Revascularization compared to medical treatment in patients with silent vs. symptomatic residual ischemia after thrombolyzed myocardial infarction--the DANAMI study.

AIMS: The aim was to compare the effect of revascularization to conservative treatment in patients with residual silent and with residual symptomatic ischemia following acute myocardial infarction (AMI). The study was a subanalysis of the DANAMI (DANish AMI) randomized study of invasive vs. conservative treatment in patients with inducible ischemia after thrombolysis in AMI. METHODS AND RESULTS: One thousand and eight patients were randomized to invasive or conservative treatment, stratified by the type of ischemia: silent, i.e. ST depression during an exercise test prior to discharge in 56%, or symptomatic, i.e. chest pain occurring either spontaneously during admission or during the exercise test, with or without ST changes, in 44%. Compared to a conservative strategy, invasive treatment reduced the incidence of nonfatal reinfarction, after in median 2.4 years, in both symptomatic patients (13.3-7.2%, p < 0.006) and patients with silent ischemia (10.1 vs. 5.7%, p < 0.05), and of admissions with unstable angina in symptomatic (44.5-27.6%, p < 0.0001) and silent ischemia (21.6-13.3%, p < 0.0006). CONCLUSIONS: Compared to conservative strategy, invasive treatment reduces the risk of nonfatal reinfarction and hospital admissions for unstable angina in thrombolyzed post-AMI patients with silent as well as symptomatic exercise-induced ischemia.

Postoperative wound infection: indicator of clinical quality?

INTRODUCTION: This study aims to gain experience with continuous electronic registration of data regarding postoperative wound infection following heart surgery. METHODOLOGY: Every patient undergoing cardiac surgery from February 1999 to May 1999 was included in a prospective study and followed for 30 days. Data regarding type of operation, development of postoperative wound infection, risk factors for wound infection and a risk stratification were submitted electronically to a central database. RESULTS: All 180 operations were registered in the database, and risk variables were registered for all patients but one (99.4%). A spot test comprising 32% of 131 operations registered at the time of the spot test, showed a predictive value of a correctly applied diagnosis of wound infection at 78%. Only 4/7 (57%) of infections in the spot test were registered in the database. All deep wound infections were registered during the study period. CONCLUSION: Data, including risk stratification, in relation to postoperative wound infection following heart surgery can be registered continuously in a central database. Registration of all wound infections, however, requires several resources and may be incomplete. The present registration's good level of cover concerning deep wound infection and risk variables indicates, that deep wound infection may provide a meaningful indicator of clinical quality, although good risk variables still need to be developed.

[Postoperative wound infection. Indicator of clinical quality?]. / Postoperativ sårinfektion. Indikator for klinisk kvalitet?

INTRODUCTION: The aim of the study was to gain experience with continuous electronic registration of data regarding surgical postoperative wound infection after heart surgery. MATERIAL AND METHODS: Every patient undergoing cardiac surgery from February 1999 to May 1999 was entered in a prospective study and followed up for 30 days. Information on the type of operation, development of postoperative wound infection, risk factors for wound infection, and a risk stratification was sent electronically to a central database. RESULTS: All 180 operations were registered in the database, and risk variables were registered for all patients except one (99.4%). A spot test comprising 32% of the operations showed a diagnostic specificity of 78% with respect to correct diagnosis of wound infection. Only 4/7 (57%) of the infections were registered in the database. All deep wound infections were registered during the study period. DISCUSSION: The study showed that risk stratification of data in relation to postoperative wound infection after heart surgery can be registered continuously in a central database. Registration of all postoperative wound infections requires several resources and may be incomplete. However, the high quality of registration of deep wound infection and risk stratification indicates that registration of deep wound infection could be an indicator of clinical quality.