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Ahmad Y. Coronary Revascularization in Ischemic Systolic Heart Failure: Focusing on Quality of Life, Not Quantity. JACC. HEART FAILURE 2024:S2213-1779(24)00502-X. [PMID: 39023493 DOI: 10.1016/j.jchf.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Yousif Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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2
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Lee Chuy K, Velazquez EJ, Lansky AJ, Jamil Y, Ahmad Y. Current Landscape and Future Directions of Coronary Revascularization in Ischemic Systolic Heart Failure: A Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101197. [PMID: 39131064 PMCID: PMC11307589 DOI: 10.1016/j.jscai.2023.101197] [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: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 08/13/2024]
Abstract
Ischemic heart disease is the largest cause of death worldwide and the most common cause of heart failure (HF). The incidence and prevalence of HF are increasing owing to an aging population and improvements in the acute cardiac care of previously fatal conditions such as myocardial infarction. Strategies to improve outcomes in patients with ischemic systolic HF are urgently needed. There is systematic underutilization of testing for coronary artery disease in patients with HF, and revascularization is performed in an even smaller minority despite evidence for reduced mortality with coronary artery bypass grafting (CABG) over medical therapy in the Surgical Treatment for Ischemic Heart Failure Extension Study. Percutaneous coronary intervention (PCI) is a less-invasive approach to coronary revascularization; however, the recent Revascularization for Ischemic Ventricular Dysfunction (REVIVED)-British Cardiovascular Intervention Society (BCIS2) trial failed to demonstrate a benefit of PCI compared with that of medical therapy in patients with ischemic systolic HF. The comparative effectiveness of PCI and CABG for patients with ischemic systolic HF remains unknown, particularly in the era of contemporary medical therapy. In this review, we discuss the benefit of CABG in ischemic systolic HF, its underutilization, and the unmet clinical need. We also review the recent REVIVED-BCIS2 trial comparing PCI to medical therapy, as well as upcoming randomized controlled trials of PCI for ischemic systolic HF and persistent evidence gaps that will exist despite anticipated data from ongoing trials. There remains a need for an adequately powered randomized controlled trials to establish the comparative clinical effectiveness of PCI vs CABG in ischemic systolic HF in the era of contemporary revascularization approaches and medical therapy, as well as trials of coronary revascularization in patients with HF with preserved ejection fraction or less severe forms of left ventricular systolic dysfunction.
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Affiliation(s)
- Katherine Lee Chuy
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Eric J. Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alexandra J. Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yasser Jamil
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
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3
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Hirai T, Grantham JA, Kandzari DE, Ballard W, Brown WM, Allen KB, Kirtane AJ, Argenziano M, Yeh RW, Khabbaz K, Lombardi W, Lasala J, Kachroo P, Karmpaliotis D, Gosch KL, Salisbury AC. Percutaneous ventricular assist device for higher-risk percutaneous coronary intervention in surgically ineligible patients: Indications and outcomes from the OPTIMUM study. Catheter Cardiovasc Interv 2023; 102:814-822. [PMID: 37676058 DOI: 10.1002/ccd.30834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Indications and outcomes for percutaneous ventricular assist device (pVAD) use in surgically ineligible patients undergoing percutaneous coronary intervention (PCI) remain poorly characterized. AIMS We sought to describe the use and timing of pVAD and outcome in surgically ineligible patients. METHODS Among 726 patients enrolled in the prospective OPTIMUM study, clinical and health status outcomes were assessed in patients who underwent pVAD-assisted PCI and those without pVAD. RESULTS Compared with patients not receiving pVAD (N = 579), those treated with pVAD (N = 142) more likely had heart failure, lower left ventricular ejection fraction (30.7 ± 13.6 vs. 45.9 ± 15.5, p < 0.01), and higher STS 30-day predicted mortality (4.2 [2.1-8.0] vs. 3.3 [1.7-6.6], p = 0.01) and SYNTAX scores (36.1 ± 12.2, vs. 31.5 ± 12.1, p < 0.01). While the pVAD group had higher in-hospital (5.6% vs. 2.2%, p = 0.046), 30-day (9.0% vs. 4.0%, p = 0.01) and 6-month (20.4% vs. 11.7%, p < 0.01) mortality compared to patients without pVAD, this difference appeared to be largely driven by significantly higher mortality among the 20 (14%) patients with unplanned pVAD use (30% in-hospital mortality with unplanned PVAD vs. 1.6% with planned, p < 0.01; 30-day mortality, 38.1% vs. 4.5%, p < 0.01). The degree of 6-month health status improvement among survivors was similar between groups. CONCLUSION Surgically ineligible patients with pVAD-assisted PCI had more complex baseline characteristics compared with those without pVAD. Higher mortality in the pVAD group appeared to be driven by very poor outcomes by patients with unplanned, rescue pVAD.
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Affiliation(s)
- Taishi Hirai
- Division of Cardiology, University of Missouri, Columbia, Missouri, USA
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Divison of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | | | | | - Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Divison of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Michael Argenziano
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - William Lombardi
- Divsion of Cardiology, University of Washington, Seattle, Washington, USA
| | - John Lasala
- Division of Cardiology, Washington University, St. Louis, Missouri, USA
| | - Puja Kachroo
- Division of Cardiology, Washington University, St. Louis, Missouri, USA
| | | | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Divison of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
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4
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Jacob P, Jayaprabha Surendran P, Gupta P, Mahinay M, Sarmiento AL, Abas ASE, Mohammed SA, Sarhan HH, Ureta J, Mathew G, Galvez ROA, Thangaraj P, Singh R. Enhancing early functional independence following cardiac surgery: a quality improvement programme. BMJ Open Qual 2023; 12:e002190. [PMID: 37931983 PMCID: PMC10632887 DOI: 10.1136/bmjoq-2022-002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/01/2023] [Indexed: 11/08/2023] Open
Abstract
Early mobility and activity programmes following cardiac surgery are vital for improved patient outcomes, as they accelerate the recovery of functional capacity and walking distance. We observed that only 5.3% of our patients achieved a Functional Independence Measurement (FIM) score of 80% or more by the third postoperative day (POD). Additionally, the average 6-minute walk distance achieved by the fourth POD was only 188 m. Therefore, a quality improvement (QI) project was implemented with the aim of attaining a FIM score of 80% by the third POD for more than 80% of patient underwent/undergoing cardiac surgery without complications.A model-for-improvement framework was used to drive continuous improvement. This project was implemented in February 2021. Baseline data were prospectively collected between November 2020 and January 2021 (preintervention). Outcomes were analysed using standard control chart rules to detect changes over time. Unpaired Student t-tests assessed significant differences in mean levels between two groups, (preintervention vs postintervention).χ2 tests were conducted between the two groups according to gender and patient satisfaction scores.The percentage of patients who achieved a FIM score of 80% or more by the third POD gradually increased to 91.4% 5 months following programme implementation and was sustained thereafter. The mean patient FIM score significantly improved to 81.20±3.77 (p<0.001) by the third POD. Similarly, the mean 6-minute walk distance increased to 267.90±36.10 m (p<0.001) by the fourth POD. The percentage of patients who displayed the level of confidence needed to carry out activities of daily living (ADL) and exercises independently at home increased to 89.4% (p<0.001) by the fifth POD. No adverse events associated with the mobility and activity programme were reported.This QI project demonstrated a substantial improvement in patient functional independence, walking distance and the level of confidence needed to independently carry out ADL and exercises following cardiac surgery.
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Affiliation(s)
- Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Poonam Gupta
- Quality and Patient Safety, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Menandro Mahinay
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Shady Ashraf Mohammed
- Cardiac-Thoracic Surgery Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hatem Hemdan Sarhan
- Cardiac-Thoracic Surgery Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Julie Ureta
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Gigi Mathew
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Li Kam Wa ME, Assar SZ, Kirtane AJ, Perera D. Revascularisation for Ischaemic Cardiomyopathy. Interv Cardiol 2023; 18:e24. [PMID: 37655258 PMCID: PMC10466461 DOI: 10.15420/icr.2023.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 09/02/2023] Open
Abstract
Coronary artery disease is a leading cause of heart failure with reduced ejection fraction. Coronary artery bypass grafting appears to provide clinical benefits such as improvements in quality of life, reductions in readmissions and MI, and favourable effects on long-term mortality; however, there is a significant short-term procedural risk when left ventricular function is severely impaired, which poses a conundrum for many patients. Could percutaneous coronary intervention provide the same benefits without the hazard of surgery? There have been no randomised studies to support this practice until recently. The REVIVED-BCIS2 trial (NCT01920048) assessed the outcomes of percutaneous coronary intervention in addition to optimal medical therapy in patients with ischaemic left ventricular dysfunction and stable coronary artery disease. This review examines the trial results in detail, suggests a pathway for investigation and revascularisation in ischaemic cardiomyopathy, and explores some of the remaining unanswered questions.
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Affiliation(s)
- Matthew E Li Kam Wa
- Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK
| | - Saba Z Assar
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US
- Cardiovascular Research Foundation New York, NY, US
| | - Divaka Perera
- Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK
- Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust London, UK
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Fremes SE, Marquis-Gravel G, Gaudino MFL, Jolicoeur EM, Bédard S, Masterson Creber R, Ruel M, Vervoort D, Wijeysundera HC, Farkouh ME, Rouleau JL. STICH3C: Rationale and Study Protocol. Circ Cardiovasc Interv 2023; 16:e012527. [PMID: 37582169 DOI: 10.1161/circinterventions.122.012527] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is the recommended mode of revascularization in patients with ischemic left ventricular dysfunction (iLVSD) and multivessel disease. However, contemporary percutaneous coronary intervention (PCI) outcomes have improved with the integration of novel technologies and refinement of revascularization strategies, and PCI is often used in clinical practice in this population. There is a lack of evidence from randomized trials comparing contemporary state-of-the-art PCI versus CABG for the treatment of iLVSD and multivessel disease. This was the impetus for the STICH3C trial (Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy), described here. METHODS The STICH3C trial is a prospective, unblinded, international, multicenter trial with an expected sample size of 754 participants from ≈45 centers. Patients with multivessel/left main coronary artery disease and iLVSD with left ventricular ejection fraction ≤40% considered by the local Heart Team appropriate for and amenable to revascularization by both modes of revascularization will be randomized in a 1:1 ratio to state-of-the-art PCI or CABG. RESULTS The primary end point is the composite of death from any cause, stroke, spontaneous myocardial infarction, urgent repeat revascularization, or heart failure readmission, summarized as a time-to-event outcome. The key hierarchical end point is time to death and frequency of hospitalizations for heart failure. The key safety outcome is a composite of major adverse events. Disease-specific quality-of-life and health economics measures will be compared between groups. Participants will be followed for a median of 5 years, with a minimum follow-up of 4 years. CONCLUSIONS STICH3C will directly inform patients, clinicians, and international practice guidelines about the efficacy and safety of CABG versus PCI in patients with iLVSD. The results will provide novel and broad evidence, including clinical events, health status, and economic assessments, to guide care for patients with iLVSD and severe coronary artery disease. REGISTRATION URL: https://clinicaltrials.gov/; Unique identifier: NCT05427370.
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Affiliation(s)
- Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - E Marc Jolicoeur
- Department of Cardiothoracic Surgery (M.F.L.G.), Weill Cornell Medicine, New York City, NY
| | - Sylvain Bédard
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, Quebec, Canada (S.B.)
| | | | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (M.R.)
| | - Dominique Vervoort
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.F., D.V., H.C.W.)
| | - Michael E Farkouh
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ontario, Canada (M.E.F.)
| | - Jean-Lucien Rouleau
- Montreal Heart Institute, University of Montreal, Quebec, Canada (G.M.-G., E.M.J., J.-L.R.)
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7
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Fernández Coronado R, Olórtegui Yzu A. [Effectiveness of tertiary prevention on quality of life and control of risk factors in patients with ischemic coronary heart disease]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:88-95. [PMID: 38046229 PMCID: PMC10688413 DOI: 10.47487/apcyccv.v4i3.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/10/2023] [Indexed: 12/05/2023]
Abstract
Objective Determine the effectiveness of cardiac rehabilitation (CR) as a tertiary prevention strategy in the quality of life and control of risk factors of patients with ischemic coronary heart disease (ICC) of the National Cardiovascular Institute (INCOR) of EsSalud- Lima during the year 2018. Materials and methods A retrospective cohort of 280 patients with a diagnosis of CCI was studied who, after medical, interventional, or surgical treatment, were referred to the INCOR CR program for tertiary prevention (PT) in 2018. The program was developed according to the institutional guide for eight weeks with exercise sessions and educational, psychological, nutritional, and recreational workshops. At the beginning and at the end of this, the QLMI-2 quality of life test was applied, and anthropometric, laboratory, and risk factor control measurements were performed. Results Quality of life levels at the end of CR showed a statistically significant improvement in the emotional, social, physical, and global dimensions (p < 0.001). The same behavior was observed for the nutritional variables of weight, abdominal circumference, and BMI (p < 0.001). Physical capacity showed a statistically significant improvement in the aspects of muscle strength (12.2%), physical activity (38.0%), and functional capability (25.4%) (p < 0.001). The result was not homogeneous for the biochemical metabolic variables, where glycosylated hemoglobin, glycemia, and lipid profile did not show significant improvement, except for HDL, which raised its levels statistically significantly (p < 0.001). Conclusions CR is effective as a central strategy to perform tertiary prevention in patients with ICC since it notably improves quality of life and coronary risk factors.
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Affiliation(s)
| | - Adriel Olórtegui Yzu
- Instituto Nacional Cardiovascular INCOR, Lima, PerúInstituto Nacional Cardiovascular INCORLimaPerú
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Sandner S, Misfeld M, Caliskan E, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Böhm J, Krane M, González-Santos JM, Tellez JC, Holubec T, Ferrari E, Doros G, Vitarello CJ, Emmert MY. Clinical outcomes and quality of life after contemporary isolated coronary bypass grafting: a prospective cohort study. Int J Surg 2023; 109:707-715. [PMID: 36912566 PMCID: PMC10389413 DOI: 10.1097/js9.0000000000000259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The objective of the European Multicenter Registry to Assess Outcomes in coronary artery bypass grafting (CABG) patients (DuraGraft Registry) was to determine clinical outcomes and quality of life (QoL) after contemporary CABG that included isolated CABG and combined CABG/valve procedures, using an endothelial damage inhibitor (DuraGraft) intraoperatively for conduit preservation. Here, we report outcomes in the patient cohort undergoing isolated CABG. METHODS The primary outcome was the composite of all-cause death, myocardial infarction (MI), or repeat revascularization (RR) [major adverse cardiac events (MACE)] at 1 year. Secondary outcomes included the composite of all-cause death, MI, RR, or stroke [major adverse cardiac and cerebrovascular events (MACCE)], and QoL. QoL was assessed with the EuroQol-5 Dimension questionnaire. Independent risk factors for MACE at 1 year were determined using Cox regression analysis. RESULTS A total of 2532 patients (mean age, 67.4±9.2 years; 82.5% male) underwent isolated CABG. The median EuroScore II was 1.4 [interquartile range (IQR), 0.9-2.3]. MACE and MACCE rates at 1 year were 6.6% and 7.8%, respectively. The rates of all-cause death, MI, RR, and stroke were 4.4, 2.0, 2.2, and 1.9%, respectively. The 30-day mortality rate was 2.3%. Age, extracardiac arteriopathy, left ventricular ejection fraction less than 50%, critical operative state, and left main disease were independent risk factors for MACE. QoL index values improved from 0.84 [IQR, 0.72-0.92] at baseline to 0.92 [IQR, 0.82-1.00] at 1 year ( P <0.0001). CONCLUSION Contemporary European patients undergoing isolated CABG have a low 1-year clinical event rate and an improved QoL.
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Affiliation(s)
| | - Martin Misfeld
- Royal Prince Alfred Hospital
- Institute of Academic Surgery at Royal Prince Alfred Hospital
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney
- Medical School, University of Sydney, Camperdown, New South Wales, Australia
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig
| | - Etem Caliskan
- Charité Universitätsmedizin Berlin
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin
| | | | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center Bad Nauheim, Campus Kerckhoff Justus-Liebig University Giessen, Giessen
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat
- Bahçeşehir University Faculty of Medicine, Istanbul, Turkey
| | | | | | | | | | - Markus Krane
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | | | - Maximilian Y. Emmert
- Charité Universitätsmedizin Berlin
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin
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Salihi S, Erkengel Hİ, Saçlı H, Kara İ. The Effectiveness of Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction. Braz J Cardiovasc Surg 2023; 38:132-138. [PMID: 35675492 PMCID: PMC10010734 DOI: 10.21470/1678-9741-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction (LVD) remains a surgical challenge and is still controversial. The aim of this study was to evaluate the effectiveness of CABG in patients with LVD. METHODS This retrospective study included a total of 160 consecutive patients (133 males, 27 females, mean age 62.1±10.12 years [range 37 to 86 years]) who had a left ventricular ejection fraction (LVEF) ≤ 45% determined by echocardiography and underwent elective isolated CABG between September 2013 and December 2018. Preoperative echocardiographic data, such as ejection fraction, left ventricular (LV) end-systolic diameter, and LV end-diastolic diameter, were collected and evaluated. Preoperatively, 85 (53.13%) patients were in New York Heart Association functional class III or IV and the mean LVEF was 38.65±5.72% (range 20 to 45). RESULTS The overall hospital mortality was 5% (eight patients). Late follow-up was obtained in 152 (90%) cases (median follow-up time was 56,5 [3-87] months postoperatively). During follow-up, mortality developed in 11.3% (16 patients). Mean LVEF increased significantly from 38.78±5.59% before surgery to 43.29±8.46% after surgery (P<0.01). Mean late survival, freedom from coronary reintervention, and congestive heart failure rates were 86.3±3.3%, 88.7±3.9%, and 89.4±3.1%, respectively. CONCLUSION In patients with LVD, CABG can be performed with low postoperative morbidity and mortality rates. Patients with LVD could benefit from coronary bypass surgery regarding postoperative LV systolic function and higher quality of life.
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Affiliation(s)
- Salih Salihi
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - Halil İbrahim Erkengel
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - Hakan Saçlı
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - İbrahim Kara
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
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Mori M, Mark DB, Khera R, Lin H, Jones P, Huang C, Lu Y, Geirsson A, Velazquez EJ, Spertus JA, Krumholz HM. Identifying quality of life outcome patterns to inform treatment choices in ischemic cardiomyopathy. Am Heart J 2022; 254:12-22. [PMID: 35932911 DOI: 10.1016/j.ahj.2022.07.007] [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: 04/07/2022] [Revised: 06/14/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Surgical Treatment for Ischemic Heart Failure (STICH) trial found that routine use of coronary artery bypass surgery (CABG) improved mean quality of life (QoL) scores relative to guideline-directed medical therapy (GDMT) in patients with ischemic cardiomyopathy. However, mean differences in QoL scores do not provide what patients want to know when facing a high-risk/high-benefit treatment choice. METHODS We analyzed Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary scores in CABG and GDMT patients over 36 months using a combination of statistical methods to group QoL data into clinically relevant outcome patterns (phenotype trajectories) and to then identify the main baseline predictors of each phenotype. QoL outcome phenotypes were developed using mixture models to define the dominant phenotype trajectories present in STICH QoL data. Logistic regression models were used to predict each patient's probability of achieving each outcome pattern with each treatment. RESULTS In STICH, 592 patients underwent CABG and 607 were managed with GDMT. Our analyses identified 3 phenotype trajectory patterns in both treatment groups. Two of the 3 trajectories showed improving patterns, and were classified as "good QoL trajectories," seen in 498 (84.1%) CABG and 449 (73.9%) GDMT patients. Defining a consequential CABG-GDMT treatment difference as a >10% higher absolute predicted probability of belonging to good QoL trajectories, 277 (23.5%) patients were more likely to have good outcome with CABG while 45 (3.8%) patients were more likely to have a good outcome with GDMT. For 644 (54.7%) patients, CABG and GDMT probabilities of a good outcome were within 5% of each other. CONCLUSIONS The pattern of QoL outcomes after CABG compared with GDMT in STICH followed 3 main phenotypic trajectories, which could be predicted based on individual baseline features. Patient-specific predictions about expected QoL outcomes with different treatment choices provide an intuitive framework for personalizing patient decision making.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, YaleNew Haven Hospital, New Haven, CT
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, YaleNew Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Haiqun Lin
- Division of Nursing Science, School of Nursing & Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Newark, NJ
| | - Philip Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO; Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO
| | - Chenxi Huang
- Center for Outcomes Research and Evaluation, YaleNew Haven Hospital, New Haven, CT
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, YaleNew Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO; Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, YaleNew Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
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Kirtane AJ. REVIVE-ing a Weak Heart - Details Matter. N Engl J Med 2022; 387:1426-1427. [PMID: 36027562 DOI: 10.1056/nejme2210183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ajay J Kirtane
- From the Columbia University Irving Medical Center, New York-Presbyterian Hospital, and the Cardiovascular Research Foundation - both in New York
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12
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Masterson Creber R, Safford M, Ballman K, Myers A, Fremes S, Gaudino M. Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts: Quality of Life (ROMA:QOL) - Rationale and Study Protocol. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:510-517. [PMID: 33779716 PMCID: PMC9638519 DOI: 10.1093/ehjqcco/qcab022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/29/2022]
Abstract
AIMS The objective of the Randomized comparison of the Outcome of single vs. Multiple Arterial grafts: Quality of Life (ROMA:QOL) trial is to evaluate the impact of coronary artery bypass graft surgery (CABG) on quality of life (QOL). The primary hypothesis of ROMA:QOL is that participants in the multiple arterial graft (MAG) will report time-varying changes in QOL that will be lower in the post-operative recovery period and higher after 12 months compared to patients in the single arterial graft (SAG). The secondary hypotheses are that both groups will have improvements in symptoms at 12 months, and that compared to the SAG group, participants in the MAG group will experience better physical functioning and physical and mental health symptoms. METHODS AND RESULTS An estimated 2111 participants will be enrolled from the parent ROMA trial from 13 countries. Outcome assessments include the Seattle Angina Questionnaire (SAQ) (primary outcome), Short Form-12v2, EuroQol-5D (EQ-5D)-5L, PROMIS-29, and PROMIS Neuropathic Pain measured at baseline, first post-operative visit, 6, 12, 24, 36, 48, and 60 months. The analysis for the primary outcome, the change in the SAQ from baseline to 12 months, will be compared across all time-points between the two treatment arms. CONCLUSION The ROMA:QOL trial will answer whether there are differences in QOL, physical and mental health symptoms overall for CABG, by MAG and SAG intervention arms, by sex, and between patients with and without diabetes.
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Affiliation(s)
- Ruth Masterson Creber
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065, USA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 1300 York Ave, F-2007, New York, NY 10065, USA
| | - Karla Ballman
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065, USA
| | - Annie Myers
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065, USA
| | - Stephen Fremes
- Department of Surgery (cardiac), Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, 2075 Bayview Avenue, H-Wing, Room H410 Toronto, ON M4N 3M5, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St M-404, New York, NY 10065, USA
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13
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 710] [Impact Index Per Article: 355.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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14
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol 2022; 79:1757-1780. [DOI: 10.1016/j.jacc.2021.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e876-e894. [PMID: 35363500 DOI: 10.1161/cir.0000000000001062] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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16
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 824] [Impact Index Per Article: 412.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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17
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Heidenreich PAULA, BOZKURT BIYKEM, AGUILAR DAVID, ALLEN LARRYA, BYUN JONIJ, COLVIN MONICAM, DESWAL ANITA, DRAZNER MARKH, DUNLAY SHANNONM, EVERS LINDAR, FANG JAMESC, FEDSON SAVITRIE, FONAROW GREGGC, HAYEK SALIMS, HERNANDEZ ADRIANF, KHAZANIE PRATEETI, KITTLESON MICHELLEM, LEE CHRISTOPHERS, LINK MARKS, MILANO CARMELOA, NNACHETA LORRAINEC, SANDHU ALEXANDERT, STEVENSON LYNNEWARNER, VARDENY ORLY, VEST AMANDAR, YANCY CLYDEW. 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guideline for the Management of Heart Failure: Executive Summary. J Card Fail 2022; 28:810-830. [DOI: 10.1016/j.cardfail.2022.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Chew DS, Cowper PA, Al-Khalidi H, Anstrom KJ, Daniels MR, Davidson-Ray L, Li Y, Michler RE, Panza JA, Piña IL, Rouleau JL, Velazquez EJ, Mark DB. Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial. Circulation 2022; 145:819-828. [PMID: 35044802 PMCID: PMC8959089 DOI: 10.1161/circulationaha.121.056276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results. METHODS We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. RESULTS For the CABG arm, we estimated 6.53 quality-adjusted life-years (95% CI, 5.70-7.53) and a lifetime cost of $140 059 (95% CI, $106 401 to $180 992). For the MED arm, the corresponding estimates were 5.52 (95% CI, 5.06-6.09) quality-adjusted life-years and $74 894 lifetime cost (95% CI, $58 372 to $93 541). The incremental cost-effectiveness ratio for CABG compared with MED was $63 989 per quality-adjusted life-year gained. At a societal willingness-to-pay threshold of $100 000 per quality-adjusted life-year gained, CABG was found to be economically favorable compared with MED in 87% of microsimulations. CONCLUSIONS In the STICH trial, in patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to MED at current benchmarks for value in the United States. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00023595.
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Affiliation(s)
- Derek S Chew
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Department of Cardiac Sciences, Libin Cardiovascular Institute (D.S.C.), University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health (D.S.C.), University of Calgary, Alberta, Canada
| | - Patricia A Cowper
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Hussein Al-Khalidi
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics (H.A., K.J.A.), Duke University, Durham, NC
| | - Kevin J Anstrom
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics (H.A., K.J.A.), Duke University, Durham, NC
| | - Melanie R Daniels
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Linda Davidson-Ray
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Yanhong Li
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Robert E Michler
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.)
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, Westchester Medical Center Health Network, Valhalla, NY (J.A.P.)
| | - Ileana L Piña
- Department of Medicine, Wayne State University, Detroit, MI (I.L.P.)
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.)
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.J.V.)
| | - Daniel B Mark
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (D.B.M.)
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19
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Rengo JL, Savage PD, Hirashima F, Leavitt BJ, Ades PA, Toth MJ. Assessment of the Early Disabling Effects of Coronary Artery Bypass Graft Surgery Using Direct Measures of Physical Function. J Cardiopulm Rehabil Prev 2022; 42:28-33. [PMID: 33797459 PMCID: PMC8464611 DOI: 10.1097/hcr.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Coronary artery bypass graft (CABG) surgery is an important treatment option in patients with coronary artery disease. Despite its beneficial effects, CABG surgery and its subsequent hospitalization may reduce physical functional capacity in patients, contributing to physical disability. Our objective was to assess the early disabling effects of CABG surgery and its subsequent hospitalization using direct measurements of physical function. METHODS Patients (n = 44) were assessed pre-surgery and at hospital discharge for physical function using the Short Physical Performance Battery (SPPB) and self-reported physical and mental health by questionnaire. RESULTS The total SPPB score (P < .001) and all of its components (P < .01-.001) decreased markedly following CABG surgery and hospitalization, with greater reductions in total SPPB score (P < .05) and gait speed (P < .01) in patients with higher body mass index. While CABG surgery and hospitalization reduced patient-reported physical function, changes in these indices largely did not correlate with changes in SPPB outcomes. CONCLUSION Our results show the early disabling effects of CABG surgery and hospitalization on directly measured physical function, and that patients with higher body mass index had greater reductions. In addition, our results underscore the need to perform direct measurements of physical function to describe reductions in physiological functional capacity. These findings suggest the need for inpatient rehabilitation or early mobility programs to address this decline in physical function.
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Affiliation(s)
- Jason L. Rengo
- Division of Cardiology, Department of Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Patrick D. Savage
- Division of Cardiology, Department of Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Fuyuki Hirashima
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Vermont, Burlington, VT
| | - Bruce J. Leavitt
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Vermont, Burlington, VT
| | - Philip A. Ades
- Division of Cardiology, Department of Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Michael J. Toth
- Division of Cardiology, Department of Medicine, College of Medicine, University of Vermont, Burlington, VT
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20
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Creber RM, Dimagli A, Spadaccio C, Myers A, Moscarelli M, Demetres M, Little M, Fremes S, Gaudino M. Effect of coronary artery bypass grafting on quality of life: a meta-analysis of randomized trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:259-268. [PMID: 34643672 PMCID: PMC9071531 DOI: 10.1093/ehjqcco/qcab075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 01/09/2023]
Abstract
AIMS We conducted a systematic review and meta-analysis to evaluate temporal trends in quality of life (QoL) after coronary artery bypass grafting (CABG) surgery in randomized clinical trials, and a quantitative comparison from before surgery to up to 5 years after surgery. METHODS AND RESULTS We searched MEDLINE, CINAHL, EMBASE, Cochrane Library, and PsycINFO from 2010 to 2020 to identify studies that included the measurement of QoL in patients undergoing CABG. The primary outcome was the Seattle Angina Questionnaire (SAQ), and secondary outcomes were the 36-item Short Form Health Survey (SF-36) and EuroQol Questionnaire (EQ-5D). We pooled the means and the weighted mean differences over the follow-up period. In the meta-analysis, 2586 studies were screened and 18 full-text studies were included. There was a significant trend towards higher QoL scores from before surgery to 1 year post-operatively for the SAQ angina frequency (AF), SAQ QoL, SF-36 physical component (PC), and EQ-5D, whereas the SF-36 mental component (MC) did not improve significantly. The weighted mean differences from before surgery to 1 year after was 24 [95% confidence interval (CI): 21.6-26.4] for the SAQ AF, 31 (95% CI: 27.5-34.6) for the SAQ QoL, 9.8 (95% CI: 7.1-12.8) for the SF-36 PC, 7.1 (95% CI: 4.2-10.0) for the SF-36 MC, and 0.1 (95% CI: 0.06-0.14) for the EQ-5D. There was no evidence of publication bias or small-study effect. CONCLUSION CABG had both short- and long-term improvements in disease-specific QoL and generic QoL, with the largest improvement in angina frequency.
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Affiliation(s)
| | | | - Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK,Lancashire Cardiac Center, Blackpool Victoria Teaching Hospital, Blackpool, UK
| | - Annie Myers
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Marco Moscarelli
- Department of Cardiac Surgery, Imperial College London, London, UK
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY USA
| | - Matthew Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Stephen Fremes
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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21
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Dani SS, Minhas AMK, Arshad A, Krupica T, Goel SS, Virani SS, Sharma G, Blankstein R, Blaha MJ, Al-Kindi SG, Nasir K, Khan SU. Trends in Characteristics and Outcomes of Hospitalized Young Patients Undergoing Coronary Artery Bypass Grafting in the United States, 2004 to 2018. J Am Heart Assoc 2021; 10:e021361. [PMID: 34459230 PMCID: PMC8649273 DOI: 10.1161/jaha.121.021361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data are limited about young adults' characteristics and outcomes undergoing coronary artery bypass grafting (CABG). Methods and Results We used the National Inpatient Sample database to identify adults aged 18 to 45 years who underwent CABG between 2004 and 2018. The data were weighted to generate national estimates of the entire US hospitalized population. We identified 110 463 CABG cases, equivalent to 62.2 per 1 000 000 person‐years; 27.1% were women, and 70.2% were White adults. Overall, annual CABG volume per 1 000 000 significantly decreased from 87.3 in 2004 to 45.7 in 2018. The prevalence of obesity, diabetes mellitus, hypertension, drug abuse, and chronic medical conditions increased over time. Overall, inpatient mortality was 1.76%; ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation myocardial infarction, heart failure, peripheral vascular disease, renal failure, and valvular surgery were associated with higher inpatient mortality. Women had higher inpatient mortality than men (2.29% versus 1.57%), and Black patients had higher deaths than White patients (2.86% versus 1.58%). Inpatient mortality remained stable overall, according to sex, race, or clinical indication of CABG. However, the mean length of stay (8.4 days in 2004 to 9.5 days in 2018) and inflation‐adjusted cost of care ($40 522.8 in 2004 to $52 434.2 in 2018) significantly increased during the study period. Conclusions Despite the increased burden of cardiometabolic risk factors, the inpatient mortality in young adults undergoing CABG remained stable during the last 15 years. However, CABG volumes have decreased, but length of stay and inflation‐adjusted costs have increased over time.
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Affiliation(s)
- Sourbha S Dani
- Division of Cardiology Lahey Hospital and Medical CenterBeth Israel Lahey Health Burlington MA
| | | | - Adeel Arshad
- Department of Medical Oncology Ohio State University Comprehensive Cancer Care Center Columbus OH
| | - Troy Krupica
- Department of Medicine West Virginia University Morgantown WV
| | - Sachin S Goel
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Ron Blankstein
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular InstituteUniversity Hospitals and Case Western Reserve University Cleveland OH
| | - Khurram Nasir
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
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22
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Myocardial Viability Assessment Before Surgical Revascularization in Ischemic Cardiomyopathy: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1068-1077. [PMID: 34474740 DOI: 10.1016/j.jacc.2021.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
Ischemic cardiomyopathy results from the combination of scar with fibrosis replacement and areas of dysfunctional but viable myocardium that may improve contractile function with revascularization. Observational studies reported that only patients with substantial amounts of myocardial viability had better outcomes following surgical revascularization. Accordingly, dedicated noninvasive techniques have evolved to quantify viable myocardium with the objective of selecting patients for this form of therapeutic intervention. However, prospective trials have not confirmed the interaction between myocardial viability and the treatment effect of revascularization. Furthermore, recent observations indicate that recovery of left ventricular function is not the principal mechanism by which surgical revascularization improves prognosis. In this paper, the authors describe a more contemporary application of viability testing that is founded on the alternative concept that the main goal of surgical revascularization is to prevent further damage by protecting the residual viable myocardium from subsequent acute coronary events.
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23
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Katsi V, Georgiopoulos G, Mitropoulou P, Kontoangelos K, Kollia Z, Tzavara C, Soulis D, Toutouzas K, Oikonomou D, Aimo A, Tsioufis K. Exercise tolerance and quality of life in patients with known or suspected coronary artery disease. Qual Life Res 2021; 30:2541-2550. [PMID: 33893931 DOI: 10.1007/s11136-021-02844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is known to impact on patients' physical and mental health. The relationship between performance on treadmill exercise tolerance test (ETT) and health-related quality of life (HRQL)has never been specifically investigated in the setting of CAD. METHODS Consecutive patients undergoing an ETT with the Bruce protocol during a diagnostic workup for CAD (n = 1,631, age 55 ± 12 years) were evaluated. Exercise-related indices were recorded. Detailed information on cardiovascular risk factors and past medical history were obtained. HRQLwas assessed with the use of the validated 36-Item Short Form Survey (SF-36) questionnaire. RESULTS Increasing age and the presence of cardiovascular risk factors and comorbidities correlated with lower scores on the physical and mental health component of SF-36(all P < 0.05). Subjects with arrhythmias during exercise and slow recovery of systolic blood pressure had lower scores on the physical health indices or the Social Role Functioning component (P < 0.05). Achieved target heart rate and good exercise tolerance were independently associated with better scores of the physical and mental health domains of SF-36 and overall HRQLscores (β = 0.05 for target HR and PCS-36, β = 1.86 and β = 1.66 per increasing stage of exercise tolerance and PCS-36 and MCS-36, respectively, P < 0.001 for all associations). Ischemic ECG changes were associated with worse scores on Physical Functioning (β = - 3.2, P = 0.02) and Bodily Pain (β = - 4.55, P = 0.026). CONCLUSION ETT parameters are associated with HRQL indices in patients evaluated for possible CAD. Physical conditioning may increase patient well-being and could serve as a complementary target in conjunction with cardiovascular drug therapy.
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Affiliation(s)
- Vasiliki Katsi
- First Department of Cardiology, Hippocration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Department of Cardiology, Hippocration Hospital, Athens, Greece.
- Cardiovascular Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.
| | - Panagiota Mitropoulou
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Konstantinos Kontoangelos
- 1st Department of Psychiatry, Eginition Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Kollia
- Emergency Department, Amalia Fleming' General Hospital, Athens, Greece
| | - Chara Tzavara
- Emergency Department, Amalia Fleming' General Hospital, Athens, Greece
| | - Dimitrios Soulis
- Emergency Department, Amalia Fleming' General Hospital, Athens, Greece
| | | | | | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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24
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Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm. J Am Coll Cardiol 2020; 76:2252-2266. [DOI: 10.1016/j.jacc.2020.08.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 01/09/2023]
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Curcio N, Bennett MM, Hebeler KR, Warren AM, Edgerton JR. Quality of Life Is Improved 1 Year After Cardiac Surgery. Ann Thorac Surg 2020; 111:1954-1960. [PMID: 33065050 DOI: 10.1016/j.athoracsur.2020.07.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/29/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Quality of life (QoL) is increasingly important in the era of patient-centered outcomes and value-based reimbursement. However most follow-up is limited to 30 days, and long-term data on QoL improvement associated with symptom relief are lacking. Therefore we sought to analyze QoL after cardiac surgery in a nonemergent, all-comers population. METHODS Four hundred two patients undergoing routine cardiac surgery at 2 large urban hospitals in the Dallas, Texas area were enrolled. Follow-up was complete for 364 patients. Data were collected from August 2013 to January 2017. The Kansas City Cardiomyopathy Questionnaire was administered at baseline, 1 month, and 1 year after surgery. Repeated-measures analysis was used for each domain of the questionnaire for all procedures and stratified by procedure. If time was found to be a significant factor, pairwise analysis was performed with P values adjusted using the Tukey-Kramer method. RESULTS There was a significant increase across all domains of Kansas City Cardiomyopathy Questionnaire scores for all procedures and for most domains when stratifying by procedure. This increase in QoL was most marked after 1 month. All domain scores increased through 1 year except symptom stability, which peaked at 1 month postsurgery and then regressed at 1 year, suggesting an overall improvement and stabilization of symptoms. The occurrence of complications did not alter this trajectory. CONCLUSIONS QoL and other patient-centered outcomes are improved at 1 month and continue to improve throughout the year. Knowledge of these data is important for patient selection, fully informed consent, and shared decision-making.
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Affiliation(s)
- Nicholas Curcio
- Division of Trauma, Critical Care and Acute Care Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Monica M Bennett
- Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Katherine R Hebeler
- Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Ann Marie Warren
- Division of Trauma, Critical Care and Acute Care Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas.
| | - James R Edgerton
- Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas; Division of Cardiothoracic Surgery, Washington University, Barnes Jewish Hospital, St Louis, Missouri; Department of Biology, College of Charleston, Charleston, South Carolina
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Pan Y, Qiu Q, Ren WH, Yu XP, Liu ZS, Dong JZ. Left ventricular systolic dysfunction in patients with unprotected left main coronary artery disease. Herz 2020; 46:262-268. [PMID: 32435839 DOI: 10.1007/s00059-020-04934-y] [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: 12/01/2019] [Revised: 02/08/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimal coronary revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease and left ventricular systolic dysfunction (LVSD) remains uncertain. The purpose of this study was to evaluate the clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) versus coronary artery bypass grafting (CABG) in patients with ULMCA disease with or without LVSD. METHODS A total of 984 patients with ULMCA disease who received a DES (n = 511) or underwent CABG (n = 473) were included in this study. We retrospectively analyzed the clinical parameters and outcomes of ULMCA disease patients with different left ventricular ejection fraction levels. RESULTS There were no significant differences in major adverse cardiac and cerebral events, all-cause death, cardiac death, myocardial infarction, or stroke between the CABG and DES groups with or without LVSD. The rate of target vessel revascularization was significantly higher with DES compared with CABG in patients without LVSD; however, the difference was not significant between the mild LVSD and severe LVSD groups. CONCLUSION For patients with ULMCA disease and LVSD, there was no significant difference between DES and CABG in terms of efficacy and safety. Treatment with DES was an acceptable alternative to CABG.
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Affiliation(s)
- Yu Pan
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Qi Qiu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei-Hong Ren
- Department of Pathology, Aviation General Hospital of China Medical University, China Medical University, Beijing, China
| | - Xian-Peng Yu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Ze-Sen Liu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
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27
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Arbab-Zadeh A, Fuster V. From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:1582-1593. [PMID: 31537269 DOI: 10.1016/j.jacc.2019.07.062] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have identified features of coronary atherosclerosis that precede acute coronary events. However, many factors influence the risk of adverse events from coronary atherosclerotic disease and available data support our transition from focusing on individual "vulnerable plaque," coronary arterial stenosis, and inducible myocardial ischemia to understanding coronary heart disease as multifactorial, chronic disease. The concept of the vulnerable patient has evolved, with the atheroma burden, its metabolic activity, and the disposition to vascular thrombosis building a platform for assessing central aspects of coronary heart disease. In turn, this model has directed us to a focus on controlling the activity of atherosclerotic disease and on modifying the susceptibility of vascular thrombosis which has led to reduced morbidity and mortality from coronary heart disease.
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Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Valentin Fuster
- Mount Sinai Heart Center, Icahn School of Medicine at Mount Sinai, New York, New York
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28
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Zuo H, Zhang Y, Ma F, Li R, Wang Y, Li C, Wang H, Wang DW. Myocardial Deformation Pattern Differs between Ischemic and Non-ischemic Dilated Cardiomyopathy: The Diagnostic Value of Longitudinal Strains. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:233-243. [PMID: 31718811 DOI: 10.1016/j.ultrasmedbio.2019.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Both ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) are characterized by left ventricular (LV) dysfunction and dilation. Differentiation between ICM and NICM using non-invasive image modalities is a clinical challenge. This study compared the myocardial deformation patterns of ICM and NICM using 2-D speckle tracking echocardiography (2-D STE) and sought to find parameters valuable in the diagnosis and management of dilated cardiomyopathy. The study population comprised 84 consecutive patients with LV end-diastolic dimension >55 mm and ejection fraction (EF) <45 %. Of these patients, 41 were diagnosed with ICM and 43 with NICM by coronary angiography. 2-D STE was performed in all patients. The LV dimension did not differ between ICM and NICM. Compared with patients with ICM, patients with NICM had lower EF (29.0% vs. 33.0%, p = 0.024), lower global longitudinal strain (-5.4 ± 2.6% vs. -7.0 ± 2.5%, p = 0.006) and lower global radial strain (7.5 ± 4.5% vs. 10.7 ± 4.7%, p = 0.019). In contrast, global longitudinal strains did not differ significantly. However, NICM patients had higher apical and lower basal longitudinal strains compared with those with ICM. The ratio of basal to sum of mid- and apical longitudinal strains could predict NICM with a sensitivity of 63.4% and specificity of 88.4% by receiver operating characteristic curve analysis (cutoff value: 0.47, area under the curve: 0.792). Moreover, the concomitant presence of non-significant coronary artery stenosis (>50% and <70%) had no significant influence on global longitudinal strain in NICM. In conclusion, LV dilation and systolic dysfunction, relative apical sparing and a basal worsening pattern of LV longitudinal strain by 2-D STE were observed in patients with NICM but not ICM. The ratio of basal to sum of mid- and apical longitudinal strains could help differentiate NICM from ICM.
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Affiliation(s)
- Houjuan Zuo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenze Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yanagawa B, Lee J, Puskas JD, Verma S. Revascularization in left ventricular dysfunction: an update. Curr Opin Cardiol 2019; 34:536-542. [PMID: 31394562 DOI: 10.1097/hco.0000000000000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an overview of revascularization in patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD). RECENT FINDINGS Patients with significant CAD and LVD are a high-risk patient population. They make up a minority of the cases from the largest, prospective coronary revascularization trials. The Surgical Treatment for Ischemic Heart Failure (STICH) Trial and its substudies are the most important and well cited in this field. The 10-year data from STICH showed that surgical revascularization was associated with lower all-cause mortality compared with medical therapy. Several smaller studies have confirmed that surgical revascularization carries a significant risk of short-term mortality but overall improved long-term outcomes in patients with LVD. Data from multiple observational studies further confirm that coronary artery bypass graft (CABG) is superior to percutaneous coronary revascularization for long-term survival and freedom from repeat revascularization in patients with LVD. We suggest that patients with LVD undergoing CABG should be considered for multiarterial grafting and that some patients may benefit from an off-pump procedure. SUMMARY Surgical revascularization confers a long-term survival benefit in patients with significant CAD and LVD. Further studies will be needed to precisely determine the ideal candidate for surgical versus percutaneous revascularization.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Lee
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John D Puskas
- Division of Cardiothoracic Surgery, Mt Sinai St Lukes, New York, New York, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Hassanabad AF, MacQueen KT, Ali I. Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of outcomes. J Card Surg 2019; 34:1075-1082. [DOI: 10.1111/jocs.14166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of MedicineUniversity of Calgary Calgary Canada
| | - Kelsey T. MacQueen
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of MedicineUniversity of Calgary Calgary Canada
| | - Imtiaz Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of MedicineUniversity of Calgary Calgary Canada
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Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:127. [PMID: 30815422 PMCID: PMC6387802 DOI: 10.14196/mjiri.32.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
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Narimani M, Ansari Jaberi A, Negahban Bonabi T, Sadeghi T. Effect of Acupressure on Pain Severity in Patients Undergoing Coronary Artery Graft: A Randomized Controlled Trial. Anesth Pain Med 2018; 8:e82920. [PMID: 30538941 PMCID: PMC6252046 DOI: 10.5812/aapm.82920] [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] [Received: 08/04/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023] Open
Abstract
Background Considering the contradictory results on the role of complementary therapies in correcting post-operative side effects, the aim of this study was to evaluate the effect of acupressure on pain severity in patients undergoing coronary artery graft admitted to a coronary care unit. Methods In this double-blind, randomized, clinical trial, 70 patients were selected randomly after coronary artery bypass grafting (CABG) surgery based on inclusion criteria and then assigned to two groups (35 in acupressure and 35 in control) randomly by the minimization method. The intervention group received acupressure at the LI4 point for 20 minutes in 10-second pressure and 2-second resting periods. In the control group, only touching was applied without any pressure in the same pattern as the intervention group. Pain severity was measured before, immediately, and 20 minutes after applying pressure and touch in both groups using the visual analogue scale. Results The results of repeated measures analysis of variance (ANOVA) showed a decrease in the pain score in the intervention group (group effect) during multiple measurements (time effect) and a reduction in the mean pain score in the various measurements taking into account the groups (the interaction between time and group; P = 0.001). Conclusions Acupressure can be used as a complementary and alternative therapeutic approach to relieve post-operative pain in CABG patients.
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Affiliation(s)
- Marayam Narimani
- Department of Medical Surgical Nursing, Students Research Committee, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Ansari Jaberi
- Department of Psychiatric and Mental Health Nursing, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Negahban Bonabi
- Department of Community Health Nursing, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Corresponding Author: Ph.D. of Community Health Nursing, Department of Community Health Nursing, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. E-mail:
| | - Tabandeh Sadeghi
- Department of Pediatric Nursing, Non-Communicable Disease Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Zolfaghari M, Mirhosseini SJ, Baghbeheshti M, Bauer BA. The Effect of Classic Chest Physiotherapy on Postoperative Pain Scores and Hospital Stay in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial. Galen Med J 2018; 7:e838. [PMID: 34466414 PMCID: PMC8343894 DOI: 10.22086/gmj.v0i0.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Abstract
Background Chest physiotherapy (CPT) is a care that increases the mobilization of several structures from both muscle and subcutaneous tissue. We planned to investigate the effect of classic CPT on pain, fatigue, satisfaction, and hospital length of stay (LOS) in patients undergoing off-pump coronary artery bypass graft (CABG). Materials and Methods This study was a randomized controlled trial that conducted on 50 patients undergoing elective off-pump CABG. The patients have been randomly divided into two groups; in the group A (n=25) patients received physiotherapy at a single session of classic CPT, 4 times during 2nd to 5th days for 15 minutes in every session, in the group B (n=25) patients had not protocol of this exercise therapy (control). Results The average age of all participants was 62.08 ±9.08 years. Of the 50 patients, 33 (66%) was male. Classic CPT significantly decreased pain (P=0.04), hospital LOS (P=0.010) and could increase in patients' satisfaction (P<0.001). However, it had no considerable effect on fatigue (P=0.725). Conclusion According to our findings, classic CPT could improve postoperative care after off-pump CABG surgery.
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Affiliation(s)
- Mohammad Zolfaghari
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Jalil Mirhosseini
- Department of Cardiovascular Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Baghbeheshti
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Brent A Bauer
- Complementary and Integrative Medicine, Division General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Stewart RAH, Szalewska D, Stebbins A, Al-Khalidi HR, Cleland JGH, Rynkiewicz A, Drazner MH, White HD, Mark DB, Roy A, Kosevic D, Rajda M, Jasinski M, Leng CY, Tungsubutra W, Desvigne-Nickens P, Velazquez EJ, Petrie MC. Six-minute walk distance after coronary artery bypass grafting compared with medical therapy in ischaemic cardiomyopathy. Open Heart 2018. [PMID: 29531766 PMCID: PMC5845417 DOI: 10.1136/openhrt-2017-000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background In patients with ischaemic left ventricular dysfunction, coronary artery bypass surgery (CABG) may decrease mortality, but it is not known whether CABG improves functional capacity. Objective To determine whether CABG compared with medical therapy alone (MED) increases 6 min walk distance in patients with ischaemic left ventricular dysfunction and coronary artery disease amenable to revascularisation. Methods The Surgical Treatment in Ischemic Heart disease trial randomised 1212 patients with ischaemic left ventricular dysfunction to CABG or MED. A 6 min walk distance test was performed both at baseline and at least one follow-up assessment at 4, 12, 24 and/or 36 months in 409 patients randomised to CABG and 466 to MED. Change in 6 min walk distance between baseline and follow-up were compared by treatment allocation. Results 6 min walk distance at baseline for CABG was mean 340±117 m and for MED 339±118 m. Change in walk distance from baseline was similar for CABG and MED groups at 4 months (mean +38 vs +28 m), 12 months (+47 vs +36 m), 24 months (+31 vs +34 m) and 36 months (-7 vs +7 m), P>0.10 for all. Change in walk distance between CABG and MED groups over all assessments was also similar after adjusting for covariates and imputation for missing values (+8 m, 95% CI -7 to 23 m, P=0.29). Results were consistent for subgroups defined by angina, New York Heart Association class ≥3, left ventricular ejection fraction, baseline walk distance and geographic region. Conclusion In patients with ischaemic left ventricular dysfunction CABG compared with MED alone is known to reduce mortality but is unlikely to result in a clinically significant improvement in functional capacity. Trial registration number NCT00023595.
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Affiliation(s)
- Ralph A H Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | | | - Amanda Stebbins
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - John G H Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Andrzej Rynkiewicz
- Department of Cardiology and Cardiosurgery, University of Warmia and Mazury, Olsztyn, Poland
| | - Mark H Drazner
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Daniel B Mark
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dragana Kosevic
- Department of Cardiology, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Miroslaw Rajda
- Nova Scotia Health Authority, Queen Elizabeth II Health Science Centre, Halifax, Canada
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Chua Yeow Leng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Eric J Velazquez
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark C Petrie
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
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35
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Faerber G, Doenst T. Cardiac (valve) surgery in the elderly-who decides you are too old? J Thorac Cardiovasc Surg 2018; 155:1461-1462. [PMID: 29395205 DOI: 10.1016/j.jtcvs.2017.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
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INTEGRAL EVALUATION OF EFFECTIVENESS OF THE RENEWAL TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AFTER MYOCARDIUM SURGICAL REVASCULARIZATION. EUREKA: HEALTH SCIENCES 2017. [DOI: 10.21303/2504-5679.2017.00414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular diseases are the one of main causes of lethality in all developed countries. In the structure of this group of diseases ischemic heart disease (IHD) occupies the leading place. In the last decade methods of myocardium surgical revascularization that allow to remodel the myocardium essentially and to increase its functional features significantly are developed. Alongside with it, myocardium surgical revascularization doesn’t eliminate main causes of atherosclerotic diseases. Ineffective rehabilitation, including insufficient management of main factors of the cardiovascular risk may essentially decrease results of this operation.
The aim of the study was to elaborate the integral evaluation of the effectiveness of the renewal treatment of patients with IHD after myocardium surgical revascularization. For this aim we offer to use metabolic (leptin, НОМА index, atherogenicity index) and clinical-functional indices (body mass index, physical working ability and ejection fraction (EF) of the left ventricle, anxiety and depression level) before and after the renewal treatment and the result – integral index (I), calculated by the formula: , where М(1+2+n) – metabolic (leptin, НОМА index, atherogenicity index) indices, F(1+2+n) – functional and anthropometric ones (BMI, physical working ability, and EF of the left ventricle).
The use of the integral index before the renewal treatment allows to elaborate the effective rehabilitation program, and after – to study the effectiveness of elaborated complexes and to decrease risks of IHD progression.
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Álvarez-Cabo R, Meana B, Díaz R, Hernández-Vaquero D, Mencía P, Martín M, Llosa JC, Morales C, Silva J. Cirugía coronaria en pacientes con disfunción ventricular severa. Resultados a medio plazo. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lewis EF, Claggett BL, McMurray JJV, Packer M, Lefkowitz MP, Rouleau JL, Liu J, Shi VC, Zile MR, Desai AS, Solomon SD, Swedberg K. Health-Related Quality of Life Outcomes in PARADIGM-HF. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003430. [DOI: 10.1161/circheartfailure.116.003430] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Eldrin F. Lewis
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Brian L. Claggett
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - John J. V. McMurray
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Milton Packer
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Martin P. Lefkowitz
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Jean L. Rouleau
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Jiankang Liu
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Victor C. Shi
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Michael R. Zile
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Akshay S. Desai
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Scott D. Solomon
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
| | - Karl Swedberg
- From the Brigham and Women’s Hospital, Boston, MA (E.F.L., B.L.C., J.L., A.S.D., S.D.S.); BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.); Novartis, East Hanover, NJ (M.P.L., V.C.S.); Institut de Cardiologie de Montreal, Université de Montreal, Canada (J.L.R.); Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC
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Aksut B, Starling R, Kapadia S. Stable coronary artery disease and left ventricular dysfunction: The role of revascularization. Catheter Cardiovasc Interv 2017; 90:777-783. [DOI: 10.1002/ccd.27175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/15/2017] [Accepted: 06/08/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Baran Aksut
- Department of Cardiovascular Medicine; Cleveland Clinic; Ohio
| | | | - Samir Kapadia
- Department of Cardiovascular Medicine; Cleveland Clinic; Ohio
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41
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McKellar SH, Fang JC. An Age-Old Question: What Is Too Old for Coronary Artery Bypass Grafting in Heart Failure? Circulation 2016; 134:1325-1327. [PMID: 27799256 DOI: 10.1161/circulationaha.116.024878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen H McKellar
- From Division of Cardiothoracic Surgery (S.H.M.) and Division of Cardiovascular Medicine (J.C.F.), University of Utah, School of Medicine, Salt Lake City, UT
| | - James C Fang
- From Division of Cardiothoracic Surgery (S.H.M.) and Division of Cardiovascular Medicine (J.C.F.), University of Utah, School of Medicine, Salt Lake City, UT.
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42
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Revascularización quirúrgica en pacientes con disfunción ventricular severa. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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43
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Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure. J Am Coll Cardiol 2016; 68:450-458. [DOI: 10.1016/j.jacc.2016.05.060] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/03/2016] [Indexed: 01/22/2023]
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Association between publication of appropriate use criteria and the temporal trends in diagnostic angiography in stable coronary artery disease: A population-based study. Am Heart J 2016; 175:153-9. [PMID: 27179734 DOI: 10.1016/j.ahj.2016.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/19/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The appropriate use criteria (AUC) were developed to aid clinicians in making clinical decisions regarding coronary angiography. The aim of the present study was to evaluate the association between the publication of the AUC criteria in diagnostic angiography and rates of angiography in Ontario. METHODS Our cohort consisted of all patients who underwent coronary angiography in Ontario from 1st October 2008 to 31st October 2013 for the indication of suspected stable coronary artery disease. We determined monthly age- and sex-standardized rates of angiography per 100,000 adults. To determine the association between the publication of the AUC for diagnostic angiograms and the rates of angiography, we conducted a time series analysis using an autoregressive integrated moving average model. As a sensitivity analyses, we evaluated the impact of the AUC on the rates of percutaneous coronary intervention (PCI) per 100 angiograms. RESULTS We included 114,551 angiograms for stable coronary artery disease. In the period prior to the publication of the AUC, the average monthly age- and sex-standardized rate of angiography was 18.7 per 100,000; post-AUC, the average monthly rate decreased to 17.6 per 100,000 adults (P = .037). In contrast, in the 29,358 PCIs included in the analysis, the monthly PCI rates per 100 angiograms were unchanged (25.2 pre-AUC; 26.8 post-AUC; P = .29). In the sensitivity analysis, the rate of appropriate/inappropriate and uncertain indication did not significantly change over the study period. CONCLUSIONS The publication of the diagnostic angiography AUC criteria was associated with a decrease in the population rates of diagnostic angiography. This suggests that the AUC potentially was associated with an increased threshold to pursue invasive diagnostic testing.
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Abstract
The field of quality-of-life (QOL) measurement grew out of attempts in the 1960s and 1970s to connect the ever-increasing levels of public expenditure on technology-based health care for chronic diseases with evidence of the benefits and harms to patients. Most of the concepts, methods, and standards for measuring QOL were derived from psychometrics, but the degree to which current tools adhere to these methods varies greatly. Despite the importance of QOL, patient-reported outcomes are not measured in most cardiovascular clinical trials. Lack of familiarity with QOL measures and their interpretation, and unrealistic expectations about the information these measures can provide, are obstacles to their use. Large clinical trials of revascularization therapy for coronary artery disease and medical treatments for heart failure show small-to-moderate QOL effects, primarily detected with disease-specific instruments. Larger treatment effects, seen in trials of device therapy for heart failure and ablation therapy for atrial fibrillation, have been detected with both generic and disease-specific instruments. A large gap remains between the parameters currently being measured in clinical research and the data needed to incorporate the 'patient's voice' into therapeutic decision-making.
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Affiliation(s)
- Daniel B Mark
- Duke Clinical Research Institute, 2400 Pratt Avenue, Room 0311, PO Box 17969, Durham, North Carolina 27715, USA
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Wei Z, Xie J, Wang K, Kang L, Dai Q, Bai J, Xu B. Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Aged Patients With Unprotected Left Main Artery Lesions. Int Heart J 2016; 57:682-688. [DOI: 10.1536/ihj.15-420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Zhonghai Wei
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Jun Xie
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Kun Wang
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Lina Kang
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Qing Dai
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Jian Bai
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
| | - Biao Xu
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University
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Pepper J. Managing Heart Failure Patients with Multivessel Disease - Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention. Card Fail Rev 2015; 1:118-122. [PMID: 28785444 PMCID: PMC5491011 DOI: 10.15420/cfr.2015.1.2.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/07/2015] [Indexed: 11/04/2022] Open
Abstract
The foundation of treatment for heart failure with reduced ejection fraction is guideline-directed medical treatment. However, surgical revascularisation offers improved survival and quality of life for patients with more extensive coronary disease and the greatest degree of left ventricular systolic dysfunction and remodelling. The most commonly considered surgical interventions for patients with heart failure with reduced ejection fraction are coronary artery bypass surgery, sometimes combined with surgical ventricular reconstruction and surgery for mitral regurgitation. In this review, the author considers the risks and benefits of coronary artery bypass graft versus percutaneous coronary intervention in the management of heart failure patients with multivessel disease.
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Affiliation(s)
- John Pepper
- National Institute for Health Research, Royal Brompton Hospital, London, UK
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Thompson LE, Bekelman DB, Allen LA, Peterson PN. Patient-Reported Outcomes in Heart Failure: Existing Measures and Future Uses. Curr Heart Fail Rep 2015; 12:236-46. [DOI: 10.1007/s11897-015-0253-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Velazquez EJ, Bonow RO. Revascularization in Severe Left Ventricular Dysfunction. J Am Coll Cardiol 2015; 65:615-24. [DOI: 10.1016/j.jacc.2014.10.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/07/2014] [Indexed: 01/04/2023]
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Téllez Cantero JC, Barquero Aroca JM. Nuevas guías de la European Association for Cardio-Thoracic Surgery de revascularización miocárdica. Segunda parte. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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