hospital Affiliated 5 to Nantong University, Taizhou People's Hospital, Taizhou 225300, Jiangsu province, China
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Ducrocq G, Calvo G, González-Juanatey JR, Durand-Zaleski I, Avendano-Sola C, Puymirat E, Lemesle G, Arnaiz JA, Martínez-Sellés M, Rousseau A, Cachanado M, Vicaut E, Silvain J, Karam C, Danchin N, Simon T, Steg PG. Restrictive vs liberal red blood cell transfusion strategies in patients with acute myocardial infarction and anemia: Rationale and design of the REALITY trial. Clin Cardiol 2021; 44:143-150. [PMID: 33405291 PMCID: PMC7852166 DOI: 10.1002/clc.23453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 01/28/2023] Open
Abstract
Background Anemia is common in patients with acute myocardial infarction (AMI), and is an independent predictor of mortality. The optimal transfusion strategy in these patients is unclear. Hypothesis We hypothesized that a “restrictive” transfusion strategy (triggered by hemoglobin ≤8 g/dL) is clinically noninferior to a “liberal” transfusion strategy (triggered by hemoglobin ≤10 g/dL), but is less costly. Methods REALITY is an international, randomized, multicenter, open‐label trial comparing a restrictive vs a liberal transfusion strategy in patients with AMI and anemia. The primary outcome is the incremental cost‐effectiveness ratio (ICER) at 30 days, using the primary composite clinical outcome of major adverse cardiovascular events (MACE; comprising all‐cause death, nonfatal stroke, nonfatal recurrent myocardial infarction, or emergency revascularization prompted by ischemia) as the effectiveness criterion. Secondary outcomes include the ICER at 1 year, and MACE (and its components) at 30 days and at 1 year. Results The trial aimed to enroll 630 patients. Based on estimated event rates of 11% in the restrictive group and 15% in the liberal group, this number will provide 80% power to demonstrate clinical noninferiority of the restrictive group, with a noninferiority margin corresponding to a relative risk equal to 1.25. The sample size will also provide 80% power to show the cost‐effectiveness of the restrictive strategy at a threshold of €50 000 per quality‐adjusted life year. Conclusions REALITY will provide important guidance on the management of patients with AMI and anemia.
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Affiliation(s)
- Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Gonzalo Calvo
- Àrea del Medicament Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José Ramón González-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabelle Durand-Zaleski
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, INSERM UMR 1153 CRESS, Paris, France
| | - Cristina Avendano-Sola
- Clinical Pharmacology Service, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Etienne Puymirat
- Hôpital Européen Georges Pompidou, AP-HP, French Alliance for Cardiovascular Trials (FACT), and Université de Paris, Paris, France
| | - Gilles Lemesle
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Faculté de Médecine de Lille, Université de Lille, Institut Pasteur de Lille, Inserm U1011, F-59000 Lille, France; French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Joan Albert Arnaiz
- Clinical Trials Unit, Clinical Pharmacology Department, Hospital Clinic, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV; Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Alexandra Rousseau
- Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, Paris, France
| | - Marine Cachanado
- Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, Paris, France
| | - Eric Vicaut
- AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, INSERM UMRS 1166, Paris, France
| | - Carma Karam
- Cardiology Department, Ambroise Paré Hospital, AP-HP, Boulogne, University of Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, AP-HP, French Alliance for Cardiovascular Trials (FACT), and Université de Paris, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, Paris, France
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France.,Royal Brompton Hospital, Imperial College, London, UK
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Daily almond consumption in cardiovascular disease prevention via LDL-C change in the U.S. population: a cost-effectiveness analysis. BMC Public Health 2020; 20:558. [PMID: 32334551 PMCID: PMC7183588 DOI: 10.1186/s12889-020-08642-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 04/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Heart disease is the leading cause of death in the United States. The U.S. Food and Drug Administration approved the health claim that 1.5 oz (42.5 g) of nut intake may reduce the risk of cardiovascular disease. Previous studies have focused on the cost-effectiveness of other foods or dietary factors on primary cardiovascular disease prevention, yet not in almond consumption. This study aimed to examine the cost-effectiveness of almond consumption in cardiovascular disease primary prevention. Perspective & Setting This study assessed the cost-effectiveness of consuming 42.5 g of almond from the U.S. healthcare sector perspective. Methods A decision model was developed for 42.5 g of almond per day versus no almond consumption and cardiovascular disease in the U.S. population. Parameters in the model were derived from the literature, which included the probabilities of increasing low-density lipoprotein cholesterol, developing acute myocardial infarction and stroke, treating acute myocardial infarction, dying from the disease and surgery, as well as the costs of the disease and procedures in the U.S. population, and the quality-adjusted life years. The cost of almonds was based on the current price in the U.S. market. Sensitivity analyses were conducted for different levels of willingness-to-pay, the probabilistic sensitivity analysis, ten-year risk prevention, different costs of procedures and almond prices, and patients with or without cardiovascular disease. Results The almond strategy had $363 lower cost and 0.02 higher quality-adjusted life years gain compared to the non-almond strategy in the base-case model. The annual net monetary benefit of almond consumption was $1421 higher per person than no almond consumption, when the willingness to pay threshold was set at $50,000 for annual health care expenditure. Almond was more cost-effective than non-almond in cardiovascular disease prevention in all the sensitivity analyses. Conclusion Consuming 42.5 g of almonds per day is a cost-effective approach to prevent cardiovascular disease in the short term and potentially in the long term.
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Zhao Y, Meng S, Liu T, Dong R. Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study. Med Sci Monit 2020; 26:e919374. [PMID: 32097388 PMCID: PMC7059453 DOI: 10.12659/msm.919374] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Surgical treatment methods for patients with complex coronary artery disease (CAD) who have undergone vascular reconstruction mainly include coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). The purpose of the study aimed to compare a 1-year follow-up for the patient clinical outcomes and costs between PCI and CABG treatment. MATERIAL AND METHODS There were 840 patients enrolled in this study from July 2015 to September 2016. Among the study participants, 420 patients underwent PCI treatment and 420 patients underwent off-pump CABG. Patients costs were assessed from the perspective of the China healthcare and medical insurance system. EuroQOL 5-dimension 3 levels (EQ-5D-3L) questionnaire was used to evaluate the general health status, and the Seattle Angina Questionnaire (SAQ) was used to assess the disease-specific health status. RESULTS After a 1-year follow-up, the all-cause mortality (P=0.0337), the incidence of major adverse cardiac and cerebrovascular events (P<0.001), and additional revascularization (P<0.001) in PCI group were significantly higher than those in CABG group. Both groups have significant sustained benefits in the SAQ subscale. The CABG group had a higher score on the frequency of angina than the PCI group. In addition, the quality-adjusted life year value of PCI and CABG resulted was 0.8. The average total cost for PCI was $14 643 versus CABG cost of $13 842 (P=0.0492). CONCLUSIONS In the short-term, among the CAD patients with stable triple-vessel or left-main, costs and clinical outcomes are substantially higher for CABG than PCI. Long-term, economic, and health benefits analysis, is warranted.
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Affiliation(s)
- Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Shuai Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
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Gholami SS, Azar FEF, Rezapour A, Tajdini M. Cost-effectiveness of coronary artery bypass graft and percutaneous coronary intervention compared to medical therapy in patients with coronary artery disease: a systematic review. Heart Fail Rev 2019; 24:967-975. [PMID: 31179517 DOI: 10.1007/s10741-019-09811-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Coronary artery disease (CAD) has significant social and economic implications. It is necessary to create tools to identify the most cost-effectiveness treatments, which can assist clinicians in their therapeutic decisions so that the maximum possible benefit is reached with the lowest possible cost. Effectiveness must be measured by final treatment goals in which the most effective interventions are those with the lowest costs. This study is aimed to systematically review and compare the studies conducted on the cost-effectiveness of the three coronary artery disease treatment strategies (medical treatment, percutaneous coronary intervention, and coronary artery bypass graft). In this systematic review, the databases NHS Economic Evaluation Database, Embase, MEDLINE, Science Direct, and Scopus were searched for studies on the cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) compared to medical therapy (MT) in patients with coronary artery disease between 1 January 2004 to 30 September 2018. The quality appraisal of the included studies was examined using the Consolidated Health Economics Evaluation Reporting Standards (CHEERS) statement. Out of 186 unique retrievals, 8 studies were included. The results showed that the all studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, in most of the studies, quality-adjusted life years (QALY) were the main outcome used for measuring the effectiveness. The studies reported various ranges of the incremental cost-effectiveness ratio (ICER); accordingly, the highest ratio was observed in the USA ($212,800) for PCI v MT and the lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the results of the studies were different in terms of a number of aspects, such as the viewpoint of the study, the study horizons, and the costs of expenditure items, they reached similar results. Based on the result of the present study, it seems that each three treatment strategies for CAD yielded improvements in QALY.
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Affiliation(s)
- Saeed Sheikh Gholami
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Ebadi Fard Azar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Voudris KV, Kavinsky CJ. Advances in Management of Stable Coronary Artery Disease: the Role of Revascularization? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:15. [PMID: 30854580 DOI: 10.1007/s11936-019-0720-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Coronary artery disease remains the most common cause of death worldwide. In patients with biomarker-positive acute coronary syndrome, the combination of guideline-directed medical therapy with routine revascularization is associated with improved outcomes. However, the role of routine revascularization in stable ischemic heart disease, in addition to medical therapy, remains a matter of debate. In this review, we aimed to describe the role of revascularization in stable ischemic heart disease. RECENT FINDINGS Revascularization is indicated in patients with stable ischemic heart disease and progressive or refractory symptoms, despite medical management. When guided by ischemia presence, revascularization has failed to show survival benefit, compared with medical therapy alone in multiple clinical trials. On the other hand, revascularization guided by coronary lesion severity, assessed by FFR or iFR, has been shown to offer survival benefit and improvement in symptom severity. PCI-revascularization of unprotected left main disease is feasible with comparable to surgical approach outcomes. Clinical decision to perform revascularization in stable ischemic heart disease necessitates a heart team approach, and no simple algorithm can guide this process. Further studies are required to assess the benefit of routine revascularization, in combination to medical therapy, in this population.
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Affiliation(s)
- Konstantinos V Voudris
- Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 West Congress Parkway, Suite 307, Kellogg Building, Chicago, IL, 60612, USA
| | - Clifford J Kavinsky
- Division of Cardiology, Department of Medicine, Rush University Medical Center, 1717 West Congress Parkway, Suite 307, Kellogg Building, Chicago, IL, 60612, USA.
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Tseng HS, Chao ZH, Huang SK, Tung TH, Chien CW. Utilization of Emergency and Hospitalization Care after Coronary Artery Bypass Surgery for Patients with Ischemic Heart Disease. Int Heart J 2018; 59:941-950. [PMID: 30101843 DOI: 10.1536/ihj.17-231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This retrospective follow-up study explored the status of patients with myocardial infarction with regard to the likelihood of being readmitted to the hospital within 30 days after undergoing coronary artery bypass surgery (CABG) and their survival status within one year of the procedure.The rate of readmission within 30 days was 10.7% (167/1,575), primarily due to surgical wound infection (11.3% of readmission cases), ischemic heart disease (10.3%), and heart failure (8.7%). The readmission group consisted mainly of older males with a high comorbidity index. No significant differences existed between the two groups with regard to case distribution, hospital level, tenure of physicians, or teaching status of the hospitals. Most subsequent emergency department visits one month after surgery involved older male patients with a high comorbidity index. Compared to patients in the non-emergency group, those in the emergency group had longer hospital stays but lower mortality rates. Males constituted a higher proportion of survivors at one year post CABG, with age and comorbidity index being the primary variables affecting the risk of death.The National Health Insurance may adopt the policy of increasing payments for medical institutions that avoid readmission within 30 days post CABG in order to encourage better patient care and avoid the costs associated with readmission.
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Affiliation(s)
- Hsiao-Shan Tseng
- Institute of Hospital and Health Care Administration, National Yang-Ming University.,Taipei Beitou Health Management Hospital
| | - Zi-Hao Chao
- Faculty of Public Health, College of Medicine, Fu Jen Catholic University
| | - Song-Kong Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4483] [Impact Index Per Article: 747.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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McCreanor V, Graves N, Barnett AG, Parsonage W, Merlo G. A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment. F1000Res 2018; 7:77. [PMID: 30026922 PMCID: PMC6039943 DOI: 10.12688/f1000research.13616.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 09/27/2023] Open
Abstract
Background: Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources. Methods: We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. Results: We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. Conclusions: The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.
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Affiliation(s)
- Victoria McCreanor
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
- Capital Markets Cooperative Research Centre, Sydney, New South Wales, 2000, Australia
| | - Nicholas Graves
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Adrian G Barnett
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Will Parsonage
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Queensland, 4029, Australia
| | - Gregory Merlo
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
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McCreanor V, Graves N, Barnett AG, Parsonage W, Merlo G. A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment. F1000Res 2018; 7:77. [PMID: 30026922 PMCID: PMC6039943 DOI: 10.12688/f1000research.13616.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 02/04/2023] Open
Abstract
Background: Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources. Methods: We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for stable coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. Results: We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. Conclusions: The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.
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Affiliation(s)
- Victoria McCreanor
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
- Capital Markets Cooperative Research Centre, Sydney, New South Wales, 2000, Australia
| | - Nicholas Graves
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Adrian G Barnett
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Will Parsonage
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Queensland, 4029, Australia
| | - Gregory Merlo
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6051] [Impact Index Per Article: 864.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Sung SH, Chen TC, Cheng HM, Lee JC, Lang HC, Chen CH. Comparison of Clinical Outcomes in Patients Undergoing Coronary Intervention with Drug-Eluting Stents or Bare-Metal Stents: A Nationwide Population Study. ACTA CARDIOLOGICA SINICA 2017; 33:10-19. [PMID: 28115802 PMCID: PMC5241431 DOI: 10.6515/acs20160608a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/08/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this propensity score-matched cohort study was to investigate the prognostic impacts of drug-eluting stents (DES) and bare-metal stents (BMS) in patients undergoing percutaneous coronary intervention (PCI). METHODS We conducted a retrospective cohort study based on the National Health Insurance program. Patients who had undergone coronary stenting between Jan. 2007 and Dec. 2008 were recruited and monitored until the end of 2010. Subjects with either BMS or DES were matched 2:1 by propensity score, which adjusted for age, sex, stent number and Charlson comorbidity index (CCI). The Kaplan-Meier method and Cox regression models were used for prognostic analyses. RESULTS Among a total of 966 patients with a mean age of 66 years, 644 subjects had BMS and 322 subjects had DES. The incidence of myocardial infarction (MI) and death were significantly lower in the DES group as compared with the BMS group for the three-year follow-up duration. With adjustments for age, sex, premium-based monthly salary, levels of hospital care, stent number, CCI, medications, and acute coronary syndrome presentation in the index hospitalization, use of DES rather than BMS was associated with reduced adverse coronary events (hazard ratio and 95% confidence interval: 0.55, 0.38-0.81 in the whole population, and 0.44, 0.26-0.73 in the subgroup patients with stable coronary artery disease). CONCLUSIONS Implantation of DES was related to better outcomes than for BMS, in terms of reducing MI and mortality after PCI. The survival benefit for patients with DES was even greater in patients with stable coronary artery disease.
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Affiliation(s)
- Shih-Hsien Sung
- Department of Medicine
- Cardiovascular Research Center
- Department of Medicine
- Department of Public Health
| | - Tzu-Ching Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education
- Laboratory of Evidence-Based Healthcare, Taipei Veterans General Hospital
- Cardiovascular Research Center
- Department of Medicine
- Department of Public Health
| | - Jia-Chun Lee
- Department of Medical Education
- Laboratory of Evidence-Based Healthcare, Taipei Veterans General Hospital
| | - Hui-Chu Lang
- Institute of Hospital and Health Care Administration, National Yang-Ming University
| | - Chen-Huan Chen
- Department of Medical Education
- Cardiovascular Research Center
- Department of Medicine
- Department of Public Health
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15
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Henderson RA. Cost and efficacy of myocardial revascularization in the drug-eluting stent era: how much for how much? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:225-228. [PMID: 29474721 DOI: 10.1093/ehjqcco/qcw047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Robert A Henderson
- Consultant Cardiologist, Trent Cardiac Centre, Nottingham University Hospitals, City Hospital Campus, Nottingham NG51PB, UK
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16
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Hiob MA, She S, Muiznieks LD, Weiss AS. Biomaterials and Modifications in the Development of Small-Diameter Vascular Grafts. ACS Biomater Sci Eng 2016; 3:712-723. [DOI: 10.1021/acsbiomaterials.6b00220] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matti A. Hiob
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Shelley She
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Lisa D. Muiznieks
- Molecular Structure and Function Program, Research Institute, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada
| | - Anthony S. Weiss
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
- Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
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17
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Prognostic value of coronary CT angiography in diabetic patients: a 5-year follow up study. Int J Cardiovasc Imaging 2015; 32:483-91. [DOI: 10.1007/s10554-015-0785-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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18
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Caruba T, Chevreul K, Zarca K, Cadier B, Juillière Y, Dubourg O, Sabatier B, Danchin N. Annual cost of stable coronary artery disease in France: A modeling study. Arch Cardiovasc Dis 2015; 108:576-88. [PMID: 26433733 DOI: 10.1016/j.acvd.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have analyzed the cost of treatment of chronic angina pectoris, especially in European countries. AIM To determine, using a modeling approach, the cost of care in 2012 for 1year of treatment of patients with stable angina, according to four therapeutic options: optimal medical therapy (OMT); percutaneous coronary intervention with bare-metal stent (PCI-BMS); PCI with drug-eluting stent (PCI-DES); and coronary artery bypass graft (CABG). METHODS Six different clinical scenarios that could occur over 1year were defined: clinical success; recurrence of symptoms without hospitalization; myocardial infarction (MI); subsequent revascularization; death from non-cardiac cause; and cardiac death. The probability of a patient being in one of the six clinical scenarios, according to the therapeutic options used, was determined from a literature search. A direct medical cost for each of the therapeutic options was calculated from the perspective of French statutory health insurance. RESULTS The annual costs per patient for each strategy, according to their efficacy results, were, in our models, €1567 with OMT, €5908 with PCI-BMS, €6623 with PCI-DES and €16,612 with CABG. These costs were significantly different (P<0.05). A part of these costs was related to management of complications (recurrence of symptoms, MI and death) during the year (between 3% and 38% depending on the therapeutic options studied); this part of the expenditure was lowest with the CABG therapeutic option. CONCLUSION OMT appears to be the least costly option, and, if reasonable from a clinical point of view, might achieve appreciable savings in health expenditure.
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Affiliation(s)
- Thibaut Caruba
- AP-HP, hôpital européen Georges-Pompidou, Pharmacie, 20, rue Leblanc, 75015 Paris, France.
| | - Karine Chevreul
- AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France; Inserm, ECEVE, U1123, Paris, France
| | - Kevin Zarca
- AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France
| | - Benjamin Cadier
- AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France
| | - Yves Juillière
- CHU Nancy-Brabois, Institut Lorrain du cœur et des vaisseaux, cardiologie, 54500 Vandœuvre-lès-Nancy, France
| | - Olivier Dubourg
- AP-HP, hôpital Ambroise-Paré, cardiologie, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Brigitte Sabatier
- AP-HP, hôpital européen Georges-Pompidou, Pharmacie, 20, rue Leblanc, 75015 Paris, France; Inserm, centre de recherche des cordeliers, UMR 1138, équipe 22, 75006 Paris, France
| | - Nicolas Danchin
- AP-HP, hôpital européen Georges-Pompidou, cardiologie, 20, rue Leblanc, 75015 Paris, France; Université René-Descartes, faculté de médecine, 15, rue de l'École-de-médecine, 75006 Paris, France
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19
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Celik IE, Yarlioglues M, Kurtul A, Duran M, Koseoglu C, Oksuz F, Aksoy O, Murat SN. Preprocedural Albumin Levels and Risk of In-Stent Restenosis After Coronary Stenting With Bare-Metal Stent. Angiology 2015; 67:478-83. [PMID: 26243483 DOI: 10.1177/0003319715598084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In-stent restenosis (ISR) remains a significant clinical problem in patients with coronary artery disease treated with percutaneous coronary intervention. Decreased serum albumin (SA) level is related to an increased risk of cardiovascular events. The aim of the present study was to assess whether SA levels at admission are an independent predictor of ISR in patients undergoing bare-metal stent (BMS) implantation. A total of 341 patients (aged 61 ± 11, 65.4% men) with a history of BMS implantation and a further control coronary angiography due to stable angina pectoris (SAP) were included. The study population was classified into 2 groups: patients with and without ISR. The ISR was observed in 140 (41.1%) patients. We found significantly lower SA levels in patients who developed ISR than in those who did not (3.69 ± 0.41 vs 4.07 ± 0.35 mg/dL,P< .001). Multivariate analysis revealed that SA level (odds ratio 0.109, 95% confidence interval 0.017-0.700,P= .020), stent diameter, reason for stent implantation, and body mass index were independent risk factors for the development of ISR. The SA level at admission is inversely associated with ISR in patients with SAP.
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Affiliation(s)
- Ibrahim Etem Celik
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mikail Yarlioglues
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Cemal Koseoglu
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Fatih Oksuz
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ozlem Aksoy
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sani Namik Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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Maranhão RC, Tavares ER. Advances in non-invasive drug delivery for atherosclerotic heart disease. Expert Opin Drug Deliv 2015; 12:1135-47. [DOI: 10.1517/17425247.2015.999663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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