Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 71
Filtrar
2.
Can J Cardiol ; 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34610383

RESUMO

BACKGROUND: Numerous studies have identified the association of socio-economic factors with outcomes of cardiac surgical procedures. Most have focused on easily measured demographic factors or on socio-economic characteristics of patients' 5-digit zip codes. The impact of socio-economic information that is derived from smaller geographic regions has rarely been studied. METHODS: The association of the Area Deprivation Index (ADI) with short-term mortality and readmissions was tested for patients undergoing percutaneous coronary intervention (PCI) in New York while adjusting for numerous patient risk factors, including race, ethnicity, and payer. Changes in hospitals' risk-adjusted outcomes and outlier status with the addition of socio-economic factors were examined. RESULTS: After adjustment, patients in the two most deprived ADI quintiles were more likely to experience in-hospital/30-day mortality following PCI (AOR = 1.39 (1.18, 1.65) and AOR = 1.24 (1.03, 1.49)), respectively, than patients in the first quintile (least deprived). Also, patients in the second (1.12 (1.01, 1.25)) and fifth (1.17 (1.04, 1.32)) ADI quintiles had higher 30-day readmissions rates than patients in the first quintile. Medicare patients had higher mortality and readmission rates, Hispanics had lower mortality, and Medicaid patients had higher readmission rates. CONCLUSIONS: Patients with the most deprived ADIs are more likely to experience short-term mortality and readmissions following PCI. Ethnicity and payer are significantly associated with adverse outcomes even while adjusting for ADI. This information should be considered when identifying patients who are at the highest risk for adverse events following PCI, and when risk-adjusting hospital outcomes and assessing quality of care.

3.
Am J Cardiol ; 156: 65-71, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34344515

RESUMO

Percutaneous ventricular assist devices (pVAD) are frequently utilized in high-risk percutaneous coronary intervention (HR-PCI) to provide hemodynamic support in patients with complex cardiovascular disease and/or multiple comorbidities who are poor candidates for surgical revascularization. Using the National Inpatient Sample we identified pVAD-assisted PCI (excluding intra-aortic balloon pump) in patients without cardiogenic shock from January 2008 to December 2018. We evaluated the trends in patient and procedural characteristics, and complication rates across the 11-year study period. A total of 26,661 pVAD-PCI was performed. From 2008 to 2018 there has was a 27-fold increase in the number of pVAD-PCIs performed annually. There has also been an increase in the proportion of procedures performed in small to medium sized hospitals. The use of atherectomy, image-guided PCI, FFR/iFR, drug-eluting stents, and multi-vessel intervention has significantly increased. Patients undergoing pVAD-PCI had a higher burden of comorbidities, without a significant difference in mortality over time. There were decreased rates of acute stroke and blood transfusions over time, while vascular complications and acute kidney injury (AKI) requiring dialysis remained mostly unchanged. In conclusion, the use of pVAD for HR-PCI has increased significantly, along with adjunctive PCI techniques such as atherectomy, intravascular imaging, and physiologic lesion assessment. With increasing use of this device, there appeared to be lower rates of peri-procedural stroke, and blood transfusions. Despite a higher burden of comorbidities, adjusted mortality remained stable over time.


Assuntos
Doença da Artéria Coronariana/cirurgia , Coração Auxiliar , Hemodinâmica/fisiologia , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/etiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
Curr Atheroscler Rep ; 23(9): 49, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34226967

RESUMO

PURPOSE OF REVIEW: The syndrome of myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is not uncommon and has multiple potential coronary etiologies. With the use of more sensitive cardiac biomarkers and advanced cardiovascular imaging, MINOCA presentations have gain increasing attention among researchers and cardiologists. Despite the presence of a myocardial infarction and elevated future risk, many patients are sent home with little or no cardio-protective treatment and no explanation for their symptoms. In this review, we emphasized the importance of MINOCA treatment based on the underlying etiology. RECENT FINDINGS: As there are multiple pathophysiological mechanisms potentially involved in MINOCA, it should be considered a working diagnosis until there is a better understanding regarding the underlying cause. It is critical to use multimodality imaging when treating patients with MINOCA to help determine the underlying etiology and rule out mimics of MINOCA, so that therapies appropriate to the etiology can be provided. A more systematic approach to managing patients with MINOCA should result in better treatment and an improved prognosis for these patients.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Fatores de Risco
5.
Circulation ; 144(5): e107-e119, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34187171

RESUMO

Cardiac catheterization procedures have rapidly evolved and expanded in scope and techniques over the past few decades. However, although some practices have emerged based on evidence, many traditions have persisted based on beliefs and theoretical concerns. The aim of this review is to highlight common preprocedure, intraprocedure, and postprocedure catheterization laboratory practices where evidence has accumulated over the past few decades to support or discount traditionally held practices.

6.
Circulation ; 144(2): e16-e35, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34126755

RESUMO

Over the past few decades, advances in pharmacological, catheter-based, and surgical reperfusion have improved outcomes for patients with acute myocardial infarctions. However, patients with large infarcts or those who do not receive timely revascularization remain at risk for mechanical complications of acute myocardial infarction. The most commonly encountered mechanical complications are acute mitral regurgitation secondary to papillary muscle rupture, ventricular septal defect, pseudoaneurysm, and free wall rupture; each complication is associated with a significant risk of morbidity, mortality, and hospital resource utilization. The care for patients with mechanical complications is complex and requires a multidisciplinary collaboration for prompt recognition, diagnosis, hemodynamic stabilization, and decision support to assist patients and families in the selection of definitive therapies or palliation. However, because of the relatively small number of high-quality studies that exist to guide clinical practice, there is significant variability in care that mainly depends on local expertise and available resources.

7.
Artigo em Inglês | MEDLINE | ID: mdl-34080774

RESUMO

The purpose of this position statement is to suggest ways in which future appropriate use criteria (AUC) for coronary revascularization might be restructured to: (1) incorporate improvement in quality of life and angina relief as primary goals of therapy, (2) integrate the findings of recent trials into quality appraisal, (3) employ the combined information of the coronary angiogram and invasive physiologic measurements together with the results of stress test imaging to assess risk, and (4) recognize the essential role that patient preference plays in making individualized therapeutic decisions. The AUC is a valuable tool within the quality assurance process; it is vital that interventionists ensure that percutaneous coronary intervention case selection is both evidence-based and patient oriented. Appropriate patient selection is an important quality indicator and adherence to evidence-based practice should be one metric in a portfolio of process and outcome indicators that measure quality.

8.
J Thorac Cardiovasc Surg ; 162(2): e183-e353, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33972115
10.
Am J Med ; 134(8): 992-1001.e4, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33872584

RESUMO

BACKGROUND: There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia. METHODS: We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia. RESULTS: The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64). CONCLUSION: In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.


Assuntos
Hospitalização/estatística & dados numéricos , Hipercolesterolemia/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
12.
J Geriatr Cardiol ; 18(3): 159-167, 2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33907545

RESUMO

OBJECTIVE: Hybrid coronary revascularization (HCR) combines a minimally invasive surgical approach to the left anterior descending (LAD) artery with percutaneous coronary intervention (PCI) for non-LAD diseased coronary arteries. It is associated with shorter hospital lengths of stay and recovery times than conventional coronary artery bypass surgery, but there is little information comparing it to isolated PCI for multivessel disease. Our objective is to compare long-term outcomes of HCR and PCI for patients with multivessel disease. METHODS: This cohort study used data from New York's cardiac surgery and PCI registries in 2010-2016 to examine mortality and repeat revascularization rates for patients with multivessel coronary artery disease who underwent HCR and PCI. Cox proportional hazards methods were used to reduce selection bias. Patients were followed for a median of four years. RESULTS: There was a total of 335 HCR patients (1.2%) and 25,557 PCI patients (98.8%) after exclusions. There was no difference in 6-year risk adjusted survival between HCR and PCI patients (83.17% vs. 81.65%, adjusted hazard ratio (aHR) = 0.90 (95% CI: 0.67-1.20). However, HCR patients were more likely to be free from repeat revascularization in the LAD artery (91.13% vs. 83.59%, aHR = 0.51 (95% CI: 0.34-0.77)). CONCLUSIONS: For patients with multi-vessel coronary artery disease, HCR is rarely performed. There are no differences in mortality rates after four years, but HCR is associated with lower repeat revascularization rates in the LAD artery, presumably due to better longevity in left arterial mammary grafts.

13.
Circulation ; 143(15): e815-e829, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33657830

RESUMO

Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations. In addition, a recent scientific statement from the American Heart Association recommended the development of CS centers using standardized protocols for diagnosis and management of CS, including mechanical circulatory support devices (MCS). A number of CS programs have implemented various protocols for treating patients with AMICS, including the use of MCS, and have published promising results using such protocols. Despite this, practice patterns in the cardiac catheterization laboratory vary across health systems, and there are inconsistencies in the use or timing of MCS for AMICS. Furthermore, mortality benefit from MCS devices in AMICS has yet to be established in randomized clinical trials. In this article, we outline the best practices for the contemporary interventional management of AMICS, including coronary revascularization, the use of MCS, and special considerations such as the treatment of patients with AMICS with cardiac arrest.

14.
Am J Cardiol ; 140: 20-24, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33147431

RESUMO

Previous studies have reported worse outcomes for patients with right bundle branch block (RBBB) complicating acute ST-segment elevation myocardial infarction (STEMI). There is a paucity of data examining outcomes with RBBB and STEMI in contemporary large-scale studies. This study aims to explore the outcomes of patients with anterior wall STEMI (AW-STEMI) and RBBB. Using ICD-9 codes, we queried the National Inpatient Sample of 1999 to 2014 to identify AW-STEMI admissions and stratified them for the presence of RBBB. Primary outcome was in-hospital mortality within 30 days. Secondary outcomes included acute heart failure, complete heart block, and permanent pacemaker implantation. Cox-proportional logistic regression models were used to determine the hazard ratios of the primary outcome and secondary outcomes and interventions. Among 1,075,875 weighted anterior wall STEMI (AW-STEMI) admissions, 19,153 (1.8%) had RBBB. Compared with patients without RBBB, mortality was significantly higher for patients with RBBB (9.2% vs 15.3%; p <0.0001). RBBB in the setting of AW-STEMI was associated with a 66% increased risk of 30-day in-hospital mortality (hazard ratios [HR], 1.66; 95% confidence interval [CI], 1.52 to1.81; p <0.0001) and a higher likelihood of acute heart failure (HR, 1.37; 95% CI, 1.29 to 1.45; p <0.0001), complete heart block (HR, 2.90; 95% CI, 2.64 to 3.18; p <0.0001) and utilization of a permanent pacemaker (HR, 2.51; 95% CI, 1.89 to 3.35; p <0.0001). In conclusion, the presence of RBBB in the setting of an AW-STEMI is a significant independent predictor of a poor prognosis, including a higher rate of acute heart failure, complete heart block, need for a permanent pacemaker, and a higher 30-day in-hospital mortality.


Assuntos
Bloqueio de Ramo/etiologia , Eletrocardiografia , Pacientes Internados , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
15.
Am J Cardiol ; 142: 25-34, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33301770

RESUMO

Little is known about regional differences in volume, treatment, and outcomes of STEMI patients undergoing PCI during the pandemic. The objectives of this study were to compare COVID-19 pandemic and prepandemic periods with respect to regional volumes, outcomes, and treatment of patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 1, 2019 and March 14, 2020 (pre-COVID period) and between March 15, 2020 and April 4, 2020 (COVID period) in 51 New York State hospitals certified to perform PCI. The hospitals were classified as being in either high-density or low-density COVID-19 counties on the basis of deaths/10,000 population. There was a decrease of 43% in procedures/week in high-density COVID-19 counties (p <0.0001) and only 4% in low-density counties (p = 0.64). There was no difference in the change in risk-adjusted in-hospital mortality rates in either type of county, but STEMI PCI patients in high-density counties had longer times from symptom onset to hospital arrival and lower cardiac arrest rates in the pandemic period. In conclusion, the decrease in STEMI PCIs during the pandemic was mainly limited to counties with a high density of COVID-19 deaths. The decrease appears to be primarily related to patients not presenting to hospitals in high-density COVID regions, rather than PCI being avoided in STEMI patients or a reduction in the incidence of STEMI. Also, high-density COVID-19 counties experienced delayed admissions and less severely ill STEMI PCI patients during the pandemic. This information can serve to focus efforts on convincing STEMI patients to seek life-saving hospital care during the pandemic.


Assuntos
COVID-19/epidemiologia , Pandemias , Intervenção Coronária Percutânea/métodos , Sistema de Registros , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Taxa de Sobrevida/tendências , Tempo para o Tratamento , Adulto Jovem
17.
Curr Cardiol Rep ; 22(11): 134, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910364

RESUMO

PURPOSE OF REVIEW: This paper will review myocardial infarction with non-obstructive coronary arteries (MINOCAs) briefly, and then focus on the imaging tools that should be employed when caring for patients with suspected MINOCA. RECENT FINDINGS: Diagnostic imaging has a critical role in assessing patients with suspected or confirmed MINOCA. The extent at which these diagnostic tests are used in any given patient will depend on the clinical acumen for the underlying condition, as well as the available resources. There are myriad conditions that can lead to MINOCA; further testing to exclude other underlying causes of myocardial injury is crucial. Cardiovascular imaging may assist in identifying the etiological cause in cases where MINOCA remains the most likely diagnosis. A systematic approach to the diagnostic assessment will help to uncover the underlying diagnosis, guide therapy, and provide the patient and their families with appropriate feedback.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Testes Diagnósticos de Rotina , Humanos , Infarto do Miocárdio/diagnóstico por imagem
18.
Int J Cardiol Heart Vasc ; 30: 100634, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32995474

RESUMO

Although most prevalent in elderly, myocardial infarction (MI) also affects younger adults. We sought to investigate baseline characteristics in young patients (<55 years) with MI using the National Inpatient Sample (NIS) database between 2004 and 2015. Multivariable logistic regression models were used to assess factors associated with acute myocardial infarction (AMI) in young patients. After multivariable analyses adjusted for age, sex, race, family history of atherosclerosis, body mass index (BMI), diabetes, hypertension, hyperlipidemia, chronic kidney disease, and current cigarette smoking; novel risk factors such as human immunodeficiency virus (HIV), systemic lupus erythematosus (SLE), and obstructive sleep apnea (OSA) were associated with a higher risk of developing an AMI in the young (adjusted OR for HIV 4.06; 95 CI 3.48-4.71, p < 0.001), (adjusted OR for SLE 2.12; 95 CI 1.89-2.39, p 0.04), and (adjusted OR for OSA 1.16; 95 CI 1.12-1.20, p < 0.001), respectively. Rheumatoid arthritis was associated with a lower risk of AMI (adjusted OR 0.83; 95 CI 0.76-0.89, p < 0.001). After multivariable analyses, cigarette smoking (adjusted OR 1.98; 95 CI 1.95-2.02, p < 0.001), obesity (adjusted OR 1.37; 95 CI 1.33-1.41, p = 0.003), hyperlipidemia (adjusted OR 1.07; 95 CI 1.04-1.08, p < 0.001) and a family history of CAD (adjusted OR 1.35; 95 CI 1.3-1.4, p < 0.001) were also associated with a higher risk of developing an AMI in the young. In conclusion, young patients with AMI have both traditional risk factors and non-traditional risk factors. In addition to traditional risk factors, close attention should be paid to emerging risk factors such as SLE, HIV and OSA.

19.
Am J Cardiol ; 133: 171-174, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32838929

RESUMO

BACKGROUND: There has been a continuous debate about the survival benefit of percutaneous coronary intervention (PCI) for the management of patients with stable ischemic heart disease (SIHD) and moderate to severe ischemia. In this study we aimed to summarize the currently available evidence from randomized controlled trials (RCTs) on PCI versus medical therapy (MT) for patients with SIHD. METHODS: An electronic database search was conducted for RCTs that compared PCI on top of MT versus MT alone. A random effects model was used to calculate relative risk (RR) and 95% confidence intervals (CIs). RESULTS: A total of 7 RCTs with 10,043 patients with a mean age of 62.54 ± 1.56 years and a median follow up of 3.9 years were identified. Among patients with SIHD and moderate to severe ischemia by stress testing, PCI didn't show any benefit for the primary outcome of all-cause mortality compared to MT(RR = 0.85; 95% CI 0.646-1.12; p = 0.639). There was also no benefit in cardiovascular (CV) death (RR = 0.88 ; 95% CI 0.71-1.09; p = 0.18) or myocardial infarction (MI) (RR = 0.271; 95% CI 0.782-1.087; P = 0.327) in the PCI group as compared to MT. CONCLUSION: Among patients with SIHD and evidence of moderate to severe ischemia by stress testing, PCI on top of MT appears to add no mortality benefit as compared to with MT alone.


Assuntos
Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea , Doença da Artéria Coronariana/complicações , Humanos
20.
Am Heart J ; 227: 9-10, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32640370

RESUMO

We aimed to investigate long-term (≥5 years) outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) using a meta-analysis from updated published randomized trials. Our data showed that the risk of all-cause death as well as cardiovascular death, myocardial infarction, and stroke was similar between PCI and CABG, whereas PCI had significantly higher rates of repeat revascularization compared to CABG. Decisions for PCI versus CABG for LMCAD should be based on weighing the upfront morbidity and mortality risk of CABG with late risk of repeat revascularization with PCI and taking into consideration patient preference.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...