RESUMO
Concerns regarding radiation exposure and its effects during pregnancy are often quoted as an important barrier preventing many women from pursuing a career in Interventional Cardiology. Finding the true risk of radiation exposure from performing cardiac catheterization procedures can be challenging and guidelines for pregnancy exposure have been inadequate. The Women in Innovations group of Cardiologists with endorsement of the Society for Cardiovascular Angiography and Interventions aim to provide guidance in this publication by describing the risk of radiation exposure to pregnant physicians and cardiac catheterization personnel, to educate on appropriate radiation monitoring and to encourage mechanisms to reduce radiation exposure. Current data do not suggest a significant increased risk to the fetus of pregnant women in the cardiac catheterization laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterization laboratory. However, radiation exposure among pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.
Assuntos
Anormalidades Induzidas por Radiação/prevenção & controle , Cardiologia/normas , Neoplasias Induzidas por Radiação/prevenção & controle , Doenças Profissionais/prevenção & controle , Saúde Ocupacional , Efeitos Tardios da Exposição Pré-Natal , Proteção Radiológica/normas , Radiografia Intervencionista/normas , Anormalidades Induzidas por Radiação/etiologia , Cateterismo Cardíaco/normas , Feminino , Feto/efeitos da radiação , Humanos , Neoplasias Induzidas por Radiação/etiologia , Doenças Profissionais/etiologia , Exposição Ocupacional , Gravidez , Doses de Radiação , Monitoramento de Radiação/normas , Proteção Radiológica/métodos , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Sociedades MédicasRESUMO
Concerns regarding radiation exposure and its effects during pregnancy are often quoted as an important barrier preventing many women from pursuing a career in Interventional Cardiology. Finding the true risk of radiation exposure from performing cardiac catheterisation procedures can be challenging and guidelines for pregnancy exposure have been inadequate. The Women in Innovations group of Cardiologists with endorsement of the Society for Cardiovascular Angiography and Interventions aim to provide guidance in this publication by describing the risk of radiation exposure to pregnant physicians and cardiac catheterisation personnel, to educate on appropriate radiation monitoring and to encourage mechanisms to reduce radiation exposure. Current data do not suggest a significant increased risk to the foetus of pregnant women in the cardiac catheterisation laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterisation laboratory. However, radiation exposure amongst pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.
Assuntos
Cateterismo Cardíaco , Cardiologia , Educação Médica Continuada , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Monitoramento de Radiação , Consenso , Feminino , Guias como Assunto , Humanos , Masculino , Gravidez , Fatores de Risco , Sociedades Médicas , Raios X/efeitos adversosRESUMO
Cardiovascular disease (CVD) is the leading cause of mortality in women, yet studies have suggested that it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularization and use of evidence-based medications. The Women in Innovations group of cardiologists aims to highlight these issues and change perceptions to optimize the treatment of female patients with CVD, to support future research, and to encourage and guide the training of female interventional cardiologists.
Assuntos
Cardiologia , Doenças Cardiovasculares/terapia , Disparidades em Assistência à Saúde , Revascularização Miocárdica , Saúde da Mulher , Cardiologia/educação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/mortalidade , Escolha da Profissão , Educação Médica , Medicina Baseada em Evidências , Feminino , Hormônios Esteroides Gonadais/metabolismo , Humanos , Masculino , Mentores , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/educação , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores Sexuais , Resultado do TratamentoAssuntos
Síndrome Coronariana Aguda/terapia , American Heart Association , Cardiologia/normas , Doença da Artéria Coronariana/terapia , Projetos de Pesquisa/normas , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Comitês Consultivos/normas , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Gerenciamento Clínico , Fundações/normas , Humanos , Relatório de Pesquisa/normas , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
Percutaneous coronary intervention (PCI) is the most common method of coronary revascularization. Over time, as operator skills and technical advances have improved procedural outcomes, the length of stay (LOS) has decreased. However, standardization in the definition of LOS following PCI has been challenging due to significant physician, procedural, and patient variables. Given the increased focus on both patient safety as well as the cost of medical care, system process issues are a concern and provide a driving force for standardization while simultaneously maintaining the quality of patient care. This document: (1) provides a summary of the existing published data on same-day patient discharge following PCI, (2) reviews studies that developed methods to predict risk following PCI, and (3) provides clarification of the terms used to define care settings following PCI. In addition, a decision matrix is proposed for the care of patients following PCI. It is intended to provide both the interventional cardiologist as well as the facilities, in which they are associated, a guide to allow for the appropriate LOS for the appropriate patient who could be considered for early discharge or outpatient intervention.
Assuntos
Assistência Ambulatorial/normas , Angioplastia Coronária com Balão/normas , Tempo de Internação , Alta do Paciente/normas , Qualidade da Assistência à Saúde/normas , Assistência Ambulatorial/economia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/economia , Competência Clínica , Protocolos Clínicos , Custos de Cuidados de Saúde , Instalações de Saúde/normas , Humanos , Reembolso de Seguro de Saúde , Tempo de Internação/economia , Observação , Alta do Paciente/economia , Qualidade da Assistência à Saúde/economia , Medição de Risco , Terminologia como Assunto , Resultado do TratamentoAssuntos
Cateterismo Cardíaco/normas , Cardiologia/normas , Certificação/normas , Competência Clínica/normas , Instalações de Saúde/normas , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca/normas , Valva Mitral , Cateterismo Cardíaco/efeitos adversos , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Privilégios do Corpo Clínico/normas , Valva Mitral/fisiopatologia , Equipe de Assistência ao Paciente/normas , Formulação de Políticas , Desenvolvimento de Programas/normas , Resultado do TratamentoAssuntos
Cateterismo Cardíaco , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Terminologia como Assunto , Ultrassonografia de Intervenção , Cateterismo Cardíaco/classificação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Humanos , Curva de Aprendizado , Intervenção Coronária Percutânea/classificação , Intervenção Coronária Percutânea/educação , Valor Preditivo dos Testes , Ultrassonografia de Intervenção/classificaçãoAssuntos
Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/normas , Competência Clínica/normas , Implante de Prótese de Valva Cardíaca/normas , Hospitais/normas , Medicina Baseada em Evidências/normas , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Bases de Conhecimento , Privilégios do Corpo Clínico/normas , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde/normas , Resultado do TratamentoAssuntos
Angioplastia Coronária com Balão/normas , Cateterismo Cardíaco/normas , Cardiologia/normas , Angiografia Coronária/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Melhoria de Qualidade/normas , Sociedades Médicas/normas , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Benchmarking/normas , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Angiografia Coronária/efeitos adversos , Angiografia Coronária/mortalidade , Coleta de Dados/normas , Humanos , Indicadores de Qualidade em Assistência à Saúde/normas , Medição de Risco , Fatores de Risco , Estados UnidosAssuntos
Angioplastia Coronária com Balão/normas , Cardiologia/normas , Competência Clínica/normas , Angiografia Coronária/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Sociedades Médicas/normas , Comitês Consultivos/normas , Angioplastia Coronária com Balão/efeitos adversos , Benchmarking/normas , Angiografia Coronária/efeitos adversos , Humanos , Seleção de Pacientes , Desenvolvimento de Programas/normas , Medição de Risco , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with triglycerides >2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease. METHODS AND RESULTS: Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 [95% confidence intervals, 1.006 to 1.093] for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 [95% confidence intervals, 1.004 to 1.096] for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up. CONCLUSIONS: Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease.
Assuntos
Angioplastia Coronária com Balão , Colesterol/sangue , Ponte de Artéria Coronária , Doença da Artéria Coronariana/sangue , Lipoproteínas/sangue , Angina Pectoris/epidemiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prognóstico , Risco , Resultado do Tratamento , Triglicerídeos/sangueRESUMO
OBJECTIVE: Clinicians need better approaches to evaluating women at midlife and beyond who present to primary care with chest pain and related symptoms. A previously validated blood-based test, which includes age, sex, and gene expression levels, showed a 96% negative predictive value for determining an individual's current likelihood of having obstructive coronary artery disease (CAD) in a combined population of men and women. We hypothesized that age/sex/gene expression score (ASGES) would be incorporated into medical decision-making and would influence the rate of further cardiac evaluation. METHODS: An aggregate analysis of female cohorts from the Investigation of a Molecular Personalized Coronary Gene Expression Test on Primary Care Practice Pattern (IMPACT-PCP; NCT01594411) and REGISTRY I (NCT01557855) studies was conducted. Data on 320 women presenting with stable symptoms suggestive of obstructive CAD and undergoing ASGES testing (from 16 primary care providers in geographically diverse sites) were pooled. The primary outcome of this analysis was the association between ASGES and referrals for further cardiac evaluation. RESULTS: The mean participant age was 57.8 years, and the mean ASGES (predefined as low [ASGES ≤15] or elevated [ASGES >15]) was 10.3. The referral rate for further cardiac evaluation was 4.0% (10 of 248) for women with low ASGES versus 83.3% (60 of 72) for women with elevated ASGES, with an overall follow-up major adverse cardiac event/revascularization rate of 1.2%. After adjustment for clinical covariates, women with low ASGES were significantly less likely to be referred for further cardiac evaluation (odds ratio, 0.013; Pâ<â0.0001). CONCLUSIONS: ASGES can be incorporated into medical decision-making to help primary care providers rule out obstructive CAD among symptomatic women who are unlikely to benefit from further cardiac testing.
Assuntos
Algoritmos , Assistência Ambulatorial/métodos , Tomada de Decisão Clínica , Doença da Artéria Coronariana/diagnóstico , Atenção Primária à Saúde/métodos , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/prevenção & controle , Feminino , Perfilação da Expressão Gênica/métodos , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco/métodos , Saúde da MulherRESUMO
We report a case of spontaneous coronary artery dissection associated with sexual intercourse in a 32-year-old, morbidly obese patient. This is the first report of spontaneous coronary artery dissection induced by coital activity and the sixth such report in a male patient.
Assuntos
Dissecção Aórtica/diagnóstico , Coito , Infarto do Miocárdio/diagnóstico , Obesidade Mórbida , Adulto , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/fisiopatologia , Angiografia , Vasos Coronários , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Dor/etiologiaRESUMO
The cutting balloon (CB) is a specialized device designed to create discrete longitudinal incisions in the atherosclerotic target coronary segment during balloon inflation. Such controlled dilatation theoretically reduces the force needed to dilate an obstructive lesion compared with standard percutaneous transluminal coronary angioplasty (PTCA). We report a multicenter, randomized trial comparing the incidence of restenosis after CB angioplasty versus conventional balloon angioplasty in 1,238 patients. Six hundred seventeen patients were randomized to CB treatment, and 621 to PTCA. The mean reference vessel diameter was 2.86 +/- 0.49 mm, mean lesion length 8.9 +/- 4.3 mm, and prevalence of diabetes mellitus in patients was 13%. The primary end point, the 6-month binary angiographic restenosis rate, was 31.4% for CB and 30.4% for PTCA (p = 0.75). Acute procedural success, defined as the attainment of <50% diameter stenosis without in-hospital major adverse cardiac events, was 92.9% for CB and 94.7% for PTCA (p = 0.24). Freedom from target vessel revascularization was slightly higher in the CB arm (88.5% vs 84.6%, log-rank p = 0.04). Five coronary perforations occurred in the CB arm only (0.8% vs 0%, p = 0.03). At 270 days, rates of myocardial infarction, death, and total major adverse cardiac events for CB and PTCA were 4.7% versus 2.4% (p = 0.03), 1.3% versus 0.3% (p = 0.06), and 13.6% versus 15.1% (p = 0.34), respectively. In summary, the proposed mechanism of controlled dilatation did not reduce the rate of angiographic restenosis for the CB compared with conventional balloon angioplasty. CB angioplasty should be reserved for difficult lesions in which controlled dilatation is believed to provide a better acute result compared with balloon angioplasty alone.
Assuntos
Angioplastia Coronária com Balão , Angioplastia com Balão , Doença da Artéria Coronariana/terapia , Reestenose Coronária/prevenção & controle , Doença Aguda , Adulto , Idoso , Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Bélgica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Intervalo Livre de Doença , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Incidência , Masculino , Massachusetts , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Quebeque , Resultado do TratamentoRESUMO
BACKGROUND: Risk-standardized all-cause 30-day readmission rates (RSRRs) after percutaneous coronary intervention (PCI) have been endorsed as a national measure of hospital quality. Little is known about variation in the performance of hospitals on this measure, and whether high hospital rates of readmission after PCI are due to modifiable deficiencies in quality of care has not been assessed. METHODS AND RESULTS: We estimated 30-day, all-cause RSRRs for all nonfederal PCI-performing hospitals in Massachusetts, adjusted for clinical and angiographic variables, between 2005 and 2008. We assessed if differences in race, insurance type, and PCI and post-PCI characteristics, including procedural complications and discharge characteristics, could explain variation between hospitals using nested hierarchical logistic regression models. Of 36 060 patients undergoing PCI at 24 hospitals and surviving to discharge, 4469 (12.4%) were readmitted within 30 days of discharge. Hospital RSRRs ranged from 9.5% to 17.9%, with 8 of 24 hospitals being identified as outliers (4 lower than expected and 4 higher than expected). Differences in race, insurance, PCI, and post-PCI factors accounted for 10.4% of the between-hospital variance in RSRRs. CONCLUSIONS: We observed wide variation in hospital 30-day all-cause RSRRs after PCI, most of which could not be explained by identifiable differences in procedural and postprocedural factors. A better understanding of etiologies of hospital variation is necessary to determine whether this measure is an actionable assessment of hospital quality, and, if so, how hospitals might improve their performance.
Assuntos
Angioplastia , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Idoso , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/patologia , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Complicações Pós-Operatórias/cirurgia , Padrões de Prática Médica , Qualidade da Assistência à Saúde , Grupos Raciais , Risco , Fatores de Tempo , Estados UnidosRESUMO
Concerns regarding radiation exposure and its effects during pregnancy are often quoted as an important barrier preventing many women from pursuing a career in Interventional Cardiology. Finding the true risk of radiation exposure from performing cardiac catheterisation procedures can be challenging and guidelines for pregnancy exposure have been inadequate. The Women in Innovations group of Cardiologists with endorsement of the Society for Cardiovascular Angiography and Interventions aim to provide guidance in this publication by describing the risk of radiation exposure to pregnant physicians and cardiac catheterisation personnel, to educate on appropriate radiation monitoring and to encourage mechanisms to reduce radiation exposure. Current data do not suggest a significant increased risk to the fetus of pregnant women in the cardiac catheterisation laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterisation laboratory. However, radiation exposure among pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.