The Utilization of Stress Tests Prior to Percutaneous Coronary Intervention for Stable Coronary Artery Disease in Taiwan.

BACKGROUND: Ischemia shown in non-invasive tests is considered to be a fundamental requirement for treating patients with stable coronary artery disease (CAD) with a percutaneous coronary intervention (PCI). In a nationwide cohort, we investigated the utilization of stress tests, including myocardial perfusion imaging (MPI), treadmill exercise test (TET) and stress echocardiography (SE) prior to elective PCI. METHODS: This retrospective study used the Longitudinal Health Insurance Database 2000 (LHID2000) of the National Health Insurance program in Taiwan. The LHID2000 is comprised of one million randomly sampled beneficiaries. We enrolled patients receiving elective PCI for stable CAD from 2000 to 2013. Stress tests performed within 90 days prior to PCI and patient characteristics correlated with the utilization of stress tests were investigated. RESULTS: During the investigation period, 3,163 patients received elective PCI for stable CAD and 1,847 (58.4%) patients had at least one stress test within 90 days prior to PCI. Among them, 1,461 (79.1%) had MPI, 1,228 had TET (66.4%) and only 1 had SE (0.05%). Age < 80 years, regional hospital and hyperlipidemia were independently associated with an increased likelihood of receiving stress tests. On the other hand, Charlson-comorbidity index score ≥ 1, prior catheterization and heart failure were independently associated with a decreased likelihood of receiving stress tests. CONCLUSIONS: In the setting of stable CAD, almost 60% of our patients received stress tests within 90 days prior to elective PCI, and MPI was the most commonly used test.

Percutaneous Transluminal Angioplasty and Stenting for Hepatic Vessel Stenosis after Orthotopic Liver Transplantation.

BACKGROUND: This study aimed to evaluate the efficacy of vascular intervention in percutaneous transluminal angioplasty (PTA) for the treatment of hepatic artery and hepatic vein stenosis after liver transplantation (LT), including thrombotic total occluded lesions. METHODS: Percutaneous transluminal angioplasty after orthotopic liver transplantation was performed to re-open hepatic vessel lesions. We daily used routine Doppler ultrasound during admission for early detection of graft hepatic vessel lesions, including hepatic artery and vein lesions. In outpatients, Doppler ultrasound was performed every month. Urokinase was delivered with a dose of 150,000-300,000 IU by catheter before PTA for thrombotic total occlusion of the graft for hepatic artery patients. Laboratory data were collected to evaluate the effects of the PTA procedure. RESULTS: The study involved a total of seven patients, six of whom were successfully treated by a first PTA procedure. Thrombolysis use of urokinase in totally occluded donor hepatic arteries post-LT following stenting was successful in three patients. One complication occurred, an arterial dissection and perforation, finalizing the success rate at ~86% and the complication rate at ~14%. Therefore, our study has a primary patency rate of 100% at 1 and 3 months. Also, the graft survival rate was 100 % and 86 % in the first and third months, respectively. CONCLUSIONS: PTA with stenting is an effective treatment for hepatic vessel stenosis, including hepatic arteries and hepatic veins, after a liver transplantation without an increase in the complication rate. In addition, thrombolysis using urokinase intra-artery infusion in graft thrombotic total occluded patients is a good treatment strategy as well. KEY WORDS: Angioplasty; Complication; Liver transplantation.

The effects of diabetes, hypertension and subsequent health control behavior on the survival of a Taiwan cohort aged over 50 years.

Purpose: This study used the Taiwan Longitudinal Study in Aging from 1996 to 2011 to investigate the effects of diabetes, hypertension, and healthy living behaviors of those aged over 50 years on the survival status in Taiwan. Methods: Among the 5,131 participants aged 50 years and above in the 1996 survey were included in this study. Cox's proportional hazards model was used to examine the incidence of diabetes, hypertension, and related mortality risk in those aged over 50 years. Results: After adjusting for age, gender, education level, diabetes, hypertension, health behavior, and leisure activity, results from the Cox model show that the elderly without diabetes have a lower mortality risk than those with diabetes. Regular exercise was associated with a lower risk of mortality. The hazard ratios of elderly with regular exercise were 0.78 (95 % CI: 0.64-0.96) for two times a week or less, 0.81 (95 % CI: 0.69-0.96) for 3-5 times a week, and 0.84 (95 % CI: 0.77-0.93) for 6 + times a week, respectively. On the other hand, leisure activity positively reduces mortality risk. For example, the hazard ratios of the elderly with watching TV and reading were 0.63 (95 % CI: 0.55-0.72) and 0.80 (95 % CI: 0.72-0.89), respectively. Moreover, smoking can increase mortality risk 23 % whether the elderly are with diabetes or hypertension or not. Conclusions: Regarding preventing and controlling chronic diseases in the future, continuously encouraging improvement in health behavior and engaging in leisure activities for the middle-aged and over should be considered essential markers.

A Comparison of Rehospitalization Risks on Diabetic and Non-Diabetic Patients after Recovery from Acute Coronary Syndrome.

BACKGROUND: The purpose of this study is to investigate whether the risks of rehospitalization caused by acute coronary syndrome (ACS) or stroke would have significant differences between diabetic and non-diabetic patients from ACS. METHODS: This was a retrospective study of 364 inpatients with ACS from 2017 to 2019. Logistic regression models included gender, age group, and the principal diagnosis of hospitalization as controlling variables which were used to analyze the dataset. RESULTS: About 10% of patients are hospitalized after recovery. Moreover, regardless of suffering from diabetes, the risk of rehospitalization does not appear to show a significant difference. In comparison with non-diabetic patients, the odds ratio of rehospitalization of diabetic patients was 0.94 (95% CI: 0.46-1.93, p-value = 0.8639) after controlling for the effects of gender, age group, and the principal diagnosis of hospitalization. CONCLUSIONS: Diabetic patients seem to perform well in controlling LDL-C (low-density lipoprotein cholesterol) after ACS recoveries.

Healthy Life Expectancies by the Effects of Hypertension and Diabetes for the Middle Aged and Over in Taiwan.

(1) Introduction: This study aims to investigate the disparity in the healthy life expectancy of the elderly with hypertension and diabetes mellitus. (2) Materials and Methods: This study used survey data collected in five waves (1996, 1999, 2003, 2007, and 2011) of the "Taiwan Longitudinal Study on Aging" (TLSA) to estimate the life expectancy and healthy life expectancy of different age groups. The activities of daily living, the health condition of hypertension and diabetes and the survival statuses of these cases were analyzed by the IMaCh (Interpolated Markov Chain) and logistic regression model. (3) Results: As regards the elderly between age 50 and 60 with hypertension and diabetes, women with hypertension only exhibited the longest life expectancy, and the healthy life expectancy and the percentage of remaining life with no functional incapacity were 33.74 years and 87.11%, respectively. In contrast, men with diabetes only showed the shortest life expectancy, and the healthy life expectancy and the percentage of remaining life with no functional incapacity were 22.51 years and 93.16%, respectively. We also found that people with diabetes showed a lower percentage of remaining life with no functional incapacity. (4) Conclusions: We suggest that policymakers should pay special attention to publicizing the importance of health control behavior in order to decrease the risk of suffering diseases and to improve the elderly's quality of life.

Vegetation on patent foramen ovale presenting as a cryptogenic brain abscess.

This paper describes a case of 51-year-old man with a vegetation on his patent foramen ovale presenting with a cryptogenic brain abscess. He received surgical evacuation and was successfully managed with septal occlusion. This is the first reported case of cryptogenic brain abscess caused by a vegetation on a patent foramen ovale directly documented with transesophageal echocardiography.