1
|
Zaki HA, Bashir I, Mahdy A, Abdurabu M, Khallafalla H, Fayed M, Elsayed WAE, Abdelrahim MG, Basharat K, Salloum W, Shaban E. Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis. Cureus 2023; 15:e49391. [PMID: 38146552 PMCID: PMC10749670 DOI: 10.7759/cureus.49391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
The United Kingdom (UK) has a sustainable healthcare system. Nonetheless, the burden of acute coronary syndrome (ACS) is still a significant challenge. A scarcity of literature primarily focuses on the continuum of care for ACS patients in the UK. Moreover, limited research studies highlight the clinical trajectories of ACS patients across the UK. Therefore, the current study was designed to explore clinical trajectories and the continuum of care for patients with ACS in the UK. Secondary data was obtained from the Myocardial Ischaemia National Audit Project (MINAP) database. The latest data available in the MINAP database was used. As our objective was to explore clinical trajectories and the continuum of care for patients, we retrieved data regarding the care received by ACS patients admitted to hospitals across the UK. The data of 85574 ACS patients was retrieved. A large number (n=47035) of patients were estimated to be eligible for the angiogram; however, an angiogram was performed for 87.15% (n=40995) of eligible patients. Angioplasty within 72 hours of admission was required for most (n=26313) ACS patients. Nonetheless, angioplasty within 72 hours of admission was performed for 59.7% (n=15703) of the eligible patients. There was a significant difference (P<0.05) between different regions of the UK and the percentage of patients for whom angioplasty was performed within 72 hours of admission. Primary percutaneous coronary intervention (PCI) was performed for 23923 ACS patients, of which the door-to-balloon interval for 17590 (73.5%) patients was ≤60 minutes while the door-to-balloon interval for 3086 (12.9%) patients was ≤90 minutes. Out of the total 85574 ACS patients, 65959 (77.08%) patients were discharged on appropriate medications, while 19615 (22.92%) were transferred to another hospital or died there. A total of 75361 were eligible to be referred to cardiac rehabilitation settings. Nonetheless, 64518 (85.61%) were referred to cardiac rehabilitation. About 85000 patients were reported in the UK (England, Northern Ireland, Wales). Optimal care was provided to most patients in the UK. However, some patients received sub-optimal care, highlighting the disparity in the healthcare system. There is a need to explore further the factors that might be responsible for the sub-optimal care to the patients.
Collapse
Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Israr Bashir
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Ahmed Mahdy
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Mohamed Fayed
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | | | - Wathek Salloum
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Eman Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, QAT
| |
Collapse
|
2
|
Jiang N, Wang Z, Deng Q, Zhou Y, Cao S, Zhou Q, Chen J, Guo R, Hu B. Low-intensity focused ultrasound guided dodecafluoropentane-loaded acoustic phase-change nanoparticles for treatment of porcine coronary microthromboembolism. Int J Cardiol 2023; 371:1-9. [PMID: 36208680 DOI: 10.1016/j.ijcard.2022.09.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/30/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Coronary microthromboembolism after acute myocardial infarction (AMI) requires urgent and effective treatment. Early and effective recovery of coronary microcirculation perfusion for the management of AMI would be crucial for better prognosis. Ultrasound assisted thrombolysis in the in-vitro experiments have great potential for the elimination of acute coronary microthromboembolism, especially with stable cavitation using low-intensity focused ultrasound (LIFU) and dodecafluoropentane-loaded acoustic phase-change nanoparticles (DDFP@NPs). Therefore, our study sought to perform animal experiments using this novel treatment method in a porcine model with acute coronary microthromboembolism for further investigation of potential therapeutic values. METHODS Porcine model with acute coronary thromboembolism was established using percutaneous coronary intervention and autologous thrombus injection. For ultrasound assisted thrombolysis, DDFP@NPs were prepared by rotary evaporation and sonication process, and LIFU was optimized. Echocardiography and TTC staining were performed for the evaluation of porcine model establishment and treatment effect. RESULTS The treatment using LIFU guided DDFP@NPs had almost completely recanalized culprit coronary branch after treatment procedure, and smaller infarcted size (5.4 ± 1.0%), better LVEF (52.5 ± 1.8%) and better coronary microcirculation after 28 days of treatment, which outperformed treatments using LIFU+SonoVue microbubbles (infarcted size: 26.4 ± 3.5% and LVEF: 37.2 ± 3.1%) and LIFU only (infarcted size: 32.2 ± 3.1% and LVEF: 32.2 ± 0.4%) (all P < 0.05), while the treatment effect were similar to treatment using intravenous tissue-plasminogen activator (infarcted size: 4.9 ± 0.9% and LVEF: 53.1 ± 1.1%) (all P > 0.05). CONCLUSIONS Our study has innovatively established a treatment method using DDFP@NPs combined with LIFU irradiation for coronary thrombolysis and verified its treatment effect with high-efficient thrombolysis in the in-vivo experiments, which can be considered as powerful experimental evident of the novel method for potential clinical use of acute coronary thrombolysis. Multidimensional experimental investigations and cautious verification may need before the method could be used as treatment before preliminary clinical trials.
Collapse
Affiliation(s)
- Nan Jiang
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhiwen Wang
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qing Deng
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yanxiang Zhou
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Sheng Cao
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qing Zhou
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jinling Chen
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Ruiqiang Guo
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Bo Hu
- Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| |
Collapse
|
3
|
Ma Y, Qi Y, Li Q, Zhu S, Zhao W, Zhang Y. The Expression Significance of LPa, BNP, and McP-1 in CHD Patients and Their Relationship with Echocardiographic Parameters. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5165203. [PMID: 36101804 PMCID: PMC9440810 DOI: 10.1155/2022/5165203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/13/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
In order to investigate the expression levels of Lipoprotein A (LPa), B-type Natriuretic Peptide (BNP) and Monocyte chemoattractor Protein-1 (McP-1) in serum of patients with coronary heart disease (CHD) are used to detect significance and to analyze the correlation between these indicators and parameters of echocardiography. The clinical data of 132 CHD patients in our hospital from January 2021 to October 2021 are retrospectively analyzed and included in the CHD group. Another 100 healthy people who came to our hospital for general physical examination were selected as the control group. The expressions of Serum McP-1 and BNP are detected by the ELISA. The expression of Serum LPa is detected by immunoturbidimetry, and the expressions of SERUM McP-1, BNP, and LPa are compared between the two groups. The experiments show that the expressions of McP-1, BNP, and LPa in serum of control group are significantly lower than those of the CHD group (P < 0.05). Echocardiography results show that left ventricular ejection fraction (LVEF) in CHD group is significantly lower than that in control group, but left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) are significantly higher than those in control group (P < 0.05).
Collapse
Affiliation(s)
- Yunpeng Ma
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Yinzun Qi
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Qiang Li
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Shuangxiong Zhu
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Wenjie Zhao
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Yu Zhang
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| |
Collapse
|
4
|
Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2019. Critical care. Minerva Anestesiol 2020; 86:102-113. [PMID: 31994860 DOI: 10.23736/s0375-9393.20.14384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, ASST - Spedali Civili Children's Hospital, Brescia, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Department of Accident and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
| |
Collapse
|